America’s Workforce Is Paying A Huge Price For The Opioid Epidemic

America’s opioid and heroin crisis was declared a national public health emergency last month. The epidemic claimed 64,000 lives last year – more than car accidents or guns. Opiate-related overdoses are now the leading cause of death for Americans under the age of 50.  Not surprisingly, data points to a significant impact on the American workforce and the economy at large.

An October PBS NewsHour report, “How Opioids Have Decimated the American Workforce,” looked at a region in Ohio where employers are hard-pressed to fill job openings for skilled workers. The CEO of Columbiana Boiler Company, Michael Sherwin, said his company has had job vacancies lasting up to two years. He estimated a business loss of $200,000 a year due to the lack of skilled workers. In many cases, candidates who have the necessary skills are unable to pass drug screenings. Sherwin said they have to turn down about 25 percent of qualified applicants for this reason. The report highlighted the story of one skilled welder who had been out of the workforce for three years due to an opioid addiction that began a decade ago when he was prescribed Vicodin for pain, as well as a machinist whose struggle with addiction had kept him out of the workforce for six years.

Even as employers across industries face skilled labor shortages, a growing number of working age men and women are disappearing from the workforce. The labor force participation rate has been declining since 2000, with a notable and consistent decline in labor force participation among men aged 25-54.

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Heroin and opioid drugs are having an impact on the American workforce and the economy at large. Image: Shutterstock

Princeton economist Paul Kruger has linked the rise in opioid prescription rates by county with a decline in labor force participation of men and women alike. His findings suggest that the opioid crisis could account for as much as twenty percent of the decline in LFP of working-age men.

Construction and manufacturing – two major industries dealing with skilled labor crunches – are being hit hard by the opioid crisis. Recent reports from insurer CNA Financial Corp showed that spending on opioid prescriptions is consistently five to ten percent higher in construction than any other industry. Spending tends to be higher in manufacturing than in most other industries, CNA also found.

Employers And Unions Tackling The Problem

A group of construction industry stakeholders in St. Louis is confronting the problem head-on. Last December, Construction Forum STL devoted their December panel to the topic, titling the forum “Opioids: A Building Epidemic.” The panel brought together union leaders, medical experts and addiction recovery specialists for a frank discussion about the opioid crisis and what can be done about it.

Don Willey spoke candidly at the forum about his 36-year-old son’s death in 2016 from an overdose, which followed a 15-year struggle with addiction.

“Over the last few years when people would ask about my kids, I would tell them Matt struggles with life. He is a heroin addict,” Willey said. “If I couldn’t admit his addiction, how could I expect him to? And it was only right to make people aware.”

Willey is the business manager for the Laborer’s International Union of North America Local #110 in St. Louis. Since his son’s death, he has led efforts within his union to raise awareness about addiction and the challenges faced by individuals and families who are struggling with it.

Robert Riley, a recovery specialist on the STL panel, emphasized that addiction is a medical issue. “An addict’s brain has been hijacked,” Riley said. “Their body is telling them that before they eat, sleep, reproduce, take a breath – they need to put opiates in their system.” Riley also said, “It starts with the prescription drugs and that’s what we need to educate people on.” Recent data suggests that four out of five heroin users started down this destructive path via prescription opioids.

The dramatic increase in opioid prescriptions over a 15-year period is at the root of the epidemic. Sales of prescription painkillers in the U.S. quadrupled between 1999 and 2010, according to the Centers for Disease control and Prevention. The CDC also reports that since 1999, deaths from prescription opioid overdoses have quadrupled.

At the end of the forum, the moderator asked for a show of hands from those whose lives had been touched by the opioid and heroin epidemic. Nearly everyone in the audience of roughly 150 people raised a hand. In fact, all but three.

De-Stigmatizing Addiction And Supporting Workers

What can employers and industry stakeholders do? “The first thing is having the conversation,” said John Gaal, director of training and workforce development for the St. Louis-Kansas City Carpenters Regional Council. “It’s a tough subject to discuss but it’s not a matter of poor moral character. It’s a form of mental illness and we need to treat it that way.”

