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Tag: opioid epidemic

  • Ohio Doctor Charged With 25 Counts Of Murder In Fentanyl Case

    Ohio Doctor Charged With 25 Counts Of Murder In Fentanyl Case

    The doctor, who pleaded not guilty to all charges, could face 15 years to life for each count if convicted.

    A former critical care doctor is facing multiple counts of murder, accused of administering fatal doses of fentanyl to patients.

    While a typical dose of fentanyl is between 25 and 100 micrograms, as the Cincinnati Enquirer noted, William Husel gave patients between 500 and 2,000 micrograms of the powerful opioid.

    Husel allegedly “purposely caused the death” of 25 patients; he “shortened their life and hastened or caused their death” by giving lethal amounts of fentanyl between February 2015 and November 2018, according to the Franklin County Prosecutor’s Office.

    Husel surrendered to police on Wednesday (June 5) and pleaded not guilty to all charges. He could face 15 years to life for each count if convicted.

    The intensive care patients that came to Mount Carmel Health System, where Husel worked until he was fired last December, were already suffering from cancer or other ailments. “In many instances, relatives had given permission to not resuscitate their family members,” the Enquirer noted.

    Husel’s attorney argued that the patients’ health would have declined whether or not Husel treated them. “The patients that we are talking about are end-of-life patients,” Richard Blake said according to the Enquirer. “The people were being kept alive primarily due to equipment in the hospital. They are going to die whether Dr. Husel was on or whether another doctor was.”

    Blake maintained that “at no time did he ever have the intent to euthanize anyone,” according to NBC News.

    Husel was fired from Mount Carmel last December after working there since 2013. Around Christmas, relatives of the deceased were informed by the hospital that Husel’s over-prescribing had led to their family members’ deaths, the Enquirer reported. This triggered lawsuits against Husel, the hospital and staff. His medical license was suspended in late January and a criminal investigation was launched.

    Mount Carmel CEO Ed Lamb recently released a video statement in which he said, “We take responsibility for the fact that the processes in place were not sufficient to prevent these actions from happening.”

    Husel is also the target of 19 wrongful-death lawsuits, according to NBC News. Eight other lawsuits have been settled.

    Dozens of employees who worked at the hospital were placed on leave or no longer work there. This case has left many wondering how Husel’s actions went unchecked for years under Mount Carmel’s system of care.

    “What remains unclear is how Husel could circumvent apparent rules that would require him to order medications through an in-house pharmacy team and then convince a nurse to administer the drug,” NBC News reported.

    View the original article at thefix.com

  • Unfounded Fears Linger About Accidental Exposure to Fentanyl

    Unfounded Fears Linger About Accidental Exposure to Fentanyl

    Lawmakers have introduced a new bill that perpetuates fears about fentanyl that many physicians consider unfounded.

    Though a wealth of information has been made public about the relatively low risk presented by accidental exposure to the synthetic opioid, fentanyl, lawmakers, law enforcement and media outlets continue to issue warnings and even propose legislation to provide safeguards to prevent overdose.

    A recent article in Reason cited a bill put forward by a bipartisan group of Congressmen that would allocate federal money to local police for drug screening devices that was spurred in part by concern over exposure to fentanyl. 

    It also quoted recent comments from a Toledo, Ohio newspaper and New York State police chief, both of which voiced concern over the alleged dangers presented by “even a minute trace of the drug.” Such fears are contrary to countless studies and testimony by medical professionals and health groups, which have stated that casual skin exposure to fentanyl presents little chance of significant harm than any other drugs.

    The bill, introduced by Representatives Conor Lamb (D-PA), David Joyce (R-OH) and David Trone (D-MD), would establish a new grant program at the Department of Justice that would assist local law enforcement agencies in securing interdiction devices—portable chemical screening technology—that would help officers determine the presence of fentanyl and other drugs at a crime scene.

    “This legislation will increase the safety of our officers and will streamline the substance testing process, providing real-time results to reduce the backlog in the legal system,” said Lamb in a statement.

    While well-intended, the bill perpetuates fears about fentanyl that many physicians consider unfounded, according to Reason. Coverage in the New York Times noted that while fentanyl and carfentanil are dangerous opioids, the drugs must be deliberately consumed, not touched or inhaled by accident, to present a health risk.

