Answer Addiction

Tag: opioids

  • Stephen Colbert Takes Aim At Big Pharma Over Opioid Crisis

    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

  • New Dosage Strength Of Opioid Addiction Drug Approved By FDA

    New Dosage Strength Of Opioid Addiction Drug Approved By FDA

    The FDA commissioner noted that the approval will expand access for patients and reduce drug development costs.

    The U.S. Food and Drug Administration (FDA) approved a new dosage strength for a maintenance drug for the treatment of opioid addiction.

    Cassipa, which is a sublingual (applied under the tongue) film that combines the opioid treatment drug buprenorphine and the opioid overdose reversal drug naloxone, will now be available in a 16 milligrams/4 milligrams dosage, and according to FDA Commissioner Scott Gottlieb, should be used in conjunction with counseling and therapy.

    The new dosage strength is approved by the FDA in both brand name and generic versions, and in various strengths.

    The approval underscores the agency’s emphasis on greater development of and access to medication-assisted treatment (MAT) for substance use disorder. The full range of MAT is a key element of the U.S. Department of Health and Human Services’ Five-Point Strategy to Combat the Opioid Crisis, and was the focus of guidelines issued to drug manufacturers for evaluating the effectiveness of new or existing MAT products. 

    In a statement issued in April 2018, Gottlieb described the FDA-approved MAT drugs—methadone, buprenorphine and naltrexone—as “safe and effective in combination with counseling and psychosocial support to stabilize brain chemistry [and] reduce or block the euphoric effects of opioids.”

    The FDA has also cited statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA), which found that patients using MAT for opioid dependency have reduced their chance of overdose death by half.

    In addition to its suggested efficacy for opioid use disorder, Gottlieb noted that newer treatment options like the increased dosage strength for Cassipa will not only “broaden access for patients,” but may also “reduce drug development costs, so products may be offered at a lower price to patients” via the agency’s “streamlined approach to drug development for certain medication-assisted treatments that are based on buprenorphine.”

    This approach is the abbreviated 505(b)(2) pathway under the Federal Food, Drug and Cosmetic Act, which allows manufacturers to use the FDA’s findings regarding the safety of their product to grant approval.

    The FDA is advising that Cassipa should be used in conjunction with a complete treatment plan that includes counseling and other support, and should only be used after the patient is introduced to the drug and stabilized up to a dose of 16 mg of buprenorphine using another marketed product. Additionally, Cassipa can only be prescribed by Drug Addiction Treatment Act-certified prescribers.

    View the original article at thefix.com

  • Purdue Pharma Accused Of Targeting Seniors For Oxy Sales

    Purdue Pharma Accused Of Targeting Seniors For Oxy Sales

    The lawsuit claims Purdue had salespeople downplay the harmful risks and side effects of OxyContin.

    Oregon’s Department of Justice claims that pharmacy giant, Purdue Pharma, lied to the state and misled customers to drive sales.

    Oregon Attorney General Ellen Rosenblum filed a lawsuit against Purdue Pharma on Thursday, accusing the company of lying to the Oregon State Board of Pharmacy to obtain permission to sell in Oregon, as well as targeting senior citizens with its products.

    The violations against a settlement with Oregon goes back 10 years, according to a June 27 filing. Rosenblum’s office is demanding Purdue submit to the terms of a 2007 settlement or risk legal consequences.

    In the Thursday filing, Rosenblum’s office is demanding Purdue Pharma pay $1 million and abide by a prohibition against marketing to Oregon’s senior citizens.

    According to the lawsuit, Purdue released misleading publications and had its salespeople downplay the harmful risks and side effects of OxyContin, and specifically targeted disabled and senior citizens.

    Purdue also stands accused of lying in its application to renew its license to sell OxyContin in Oregon, erroneously claiming that the company had not faced state or federal punishment. In the past, they’ve been made to pay fines, and some of its top executives faced charges related to the company’s OxyContin marketing practices.

    “Ten years later, it is clear Purdue has flouted the judgment and ignored the severe federal penalties,” reads the lawsuit.

    Advocates for substance abuse prevention lauded the move, praising it as holding pharma companies accountable, to push them to cooperate in combating the opioid epidemic.

    “My hope is that this action will help establish some accountability and bring them to the table to help solve this,” said Dwight Holton, CEO of Lines for Life. “They ought to be helping us and they haven’t been.”

    Representatives of Purdue, however, disagree with this assessment of the situation.

    “We vigorously deny the state’s allegations,” said Purdue spokesperson Robert Josephson, according to the Oregonian. “The state claims Purdue acted improperly by communicating with prescribers about scientific and medical information that FDA has expressly considered and continues to approve. We believe it is inappropriate for the state to substitute its judgment for the judgment of the regulatory, scientific and medical experts at FDA. We look forward to presenting our substantial defenses regarding this lawsuit.”

    Working to improve its image in the shadow of the opioid crisis, Purdue has eliminated 350 sales positions, closed its “speakers” program that paid doctors and other professionals to sing OxyContin’s praises, and reshuffled its efforts towards researching cancer-fighting drugs.

    However, the opioid crisis has already damaged the state. Oregon saw a spike in opioid-related deaths in this past year, with Oregon’s Jackson County seeing a 70% increase in such deaths in just the first quarter of this year.

    View the original article at thefix.com

  • A Practical and Comprehensive Guide to Finding a Suboxone Clinic

    A Practical and Comprehensive Guide to Finding a Suboxone Clinic

    It took me 10 hours of phone calls, 20 voicemails, 3 chewed fingernails, and many packs of cigarettes before I found a Suboxone provider in my new town. This is the list I wish I had then.

