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Tag: opioid-related deaths

  • 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

  • Opioid Vending Machines Proposed By Health Expert

    Opioid Vending Machines Proposed By Health Expert

    The safe supply program has already secured a $1.4 million federal grant. 

    Can a free supply of “safer drugs” help push back rising rates of drug overdose and death? What if they were dispensed by high-tech vending machines?

    A leading Vancouver-based public health expert is pushing this proposal, faced with the challenge of reducing drug-related harms among the drug-using population in Vancouver, Canada’s Downtown Eastside—described as “one of North America’s densest populations of injection drug users”—and beyond.

    Today’s illicit drugs pose a new challenge for public health officials like Dr. Mark Tyndall. According to the BC coroner, in 2018 fentanyl was detected in 4 out of 5 illicit drug deaths in British Columbia. “The plight of people using drugs didn’t change four years ago. The drugs they’re using changed,” Tyndall said in a new interview with Wired.

    Pre-approved participants who have proven that they are chronic drug users and have obtained a doctor’s prescription can access the opioid vending machines with a biometric scan of the veins in their hands to confirm their identity. They must undergo regular urine tests to prove that they are taking the drugs.

    While Tyndall, a long-time public health advocate and former executive medical director of the British Columbia Centre for Disease Control (BCCDC), has already secured a $1.4 million federal grant for the BCCDC from Health Canada to test his safe supply program—giving a regular supply of hydromorphone pills—the national health agency is still reviewing his vending machine proposal.

    Safe supply programs already exist throughout Europe, and some Vancouver clinics are testing this idea as well. Some require daily visits to the clinic to get the daily dose. But under Tyndall’s proposal, participation in the free-opioid program would not need to happen under medical supervision. The key to Tyndall’s plan is that participants may access the drugs and use them without going to a designated clinic.

    While creating designated spaces for supervised drug consumption (also known as supervised injection facilities) have helped prevent drug overdose deaths and given people easy access to treatment options, Tyndall says there is still a segment of the drug-using population that will not step foot in such a place. 

    “We’re acknowledging people will go to any extreme to use this drug. To tell them not to use because it’s unsafe is ridiculous,” said Tyndall.

    Insite, North America’s first official supervised injection facility, is just one of several such sites throughout Canada.

    Tyndall says no matter what his detractors say, it’s all about keeping people alive. “To me, its only ethical,” he said.

    View the original article at thefix.com

  • Opioids, Suicide Push Life Expectancy Down Again In The US

    Opioids, Suicide Push Life Expectancy Down Again In The US

    This is the “longest sustained decline” in life expectancy in a century.

    The life expectancy of Americans has declined for the third year in a row, according to 2016-2017 data.

    Rising drug overdose deaths and suicide are to blame, says the Centers for Disease Control and Prevention (CDC).

    As the Washington Post stated, this marks the “longest sustained decline” in life expectancy in a century, a trend not seen in the U.S. since 1915-1918, a period which included World War I and a flu pandemic.

    A person born in 2017 can expect to live 78.6 years in the U.S., according to the new data. This marks a decrease of 0.1 year from 2016.

    Females continue to outlive men. From 2016-2017, the life expectancy of American women did not change (81.1 years), while men’s life expectancy declined from 76.2 to 76.1 years.

    Drug overdose deaths hit a record high in 2017 at 70,237, the CDC confirmed—a 9.6% increase from 2016. The demographics most affected were men, and people between the ages of 25-54.

    West Virginia saw the highest rates of drug overdose deaths (57.8 per 100,000), with Ohio, Pennsylvania and Washington, D.C. trailing behind. Meanwhile, Texas, North Dakota, South Dakota and Nebraska had the lowest rates, with about 10 or fewer drug overdose deaths per 100,000.

    Deaths from fentanyl and its analogs, and similar drugs, increased by 45%, while heroin-related deaths remained constant.

    Prescription painkiller-related deaths also did not increase in 2017, the Washington Post noted. This may be the result of efforts to address over-prescribing through prescription drug monitoring programs and awareness initiatives, said Robert Anderson, chief of the mortality statistics branch at the CDC’s National Center for Health Statistics.

    Efforts to increase access to naloxone, the drug that reverses opioid overdose, may have helped mitigate some death rates as well.

