Answer Addiction

Tag: naloxone

  • They Fell In Love Helping Drug Users. But Fear Kept Him From Helping Himself.

    Beeler worried that a failed drug test — even if it was for a medication to treat his addiction (like buprenorphine) — would land him in prison.

    She was in medical school. He was just out of prison.

    Sarah Ziegenhorn and Andy Beeler’s romance grew out of a shared passion to do more about the country’s drug overdose crisis.

    Ziegenhorn moved back to her home state of Iowa when she was 26. She had been working in Washington, D.C., where she also volunteered at a needle exchange — where drug users can get clean needles. She was ambitious and driven to help those in her community who were overdosing and dying, including people she had grown up with.

    “Many people were just missing because they were dead,” said Ziegenhorn, now 31. “I couldn’t believe more wasn’t being done.”

    She started doing addiction advocacy in Iowa City while in medical school — lobbying local officials and others to support drug users with social services.

    Beeler had the same conviction, born from his personal experience.

    “He had been a drug user for about half of his life — primarily a longtime opiate user,” Ziegenhorn said.

    Beeler spent years in and out of the criminal justice system for a variety of drug-related crimes, such as burglary and possession. In early 2018, he was released from prison. He was on parole and looking for ways to help drug users in his hometown.

    He found his way to advocacy work and, through that work, found Ziegenhorn. Soon they were dating.

    “He was just this really sweet, no-nonsense person who was committed to justice and equity,” she said. “Even though he was suffering in many ways, he had a very calming presence.”

    People close to Beeler describe him as a “blue-collar guy” who liked motorcycles and home carpentry, someone who was gentle and endlessly curious. Those qualities could sometimes hide his struggle with anxiety and depression. Over the next year, Beeler’s other struggle, with opioid addiction, would flicker around the edges of their life together.

    Eventually, it killed him.

    People on parole and under supervision of the corrections system can face barriers to receiving appropriate treatment for opioid addiction. Ziegenhorn said she believes Beeler’s death is linked to the many obstacles to medical care he experienced while on parole.

    About 4.5 million people are on parole or probation in the U.S., and research shows that those under community supervision are much more likely to have a history of substance use disorder than the general population. Yet rules and practices guiding these agencies can preclude parolees and people on probation from getting evidence-based treatment for their addiction.

    A Shared Passion For Reducing Harm

    From their first meeting, Ziegenhorn said, she and Beeler were in sync, partners and passionate about their work in harm reduction — public health strategies designed to reduce risky behaviors that can hurt health.

    After she moved to Iowa, Ziegenhorn founded a small nonprofit called the Iowa Harm Reduction Coalition. The group distributes the opioid-overdose reversal drug naloxone and other free supplies to drug users, with the goal of keeping them safe from illness and overdose. The group also works to reduce the stigma that can dehumanize and isolate drug users. Beeler served as the group’s coordinator of harm reduction services.

    “In Iowa, there was a feeling that this kind of work was really radical,” Ziegenhorn said. “Andy was just so excited to find out someone was doing it.”

    Meanwhile, Ziegenhorn was busy with medical school. Beeler helped her study. She recalled how they used to take her practice tests together.

    “Andy had a really sophisticated knowledge of science and medicine,” she said. “Most of the time he’d been in prison and jails, he’d spent his time reading and learning.”

    Beeler was trying to stay away from opioids, but Ziegenhorn said he still used heroin sometimes. Twice she was there to save his life when he overdosed. During one episode, a bystander called the police, which led to his parole officer finding out.

    “That was really a period of a lot of terror for him,” Ziegenhorn said.

    Beeler was constantly afraid the next slip — another overdose or a failed drug test — would send him back to prison.

    An Injury, A Search For Relief

    A year into their relationship, a series of events suddenly brought Beeler’s history of opioid use into painful focus.

    It began with a fall on the winter ice. Beeler dislocated his shoulder — the same one he’d had surgery on as a teenager.

    “At the emergency room, they put his shoulder back into place for him,” Ziegenhorn said. “The next day it came out again.”

    She said doctors wouldn’t prescribe him prescription opioids for the pain because Beeler had a history of illegal drug use. His shoulder would dislocate often, sometimes more than once a day.

    “He was living with this daily, really severe constant pain — he started using heroin very regularly,” Ziegenhorn said.

    Beeler knew what precautions to take when using opioids: Keep naloxone on hand, test the drugs first and never use alone. Still, his use was escalating quickly.

    A Painful Dilemma 

    The couple discussed the future and their hope of having a baby together, and eventually Ziegenhorn and Beeler agreed: He had to stop using heroin.

    They thought his best chance was to start on a Food and Drug Administration-approved medication for opioid addiction, such as methadone or buprenorphine. Methadone is an opioid, and buprenorphine engages many of the same opioid receptors in the brain; both drugs can curb opioid cravings and stabilize patients. Studies show daily maintenance therapy with such treatment reduces the risks of overdose and improves health outcomes.

    But Beeler was on parole, and his parole officer drug-tested him for opioids and buprenorphine specifically. Beeler worried that if a test came back positive, the officer might see that as a signal that Beeler had been using drugs illegally.

    Ziegenhorn said Beeler felt trapped: “He could go back to prison or continue trying to obtain opioids off the street and slowly detox himself.”

    He worried that a failed drug test — even if it was for a medication to treat his addiction — would land him in prison. Beeler decided against the medication.

    A few days later, Ziegenhorn woke up early for school. Beeler had worked late and fallen asleep in the living room. Ziegenhorn gave him a kiss and headed out the door. Later that day, she texted him. No reply.

    She started to worry and asked a friend to check on him. Not long afterward, Beeler was found dead, slumped in his chair at his desk. He’d overdosed.

    “He was my partner in thought, and in life and in love,” Ziegenhorn said.

    It’s hard for her not to rewind what happened that day and wonder how it could have been different. But mostly she’s angry that he didn’t have better choices.

    “Andy died because he was too afraid to get treatment,” she said.


    Beeler was services coordinator for the Iowa Harm Reduction Coalition, a group that works to help keep drug users safe. A tribute in Iowa City after his death began, “He died of an overdose, but he’ll be remembered for helping others avoid a similar fate.” (COURTESY OF SARAH ZIEGENHORN)

    How Does Parole Handle Relapse? It Depends

    It’s not clear that Beeler would have gone back to prison for admitting he’d relapsed and was taking treatment. His parole officer did not agree to an interview.

    But Ken Kolthoff, who oversees the parole program that supervised Beeler in Iowa’s First Judicial District Department of Correctional Services, said generally he and his colleagues would not punish someone who sought out treatment because of a relapse.

    “We would see that that would be an example of somebody actually taking an active role in their treatment and getting the help they needed,” said Kolthoff.

    The department doesn’t have rules prohibiting any form of medication for opioid addiction, he said, as long as it’s prescribed by a doctor.

    “We have people relapse every single day under our supervision. And are they being sent to prison? No. Are they being sent to jail? No,” Kolthoff said.

    But Dr. Andrea Weber, an addiction psychiatrist with the University of Iowa, said Beeler’s reluctance to start treatment is not unusual.

    “I think a majority of my patients would tell me they wouldn’t necessarily trust going to their [parole officer],” said Weber, assistant director of addiction medicine at the University of Iowa’s Carver College of Medicine. “The punishment is so high. The consequences can be so great.”

