President Trump Plans to Declare National Emergency in Response to Opioid Crisis

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WASHINGTON, D.C. – August 10, 2017

Following the recent recommendation of the White House’s opioid commission, President Trump announced today that the Administration is moving to declare a national emergency on opioid abuse.

Jessica Nickel, President and CEO of the Addiction Policy Forum, released this statement in response to the announcement:

“We applaud President Trump for taking this important step today to declare a national emergency on this crisis. This declaration can help communities with flexibility and resources to help implement a comprehensive response to the opioid epidemic. Every day we are losing 144 people to drug overdoses — 144 daughters, sons, mothers, sisters and fathers. We can do better for our families and communities.”

In June, the Addiction Policy Forum testified before Governor Christie and the White House’s Opioid Commission and presented 63 recommendations spanning the six key pillars of a comprehensive response. For full testimony and video click here.

Link to article here: President Trump Plans to Declare National Emergency in Response to Opioid Crisis

Imprisoning Drug Offenders Doesn’t Affect Use, Study Says

Sending more people to prison for drug offenses won’t have an effect on drug use and deaths, according to a new analysis released this week.

Researchers from the Pew Charitable Trusts crunched state-by-state data on drug imprisonment, drug use, overdoses and drug arrests and found no evidence that they affected one another.

That lack of a pattern shows the flaw in a central philosophy in the war on drugs: That doling out harsh penalties makes people less inclined to use drugs or join the drug trade, said Adam Gelb, director of Pew’s public safety performance project, which works to reform state-level drug policies.

“There seems to be this assumption that tougher penalties will send a stronger message and deter people from involvement with drugs. This is not borne out by the data,” Gelb said.

He included the entire analysis in a letter Monday to Chris Christie, who is both governor of New Jersey and head of President Donald Trump’s Commission on Combating Drug Addiction and the Opioid Crisis.

The commission held its first public meeting on Friday. It is responsible for coming up with a plan to help the federal government tackle an addiction crisis that killed more than 50,000 people last year. The growing number of overdoses is being driven by runaway rates of addiction to prescription painkillers and heroin, researchers say.

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A line of inmates at the Los Angeles County Sheriff’s Department’s Men’s Central Jail, on October 27, 2011. Reed Saxon / ASSOCIATED PRESS

Meanwhile at the Justice Department, Attorney General Jeff Sessions is carving out his own approach — focused on punishment.  He issued a memo to federal prosecutors in May ordering them to seek the maximum punishment for drug offenses, a return to harsh policies that predate former President Barack Obama.

Pew’s study was relatively simple: gather data from each state in four categories: incarceration of drug offenders, overdose deaths, drug arrests and drug use. The latest year for which all the data was available was 2014.

The theory, Gelb said, was that if deterrence worked, the states with the highest incarceration rates would have lower rates of drug use.

But that’s not what they found.

For example, Louisiana, the state with the highest incarceration rate, was in the middle of the pack on overdoses, drug arrests and drug use. Massachusetts, with the lowest incarceration rate, was toward the bottom in arrests and use, but near the top in overdoses. West Virginia, with the highest overdose rate, was 21st in incarcerations. And Colorado, with the highest rate of drug use, was 37th in incarcerations.

Gelb said he hoped the commission and other policy makers would use it to chart their course forward.

“This is fresh data that should inform the important conversation happening in Washington and around the country about what the most effective strategies are for combatting the rise in opioid addiction and other substance abuse,” Gelb said.

by posted June 20, 2017

Link to original article here: Imprisoning Drug Offenders Doesn’t Affect Use, Study Says

Lives Lost: One story of opioid recovery

Lisa is alive today because of new tactics in the fight against opioid addiction.

CANTON, OH Every morning, Lisa dissolves a pill under her tongue. She doesn’t mind the flavor: chalky, like children’s aspirin, with a hint of orange.

The pill is Suboxone, a medication that helps Lisa control her cravings for opioids. After years of abusing prescription pills and heroin, and surviving more than a dozen overdoses, she has been sober four months and counting.

Her bills are paid. There is food in the refrigerator. She spends time with her children.

“I’m happy, actually,” Lisa said. “This is the best things have been in a long, long time.”

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But her story is about more than a pill. Lisa is alive and in recovery because Stark County embraced new techniques to fight an opioid epidemic that has killed hundreds locally and thousands across the state.

Medication-assisted treatment, outreach by police officers, the wide-spread use of overdose-reversing naloxone and peer support all played a role in Lisa’s story.

Lisa is 51 years old and lives in Canton. She agreed to speak with The Canton Repository on the condition her last name not be used because of concerns regarding her past associates.

Lisa almost didn’t make it to this point. By her own count, she overdosed at least nine times that landed her in a hospital. That number doesn’t include the dozen or so times her teenage son waited anxiously at her side to blast overdose-reversing naloxone up her nose.

“He saved my life more times than I know,” she said.

Lisa started smoking marijuana when she was 13 years old. In her 20s, she started using methamphetamine, cocaine and prescription pills. Vicodin was the first opioid she tried. Her mother gave her the pill to ease a headache.

“That was the miracle cure for hangovers after that,” Lisa said.

Sometime later, a pain management doctor prescribed Lisa opioids such as Percocet, Vicodin and OxyContin for migraines and pain related to scar tissue. The doctor didn’t ask about her past drug use, she said.

Lisa had a medicine cabinet full of opioids, but she would blow through a month’s worth of pills in a few weeks. The first pain management doctor ultimately dropped Lisa after she got an opioid prescription from a dentist. She found another clinic, but authorities shut it down.

Drugs such as heroin, cocaine or opioid painkillers flood the brain with dopamine, causing a feeling of pleasure. Food, sex and exercise also release dopamine, but can’t compete with surge from the drugs.