    The rate of suicide, the 10th leading cause of death in the U.S., increased by 3.7% in 2017. Female suicides increased at a higher rate than male suicides (53% vs. 26%), however, men still die in greater numbers by suicide each year.

    The statistics paint a grim picture of drug and mental health problems in the U.S..

    “Life expectancy gives us a snapshot of the nation’s overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable,” said CDC director Dr. Robert Redfield.

    “We must all work together to reverse this trend and help ensure that all Americans live longer and healthier.”

    View the original article at thefix.com

  • Purdue Pharma Accused Of Targeting Seniors For Oxy Sales

    Purdue Pharma Accused Of Targeting Seniors For Oxy Sales

    The lawsuit claims Purdue had salespeople downplay the harmful risks and side effects of OxyContin.

    Oregon’s Department of Justice claims that pharmacy giant, Purdue Pharma, lied to the state and misled customers to drive sales.

    Oregon Attorney General Ellen Rosenblum filed a lawsuit against Purdue Pharma on Thursday, accusing the company of lying to the Oregon State Board of Pharmacy to obtain permission to sell in Oregon, as well as targeting senior citizens with its products.

    The violations against a settlement with Oregon goes back 10 years, according to a June 27 filing. Rosenblum’s office is demanding Purdue submit to the terms of a 2007 settlement or risk legal consequences.

    In the Thursday filing, Rosenblum’s office is demanding Purdue Pharma pay $1 million and abide by a prohibition against marketing to Oregon’s senior citizens.

    According to the lawsuit, Purdue released misleading publications and had its salespeople downplay the harmful risks and side effects of OxyContin, and specifically targeted disabled and senior citizens.

    Purdue also stands accused of lying in its application to renew its license to sell OxyContin in Oregon, erroneously claiming that the company had not faced state or federal punishment. In the past, they’ve been made to pay fines, and some of its top executives faced charges related to the company’s OxyContin marketing practices.

    “Ten years later, it is clear Purdue has flouted the judgment and ignored the severe federal penalties,” reads the lawsuit.

    Advocates for substance abuse prevention lauded the move, praising it as holding pharma companies accountable, to push them to cooperate in combating the opioid epidemic.

    “My hope is that this action will help establish some accountability and bring them to the table to help solve this,” said Dwight Holton, CEO of Lines for Life. “They ought to be helping us and they haven’t been.”

    Representatives of Purdue, however, disagree with this assessment of the situation.

    “We vigorously deny the state’s allegations,” said Purdue spokesperson Robert Josephson, according to the Oregonian. “The state claims Purdue acted improperly by communicating with prescribers about scientific and medical information that FDA has expressly considered and continues to approve. We believe it is inappropriate for the state to substitute its judgment for the judgment of the regulatory, scientific and medical experts at FDA. We look forward to presenting our substantial defenses regarding this lawsuit.”

    Working to improve its image in the shadow of the opioid crisis, Purdue has eliminated 350 sales positions, closed its “speakers” program that paid doctors and other professionals to sing OxyContin’s praises, and reshuffled its efforts towards researching cancer-fighting drugs.

    However, the opioid crisis has already damaged the state. Oregon saw a spike in opioid-related deaths in this past year, with Oregon’s Jackson County seeing a 70% increase in such deaths in just the first quarter of this year.

    View the original article at thefix.com

  • 2017 Worst Year Yet for Drug Deaths

    2017 Worst Year Yet for Drug Deaths

    Last year has usurped the dubious title from 2016 with the most lives claimed by drug overdoses ever.

    According to a preliminary report by the Centers for Disease Control and Prevention (CDC), over 72,000 people in the United States died from a drug overdose in 2017. The number translates to nearly 200 people lost per day.

    This shatters the record previously held by the year 2016, which saw about 64,000 overdose deaths. In both 2016 and 2017, “at least” two-thirds of the deaths could be linked to the use of opioids.

    For comparison, the number of drug overdose deaths in 2017 exceeds the number killed by guns, car accidents, or HIV/AIDS within the span of a single year. The number is also larger than the casualties in both the Vietnam and Iraq conflicts combined.

    These figures are simply estimates, with more accurate figures due later. However, the CDC claims a trend is clear: the massive uptick is correlated to the rise of fentanyl.

