Answer Addiction

Tag: opioid use disorder

  • West Virginia HIV Outbreak Is A "Nightmare"

    West Virginia HIV Outbreak Is A "Nightmare"

    Approximately 74 new cases of HIV have been reported in Cabell County since January 2018.

    Despite having many public health policies in place to prevent the spread of disease—including a needle exchange program—one West Virginia county is seeing an alarming spike in new HIV transmissions largely brought about by drug users sharing needles. 

    Seventy-four new cases of HIV have been reported in Cabell County since January 2018, according to Politico. 

    “The ground is fertile,” Judith Feinberg, a professor of behavioral medicine and infectious diseases at West Virginia University, told Politico. “This is the nightmare everyone is worried about.”

    Harm Reduction Efforts

    In 2015, Cabell County started a needle exchange program. It also has drug treatment programs, STI testing and expanded access to PrEP, a treatment regimen that can reduce the risk of contracting HIV if taken daily. All of this is unusual, especially for a rural county. The fact that HIV has taken hold despite these efforts make the outbreak especially concerning. 

    Michael Kilkenny, physician director at Cabell’s health department, said he can’t explain why HIV cases are increasing, despite the county’s efforts. “I have no answer for that. At night, it’s what you ask when you are screaming at the sky,” he said. 

    Jay Adams, an HIV care coordinator at the federal Ryan White HIV/AIDS program, said that the outbreak would have been significantly worse in any other county. 

    “I don’t think this would have been contained with any degree of success in any other county in the state,” he said. 

    High-Risk Counties

    A 2016 report from the Centers for Disease Control and Prevention (CDC) identified counties that were at high risk for new HIV infections because of the prevalence of intravenous drug use. Half of West Virginia’s counties—including Cabell—were on the list.

    Other areas of the country, including Indiana and Massachusetts have seen spikes in HIV infections related to the opioid epidemic. 

    John Wiesman, Washington state health secretary and co-chair the Presidential Advisory Council on HIV/AIDS, said that officials are realizing how much the opioid epidemic is impacting HIV transmission. The Trump administration has aimed to stop new HIV transmissions by 2030, but that is a lofty goal, said Wiesman. 

    “We’re recognizing every day just how big a challenge this is,” he said. “There are a lot of things making this a really difficult task, and one of those is the opioid epidemic. We’ve got all of these overlapping issues coming together, a lot of which are social factors, which is why it is so important to have both a medical approach and a larger health and human services approach to this epidemic.”

    View the original article at thefix.com

  • How Cannabis Dispensaries Impacted Opioid Death Rates

    How Cannabis Dispensaries Impacted Opioid Death Rates

    Access to marijuana dispensaries played a role in reducing opioid deaths by 21%, according to a new study.

    With the opioid crisis in America still a major concern, many have been in search of a solution. While cannabis becoming legal across the country is certainly not a cure-all, according to a report in Leafly, cannabis dispensaries have reportedly reduced opioid deaths by 21%.

    Economists at the University of Massachusetts and Colorado State University conducted a study on cannabis’ effect on the opioid crisis. As their report states, “Our principal finding is that recreational marijuana access significantly decreases opioid mortality, with the most pronounced effects for synthetic opioids. [This] stems primarily from access via dispensaries rather than legality per se.”

    Leafly cited another report in 2014 from JAMA, which claimed that in states with medical marijuana laws, there were 25% fewer opioid deaths than in states without medical marijuana laws.

    Studying the data, the current research showed that 47,600 people died from opioids in the U.S. in 2017. If dispensaries did indeed reduce the death rate, that means that close to 10,000 people were saved from opioid overdoses.

    “Our results have direct relevance for policy, as they indicate that recent expansions to marijuana access have significant co-benefits in the form of reduced opioid mortality,” researchers wrote. “States with legal access to marijuana were far less affected by the opioid mortality boom of the past decade than those without. Thus, our work provides important food for thought for state and federal authorities that continue to mull medical and/or recreational legalization of marijuana.”

