US needs to invest ‘tens of billions or hundreds of billions’ to fight opioid epidemic

The goal of an opioid is to reduce pain, but the addictive drugs are creating pain for millions of families suffering through the crisis.

Deaths from opioid overdoses number at least 42,000 a year in the U.S., according to the Center for Disease Control.

“This is an epidemic that’s been getting worse over 10 to 20 years,” Caleb Alexander, co-director of Johns Hopkins Center for Drug Safety, told CNBC’s “On The Money” in a recent interview.

“I think it’s important that we have realistic expectations about the amount of work that it will take and the amount of coordination to turn this steamship around,” Alexander added.

President Donald Trump declared the opioid epidemic a public health emergency last fall, and he announced an initiative in March to confront the national health crisis.

“No doubt there’s a lot of efforts underway at every level to address the epidemic,” Alexander explained.

“There’s a flurry of legislation right now working its way through Congress and these legislative efforts address everything from safer packaging to better use of information to try to address the diversion of prescription opioids.”

Opioids include not just prescription drugs, like OxyContin, codeine, and morphine, but also heroin and synthetic drugs like fentanyl.

But Alexander says some progress has been made in reducing the overprescribing of the prescription painkillers, “this was one of the primary drivers of the epidemic in the first place.”

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“There’s been modest declines in prescription opioid sales over the past 5 to 7 years. But we’re still way beyond the volume of opioids prescribed compared with every other country in the world. We have a long way to go before we get to the levels of opioid prescribing that we were at in the late 1990’s before this epidemic began.”

Alexander says his research is focused on identifying clinical and policy solutions to the opioid epidemic.

Beyond reducing opioid prescriptions, he sees another step as crucial in addressing the epidemic.

“We need to better identify and treat people with opioid addiction. This is a treatable condition, just like diabetes or high cholesterol and yet the vast majority of people with opioid use disorder are not enrolled and seeking care.”

Alexander added: “The statistics are stunning. More than 2.1 million Americans have an opioid use disorder or opioid addiction” and he says the country needs to “invest tens of billions or hundreds of billions of dollars” to shore up the treatment system.

He said patients should be able to access medications that “we know work to help reduce the cravings for further opioids.”

With treatment, Alexander said “they can return to normal healthy productive lives in recovery.”

Original article here on CNBC.com.

Medication-Assisted Treatment Needs Community Support

Communities like Portsmouth, Ohio, regularly make national news for waves of overdoses. On any given day, nearly 100 people across the country die due to opioid overdose. The problem always feels like an uphill battle, and often a losing one for social workers and drug counselors who hope to get clients on the path to sobriety.

Evidence shows that one method, medication assisted treatment (MAT), works; however, for MAT to be truly effective, it takes an entire community.

What Is Medication Assisted Treatment?

Medication assisted treatment is an evidence-based recovery process that combines traditional therapies and detox programs with the use of medication. Medication helps patients manage cravings and provides relief from detoxification symptoms. MAT is useful for people who are addicted to opioids or alcohol.

Addiction Spelled Out in Scrabble Pieces

These are some of the most common medications used to treat in MAT.

  • Buprenorphine: A partial opioid agonist, buprenorphine is used for the treatment of patients who are addicted to prescription painkillers. This medication is the first opioid treatment not required to be administered in a clinic.
  • Probuphine: Approved by the FDA in 2016, the probuphine implant requires four rods to be inserted into the upper arm. The rods provide a continuous dose of buprenorphine for six months to alleviate cravings and withdrawal symptoms.
  • Methadone: Methadone is known as a full opioid agonist, which means that it provides many of the same effects of other opioids. The effects are usually milder and do not impact the patient’s ability to function as much, though.
  • Naloxone: An opioid antagonist, naloxone can reverse or prevent life-threatening overdoses by blocking opioid activity at receptor sites. Police officers and medical workers typically carry these injections and administer as necessary. Sometimes, users also carry them in case of an emergency.
  • Naltrexone: Available as an injectable or in pill form, naltrexone is available as a monthly or daily dose and lacks the potential for abuse.
  • Acamprosate: Sometimes referred to as Campral, acamprosate is used to prevent relapse in alcoholics by lessening the post-acute withdrawal symptoms that often lead to relapse.

Along with medication, patients in an MAT program are required to participate in therapy or counseling.

