Tag: opioids

Are Opioid Prescription Rates Actually Declining?

While individual states have reported declines in opioid prescription rates, this did not apply for all Americans, according to Mayo Clinic researchers.

After reviewing anonymous insurance claims data covering 48 million people between 2007 and 2016, the researchers concluded that “opioid prescription rates have remained flat for insured patients over the last 10 years,” as Forbes reported.

Specifically, disabled Medicare patients displayed the highest rates of use and the largest proportion of long-term use of prescription opioids.

More than 51% of disabled Medicare patients used opioids, while this number was just 14% for privately insured patients and 26% of non-disabled Medicare patients used opioids.

As lead author Molly Jeffery explained, even though integrative pain programs that use over-the-counter pain medication like Advil and Tylenol, alongside physical therapy, can be just as if not more effective than opioid painkillers for some patients, they tend to cost more than opioid painkillers alone, leading insurers to favor the cheaper option.

“We wanted to know how the declines were experienced by individual people,” said Jeffery. “Did fewer people have opioid prescriptions? Did people taking opioids take less over time? When we looked at it that way, we found a different picture.”

The Mayo Clinic is now prescribing fewer pain pills per patient, Jeffery said, trying to find a balance of giving “enough medication to relieve pain without raising the risk of addiction.”

Establishing prescription limits could reduce the risk of opioid overdose for some patients, the researchers said, “but that reduction in risk must be weighed against the burden to patients and their physicians.”

Former The Fix contributor, journalist and author Maia Szalavitz warned as early as 2012 of the consequences of a nationwide crackdown on pain medication. In her article “The Innocent Victims of America’s Painkiller Panic,” she offers a critique of opioid “policing”—which is not limited to prescription limits.

“There’s little evidence that such policing prevents addiction or does anything else beyond inconveniencing and stigmatizing pain patients,” Szalavitz wrote.

According to Ballotpedia, as of this past April, 28 states have established policies or guidelines that set limits on the supply of opioids that can be prescribed by doctors.

View the original article at thefix.com

8 August 2018
New York Moves To Replace Opioids With Medical Marijuana

Opioid use disorder has been added to the list of qualifying conditions that medical cannabis can be used to treat in the state.

Officials in New York have changed medical marijuana policy in order to make it easier for patients to access medical cannabis in lieu of opioids, and have added opioid use disorder to the list of qualifying conditions that medical cannabis can be used to treat.

The New York Department of Health announced the expansion on July 12. Under the emergency regulations, any condition that could be prescribed an opioid is now a qualifying condition for medical marijuana.

“Effective immediately, registered practitioners may certify patients to use medical marijuana as a replacement for opioids, provided that the precise underlying condition for which an opioid would otherwise be prescribed is stated on the patient’s certification,” the state’s press release said. “This allows patients with severe pain that doesn’t meet the definition of chronic pain to use medical marijuana as a replacement for opioids.”

The expansion also allows people who are being treated for opioid use disorder in a qualified treatment setting to be issued a medical marijuana license to use cannabis as a replacement for opioids.

Only 12 other medical conditions are currently listed as qualifying conditions for medical cannabis, so the expansion could have a significant effect on New York’s medical marijuana system. At the time of the announcement, just over 62,000 New Yorkers had a medical marijuana license, according to the health department.

Lawmakers hope that by expanding access to medical marijuana, they can reduce the number of opioids prescribed in the state.

“Medical marijuana has been shown to be an effective treatment for pain that may also reduce the chance of opioid dependence,” said New York State Health Commissioner Dr. Howard Zucker. “Adding opioid replacement as a qualifying condition for medical marijuana offers providers another treatment option, which is a critical step in combatting the deadly opioid epidemic affecting people across the state.”

Additional changes will make it easier for people to access medical cannabis after they are approved for the program. Lawmakers hope that this will help reduce overdose deaths from opioids.

“I have been strongly advocating to remove barriers and allow the use of medical marijuana as an alternative to opioids because it will help patients, reduce the number of highly addictive opioids in circulation, and ultimately, it will save lives,” state Senator George Amedore, co-chair of the Senate Task Force on Heroin and Opioid Addiction said in a June press release.