The Carpenters Council is addressing the issue in a number of ways aimed at raising awareness and providing support for workers and their family members who are struggling with opioid addiction.

In May, the council adjusted their drug testing policy. Formerly, policy dictated that a worker who didn’t pass a drug test was not eligible to work for a minimum of thirty days. The new policy gives workers the chance to return to work sooner, as long as they are following a treatment plan.

“We now know that isolation is an addict’s worst enemy,” said Gaal. “Sending someone home for thirty days with nothing to do isn’t the answer.”

The new drug-screening policy is more realistic, Gaal explained. “As long as they’re following their plan of treatment, they can return to work as soon as they’re able to test clean,” he said.

The council is also focusing on individual case management and resources to help struggling workers.

Both the Carpenter’s Union and the Laborer’s Union manage their own health care plans. Gaal said this offers an opportunity to provide focused case management for workers who have been prescribed opioids.

“We’ve got the ability to appropriately mine our data and follow up with our workers who have been prescribed opioids,” Gaal said. “And we can use that to educate people about the potential for addiction and provide support for individuals and families struggling with this.”

The Carpenters Council includes mental health courses in their safety training. Mentors in the apprenticeship program are required to complete eight hours of mental health “first aid”.

The Carpenters also participate in the Second Chance program, offering apprenticeships and a pathway to ex-offenders re-entering the workforce who have served their time and want to learn a trade.

“We can’t keep our heads in the sand about this issue. If we’re not talking about it, we’re not going to collectively solve it,” Gaal said.

Author: Nicholas Wyman  Published: 12/12/2017

Link to original article here.

What’s Missing from the National Discussion About the Opioid Epidemic

Last Wednesday, less than a week after Donald Trump declared America’s opioid epidemic a national public-health emergency, the President’s Commission on Combating Drug Addiction and the Opioid Crisis released its final set of policy recommendations. The panel called on Congress and the White House to consider fifty-six proposals, among them streamlining federal funding for addiction treatment, instituting stricter prison sentences for some opioid traffickers, and launching an “aggressive” TV and social-media campaign to dissuade children and teens from taking the drugs. (In his earlier announcement, Trump had promised “really tough, really big, really great advertising, so we get to people before they start.”) The commission also urged the Department of Health and Human Services to develop “a national curriculum and standard of care for opioid prescribers,” to supplement the Centers for Disease Control and Prevention’s existing guide for primary-care physicians.

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The medical community has long shunned and stigmatized drug users. Can policymakers help doctors keep their compassion alive?

There is no doubt that the epidemic warrants urgent, wide-ranging action. According to a recent C.D.C. report, some twelve and a half million Americans misused prescription opioids in 2015, the latest year for which reliable figures are available, and more than three-quarters of a million used heroin. All told, thirty-three thousand people died of opioid overdoses that year. The situation appears to be worsening; provisional data suggests that the over-all rate of drug-overdose deaths jumped twenty per cent in 2016, with a substantial portion of that likely coming from opioids. Trump has repeatedly acknowledged the scale of the problem, but he has yet to free up the funds to address it. For now, he seems most interested in another round of “just say no” campaigns, which will do nothing to help those already addicted. The idea of creating a curriculum for opioid prescribers is a good one—measures like it have already made the drugs harder to obtain—but the Administration must also work to confront another obstacle within the medical community. The fact is that, for many physicians, caring for drug users is a source of enormous frustration.

This truth became vividly apparent to me early in my training. As an intern at Massachusetts General Hospital in the nineteen-seventies, I was once called to the emergency room to attend to a man in his twenties whom I will call Vinny. He had a fever of a hundred and four, was struggling to breathe, and his blood pressure was falling. On physical examination, I heard a loud heart murmur, indicating that his cardiac valves were malfunctioning. Then I noticed several track marks on his arms. The diagnosis became apparent: Vinny had injected himself with heroin using a dirty needle, and in so doing he had introduced microbes directly into his bloodstream, which had landed inside the heart, causing an infection called bacterial endocarditis.

