Tag: opioid use disorder

  • New Bill Aims To Deregulate Buprenorphine & Other Addiction Treatment Meds

    New Bill Aims To Deregulate Buprenorphine & Other Addiction Treatment Meds

    The proposed bill would remove the extra barrier that prevents all doctors from being able to prescribe opioid treatment meds.

    The movement to deregulate drugs that treat opioid addiction is gaining steam in New York with the support of 18 state public health directors and U.S. Rep. Paul Tonko, who will soon introduce federal legislation to make it easier for doctors to prescribe medications like buprenorphine.

    Currently, prescribers need special training and permission to give out addiction treatment drugs which they don’t need to prescribe opioid pain medications like oxycodone. The proposed bill would remove that extra barrier.

    “These professionals can use their training and skill and ability to provide medication for treatment of pain,” said Tonko to STAT News. “But when it comes to addressing the illness of addiction, they have to jump through additional hoops.”

    Buprenorphine, a major ingredient in medications like Suboxone, is an opioid initially designed to relieve pain without producing as many side effects as morphine. Though it is possible to abuse and become addicted to buprenorphine, opioid-tolerant individuals are generally unable to get high on controlled doses. It can therefore be used to treat cravings and withdrawal symptoms without getting patients high.

    Opponents have expressed concern that deregulation could result in an increase in diversion and misuse of these drugs. However, addiction experts say that most illegal use of buprenorphine and similar drugs is used to treat addiction rather than for recreation. If access to addiction-treating drugs is expanded, they argue, non-prescription use should decrease.

    “We want people to be getting medication from health care providers,” says addiction medicine specialist Dr. Sarah Wakeman. “The question with buprenorphine diversion is how you best reduce its non-prescribed use—and the answer is probably expanding access to treatment.”

    Less than 7% of health professionals hold the DEA waivers necessary to prescribe addiction treatment medications. Currently, physicians need to go through an extra eight hours of training in order to obtain these waivers, and nurses and physician assistants have to complete 24 hours of training.

    The lack of available prescribers means that even those who seek out addiction treatment may have to see a different health professional just to obtain a prescription for buprenorphine.

    In March 2019, two physicians published a call for the deregulation of buprenorphine, saying that it could save thousands of lives. They cited the example of France, which removed additional restrictions on prescribing opioid addiction treatment drugs in 1995 and saw an 80% decrease in opioid overdose cases in the following years.

    With opioid overdose deaths in the U.S. drawing close to 50,000 each year, even “just” a 50% decrease could save tens of thousands of lives.

    View the original article at thefix.com

  • Doctor Receives 20-Year Sentence For Reckless Opioid Prescribing

    Doctor Receives 20-Year Sentence For Reckless Opioid Prescribing

    The Manhattan doctor was convicted on 10 counts of unlawful distribution of oxycodone without legitimate medical purpose.

    A family doctor based in Manhattan’s Upper East Side was sentenced to 20 years in prison on Tuesday (April 30) for recklessly prescribing opioid painkillers that played a role in one patient’s fatal overdose.

    Dr. Martin Tesher, 83, was convicted in July of 10 counts of unlawful distribution of oxycodone without legitimate medical purpose to five patients, including 27-year-old Nicholas Benedetto.

    In March of 2016, two days after visiting Tesher and receiving prescriptions for oxycodone and fentanyl patches, Benedetto fatally overdosed on the drugs.

    According to SILive.com, one month before his death, Benedetto’s mother called Tesher asking him to stop giving her son prescriptions because he needed treatment. She told authorities that her son was smoking the fentanyl patches.

    Tesher prescribed oxycodone and fentanyl patches to Benedetto and four other patients “after he learned, or had reason to believe, that these patients were addicted to drugs,” according to the Justice Department.

    An expert witness testified that none of them “had verified medical conditions that would require the prescription of Schedule II opioids.”

    Benedetto, while under the doctor’s care, tested positive for cocaine, heroin, morphine and methadone in addition to the oxycodone and fentanyl prescribed by Tesher.

    Twenty years was the minimum sentence Tesher faced for his crime. The maximum was life in prison.