Over time, drug use depletes the amount of dopamine in the brain. Addiction takes hold and the brain’s structure changes.

“They have to seek substances to fill that gap,” said Dr. Jamesetta Lewis, of Mercy Medical Center’s Pain Management Center. “That’s when an addiction develops. They have to get more and more substances to bridge that dopamine gap the brain can’t fill itself.”

Unable to get pills, Lisa used heroin. That was about eight years ago. Heroin was cheaper than pills and stronger. She used every day. When she heard about someone overdosing, she’d try to buy the same stuff.

“I never cared if I died,” Lisa said. “I never cared. I just didn’t care. And if I was going to die, that was the way to do it because it was completely painless. You just go to sleep.”

Addiction consumed her life and hurt those closest to her. Her adult daughter started using opioids. Lisa’s teenage son worried every time he left the house or went to school that he’d return to find her dead or in jail. At night he skipped sleep to make sure she didn’t die.

“Growing up seeing your family do that, it does something to you,” he said.

Ready for help

Two Canton Police narcotics officers knocked on Lisa’s door one day this winter.

Detective Mike Rastetter and a supervisor were checking complaints about drug activity at Lisa’s home. They knew Lisa from all the times she had overdosed.

“She looked skin and bones,” Rastetter said. “She looked really bad.”

Lisa was sick from withdrawal and desperate when they knocked. What she didn’t know at the time was that the department had told officers to look for ways to help people addicted to drugs get treatment.

Lisa told the detectives she was going to die if she didn’t get help. They started making calls. About four hours later, Lisa was in a detox bed at the Crisis Intervention & Recovery Center.

“We were fortunate enough that day that it was available,” Rastetter said.

Medication-assisted treatment

Addiction treatment can take different forms. After a week of detox, Lisa went to CommQuest Services’ Regional Center For Opiate Recovery in Massillon, which opened in 2015 specifically to treat opioid addiction. Since then, it has received 2,500 unduplicated referrals from more than 20 counties.

“We talk about recovery being a process of learning to enjoy life and repairing the damage you did while you were using and improving the overall quality of your life,” said CommQuest President and CEO Keith Hochadel.

Lisa’s treatment plan combined counseling and 12-step meetings with daily doses of Suboxone, a combination of naloxone and buprenorphine, an opioid. Suboxone reduces the euphoria and cravings associated with opioids so a patient can focus on recovery.

The thought of getting high is always in her mind, Lisa said, but she counts to 20 and thinks about something else and the craving passes.

“I can function every day,” Lisa said. “I function.”

Starting this month, Stark Mental Health and Addiction Recovery will use two-thirds of a $741,000 federal and local funding package to expand treatment with Suboxone and Vivitrol, a medication that blocks an opioid from making the user high.

But the local treatment community has realized that treating addiction involves more than medication and counseling sessions. Men and women in recovery need help to rebuild their lives and the best guide can be a person who has walked the same road.

Rebuilding lives

When Lisa started at ReCOR, she had to go to Massillon every day to get her dose of Suboxone. She couldn’t drive and everyone she knew who had a car was using drugs. She was able to get a ride with a peer supporter from Stark County TASC.

Peer supporters are individuals in recovery who are trained to help others addicted to drugs or alcohol.

“You actually know what they’re talking about,” said Nicole Osborne, who oversees TASC’s peer supporters. “You actually know where they’re coming from. You didn’t just read it in a book in school.”

Three times a week peer supporters from TASC visit individuals detoxing at the Crisis Center. Rides to treatment appointments are just some of the help they offer.

People addicted to alcohol or drugs put everything else in their lives on hold, Osborne said.

When she meets a new client, she asks the woman about her “life to-do list,” the things she’s avoided or ignored for months or years. That can be getting a driver’s license, finding a home, clearing up arrest warrants or getting a job.

“You need the basics of life,” Osborne said. “You need to know where you’re going to sleep that night. It’s hard to even think about being sober or not using drugs if you don’t have a place to live or no food.”

Peer supporters also link clients to others who can help them stay sober.

Lisa said teaming with a peer supporter removed any excuses she might have had for not going to treatment.

“You don’t have a reason to say, ‘I can’t do it,’” she said.

Police outreach

Lisa is drug-tested regularly in the ReCOR program and said she goes to 12-step meetings almost daily.

Rastetter stops and checks on Lisa and her family about once a month. Right now he’s trying to find her a job.

The 11-year Canton police veteran said he never thought his job would include navigating the maze of addiction services, insurance and housing assistance. Finding local resources on the fly is a challenge, he said, but it’s getting better.

“It’s worth a chance,” Rastetter said. “If we save two or three people’s lives and they get off heroin, then it’s worth it. It really is.”

Lisa is one of about five people the police have helped get into detox, and the department is trying to assist more.

Taking a cue from communities such as Mansfield, Akron and Green, Canton police started a Recovery Response Team in late June. The team includes police, a caseworker from TASC and a Crisis Center nurse. Every week, the team visits individuals who recently overdosed.

“The jails are not equipped to deal with addiction recovery, and I think that looking at this from a health care standpoint and as a health care crisis is very important,” said Lt. John Gabbard, who oversees the initiative.

The police will still pursue drug dealers, but Gabbard asked for patience from residents who might not understand the new approach toward individuals using drugs.

“Give us a chance to convince you that taking the long-term approach of getting them help will be more beneficial to the neighborhood than trying to evict them into someone else’s neighborhood and not dealing with that problem,” Gabbard said.

Looking forward

Now that Lisa’s life isn’t ruled by a daily hustle for drugs, she has a lot of things she wants to do.

She wants to get a job and more furniture for her home. She wants to drive again. She wants to spend time with her family, including her daughter who is now in recovery.

