Overdose Deaths from Opioids, Heroin on the Rise

News Update 7-18-14“Overdose deaths from both prescription opioids and heroin increased in 2011, the most recent year available, according to new data from the U.S. Centers for Disease Control and Prevention.

While prescription opioid deaths followed a more than decade long trend and increased by about 2% from 2010 to 2011, to 16,917; heroin deaths jumped by about 44% in the same span of time to 4,397.

Officials with the CDC said the increase in heroin deaths may be partly due to users having less access to prescription opioids and switching to the illicit drug.

Leonard Paulozzi, a physician and researcher with the CDC, said about 75% of heroin users say they started out by using prescription opioids.

Paulozzi said doctors need to do a better of job of screening for opioid abusers by checking prescription drug monitoring programs in their states for patients who are doctor shopping and using urine screens to detect if they are using illicit drugs.”

http://www.jsonline.com/watchdog/watchdogreports/overdose-deaths-from-opioids-heroin-on-the-rise-b99302962z1-265452991.html

Source: Milwaukee Journal Sentinel – July 2, 2014

Treat Patients with Addiction During, After Hospitalization, Researchers Say

hospital sign purchasedshutterstock_33280960The results of a new study demonstrate that starting hospitalized patients who have an opioid (heroin) addiction on buprenorphine treatment in the hospital and seamlessly connecting them with an outpatient office based treatment program can greatly reduce whether they relapse after they are discharged.

Led by researchers at Boston Medical Center (BMC), the study shows the important role that providers play in offering these patients addiction treatment both while in the hospital and after – even if their primary reason for being in the hospital is not for their addiction.

In this study, 139 hospitalized individuals with opioid addiction who were not already in treatment were randomized into two groups. One group received a tapered dose treatment of buprenorphine for withdrawal and referral information about community treatment programs and the other were initiated on buprenorphine, an opioid substitute proven to treat opioid addiction, along with referral to a primary care office-based buprenorphine treatment program.

Of those in the buprenorphine maintenance group, more than one third (37 percent) reported no illicit opioid/drug use for the month after they left the hospital compared to less than one in ten (nine percent) among the control group. These patients also reported, on average, fewer days of illicit drug use and continued to use less over the following six months. This effect was evident despite the fact that these patients did not initially come to the hospital seeking treatment for their addiction.

“Unfortunately, referral to substance abuse treatment after discharge is often a secondary concern of physicians caring for hospitalized patients,” said Jane Liebschutz, MD, MPH, a physician in general internal medicine at BMC and associate professor of medicine at Boston University School of Medicine, who served as the study’s corresponding author. “However, our results show that we can have a marked impact on patient’s addiction by addressing it during their hospitalization.”

This study is published in JAMA Internal Medicine.

http://medicalxpress.com/news/2014-06-patients-addiction-hospitalization.html

Source: Boston Medical University –  June 30, 2014

Opinion by Maia Szalavitz : We Try More Drugs than Anyone Else, and 9 Other Ways Addiction Is Different in America

“We Americans like to think of ourselves as exceptional, the land of the free and the home of the brave, the City on the Hill and all that. When it comes to the politics and culture of drugs, we are indeed special—or at least dramatically different from the rest of the Western world. Too often, however, we are special for the wrong reasons.”

  1. We Try More Drugs Than Anyone Else
  2. We Incarcerate More People Than Anyone Else
  3. We Use More Opioids Medically (But Not for the Reasons You Might Think)
  4. We’re in the Middle of the Road on Alcohol
  5. We Have the World’s Highest Legal Drinking Age
  6. Our Treatment System Is Dominated by 12-Step Programs
  7. Coercion Is a Common Route to Treatment
  8. We Spend the Most Money on Addiction Research
  9. We Determine What Is and What Isn’t Legal Worldwide (But for No Rational Reason)
  10. We’re Not Very Good at Measuring Addiction

http://www.psmag.com/navigation/health-and-behavior/try-drugs-anyone-else-9-ways-addiction-different-america-85093/

Source:Pacific Standard – July 4, 2014

 

FDA Designates Opioid Overdose Treatment for Fast Track Development Program

FDA“A Kentucky company headed by a recognized expert in nasal delivery of medication says its intranasal naloxone spray, a drug designed to treat opioid overdoses, has received Fast Track designation from the Food and Drug Administration (FDA).

