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Tag: opioid epidemic

  • "Death Certificate Project" Helps Identify Doctors Who Overprescribe

    "Death Certificate Project" Helps Identify Doctors Who Overprescribe

    The crackdown has spooked physicians, including some who say they’re now less inclined to treat complex patients. 

    Hundreds of California physicians are under investigation for their prescribing habits, as the state medical board cracks down on overprescribing.

    Under the “Death Certificate Project,” the Medical Board of California is trying to take a proactive approach to identifying overprescribing behavior.

    The board, a state agency that licenses/disciplines physicians, has reviewed death certificates that list a prescription opioid (or more) as the cause of death, then identify the provider(s) who prescribed the controlled substance to the patient “within three years of death, regardless of whether the particular drug caused the death or whether that doctor prescribed the lethal dose,” MedPage Today reports.

    Prescribers were matched to patients through California’s prescription drug database, CURES (California Controlled Substance Utilization Review and Evaluation System).

    “Our goal is consumer protection… (to) identify physicians who may be inappropriately prescribing to patients and to make sure that those individuals are educated (about opioid guidelines), and where there are violations of the Medical Practices Act, the board takes (disciplinary) action,” said Kimberly Kirchmeyer, the medical board’s executive director.

    So far, 462 physicians have been identified as “warranting an investigation of patients’ files,” according to MedPage. Of these cases, 223 have been closed for either insufficient evidence, no violation, their license was already revoked/surrendered, or the physician has died.

    Nine physicians have been targeted in opioid-related prescribing accusations filed by the state Attorney General; four of them were already under scrutiny on “unrelated charges.”

    The state’s crackdown has spooked physicians, including some who say they’re now less inclined to treat complex patients.

    “When you hear a bunch of doctors all at the same time all getting the same letter, and you realize they’re going through the same thing, you see why some are saying [to patients], ‘Sorry, if you have a lot of medical conditions, we’re not going to take care of you,’” said Dr. Brian J. Lenzkes, a San Diego internist and one of the targets of the Death Certificate Project.

    Last December, Lenzkes received a letter from the state medical board notifying him that there had been a “complaint filed against you” about a patient who had died of a prescription drug overdose in 2013.

    According to Lenzkes, the patient’s severe condition required him to take a regimen of prescription drugs including painkillers.

    After receiving the letter, however, Lenzkes says he’s more wary of taking on pain management, saying that he’ll refer patients to pain specialists instead. “I’m not taking any more. That’s just how I feel,” he said.

    View the original article at thefix.com

  • Can Pre-Birth Opioid Exposure Lead To Learning Disorders?

    Can Pre-Birth Opioid Exposure Lead To Learning Disorders?

    A new study examined the potential link between pre-birth opioid exposure and developmental issues. 

    Children born to mothers using opioids may grow up to demonstrate difficulty learning, a new study has found.

    The study examined the potential long-term issues for infants born to mothers who used opioids while pregnant, according to NBC News.

    The study, published in the journal Pediatrics, found that one in seven children affected by a mother using opioids needed to be placed in special education classrooms for various issues, including developmental issues and speech delay. In comparison, one in 10 children who were not exposed to opioids before birth required the same. 

    About 7,200 children from Tennessee’s Medicaid program were involved in the study, ranging in age from 3 to 8 years old. Of those children, nearly 2,000 were born with neonatal abstinence syndrome (NAS)—or, in simpler terms, withdrawal from opioids due to a mother’s use.

    Tennessee has been greatly affected by the opioid epidemic, which is reflected in the number of infants exposed to opioids before birth. In 1999, it was one per 1,000 infants. But in 2015, it was 13 per 1,000.

    Researchers said they took specific factors into account like birth weight and mother’s education and tobacco use, but that those did not change the results. 

    According to study co-author Dr. William Schaffner of Vanderbilt University, the results make sense, as other studies have determined that there are brain differences in children affected by opioids while in utero. 

    Dr. Mary-Margaret Fill, lead author and a researcher with Tennessee’s health department, tells NBC News that affected children “are definitely not doomed. There are great programs and services that exist to help these children and their families. We just have to make sure they get plugged in.”

