Tag: opioids

Why Some Pharmacies Still Fail To Carry Naloxone

Though many states have passed laws to expand naloxone access, some pharmacies have been too slow to get onboard with carrying the life-saving medication.

According to new research, expanding access to naloxone still has room for improvement.

Two new studies that surveyed pharmacies in California and Texas suggest that access to the opioid overdose “antidote” is still not optimal, despite the passage of laws across the U.S to expand naloxone access.

Both California and Texas have passed laws that allow pharmacists to dispense naloxone without a prescription. But some pharmacies are still not on board with the new policies.

“There is still significant room for improvement with regards to making this potentially lifesaving medication available to patents who need it,” said one researcher.

Just 23.5% of retail pharmacies in California were dispensing naloxone sans prescription two years after the new policy was established. Dr. Talia Puzantian and Dr. James Gasper, who co-authored the research, say this may be due to a lack of training, stigma about substance use, and time, according to Family Practice News.

In Texas, 83.7% of pharmacies surveyed said they would dispense naloxone without a prescription, while 76.4% said they currently stocked naloxone.

The benefit of increasing access to naloxone—not only to first responders and medical providers, but the public—is to save lives, says Texas study lead Kirk Evoy of the University of Texas at Austin College of Pharmacy and University Health System in San Antonio.

“Being able to administer naloxone immediately, while waiting for emergency medical services to arrive, greatly increases the chances of survival and reduces the risk of long-term negative health consequences, because the body cannot last long without oxygen,” Evoy said.

Improving access to naloxone is just one way to lessen the death toll of the opioid crisis.

The total number of drug overdose deaths in 2017 is projected to exceed 72,000, according to the Centers for Disease Control and Prevention (CDC).

“I do not know how many of these people overdosed alone,” says Dr. Seth Landefeld of the University of Alabama at Birmingham in an editorial accompanying the research. “But ready availability of naloxone would undoubtedly have saved many lives.”

While all 50 states and the District of Columbia have enacted some form of a naloxone access law, all but Nebraska allows for a pharmacist to dispense the drug without a prescription, according to PDAPS (Prescription Drug Abuse Policy System).

Other naloxone access laws include providing immunity from criminal or civil liability for prescribers, pharmacists, and laypeople for dispensing or administering the drug.

View the original article at thefix.com

15 November 2018
Promising New Treatments for Opioid-Dependent Babies

Compassionate care for the mothers was crucial to positive outcomes for opioid-dependent babies.

I gave birth to my daughter in late January of 2014. It was the kind of birth you see in the movies—the contractions started hard and grew closer together within moments. By the time I realized I was in labor, I was already in too much pain to walk. I began needing to push while my husband was on the phone calling for an ambulance. The 911 operator had to walk him through the beginning of my daughter’s delivery. Luckily, paramedics showed up to take over while she was still crowning. The lieutenant who delivered her said it was her first completed childbirth. I will never forget holding my newborn daughter in the elevator while we rode down to the ambulance, or how the entire labor and delivery staff burst into applause when we wheeled into the hospital. But the joy and pride of my wild, badass childbirth was quickly replaced by a deep sense of guilt.

Within hours, my daughter began showing symptoms of opioid withdrawal—symptoms like rigid limbs, sneezing, and a sharp, screeching cry that burrowed into my belly and filled me with self-loathing. The withdrawal was from methadone, which I was prescribed and taking under a doctor’s supervision. Methadone has been the gold standard of care for pregnant people with opioid dependencies since the 1960s. I did the right thing. Still, watching my newborn daughter go through withdrawal was excruciating. Unfortunately, the treatment she and I received at the hospital—after that initial congratulatory applause—did not make the experience easier.

My daughter’s level of discomfort was rated using the same system used by the majority of U.S. hospitals. It’s called the Finnegan Neonatal Abstinence Scoring Tool (though its inventor, Dr. Loretta Finnegan, notes with a laugh that her name was tacked onto it later without her knowledge). It consists of a comprehensive list of observable newborn withdrawal symptoms. Hospital staff, usually treating nurses, observe the babies every four hours and tally up the number of listed symptoms they observe. Each symptom is a point, and the overall score for that observation period is used to determine how to move forward with treatment. Usually a score above eight means the infant should begin an opiate wean, or have his dose raised if he has already been started on medication.