    Lead author Nathan Chan thinks that people may be “dealing with pain through marijuana use, and therefore they’re less likely to take on addictive opioids.”

    In a previous report in Leafly, Philippe Lucas, a cannabis researcher in Canada, said, “Whether it’s medical use or recreational use, cannabis appears to be having an impact on the rates of opioid abuse. If physicians start recommending the use of medical cannabis prior to introducing patients to opioids, those patients that find cannabis to be a successful treatment for their chronic pain might never have to walk down the very tricky path of opioid use that all too often leads to abuse or overuse or overdose.”

    Not only is the opioid crisis a major concern in the U.S., but Lucas added that in Canada, “Opioid overdose is the most common cause of accidental death… Right now in Canada and in U.S. states with medical marijuana, physicians are encouraged to prescribe opioids first and if those don’t work, cannabis is considered as a third or fourth-line treatment option. We need to flip that around and make cannabis the second-line treatment option and move opioids to third or fourth option if cannabinoids are not successful.”

    View the original article at thefix.com

  • Cities Now Outpace Rural Towns In Overdose Deaths

    Cities Now Outpace Rural Towns In Overdose Deaths

    In 2017, there were a reported 22 overdose deaths per 100,000 people in urban areas, officially surpassing the 20 deaths per 100,000 in rural areas by a slim margin.

    Rural areas have been hardest hit by the opioid crisis, but overdoses in cities are now on the rise.

    As it developed, coverage of the opioid crisis seemed to center on rural white Americans. Now, overdose rates in urban areas of the United States has overtaken rural rates.

    This shift began happening in 2015 and, according to experts like Dr. Daniel Ciccarone, is due to a change in the dynamic of opioid addiction. The exact nature of this shift isn’t precisely known.

    One argument is that the crisis initially began because prescription opioid painkillers were available to virtually anyone in the United States at the discretion of a doctor. This allowed opioid addiction to grip Midwestern and Appalachian areas in a way other drugs could not. 

    Theories

    As awareness of opioids grew, prescription pills became harder to come by. This pushed people who were already hooked to look for heroin and fentanyl–drugs more easily found in urban areas where illicit markets are already in place.

    An alternative theory is that the epidemic has simply expanded to the point where it’s started to affect black and Hispanic populations who tend to live in more urban areas.

    “Early on, this was seen as an epidemic affecting whites more than other groups,” said Dr. Ciccarone. “Increasingly, deaths in urban areas are starting to look brown and black.”

    In 2017, there were a reported 22 overdose deaths per 100,000 people in urban areas, officially surpassing the 20 deaths per 100,000 in rural areas by a narrow margin.

    Overdoses continue to be an epidemic, killing about 68,000 Americans last year. According to data from the Centers for Disease Control (CDC), overdoses in urban areas are affecting mostly men and are caused mostly by fentanyl and heroin. However, overdoses are killing more women in rural areas. These rural deaths are mostly caused by meth and opioid painkillers.

    This epidemic doesn’t discriminate, not only between race and geography, but wealth and fame as well. Most recently, Saoirse Kennedy Hill, the granddaughter of Robert F. Kennedy, was found dead of an overdose on Thursday at just 22 years old. Other prominent people who lost their lives to overdose include the actor Philip Seymour Hoffman, the legendary musician Prince, and rapper Mac Miller.

    View the original article at thefix.com

  • Meth And Opioids: Exploring The Dual Addiction

    Meth And Opioids: Exploring The Dual Addiction

    Researchers speculate that meth has become a more viable option as the price of heroin has risen and opioid painkillers are harder to get.

    The number of people who are addicted to both opioids and methamphetamine is rising, particularly in the West of the country, complicating recovery efforts and leaving users even more at risk. 

    “You’re like a chemist with your own body,” said Kim, a former meth and heroin user who spoke to NPR. “You’re balancing, trying to figure out your own prescription to how to make you feel good.”

