Tag: opioids

Cher's Houseguest Arrested For Allegedly Selling Illicit Fentanyl

Cher was on tour in Australia at the time of the arrest.

Police in Los Angeles descended on the home of Oscar-winning entertainer Cher to arrest a houseguest who was allegedly involved in the sale of fentanyl that resulted in an overdose death.

Law enforcement executed a search warrant at Cher’s Malibu home on September 27 and arrested 23-year-old Donovan Ruiz whom officials said was living at the residence.

A spokesperson for the Ventura County Sheriff’s Office said that Ruiz was arrested for a “narcotics overdose that occurred within the last two weeks.” Cher was on tour in Australia at the time of the arrest.

Some media sources have alleged that Ruiz is the son of Cher’s longtime assistant, though this has yet to be verified by police.

What is known, according to a press release from the Ventura County Sheriff’s Department, is that law enforcement from the Ventura County Sheriff’s Interagency Pharmaceutical Crimes Unit had been conducting a narcotics investigation into Ruiz for a period of two weeks prior to the arrest, and that Ruiz allegedly sold fentanyl to “many users in Ventura County,” including a Thousand Oaks resident who later died from an overdose in mid-September.

As numerous media sources reported, police served a search warrant at Cher’s home in the afternoon of the 25th. Witnesses saw several patrol cars and first responder vehicles at the residence, which initially prompted concerns about the singer’s health.

The Blast reported that Ventura County had contacted the Los Angeles County Sheriff’s Department to inform them of their intent to conduct a search on the premises in regard to a drug-related offense.

Detectives reportedly seized evidence that was allegedly linked to Ruiz and sales of an “illegal controlled substance.” Ruiz was subsequently arrested and charged with the sale of such a substance, but again, according to The Blast, additional charges related to the overdose could be expected.

Ruiz’s bond was set at $500,000, and it remained undetermined if he would make bail prior to his arraignment in Ventura County Superior Court at 1:30 p.m. on October 1. The Blast cited sources that said that Ruiz was a “good person” who would never “sell drugs that would kill someone.”

At the time of the incident, Cher was slated to perform at shows in Brisbane, Australia.

View the original article at thefix.com

2 October 2018
Organ Donations Increase As Opioid Overdose Deaths Climb

“Some refuse due to the stigma but when posed with lifesaving transplants in very sick people, that refusal rate for a quality organ is low.”

The number of Americans waiting for organ donation is dropping for the first time in 25 years, in part because there are more organs available for donation from people who have died of a drug overdose.

“We started noticing the increase in overdose deaths in 2012,” Alexandra Glazier, director of New England Donor Services, which coordinates organ donation, told Vox. “Although it has a silver lining, in terms of its impact on organ availability, or at least it has in our region, it’s still not something we hope continues.”

“Those people are better off here, having fought their battles with drugs and won, for their families and for their kids,” said Daniel Miller-Dempsey, a family services coordinator with New England Donor Services. “It’s heartbreaking to know that so many people are dying from this.”

However, organ donation can provide a small silver lining for family members left behind. When David Maleham lost his son Matt to opioid overdose, he was not surprised. “It was a call I had dreaded for years,” he told Vox.

Matt was in the hospital and his driver’s license indicated that he was an organ donor. Eventually, Maleham and his wife received a letter from the man who received Matt’s organ and felt a connection to his story. Maleham said that knowing his son’s donation gave this man a second chance at life eased the sense of loss.

“If it weren’t for that, what a waste. What a pointless death. What did that accomplish?” he said. “The answer would have been nothing.”

The medical community has also become more willing to accept donations from so-called high risk donors. Federal law now allows donations from HIV-positive individuals. However, many people who die from opioid overdoses don’t have a long history of drug use.

Most people who are in dire need of a transplant do not mind having an organ from someone who died from drug overdose.

