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Tag: opioids

  • Fentanyl Use Rising Across The US

    Fentanyl Use Rising Across The US

    The potent synthetic opioid has been showing up more on its own, rather than mixed with other drugs.

    The use of fentanyl, the synthetic opioid said to be 50 times as potent as heroin, is growing on both a local and national level, according to new research.

    A new analysis, conducted by Indiana University-Purdue University Indianapolis (IUPUI) researchers, found that fentanyl was present in nearly 50% of overdose deaths in Marion County, Indiana in 2017. This is a significant increase compared to less than a decade prior, when fentanyl was present in fewer than 15% of overdose deaths.

    “We found fentanyl present in 47% of cases,” said Brad Ray, assistant professor at IUPUI’s School of Public and Environmental Affairs. “That’s nearly half of every single person that dies of a drug overdose. That’s far outpaced heroin.”

    These numbers mirror national statistics. In May, the Journal of the American Medical Association published research that showed that of the 42,249 opioid-related deaths in the United States in 2016, almost 46% involved fentanyl. Six years prior—similar to the IUPUI research—fentanyl was involved in just 14% of opioid-related deaths.

    The IUPUI research also found that over time, the potent opioid has been showing up more on its own, rather than mixed with other drugs, according to the Indy Star. When fentanyl first emerged as a threat to public health, it was said primarily to be used to boost the potency of heroin and other drugs.

    A previous study by IUPUI’s School of Public and Environmental Affairs from 2017 reported an association between tighter opioid restrictions and an increase in opioid-related deaths.

    Researchers looked at prescription data from Indiana’s prescription drug monitoring program and analyzed that alongside toxicology data from the Marion County Coroner’s office, which tracks the specific substances involved in each drug-related death. With that, they found an “alarming trend”: the prescription drug crackdown occurred alongside a “considerable” rise in heroin and fentanyl overdoses.

    “As people move away from pills, they do move on to heroin,” explained Ray, who was the lead author of that study. “It’s a cheaper substance to purchase but it’s much more dangerous because you don’t know what’s in it, you don’t know how much to take.”

    Ray went on to say that a lack of treatment options in Indiana exacerbates the issue.

    View the original article at thefix.com

  • Overdoses Increasingly Lead To Criminal Charges

    Overdoses Increasingly Lead To Criminal Charges

    Family members and the public aren’t convinced that prosecuting friends—who are often on drugs themselves—is the best use of resources. 

    When someone dies from an overdose it is undeniably a tragedy, but is there someone to blame? Increasingly, the answer—legally speaking—is yes.

    It’s becoming more common for authorities to charge family members, friends and dealers with homicide for their role in securing drugs, or even their presence when the drugs were taken, according to a report by The New York Times. 

    “I look at it in a real micro way,” Pete Orput, the chief prosecutor in Washington County outside Minneapolis, told the paper. “You owe me for that dead kid.”

    Mark S. Rubin, a county attorney in Minnesota who has brought charges related to overdoses, said that the situation is complicated, but ultimately there is criminal responsibility. 

    “People agree, you know, there’s nobody forcing someone to take the controlled substance. But somebody might agree to take it from their friend or their boyfriend or girlfriend and they end up dying because of it,” Rubin said. “We feel that constitutes a crime of possibly murder in the third degree, but at least manslaughter in the second degree.”

    The Times found that in 15 states that keep records, there have been more than 1,000 charges of homicides related to overdose deaths since 2015. Between 2015 and 2017, prosecutions of this nature nearly doubled.

    While law enforcement officials say that this tough approach is justified and will stem the use of drugs, family members and the public aren’t convinced that prosecuting friends—who are often on drugs themselves—is the best use of resources. 

    “It’s kind of like blaming the leaves on the tree, you know?” said Michael Malcolm, of Breckenridge, Colorado, whose younger son was charged with the death of his brother, who overdosed on drugs that the boys had bought together online. “What about the roots?”

    The Times investigation found that charges are brought under a variety of laws. Twenty states have specifically made delivering drugs that result in death a crime. Others use standard homicide and manslaughter charges. In some cases, friends and family have been charged with dealing or distributing drugs, even if they did not exchange drugs for money with the person who died. 

