Answer Addiction

Tag: naloxone

  • Why Some Pharmacies Still Fail To Carry Naloxone

    Why Some Pharmacies Still Fail To Carry Naloxone

    Though many states have passed laws to expand naloxone access, some pharmacies have been too slow to get onboard with carrying the life-saving medication.

    According to new research, expanding access to naloxone still has room for improvement.

    Two new studies that surveyed pharmacies in California and Texas suggest that access to the opioid overdose “antidote” is still not optimal, despite the passage of laws across the U.S to expand naloxone access.

    Both California and Texas have passed laws that allow pharmacists to dispense naloxone without a prescription. But some pharmacies are still not on board with the new policies.

    “There is still significant room for improvement with regards to making this potentially lifesaving medication available to patents who need it,” said one researcher.

    Just 23.5% of retail pharmacies in California were dispensing naloxone sans prescription two years after the new policy was established. Dr. Talia Puzantian and Dr. James Gasper, who co-authored the research, say this may be due to a lack of training, stigma about substance use, and time, according to Family Practice News.

    In Texas, 83.7% of pharmacies surveyed said they would dispense naloxone without a prescription, while 76.4% said they currently stocked naloxone.

    The benefit of increasing access to naloxone—not only to first responders and medical providers, but the public—is to save lives, says Texas study lead Kirk Evoy of the University of Texas at Austin College of Pharmacy and University Health System in San Antonio.

    “Being able to administer naloxone immediately, while waiting for emergency medical services to arrive, greatly increases the chances of survival and reduces the risk of long-term negative health consequences, because the body cannot last long without oxygen,” Evoy said.

    Improving access to naloxone is just one way to lessen the death toll of the opioid crisis.

    The total number of drug overdose deaths in 2017 is projected to exceed 72,000, according to the Centers for Disease Control and Prevention (CDC).

    “I do not know how many of these people overdosed alone,” says Dr. Seth Landefeld of the University of Alabama at Birmingham in an editorial accompanying the research. “But ready availability of naloxone would undoubtedly have saved many lives.”

    While all 50 states and the District of Columbia have enacted some form of a naloxone access law, all but Nebraska allows for a pharmacist to dispense the drug without a prescription, according to PDAPS (Prescription Drug Abuse Policy System).

    Other naloxone access laws include providing immunity from criminal or civil liability for prescribers, pharmacists, and laypeople for dispensing or administering the drug.

    View the original article at thefix.com

  • Will Naloxone Be Co-Prescribed With Opioid Painkillers In The Future?

    Will Naloxone Be Co-Prescribed With Opioid Painkillers In The Future?

    While some states already require the co-prescription, the FDA is considering making it a requirement across the US.

    In an effort to decrease overdose deaths, doctors could soon be required to prescribe an opioid overdose antidote any time they prescribe prescription painkillers, according to Food and Drug Administration (FDA) Commissioner Scott Gottlieb.  

    The idea of co-prescription, according to the Washington Examiner, isn’t a new idea. In fact, some states such as Arizona, Virginia, and Vermont, already require the co-prescription of the overdose reversal drug known as naloxone.

    Naloxone comes in the form of a nasal spray as well as an auto-injection so it may be administered by those not in the medical field.  

    Other states considering such laws include California, Florida, New York, Ohio, Texas, and Utah. 

    Such laws are supported by the manufacturers of popular overdose antidotes, such as Adapt Pharma, the company that distributes Narcan. 

    “We are trying to do anything we can to build awareness and broaden support,” said company chairman and CEO Seamus Mulligan, according to the Examiner. 

    Kaleo, the manufacturer of the naloxone auto-injector, is also supportive, telling the Examiner in May that it “welcomes” the idea of co-prescribing.

    “We believe that doctors, pharmacists and other healthcare professionals play a critical role in developing and managing a comprehensive treatment plan for their patients, as well as helping a patient and their loved ones recognize the potential risk for opioid emergencies, even when pain medications are taken as directed,” the company said.

    Current laws vary from state to state. In Vermont, prescription rules are connected to other laws requiring doctors to check patient databases before prescribing an opioid.

    In Virginia, it’s recommended that high doses of pain prescriptions are given with an overdose antidote prescription as well.

    Additionally, doctors are encouraged to prescribe the antidote when prescribing opioids and benzodiazepines, as the two can lead to overdose.

    The Centers for Disease Control and Prevention (CDC) has made similar recommendations in its guidelines to doctors. 

    While naloxone can save lives, it’s not considered a treatment for substance use disorder. 

    “Naloxone allows someone another day to have an opportunity to overcome their addiction,” New York state Sen. George Amedore Jr. said, according to the Examiner. “It’s not the whole answer or the cure-all.”

    As such, some officials are also calling for wider access to buprenorphine, a medication that helps to lessen cravings and withdrawals. 

    The FDA will hold a meeting on Dec. 17-18 to determine more ways to make the overdose antidote more readily available. 

    View the original article at thefix.com

  • Maryland Funeral Directors: We're The "Last Responders" To Opioid Crisis

    Maryland Funeral Directors: We're The "Last Responders" To Opioid Crisis

    Funeral directors in the state claim that safety has become an issue when dealing with opioid overdose victims. 

    Proactive funeral directors in Maryland are stocking up on naloxone, the opioid overdose antidote, as they’ve seen a dramatic increase in the number of opioid-related deaths.

    They’re calling themselves the “last responders” to Maryland’s opioid crisis, the Baltimore Sun reports.

