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Tag: opioid overdoses

  • Does Restricting Prescription Opioids Save Lives In The Long Term?

    Does Restricting Prescription Opioids Save Lives In The Long Term?

    A new study found that over a five- to 10-year period, policies limiting the prescription of opioids would initially increase deaths as many individuals turn to heroin or fentanyl.

    Combating the opioid epidemic is complicated for a number of reasons—one of which, according to new research, is that cutting back on prescriptions may cause more deaths in the short-term, despite saving them in the long-term.

    This information comes from a simulation study recently published in the American Journal of Public Health. The study determined that over a five- to 10-year period, policies limiting the prescription of opioids would initially increase deaths as individuals may turn to heroin or fentanyl.

    The simulation study was led by Stanford University researchers Allison Pitt, Keith Humphreys and Margaret Brandeau.

    “This doesn’t mean these policies should not be considered,” said Humphreys, who was a former senior policy adviser at the White House Office of National Drug Control Policy (ONDCP) during the Obama administration. “Over longer periods, they will reduce deaths by reducing the number of people who initiate prescription opioids.”

    Austin Frakt, director of the Partnered Evidence-Based Policy Resource Center at the VA Boston Healthcare System, wrote in a New York Times opinion piece that restrictions on prescribing opioids seem to be a logical response to curbing the crisis. As many as 80% of heroin users in the U.S. are estimated to have previously used prescription opioids.

    However, the idea of limiting prescriptions becomes more complicated when individuals who are truly in need of the medications for pain management are taken into account. 

    It’s a situation in which there has to be a trade-off of some sort, according to Frakt.

    “This is the fundamental trade-off opioids present, with which we have been battling for decades,” Frakt writes. “As the pendulum swung further toward treating pain, opioid-related deaths ballooned. Now to stem the deaths, it is swinging back, challenging us to treat pain in other ways.”

    According to the researchers of the simulation study, there is no one policy that would solve the crisis or even make a significant difference. The policy that could be most effective, according to the researchers, is increasing access to naloxone, an opioid overdose antidote. Even so, this would likely only bring the deaths down about 4% over the next decade. 

    “Expanding access to naloxone is inexpensive and saves lives,” Pitt said. “That’s an attractive combination, but we should be realistic that it will only save a small percentage of opioid deaths.” 

    As such, researchers note that combining policies such as increasing naloxone access, expanding treatment and more needle exchanges could help to save twice that number of lives. 

    “Policy interventions can prevent many deaths, as well as the other destruction that opioids bring to individuals, families and communities,” Frakt concludes. “But prescription opioids are neither all bad nor all good. Policies that sound sensible—potentially helping many people—could also cause a lot of damage, particularly in the short run.”

    View the original article at thefix.com

  • Opioid Addiction Isn't Just A Rural Problem

    Opioid Addiction Isn't Just A Rural Problem

    While the epidemic has been framed as one that mostly affects rural America, new research shows that overdose rates are actually higher in urban areas.

    The common narrative of the national opioid crisis has been that this “disease of despair” has affected rural areas the most.

    However, a new working paper argues that economic depression and access to opioids are the biggest determinants of overdose rates in both rural and urban areas. 

    “I really do want to push back against this cliche that addiction does not discriminate,” Shannon Monnat, the paper’s author and a sociologist at Syracuse University, told Pacific Standard. “The physiological processes that underlie addiction themselves may not discriminate, but the factors that put people in communities at higher risk are are not spatially random.”

    Looking at non-Hispanic whites and controlling for demographics, Monnat found that overdose rates were highest in urban areas. The rate decreased the further one moved from cities, a trend that held true for all racial groups. Overall, urban counties had an average of 6.2 more deaths per 100,000 people than rural counties. 

    Interestingly, supply and demand interacted differently in rural and urban settings. In the city, supply of drugs seemed to have the biggest effect on overdose rates. In rural areas, economic distress was the stronger predictor of overdose rates.

    “A lot of what’s going on here are regional effects,” she said. “You get regional levels of despair and distress that seemed to reinforce and exacerbate the problem.”