The medical team moved Vinny to the intensive-care unit and stayed up through the night, working to keep him from going into shock. In addition to antibiotics, he required numerous medications to keep his blood pressure up. By the time the sun rose, his vital signs were stable. I felt heroic, having saved this young man’s life. When I exited the I.C.U. to tell his distraught mother, she burst into tears and kissed my hands.

In the ensuing weeks, as Vinny recovered, I got to know him well. He claimed that he had shot drugs only occasionally and swore on his mother’s life that, after this brush with death, he would never touch heroin again. But, less than a month later, he was back in the E.R., spiking a fever and struggling to breathe. Though a hospital social worker had put him in touch with an addiction clinic, he had continued using drugs. Again the I.C.U. team did its best, and again Vinny survived. But I was filled with anger and resentment: my colleagues and I had been lied to, taken in by his charm, and now it appeared that our time and energy had been for naught. My supervising resident told me that I had been naïve to have any faith in Vinny’s promises; he was, in the parlance of the resident, like all addicts, an S.P.O.S.—a subhuman piece of shit.

The acronym still appalls me, more than four decades later. It was a betrayal of the spirit of compassion that good physicians must bring to the practice of medicine. But I understood then why most doctors I worked with wanted nothing to do with such patients. I later heard that Vinny had died of a drug overdose, but not before infecting his girlfriend with H.I.V. She ended up succumbing to aids. (As it happened, I would devote much of my career to the aids epidemic. Nearly all of my patients in the eighties and nineties were gay men who saw their caregivers as allies.)

As policymakers step up their efforts to check the opioid crisis, how can they best support the physicians on the front line? In August, two infectious-disease specialists at Boston’s Beth Israel Deaconess Medical Center, where I also work, took up that question in the New England Journal of Medicine. “At some point, it became culturally acceptable to treat all conditions in a patient except addiction,” Alison Rapoport and Christopher Rowley write. “It’s a diagnosis still frequently and falsely regarded as untreatable—a convenient assumption driven by the stigma against people with this disease.” The authors tell the story of one of their patients, a Mr. C., who was struggling with opioid-use disorder and bacterial endocarditis. In consultation with Mr. C. and the hospital’s social workers, Rapoport and Rowley devised a successful course of treatment—regular doses of buprenorphine, an opioid that lessens the effects of withdrawal, along with counselling sessions and weekly group meetings. Like Mr. C. himself, they write, “the medical community is also in early recovery—moving past implicit biases, stigma, and fear to connect with our patients and respond to a defining crisis of our time.” Only then, they add, can physicians begin to mend patients’ “badly damaged sense of trust in a medical system that has long treated them with judgment and neglect.”

It is fitting that this call to action should come from a pair of infectious-disease doctors. As Rapoport and Rowley note, members of their field “have historically been ardent advocates for social justice and public health, championing patients on the margins of society.” One concrete step toward addressing the epidemic, they write, is to expand the use of buprenorphine. Currently, only four per cent of all working doctors in the United States possess the necessary waivers from the Drug Enforcement Administration to prescribe the medication for opioid treatment. Indeed, according to the Trump commission’s final report, nearly half of all counties in the U.S., including almost three-quarters of all rural counties, lack access to buprenorphine. Echoing Rapoport and Rowley, the panel recommends that federally funded health centers mandate that their staff obtain D.E.A. waivers.

Let us hope that the Trump Administration listens. To be sure, many more American doctors will need training in modern methods of treating addiction. That’s actually an easy education. It will be harder to learn how to overcome our disdain for the afflicted, to see the humanity in their plight. Without that change, there is scant hope of success.

The author, Jerome Groopman, has been a staff writer since 1998 and writes primarily about medicine and biology.