    “In the midst of an unprecedented opioid epidemic, Dr. Tesher used his medical skills to harm, not heal and in doing so he cost a young man his life,” said U.S. Eastern District Attorney Richard Donoghue. “Such criminal conduct is an utter betrayal of the trust our society places in doctors and it warrants the severe sentence imposed today.”

    The DOJ has recently cracked down on health care providers and drug companies accused of playing a role in fueling the opioid crisis.

    Also last month, 60 people were indicted for the illegal prescribing of painkillers including doctors, pharmacists, nurse practitioners and other licensed medical professionals.

    According to the Washington Post, the indictment included “doctors who prosecutors said traded sex for prescriptions and a dentist who unnecessarily pulled teeth from patients to justify giving them opioids.”

    View the original article at thefix.com

  • Doctor-Turned-Sober Home Owner Describes Descent Into Addiction

    Doctor-Turned-Sober Home Owner Describes Descent Into Addiction

    The former small town West Virginia doctor described how his own addiction and poor prescribing habits changed his life forever.

    Dr. Lou Ortenzio popped his first opioid pain pills in 1988, long before most Americans knew what an opioid was. 

    Over the next 15 years, the small town doctor in West Virginia saw more and more patients asking for powerful painkillers, while he himself became more addicted.

    Whereas older generations in Appalachia had lived with ailments and pain, never wanting to seem “complainy,” in the 1990s Ortenzio began to see a shift in patient perspective. 

    “The new generation that came in the 1980s, those kids began to have the expectation that life should be pain-free,” he told The Atlantic. “If you went to your physician and you didn’t come away with a prescription, you did not have a successful visit.”

    Between 1995 and 2005 the number of pharmaceutical sales reps nearly tripled and Ortenzio began to have more and more sales reps knocking on his door pushing the latest painkillers. 

    “It went from a dozen [salesmen] a week to a dozen a day,” he said. “If you wrote a lot of scrips, you were high on their call list. You would be marketed to several times a day by the same company with different reps.”

    Throughout the late 90s and early 2000s Ortenzio found himself writing more and more prescriptions. As he became known as a doctor who would easily prescribe pills, more patients sought him out.

    At the same time he was taking more pills, even asking a friend to fill prescriptions for him. When he tried to quit he would experience symptoms of withdrawal, which gave him understanding for the predicament that many of his patients found themselves in. 

    He said, “I couldn’t be away from my supply.”

    In 2004, after his wife divorced him, Ortenzio got sober following a religious experience. Other doctors turned to The Physician Health Program, run by the West Virginia State Medical Association, which has helped more than 230 doctors in West Virginia get sober.

    Yet Ortenzio’s sobriety wasn’t the end of opioids ruining his life. Soon after he stopped using, federal agents raided his office, and in 2006 Ortenzio pleaded guilty to fraudulent prescribing. He paid $200,000 in restitution, lost his medical license, and had to complete 1,000 hours of community service while under supervised release for five years. 

    Once a promising physician, Ortenzio was 53 and delivering pizzas, but he was at peace. After years of volunteering with a recovery center, Ortenzio opened a sober living home, which now serves six men, with plans to expand by opening another center for women.

    Although he will never be able to practice medicine again, Ortenzio is happy where he is today, sustaining his own recovery and helping other people get sober. 

    “I made pizza deliveries where I used to make house calls,” he said. “I delivered pizzas to people who were former patients. They felt very uncomfortable, felt sorry for me. It didn’t bother me. I was in a much better place.” 

    View the original article at thefix.com

  • Harm Reduction Advocate Who Lost Son To Overdose Joins Drug Policy Alliance

    Harm Reduction Advocate Who Lost Son To Overdose Joins Drug Policy Alliance

    In her new role, Joy Fishman is working on behalf of the legacy of both her husband, who invented naloxone, and her son.

    Her husband invented naloxone. But that wasn’t enough to save her son from a fatal opioid overdose. Now, Joy Fishman channels her grief through advocacy for harm reduction policies toward drug use.

    To further her important work—including expanding syringe access programs in Florida—Fishman has joined the Drug Policy Alliance as its newest board member.

    The drug policy organization announced in early April that Fishman will be joining its Board of Directors.