    Monnat did find that some of the things associated with rural living were connected with an increased risk for overdose. For example, areas with an economy heavily dependent on mining or the service industries had higher rates of overdose. Controlling for how many drugs were supplied to an area, places with higher economic distress had higher overdose rates. 

    “What that means is that drug mortality rates aren’t higher in economically distressed places simply because they’ve had a greater supply of opioid prescribing there,” she said. “There’s something about economic distress in and of itself that helps to explain the variation that we’re seeing across the country and the magnitude of the drug crisis.”

    Places hardest hit by the crisis, like West Virginia, had both economic vulnerabilities and an excessive supply of opioids, Monnat said.

    “It’s no coincidence that widespread opioid prescribing first started in the most economically vulnerable places of the country—there was vulnerability there. These places had been primed to be vulnerable to opioids, which are drugs that numb both physical and mental pain, through decades of economic and social decline.”

    View the original article at thefix.com

  • FDA May Recommend Naloxone Be Co-Prescribed With Opioids

    FDA May Recommend Naloxone Be Co-Prescribed With Opioids

    The “co-prescribing” recommendation would apply to patients who are at high risk of overdose, including people who take a high-dose opioid.

    The Food and Drug Administration (FDA) is considering recommending that people who receive an opioid prescription are also offered a prescription for naloxone, the opioid overdose reversal drug. 

    The move is intended to reduce deaths from opioid overdose, but some people say that the effort is misguided. 

    The so-called co-prescribing recommendation would apply to patients who are at high risk of overdose, including people who take a high-dose opioid, have a history of addiction or have sleep apnea, according to CNN.

    Kristy Shepard, a Virginia patient who uses opioids, didn’t know that she had a naloxone prescription waiting for her at the pharmacy. She said that her doctor didn’t give her a heads up about the state’s new co-prescribing recommendations. Other states, including California and Ohio have made similar recommendations, but Shepard doesn’t understand why. 

    “It’s so silly. I didn’t feel like I needed it. Unless I plan to hurt myself, I’m not likely to overdose,” she said. 

    However, Dr. Nathan Schlicher, who is on Washington state’s opioid task force and works as an emergency medicine physician, said this is a common misunderstanding. 

    “You can take pain meds responsibly, and you can be at risk for an accidental overdose even when you’re doing everything right,” he said. Washington also has a co-prescribing recommendation. 

    If the FDA recommends co-prescribing, the need for naloxone would increase by 48 million dosages annually, according to an FDA report. That could be a big financial incentive to drug makers, who have spent money lobbying for similar efforts at the state level, especially in California. 

    Some opponents point out that having naloxone on hand only works if the people taking opioids have someone around who could administer the drug if they overdose. 

    Katie O’Leary, who deals with pain, said that talking about overdose risk and carrying naloxone should be a conversation between individual providers and their patients, not a federal requirement. 

    “So many patients already jump through so many hoops to get their meds,” she said. “And if you live alone and don’t have family or friends to take care of you, the naloxone might not be something that could actually help.” 

    Dr. Farshad Ahadian, medical director at the University of California San Diego Health Center for Pain Medicine, agreed, saying, “Most providers probably feel that it’s better for physicians to self-regulate rather than practice medicine from the seat of the legislature. The truth is there’s been a lot of harm from opioids, a lot of addiction. It’s undeniable that we have to yield to that and to recognize that public safety is critical.”

    View the original article at thefix.com

  • Can A Google Search Predict An Overdose?

    Can A Google Search Predict An Overdose?

    Researchers examined whether Internet search data from Google could help them predict where an overdose will occur.

    Technology has no doubt played a role in the opioid epidemic, with drug users and dealers able to order narcotics online and have them delivered directly to their homes. Now a new study suggests that the internet could also play an important role in alleviating the crisis by helping to predict opioid overdoses. 

    The study, titled “Internet searches for opioids predict future emergency department heroin admissions,” was published in the September issue of the journal Drug and Alcohol Dependence and reported in Scientific American last week. 