Link to the original article here in the New Yorker: What’s Missing from the National Discussion About the Opioid Epidemic

Survey: nearly half of Americans have a family member or close friend who’s been addicted to drugs

It’s a statistic that shows America’s drug addiction crisis is truly an epidemic.

This is America on a drug addiction epidemic: Nearly half of US adults have a close friend or family member who’s been addicted to drugs.

That comes from a Pew survey of US adults conducted in August, which found that 46 percent meet the criteria.

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It’s not just opioids. According to the National Survey on Drug Use and Health, in 2016 approximately 20.1 million Americans 12 or older had a substance use disorder. About 2.1 million had an opioid use disorder. The biggest group was for alcohol use disorder, with about 15.1 million reporting an alcohol addiction. (A caveat: Since the survey is based on households’ self-reports, these are very likely underestimates.)

But opioids have been the key driver of the recent US increase in drug overdose deaths, from nearly 17,000 overdose deaths in 1999 to more than 64,000 in 2016. We don’t have reliable drug-by-drug data for 2016 yet, but over the previous few years nearly two-thirds of overdose deaths were linked to opioids.

Last week, President Donald Trump declared the opioid epidemic a public health emergency — activating a very limited set of tools to address the crisis. This week, his opioid commission is expected to release its final recommendations on dealing with opioids.

The opioid epidemic goes back to the 1990s, with the release of OxyContin and mass marketing of prescription painkillers, as well as campaigns like “Pain as the Fifth Vital Sign” that pushed doctors to treat pain as a serious medical problem. This contributed to the spread of opioid painkiller misuse and addiction, which over time also led to greater use of illicitly produced opioids like heroin and fentanyl. Drug overdose deaths have climbed every year since the late ’90s as a result.

Last week, President Donald Trump declared the opioid epidemic a public health emergency — activating a very limited set of tools to address the crisis. This week, his opioid commission is expected to release its final recommendations on dealing with opioids.

The opioid epidemic goes back to the 1990s, with the release of OxyContin and mass marketing of prescription painkillers, as well as campaigns like “Pain as the Fifth Vital Sign” that pushed doctors to treat pain as a serious medical problem. This contributed to the spread of opioid painkiller misuse and addiction, which over time also led to greater use of illicitly produced opioids like heroin and fentanyl. Drug overdose deaths have climbed every year since the late ’90s as a result.

The issue has really turned into two simultaneous crises — which Keith Humphreys, a Stanford University drug policy expert, has described as the dual problems of “stock” and “flow.” On one hand, you have the current stock of opioid users who are addicted; the people in this population need treatment or they will simply find other, potentially deadlier opioids to use if they lose access to prescribed painkillers. On the other hand, you have to stop new generations of potential drug users from accessing and misusing opioids.

Addressing two crises at once will, obviously, require a lot of resources. But as I previously explained, we have a pretty good idea of what these resources would go to: They could be used to boost access to treatment, pull back lax access to opioid painkillers while keeping them accessible to patients who truly need them, and adopt harm reduction policies that mitigate the damage caused by opioids and other drugs.

Some states are attempting to confront this issue. Vermont, for example, has built a “hub and spoke” system that treats addiction as a public health issue and integrates treatment into the health care system. Potentially as a result, the state was the only one in New England to have a drug overdose death rate below the national average in 2015.

Link to the full article here: Survey: nearly half of Americans have a family member or close friend who’s been addicted to drugs

8 Care Principles to Improve Substance Use Disorder Treatment

Task force cites medication-assisted treatment, universal screening as key to better outcomes.

More than 20 million Americans struggle with substance use disorder (SUD), and upwards of 33,000 people died from opioid overdose in 2015. Fortunately, effective treatment exists. Medication-assisted treatment (MAT), which pairs U.S. Food and Drug Administration-approved drugs with behavioral therapies, reduces both illicit opioid use and overdose fatalities.

