Tag: opioid use disorder

What’s Actually Happened Since Trump Declared An Opioid Emergency

Critics say the emergency declaration was more for show than to actually resolve the crisis.

A year ago, President Trump declared a national public health emergency because of the opioid epidemic, vowing that doing so would streamline responses to a health crisis that killed more than 70,000 Americans last year.

However, a new report shows that the declaration has led to little change.

The report, prepared by the Government Accountability Office, found that the administration has used just three of 17 available authorities that are activated when the government proclaims a public health crisis. These authorities include, for example, waiving certain administrative processes in order to quicken responses in an emergency.

The Trump administration used one authority to more quickly field a survey of healthcare providers about their prescription practices. The results of the survey will help inform policy decisions going forward, the administration said.

Secondly, authorities waived the public notice period for approval of two state Medicaid demonstration projects related to substance use disorder treatment, which was intended to speed up implementation of the projects, allowing the states to test and evaluate new addiction-related services delivered through Medicaid.

Finally, the Department of Health and Human Services (HHS) increased support for research on opioid use disorder treatments and gave out information on opioid misuse and addiction.

The Department of Health and Human Services said that more authorities haven’t been used because many of the abilities enabled by the state of emergency declaration are not applicable to the opioid epidemic. Instead, they are designed for response to infectious diseases or natural disaster.

“HHS officials determined that many are not relevant to the circumstances presented by the opioid crisis,” the report reads. However, the potential for additional responses will be reviewed. “Officials told GAO they will continue to review the authorities as the opioid crisis evolves and in the context of HHS’s other efforts to address the opioid crisis.”

Still, critics of the administration say that the fact that so few resources have been utilized shows that the administration’s declaration was more for show than in hope of solving the problem.

“Communities are desperately in need of more help to address the opioid epidemic. President Trump, as this report shows, has broken his promises to do his part,” Senator Elizabeth Warren (D-MA) said in a statement reported by Vox. “I’ve asked this administration time and time again to show what actions they are taking to meaningfully address this crisis. No response. To me, it looks like empty words and broken promises. Hand-waving about faster paperwork and speeding up a few grants is not enough — the Trump Administration needs to do far more to stop the opioid epidemic.”

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26 October 2018
White House Launches Treatment Program For Moms With Opioid Addiction

The program will streamline care and reduce healthcare costs for mothers and children who are affected by opioid addiction.

The Trump administration announced this week that it will begin a program to address opioid abuse among pregnant and postpartum women, in an attempt to address health complications related to addiction and reduce the number of infants born dependent on opioids.

Health and Human Services (HHS) Secretary Alex Azar announced the model during a conference on Tuesday.

“The M-O-M model, for ‘Maternal Opioid Misuse,’ will partner with state Medicaid agencies to integrate a wide range of services for pregnant and postpartum women struggling with opioid misuse, to ensure not only their health, well-being, and recovery, but protect the health of their children as well,” Azar said, according to Medpage Today.

In a press release about the program, the Centers for Medicare & Medicaid Services said that it is designed to streamline care and reduce healthcare costs for mothers and children who are affected by opioid addiction.

“Too many barriers impede the delivery of well-coordinated, high-quality care to pregnant and postpartum women struggling with opioid misuse, including lack of access to treatment and a shortage of providers in rural areas, where the opioid crisis is especially destructive,” Azar said in that release. “The MOM model will support state Medicaid agencies, front-line providers and healthcare systems to help ensure that mothers and infants afflicted by the opioid epidemic get the care they need.”

The program will be tested in up to 12 states over the next five years. As the opioid epidemic has unfolded, complications from addiction have become a leading cause of maternal death. In addition, the number of babies born dependent on opioids has increased sharply, from 1.19 cases per 1,000 hospital births in 2000, to 5.63 in 2012, according to The Washington Post. Those infants can have lifelong complications from being exposed to opioids in the womb.

Azar said that the MOM model is the latest step that the Trump administration has taken to make real changes to how opioid addiction is addressed.