    Sean D. Young, a researcher at the University of California Institute for Prediction Technology, led a team that analyzed Google search prevalence of opioid-related terms, including “Avinza,” “Brown Sugar,” “China White,” “Codeine,” “Kadian,” “Methadone,” and “Oxymorphone.”

    The researchers compared that data to heroin-related emergency room visits in nine different areas around the US over the following year. They found that in the best model, search data could explain 72% of the variance in emergency department visits. Overall, the more a keyword was searched, the more opioid-related hospitalizations were likely to happen in that region in the next year. 

    “Internet search-based modeling should be explored as a new source of insights for predicting heroin-related admissions,” the study authors wrote. 

    Internet search data could be particularly important in areas where there is little information on the drug epidemic. Analyzing the data is a cost-effective way of predicting how opioid abuse might change in the upcoming year, they said. 

    “In geographic regions where no current heroin-related data exist, Internet search modeling might be a particularly valuable and inexpensive tool for estimating changing heroin use trends,” the authors wrote. “We discuss the immediate implications for using this approach to assist in managing opioid-related morbidity and mortality in the United States.”

    Researchers said this tool could be important for helping to understand and prevent overdose deaths. For example, in areas expecting to see an increase in drug-related hospital visits, community organizations could distribute more doses of naloxone, the opioid overdose reversal drug. 

    “For a number of fiscal and practical reasons, data on heroin use have been of poor quality, which has hampered the ability to halt the growing epidemic,” the researchers wrote. “Internet search data, such as those made available by Google Trends, have been used as a low-cost, real-time data source for monitoring and predicting a variety of public health outcomes.”

    View the original article at thefix.com

  • Young Mayor’s Overdose Death Captures National Epidemic

    Young Mayor’s Overdose Death Captures National Epidemic

    “I never would’ve thought he had an issue. Brandon made a mistake and paid the ultimate price,” the former mayor’s mother said after his fatal overdose. 

    The story of a small-town Pennsylvania mayor and his friend who both fatally overdosed on opioids is highlighting the dangers of the national drug epidemic and the heartbreak of families left behind. 

    Brandon Wentz was 24 when he overdosed last year. He had recently resigned as mayor of Mount Carbon, population 87, because his family had moved to a nearby town. The resignation hit Wentz hard, said his mother, Janel Firestone.

    “You could just see the stress and sadness in him,” she told the Associated Press.

    After struggling to write his resignation letter, which ended up being just 180 words, Wentz’s friend Ryan Fessler came over. The pair had been spending more time together, according to Fessler’s childhood friend. 

    “They were the same person,” she said. “They both wrote, they both drew, they would make up funny raps together. They really did want the best for each other.”

    However, this worried some of Wentz’s friends, who knew that Fessler struggled with substance abuse. 

    “He wasn’t a bad person, he was nice, but he had his own demons, too, and demons will invite more demons,” said Brandon Radziewicz, Wentz’s longtime friend. “I think they were good at fueling each other’s habits.”

    The day of the resignation letter, the two men went to Wentz’s room until Fessler left. That afternoon, Firestone tried to wake her son for his overnight shift, but he wouldn’t rouse. She suspected he had a migraine, and since he had always been a heavy sleeper she wasn’t concerned. However, the next morning Wentz was dead of an overdose of heroin and fentanyl, something that shocked Firestone.

    “I never would’ve thought he had an issue,” she said. “Brandon made a mistake and paid the ultimate price.” 

    While Wentz’s family was blindsided, Fessler’s family knew of his addiction and did everything possible to protect him from overdose until he died just six months after Wentz, even sending him to treatment in Florida. However, Fessler’s grief over losing his best friend just made his addiction worse. A few weeks after Wentz died, Fessler’s girlfriend found him in bed crying, saying, “I killed my best friend. I gave it to him.” 

    Firestone, who was always skeptical of her son’s relationship with Fessler, blamed him for Wentz’s overdose. Fessler’s mother, Kim Kramer, said she understands completely.

