Tag: opioid epidemic

Chronic Pain Patients Feel The Effects Of Arizona Opioid Legislation

“They told me because of the new law they had to cut me back. It just hurts, I don’t want to walk, I don’t want to… pretty much don’t want to do anything,” said one pain patient.

New bipartisan legislation curbing the pharmaceutical use of opioids in Arizona has been put into action. In January, Arizona Governor Doug Ducey signed the Arizona Opioid Epidemic Act, calling it “vital to combat an epidemic felt statewide and across the nation,” according to Reuters.

However, some chronic pain patients in Arizona are already feeling harmful effects as the law is put into place. NPR reported that although the act was not written around the issues of chronic pain patients, it negatively impacts them, as doctors who are worried about legal trouble curb their patients’ access to the pain-relieving drugs.

Governor Ducey’s administration had stated that the law would “maintain access for chronic pain sufferers and others who rely on these drugs.”

This is mostly true: restrictions are written to apply to new patients only. Some were exempted, such as cancer and trauma patients, and patients in end-of-life care.

However, in practice, some Arizona doctors are pulling back hard on prescribing opioids for all of their patients.

Dr. Julian Grove, president of the Arizona Pain Society and contributor to the act told NPR that, “A lot of practitioners are reducing opioid medications, not from a clinical perspective, but more from a legal and regulatory perspective for fear of investigation. No practitioner wants to be the highest prescriber.”

Shannon Hubbard, Arizona resident and chronic pain sufferer (she has a condition called complex regional pain syndrome) had her opioid pain relievers reduced by 10 mg in April. “They told me because of the new Arizona law they had to cut me back,” she told NPR, saying that her pain was now terrible. “It just hurts, I don’t want to walk, I don’t want to… pretty much don’t want to do anything.”

The legislation created regulations around opioid use, citing that 75% of those addicted to heroin began their use with an opioid prescription. The act includes a limited initial opioid prescription of five days, and for certain extremely addictive painkillers, set a maximum 30-day prescription.

The law includes $10 million to be spent treating people with opioid addiction who are not insured and ineligible for Medicaid. The “Good Samaritan” provision allows immunity for those reporting an overdose.

Dr. Cara Christ, head of Arizona’s Department of Health Services and contributor to the state’s opioid response laws, told NPR, “The intent was never to stop prescribers from utilizing opioids. It’s really meant to prevent a future generation from developing opioid use disorder, while not impacting current chronic pain patients.”

Still, Shannon Hubbard is living with the effects of the law, and not the intentions.

“What they are doing is not working,” she told NPR. “They are having no effect on the guy who is on the street shooting heroin and is really in danger of overdosing. Instead they are hurting people that are actually helped by the drugs.”

View the original article at thefix.com

11 July 2018
Are Dentists Still Overprescribing Opioids?

A new study examined the opioid prescription patterns of dentists who care for patients with private insurance.

While dentists have been writing a declining number of opioid prescriptions in the past few years, two new studies indicate that there still may be reason for dental professionals to take precautions when prescribing.

According to PEW Trusts, one such study published in the Journal of the American Dental Association in April examined the prescribing patterns among dentists who tended to privately insured patients. From 2010 to 2015, opioid prescriptions per 1,000 patients increased from 131 to 147, study authors found.

“The fact that we’re still prescribing opioids when we’ve demonstrated that nonsteroidals are as effective most of the time is a little disturbing,” Dr. Paul Moore, co-author of the analysis and professor at the University of Pittsburgh’s dental school, told Modern Health Care.

The study found that the biggest increase—about 66%—was in those ages 11 to 18. The study also noted that for all age groups, almost one-third of the opioid prescriptions written were for visits that were not surgical in nature, for which study authors state non-opioids could also be effective for pain.

According to Modern Health Care, an analysis of five studies in the Journal of the American Dental Association found that nonsteroidal anti-inflammation drugs like ibuprofen are effective for dental pain.

The second study was published at the same time in the same journal, and examined outpatient care for Medicaid patients. Researchers found that from 2013 to 2015, nearly 25% of those patients filled a prescription for opioids. They also discovered that emergency department providers were more likely to give opioids to patients with dental issues.

The study found that 38% of patients who sought care in an emergency department then filled an opioid prescription in comparison to 11% of those who went to the dentist.