    Weber finds probation and parole officers have “inconsistent” attitudes toward her patients who are on medication-assisted treatment.

    “Treatment providers, especially in our area, are still very much ingrained in an abstinence-only, 12-step mentality, which traditionally has meant no medications,” Weber said. “That perception then invades the entire system.”

    Attitudes And Policies Vary Widely

    Experts say it’s difficult to draw any comprehensive picture about the availability of medication for opioid addiction in the parole and probation system. The limited amount of research suggests that medication-assisted treatment is significantly underused.

    “It’s hard to quantify because there are such a large number of individuals under community supervision in different jurisdictions,” said Michael Gordon, a senior research scientist at the Friends Research Institute, based in Baltimore.

    A national survey published in 2013 found that about half of drug courts did not allow methadone or other evidence-based medications used to treat opioid use disorder.

    A more recent study of probation and parole agencies in Illinois reported that about a third had regulations preventing the use of medications for opioid use disorder. Researchers found the most common barrier for those on probation or parole “was lack of experience by medical personnel.”

    Faye Taxman, a criminology professor at George Mason University, said decisions about how to handle a client’s treatment often boil down to the individual officer’s judgment.

    “We have a long way to go,” she said. “Given that these agencies don’t typically have access to medical care for clients, they are often fumbling in terms of trying to think of the best policies and practices.”

    Increasingly, there is a push to make opioid addiction treatment available within prisons and jails. In 2016, the Rhode Island Department of Corrections started allowing all three FDA-approved medications for opioid addiction. That led to a dramatic decrease in fatal opioid overdoses among those who had been recently incarcerated.

    Massachusetts has taken similar steps. Such efforts have only indirectly affected parole and probation.

    “When you are incarcerated in prison or jail, the institution has a constitutional responsibility to provide medical services,” Taxman said. “In community corrections, that same standard does not exist.”

    Taxman said agencies may be reluctant to offer these medications because it’s one more thing to monitor. Those under supervision are often left to figure out on their own what’s allowed.

    “They don’t want to raise too many issues because their freedom and liberties are attached to the response,” she said.

    Richard Hahn, a researcher at New York University’s Marron Institute of Urban Management who consults on crime and drug policy, said some agencies are shifting their approach.

    “There is a lot of pressure on probation and parole agencies not to violate people just on a dirty urine or for an overdose” said Hahn, who is executive director of the institute’s Crime & Justice Program.

    The federal government’s Substance Abuse and Mental Health Services Administration calls medication-assisted treatment the “gold standard” for treating opioid addiction when used alongside “other psychosocial support.”

    Addiction is considered a disability under the Americans with Disabilities Act, said Sally Friedman, vice president of legal advocacy for the Legal Action Center, a nonprofit law firm based in New York City.

    She said disability protections extend to the millions of people on parole or probation. But people under community supervision, Friedman said, often don’t have an attorney who can use this legal argument to advocate for them when they need treatment.

    “Prohibiting people with that disability from taking medication that can keep them alive and well violates the ADA,” she said.

    This story is part of a partnership between NPR and Kaiser Health News.

    View the original article at thefix.com

  • The Opioid Crisis Is Our Greatest Opportunity

    The Opioid Crisis Is Our Greatest Opportunity

    Overdose survivors need more than a second (or third) chance: they need a parachute. When you’re in free fall, a little more time isn’t much help.

    Perhaps everything that is terrible is,
    in the deepest sense, something
    that wants our love.

    Rilke

    The overdose epidemic in the U.S. has been called “the greatest public health crisis of our time.” It’s also our greatest opportunity.

    The opioid crisis is an identity crisis: it’s a challenge to how we see ourselves. Do we truly believe that we are all in this together? One answer leads us deeper into despair. The other, into a hopeful future.

    It’s been said that “doing more things faster is no substitute for doing the right things.” What are the “right things,” the measures that can resolve the crisis, not just postpone it? The right actions come from the right thoughts. Those thoughts come from feelings, and feelings are never right or wrong. But there are some feelings we are born with. They are our birthright. And one of them is love.

    The Kindness of Strangers

    Hatred never ceases by hatred, but by love alone is healed.

    The Buddha

    Behind the opioid epidemic is a prevailing lack of compassion, of caring about everyone equally. At the heart (or lack of it) of this societal disease is rampant inequality. The social determinants of health: stress, unemployment, lack of support, poor health care, etc. are major drivers of addiction. Many authors promote this view, including Gabor Mate, Bruce Alexander, Sam Quinones, Robert Putnam, and Harry Nelson.

    Our increasing fragmentation affects everyone, poor or rich.

    Drug overdose is the leading cause of death for Americans under the age of fifty…

    Our material lives may be outwardly prosperous, but our psychological and spiritual lives are in freefall. What is driving us to self-destruction? There are many factors, all with one unifying theme: we are no longer living in community with one another and, consequently, we are lonely.

    Francie Hart Broghammer

    We all hunger for the same thing. The question is this: do we love our neighbor as ourselves? That’s not just a commandment; it’s a requirement. How do we rebuild community? First, by taking full responsibility for the fallout of not being one.

    For Whom the Boom Tolls

    Compassion is not a relationship between the healer and the wounded. It’s a relationship between equals. Compassion becomes real when we recognize our shared humanity.

    Pema Chodron

    I live in Asheville, a city that has recently, like the opioid crisis, exploded. Tourism is at an all-time high, and Asheville has appeared in dozens of destination top ten lists. It has also been ranked second in the country in gentrification.

    Asheville sits in the heart of Appalachia, where the opioid crisis is at its worst. In 2017, North Carolina had the second highest increase in opioid deaths in the country. The Blue Ridge Parkway runs through town and I spend a lot of time there, mostly foraging. That’s where last summer, for the first time, I found not mushrooms, but needles.

    Despite the crisis, the city just spent six months trying to shut down the local syringe exchange. The same thing is happening in other cities. In Asheville, the exchange had been operating without incident for over two years — until the houseless (a.k.a., homeless) in adjacent areas were kicked out to make way for new development.

    Addiction depends on denial. What if development is the real addiction? Will we face up to the dark side of gentrification or just try to make it “go away?”

    If a canary dies in a coal mine, you don’t blame the canary. Yet blaming the victim is exactly what we’ve been doing.


    Blue Ridge Parkway, 8/20/18 

    License to Ill

    A man came to the Rabbi and said, “Rebbe, my son has turned against me. What should I do?” The rabbi said, “love him even more.”

    Hasidic story

    Most people by now have heard that naloxone (Narcan) can prevent a deadly overdose. So many Americans are dying — often from a mix of drugs, but mainly due to opioids — that naloxone should be as ubiquitous as aspirin. Everyone using a drug that may contain opioids should carry it like an EPI pen. And with the increasing prevalence of fentanyl, a single dose may not be enough. Everyone should know how to tell how much naloxone to give someone in the midst of an overdose. This should be basic, universal knowledge.

    But keeping someone alive is just the beginning. In fact, while naloxone may be physically safe, it does have one significant side effect: precipitated withdrawal. And not helping someone through it is like catching them from falling only to drop them from higher up.

    A Devil’s Bargain

    Be kind, for everyone you meet is fighting a hard battle.

