Tag: opioid epidemic

New York Sues Purdue Pharma Over Opioid Marketing

New York plans to work with other states that are investigating opioid manufacturers and distributors in the US.

This week, New York became the 27th state to sue Purdue Pharma, a producer of OxyContin, for alleged fraud and deception in its marketing of opioids.

The Wall Street Journal reported that Purdue is the only defendant listed in the lawsuit, driven by the administration under Governor Andrew Cuomo and New York Attorney General Barbara Underwood.

The complaint was filed in Suffolk County Supreme Court and charged that a community flooded with opioids has been devastated while Purdue has increased profits and prescriptions.

The suit charges that as of 2016, over 75% of New York’s opioid overdose deaths were caused by painkillers which include Purdue’s product, OxyContin.

Governor Cuomo was quoted in Insurance Journal as saying, “The opioid epidemic was manufactured by unscrupulous distributors who developed a $400 billion industry pumping human misery into our communities. This lawsuit sends a clear message (to those) who mislead the public to increase their profit margins that we will hold you accountable.”

Purdue released a response which called New York’s allegations false, while citing that the company also shares the state’s concerns about the opioid crisis.

Purdue noted that the U.S. Food and Drug Administration (FDA) “continues to approve” of scientific and medical information it provides to physicians.

In the suit, New York is seeking civil fines to be levied against Purdue. The state asks to recoup profits the drug company has made and pay fines for what they allege in the Insurance Journal is “criminal nuisance.”

In 2007, Purdue and three executives pleaded guilty to misbranding OxyContin. The company was charged with $634.5 million after a U.S. Department of Justice investigation.

The New York lawsuit against Purdue is part of a trend; a number of U.S. states are suing opioid makers and distributors over opioid marketing.

New York joined 26 other states, and Puerto Rico, in suing Purdue over their allegedly deceptive opioid marketing practices and the resulting health crisis.

Cuomo released a statement published in the Wall Street Journal that the country is fed up with the practice of pharmaceutical companies purposefully creating addiction for the purpose of profit.

Barbara Underwood in the Wall Street Journal said that the complaint is only New York’s first step toward holding pharmaceutical companies responsible. “Our work won’t stop with this lawsuit,” she said.

New York plans to work with other states to investigate United States opioid manufacturers and distributors.

View the original article at thefix.com

17 August 2018
Planned Safe Injection Sites Put On Hold In Canada

Advocates of safe injection sites called the Canadian health minister’s decision to halt the opening of the facilities “horrifying.”

A trio of planned safe injection sites in Ontario, Canada have been put on hold while the province’s new health minister conducts a review to determine if such facilities “have merit.”

Health Minister Christine Elliott said that she remains unconvinced that such sites are effective in reducing drug overdose deaths and the spread of HIV infection; she also cited concerns from neighboring businesses over security and biohazard refuse as core reasons for the review.

Advocates of safe injection sites and harm reduction policies called the health minister’s decision “horrifying,” that runs contrary to the needs of individuals in the midst of Canada’s opioid epidemic.

The CBC reported that in a letter sent on Friday, August 10, to health integration networks and health units in the province, Roselle Martino, assistant deputy minister of the population and public health division, said that the approval process for new safe injection sites in the cities of Toronto, Thunder Bay, and St. Catharines would be halted immediately.

The sites would allow for supervised injection of opioid drugs, grant access to harm reduction support and allow users to safely dispose of needles and other paraphernalia.

In the letter, Elliott wrote that she will be “reviewing the evidence and speaking to experts to ensure that any continuation of supervised consumption services and overdose prevention sites are going to introduce people into rehabilitation and ensure people struggling with addiction will get the help they need.”

CTV News also noted that Elliott will address how local businesses have been impacted by existing sites. The network cited concerns by Mark Garner, a member of the Downtown Yonge Business Improvement Area (BIA) in Toronto, who said that his organization has found discarded needles in the area near the Works, the city’s first supervised injection site, which opened in November 2017.