Her plan is to “do things and make memories,” Lisa said. “Ones that I can remember and ones where everybody’s happy.

Relapse is always a risk, and with opioids, the consequence of one slip can be fatal.

Her kids were proud of her recovery.

“Not everyone is as lucky as her to where you can OD as many times as she did and be alive to this day,” her son said.

Article written by: Shane Hoover, Cantonrep.com staff writer

Link to original article here: Lives Lost: One story of opioid recovery

OHSAM president, Dr. Ryan, is the featured speaker in this podcast where they interview experts about addiction and addiction education. Listen at the 1:30 minute mark!

The Cover2 Podcast is an ongoing series of interviews with people who are making a difference in the fight against opioid addiction.  The Cover2 Podcast seeks to raise awareness and to connect users.

Click here for: Podcast – Dr. Shawn Ryan, MD, MBA, ABEM

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Route to recovery: how people overcome an opioid addiction

More and more people in the US are able to identify a friend, relative or neighbor who has succumbed to opioid addiction as it increasingly damages the nation.

It’s a frightening reality, but there are options available for people hoping to gain control of their condition and live a life that isn’t dictated by these potent drugs.

What are the routes to recovery from addiction? The Guardian explored that question and more as part of a series of pieces this week looking at survivors of addiction and how to tackle it.

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Can opioid addiction be cured?

There is no cure for addiction, but the disease can be managed just like other chronic medical conditions including diabetes and high blood pressure.

That’s one of the reasons people who are no longer addicted to drugs or alcohol might describe themselves as being “in recovery”. Recovery means different things to different people but generally describes someone who is able to live life without it being disrupted by addiction.

How do you get to be in recovery from opioid addiction?

There are many routes for addiction treatment but the one with the most scientific support combines medication, counseling and recovery meetings.

“If people do those three things together, their chances of getting onto a path of recovery are significantly better than if they try to detoxify off the heroin or the pills they are taking and try to go immediately go to an abstinence-oriented program, where they are not taking any medication to help them during the early stage of their recovery,” said Samuel Ball, president and CEO at the National Center on Addiction and Substance Abuse.

How does medication help treat drug addiction?

Medication is used to stabilize people when they quit using opioids. These drugs include opioids like methadone and buprenorphine, which can reduce the painful effects of withdrawal by lowering the amount of opioids people are taking. They can also help people who want to quit using stave off overwhelming cravings.

A third medication treatment, naltrexone, is different in that it blocks the effect of opioids and it has been studied less closely than the other two drugs.

Isn’t using these drugs just substituting one type of opioid drug for another?

No, though the US health secretary Tom Price said it was last month. Price’s comment sparked a furor among health professionals – nearly 700 researchers and practitioners sent a letter urging Price to “set the record straight”.

“The perception that persons receiving long-term therapy with medications – especially with buprenorphine and methadone – are not actually in recovery is widespread but grossly inaccurate,” the letter said.

The Department of Health and Human Services then clarified that expanding access to medication-assisted treatments is a key element of the federal government’s plans to curb opioid addiction.

That said, these drugs aren’t perfect. Buprenorphine and methadone can and have been abused by opiate users, which is why it is recommended these drugs be taken alongside other therapies.

What happens if people quit using opioids without medication?

For people who abruptly quit, a cluster of unpleasant symptoms can occur as part of withdrawal: anxiety, body aches, nausea, vomiting, diarrhea, agitation.

There is a school of thought that the sheer unpleasantness of withdrawal will push someone out of addiction for good, and that certainly works for some people, but Ball warned it is not something worth betting on.

“I think If you asked me 10 years ago, I might have said detoxing and trying an abstinence-oriented approach, maybe that’s worth a try one time,” said Ball. “And then if that doesn’t work try one of the medications.”

These days, however, Ball said the addiction crisis has “become so life and death” that he thinks medication should be incorporated from the beginning of addiction treatment.

Why can’t people just decide to quit?

There is a narrative, often perpetuated by the media, of people becoming stubborn and quitting on their own once and for all – whether it’s because of a revelation triggered by an emotional low point or, in the case of one person the Guardian spoke with, spending some time in jail where they were forced to withdraw without any support.

“It’s miraculous, and great stories to hear, but I think for many people with opioid addiction, it’s not a realistic thing to plan for, if that kind of epiphany happens for you, it’s wonderful, but you can’t make it happen,” Ball said.

He said the “chances of you staying alive for a longer period of time” are much higher if you access other forms of treatment, particularly medication.

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How effective is rehab at treating addiction?

If pop culture is your guide, the answer to addiction can be found at a swanky beach house rehab center in Malibu, California, or sunny Florida.

These centers – just like residential centers in less idyllic locations across the US – can certainly be effective, but they aren’t required to provide evidence-based treatment, so the efficacy varies wildly.

Some centers don’t have a trained physician or psychiatrist on staff around the clock or only offer a couple hours of therapy each week – an insufficient amount for someone who has deemed their problem so severe they aren’t safe at home.

Also, there is a potentially enormous cost tied to rehab that do not always reflect the quality of service. Insurers don’t always cover these programs, and if they do, they limit how long they will cover the service for.

That is a huge problem because addiction experts agree that addiction can’t be resolved in a short period of time.

How long does it take to recover?

This is obviously different from everyone, and must be considered alongside the fact that relapse is common.

Though it would seem like taking up drugs again is a failure, the US National Institute of Drug Abuse (Nida) said relapse is a sign that treatment needs to be adjusted or started again and is certainly not an indication that someone has irreparably harmed their chances of living a life free from addiction.

Relapse is common for 40% to 60% of patients being treated for addiction and 50% to 70% of people with asthma and hypertension, according to the Nida. The agency notes those disease also have physiological and behavioral components people must manage, particularly when experiencing a relapse.

