Tag: prescription opioids

Will Naloxone Be Co-Prescribed With Opioid Painkillers In The Future?

While some states already require the co-prescription, the FDA is considering making it a requirement across the US.

In an effort to decrease overdose deaths, doctors could soon be required to prescribe an opioid overdose antidote any time they prescribe prescription painkillers, according to Food and Drug Administration (FDA) Commissioner Scott Gottlieb.

The idea of co-prescription, according to the Washington Examiner, isn’t a new idea. In fact, some states such as Arizona, Virginia, and Vermont, already require the co-prescription of the overdose reversal drug known as naloxone.

Naloxone comes in the form of a nasal spray as well as an auto-injection so it may be administered by those not in the medical field.

Other states considering such laws include California, Florida, New York, Ohio, Texas, and Utah.

Such laws are supported by the manufacturers of popular overdose antidotes, such as Adapt Pharma, the company that distributes Narcan.

“We are trying to do anything we can to build awareness and broaden support,” said company chairman and CEO Seamus Mulligan, according to the Examiner.

Kaleo, the manufacturer of the naloxone auto-injector, is also supportive, telling the Examiner in May that it “welcomes” the idea of co-prescribing.

“We believe that doctors, pharmacists and other healthcare professionals play a critical role in developing and managing a comprehensive treatment plan for their patients, as well as helping a patient and their loved ones recognize the potential risk for opioid emergencies, even when pain medications are taken as directed,” the company said.

Current laws vary from state to state. In Vermont, prescription rules are connected to other laws requiring doctors to check patient databases before prescribing an opioid.

In Virginia, it’s recommended that high doses of pain prescriptions are given with an overdose antidote prescription as well.

Additionally, doctors are encouraged to prescribe the antidote when prescribing opioids and benzodiazepines, as the two can lead to overdose.

The Centers for Disease Control and Prevention (CDC) has made similar recommendations in its guidelines to doctors.

While naloxone can save lives, it’s not considered a treatment for substance use disorder.

“Naloxone allows someone another day to have an opportunity to overcome their addiction,” New York state Sen. George Amedore Jr. said, according to the Examiner. “It’s not the whole answer or the cure-all.”

As such, some officials are also calling for wider access to buprenorphine, a medication that helps to lessen cravings and withdrawals.

The FDA will hold a meeting on Dec. 17-18 to determine more ways to make the overdose antidote more readily available.

View the original article at thefix.com

24 October 2018
Link Between Suicide And Opioid Use Examined

Researchers hope that the results of a new study will help them better identify those at risk for suicide.

A three-year, $1.4 million study will examine the connection between opioid use and death by suicide, in hopes of more effectively identifying high-risk patients.

“We know that opioid use, opioid overdose and suicide are related, but we need much more specific information to guide our efforts at prevention,” Gregory Simon, MD, principal investigator of the Mental Health Research Network and a co-investigator on the study, told Health IT Analytics. “The findings from this study will be a great asset to the public health community.”

The goal of the research is to develop predictive models that can help doctors better identify and intervene with patients who are at higher risk of attempting suicide.

Researchers will analyze data covering about 24 million medical visits, 35,000 suicide attempts, and 2,600 suicide deaths. They will try to predict how likely it is that a suicide will occur within 90 days of the time an individual visits a medical professional.

Opioid overdose deaths have increased exponentially in the past decade, while deaths by suicide increased 27% between 1999 and 2015. During that time suicides that involved opioids doubled, and may have increased even more.

“We’ve done preliminary work suggesting that 22 to 37% of opioid-related overdoses are, in fact, suicides or suicide attempts,” said Bobbi Jo Yarborough, PsyD, an investigator at the Kaiser Permanente Center for Health Research in Portland, Oregon.

Despite the rising risks, doctors and mental health providers often have difficultly identifying which patients are at risk for suicide.

“While health care settings are ideal places to intervene to prevent suicides, clinicians aren’t able to easily determine which of their patients are at elevated risk,” Yarborough said. “Our ultimate goal is to develop the most accurate suicide risk prediction tools and put them into the hands of clinicians. If our study is successful, clinicians will have a powerful new resource in the fight against suicide.”