“Dentists are providing substantially less opioid prescriptions compared to their medical colleagues for pain treatment following a dental diagnosis in the Medicaid population,” study authors wrote. “When considering pain management for dental and related conditions, dentists should continue with conservative prescribing practices as recommended.”

According to PEW Trusts, the results of the study come at a good time, as the American Dental Association recently released an interim policy on prescribing opioids.

The policy lays out a number of guidelines for providers to follow and encourages continuing education about opioid use for dentists. It also states that dentists should follow the Centers for Disease Control and Prevention (CDC) guidelines about dosage and length of opioid prescriptions.

View the original article at thefix.com

11 July 2018
Massachusetts Sues Purdue Pharma Over Opioid Crisis

Sixteen individuals are named in the lawsuit, including a few members of the Sackler family.

The state of Massachusetts is suing 16 current and former Purdue Pharma board members and executives for their alleged role in the continuing opioid crisis.

Massachusetts Attorney General Maura Healey says this is the first lawsuit brought on by a state that directly names executives and directors in connection with opioid-related deaths.

The BBC reports that Judy Lewent, a non-executive director of GlaxoSmithKline, is named in the charges for her involvement with the board of Purdue Pharma until 2014.

Lewent currently serves as a director in GlaxoSmithKline (GSK), one of the six largest British pharmaceutical companies. In 2012, GSK pleaded guilty to promotion of drugs for unapproved uses, failure to report safety data, and kickbacks to physicians in the United States. The company was sentenced to pay a $3 billion settlement—the largest settlement for a drug company at that time.

Sixteen individuals are named in the Massachusetts lawsuit, including a few members of the Sackler family.

Purdue Pharma is owned by the descendants of Raymond and Mortimer Sackler who earned their fortune off of the drug OxyContin, which their company, Purdue Pharma, still produces.

The Massachusetts lawsuit claims that Purdue Pharma “created the [opioid] epidemic and profited from it through a web of illegal deceit.”

Judy Lewent was tagged as one “who oversaw and engaged in a deadly, deceptive scheme to sell opioids in Massachusetts.”

AG Healey addressed the lawsuit in a press conference, “We found that Purdue misled doctors, patients, and the public about the real risks of their dangerous opioids, including OxyContin. Their strategy was simple: The more drugs they sold, the more money they made—and the more people died.”

Purdue Pharma “vigorously denies the allegations,” while GlaxoSmithKline declined to “comment on legal matters faced by another company,” according to the BBC.

Purdue told the BBC, “The Attorney General claims Purdue acted improperly by communicating with prescribers about scientific and medical information that FDA (Food and Drug Administration) has expressly considered and continues to approve. We believe it is inappropriate for the Commonwealth [of Massachusetts] to substitute its judgment for the judgment of the regulatory, scientific and medical experts at FDA.”

The company added that it shared “the Attorney General’s concern about the opioid crisis,” and that its “opioid medications account for less than 2% of total opioid prescriptions.”

The state of Minnesota also recently filed a lawsuit against Purdue Pharma over the marketing of OxyContin.

Purdue Pharma has recently stopped the marketing of opioid-based drugs in Canada, Westfair reported. Purdue already pulled marketing for these drugs in the U.S. back in February. Canada has asked drug companies to suspend marketing and advertising of opioid-based drugs.

View the original article at thefix.com

11 July 2018
Grieving Mothers Band Together To Support People In Recovery

“If we can save just one person, it’s worth it,” said one of the mothers in the Moms of Cherished Angels group.

A group of grieving mothers are turning their losses into something positive.

The Moms of Cherished Angels—a group of women who lost a child or family member to drugs—donate toothpaste, shampoo, other toiletries, and notebooks to people entering rehab across Pennsylvania.

In each care package, they add a note telling their story.

“We decided we wanted to do something to keep our children’s memories alive and help others suffering with this horrible disease,” said Judy Provanzo, whose son Michael died last August.

Judy and her husband decided to address Michael’s drug use in his obituary: “We do not want his death to be in vain,” it read. “Michael did not want to be an addict. His demons were more than he could handle. Addiction is a disease and does not discriminate. Many loved ones did everything they could to get him to stop but the drugs won their battle.”