Garner stated to CTV that while his organization supports efforts to reduce drug overdoses, the businesses in the BIA have felt the need to increase security and allocate funding to clean up discarded needles, especially ones discarded in toilets which have caused plumbing issues.

“This is the number one tourist destination in Canada,” he said. “How do we integrate that into the neighborhood, what resources are needed, and how do we make it safe for everybody?”

But harm reduction advocates and health care professionals have expressed alarm at the province’s move, which some described as a decision motivated more by politics than any actual health concern.

“It’s a complete disaster, and I do worry about people on the ground,” said Marilou Gagnon, an associate professor of nursing and president of the Harm Reduction Nurses Association. “The science is very clear that overdose prevention sites do work, and we’ve known this since the ’80s. [I’m] extremely concerned about a government going against science.”

View the original article at thefix.com

16 August 2018
Vets Believe That Some Pet Owners Injure Their Animals To Get Opioids

A new study reveals that 13% of veterinarians believed a client had intentionally injured a pet or made them ill in order to be prescribed a drug.

A small research study in Colorado had disturbing results: the study found that 13% of veterinarians believe that people are using their pets to obtain opioids—by making them appear to be injured, or by actually injuring the animal.

Gizmodo interviewed the author of the study, Liliana Tenney, a public health researcher at the University of Colorado Anschutz Medical Campus. Tenney is concerned about the lack of training and education for veterinarians regarding their responsibilities in the opioid crisis.

“In conversations with these doctors, they often ask: ‘Well, what do we do? We need to treat pets who are in pain but we also need to know how to identify and handle suspicious behavior,’” she said. “But there’s not a lot of resources or training right now to direct these veterinarians.”

According to Gizmodo, almost three-quarters of vets reported that their veterinary medical school training on opioids was mediocre, poor, or non-existent. Sixty-four percent said that following veterinarian school, they had no further training on the issue.

Newsweek reported that in the survey of 189 vets; 13% reported that they believed a client had intentionally injured a pet, made them ill, or made them appear unwell, in order to be prescribed a drug. Tramadol is the most common opioid stocked by veterinary practices.

The emailed survey also revealed that 45% of the vets knew of someone at work or a client who was abusing opioids, and 12% said they knew of a staff member that was giving out opioids.

Lee Newman, director of the Center for Health, Work & Environment at the Colorado School of Public Health, told Newsweek, “There were also reports of diversion of drugs within the veterinary practices. Doctors [of animals] can prescribe the full range of opioids that are prescribed and administered to humans.

“In fact, veterinarians have the ability to prescribe, administer, carry, stock, and dispense narcotics in clinics, depending on the pain needs of their animal patients.”

The survey results indicate that veterinarians have been dramatically undereducated about their role in drug monitoring. Sixty-two percent believed they had a role in preventing opioid abuse, and 40% were unsure if opioid abuse was an issue in their communities.

To address this gap, Liliana Tenney, along with her team, has built an online education course for veterinary providers. Tenney and others are also working on building a better surveillance program within Colorado, where the survey was conducted.

View the original article at thefix.com

15 August 2018
Opioid Use Quadrupled Among Pregnant Women

The prevalence of opioid use disorder present at a hospital delivery rose from 1.5 per 1,000 deliveries in 1999 to 6.5 per 1,000 in 2014.

Opioid use among pregnant women quadrupled between 1999 and 2014, rising alongside the rate at which opioid use disorder has increased in the general population, according to a new report.

“When something is so broad and affects all populations, we also see it reflected in the pregnant population,” Dr. Elizabeth E. Krans, an assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at the University of Pittsburgh, told CNN Health.

The Centers for Disease Control and Prevention (CDC) published its report on Friday (August 10). The CDC analysis found that nationally, the prevalence of opioid use disorder present at a hospital delivery rose from 1.5 per 1,000 deliveries in 1999 to 6.5 per 1,000 in 2014.