    “I would say it’s extraordinarily improbable that a first responder would be poisoned by an ultra-potent opioid,” said Dr. David Juurlink, a clinical researcher based in Toronto. “I don’t say it can’t happen. But for it to happen would require extraordinary circumstances, and those would be very hard to achieve.”

    Despite testimony of that nature, fear about exposure to fentanyl continues to find its way into the public sphere. The Toledo Blade called for immediate passage of Lamb’s bill, stating “police, firefighters and other first responders are in jeopardy if they come into contact with even a minute trace of the drug.”

    And in a February 2019 interview, John Anton, police chief for DeWitt, New York, said on WRVO Public Media that he feared his officers are “getting exposed to fentanyl, getting it on their clothes, bringing it home to their families, getting it on their boots and so on.”

    As many medical professionals have noted, such fears are largely unfounded.

    “I want to tell first responders, ‘Look, you’re safe,’” said Dr. Jeremy S. Faust, an emergency doctor at Brigham and Women’s Faulkner Hospital in Boston, Massachusetts, in the New York Times coverage. “You can touch these people. You can interact with them. You can go on and do the heroic lifesaving work that you do for anyone else.”

    View the original article at thefix.com

  • Majority Of Post-Op Patients Managed Pain Without Opioids, Study Finds

    Majority Of Post-Op Patients Managed Pain Without Opioids, Study Finds

    The study’s lead author believes that keeping people from taking opioids for the first time could help mitigate the opioid epidemic. 

    Patients who have undergone surgery may not always need opioid painkillers to manage post-operative pain, according to a new study. 

    The research, which is pending publication in the Journal of the American College of Surgeons, found that a majority of patients were able to manage their pain using a regimen of over-the-counter pills.

    For the study, researchers selected patients who were undergoing one of six surgical procedures. These patients were given the option to use acetaminophen (Tylenol) and ibuprofen (Advil) to control their pain. They were instructed to take an alternating dose of these over-the-counter medications every three hours. 

    The patients were also given a “rescue” opioid prescription to use in case they experienced breakthrough pain and needed more relief. However, 52% of patients did not use the opioids, and 98% used 10 opioid pills or fewer. People who used the opioids needed, on average, four pills. 

    “Patients reported minimal or no opioid use after implementation of an opioid-sparing pathway, and still reported high satisfaction and pain control,” study authors wrote. “These results demonstrate the effectiveness and acceptability of major reduction and even elimination of opioids after discharge from minor surgical procedures.” 

    Lead study author Michael Englesbe, a professor of surgery at the University of Michigan, told Medical Xpress that keeping people from taking opioids for the first time could help mitigate the opioid epidemic. 

    “We think a fundamental root cause of the opioid epidemic is opioid-naïve patients getting exposed to opioids and then really struggling to stop taking them postoperatively, and then moving on to chronic opioid use, abuse, addiction, and overdose,” he said. 

    The study proves that many patients can manage pain effectively without opioids. Englesbe will now expand the research to study an additional 12 types of surgical procedures. Demonstrating that patients can manage pain without opioids could change how prescriptions are handled, he said. 

    “Our overall goal is to have half the operations done in the state of Michigan without patients needing opioids and still getting excellent pain care,” he said. “There are alternatives to opioids for surgical pain that work well and we should be using them more.”

    However, he said that this involves talking openly to patients, and realizing that in some cases opioids are needed to effectively manage pain. 

    “Just not giving opioids is not the answer—we have to give the best pain care,” he said. “From the beginning, everyone was on the same page with talking to patients about their pain and letting them know that operations hurt.”

    View the original article at thefix.com

  • Overdose Death Rates Skyrocket Among Middle-Aged Women

    Overdose Death Rates Skyrocket Among Middle-Aged Women

    Overdose death rates among women aged 30 to 64 years rose by 260% between 1999 and 2017.

    A recent news story from KNXV-TV adds a human perspective to recent statistics from the Centers for Disease Control and Prevention (CDC) about a demographic on the rise for national drug overdose deaths.

    The Phoenix, Arizona-based ABC affiliate profiled several area women who developed dependencies on drugs or alcohol between the ages of 40 and 64.