    Kim has been in recovery for a year, and her experience of trying to get off both heroin and meth is becoming more common. In San Francisco, 22% of people who use heroin starting rehab said they also had a problem with meth; that’s up from 14% in 2014. 

    University of California professor Dr. Dan Ciccarone, who teaches family community medicine, said that is a very high rate. 

    “That’s alarming and new and intriguing and needs to be explored,” he said. 

    While heroin and cocaine — a speedball — is traditionally a more common drug combination, using meth and opioids is an odd choice, he said. 

    “Methamphetamine and heroin are an unusual combination” that makes people feel “a little bit silly and a little bit blissful,” he said. 

    For Amelia, who has also been in recovery from heroin and meth addiction for a year, using both drugs was a matter of survival. She started using heroin to keep up with work. When that became too expensive, she turned to meth. 

    “The heroin was the most expensive part. That was $200 a day at one point. And the meth was $150 a week,” she said. 

    A study published in December 2018 found that 34% of heroin users said they also use meth. In 2011, only 19% of heroin users took meth as well. Researchers speculated that as opioids became harder to come by and heroin more expensive, drug users turned to meth, which is cheaper and more readily available, especially in the west. Meth — an upper — can also help people feel and function more normally despite using opioids. 

    “Methamphetamine served as an opioid substitute, provided a synergistic high, and balanced out the effects of opioids so one could function ‘normally,’” study authors wrote. 

    However, for Kim, the progression went from meth to heroin, not the other way. 

    “I thought, ‘Oh, heroin’s great. I don’t do speed anymore.’ To me, it saved me from the tweaker-ness,” she said. 

    No matter which drug comes first, the San Francisco Department of Public Healths’ Director of Substance Use Research, Dr. Phillip Coffin, said there is certainly a connection between opioid and methamphetamine use. 

    “There is absolutely an association,” he said. 

    View the original article at thefix.com

  • Can Taking Opioids During A Hospital Stay Lead To Long-Term Risk?

    Can Taking Opioids During A Hospital Stay Lead To Long-Term Risk?

    Researchers found that 48% of patients who had never before had opioids were given opioids during their hospital admission.

    While the medical community has rethought outpatient opioid use in recent years and drastically reduced prescriptions, little has changed in the way that opioids are prescribed to patients in a hospital setting.

    Now, a new study indicates that receiving opioids even in a hospital setting can increase a patient’s risk of long-term opioid use.

    The study, published in the journal Annals of Internal Medicine, found that prescribing opioids is still extremely common for hospitalized patients.

    “I was surprised by the level of opioid prescribing to patients without a history of opioid use,” lead author Julie Donohue, professor in Pitt Public Health’s Department of Health Policy and Management, told Science Daily. “About half of the people admitted to the hospital for a wide variety of medical conditions were given opioids. The stability of this prescribing also was surprising. Nationally and regionally, as people have become more aware of how addictive opioids can be, we’ve seen declines in outpatient opioid prescribing. But we didn’t see that in inpatient prescribing.”

    In fact, researchers found that 48% of patients who had never before had opioids were given opioids during their hospital admission.

    The study, which looked at 191,249 hospitalizations between 2010 and 2014, found that people who were prescribed opioids for the first time in an inpatient setting were twice as likely to still be using opioids three months after they were discharged, compared with those who did not receive opioids in the hospital.

    The time when people were given opioids also made a difference in their long-term use of the drugs. Only 3.9% of people who had no opioids for 24 hours before their discharge were still using opioids three months later. By comparison, 7.5% of patients who took opioids within 12 hours of discharge reported long-term use.

    The study also found that opioids were often the first line response to pain. Less dangerous options like over-the-counter painkillers were given first only 8% of the time, researchers found.

    “Inpatient opioid use has been something of a black box,” Donohue said. “And, while our study could not assess the appropriateness of opioid administration, we identified several practices—low use of non-opioid painkillers, continuous use of opioids while hospitalized, opioid use shortly before discharge—which may be opportunities to reduce risk of outpatient opioid use and warrant further study.”