However, in some states the problem was much more prevalent. In Vermont, for example, opioids are a factor in 48.6 out of every 1,000 deliveries.

Data was only available in 28 states, but indicated that opioid use in pregnant populations varies widely. Washington, D.C. had the lowest prevalence in 2014 at just 0.7 deliveries per 1,000, while Vermont had the highest.

The increase in the prevalence of opioids was also uneven: California and Hawaii saw relatively small increases, while Maine, New Mexico, Vermont and West Virginia saw large spikes in the reported use of opioids among pregnant women.

State policies on drug use during pregnancy can affect reporting, since in 23 states and Washington, D.C., using drugs while pregnant is considered child abuse. This might prevent some women from being honest about their drug use.

“Data on the impact of these policies are scarce,” the authors wrote.

“Pregnancy is a really important time. Women are often worried that invested in their own health and the health of their baby, but they’re also fearful of judgment,” Krans said.

Women who are using opioids when they become pregnant are often told to go on medication-assisted treatment throughout their pregnancies, as that is the safest option for mother and baby. “We have effective treatments that are available during pregnancy, and we want to encourage women to seek early care and engage in treatment as soon as possible,” Krans said.

Left untreated, opioid use can lead to a variety of pregnancy complications and negative health effects for the child.

“Opioid use by pregnant women represents a significant public health concern given the association of opioid exposure and adverse maternal and neonatal outcomes, including preterm labor, stillbirth, neonatal abstinence syndrome, and maternal mortality,” the authors wrote.

View the original article at thefix.com

15 August 2018
Paramedics Use Laughing Gas In Lieu Of Opioids To Treat Pain

“We feel if we can prevent someone from getting an opioid we are ahead of the game,” said one Indianapolis emergency responder.

Paramedics in one Indiana town have decided to switch from fentanyl to laughing gas in an effort to keep injured patients from taking the drug, a synthetic opioid which has a high potential for addiction.

The move comes as fentanyl is tightening its grip on the state’s capital, accounting for nearly 50% of opioid-related deaths in 2017—up from just 14% in 2013.

The shift won’t entirely eliminate the Fishers Fire Department’s use of the addictive painkiller, but it could cut it down by about two-thirds, Capt. John Mehling told the Indy Star.

“If it hurts a little, why give a lot?” Mehling said. “If you are going squirrel hunting, don’t bring an elephant gun.”

For some cases—including head injuries and collapsed lungs—paramedics will still give out fentanyl. But when it comes to things like broken bones, they’ll turn to laughing gas instead.

“We feel if we can prevent someone from getting an opioid we are ahead of the game,” Mehling told the Indianapolis paper.

After decades of use in dentistry, it wasn’t until relatively recently that laughing gas started making its way into emergency room settings. It offers some advantages over other painkiller options, including the fact that it’s not addictive and doesn’t require an IV. Also, it typically takes effect within about a minute and has a good safety record.

But to use nitrous oxide, the patient has to be in good enough condition to put on the mask or tube and inhale to self-administer the gas. Then, three to five minutes later, they’ll need to do it again. Also, there have been some fatalities, and it can still present the potential for abuse, which makes it a potential target for thieves.

The shift at the Fishers Fire Department is just the latest in a growing trend. Paramedics in more than two dozen states have already started buying laughing gas for ambulances—though not always in an effort to avoid using opioids, according to the Associated Press.

For some departments, laughing gas is convenient because it offers a means to combat pain even when medical workers who can legally provide narcotic painkillers are not along for the ride.

View the original article at thefix.com

13 August 2018
Long-Term Opioid Use Linked To Wisdom Teeth Extraction

Researchers examined whether opioids prescribed to manage pain from wisdom teeth extraction heightened the risk of long-term use.

Nearly 85% of people will need to have their wisdom teeth extracted at some point during their lives, and a new study shows that this routine dental procedure can have severe consequences—with young people who use opioids after the procedure three times more likely to fill opioid prescriptions long-term.