“Some refuse due to the stigma,” said Jay Fishman, who co-directs the transplant program at Massachusetts General Hospital, “but when posed with lifesaving transplants in very sick people, that refusal rate for a quality organ is low.”

View the original article at thefix.com

1 October 2018
Opioid Crisis At Forefront As Midterms Approach

Politicians are eager to offer their take on the crisis, in hopes of connecting with constituents who have been affected by it.

As November fast approaches, those on Capitol Hill know that the opioid crisis is an issue voters are taking into consideration.

“We see more and more deaths being attributed to opiates and illicit drugs than ever before. It’s of epidemic proportion and we’re going to lose a whole generation,” said Sen. Joe Manchin of West Virginia during an interview.

With a vote of 99 to 1 on Monday (Sept. 17), the Senate passed a package of 70 bills aimed at opioid prevention and expanding treatment.

According to KATV, those in support of the legislation say it is just the beginning. The bill package would mean increased the screening of packages sent via the U.S. Postal Service, which U.S. Representative Erik Paulsen has been supportive of, according to a blog post by Advanced Medical Integration, a consulting firm.

“While private carriers have to submit electronic data for any of their packages that come into the United States, the postal service has been exempt,” Paulsen stated. “We have a loophole that is being exploited by smugglers.”

The bill package would also mean shorter opioid prescriptions and increased funding for treatment.

“Now we’re able to get money coming to the most addicted areas and that’s gonna be the biggest help to West Virginia,” Manchin stated.

Manchin is in a tight race for his Senate seat. His opponent, Attorney General Patrick Morrissey, states that Manchin did nothing to help the opioid crisis when he served as governor of West Virginia.

“Quite frankly Joe Manchin was governor and I inherited the fact that he was asleep at the switch all while this crisis was raging,” Morrissey said, according to KATV.

However, Morrissey himself has had to contend with some backlash due to his ties to pharmaceutical companies, which he has lobbied for in the past. “Last year I sued the DEA because I thought that their whole drug quota system was fundamentally flawed and it was spitting out in excess hundreds of millions of pills that were not warranted,” Morrissey stated.

Midterms and the passing of the bill package could bring some clarity and direction, according to AMI.

“We have to take some responsibility as a public for we should have recognized it as soon as it reared its ugly head and squashed it then,” the AMI blog post notes. “Now it is out of control. There is hope that one of these programs before Congress will take hold and slowly but surely begin to usher in the change we so desperately need.”

View the original article at thefix.com

1 October 2018
Doctor Stands By Writing More Than 300k Opioid Prescriptions

“I was never charged or ever investigated because I didn’t commit any crimes. I prescribed narcotics to people in pain.”

When Dr. Katherine Hoover was working at a pain clinic in West Virginia between 2002 and 2010, she wrote more than 335,130 prescriptions for painkillers, which breaks down to 130 prescriptions each day, seven days per week.

Despite the outrageous numbers, Hoover recently told NBC News that she stands by her actions and she didn’t do anything wrong.

“I was never charged or ever investigated because I didn’t commit any crimes,” Hoover said in a telephone interview. “I prescribed narcotics to people in pain. I did everything I could to help people have a better life, which I told the FBI. Every prescription I wrote was justified for the person who had gotten it.”

Despite the fact that she practiced in the state with the highest rates of opioid overdose deaths, Hoover sees no connection between her actions and the crisis.

“That’s not because of doctors,” Hoover said. “It’s actually gotten worse since they forced doctors out of business who do their best to treat pain patients. … The first and real problem in our country is the high rate of suicide and the distress people are in. That’s the epidemic that we need to start looking at.”

Hoover began working at Mountain Medical Care Center, a private clinic in Williamson, West Virginia that was reportedly known for easily giving out prescriptions.

Each morning, cash patients would line up outside the clinic, where first-time patients paid $450 to see a doctor, and returning patients paid $150 to the receptionist to write a refill for their prescriptions. In 2009 alone the clinic took in more than $4.6 million in cash, according to court documents.