The scoring system is the product of meticulous observations recorded by Finnegan in the early 1970s, when babies were dying from opioid withdrawal simply because nobody knew how to define and treat it. But in 2014, when my daughter was subject to it, and when her scores caused her to be sent to the Neonatal Intensive Care Unit (NICU) to be medicated with titrated doses of morphine for over a month by staff who were less than welcoming to me, I resented the Finnegan Score. Other methadone and buprenorphine-dependent mothers whom I have spoken with have related similar discontent with the system. Usually, the complaints center around variability between the way that different nurses score the babies, or at having their babies sent to the NICU. It turns out, the way some of these hospitals use the scoring system is not in keeping with best practice, according to its creator.

Loretta Finnegan, who is now the Executive Officer of the College on Problems of Drug Dependence, says that inter-rater reliability is key to correct usage of the tool, and recommends that hospitals which use it conduct re-orientations “a minimum of every six months.” She also doesn’t believe that the modern NICU set-up is appropriate for babies who are experiencing NAS without other complications. In fact, she says that “the NICU is the worst place for these babies,” because of the overstimulation caused by the noise and bright lights. Finnegan puts out a training manual, and gives recommendations for the care of infants include swaddling, non-nutritive sucking, decreased stimulation, and plenty of access to mom. When she was doing her clinical work in Philadelphia, she says they “had [their] moms come in every day,” and that “compassionate care for the mothers” was crucial to positive outcomes for the babies. If I had received treatment more in line with Finnegan’s protocols, I probably would have resented the scoring system—and my daughter’s extended hospital stay—a lot less, and I suspect that other mothers would agree.

But besides providing better training to staff who are using the current standard NAS protocol, there are a couple of promising new tools for NAS that could help decrease hospital stays for infants, and promote better trust between parents and hospital staff. One of these tools, developed by Matthew Grossman, M.D., an assistant professor of pediatrics at Yale School of Medicine, is called “Eat, Sleep, Console.”

Renee Rushka gave birth to her daughter in July 2018, while taking methadone prescribed for opioid addiction. Her daughter was treated for NAS at Danbury Hospital in Connecticut. She says that they used the Finnegan NAS Scoring System to assess her baby, but they also performed another form of assessment. Although she says she never heard the term “Eat, Sleep, Console,” and she can’t remember the exact measures, she describes a protocol that sounds very much like the system first developed and researched by Grossman in 2014.

Grossman’s system essentially measures exactly what the name implies—whether the baby is eating at least one ounce of milk, whether the baby can sleep for an hour straight, and whether she can be consoled within 10 minutes of becoming fussy. The protocol suggests maternal contact and non-pharmacological approaches whenever possible. Pharmacological intervention is indicated based on the infant’s level of functioning and comfort, rather than with the goal of reducing all withdrawal symptoms. According to Grossman’s trial conducted at Yale New Haven Children’s Hospital, only 12% of infants required morphine therapy, as opposed to 61% using the Finnegan system (though the study does not tell us whether they used it the way Finnegan herself recommends), and it significantly reduced the length of stay for many of the babies.

Rushka reports that her experience with the combined Finnegan and ESC-like approach was extremely positive. She brought her baby home, healthy, after five days, having required zero medication intervention. She also notes that she did not feel judged by the staff, and even recalls receiving compliments and affirmations about her recovery—pointing toward the compassionate, inclusive approach that both Finnegan and Grossman deem crucial to the care of opioid-dependent infants. Finnegan expresses concerns that inter-rater reliability might also be an issue should ESC become more wide-spread, in part because of the design simplicity. But she’s definitely in favor of various treatments being designed for NAS. “In most diseases there are many ways to treat them,” she notes, adding, “I just need to see more proof [that ESC works.]”