The Fast Track program of the FDA is designed to expedite the development and review of new drugs that are intended to treat serious or life-threatening conditions and that demonstrate the potential to address unmet medical needs. Fast Track-designated drugs ordinarily qualify for priority review, thereby expediting the FDA review process. AntiOp and the FDA may also be able to employ additional tools to expedite the FDA review process such as “rolling submission,” whereby AntiOp may submit portions of the new drug application (NDA) in a staged NDA submission process.”

http://www.marketwatch.com/story/fda-designates-opioid-overdose-treatment-for-fast-track-development-program-2014-07-15 

Source: MarketWatch.com – July 15, 2014

 

 

APA Archived Webinar: Managing Pain in Patients with an Addiction History

pain collagePCCS-MAT has a new webinar archived on their website made available from the American Psychiatric Association on “Managing Pain in Patients with an Addiction History”. The webinar can be accessed at: http://pcssmat.org/education-training/archived-webinars/apa-archived-webinar-managing-pain-in-patients-with-an-addiction-history/.

The 1 hour webinar is presented by Jan Kauffman, RN, Vice President, Addiction Treatment Services North Charles Foundation, Inc., and Assistant Professor of Psychiatry, Harvard Medical School. One CME credit is available.

The goal of the presentation is to familiarize clinicians with the tools to identify chronic pain patients at risk for misuse of opioids, and provide strategies for managing chronic pain patients with addictive disorders. Guidelines for risk stratification, safe prescribing, and assessing, monitoring and managing errant behavior will be discussed.

Source: PCSS – MAT Training – May 13, 2014

A New Edition of Slaying the Dragon: The History Of Addiction Treatment And Recovery In America By William L. White

Slaying the Dragon“A new edition of Slaying the Dragon: The History of Addiction Treatment and Recovery in America has just rolled off the presses. The first edition (1998) went through multiple printings and has been used as a text in collegiate addictions studies programs. Of even greater import has been how this history helped many people in recovery see themselves as “a people” and contributed to the rise of a new recovery advocacy movement in the U.S.

Multiple circumstances created the need for a new edition of Slaying the Dragon–recent seminal research on earlier periods of history, the accumulation of more than 16 years of new addiction and recovery research and, of course, events of enormous significance that have transpired since 1998. That addiction treatment has gone through significant challenges and changes in the past 16 years is self-evident, but readers may not appreciate some of the momentous and unprecedented events that have occurred within the larger history of addiction recovery. Such events include the growth and diversification of recovery mutual aid societies, the cultural and political mobilization of people in recovery, the emergence of new grassroots recovery support institutions, the rise of recovery as a potentially new organizing paradigm for national drug policy, key breakthroughs in recovery research, and rising efforts to fundamentally redesign addiction treatment.”

http://www.williamwhitepapers.com/blog/2014/06/year-of-the-dragon.html

Source: WilliamWhitePaper.com – June 29, 2014

STATE NEWS OF INTEREST

Feds Seek Ways to Expand Use of Addiction Drug

White House“The government’s top drug abuse experts are struggling to find ways to expand use of a medicine that is considered the best therapy for treating heroin and painkiller addiction.

Sen. Carl Levin of Michigan on Wednesday pressed officials from the White House, the National Institute of Drug Abuse and other agencies to increase access to buprenorphine, a medication which helps control drug cravings and withdrawal symptoms. It remains underused a decade after its launch.

“As long as we have too few doctors certified to prescribe bupe, we will be missing a major weapon in the fight against the ravages of addiction,” Levin told the forum, which also included patients and non-government medical experts.”

http://bostonherald.com/business/business_markets/2014/06/feds_seek_ways_to_expand_use_of_addiction_drug

Source: BostonHerald.com – June 18, 2014

Across The US, An Explosion of Addiction

heroin and injection“Over the last 18 months, The Cincinnati Enquirer has used a team of reporters to cover the heroin problem locally. We joined with Gannett papers in Arizona, Delaware and Vermont for this series on heroin nationally.”