    Ian Maclaren

    As one response coordinator describes it, precipitated withdrawal is like “the worst flu you’ve had… times 100.” For some, the feeling is so bad that they find themselves dying, so to speak, to use again.

    To the uninformed, it is inconceivable that someone who nearly died from a drug would run out that very same day and buy more of it. Narcan works by binding to opioid receptors, blocking the effect of narcotics like heroin. In drug users with a physical dependency, it also has the effect of causing severe withdrawal symptoms. This all but guarantees that the first thing a user will think of after their overdose is reversed is getting another fix…

    Christopher Moraff

    Naloxone is not just a “bandaid on a bullet hole.” It can feel like ripping open a wound. For “withdrawal is the very situation that [users] are seeking to avoid in the first place.”

    “A dose of naloxone,” according to the Chief Medical Officer for a Connecticut health agency, “is a chance. But if it’s not coupled with immediate offers of treatment, it may be a slim chance that leaves the revived individual running back to the same dealer who sold them their last lethal dose.”

    Overdose survivors need more than a second (or third) chance: they need a parachute. When you’re in free fall, a little more time isn’t much help.

    Back on the Chain Gang

    Without forgiveness, our lives are chained, forced to carry the sufferings of the past and repeat them with no release.

    Jack Kornfield

    “They’re usually very angry when we bring them around,” says one responder. “One kid yelled at me, ‘You think this will make me stop doing drugs?’” Indeed, one substance abuse specialist in Ohio says that 67% of people revived with naloxone in her area use again within 24 hours. NPR reports that “about 30 percent of those revived with Narcan at Boston Medical Center have been revived there more than once… and about 10 percent of patients more than three times. Those statistics are in line with what’s seen in ERs elsewhere, public health officials say.”

    According to a former agent for the DEA, one woman in Ohio, within 24 hours of being revived for the the sixth time, was using again. In the first half of 2017, one man in North Carolina was revived fourteen times.

    To be clear, I am not saying naloxone provides a safety net that encourages people to take bigger chances. Studies have shown that naloxone does not increase drug use any more than free condoms increase sex. Nor am I saying we should place limits on the number of times we revive people.

    What I am saying is that naloxone is no miracle drug. When you “come to,” the problem remains. Overdose survivors are 24 times more likely than the general population to die in the following year. One study found that for those revived with naloxone, nearly one in ten are dead within a year, the majority within the first month. Follow up is critical. But even that is not enough.

    Not by Locks Alone

    Few things can help an individual more than to place responsibility on him, and to let him know that you trust him.

    Booker T. Washington

    In June of 2019, New Jersey became the first state to allow paramedics to administer buprenorphine along with naloxone to ease the pain of withdrawal. Buprenorphine is the drug that, like methadone, is used in opioid replacement therapy. But this measure will, according to one expert, “make a meaningful difference only if rescued individuals are linked immediately to ongoing treatment and agree to participate in that treatment.”

    “Immediate” is key. And at least one hospital in New Jersey has been making that link, through state-paid recovery coaches, since 2017. A coach might work with someone “for weeks or months.” And the cost to taxpayers of helping people in this way is surely far less than the cost of leaving them on their own.

    Unfortunately, however, getting people into treatment is not enough. Not all treatment is good treatment. In fact, much of it is worse than doing nothing at all.

    Under the Rug

    Beware of all enterprises that require new clothes, and not rather a new wearer of clothes.

    Thoreau

    People usually go to rehab for 28 days, maybe a month and a half. In most cases, the treatment fails, if you regard failure as return to use. A study reported in the Irish Medical Journal found that 91% of people who go through rehab are using again within a year; 80% in the first month.

    “Most honest program directors,” says veteran addiction expert Julia Ross, “will admit to 90% relapse rates, and I assume that if they admit to 90%, it’s probably worse.” Drug courts are no better. A national study of seventy-six drug courts found a reduction in the rate of rearrest of only 10 percent.

    Moreover, when people come out of abstinence-based rehab, their tolerance has gone way down, so they are more likely to overdose. This is a common reason why fentanyl is killing people: it’s much stronger than they are expecting, especially in an opioid-naïve state. Making fentanyl test strips available can help prevent overdose, but that still doesn’t deal with the basic issue of why they’re using in the first place. What pain are they killing?

    Zero Tolerance

    Winning isn’t everything; it’s the only thing.

    Henry “Red” Sanders

    I watched my grandmother die a very slow death. At 90 years old, after three cancers, open heart surgery, and several strokes, she still fought tooth and nail. Christopher Ryan, author of Civilized to Death, compares our approach to death to the final minutes of an NBA basketball game. We drag it out. We go for quantity instead of quality. Is that also our approach to addiction? As long as they don’t die, we’re OK. This is similar to abstinence-based approaches to addiction treatment: As long as you don’t use, you’re OK. This amounts to saying, “it’s more important to look good than to feel good.”

    To be clear: I’m not saying we should just let our neighbors die. I’m saying we need to do more than just keep people alive; not less. We need to treat the cause, not just the symptom.

    Spare the Prod

    If you want to be heard, whisper.

    Author Unknown

    The overdose crisis is part of a larger epidemic of despair. The facade of America as the “land of opportunity” is failing. Asheville today is “booming.” For whom? Are we saving lives or just saving face?

    Fortunately, Asheville has begun to address its weak spots, and we now have three needle exchanges. We all need to look in the mirror and face where we — as a community, as a country — are really at. Because not doing so is killing us. Whether we die quickly from overdose or slowly from alcoholism, cancer, or depression, we are ALL canaries in a coal mine. And you can’t just rake the canary over the coals.

    It’s one thing to save lives. But throwing someone into withdrawal without providing detox support or throwing them out of treatment because they’ve relapsed is like hitting a child to make them stop hitting other children. Such heavy-handed measures only perpetuate a cycle of abuse. Even a magic bullet leaves a wound.

    Sticks and Phones

    Can you love people and lead them
    without imposing your will?

    …leading and not trying to control:
    this is the supreme virtue.

    The Tao Te Ching

    There’s a reason our greatest leaders practice nonviolence. If all we do is arm people with naloxone, if we fight firearms with firearms, the conflict will only escalate. Stronger opioids are already requiring stronger antidotes.

    With this approach, we may win a few battles, but we will lose the war. You can’t win when you see this as a war to begin with. Because you can’t force someone out of addiction any more than you can force them to stay alive. Force is what causes addiction.

    In 2015, Victoria Siegel, 18, died of a methadone overdose precipitated by cyberbullying. We worry about bullying in schools. What about parental bullying — or governmental? Some of us are aware of the alarming incidence of domestic violence. How many of us recognize how our culture is inherently abusive, our very way of life?

    Sometimes we forget that we are treating people, not diseases. We are bio-psycho-social beings. We have feelings. If addiction comes from pain, and pain comes from hurt, then we need to reduce hurt, not just harm.

    A Dying Shame

    You cannot be lonely if you like the person you’re alone with.

    Wayne Dyer

    We will not end drug abuse until we end human abuse. We will not end human abuse until we end abusive thinking, because violence starts with what you think. A saying often attributed to Martin Luther King Jr. is that “you can have no influence over those for whom you have underlying contempt.” As long as I think, “you’re not good enough; this is all your fault,” or I say that to myself, addiction has a foothold.