    Because the study was focused in Tennessee, it’s not clear if the results are similar in other U.S. states, and no other studies with the same focus have been conducted in the country. 

    However, a similar study was conducted in Australia last year, and found that children exposed to opioids before birth had worse academic scores in seventh grade in comparison to others their age. The U.S. study did not examine academic performance.

    Dr. Matthew Davis, co-chair of the Opioid Task Force at Lurie Children’s Hospital of Chicago, tells the Chicago Tribune that the study results should serve as a sign that opioid use affects a wide range.

    “There’s a sense that the opioid epidemic is somebody else’s problem, but it affects more than those who take the drugs,” Davis said. “I hope the study is a wake-up call, so people understand that this epidemic is a community-level, multigenerational problem that will only grow if we don’t take the proper steps to address it.”

    View the original article at thefix.com

  • Senate Considers Opioid Crisis Bill, But Critics Say It Isn’t Enough

    Senate Considers Opioid Crisis Bill, But Critics Say It Isn’t Enough

    “A little drama for little substance,” said one addiction advocate familiar with the bill. 

    The Senate is preparing to pass a bill to address the opioid epidemic, but critics say that the legislation skirts around the most important — and contentious — issues that could help change the way that opioid addiction is handled. 

    “A little drama for little substance,” one addiction advocate familiar with the bill told STAT News. 

    The bill addresses treatment and prevention, according to a copy reviewed by STAT. There are provisions that will better equip law enforcement to detect fentanyl being shipped in the mail system and that will help develop a have a better disposal system for unused opioids, in order to reduce the amount of opioids on the street. In addition, there are provisions to expand treatment by easing access to medication-assisted treatment with buprenorphine, training doctors to screen for substance use disorder and increasing access to treatment via telemedicine. 

    However, treatment advocates say that the bill will do little to affect how treatment is delivered because it does not take enough bold steps to change the status quo. 

    “Overdose rates continue to rise, and our response is still falling short given the mammoth size of the problem,” said Andrew Kessler, the founder of Slingshot Solutions, a behavioral health consulting group. “We are in the early phases of our response to this epidemic, and I can only hope that this bill is the first of many we can pass.”

    One big change that has a chance of passing is repealing the IMD exclusion, which prevents treatment centers with more than 16 beds from receiving Medicaid payments.

    An opioid response bill passed in June repealed the exclusion, but only for treatment for opioid and cocaine addiction.

    Despite the fact that the current Senate bill doesn’t mention the exclusion, Ohio Senator Rob Portman said that he is hopeful a repeal will be included in the final bill. He said that leadership has agreed on the repeal, but could not gather enough votes. 

    “We’ve worked out an agreement that I think most leadership on both sides agree with, but we weren’t able to get the signoff from everybody,” Portman said.

    The Senate bill also includes a call for the development of best practices in disclosing a patient’s history with substance abuse. The House bill would allow a history of addiction treatment to be disclosed without a patient’s expressed permission, but Senate lawmakers are concerned that this could lead to breaches of privacy and stigma. 

    With the coming November election, many lawmakers are hesitant to vote on anything controversial, meaning that the bill may languish. However, some Senators are pushing to make sure it gets a vote this month. 

    “As soon as both parties agree, we can have a roll call vote next week. When we do that, it’ll get virtually unanimous support, and then we’ll work with the House and put the bills together,” said Sen. Lamar Alexander (R-Tenn.), who has spearheaded the bill. 

    View the original article at thefix.com

  • Older Americans Sorely Under-Informed About Opioid Risks

    Older Americans Sorely Under-Informed About Opioid Risks

    A new poll uncovered a major lack of communication between doctors and their older patients who use opioids.

    A new poll from the University of Michigan involved a nationally representative sample of 2,000 Americans between ages 50 to 80.

    According to The Atlantic, the results of the poll were an indication of why elderly patients at high risk of opioid overdose: 40% aid their doctor’s did not speak to them about opioid side effects or how to decide when to cut back on the medication.