Healthcare Providers and Community Members Can Erase Stigma

Even though MAT has proven to be an effective form of treatment, there’s still a stigma associated with it, as many believe that it’s about replacing one drug with another. What can be done so that members of behavioral healthcare can recommend this treatment?

Change in Mindset

Addiction is complex. It is a brain disease. Simply viewing addiction as a disease rather than a moral or criminal problem can help make addiction treatment programs, including MAT, more accessible. Despite inclusion in the Diagnostic and Statistical Manual (DSM) and research that states addiction is a disease, many community members and medical professionals do not view addiction in this way. If behavioral healthcare professionals don’t understand addiction as a disease, MAT will continue to be underutilized.

Education

Addiction professionals have a responsibility to educate others on MAT and its effectiveness. There are still misconceptions about what the treatment actually entails.

Social workers, counselors, and others must understand MAT and the evidence that supports this type of program. This also means that healthcare organizations need to mandate ongoing education for staff. Education enables counselors to make appropriate recommendations as to when individuals need abstinence-based treatment or MAT. Both types of treatment can be effective, but which is appropriate for the patients they are treating?

Law enforcement officials should also receive education and training on MAT. This includes promoting MAT as a treatment method for incarcerated addicts. A lack of MAT in prisons means many addicts end up relapsing, and even dying of an overdose because they didn’t receive proper treatment.

Access to Naloxone

Reducing stigma associated with MAT means that access to medication should go beyond the treatment setting. First responders should be trained to carry and administer naloxone. As mentioned earlier in this article, it can be a life-saving step in reducing overdose fatalities. Many states already passed legislation to allow access to naloxone. Healthcare professionals can share research and evidence with community officials to allow access to naloxone or increase supply in cities that already have it.

A holistic solution that involves the whole community is necessary to combat the opioid epidemic, reduce fatalities, and direct people to the appropriate treatment option, whether it’s MAT or not. Community officials and healthcare providers should also look to treatment centers as resources. What can they learn from the individuals who are working with these patients? In order to make MAT effective, it takes community involvement before, during, and after treatment.

Original article here posted on psychcentral.com

Annals of Emergency Medicine

Identification, Management, and Transition of Care for Patients With Opioid Use Disorder in the Emergency Department

Herbert C. Duber, MD, MPHIsabel A. Barata, MD, MBAEric Cioè-Peña, MD, MPHStephen Y. Liang, MD, MPHSEric Ketcham, MD, MBAWendy Macias-Konstantopoulos, MD, MPHShawn A. Ryan, MD, MBAMark Stavros, MDLauren K. Whiteside, MD, MS

Because of a soaring number of opioid-related deaths during the past decade, opioid use disorder has become a prominent issue in both the scientific literature and lay press. Although most of the focus within the emergency medicine community has been on opioid prescribing—specifically, on reducing the incidence of opioid prescribing and examining alternative pain treatment—interest is heightening in identifying and managing patients with opioid use disorder in an effective and evidence-based manner. In this clinical review article, we examine current strategies for identifying patients with opioid use disorder, the treatment of patients with acute opioid withdrawal syndrome, approaches to medication-assisted therapy, and the transition of patients with opioid use disorder from the emergency department to outpatient services.

See full article here.

What is Opioid Use Disorder in the New DSM-5?

Opioid Use Disorder is a diagnosis introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5. It combines two disorders from the previous edition of the Diagnostic and Statistical Manual, the DSM-IV-TR, known as Opioid Dependence and Opioid Abuse, and incorporates a wide range of illicit and prescribed drugs of the opioid class.

Probably the most well-known and notorious type of Opioid Use Disorder is Heroin Use Disorder, yet less than 10% of people aged 12-17 years old in the United States with Opioid Use Disorder take heroin.

 Most people with Opioid Use Disorder use analgesic opioids, or painkillers whether they are prescribed for themselves of for someone else, or obtained some other way.

Symptoms of Opioid Use Disorder

The diagnosis of Opioid Use Disorder can be applied to someone who uses opioid drugs and has at least two of the following symptoms within a 12 month period:

  • Taking more opioid drugs than intended.
  • Wanting or trying to control opioid drug use without success.
  • Spending a lot of time obtaining, taking, or recovering from the effects of opioid drugs.
  • Cravings opioids.
  • Failing to carry out important roles at home, work or school because of opioid use.
  • Continuing to use opioids, despite use of the drug causing relationship or social problems.
  • Giving up or reducing other activities because of opioid use.
  • Using opioids even when it is physically unsafe.
  • Knowing that opioid use is causing a physical or psychological problem, but continuing to take the drug anyway
  • Tolerance for opioids.
  • Withdrawal symptoms when opioids are not taken.