    When I pulled a “geographic” a few years ago, leaving Portland for my home state of North Dakota, I underestimated the stress of starting over. In fact, stress isn’t a strong enough word to describe driving 1,300 miles with my recent ex-boyfriend in the passenger seat and the fear of restarting life without heroin; not to mention I had no full-time job prospect, no health insurance, no apartment, and very few of my possessions. I also had a unique fear that loomed over me like an ominous storm cloud: trying to find a new Suboxone* provider in a rural state. 

    It took me almost ten hours of phone calls, twenty voicemails, ten games of phone tag, three chewed fingernails, and many packs of cigarettes to find a clinic that would dispense the medicine I take to maintain my recovery. 

    Unfortunately, my situation is a common one. Despite our nation being in the throes of an opioid epidemic, finding a Suboxone provider is a widespread problem; only about one-third of addiction rehabilitation programs offer long-term use of methadone or buprenorphine (the active ingredient in Suboxone). And according to the National Alliance of Advocates for Buprenorphine Treatment (NAABT), only about half of all Suboxone providers are accepting new patients.

    Finding this life-saving medication shouldn’t be so hard. When you are committed to getting better, you shouldn’t have to worry about whether or not you’ll be able to find a clinic to dispense your medicine. A person with diabetes wouldn’t have to search hard to find insulin. So I’ve compiled a round-up of tips and suggestions. 

    This is the list I wish I’d had in early recovery:

    1. Find friends and family who are supportive of your Suboxone journey.

    2. Remember that your form of treatment is just as valid as all other types of treatment and recovery.

    Although Suboxone is a widely stigmatized and divisive medication in the recovery community, it has been shown to reduce opioid overdose death rates by 40 percent.

    3. Join online support groups and forums for people on Suboxone.

    Since I lived in a rural area, I couldn’t find any in person groups. So I joined secret social media Suboxone support groups on Facebook, recovery Reddit threads, and peer-support forums such as the Addiction Survivors website and Suboxone Talk Zone.

    4. Allow Plenty of Time to Research, Call, and Locate Providers.

    This was the most daunting and lengthy part of finding a new provider. Dr. Bruce Seligsohn has been a board-certified internist in Southern California for 30 years and practicing addiction medicine for 10 years. Dr. Seligsohn advises: “Patients really need to be very careful selecting a doctor if they have a choice. I would suggest that a patient looking for a new doctor do their due diligence and see what comes up online about the doctor.”

    I have compiled the most current resources available as of August 2018. See the sidebar for a sample phone script for calling providers.  

    Pros: Convenience, ease of navigation. You will be able to easily search for a provider based upon zip code, state, and the distance that you’re able to travel for a clinic.

    Cons: Out of date, inaccurate, not comprehensive. Be prepared for hours of phone calls depending on your location and financial situation. Not all providers are listed on the site. I also found that some of the clinics listed were not accepting new patients, had been closed, or had their numbers disconnected.

    Pros: Ease of navigation, instant results. Similar to the Suboxone manufacturer’s website, this is a good launching point for starting your search based upon zip code, state, and the distance that you’re able to travel. 

    Cons:  Not comprehensive and despite being a government resource, it is not up-to-date.

    Pros: Easy to use, more accurate. Treatment Match only connects you with providers in your area who are accepting new patients, reducing dead ends and calls to providers who aren’t accepting new patients or insurance. 

    Cons: Wait time/ lack of timeliness, not as many provider connections. This is not a straightforward directory and while it’s easy to sign up, you have to wait for a provider to respond to your email. The site claims that doctors respond 24/7, including weekends and holidays, but I only heard from them during normal business hours.

    • Yelp Reviews of Clinics

    Pros: Hearing directly from other patients about their experiences, easy to use, instantaneous, accessible.

    Cons: Questionable trustworthiness. Dr Seligsohn said: “Patient reviews can sometimes be very misleading.”

    • Calling Your Insurance Company

    Note: Insurance companies vary widely, so I can only speak from my experience. For example, in Oregon I was easily able to locate a Suboxone provider through my insurance company, but my North Dakota insurance did not provide referrals. They stated that their preferred addiction treatment was therapy and 12-step based treatment programs rather than medication.  

    Pros: Possible thorough list of doctors certified to prescribe Suboxone. Those Suboxone providers who accept your insurance are required to keep their information listed and up-to-date.

    Cons: Time-consuming and you have to deal with the hurdles of bureaucracy. Plus, some studies have found that only about 50% of eligible Suboxone doctors accept insurance. Some insurance companies like mine will allow you to submit an appeal asking them to cover part of your Suboxone visit or prescription, especially in rural areas. I saved all of my receipts and had my psychiatrist and Suboxone doctors write letters of support. After months of appeals, the insurance company agreed to cover part of each appointment. Each month I sent in a claim and receipt, and then I received a reimbursement check about a month later. 

    • Asking for a referral from your primary care provider, psychiatrist, or hospital.

    Another note: This is also difficult to give specific advice on because they vary depending according to location and providers, among many other factors.

    Pros: In-person support and assistance, more direct medical guidance and advice. 

    Cons: Stigma, lack of education about Suboxone, judgement, lack of timeliness. 