After that, others who had lost loved ones to drugs reached out to Provanzo, and from there, the support group formed. The women meet every week. One member, who lost her daughter in 2016, called it a “sisterhood.”

“Everybody is different and everybody grieves differently,” said Provanzo. “We get to different places in the process at different times. But if we didn’t have this every Tuesday, I’d be in a loony bin.”

The support of others who are going through the same experience is invaluable to the grieving moms. “We understand one another. There are times we’ll say, ‘Did you get out of bed today?’” said Provanzo.

In her note about Mikey, Provanzo wrote: “The day Mikey died a part of me and his father died with him. I’m sharing this with you in hopes it helps you along your journey. Mikey always thought he had his addiction under control and this wouldn’t happen to him. If you’re feeling like you want to give up, please think of Mikey and how my heart is breaking not having him. Remember you are loved and you can do this one day at a time.”

The mothers honor the memory of their children and loved ones by supporting not only one another, but others in recovery.

“If we can save just one person, it’s worth it,” said Kim Janeczek, who lost her 21-year-old son Matthew in 2017.

In her care package note she wrote, “He had a heart of gold. He helped so many people in the short time he was here.”

View the original article at thefix.com

10 July 2018
Opioid Crisis “More Deadly” Than AIDS Epidemic, CDC Director Says

CDC director Dr. Robert Redfield discussed the parallels between the crises and his plans to combat opioids during a recent interview.

Robert Redfield has only been the director of the Centers for Disease Control and Prevention (CDC) since March, but in that time he has made his stance on the opioid crisis known.

Redfield, 66, tells The Washington Times that the opioid crisis will be worse than the HIV/AIDS epidemic of the 1980s, which he was also involved in fighting. “I would say the opioids-fueled epidemic is clearly already more deadly than the AIDS epidemic ever was,” he told the Times.

According to Redfield, the CDC is working with pharmacies and states to keep up with the opioid epidemic in real time and collect overdose death data as quickly as possible. He says the goal is to release the figures for 2017 in the fall of 2018.

The most recent data, from 2016, has overdose deaths at 42,000. The Times notes that some researchers predict that the newest data will show that overdose deaths have passed the 48,000 HIV/AIDS deaths in 1995 which was the most fatal year of that epidemic.

Redfield says that when it comes to annual rates, drug overdose deaths have already overtaken those of the HIV/AIDS crisis. “If you look at all overdose deaths, not just opioids deaths, we’re over 60,000 now,” he told the Times.

The number of deaths isn’t the only similarity Redfield sees between the two epidemics. He tells the Times that with both, there have been empathy gaps, meaning people initially saw the diseases as something that happened because of dangerous behavior.

“It’s a medical condition. It’s not a moral choice,” Redfield told the Times. He added that as with the HIV/AIDS crisis, combating the opioid crisis will take new scientific innovations and “public health efforts.”

In June, Redfield told the Wall Street Journal that the CDC would be increasing efforts to fight the opioid crisis. He stated the organization would be developing new guidelines for opioid prescriptions for acute pain, as well as introducing a new system to track emergency department data.

Redfield also told the Wall Street Journal that he has personal experience with the opioid crisis, as a close family member had struggled with opioid use. “I think part of my understanding of the epidemic has come from seeing it not just as a public-health person and not just as a doctor,” he told the Wall Street Journal. “It is something that has impacted me also at a personal level.”

Redfield also called stigma the “enemy of public health” and stated that it’s vital to find “a path to destigmatize” opioid use.

“We were able to do it to some degree for HIV, and I think pretty successfully, but it’s not over,” he said.

View the original article at thefix.com

10 July 2018
Kids, Parents & Grandparents All Face Strain Of Opioid Crisis

One expert estimates that for every child in foster care due to a parent’s addiction there are 18 to 20 children who have been informally taken in by family members.

When parents are living with opioid addiction—or even trying to establish their lives in recovery—it can take a toll on the whole family, from kids to grandparents, as roles are redefined.

Donna Butts, the executive director of Generations United, a Washington, D.C.-based organization, has seen how families have coped with drug epidemics fueled by cocaine or meth. This time, she told CBS News, feels different.

“With the opioid epidemic, it seems so much more severe and, in some ways, more hopeless,” she said. “Which is why I think the grandparents and other relatives that are stepping forward are playing such a critical role because the hope is with the children.”