“We believe in evidence-based treatment, we believe in a public-health approach to this epidemic, and we believe in approaching addiction as a disease, never a moral failing,” Azar said.

The health secretary added that early indications show that opioid overdose deaths seem to be plateauing this year. Although he acknowledged that too many people are still dying from opioid addiction, he said that there are signs of progress.

“Since President Trump took office in January 2017, the number of patients receiving buprenorphine, one form of medication-assisted treatment, has increased by 21%… [and] from 2015 to 2017, we have seen a statistically significant decline in the number of Americans who misuse prescription opioids,” Azar said.

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25 October 2018
HHS Secretary Discusses "Plateau" Of The Opioid Epidemic

Health Secretary Alex Azar discussed the state of the opioid epidemic at a recent health summit.

Drug overdose deaths in the U.S. may be plateauing, but it’s still too soon to know for sure.

“We are so far from the end of the epidemic, but we are perhaps, at the end of the beginning,” said U.S. Health Secretary Alex Azar at a recent Future of Health Summit in Washington, D.C. on Tuesday (Oct. 23).

Azar said that the rate of drug overdose deaths had “begun to plateau” toward the end of 2017 and beginning of 2018. More than 70,000 Americans died of drug overdose in 2017, a 10% increase from 2016, according to preliminary figures by the Centers for Disease Control and Prevention (CDC).

Azar’s remarks also reflect recent CDC figures from this month which show that from December 2017 to March 2018, the rate of increasing drug overdose deaths over the last 12 months has gone down from 10% to 3%, suggesting a slow-down. However, these figures won’t be final until all death investigations are completed.

“It appears at this point that we may have reached a peak and we may start to see a decline,” says Bob Anderson, senior statistician with the National Center for Health Statistics, according to AP. “This reminds me of what we saw with HIV in the ‘90s.”

Azar, who heads the U.S. Department of Health and Human Services, cited the success of multi-pronged efforts to mitigate the opioid crisis.

Promoting medication-assisted treatment (with drugs like buprenorphine, naltrexone and methadone), the use of naloxone, and increasing scrutiny on doctors’ prescribing practices have all played a part.

However, AP reports that while opioid deaths may be leveling off, “deaths involving fentanyl, cocaine and methamphetamines are on the rise.”

The New York Times reported in February that “meth has returned with a vengeance.”

“At the United States border, agents are seizing 10 to 20 times the amounts they did a decade ago,” the Times reported. “Methamphetamine, experts say, has never been purer, cheaper or more lethal.”

Fentanyl is now notorious for being the synthetic opioid that is 50-100 times more potent than morphine. Though traditionally it is a pharmaceutical drug, illicitly-made fentanyl is said to have fueled rising rates of drug overdose deaths in the U.S.

This month, the maker of Narcan (naloxone) announced plans to release a new opioid overdose antidote that will match the strength of increasingly potent fentanyl analogs.

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

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25 October 2018
New PSA Follows Woman As She Publicly Detoxes From Opioids

“I am the most camera shy person in the world. But if making my detox public is going to help somebody…I’m all for it,” said the 26-year-old.

The Truth Initiative, which has produced 20 years of anti-tobacco public health messaging, just released a new opioid PSA.

This time, we meet 26-year-old Rebekkah, who agreed to allow her opioid detox to be filmed for the Truth Initiative to show the world.

“I know these next few days aren’t going to be pretty,” she says in the six-minute video. “And I am the most camera shy person in the world. But if making my detox public is going to help somebody—even just one person—I’m all for it.”

Rebekkah was once a promising dancer and athlete, but that all came to a halt when she was 14 and blew out her ankle during cheerleading practice. A doctor prescribed opioid painkillers, and as she says, it was all downhill from there.

“That decision I made, to go to the doctor and not get the surgery, that’s the worst decision I ever made in my whole life,” she said. Her painkiller addiction eventually turned to heroin.

The video fast-forwards through the early days of Rebekkah’s detox, describing the withdrawal symptoms that arise with each day. The video is shown in a public space, what appear to be busy New York City streets, as the public watches on.