    In 2017, the Tri-County Funeral Directors Association launched an awareness campaign in local newspapers to notify communities that “We Don’t Want Your Business” when it comes to opioid abuse.

    “We see a side of this tragic epidemic that many don’t see,” said association president James Schwartz. “The devastation families are facing is heartbreaking.”

    Schwartz tells the Baltimore Sun that other funeral home directors have known not only family members, but funeral home guests “who have come and had either an opioid reaction in the parking lot or other areas during the service time.” 

    “This has caused the folks stress because not only are they grieving this person and now somebody else is having the same tragic result,” Schwartz said.

    The National Funeral Directors Association urges members to protect themselves while handling deceased victims of opioid overdose.

    “Coming into contact with a minuscule dose of fentanyl or carfentanil can be fatal,” the association warns. (This point is oft-repeated, but harm reduction and addiction/recovery advocates say it’s merely a harmful myth.)

    “The opioid crisis presents unique challenges for funeral directors, from working with families whose loved one has died from an overdose to protecting themselves from harm when handling the body of an overdose victim during removal or embalming,” says the funeral directors association.

    In 2017, opioid overdose deaths continued to climb in Maryland, accounting for the majority of drug/alcohol-related deaths—2,009 of 2,282 overdoses were opioid-related, according to the state’s Department of Health.

    “This is an escalating epidemic,” said Baltimore Health Commissioner Dr. Leana Wen, whose city saw the worst of the opioid crisis. “But still we don’t even see the peak of this epidemic yet.”

    In response, Maryland schools and libraries are also stocking up on naloxone. “The rule of thumb is: when in doubt, use it,” said funeral director Jeffrey L. Gair.

    The antidote is there “if there’s ever the need while we’re on duty at the funeral home,” Gair said.

    View the original article at thefix.com

  • Bringing Harm Reduction to Haywood County

    Bringing Harm Reduction to Haywood County

    The man in the camouflage shirt who emerges from the cabin is drawn and thin with circles under his eyes. He tenses at my presence, especially once Jeremy tells him I am there to write an article.

    It is a cloudy evening and mosquitoes patrol in full force as Nancy Bauman and I pick our way gingerly over trash-strewn ground, searching for syringes. Under a creekside bridge splashed with graffiti, a pair of neatly folded jeans, a plastic bag of food items, and a pair of shoes offer evidence of a homeless encampment.

    As we search, Nancy opens up about her life as a former injection drug user. She recounts how her only brother died of a heroin overdose shortly after returning from Vietnam. Her own struggle with addiction began through recreational drug use with homecoming soldiers, and years ago she lost her husband to hepatitis C infection. Drugs ruled much of her youth, but Nancy has spunk. She entertains me with tales of how she used to run an illegal syringe exchange program with two Catholic nuns in Los Angeles. 

    As I listen to Nancy, I am not putting much effort into the search for syringes. Truth be told, I feel guilty about picking through someone’s home and also for the assumption that a homeless person must also be an injection drug user. Under the bridge, Nancy and I find nothing but an overturned shopping cart, bits of trash, and a spoon. When the time comes to return to the health department, I feel relieved.

    Nancy and I drive back to the health department to rejoin the rest of the newly formed Substance Use Task Force of Haywood County, North Carolina. The community syringe pick-up event is the inaugural event for this group, which is comprised of public health employees, harm reduction advocates, law enforcement personnel and impacted citizens who hope to address the growing incidence of drug use in Haywood County. The dozen or so members are an eager bunch, well-intentioned but so far lacking clear direction on how to tackle such a complex problem. The group finds only two discarded syringes that evening; still, enthusiasm reigns.

    We are debriefed by members of the North Carolina Harm Reduction Coalition (NCHRC), which in spring 2018 hired three staff members for the area under a grant funded by the Aetna Foundation. Haywood County, and western North Carolina in general, is relatively new territory for NCHRC, which has more established programs in eastern and central parts of the state. In one sense, this is an advantage since advocates can draw on the experience of harm reduction programs in other counties. In another sense, it is a disadvantage. Few people in Haywood County have even heard of the term “harm reduction.” Appalachian residents, often tough and resistant to change, are not easily convinced and stigma against drug users runs deep. For the three new staff members, Gariann Yochym, Virgil Hayes, and Jeremy Sharp, the task of introducing harm reduction to Haywood County is both challenge and an opportunity.

    After the task force disbands, I join Jeremy Sharp to deliver supplies to participants of the mobile syringe exchange program he has helped establish. The clouds have rolled away and the sun is just beginning to set behind the backdrop of the Blue Ridge mountains. We drive past picturesque fields of hay bales and grain silos. The town is so pretty it almost looks painted. We pull up to a log cabin with a single tire swing swaying in the breeze under a tree.

    But the beauty ends here. The man in the camouflage shirt who emerges from the cabin is drawn and thin with circles under his eyes. He tenses at my presence, especially once Jeremy tells him I am there to write an article. As a peace offering, I put away my notebook.

    Jeremy delivers syringes and naloxone to the man and his wife, who emerges from the house. The wife gives a sobering account of her recent arrest for drug possession and the agony of opioid withdrawal she endured while in jail. She asks Jeremy for help getting Suboxone treatment for opioid use and he offers to connect her to his co-worker, Gariann, who can arrange an appointment. Jeremy is quirky but likeable, and the couple’s affection for him is clear.