    The blame game has no winners. “We’ve lost what it means to just be ourselves and for that to be ok and for that to be enough. So we find ways to self-medicate,” says Rev. Shannon Spencer. People will use painkillers as long as the pain is killing them, for there are few emotions more agonizing than shame.

    We Are Faminy

    I don’t remember now how many days we stayed—long enough to hear David sing often and tease us about white people’s music, which, according to him, is only about “love.” He observed that the Hopi have many songs about water, which they consider the rarest and most precious of resources, and then asked, with feigned innocence, if white people sang so often about love because it was equally rare in our world.

    Peter Coyote

    To many, opioids feel like the opposite of shame. One user describes the feeling as “like being hugged by Jesus.” Indeed, “the very essence of the opiate high,” according to Gabor Mate, is that it feels “like a warm soft hug.” This is the feeling of unconditional acceptance and support, or love.

    We live in a culture where love is the one thing we sorely lack. Millions of people are starving for just a few drops of it. If only for a few moments, we desperately need to feel like we’re OK, that someone wants us to be here, as we truly are. Like they say, it is rain that grows flowers, not thunder.

    Inside, we know we’re not just here to feed The System. We know it should be feeding us. We should not be starving. We should not have to be forced, or force ourselves, to do anything. People need to be supported to decide for themselves what healing looks like for them and to approach it in their own time.

    The Emperor in the Room

    Opioids are like guns handed out in a suicide ward; they have certainly made the total epidemic much worse, but they are not the cause of the underlying depression.

    Anne Case and Angus Deaton

    To solve the drug problem, we need to focus on more than drugs. Otherwise, we are shooting the messenger. Drugs are like the emperor’s clothes; it’s time to look at who’s wearing them.

    Like Dr. Jekyll and Mr. Hyde, opioids and their antagonists are two sides of the same coin. Focusing on either is like looking for your keys under the streetlamp when you know you dropped them further up the street. There is an “upstream” issue here. That issue is our domination-based, “have to” culture. If we stick to our guns, if we continue to be violent, inside and out, we will continue to die.

    Whether we kill another person, the planet, or ourselves, we are a culture committing suicide. We are overdosing on “progress.” We are addicted to things far more insidious than opioids; you’re looking at one.

    Progress isn’t progress when it’s in the wrong direction. The direction we’re going is apart. The direction we need to go is back together.

    Only the Lonely

    Humanity’s current crisis may not, at its root, be an economic crisis or an environmental crisis. It may well be a crisis of consciousness, a crisis in how see ourselves and the world around.

    Peter Russell

    If you’re in the right place at the right time, armed with enough naloxone, you can save a life. But what about an hour later, or the next day? You might get someone into treatment, but what about after that? A person that susceptible to overdose can scarcely be left alone. And that aloneness is the real problem. In fact, it’s how addiction starts.

    The connection between social isolation and addiction shows up on many levels, from treatment to prevention. The most obvious is that you can get naloxone into the hands of every drug user, but it will do them no good if they overdose alone.

    Human beings may be the most social animals on earth. Social isolation can drive us to despair, addiction, and even suicide. Loneliness is self-reinforcing and can lead to shame, for it can mean “I don’t deserve to be loved.” This can be the underlying emotional pain that comes back during withdrawal, whether from an opioid or from someone withholding their affection. And that lack of affection could be the primary cause of addiction.

    Fatal Attraction

    If one has a friend, what need has one of medicines?

    Bhartrihari

    There can be no healing without community. “This unique American moment asks not for a call to arms, but for a call to neighborliness.” (Francie Hart Broghammer)

    No amount of “care” can substitute for the watchful eye of loving family, friends, or neighbors. No amount of “treatment” can make up for how we treat each other. It truly takes a village.

    Ultimately, it’s not drugs that are killing us; they are just finishing us off. Whether or not we beat the horse, we’re already practically dead. Something has weakened us enough to succumb to drugs. It’s the same thing that allows dealers to intentionally make some of their merchandise deadly, or if it’s naloxone, to jack up their prices.

    What our culture is most addicted to is exploitation. It’s what the system is set up for. It compels us not to care. As Ken Eisold says, “The loss of community is not a problem that can be dealt with through psychotherapy,” for what needs rehabilitation is our society. There’s something wrong “with the village.”

    The greatest tool I know for rebuilding community is Nonviolent Communication (NVC). The best approach I’ve encountered for addressing the disconnection inherent in addiction is SeekHealing.

    We are the Medicine

    At the root of the opioid epidemic are deeper questions that we have to ask about society. What kind of society do we want to live in? Do we want to live in a society where we believe every life truly matters? Do we want to live in a society where we all chip in, recognizing that we are vulnerable in some way, whether it’s to addiction or loneliness or other conditions, and that we are stronger when we come together, when we recognize our interdependence, and when we help each other?

    As tragic as the opioid epidemic is, if it can move us in a direction of shared understanding about our interdependence, if it can help us address these deeper social roots of disease, then I believe that we will have used it ultimately to improve ourselves to become stronger as a country.

    Vivek Murthy

    To make it out of this crisis, we need to look at the big picture. As writer David Dobbs puts it, “trying to understand mental illness without accounting for the power of social connection is like studying planetary motion without accounting for gravity.” If we only look at addiction on an individual level, we are missing the forest for the trees. If you don’t heal the forest, it gets harder and harder to heal each tree.

    It’s especially hard to heal when you’re continually cut down. In this culture of mutual exploitation, we treat each other like truffula trees. We factory-farm humans and clear-cut them for fuel. We do it to each other and we do it to ourselves. All to feed the machine, the matrix. To race into space, we’re melting our wings.

    Saving lives, then, is only the beginning. It’s the tip of the iceberg. Because it is we, not “they,” who have an addiction. This isn’t about how we use drugs; it’s about how we use each other. Because ultimately, there are no others. We are not just a bunch of individuals. We are one, interdependent whole. Our greatest public health crisis is that we’ve forgotten who we are.

    The Opposite of Addiction

    Sometimes out of really horrible things come really beautiful things.

    Anthony Kiedis

    This crisis is an opportunity, a wake-up call. If we take responsibility for it, there’s no limit to what we can do. It’s said that anything is possible if it doesn’t matter who gets credit for it. The same is true of blame.

    We are all in this together. That’s the bottom line. There is but one answer to this crisis, and we each carry it at the bottom of our heart.

    View the original article at thefix.com

  • Pennsylvania Giving Away Free Naloxone To Combat Overdoses

    Pennsylvania Giving Away Free Naloxone To Combat Overdoses

    The state is set to give away one free dose of naloxone on September 25th from 9 AM to 3 PM.

    Residents of Pennsylvania were able to claim a free dose of naloxone last Wednesday (Sept. 18), thanks to Governor Tom Wolf and the state’s Department of Health. The medication was made available to anyone who wanted it, whether they used opioid drugs or simply wanted to hang on to a dose just in case.

    Naloxone has made waves as something of a miracle drug, able to instantly reverse an opioid overdose with a single injection or nasal spray. By binding to opioid receptors in the brain, naloxone can and has saved many lives.

    Increasing Access To Naloxone

    Advocates for increasing the accessibility of naloxone believe it is simply a common sense approach that must be undertaken to combat the opioid crisis.