    Addiction treatment centers in the Phoenix Metropolitan Area reported an increase in admission for women in that age group, which coincides with the CDC’s report that overdose death rates among women aged 30 to 64 years rose by 260% between 1999 and 2017.

    To determine this statistic, the CDC reported in January 2019 that it had examined overdose death rates for this age group during the aforementioned time period, and categorized these fatalities according to drug subcategories, including antidepressants, cocaine, heroin, prescription opioids and synthetic opioids (except methadone).

    From this data, they determined that the unadjusted drug overdose death rate increased from 6.7 deaths per 100,000 population (or 4,314 total drug overdose deaths) in 1999 to 24.3 (or 18,110 deaths) in 2017. 

    The rate of overdose deaths involving any opioid increased 492% during this time period, while nearly all subcategories of drugs saw increases in deaths, save for cocaine, which decreased significantly between 2006 and 2009. The highest death rate increases involved synthetic opioids (1,643%), heroin (915%) and benzodiazepines (830%).

    Those figures reflect the experiences of the women profiled in the KNXV piece. Pamela Aguilu became dependent on prescription opioids after undergoing spinal surgeries. “I would say that I got addicted right away,” she said. “I was taking massive amounts of oxycodone.”

    Aguilu expressed gratitude that she had not become one of the overdose statistics cited by the CDC. But she certainly came close. After confronting a police officer who had been sent by her landlord, Aguilu said, “The last thing I remember is the ER physician saying we need the Narcan now, and then I was out. I was out for two days.”

    KNXV also cited Cheryl Hawley, a clinical director at the Valley Hope alcohol and drug treatment center, who said that women between 30 and 64 often put their roles as mother, wife and homemaker ahead of their own health, and then refuse to share their struggles with their families.

    Aguilu agrees. “You hit middle age, and you think you’ve got it all figured out,” she said. “We live in a society where we take pills for everything.”

    View the original article at thefix.com

  • Purdue Pharma Accused Of “Corrupting” WHO To Sell More Opioids

    Purdue Pharma Accused Of “Corrupting” WHO To Sell More Opioids

    Officials say the World Health Organization helped Purdue “traffic dangerous misinformation” about opioids.

    Members of Congress released a report last week alleging that the World Health Organization (WHO) has been “corrupted” by the leaders of the opioid industry, particularly Purdue Pharma and Mundipharma International, both of which are owned by members of the Sackler family.

    U.S. Representatives Katherine Clark and Hal Rogers accuse WHO of essentially replicating claims made by these companies’ marketing materials, some of which have been found in court to be inaccurate and misleading.

    “The web of influence we uncovered paints a picture of a public health organization that has been corrupted by the opioid industry,” said Clark according to the Guardian. “The WHO appears to be lending the opioid industry its voice and credibility, and as a result, a trusted public health organization is trafficking dangerous misinformation that could lead to a global opioid epidemic.”

    The report claims that current WHO guidelines, implemented several years ago, still “mirror Purdue’s marketing strategies to increase prescriptions and expand sales.” This includes statistics and statements that have been contradicted by multiple studies, such as the assertion that less than one percent of patients who are prescribed opioids develop a dependence on the drug.

    Additionally, the WHO removed guidelines recommending that pain patients be started on a combination of low-dose opioids and non-opioid pain relievers to instead recommend that highly potent opioids, such as Purdue’s OxyContin, can be given immediately.

    To make matters worse, the WHO did not change its pro-opioid guidelines even after several members of Congress sent a letter to the organization in 2017 warning that Purdue was attempting to take its business worldwide after allegedly causing or heavily contributing to the opioid epidemic in the U.S.

    The WHO did not respond to the letter, which led Clark and Rogers to launch their investigation.

    In addition to mirroring Purdue marketing materials, the report alleges that the WHO was influenced by “industry-funded” advocacy groups such as the American Pain Society and the International Association for the Study of Pain (IASP).

    The American Pain Society recently announced that it may cease operation due to legal costs related to accusations that the organization is little more than a front for opioid industry interests. 

    “While the findings in this report are tragic and alarming, they are unsurprising given this company’s unscrupulous history,” said Rogers. “The WHO must take action now to right the ship and protect patients around the world, especially children, from the dangers associated with chronic opioid use.”