Researchers will look at risk factors including illegal or prescribed opioid use, opioid use disorder, discontinuation or substantial dose reduction of prescription opioids, and prior non-fatal opioid-related overdoses. They will also examine how these factors affect men and women differently in order to understand whether one group is more likely to attempt suicide while using opioids.

Healthcare providers say that while suicide is highly stigmatized, talking openly about it can reduce the number of deaths.

“I have learned that it is important to talk about survivor stories. We know that suicide is preventable,” Dr. Anne Schuchat, the principal deputy director at the CDC, said in June. “We are in a different era right now, with social media increased and also social isolation is high… We think helping overcome the isolation can improve the connectedness.”

View the original article at thefix.com

12 September 2018
Could Informing Doctors Of Patients' Opioid Deaths Curb Prescribing?

How are doctors’ prescribing behavior affected when they’re notified of their own patients’ opioid-related deaths?

Some California doctors have recently received letters that changed how they prescribed opioids, according to new research.

The letters informed doctors of the deaths of patients to whom they had prescribed opioids, according to the Washington Post. Such letters were part of a study conducted by researchers at the University of Southern California and published Thursday (August 9) in the journal Science.

The letters were sent by the San Diego County Medical Examiner Office to hundreds of doctors who, in the past year, had prescribed opioids to a patient who later died.

“This is a courtesy communication to inform you that your patient [name, date of birth] died on [date]. Prescription drug overdose was either the primary cause of death or contributed to the death,” the letters read. “We hope that you will take this as an opportunity to join us in preventing future deaths from drug overdose.”

According to the Post, the idea behind the study was to close the gap between a doctor’s care and a doctor’s knowledge about the potential consequences of prescribing opioids.

While many doctors are aware that opioid use disorder is a widespread issue, they may believe that the consequences affect other doctors’ patients rather than their own, the Post noted.

According to the results of the study, doctors who learned of a patient’s death at the hands of opioids were 7% less likely to prescribe opioids to new patients. Doctors who received a letter also had a tendency to prescribe fewer high-dose prescriptions within the next three months of receiving the letter. The total amount of opioids these doctors prescribed decreased by 9.7%.

“What’s particularly interesting to me is the personal nature of it,” Alexander Chiu, a surgeon at Yale New Haven Hospital who was not involved in the study, told the Post. “Depending on what field you’re in, [the opioid epidemic] can feel a little remote. If you’re not a pain doctor or a primary-care doctor, it’s not quite as common to know or see your actions having a negative impact, which is what this is showing—it makes it very real. As evidence-based as we are as a profession, sometimes anecdotes can be really powerful.”

Lead researcher Jason Doctor, director of health informatics at the University of Southern California’s Schaeffer Center for Health Policy and Economics, tells the Post that while doctors have knowledge of facts, they are still human.

“One of the takeaways I’d like people to have is that doctors learn a lot of clinical facts, but when it comes to clinical judgment and decision-making, they fall prey to the same biases that we all do,” he said.

According to Doctor, San Diego County plans to continue sending these letters, and other counties have also said they are interested in doing something similar.

View the original article at thefix.com

20 August 2018
Vets Believe That Some Pet Owners Injure Their Animals To Get Opioids

A new study reveals that 13% of veterinarians believed a client had intentionally injured a pet or made them ill in order to be prescribed a drug.

A small research study in Colorado had disturbing results: the study found that 13% of veterinarians believe that people are using their pets to obtain opioids—by making them appear to be injured, or by actually injuring the animal.

Gizmodo interviewed the author of the study, Liliana Tenney, a public health researcher at the University of Colorado Anschutz Medical Campus. Tenney is concerned about the lack of training and education for veterinarians regarding their responsibilities in the opioid crisis.

“In conversations with these doctors, they often ask: ‘Well, what do we do? We need to treat pets who are in pain but we also need to know how to identify and handle suspicious behavior,’” she said. “But there’s not a lot of resources or training right now to direct these veterinarians.”

According to Gizmodo, almost three-quarters of vets reported that their veterinary medical school training on opioids was mediocre, poor, or non-existent. Sixty-four percent said that following veterinarian school, they had no further training on the issue.