    Her late husband, Jack Fishman, was the first to synthesize naloxone in 1961. In 1971, the drug was approved by the FDA. But Fishman never profited from the enormous potential of the opioid antagonist. He let the original patent expire and did not reapply for one, allowing Big Pharma to get a hold of it.

    Demand for the lifesaving medication significantly expanded over the last decade as the opioid epidemic’s death toll increased. Through the advocacy of organizations like the Drug Policy Alliance, naloxone has become a household name.

    Last April, U.S. Surgeon General Jerome Adams urged more people to carry naloxone so they may be equipped to save a life. “Each day we lose 115 Americans to an opioid overdose—that’s one person every 12.5 minutes,” said Adams. “It is time to make sure more people have access to this lifesaving medication, because 77% of opioid overdose deaths occur outside of a medical setting and more than half occur at home.”

    In 2003, it wasn’t as easy to access naloxone. That year, Joy’s son Jonathan died from a heroin overdose. “It never even occurred to us that naloxone could save Jonathan,” Joy said to the Huffington Post in 2014. “Back then we didn’t think of naloxone as a household item. Doctors weren’t writing take-home prescriptions for it. It was hard for Jack to get naloxone even though he invented it!”

    Jack Fishman regretted that he couldn’t prevent the death of his stepson. “One of Jack’s greatest sadnesses was that he couldn’t save my brother,” said Julie Stampler, Jonathan’s sister. “Jack had invented naloxone so many years ago that he had no connection to it anymore.”

    With her new role at the Drug Policy Alliance, Fishman is working on behalf of the legacy of both her husband and her son. Expanding access to naloxone is just one of her goals.

    At the 2017 International Drug Policy Reform Conference, Fishman accepted the Norman E. Zinberg Award for Achievement in the Field of Medicine on behalf of her husband.

    “I don’t want any more mothers to experience the same pain I have,” she said. “I’m not a fearless person, but I have drawn strength from the Drug Policy Alliance and their work. I feel such immense gratitude to be able to collaborate with them to honor the life of my son and to fulfill the promise of my husband’s work.”

    View the original article at thefix.com

  • Grandparents Raising Kids Affected By Opioid Crisis Get Support From New Bill

    Grandparents Raising Kids Affected By Opioid Crisis Get Support From New Bill

    Louisiana and New Mexico have already passed similar bills to help grandfamilies affected by opioid crisis.

    One of the most devastating effects of the opioid crisis has been the enormous amount of children with addicted parents who are abused, neglected, or left without parents due to the parent’s death or inability to caretake.

    A new bipartisan bill in Washington, D.C., Help Grandfamilies Prevent Child Abuse Act, is seeking to support those children and their grandparents.

    The act, introduced by Senator Maggie Hassan (D-NH), a member of the Health, Education, Labor, and Pension Committee, and Senator Susan Collins (R-ME), would grant access to services under the Child Abuse Prevention and Treatment Act (CAPTA).

    Families raising these children (typically grandparents) would have access to support for the children who have experienced various traumas, including specialized training to help families access, understand and take advantage of the myriad supports they could be eligible to receive.

    Grandparents and caregivers often have numerous resources as foster parents that disappear once they are given permanent custody. Generations United reported that 21% of grandparents caring for grandchildren are living below the poverty line.

    States like Louisiana and New Mexico passed similar bills as the Help Grandfamilies Prevent Child Abuse Act, while many states, including Massachusetts, Illinois and Georgia, have bills that still have not been voted on.

    “We must be there for the children whose parents have died or are absent because of their substance use disorder,” Senator Hassan said. “Largely due to the opioid epidemic, 2.6 million children are currently being raised by their grandparent—or other relatives or close family friends—without their parents in the home. This bipartisan bill will help ensure that these children get the care and support that they need to thrive.”

    Last year, Senator Collins and Senator Hassan worked together to introduce and get passed into law the bipartisan Supporting Grandparents Raising Grandchildren Act. Senator Hassan met this year with grandparents and children in New Hampshire who have been impacted by the opioid epidemic to brainstorm strengthening child abuse prevention laws in order to better support these unique families.