    Clark and Rogers are calling on the WHO to withdraw its current guidelines related to opioid prescription. The WHO has said it is currently studying the report, and as usual, Purdue Pharma issued a statement denying all allegations of wrongdoing.

    View the original article at thefix.com

  • Opioid Manufacturer Teva Reaches $85 Million Settlement With Oklahoma

    Opioid Manufacturer Teva Reaches $85 Million Settlement With Oklahoma

    Teva did not acknowledge any wrongdoings in the settlement. 

    The state of Oklahoma has reached an $85 million settlement with Teva Pharmaceuticals, the world’s largest manufacturer of generic drugs. 

    The settlement was announced on Sunday, ahead of a trial slated to start on Tuesday (May 28). Purdue Pharma had previously reached a $270 million settlement with the state in the case, but the trial will move forward with Johnson & Johnson and its subsidiaries, which have not reached a settlement. 

    “Today’s announcement is a testament to the state’s legal team’s countless hours and resources preparing for this trial and their dedication and resolve to hold the defendants in this case accountable for the ongoing opioid overdose and addiction epidemic that continues to claim thousands of lives each year,” Attorney General Mike Hunter said in a statement. “Nearly all Oklahomans have been negatively impacted by this deadly crisis and we look forward to Tuesday, where we will prove our case against Johnson & Johnson and its subsidiaries.”

    Teva, like Purdue, did not acknowledge any wrongdoings in the settlement. 

    “The settlement does not establish any wrongdoing on the part of the company,” Teva representatives said in a statement, according to The Oklahoman. “Teva has not contributed to the abuse of opioids in Oklahoma in any way.”

    “The company has resolved this matter in a way that benefits the people who have suffered from abuse of opioids and to help stop the effects of the opioid crisis,” the statement said. That much is true—the state will allocate the funds to combat the opioid epidemic and increase access to treatment. 

    Teva faces other ongoing opioid lawsuits, including a large suit in federal court in Ohio. 

    “While the company has long stated that the courtroom is not a place to address the crisis, Teva is pleased to put the Oklahoma case behind it and remains prepared to vigorously defend claims against the company, including the upcoming federal court trial in Cleveland where the majority of the cases are pending,” the company’s statement said. 

    Hunter told NPR ahead of the trial’s start on Tuesday that he is confident that he can make the case that Johnson & Johnson and its subsidiaries are responsible for the opioid epidemic in the state.

    “We have looked at literally millions of documents, taken hundreds of depositions, and we are even more convinced that these companies are the proximate cause for the epidemic in our state and in our country,” Hunter said.

    Richard Ausness, a law professor at the University of Kentucky, said that the settlements and outcome in the Oklahoma case will set a precedent for the federal case. 

    “Lurking in the background is the multi-state litigation in Cleveland, where there will ultimately be a settlement in all likelihood, but the size of the settlement and the terms of the settlement may be influenced by Oklahoma,” he said. 

    View the original article at thefix.com

  • How One County Reduced Opioid Deaths By 50%

    How One County Reduced Opioid Deaths By 50%

    The statewide effort to provide more access to medication-assisted treatment and harm reduction programs has saved lives. 

    One county in rural Vermont reduced opioid overdose deaths by 50% last year, using a combination of strategies meant to stop opioid abuse and reduce harm to people who choose to continue using. 

    In Chittenden County, which includes the state capital of Burlington, opioid overdose deaths dropped from 35 in 2017 to just 17 last year. Bob Bick, CEO of the region’s largest treatment provider, said that a number of interventions paid off significantly. 

    “You’ve had this coming together of a whole bunch of strategies that were directly targeting active users and high-risk users,” Bick told VT Digger. 

    One of the most effective means of intervention was offering people the chance to start medication-assisted treatment (MAT) as soon as they expressed interest.

    Rather than having to wait to get into a MAT program, people in Chittenden County could receive MAT at any time through two area emergency rooms, at University of Vermont Medical Center and Central Vermont Medical Center. The program has since been expanded to all emergency rooms in the area. 

    Dr. Stephen Leffler, MD, chief population health and quality officer for the health network that includes the two hospitals, said that the program makes a big difference for people who have a moment of wanting help. 

    “They are already showing positive results,” he said. “This is a statewide, team effort.”