“They called it ‘Pilliamson,’ instead of Williamson,” Mingo County Prosecuting Attorney Michael Sparks told The Charleston Gazette in 2011. “It was an open secret, you might say.”

In 2010, federal authorities shut down the clinic. The office manager and another doctor who worked at the clinic were charged with crimes including selling narcotics prescriptions, but Hoover was never charged. She received a civil penalty of about $90,000 and reportedly fled to the Bahamas.

Over the past eight years, according to NBC, Hoover has been reportedly elusive with her whereabouts, although she is still engaging in lawsuits, including with a dry dock company that she says wrecked her yacht.

Speaking with NBC, Hoover said that her doing time in jail would not solve anything.

“We need to stop putting people in jail,” she said. “Our jails are full of innocent people. This needs to be addressed as a public health problem. Everybody in our society is addicted to something.”

View the original article at thefix.com

28 September 2018
Prince’s Half-Sister Talks About His Death, Fentanyl

Sharon Nelson says the music icon was just trying to control his pain when he took the fatal dose of fentanyl.

First came prescription drugs and heroin. Now, the synthetic opioid, fentanyl, is ripping through the country, killing scores of people who take heroin, cocaine or prescription pills that have been laced with fentanyl.

That’s exactly what happened to Prince, according to his half-sister, Sharon Nelson.

Speaking with ABC News correspondent Bob Woodruff for a 20/20 segment that will air Friday night, Nelson said that her brother was just trying to control his pain.

“He wouldn’t have taken a pill like that at all,” Nelson, Prince’s oldest sister, said in a preview released by ABC. “When you’re in pain, you’re going to take a pill, hoping it relieves it. You’re not thinking like that; you’re not thinking like a normal person who isn’t in pain.”

Woodruff said that Prince’s death made fentanyl a household name and raised awareness about the drug.

“This is kind of a wakeup call for people around the country about the power and danger of these pills, from a man who—no chance given his intelligence and position in life—would never have taken a pill with so much fentanyl,” Woodruff said.

Fentanyl can be used in a medical setting to control severe pain. However, toxicology reports showed that the levels of the drug in Prince’s blood when he died in April of 2016 were extremely high and were a “smoking gun,” as to his cause of death.

“The amount in his blood is exceedingly high, even for somebody who is a chronic pain patient on fentanyl patches,” Dr. Lewis Nelson, chairman of emergency medicine at Rutgers New Jersey Medical School, told the Associated Press earlier this year.

However, there are reports that the singer thought that he was taking Vicodin, not fentanyl pills. Nelson said the fact that her brother, an experienced opioid user, died from an overdose shows how dangerous fentanyl is.

She said she hopes fans will realize that fentanyl is extremely dangerous and that it can be lurking anywhere—even when people think they know what drugs they are taking.

“After all that’s happened to Prince, I know, I can say for sure that his fans will never take that pill,” she said.

The episode of 20/20 that Nelson appears on is focused on fentanyl, including investigating the source of illicit fentanyl from China and speaking with families who have lost loved ones to fentanyl overdose.

View the original article at thefix.com

28 September 2018
Overdose Deaths Increase in New Jersey Even As Prescriptions Decline

State attorney General Gurbir S. Grewal says that despite the fatal OD increase “there are reasons for hope.”

Opioid overdose deaths in New Jersey increased by 24% last year, even as the number of prescriptions written for opioids fell for the first time in recent years.

According to a press release from the state attorney general’s office, just over half of opioid overdose deaths in the state were caused by fentanyl and other synthetic opioids meant to mimic its strength.

“We still lose too many of our residents to drug overdoses, and the death toll continues to rise,” said Attorney General Gurbir S. Grewal. “But, if we look at the numbers, there are reasons for hope.”