Written by: Amanda Holpuch 6/22/2017

Link to article here: Route to recovery: how people overcome an opioid addiction

 

Rise In Hospital Visits For Opioids Spotlight The Epidemic

The latest government numbers on opioid-related hospitalizations paint a picture of a country in a drug-related crisis. Between 2005 to 2014, emergency room visits stemming from opioid use rose 99 percent and inpatient stays jumped 64 percent, according to the Agency for Healthcare Research and Quality.

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In 2014 alone, opioid-related hospitalizations totaled 1.27 million.

The spike in hospital visits was driven largely by people ages 25 to 44. The report by the Rockville, Maryland-based agency also noted gender differences in the way men and women used hospital services.

Women were more likely to have inpatient stays, while men were more likely to visit the ER in 2014.  “Our data tell us what is going on. They tell us what the facts are. But they don’t give us the underlying reasons for what we’re seeing here,” Anne Elixhauser, co-author of the report and senior research scientist at AHRQ, told the Washington Post.

“It is no surprise that opioid-related hospitalizations rose significantly during that time period,” Dr. Peter Friedmann, associate dean for research at the University of Massachusetts Medical School and chief research officer at the nonprofit Baystate Health, told HuffPost.

“The surge of opioid use disorder and opioid-related overdose deaths that started in the late ’90s continues unabated in most of the U.S. Overdose deaths are the tip of the iceberg,” Friedmann said.

A U.S. Centers for Disease Control and Prevention report published in June found that between 2010 to 2015, North Carolina hospitals saw a 12-fold increase in patients suffering from endocarditis, an infection of the heart, that was linked to drug dependence.

“As the U.S. opioid epidemic continues to grow, hospitalizations for infectious complications associated with injection drug use are likely to increase,” the report said.

The AHRQ report follows a New York Times Upshot analysis of data from health agencies around the country that estimated drug overdose deaths will top 59,000 in 2016. That’s up from 52,404 overdose deaths in 2015, a 19 percent increase that would be the largest such jump in U.S. history.

According to the Times, the numbers are expected to rise again in 2017.

Link to the original article with informative video here:  Rise In Hospital Visits For Opioids Spotlight The Epidemic

By Erin Shumaker 6/20/2017

Drug Deaths in America Are Rising Faster Than Ever

The death count is the latest consequence of an escalating public health crisis: opioid addiction, now made more deadly by an influx of illicitly manufactured fentanyl and similar drugs. Drug overdoses are now the leading cause of death among Americans under 50.

Although the data is preliminary, the Times’s best estimate is that deaths rose 19 percent over the 52,404 recorded in 2015. And all evidence suggests the problem has continued to worsen in 2017.   Image result for Drug overdose deaths in Philadelphia and San Francisco Drug overdose deaths since 1980 have surged in Philadelphia despite a shrinking population; most heroin there is powdered. They have remained relatively flat in San Francisco, where most heroin is black tar.

Because drug deaths take a long time to certify, the Centers for Disease Control and Prevention will not be able to calculate final numbers until December. The Times compiled estimates for 2016 from hundreds of state health departments and county coroners and medical examiners. Together they represent data from states and counties that accounted for 76 percent of overdose deaths in 2015. They are a first look at the extent of the drug overdose epidemic last year, a detailed accounting of a modern plague.

The initial data points to large increases in drug overdose deaths in states along the East Coast, particularly Maryland, Florida, Pennsylvania and Maine. In Ohio, which filed a lawsuit last week accusing five drug companies of abetting the opioid epidemic, we estimate overdose deaths increased by more than 25 percent in 2016.

“Heroin is the devil’s drug, man. It is,” Cliff Parker said, sitting on a bench in Grace Park in Akron. Mr. Parker, 24, graduated from high school not too far from here, in nearby Copley, where he was a multisport athlete. In his senior year, he was a varsity wrestler and earned a scholarship to the University of Akron. Like his friends and teammates, he started using prescription painkillers at parties. It was fun, he said. By the time it stopped being fun, it was too late. Pills soon turned to heroin, and his life began slipping away from him.

Mr. Parker’s story is familiar in the Akron area. From a distance, it would be easy to paint Akron — “Rubber Capital of the World” — as a stereotypical example of Rust Belt decay. But that’s far from a complete picture. While manufacturing jobs have declined and the recovery from the 2008 recession has been slow, unemployment in Summit County, where Akron sits, is roughly in line with the United States as a whole. The Goodyear factories have been retooled into technology centers for research and polymer science. The city has begun to rebuild. But deaths from drug overdose here have skyrocketed.

In 2016, Summit County had 312 drug deaths, according to Gary Guenther, the county medical examiner’s chief investigator — a 46 percent increase from 2015 and more than triple the 99 cases that went through the medical examiner’s office just two years before. There were so many last year, Mr. Guenther said, that on three separate occasions the county had to request refrigerated trailers to store the bodies because they’d run out of space in the morgue.It’s not unique to Akron. Coroners’ offices throughout the state are being overwhelmed.

 

Drug overdose deaths in six Ohio counties, 2010 to 2017

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Totals for 2017 assume that overdose deaths continue at the same rate through the remainder of the year. Source: Butler County Coroner’s Office; Cuyahoga County Medical Examiner’s Office; Hamilton County Coroner; Montgomery County Alcohol, Drug Addiction & Mental Health Service; Montgomery County Sheriff’s Office; Summit County Department of the Medical Examiner

In some Ohio counties, deaths from heroin have virtually disappeared. Instead, the culprit is fentanyl or one of its many analogues. In Montgomery County, home to Dayton, of the 100 drug overdose deaths recorded in January and February, only three people tested positive for heroin; 99 tested positive for fentanyl or an analogues.