Part IThe Resurgence Of The Deadly Drug Has Sparked A Flurry Of Action From Governors’ Mansions And Statehouses Across New England And The Midwest To Small-Town Police Stations From Northern Kentucky To Wisconsin

Part II – Heroin’s Hidden Journey – Nearly All Heroin Fueling A U.S. Resurgence Enters Over the 1,933-Mile Mexico Border

Part III – Heroin addicts left trapped; families, heartbroken

Part IV – Scanning the battlefield in war on heroin

Part V – In Vermont, on the front lines of war on heroin

Source: USAToday.com – June 12, 2014

Heroin Users Are 90 Percent White, Living Outside Urban Areas

“The image of the heroin user is changing, according to researchers who say the great majority are now white men and women who mostly live outside the cities.

Their study published in JAMA Psychiatry, tracked data from almost 2,800 heroin users and found that first-time users are now generally older than those who began taking the drug in the 1960s. About 90 percent are white, according to the study, and 75 percent now live in non-urban areas.

The research also confirmed a link between the rise of opioid abuse and the growing use of heroin that had been noted in earlier studies. Heroin use has jumped 80 percent to 669,000 users from 2007 to 2012, according to the National Survey on Drug Use and Health, after being relatively stable since 2000.”

http://washpost.bloomberg.com/Story?docId=1376-N6AV3H6S972C01-71HUL1EQ4U5J4QKSAPSPOBBT5I

See related article  - Opioids leading to new class of heroin abusers, study finds at: http://www.jsonline.com/news/health/opioids-leading-to-new-class-of-heroin-abusers-study-finds-b99278535z1-260996001.html

Source: WashingtonPost.com – May 29, 2014

Drugs for Treating Heroin Users: A New Abuse Problem in the Making?

“Evidence is mounting that certain drugs used to treat heroin users are themselves being sold on the streets – and may even be a ‘gateway’ to heroin or opioid use. As some experts herald their value for treating addiction, others ask if the ‘cure’ is making things worse.

More than a decade ago, the FDA partnered with a British company to develop Suboxone, a new treatment for addiction to opioids. But that effort has had highs and lows, experts say. Lifesaving to some opioid abusers, Suboxone and generic drugs like it have not helped others to whom they have been prescribed – in part, these experts say, because of poor oversight of how the opioids are dispensed and used.

Those drugs have also ended up where the U.S .government hoped they wouldn’t: on the street, where they are sold in the same illicit subculture in which heroin and prescription painkillers are peddled.”

http://www.csmonitor.com/USA/Society/2014/0530/Drugs-for-treating-heroin-users-a-new-abuse-problem-in-the-making

Source: Christian Science Monitor – May 30, 2014

To Beat Heroin Addiction, A Turn To Coaches

“Recommendations out this week from a task force on opiate abuse include more peer support and home-based counseling. Health insurers and state Medicaid leaders say they will look at funding for recovery coaches, but there is no plan to do so right now.

Across the country, there’s growing interest in using recovery coaches to help heroin users stop, says Robert Lubran, director of the division of pharmacologic therapies at the federal Substance Abuse and Mental Health Services Administration. At least one state, New York, is paying for coaches to help treat addiction through its Medicaid program.

“This is an evolving field,” Lubran says. “[We are] learning more and more about the best ways to treat addiction and certainly the use of peer counselors, or peer coaches, has become more and more widespread.”

http://commonhealth.wbur.org/2014/06/heroin-recovery-coaches

Source: WBUR’s CommonHealth Reform and Community – June 13, 2014

Opioid Prevention Programs Could Reduce Deaths from Overdose

hospital sign purchasedshutterstock_33280960“Researchers at the University of Cincinnati  School of Medicine conducted a study that analyzed 19 published studies evaluating the effectiveness of Opioid Overdose Prevention Programs (OOPPs) in terms of recognition, prevention, and risk factors for opioid overdoses. Fourteen of the studies analyzed featured follow-up data on over 9,000 people enrolled in an OOPP, of which half had experienced an overdose and 80% witnessed one.