Newsweek reported that in the survey of 189 vets; 13% reported that they believed a client had intentionally injured a pet, made them ill, or made them appear unwell, in order to be prescribed a drug. Tramadol is the most common opioid stocked by veterinary practices.

The emailed survey also revealed that 45% of the vets knew of someone at work or a client who was abusing opioids, and 12% said they knew of a staff member that was giving out opioids.

Lee Newman, director of the Center for Health, Work & Environment at the Colorado School of Public Health, told Newsweek, “There were also reports of diversion of drugs within the veterinary practices. Doctors [of animals] can prescribe the full range of opioids that are prescribed and administered to humans.

“In fact, veterinarians have the ability to prescribe, administer, carry, stock, and dispense narcotics in clinics, depending on the pain needs of their animal patients.”

The survey results indicate that veterinarians have been dramatically undereducated about their role in drug monitoring. Sixty-two percent believed they had a role in preventing opioid abuse, and 40% were unsure if opioid abuse was an issue in their communities.

To address this gap, Liliana Tenney, along with her team, has built an online education course for veterinary providers. Tenney and others are also working on building a better surveillance program within Colorado, where the survey was conducted.

View the original article at thefix.com

15 August 2018
New Book "Dopesick" Explores The Opioid Crisis From All Angles

“My goal with this book was not to just show you how we got here and what it’s going to take to get out of it but also to inspire people to care,” says author Beth Macy.

Journalist Beth Macy set out with a mission: to address the opioid epidemic from every possible angle.

In her new book, Dopesick: Dealers, Doctors and the Drug Company that Addicted America, she does that through examining the opioid epidemic from the very beginning to its current state.

According to NPR, Macy begins the book by detailing the story of Jesse, a 19-year-old whose struggles began with pills and ended with heroin. Jesse is one of the many lives taken at the hands of the opioid crisis.

“He was one of these rambunctious kids who rarely napped,” Macy told NPR. “As a little boy, he would fall asleep with toys still in his hands. And early on, they put him on ADHD medication. He also had some football and snowboarding injuries when he was 15 and 16 and was prescribed opioid painkillers then.

“His mother isn’t exactly sure at what point he became hooked, at what point he realized he was dope sick. But he knew he could trade his ADHD medicine for the opioid pills. And one thing led to another. When the pills got harder to get because of doctors cracking down on prescribing, that’s when the heroin started coming in.”

Initially, Macy tells CBS, Jesse’s mother was unaware of the depths her son’s use had gone to.

“She said something else that I heard a lot, which is ‘I thought it was just pills,’ and it had progressed to heroin unbeknownst to her, and he never missed a day at work,” Macy told CBS.

As journalists do, Macy comes at the opioid epidemic from all angles. Her book also details her conversations with a drug dealer named Ronnie Jones, who “ran one of the largest heroin rings in the mid-Atlantic region,” according to NPR.

Jones had tried a few times to recreate his life after spending time in jail, but with little luck.

“Ronnie’s story illustrates how little we do for felons trying to re-enter our society. You know, we don’t make it easy for them to get jobs,” Macy told NPR. “They often come out, and they owe lots of fines. And he tries to go legit. And he ends up—you know, he starts out selling weed again, which he had been selling before. But meanwhile, since he’s been in prison, this opioid thing has exploded. And somebody tells him in the break room of George’s Chicken, hey, man, if you want to make the real money, you need to be bringing heroin in.”

Also in her book, Macy examines the role that Purdue Pharma (the manufacturer of OxyContin) has played in the epidemic. She states that when Purdue introduced OxyContin, it was marketed as being more safe than other painkillers because of its 12-hour time release mechanism.

For the past three years, Macy says, she has been following Google alerts for articles pertaining to the opioid crisis. However, she says, none of them addressed every angle of the crisis as she hoped to.

“Each of them only deal with a little piece of something going on right now,” she tells NPR. “And my goal with this book was not to just show you how we got here and what it’s going to take to get out of it, but also to inspire people to care. And I really hope that that’s what I’ve done.”

View the original article at thefix.com

13 August 2018
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
Prescription Opioid Use And Its Connection To The Criminal Justice System

A new study examined the link between people with a history of prescription opioid use and their involvement with the criminal justice system.