Despite the fact that an average of eight New Jersey residents die from an opioid overdose each day, Grewal said that policies to limit prescriptions of opioids are working. The state’s opioid prescription rate peaked in 2015, when 5.64 million opioid prescriptions were dispensed.

By 2017, that number was down to 4.87 million, making last year the first “in recent memory when the number of opioid prescriptions fell below 5 million,” said the press release.

In March 2017, the state enacted a five-day limit on first-time opioid prescriptions. Since then, prescriptions of opioids have decreased 26%.

Between January 2014 and March 2017 they were reduced just 18%, so this suggests a significant improvement in cutting back on opioid prescriptions. Overall, opioid prescriptions have been reduced by 39% between January 2014 and July of this year.

“The decreasing rate of prescription opioids dispensed in New Jersey shows that a smart approach to the opioid epidemic can help turn the tide. If we persist in our efforts to prevent addiction and overdoses, we can save lives,” said Sharon Joyce, director of the Office of the New Jersey Coordinator for Addiction Responses and Enforcement Strategies (NJ CARES).

In order to try and decrease the opioid overdose rate, the state will begin offering more information online, including data on naloxone administration rates and overdose rates for specific counties.

“The Attorney General is not only making his Department’s opioids data publicly available,” the press release said. “Through NJ CARES, the Department is relying on data to target its education efforts and identify its enforcement priorities.”

The administration is also focusing on outreach efforts, including an ad campaign to highlight a safe disposal program for unused prescriptions.

And the musical Anytown will be performing at middle and high schools across the state to raise awareness about the dangers of opioids.

View the original article at thefix.com

27 September 2018
God Hates Pikachu and He Also Killed My Daddy
My higher power doesn’t want me sticking a needle in my arm. For me today, it’s as simple as that.

I didn’t want to unpack this story so soon. My aim was to share my experience with getting and staying sober in a dry and witty way, do that for a while with you, maybe unpack the heavy stuff after we got to know each other a little more, and then go for the gusto. I didn’t want to bring up a subject that might rub you the wrong way but I recently finished a writing exercise that really got me thinking about my dad. He’s dead.

My father died when I was two years old. He was a heroin user who shared needles. Nobody was talking about harm reduction in the late 80’s nor were they concerned about the consequences of IV drug use. After he got sober, he found out that he had contracted HIV. It wasn’t long after that diagnosis that he lost his battle to AIDS.

I believe growing up without a father had an effect on the man I am today; but this isn’t a story about my dad. This isn’t a story about harm reduction or AIDS awareness. This is a story about God.

Wait! Stay with me, please. Don’t go.

I promise you this isn’t that kind of story. I’ve done right by you with the last two articles. I plan on doing the same with this one. I know the God word bothers some people. It bothers me sometimes. It’s okay, just keep scrolling. We’ll do this one together. Besides, you have to at least get to the part about Pikachu. I’m sure you’re wondering what the heck he’s got to do with all this. Stick around, I’ll tell you.

I grew up in an extremely charismatic religious household; the crazy dogmatic type. Let me tell you how crazy: Did you know that if you listen to any music that isn’t religious, demons will literally fly out of your headphones like a vapor of smoke and possess you? It’s true. My aunt told me that when I was only eight years old. Also, if you watch any movie that isn’t rated G or about the crucifixion of Christ, you run the chance of committing your soul into the fiery pits of hell. Here’s a good one: My younger brother and I were not allowed to watch Pokemon because our grandmother told us that those cute little Japanese cartoons were actually demons and it was Satan’s master plan to trick unassuming kids into falling in love with his minions.

Here’s a few more examples:
1. Don’t drink beer. You’re ingesting the semen of the devil.
2. True love waits. So if you have sex before marriage, you’re going to burn in hell.
3. Never smoke cigarettes, you’ll accidentally inhale a demon.
4. Don’t use profanity unless you want God to give your tongue cancer.
5. Hey boys, do you like your hands? Well, don’t play with your penis, that’s how you lose them.
Here’s my absolute favorite. When I was kid, my mom brought my younger brother and me to this old-time-holy-ghost Pentecostal church in the hood. The younger children had to go to Sunday school with some 16-year-old babysitter while the adults went to “big church” in the main auditorium. While we were waiting for our mom to pick us up, our babysitter kindly told me that God killed my dad because he was a junkie.