Another promising new tool for treating NAS takes a surprising form. It’s a crib called SNOO, whose designer was not initially thinking about NAS at all—his goal was to reduce Sudden Infant Death Syndrome (SIDS). Pediatrician Harvey Karp says that the crib can not only sense when a baby is in distress, but also what level of distress he’s experiencing—and will rock and emit soothing sounds to help calm the baby, similar to a human caregiver, but all while the real caregiver gets some much-needed rest. Karp says that “NAS babies are more skewed to the irritable side,” then, “the more sciencey way of saying it is that they have poor state control…basically you take a child with terrible state control and give them the rhythmic stimulation they need to get down to a calmer state…it’s so important to our neurology that even adults calm down this way; it’s not an accident we fall asleep in planes, trains, and cars. It’s an echo to this ancient, ancient response to the normal womb sensation.”

Currently, Mark Waltzman, Chief of Pediatrics at South Shore Hospital in Boston, is conducting a study to test the efficacy of the SNOO in reducing distress in babies with NAS. He’s also using Grossman’s Eat, Sleep, Console tool to assess the babies’ level of discomfort. Waltzman’s study is still enrolling, so there’s no data available yet, but he is hopeful that SNOO will offer a relatively simple, non-pharmacological approach to treating the discomfort associated with NAS.

It has been almost five years since my elder daughter was treated for NAS. Mothers across the country still report complaints similar to the ones I had then—but there are also moms like Rushka who are finding community and support in the hospitals where their babies are being treated. Regardless of the outcome of Waltzman’s SNOO trial, or further testing for Grossman’s Eat, Sleep, Console tool, the fact that this kind of diverse attention is being paid toward NAS—and alongside it a resurgence of the compassion toward the mothers that Finnegan first championed in the 70s—gives me a sense of much-needed hope. Maybe attitudes about addiction are making a positive shift within the medical community. Maybe, in the future, experiences like mine will be obsolete, and all opioid-dependent mothers and infants will have the compassionate care and affirmative respect enjoyed by Rushka and her daughter.

View the original article at thefix.com

14 November 2018
Teen Drug Use Drops In Ohio

A local prevention expert credits greater awareness, media attention and personal tragedies for the decrease.

There’s some good news out of Ohio, as a new survey indicates teen prescription painkiller and heroin use are on the decline.

According to the Cincinnati Enquirer, the numbers come from a survey administered every two years by PreventionFirst, a nonprofit with the goal of stopping teen drug use before it begins.

“2018 is the lowest I’ve ever seen it,” Mary Haag, president and CEO of PreventionFirst, told the Enquirer.

The survey involved almost 33,000 students in grades 7-12 from both private and public schools in the greater Cincinnati area.

According to the findings, 2.4% of surveyed students reported using any type of prescription drugs in the 30 days prior to the survey, and 0.3% reported using heroin in that same timeframe. In comparison, in 2012, 6.5% reported using prescription pain pills and 1.8% reported heroin use.

Haag tells the Enquirer that these numbers are encouraging and she credits greater awareness, media attention and personal tragedies for the decrease.

However, the survey did raise some concerns when it came to alcohol and marijuana. According to the results, in the 30 days before the survey, 13.7% of students reported using alcohol and 8.1% reported using marijuana.

Another recent survey, the CDC’s 2017 Youth Risk Behavior Survey, also asked questions about teen opioid use. This survey asked whether students had ever misused prescription opioids and the number answering yes was higher, at 14%.

Nancy Brener, lead health scientist for the Centers for Disease Control and Prevention’s Division of Adolescent and School Health, tells the Enquirer that this response is concerning. However, the same survey also showed a decrease in overall drug use in teens.

“I think it’s important to understand that we have made progress,“ Brener noted.

The survey also indicates that those who do not smoke cigarettes or use alcohol, illegal drugs or prescription drugs by age 21 are “virtually certain never to do so.”

According to Marc Fishman, medical director of Maryland Treatment Centers and assistant professor at Johns Hopkins University Department of Psychiatry, tells the Enquirer that it’s vital that treatment centers be willing to treat all types of substance use disorders in teenagers.

“We need more treatment,” Fishman told the Enquirer. “Treatment of cocaine-use disorder. Treatment of alcohol-use disorder. Treatment of marijuana-use disorder.”