    “Naloxone has one function: to reverse the effects of opioids on the brain and respiratory system to save someone’s life,” Pennsylvania Health Secretary Dr. Rachel Levine said. “It is impossible to get someone into treatment who is dead. In 2018, more than 4,400 people died from a drug overdose. Every Pennsylvanian has a role to play as a potential first responder and can save a life by having naloxone on hand and using it if they come across someone who has overdosed.”

    Another Naloxone Giveaway Is Coming Up

    The lifesaving medication could be claimed for free in 87 locations across the state, including state health centers and municipal health departments. The state will do another round of freebies on September 25th from 9 AM to 3 PM.

    This kind of progressive policy to combat overdoses has been done before in New Jersey, which gave away doses of the stuff for free through select pharmacies on June 18th this year. Such approaches were based on a study that showed that a combination of increased access to naloxone and Good Samaritan laws could save lives.

    “Naloxone access and Good Samaritan laws are associated with 14% and 15% reductions, respectively, in opioid overdose deaths,” read the paper, published in Addictive Behaviors. “Among African-Americans, naloxone and Good Samaritan laws reduce opioid overdose deaths by 23% and 26% respectively. Neither of these harm reduction measures result in increases in non-medical opioid use.”

    Better yet, this was achieved without the negative effects some predicted. Critics of such programs believed that with such a strong safety net, people may use more opioids than before, but the data do not support anything like this happening.

    “The scourge of opioids continues to devastate families and communities across our state, and we must do everything we can to end the opioid epidemic,” said New Jersey Governor Phil Murphy. “Through this initiative, people who are battling with addiction will be able to receive access to this critical medication and help them get on a path to recovery.”

    View the original article at thefix.com

  • 7 Things I Wish I Could Tell My Parents About My Addiction

    7 Things I Wish I Could Tell My Parents About My Addiction

    Here, on this motel floor, I need to know that you still love me. If it isn’t too painful for you, please visit me in rehab. When I tell you that I’m finally ready to get clean, please believe me even if it’s the 100th time.

    I constantly find myself in conversations with both of my parents about that dark time in my life. In the beginning of my sobriety, I tried to explain to them about opioid receptors and dopamine levels but it never seemed to make a difference. Many parents have a “You did this because you are weak!” mindset. They think that you can just quit. Well, Mom…

    1. I Can’t Just Quit

    I’ve been tired of this life for a long time and I have the desire to be the person you once trusted. But every time I quit, I get sick and believe that life just isn’t worth living. I’ve tried to get clean but once the fog clears I realize how much I’ve damaged my life and I go back. I wish I could snap my fingers and be normal with a job and home, but my brain has changed. I want to be the child who you loved unconditionally but I’m not, I’m sick. I don’t like sleeping outside and going to rehab every few months, but that’s what this drug has done to me. It’s a part of me now and unless I have it I can’t even get out of bed. I hate myself and what I’m putting you through, but my mind and body are broken right now.

    2. This Isn’t Your Fault

    This didn’t happen because you left me to cry it out in the crib for too long or because you weren’t strict enough. There isn’t a recipe that you followed to make me a drug addict. This happened because I tried something out of curiosity and my brain and body responded in a way that made it impossible to stop. Ever since that first time, my brain hasn’t worked the same. I am not lazy, stupid, or weak. I wish that I could sleep this off with a hot shower and an iron-rich diet but it doesn’t work like that. It started off as fun, but now I’m trapped.

    3. My Addiction Shouldn’t Be the Topic of Gossip

    I wish you could tell all your coworkers that I graduated from that expensive university we planned on me attending. I know you aren’t proud of me right now, but I’m still a person. I want you to heal and be able to talk about how much I’ve hurt you, but please don’t use me and my addiction as entertainment. I am still your child.

    You might not know much about how addiction works but I need for you to keep my most embarrassing secret close to you. Your coworkers and distant relatives don’t need to know that I’m in jail yet again. My great grandmother that lives a thousand miles away doesn’t want to hear about how I am living in a dirty motel. Unless I’m a threat to them or their belongings, I ask that you protect my dignity. People assume the absolute worst about people like me and I’m not proud of anything I’ve done to feed my addiction. Along with getting high, I have engaged in degrading behaviors and even exposed myself to disease and violence.

    When people hear, “My child is a drug addict,” they think about every negative thing they’ve ever seen in a movie or heard on the news and they will apply it to me. Why would you even want to share these awful things? Talk about the president or what movie you just saw instead. When I get better, I will have to face what I have done and accept the mistakes that I have made. I will have to face the people that you shared my humiliation with. Please don’t think that I am asking you to suffer in silence. There are support groups and therapists who have the knowledge and skills to help you get through this, too.

    4. Try to Learn About My Addiction

    Did you know that the American Medical Association classifies my addiction as a disease? I didn’t make this up to make you feel sorry for me, it really is. I made the initial choice to start using drugs but when I wanted to stop, my brain said no. It made everything else in the world unenjoyable. Could you imagine not being able to enjoy your favorite piece of cake from the best bakery in town? This is my life right now. The chemicals in my brain have been reprogrammed to want one thing only.

    If you don’t believe me, and you probably won’t, take ten minutes and do a little research on addiction. While you are clicking on different links and learning about what I’m going through, please look at all of the different treatment options too. Did you know that there is a medication you can give me in an emergency that will reverse an opioid overdose at home? It’s called naloxone and you can get it from the pharmacy and it could possibly save my life.

    I know that you want me to get better. I do, too, but it’s much harder than just saying no. It’s important that you know that there are some medications available that can help my cravings and others that will completely block the effects of opioids. Whether or not these are what’s best for me is something I will have to decide on my own but you should know about them. As long as I am seeking treatment or have even talked about how I want to get better, I am still here fighting.

    5. I Have Suffered Through Incredible Trauma

    I have seen death and loss. I have lost my dignity and self-respect. Some of my friends have died because of these drugs and I have been close to death myself.

    I don’t know if I’ll ever be able to talk about the terrible things that have happened in my addiction because I know how much it will hurt you. You might say that this is my fault and that I’m weak, but I’m not. I’m in here fighting with these memories and still waking up in the morning. When I get clean, I will need time to heal. I will need counseling and even a little bit of space.

    6. I’m Sorry

    I’m sorry I stole from you and constantly lied to you. I’m sorry I didn’t make it to Thanksgiving last year, and I’m sorry you found me unconscious. I’m sorry that I made you cry. If I had a penny for every regret, I could pay you back for everything you’ve done for me. Right now, however, I would probably spend that money on drugs because I’m sick. One day I hope that you will forgive me. I don’t expect you to forgive me soon, but hopefully you realize that your child is still in here.

    7. Please Don’t Give Up on Me

    I’m not asking you to give me money, that ship has long sailed. I’m not asking you to let me come home or even to trust me right now. Here, on this motel floor, I need to know that you still love me. I need you to call me and tell me how you are. Please be a constant in my life, even if it’s just through text messages. If it isn’t too painful for you, please visit me in rehab. When I tell you that I’m finally ready to get clean, please believe me even if it’s the 100th time. If I tell you that I’m going to start taking medication to help with my sobriety, be proud of me! Don’t tell me that I’m trading one drug for another, because I’m trying.

    Just please, don’t give up on me.