Individuals with a history of opioid use are up to 13 times more likely to be involved in some manner with law enforcement or justice system officials, including arrest, parole or probation.

Those are the conclusions suggested by a new study that explored what NPR described as the “intersection of the criminal justice system and the ongoing opioid epidemic.”

Data from more than 78,000 respondents to a national survey on drug use found that prescription opioid users were more likely to have some involvement with the criminal justice system than those with no history of opioid use; opioid users were also more likely to suffer from chronic health issues and have higher susceptibility to overdose upon release from the prison system.

The study authors also suggested that greater access to alternatives to incarceration or treatment within the prison system could have a significant impact on lowering these rates.

The study, conducted by researchers from New York University, the University of Colorado School of Medicine and Kaiser Permanente’s Institute for Health Research, among other institutions, examined information culled by the National Survey on Drug and Use and Health from 78,976 respondents—all U.S. residents between the ages of 18 and 64—including substance use, socioeconomic status and health.

Involvement with the criminal justice system was defined by three criteria: whether the respondent had been recently arrested, released on parole or placed on probation.

The data suggested that only 3% of the general population with no history of opioid use—prescription or other forms, like heroin—fell into those three categories.

However, 20% of respondents who said that they had a dependency on prescription opioids and 40% of those who reported using heroin had some level of involvement with the criminal justice system.

The data also revealed that individuals reporting opioid use or dependency were more likely to have some form of health issue, whether a mental illness or chronic health conditions like asthma or chronic obstructive pulmonary disease.

Using this information, the researchers opined that the criminal justice system needed greater involvement in providing treatment for individuals with opioid dependency.

They noted that many prison systems do not offer medication-assisted treatment (MAT), which has been regarded as the most effective means of treating opioid issues by several studies.

Individuals in the criminal justice system who do not receive some form of treatment are more likely to experience a lower tolerance to opioids and in turn, a greater chance of overdose upon release, according to 2012 research conducted with former inmates.

Study lead author Tyler Winkelman, a clinician-investigator at Hennepin Healthcare in Minneapolis, also suggested that placing individuals in treatment facilities instead of jails may prove more effective in breaking the cycle of dependency and incarceration. “We need a response that will ideally prevent people from entering the criminal justice system,” he noted.

The NPR coverage cited a 2016 study, which reviewed rates of death by overdose among inmates exiting the Rhode Island Department of Corrections after it began a medication-assisted treatment program for its prison population. The study suggested that overdose deaths dropped by nearly 61% among that demographic—an “unheard of” drop in mortality rates, according to study author Josiah Rich, a professor of medicine and epidemiology at Brown University.

“At this point of the epidemic, we can’t afford to not put people on treatment,” he added.

View the original article at thefix.com

16 July 2018
Link Between Trump Support And Opioid Use Revealed In New Study

“When we look at the two maps, there was a clear overlap between counties that had high opioid use … and the vote for Donald Trump,” said the study’s author.

There may be a geographic connection between those who supported Trump in the 2016 election and prescriptions for opioids, according to a new study published in the medical journal JAMA Network Open.

James S. Goodwin, chair of geriatrics at the University of Texas Medical Branch and the study’s lead author, along with other researchers, examined data from numerous sources which included the Census Bureau and the 2016 election, as well as data from Medicare Part D, a program for prescription drugs that helps those with disabilities and the elderly.

“When we look at the two maps, there was a clear overlap between counties that had high opioid use… and the vote for Donald Trump,” Goodwin told NPR. “There were blogs from various people saying there was this overlap. But we had national data.”

In order to estimate the amount of opioid use by county, Goodwin and his team utilized the number of Medicare Part D enrollees who had three months or more worth of opioid prescriptions. According to Goodwin, it was harder to estimate the amount of illegal opioid use, though prescription opioid use is strongly correlated with it.

“There are very inexact ways of measuring illegal opioid use,” Goodwin told NPR. “All we can really measure with precision is legal opioid use.”