Fentanyl isn’t new. But over the past three years, it has been popping up in drug seizures across the country.

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Most of the time, it’s sold on the street as heroin, or drug traffickers use it to make cheap counterfeit prescription opioids. Fentanyls are showing up in cocaine as well, contributing to an increase in cocaine-related overdoses.

The most deadly of the fentanyl analogues is carfentanil, an elephant tranquilizer 5,000 times stronger than heroin. An amount smaller than a few grains of salt can be a lethal dose.

“July 5th, 2016 — that’s the day carfentanil hit the streets of Akron,” said Capt. Michael Shearer, the commander of the Narcotics Unit for the Akron Police Department. On that day, 17 people overdosed and one person died in a span of nine hours. Over the next six months, the county medical examiner recorded 140 overdose deaths of people testing positive for carfentanil. Just three years earlier, there were fewer than a hundred drug overdose deaths of any kind for the entire year.

This exponential growth in overdose deaths in 2016 didn’t extend to all parts of the country. In some states in the western half of the U.S., our data suggests deaths may have leveled off or even declined. According to Dr. Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco, and an expert in heroin use in the United States, this geographic variation may reflect a historical divide in the nation’s heroin market between the powdered heroin generally found east of the Mississippi River and the Mexican black tar heroin found to the west.

 This divide may have kept deaths down in the West for now, but according to Dr. Ciccarone, there is little evidence of differences in the severity of opioid addiction or heroin use. If drug traffickers begin to shift production and distribution in the West from black tar to powdered heroin in large quantities, fentanyl will most likely come along with it, and deaths will rise.

Drug overdose deaths in Philadelphia and San Francisco
Drug overdose deaths in Philadelphia and San Francisco Drug overdose deaths since 1980 have surged in Philadelphia despite a shrinking population; most heroin there is powdered. They have remained relatively flat in San Francisco, where most heroin is black tar.

First responders are finding that, with fentanyl and carfentanil, the overdoses can be so severe that multiple doses of naloxone — the anti-overdose medication that often goes by the brand name Narcan — are needed to pull people out. In Warren County in Ohio, Doyle Burke, the chief investigator at the county coroner’s office, has been watching the number of drug deaths rise as the effectiveness of Narcan falls. “E.M.S. crews are hitting them with 12, 13, 14 hits of Narcan with no effect,” said Mr. Burke, likening a shot of Narcan to “a squirt gun in a house fire.”

Early data from 2017 suggests that drug overdose deaths will continue to rise this year. It’s the only aspect of American health, said Dr. Tom Frieden, the former director of the C.D.C., that is getting significantly worse. Over two million Americans are estimated to be dependent on opioids, and an additional 95 million used prescription painkillers in the past year — more than used tobacco. “This epidemic, it’s got no face,” said Chris Eisele, the president of the Warren County Fire Chiefs’ Association and fire chief of Deerfield Township. The Narcotics Anonymous meetings here are populated by lawyers, accountants, young adults and teenagers who described comfortable middle-class upbringings.

 Back in Akron, Mr. Parker has been clean for seven months, though he is still living on the streets. The ground of the park is littered with discarded needles, and many among the homeless here are current or former heroin users. Like most recovering from addiction, Mr. Parker needed several tries to get clean — six, by his count. The severity of opioid withdrawal means users rarely get clean unless they are determined and have treatment readily available. “No one wants their family to find them face down with a needle in their arm,” Mr. Parker said. “But no one stops until they’re ready.”

About the data

Our count of drug overdoses for 2016 is an estimate. A precise number of drug overdose deaths will not be available until December.

As the chief of the Mortality Statistics Branch of the National Center for Health Statistics at the C.D.C., Robert Anderson oversees the collection and codification of the nation’s mortality data. He noted that toxicology results, which are necessary to assign a cause of death, can take three to six months or longer. “It’s frustrating, because we really do want to track this stuff,” he said, describing how timely data on cause of death would let public health workers allocate resources in the right places.

To come up with our count, we contacted state health departments in all 50 states, in addition to the District of Columbia, asking for their statistics on drug overdose deaths among residents. In states that didn’t have numbers available, we turned to county medical examiners and coroners’ offices. In some cases, partial results were extrapolated through the end of the year to get estimates for 2016.

While noting the difficulty of making predictions, Mr. Anderson reviewed The Times’s estimates and said they seemed reasonable. The overdose death rate reported by the N.C.H.S. provisional estimates for the first half of 2016 would imply a total of 59,779 overdose deaths, if the death rate remains flat through the second half of the year. Based on our reporting, we believe this rate increased.

While the process in each state varies slightly, death certificates are usually first filled out by a coroner, medical examiner or attending physician. These death certificates are then collected by state health departments and sent to the N.C.H.S., which assigns what’s called an ICD-10 code to each death. This code specifies the underlying cause of death, and it’s what determines whether a death is classified as a drug overdose.

Sometimes, the cases are straightforward; other times, it’s not so easy. The people in charge of coding each death — called nosologists — have to differentiate between deaths due to drug overdose and those due to the long-term effects of drug abuse, which get a different code. (There were 2,573 such deaths in 2015.) When alcohol and drugs are both present, they must specify which of the two was the underlying cause. If it’s alcohol, it’s not a “drug overdose” under the commonly used definition. Ideally, every medical examiner, coroner and attending physician would fill out death certificates with perfect consistency, but there are often variations from jurisdiction to jurisdiction that can introduce inconsistencies to the data.

These inconsistencies are part of the reason there is a delay in drug death reporting, and among the reasons we can still only estimate the number of drug overdoses in 2016. Since we compiled our data from state health departments and county coroners and medical examiners directly, the deaths have not yet been assigned ICD-10 codes by the N.C.H.S. — that is, the official underlying cause of death has not yet been categorized. In addition, the mortality data in official statistics focuses on deaths among residents. But county coroners typically count up whichever deaths come through their office, regardless of residency. When there were large discrepancies between the 2015 counts from the C.D.C. and the state or county, we used the percent change from 2015 to calculate our 2016 estimate.