    In addition to connecting people with treatment quickly, the county also focused on reducing deaths among people who chose to continue using drugs. They did this by distributing fentanyl test kits to active users.

    “We know that relapse is part of the recovery process,” Bick said. “So we wanted to make these widely available.”

    He noted that people reported not using drugs that tested positive for fentanyl. A program called Safe Recovery in the state also provides naloxone and clean needles to people to request them. While this is harm reduction in and of itself, people who came in for needles were also offered the chance to begin MAT immediately. 

    “We are seeing the people who need us the most, and we need to be able to see them when they ask for help,” Program Director Grace Keller said at a panel recently. 

    Vermont has been praised for its hub-and-spoke model to curb opioid addiction, which has since been replicated in other states around the nation.

    Under the model, primary care providers serve as the “spoke” who provide ongoing treatment and channel people toward “hubs,” like Safe Recovery, that provide medication-assisted treatment. 

    “The parallel universe would be cardiology or infectious disease, where if you get sick and your primary care doc can’t take care of you, you’d get referred to a cardiologist,” John Brooklyn, a family doctor and addiction specialist in Vermont who helped design the system, said in 2017. “The nexus of this was really to try to integrate substance use treatment in primary care.”

    View the original article at thefix.com

  • Self-Described "El Chapo Of Opioids" Doctor Accused Of Drug Crimes

    Self-Described "El Chapo Of Opioids" Doctor Accused Of Drug Crimes

    The former New Jersey doctor stands accused of a number of charges including prescribing oxycodone over a text message.

    Former North Jersey family medicine doctor Robert Delagente is being charged with distribution of controlled substances and obstruction of justice after years of allegedly calling himself the “Candy Man” and the “El Chapo of Opioids.”

    Federal prosecutors are charging Delagente with improperly prescribing drugs such as oxycodone, Percocet, and Tylenol with codeine, failing to monitor his patients for addiction, and agreeing to prescribe oxycodone, the generic form of OxyContin, to one patient over a text message.

    “I’m literally sticking my neck out and can lose my medical license or [be] arrested for what I just did,” Delagente allegedly texted.

    Furthermore, he’s been accused of altering patient medical records after law enforcement began seeking to gain access to them following other allegations of misconduct. According to federal court documents obtained by NorthJersey.com, he also once referred to an opioid prescription for one of his patients as “oral heroin.”

    These allegations come as part of a widespread crackdown on doctors who failed to follow the law when prescribing controlled substances such as opioids. In addition to going after the manufacturers of drugs like OxyContin, prosecutors are shutting down “pill mills” where doctors allegedly excessively prescribe addictive drugs to patients while enjoying perks provided to them by manufacturers like Purdue Pharma.

    Last month, 60 people were charged in a crackdown, including 31 doctors. These individuals are accused of prescribing millions of pills in the space of only a couple of years. Some allegedly wrote unnecessary prescriptions for Facebook friends, left blank prescription pads for staff to fill out, and even exchanged sex for prescriptions of oxycodone and fentanyl. One doctor operating in Dayton, Ohio stands accused of giving out 1.75 million pills in the space of just two years.

    These charges were part of a single operation by the Appalachian Regional Prescription Opioid Strike Force, which was launched by the Trump administration in 2018.

    Opioid addiction and overdose deaths have disproportionately affected the Appalachian Region of the U.S., leading the federal government to take targeted action in the area.

    “The opioid crisis is the deadliest drug crisis in American history, and Appalachia has suffered the consequences more than perhaps any other region,” said Attorney General William Barr of the charges.

    Back in New Jersey, Dr. Delagente faces up to 20 years in prison and a fine of $1 million for the distribution of controlled dangerous substances and another 20 years and $250,000 for obstruction of justice. His attorney has not responded to requests for comment.

    View the original article at thefix.com

  • Tramadol Carries Addiction Risks Too, Study Finds

    Tramadol Carries Addiction Risks Too, Study Finds

    A new study has found that tramadol, a less powerful opioid painkiller, carries the same risks of addiction as other opioids.

    As doctors have become more vigilant about the addiction risks of opioids like oxycodone and morphine, they have turned to tramadol, perceived as less powerful and thus safer. However, a new study has found that tramadol carries the same risk of addiction as other opioids, CBC reports.