“From our findings, we should strongly consider not prescribing any opioids routinely after wisdom teeth are pulled. Particularly since there is evidence that anti-inflammatories may be just as good, if not better, for pain management after wisdom teeth are pulled,” Dr. Calista Harbaugh, lead study author and a general surgery resident at the University of Michigan, where the research was conducted, told ABC News.

For the study, published in the Journal of the American Medical Association on August 7, researchers looked at 71,000 insured people from 2009 to 2015.

About 60,000 filled prescriptions for opioids intended to relieve the pain from the tooth extraction. Researchers then looked at future opioid use and found that young people were most likely to fill additional opioid prescriptions in the future.

This is not the first time that researchers have connected dental work with risk for long-term use of opioids. Last summer, another study published in JAMA warned that doctors and dentists should be weighing opioid dependence as a potential complication from surgery.

“New persistent opioid use represents but previously underappreciated surgical complication that warrants increased awareness,” they wrote.

Harbaugh said wisdom tooth extraction is especially risky because it comes at a time when people may be more likely to become addicted, and it is a very common procedure, with more than 3.5 million extractions taking place each year.

“Teens and young adults are an important population to understand the effects of exposure to opioids for predictable reasons, like having wisdom teeth pulled,” she said. “They are vulnerable from the standpoint of ongoing development as well as social pressures.”

Despite increased awareness about the dangers of opioids, dentists have been accused of over-prescribing painkillers as rates of opioid prescription continue to climb. In March, the American Dental Association announced new guidelines meant to limit opioid prescribing.

“As president of the ADA, I call upon dentists everywhere to double down on their efforts to prevent opioids from harming our patients and their families,” ADA President Joseph P. Crowley said in a news release. “This new policy demonstrates ADA’s firm commitment to help fight the country’s opioid epidemic while continuing to help patients manage dental pain.”

The newest study suggests that these efforts are critical.

“It will be important to find areas where we can help eliminate the exposure to opioids in this group to show long-term decrease in opioid use,” said Dr. Chad Brummett, an assistant professor of anesthesiology at the University of Michigan.

View the original article at thefix.com

11 August 2018
HIV Outbreak In Massachusetts Linked To Injection Drug Use

Between 2015 and 2018 there were 129 new HIV cases linked to drug use in two Massachusetts cities.

Fentanyl use in two Massachusetts cities is driving an HIV outbreak that officials say could be forecasting a national public health crisis.

Lawrence and Lowell Massachusetts, two cities along the New Hampshire border, have seen such a sharp spike in new HIV cases that the Centers for Disease Control and Prevention has become involved, according to The Huffington Post.

Between 2015 and 2018 there were 129 new HIV cases linked to drug use diagnosed in the cities. In the four years prior to that there were only 41 new cases of HIV related to injecting drugs diagnosed annually in the entire state.

“This tells us we cannot rest on our laurels,” said Thomas Stopka, an infectious disease epidemiologist and assistant professor at Tufts University School of Medicine. “There are potentially other communities that are at great risk as well. HIV can and is raising its head again in places where risks align.”

In 2015, opioid injecting was linked to an HIV outbreak in rural Indiana. The risk factors in the Massachusetts outbreak are similar, but in an urban setting. One risk is pervasive fentanyl use. Because the synthetic opioid has a shorter half life than heroin, users inject more often. This means they have more opportunity to be exposed to dirty needles.

In addition, neither city had a needle exchange program before the outbreak, although both have since established exchanges. Finally, high rates of homelessness compound health risks, as does the fact that doctors don’t routinely screen for HIV, even among intravenous drug users.

“This may be forecasting what could conceivably happen around the country,” said Amy Nunn, executive director of the Rhode Island Public Health Institute.

This spring, epidemiologists from the CDC spent time in Lawrence and Lowell to try to establish why the outbreak was occurring. They presented their findings in a meeting on July 24.

“The most striking finding was the sheer number of cases,” said Stopka “[It] was substantially higher than what was seen in years prior.”