    Another recent study found that about half of patients who underwent surgery were able to manage their pain without opioids, using just over-the-counter painkillers. Research like that indicates that opioids are likely unnecessary for some patients who receive them, even in a hospital setting.

    “There are alternatives to opioids for surgical pain that work well and we should be using them more,” said lead study author Michael Englesbe.

    View the original article at thefix.com

  • Nurse Accused Of Stealing Hydromorphone, Possibly Infecting Patients With HIV

    Nurse Accused Of Stealing Hydromorphone, Possibly Infecting Patients With HIV

    Investigators say they found video footage of the HIV-positive nurse stealing the drugs.

    A nurse may have infected patients with the HIV virus by injecting himself with hydromorphone intended for patients, say authorities in the San Antonio area.

    Kyle Evans, 29, was arrested last Thursday (June 13) for stealing vials of hydromorphone, an opioid painkiller, while he was on the job. He allegedly injected himself with the drug, then would place the vials back where he found them after refilling them with saline solution. He is now facing multiple felony charges—tampering with a consumer product and drug diversion.

    Evans was working as a registered nurse at Northeast Methodist Hospital outside of San Antonio when he stole the drugs, My San Antonio reported.

    His activity first came to light in February after he was “caught stealing five vials of hydromorphone” from the hospital. According to My San Antonio, he later admitted to stealing the drugs, triggering a DEA investigation. Investigators say they found video footage of Evans in the act.

    In May, during questioning by Live Oak Police Department investigators, Evans allegedly confessed to stealing the drugs, injecting himself with them, and returning the vials after he’d filled them with saline solution and glued the lids shut to hide the fact that they were tampered with. (Instead of saline solution, authorities found that in one vial Evans had replaced the hydromorphone with lidocaine, a local anesthetic. The test results of two other vials are pending.)

    Authorities voiced concern over the fact that Evans is HIV positive, and may have exposed patients to the virus if he used the same syringes to refill the vials before putting them back.

    Hospital officials addressed the concern in a statement: “Upon learning the former employee was diagnosed with HIV, we took several precautions including consulting with third-party infectious disease experts who concluded that there was virtually no risk of exposure to others, most notably due to the virus being below detectable levels in the employee’s blood,” said Paul Hancock, MD, Chief Medical Officer of Methodist Healthcare System.

    Though so far authorities were “not able to determine” if Evans did share the contaminated needles, it would not be the first time patients have been infected by hospital workers doing the same thing.

    In 2013, a former hospital worker was sentenced to 39 years in prison for possibly infecting hundreds of patients with hepatitis C. David Kwiatkowski was working as an itinerant (traveling) cardiac technologist while he injected himself with drugs—primarily fentanyl—stolen from hospitals across the U.S.

    Another nurse, Cora Weberg, contributed to a hepatitis C “outbreak” at Good Samaritan Hospital in Puyallup, Washington in recent years, according to the CDC.

    View the original article at thefix.com

  • 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

  • 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

  • People Who Lost Loved Ones To Opioids Invited To Sign Heroin Spoon Sculpture

    People Who Lost Loved Ones To Opioids Invited To Sign Heroin Spoon Sculpture

    Artist Domenic Esposito is using his symbolic sculpture to confront the opioid crisis head-on.

    Since last summer, a giant 800-pound spoon—burnt and bent at the handle—has been drawing attention to the opioid crisis. The massive sculpture is a symbol recognized by people who have been affected by a loved one’s opioid and heroin use. Its sheer size and weight of its meaning make it hard to look away.

    “There’s a negative memory attached in many people’s heads because you think your loved one is doing better, you find a burned spoon and you realize they’ve relapsed,” said artist Domenic Esposito. “It’s the reality of the situation and resonates with a lot of families.”

    Now Esposito has created a brand new spoon that will tour New England—with stops in Massachusetts, Connecticut, Rhode Island and New Hampshire. Esposito has invited people who have lost a loved one to the opioid crisis to come and sign the sculpture.