    SAMHSA reports that the population of those 65 and older expected to use opioids will most likely double between 2004 and 2020.

    The University of Michigan National Poll on Healthy Aging asked the patients what their health-care providers discussed when prescribing opioid medication to them.

    Of the responders, 589 said they had filled an opioid prescription. While they indicated that they knew how often to take the medication, the majority said their doctors or pharmacists did not address the risk of addiction, the risk of overdose, or what to do with excess pills.

    Interestingly, the poll also showed that respondents overwhelmingly support policies that require providers to receive special training for opioid prescribing, as well as to review prescription records and requiring patients to disclose prior opioid medication.

    The populous of the poll include baby boomers (which CNN defines as people born from 1946 to 1964). Sheila Vakharia, a policy manager at the Drug Policy Alliance, told The Atlantic that this group “used alcohol and other drugs at higher rates compared to other generations of older people that have preceded them, which means these same people are at higher risk of overdose and adverse effects because they may be drinking a little bit more often and a little heavier than some folks who are in their 80s.”

    Doctors can sometimes find it difficult to communicate effectively with their older patients for a variety of reasons. Many doctors are overextended, “burnt out,” and simply don’t have enough time with each individual patient. In addition, doctors often don’t think patients’ of a certain age are at risk for addiction, Vakharia mentioned.

    “The messages that doctors give to patients are largely dictated by how they perceive patients,” Vakharia told The Atlantic. “You don’t often see the elderly as a population at risk for developing substance-use disorders.”

    Indeed, older patients who use opioids are not only at risk for addiction, but they are at a higher risk of overdose death than the younger population.

    View the original article at thefix.com

  • "Killing Pain" Docu-Series Spotlights Oklahoma's Opioid Crisis

    "Killing Pain" Docu-Series Spotlights Oklahoma's Opioid Crisis

    Oklahoma’s Attorney General, who is interviewed for Killing Pain, lauded its coverage of the “many tragic aspects” of the state’s opioid crisis.

    A new seven-part documentary focuses on the impact of the opioid crisis on Oklahomans.

    Killing Pain, which is free to watch online, is a multi-faceted exploration of the opioid crisis, from the perspective of Oklahomans.

    The seven-part series was produced by the Oklahoma City-based non-profit organization Fighting Addiction Through Education (FATE). The docu-series is just another arm of founder Reggie Whitten’s fight to spread awareness about the risks of opioid drugs.

    Whitten has been doing this for 16 years, since the death of his son Brandon. Brandon’s addiction to alcohol and prescription drugs led to his death in 2002 at the age of 25.

    “That’s when a part of me died and my life changed forever,” said Reggie Whitten. “I really don’t even remember who I used to be. It’s hard to believe the power of this little molecule called an opioid.”

    Whitten travels to Oklahoma communities to tell Brandon’s story and speak about the opioid crisis. “You can’t fight an enemy until you know everything there is to know about it and I’ve spent the last 16 years obsessively learning about the enemy,” said Whitten. “Addiction is a very difficult adversary.”

    Whitten noted that opioid-based prescription drugs are important for some, but that education about the risks is just as important. “For every one person that dies, we have tens of thousands who are living a life of misery,” said Whitten. “They’re highly addicted to this… drug.”

    FATE also offers various programs designed for specific audiences such as the Life of an Athlete program, Native Fate (designed for Native American communities), elementary schoolers, college students, working professionals, and everyone in between.

    Oklahoma Attorney General Mike Hunger, who is interviewed for Killing Pain, lauded the documentary’s coverage of the “many tragic aspects” of Oklahoma’s opioid crisis.

    “Although the reality of the story is painful, the good news is, Oklahoma is rising to meet this challenge,” said Hunger, according to News 4. “State officials, business leaders and community organizers are tired of watching our families suffer and are stepping up and doing something about it.”

    The entire Killing Pain series is available to watch for free on YouTube.

    View the original article at thefix.com

  • Meth Remains Greater Issue Than Opioids In Rural Minnesota

    Meth Remains Greater Issue Than Opioids In Rural Minnesota

    “In 2009 meth use shot upward and it’s been steadily climbing,” said one city official.