Day 3 is characterized by nausea and vomiting, diarrhea, drug cravings and depression. “I have a lot of self-image issues. My mind doesn’t tell me anything nice,” says Rebekkah.

As the days go by, things are looking better. “Each day that passes I feel more and more alive,” she said.

Rebekkah’s story—titled “Treatment Box”—marks the second installment of the Truth About Opioids public awareness campaign, made possible by a collaboration between the Truth Initiative, the Ad Council, and the U.S. Office of National Drug Control Policy (ONDCP).

The first round of anti-opioid PSAs released in June went for shock value. The four ads profiled four individuals who went to extreme lengths to obtain prescription opioids.

Allegedly based on true stories, “Chris from Atlanta” breaks his own arm by slamming it in a door, “Kyle from Dallas” breaks his own hand with a hammer, “Joe from Maine” crushes his body under a car, and “Amy from Columbus” crashes her car into a dumpster.

Critics of the ads say they were “disingenuous and misleading.”

Aside from PSAs, Truth also offers resources on its website to educate and help those who need support—such as “What if your doctor wants to prescribe you opioids? Here are 12 questions to ask your doctor,” and how to locate a treatment center near you.

View the original article at thefix.com

24 October 2018
Moving Obituary For Mom With Opioid Addiction Goes Viral

The obituary recounts Madelyn Ellen Linsenmeir’s ensuing addiction to opioids and her family’s determination to help her overcome it.

The heartbreaking and loving obituary written for Madelyn Ellen Linsenmeir after her overdose death has gone viral. Her family shared Madelyn’s long struggle with addiction while reaching out to those still struggling, asking them to hold on to hope and keep trying.

Madelyn Ellen Linsenmeir died on October 7, 2018, leaving behind her family and a small son, Ayden. Madelyn’s family recounted how after a move from Vermont to Florida, she took her first OxyContin pill at a party.

The obituary, which was originally published in the Burlington Free Press, recounts Madelyn’s ensuing addiction to opioids and her family’s determination to help her overcome it.

Madelyn’s family also emphasized that she was, first and foremost, a human being who was loved.

“It is impossible to capture a person in an obituary, and especially someone whose adult life was largely defined by drug addiction. To some, Maddie was just a junkie—when they saw her addiction they stopped seeing her. And what a loss for them. Because Maddie was hilarious, and warm, and fearless, and resilient. She could and would talk to anyone, and when you were in her company you wanted to stay. In a system that seems to have hardened itself against addicts and is failing them every day, she befriended and delighted cops, social workers, public defenders, and doctors, who advocated for and believed in her till the end.”

Madelyn’s family wrote about her determination to stay sober after the birth of her son. “After having Ayden Maddie tried harder and more relentlessly to stay sober than we have ever seen anyone try at anything. But she relapsed and ultimately lost custody of her son, a loss that was unbearable.”

The family continued with unusual honesty to recount the reality of what an ongoing drug addiction does to a person. “During the past two years especially, her disease brought her to places of incredible darkness, and this darkness compounded on itself, as each unspeakable thing that happened to her and each horrible thing she did in the name of her disease exponentially increased her pain and shame.”

Yet they cherished every moment with her, writing, “For 12 days this summer she was home, and for most of that time she was sober. For those 12 wonderful days, full of swimming and Disney movies and family dinners, we believed as we always did that she would overcome her disease and make the life for herself we knew she deserved. We believed this until the moment she took her last breath.”

In 2016, 63,600 Americans fatally overdosed with nearly two-thirds of deaths involving a prescription or illegal opioid. Since 2016 the problem has only increased.

Linsenmeir’s family is just one of many that have written searingly honest obituaries illustrating the ultimate cost of addiction. When Gwen Knox lost her son Kurt to an overdose at 49 years old, she also wrote an honest and loving obituary on the reality of Kurt’s addiction that went viral.

The family asked for donations in Madelyn’s name be made to the Turning Point Center. They asked those who judge addiction issues to “educate yourself about this disease, because that is what it is. It is not a choice or a weakness.”

