Tag: opioid use disorder

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

30 November 2018
Drug-Related Deaths Plunge In Ohio: How They Did It

The fading presence of carfentanil may have played a major role in the decline of drug-related deaths in some parts of Ohio.

Overdose deaths in Montgomery County—in Dayton, Ohio—have dramatically decreased in 2018. The county has seen an incredible 54% decline in overdose deaths: there were 548 by November 30 last year; this year there have been 250.

Dayton is an economically-challenged city, deserted of jobs after manufacturers left in droves. Some speculate that this is part of the reason why Dayton had the highest opioid overdose death rates in the nation in 2017.

The overdose deaths were so rapid and unrelenting that according to Wral.com, the coroner’s office continuously ran out of space, and ended up renting refrigerated trailers. So what has changed?

The New York Times did extensive research and reporting on the ground to look into the positive changes in Dayton. Dayton Mayor Nan Whaley believes the largest impact on the rate of overdose deaths came from Gov. John Kasich’s decision to expand Medicaid in 2015. This expansion allowed almost 700,000 low-income adults access to free addiction and mental health treatment.

In addition to the treatments being free for low-income residents, the expansion of Medicaid pulled in more than a dozen new treatment providers within a year. Some of these providers are residential programs and outpatient clinics that utilize methadone, buprenorphine and naltrexone for their patients. These are the three FDA-approved medications to treat opioid addiction.

“It’s the basis — the basis — for everything we’ve built regarding treatment,” NYT reported Mayor Whaley said at City Hall. “If you’re a state that does not have Medicaid expansion, you can’t build a system for addressing this disease.”

Dayton’s East Held holds a bimonthly event called Conversations for Change, which lays out the available addiction treatment options. Food is served, and anyone attending can meet treatment providers. The New York Times reported the evening they attended there were more than a dozen tables of providers.

Significant to a large degree is the fading presence on the streets of Dayton of carfentanil, an analog of the synthetic opioid fentanyl. Carfentanil is described by the CDC as 10,000 times more powerful than morphine.

In recent years carfentanil was very present in Ohio street drugs, for unknown reasons. Mid-2017 carfentanil’s hold began to loosen, possibly because drug traffickers realized they were losing money due to the large upsurge in overdose deaths, said Timothy Plancon, a DEA special agent in charge of Ohio.

A crucial decision was made by Richard Biehl, Dayton police chief, in 2014. Chief Biehl ordered all officers to carry naloxone, directly contrary to some of his peers in other Ohio cities. Naloxone, or Narcan, is the well-known medication that reverses opioid overdoses if administered in a timely manner.

Police in Ohio and others elsewhere oppose harm reduction tools like naloxone due to a belief that they simply enable drug use. Still, the evidence is overwhelming that they save lives.

View the original article at thefix.com

28 November 2018
New York's Opioid Prescription Monitoring System Needs Improvement

The newly re-elected State Comptroller has found some major issues with the opioid prescription monitoring system.

An audit of the New York State opioid prescription monitoring database found that patients in treatment for opioid dependency may have received potentially dangerous opioid prescriptions outside of their treatment programs.

Newly re-elected State Comptroller Thomas P. DiNapoli issued a statement indicating that some treatment programs were not cross-referencing patients’ treatment with other opioid prescriptions, or coordinating with health care professionals.

The audit showed that a third of Medicaid recipients in treatment received opioid prescriptions outside of their program; of that number, nearly 500 were said to need medical treatment for an opioid or narcotic overdose within a month of receiving the prescription, and 12 died as a result of said overdose.

The Internet System for Tracking Over-Prescribing (I-STOP) is a database of records for all controlled substances dispensed in the state and reported by either a pharmacy or dispenser. Treatment programs are not required to disclose the medication they give to patients, but in some cases, are required to check I-STOP to determine if a patient is receiving opioid prescriptions from other sources.

If outside prescriptions are found, the program can consult with health care professionals to determine the appropriate response, after consent from the patient is obtained.

According to the statement, DiNapoli’s auditors looked at state Department of Health (DOH) records from October 1, 2013 to September 30, 2017 and found 18,786 Medicaid patients who were receiving opioid treatment—usually methadone—through a recovery program as well as additional opioid prescriptions. Of that group, 493 required medical attention as a result of 691 opioid or narcotic overdoses that occurred within a month of receiving the opioid, and 12 died while under medical care.