    “I get it, I truly do,” she said. “You wake up, you think about it all day, it’s forever there. You want to find out who gave it to them. … You want to hate the one who handed your son the bag.”

    Firestone says she wishes Wentz’s friends had brought his drug abuse to her attention, something Radziewicz says he should have done, in hindsight. 

    “I was thinking, foolishly, that I would lose my best friend, and he wouldn’t talk to me again,” he said. “Guess what? I lost my best friend.”

    View the original article at thefix.com

  • "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

  • Opioid Crisis Has Peaked, Former Cleveland Clinic CEO Suggests

    Opioid Crisis Has Peaked, Former Cleveland Clinic CEO Suggests

    The doctor says that while opioid prescribing is down, synthetic opioids are now driving the opioid epidemic.  

    The former CEO of the Cleveland Clinic said that the opioid epidemic has peaked now that more healthcare providers and laypeople are aware of the dangers of opioid painkillers.

    “I think we’ve peaked,” Dr. Toby Cosgrove said on CNBC’s Squawk Box. “I think we’re starting to see the understanding of the problem, and getting to the point where people are certainly prescribing fewer drugs and people are recognizing how serious this is.”

    However, he said that synthetic opioids are continuing to drive opioid deaths. 

    “The other issue is that drugs are now being laced with fentanyl and carfentanil, which are highly potent,” said Cosgrove, a cardiac surgeon who led the Cleveland Clinic hospital for 13 years before stepping down in 2017.

    “Carfentanil is 10,000 times as potent as morphine. We just had an outbreak of deaths in Ohio from drugs being laced with very potent carfentanil and fentanyl,” Cosgrove noted.

    Cosgrove now works as an executive advisor to Google Cloud Healthcare and Life Sciences team, and is a proponent for healthcare reform. During his CNBC appearance he talked about ways to reduce healthcare costs.

    He noted that while the United States has the highest healthcare costs in the world, the country is about average in the amount spent on healthcare and social programs combined. He said that this shows that investing in social programs can help alleviate the burden of healthcare costs. 

    “Social programs, frankly, are driving down the healthcare costs” in other countries, he said. 

    Although there has been some leveling of opioid overdose rates in certain areas, the national overdose rate climbed in many places between 2016 and 2017. In fact, 45 states saw opioid overdoses increase 30% between July 2016 and September 2017, according to federal data.

    During that time period, the Midwest—including the area served by the Cleveland Clinic—saw opioid overdose rates increase 70%, driven largely by an influx of synthetic opioids. In fact, fentanyl is a factor in nearly half of opioid-related deaths. 

    As Cosgrove suggested, opioid prescribing is down. However, this isn’t necessarily linked to a reduction in overdose deaths. In fact, West Virginia decreased the amount of opioids prescribed by 12% between 2016 and 2017, but still saw opioid-related overdose deaths rise. Because of this, some medical experts warn that the opioid crisis could continue to get worse before improving. 

    “I think we have to realize that we’re on a trajectory that may get a lot worse before it gets better,” said Donald S. Burke, dean of the University of Pittsburgh’s Graduate School of Public Health. 

    View the original article at thefix.com

  • Overdose Risks During Pregnancy Examined In New Study

    Overdose Risks During Pregnancy Examined In New Study

    The study revealed the need for better addiction recovery support for pregnant women with substance use disorder. 

    A new study has found that the risk of overdose drops in pregnant women but increases after giving birth.

    The study, published in the journal Obstetrics & Gynecology, looked at women giving birth in Massachusetts. In doing so, researchers found a greater number of women with opioid use disorder than had been found in other states. 

    Researchers also discovered that during pregnancy, opioid overdose events went down, the third trimester resulting in the lowest amount. However, after birth, that number rose and became especially high from 6 to 12 months after delivery.

    “Our findings suggest we need to develop extended and long-term services to support women and families impacted by substance use disorder,” said Davida Schiff, a pediatrician at MassGeneral Hospital for Children and the lead author of the paper, according to Science Daily. “We need additional research to determine the best ways to improve retention in treatment and adherence to medication therapy after delivery, and we need to enhance our medical and public health infrastructure to provide support to women in achieving long-term recovery.”