    While many areas of the United States are battling the opioid epidemic, parts of rural Minnesota are facing a different battle: meth. 

    According to the Mankato Free Press, a new study by the Center for Rural Policy and Development has found that treatment admissions for meth are increasing, as are fatalities from the drug.

    The study determined that in 2016, 7,664 people in Greater Minnesota entered treatment for meth, which was a 25% increase from 2015 and about double the amount of people seeking treatment for meth in the Twin Cities.

    “We’ve been bombarded with the news of all the deaths from opioids. Our job is to find out what may be the same or different in Greater Minnesota than in the Twin Cities,” Marnie Werner, interim executive director of the Center for Rural Policy and Development, told the Mankato Free Press. “As soon as we started talking to a few county administrators, we found that opioids are a problem, but meth is a bigger problem.”

    According to Werner, the state as a whole appears to have a large issue with opioids due to the size of the Twin Cities. “The Twin Cities is so large it skews the statewide data,” she said. 

    For Blue Earth County Attorney Pat McDermott, the report’s findings were not new information.

    “Meth continues to be the drug of choice and probably the primary controlled substance we deal with and the drug task force deals with,” he told the Mankato Free Press. “Meth crimes are what’s driving our numbers and the drug task force’s numbers. There are five times as many meth cases than cocaine… (and) four times more meth cases than prescription cases.”

    While Werner says that meth use dropped in the early 2000s—when it became required that pseudoephedrine cold medicines, often used to make meth, be sold behind pharmacy counters and be limited in quantity. However, she says, meth manufacturing then picked up in Mexico and entered the U.S.

    “In 2009 meth use shot upward and it’s been steadily climbing,” Werner told the Free Press. “The way it’s being mass produced, prices have dropped and it’s very affordable to people. So these people who have underlying addiction or mental health problems who maybe couldn’t afford drugs before can now.” 

    Blue Earth County has some initiatives in place to help combat drug issues, such as the Yellow Line Project, which allows first-time offenders to seek treatment rather than go to jail. 

    “If you get them connected to services sooner rather than later, you’re better off. If you put someone in prison for three years, they’re going to come out with the same mindset they had,” McDermott told the Free Press.

    View the original article at thefix.com

  • Stop Illegally Selling Opioids Online, FDA Warns

    Stop Illegally Selling Opioids Online, FDA Warns

    Over the summer, the FDA has issued similar warnings to 70 websites. 

    The Food and Drug Administration issued a warning this week to the operators of 21 websites that the administration says sell mislabeled and illegal opioids to Americans. 

    The websites, which are run by four companies, have been “illegally marketing potentially dangerous, unapproved, and misbranded versions of opioid medications, including tramadol,” according to a press release issued by the FDA on Tuesday (August 28). 

    “The illegal online sale of opioids represents a serious risk to Americans and is helping to fuel the opioid crisis. Cutting off this flow of illicit internet traffic in opioids is critical, and we’ll continue to pursue all means of enforcement to hinder online drug dealers and curb this dangerous practice,” FDA Commissioner Scott Gottlieb said in the news release.

    Over the summer, the FDA has issued similar warnings to 70 websites. 

    “The FDA remains resolute in our promise to continue cracking down on these networks to protect the public health,” Gottlieb said. “We have more operations underway, and additional actions planned. We are also working closely with legitimate Internet stakeholders, including leading social media sites, in these public health efforts.”

    People who buy their opioids online can often wind up with expired, counterfeit or contaminated pills, according to the FDA. Some of the pills are marketed under one name, but are really just pressed fentanyl, a dangerous synthetic opioid. On CNBC’s Squawk Box, Gottlieb said that online sales are making the ongoing opioid crisis worse.

    “As we see doctors prescribe fewer opioids, we’re fearful that more and more of the new addiction is going to shift to illicit sources, and a lot of those illicit sales are taking place online,” he said on Tuesday.

    The four companies that received warnings on Tuesday were CoinRX, MedInc.biz, PharmacyAffiliates.org and PharmaMedics. They have 10 days to respond to the FDA’s letter, outlining the specific actions that they will take to avoid selling illegal opioids to Americans. If the companies do not respond they may face legal action. 