    “It’s a blank canvas,” said Esposito. “It becomes very therapeutic for people to be there and sign because they know someone is listening—someone is acknowledging that they’ve had to go through all this horror. It’s just like this disease that basically takes entire families with it.”

    The 10.5-foot-long guerrilla art exhibit has confronted drug companies about their role in exacerbating the epidemic of opioid abuse in the United States. Last June, the original spoon sculpture appeared outside of Purdue Pharma headquarters in Stamford, Connecticut. 

    And in February, it was placed outside Rhodes Pharmaceuticals in Coventry, Rhode Island. Last fall, the Financial Times reported that Rhodes was founded in 2007 by members of the Sackler family, who also own Purdue Pharma, just “four months after Purdue pleaded guilty to federal criminal charges that it had mis-marketed OxyContin over the previous decade.” Rhodes is “among the largest producers of off-patent generic opioids” in the U.S.

    “It was really about pointing fingers to, in my mind, the architects of the opioid epidemic,” Esposito told the Concord Monitor.

    More spoons were placed in front of the Massachusetts State House in Boston as a gift to state attorney general Maura Healey for her efforts in holding Big Pharma accountable, and the U.S. Department of Health and Human Services.

    Esposito drew from his own experience watching his brother Danny struggle with heroin addiction to create his sculptures. “The spoon has always been an albatross for my family,” Esposito said last year. “It’s kind of an emotional symbol, a dark symbol for me.”

    Through his installations, Esposito is hoping to “protest and hold accountable the people who in our minds have created this epidemic that has killed close to 300,000 people.”

    View the original article at thefix.com

  • CBD May Help Curb Heroin Cravings

    CBD May Help Curb Heroin Cravings

    A new study examined whether CBD oil could curb heroin cravings for long-term users.  

    Cannabidiol, a compound of marijuana commonly known as CBD, is effective at reducing anxiety and cravings in people who are dependent on heroin, according to a new study that could potentially open up new means of treating opioid use disorder. 

    As part of the study, researchers gave heroin users doses of CBD in the form of Epidiolex, an FDA-approved cannabis-based medication. They received doses for three days, with follow-up doses over a two-week period.

    The study participants were long-time heroin users with an average history of 13 years of heroin use, who had not successfully stayed clean for more than a month, according to CNN. 

    Researchers found that people who received CBD had 2 to 3 times fewer cravings for heroin than people on a placebo, and also had less stress hormones. 

    Lead researcher Yasmin Hurd, director of the Addiction Institute of Mount Sinai in New York, said that reducing cravings can help people stay sober. 

    “The intense craving is what drives the drug use,” she said. “If we can have the medications that can dampen that [craving], that can greatly reduce the chance of relapse and overdose risk.”

    Hurd was careful to point out that the study participants were using a regulated medication, not traditional marijuana. “We are developing a medicine,” she said. “We are not developing… recreational cannabis.”

    Psychiatrist Julie Holland, former assistant professor of psychiatry at the New York University School of Medicine, said that the study—though small—is very important. 

    “This is an extremely significant paper. We need to utilize every possible treatment in helping people with chronic pain to find other ways to manage their symptoms and in people with opiate addiction to find relief,” she said. “CBD not only manages the anxiety and cue/craving cycle, it also diminishes the original pain and inflammation that leads to opiate use in the first place.”

    Hurd said that the study indicated that CBD could be a better alternative to current medication-assisted treatment options like methadone or buprenorphine. Those medications are opioids that can be abused, so their use is tightly regulated. CBD could offer a less restrictive form of medication-assisted treatment. 

    “It’s not addictive. No one is diverting it. It doesn’t get you high, but it can reduce craving and anxiety,” Hurd said. “This can really help save lives.”

    Although some states allow medical marijuana as a treatment for opioid use disorder, there has been controversy over whether cannabis is helpful for people with opioid addiction.

    In March, National Institute on Drug Abuse (NIDA) Director Nora Volkow said that there is no evidence that cannabis can help treat opioid addiction. 

    View the original article at thefix.com