Does Anyone on Opioids Have Opioid Use Disorder?

No. Many people are prescribed opioids for pain, for long and short periods, and do not develop an opioid use disorder. And while it is often the case that people will develop physical tolerance to prescribed opioids, and experience physical withdrawal symptoms if they do not take the drug, DSM-5 explicitly states that these are not applicable if the individual is experiencing these symptoms under appropriate medical supervision. Why? Because addictive disorders are primarily psychological in nature, and although someone can develop normal physical responses to prolonged drug exposure, that in itself does not constitute a disorder, if they have no cravings for the drug, no difficulty using appropriate dosages, and no lifestyle problems as a result of taking the drug (although someone in pain may have reduced activity as a result of their pain, that is not the same as reduced activity because they are seeking out opioid drugs.) This is a major step forward in the understanding of substance use disorders.

While many problematic heroin users claim their use is non-problematic, typically heroin use causes more significant and long lasting problems for users than use of other drugs. The exact numbers of problematic and non-problematic heroin users is unknown, and because of the secrecy surrounding heroin use, so it is difficult to compare problematic and non-problematic users. It does appear that those who develop Heroin Use Disorder have very significant psychological problems even before they start using the drug. In contrast, those who are able to control and manage their use tend to be more psychologically healthy and socially advantaged prior to use. The same may be true of those who do or do not become addicted to pain medication, but much more research is needed to understand exactly why some people become addicted when they take opioids, while others do not.

Screening

There are several screening tools available that have been developed by experts in addiction, and published so that others can use them. These screening tools can be used to determine whether someone is may need to be assessed for opioid use disorder. One very commonly use, simple tool that is used to screen for substance use disorders is the CAGE questionnaire, which is easy to remember using the acronym CAGE as key letters in four revealing questions. If someone answers yes to any of these questions, they would benefit from a more complete assessment.

C – stands for “cut down” – “Have you tried to cut down on your drinking or drug use, but couldn’t?”

A – stands for “annoyed” – “Are family and friends annoyed about your drinking or drug use?”

G – stands for “guilty” –  “Do you ever feel guilty about your drinking or drug use?”

E – stands for “eye opener” – “Do you have a drink or use drugs as an ‘eye-opener” in the morning?

A more complex screening tool is the Opioid Risk Tool, which calculates the factors that place individuals at greater risk of having a substance use disorder. These factors include past family and personal history of substance use, a history of childhood sexual abuse, age, and history of past or present psychological disorders, including depression and schizophrenia.

Sources

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fifth edition, DSM-5TM. American Psychiatric Association. 2013.
  • Hser, Y., Evans, E., Huang, D., Brecht, M. and Li, L. “Comparing the dynamic course of heroin, cocaine, and methamphetamine use over 10 years.” Addict Behav 33:1581-1598. 2008.
  • Powell, D. “A pilot study of occasional heroin users.” Arch Gen Psychiatry 28 (4), pp. 586-94. 1973.
  • Sanchez, J., Chitwood, D. and Koo, D. “Risk Factors Associated with the Transition from Heroin Sniffing to Heroin Injection: A Street Addict Role Perspective.” Journal of Urban Health 83:896-910. 2006.

Original article here on verywellmind.com

Why Genetics Makes Some People More Vulnerable to Opioid Addiction — and Protects Others

Every day, 91 Americans die from an opioid overdose. Rates of abuse of these drugs have shot up over the past 15 years and continue to climb. Why is this happening? Is there hope for helping individuals with opioid addiction? From a scientific standpoint, addiction is a disease. And, as researchers who study opioid addiction, we’re hopeful about where epigenetics, the science of how DNA code is regulated, can lead us.  This research could one day unlock preventative therapeutics — treatments that not only help those currently struggling with substance abuse but protect future generations.

Nature and nurture

Just as genetics can affect a person’s risk for heart disease, cancer or diabetes, it can also make them more or less susceptible to addiction.

A great deal of research in the last decade has focused on tiny differences in a person’s DNA — termed single-nucleotide polymorphisms, or SNPs. These SNPs can indicate whether you have a higher or lower rick for addiction.