We can say with confidence that drug deaths rose a great deal in 2016, but it is hard to say precisely how many died or in which places drug deaths rose most steeply. Because of the delay associated with toxicology reports and inconsistencies in the reported data, our exact estimate — 62,497 total drug overdose deaths — could vary from the true number by several thousand.

 

Full article with citations can be found here:

Drug Deaths in America Are Rising Faster Than Ever

Written by: Josh Katz, June 5th 2017

GOP bill would devastate efforts to end the opioid epidemic

OHSAM President Dr. Shawn Ryan is co-author of this striking contribution about the potential newly proposed health care bill and how families and individuals suffering from opioid addiction will be among the hardest hit.

Of the many emotions evoked by House passage of the American Health Care Act, the Republican bill to repeal and replace the Affordable Care Act (aka Obamacare), sadness and fear were among the most pervasive. While the legislation reduces the benefits and increases the coverage costs for almost every demographic of our country, families and individuals suffering from opioid addiction will be among the hardest hit. In places like Ohio that are being ravaged by addiction, that is unacceptable.

In 2015, 52,000 Americans died from overdoses; that’s 144 a day. The opioid and prescription drug epidemic is clearly a national crisis. Entire communities are collapsing because of a lack of resources to push back against the rising tide.

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Congressman Tim Ryan, is a Democrat who has been representing Ohio’s 13th District since 2002. He is a member of the House Appropriations Committee. 

Last year, Congress took some concrete steps towards fighting back. Last July, the Comprehensive Addiction and Recovery Act was signed into law, creating a comprehensive framework to address substance use disorder and key resources for communities. Congress also passed the 21st Century CURES Act, which included $1 billion for states to help with the local response to this ongoing epidemic. While these programs are positive efforts to confront this crisis, the Affordable Care Act has played a central role in getting people the treatment they need.

The Affordable Care Act made it possible for Americans suffering from substance use disorder to get access to quality treatment – many for the first time in their lives. Through the inclusion of substance use disorder treatment as an essential health benefit, the extension of the parity law to the small group and individual market, and the expansion of Medicaid, millions of Americans were able to gain the coverage they desperately needed to treat addiction. The House Republican health care bill, on the other hand, would not only roll back these advancements, but it could rip health coverage away from the 2.8 million Americans still struggling with addiction.

Shawn Ryan
Shawn A. Ryan is the president and CMO of BrightView Addiction Treatment, an assistant professor in the Department of Emergency Medicine at the University of Cincinnati, president of the Ohio Society of Addiction Medicine and chair of Payer Relations for the American Society of Addiction Medicine. 

Our country is suffering. We should be moving forward, not backward. We fully recognize that passage of this legislation might make political sense to some, but doing so is leaving behind millions of Americans most in need. This epidemic is costing our nation $700 billion in health, crime and lost productivity, but that is nothing compared to the toll it is taking on our communities. These men and women are not strangers – they are our friends and neighbors, our brothers and sisters. There is a reason over 435 addiction and mental health groups nationwide have spoken out against this House Republican health care bill: it’s because it would leave people in need without coverage or access to care.

This legislation still needs to pass the Senate before it can be signed into law by President Trump. We urge the Senate to do the right thing and toss out this bill. It is dangerous and short-sighted, and it would be devastating for our nation’s struggle to end the opioid and prescription drug epidemic that is ravaging every corner of the United States of America.

Link to article here: GOP bill would devastate efforts to end the opioid epidemic

The New England Journal of Medicine

NEWENGLANDJOURNALMEDOpioid misuse and addiction is an ongoing and rapidly evolving public health crisis, requiring innovative scientific solutions. In response, and because no existing medication is ideal for every patient, the National Institutes of Health (NIH) is joining with private partners to launch an initiative in three scientific areas: developing better overdose-reversal and prevention interventions to reduce mortality, saving lives for future treatment and recovery; finding new, innovative medications and technologies to treat opioid addiction; and finding safe, effective, nonaddictive interventions to manage chronic pain. Each of these areas requires a range of short-, intermediate-, and long-term research strategies.

OVERDOSE-REVERSAL INTERVENTIONS

Every day more than 90 Americans die from opioid overdoses. Overdoses result from an opioid’s agonist effects at the mu-opioid receptor (MOR), located on brainstem neurons that control breathing. The MOR antagonist naloxone can reverse an overdose, if it is administered shortly after the overdose occurs. Although naloxone has saved tens of thousands of lives, overdoses frequently occur when no one else is around, and often no one arrives in time to administer it.

Overdose fatalities have also been fueled by the increased availability of very potent synthetic opioids such as fentanyl and carfentanil (50 and 5000 times as potent as heroin, respectively). Misuse of or accidental exposure to these drugs (e.g., laced in heroin) is associated with very high overdose risk, and naloxone doses that could reverse prescription-opioid or heroin overdoses may be ineffective. New and improved approaches are needed to prevent, detect, and reverse overdoses.

Through a successful partnership, the National Institute on Drug Abuse (NIDA) and industry developed a user-friendly intranasal naloxone formulation (Narcan Nasal Spray) that results in blood naloxone levels equivalent to those achieved with parenteral administration; it was approved by the Food and Drug Administration (FDA) in 2015. The NIH will now work with private partners to develop stronger, longer-acting formulations of antagonists, including naloxone, to counteract the very-high-potency synthetic opioids that are now claiming thousands of lives each year.