    When we are back in the car and I have use of my notebook again, Jeremy admits that the stories of death and despair that he encounters on a daily basis can get to him. “I walk into people’s lives for 20 minutes to do an exchange and it can be overwhelming to hear even just a description of all the things they are going through,” he says. 

    “But,” he adds, brightening. “There is nothing like that first naloxone reversal.”

    The struggle to find hope in a grim situation is one that plagues other advocates as well. NCHRC’s Gariann Yochym, who connects Haywood County program participants to social services, lives this fight every day.

    At first glance, Gariann gives off strong hippie vibes. She hails from Asheville, North Carolina’s most notoriously liberal city, but was born and raised in the hills of West Virginia. She glides easily between country twang and the Queen’s English, comfortable in both worlds but fully belonging to neither. In that way, she is well-suited to the work in Haywood County, which necessitates a level of mastery in both progressive public health policy and rural resistance to change.

    Since arriving in Haywood County, Yochym has been laying foundational work to connect drug users to services that can help them improve their health. Introducing harm reduction to an often hostile political environment is not easy. When I first ask Yochym what she thinks of her job, she offers a sunny response: She loves to help people and make a difference. But with prodding, she admits that the work can be difficult.

    “Trying to build relationships and respect, sometimes I don’t know when I should bite my tongue or hold my ground,” she says. “It can be challenging to build new partnerships, but I think we all recognize the importance of working together to address these complex problems.”

    Haywood County is a microcosm of the challenges that harm reduction faces in general. Though the harm reduction movement has existed for decades, in many ways it is still the new kid in town, pushing back against centuries of punitive and abstinence-only approaches to drug use. Long a stronghold in northern states, harm reduction has more recently begun laying foundation in southern states, where politics can be antagonistic. For advocates, the constant dilemma of when to compromise and when to hold firm is exhausting. Bringing opposite sides together often means that neither gets what it wants, and advocates are criticized both for pushing too hard and not pushing hard enough.

    Virgil Hayes, who supervises the Haywood County staff and programs, also lives under this constant pressure. “Not everyone is where you would like them to be in terms of support for harm reduction,” he says as we talk over lunch at a small diner. “We need to understand that change is inevitable, but people need time to part ways with what they have always known.”

    Hayes seems to embrace the opportunity that Haywood County presents. “It’s been an adventure,” he says, smiling and shaking his head. I sense this is an understatement.

    Hayes sees his most important task as working to create a seat at the decision-making table for active drug users. Even in other parts of the state where harm reduction is more accepted, there is still a tendency for non-impacted professionals to speak on behalf of people who use drugs. However, while in other counties stakeholders may have already marked their territory and become resistant to new voices, Haywood County has the opportunity to invite those voices from the beginning. Hayes and his co-workers are actively working to do just that.

    Ultimately, the small team is game for the challenge of bringing harm reduction to Haywood County.

    “I am inspired by the way this community has come together and opened themselves up to our program,” says Yochym. “We have been welcomed with an incredible amount of hospitality and support from unlikely partners.”

    Hayes thinks that education will be key to getting people on board with harm reduction. “People’s hearts change when they realize everything is not what it seems,” he says. He hopes to draw attention and resources to rural counties, where the effects of drug use are often swept under the rug.

    “I want to show how this problem impacts all areas across race, gender, class and geography,” he says. “I want to pull the covers back and show the issue is just as bad here [as in cities] and to present solutions for what we are going to do to change it.”

    It is not easy being dropped into a geographically isolated area and launching a harm reduction program without much precedent or guidance, relying on intuition and experience to know when to compromise and when to stand your ground. It’s an even bigger challenge to fight centuries of stigma to bring active drug users to the decision-making table. But if anyone can do it, I think Haywood County can.

    View the original article at thefix.com

  • New Dosage Strength Of Opioid Addiction Drug Approved By FDA

    New Dosage Strength Of Opioid Addiction Drug Approved By FDA

    The FDA commissioner noted that the approval will expand access for patients and reduce drug development costs.

    The U.S. Food and Drug Administration (FDA) approved a new dosage strength for a maintenance drug for the treatment of opioid addiction.

    Cassipa, which is a sublingual (applied under the tongue) film that combines the opioid treatment drug buprenorphine and the opioid overdose reversal drug naloxone, will now be available in a 16 milligrams/4 milligrams dosage, and according to FDA Commissioner Scott Gottlieb, should be used in conjunction with counseling and therapy.

    The new dosage strength is approved by the FDA in both brand name and generic versions, and in various strengths.

    The approval underscores the agency’s emphasis on greater development of and access to medication-assisted treatment (MAT) for substance use disorder. The full range of MAT is a key element of the U.S. Department of Health and Human Services’ Five-Point Strategy to Combat the Opioid Crisis, and was the focus of guidelines issued to drug manufacturers for evaluating the effectiveness of new or existing MAT products. 

    In a statement issued in April 2018, Gottlieb described the FDA-approved MAT drugs—methadone, buprenorphine and naltrexone—as “safe and effective in combination with counseling and psychosocial support to stabilize brain chemistry [and] reduce or block the euphoric effects of opioids.”

    The FDA has also cited statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA), which found that patients using MAT for opioid dependency have reduced their chance of overdose death by half.

    In addition to its suggested efficacy for opioid use disorder, Gottlieb noted that newer treatment options like the increased dosage strength for Cassipa will not only “broaden access for patients,” but may also “reduce drug development costs, so products may be offered at a lower price to patients” via the agency’s “streamlined approach to drug development for certain medication-assisted treatments that are based on buprenorphine.”

    This approach is the abbreviated 505(b)(2) pathway under the Federal Food, Drug and Cosmetic Act, which allows manufacturers to use the FDA’s findings regarding the safety of their product to grant approval.

    The FDA is advising that Cassipa should be used in conjunction with a complete treatment plan that includes counseling and other support, and should only be used after the patient is introduced to the drug and stabilized up to a dose of 16 mg of buprenorphine using another marketed product. Additionally, Cassipa can only be prescribed by Drug Addiction Treatment Act-certified prescribers.

    View the original article at thefix.com

  • Pawn Stars: The Opioid Edition

    Pawn Stars: The Opioid Edition

    If you are at risk for overdose or use needles to shoot up drugs, come see Brandi and she’ll take care of you – no frills, no questions, no judgment.

    On a cold November morning in 2015, Brandi Tanner and her husband stopped to pick up their 10-year-old niece from her grandmother’s house.

    “Grandma’s sleeping funny,” said the little girl when they came to the door. She wasn’t dressed for school, as she usually would be at this time of morning. Concerned, Tanner and her husband stepped into the house and headed for his mother’s bedroom. They knocked on the door, but no one answered. Glancing at each other with wide eyes, they swung open the door. Grandma had rolled off the bed and her body was wedged between the dresser and the nightstand. She wasn’t breathing.

    “I didn’t really have time to process that she was dead,” says Tanner. “The only thing I could think was ‘Damn, I need to call people. I need get the family out of the house so the police can take pictures.’”

    Tanner’s mother-in-law had died of an opioid overdose, an increasingly common cause of death in Vance County, North Carolina. Tanner herself had previously struggled with dependence on opioids and though the years she’d seen the prevalence of addiction rise in her community.

    “It was so hard to see my husband lose his mother,” she says. “I wanted to do something to help him and other people, but I didn’t know what to do.”

    About a month after her mother-in-law’s death, Tanner was working at a pawn shop where she had been employed for several years. It was right before closing and she was tired. Every day people came into the shop to sell items in order to buy opioids. And it seemed like every week she received news of someone else who had lost a family member. She had just started to shut down the register when a tall stranger strode into the shop.

    “There were other employees in the store but he headed straight for me like he knew I was the one who needed him,” Tanner recalls. “He walked up and asked if I wanted to help save lives from overdose. I was like, hell yeah. Where do I sign up?”

    The tall stranger was Loftin Wilson, an outreach worker with the North Carolina Harm Reduction Coalition, a statewide nonprofit that works to reduce death and disease among people impacted by drugs. That year, the organization had received a federal grant to prevent overdose death in Vance County in partnership with the Granville-Vance District Health Department. Over the past few years, the two agencies have worked closely to increase access to harm reduction services and medication-assisted treatment in Vance County.

    Vance is a rural community of fewer than 50,000 people. Driving through, one can’t help but notice large, pillared villas adjacent to dilapidated trailer parks, a scene that amidst acres of yellowing tobacco fields is reminiscent of plantations and slave quarters. In Vance County, a quarter of the population lives below the poverty line and addiction has flourished. From 2008-2013 Vance had the highest rate of heroin overdose deaths in the state: 4.9 residents per 100,000 compared to the state average of 1.0 per 100,000 (NC Injury Violence Prevention Surveillance Data). But those were sunnier days. By 2016, the heroin overdose rate for Vance County had jumped to 11.2 per 100,000. In 2017, based on provisional data, it was 24.2 per 100,000 (NC Office of Medical Examiners) and 2018 is already shaping up to be the deadliest year yet.

    The chance meeting between Wilson and Tanner at the pawn shop proved to be pivotal to outreach efforts in Vance County. Wilson had years of overdose prevention experience in a neighboring county, Durham, but Tanner knew her community and everyone in it. The two teamed up and began reaching out to people in need. Driving around in Wilson’s rattling pick-up, they visited the homes of people at risk for opioid overdose to distribute naloxone kits.

    The following summer, the North Carolina General Assembly legalized syringe exchange programs, and Wilson and Tanner began delivering sterile injection supplies along with naloxone. By 2018, a grant from the Aetna Foundation to combat opioid overdose had enabled them to purchase a van in which to transport supplies and to expand outreach work in Vance County.

    In July 2018 I visited Tanner at the pawn shop, where she still works. Thanks to Tanner’s efforts, the pawn shop has become a de facto site for syringe exchange and overdose prevention. Walking into the shop, the first thing I notice is that Tanner packs a glock on her right hip. It’s necessary these days in Vance County, which has seen a remarkable rise in drug-related gang violence this year. In March 2018, nine people were shot over a span of two weeks in Henderson, a small town of 15,000 residents. In May, four more people were killed in less than a week, prompting Henderson Mayor Eddie Ellington to make a formal plea to the state for resources. One of the murders occurred at a hotel a stone’s throw from the pawn shop.

    The danger doesn’t seem to faze Tanner. She weaves through displays of jewelry, rifles, and old DVDs as customers drop in to buy and sell. It’s a respectable stream of business for a Monday afternoon. Tanner handles the customers with ease, teasing them in a thick southern twang, inquiring after their kids and families, and discussing the murders, which more than one person brings up unprompted. She calls everyone “baby” and is the kind of person who will buy gift cards and toiletries just so she can slip them unnoticed into a customer’s bag if she knows the individual is down on her luck.

    Later in the afternoon, a young female enters the shop. She and Tanner nod at each other without exchanging words. Tanner finishes up a transaction with a customer and slips out the back door. She is gone for a couple of minutes, then reappears alone. This, I come to find, is what overdose prevention looks like in Vance County.

    “I used to hand out [overdose prevention supplies] from inside the shop, but people were embarrassed to come in and be seen taking them,” explains Tanner. “Now people just text me to let me know they are coming. Sometimes they come in the shop and other times I just leave my truck open out back and they get the supplies and leave.”

    Henderson is the kind of town where everyone knows everyone’s business. News travels fast and so do rumors. Even though almost everyone has someone in their family using opioids, stigma still runs deep, so Tanner doesn’t advertise the exchange. Word travels by mouth: If you are at risk for overdose or use needles to shoot up drugs, come see Brandi and she’ll take care of you – no frills, no questions, no judgment. She sees a couple participants a day on weekdays and nearly a dozen every Friday and Saturday. A couple times a week she drives her truck to visit people who don’t have transportation, just to make sure they are taken care of too.

    I ask Tanner to take me to her truck where she keeps the supplies, and she obliges, leading me behind the store to a dusty parking lot where her SUV is stuffed with naloxone, syringes, and other sterile injection equipment. I pepper her with questions as she moves the boxes around to show me what’s inside.

    Tanner looks younger than her 35 years, but acts much older. Over the next half hour she recounts a life of homelessness, addiction, incarceration, losing friend after friend to opioid overdose, and finding her mother-in-law’s body three years ago. She relates the stories as though we were discussing the weather, completely emotionless, but still, you can tell it hurts.

    “I try not to think about it,” she says with a wave of her hand when asked how she handles the trauma of losing so many people. Later, she admits that some nights she sits at home and writes down her feelings, then tears up the thoughts and throws them away.

    “It’s hard not to get attached to people if you see them every week,” she acknowledges. “But I do the work because I want to help my town and my people. This is the place where my kids are growing up.”

    We go back inside and I take a last look around the store. The blue-screened computers and racks of DVDs create the feeling that you’ve gone back in time, yet in some ways this pawn shop is the most forward-thinking entity in Vance County. Here, people received tools to save lives even before they were legal.

    Before leaving Vance’s open fields to return to the city, I ask Tanner if she has a final message for people at risk for opioid overdose. For a moment, her voice hardens.

    “I know what it feels like to not have anybody give a shit if you are here or not,” she says. Then her tone softens. “But I want people to know they are not alone. There are people out there who care and can help.”

    View the original article at thefix.com

  • Relapsing While Famous: Demi Lovato, Stigma, and Compassion

    Relapsing While Famous: Demi Lovato, Stigma, and Compassion

    “We would typically not blame a patient with a chronic medical condition for their problem; nor imbue the patient with shame over their offending organ—why do we seem to do this with addiction?”

    The news that Demi Lovato was hospitalized of a suspected drug overdose has sent her celebrity friends and fans into overdrive; they are full of praise and well wishes for the singer.

    The support offered has been a beautiful response to witness, and this outpouring of encouragement is the exact caring that Lovato needs right now.

    This overwhelmingly positive response is a very different reaction than we normally associate with people falling off the wagon. Our society has painted the ordinary (non-celebrity) person with an addiction—whether it be to drugs, alcohol, sex or some other negatively perceived behavior—who loses their sobriety as a monster, as someone who cannot fix themselves, as a loser, as an undisciplined and unhealable soul.

    How many Internet memes have been generated that show the unforgiving and unflattering face of addiction? How many ill-conceived jokes about addicts relapsing have you heard? How often do you see mockery of those who have lost their fight? Or a sense of them being not strong enough to withstand the urges we all face?

    But the reality is that relapses are oftentimes part of the process, even for those who have spoken about their recovery. Just because someone has stood up and celebrated their recovery does not mean they will never possibly have a setback.

    Demi Lovato has been open about sharing her struggles through addiction, eating disorders and bipolar disorder. In her music (her song “Sober” details her ongoing struggle with sobriety), her interviews and social media accounts, Lovato has never shied away from speaking her truth. She is proud to be a mental health advocate and has spoken about how she knows her music has helped other young women struggling with some of the same issues that she has.

    Lovato’s openness in sharing her fight and the help her art has provided for others is all the more remarkable considering she was on the Disney Channel when she first entered rehab. There were many pressures and expectations upon her young shoulders and no one would have blamed her for wanting to keep that part of her life private.

    But admitting that the struggle continues after a setback can be the hardest part. Often, as a culture, we are not gung ho on offering people second chances, and especially not third or fourth chances.

    What’s that famous saying? Hurt me once, shame on you. Hurt me twice, shame on me.

    As a society, we can be unforgiving when it comes to people relapsing, but we seem to be much more sympathetic and forgiving with celebrities who struggle with addiction than we are with our ordinary peers.

    There is an unwritten social contract that we follow with celebrities that allows them to loom larger in our minds than normal, everyday people. We see them as larger than life while at the same time feeling intimately connected to them, as though they are family. We feel we know them.

    And we do know them when they share their personal demons with us. We recognize our own struggles and feel buoyed up by their example of openness and honesty.