For example, some people have an opioid receptor gene with a single building block change that protects them against substance dependence in general and opioid dependence in particular. Conversely, variations in genes for three different dopamine receptors — the molecules responsible for signaling pleasure in the brain — are linked to increased risk for opioid addiction.
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Environment matters, too. Your parents’ or grandparents’ experiences can affect the way your genetics are expressed years down the line. For example, say you have a dopamine receptor SNP that makes you more likely to develop an addiction. While it’s useful to know that you’re at greater risk, if that gene is “read” differently by your body’s cells due to epigenetic changes, then that risk may not impact your life.

Exposure to drugs like opioids can cause significant epigenetic changes across generations. In one study, we gave opioids to a group of female rats for just 10 days during adolescence, while another group of female rats didn’t receive any. The rats then remained drug-free until adulthood.

The children of the rats who received opioids were actually less susceptible to opioid addiction. In tests, they were not willing to search as hard for opioids and found opioids less rewarding. In addition, the brains of these offspring – and their offspring – expressed genes differently from their peers.

 Why did this happen? It was the result of epigenetic changes. The mother rat’s childhood exposure to opioids changed how their children’s DNA was “read.” In this case, the epigenetic changes helped to prepare the offspring for an environment that they were likely to encounter. The parents’ experiences had changed the way cells in their offspring read their DNA code, lessening their susceptibility to addiction and adapting them to a world with opioids.

This rodent experiment shows how one generation’s experiences can change the destiny of the next generation. However, in humans, the situation can be far more complicated. Scientists haven’t yet studied the role of epigenetics in human substance abuse. But they have observed epigenetic effects in complex diseases like obesity.

Knowing the risks

Early research suggests that people born into a culture of drug use may be more inclined to get and stay sober. While still unclear, epigenetics may play a role.

 In the meantime, hearing about the science of genetics and epigenetics may help people with substance use disorders in unexpected ways.

One therapeutic approach for substance use disorder that’s now popular is cognitive behavioral therapy. This focuses on strengthening an individual’s problem-solving abilities in order to change their thinking and behavioral patterns.

One vital tool entails using predictive language to instill hope in patients — for example, reminding them of the skills they already have within them to prevent relapse and pointing out where those skills have helped them survive so far. For people with a generational exposure to opioids, the knowledge that they may actually have biology on their side to stay opioid-free could lead to better outcomes by giving them a psychological boost.

Could communicating basic science findings regarding protective epigenetic changes help tip the scales? While this is still a theory, scientists are currently evaluating a similar approach for diabetes and coronary heart disease. Perhaps communicating about genetic predisposition can help individuals stick to their treatment programs and reduce their risk of complications.

 A treatment for addiction

Epigenetics research may also lead us to develop new medications.

Clinicians already use personalized medicine to treat nicotine addiction. In this case, a doctor will prescribe different medication to an individual trying to quit smoking, depending on his or her genes.

Better understanding of genetics and opioid addiction may lead to similar approaches. Since we are just beginning to understand how epigenetics impacts opioid addiction, such treatments are likely years away. The first step is to understand which genes are responsible for making offspring more resistant, like the rats in our study, and how these genes then impact brain function and addictive behaviors.

Once scientists understand these processes, we might one day be able to develop drugs that target those same genes and help protect people from developing addiction — in effect, inoculating people against this deadly disease

Jill Turner, Assistant Professor of Pharmacy, University of South Carolina; Fair Vassoler, Research Assistant Professor of Biomedical Sciences, Tufts University, and Kathleen Chiasson-Downs, Clinical Therapist, West Virginia University

Original article here,  published on theconversation.com.

 

National Group Salutes County for its Response to Opioid Crisis

Heroin and fentanyl once ravaged the region to such a degree the coroner said Montgomery County was suffering an “emergency of mass disaster proportions.”

Now, a collaborative community response that helped bring overdose deaths to a recent three year low is drawing recognition with an award from the National Association of Counties.

“After a few rough years of being identified as the epicenter of the opioid crisis, I think we’re demonstrating again why Montgomery County is known for innovation,” said Helen Jones-Kelley, executive director of the Montgomery County Alcohol, Drug Addiction and Mental Health Services (ADAMHS) board.

The Community Over dose Action Team (COAT), formed in the fall of 2016 in response to the epidemic, will be honored in July with a human services achievement award at the association’s annual conference in Tennessee.