The number of new drug-related HIV cases “definitely caught a lot of folks’ attention and really spoke to the great need in terms of a response,” he said.

Most of the new cases were among white men ages 20-39, men like Mark, a 29-year-old who injected drugs before finding out that he was HIV positive.

“We all use,” Mark said. “We all know the other one has it. We don’t tell each other. People will lie right to your face about having it. It’s spreading around like wildfire.”

Stigma around HIV — even among drug users — keeps them from disclosing their status even if they know if. In addition, the draw of a high can cause people to put their health on the back burner, Mark said.

“People just don’t care,” he said. “When it comes down to it, if you’ve got a bag in your hand and somebody next to you’s got a dirty needle, you’re not going to run and find a clean one.”

View the original article at thefix.com

10 August 2018
Are Opioid Prescription Rates Actually Declining?

While individual states have reported declines in opioid prescription rates, this did not apply for all Americans, according to Mayo Clinic researchers.

After reviewing anonymous insurance claims data covering 48 million people between 2007 and 2016, the researchers concluded that “opioid prescription rates have remained flat for insured patients over the last 10 years,” as Forbes reported.

Specifically, disabled Medicare patients displayed the highest rates of use and the largest proportion of long-term use of prescription opioids.

More than 51% of disabled Medicare patients used opioids, while this number was just 14% for privately insured patients and 26% of non-disabled Medicare patients used opioids.

As lead author Molly Jeffery explained, even though integrative pain programs that use over-the-counter pain medication like Advil and Tylenol, alongside physical therapy, can be just as if not more effective than opioid painkillers for some patients, they tend to cost more than opioid painkillers alone, leading insurers to favor the cheaper option.

“We wanted to know how the declines were experienced by individual people,” said Jeffery. “Did fewer people have opioid prescriptions? Did people taking opioids take less over time? When we looked at it that way, we found a different picture.”

The Mayo Clinic is now prescribing fewer pain pills per patient, Jeffery said, trying to find a balance of giving “enough medication to relieve pain without raising the risk of addiction.”

Establishing prescription limits could reduce the risk of opioid overdose for some patients, the researchers said, “but that reduction in risk must be weighed against the burden to patients and their physicians.”

Former The Fix contributor, journalist and author Maia Szalavitz warned as early as 2012 of the consequences of a nationwide crackdown on pain medication. In her article “The Innocent Victims of America’s Painkiller Panic,” she offers a critique of opioid “policing”—which is not limited to prescription limits.

“There’s little evidence that such policing prevents addiction or does anything else beyond inconveniencing and stigmatizing pain patients,” Szalavitz wrote.

According to Ballotpedia, as of this past April, 28 states have established policies or guidelines that set limits on the supply of opioids that can be prescribed by doctors.

View the original article at thefix.com

8 August 2018
Misuse Of Unapproved Antidepressant With Opioid-Like Effects Spikes

Though tianeptine isn’t FDA-approved, it’s not illegal and can be purchased online as a dietary supplement.

An apparent spike in the use of an unapproved antidepressant called tianeptine is poisoning people who are looking to benefit from the drug’s mild opioid-like effects, according to a Centers for Disease Control and Prevention (CDC) report released last week.

From 2000 to 2013, the U.S. saw 11 tianeptine-related poison control center calls; from 2014 to 2017, there were more than 200. That’s all according to the CDC analysis of National Poison Data System information, which sheds new light on a growing trend.

Though tianeptine isn’t FDA-approved, it’s not illegal and can be purchased online as a dietary supplement. It’s often marketed elsewhere under brand names Coaxil and Stablon, according to Vice News.

The drug was first discovered by the French Society of Medical Research back in the 1960s, and it’s been shown to help fight depression and anxiety, according to CNN.

When it was patented, scientists weren’t entirely clear on how it worked. But in 2014, researchers found that the drug lights up certain opioid receptors. While that appears to help with some depression symptoms, it also means that people taking tianeptine can have opioid-like withdrawal when they stop taking the drug.