View the original article at thefix.com

18 October 2018
Nurse Prescribed Patient 51 Pills Per Day, Kept License

The nurse practitioner was the ninth most heavy-handed opioid prescriber in Tennessee.

Forty opioid pills, four muscle relaxers, six Xanax and an Ambien in a day would likely do more harm than good for even the sickest of patients, but that’s the amount that a Tennessee nurse prescribed a patient eight years ago, exceeding today’s opioid recommendations by more than 31 times.

And yet, the nurse is still licensed to prescribe today.

Christina Collins, a nurse practitioner near Knoxville, was the ninth most heavy-handed opioid prescriber in Tennessee, and officials now say that she must have known that her patients were not taking the pills as she prescribed them.

“In short, Mrs. Collins was a machine that dispensed prescriptions without regard for any professional responsibility,” Mary Katherine Bratton, a Tennessee Health Department attorney, wrote in state documents analyzed by The Tennessean. “Her own lawyers argued that Mrs. Collins engaged in patient-led prescribing, simply giving patients whatever dangerous drugs they requested.”

Last year, officials attempted to have Collins’ license revoked, but the state nursing board opted to instead put her on professional probation, which means she can still write prescriptions. She still works as a nurse in the Knoxville area.

However, the state’s health department and attorney general are now appealing that decision in a move that a spokesperson called “rare but not unprecedented.”

Collins and her lawyer claim that despite doing things like telling one patient to wear three fentanyl patches at once in addition to taking other medications, Collins thought she was giving good medical advice at the time the prescriptions were written.

“She became a victim of her environment and the medical community and the ideas that were floating around out there at that time period,” said Eric Vinsant, her lawyer. “This case stretches from 2011 and 2012, which was a time before Tennessee really began looking at the prescribing of opioids and other controlled substances for pain, and there was really a very limited amount of guidance for practitioners on what was expected and what were best practices.”

Vinsant added that there was “no real evidence” that Collins’ pills were resold on the black market.

During a hearing with the nursing board last year, Collins said that she left the clinic she was with at the time when she became suspicious that Dr. Frank McNiel, who ran the clinic, was overprescribing. McNiel surrendered his medical license.

“When I initially started there … obviously I did not think that there was anything below the standard of care or anything wrong with the patients or the prescriptions they were taking,” Collins said, according to a transcript of the hearing. “If I were looking at doses like that in today’s time after the guidelines and everything that I’ve learned, yeah, I would think that was very high amounts.”

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16 October 2018
Lack Of Suboxone Access Leads Users In Need To The Black Market

President Trump is expected to sign a bill to expand medication-assisted treatment but it remains unclear as to how soon that will take place.

A new feature by NPR underscores a potentially dangerous conundrum for health care professionals and individuals seeking treatment for opioid use disorder: while buprenorphine (also known as Suboxone, Subutex and Zubsolv) has proven effective in blocking the effects of opioids, it’s also difficult to find and a challenge to obtain due to federal limits on prescribers.

As a result, many prospective patients have turned to the illicit market, where Suboxone can be obtained via diversion, or from patients who sell or give away their own prescriptions.

President Donald Trump is expected to sign a bill to expand medication-assisted treatment (MAT), but as NPR noted, it remains unclear as to how much access will be granted and how soon that will take place.

Along with methadone and naltrexone (Vivitrol), buprenorphine is one of three federally-approved drugs to treat opioid dependency.

As the NPR feature stated, while it is less potent than heroin or prescription opioids, including fentanyl, it is possible to overdose on buprenorphine if mixed with other substances.

But such instances are rare, especially when the drug is formatted with the overdose reversal drug naloxone. As Dr. Zev Schuman-Olivier, an addiction specialist and instructor at Harvard Medical School, said, “The majority of people are using it in a way that reduces their risk of overdose.”

Despite its effectiveness and relative lack of harmful side effects, obtaining buprenorphine is subject to federal regulations in regard to who can prescribe it—medical professionals need a special waiver to do so—and how much can be obtained. Currently, those doctors that meet the federal requirements to prescribe buprenorphine are limited to treating 275 patients.