    On Wednesday, Gottlieb said that the FDA will continue to aggressively pursue companies and practices that make opioids too easily available. 

    “The reason that we find ourselves with a crisis of such proportion is that as a medical profession, we’ve been one step behind its sinister advance,” he said in a press release.

    “Collectively, we didn’t take all the steps we could, when we could, to stop the advance of this crisis. We shunned hard decisions. As a profession, providers were too liberal in our use of these drugs well past the point where there were signs of trouble, and the beginning of a crisis of addiction. I’m committed to making sure that we don’t perpetuate these mistakes of the past. And so, when we see this crisis taking new twists and turns, we’ve acted swiftly.”

    View the original article at thefix.com

  • Fentanyl Present In 90% Of Drugs, Massachusetts Officials Warn

    Fentanyl Present In 90% Of Drugs, Massachusetts Officials Warn

    The synthetic opioid is found more in combination with cocaine and benzodiazepines than heroin.

    Officials in Massachusetts are warning the public that the presence of the deadly synthetic opioid, fentanyl, is increasingly common in all types of illicit drugs in the state—not just in heroin or other opioids—raising the overdose risk for users of cocaine and other illegal substances. 

    “If an individual is using illicit drugs in Massachusetts, there’s a very high likelihood that fentanyl, which is so deadly, could be present,” said Dr. Monica Bharel, commissioner of the state Department of Public Health, according to New England Public Radio. “Anybody using illicit drugs should understand the risks, carry naloxone, and access treatment.”

    The state’s quarterly report found that fentanyl is present in 90% of overdose deaths in Massachusetts. It is found more in combination with cocaine and benzodiazepines than with heroin. In 2014, fentanyl was found in less than 30% of overdose deaths in the Bay State. 

    Because fentanyl is becoming more prevalent in cocaine and benzodiazepines, officials are advising family members of people who use illicit drugs to carry naloxone, the opioid overdose reversal drug. People who do not use opioids regularly are more susceptible to fentanyl overdose because they have not built up an opioid tolerance. 

    Because of this, the state is urging healthcare providers to help all drug users get into treatment, not just those who report that their primary drug of choice is an opioid. 

    “When analyzing opioid overdose deaths, we have become aware that a significant portion of the deaths are associated with concurrent cocaine use,” the state wrote in a letter to providers. “We believe this information is useful for you in your clinical work. Additionally, patients should be aware that polysubstance use can NOT be a reason for refusal for admission in the treatment system.” 

    The report also showed that overdose deaths are declining in Massachusetts for the third straight quarter, even as such deaths continue to rise nationally. This could be due in part to the rising rates at which EMTs in the state are administering naloxone, as well as public health campaigns, Bharel said. 

    “In Massachusetts we have a multi-pronged approach,” she said. “This is about prevention, raising awareness in our communities, and raising awareness among our prescribers.” 

    However, not all demographics are seeing the improvement. Hispanics are disproportionately likely to die of an overdose in Massachusetts, and the overdose rates for black men continue to rise. 

    “While the results of our efforts are having an impact, we must double down on our efforts to implement treatment strategies that meet the needs of the highest risk individuals and communities,” Health and Human Services Secretary Marylou Sudders said in a statement.

    View the original article at thefix.com

  • Iceland May Be On The Verge Of Opioid Epidemic Similar To The US

    Iceland May Be On The Verge Of Opioid Epidemic Similar To The US

    In 2017, there was about one drug-related death per 10,000 people in Iceland, compared to one per 4,500 in the US. 

    During the first half of this year, Iceland has already seen 29 likely drug overdose deaths—nearly as many as the 32 total that the country had in 2017. 

    The alarming increase, according to Reykjavík Grapevine magazine, could be due to a developing crisis in the country. 

    Ólafur B. Einarsson of the Directorate Of Health—a government agency under Iceland’s Ministry of Welfare—tells the Grapevine that substances like amphetamine and cocaine have been discovered in various samples from those who have died, though those substances have not been determined to be the cause of death. 