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The effort is succeeding because of participation beyond elected officials, and beyond those in public health and law enforcement, said Montgomery County Sheriff Phil Plummer.

“The credit goes to the grassroots organizations that were in the trenches,” he said “Groups like Families of Addicts and the Drug Free Coa lit ion are doing tremendous work out there.”

More than 200 people from 100-plus organizations worked to put the opioid epidemic in retreat, said Montgomery County Health Commissioner Jeff Cooper.

“The award is a reflection of our community’s willingness to come together and work united and align our resources to respond to a public health crisis,” he said.

Heroin and fentanyl are largely responsible for the overdose deaths of more than 1,600 people in Montgomery County over the past five years, including 566 in 2017.

But last year could have been worse.

Beginning in June, the numbers took a dramatic turn for the better after 81 people died in May. By March this year, fewer people were dying each month than at any time since early 2015.

“We obviously didn’t set out to win awards when we started this. Our focus was to get organized and reduce the number of opiate deaths,” said Montgomery County Commissioner Dan Foley. “While there are still too many people dying of drug overdoses, the COAT is working and the community should feel good about it.”

Between January and May of last year, 1,773 overdose calls were reported in the county, Plummer said. The number is about a third of that this year.

Bar bar a Marsh, assistant health commissioner for Public Health-Dayton and Montgomery County, said COAT developed, expanded or enhanced more than 45-plus programs across the community.

The collaborative continues to work on eight areas of focus from increasing treatment accessibility to decreasing the illegal supply of drugs, as well as distributing Narc an, educating the public and promoting the careful prescribing of opioids.

“I think there are many counties that are very interested in the structure, and they are looking at how to implement it,” Marsh said.

New programs were put in place at the Montgomery County Jail, including medication-assisted treatment, peer support counseling and a streamlined process for getting inmates into residential and outpatient programs once released, Plummer said. But on any given day, dozens of inmates are still waiting for treatment.

“We have made great strides in dealing with the individuals who suffer from substance abuse and mental illness in our jail,” Plummer said. “We still have about 50 people per day going through withdrawal in our jail.”

Among other initiatives, COAT works with employers to give those struggling to get clean second and third chances at jobs, Jones-Kelley said.

“It was an all-out effort. It wasn’t a traditional response to a problem,” she said.

Cooper said the group effort won’t be disbanding anytime soon, the structure will stay in place to address other health crises.

“We know we still have a long way to go,” he said.

“But it truly is a model-the Community Over dose Acti on Team-that we can now build upon to respond to when the drug of choice changes in the community.”

Contact this reporter at 937-225-2442 or Chris.Stewart@coxinc.com.

Original article here on daytondailynews.com.

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Webinar Friday 5/25: Treatment of Pain in the Addicted Person

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Friday| May 25, 2018 | 12:00 – 1:00 pm ET

Presenters: Allen Masry, MD

Sponsor: International Nurses Society on Addictions (IntNSA)

About the webinar: This webinar will cover material on chronic and acute pain in the person with Substance Use Disorders. The differences between chronic and acute pain will be described. Treatment for patients with Substance Use Disorders and pain will be discussed.

Educational objectives:

·     Describe the difference between chronic pain and acute pain

·     Discuss pain in the addicted person

·     Describe one evidence-based intervention for pain in the addicted person

Continuing education information: This webinar has been approved by the California Board of Nursing for 1 contact hour of continuing nursing education. Credit will be granted for each individual participating for the duration of the event.

Click on the Register icon below to register.

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The Benefits of Having Naloxone Readily Available

Dr. Hillary Kunins, a Providers Clinical Support System Clinical expert, explains the benefits of naloxone, a medication that can immediately revive a person who has overdosed on an opioid.

Dr. Kunins discusses who should have naloxone prescribed and where should it be made available.

Dr. Kunins is an Assistant Commissioner at the New York City Department of Health and Mental Hygiene.

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View more videos at www.pcssNOW.org.

Study Looks At Barriers To Getting Treatment For Substance Use Disorders

For patients with substance use disorders seen in the emergency department or doctor’s office, locating and accessing appropriate treatment all too often poses difficult challenges. Healthcare providers and treatment facility administrators share their views on delays and obstacles to prompt receipt of substance use disorder treatment after referral in a study in the Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine (ASAM). This journal is published in the Lippincott portfolio by Wolters Kluwer.