Nurse practitioners and physician assistants may apply for a waiver to administer the medication as well. Under the SUPPORT for Patients and Communities Act, the number of such health professionals and the length of prescription may be increased.

Until that bill is signed, buprenorphine remains both difficult to obtain and expensive. According to 2016 estimates provided by the U.S. Department of Defense, medication and twice-weekly visits to a certified opioid treatment program are $115 per week or nearly $6,000 per year. That puts the medication out of range for many in need, forcing them to turn to diversion situations for assistance.

But as NPR noted, that scenario can be dangerous: patients need assistance from a treatment professional for proper dosage and treatment for mental health issues that may come as a part of addiction.

Diversion has become prevalent enough to warrant calls for more regulations regarding buprenorphine and stronger enforcement against those that break the law. But the NPR story quoted Basia Andraka-Christou, an assistant professor and addiction policy researcher at the University of Central Florida, who said that stricter rules are not what’s needed for patients.

“I guarantee you, they’re either going to go and buy heroin and get high, which surely is not a great policy solution here,” she said. “Or they’re going to go buy Suboxone on the street.”

View the original article at thefix.com

9 October 2018
Surgeon General Mentions Brother’s Opioid Addiction In New Report

“I tell my family’s story because far too many are facing the same worries for their loved ones,” the Surgeon General wrote in the report.

The U.S. Surgeon General has released an updated report on the opioid crisis—to call for Americans to talk about opioid abuse, understand addiction as a disease and be prepared to use naloxone if needed.

Facing Addiction in America: The Surgeon General’s Spotlight on Opioids was released on September 20 and updates the previous Surgeon General’s report on addiction.

In the report, Surgeon General Jerome M. Adams opened up about his own family’s experience with opioid addiction.

“My family and I are among the millions of Americans affected by substance use disorder,” Adams wrote in the report. “My younger brother has struggled with this disease, which started with untreated depression leading to opioid pain reliever misuse. Like many with co-occurring mental health and substance use disorder conditions, my brother has cycled in and out of incarceration. I tell my family’s story because far too many are facing the same worries for their loved ones. We all ask the same question: How can I contribute to ending the opioid crisis and helping those suffering with addiction?”

The updated report highlights the fact that available addiction treatment often lags behind what science says are best practices.

“The existing healthcare workforce is understaffed, often lacks the necessary training, and has been slow to implement Medicated-Assisted Treatment, as well as prevention, early identification, and other evidenced-based recommendations,” the U.S. Department of Health and Human Services said in a news release.

Partially because of this, only 1 in 4 people with opioid use disorder receive specialized treatment. In order to help more people get sober, law enforcement, faith communities and healthcare providers need to come together to streamline access to treatment.

“Now is the time to work together and apply what we know to end the opioid crisis,” said Dr. Elinore McCance-Katz, assistant secretary for Mental Health and Substance Use (under the Substance Abuse and Mental Health Services Administration). “Medication-assisted treatment combined with psychosocial therapies and community-based recovery supports is the gold standard for treating opioid addiction.”

The report concludes with actionable steps that various people can take to reduce the harm from opioid addiction. Family members should be non-judgmental and trained in using naloxone, the report says.

Healthcare providers should treat addiction with the same care that they dedicate to other chronic diseases. Communities should raise awareness by talking about substance abuse as a public health concern.

“Through partnerships, we can address the overall health inequities and determinants of health that exist where we live, learn, work, and play,” Adams wrote. “Together we can reduce the risks of opioid misuse, opioid use disorder, and related health consequences such as overdose and infectious disease transmission.”

View the original article at thefix.com

5 October 2018
Treatment Clinic Beat The Odds To Help Patients During Hurricane Florence

“Some of those nurses were without power, they sustained damage to their homes, but they showed up every day.”

When Hurricane Florence swept through the middle of the country, it left behind patients in treatment without access to their possibly life-saving medications.

The hurricane brought with it flooding and blocked roads and bridges—putting patients in addiction treatment who use methadone or buprenorphine at risk of withdrawal or worse, relapse.