    View the original article at thefix.com

  • Four Advocates on How Harm Reduction Can Change the Trajectory of the Opioid Crisis

    Four Advocates on How Harm Reduction Can Change the Trajectory of the Opioid Crisis

    There is overwhelming evidence that harm reduction keeps people alive and can bring them into recovery, yet it’s still met with opposition. We ask four harm reduction workers what inspires them and what we can do to help.

    Harm reduction has been a contentious topic for a while: staunch 12-step proponents who insist that abstinence is the only way to achieve recovery are met with resistance from a growing number of harm reduction activists who consider the reality of drug use more holistically while advocating for individual choice and safety. Many of us have deep-seated beliefs and strong feelings about recovery, but now more than ever we need to analyze and hopefully remove our biases, accept the overwhelming data in favor of harm reduction, and face the failed policies that have led to a national crisis. Every day 130 people die from opioid overdose in the U.S., and misuse of prescription opioids costs us an estimated 78.5 billion dollars each year.

    Abstinence alone isn’t working. If it were, we wouldn’t have an epidemic on our hands. Perhaps this realization is why we are seeing an increase in harm reduction measures—increased naloxone access, fentanyl testing strips, Good Samaritan laws, and needle exchange programs. And they work: many individuals enter recovery through various harm reduction programs. But regardless of whether people get treatment or not, harm reduction measures prevent disease and save lives.

    What Is Harm Reduction?

    Harm reduction is frequently misunderstood. Often people think it means the use of medication-assisted treatments (pharmacology), or moderating drug use instead of eliminating it entirely. But these are narrow definitions. Harm reduction is not a particular pathway of recovery; it is a means of reducing the harm associated with drug use.

    According to the Harm Reduction Coalition, “Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”

    The philosophy of harm reduction accepts that drug use is complex and multifaceted, and that it involves a range of behaviors from frequent use to total abstinence. It acknowledges that some ways of using drugs are clearly safer than others. Harm reduction includes strategies such as safer use, managed use, needle exchanges, supervised injection sites, treatment instead of jail, and abstinence. It advocates for meeting the individual where they are and addressing their reasons for using and the conditions surrounding their drug use. Successful implementation of harm reduction should lead to well-being for individuals and communities, but not necessarily cessation of all drug use.

    Tracey Helton Mitchell, Devin Reaves, Brooke Feldman, and Chad Sabora advocate for the acceptance and practice of harm reduction. We asked what motivated them to pursue their activism and how we can all be more mindful of harm reduction principles.

    Tracey Helton Mitchell

    Tracey Helton Mitchell came into the public eye when she was featured in HBO’s documentary Black Tar Heroin, which documented her life on the streets on San Francisco. After she found recovery, she rebuilt her life and went back to school for a bachelor’s degree in business administration and a master’s in public administration. She has dedicated her life to advocating for the individual needs of people with addiction. She documents her journey in her book The Big Fix: Hope After Heroin.

    In 2016 Tracey told NPR that “We need to have a variety of different kinds of treatment interventions that address people’s needs.” In response to the argument that harm reduction measures such as needle exchange enable drug use, she said: “We’re not encouraging people to do anything, we’re taking a look at their public health behaviors and then addressing what the particular needs are, so look at the cost of one syringe versus the cost of someone getting hepatitis C and having to take care of them for a lifetime.”

    What motivated you to work in harm reduction?

    I started in harm reduction in response to the overdose crisis that was happening in San Francisco and the Pacific Northwest in the late 90s. I knew many people who had died, including Jennifer H., a person I loved very much. 

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    Harm reduction is seen by many in the recovery community as a crutch when it should be seen as a lifeline. Harm reduction should be included as part of a continuum of care with a wide variety of options based around what is best for the person. Too much focus has been made on “abstinence only” as the standard for recovery. We need to broaden our scope. 

    See also: Naloxone and the High Price of Doing Nothing

    Devin Reaves

    Devin Reaves, MSW, is a community organizer and grassroots advocacy leader who is in long-term recovery. He is also the co-founder and executive director of the Pennsylvania Harm Reduction Coalition (PAHRC), serves on the Camden County Addiction Awareness Task Force, and sits on the board of directors for the Association of Recovery High Schools. He has worked on the expansion of access to naloxone, the implementation of Good Samaritan policies, and the development of youth-oriented systems, and he is leading conversations to bring about public health policy changes in the area of substance use disorders.

    PAHRC’s mission is to promote the health, dignity, and human rights of individuals who use drugs and the communities affected by drug use.

    What motivated you to work in harm reduction?

    As someone in recovery who lost a lot of friends to substance use disorder, when I learned about Narcan, I wanted it to be more available because I was sick of my friends dying. Seeing that harm reduction wasn’t utilized made me want to fight to see more of it: syringe services programs or more innovative programs.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    We can provide Fentanyl testing strips, Narcan, and sterile needles to use. For those seeking recovery, we should also provide Narcan because they are still at risk. What people don’t know about harm reduction is that individuals in programs of harm reduction are five times more likely to enter treatment—it is a pathway of recovery. 

    Brooke Feldman

    Brooke Feldman, MSW, is a social justice activist who identifies as a member of the LGBTQ+ community and a person in long-term recovery from substance use disorder. She has spent the past decade advocating for wellness and long-term recovery being accessible to all.

    What motivated you to work in harm reduction?

    Well, I think I was pretty primed to embrace harm reduction principles over 10 years ago when I was taught what are called “recovery-oriented” care principles. Back in 2008, and only a few years into my own recovery journey, I was working for an organization called PRO-ACT at Philly’s first Recovery Community Center. We had a sign on the wall that greeted people with, “How can I help you with YOUR recovery?” and we were educated and trained in practices such as meeting people where they’re at, supporting people in working toward their own goals rather than our goals for them, recognizing that abstinence is not the goal for everybody, and embracing diversity in recovery experiences and mosaics of pathways. My experience with what we call recovery-oriented practice over the past decade set the stage for harm reduction principles and practices to fit perfectly. Unfortunately, while I have found my own professional experience, education, and training in recovery-oriented care to fit neatly with harm reduction, I still see many gaps between the harm reduction and recovery movements. A large motivator for me currently is the strong desire to bridge those gaps, to highlight shared goals and values, and to be part of unifying the two movements wherever possible. I believe people die in the cracks of the divide, and I hope to serve as part of the glue that seals the cracks.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    I think that if we center the human rights of choice, self-determination and autonomy when it comes to directing the course of one’s own life, we become more inclusive of harm reduction principles across the board. One concrete area for centering these principles is that of the use—or declined use—of medications to treat opioid use disorders. People have a right to utilize evidence-based medications to aid in their recovery, and people also have a right to decline the use of medication as part of their recovery. Nobody should face discrimination or refusal of resources, supports, and services based on this choice of what to put in their bodies. Also, one of the things I love about the harm reduction movement is the social justice focus. In my experience, the harm reduction movement centers the roles that oppression and marginalization play when it comes to how our systems, and society at large, respond differently to drug use depending on the skin color or socioeconomic status of the drug user. I think that centering social justice would put us all in the right position when it comes to both people currently using drugs and people in recovery, however that recovery is self-defined.