The research found that eleven of the OOPP studies reported a 100% survival rate when administering naloxone, and the others featured at least an 83% rate. The percentages were determined out of nearly 2,000 naloxone administrations.

However, the researchers believe further studies must be conducted to ensure the strength of knowledge of overdose prevention and risk factors for those who are enrolled in OOPPs. Their findings are promising, but there is limited research and data on OOPPs and that’s really the only way more can be determined about overdose prevention efforts.”

http://www.scienceworldreport.com/articles/15166/20140603/opioid-prevention-programs-reduce-deaths-overdose.htm

The article Development and Implementation of an Opioid Overdose Prevention Program Within a Preexisting Substance Use Disorders Treatment Center which was published in the Journal of Addiction Medicine.

Also see article from Medscape ‘Project Lazarus’ Making Headway on Opioid Overdoses available at: http://www.medscape.com/viewarticle/826865. Free registration required.

Source: ScienceWorldReport.com – June 3, 2014

Blog by Jana Burson – Naloxone

“Naloxone is the opioid buzz-kill drug… and it’s also the opioid overdose life saver.

People die from opioid overdoses because the brain gets saturated with opioids. The part of the brain that tells us to breathe during sleep, the medulla, also gets saturated, and eventually shuts off. This usually occurs gradually. The respiratory rate slows over one to three hours, until all respirations stop. Then tissues of essential organs like the brain and heart die from lack of oxygen.

If naloxone can be given during this process, the opioids are tossed off brain receptors, and the medulla fires urgent orders for the body to resume breathing. The patient wakes up, so long as irreversible damage hasn’t yet been done to the brain and heart. In some cases, the patient goes into full precipitated opioid withdrawal, but usually the naloxone doesn’t reverse all of the opioids on board, just enough to save the patient’s life.”

http://janaburson.wordpress.com/2014/06/15/naloxone/

Source: Jana Burson – June 15, 2014

Death by Prescription Painkiller – First Major Review Provides Evidence of Sharp Increase in Deaths from Painkillers in US and Canada and Leading Causes

The number of deaths involving commonly prescribed painkillers is higher than the number of deaths by overdose from heroin and cocaine combined, according to researchers at McGill University. In a first-of-its-kind review of existing research, the McGill team has put the spotlight on a major public health problem: the dramatic increase in deaths due to prescribed painkillers, which were involved in more than 16,000 deaths in 2010 in the U.S. alone. Currently, the US and Canada rank #1 and #2 in per capita opioid consumption.

In an effort to identify and summarize available evidence, Nicholas King, of the Biomedical Ethics Unit in the Faculty of Medicine and his team conducted a systematic review of existing literature, comprehensively surveying the scientific literature and including only reports with quantitative evidence.

“We also wanted to find out why thousands of people in the U.S and Canada are dying from prescription painkillers every year, and why these rates have climbed steadily during the past two decades,” says King. “We found evidence for at least 17 different determinants of increasing opioid-related mortality, mainly, dramatically increased prescription and sales of opioids; increased use of strong, long-acting opioids like Oxycontin and methadone; combined use of opioids and other (licit and illicit) drugs and alcohol; and social and demographic factors.”

“We found little evidence that Internet sales of pharmaceuticals and errors by doctors and patients–factors commonly cited in the media — have played a significant role,” Prof. King adds.

The findings point to a complicated “epidemic” in which physicians, users, the health care system, and the social environment all play a role, according to the researchers.

The results of this research are published in the American Journal of Public Health.

Source: McGill University – June 17, 2014

ASAM Article: Twelve Step Recovery and Medication Assisted Therapies

“You’re not clean and sober if you keep taking that medication from your doctor!”

“You’re just substituting one drug for another.”

“You are depressed because you are not grateful enough.”

These and other statements are often made to 12-step members who are legitimately prescribed and taking FDA approved medications to treat their addictions and other co-occurring illnesses. Unfortunately, this so- called “advice” from well-intended but misinformed members is not founded in scientific or 12-step philosophy and violates a long held 12- step policy of ” AA members should not give medical advice to each other.”

http://www.asam.org/magazine/read/article/2014/06/12/twelve-step-recovery-and-medication-assisted-therapies

Source: American Society of Addiction Medicine – June 12, 2014

Pope Francis Opposes Marijuana Legalization, Questions Methadone

Pope Francis said he opposed efforts to legalize marijuana and questioned the use of substitute drugs like methadone to treat heroin addicts.