Oftentimes family members will step up to care for the children of people who are addicted without going through the formal foster care system, making it difficult to get an estimate on how many families have been rearranged because opioid addiction.

The foster care statistics themselves are overwhelming; Butts estimates that for every child in foster care because of a parent’s addiction there are 18 to 20 children who have been informally taken in by family members.

This has financial implications for the family member taking responsibility for the children, usually the grandparents. Twenty percent of grandparents raising grandchildren are living in poverty, and 40% are older than 60, which often means they are retired or semi-retired and living on a fixed income.

In addition, many children have been exposed to trauma, and their grandparents have been through their own traumatic experiences in seeing their child battle addiction.

“What they really need is to understand the impact of trauma on the children and try to help support them as they deal with that. Also, they need to have access to trauma-informed services, the services that can really help them to overcome what they’ve experienced,” Butts said.

However, she noted that having stable grandparents can really help children overcome the harms of having a parent battling addiction.

Even for parents who are working to get clean, keeping custody of the children can be challenging.

Jillian Broomstein, of New Hampshire, was in a methadone program when her son was born. Because the baby tested positive for opioids, he was taken by the Division for Children, Youth and Families. Broomstein had just one year to be off opioids and in a stable housing situation, or she would risk losing custody permanently, according to WGBH.

“I cannot stress enough that 12 months is a really short window for somebody who’s in early recovery,” says Courtney Tanner, who runs a New Hampshire recovery home where pregnant women and new moms can live with their babies while getting sober.

Situations like Broomstein’s are too common, she said.

“Here in New Hampshire what I have seen is a mom can be enrolled in this program and compliant in treatment and they are giving birth to a child and that child is still being removed and put into foster care.”

However, given the right resources, people in recovery are able to be reunited with their children.

“We see a lot of that,” said Dr. Frank Kunkel, the president and chief medical officer of Accessible Recovery Services. “We see a lot of people that spin out of control. They’re involved with the judicial system and all that. And we see grandma have the kids for a while. Then they’ll get back on track with things legally, and they’ll get on our medications, and they’ll get in seeing their therapist, and they’ll turn their life around. We see that every day.”

View the original article at thefix.com

10 July 2018
Opioid Makers Cut Back On Marketing Payouts To Doctors

In 2016, Big Pharma shelled out more than $15 million to doctors for opioid-related marketing—33% less than the year prior.

Drugmakers are cutting back on opioid-related marketing payouts to doctors, according to a data analysis by ProPublica.

The newly released figures come as the latest update to the nonprofit news site’s Dollars for Docs online tool that tracks payments to physicians from drug companies and other medical companies.

In 2016, the latest numbers show, Big Pharma shelled out more than $15 million to doctors in exchange for opioid-related speaking and consulting work. That was 33% less than the 2015 figure and 21% less than the 2014 figure. Repeatedly, research has drawn a link between marketing and prescribing practices.

“Given the deluge of media attention with the opioid epidemic, I think we’ve seen the pendulum swing in the opposite direction,” Michael Barnett, an assistant professor of health policy and management at Harvard, told ProPublica. “If this is actually a result of manufacturers actually saying, ‘Holy crap, people actually care about opioids being used responsibly’ and they’re aware that their advocacy and payments to physicians could be seen as pushing these medications in a way that is ethically dubious, then that’s a beneficial development and something I’d like to see more of.”

The shift comes amid a growing number of lawsuits against drug companies accused of downplaying the risks of painkillers in aggressive marketing campaigns over a yearslong uptick in opioid use.

It’s not clear exactly what’s driving the changing numbers, though, experts said.

“It’s possible that the pharmaceutical companies voluntarily reduced their marketing, realizing that they may have been contributing to overprescribing,” Dr. Scott Hadland of Boston University School of Medicine told ProPublica.

At the same time the marketing dollars decreased, the number of opioid prescriptions started on the downswing as well. But, so far, the fall in marketing funds has outpaced the reduction in prescriptions.

OxyContin maker Purdue Pharma cut off its speaker program for the drug in 2016, and this year the company halted all physician-targeted promotional efforts of its addictive painkillers and laid off sales reps.