Yup, that’s right. This ignorant girl basically told me that God “gave” my dad AIDS because he was in love with heroin. And it was God’s perfect judgment to execute my powerless addict of a father. Cool, right? I’m going to grow up to be a perfectly normal man, unscathed by any of this tomfoolery.

When you grow up in an overbearing legalistic household and finally start doing some of the things that they told you not to and nothing bad happens, you end up slamming your foot on the gas, speeding straight into the freedom to do everything you’re not supposed to. The things you didn’t do growing up because you believed they would kill you turn into myths created to control you.

This isn’t going to end well for an addict like me. Once I started thinking for myself and realized that my dick wouldn’t fall off if I watch porn, I started watching all the porn. When I realized that I wasn’t possessed after smoking a cigarette, I started smoking all the cigarettes. Add sex to the mix, sprinkle a little drugs on top, and my newfound freedom as a junkie sinner is complete.

Let’s fast-forward a few years because I don’t want to get into other stories that deserve their own headline. Let’s land where I’m walking down the steps of the courthouse with a piece of paper that mandates that I start attending 12-step meetings. Meetings that I must go to or I’m going back to jail and possibly prison.

Imagine my delight, sitting in my first meeting while they’re doing the readings. I hear the 3rd step read aloud for the first time and everything within my gut cringes. I die on the inside. I’m powerless over drugs and alcohol. I can’t stop. I need to stop. And now I’m being told that the only way to do this is with God. I’m in big trouble.

I have a confession to make. Remember when I told you that this story was about God? It isn’t. I mean it is and it can be for you, too, but it really isn’t. It’s about a higher power; something greater than you. It’s crucial that you hear what I’m about to say.

If you’re a 12-stepper who’s all gung-ho about the 3rd step, that’s cool. If you’re not a 12-stepper who’s grasped the God concept, that’s cool too.

What I want to be explicitly clear about is just one thing. It’s my experience, being an addict in recovery— whether it’s the 12-step route or not—that at some point I have to accept the fact that I need saving. And it’s not going to be me that’s going to do the saving. It’s got to be something greater than me. What I’m good at is getting high. Getting sober is easy. Staying sober isn’t. That’s where the saving comes in for me.

In the beginning. G-O-D meant a lot of things.
- Group of Druggies
- Group of Drunks
- Grow or Die
- Guaranteed Overnight Delivery (kidding)
- Good Orderly Direction
A wise man once told me, “I don’t know what God’s will is for my life… but I know what it isn’t.” I know that my higher power doesn’t want me stealing in sobriety. I know I shouldn’t be smoking crack. I know that now that I’m attempting to live a new way, maybe I should concern myself with my physical health since I neglected it for so long. My higher power doesn’t want me sticking a needle in my arm. For me today, it’s as simple as that.

For people who don’t subscribe to an acronym but actually believe in a God, it can be slippery if it’s not kept simple. It’s common for people to get sober and say, “Okay, what do I do know? What is my life’s purpose and what is God’s will for me?” If they do that, they end up stressing themselves out and thinking themselves out of the game, thinking that they have to understand the meaning of life at 12 months sober; or that they should have a roadmap for their life drawn out, down to every little specific detail.

It’s not that serious. Instead of concerning yourself with some huge existential question mark, keep it simple. Get off the bench, get back on the field and play. Before you know it, you’ll find yourself sober years later with a beautiful life filled with purpose and meaning. I can promise you that only because I’ve seen it happen for many of my junkie friends around me.