But access to MAT remains elusive for many people largely because treatment providers do not always provide their patients with the evidence-based care shown to be most effective. Public and private payers can play a key role in addressing this problem by encouraging their enrollees to use providers who deliver high-quality, evidence-based care and rewarding those who do.

As a needed step in this direction, the new Substance Use Disorder Treatment Task Force— launched last spring by Shatterproof, a national nonprofit organization dedicated to the implementation of evidence-based solutions to address the SUD epidemic—created a list of national principles of care for SUD treatment to help guide effective care. These eight evidence-based principles have been shown to improve health outcomes and save lives. Sixteen insurance companies have agreed to identify, promote, and reward SUD treatment that aligns with these principles, which are:

  1. Universal screening for SUD across medical care settings.
  2. Personalized diagnosis, assessment, and treatment planning.
  3. Rapid access to appropriate SUD care.
  4. Engagement in continuing long-term outpatient care, with monitoring and adjustments to treatment.
  5. Concurrent, coordinated care for physical and mental illness.
  6. Access to fully trained and accredited behavioral health professionals.
  7. Access to FDA-approved medications.
  8. Access to nonmedical recovery support services.

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The task force brings together public and private payers as well as advocates, policymakers, and other stakeholders. The Pew Charitable Trusts hosted the inaugural meeting of the task force this fall, during which members met to outline and discuss principles of care. Following that meeting, the group refined and reached consensus on the final list, with principles based on research from the past 30 years, including recommendations from the 2016 “Facing Addiction in America: Surgeon General’s Report on Alcohol, Drugs, and Health.”

The task force will continue its work by focusing on implementing the principles, providing a platform to learn and share innovative strategies, and measuring the initiative’s success. In particular, the task force will examine the possibility of establishing a process for certifying providers who have implemented the principles. It will also engage with the broader stakeholder community in the next phases of work.

By joining together, patients, providers, and payers have the opportunity to dramatically increase the quality of substance use treatment in the United States. Incorporating these evidence-based principles of care in insurance programs is a much needed step forward in addressing the opioid epidemic and improving the lives of people with SUD and their families.

Link to original article here: 8 Care Principles to Improve Substance Use Disorder Treatment

How My Overdose Saved My Life

I’m a mom and a wife. I’m a Chemical Dependency Counselor Assistant and Peer Recovery Support Specialist for BrightView Health in Cincinnati, Ohio, supporting those struggling with substance use disorder.

And I’ve been in recovery from heroin addiction for five years.

That’s today.

Five years ago, I was sprawled on the pavement getting a dose of naloxone. I had overdosed on heroin. It was a near-death end to a reckless existence that had started without warning.

Naloxone didn’t just bring me back to life, it gave me a second chance at life. But more than that – naloxone was the bridge that got me from the brink of death to treatment and recovery.

When I was young, I had several knee surgeries. I was prescribed pain medication on a regular basis, whether or not I needed it. And at no point was naloxone part of any medical conversation.

If it were, maybe I would have been more aware of the high risks and addictive properties of prescription opioids.

Suddenly, I was hooked. By 15, I was diagnosed as an addict and the cycle of addiction consumed the next decade of my life. I doctor shopped for pills, took opioids, used cocaine, methamphetamine and ecstasy to get my fix. I dropped out of high school, gave up the rights to my first child, and married an abusive man whose drug use was like my own.

What started as a prescription from my doctor spiraled into a deadly mission of finding the next, stronger high – eventually leading me to heroin.

I committed felonies for drug money and couldn’t hold a steady job. My young life was decaying. I became associated with members of a Mexican drug cartel and eventually became a drug mule, buying and selling black tar heroin.

I was so far gone, until thankfully, I overdosed. I say thankfully because had it not happened then, I may not be here to share my story.

Addiction is no joke. It’s not a choice. Yes, I chose heroin, but I didn’t choose to be an addict. Naloxone gave me the chance to correct my wrong choice. It didn’t enable me to keep using, like some may think.