    On Senator Hassan’s press release, Senator Collins said, “As the opioid epidemic continues to devastate families across Maine, grandparents increasingly are being called on to become the primary caregivers of their grandchildren. Although this caretaker role can be a source of tremendous comfort and stability for families, it also presents several challenges. The Help Grandfamilies Prevent Child Abuse Act would provide grandparents access to important resources they need to help their grandchildren succeed.”

    Click here for more information on the bill and read the bill text here.

    View the original article at thefix.com

  • Feds Undertake Four-State Study to Address Opioid Crisis

    Feds Undertake Four-State Study to Address Opioid Crisis

    The $350 million research project aims to find a way to reduce opioid deaths by 40% within 3 years.

    The National Institutes of Health (NIH) is gearing up to dole out $350 million to Kentucky, Massachusetts, New York and Ohio to figure out how to stop opioid deaths by 40% in those states over the next three years.

    By disbursing the money to the University of Kentucky, Boston Medical Center, Columbia University and Ohio State University, the NIH hopes to curb fatalities from drugs like fentanyl and heroin, which took the lives of about 47,600 people in the U.S. in 2017.

    Researchers will get deeply involved with 15 communities that have been hit hard by the opioid crisis to figure out how best to effectively prevent and treat addiction there. They’ll also take a hard look at how factors like unemployment and the justice system contribute to the continued crisis, and experiment with distributing anti-overdose medications to first responders, police, and even schools.

    “The most important work to combat our country’s opioid crisis is happening in local communities,” said Alex Azar, U.S. Health and Human Services Secretary. “We believe this effort will show that truly dramatic and material reductions in overdose deaths are possible, and provide lessons and models for other communities to adopt and emulate.”

    The program will proceed no matter what kind of budget cuts the NIH faces, according to Azar. This is welcome news as some experts believe there is no time to waste.

    “We are in such a period of crisis that we need to know in real time what is working and what is not working,” said Dr. Alysse Wurcel of the Tufts Medical Center in Boston.

    The opioid crisis is a major issue that requires a multi-faceted approach to solve. On his show, Last Week Tonight, John Oliver called for holding members of the Sackler family, the minds behind OxyContin, accountable for their alleged aggressive and irresponsible marketing of their powerful opioid painkiller. Oliver had several celebrities dramatize testimony given by Richard Sackler.

    “The launch of OxyContin tablets will be followed by a blizzard of prescriptions that will bury the competition,” performed Michael K. Williams, repeating Sackler’s infamous proclamation. “The prescription blizzard will be so deep, dense and white.”

    Some solutions to the opioid crisis may seem unorthodox and unintuitive, such as a Canadian public health expert’s suggestion to install opioid vending machines in Vancouver, home to “one of North America’s densest populations of injection drug users.” Only proven chronic drug users could scan themselves to get clean drugs for safer consumption.

    “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 program mastermind Dr. Mark Tyndall.

    View the original article at thefix.com

  • Delaware Passes Opioid Prescription Tax

    Delaware Passes Opioid Prescription Tax

    New York passed a similar measure earlier this month.

    Lawmakers in Delaware have passed a measure to tax prescription opioids, a move that they expect will generate $8 million over three years to support addiction treatment in the state. 

    Democratic Sen. Stephanie Hansen, who sponsored the bill, said that it will pass on costs to the manufacturers who contributed to the opioid epidemic, according to the Associated Press.  

    “These multi-million dollar companies that have reaped record profits after flooding our doctors’ offices and getting people in pain hooked on these drugs will no longer be able to avoid responsibility for the pain and suffering caused by their products,” she said. 

    However, people who oppose the measure say that manufacturers will pass the costs on to insurance companies, which will then pass them to consumers. Others said that the tax is a misguided and unfair way to address opioid addiction. 

    “Unfortunately, what’s being proposed—taxing legitimately prescribed medicines that patients rely on for legitimate medical needs to raise revenues for the state—ignores evidence-based solutions, sets a dangerous precedent and ultimately won’t help patients and families,” said Nick McGee, a spokesperson for Pharmaceutical Research and Manufacturers of America, an industry group that opposes the measure. 