My higher power doesn’t hate Pikachu. That’s just silly. If you believe in God, that’s cool. If you don’t, that’s cool too. Just find something greater than you when the days get dark in your life. Hey! Maybe it’s this story. Who knows.

If nobody told you that they love you today: I do. I love you.

View the original article at thefix.com
27 September 2018
New Opioid Laws Seek To Curb Overprescribing

Though there is no hard evidence of the effectiveness of the laws yet, some professionals see the numbers as heading in the right direction.

As the opioid epidemic has continued to claim lives, more than two dozen states have put laws in place in the hope of limiting the damage.

Of those two dozen, the most recent states to take action are Florida, Michigan and Tennessee, according to Harvard Health Publishing. The new rules put in place set limits for the amount of opioids medical professionals can prescribe for pain relief from surgery, injury or illness.

Opioid laws vary from state to state, according to Harvard Health. While most states limit first-time opioid prescriptions to seven days, some states, such as Florida, Kentucky and Minnesota, have shortened it to three days unless a medical professional can give reason for a week-long supply.

“For almost all acute pain problems, including after surgery, a week is usually sufficient,” Dr. Edgar Ross, senior clinician at the Pain Management Center at Harvard-affiliated Brigham and Women’s Hospital, told Harvard Health.

Additionally, some states have put procedures in place that require doctors to take more steps when prescribing. In Florida, both physicians and pharmacists are required to take courses about prescribing practices. They must also search a drug database to make sure doctors aren’t doubling up on prescriptions for patients.

Massachusetts has a similar procedure in place, but some medical professionals say it’s not as simple as it sounds.

“We have the ability to check the registry to see who else has prescribed it, but it’s not integrated with electronic records,” Dr. Dennis Orgill, a surgeon at Harvard-affiliated Brigham and Women’s Hospital, told Harvard Health. “If you have someone who needs opioids over the weekend, you can imagine the logistics of that.”

Another new law, this one in Ohio, allows doctors to override and refill acute pain prescriptions, but only after a patient has gone through the first prescription.

According to Harvard Health, patients will typically have to return to the doctor to get a prescription rather than getting a refill on the phone. If for some reason a refill is made over the phone, Harvard Health states patients will end up visiting the pharmacy more often and making more copays as a result.

If doctors do not follow the new laws, they may face consequences. As a result, Harvard Health states some patients that need prescriptions for chronic pain are not getting them.

“Many doctors now refuse to prescribe any opioids because of the fear of sanctions,” Ross told Harvard Health. “I have had several cancer patients whose pain was not well managed because of incorrect perceptions.”

Although there is no hard evidence of the effectiveness of the laws yet, some professionals see the numbers as heading in the right direction.

“Massachusetts’ opioid legislation was signed into law in March of 2016. The overdose death rate then decreased by 8.3% in 2017, the first decrease since the beginning of the opioid epidemic,” Dr. Karsten Kueppenbender, an addiction psychiatrist at Harvard-affiliated Massachusetts General Hospital, told Harvard Health. “While it’s impossible to say the law caused the decrease, it’s certainly a welcome association.”

View the original article at thefix.com

27 September 2018
An Open Letter to Addiction Treatment Providers
There’s something wrong with addiction patients feeling the need to ask for medical advice from their communities because they don’t trust their providers.

Maybe you’re a psychiatrist. Maybe you’re a dosing nurse at a methadone clinic. Maybe you’re an inpatient counselor. Maybe you work in an emergency department, or you’re an OBGYN; maybe you don’t specialize in addiction at all, but you regularly come into contact with people who are struggling with the condition. If you’re a medical professional, and all or some of your clients have a substance use disorder (SUD) diagnosis, this letter is for you.

I am a person in remission from a substance use disorder. I’m here to tell you that addiction patients need you to understand our condition. That sounds basic, I know. It is basic. But here’s the thing: too many of you don’t understand. I’m not trying to attack you. I’m not saying you’re all misinformed. There are unquestionably many caring and well-informed providers doing excellent work in this arena. But it’s also true that enough of you are misinformed to be causing major problems for SUD patients. And that needs to change. Like yesterday.