    “State laws vary, but drug ‘distribution’ or ‘delivery’ is generally not limited to selling,” the Times reporters wrote in an accompanying question and answer piece. “It can include sharing drugs, giving them away, or having a friend pay you back for drugs you bought.”

    Many states have Good Samaritan laws, which are meant to protect the person who calls 911 when someone is overdosing. Often, these laws protect someone who may also be using, but if that person was involved in securing the drugs that caused the overdose they can still be charged, according to the report. Vermont and Delaware are the only states that explicitly protect callers from prosecution.

    View the original article at thefix.com

  • Searching For The Next Naloxone

    Searching For The Next Naloxone

    Experts are concerned that naloxone may not be strong enough for synthetic opioids such as fentanyl and carfentanil.

    Naloxone is—at times—a seemingly miraculous drug. Within minutes of naloxone being administered, someone who was unresponsive because of an opioid overdose can start breathing on their own and regain consciousness.

    However, despite its strengths, there are issues with the drug that have left healthcare professionals and policy makers pushing for alternatives. 

    One of the biggest issues with naloxone today is that it is reportedly not as effective at reversing overdoses from powerful synthetic opioids like fentanyl and carfentanil.

    In these cases, a person might need multiple doses of the opioid reversal drug in order to see a benefit. This isn’t just expensive, but can also cost someone their life if there aren’t enough doses immediately available. 

    Another issue is that opioids remain active in the body for longer than naloxone does. Because of this, someone can be revived using the opioid reversal drug, but later slip back into an overdose when the effects of naloxone have worn off. 

    Both of these concerns have led to the search for alternatives to naloxone. 

    “The strategies we’ve done in the past for reversing overdoses may not be sufficient,” Nora Volkow, director of the National Institute on Drug Abuse (NIDA), recently said in a speech at the 2018 National Rx Drug Abuse and Heroin Summit, according to STAT News. “We need to develop alternative solutions to reversing overdoses.”

    Dr. Jay Kuchera, a Florida-based addiction medicine specialist for Resolute Pain Solutions, said that “naloxone is being outgunned” by synthetic opioids that have largely replaced heroin in many areas of the country. 

    “Naloxone seemed to be great for the older opioids,” Kuchera said. “But now that we’re encountering these nonmedical, ungodly [opioids] like carfentanil… we need to get with the times.”

    In 2016, one report found that the market for opioid reversal drugs was valued at nearly $1 billion, so there are good economic incentives for companies to find alternatives to naloxone.

    Opiant Pharmaceuticals, which developed Narcan (the nasal spray version of naloxone), has had early success with a drug that works the same way as naloxone but lasts longer, so that the victim would be less likely to slip into another overdose after administration. 

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

    Because many overdose deaths occur when a person stops breathing, scientists are also examining whether they can use drugs to keep a person breathing even while not reversing the overdose itself. For this, researchers are looking at ampakines, a class of drugs that can counteract respiratory depression. 

    Some people argue that funds would be better used to address the causes of addiction or to further study naloxone to see if it is indeed less effective against synthetic opioids, but Volkow said that having new and potentially better options for saving people from overdose is critical.  

    “There are so many people dying that we have to recognize the urgency,” Volkow said. “We obviously value basic science, but at the same time we have to recognize because of the current situation, the development of medication the can help address the crisis has become our top priority.”

    View the original article at thefix.com

  • Colleges Create Opioid Response Plans Amid National Crisis

    Colleges Create Opioid Response Plans Amid National Crisis

    Even though overdose deaths on college campuses are relatively rare, many schools are still choosing to put a plan in place. 

    Colleges across the country are focused on responding to the opioid epidemic, even as opioid abuse and overdose deaths remain very rare on campus. 

    According to the American College Health Association, about 7 to 12% of the college-aged population use opioids for non-medical purposes, and about 2 to 3% use heroin. Comparatively, about 5% of U.S. adults report misusing opioids. 

    “Colleges definitely have an obligation to address the opioid epidemic as it manifests on their campuses,” Beth DeRicco, director of higher education outreach at Caron Treatment Centers, told Inside Higher Ed. “While a small percentage of students misuse pain relievers, the danger of opioids and the way in which use has risen makes it an incredible concern.”