    The tax rates depend on the dosage, and whether an opioid is a brand name or generic. It ranges from a few cents per pill, to up to a dollar per pill. The bill sets the tax rate of one cent for every morphine milligram equivalent, or MME, a measure of an opioid’s strength. In addition, there is a surcharge for brand-name pills. 

    For example, a 10-milligram pill of oxycodone would be taxed at 4 cents, while OxyContin, the brand-name alternative, would have a 15-cent tax. 

    Johns Hopkins University health economist Jeromie Ballreich said that these amounts would not change what people can expect to pay for their pain medication. 

    He said, “I do not expect copays to change based on this fee, just as they don’t change for drug price increases.”

    Delaware isn’t the only state that hopes to fund treatment through taxing opioids. New York passed a similar measure last week, its second attempt since 2018. Last year the measure was struck down by a federal judge because of the way that it would affect interstate commerce. 

    While New York lawmakers also insisted that patients would not be affected, an academic report on the measure found a different result. 

    “While the language of the proposed law attempts to place the burden of the tax on drug manufacturers, in practice market forces determine how the burden of the tax is shared between producers and consumers,” Lewis Davis, professor of economics at Union College, wrote in the report.

    View the original article at thefix.com

  • West Virginia Teachers “Burned Out” From Dealing With Students Affected By Opioid Abuse

    West Virginia Teachers “Burned Out” From Dealing With Students Affected By Opioid Abuse

    “We expected to hear that the opioid epidemic had an impact in classrooms, but not to this extent,” said one researcher.

    The results of a unique survey illustrate the harms that the opioid epidemic has inflicted not only on young children, but their education as well. Teachers surveyed throughout West Virginia reported feeling “burned out” from having to deal with students affected by opioid abuse at home.

    Among the 2,205 teachers surveyed across 49 counties, 70% say they observed a rise in the number of kids who are affected by substance abuse at home. Only 10% of teachers say they felt confident in knowing how to support students in this situation.

    The survey’s findings were presented to the state Board of Education in March.

    “The comments from the teachers were pretty shocking. We expected to hear that the opioid epidemic had an impact in classrooms, but not to this extent,” said Frankie Tack, addiction studies minor coordinator and clinical assistant professor at West Virginia University.

    When kids are not taken care of at home, they carry those needs to the classroom.

    “Teachers talked about having to wash the kids’ clothes at school. Letting kids not participate in class and go over to a corner on a mat and sleep because they hadn’t gotten sleep the night before because people were in and out of the home. Having extra snacks during the day because they don’t have enough food at home. Just all kinds of things that normally wouldn’t happen in the classroom,” said Tack.

    These kids not only affect teachers, their behavior affects other students as well.

    “What we’re also seeing is that the impact on students extends beyond those with direct experience with substance use disorders at home,” said another researcher Jessica Troilo, associate professor in the Department of Learning Sciences and Human Development. “The students who don’t have those experiences at home are witnessing behaviors in the classroom that they aren’t accustomed to. This is what we call the tertiary effect of higher classroom stress linked to the opioid crisis.”

    The goal of the study is to use the findings to develop a teacher training module for dealing with the effects of addiction in the classroom, to implement statewide.

    “West Virginia teachers are in desperate need of support in this area, and that’s what we hope to provide,” said Troilo.

    Based on the findings, the research team recommends more training for teachers on how to handle students affected by substance use disorder, and how to interact with their families. They also recommend increasing support from counselors and other mental health professionals, and providing teachers information on 12-step support groups for friends and family members.

    View the original article at thefix.com

  • The Opioid Epidemic Is A "Very American Crisis"

    The Opioid Epidemic Is A "Very American Crisis"

    One of the hosts of the NPR podcast Throughline, broke down America’s history with opioids and how it evolved into the crisis it has become. 

    Opioid use disorder has its roots in the powerful biological processes that opioids tap into, but there are also cultural factors that make Americans particularly susceptible to opioid addiction, both now and in the past, according to one journalist. 

    “Our culture has gotten so good at marketing and that marriage of capitalism and marketing and medicine has been perfected here in America, for good or bad,” Ramtin Arablouei, one of the hosts of the NPR podcast Throughline, told Rolling Stone. “That has made it a very American crisis.”