    Fentanyl is an opiate stronger than heroin, sometimes used to lace other opioid products. Its potency makes it a dangerous high, especially when added to heroin, especially east of the Mississippi. But apparently, this “trend” is moving West.

    “Dr. [Chris] Jones said there is some early evidence that drug distributors are finding ways to mix fentanyl with black tar heroin, which could increase death rates in the West,” reported New York Times’ Margot Sanger-Katz. “If that becomes more widespread, the overdose rates in the West could explode as they have in parts of the East.”

    Fentanyl has been exacerbating the already burgeoning opioid crisis in the United States. Experts say the crisis is a fixable one, with one solid step in the right direction being making access to addiction treatment more available.

    In France, doctors were given the green light to prescribe buprenorphine in 1995, leading to a 79% decrease in opioid deaths in four years, Vox noted.

    Another recommended step would be to enact harm reduction policies, including needle exchanges and making naloxone, the overdose reversal drug, more available. Such measures have resulted in steep drop-offs of deaths in states that have put such plans in place.

    The Trump administration, however, has not made significant progress in these steps, according to Senator Elizabeth Warren.

    “Experts and observers have concluded that your efforts to address the opioid crisis are ‘pathetic,’ and ‘ambiguous promises’ that are ‘falling far short of what is needed’ are ‘not… addressing the epidemic with the urgency it demands,’” she wrote in a letter to President Trump. “I agree, and I urge you to move quickly to address these problems.”

    View the original article at thefix.com

  • Fentanyl, Other Synthetic Drugs Drive National Overdose Rates Up

    Fentanyl, Other Synthetic Drugs Drive National Overdose Rates Up

    Nearly 30,000 Americans died from overdoses stemming from fentanyl and other synthetic opioids in 2017.

    Driven in large part by widespread opioid use, the number of drug overdoses nationwide shot up nearly 10% last year, according to preliminary federal figures. 

    The U.S. clocked more than 72,000 drug fatalities in 2017, the Centers for Disease Control and Prevention (CDC) reported last week. That’s up by more than 6,000 from the 2016 figures, bringing the tally to nearly 200 deaths a day—more than the total number of gun, car crash or HIV deaths in any single year, ever. 

    But the new numbers—which represent a two-fold increase over 10 years ago—could actually be underestimating the true scope of the problem as full data from some states still isn’t in yet. 

    A big chunk of the increase—nearly 50,000 fatalities—comes from opioid deaths, a category that’s more than quadrupled since 2002. An increase in cocaine fatalities is also feeding into the higher figures. 

    Meanwhile heroin, painkiller, and methadone fatality figures have started to flatten out; it’s fentanyl deaths that are continuing to rise. Last year, close to 30,000 Americans died from overdoses stemming from fentanyl and other synthetic opioids.

    “Seventy-five percent of the deaths we get are fentanyl-related,”  Al Della Fave, a spokesman for the Ocean County, New Jersey prosecutor, told the Washington Post. “It’s the heroin laced with synthetic opioids that we’re getting creamed with.”

    The biggest increases are in some of the East Coast states already hardest hit by opioids, including Ohio, West Virginia and New Jersey. 

    In part, that’s due to the geography of drug-trafficking patterns. On the East Coast, heroin typically comes in a stronger powdered form—a form more easily mixed with deadly fentanyl. But in the western part of the country, cartels bring in black tar heroin from Mexico, which is both weaker and harder to mix with fentanyl. 

    “It is the 2.0 of drugs right now, the synthetics,” Tom Synan, the police chief in Newtown, Ohio, told the Post. 

    The current influx in opioid fatalities is commonly traced back to the 1990s, when drugmakers pushed addictive painkillers and doctors overprescribed them.

    Over a decade later, heroin took hold again when a cheap supply reshaped the market. But in recent years, it’s the introduction of fentanyl and other powerful synthetics that has driven the crisis to a deadlier point.

    And now that there’s finally been a downturn in some types of opioid fatalities, experts predict that any downward trend could be gradual given the nature of addiction and the stigma surrounding it.

    “Because it’s a drug epidemic as opposed to an infectious disease epidemic like Zika, the response is slower,” University of California San Francisco professor Dan Ciccarone told the New York Times. “Because of the forces of stigma, the population is reluctant to seek care. I wouldn’t expect a rapid downturn; I would expect a slow, smooth downturn.”