    “There have been 29 deaths that are probably related to drugs from January to the middle of June this year,” Einarsson said. “But it remains to be confirmed whether they are all directly linked to drugs.” 

    Einarsson added that cocaine has been discovered in five of the deaths, which is “a lot.” However, he says, a bigger concern is the abuse of prescription drugs in the country. 

    “Compared to other Nordic countries, Iceland has a 30% higher consumption rate of nervous system medication like oxycodone,” Einarsson says. 

    Because of this statistic, the Grapevine notes, the Directorate Of Health in Iceland began an online prescription database in 2016 with the hope that it would prevent physicians from prescribing numerous medications to the same patient. 

    According to Einarsson, another alarming trend lies in the ages of those abusing drugs. “This year, we discovered that more young people consumed a mix of strong opioid analgesics and cannabis or alcohol,” Einarsson told the Grapevine. 

    According to Einarsson, the group most at risk is young men. In fact, 79% of those dead in 2018 were males. 

    While the specific numbers don’t touch the United States in terms of quantity, the per capita ratio does. Iceland is home to only 338,000 people, while the U.S. has a population of more than 326,000,000.

    According to the Grapevine, there was about one drug-related death per 10,000 people in Iceland last year, compared to one per 4,500 in the U.S. 

    “In my opinion, the current situation is a crisis and if the numbers will continue to rise this year, we will in fact be very close to the figures of the United States, proportionally speaking,” Einarsson said. 

    The drug-related deaths reflect a larger problem in Iceland.  

    “Overall, there’s a lot more going on than drug-related deaths,” Einarsson told the Grapevine. “This is the darkest part of the whole picture and there are hundreds of people who are admitted to the hospitals every year due to drug overuse. There have been questions about the healthcare system and how to improve it for several years now.”

    View the original article at thefix.com

  • Woman Reportedly Caught With 1.5 Million Lethal Doses Of Fentanyl

    Woman Reportedly Caught With 1.5 Million Lethal Doses Of Fentanyl

    A woman traveling from Los Angeles to New York City was reportedly caught with five pounds of fentanyl in a suitcase.

    Authorities in Kansas City arrested a woman at a bus station who was traveling across the country, from Los Angeles to New York, carrying five pounds of fentanyl—reportedly enough of the drug to cause 1.5 million lethal overdoses.

    Kansas City Police noticed 33-year-old Evelyn C. Sanchez was “intently watching” detectives as they searched through the luggage on the bus.

    When asked, Sanchez told authorities she was heading to New York for “maybe a week,” but the story fell apart when officers reportedly noticed she had not packed a lot of clothing in her luggage.

    Following her questioning, K-9 units sniffed inside the bus and indicated a suitcase near Sanchez’s seat on the bus. When the other bus passengers did not claim the suitcase as theirs, police asked Sanchez and she admitted it was hers before allowing officers to search it.

    Authorities noted that she seemed “very nervous.”

    When asked, Sanchez told police she had “drugs,” according to court records. She did not seem to know what exactly she had, “but it’s a lot.”

    Officers checked inside and did indeed find a lot of drugs—over five pounds of fentanyl, “capable of killing thousands of people,” according to Kansas City Police Chief Rick Smith.

    Local authorities cooperated with the Drug Enforcement Administration (DEA) in the investigation. The DEA estimates the amount of fentanyl could kill several orders of magnitude more people than Smith’s estimates, claiming the operation took “1.5 million lethal doses from the streets.”

    There’s no telling where the fentanyl was ultimately heading yet, but it was almost guaranteed to help drive up the number of overdose deaths in the United States and further exacerbate the impact of the opioid crisis.

    Of 72,000 overdose deaths in 2017, 50,000 of those were opioid-related—30,000 of which were from fentanyl or related synthetic opioids.

    The drug is even getting to people who don’t want them—of 907 samples of drugs sold as heroin in Vancouver, Canada, 822 contained fentanyl.

    The U.S. Attorney’s office says Sanchez is in federal custody and awaiting a court date to be scheduled.

    View the original article at thefix.com