    Arablouei and his cohost, Rund Abdelfatah, followed American’s use of opioids starting with morphine in the 1800s. 

    “There was a recurring question of whose pain is taken as ‘real pain’ and how do we address it?” Abdelfatah said. “There was definitely a gender bias in the 19th Century around treating pain; there was a racial bias, and a lot of these biases remain in different forms today.”

    Morphine was prescribed to Civil War soldiers, and later used to treat ailments ranging from cramps to cough. 

    “When the war ended, not only do you have a lot of soldiers addicted, but you have this new drug introduced into American life,” Abdelfatah said, pointing out that doctors often prescribed morphine to women, who were thought to be weaker and thus have a lower pain tolerance. 

    When doctors began to realize that morphine was addictive, they turned to heroin as a “safer” alternative. It was even advertised as a medication that was safe for children, Arablouei said.

    “It’s fascinating how in-your-face it is, and it shows the evolving attitude we and the advertising community have had toward opiates in our culture,” he said.

    When heroin was criminalized in 1924, opioids became a law enforcement issue, particularly in communities of color. This reflects the way that racist policies have affected the war on drugs in modern America. 

    “There tends to be a more aggressive response to drug epidemics—as in, more criminalization—when it happens in communities that are urban, black or brown. That tends to be the historical pattern,” said Arablouei.

    “You see that play out with heroin, when the problem plays out underground. And you can see that today: a lot of attention is paid to the opioid crisis, and there’s a lot more empathy from politicians than you saw from them toward, say, the heroin epidemic [in urban communities], or the crack epidemic in the Nineties.”

    View the original article at thefix.com

  • Rejected Depression Drug Could Provide Relief For Opioid Withdrawal

    Rejected Depression Drug Could Provide Relief For Opioid Withdrawal

    A rejected depression drug is being reexamined as a potential non-addictive treatment for opioid withdrawal symptoms. 

    A drug that was developed to treat depression but was ultimately shown in clinical trials to be ineffective could have a new purpose: helping people overcome withdrawal symptoms when they stop using opioids. 

    The drug, rapastinel, binds to the same receptors as ketamine, NMDA receptors, and was being explored as a treatment for depression, similar to the newly-approved esketamine. However, in March, clinical trials showed that rapastinel was not effective in alleviating depression symptoms. 

    Yet, researchers found that in rats, rapastinel provided relief from opioid withdrawal symptoms, according to a press release. The findings were presented at the 2019 Experimental Biology Meeting of the American Society for Pharmacology and Experimental Therapeutics, held April 6-9 in Orlando. 

    Researchers Julia Ferrante, an undergraduate at Villanova University, and Cynthia M. Kuhn, a professor of pharmacology and cancer biology at Duke University, say that rapastinel could serve as a non-addictive medication to treat opioid withdrawal symptoms. 

    “We have found that rapastinel has potential as a new treatment for opioid dependence, as it is effective in reducing withdrawal signs and has not been shown to produce any negative side effects,” Ferrante said. “By reducing withdrawal symptoms, the patient feels less discomfort during treatment, and we hypothesize this would lead to a decreased risk of relapse.”

    Currently, buprenorphine and methadone are used to manage symptoms of opioid withdrawal, but since both are opioids they are problematic for people with opioid use disorder. Ketamine has been explored as a possible way to manage withdrawal symptoms, but it also has the possibility for abuse, and can cause hallucinations that are particularly problematic for people with underlying mental health issues. 

    During the research, rats with opioid dependence were given saline, ketamine, or rapastinel. Those given rapastinel showed the fewest withdrawal symptoms. With that data in mind, Ferrante said that in humans rapastinel could potentially be delivered intravenously in an outpatient setting, in order to help people through the painful opioid withdrawal process. 

    “Our research suggests that new alternatives to standard treatments for opioid dependence have potential to be safer and more effective,” Ferrante said. 

    Unfortunately, that goal may be a long way off, since additional research is needed before rapastinel could even begin human trials. 

    “Rapastinel research for opioid dependency is currently only being done in rodents, but if the drug continues to have successful trials, it may enter clinical trials for use in humans,” Ferrante said. 

    View the original article at thefix.com