The statement also reviewed medical records from a sample group of 25 Medicaid recipients from three treatment programs. Data from Medicaid showed that these individuals had received 1,065 Medicaid opioid prescriptions while undergoing treatment; additionally, these treatment programs only cross-referenced the patients’ data on 18 occasions, and did not check if a medication-assisted opioid was prescribed for take-home use, which is required by state law.

Consent forms to coordinate care with prescribers were required of only 13 of the 25 in the sample group, of which three did not sign the form. The programs were aware of only 53% of those Medicaid prescriptions for these patients, while consent to care was coordinated for just 8% of those prescriptions.

“New York and the rest of the country are facing an opioid addiction epidemic, and people’s lives are at stake,” said DiNapoli in the statement. “Programs designed to get individuals off highly addicted opioids can only be effective with proper vigilance. The state Department of Health should take steps to help treatment programs and health care providers work together to prevent overdoses that could lead to hospitalizations or death.”

DiNapoli’s statement also included a list of recommendations for the DOH to improve I-STOP, including a report that notifies treatment programs when recipients are receiving opioid prescriptions. The DOH did not agree with all of the audit’s conclusions, but added that actions would be taken to address the suggestions.

View the original article at thefix.com

27 November 2018
Opioid 10 Times Stonger Than Fentanyl Approved By FDA Amid Controversy

“It is certain that Dsuvia will worsen the opioid epidemic and kill people needlessly,” said one critical health expert.

Amid controversy and despite warnings from some in the medical community, the Food and Drug Administration (FDA) last week green-lit a new opioid called Dsuvia, a drug estimated to be 10 times as strong as fentanyl.

The powerful painkiller is an under-the-tongue version of sufentanil, available in a pre-filled single-dose applicator, according to the federal agency. In theory, it would be used in hospitals, surgery centers and emergency departments.

Though it wouldn’t be available for take-home prescriptions, some worry that it will be diverted and abused—to deadly effect.

“It is certain that Dsuvia will worsen the opioid epidemic and kill people needlessly,” Dr. Sidney Wolfe of Public Citizen’s Health Research Group said in a press release. “It will be taken by medical personnel and others for whom it has not been prescribed. And many of those will overdose and die.”

FDA Commissioner Scott Gottlieb released a statement defending his agency’s decision, highlighting the drug’s potential for use in war in light of its specific packaging and formulation.

Because it is sublingual, the painkiller doesn’t necessitate venous access and doesn’t require that the patient be alert enough to swallow. That could make it incredibly useful in extreme emergency situations, such as on the battlefield—and that’s what drew the Department of Defense to take interest in the drug.

“This opioid formulation, along with Dsuvia’s unique delivery device, was a priority medical product for the Pentagon because it fills a specific and important, but limited, unmet medical need in treating our nation’s soldiers on the battlefield,” Gottlieb wrote.

Indeed, the Pentagon has poured millions of dollars in funding research by AcelRx, the drug company behind Dsuvia, according to the Washington Post.

Despite the assurances Gottlieb sought to offer, his agency generated controversy not just for its decision to approve the drug, but also for the way in which they did it.

The FDA advisory committee that recommended allowing the painkiller voted 10-3 in favor of the drug—even though committee chair Dr. Raeford Brown was out of town speaking at a medical conference, according to the Washington Post.

Brown condemned the decision, raising concerns about the efficacy data and the sponsor’s response to safety questions.

“Clearly the issue of the safety of the public is not important to the commissioner, despite his attempts to obfuscate and misdirect,” Brown wrote. “I will continue to hold the agency accountable for their response to the worst public health problem since the 1918 influenza epidemic.”

View the original article at thefix.com

5 November 2018
Births Affected By Opioids Continue To Rise Among Rural Women

“More than 60% of rural moms with opioid use disorder give birth locally. These rural hospitals may have more limited capacity to care for them and their babies.”

The opioid epidemic has meant that more rural moms and babies are affected by drug abuse, often requiring specialized care at hospitals that are located far from home, according to a new study.

The study, published in the Journal of Rural Health, found that the numbers of mothers with opioid use disorder giving birth and infants with neonatal abstinence syndrome increased in rural hospitals, urban non-teaching hospitals and urban teaching hospitals.

Mothers who abuse opioids are at increased risks of complications during pregnancy and childbirth, including pre-term labor. At the same time, infants who are born dependent on opioids often have health issues that require a stay in the neonatal intensive care unit.

This is significant because as the rates of maternal opioid abuse and neonatal abstinence syndrome increase, rural hospitals with fewer resources can be overwhelmed, and urban teaching hospitals—often with the best resources—see more patients from far away.