“Substitute drugs, moreover, aren’t a sufficient therapy, but rather a hidden way to surrender,” Francis said. “I want to emphasize what I’ve said in other occasions. No to every type of drug. Simply no to every type of drug.”

http://www.bloomberg.com/news/2014-06-20/pope-francis-opposes-marijuana-legalization-questions-methadone.html

Source: – Bloomberg News.com – June 20, 2014

A Fix Special Report—The Maddening State of Addiction Research Funding

funding“Most of us understand that substance addiction and alcoholism is a major social, health, and economic issue. The costs to the economy alone in health care, productivity loss, crime, drug enforcement and incarceration are estimated to be more than $500 billion a year – and that number is from a study ten years ago. In response, only a tiny percentage of this is spent every year by all players – government, private Pharma companies and foundations – on developing and testing a variety of would-be miracle cures (or even just helpful medications or processes).

In the substance abuse funding game there are gamemakers – those who decide which projects are worthy of the awarded dollars – and competitors: researchers vying for limited funds. The gamemakers come from the public and private sector and ultimately determine whether a competitor moves forward or gets denied.

This article is an inside peek at how that game is played and who gets to be the winners and who the losers.”

http://www.thefix.com/content/fix-special-report-maddening-state-addiction-research-funding

Source: TheFix.com – June 6, 2014

Blog by William White: The Language of Recovery Advocacy

RecoverySome will question why we as recovery advocates should invest valuable time debating the words used to convey alcohol and other drug (AOD) problems and their solutions when there are suffering individuals and families that need to be engaged, recovery support resources that need to be created, communities that need to be educated, and regressive, discriminatory policies that need to be changed.  We must invest this time because achieving our broader goals depends on our ability to forge a recovery-oriented vocabulary.

Words have immense power to wound or heal.  The wrong words shame people with AOD problems and drive them into the shadows of subterranean cultures.  The wrong words, by conveying that people are not worthy of recovery and not capable of recovery, fuel self-destruction and prevent or postpone help-seeking. The right words serve as catalysts of personal transformation and offer invitations to citizenship and community service.  The right words awaken processes of personal healing, family renewal, and community and cultural revitalization.  The wrong words stigmatize and disempower individuals, families and communities.

It is time people in recovery rejected imposed language and laid claim to words that adequately convey the nature of our experience, strength and hope.  We must forge a new vocabulary that humanizes AOD problems and widens the doorways of entry into recovery.  We must forever banish language that, by objectifying and demonizing addiction, sets the stage for our sequestration and punishment.  We must counter the clinical language that reduces human beings to diagnostic labels that pigeon-hole our pathologies while ignoring our strengths and resiliencies.  We must also reject the disrespectful and demeaning epithets (e.g., “retreads”, “frequent flyers”) professionals sometimes use to castigate those who need repeated treatment episodes.”

http://www.williamwhitepapers.com/blog/2014/06/the-language-of-recovery-advocacy.html

Source: WilliamWhitePapers.com – June 7, 2014

Blog by William White: Volunteerism and Addiction Treatment

blog1“A 1976 national survey of addiction treatment programs in the United States revealed a workforce of nearly 60,000 workers.  The treatment workforce at that time consisted of 31,000 full-time workers and 15,000 part-time paid workers.  The paid professional workforce included 20,000 counselors, 5,000 nurses, 3,000 social workers, 2,500 psychologists, and a small and slowly growing cadre of physicians.  But what is most striking to me in this survey is the reported presence of more than 1,000 full-time volunteers and 13,000 part-time volunteers. As volunteers disappeared from the addiction treatment milieu during the 1980s and 1990s, the story of their role in early addiction treatment and what they meant to people seeking recovery also disappeared.”

http://www.williamwhitepapers.com/blog/2014/06/volunteerism-and-addiction-treatment.html

Source: WilliamWhitePapers.com – June 14, 2014

Site last updated July 17, 2014 @ 5:55 pm