    View the original article at thefix.com

  • Paramedics Use Laughing Gas In Lieu Of Opioids To Treat Pain

    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

  • Fentanyl Use Rising Across The US

    Fentanyl Use Rising Across The US

    The potent synthetic opioid has been showing up more on its own, rather than mixed with other drugs.

    The use of fentanyl, the synthetic opioid said to be 50 times as potent as heroin, is growing on both a local and national level, according to new research.

    A new analysis, conducted by Indiana University-Purdue University Indianapolis (IUPUI) researchers, found that fentanyl was present in nearly 50% of overdose deaths in Marion County, Indiana in 2017. This is a significant increase compared to less than a decade prior, when fentanyl was present in fewer than 15% of overdose deaths.

    “We found fentanyl present in 47% of cases,” said Brad Ray, assistant professor at IUPUI’s School of Public and Environmental Affairs. “That’s nearly half of every single person that dies of a drug overdose. That’s far outpaced heroin.”

    These numbers mirror national statistics. In May, the Journal of the American Medical Association published research that showed that of the 42,249 opioid-related deaths in the United States in 2016, almost 46% involved fentanyl. Six years prior—similar to the IUPUI research—fentanyl was involved in just 14% of opioid-related deaths.

    The IUPUI research also found that over time, the potent opioid has been showing up more on its own, rather than mixed with other drugs, according to the Indy Star. When fentanyl first emerged as a threat to public health, it was said primarily to be used to boost the potency of heroin and other drugs.

    A previous study by IUPUI’s School of Public and Environmental Affairs from 2017 reported an association between tighter opioid restrictions and an increase in opioid-related deaths.

    Researchers looked at prescription data from Indiana’s prescription drug monitoring program and analyzed that alongside toxicology data from the Marion County Coroner’s office, which tracks the specific substances involved in each drug-related death. With that, they found an “alarming trend”: the prescription drug crackdown occurred alongside a “considerable” rise in heroin and fentanyl overdoses.

    “As people move away from pills, they do move on to heroin,” explained Ray, who was the lead author of that study. “It’s a cheaper substance to purchase but it’s much more dangerous because you don’t know what’s in it, you don’t know how much to take.”

    Ray went on to say that a lack of treatment options in Indiana exacerbates the issue.

    View the original article at thefix.com

  • China Presses US To Reduce Opioid Demands

    China Presses US To Reduce Opioid Demands

    “When fewer and fewer Americans use fentanyl, there would be no market for it,” said one Chinese official.

    China’s drug control agency has challenged the U.S. to sharply reduce its demand for opioids, The Hill reported. The agency specifically called out the United States’ role in driving demand for drugs like fentanyl.

    “It’s common knowledge that most new psychoactive substances (NPS) have been designed in laboratories in the United States and Europe, and their deep-processing and consumption also mostly take place there,” said Liu Yuejin, deputy chair of China’s National Narcotics Control Commission. “The U.S. should adopt a comprehensive and balanced strategy to reduce and suppress the huge demand in the country for fentanyl and other similar drugs as soon as possible. When fewer and fewer Americans use fentanyl, there would be no market for it.”

    While the U.S. doesn’t deny the situation, a congressional report from 2017 singled out China as the “top source” of all fentanyl in the U.S. The year-long probe found that fentanyl could be easily purchased online from Chinese labs and mailed to buyers in the U.S.

    Last November, on a state visit to Beijing, President Trump said that China and the U.S. would work together to curb the “flood of cheap and deadly” Chinese-made fentanyl from making it stateside. China quickly disputed the claim that it was responsible for the “flood” of fentanyl into the U.S.

    A recent Bloomberg feature called fentanyl “an Internet-era plague,” though fentanyl has been around since 1960.

    At the time, it was the world’s “strongest opioid approved for human medical use,” and intended to treat extreme pain and to help put surgical patients to sleep. Fentanyl is said to be 50 times stronger than heroin and 100 times more potent than morphine.

    In 2014, Bloomberg noted, fentanyl killed 5,000 people in the U.S. By September 2017, the drug was responsible for more than 26,000 deaths, accounting for more than half of all opioid-related deaths that year.

    “China’s drug control agencies, now and in the years to come, will place greater emphasis on drug control cooperation between China and the United States,” Liu insisted. “But I believe that to resolve this the more important issue is for the United States to strive to reduce and compress the great demand and drug consumption markets of opioids.”