“Some of these rural moms, especially those with clinical complications, give birth in urban, teaching hospitals, often far from home,” said Katy Kozhimannil, associate professor in the University of Minnesota School of Public Health and director of the University of Minnesota Rural Health Research Center. “Yet, our study findings show that more than 60% of rural moms with opioid use disorder give birth locally. These rural hospitals may have more limited capacity to care for them and their babies.”

The study found that many expectant moms with opioid use disorder are sent to urban teaching hospitals, suggesting that healthcare providers in rural settings have become adept at identifying patients with this condition and referring them to the appropriate level of care.

In fact, rural women who gave birth in urban teaching hospitals had the highest rate of maternal opioid use disorder, at 8.9 per 1,000 deliveries, since high-risk patients are often referred to this setting.

However, since many women still have high-risk opioid-affected births at rural hospitals, Kozhimannil says more resources need to be made available in that setting. At rural hospitals, the rate of moms with opioid use disorder is 4.3 per 1,000 deliveries.

“Recent policy and clinical efforts to address opioid-affected births have frequently focused on specialized capacity building within tertiary care settings, often urban teaching hospitals,” said Kozhimannil. “Yet, these results show that resources are also needed in rural hospitals that are caring for more and more opioid-affected moms and babies each year.”

View the original article at thefix.com

2 November 2018
One Washington County Is Treating The Opioid Crisis As A Natural Disaster

What if the government used the natural disaster coordinated system to mitigate the opioid epidemic?

In Snohomish County in Western Washington, officials are taking a unique approach to the opioid crisis by declaring it a life-threatening emergency, as if it were a natural disaster.

As overdose deaths are threatening more lives than hurricanes and mud slides, they say it makes practical sense. Ty Trenary, former police chief in Snohomish County, thought that his rural community was not affected by the drug crisis.

Trenary told NPR that at the time he thought, “This is Stanwood, and heroin is in big cities with homeless populations. It’s not in rural America.”

A new poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health showed the truth: 48% of people said opioid addiction in their communities has worsened over the past five years.

After Chief Trenary toured the local jails, he realized the problem was enormous. He witnessed over half of the jail inmates withdrawing from heroin or other opioid drugs.

“It took becoming the sheriff to see the impacts inside the jail with heroin abuse, to see the impacts in the community across the entire county for me to realize that we had to change a lot about what we were doing,” Trenary told NPR.

The idea to go the natural disaster route was the brainchild of Shari Ireton, the director of communications for the sheriff’s office. In 2014, a massive landslide in Washington killed 43 people. As the communications director, Ireton was in charge of organizing the press for field trips to the worst areas of landslide damage.

“It was amazing to see Black Hawk helicopters flying with our helicopter and a fixed wing over the top of that,” she told NPR. “All in coordination with each other, all with the same objective, which is life safety.”

Ireton had a moment of inspiration: what if the government used the natural disaster coordinated system with everyone working together, across government agencies, to treat the opioid epidemic?

The county loved the idea, and a group was formed called the Multi-Agency Coordination group, or MAC group. The group follows FEMA’s emergency response playbook and is run out of a special emergency operations center.

MAC includes seven overarching goals, which include reducing opioid misuse and reducing damage to the community. The goals are dissembled to smaller, workable steps, such as distributing needle cleanup kits and training schoolteachers to recognize trauma and addiction.

MAC is too new to understand the scope of the group’s impact on the community just yet. Those being helped will surely feel that it is a positive direction for Washington and for addiction treatment.

View the original article at thefix.com

2 November 2018
Does Opioid Abuse Play A Role In Breast Cancer Deaths In Appalachia?

One expert believes that opioid use disorder is connected to the high rates of breast cancer deaths in the region.

Women in Appalachia—especially West Virginia and Kentucky—have higher mortality rates from breast cancer than their counterparts around the country, and one researcher says that opioid abuse might be to blame.

In an essay for The Conversation, Rajesh Balkrishnan, a professor of public health sciences at the University of Virginia, said that opioid abuse could be a factor in up to 60% of breast cancer deaths in the region.

“Breast cancer death rates continue to remain abnormally high in the Appalachian region of the United States, and it’s partially due to a different epidemic in the U.S: opioid use,” he writes.

Long-term hormone treatments can be lifesaving for breast cancer patients, but using opioids to combat their side effects opens people up to another deadly disease: opioid use disorder. Cancer patients are often prescribed opioids for pain management, including the pain and fatigue that accompany hormone treatments.