The only thing naloxone enables is breathing.

When I overdosed, my body was pushed out of a car and onto the pavement of a parking lot. I was revived by naloxone, I woke up to strangers around me. I refused treatment and within minutes, I stood up and walked away from where my body laid, moments from death. Six weeks later, I entered into treatment, March 9, 2012.

For ten days, I slowly purged my body of the deadly drugs that brought me to that place. I left clean and with a conviction to stay that way.

Quitting heroin was the easy part, rebuilding my life was hard. But it is possible.

I cleared my criminal record, I mended relationships with my family – my daughter that I had walked away from so long ago. I remarried and gave birth to another beautiful baby girl.

As I rebuilt my life, I decided to focus my energy on helping those that were in the same nightmare I had just escaped. I went through a certification course to become a Chemical Dependency Counselor Assistant. I have worked incredibly hard to build my credibility as someone working in the field to show other addicts that recovery is possible.

So today, on International Overdose Awareness Day, what I want everyone to know is that if it weren’t for naloxone, I’d be one of the mourned, not one of the recovered.

The second chance I got is only possible with the ability to enter treatment. If an addict is still alive, there is still hope.

When a person is revived with naloxone, that is the crucial time when we as a society must offer love and compassion to them. That is the moment to look at the patient and say, “You’ve been through a lot, I want to help you find treatment and change your life.” Because no matter how far a person has gone in their life to support their addiction, as long as they are alive, hope is never gone.

I carry naloxone with me everywhere I go. It is the world we are living in today, that I need to be prepared to reverse an overdose at any time. The only way we are going to change this epidemic is if we as members of society and fellow human beings call upon each other to show compassion and love. Not one person is immune to addiction. Addiction has no prejudice and does not care who you are or how much money you have or what you look like. I am living and breathing proof why naloxone needs to be in everyone’s possession. My life is beautiful today, because of naloxone.

Amy Parker is a Chemical Dependency Counselor Assistant and Peer Recovery Support Specialist for BrightView Health in Cincinnati, Ohio. She is a member of the WCPO 9 News Heroin Advisory Board and a Motivational Speaker. Amy has been in recovery from heroin addiction for more than five years.

Link to article on Huffingtonpost.com here: How My Overdose Saved My Life

 

 

Short Answers to Hard Questions About the Opioid Crisis

This week, President Trump’s commission on combating the opioid crisis, led by Gov. Chris Christie of New Jersey, recommended that the president declare a national emergency.

The problem has become significantly worse recently, so you might feel that you could use a little catching up. Here are 11 things you need to know.

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1. How bad is it?
It’s the deadliest drug crisis in American history.
2. What is an “opioid”?
Something that acts on opioid receptors in the nervous system.

That’s not really a helpful answer.

The first such drug, and the one from which the opioid receptors get their name, was opium. Opium, a narcotic obtained from a kind of poppy, has been used in human societies for thousands of years. From opium people derived a whole host of other drugs with similar properties: first morphine, then heroin, then prescription painkillers like Vicodin, Percocet and OxyContin. Opium along with all of these derivatives are collectively known as opiates.

Then there are a handful of compounds that act just like opiates but aren’t made from the plant. Opiates along with these synthetic drugs — chiefly methadone and fentanyl — are grouped together into the category of substances called opioids.

Opioid receptors regulate pain and the reward system in the human body. That makes opioids powerful painkillers, but also debilitatingly addictive.

3. So is this crisis about prescription painkillers or heroin?
 Both.

The crisis has its roots in the overprescription of opioid painkillers, but since 2011 overdose deaths from prescription opioids have leveled off. Deaths from heroin and fentanyl, on the other hand, are rising fast. In several states where the drug crisis is particularly severe, including Rhode Island, Pennsylvania and Massachusetts, fentanyl is now involved in over half of all overdose fatalities.

While heroin and fentanyl are the primary killers now, experts agree that the epidemic will not stop without halting the flow of prescription opioids that got people hooked in the first place.