Issues related to patient eligibility, treatment capacity, understanding of options, and communication problems all contribute to gaps in referral and delays to getting treatment for patients with substance use disorders, according to the new research by Claire Evelyn Blevins, PhD, of Warren Alpert Medical School of Brown University and Butler Hospital, Providence, RI; Nishi Rawat, MD, of OpenBeds, Inc., Washington. DC; and Michael Stein, MD, of Boston University and Butler Hospital.

Four Themes Affecting Obstacles to Treatment for Substance Use Disorders

The ongoing opioid crisis has drawn attention to the widening gap between the high need and limited access to substance use treatment in the United States. A recent Substance Abuse and Mental Health Services Administration report found that of 21.7 million Americans in need of substance use disorder treatment, only 2.35 million received treatment at a specialty facility. Yet there is little information on the organizational-level barriers to treatment for substance use disorders.

Beakers Full of Liquid

To address this issue, Dr. Blevins and colleagues performed a series of interviews with 59 stakeholders in the treatment referral process. The study gathered input from those who make referrals for substance use treatment, including emergency medicine physicians, addiction specialists, and other medical providers; as well as those who receive referrals, including substance use treatment facility staff and administrators.

Analysis of the interviews identified four broad themes:

  • Patient Eligibility. Healthcare providers face difficulties in determining whether patients meet criteria for admission to a particular treatment center, including the application of treatment eligibility criteria. “Eligibility requirements may prevent a patient from entering a treatment center,” the researchers write.
  • Treatment Capacity. Even if a patient is eligible, providers have trouble finding out whether space is available. “Despite the need for services, treatment centers may not run at capacity, because of frustrations encountered and time wasted on the referral and admission process.”
  • Knowledge of Treatment Options. Providers may not understand the levels of available care for substance use treatment, and how to select the best treatment for their patient. “After determining appropriate level of care, a provider must then find a program that meets the patient’s needs, which becomes more difficult with the differences in terminology and program guidelines.”
  • Communication. Difficulties in communication between referring providers and treatment facilities can contribute to delays to starting treatment. The need for direct referral – “from the emergency department to a bed” – is particularly high for patients with opioid use disorders.

“Access to substance use disorder treatment is often a maze that can be difficult to navigate for both providers and patients,” Dr. Blevins and coauthors write. Based on the themes identified, they make recommendations for improvement in the referral process, including a database of clear eligibility criteria, real-time information on treatment capacity, and increased education and training for providers on substance use treatment.

They also propose ways to improve communication and reduce treatment waiting times, including new information technologies. The researchers write: “By improving systems that enhance communication across organizations, patient referrals may be more easily completed, improving access to care and expanding the use of appropriate treatments for the many patients in need.”

In an accompanying commentary, David L. Rosenbloom, PhD, of Boston University School of Public Health discusses the underlying reasons for the current “dysfunctional referral system.” He notes that referrals for other chronic diseases “may be more effective because they are to ‘in-house’ affiliated providers.” Dr. Rosenbloom writes: “The standard of care should be to stabilize, initiate treatment, and provide a hands-on transfer to an entity that can complete a diagnostic assessment and provide evidence-based treatment” for patients with substance use disorders.

Original article here on Sciencemag.com.

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Event in Chillicothe: Thursday 4/26, OHSAM President To Speak

Connection is the Opposite of Addiction. There are many local resources available to addicts and families wishing to connect; and people and organizations that are ready to help.

Join us for Addiction: Understanding Local Support and Resources, a free, community-focused forum on the health crisis of opioid addiction; and the help that is available in our region.

Hear from representatives from Adena Health System who will share how it is fast becoming a catalyst in saving lives, while fighting addiction. Also hear from experts about medication-assisted treatment; ambulatory detox options; and how the City of Chillicothe and Ross County are taking a proactive approach in reaching addicts and families following an overdose.

Dr. Shawn Ryan, OHSAM president, will also be speaking at this event in Chillicothe tomorrow evening.

The event is free, but participants are asked to register. Light refreshments will be available.

To register, and get your free tickets, click the green REGISTER button below and follow the steps.

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Location: Adena PACCAR Medical, Education Center 446 Hospital Road, Chillicothe, OH 45601

When: Thursday April 26, 6:00pm-8:00pm EDT

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Original post here.

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Click the above PDF icon for the official addiction panel flier and feel free to share with anyone who might be interested in this event. If the above PDF does not work, please use the link below:

Addiction Panel Flier