    In 2016, the American College Health Association released guidelines for how colleges can address opioids and opioid misuse. 

    Since then, campuses around the country have crafted their own responses to the opioid epidemic. At Bridgewater State University in Massachusetts, naloxone is now available in 50 defibrillator boxes around campus, including in all 11 dormitories. Asheville-Buncombe Technical Community College in North Carolina trained staff on how to recognize signs of opioid addiction, changed the locks on single-stall bathrooms and had school security officers begin to carry naloxone.

    The University of Wisconsin Madison hired two substance abuse counselors and made an agreement with Walgreens to allow students to purchase naloxone. 

    At the same time, a 2016 survey of students at the University of Wisconsin Madison found that just 0.8% of the campus population, or 55 students, reported having any issues with substance use disorder. Of those, only 5.4%—less than 3 students—reported opioid misuse. 

    One reason opioid abuse may be lower on campus is that opioid addiction is most common among people who have less education, fewer job prospects and live in poverty. However, reaching out to students might help those in their personal lives who are not enrolled in college. 

    For example, Anne Arundel Community College in Maryland has not seen any opioid overdoses, according to Tiffany Boykin, dean of student engagement. However, in the surrounding county 37 people overdosed in the first quarter of this year, she noted. 

    “It may not be a student who is actively engaged in practicing. They may have a parent or spouse or a friend who is affected,” Boykin said. “The majority of our students are working professionals. When they’re trying to cope with a family member or a loved one who is affected, it’s very difficult for them to be successful.”

    View the original article at thefix.com

  • Link Between Heroin Addiction And Narcolepsy Examined

    Link Between Heroin Addiction And Narcolepsy Examined

    Could opiates be the key to treating the chronic sleep disorder?

    Heroin could be the next big breakthrough in treating narcolepsy. 

    That’s one possibility raised in a paper published recently in the journal Science Translational Medicine, detailing new work probing the connection between addiction and the chronic sleep disorder.a

    When narcoleptics nod off or lose muscle control, it’s caused by a lack of hypocretin in the brain. But to probe the connection further between the wakefulness-controlling chemical and the sleep disorder linked to it, researchers started studying the brains of dead narcoleptics. In the process, they stumbled across one brain that stood out. 

    It had a lot more hypocretin-producing cells than the other brains – and then the researchers learned that person had been addicted to heroin. So the scientists decided to start looking at the brains of people who had struggled with opioid use disorder before their deaths.

    In the first four samples they studied, researchers found the opioid-addicted brains had an average of 54% more hypocretin-producing cells than regular brains. 

    “So it was natural to ask if opiates would reverse narcolepsy,” study co-author Jerry Siegel, a neuroscientist at the University of California Los Angeles, told Gizmodo.

    The next step, Siegel explained, was trying a study with mice. 

    Over a two-week period, researchers drugged up narcoleptic mice with regular doses of morphine. The experiment upped their hypocretin-making cells, and the effect lasted for a few weeks after scientists cut off the dosage. 

    Basically, the researchers said, the opiates wake up dormant cells that make the necessary chemical. 

    “Understanding why opiates ‘awaken’ these cells is a task for the future,” Siegel said. 

    But other scientists voiced reservations about the work. Even if opioids turn out to be an effective treatment in humans, there are practical limitations. 

    “No mother of a 15-year-old with narcolepsy would sign onto us giving them several doses of morphine a day,” sleep expert Thomas Scammell of Harvard Medical School told Gizmodo.

    Yet, the findings could herald new hope for addiction treatment. If opiates users have more neurons that make hypocretin, the researchers suggested, then maybe they need less. 

    “If chronic use of opioids is increasing hypocretin production—and the authors show that nicely—then that could amplify the rewarding aspects of these drugs, making addiction all that much worse,” Scammell said. “I think that’s actually the most interesting part of their research.”

    View the original article at thefix.com

  • Tech Companies Dispute Playing Major Role In Opioid Crisis

    Tech Companies Dispute Playing Major Role In Opioid Crisis

    “The opioid epidemic is, in a majority of cases, primarily an offline problem,” said a representative of the Internet Association.