“We continue to be faced with an opioid epidemic that is devastating communities throughout our state. It’s important we continue to do everything possible to address this issue from all sides, so I’m glad the Department of Health is taking this measure that will help high risk patients, as well as those that are struggling with, or have overcome, addiction.”

View the original article at thefix.com

7 August 2018
Misuse Of Unapproved Antidepressant With Opioid-Like Effects Spikes

Though tianeptine isn’t FDA-approved, it’s not illegal and can be purchased online as a dietary supplement.

An apparent spike in the use of an unapproved antidepressant called tianeptine is poisoning people who are looking to benefit from the drug’s mild opioid-like effects, according to a Centers for Disease Control and Prevention (CDC) report released last week.

From 2000 to 2013, the U.S. saw 11 tianeptine-related poison control center calls; from 2014 to 2017, there were more than 200. That’s all according to the CDC analysis of National Poison Data System information, which sheds new light on a growing trend.

Though tianeptine isn’t FDA-approved, it’s not illegal and can be purchased online as a dietary supplement. It’s often marketed elsewhere under brand names Coaxil and Stablon, according to Vice News.

The drug was first discovered by the French Society of Medical Research back in the 1960s, and it’s been shown to help fight depression and anxiety, according to CNN.

When it was patented, scientists weren’t entirely clear on how it worked. But in 2014, researchers found that the drug lights up certain opioid receptors. While that appears to help with some depression symptoms, it also means that people taking tianeptine can have opioid-like withdrawal when they stop taking the drug.

“Tianeptine has an abuse potential in former opiate drug users,” the CDC researchers wrote. “This study further highlights that the withdrawal effects of tianeptine mimic those of opioid withdrawal.”

But, unlike with traditional opioids of abuse, tianeptine doesn’t show up on drug screens, which can make it a tempting choice for justice-involved individuals looking for a high that won’t land them in legal hot water.

“I think people have this misguided belief that if you can get it on the internet and it’s not overtly illegal and you’re not going through the dark web to acquire these substances, so it must be OK,” Raphael Leo, an associate professor in the Department of Psychiatry at the University of Buffalo, told CNN.

But, earlier this year, the Journal of Analytical Toxicology reported on two tianeptine-related deaths in Texas, and more have been reported in other countries.

The potential dangers of the unapproved drug have sparked some calls to ban it. In April, Michigan greenlit a law banning the substance on the heels of a number of overdoses, according to the Associated Press.

View the original article at thefix.com

7 August 2018
Addiction Likely Reason For Alarming Parental Loss Rates In One Region

Nearly 15% of children in one surveyed area have a parent who has been in jail, in comparison to 8% of children across the nation.

Children in parts of Ohio, Kentucky and Indiana may be at greater risk of being separated from their parents, likely due to the opioid crisis, according to a new survey.

Interact for Health released the 2017 Child Well-Being Survey on Friday, August 3. The survey was taken by more than 2,700 parents and guardians in 22 counties across southwest Ohio, northern Kentucky and southeast Indiana.

According to the Cincinnati Enquirer, the stand-out results from the survey include the fact that nearly 15% of children in the surveyed area have a parent who has been in jail, in comparison to 8% of children across the nation.

Additionally, approximately 8% of the children in the surveyed area had a parent who had died, in comparison to 3% across the country.

“While this survey doesn’t tell us why, substance abuse is a likely contributor,” Sonya Carrico, senior program officer for the opioid team at Interact for Health, told the Enquirer. “Our region has some of the highest rates of drug overdose deaths in the nation, many among adults age 25 to 44, and the percentage of youth in foster care due to parental substance abuse is on the rise.”

This reasoning would make sense, as Ohio and Kentucky have been some of the states hardest hit by the opioid epidemic, according to the Enquirer. In 2016, the Centers for Disease Control and Prevention’s drug overdose mortality by state had Ohio ranked second in the U.S., and Kentucky fifth.

Another piece of information that supports this idea, the Enquirer states, is that 30% of the children in custody of the Hamilton County Job and Family Services were taken out of their homes due to having a parent struggling with substance use.

In some cases, this leads to children being taken in by other family members. Maureen Sharib of Cincinnati is caring for her 10-year-old granddaughter Brianna, and has been since she was 15 months old. Sharib’s daughter and Brianna’s mother, Natalie, died in 2017 after an overdose. Brianna’s 5-year-old brother, Jaxon, is in the custody of Sharib’s sister.