    Chad Sabora

    Chad Sabora is the co-founder and executive director of the Missouri Network for Opiate Reform and Recovery (Mo Network), an organization that offers services to those struggling with substance use disorder and their loved ones. He has been the focus of several episodes of the show Drug Wars on Fusion and was part of an Emmy award-winning episode of NBC News with Brian Williams. Sabora has been an expert correspondent on CNN and MSNBC. He is also president and co-founder of the nonprofit Rebel Recovery Florida, and he is on the board of directors of the Discovery Institute for Addictive Disorders in Marlboro, New Jersey. Sabora is also known for filming himself while touching fentanyl, thus debunking the myth that you can overdose through skin contact with the illicit substance.

    Uniquely experienced as a former prosecutor and a person in long-term recovery, Sabora left legal practice in favor of pursuing drug policy reform and advocacy. He founded Mo Network in 2013, where he heads their work on legislative policy reform. Sabora and Mo Network focus on expanding services based on evidence-based solutions, and they lobby for more effective drug policy locally in Missouri and also at the federal level.

    He has helped write, advocate for, and pass several pieces of legislation in Missouri, namely first responder access to Narcan, third-party and over-the-counter access to Narcan, 911 Good Samaritan immunity, and access to medication-assisted treatment in various environments such as addiction treatment, mental health facilities, family court, and for certain frequently-overlooked populations such as veterans.

    What motivated you to work in harm reduction?

    The overwhelming data, basic common sense, failed policies of the past, and unconditional love was the motivation.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    Inclusion will come in time, as long as we stay vigilant. Changing moral compasses and inherent biases could take a generation before we see the full impact.

    Read Chad’s rules for staying alive while using drugs (including how to use naloxone to reverse an opioid overdose)

     

    A Call to Action: We Need Harm Reduction Now

    The evidence is clear: If we provide the education and resources for people to use drugs safely, we reduce disease and save lives. Frequently we open the door to recovery. Isn’t it time for us all to start advocating for (or at least accepting) harm reduction wherever and whenever we can?

    View the original article at thefix.com

  • FDA Admits Past Mistakes In Handling Opioid Crisis

    FDA Admits Past Mistakes In Handling Opioid Crisis

    The Food and Drug Administration addressed its missteps in handling the crisis and outlined its future plans in a new statement.

    FDA Commissioner Scott Gottlieb issued a far-ranging statement about his agency’s most recent and upcoming actions, while also addressing past missteps, in regard to the national opioid epidemic.

    Noting that the FDA’s previous wait-and-see policy in regard to evidence and intervention left it “a step behind a crisis that was evolving quickly,” Gottlieb said in the statement that his agency will implement more effective measures to reduce exposure to opioids, including prescription and labeling changes, promotion of treatment therapies, and approval of non-dependency-forming pain treatment.

    Calling the opioid crisis “a top priority” of both Secretary of Health and Human Services Alex Azar and the Trump Administration as a whole, Gottlieb wrote that faster and more decisive action will define the FDA’s policy in 2019.

    The rise in synthetic opioids like fentanyl and the “continued prevalence” of opioid prescriptions with overly long durations has prompted the agency to “step up its intervention,” according to Gottlieb.

    The commissioner also noted that the FDA’s previous approach—”waiting for the accumulation of definitive evidence of harm” put them in a position of catching up to the crisis as it ravaged “vulnerable communities.”

    “We don’t want to look back five years from now, at an even bigger crisis, with regret that there were more aggressive steps that we could have taken sooner,” wrote Gottlieb. “All options are on the table.”

    As Gottlieb outlined in his statement, these options have included expanded information on drug labeling. Passage of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act in October 2018 has also given the agency new authority to assess and reduce dependency and misuse of opioids, including requirements for packaging on opioids and other drugs that carry a high risk of abuse or overdose.

    According to the statement, FDA will issue a report on their recommendations for prescription guidelines at the end of 2019.

    The FDA is also considering an option to require certain immediate-release formulations of opioids be made available in blister packages containing one- and two-day dosages, which would “comport with evidence demonstrating that a day or two of medication is sufficient” and could “reduce the overall amount of dispensed drugs available for misuse, abuse and diversion.”

    Gottlieb also wrote that the agency will consider a formal evaluation of prospective opioid drugs to determine its application for specific patients, and whether or not the newer application is safer or more effective for treatment than existing, non-addictive medication. The Risk Evaluation and Mitigation Strategies (REMS) program, which measures the benefits of a particular drug over its potential risks, will also be subject to review to determine if it is properly addressing such concerns.

    The FDA will also prioritize the development of new and effective forms of medication-assisted treatment (MAT) to treat opioid dependency and non-addictive pain medication, and expand access to the overdose reversal drug naloxone.

    The agency will also continue to partner with U.S. Customs and Border Protection to reduce the marketing and distribution of illegal opioids through national borders and through international shipping.

    View the original article at thefix.com

  • FDA May Recommend Naloxone Be Co-Prescribed With Opioids

    FDA May Recommend Naloxone Be Co-Prescribed With Opioids

    The “co-prescribing” recommendation would apply to patients who are at high risk of overdose, including people who take a high-dose opioid.

    The Food and Drug Administration (FDA) is considering recommending that people who receive an opioid prescription are also offered a prescription for naloxone, the opioid overdose reversal drug. 

    The move is intended to reduce deaths from opioid overdose, but some people say that the effort is misguided. 

    The so-called co-prescribing recommendation would apply to patients who are at high risk of overdose, including people who take a high-dose opioid, have a history of addiction or have sleep apnea, according to CNN.

    Kristy Shepard, a Virginia patient who uses opioids, didn’t know that she had a naloxone prescription waiting for her at the pharmacy. She said that her doctor didn’t give her a heads up about the state’s new co-prescribing recommendations. Other states, including California and Ohio have made similar recommendations, but Shepard doesn’t understand why. 

    “It’s so silly. I didn’t feel like I needed it. Unless I plan to hurt myself, I’m not likely to overdose,” she said. 

    However, Dr. Nathan Schlicher, who is on Washington state’s opioid task force and works as an emergency medicine physician, said this is a common misunderstanding. 

    “You can take pain meds responsibly, and you can be at risk for an accidental overdose even when you’re doing everything right,” he said. Washington also has a co-prescribing recommendation. 

    If the FDA recommends co-prescribing, the need for naloxone would increase by 48 million dosages annually, according to an FDA report. That could be a big financial incentive to drug makers, who have spent money lobbying for similar efforts at the state level, especially in California. 

    Some opponents point out that having naloxone on hand only works if the people taking opioids have someone around who could administer the drug if they overdose. 

    Katie O’Leary, who deals with pain, said that talking about overdose risk and carrying naloxone should be a conversation between individual providers and their patients, not a federal requirement. 

    “So many patients already jump through so many hoops to get their meds,” she said. “And if you live alone and don’t have family or friends to take care of you, the naloxone might not be something that could actually help.” 

    Dr. Farshad Ahadian, medical director at the University of California San Diego Health Center for Pain Medicine, agreed, saying, “Most providers probably feel that it’s better for physicians to self-regulate rather than practice medicine from the seat of the legislature. The truth is there’s been a lot of harm from opioids, a lot of addiction. It’s undeniable that we have to yield to that and to recognize that public safety is critical.”