In the research process, the team looked at a number of factors to determine how a county’s rate of chronic opioid prescriptions was influenced. They found that in the 2016 election, Trump support was closely tied to opioid prescriptions. In counties with higher-than-average numbers of chronic opioid prescriptions, 60% of those who voted did so for Trump whereas in counties with lower-than-average prescriptions, only 39% voted for him.

NPR also states that some of the correlation could have to do with social and economic factors, as many rural counties with struggling economies voted for Trump, and those are the areas where opioid use is common.

“As a result, opioid use and support for Trump might not be directly related, but rather two symptoms of the same problem—a lack of economic opportunity,” NPR noted.

Goodwin and his team also analyzed factors such as unemployment rate, median income, how rural areas were, education level and religious service attendance. They found that these factors account for about 66% of the connection between Trump voters and opioid use, but not the remaining percentage.

“It very well may be that if you’re in a county that is dissolving because of opioids, you’re looking around and you’re seeing ruin. That can lead to a sense of despair,” Goodwin told NPR. “You want something different. You want radical change.”

For some areas hit hard by the opioid crisis, NPR states, the Trump presidency may have seemed like a solution.

While the study shows a likely link, it isn’t definitive and has shortcomings, Goodwin states.

“We were not implying causality, that the Trump vote caused opioids or that opioids caused the Trump vote,” he cautions. “We’re talking about associations.”

View the original article at thefix.com

25 June 2018
Older Americans Among "The Unseen" In The Opioid Epidemic

Opioid misuse nearly doubled for Americans older than 50 over a 12-year span.

The focus of the opioid crisis tends to be on younger generations. But this could be problematic, as, according to the Washington Post, older generations are increasingly at risk to develop opioid use disorders.

This is backed up by information from the Substance Abuse and Mental Health Services Administration (SAMHSA), which states that from 2002 to 2014, opioid misuse decreased in younger age groups, especially in those age 18-25.

However, in Americans older than 50, use just about doubled.

On Wednesday, May 23, the Senate Special Committee on Aging held a session to discuss opioid use by the elderly population.

“Older Americans are among those unseen in this epidemic,” Sen. Robert P. Casey Jr. of Pennsylvania said, according to the Post. “In 2016, one in three people with a Medicare prescription drug plan received an opioid prescription. This puts baby boomers and our oldest generation at great risk.”

Medicare can be problematic in situations such as this, because it funds opioids for patients, but it does not assist with care or medication that can be used to combat the opioid crisis, the Post notes.

William B. Stauffer, executive director of the Pennsylvania Recovery Organizations Alliance, in Harrisburg, Pennsylvania, spoke at the hearing and said one in three older Americans that have Medicare are prescribed opioids.

“However, while Medicare pays for opioid painkillers, Medicare does not pay for drug and alcohol treatment in most instances, nor does it pay for all of the medications that are used to help people in the treatment and recovery process,” he said, according to the Post. “Methadone, specifically, is a medication that is not covered by Medicare to treat opioid use conditions.”

Gary Cantrell, a deputy inspector general at the Department of Health and Human Services, addressed Medicare Part D (prescription medication) beneficiaries, according to the Post.

In 2016, Cantrell says, about 500,000 people “received high amounts of opioids” and nearly 20% of those are at “serious risk of opioid misuse or overdose.”

For the elderly population, problematic use of opioids often starts with prescriptions rather than street drugs.

“Older adults are at high risk for medication misuse due to conditions like pain, sleep disorders/insomnia, and anxiety that commonly occur in this population,” Stauffer said, according to the Post. “They are more likely to receive prescriptions for psychoactive medications with misuse potential, such as opioid analgesics for pain and central nervous system depressants like benzodiazepines for sleep disorders and anxiety.”

Apart from abuse, there are other risks associated with opioid use in older populations, too. The Post states that Sen. Susan Collins (R-Maine) pointed out at the hearing that, “Older adults taking opioids are also four to five times more likely to fall than those taking nonsteroidal, anti-inflammatory drugs.”

Opioid misuse in seniors becomes even more dangerous because doctors can have a harder time recognizing the signs, Collins says.

“Regrettably,” Collins said, according to the Post, “health-care providers sometimes miss substance abuse among older adults, as the symptoms can be similar to depression or dementia.”

View the original article at thefix.com

2 June 2018