    5. Be Persistent!  

    6. Moving? Set Up an Appointment Months in Advance.

    Dr. Seligsohn advises finding a doctor and setting up an appointment prior to moving. “Patients need to find out as much information about how their perspective new doctor runs his practice…They also need to find out what the doctor’s philosophy is about long-term vs short-term Suboxone. If I was a patient I’d be reluctant to move to an area where there’s a shortage of Suboxone doctors.”


    Sidebar: Sample Phone Script for Calling Suboxone Providers

    I remember being so nervous, overwhelmed, and frustrated while also dealing with the symptoms of opioid withdrawal. Make sure you set aside a few hours for making calls in a quiet, safe place. I know some of these tips might seem like common sense, but when you’re in crisis and everything feels overwhelming, it can be a relief to have a guide.

    1. Introduce yourself and tell them that you’re looking for a suboxone provider.

    2. Where are you located?

    3. Are you accepting new patients?

    • If yes- when is your earliest available appointment?
    • If no- don’t hang up just yet! Ask: do you have a waiting list? Can you give me an estimate for how long it would take me to get an appointment? 
    • Do you have a cancellation list and if so, can you please add me to it?

    4. How often do I need to come to the clinic or office? 

    • Most clinics and offices require monthly or bi-monthly visits, but some require daily visits and dispense suboxone in a similar manner to methadone.

    4. Do you accept my insurance? 

    5. If the clinic does not accept insurance, how much does each appointment cost?

    • How much does the intake appointment/ first visit cost? This is an important question to ask because initial intake appointments can cost anywhere from $100 – $200 more than a regular visit.
    • Some clinics require pre-payment to reserve your appointment and prevent cancellation. Do you require a down payment before the appointment?
    • What forms of payment do you accept? (cash, credit, check?) Note that most clinics do not accept checks.
    • Do you allow payment plans or is payment due on the day of the appointment? A majority of clinics will not allow patients to do a payment plan and payment is due on the day of the appointment.
    • Are there any additional costs or required fees? Some charge additional fees for mandatory counseling, drug screens, etc.

    6. What are the counseling requirements?

    • You may be required to do weekly or monthly therapy groups with others at the clinic, and/or meet with an addiction counselor. This varies depending on how long you’ve been clean and your insurance coverage. (For example, one of my previous clinics had no counseling requirement, but my new clinic requires me to meet with an addiction counselor for one hour each month. Other clinics require weekly or bi-monthly group support meetings.)

    Quick Resource List:

    The Substance Abuse and Mental Health Administration (SAMHSA)’s Buprenorphine Treatment Practitioner Locator

    Suboxone Website’s Treatment Provider Directory

    Buprenorphine Matching System on Treatment Match on The National Alliance of Advocates for Buprenorphine Treatment (NAABT)

    Addiction Survivors

    Suboxone Talk Zone

      

    *(Writer’s Note: Suboxone is the most common brand-name buprenorphine medication, but this article is also applicable for patients seeking any form of buprenorphine treatment including: Subutex, Zubsolv, Bunavail, and Probuphine).  

    View the original article at thefix.com

  • Doctors Gave No Reason For Writing Opioid Scripts In Nearly 30% Of Cases

    Doctors Gave No Reason For Writing Opioid Scripts In Nearly 30% Of Cases

    A new study uncovered that doctors were prescribing opioids for hypertension and high cholesterol when no pain diagnosis was recorded. 

    A team at Harvard Medical School and the Rand Corp. combed through medical records from 2006 to 2015 and found that physicians gave no explanation for writing an opioid prescription in 29% of the cases.

    According to NBC News, the Centers for Disease Control and Prevention (CDC) has been working to get doctors to pull back on opioid prescriptions, citing careless prescribing as one cause of the opioid crisis. In 2016, more than 42,000 people died of opioid overdose, according to the CDC.

    The new study was led by Nicole Maestas, professor of health care policy at Harvard. Maestas and study coauthors went through tens of thousands of medical records, and then honed in on more than 31,000 physician surveys that included an opioid prescription.

    In two-thirds of the prescriptions, some type of pain diagnosis was present.

    The report, published in the Annals of Internal Medicine, then concluded, “No pain diagnosis was recorded at the remaining 28.5%.”

    “At visits with no pain diagnosis recorded, the most common diagnoses were hypertension, hyperlipidemia (high cholesterol), opioid dependence and ‘other follow-up examination,’” the research revealed.

    This over-prescribing could be unfairly impacting people who do have serious pain conditions and are finding it difficult to access the opioids they need to manage their pain due to new restrictions and doctors who fear that they will be targeted for over-prescribing.

    Dr. Tisamarie Sherry, who worked on the study, was reported in NBC News as emphasizing, “Whatever the reasons, lack of robust documentation undermines our efforts to understand physician prescribing patterns and curtails our ability to stem overprescribing.”

    The study also showed that 24% of youth who appeared with an opioid use disorder did not have a prescription to a medication-assisted treatment (MAT) drug to control their cravings.

    Drugs like buprenorphine and methadone are approved by the Food and Drug Administration for the treatment of opioid use disorder.

    “In this multistate study of addiction treatment and retention in care, we found that three-quarters of youths diagnosed with opioid use disorder received treatment within three months,” researchers wrote in JAMA Pediatrics. “However, most treatment included behavioral health services only, and fewer than one of four youths received timely buprenorphine, naltrexone or methadone treatment.”

    View the original article at thefix.com

  • OxyContin No Longer Covered By Some Insurers

    OxyContin No Longer Covered By Some Insurers

    “This is a whack-a-mole solution… I don’t believe we should be isolating one category of opioid versus another,” said one expert.

