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

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

Methadone Programs Can be Key in Educating, Treating Hepatitis C Patients

liver“People who inject drugs and are enrolled in a drug treatment program are receptive to education about, and treatment for, hepatitis C virus, according to a study by researchers at several institutions, including the University at Buffalo.

That finding, published online this week in the Journal of Addiction Medicine will be welcome news to health care providers. “One of the most important findings of this work is that people who inject drugs do want to be educated about the disease and that education is associated with willingness to be treated,” says senior author Andrew H. Talal, MD, professor of medicine in the Division of Gastroenterology, Hepatology and Nutrition at UB and adjunct associate professor of medicine at Weill Cornell Medical College. research assistant professor of medicine at UB.”

http://www.sciencedaily.com/releases/2014/05/140516203359.htm

Source: ScienceDaily.com -May 16, 2014

Opioid Substitution Therapy Is Linked to Lowered HIV Risk

“Methadone maintenance therapy and treatment with buprenorphine-naloxone are equally effective at reducing HIV injecting risk behaviours among people who inject drugs, investigators from the United States report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

Both treatments were associated with significant reductions in injecting practices linked to a risk of HIV transmission. Sexual risk behaviour also decreased in women taking both therapies. However, drop-out rates were higher among people treated with buprenorphine-naloxone and men taking this therapy reported significantly higher rates of sexual risk-taking.”

http://www.aidsmap.com/Methadone-and-buprenorphine-naloxone-both-associated-with-reduced-HIV-risk-among-people-who-inject-drugs/page/2849368/

Source: Aidsmap.com – April 29, 2014

Heroin a Growing Threat Across USA, Police Say

heroin and injection“Between 2009 and 2013, according to the assessment produced by the government’s National Drug Intelligence Center, heroin seizures increased 87%. The average size of those seizures increased 81% during the same time.”

“The consciousness of the nation has not really focused on the problem,” Attorney General Eric Holder told the conference of more than 200 officials organized by the Police Executive Research Forum, a D.C.-based think tank. “People saw this more as a state and local problem. …This is truly a national problem. Standing by itself, the heroin problem is worthy of our national attention.”

http://www.usatoday.com/story/news/nation/2014/04/16/heroin-overdose-addiction-threat/7785549/

Source: USAToday.com – April 17, 2014

Message from AATOD Regarding the Death of Philip Seymour Hoffman

AATOD“Philip Seymour Hoffman’s death has attracted national media attention as most celebrity deaths do, especially when they relate to a drug overdose. We have seen this phenomenon shortly after the deaths of Anna Nicole Smith and Michael Jackson. There was an immediate flurry of media attention, and then other stories took center stage.

For many addiction treatment professionals and patient advocates, the issues surrounding celebrity deaths represent the daily struggles that must be confronted by a wary public. A number of issues naturally come to surface during such times about opioid addiction and treatment.”

The AATOD message addresses:

  • