Tag: opioid epidemic

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

15 November 2018
Teen Drug Use Drops In Ohio

A local prevention expert credits greater awareness, media attention and personal tragedies for the decrease.

There’s some good news out of Ohio, as a new survey indicates teen prescription painkiller and heroin use are on the decline.

According to the Cincinnati Enquirer, the numbers come from a survey administered every two years by PreventionFirst, a nonprofit with the goal of stopping teen drug use before it begins.

“2018 is the lowest I’ve ever seen it,” Mary Haag, president and CEO of PreventionFirst, told the Enquirer.

The survey involved almost 33,000 students in grades 7-12 from both private and public schools in the greater Cincinnati area.

According to the findings, 2.4% of surveyed students reported using any type of prescription drugs in the 30 days prior to the survey, and 0.3% reported using heroin in that same timeframe. In comparison, in 2012, 6.5% reported using prescription pain pills and 1.8% reported heroin use.

Haag tells the Enquirer that these numbers are encouraging and she credits greater awareness, media attention and personal tragedies for the decrease.

However, the survey did raise some concerns when it came to alcohol and marijuana. According to the results, in the 30 days before the survey, 13.7% of students reported using alcohol and 8.1% reported using marijuana.

Another recent survey, the CDC’s 2017 Youth Risk Behavior Survey, also asked questions about teen opioid use. This survey asked whether students had ever misused prescription opioids and the number answering yes was higher, at 14%.

Nancy Brener, lead health scientist for the Centers for Disease Control and Prevention’s Division of Adolescent and School Health, tells the Enquirer that this response is concerning. However, the same survey also showed a decrease in overall drug use in teens.

“I think it’s important to understand that we have made progress,“ Brener noted.

The survey also indicates that those who do not smoke cigarettes or use alcohol, illegal drugs or prescription drugs by age 21 are “virtually certain never to do so.”

According to Marc Fishman, medical director of Maryland Treatment Centers and assistant professor at Johns Hopkins University Department of Psychiatry, tells the Enquirer that it’s vital that treatment centers be willing to treat all types of substance use disorders in teenagers.

“We need more treatment,” Fishman told the Enquirer. “Treatment of cocaine-use disorder. Treatment of alcohol-use disorder. Treatment of marijuana-use disorder.”

“The vast majority of people with opioid-use disorder start with non-opioid use,” Fishman added. “Most of them don’t progress, but almost all of the cases of opioid-use disorder started there.”

View the original article at thefix.com

14 November 2018
Mac Miller’s Official Cause Of Death Revealed

The 28-year-old rapper passed away in early August.

A coroner has confirmed Mac Miller’s cause of death. The 26-year-old rapper and music producer (born Malcolm McCormick) died at home in Studio City, California on Sept. 7. Given his history of substance use, early reports pointed to drugs.

On Monday (Nov. 7), the Los Angeles County Department of Medical Examiner-Coroner confirmed that McCormick had died from an accidental overdose of fentanyl, cocaine and alcohol due to mixed drug toxicity.

The rapper, who had a tour planned for October following the Aug. 3rd release of his album Swimming, was discovered by his personal assistant in his bedroom. McCormick “struggles with sobriety and when he ‘slips’ he consumes them in excess,” his assistant said, adding that he’d had “several recent ‘slips’” including one three days prior to his death.

In a 2015 interview with Billboard, the rapper said he was in a good place. “I’m not doing as many drugs. It just eats at your mind, doing drugs every single day, every second. It’s rough on your body,” he said.

Fentanyl, the synthetic opioid painkiller said to be 50 times stronger than heroin, has also been cited in the deaths of Prince (April 2016) and Tom Petty (October 2017). According to the National Center on Health Statistics, fentanyl was involved in 60% of opioid-related deaths in 2017, an 11% increase from five years prior.

While fentanyl was created for cancer pain, it is now fueling rising rates of drug overdose deaths. This has prompted the need for a stronger opioid overdose “antidote” to match the strength of increasingly potent fentanyl analogs.

And this month, the Food and Drug Administration approved a new, more powerful opioid painkiller called Dsuvia. This new drug is said to be 10 times stronger than fentanyl and 1,000 times stronger than morphine.

While Dsuvia is intended for restricted use only in health care settings—the FDA promised to place “very tight restrictions” on the drug—critics worry that it will only worsen the opioid crisis.

“We have worked very diligently over the last three or four years to try to improve the public health, to reduce the number of potent opioids on the street,” said Dr. Raeford Brown, who chairs the FDA advisory committee that voted to approve Dsuvia, despite his opposition. “I don’t think this is going to help us in any way.”

View the original article at thefix.com

7 November 2018
Opioid 10 Times Stonger Than Fentanyl Approved By FDA Amid Controversy

“It is certain that Dsuvia will worsen the opioid epidemic and kill people needlessly,” said one critical health expert.

Amid controversy and despite warnings from some in the medical community, the Food and Drug Administration (FDA) last week green-lit a new opioid called Dsuvia, a drug estimated to be 10 times as strong as fentanyl.

The powerful painkiller is an under-the-tongue version of sufentanil, available in a pre-filled single-dose applicator, according to the federal agency. In theory, it would be used in hospitals, surgery centers and emergency departments.

Though it wouldn’t be available for take-home prescriptions, some worry that it will be diverted and abused—to deadly effect.

“It is certain that Dsuvia will worsen the opioid epidemic and kill people needlessly,” Dr. Sidney Wolfe of Public Citizen’s Health Research Group said in a press release. “It will be taken by medical personnel and others for whom it has not been prescribed. And many of those will overdose and die.”

FDA Commissioner Scott Gottlieb released a statement defending his agency’s decision, highlighting the drug’s potential for use in war in light of its specific packaging and formulation.

Because it is sublingual, the painkiller doesn’t necessitate venous access and doesn’t require that the patient be alert enough to swallow. That could make it incredibly useful in extreme emergency situations, such as on the battlefield—and that’s what drew the Department of Defense to take interest in the drug.

“This opioid formulation, along with Dsuvia’s unique delivery device, was a priority medical product for the Pentagon because it fills a specific and important, but limited, unmet medical need in treating our nation’s soldiers on the battlefield,” Gottlieb wrote.

Indeed, the Pentagon has poured millions of dollars in funding research by AcelRx, the drug company behind Dsuvia, according to the Washington Post.

Despite the assurances Gottlieb sought to offer, his agency generated controversy not just for its decision to approve the drug, but also for the way in which they did it.

The FDA advisory committee that recommended allowing the painkiller voted 10-3 in favor of the drug—even though committee chair Dr. Raeford Brown was out of town speaking at a medical conference, according to the Washington Post.

Brown condemned the decision, raising concerns about the efficacy data and the sponsor’s response to safety questions.

“Clearly the issue of the safety of the public is not important to the commissioner, despite his attempts to obfuscate and misdirect,” Brown wrote. “I will continue to hold the agency accountable for their response to the worst public health problem since the 1918 influenza epidemic.”

View the original article at thefix.com

5 November 2018
One Washington County Is Treating The Opioid Crisis As A Natural Disaster

What if the government used the natural disaster coordinated system to mitigate the opioid epidemic?

In Snohomish County in Western Washington, officials are taking a unique approach to the opioid crisis by declaring it a life-threatening emergency, as if it were a natural disaster.

As overdose deaths are threatening more lives than hurricanes and mud slides, they say it makes practical sense. Ty Trenary, former police chief in Snohomish County, thought that his rural community was not affected by the drug crisis.

Trenary told NPR that at the time he thought, “This is Stanwood, and heroin is in big cities with homeless populations. It’s not in rural America.”

A new poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health showed the truth: 48% of people said opioid addiction in their communities has worsened over the past five years.

After Chief Trenary toured the local jails, he realized the problem was enormous. He witnessed over half of the jail inmates withdrawing from heroin or other opioid drugs.

“It took becoming the sheriff to see the impacts inside the jail with heroin abuse, to see the impacts in the community across the entire county for me to realize that we had to change a lot about what we were doing,” Trenary told NPR.

The idea to go the natural disaster route was the brainchild of Shari Ireton, the director of communications for the sheriff’s office. In 2014, a massive landslide in Washington killed 43 people. As the communications director, Ireton was in charge of organizing the press for field trips to the worst areas of landslide damage.

“It was amazing to see Black Hawk helicopters flying with our helicopter and a fixed wing over the top of that,” she told NPR. “All in coordination with each other, all with the same objective, which is life safety.”

Ireton had a moment of inspiration: what if the government used the natural disaster coordinated system with everyone working together, across government agencies, to treat the opioid epidemic?

The county loved the idea, and a group was formed called the Multi-Agency Coordination group, or MAC group. The group follows FEMA’s emergency response playbook and is run out of a special emergency operations center.

MAC includes seven overarching goals, which include reducing opioid misuse and reducing damage to the community. The goals are dissembled to smaller, workable steps, such as distributing needle cleanup kits and training schoolteachers to recognize trauma and addiction.

MAC is too new to understand the scope of the group’s impact on the community just yet. Those being helped will surely feel that it is a positive direction for Washington and for addiction treatment.

View the original article at thefix.com

2 November 2018
Does Opioid Abuse Play A Role In Breast Cancer Deaths In Appalachia?

One expert believes that opioid use disorder is connected to the high rates of breast cancer deaths in the region.

Women in Appalachia—especially West Virginia and Kentucky—have higher mortality rates from breast cancer than their counterparts around the country, and one researcher says that opioid abuse might be to blame.

In an essay for The Conversation, Rajesh Balkrishnan, a professor of public health sciences at the University of Virginia, said that opioid abuse could be a factor in up to 60% of breast cancer deaths in the region.

“Breast cancer death rates continue to remain abnormally high in the Appalachian region of the United States, and it’s partially due to a different epidemic in the U.S: opioid use,” he writes.

Long-term hormone treatments can be lifesaving for breast cancer patients, but using opioids to combat their side effects opens people up to another deadly disease: opioid use disorder. Cancer patients are often prescribed opioids for pain management, including the pain and fatigue that accompany hormone treatments.

“Although opioids are not considered first-line treatment for cancer-related pain, they are increasingly used to manage unbearable pain in breast cancer survivors,” Balkrishnan writes. “One thing that struck me when I looked at health insurance and cancer registry data was the extremely high and prolonged rate of use of dangerous medications like opioids in this population, sometimes as high as 50% in some areas.”

Balkrishnan’s team of researchers found that Appalachia has the most concentrated number of counties with exceptionally high opioid prescription rates—up to 65% above the national average.

This leaves people at risk for developing addiction, and can interfere with the long-term health of breast cancer patients, since many stop taking their hormone therapy medications when they become dependent on opioids, Balkrishnan believes.

“The picture that emerges is indeed a grim one. We find many patients in Appalachia who undergo successful breast cancer treatment and then start life-prolonging hormone treatments along with opioids to manage side effects such as pain,” Balkrishnan writes.

“But many (over half in some counties) continue to remain on opioids, which are usually supposed to be prescribed only for the short term, and then discontinue long-term survivorship treatments such as hormones. The reasons these women discontinue traditional treatments is not completely clear, but my colleagues and I suspect it is related to people’s dependence on opioids.”

Appalachian women have the lowest breast cancer survival rates in the country.

“It is heartbreaking to see a woman able to beat cancer, only to die because of sub-optimal use of a life-prolonging treatment or misuse of a short-term relief treatment such as opioids,” Balkrishnan writes.

“We need to work harder to educate and empower Appalachian breast cancer survivors about their treatment choices and decision-making that can be most beneficial to improving their life quality and quantity.”

View the original article at thefix.com

31 October 2018
Opioid Addiction Rates Higher Than Expected In Massachusetts, Study Says

Nearly 5% of Massachusetts residents may be battling opioid use disorder, according to a new study.

Health officials in Massachusetts are expressing concern over the results of a new study, which suggests that more residents are struggling with opioid use disorder than previous research had suggested.

Using information culled from a database for public health information, the study authors found that the number of individuals in the Bay State who have either received treatment for addiction, or who qualify as addicted but have gone undiagnosed, may be as high as 4.6% of residents over the age of 11.

That number is significantly higher than previous records, which suggested that addiction rates hovered at just over 1%.

The study was published in the American Journal of Public Health, and sought to determine the annual prevalence of opioid use between 2011 and 2015.

To do so, researchers used the Massachusetts Public Health Data Warehouse, which links information on hospital and emergency room visits, prescriptions and insurance claims, among other sources, from more than a dozen state agencies.

Patients are identified with their own unique number so it is possible to track a single individual who may have been admitted to a hospital or ER or received treatment from first responders.

Researchers looked at information on individuals who, based on such encounters with the health care system, had been or could be determined as suffering from opioid addiction—and identified 119,000 people, or 2% of the state population over the age of 11 in 2015.

From there, they used statistical methods to estimate the number of people who would be considered as opioid-dependent but have not received any treatment.

That formula brought the total number of individuals up to 4.6%, or 275,000 Massachusetts residents over the age of 11 years. Previous research, which determined the 1% rate, was based on national surveys that interviewed only those people who had sought help from the health care system for opioid-related issues.

Response from the Massachusetts medical community was largely positive in regard to the study’s findings. The Boston Globe quoted Dr. Joshua A. Barocas, an infectious disease physician at Boston Medical Center, who said, “[The study] is a good wake-up call. Our pool of people who are at risk for overdoses is potentially higher than we thought it was.”

The study also drew criticism from Dr. Silvia S. Martins, director of the Substance Abuse Epidemiology Unit at the Columbia University Mailman School of Public Health. Her response stemmed from what she viewed as a broad definition of opioid use disorder, which may have inflated the statistics.

“The analysis could have been done in a more precise way,” she said.

View the original article at thefix.com

30 October 2018
What’s Actually Happened Since Trump Declared An Opioid Emergency

Critics say the emergency declaration was more for show than to actually resolve the crisis.

A year ago, President Trump declared a national public health emergency because of the opioid epidemic, vowing that doing so would streamline responses to a health crisis that killed more than 70,000 Americans last year.

However, a new report shows that the declaration has led to little change.

The report, prepared by the Government Accountability Office, found that the administration has used just three of 17 available authorities that are activated when the government proclaims a public health crisis. These authorities include, for example, waiving certain administrative processes in order to quicken responses in an emergency.

The Trump administration used one authority to more quickly field a survey of healthcare providers about their prescription practices. The results of the survey will help inform policy decisions going forward, the administration said.

Secondly, authorities waived the public notice period for approval of two state Medicaid demonstration projects related to substance use disorder treatment, which was intended to speed up implementation of the projects, allowing the states to test and evaluate new addiction-related services delivered through Medicaid.

Finally, the Department of Health and Human Services (HHS) increased support for research on opioid use disorder treatments and gave out information on opioid misuse and addiction.

The Department of Health and Human Services said that more authorities haven’t been used because many of the abilities enabled by the state of emergency declaration are not applicable to the opioid epidemic. Instead, they are designed for response to infectious diseases or natural disaster.

“HHS officials determined that many are not relevant to the circumstances presented by the opioid crisis,” the report reads. However, the potential for additional responses will be reviewed. “Officials told GAO they will continue to review the authorities as the opioid crisis evolves and in the context of HHS’s other efforts to address the opioid crisis.”

Still, critics of the administration say that the fact that so few resources have been utilized shows that the administration’s declaration was more for show than in hope of solving the problem.

“Communities are desperately in need of more help to address the opioid epidemic. President Trump, as this report shows, has broken his promises to do his part,” Senator Elizabeth Warren (D-MA) said in a statement reported by Vox. “I’ve asked this administration time and time again to show what actions they are taking to meaningfully address this crisis. No response. To me, it looks like empty words and broken promises. Hand-waving about faster paperwork and speeding up a few grants is not enough — the Trump Administration needs to do far more to stop the opioid epidemic.”

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View the original article at thefix.com

26 October 2018
White House Launches Treatment Program For Moms With Opioid Addiction

The program will streamline care and reduce healthcare costs for mothers and children who are affected by opioid addiction.

The Trump administration announced this week that it will begin a program to address opioid abuse among pregnant and postpartum women, in an attempt to address health complications related to addiction and reduce the number of infants born dependent on opioids.

Health and Human Services (HHS) Secretary Alex Azar announced the model during a conference on Tuesday.

“The M-O-M model, for ‘Maternal Opioid Misuse,’ will partner with state Medicaid agencies to integrate a wide range of services for pregnant and postpartum women struggling with opioid misuse, to ensure not only their health, well-being, and recovery, but protect the health of their children as well,” Azar said, according to Medpage Today.

In a press release about the program, the Centers for Medicare & Medicaid Services said that it is designed to streamline care and reduce healthcare costs for mothers and children who are affected by opioid addiction.

“Too many barriers impede the delivery of well-coordinated, high-quality care to pregnant and postpartum women struggling with opioid misuse, including lack of access to treatment and a shortage of providers in rural areas, where the opioid crisis is especially destructive,” Azar said in that release. “The MOM model will support state Medicaid agencies, front-line providers and healthcare systems to help ensure that mothers and infants afflicted by the opioid epidemic get the care they need.”

The program will be tested in up to 12 states over the next five years. As the opioid epidemic has unfolded, complications from addiction have become a leading cause of maternal death. In addition, the number of babies born dependent on opioids has increased sharply, from 1.19 cases per 1,000 hospital births in 2000, to 5.63 in 2012, according to The Washington Post. Those infants can have lifelong complications from being exposed to opioids in the womb.

Azar said that the MOM model is the latest step that the Trump administration has taken to make real changes to how opioid addiction is addressed.

“We believe in evidence-based treatment, we believe in a public-health approach to this epidemic, and we believe in approaching addiction as a disease, never a moral failing,” Azar said.

The health secretary added that early indications show that opioid overdose deaths seem to be plateauing this year. Although he acknowledged that too many people are still dying from opioid addiction, he said that there are signs of progress.

“Since President Trump took office in January 2017, the number of patients receiving buprenorphine, one form of medication-assisted treatment, has increased by 21%… [and] from 2015 to 2017, we have seen a statistically significant decline in the number of Americans who misuse prescription opioids,” Azar said.

View the original article at thefix.com

25 October 2018
New Opioid 500 Times Stronger Than Morphine Nears FDA Approval

Sufentanil is currently used intravenously in operating rooms in tightly-controlled circumstances.

The chair of an FDA advisory panel is speaking out against the approval of a powerful new opioid that is even stronger than fentanyl, but despite his public stances it appears likely that the FDA will approve the drug.

“Opioids are substantially different than almost any other classification of drugs in that they carry with them the risks of tolerance, addiction, and death, and what we’ve been trying to get the FDA to come to grips with is that this class of drugs needs to be treated differently,” Raeford Brown, Jr., MD, chair of the Anesthetic and Analgesic Drug Products Advisory Committee and professor at the University of Kentucky told MedPage Today. “Some of the methodology they use to manage other drug classes are perhaps not reasonable with this.”

The drug in question is DSUVIA, a form of sufentanil, a synthetic opioid that is 500 times more powerful than morphine. Sufentanil is currently used intravenously in operating rooms in tightly-controlled circumstances, but DSUVIA would make it available in a tablet that is administered under the tongue.

On Oct. 12, the FDA’s advising committee voted 10-3 to allow the drug to go to market.

However, Brown said that many committee members — himself included — were absent for that vote because they were attending the American Society of Anesthesiologists conference.

“That’s one of the reasons I felt that I needed to speak up, because people that are regulating this drug need to be very thoughtful about the public health in this particular circumstance,” he said.

The drug would be approved with a Risk Evaluation and Mitigation Strategy (REMS) program, but Brown said that is not enough of a safeguard.

“There’s no indication whatsoever that any of the REMS programs for opioids have been effective in improving the safety,” he said.

Brown is so against the approval of DSUVIA that he penned an open letter to the FDA, saying that sufentanil has “substantial risks of respiratory depression, diversion, abuse, and death,” and that its benefits do not outweigh these risks.

“It is my observation that once the FDA approves an opioid compound, there are no safeguards as to the population that will be exposed, the post-marketing analysis of prescribing behavior, or the ongoing analysis of the risks of the drug to the general population relative to its benefit to the public health,” he wrote. “Briefly stated, for all of the opioids that have been marketed in the last 10 years, there has not been sufficient demonstration of safety, nor has there been post-marketing assessment of who is taking the drug, how often prescribing is inappropriate, and whether there was ever a reason to risk the health of the general population by having one more opioid on the market.”

Further information on the approval of DSUVIA is expected in early November.

View the original article at thefix.com

25 October 2018