    Some insurers are taking a rather bold stand against the opioid crisis by refusing coverage of OxyContin, a popular brand-name opioid painkiller. 

    The decision, according to the Houston Chronicle, has drawn controversy as some people question whether refusing to cover one specific medication will really make a difference. 

    “This is a whack-a-mole solution,” James Langabeer, professor of emergency medicine at McGovern Medical School at UTHealth, told the Chronicle. “On the one hand, it’s good that the insurance industry is weighing in, but I don’t believe we should be isolating one category of opioid versus another.”

    OxyContin, a brand name for oxycodone, is manufactured by Purdue Pharma, a company that has faced a slew of federal lawsuits for its alleged role in fueling the current opioid crisis.

    One concern, Langabeer says, is that denying access to OxyContin won’t necessarily force individuals to stop abusing opioids. In fact, he says, some may even begin using heroin instead, as it’s cheaper and more accessible.

    The Chronicle reports that last week, Blue Cross and Blue Shield of Tennessee announced that it will discontinue coverage at the start of 2019, stating it was “drawing a line that we will not continue to pay for this.”

    Previously, Cigna and UnitedHealthcare also announced the same. 

    A Cigna spokeswoman told the Chronicle via email that Cigna will consider covering the medication in some situations if a doctor feels it is “medically necessary.” She added that those using the medication for hospice care or cancer treatment will be allowed to continue use.

    UnitedHealthcare ceased to cover OxyContin in employer-sponsored plans beginning January 2017, according to the Chronicle.

    “There are therapeutically equivalent, covered alternatives that can be used for pain indications,” a spokesman for UnitedHealthcare told the Chronicle via email.

    Cigna, as well as insurer Florida Blue, will be replacing OxyContin with Xtampza, which they claim is more difficult to abuse. 

    Purdue Pharma has not been silent as insurance companies have rolled out these decisions. The company, according to the Chronicle, argues that it has been working to make the medication harder to abuse. It has also accused insurers of supporting its competitors for “financial gain.”

    “These recent decisions by insurance companies limit prescribers’ options to help address the opioid crisis,” a company spokesman told the Chronicle via email. “Unfortunately, these decisions appear to be more about pharmaceutical rebates.”

    Katharine Neill Harris, a fellow in Drug Policy at Rice University’s Baker Institute of Public Policy, tells the Chronicle that she has mixed feelings about the involvement of insurers. 

    “They do have a role and I don’t think they have done enough yet,” she said. “The easiest way to say we’re doing something is by stopping covering a drug.”

    For Harris, a better alternative is for insurers and doctors to look into long-term solutions for chronic pain, such as physical therapy.

    View the original article at thefix.com

  • Harm Reduction Program Offers Cannabis As Alternative To Hard Drugs

    Harm Reduction Program Offers Cannabis As Alternative To Hard Drugs

    The Canadian program also offers free fentanyl testing strips and naloxone training.

    A Canadian harm reduction program is hitting the local opioid addiction crisis from a unique angle—by providing cannabis at little to no cost as an alternative to street drugs.

    The High Hopes Foundation, based in Vancouver, Canada—also home to North America’s first legal supervised injection site (SIF)—is the country’s first “full-time cannabis harm reduction program,” CTV News reports.

    While this isn’t the first recovery program to feature cannabis as a treatment, it’s still a rather novel idea that some consider controversial. But Sarah Blyth, president of High Hopes, says the program is a realistic approach to attacking the most potent addictions.

    “It’s not always possible for people to just completely come off all drugs, because they’ve got trauma. They have pain. They need something,” Blyth said last August, according to CBC. “Opiates may not be the best option for everyone so we’re trying to give them the options we have available.”

    High Hopes offers free or low-cost cannabis and CBD oils to people trying to wean off drugs like opioids, which have been a big problem in Canada as well.

    According to CTV News, nearly 4,000 Canadians died of opioid overdose in 2017; about 1,400 of them were in British Columbia, the province that Vancouver resides in.

    The foundation also offers free fentanyl testing strips and naloxone training. According to Blyth, the majority of illicit drug samples analyzed by the Vancouver Overdose Prevention Society tested positive for fentanyl, which raises the risk of overdose.

    The cannabis program, established last year, started out by collecting cannabis donations from registered patients or dispensaries. Once Canada’s marijuana legalization law goes into effect this October, perhaps High Hopes will have an easier time procuring legal cannabis.

    “What we are doing is not fully legal but we see it helps and we are desperate to help people. Watching people die isn’t okay,” said Blyth.

    The program’s goal is to give people with addictions an alternative to using potentially dangerous street drugs. Blyth noted that many are just seeking relief for pain, anxiety or inflammation. “It gives them a way to have an alternative to the drugs that they’re getting on the street,” said Blyth, who is also the founder of the Overdose Prevention Society. “It’s safe, it can reduce pain.”

    View the original article at thefix.com

  • Bill Targeting Opioids Sent By Mail Up For Senate Vote

    Bill Targeting Opioids Sent By Mail Up For Senate Vote

    The STOP Act will require the U.S. Postal Service to collect electronic data on packages being shipped into the country.

    The Senate will likely pass a bill this week that aims to reduce the number of fentanyl shipments coming into the country via the U.S. Postal Service (USPS). 

    The STOP Act, which stands for Synthetics Trafficking and Overdose Prevention, will require the postal service to collect electronic data on packages being shipped into the country, including the sender’s and recipient’s addresses and the contents as described by the sender.