    Could Lovato’s suspected relapse be an opening for a new understanding of the addiction cycle and conversation about the role of relapse in recovery? Perhaps her experience can shine a light on why no one deserves to be stigmatized for their illness.

    Of course, this goes for all mental health conditions, whether the diagnosis is addiction, bipolar disorder, depression, schizophrenia or others. Historically, our culture has stigmatized people with mental illness so that they feel embarrassed or that they need to hide their condition. It is only in recent decades that more individuals have been brave enough to come forward and speak about their struggles.

    Lovato’s overdose can serve as an example and a beacon to help people understand that addiction and other mental health issues are illnesses which aren’t always cured on the first, second or even third try.

    The fact that wealthy celebrities, who often have the best treatments and practitioners at their fingertips, still suffer relapses shows us how devastating mental health conditions can be. How can we expect our neighbors—who have those same diagnoses but may be struggling to make ends meet—to fare any better than our most celebrated and privileged?

    Many individuals prefer to suffer in silence rather than seek help because of this prejudice. They would rather live with often debilitating diseases rather than expose themselves to the potential stigma that comes with admitting they need help.

    What can we do to help alleviate the suffering of those around us?

    We can read and learn more about addiction and how difficult the road is to recovery and we can work to understand that the road is not always without bends and turns and sometimes brief exits.

    “Research has consistently shown addiction to be a chronic/relapsing disease, where multiple treatment episodes are often necessary, and that recovery may be a cumulative and progressive (non-linear) process,” says Dr. David Greenfield, Assistant Clinical Professor of Psychiatry at University of Connecticut Medical School and a specialist in addiction medicine. “We would typically not blame a patient with a chronic medical condition for their problem; nor imbue the patient with shame over their offending organ—why do we seem to do this with addiction?”

    We can have compassion for those who struggle and sometimes fall in their recovery, which will help alleviate their feelings of shame. For those closest to us, we can be supportive without enabling them or being codependent. The celebrity outpouring of love and caring through social media is an example of how compassion can be expressed through this modern tool.

    But Lovato’s friends are not the only ones sharing the love; her fans are sending messages of support, too.

    How Demi Lovato speaks to the public about her reported relapse can have real consequences for the greater conversation society needs to have. Hopefully, she will use her celebrity status to continue the dialogue with her fans about addiction; at the same time, she may express a need for privacy and time for reflection.

    The real opportunity for change will occur around the water coolers at work or on our social media feeds. When we can openly discuss mental health conditions—not as signs of weak moral character or evidence of being less than or incapable—but as true illnesses which require assistance from all corners—financial, family and friends, and sociocultural—we will then be truly supporting not only the celebrities amongst us, but our neighbors and ourselves as well.

    View the original article at thefix.com

  • How One Rural Community Is Fighting to Save Lives from Drug Overdose

    How One Rural Community Is Fighting to Save Lives from Drug Overdose

    “I don’t want another parent to pick out a casket. I don’t want another grandparent to have to look a grandchild in the eye and say ‘your momma is gone.’”

    The Driftwood Motel on Oak Island, North Carolina, has seen better days. All around it, pastel-colored vacation homes with kitschy names like After Dune Delight reel in tourists with promises of beachfront sunsets and shaded hammocks by the pier. Though the Driftwood Motel is also painted in cheerful pastels, the paint is flaking off in dry strips and littering the ground next to cigarette butts and busted beer bottles. Rhonda C. lives on the bottom floor of the Driftwood with her bed, couch and kitchen furniture crammed into a room with dark sheets that cover the windows. She is one of the motel’s many long-term residents – people drawn in by the $100 a week price tag who end up staying far longer than they had planned. A gray-haired, matronly woman, Rhonda looks after the other residents, especially the young ones who drift in and out in various stages of inebriation. She hadn’t been able to offer them much, until she met Margaret Bordeaux.

    Margaret is a petite, African American woman, quiet and unassuming until you get to know her fiery side. As an outreach worker for the North Carolina Harm Reduction Coalition, Margaret runs a mobile harm reduction unit in Brunswick County, a sparsely populated rural community hugging North Carolina’s Southeast coast. Brunswick is also one of the counties hardest hit by drug-related deaths in the state. At least once a week Margaret drives its lonely roads, seeking out places like the Driftwood Motel that collect people who have lost every other home. Thanks to a grant from the Aetna Foundation to combat the opioid epidemic, Margaret has a van stocked with supplies to help reduce drug-related death and disease. She gives out naloxone (a medicine that reverses overdose from opioids such as heroin, fentanyl, and prescription painkillers), syringes, and other resources, and she teaches people how to prevent, recognize and respond to an overdose.

    “I make friends and develop relationships in Brunswick County,” says Margaret. “Many of the people I’ve met here thought that naloxone and clean syringes were magical things only available in [cities]. No one has been coming out here to offer these services until now.”

    Some people are wary when Margaret first pulls up because they have been treated poorly by health care workers and aren’t accustomed to a warm, non-judgmental person offering them free services. But after a few visits, Margaret wins them over.

    “My whole life I have rooted for the underdog and the underserved,” says Margaret. “I want to care for people that society doesn’t care for. People use superficial reasons to ignore each other and I want to remove those reasons and say, hey, there is a person here.”