“While the development of important new medicines will be the company’s priority going forward,” the company said last month, “we will continue to support our opioid analgesic product portfolio while continuing our commitment to take meaningful steps to reduce opioid abuse and addiction.”

The FDA greenlit OxyContin in 1995 and since then it’s been Purdue’s biggest financial success, even amid the rise of generic alternatives and the growing popularity of other opioid painkillers.

View the original article at thefix.com

9 July 2018
Kratom Draws Support And Controversy As Opioid Addiction Treatment

“It’s like a cruel joke that I finally found something that works and the FDA and DEA want it banned,” said one kratom user.

A controversial supplement, kratom, could have benefits when it comes to treating opioid use disorder, according to a new study. However, there is still much controversy around it due to safety concerns.

Kratom is a psychoactive drug that comes from the leaves of Mitragyna speciosa, which is an Asian plant in the coffee family.

Some believe it is effective for treating substance use disorders, but organizations such as the Food and Drug Administration (FDA) and the Drug Enforcement Administration are wary of that. In fact, the DEA even attempted to ban the substance.

In February, FDA commissioner Scott Gottlieb spoke against kratom, saying “there is no evidence to indicate that kratom is safe or effective for any medical use.”

Scott Hemby, a professor of pharmaceutical science at High Point University in North Carolina, led a new study recently published in Addiction Biology, which found that kratom may in fact have some benefits.

Kratom has two main ingredients: mitragynine (MG) and 7‐hydroxymitragynine (7‐HMG). MG accounts for 60% of the compound in the plant while HMG is about 2%. Using rats, Hemby’s study examined how both these ingredients affect the brain.

Hemby and other researchers allowed rats to self-administer both components of kratom. They found that the rats quickly began self-administering HMG, but did not have interest in MG.

“In other words, while one of kratom’s main compounds appeared to be addictive, the other wasn’t at all—in fact, it appeared to have the opposite effect,” Business Insider reported.

Because kratom affects some of the same receptors in the brain as opioids, the FDA announced in February that it would be called an “opioid.” But others believe kratom could be beneficial and treat cravings while reducing symptoms of withdrawal and the likelihood of relapse.

The results of the study suggest that it could be beneficial to breed the plant to have higher concentrations of one compound versus the other. However, the results are preliminary because the study was not done on humans.

Some people, such as 26-year-old Bryce Avey, began using kratom because they could not get access to other opioid treatments like buprenorphine and naltrexone. “It’s like a cruel joke that I finally found something that works and the FDA and DEA want it banned,” Avey told Business Insider.

David Juurlink, professor of medicine at the University of Toronto, told Business Insider that the use of kratom makes sense, as it affects the same brain receptors as opioids. “It makes sense that this product would mitigate the symptoms of opioid withdrawal or allow someone to transition from a higher dose to lower dose, or help get them off of opioids altogether,” he said.

Business Insider notes that concern about the supplement arises because there is no “quality oversight of kratom,” meaning people don’t know what the pills actually contain.

“Personally, I would never take this stuff,” Juurlink told Business Insider. “When you go to a pharmacy, you know there’s quality control, you know precisely how much you’re getting, and you know exactly what you’re getting. With this, it’s impossible to know.”

View the original article at thefix.com

9 July 2018
Too Often, Insurers Cover Opioids But Not Addiction Treatment Meds

“Buprenorphine and methadone are incredibly effective medications… So I really do think it’s a stigma issue.”

As is the case for many people battling opioid addiction, Mandy’s dependency started at home. She was prescribed an opioid for back pain, and her insurance company gladly covered the cost of the pills.

However, after Mandy became dependent on opioids and was prescribed buprenorphine to help with her rehabilitation program, her insurer stepped back, unwilling to pay.

“It makes me want to go out and use [drugs],” Mandy said when she spoke to Vox. The 29-year-old who lives in the Chicago area asked that only her first name be used. “It’s way easier to get opiates or heroin… It’s so much easier than dealing with this bullshit.”

Many Americans who had no problem getting their insurance companies to pay for addictive opioid pain pills have found that getting insurers to cover treatment—particularly medication-assisted treatment (MAT) that relies on pharmaceuticals like buprenorphine—is an uphill battle despite the fact that the drugs have been proven effective.