    Right now, only private courier services like FedEx, UPS and DHL require this information, which means that people can send opioids through the postal service and be virtually untraceable. 

    Illicit fentanyl can be easily made in China and shipped to the United States, since a small volume is immensely powerful and profitable. 

    “We are being overrun with fentanyl,” Senator Rob Portman (R-Ohio), who led an 18-month study of illegal imports, told the New York Times. “It is 50 times more powerful than heroin. It is very inexpensive. It is coming primarily from China and coming primarily through our U.S. Postal Service, if you can believe it.”

    In addition to requiring that the postal service gather additional information on packages, the bill would make is possible for the government to levy fines to the postal service if it does not comply. The postal service would also have the authority to block or destroy packages that have not been properly identified.

    Right now, the postal service must “obtain a warrant to inspect the contents of suspect parcels,” according to William Siemer, acting deputy inspector general of USPS, who testified before Congress this year.

    President Trump supports the measures, taking to Twitter to voice his enthusiasm. 

    “It is outrageous that Poisonous Synthetic Heroin Fentanyl comes pouring into the U.S. Postal System from China,” he wrote last month in a tweet. “We can, and must, END THIS NOW! The Senate should pass the STOP ACT—and firmly STOP this poison from killing our children and destroying our country.”

    The STOP Act has been languishing after it was introduced nearly 18 months ago, allowing shipments of opioids to continue. However, the House passed a similar initiative over the summer, prompting the Senate to move on the issue.

    In addition to addressing the dangers of opioid shipments, the bill would also expand access to treatment for infants born dependent on opioids, implement more stringent packaging requirements for some medications, and accelerate research into non-addictive painkillers that could potentially replace opioids. 

    View the original article at thefix.com

  • A Dopeman's Grocery List

    A Dopeman's Grocery List

    The reality and gravity of the entire situation was this: if I don’t steal this shit, I’m not getting high. If I’m not getting high, I’m dying. That’s how bad I was strung out on opioids; that’s how much of a slave I was to the drugs.

    The following story is based on actual events. In an effort to protect anonymity as well as keep people out of potential legal trouble; names, places and identifying characteristics have been modified. I hope you enjoy these stories. Whatever you do. DO NOT try this at home.

    What happens when you run out of money and need a fix bad?

    What happens when you just don’t have it in you to stick someone up on that particular day?

    What happens when you run out of shit to pawn?

    What happens when there’s nothing left to post on OfferUp, LetGo and Craigslist?

    You can always go grocery shopping for your drug dealer like I did. I mean, I didn’t have any money at the time and I already traded my food stamps for dope that month but I knew there were a few items that “D” needed me to pick up from one of those big-box-retail-stores. If I could get the items he needed, he would trade me 50% of whatever it cost in cash or trade me 75% of what it cost in dope. This was a no brainer. Get the grocery list, steal the items, get the dope and get high.

    I’ve always been a fan of “heist” movies. Mission Impossible, Ocean’s Eleven and Catch Me If You Can come to mind when I think about the excitement I felt when the “bad guys” got away with whatever it was that they were taking. Sometimes rooting for the bad guy feels good. Every time I received one of these lists via text message from D, I felt like Ethan Hunt accepting some kind of grand mission that was of the utmost importance. The reality and gravity of the entire situation was this: if I don’t steal this shit, I’m not getting high. If I’m not getting high, I’m dying. That’s how bad I was strung out on opioids; that’s how much of a slave I was to the drugs. When opioids told me to jump, my response was always: how high?

    It’s been four and a half hours since I last shot up. My stomach is beginning to turn like that sensation you get when a roller coaster takes its first plunge, except it felt like it was my life that was diving into utter oblivion. My palms have begun to get clammy. I got the cold-sweats and it’s pissing me off. It’s 73 degrees in my room but I’m soaking wet like “Dollar Debbie” taking a stroll down MLK in the middle of August. Life sucks and I need to get “one” in me… like yesterday.

    BEEP! BEEP! A text comes in. God I hope it’s D. I unlock my phone and see the good news I’ve been waiting for:

    1 bottle of Pine-Sol
    2 boxes of Huggies
    Peanut Butter and Jelly – not that shit with the peanuts in it
    1 Mop
    1 Case of Ramen Noodles
    5-10 assorted girl’s tees
    1 pair of white sneakers, size 6 – I don’t care what the brand is

    Oh, I also need a new Bluetooth speaker, some crackhead stole mine last night. See if you can get one of those dope ass Dyson vacuums too.

    And hurry the fuck up, I’m trying to go to the casino. You got one hour!

    Finally! I got the grocery list! Now I have to find a ride. That means I have to cut somebody in on the payoff, which means fewer drugs for me. Fuck it, I’m hurting bad. At this point, I’m not going to argue over whose half of a dilaudid is bigger. It doesn’t matter anymore.

    I scroll through my contacts and find the guy I’m looking for. I just hope he’s awake. It’s three in the afternoon, a little early for Tony. He usually gets up around four or five because he’s been up all morning trying to come down from the “shards” he shot up the night before. I know an offer to score some dope to come down off the shit will lure him into my latest scheme.

    “But what color vacuum does he want?” Tony asked, dazed.

    “Does it fucking matter?!” I yelled back. Tony had a way of asking questions that didn’t matter. He was slow, he was sloppy, and he smelled like a piece of toasted Chore Boy. It’s mind boggling to me that this guy was ever successful at pickpocketing when he lived in New York. He had been down here in Florida for only six years and had already visited the local jail well over 12 times. Thing is, he always stayed high, had a car, and was just as sick as I was.