    “What we know now is there really is no safe opioid, and tramadol is not a safe alternative,” lead study author Cornelius Thiels told CBC. “Tramadol essentially has a similar risk of long-term dependence or long-term opioid use compared to other opioids.”

    Thiels led a team of researchers from the Mayo Clinic who examined whether people who were prescribed tramadol were still filling opioids prescriptions more than 90 days after surgery. Long-term use of opioids is associated with a vastly increased risk of addiction.

    The study, published in the British Medical Journal, concluded, “People receiving tramadol alone after surgery had similar to somewhat higher risks of prolonged opioid use compared with those receiving other short acting opioids. Federal governing bodies should consider reclassifying tramadol, and providers should use as much caution when prescribing tramadol in the setting of acute pain as for other short acting opioids.”

    “We found that people who got tramadol were just as likely as people who got hydrocodone or oxycodone to continue using opioids past the point where their surgery pain would have been expected to be resolved,” Molly Jeffery, one of the researchers, said.

    Tramadol is classified differently by the federal government, but study authors call for this to change.

    “We found that tramadol, a drug that is scheduled at a lower risk level than other common short acting opioids (Schedule IV versus Schedule II for hydrocodone and oxycodone), has a similar or somewhat greater risk of prolonged opioid use after surgery,” they wrote. “Although all factors related to the safety of a drug must be considered, from the standpoint of opioid dependence, the Drug Enforcement Administration and FDA should consider rescheduling tramadol to a level that better reflects its risks of prolonged use.”

    The study is important since use of tramadol has increased in recent years.

    “Tramadol has seen a surge in use in the past few years, likely due to its perceived benefits, including what physicians may consider a favorable side effects profile and the widespread assumption that it is safer and less addictive than other short acting opioids,” study authors wrote. “As a result, tramadol is now among the most commonly prescribed opioids in the US, and it is frequently used by surgeons for the treatment of postoperative acute pain.”

    View the original article at thefix.com

  • Overdose-Resistant Bathrooms Are Coming To Boston

    Overdose-Resistant Bathrooms Are Coming To Boston

    The new system can alert employees to possible overdose cases and allow them to take action before it’s too late.

    A Boston-based contractor is currently developing and implementing a system to detect overdose in bathrooms so that employees at common locations for drug use can be alerted to an overdose and intervene, according to Filter.

    The technology, which detects if a person in a single-occupancy bathroom has fallen to the floor and laid unmoving for an extended period of time, could save lives—if companies agree to adopt it.

    As the opioid epidemic rages on in the U.S., people without a safe place to use drugs have come to use public bathrooms in fast food restaurants, coffee shops, convenience stores, homeless shelters and health clinics for this purpose.

    Particularly as fentanyl contamination becomes more common, overdose cases are spiking. Busy employees are unable to keep track of how long every customer has been in the bathroom and some find themselves dealing with overdose deaths on a regular basis.

    This new system, created by John King, can alert employees to a possible overdose and allow them to take action before it’s too late. The technology has already been tested at the Boston Health Care for the Homeless Program and has been incredibly successful, according to Chief Medical Officer Jessie Gaeta.

    “We have about five overdoses a week in our facility, and since we installed John’s system none have been fatal,” said Gaeta.

    A similar system created by the Brave Cooperative in Vancouver, BC, goes a step further by using radar to calculate the breathing rates of individuals using the bathroom. This could be even more effective than King’s system due to the fact that opioid overdose can cause seizures or spasms during unconsciousness, which might render an anti-movement detector useless. 

    While health clinics and other non-profit organizations have been eager to adopt systems like King’s, selling them to for-profit businesses may be more difficult due to fears of litigation if the system fails. 

    “We live in a litigious society,” says King. “If someone goes into a bathroom with an expectation of being revived if they overdose and they die… well, businesses are afraid of being sued.”

    However, the threat of being sued may be preferable to the costs of regularly finding bodies in customer bathrooms.

    Massachusetts General Hospital Substance Use Disorders Initiative Director Sarah Wakeman believes that the ability to effectively intervene and save lives could reduce that trauma.

    “There’s definitely secondary trauma to witnessing overdoses and seeing people near death,” she said to The Atlantic. “I think it’s much more traumatizing to find someone dead in the bathroom and not be able to help them.”

    View the original article at thefix.com