4. Show me one way the epidemic has changed.
Sure.

The latest iteration of the opioid epidemic has been especially deadly among adults in their 20s and early 30s.

In 2000, the most common age for drug deaths, including those not involving opioids, was around 40. This was the generation that first grew addicted to prescription opioids in large numbers — white people especially so. Now there’s evidence that the opioid epidemic is dividing into two waves, with a new group of younger drug users growing addicted to, and dying from, heroin or fentanyl rather than prescription pills.

5. Where is the worst of the problem?

The Midwest, Appalachia and New England. For now.

There’s a lot of geographic variation in the rate of drug deaths, with the highest overdose rates clustered in Appalachia, the Rust Belt and New England.

Teasing out the reasons for the geographical differences is not easy. In certain places, the ways in which people use drugs could be more dangerous (you’re more likely to die from injecting heroin than you are from smoking it, for example).

But it’s clear that a significant portion of the variation in deaths, if not necessarily in use, is being driven by the appearance of fentanyl in the drug supply. Fentanyl, a highly potent opioid, affects heroin users and pill users both, the latter often falling victim to counterfeit pills that look like prescription painkillers.

So far, the white population has been hardest hit, but this is beginning to change. Several critics have been quick to point out that the country’s response was not nearly as public-health-oriented during the crack cocaine epidemic in the 1980s, which disproportionately affected African-Americans.

6. Why has this problem gotten so much worse in recent years?

Decades of opioid overprescription, an influx of cheap heroin and the emergence of fentanyl.  Addiction to opioids goes back centuries, but the current crisis really starts in the 1980s. A handful of highly influential journal articles relaxed long-standing fears among doctors about prescribing opioids for chronic pain. The pharmaceutical industry took note, and in the mid-1990s began aggressively marketing drugs like OxyContin. This aggressive and at times fraudulent marketing, combined with a new focus on patient satisfaction and the elimination of pain, sharply increased the availability of pharmaceutical narcotics.

Pill mills began popping up around the country as communities were flooded with prescription opioids. Over the next decade, a growing number of people grew addicted to the drugs, whether from prescriptions or from taking them recreationally. For many, what started with pills evolved into a heroin addiction.

At the same time, the heroin market was changing. The price plummeted. Newly decentralized drug distribution networks pushed heroin and counterfeit pharmaceuticals into suburban and rural areas where they had never been. Everywhere the suppliers went, they found a ready and willing customer base, primed for addiction by decades of prescription opiate use.

Then in 2014, fentanyl began entering the drug supply in large amounts.

7. What is fentanyl and why is it killing people?
It’s a synthetic opioid 50 times more potent than heroin.

Heroin is derived from opium, a plant. That means its growers need fields and labor to harvest the crop. They are tied to land, weather and time.

Fentanyl is purely synthetic. Think chemistry, not agriculture. It’s commonly used for surgical anesthesia and is prescribed to treat pain, but almost all of the fentanyl on the streets is illicitly manufactured. According to the Drug Enforcement Administration, the majority of illicit fentanyl in the United States is manufactured either in China or in Mexico using precursors bought from China. And at least some portion of it comes to the United States in the mail, ordered from dark web sources like the recently shuttered AlphaBay. But we don’t know how much.

Fentanyl is a fine-grained powder, meaning that it’s easy to mix into other drugs. This is how most people are exposed to illicit fentanyl: It will be mixed into, or made to look like, powdered heroin or it will be used to produce counterfeit prescription pills.

It’s super potent, meaning you’re dealing with very small quantities. That makes it almost impossible to control supply. Though most of the fentanyl in America is thought to originate in China, the fact that it’s synthetic means it’s much harder to know where the drugs are coming from. With heroin, investigators could rely on regionally specific chemical markers to indicate where the drugs had been produced. With drugs synthesized in a lab, it’s harder to tell.