“Tianeptine has an abuse potential in former opiate drug users,” the CDC researchers wrote. “This study further highlights that the withdrawal effects of tianeptine mimic those of opioid withdrawal.”

But, unlike with traditional opioids of abuse, tianeptine doesn’t show up on drug screens, which can make it a tempting choice for justice-involved individuals looking for a high that won’t land them in legal hot water.

“I think people have this misguided belief that if you can get it on the internet and it’s not overtly illegal and you’re not going through the dark web to acquire these substances, so it must be OK,” Raphael Leo, an associate professor in the Department of Psychiatry at the University of Buffalo, told CNN.

But, earlier this year, the Journal of Analytical Toxicology reported on two tianeptine-related deaths in Texas, and more have been reported in other countries.

The potential dangers of the unapproved drug have sparked some calls to ban it. In April, Michigan greenlit a law banning the substance on the heels of a number of overdoses, according to the Associated Press.

View the original article at thefix.com

7 August 2018
Addiction Likely Reason For Alarming Parental Loss Rates In One Region

Nearly 15% of children in one surveyed area have a parent who has been in jail, in comparison to 8% of children across the nation.

Children in parts of Ohio, Kentucky and Indiana may be at greater risk of being separated from their parents, likely due to the opioid crisis, according to a new survey.

Interact for Health released the 2017 Child Well-Being Survey on Friday, August 3. The survey was taken by more than 2,700 parents and guardians in 22 counties across southwest Ohio, northern Kentucky and southeast Indiana.

According to the Cincinnati Enquirer, the stand-out results from the survey include the fact that nearly 15% of children in the surveyed area have a parent who has been in jail, in comparison to 8% of children across the nation.

Additionally, approximately 8% of the children in the surveyed area had a parent who had died, in comparison to 3% across the country.

“While this survey doesn’t tell us why, substance abuse is a likely contributor,” Sonya Carrico, senior program officer for the opioid team at Interact for Health, told the Enquirer. “Our region has some of the highest rates of drug overdose deaths in the nation, many among adults age 25 to 44, and the percentage of youth in foster care due to parental substance abuse is on the rise.”

This reasoning would make sense, as Ohio and Kentucky have been some of the states hardest hit by the opioid epidemic, according to the Enquirer. In 2016, the Centers for Disease Control and Prevention’s drug overdose mortality by state had Ohio ranked second in the U.S., and Kentucky fifth.

Another piece of information that supports this idea, the Enquirer states, is that 30% of the children in custody of the Hamilton County Job and Family Services were taken out of their homes due to having a parent struggling with substance use.

In some cases, this leads to children being taken in by other family members. Maureen Sharib of Cincinnati is caring for her 10-year-old granddaughter Brianna, and has been since she was 15 months old. Sharib’s daughter and Brianna’s mother, Natalie, died in 2017 after an overdose. Brianna’s 5-year-old brother, Jaxon, is in the custody of Sharib’s sister.

“The epidemic’s toll is hard to measure, but these numbers have to be considered every time you hear an ambulance passing or see one parked in the street,” Sharib told the Enquirer. “Just about every time you see that, there are children involved… Innocent children standing by, watching the horror of what’s happening to the people who are most important to them in their lives. There is no taking that away—ever. There is no bandage that can salve those wounds.”

Situations such as these, according to the Enquirer, could affect children’s mental and physical health later in life.

“When children experience prolonged, intense, frequent stress, their bodies may respond to elevated stress hormone levels in ways harmful to their growth and development,” Dr. Robert Shapiro, director of the Mayerson Center for Safe and Healthy Children at Cincinnati Children’s Hospital Medical Center, told the Enquirer.

However, Shapiro tells the Enquirer, there are ways to help children cope and stay on a healthy path later in life.

“We can prevent these harmful effects by building supportive communities, by promoting strong caring relationships with adults and by strengthening a child’s social and emotional skills,” Shapiro said.

View the original article at thefix.com

6 August 2018