    China doesn’t deny that some of the NPS in America were manufactured on Chinese soil, but said that “the substances are not yet readily abused and trafficked in China itself,” The Hill noted.

    Liu contends that Beijing has already taken steps to curb the production and export of synthetic drugs like fentanyl. They have even gone so far as to place fentanyl and 22 other compounds on a controlled-substances list. Liu also said that current political tensions between China and the U.S. wouldn’t affect China’s resolve in putting an end to the manufacture and trafficking of those drugs.

    “The U.S. should strengthen its crackdown on distributors, traffickers and drug-related criminal rings,” Liu argued, adding that it should “investigate and arrest more lawbreakers.”

    Last year, Trump labeled the opioid crisis as a public health emergency (stopping short of calling it a full-scale national emergency), and promised a comprehensive awareness campaign to help deter people from abusing drugs. 

    View the original article at thefix.com

  • Healthcare Pros Talk Unintended Consequences Of Addressing Opioid Crisis

    Healthcare Pros Talk Unintended Consequences Of Addressing Opioid Crisis

    “Doctors just say, ‘That’s it, I’m done. I’m not going to lose my license over you and good luck,’ and that’s unconscionable,” said one health expert.

    The opioid epidemic has drawn more political and media attention than any other public health crisis in recent memory, but healthcare professionals say that the focus on preventing opioid-related deaths is having unintended consequences for patients dealing with other conditions including cancer, chronic pain and other forms of substance use disorder. 

    One of the biggest concerns is that patients are being taken off their opioids too quickly, which can increase physical symptoms of withdrawal and leave patients feeling overwhelmed by the idea of quitting. 

    “Some people will be tapered too quickly or in a way that is intolerable to them,” Elinore McCance-Katz, the Health and Human Services assistant secretary for mental health and substance use, told Politico. 

    Sally Satel, a psychiatrist and Yale University School of Medicine lecturer, said that some doctors are less understanding of slowly tapering patients because they’re concerned about their own liability. 

    “I’ve seen patients where doctors just say ‘That’s it, I’m done. I’m not going to lose my license over you and good luck,’ and that’s unconscionable,” she said.

    Although policies have shifted to focus on non-opioid pain relief, these options are still less likely to be covered by insurance, leaving patients with chronic pain with few options.

    The Department of Veterans Affairs and the Defense Department have begun paying for alternative care, but “beyond that it’s pretty much just been lip service and it’s a little challenging how to craft legislation that affects what private payers are able to offer in this arena,” said Bob Twillman, executive director of the Academy of Integrative Pain Management. 

    “It’s one thing for an insurer to cover [an opioid alternative]. It’s another thing to cover it at a co-pay that the patient can afford,” said Cindy Reilly, who recently left the Pew Charitable Trust, where she focused on issues around opioid use and access to effective pain management. “We need to stop making opioids the easy decision—in terms of writing prescriptions and patient access. Higher co-pays will stand in the way.”

    Sean Morrison, chairman of the geriatrics and palliative medicine department at the Icahn School of Medicine at Mount Sinai, said that he is increasingly seeing hospice patients unable to get the opioid drugs needed to make their end of life more bearable. 

    “Almost every patient I have prescribed for recently has either a) run into pharmacies that no longer carry common opioids; b) cannot receive a full supply; and c) worst of all had their mail order pharmacy refuse to fill or have had arbitrary and non-science based dose or pill limits imposed,” he said. 

    Joe Rotella, the chief medical officer for the American Academy of Hospice and Palliative Medicine, agreed. 

    “Even with exemptions for hospice care, prescription limits are still having an impact,” he said. “Patients have a tougher time getting these medications and it’s a lot more hassle for providers.”

    Cancer patients are also being affected as hospitals experience a shortage of IV fentanyl and morphine. 

    Finally, the focus on funding interventions for people abusing opioids has deflected money from other drug-intervention programs. This is especially problematic in areas like the Southwest, where overdose deaths from methamphetamine are rising sharply. 

    “We treat drug epidemics like ‘whack a mole,’” said West Virginia Public Health Commissioner Rahul Gupta. “We get one under control, another pops up.”

    View the original article at thefix.com