In the intermediate and longer term, alternative interventions against opioid-induced respiratory depression, such as 5-hydroxytryptamine type 1A (5-HT1A) agonists, ampakines, and phrenic-nerve-stimulation devices, could protect persons at particularly high risk for overdose. Research is also under way to characterize the physiological signals that can predict an impending overdose, which would allow wearable devices to detect an overdose when it is occurring and signal for help, automatically inject naloxone, or both.

TREATMENTS FOR OPIOID ADDICTION

This partnership will also focus on opioid addiction (the most severe form of opioid use disorder [OUD]), which is a chronic, relapsing illness. Abundant research has shown that sustained treatment over years or even a lifetime is often necessary to achieve and maintain long-term recovery. Currently, there are only three medications approved for treating OUD: methadone, buprenorphine, and extended-release naltrexone. These medications coupled with psychosocial support are the current standard of care for reducing illicit opioid use, relapse risk, and overdoses, while improving social function. However, limited access to providers and programs can create barriers to treatment.

The NIH has successfully partnered with industry to help develop new formulations of existing medications to improve compliance and reduce the potential for diversion. To facilitate compliance with buprenorphine treatment, NIDA worked with Titan and Braeburn Pharmaceuticals to produce a long-lasting (6-month) implant, Probuphine, which the FDA approved in 2016. Initial clinical trials testing the safety, efficacy, and pharmacokinetics of buprenorphine formulations that deliver therapeutic doses over 1-week or 1-month periods have also been completed; such formulations may be particularly valuable for patients in emergency departments after nonfatal opioid overdoses, to facilitate engagement in long-term treatment.

There is a clear need to develop new treatment strategies for opioid-use disorders. New pharmacologic approaches aim to modulate activity of the reward circuit through antagonists of the neurokinin-1 receptor and counteract the aversive state of withdrawal through antagonists of kappa-opioid receptors. The selective 5-HT2C-receptor agonist lorcaserin, an FDA-approved diet drug, was found to reduce opioid seeking in a rodent model. NIDA has also helped fund clinical trials of lofexidine, an α2A-adrenergic-receptor agonist not currently approved in the United States. Lofexidine was originally developed as an antihypertensive drug and is currently used in the United Kingdom for opioid detoxification, since it controls withdrawal symptoms (although not cravings).

Vaccines against prescription opioids, heroin, and fentanyl, which induce antibodies to opioids in the bloodstream to keep them from entering the brain, have shown great promise in preclinical studies. Similarly, long-lasting monoclonal antibodies against very potent synthetic opioids (e.g., fentanyl and its analogues) have the potential to prevent overdoses and relapses.

NONADDICTIVE TREATMENTS FOR CHRONIC PAIN

The third area of focus is chronic pain treatment: overprescription of opioid medications reflects in part the limited number of alternative medications for chronic pain. Thus, we cannot hope to prevent opioid misuse and overdose without addressing the treatment needs of people with moderate-to-severe chronic pain. Though more cautious opioid prescribing is an important first step, there is a clear need for safer, more effective treatments.

One short-term goal is the development of formulations of opioid analgesics with abuse-deterrent properties that are more difficult to manipulate for snorting or injecting, the routes of administration most frequently associated with misuse because of their rewarding effects. Such formulations, however, can still be misused orally and still lead to addiction. Thus, a more promising longer-term avenue to advancing pain treatment is developing a new generation of powerful, nonaddicting opioid analgesics. Recent x-ray crystallography studies of the MOR have provided insight into two separate intracellular signaling pathways: a pathway originating with the Gi protein is believed to underlie analgesia, while a separate pathway involving β-arrestin is believed to underlie the rewarding and respiratory-depressing effects of opioid agonists. One MOR-biased agonist (TRV130) has successfully completed phase 2 clinical testing. If the trials show that TRV130 is not associated with rewarding or respiratory effects, it could energize industry to accelerate development of other MOR-biased agonists.

Ongoing research is also exploring compounds that target other opioid receptors. Through the NIH Blueprint Neurotherapeutics Program, a team of researchers is working to optimize a recently discovered series of selective and orally available kappa-opioid antagonists as nonaddictive medications for stress-induced pain disorders, such as headache and fibromyalgia. Antagonists of the kappa-opioid system are also therapeutic targets for OUD. Encouraging pharmacokinetic studies suggest that these compounds have the potential to be safe and effective drugs for pain, and perhaps also for opioid addiction.

Compounds that target nonopioid pain pathways, such as the endocannabinoid system, are also being evaluated for chronic pain management. There is strong evidence of the efficacy of cannabinoids, including tetrahydrocannabinol (THC), in treating pain. Medications that target the endocannabinoid system without producing the cognitive impairment and rewarding effects of marijuana could provide a powerful new tool. Other targets being investigated include a dopamine D3 antagonist, which was shown to reduce morphine tolerance and dependence without inhibiting analgesia when administered in conjunction with morphine, making this a potentially promising approach to enhancing the safety of existing opioids.Genetic mutations in the sodium channel Nav1.7 in humans modulate pain; loss-of-function mutations result in congenital insensitivity to pain, and gain-of-function mutations cause pain syndromes. Several Nav1.7 antagonists are being explored as analgesics.

Therapeutics that antagonize inflammatory signals involved in pain have led to FDA-approved treatments for specific pain conditions, such as tumor necrosis factor inhibitors for rheumatoid arthritis and monoclonal antibodies to nerve growth factor for osteoarthritis; researchers are exploring their value in other pain conditions. In parallel, clinical trials are testing the efficacy of antibodies to calcitonin gene–related peptide for treating migraine.