One opioid addiction clinic, the Carolina Treatment Center, worked beyond its means to provide care for the stranded and desperate coming in from far and wide.

The clinic would have been in dire straits if the nurses working there—most of them severely and personally affected by the hurricane—had not been able to show up.

The clinic’s head nurse Kristen Morales worked 16 days in a row while living at a nearby hotel to ensure she could show up for her job. Huffington Post interviewed the treatment center director, Louis Leake, as he worked cases from as far off as Louisiana.

“We can do a lot of things, but we can’t do a lot of things without nurses,” Leake said. “Some of those nurses were without power, they sustained damage to their homes, but they showed up every day.”

Past studies have shown the toll that intense storms take on the community of addiction recovery. One study published in Substance Use Misuse, on Hurricane Sandy, concluded that among other troubling findings (such as the increase of shared use of needles) 70% of those in opioid maintenance therapy could not obtain sufficient doses to remain off of opioids.

The town of Fayetteville’s clinic was closed for a mandatory three-day evacuation. Patients were given between three and six days of treatment medication to take home, after which they had to be resupplied.

The Carolina Treatment Center was outside of the evacuation zone and took in all of Fayetteville’s addiction treatment patients, to treat a total of more than 900 patients.

Despite the four days of medication that patients could take home, between the three-day evacuation and road closures and flooding, many patients would have had to suffer through withdrawal or relapse if the Carolina Treatment Center had not gone above and beyond to provide a safety net for this vulnerable community.

Patient Teri Cooper told The Huffington Post, “It was busy, but thank God I could come here. I guess I would have got some damn drugs, to be honest. [if the clinic were closed] If I didn’t feel good. That’s the truth.”

View the original article at thefix.com

27 September 2018
Stephen Colbert Takes Aim At Big Pharma Over Opioid Crisis

“You know you’ve been bad when the government fines you one aircraft carrier.”

Stephen Colbert publicly called out those responsible for the opioid crisis, as the Late Show host laid into Big Pharma during a segment last Friday (Sept. 14).

“There are certain subjects that are genuinely hard to talk about like, the opioid crisis. It’s an epidemic that affects both political parties, Republican, Democrat, rich people, poor people, it does not discriminate,” Colbert said in the segment. “And a lot of people blame Big Pharma, but only because it’s their fault.”

Colbert went on to single out Purdue Pharma, which manufactures OxyContin and is owned by members of the billionaire Sackler family. Colbert discussed the various lawsuits against the company accused of downplaying how addictive the medication could be “even as their sales reps used the words ‘street value,’ ‘crush’ and ‘snort’ in the late nineties.”

“That’s what happens when the head of sales is El Chapo,” Colbert joked in the segment, referring to the former head of the Sinaloa drug cartel, who is now in U.S. custody.

In 2007, Purdue was fined more than $600 million after pleading guilty to misrepresenting OxyContin’s potential for abuse.

“You know you’ve been bad when the government fines you one aircraft carrier,” Colbert stated. “Of course, this same time they made $35 billion.”

He went on to add that the Sackler family wants to expand globally and that they already own a lesser-known company called Rhodes Pharma.

Colbert stated, “It was revealed just this week that they own a second, secret company, Rhodes Pharma, a little-known Rhode Island-based drug maker that is among the largest producers of off-patent generic opioids in the U.S.”

Colbert went on to discuss the fact that Rhodes Pharma recently was granted a patent for a new medication—a “fast-acting form of buprenorphine”—that could potentially treat opioid use disorder. The new medication would be in wafer form rather than a tablet, meaning it would dissolve quickly and work faster.

“Another not-so-fun fact about Rhodes Pharmaceuticals is, in addition to selling all these off-brand opiates, they also just patented a new drug to help wean addicts off opioids,” Colbert said.

“So, the Sacklers addicted the country to opioids, now they’re going to profit off the cure?” Colbert noted. “That takes a pair of swingin’ Sacklers.”

View the original article at thefix.com

18 September 2018