Right now my husband is white-knuckling his way through methadone withdrawal while his clinic works on getting him safely back on his therapeutic dose after one of you, a behavioral health doctor, rapidly dropped him 100 milligrams without consent, for no medical reason, while he was in the hospital for mental health reasons. And in 2014, my newborn daughter went through over a month of neonatal withdrawal from my prescribed methadone, which could have been prevented or lessened if my pre- and postnatal providers had made a few small changes to their protocols; sadly, this kind of medical treatment is still provided to mothers and infants across the country.

Every damn day SUD patients crowdsource medical information from social media communities and online forums, often due to mistrust in the medical community when it comes to addiction care.

Sara E. Gefvert, a certified recovery specialist who runs the Methadone Information Patient and Support Advocacy (MIPSA) Facebook group, says that she created MIPSA because she saw members of other communities receiving unreliable responses to medical questions. “Many MAT sites and groups I saw were not monitored frequently for correct and accurate content or were only adding to the misinformation and stigma that persons in recovery face, especially being on medication-assisted treatment.”

In just one day, questions asked in five separate addiction treatment-focused Facebook groups included:

What kind of pain relief options are available during labor while I’m on buprenorphine?
Should I raise my methadone dose if I have psychological but not physical cravings?
Is it normal to lose my sex drive while on methadone?
Am I still in recovery if I drink alcohol occasionally?
Can cold-turkey opioid withdrawal kill you?
Is it safe to detox while pregnant?
Can you combine buprenorphine and methadone?
Should my methadone be making me nod out?

And others along those lines.

These are all medical questions with real world consequences—some dire. The answers to these questions should be coming from trusted providers with medical expertise. Sure, people crowdsource medical information from the internet all the time, but it’s usually about pretty mild concerns, or trying to squirrel out whether they should go to a doctor. On the other hand, these addiction specific questions are often accompanied by complaints that the patient couldn’t get a straight answer from her treatment provider, or that the information she received was the opposite of what she read in a research study or an online article. There’s nothing wrong with people seeking community input on issues they’re facing, especially when the answers are reviewed by knowledgeable and professionally trained administrators like in the MIPSA group.

There is, however, something wrong with addiction patients feeling the need to ask for medical advice from their communities because they don’t trust their providers.

This seems to be an especially prevalent issue for medication-assisted treatment (MAT) patients. I was on methadone for about a year in 2013 and 2014, and on buprenorphine from 2014 to June of 2018 (with a short break of about five months in 2016). Before starting methadone, I was actively addicted to heroin for close to five years. In all of that time, I heard a lot of different things from a lot of different doctors, nurses, counselors and detox staff in virtually every region of the country. For example:

Buprenorphine is only good as a detox aid.
Buprenorphine works best as a long-term treatment.

Methadone is more addictive than heroin.
Methadone creates a dependency but effectively treats addiction.

Breastfeeding while on methadone is unsafe.
Breastfeeding while on methadone can help ease neonatal withdrawal.

I can’t count myself sober if I take medication
I’m at an increased risk of relapsing and overdosing if I detox.

Addiction is a disease.
Addiction is a spiritual malady.

How was I supposed to tease out the truth from all that?

With all the confusing and contradictory information that patients receive about addiction, it would be easy for someone to assume that the medical science is still out. In reality, there’s quite a lot of straightforward, peer-reviewed data about substance use disorders. Frankly, there is no excuse for a medical provider to ignore these facts. For example, decades of research have shown that methadone (a long-acting opioid agonist) and buprenorphine (a partial opioid agonist), help deter opioid misuse, decrease the risk of fatal overdose, and may help to correct neurochemical changes that took place during active addiction.