    A summit on Wednesday, June 27, hosted by the Food and Drug Administration, was predicted to draw representatives from Facebook, Google and Twitter, among other relevant tech companies, as well as academics, lobbyists and government officials. 

    According to Wired, the FDA said the summit was meant to encourage tech officials to “discuss ways to collaboratively take stronger action” when it comes to illegal opioids in the online market.

    However, there was some controversy around the summit due to tech and pharmaceutical companies disagreeing about who was more responsible for the opioid crisis. 

    Initially, the invitation for the summit stated that the FDA planned to ask tech companies to sign what it called a “Pledge to Reduce the Availability of Illicit Opioids Online,” which would be published 30 days after the summit. 

    However, after discussing it with tech companies, the FDA decided not to follow through with the plan. 

    “We will consolidate the feedback and ideas discussed at the summit and turn it into an actionable plan—not just for those in the room but for all internet stakeholders to join,” an FDA spokesperson said, according to Wired.

    The involvement of the tech industry in the opioid crisis has been a topic of discussion in the past few months in Washington, D.C., Wired states. 

    Back in April, at the National Rx Drug Abuse and Heroin Summit, FDA commissioner Scott Gottlieb said that tech companies had not been “proactive enough” when it came to getting rid of illegal drugs online.

    Additionally, earlier this month the FDA sent letters to nine companies operating 53 online pharmacies, and instructed them to cease the marketing of opioids. 

    But tech companies are fighting back, claiming they aren’t to blame. On Tuesday, June 26, the Internet Association—which represents tech companies like Twitter, Google, Facebook Reddit and more—held a call with reporters prior to the summit.

    “The opioid epidemic is, in a majority of cases, primarily an offline problem,” said a representative of the Association, according to Wired. The representative cited research by the Substance Abuse and Mental Health Services Administration (SAMHSA), which stated that most people misusing opioids get them from non-online sources. 

    Of those sales that are taking place online, the Center for Safe Internet Pharmacies cited a report stating that most of them are happening on the dark web. Additionally, the report found that some of the “open” web sites claim to sell opioids but actually do not, and instead steal people’s information.

    Despite some tech companies claiming they are not to blame, some steps have been taken to eliminate opioid sales online. Google promoted the DEA’s Drug Take-Back Day in April with a special tool on its homepage.

    Additionally, Facebook recently announced it would redirect users who are trying to buy opioids on the platform to a help hotline, and Instagram has begun monitoring hashtags related to opioids. 

    Libby Baney, an advisor to the Alliance for Safe Online Pharmacies, tells Wired that this is a start but companies also need to acknowledge the role they have played. 

    “This is a historic opportunity to do more with what we already know is true,” she said. “If it ends up being us versus them and there’s pointing fingers and a lot of ‘We’re already doing this or that,’ that’s an old-school way of thinking that isn’t responsive to the public health need.”

    View the original article at thefix.com

  • Medication-Assisted Treatment Options Limited For Medicare Recipients

    Medication-Assisted Treatment Options Limited For Medicare Recipients

    “Medicare beneficiaries have among the fastest growing rate of opioid use disorder, but they don’t currently have coverage for the most effective treatment,” says one official.

    Medication-assisted treatment (MAT) for opioid addiction and dependence is now seen as the gold standard of care by many addiction treatment professionals, but barriers to treatment make it difficult for many Americans over the age of 65 to access medication-assisted treatment on Medicare. 

    According to a report by the Associated Press, Medicare, the federal health insurance program for seniors, will not cover treatment with methadone, one of the oldest and most effective forms of medication-assisted treatment.

    The program covers buprenorphine, another form of MAT, but only a fraction of doctors who accept Medicare have obtained a federal waiver that allows them to prescribe buprenorphine. 

    This combination leaves a vulnerable population at risk. The AP reports that 300,000 Medicare patients have been diagnosed with opioid addiction, but only 81,000 prescriptions for buprenorphine have been written for Medicare patients. 

    “Medicare beneficiaries have among the highest and fastest growing rate of opioid use disorder, but they don’t currently have coverage for the most effective treatment,” said Rep. George Holding, a Republican from North Carolina. Holding is sponsoring a bill that would recommend changes to Medicare’s policy toward methadone. 