“The vast majority of people with opioid-use disorder start with non-opioid use,” Fishman added. “Most of them don’t progress, but almost all of the cases of opioid-use disorder started there.”

View the original article at thefix.com

14 November 2018
Artie Lange Ready For Sobriety: "It’s Been Long Enough"

“I’m about to take a big step to help myself, to save my life. I’m sure you will hear about it. I feel like I’m not done. I have another run of laughing with you all.”

Comedian Artie Lange seems ready for a change.

Now 51 years old, his health fading, Lange appears ready to commit to sobriety. And it begins with a treatment program.

“I’m about to go into drug treatment and commit to a full rehab, in-patient,” he said in a recent interview on The Steve Trevelise Show. “I don’t know. I’m a very humble guy at this point. And I think I”m ready to go and do what I gotta do. It’s been long enough.”

With Kevin Meara walking him through the process, Lange is ready to receive help. This time he’s hoping it will stick. Meara is the co-chair of City of Angels, a Groveville, New Jersey-based organization that provides interventions, recovery support, counseling services and more at no cost.

Lange did not expect to live past 25, he said in a previous interview. He was 37 at the time fellow comedian Mitch Hedberg died at the same age of a drug overdose in 2005.

“When I heard [Mitch] died, I had such guilt and said to myself, ‘God, if I was a better person I would have just said, you know what, the heck with the Stern show, forget Caroline’s.’ I should have grabbed him and said, let’s go to the hospital right now. Let’s get detoxed and get better right now,” Lange said on The Steve Trevelise Show.

“But Mitch was the kind of guy who openly said—he was so far gone—[that] he goes, ‘Guys, don’t try to help me. I wanna do heroin ’til I die.’ And that’s a mindset that people get into because they’re so afraid of not being on it that you lose sense of reality. It just is so sad to think of that. And even that didn’t stop me.”

When Trevelise asked if Lange can see himself getting to this point, he replied, “I hope not. I don’t think so. I don’t think I’m even close to there yet.”

Lange, who said in a previous interview that his fading health is starting to worry him, does not want to end up like Hedberg or Greg Giraldo, another comedian who died of a drug overdose in 2010. He was 44 years old.

“I get nervous now, because now I wanna live. Now I do care about it, and I think that maybe I’ve done too much damage,” Lange said to NJ Advance Media in July.

The day after his recent interview on Nov. 5, Lange tweeted some uplifting words to his followers: “I’m about to take a big step to help myself, to save my life. I’m sure you will hear about it. I feel like I’m not done. I have another run of laughing with you all. I want to thank you fans the way you thank me. You have saved my life. You are special to me. Wish me luck.”

View the original article at thefix.com

13 November 2018
How The Situation's Wife Helped During His Journey To Sobriety

“She’s definitely my better half and the reason why I strive to be the best version of myself and to fight for our future,” the reality star says.

With the popularity of Jersey Shore, Mike “The Situation” Sorrentino has become a reality TV fixture. He battled a painkiller addiction in the public eye, and now he is a recovery advocate, speaking candidly about his own experience.

Now Sorrentino’s wife, Lauren Pesce, has been credited with helping Sorrentino stay sober, even as he’s preparing to serve an eight-month jail sentence for tax evasion, which is set to begin on January 15.

As People reports, Sorrentino and Pesce met in junior college and dated for about four years. The couple took a break from each other during the Jersey Shore heyday, then got back together once the show had ended.

Pesce has had to endure a lot as Sorrentino’s significant other, including witnessing his fight for sobriety. Having battled an addiction to painkillers, Sorrentino is reportedly nearly three years sober after two visits to rehab—the first in 2012 and the second in 2015.

As a practicing Catholic, Pesce said she relied on her faith when Sorrentino needed help.

“It’s not so much just going to church,” she says. “It’s finding my belief, that God has a reason for everything, and knowing you’re able to overcome anything as long as you have your faith and trust in God. That’s what I did, and Mike really came into that as well and found his own spirituality.”

Pesce adds, “What I dreamed of, the expectations I had set for him, him getting healthy and sober—I didn’t know that our relationship would survive had those miracles not happened, and they did. He put in the hard work and thanks to the faith in God that we have, we’re in the position we’re in today.”