8. Why would people take fentanyl? It does not sound fun.  

Many aren’t intending to.

From a dealer’s perspective, fentanyl is easier to get and more profitable to sell. Some law enforcement officials argue that drug users will seek out batches of drugs that contain fentanyl or that are known to have killed people, as that demonstrates the drugs’ potency.

While that is certainly true for some number of drug users, research suggests that they are a minority. Most are exposed to fentanyl inadvertently — it’s difficult to know just what is in the drugs they are buying (many dealers don’t know themselves), one more risk in a dangerous pursuit of a high.

For long-time drug users, their continued use underlines the grip of addiction and the agony of withdrawal: They know it could kill them but do it anyway. Casual drug users are also at risk of fentanyl poisoning, particularly with increased reports of fentanyl-adulterated cocaine.

9. So shouldn’t we just stop prescribing opioids?
No.

Opioids are a vital component of modern medicine that have measurably improved the quality of life for millions of people, particularly cancer patients and those with acute pain. But their efficacy in treating chronic pain is less clear, especially when weighed against the risks of overdose and addiction.

Though prescription opioid consumption has been decreasing in the United States since 2010 or 2011, it remains high. According to the International Narcotics Control Board, if the amount of opioids prescribed per year were averaged out over each person living in America, everyone would get about a two-week supply. (Or a three-week supply, according to the C.D.C. Different ways of measuring what counts as a daily opioid dose give different values.) Either way you count, it’s higher than anywhere else in the world.

At the same time, some chronicpainpatientsnow struggle to fill their prescriptions. Solving the opioid problem requires controlling prescription opioid distribution while maintaining access for patients with legitimate medical needs. Suddenly removing access to opioids from those who are dependent on them to function could easily push people to illicit opioid sources, like heroin or counterfeit pills.

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10. What can be done?

There’s no silver bullet.

Experts agree fixing the opioid epidemic will take a combination of solutions. But it’s a question of priorities: Which approaches will be most effective and most efficient? What is the best use of resources?

Officials want to use state prescription drug monitoring programsto reduce the supply of prescription opioids that end up being used recreationally while maintaining adequate access for current chronic pain patients. More broadly, experts say we need to improve the way our medical system manages pain. Remember the 12 million people we said took prescription painkillers outside of medical use? Roughly two-thirds of those did so to relieve physical pain. A more holistic approach to pain treatment would lessen the need for opioids.

On the treatment side, experts stress the importance of having treatment readily available for those who are already addicted. Often that means going to where the people are, not waiting for them to seek out treatment themselves. And addiction treatment doesn’t just mean counseling or an inpatient clinic. Studies show the most effective treatment for opioid addiction often requires opioid medications like methadone or buprenorphine.

In the meantime, widespread distribution of naloxone — an overdose antidote — will save lives in acute cases.

There isn’t agreement about other possible measures that could help. Public health experts advocate things like safe injection sites, where people could use drugs under medical supervision, and drug checking services that people could use to test drugs for fentanyl, but many in law enforcement remain reluctant to adopt such measures.

11. Will the commission’s recommendations help?
Maybe, but only if they’re adopted. The commission laid out a series of recommendations in its interim report, with a final report expected in October.

Some of the recommendations — like enhancing prescription drug monitoring programs and mandatory physician education on the dangers of opioids — are aimed at prevention. Some — expanding access to and funding development of medication-assisted treatment, eliminating Medicaid barriers to in-patient addiction treatment and enforcing laws that prevent health insurance companies from limiting mental health coverage — are aimed at treatment. The commission’s report also called upon the president to mandate that naloxone be carried by every American law enforcement officer.

Of course, these are only recommendations. It’s up to the president and the various executive agencies to implement them. Experts know how to attack the problem. It’s just a matter of having the will to put those policies into practice.

Link to the original article with an accompanying interactive graph and charts here:

Short Answers to Hard Questions About the Opioid Crisis

 

Author: Josh Katz

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.

EDRoom

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