    Some patients on Medicaid can access methadone treatment, either by paying about $80 per week out of pocket or qualifying for state programs that cover the treatment. However, worrying about how and if their treatment will be covered can take a real toll on their mental health. 

    Joseph Purvis, a former heroin and prescription painkiller user, said he became depressed when he realized that Medicare might not cover his methadone treatment. “I was terrified that I might have to leave the program,” he said. “There’s no way I wanted to go back to addiction on the streets.” 

    Luckily, he was able to access treatment, thanks to a state program. However, he believes that Medicaid should cover this important treatment. “Some people think of methadone as a crutch for addiction but it’s not,” Purvis said. “It’s a tool that allows people to live a somewhat normal life.”

    The issue of access to MAT is especially important given that Medicaid just passed regulations drastically tightening access to opioid pills. The restrictions passed despite objections from some medical professionals who said that many seniors are on high levels of opioids that need to be carefully reduced. 

    “The decision to taper opioids should be based on whether the benefits for pain and function outweigh the harm for that patient,” Dr. Joanna L. Starrels, an opioid researcher and associate professor at Albert Einstein College of Medicine, said in response to the regulations. “That takes a lot of clinical judgment. It’s individualized and nuanced. We can’t codify it with an arbitrary threshold.”

    View the original article at thefix.com

  • Support Group Helps Mothers Affected By Opioid Crisis

    Support Group Helps Mothers Affected By Opioid Crisis

    “Families that are battling this disease, we suffer in silence. The fact that we can have love and kindness from somebody makes a world of difference.”

    For families affected by opioid use disorder, support groups can be their only outlet. More have cropped up amid the national epidemic of chronic opioid use and death, allowing parents, sisters, brothers, friends, and more to share their pain, frustration and loss with others who are going through the same thing.

    One such group, based in Plainville, Massachusetts, brings together mothers who meet every Saturday to talk about how opioid addiction has affected their lives.

    The group, called Unconditional Love, first began meeting in June 2014 at Plainville United Methodist Church. The women come from every stage of addiction and recovery, whether they have children with years’ worth of sobriety or whether they have lost them to addiction.

    “Families that are battling this disease, we suffer in silence,” said founder Robin Hamlin. “The fact that we can have love and kindness from somebody makes a world of difference.”

    “They all had their own journey and their own ways of dealing, and I got something from each and every one,” said Linda Irvin, who lost her son Danny. “It helped me get up in the morning and do something, even if it was just get up.”

    Hamlin, 56, started Unconditional Love four days after the death of her son Brian, who suffered a seizure with one year sober, according to The Sun Chronicle.

    Brian first became hooked on painkillers that were prescribed for an injury during college. Thirteen years later, he committed to sobriety. He was very active in his recovery, Hamlin recalled. He managed the sober home he was living in and would help his mother plan support group meetings.

    Hamlin not only runs the support group, she also visits recovery centers to share her story. Her long-term goal is to open a recovery center in Brian’s name.

    “I’m trying to have this make a difference. Is it going to change what happened to our children? No,” she said. “But it’s going to help other people, and that’s what we fight for. Because when you can talk about it, save a family or give an addict hope, then it’s a beautiful day.”

    According to the women in the group, letting go of blame, and realizing that addiction is a family disease, made it easier to cope with their pain and loss.

    “We’re all in that war, and have beautiful families that are devastated. And it needs to stop,” said Hamlin. “You work on your family your whole life and this disease comes in and slowly takes everything apart, and that’s why it’s a family disease.”

    View the original article at thefix.com

  • "Recovery Boys" Doc Candidly Explores Addiction, Trauma & Rehabilitation

    "Recovery Boys" Doc Candidly Explores Addiction, Trauma & Rehabilitation

    The documentary follows 4 young men who find support and relief through delving deep into their emotions in a rehabilitation setting.

    The documentary Recovery Boys, which is screening on Netflix as well as in select theaters, focuses on four young men seeking recovery from opioid dependency at a rehabilitation facility in West Virginia.