“The epidemic’s toll is hard to measure, but these numbers have to be considered every time you hear an ambulance passing or see one parked in the street,” Sharib told the Enquirer. “Just about every time you see that, there are children involved… Innocent children standing by, watching the horror of what’s happening to the people who are most important to them in their lives. There is no taking that away—ever. There is no bandage that can salve those wounds.”

Situations such as these, according to the Enquirer, could affect children’s mental and physical health later in life.

“When children experience prolonged, intense, frequent stress, their bodies may respond to elevated stress hormone levels in ways harmful to their growth and development,” Dr. Robert Shapiro, director of the Mayerson Center for Safe and Healthy Children at Cincinnati Children’s Hospital Medical Center, told the Enquirer.

However, Shapiro tells the Enquirer, there are ways to help children cope and stay on a healthy path later in life.

“We can prevent these harmful effects by building supportive communities, by promoting strong caring relationships with adults and by strengthening a child’s social and emotional skills,” Shapiro said.

View the original article at thefix.com

6 August 2018
Dr. Drew and Dave Discuss Overdose Death of "Dopey Podcast" Host

Chris from Dopey Podcast had been clean for almost five years before his fatal relapse.

Dopey Podcast co-host, Chris, 33, passed away from an overdose on July 24.

The Fix spoke with Dave, his friend and Dopey co-host, about the sudden loss. The two met eight years ago at Chris’s 14th rehab. They stayed in touch and became close friends.

Chris had a year and a half sober and Dave was three months sober when they started the Dopey Podcast.

“I loved Chris and I will always miss him,” Dave told The Fix, his voice cracking with emotion. Dave is unsure of the exact date that Chris’s relapse began.

Board-certified internist and addiction specialist “Dr. Drew” Pinsky is a big fan of Dopey. Back in March, he sat down with the guys to discuss addiction, rehab and romance for their 124th episode.

The Fix spoke with Dr. Drew about Dopey after his appearance on the show. “If you’re an addict,” he said, “and you listen to Dopey, you will find your people, and your story here. Listen to it and you’ll see what I mean.”

During the episode, it was revealed that Pinsky had treated Chris years ago after one of his relapses. Dr. Drew joked with Chris about what a difficult case he’d been.

After finding out about Chris’s death, Pinsky offered his condolences to Dave, “Chris’s death is such a huge loss. His was a great success story—especially after so many years of chronic relapses. This is a real tragedy.”

“Chris loved being sober and he loved Dopey,” Dave said. “He drove to New York every week—10 to 12 hours roundtrip—just to record each episode of Dopey with me. But the last month he became really unreliable.”

Annie Giron, Chris’s girlfriend, told The Fix that she was the one who found his body in the bedroom of their Boston apartment. Giron has extensive training in the medical field of addiction.

“Chris had just finished his MA and was working towards a PhD in Clinical Psychology,” said Giron, fighting back tears. “I’m studying to be a psychiatrist. I know his death was not intentional. He was not suicidal at all. We were very much in love and excited about the future.”

“I’ve never been an addict and there are no addicts in my family but I have always been passionate about the field of addiction,” she said. “Over the years, I have administered Narcan to so many patients in the ER. I treated one patient 17 times and Narcan saved his life. That’s why the minute I saw Chris, I knew that he was dead. I tried to revive him with Narcan anyway even though I knew it was too late.”

Dave said, “Over the past month Chris had started acting really weird. I asked him what was going on. He blamed it on exhaustion. I believed him. He was really busy as a manager in a sober living facility and always studying.

Chris had a long history of drug abuse but had been clean for almost five years before his final relapse. Dave, Annie and friends were concerned that Chris was close to relapsing. Annie said he wasn’t depressed but had been anxious and agitated. He’d spent a week helping a patient and he may have confiscated medication.

“Chris tore a ligament in his leg that was extremely painful. He couldn’t sleep and I’d hear him moaning in agony. A doctor said it would take 4-6 months before Chris would feel any better. He needed to do physical therapy which the doctor warned would be painful. He hadn’t wanted to take painkillers but the injury was excruciating.”