“Buprenorphine and methadone are incredibly effective medications,” said Tami Mark, a health economist at RTI International, a non-profit that conducts policy research. “If you had any other drug with their kind of effect size, it would be immediately covered… So I really do think it’s a stigma issue.”

For people in early recovery, like Mandy, refusals to cover medications or delays in getting prescriptions approved can be deadly.

“The risk of relapse is incredibly high,” said Sara Ballare-Jones, a social work case manager at the University of Kansas Health System. She often has patients wait three days to get their medications approved because they require prior authorization from the insurance companies.

In Mandy’s case her claim was denied, leaving her to pay out of pocket for buprenorphine, which costs nearly $3,000 each year. The 29-year-old said that is a huge amount to have to pay while also handling daily expenses like student loans and rent.

“I’m feeling all these old issues and all this shit, and then it’s just more bullshit,” she said. “I’m just trying to reenter society… It’s really hard.”

It’s also incredibly frustrating for Mandy, who knows firsthand how easy it is to get insurers to cover opioids. “I never paid a dime for my opioids. Those were always covered,” she said. “But I’m paying all this money for the treatment.”

Mandy’s doctor, Dennis Brightwell, said that he usually sees issues with private insurance companies. While Medicaid is required to cover most medication-assisted treatments, most private insurers balk at covering them, putting vulnerable patients in an awkward position.

“If you send a commercial patient to the pharmacy, you don’t know until they get there how it’s going to go,” Brightwell said. “Sometimes it’s not such a problem. Sometimes it’s a prior authorization that is pretty straightforward. Sometimes it’s very difficult to get them to approve it. And there’s not an easy way to find out upfront what medications they approve.”

View the original article at thefix.com

7 July 2018
Tougher Laws, Stricter Prescription Limits For Opioids In Tennessee

The state’s TN Together opioid plan is a multi-faceted initiative with three areas of focus: prevention, treatment, and law enforcement.

In Tennessee, Governor Bill Haslam has put together a new plan to fight the opioid epidemic, called TN Together.

New laws just passed in Tennessee include policies from Governor Haslam’s plan, intended to both decrease access to opioids and to incentivize treatment for those suffering from dependence, according to WSMV News.

Beginning July 1, the laws include Henry’s Law, created by the family of Henry Granju, a teenage boy who died in east Tennessee from an opioid overdose.

Henry’s Law requires that a person convicted of second-degree murder resulting from unlawful distribution of Schedule I or II drugs where the victim is a minor be punished from within one range higher than they would normally be charged. Henry’s Law creates tougher laws for people convicted of second-degree murder by distributing drugs to minors.

Henry’s mother, Katie Granju, told The Fix, “I’m a harm reduction supporter who also believes that drug-induced homicide prosecutions are vital in addressing the opioid epidemic.”

Katie Granju’s son Henry was being supplied opioids at age 18 by adult dealers before his fatal overdose.

Tennessee will begin limiting a first opioid prescription to a five-day supply with daily dosage limits of 40 MME.

Exceptions will be made for major surgical procedures, cancer and hospice treatment, as well as treatment in certain licensed facilities.

The TN Together plan also intends to provide every Tennessee state trooper with naloxone for the emergency treatment of opioid overdose.

The Tennessee Municipal League states that the TN Together plan is a multi-faceted initiative with three areas of focus: prevention, treatment, and law enforcement. Haslam said the initiative will include legislation, executive actions, and task forces.

The $37.5 billion Tennessee state budget sets aside more than $16 million to fight the opioid epidemic through additional services.

On June 29, Haslam tweeted about the bill, “My final bill signing ceremony today was an important one: the @TNTogether legislation is critical to fighting the opioid crisis in Tennessee. Thank you to the many partners across the state who will work together through this initiative to address opioid abuse.”

According to The TN Municipal League, the number of opioid-related overdose deaths in the U.S. has quadrupled since 1999; Tennessee remains one of the top 15 of all states in drug overdose deaths.

Tennesseans are more likely to die of an opioid-related overdose than in a vehicle crash. Three people die of overdose in Tennessee each day.

“It is an epidemic. It has reached this state,” Brian Sullivan with Addiction Campuses in Nashville told WSMN News. “We believe this is a step in the right direction.”

View the original article at thefix.com

6 July 2018