    Directed by Elaine McMillion Sheldon, whose Oscar-nominated short Heroin(e) looked at women on the front lines of the opioid epidemic in the Mountain State, Recovery Boys breaks from what The Guardian calls the established narrative about dependency, with poor people locked in a cycle of use and despair in impoverished areas.

    Instead, Sheldon’s camera follows young men who find support and relief through delving deep into their emotions in a rehabilitation setting.

    Recovery Boys unfolds over an 18-month period in the lives of four men in treatment at the Jacob’s Ladder rehabilitation program in West Virginia.

    Each of the individuals struggled with not only opioid addiction but an array of related wreckage in their lives—Ryan, 35, told The Guardian that he went through “overdoses and car wrecks, and I was jailed a couple of times, but I didn’t want to give up.”

    For 26-year-old Rush, his stint at Jacob’s Ladder was his tenth try at rehab. “I know what people want to hear, so it is really easy for me to skate through a program undetected,” he said in the film.

    But through a program of long-term residential treatment focused on holistic therapy like meditation and daily responsibilities of farm work, the men learn to speak plainly and honestly about the pain of their emotional lives and the depths of their dependency. The benefits of such work are touched upon by a patient named Jeff, who said in the film, “Now that you’re not high, you come out and listen to all the birds. When you’re high, you don’t focus on shit like that.”

    Anchoring the film on a message of hope and not despair was crucial for Sheldon, who said in a statement, “I make this film not to victimize, pity or make excuses for individuals, but to uplift the stories of people who are actively trying to make change, no matter how big or small.”

    Her intention resonated with the film’s subjects, whose desire to portray their struggle with equal shades of dark and light has carried forward after the film’s completion. “My hope for this documentary is that it destigmatized the addict,” said Rush. “Everybody thinks of the guy under the bridge with the tattoos, the beard. We’re not just all bad people. We are good people inside.”

    View the original article at thefix.com

  • Can Combining Opioids And Benzos Increase Overdose Risk?

    Can Combining Opioids And Benzos Increase Overdose Risk?

    The National Institute on Drug Abuse reports that more than 30% of all overdose deaths that involve opioids also involve benzodiazepines.

    When used in combination with opioids, benzodiazepines such as Xanax and Valium can make an individual five times more likely to overdose, a new study published in JAMA Network Open has determined. 

    The study found that benzodiazepines, which are often prescribed for anxiety, can increase the likelihood of overdose when used with opioids, especially in the first 90 days they are used together.

    The National Institute on Drug Abuse (NIDA) reports that more than 30% of all overdose deaths that involve opioids also involve benzodiazepines.

    The new study looked at data from over 71,000 people on Medicare Part D. Researchers divided patients into two groups: those who had taken only opioids prior to overdosing and those who had both opioids and benzodiazepines. Researchers “subdivided [the second group] by the cumulative number of days the patients had taken an opioid with a benzo,” Forbes states.

    The results showed that for individuals taking both forms of medication, overdose risk was five times higher during the first three months when compared to those using only an opioid.

    For the 90 days after the first three months, the risk of overdose doubled. After six months, the risk decreased to the same likelihood as taking only opioids. 

    “Patients who must be prescribed both an opioid and a benzodiazepine should be closely monitored by health care professionals due to an increased risk for overdose, particularly in the early days of this medication regimen,” lead study author Inmaculada Hernandez, assistant professor at the University of Pittsburgh School of Pharmacy, said in a press release.

    A 2017 study published in the BMJ found that from 2001 to 2013, simultaneous opioid and benzodiazepine prescriptions in 315,000 privately insured patients increased by 80%. 

    As such, one of the factors that researchers considered was the number of clinicians involved with a patient. They found that the more clinicians there were prescribing drugs to a single patient, the greater the risk of overdose.

    “These findings demonstrate that fragmented care plays a role in the inappropriate use of opioids, and having multiple prescribers who are not in communication increases the risk for overdose,” said senior study author Yuting Zhang, PhD, of the University of Pittsburgh Graduate School of Public Health, according to Forbes.

    This study is not the only one of its kind, as the relationship between opioids and benzodiazepines and the associated risks has been studied previously.

    Additionally, earlier in 2018, the FDA published a warning about the potential for respiratory depression issues when taking both medications together, since both depress the central nervous system.

    View the original article at thefix.com