Sorrentino called Pesce “my better half and the reason why I strive to be the best version of myself and to fight for our future.” Sorrentino also wants to be “a good example to her, her family and everyone watching—because my life has been under a microscope. I have a lot to prove.”

Right before Jersey Shore returned to MTV in April, Sorrentino hit a 28-month sober milestone the month before.

He told Entertainment Tonight, “I’m very proud, it’s one of my finest accomplishments and it was a huge challenge. It’s a ‘one day at a time’ thing and [I’m] just showing people that it’s very possible.”

Sorrentino also showed off his two-year Narcotics Anonymous medallion in an Instagram post: “28 months clean and sober. We do recover.”

View the original article at thefix.com

6 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
How to Taper Off Suboxone: A Survival Guide

“Fear is common and normal for a number of reasons, but the fear usually gives way to a sense of confidence and optimism when a taper is done correctly…Be patient.”

Note: This article is not intended as a replacement for medical advice. This is merely the experience of 21 people interviewed by the author who have successfully tapered off buprenorphine-based medications (Suboxone, Zubsolv, Bunavail, Subutex, etc.) or significantly reduced their dose. Please consult your doctor before beginning a taper.

After two and a half years of taking Suboxone, I’ve decided that it’s time to start the tapering process. I don’t like having to rely on this little orange film strip each morning to get out of bed, the tidal wave of nausea, being constantly hot, the restless legs, and the constipation. This is an incredibly difficult decision because Suboxone has saved my life. Additionally, studies have demonstrated the effectiveness of Suboxone and found it’s reduced overdose death rates by 40 percent.

Some people decide that it is best for them to take Suboxone for life. Shannon has been taking 16 milligrams of Suboxone for 17 years and has no intention of tapering. She said: “I’m never getting off, why fix something that isn’t broken? I love life now. I’m a great mother, wife, daughter, sister, aunt, and trustworthy friend to all those that know and love me. I have absolutely no shame being a lifer. I’ve been to the depths of hell and now I’m in heaven. I believe without subs, I would be dead.”

Like Shannon, fear of relapse and withdrawals makes me terrified of coming off Suboxone. I imagine waking up panicked and glazed in sweat, running to the bathroom to puke and worst of all, the black hole of depression and existential dread that is common with opioid withdrawal. These are common fears for people coming off opioid addiction treatment medications. In order to help others like me who are interested in tapering, I researched this topic and surveyed 21 people: 13 have successfully tapered off Suboxone and eight have significantly lowered their doses and are currently at or under six milligrams per day.

Slow Taper

Sixteen of 21 people I surveyed reported using a slow taper to come off or lower their dose. Dr. Jeffrey Junig of the Suboxone Talk Zone Blog suggests that the optimal dose to “jump” or quit taking Suboxone is .3 mg (about 1/3 of 1 mg).

Junig writes: “I have had many patients taper successfully off buprenorphine. Fear is common and normal for a number of reasons, but the fear usually gives way to a sense of confidence and optimism when a taper is done correctly…Be patient. Tapering by too much, or too quickly, causes withdrawal symptoms that lead to ‘yo-yos’ in dose.”

Amanda* agrees with Junig’s advice not to try to jump from too high of a dose. She said that when she jumped from 2 mg cold turkey it was “40 days of hell.”

To avoid a hellish experience like Amanda’s, Junig advises reducing your dose by 5% or less every two weeks or 10% every month. Sound confusing? Junig simplifies: Use scissors to cut half of an 8 mg film. Then cut half of that, then half again. Put the doses in a pill organizer so they don’t get lost or accidentally consumed by children or pets.

Holistic Remedies

There are a handful of holistic remedies that can help with the tapering process. Folks I surveyed said that yoga, meditation, and healthy eating are pillars of their recovery. Studies have confirmed the benefit of yoga for improving quality of life in those withdrawing from opioids as it alleviates anxiety, restless legs, insomnia, and even nausea.

Sarah said: “I tapered with a clean diet with digestible nutrient-dense food and smoothies and stayed hydrated. I got plenty of sun, used yoga and exercise too.”