    “I’ll be there in five minutes.” he murmured. “Meet me two streets over by the bando,” he instructed before hanging up.

    Twenty-five minutes later, Tony pulls up in a hurry, looking annoyed like I’m the asshole who’s twenty minutes late. I’m livid. He always does that; he’s worse than a drug dealer and I hate waiting. I need a fix bad. My nose is beginning to run and I’m getting these random sensations in my stomach. Feels like someone is taking a blade and stabbing me erratically. My body is telling me that I’m supposed to eat but the appetite isn’t there. The worst symptom I get when withdrawing is when I smoke a cigarette: I gag every time I hit it and they don’t taste the way they normally do. It doesn’t help that the cigarettes I’m smoking are the ones I’ve collected from all the public ashtrays around town. They already taste bad. This life sucks. I need a pill, now.

    “Here’s the plan,” I say to Tony as I get in the passenger seat. “We have a half hour to grab the shit and meet D at his place before he leaves for the casino.” Tony is already driving to the store. Like me, he knows which one to go to at any particular time of day. We know when loss prevention does their shift change, we know which side of the store the greeters are on, we know which store we hit last time and that dictates which store we hit next.

    “Five minutes or less!” I say assertively. “If it takes longer than that, we’re going to the other store.” I know that if I have to come up with a story to buy more time with D, it shouldn’t be a problem.

    “Flip a coin to see who’s building the cart this time?” Tony asks.

    “Run it,” I reply.

    “Heads!” He yells as I flip the coin. “Yes!” He screams. He gets to build the cart. I’m getting excited. As we near the store, the symptoms of my withdrawal seem to lessen. I’m getting turned on over the idea of committing a crime. Sounds crazy, doesn’t it? Not only am I addicted to drugs, I’m in love with the crazy and dangerous lifestyle that comes along with it.

    Let me break down the lick for you.

    This is a two man job. Park near the front and keep the car running. Pop the trunk but leave it down so it looks shut. Leave all the doors unlocked. First man goes inside alone to “build the cart.” Building the cart is the easy part, that’s why we flipped a coin for it. You basically go in the store, acquire the items on the list, and place them inside a shopping cart. This must be done in five minutes or less. The other man, the one in the car, is on the phone with you, the cart builder, talking in your ear while he looks through the store window, informing you on what the employees are doing. Are they watching you? Is there an undercover loss prevention guy following you? These are things that must be known.

    General rule of thumb when building a cart: look like you belong there. Just go shopping. Smile; say hi to an employee; maybe ask them where you can find a particular item. You’re the customer, act like one.

    Tony gets everything on the list in less than five minutes. His slow ass must really need a pill as bad as I do. If he’s hurting, he’s not showing it. I think he’s as excited as I am.

    Once the cart is built, head to an aisle that runs along the cash register that’s nearest to the exit. Ditch the cart. Leave it in the aisle and get the fuck out. Once you get back in the car, look your partner in the eye, wish him luck, light a cigarette, sit back and relax. Your work is almost done.

    Here’s the dicey part. It’s the driver’s turn to enter the store. I exit the whip and walk to the entrance. Tony keeps his earpiece in and puts the car in drive while he keeps his foot on the brake. I almost forgot to mention, never pull into a parking space. Back in, so when it’s time to make the getaway, you just let off the brake and get the hell out. No one is trying to get into a little fender-bender while trying to elude potential law enforcement. I mean seriously, if my ass goes to jail over a fucking bottle of Pine-Sol, I’m killing somebody.

    I’m in the store. My heart is racing! Do I look like I belong? Do I look like a junkie? I know I showered. My shirt is wrinkled but my shoe game is on point. I don’t look homeless but I feel like shit. Do the employees notice? Keep walking. Eyes forward. Listen for Tony on the phone. It’s going to be okay.

    I find the cart. My palms are sweaty as I grab it and head towards the exit. I dig into my pocket and pull out an old receipt from the gas station. This is what I’m going to use as I walk out the door with my head down. I’m going to make it look like I’m going over the items I “just purchased” as I walk out; never mind the fact that nothing is bagged up.

    “How’s my back, T?” I ask nervously.

    “I don’t see anyone behind you, bro. Just keep coming. The trunk is already open.”

    We chose the correct side. As I near the exit, I notice there aren’t any greeters, AKA receipt checkers. This is expected but I still don’t get it. There are two entrances, spaced out on either end of this store, but they keep a greeter on only one side. Idiots. I’m about to walk out; just a few more steps.

    “Excuse me, Sir!” I hear behind me. I ignore it and keep on walking.

    “Sir! Excuse me, hey sir!” I hear again. She sounds cute. I stop and begin to turn around. I got to be honest, my heart is racing and I’m extremely turned on at this point. Why does crime excite me so much?! I can hear Tony screaming and yelling expletives in my ear.

    “What’s up?” I casually ask while making eye contact with this cute employee. She can’t be older than 22 and she looks perfect, like those black pants and blue vest were custom made to wrap around her beautiful figure. I wish I wasn’t a junkie. She seems like a good girl. If I wasn’t so concerned with getting high, maybe I’d ask a woman like her out. I don’t have time for women. They get in the way of my using. Just give me a crack-whore that wants to fuck before or after we get loaded. That’s all I have time for.

    Shit. I forgot what’s happening here. My ADHD gets the best of me sometimes. I’m supposed to be walking out of a store with a shopping cart full of stolen goods.