    Kathy Williams is one of the people whose lives Margaret has touched. A middle-aged, Caucasian woman with a defiant personality, Kathy’s backstory is the stuff of nightmares. She raised two kids as a single mom, Josh and Kirby. As an adult, Josh married a wonderful woman and had two children. Kirby struggled with drug use, and whenever she hit a rough spot, Josh and his wife would take her in and help her get back on her feet. But in 2011, Josh’s car was t-boned by a school bus. He, his wife, and both their young children died in the crash. The loss hit Kirby hard. Her drug use escalated and five years later, she too died of a drug overdose.

    Kathy tells this story completely dry-eyed. It’s as though she has endured so much pain that nothing can faze her anymore. These days she is raising her 14-year-old grandson, Kirby’s child, and also caring for her own aging parents. She is also one of the founding members of B.A.C.K. O.F.F., an organization of Brunswick County families who are fed up with losing their loved ones to drugs. What started as a support group in March 2017 has morphed into an organization with a mission to educate people about the realities of drug use and to help save lives.

    “A mother is not supposed to bury her child,” says Kathy. “I don’t want another parent to pick out a casket. I don’t want another grandparent to have to look a grandchild in the eye and say ‘your momma is gone.’”

    B.A.C.K. O.F.F., which stands for Bringing Addiction Crisis Knowledge, Offering Families Focus, makes and distributes overdose prevention kits containing naloxone to families with a loved one who uses opioids. They also spread awareness about North Carolina’s 911 Good Samaritan law, which protects people from prosecution if they seek medical assistance for an overdose. B.A.C.K. O.F.F. members provide community, resources and support for families impacted by drugs and offer space for honest talk about drug use. No denial, no sugarcoating, no pithy slogans about just saying no. Real talk from real families caught in the same struggle. But not everyone is willing to speak up.

    Elsewhere in Brunswick County, Alex Murillo has been trying to convince Hispanic parents who have lost child to drug poisoning to get involved in B.A.C.K. O.F.F. It hasn’t been easy.

    “Many Hispanics here deny that drug use is happening in their families,” says Alex, who recently lost his 19-year-old nephew to overdose. “If a parent loses a child to overdose, they say they died in their sleep. No one wants to talk about it.”

    A tall, dimpled man with a perpetual smile, Alex’s cheerful demeanor hides a tragic history. Alex is originally from Mexico. When he was brutally raped at 12 years old, his parents threw him out of the house, claiming he deserved to be raped because he “acted gay.” At 15 years old, Alex married a girl, but the marriage made him so miserable that he decided to come to the United States where he hoped to be able to express himself more freely. At the border he was apprehended by a human trafficking cartel and forced into sex slavery.

    “They forced me to take drugs. They beat me and pimped me out,” he says. “I was so shocked. I didn’t think things like that happened in the U.S.”

    Alex eventually escaped. He tried to join a church community but was turned away after admitting he was gay. He attempted suicide, but his brother found him passed out from a bottle of sleeping pills and took him to the hospital. When Alex woke days later, his attitude on life had changed.

    “I was surprised to be alive,” he says. “But I realized that I was still here for a reason and I decided to dedicate my life to helping other people.”

    Today Alex owns a small Hispanic tienda in Brunswick County where he offers help to anyone who comes to his doorstep, whether they are seeking food, advice, or help paying rent. Every year he hosts a multicultural festival in his store parking lot, though other Brunswick County residents have threatened to shut it down because they are unhappy with the area’s growing diversity. He is also happily married to his husband, who works in the store and supports Alex’s outreach efforts. Alex hopes to become more involved in educating the Hispanic community about drugs.

    “We can’t just ignore this problem. The drugs are in our schools. They are everywhere,” says Alex. “We need to do more outreach to the Hispanic community to teach them how to talk about drugs with their kids. They can’t just tell kids not to do drugs. Kids see their friends doing it and they want to try too. We need to have honest conversations as a community.”

    Margaret, Kathy and Alex may be an unlikely team, but together they are working to bring resources and hope to a county that has suffered devastating loss. Little by little, their efforts are making a difference. Margaret has helped people enter drug treatment programs and reconnect with family members where ties had been severed. Alex is making headway on opening up conversations about drugs in the Hispanic community. B.A.C.K. O.F.F. provides Kathy with an outlet to teach families how to help their loved ones who use drugs.

    “I used to look at a person who uses drugs as an addict, but now I look at them as someone’s brother, son or family member,” says Kathy. “I feel that if we had had these tools like naloxone, overdose education, and a support group years ago, my daughter might still be alive today.”

    At a small Mexican diner where we meet for lunch, I ask Kathy what her message is to people in rural communities impacted by drugs. For a moment, she is quiet. Finally she says:

    “I want people to know they are not alone. You might think you are alone, but there are so many of us going through the same thing. We can hold each other up.”

    View the original article at thefix.com

  • Searching For The Next Naloxone

    Searching For The Next Naloxone

    Experts are concerned that naloxone may not be strong enough for synthetic opioids such as fentanyl and carfentanil.

    Naloxone is—at times—a seemingly miraculous drug. Within minutes of naloxone being administered, someone who was unresponsive because of an opioid overdose can start breathing on their own and regain consciousness.

    However, despite its strengths, there are issues with the drug that have left healthcare professionals and policy makers pushing for alternatives. 

    One of the biggest issues with naloxone today is that it is reportedly not as effective at reversing overdoses from powerful synthetic opioids like fentanyl and carfentanil.

    In these cases, a person might need multiple doses of the opioid reversal drug in order to see a benefit. This isn’t just expensive, but can also cost someone their life if there aren’t enough doses immediately available. 