Dave said he’d talked with Dr. Drew and Annie about how far Chris had come in his life and how shocked and heartbroken they are at this unexpected loss.

Dr. Drew’s next Dopey episode will go live on Saturday, August 11. He and Dave will discuss addiction, recovery, and the frightening reality of America’s spike in fatal relapses.

View the original article at thefix.com

4 August 2018
Pain Patients Turn To Controversial Injection After Cuts To Opioid Coverage

The anti-inflammatory drug has been banned in Australia, Brazil, Canada, France, Italy, New Zealand and Switzerland.

Back problems are the most common cause of chronic pain, and at the time when Medicare is cutting coverage for many opioid pain relievers, lawmakers are increasing Medicare coverage for a potentially dangerous off-label treatment for back pain.

Depo-Medrol is an injectable anti-inflammatory drug made by Pfizer. When it is injected into muscles and joints it can provide pain relief, but the drug is not supposed to be injected into or near the spinal chord. In fact, in 2013 Pfizer asked the Food and Drug Administration to ban back injections.

The FDA declined to issue the ban, despite the fact that Australia, Brazil, Canada, France, Italy, New Zealand and Switzerland all issued bans, according to The New York Times.

“Serious neurologic events, some resulting in death, have been reported with epidural injection of corticosteroids,” Pfizer told the FDA. “Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke.”

In June, legislators approved an increase in reimbursements for the Depo-Medrol shot.

At the same time, Medicare finalized a restrictive plan for covering opioids that will make it difficult for all but the most severe patients to access opioids long-term. This combination could make injectables a more appealing treatment, despite their risks.

“The victims of our era of aggressive opioid prescribing are being exploited in some cases by interventional pain doctors, who will continue them on opioids in exchange for allowing them to perform expensive procedures that they don’t need,” said Dr. Andrew Kolodny, co-director of opioid policy research at Brandeis University and executive director of Physicians for Responsible Opioid Prescribing. “These are not benign procedures. Patients can be harmed and are harmed.”

Despite this, use of Depo-Medrol and similar drugs increased 7.5% among Medicare patients between 2012 and 2016. Dr. James P. Rathmell, chairman of anesthesiology, perioperative and pain medicine at Brigham and Women’s Hospital, said that Medicare coverage policies have the potential to make the shots even more popular.

“The truth underlying it is that doing an injection is faster and results in higher reimbursements, compared to other ways of managing the same pain,” he said. “The use of injections has increased dramatically, yet the prevalence of back pain has remained relatively unchanged.”

Dr. Brian Yee, an anesthesiologist who practices in West Virginia, said that injections have the potential to be useful, but that they need to be handled carefully in order to ensure that they are being used responsibly.

“With people trying to take away opioids now, we are opening up another doorway for people to overutilize other options that can be helpful with the right doctors and the right patients,” he said.

View the original article at thefix.com

2 August 2018
Chuck Schumer: Feds Playing Yo-Yo With Funds To Fight Opioid Crisis

Senator Schumer is pushing for the CDC to reconsider its decision to pull anti-opioid funding from New York City.

Senator Chuck Schumer of New York is unhappy with a recent decision from the Centers for Disease Control and Prevention (CDC).

Schumer says that last year, he added $350 million to a budget designed for the CDC to allocate funding to large cities including New York City, Philadelphia and Houston, Pix 11 reports.

However, Schumer said, that funding was suddenly taken away with no reason provided.

“Even more galling, New York City had already allocated this money,” Schumer said. “The CDC already said we’re going to send you this money.”

According to the New York Daily News, rather than be allocated to metropolitan areas, CDC officials say that a new federal policy dictates that the funds will be distributed between state offices.

This, Schumer says, will set up cities like New York, Chicago and Los Angeles to get less funding than initially thought.

“There is simply no good reason for the feds to play yo-yo with critical federal funds that New York needs to beat back and address the opioid epidemic,” Schumer said in a statement. “By playing this dangerous and irresponsible game with these dollars, the federal government is setting an aberrant precedent and making a big mistake all at the same time.”

Schumer added that the city already had plans for the funding.

Pix 11 reports that New York City planned to use the federal funding for various programs, including one in which paramedics from the city’s fire department leave the opioid antidote, naloxone, in the homes of those with a history of substance use.