“Although opioids are not considered first-line treatment for cancer-related pain, they are increasingly used to manage unbearable pain in breast cancer survivors,” Balkrishnan writes. “One thing that struck me when I looked at health insurance and cancer registry data was the extremely high and prolonged rate of use of dangerous medications like opioids in this population, sometimes as high as 50% in some areas.”

Balkrishnan’s team of researchers found that Appalachia has the most concentrated number of counties with exceptionally high opioid prescription rates—up to 65% above the national average.

This leaves people at risk for developing addiction, and can interfere with the long-term health of breast cancer patients, since many stop taking their hormone therapy medications when they become dependent on opioids, Balkrishnan believes.

“The picture that emerges is indeed a grim one. We find many patients in Appalachia who undergo successful breast cancer treatment and then start life-prolonging hormone treatments along with opioids to manage side effects such as pain,” Balkrishnan writes.

“But many (over half in some counties) continue to remain on opioids, which are usually supposed to be prescribed only for the short term, and then discontinue long-term survivorship treatments such as hormones. The reasons these women discontinue traditional treatments is not completely clear, but my colleagues and I suspect it is related to people’s dependence on opioids.”

Appalachian women have the lowest breast cancer survival rates in the country.

“It is heartbreaking to see a woman able to beat cancer, only to die because of sub-optimal use of a life-prolonging treatment or misuse of a short-term relief treatment such as opioids,” Balkrishnan writes.

“We need to work harder to educate and empower Appalachian breast cancer survivors about their treatment choices and decision-making that can be most beneficial to improving their life quality and quantity.”

View the original article at thefix.com

31 October 2018
"Heroin Spoon" Art Exhibit Re-Emerges In Boston

The artwork was placed as a “gift” to Massachusetts Attorney General Maura Healey outside of the State House.

The massive, 800-pound “heroin spoon” sculpture has re-emerged.

This past June, the guerrilla art exhibit sat in front of Purdue Pharma headquarters in Stamford, Connecticut, for about two hours before it was hauled away by city workers.

The spoon appears burnt and bent at the handle. The artist, Domenic Esposito, said the purpose of the massive symbol is to “protest and hold accountable the people who in our minds have created this epidemic that has killed close to 300,000 people.” Purdue Pharma is the maker of OxyContin.

Gallery owner Fernando Louis Alvarez was arrested and charged with obstruction of free passage, a criminal misdemeanor. But a judge has since agreed to erase the charge from his record upon completion of one year’s probation.

Last Friday (Oct. 26), the 10.5-foot-long sculpture re-appeared in front of the Massachusetts State House in Boston. But this time, the artwork was placed as a “gift” to Massachusetts Attorney General Maura Healey for her efforts in holding Big Pharma accountable for its part in fueling the opioid crisis.

In June, the state of Massachusetts filed a lawsuit against Purdue Pharma, accusing the company of recklessly promoting its opioid painkillers “without regard to the very real risks of addiction, overdose and death.”

The lawsuit is the first in the U.S. to name company executives. Many other states, cities and counties have sued Purdue Pharma as well.

“Purdue peddled falsehoods to keep patients away from safer alternatives,” Healey stated in her complaint. “Even when Purdue knew people were addicted and dying, Purdue treated the patients and their doctors as ‘targets’ to sell more drugs.”

A group of mothers who have lost children to drug overdose peacefully rallied beside the spoon sculpture on Friday.

The artist Esposito has personally been affected by the opioid crisis. He described the toll that his brother Danny’s nearly 14-year addiction to heroin, which began with OxyContin and Percocet, had on his family.

“My mom would call me in a panic… screaming she found another burnt spoon. This is a story thousands of families go through. He’s lucky to be alive,” he said according to the Hartford Courant.

“The spoon has always been an albatross for my family,” he added. “It’s kind of an emotional symbol, a dark symbol for me.”

View the original article at thefix.com

30 October 2018
County Pays Millions Over Teen’s Heroin Withdrawal Death In Jail

“Anyone who looked at her would have known that she was very sick and that she needed attention,” said the family’s lawyer.

A Pennsylvania county has agreed to pay nearly $5 million as part of a settlement in the case of a teenager who died in jail after guards ignored her worsening medical condition during four brutal days of heroin withdrawal.

Despite the costly payout, it’s not clear whether the Lebanon County Correctional Facility death will lead to any policy change—but attorneys say it sends a message that even small lock-ups need to take care of inmates who are physically dependent on drugs.

“The days of viewing people addicted to drugs as junkies unworthy of sympathy and care, are long past,” Jonathan Feinberg, a civil rights attorney representing the family, told the Associated Press. “It’s a very short chain of events that leads to death.”