    “Sir, are you forgetting something?” She asks. I stare blankly back at her. I don’t have a response and I kind of just want to stare at her before she calls the authorities and I have to turn around and make a break for it. The only thing I can muster up to answer her question is “I don’t know, am I forgetting something?”

    She raises a fist and begins open to up her cute little hand. I quickly picture her cute fingers with the chipped nail polish dancing all over my body. Focus!

    “Get the fuck out of there!” I hear Tony screaming in my ear.

    She opens her fist. “You dropped your lighter, Sir,” she says as she hands it back to me. Tony can hear her on his end and I hear him let out a sigh of relief.

    “Okay we’re good” I hear him say as I thank her and head out the door.

    I throw the items in the trunk and we head over to meet up with D. We’re in a hurry to get high; he’s in a hurry to get to the casino. Both parties are bitching at each other. We engage in the usual small talk that really is just a load of bullshit. D doesn’t care about me or my well-being, and I could give a shit about him and his family. I just want my dope and I want to go home. He just wants his shit and wants me to leave. We do the same shit every day. Act like we’re family. Like there’s some “street code” of honor or something. The truth is, nobody cares. Everyone is out to get theirs and theirs only.

    Tony and I head home and split the shit we scored. As soon as I get mine in me, all in the world is right again. For those brief ten seconds of numbness and euphoria, as the opioids flow into my bloodstream, I forget that I am a slave. I forget that just ten seconds ago, my body was writhing in pain. I forget that I was almost stopped inside of a store for shoplifting while on probation. I forget that if I violate, I’m going up-the-road for at least five years. I forget about that girl that broke my heart. I forget that I’m a lying piece of shit that steals from my mother every time she goes to sleep. For ten seconds, I’m free…

    And in four hours, I’m doing it all over again.

    If no one told you today that they love you, fuck it, there’s always tomorrow. 😉

    View the original article at thefix.com

  • Anatomy of a Relapse

    Anatomy of a Relapse

    When my father died, I hadn’t been to a meeting in over a year. I had no active knowledge of how to apply healthy coping mechanisms to a devastating situation so I just went back to what I knew: opioids and numbness.

    Two years ago I wrote a controversial feature for The Fix, “I Take Psychedelic Drugs and I’m in Recovery.” It was controversial in the sense that the response from the publication’s readers — many of whom have an obviously vested interest in topics related to addiction recovery — ranged from sarcastic, hyperbolic criticism to open-minded consideration, with some even condoning the perspective I was sharing.

    The reason I chose to write this honest, albeit uncomfortable “Part 2” of sorts, is to do what folks in certain recovery circles do best (when at their best): share experience, strength, and hope, so that whoever may be listening, reading, or watching may, at the very least, relate and ideally, be helped by it.

    Full disclosure: My name is not James Renato. It’s a pseudonym, adopted out of respect for the principle of anonymity in a 12-step offshoot group I am a member of. It’s also, of course, meant to protect myself from facing unnecessary personal backlash merely for engaging in public discourse.

    Now that I’ve successfully buried the lede, in the spirit of qualifying in the style of an Alcoholics Anonymous meeting: “here’s what it was like, what happened, and what it’s like now.”

    Last April, I ended a full-blown relapse of what previously was an opioid use disorder in remission. In other words, I’d started injecting heroin again eight months earlier, for the first time in over six years.

    It was the culmination of a tripartite experiment involving: firstly, a noble attempt to actively practice a program I helped form (namely, Psychedelics in Recovery [PIR]). Secondly, a misguided lack of acknowledgement that I was inviting a serious risk to my life by no longer practicing abstinence (not just from psychedelics). And lastly, a gradual ceasing of the daily commitment to personal growth in the form of meeting attendance, regular contact with a sponsor, associating with peers in recovery, and just continuing to work on improving the overall quality of my life and relationships with others.

    People in recovery continue to regularly engage in their program of choice because life is unpredictable, and the myriad tools we learn are not always the same ones we rely on for every situation. One day a simple phone call can be all that’s necessary to get ourselves out of “a funk.” Another day it’s hitting four meetings, extensively praying and meditating, and taking a newcomer out for coffee because we were just laid off from a full-time job and needed to avoid the danger that can come from “feeding the poor me’s.”

    In my case, when I stopped participating in my ongoing recovery process, I made an inexplicably impulsive decision to reintroduce opioids to my system. When the DEA announced that they were planning to classify kratom as Schedule 1, I purchased a kilogram from an online vendor for literally no good reason. Several weeks after I received the package of high potency kratom leaf powder (of the “super green vein” variety), I conducted a dose-response self-experiment. I have a history of progressing down the road of “continued use [of opioids] despite negative consequences” (the current best definition of addiction), and within a few months I developed a dependency and went through the entire kilo, despite attempts to reassure my partner that the amount I purchased was intended to last for years, and would only be used when absolutely necessary.

    Right around the time my supply ran out, a friend who had no idea of the habitual relationship I had with kratom use told me about another mild opioid sold on the supplement market called tianeptine sulfate. Tianeptine had undergone clinical trials as an opioid-based antidepressant in the 1990s but did not progress past the second of three phases required by the Food and Drug Administration (for unknown reasons). With the drug’s unscheduled status, enterprising entrepreneurs in the unregulated supplement industry capitalized on tianeptine’s acute, short-acting antidepressive effects at low doses, but savvy opioid connoisseurs discovered the euphoric high it brought on (also short-acting) at much larger doses.