To quickly address some of the other misinformation I’ve encountered:
- Both methadone and buprenorphine treatment are appropriate, and in fact designed, for long-term use. Patients who choose to taper from these medicines can do so safely, but there is no generalized medical reason why someone with an opioid use disorder should be forced off either medication.
- Breastfeeding while on methadone or buprenorphine is considered safe as long as the mother is not using other substances.
- If a patient is using these medicines as prescribed and is not using other substances in a compulsive manner, they are in remission from their substance use disorder. In other words, they’re sober (though defining oneself with the term “sober” is a personal choice).
- Addiction is medically defined as a disease. Which means that the onus is on our medical providers to stay informed about the science of this disease.
Ultimately, you can’t be held responsible for everything your patient does. But you do have a responsibility as a treatment provider to give your patients accurate and informed medical advice.

According to the Substance Abuse and Mental Health Administration (SAMHSA), about 20 million adults in the United States have a substance use disorder. So we’re not talking about some rare condition that only a handful of specialists can be reasonably expected to understand. This is a common, treatable disorder with a robust body of solid research behind it. You need to read that research. You need to stay informed. If you don’t have an answer to a patient’s question, you need to refer them to an accessible colleague who will. You took an oath to do no harm. Staying informed about addiction medicine is part of keeping that oath.

Sincerely,

Elizabeth Brico

View the original article at thefix.com
26 September 2018
Underlying Social Issues May Be Fueling The Opioid Epidemic

“If we solve the [opioid] sub-epidemic, will there be another sub-epidemic that comes on its heels?” asks one expert.

A new study has affirmed that there are underlying social issues when it comes to the opioid epidemic.

The study, published Thursday (Sept. 20) in the journal Science, determined that drug overdose deaths have been increasing since 1979, well before opioid abuse began climbing in the 1990s.

According to researchers from the University of Pittsburgh, this could mean that rising overdose deaths are actually connected to “larger societal problems like alienated communities and an increasingly disaffected population.”

During the study, researchers examined data from about 600,000 deaths categorized as drug overdoses from the National Vital Statistics System. In doing so, they discovered that the overdose deaths “followed an almost perfectly exponential trajectory” from 1979 to 2016.

Researchers found that the overdose deaths doubled about every nine years, and that by 2016 it had increased to one death every eight minutes.

“This smooth, exponential growth pattern caught us by surprise,” Dr. Donald S. Burke, senior author and dean of the University of Pittsburgh Graduate School of Public Health, told ABC News. “It can be hard to grasp what exponential growth really means, but you can think of it as a nuclear explosion: you start with 2 [deaths due to drug overdose], then 4, then 8, then 16, and so on.”

Though the increase in overdose deaths was consistent, researchers did not find that there was any similar predictability when determining deaths from a specific drug.

By utilizing a method called heat-mapping, researchers were able to plot overdose patterns across the country and found that while certain drugs were more prominent in certain areas, nearly every region showed an overdose “hotspot” for at least one drug.

In doing so, the researchers came to the conclusion that overdose deaths have continued to increase even though the use of individual drugs has fluctuated over time.

“It implies that there are other forces at work, besides the specific drugs,” Burke told ABC News. “The forces are broader and deeper than we thought, including social determinants of health and technological determinants of health.”

Burke further explains, “The drugs have become cheaper over the years and their delivery systems have become more efficient… These factors increase drug availability. People are losing a sense of purpose in their lives and there has been dissolution of communities, making people more susceptible to using drugs—increasing demand.”

While Burke agrees that treatment programs and availability of the overdose antidote naloxone are helpful for individuals, he worries that not enough is being done to address the underlying issues.

“If we solve the [opioid] sub-epidemic, will there be another sub-epidemic that comes on its heels?” Burke said. “If we don’t address the social determinants of health that underlie drug use and addiction, there’s a good possibility that the drug overdoses will start to emerge again.”

View the original article at thefix.com

24 September 2018