    View the original article at thefix.com

  • Inside The Push For Over-The-Counter Naloxone

    Inside The Push For Over-The-Counter Naloxone

    The FDA has recently taken an unprecedented step to kickstart the development of over-the-counter naloxone products. 

    Last week the FDA took an unprecedented step to make the anti-overdose drug naloxone directly available to opioid users.

    Currently, naloxone requires a prescription. But in an effort to make approval for non-prescription versions of the drug easier for pharmaceutical companies to get, the FDA developed sample labels that would meet federal Drug-Facts Label requirements for over-the-counter products. It marks the first time the drug agency has ever proactively created labelling to expedite the process.

    “Naloxone is a critical drug to help reduce opioid overdose deaths. Prevention and treatment of opioid overdose is an urgent priority,” the agency wrote in an unsigned statement. “Increased availability of naloxone for emergency treatment of overdoses is an important step.”

    The agency created two model labels, one for a nasal spray version of the drug and one for an auto-injector version. Both versions include a short information box about the drug and its uses, followed by an illustrated guide on how to administer the life-saving treatment and a warning about the drug’s expected effects.

    “These efforts should jumpstart the development of OTC naloxone products to promote wider access to this medicine,” the FDA wrote. The agency tested the labeling through a research contractor to verify that potential users could understand the images and warnings.

    “This work builds on our ongoing efforts to get this life-saving drug into the hands of those who need it most,” the statement continued. “In addition to the approval of injectable naloxone for use in a health care setting and both prescription auto-injector and intranasal forms of naloxone, which facilitate use by laypersons, we also released draft guidance to advance development of generic naloxone hydrochloride nasal spray.”

    The move comes amid a long-term rise in overdose deaths, as close to 48,000 people died from opioids in 2017 – double what the figure was seven years earlier, according to the federal agency. Overdoses can cause drug users to lose consciousness and stop breathing, but naloxone reverses those effects if given quickly enough. 

    Though the injectable version is pricier, a two-pack of the brand-name nasal spray version sells for about $125, according to CNBC. The generic is around $40 per dose. In theory, offering up a label that could make over-the-counter access easier might help lower those figures further by eliminating the need for would-be buyers to spend money on seeing a doctor for a prescription.

    “While the person administering naloxone should also seek immediate medical attention for the patient,” the agency said, “the bottom line is that wider availability of naloxone and quick action to administer it can save lives.”

    View the original article at thefix.com

  • Mass Overdose In California Leaves One Dead, 12 Hospitalized

    Mass Overdose In California Leaves One Dead, 12 Hospitalized

    “Every indication is that this mass overdose incident was caused from the ingestion of some form of fentanyl in combination with another substance,” said a police chief at the scene.

    The synthetic opioid fentanyl is most likely responsible for a cluster of overdoses in one Chico, California house. One person died after overdosing and four are in critical condition; a total of 12 people were taken to the hospital. 

    According to NPR, Chico police are fairly sure the mass overdose was caused by the use of fentanyl, in combination with another substance.

    “Every indication is that this mass overdose incident was caused from the ingestion of some form of fentanyl in combination with another substance. That is yet to be confirmed, but we do anticipate confirmation in the coming days,” Chico Police Chief Michael O’Brien said.

    According to Anna Lembke, MD, fentanyl (a synthetic opioid pain reliever) can be 50 to 100 times more potent than heroin. Lembke gives this chilling example: “If you ingest a ‘bag of heroin,’ which is typically 100 mg of heroin, and that bag contains 20% pure fentanyl in place of heroin, you will be ingesting the rough equivalent of 2,000 mg of heroin, enough to kill even a highly tolerant user.”

    Chico Fire Department Division Chief Jesse Alexander said it was the largest mass casualty incident he had seen in years, with six people receiving CPR simultaneously.

    Chief O’Brien reported on the crime scene. “Upon arrival, Chico police officers found multiple individuals in what appeared to be life-threatening, overdose conditions. . . . Officers began to both administer CPR and also naloxone to those individuals. . . . Unfortunately one male individual was pronounced dead at the scene.”

    Chico officers began carrying naloxone on their person one year ago, according to CNN, and in this case lives were saved with the opioid-reversing drug. Police Chief O’Brien reported that officers administered CPR and six doses of naloxone.

    After working the crime scene, two officers reported feeling fentanyl-like symptoms from possible exposure and were treated and later released from a local hospital.

    The Chico Enterprise-Record reported that all of the people hospitalized were over the age of 18, with most of them appearing to be in their 20s. The National Institute on Drug Abuse reports that in 2017 there were more than 72,000 drug overdose deaths, with the sharpest increase seen among deaths related to fentanyl and fentanyl analogs (synthetic opioids) for a staggering total of nearly 30,000 overdose deaths. 

    View the original article at thefix.com

  • Naloxone Price Spiked 600% During Opioid Crisis By Drug Maker

    Naloxone Price Spiked 600% During Opioid Crisis By Drug Maker

    One drug manufacturer reportedly increased the price of its naloxone drug Evzio from $575 per dose to $4,100 per dose.

    Naloxone, the opioid overdose reversal drug, has been heralded as a lifesaving intervention credited with helping stem the death toll of the opioid epidemic. However, one drug manufacturer reportedly saw the demand for the drug as a lucrative opportunity, raising its price 600% over the past four years. 

    According to a report commissioned by Sens. Rob Portman (R-OH) and Tom Carper (D-DE), drug manufacturer Kaléo “exploited the opioid crisis” by increasing the price of its naloxone drug Evzio from $575 per dose to $4,100 per dose. 

    Naloxone can save people’s lives during opioid overdoses by reversing the effects of opioids. Sometimes, in the case of powerful synthetic opioids like fentanyl, multiple doses need to be administered. 

    According to the report, Kaléo intentionally increased the price of Evzio, in addition to manipulating how the drug was processed by insurance companies to take advantage of a money-making opportunity.

    “In conjunction with the price increase, Kaléo launched its new business plan,” the report reads. “The Evzio Commercial Update Executive Summary, pictured here, dated April 2016, noted ‘2016 is critical to long-term success.’ With the increased price and new business model, Kaléo sought to ‘[c]apitalize on the opportunity’ of ‘opioid overdose at epidemic levels—a well-established public health crisis.’”

    The report concluded that Kaléo’s aggressive pricing cost taxpayers $142 million through payments made through Medicare and Medicaid, according to a press release from Portman’s office. 

    “Naloxone is a critically important overdose reversal drug that our first responders have used to save tens of thousands of lives,” Portman said. “The fact that one company dramatically raised the price of its naloxone drug and cost taxpayers tens of millions of dollars in increased drug costs, all during a national opioid crisis no less, is simply outrageous. The Subcommittee will continue its efforts to protect taxpayers from drug manufacturers that are exploiting loopholes in the Medicare and Medicaid system in order to profit from a national opioid crisis.”

    Carper agreed, saying, “We know that naloxone can save lives. We need to take the necessary steps to ensure that drugs like this are affordable and accessible to those in need, especially during a public health emergency of this magnitude.”

    In response to the report, Kaléo issued a statement pointing out that it has donated thousands of doses of Evzio, and claimed that it has never turned a profit from the drug. 

    “Patients, not profits, have driven our actions,” the company said.

    Read more about the report’s findings and how Kaléo manipulated pricing here.  

    View the original article at thefix.com