    My kratom habit switched to tianeptine, in large part because of how disgusting I found the taste of the tea I made from brewing the leaf powder, and the hassle of masking the taste by encapsulating the amount I needed to take to reach the effects I preferred. In addition to the perfect storm of things perpetuating my now very active addiction, I’d even stopped attending PIR meetings, was becoming increasingly disillusioned with my graduate studies, and was now too ashamed to admit to anyone that I was seriously struggling.

    Then, tragedy struck. My father, a seemingly healthy 64-year-old on the verge of retirement, suffered a sudden, fatal heart attack on a scuba diving trip in the Caribbean. I was already treading on thin ice, and this kind of event is something I’d long heard people in 12-step meetings share reservations over in their commitment to recovery. But I hadn’t been to a meeting in over a year at this point, so I had no active knowledge of how to apply healthy coping mechanisms to a devastating situation. It was a situation that countless people have gone through, relying on their recovery program to help them navigate as safely as possible, but I’d learned from the opioids I’d been relying on that if I could just figure out how to stay numb 24/7, that’s all I needed to do.

    After the standard bereavement rituals of a wake, funeral, and burial at the family cemetery plot, which was actually a very supportive and comforting assemblage of close friends, loved ones, and long-lost acquaintances paying their respects, I ended up alone in a dangerous situation. I called my old dealer, whose number I still had memorized after over six years of no contact, and one night drove out to meet him just like old times. No need to bother snorting or smoking whatever powder he claimed to be heroin; I had already been well reacquainted with the too-mild results of those routes of administration, so I went right back to the needle.

    I’ll spare you all the details of the familiar downward spiral and just hit on the highlights: I depleted all of my savings, misappropriated funds from an award I’d received, stole thousands of dollars from my father’s still active bank account, then my mother’s shared account, totaled my partner’s car from multiple accidents, couldn’t maintain my job, took a leave of absence from school, and wreaked a devastating emotional toll by shattering the trust of my friends and family.

    Miraculously, I was not arrested, did not overdose (though I came close), and was not robbed (although certainly ripped off repeatedly). About six weeks before I was confronted about the missing money, I obtained a 15-day supply of Suboxone from a chemical dependency clinic, but I shelved it, having no intention of taking it. Towards the end of the first week of April, my partner was preparing to go out of town for the weekend, and I had just been asked by my mom if I knew anything about the empty bank accounts.

    I woke up alone on April 5th, a Thursday, and began my morning ritual of taking stock of the heroin I had left, trying to negotiate with myself on how to titrate the remaining amount throughout the day. I always lost these negotiations and usually just did all of it, or the rest soon thereafter. But after I injected the last of it, I didn’t feel the slightest bit high. Instead, I wept. With only the company of my two cats (who avoided me as much as possible), I realized that I could no longer hide. I faced a crossroads: I could escalate my lies and attempt to find another hustle — knowing full well how inept I am when it comes to actual criminal behavior — or, surrender.

    I remembered the Suboxone sublingual film, and without really taking any time to talk myself out of it, I tore open the package and put the film under my tongue — realizing that if I kept it in long enough to absorb the full dose, I’d be inducing opioid withdrawal. I felt incredibly lonely and remorseful, so I begged my partner to come home from work, admitting to her what she had long known but felt powerless to help me with. Then I texted my mom, hinting to her that I was in a desperate state, and needed to spend the weekend at her home or I wouldn’t be able to “see things through.”

    Tears were pouring down my face in these moments, and I was wailing — one of the deepest emotional pits of despair I’ve ever found myself in. I’ve never found the concept of rock bottom useful. Instead of labeling that moment or attempting to explain it, I attribute my actions to grace.

    A New Perspective on an Old Idea

    I’m a wholehearted believer in the potential of psychedelics or plant medicines in recovery. I have heard first-hand tremendously powerful stories from people who have overcome their reluctance and the doubt instilled upon them by their peers, and are actively integrating the spiritual insights from their psychedelic journeys into their lives. PIR continues to meet regularly via an online meeting, twice a month, and our members gather from across whatever time zones they’re in to come together and share experience, strength, and hope with each other. We’ve formulated a list of guiding principles, meant to clarify the scope of our suggested program. I had strayed from those principles and met the predictable outcome we’re hoping to help others avoid.

    There are ongoing FDA-approved clinical trials for the use of psilocybin (the active pro-drug of psilocin, a psychedelic found in several species of mushrooms) for nicotine, cocaine, and alcohol use disorder, as well as a recently approved study in Europe looking at MDMA-assisted psychotherapy for treatment of alcohol use disorder. While these trials are aimed at treatment of an acutely manifesting substance use disorder, one of the primary guidelines for PIR is that our members should have a firmly established foundation of recovery in a primary qualifying recovery fellowship, and are actively working that program as it’s suggested.

    Recently, now just five months out from ending my relapse, I considered having a ceremony with iboga (the alkaloid-containing root bark of a shrub indigenous to western equatorial Africa), as I wanted to commemorate the one-year anniversary of my father’s death. After soliciting the feedback of my support network, none of whom gave me any advice, but instead offered honest and open perspective to help guide me in making a decision, I decided against it. Ultimately, the decision to commemorate the anniversary unaided came during several of my morning sitting meditations, a practice that has become vital to my ongoing recovery.

    Instead, friends, family, and loved ones gathered at our house on the anniversary day, and shared memories, pictures, and videos of my father.

    View the original article at thefix.com