Nonpharmacologic approaches including brain-stimulation technologies such as high-frequency repetitive transcranial magnetic stimulation (rTMS, already FDA-approved for depression) have shown efficacy in multiple chronic pain conditions. At a more preliminary stage are viral-based gene therapies and transplantation of progenitor cells to treat pain. NIH researchers are investigating the use of gene therapy to deliver a potent antiinflammatory protein to painful sites. Preclinical studies show powerful and long-lasting effects in reducing pain without side effects such as numbness, sedation, addiction, or tolerance.

Development of new pain treatments builds on a foundation of basic research on the complex pathophysiology of chronic pain and the mechanisms underlying the transition from acute to chronic pain. The NIH is committed to working with industry partners to advance basic research in this area and to identify and validate biomarkers for pain and pain relief. Biomarkers can move the field away from reliance on subjective pain assessments, and will facilitate medication development and individualized clinical management. Precision-medicine research is expected to help identify the pain-management interventions likely to be most effective for specific patients.

PUBLIC–PRIVATE PARTNERSHIPS

Recent NIH–industry partnerships, such as the Accelerating Medicines Partnership, demonstrate the power of public–private collaboration in speeding the development of new medications. Ending the opioid crisis will require this kind of collaboration. In April 2017, the NIH began discussions with pharmaceutical companies to accelerate progress on identifying and developing new treatments that can end the opioid crisis. Some advances may occur rapidly, such as improved formulations of existing medications, opioids with abuse-deterrent properties, longer-acting overdose-reversal drugs, and repurposing of treatments approved for other conditions. Others may take longer, such as MOR-biased agonists, opioid vaccines, and novel overdose-reversal medications. For all three areas, our goal is to cut in half the time typically required to develop new safe and effective therapeutics.

As we have seen repeatedly in the history of medicine, science is one of the strongest allies in resolving public health crises. Ending the opioid epidemic will not be any different. In the past few decades, we have made remarkable strides in our understanding of the biologic mechanisms that underlie pain and addiction. But intensified and better-coordinated research is needed to accelerate the development of medications and technologies to prevent and treat these disorders. The scope of the tragedy of addiction and overdose deaths plaguing our country is daunting. With our partners, the NIH will take an “all hands on deck” approach to developing and delivering the scientific tools that will help end this crisis and prevent it from reemerging in the future.

This article was published on May 31, 2017, at NEJM.org.

SOURCE INFORMATION

From the National Institute on Drug Abuse (N.D.V.), and the Office of the Director (F.S.C.), National Institutes of Health, Bethesda, MD.

Link to article here: The Role of Science in Addressing the Opioid Crisis

Ohio Attorney General Sues 5 Drug Companies Related to Opioid Crisis

The Ohio attorney general sued five drugmakers on Wednesday, accusing the companies of perpetrating the state’s addictions epidemic by intentionally misleading patients about the dangers of painkillers and promoting benefits of the drugs not backed by science.

Attorney General Mike DeWine said the companies created a deadly mess in Ohio that they now need to pay to clean up.

“This lawsuit is about justice, it’s about fairness, it’s about what is right,” DeWine said in announcing the complaint filed in Ross County, a southern Ohio community slammed by fatal drug overdoses from painkillers and heroin.

A record 3,050 Ohioans died from drug overdoses in 2015, a figure expected to jump sharply once 2016 figures are tallied.

DeWine wants an injunction stopping the companies from their alleged misconduct and damages for money the state spent on opiates sold and marketed in Ohio. The attorney general also wants customers repaid for unnecessary opiate prescriptions for chronic pain.

“These drug companies knew that what they were doing was wrong and they did it anyway,” DeWine said.

The drugmakers sued by DeWine are Purdue Pharma; Endo Health Solutions; Teva Pharmaceutical Industries, and its subsidiary, Cephalon; Johnson & Johnson and its subsidiary Janssen Pharmaceuticals; and Allergan.

They variously manufacture OxyContin, Percocet and a host of other painkillers that DeWine said represent the heart of the problem.

Christina Arredondo said her 24-year-old pregnant daughter, Felicia Detty, died after a painkiller addiction led to heroin and overdose. She said she’s hopeful the Ohio lawsuit can begin to curtail the epidemic by fighting it “from the top.”

“It’s not like they’re going out to buy some cocaine on the street,” she said. “They’re going to the doctor for a torn ligament in their shoulder, or migraines, or having a tooth pulled.”

Janssen on Wednesday called the lawsuit’s accusations legally and factually unfounded. The company said it acted appropriately, responsibly and in the best interests of patients.

Another defendant, Purdue Pharma, said it shares DeWine’s concerns about the opiate crisis and is committed to working together on a solution. It won’t say if it’s challenging the lawsuit.

Teva Pharmaceuticals says it’s still reviewing the lawsuit and is unable to comment.

Endo declined comment. A message was left seeking comment with Allergan.

DeWine, a Republican expected to run for governor next year, joins other states that have filed similar lawsuits. His move comes after years of calls for such action by Ohio Democrats.

Democratic candidate Nan Whaley, Dayton’s mayor, is airing online video spots in which she criticizes sitting Republicans for doing too little to solve the heroin and opioid epidemic. Whaley says taking on drug companies for their role in the crisis will be her highest priority as governor.

Another gubernatorial contender, Democratic state Sen. Joe Schiavoni, said he had previously called for such an action.

“I hope that whatever financial settlement this lawsuit might bring will be put toward helping the victims of this epidemic,” he said. “In the meantime, the General Assembly must do more to provide the resources our counties desperately need now for drug treatment and other services.”

In 2015, Kentucky settled a similar lawsuit with Purdue Pharma for $24 million.

Oregon reached a settlement in 2015 with opioid painkiller manufacturer Insys for off-label promotion of Subsys, a fentanyl spray more powerful than heroin. It was also among 27 states that reached a settlement with Purdue, the maker of OxyContin, in 2007.

Link to article here: Ohio attorney general sues 5 drug companies related to opioid crisis