    In many states, opioid overdoses have been “major contributors to pregnancy-associated deaths.” In pregnant women, estimates of opioid use disorder range from .4 to .8%, and up to 2% in all women that fall into the reproductive age category. 

    Pregnancy can drive a woman to seek treatment, Science Daily notes. Often, such treatment includes therapy and potentially medications like methadone or buprenorphine.

    Researchers chose to study a Department of Public Health dataset, which included nearly 178,000 deliveries of an infant 20 or more gestational weeks to Massachusetts women between Jan. 1, 2012 and Sept. 30, 2014. Of those, 4,154 women were found to have likelihood of opioid use disorder within a year before giving birth.

    Additionally, of the women in the dataset, 184 experienced what researchers refer to as an opioid overdose event in the year preceding or following delivery. Such an event means the woman faced admission to a heath care facility for an overdose or death as a result of an overdose.

    Those who experienced an overdose event were “more likely to be younger, single, unemployed, less educated and less likely to have received adequate prenatal care,” Science Daily reported. They were more likely “to have evidence of homelessness or a diagnosis of anxiety or depression.”

    Co-author and Massachusetts Commissioner of Public Health Monica Bhare says that this research is vital in gaining a bigger picture of who is most at risk.

    “These findings help expand the lens from which we view the epidemic and allow us to tailor our policies and programs in ways that will increase opportunities for treatment and recovery for these women and their children,” she said. 

    View the original article at thefix.com

  • Narcan Administered At Record Pace In Boston

    Narcan Administered At Record Pace In Boston

    New city stats reveal that there were over 3,000 “narcotic-related illness” ambulance trips in 2017.

    In 2017, Boston’s first responders ran thousands of ambulance trips and administered Narcan for opioid overdoses in record numbers.

    New statistics revealed that Boston not only has a rising opioid epidemic in its own population, but that opioid use in the visiting population has risen alarmingly.

    According to the Boston Herald, Boston Emergency Medical Statistics revealed 3,557 “narcotic-related illness” ambulance trips to city hospitals in 2017—up from 2,848 in 2016.

    Twenty-nine percent of Boston’s narcotic-related ambulance trips were for patients who reported living outside Boston, EMS numbers show; this is a staggering 58% jump over 2016.

    Police and medical experts warn that 2018 could be just as bad with no signs that the drug epidemic is letting up. Boston police think it could be cheap heroin luring people with addiction to use in Boston.

    State police spokesman Dave Procopio told The Boston Herald that the drug fentanyl is increasingly laced into heroin to increase dealers’ profits.

    “Some users are actually seeking out fentanyl because it’s more potent,” said Procopio. He noted that the State Police Detective Unit for Suffolk County reported that a majority of current overdoses involved fentanyl.

    The Fix reported that some medical experts are seeking another avenue for reviving patients who have ingested fentanyl. The drug is so powerful that Narcan often does not work effectively.

    “Compounds like fentanyl, carfentanil, and other synthetic opioids act for longer periods of time,” said Dr. Roger Crystal, CEO of Opiant. “The concern is that naloxone’s half-life doesn’t provide sufficient cover to prevailing amounts of fentanyl in the blood.”

    Patients who overdosed with fentanyl in their system often have to receive multiple injections of Narcan over a period of time to be revived.

    Dr. Paul Biddinger, director of the Emergency Department at Massachusetts General Hospital in Boston, told The Boston Herald of the increasing number of Boston overdoses. “We don’t know what the cause is. The cost? Fentanyl? Unfortunately, it’s not going away for a while,” he said.

    The city of Boston reported that funds acquired to address the opioid epidemic are going to be put to use in the Boston Post-Overdose Response Team, or PORT. The program will be expanded and its hours increased.

    Paul Biddinger encourages “families, loved ones, even bystanders” to obtain and learn to use Narcan to save overdose victims.

    Of course treatment is necessary for recovery, but Narcan saves the person’s life so that they are here to participate in that recovery, he says.

    View the original article at thefix.com