When 18-year-old Victoria Herr was arrested in March 2015, she had a 10-bag-a-day heroin habit. She’d been picked up when police looking for her boyfriend found drugs in their apartment. It was her first time in jail, and she warned staff about the amount of drugs she’d been doing and told her cellmate she was worried about how bad the withdrawal would be.

For four days, the teen was vomiting and had diarrhea. But the jail only gave her Ensure, water and adult diapers. She couldn’t keep down any liquids and became severely dehydrated. The day before she collapsed, Herr begged for lemonade during a phone call home to her mother.

“Anyone who looked at her would have known that she was very sick and that she needed attention,” Feinberg said. “There was a complete disregard for her needs, which can only be tied back to the fact that she was addicted to drugs.”

On March 31—four days after her arrest—she collapsed in the jail and was rushed to the hospital. She went into cardiac arrest, according to the Lebanon Daily News, but lingered for days on a ventilator before finally dying on April 5.

The fatality, her lawyers said, could have been prevented if jailers had simply taken her to the hospital sooner for intravenous fluids.

Although opioid withdrawal does not always lead to death, it can be fatal in cases of severe dehydration. That possibility has prompted some jails to begin offering medications—like buprenorphine—to ease withdrawal, and sometimes continue use for long-term treatment.

Despite the hefty size of the agreed-upon payout in Herr’s case, an attorney for the jailers stressed that no one actually copped to doing anything wrong as any part of the settlement.

“The case was resolved amicably,” the attorney, Hugh O’Neill, told the Associated Press. He declined to say whether the county had changed any policies since the teen’s death. The county administrator, Jamie Wolgemuth, issued a statement to the local news highlighting the fact that state police and the Lehigh County Coroner did not send the case to prosecutors for “further inquiry.”

Regardless, lawyers for Herr’s family framed the settlement as a win for correctional accountability.

“It’s certainly one of the largest settlements in at least the last 10 years involving the death of a prisoner in civil rights litigation,” Feinberg told the Lebanon paper. “When there are breakdowns in the way a prison is run, and when those breakdowns cause harm like the unimaginable harm that was caused to Tori Herr, this suit shows that prisons and staff will be held accountable.”

View the original article at thefix.com

30 October 2018
Opioid Addiction Rates Higher Than Expected In Massachusetts, Study Says

Nearly 5% of Massachusetts residents may be battling opioid use disorder, according to a new study.

Health officials in Massachusetts are expressing concern over the results of a new study, which suggests that more residents are struggling with opioid use disorder than previous research had suggested.

Using information culled from a database for public health information, the study authors found that the number of individuals in the Bay State who have either received treatment for addiction, or who qualify as addicted but have gone undiagnosed, may be as high as 4.6% of residents over the age of 11.

That number is significantly higher than previous records, which suggested that addiction rates hovered at just over 1%.

The study was published in the American Journal of Public Health, and sought to determine the annual prevalence of opioid use between 2011 and 2015.

To do so, researchers used the Massachusetts Public Health Data Warehouse, which links information on hospital and emergency room visits, prescriptions and insurance claims, among other sources, from more than a dozen state agencies.

Patients are identified with their own unique number so it is possible to track a single individual who may have been admitted to a hospital or ER or received treatment from first responders.

Researchers looked at information on individuals who, based on such encounters with the health care system, had been or could be determined as suffering from opioid addiction—and identified 119,000 people, or 2% of the state population over the age of 11 in 2015.

From there, they used statistical methods to estimate the number of people who would be considered as opioid-dependent but have not received any treatment.

That formula brought the total number of individuals up to 4.6%, or 275,000 Massachusetts residents over the age of 11 years. Previous research, which determined the 1% rate, was based on national surveys that interviewed only those people who had sought help from the health care system for opioid-related issues.

Response from the Massachusetts medical community was largely positive in regard to the study’s findings. The Boston Globe quoted Dr. Joshua A. Barocas, an infectious disease physician at Boston Medical Center, who said, “[The study] is a good wake-up call. Our pool of people who are at risk for overdoses is potentially higher than we thought it was.”

The study also drew criticism from Dr. Silvia S. Martins, director of the Substance Abuse Epidemiology Unit at the Columbia University Mailman School of Public Health. Her response stemmed from what she viewed as a broad definition of opioid use disorder, which may have inflated the statistics.

“The analysis could have been done in a more precise way,” she said.

View the original article at thefix.com

30 October 2018