Schumer says he plans to fight the funding takeaway, which he claims will affect the state as a whole.

“Because when the city doesn’t get this money, the state has less money to go around,” he said. “New York City will have to now fight for state money, and that’ll hurt Long Island, hurt Westchester and frankly the whole state.”

In a letter to CDC Director Robert Redfield, Schumer pushed for the organization to reconsider.

“As some of the nation’s largest localities, which are facing some of the harshest impacts from the current addiction and overdose crisis, it is imperative that CDC provide fair funding allocation mechanisms that effectively address public health needs,” he wrote.

View the original article at thefix.com

2 August 2018
After Losing 2 Sons To Overdose, Mom Shares Their Story To Help Others

Becky Savage is on a mission to help parents understand the dangers of prescription pills.

Losing a child is a parent’s worst nightmare. For Becky Savage, that nightmare became a reality twice within the same day, when her teenage sons Nick and Jack were both pronounced dead in her home after overdosing on prescription opioids.

On the evening of June 13, 2015, the boys attended a graduation party, and came home to check in with their mom just after midnight. On June 14, Savage noticed that Jack wasn’t breathing. She called 911 and frantically yelled for Nick, who was sleeping in the basement.

The paramedics arrived and tried to resuscitate Jack, before heading downstairs.

“I had no idea at that point what they were doing in our basement,” Savage said to CNN. “And then I remember one of them coming up and asking for a coroner. That’s the last thing that I remember that day.”

The night before, Jack and Nick had combined hydrocodone and alcohol, “a bad choice that unfortunately cost them their lives,” Savage said.

At first, Savage, her husband and her two younger sons were just focused on surviving their grief. “Everything just kind of seemed like a blur that day,” Savage said. “Your mind is not really meant to process something that extreme.”

However, more than a year later Savage was asked to speak about underage drinking. She thought she would be talking to about 20 people, but 200 showed up.

“It was just overwhelming,” she said. That’s when Savage realized that sharing her story and speaking openly about Jack and Nick’s deaths could potentially save other families from tragedy.

The Savage family started the 525 Foundation, named after the boys’ hockey numbers (Jack’s 5 and Nick’s 25). Now, Savage focuses on sharing her story with as many people as possible, and helping parents understand the dangers of prescription pills.

“We’ve talked to our kids about drinking, but we had never talked to them about prescription drugs, because it wasn’t even on our radar,” she said. “In different communities, there are still people who are unaware of the dangers. After I get done talking to them, the first thing they say is they’re going to go home and clean out their medicine cabinets.”

Since 2016, Savage estimates that she has spoken to more than 23,000 students. She has also testified in front of a Congressional committee, and the 525 Foundation has started organizing events to collect unused prescription pills. At just three events they’ve collected 1,500 pounds of pills.

“If you think about how much one pill weighs, that’s a lot of pills collected,” Savage said. “And when you think that one of those pills could take a life, that could potentially be a lot of lives saved.”

For Savage, this is a small silver lining to the unimaginable heartbreak of losing her sons.

“By me telling their story, they’re still able to make a difference in the lives of others,” she said. “There can’t be a better goal than that.”

View the original article at thefix.com

31 July 2018
Americans Not As Aware Of Opioid Crisis In Their Own Backyards, Study Finds

Americans are three times more likely to be informed about the opioid epidemic as a national problem rather than one in their own area.

Despite the opioid epidemic dominating headlines, a new study has found that most Americans are not aware of the extent of the epidemic in their own areas of residence.

The study, conducted by Laguna Treatment Hospital in Aliso Viejo, California, found that Americans are three times more likely to be informed about the opioid epidemic as a national problem rather than one in their own areas, The Guardian states.

The study found that a mere 13% of participants in the southern part of the country and 10% of those in the northeastern region felt that “drugs posed a crisis in their own communities.” But based on past data, states like West Virginia, Kentucky, Pennsylvania and Vermont have been among the states most affected by the crisis.

Dr. Lawrence Tucker, medical director of Laguna, tells the Guardian that the results of the study were surprising due to the prevalence of the epidemic “despite regional differences.”

“You can see those differences in not just the prescriptions of opioids but the amount of heroin that is available—China White, for example, is prevalent along the east coast as is fentanyl,” he stated. “There is oxycodone in the midwest and Black Tar heroin on the west coast.”