    Another issue is that opioids remain active in the body for longer than naloxone does. Because of this, someone can be revived using the opioid reversal drug, but later slip back into an overdose when the effects of naloxone have worn off. 

    Both of these concerns have led to the search for alternatives to naloxone. 

    “The strategies we’ve done in the past for reversing overdoses may not be sufficient,” Nora Volkow, director of the National Institute on Drug Abuse (NIDA), recently said in a speech at the 2018 National Rx Drug Abuse and Heroin Summit, according to STAT News. “We need to develop alternative solutions to reversing overdoses.”

    Dr. Jay Kuchera, a Florida-based addiction medicine specialist for Resolute Pain Solutions, said that “naloxone is being outgunned” by synthetic opioids that have largely replaced heroin in many areas of the country. 

    “Naloxone seemed to be great for the older opioids,” Kuchera said. “But now that we’re encountering these nonmedical, ungodly [opioids] like carfentanil… we need to get with the times.”

    In 2016, one report found that the market for opioid reversal drugs was valued at nearly $1 billion, so there are good economic incentives for companies to find alternatives to naloxone.

    Opiant Pharmaceuticals, which developed Narcan (the nasal spray version of naloxone), has had early success with a drug that works the same way as naloxone but lasts longer, so that the victim would be less likely to slip into another overdose after administration. 

    “Compounds like fentanyl, carfentanil, and other synthetic opioids act for longer periods of time,” said Dr. Roger Crystal, CEO of Opiant. “The concern is that naloxone’s half-life doesn’t provide sufficient cover to prevailing amounts of fentanyl in the blood.”

    Because many overdose deaths occur when a person stops breathing, scientists are also examining whether they can use drugs to keep a person breathing even while not reversing the overdose itself. For this, researchers are looking at ampakines, a class of drugs that can counteract respiratory depression. 

    Some people argue that funds would be better used to address the causes of addiction or to further study naloxone to see if it is indeed less effective against synthetic opioids, but Volkow said that having new and potentially better options for saving people from overdose is critical.  

    “There are so many people dying that we have to recognize the urgency,” Volkow said. “We obviously value basic science, but at the same time we have to recognize because of the current situation, the development of medication the can help address the crisis has become our top priority.”

    View the original article at thefix.com

  • House Passes 25 Bills To Aid Fight Against Opioid Crisis

    House Passes 25 Bills To Aid Fight Against Opioid Crisis

    The bills cover a variety of issues ranging from improving sober living homes to disposal of unused medication.

    In an effort to lend legislative support to the fight against the national opioid epidemic, the House of Representatives passed 25 bills that would provide crucial support to both government and public organizations to combat the crisis on a number of fronts.

    The bills, authored by both Democratic and Republican representatives, include measures to expand access to the overdose reversal drug naloxone, develop new forms of pain medication that are non-dependency-forming, and allow medical professionals to view a patient’s medical history for previous substance abuse.

    Greg Walden (R-OR), the Energy and Commerce Committee Chairman, and Michael C. Burger (R-TX), Health Subcommittee Chairman, said in a joint statement that the bills are “real solutions that will change how we respond to this crisis.”

    Among the bills passed are:

    • H.R. 449, the Synthetic Drug Awareness Act of 2018, which will require U.S. Surgeon General Jerome Adams to submit a “comprehensive report to Congress on the public health effects of the rise of synthetic drug use among youth aged 12 to 18,” authored by Reps. Hakeem Jeffries (D-NY) and Chris Collins (D-NY)
    • H.R. 4684, the Ensuring Access to Quality Sober Living Act of 2018, which will authorize the Substance Abuse and Mental Health Services Administration (SAMHSA) to “develop, publish, and disseminate best practices for operating recovery housing that promotes a safe environment for sustained recovery,” authored by Reps. Judy Chu (D-CA), Mimi Walters (R-CA), Gus Bilirakis (R-FL) and Raul Ruiz (D-CA)
    • H.R. 5009, Jessie’s Law, which will require the Department of Health and Human Services to develop the best way to present information about substance use disorder in a consenting patient’s history for medical professionals to make informed decisions about treatment, authored by Reps. Tim Walberg (R-MI) and Debbie Dingell (D-MD)
    • H.R. 5012, the Safe Disposal of Unused Medication Act, which will allow hospice employees to remove and dispose of unused controlled substances after the death of a patient, authored by Reps. Walberg and Dingell
    • H.R. 5327, the Comprehensive Opioid Recovery Centers Act of 2018, which will establish such centers to “dramatically improve the opportunities for individuals to establish and maintain long-term recovery through the use of FDA-approved medications and evidence-based treatment, authored by Health Subcommittee Vice Chairman Brett Guthrie (R-KY) and Ranking Member Gene Green (R-TX)
    • And H.R. 4275, the Empowering Pharmacists in the Fight Against Opioid Abuse Act, which will give pharmacists more information and ability to decline prescriptions for controlled substances which they suspect to be fraudulent or for abuse, authored by Reps. Mark DeSaulnier (D-CA) and Buddy Carter (R-GA).

    Reps. Walden and Burgess noted in their statement that the bills will “make our states and local communities better equipped in the nationwide efforts to stem this tide” of opioid dependency and overdose.

    The House will continue to review related bills on January 14, including H.R. 6069, which will require the Comptroller General to conduct a study on how virtual currencies are used to facilitate goods or services linked to drug or sex trafficking.

    View the original article at thefix.com