Others recommended vitamins and other supplements including: L-Tyrosine, DLPA, Vitamin C, Omega 3 Fish Oil, and ashwagandha. They used melatonin for sleep and Kava tea for relaxation. (Consult your physician before taking any supplements. Even benign substances may interact with other medications or have unintended side effects.)

Marijuana

Four out of 21 people polled used marijuana to deal with the difficult side effects of tapering off Suboxone. Barry said: “I know that some people may not see marijuana as a way that should be used to taper, but for me I was desperate to try anything that worked. I consider marijuana a lesser of evils. It helped with restless legs, nausea, pain, and anxiety.”

Marijuana may now be a viable option for those who wish to try it, because it’s now legal for medical use in 29 states and for recreational use in nine states plus Washington DC. Unlike opioids, marijuana provides pain relief with a lower risk of addiction and nearly no risk of overdose. Plus, comprehensive studies like this one from the American Pain Society found that medical cannabis use is associated with a 64 percent decrease in opiate medication use.

While studies have supported the use of marijuana to reduce opioid use, further research needs to be done as reported in the The Daily Beast. Dr. Junig also advises that patients should not start new mood-altering, addictive substances in order to taper off Suboxone.

CBD Oil

Three of the Suboxone patients polled were able to taper with the help of cannabidiol, also known as CBD oil. Experts emphasize the distinction between marijuana and CBD oil: CBD oil is not psychoactive, meaning that it doesn’t make patients feel “high” like the THC in marijuana. CBD oil may be a more viable option for people in states where marijuana has not been legalized and also for those who do not want mood altering affects, but strictly relief from physical symptoms. “I used CBD oil during the taper because pot isn’t legal in my state and it helped with restless legs, sleep, and anxiety,” Pablo said.

A 2015 study in Neurotherapeutics examined the therapeutic benefits of cannabidiol as a treatment for opioid addiction. They found that CBD oil is effective in reducing the addictive properties of opioids, mitigating withdrawals, and lessening heroin-related cravings. Specifically, it relieved physical symptoms such as: nausea, vomiting, diarrhea, runny nose, sweating, cramping, muscle spasm. Additionally, it treats mental symptoms like anxiety, agitation, insomnia, and restlessness. The study states CBD oil is effective with minimal side effects and toxicity.

Kratom

In our survey, the people who tried kratom claim that the herb is a controversial yet effective way for tapering from Suboxone. Some experts agree. According to the Mayo Clinic: “In Asia, people have used kratom in small amounts to reduce fatigue or treat opium addiction. In other parts of the world, people take kratom to ease withdrawal, feel more energetic, relieve pain, or reduce anxiety or depression.”

Four of the individuals surveyed used kratom for tapering off Suboxone. Christine said, “I was very tired when coming off Suboxone, so kratom helped give me the energy to work, clean my house, and take care of my kids.”

Cristopher R. McCurdy, PhD, a professor of medicinal chemistry at University of Florida’s College of Pharmacy in Gainesville, studies kratom. McCurdy told WebMD: “I definitely believe there is legitimacy to using kratom to self-treat an opiate addiction.”

Despite these positive reviews, the Mayo Clinic and Web MD caution that kratom can also lead to addiction and withdrawal. According to an article on WebMD, “There’s little research on the herb’s effects on people, and some experts say it also can be addictive. The herb is illegal in six states and the District of Columbia, and the Drug Enforcement Administration is considering labeling it as a Schedule I drug…For now, the agency calls it a ‘drug of concern.’”

Pharmaceutical Remedies

Five of the people surveyed said that they tapered with the support of medications prescribed by their doctors to treat individual withdrawal symptoms. It is best that patients talk with their doctors and addiction professionals to see if a particular medication is right for their situation.

Happy tapering! I plan on writing more in the future about my experience and progress tapering off Suboxone. If you’re embarking on this journey, I wish you luck!

The names of some individuals have been changed to respect their privacy.

Have you successfully tapered off Suboxone or methadone? Or are you a “lifer” like Shannon? We’d love to hear your thoughts, experiences, and tips in the comment section.

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