Tucker played a large role in the recent study, called “Perceptions of Addiction.” The study surveyed 999 participants, 45% of which were male and 55% of which were female, from all parts of the country. The participants were between the ages of 18 and 76, and about 33% stated that they had dealt with substance use disorder at some point.

In 2014, a Pew Research study found that very few Americans had knowledge of the growing opioid epidemic. Tucker and others involved in the study wanted to find out if four years later, in light of the growing spotlight on the epidemic, the perceptions had changed.

“The survey’s verbiage attempted to achieve admittance of, versus just awareness of, addiction across the United States,” Taylor Bloom, the survey’s project manager, told the Guardian. “We would ask questions using the word ‘perceive’ instead of ‘aware.’ For example: ‘Do you perceive an addiction crisis in your community?’”

According to the Guardian, Bloom and other researchers did discover some improvements when compared to the 2014 study.

“We saw increased awareness among Hispanic and African American demographics,” said Bloom. “But then we saw that Americans are 79% less likely to perceive an addiction crisis in their communities today as they were four years ago… which is kind of crazy.”

According to Tucker, race plays a large part in awareness.

“Some races, particularly white young adults, are being hit harder than others,” he told the Guardian. “Which is why the neighborhoods that are affected the most are certainly aware of the epidemic, because they have lost loved ones and friends. But the communities that aren’t really aware of the opioid epidemic is because it’s just not affecting them as much due to the racial makeup of their neighborhoods.”

View the original article at thefix.com

31 July 2018
Man Sues Prison For Addiction Medication Access

The 30-year-old at the center of the suit started using painkillers as a teen and was prescribed Suboxone five years ago.

Last week, the ACLU sued Maine’s prisons and one county jail over their continued refusal to give addiction medication to inmates.

Zachary Smith, who is scheduled to go to prison in September, filed a federal lawsuit targeting the Aroostook County Sheriff’s Office and Maine Department of Corrections, claiming violations of the Eighth Amendment’s ban on cruel and unusual punishment and also of the Americans with Disabilities Act.

“Denying needed medication to people with opioid use disorders serves absolutely no good purpose, and actually undermines the important goal of keeping people off of opiates,” ACLU of Maine legal director Zachary Heiden said in a statement. “Going to prison shouldn’t be an automatic death sentence, but that is the chance we take when we cut prisoners off from adequate medical care.”

Failure to provide medication can lead to painful forced withdrawal and increase the risk of overdose.

The 30-year-old at the center of the suit started using painkillers as a teen and was prescribed Suboxone five years ago. “If I did not get on buprenorphine I’d probably be dead,” he told the Bangor Daily News.

He was denied access to his medication last year during a short stint in the county jail. So, once he knew he had prison time in his future—a nine-month sentence for domestic assault—Smith and the ACLU wrote a letter to the state’s correctional system requesting that he continue to receive his medication behind bars.

When they got no response, they filed suit.

Although medication-assisted treatment (MAT) is considered the standard of care on the outside, many county jails and state prisons refuse to provide it. In Maine, according to the Bangor paper, only Knox County Jail provides Suboxone, though the Penobscot County Jail offers another alternative, the injectable treatment Vivitrol.

Prison officials declined to comment.

“If we’re being sued, I can’t speak about that,” Maine Department of Corrections Commissioner Joseph Fitzpatrick told the Press Herald. “Once they’ve filed, I’m not able to comment.”

Though the legal action could be ground-breaking for Maine prisoners, it’s not the first of its kind. In June, the ACLU of Washington launched a class-action suit against a jail there for denying inmates access to methadone and Suboxone as part of a policy the organization called “harmful, unwise and illegal.”

“The ADA prohibits singling out a group of people because of their disability and denying them access to medical services to which they would otherwise be entitled,” the organization wrote at the time. “The Whatcom County Jail has a policy of denying people with (opioid use disorder) the medication they need while providing necessary medication to everyone else, which is discrimination.”

Two months earlier, advocates in Massachusetts publicly pondered a lawsuit there, even as federal prosecutors announced an investigation into whether failure to provide addiction medications is a violation of the ADA.

View the original article at thefix.com

30 July 2018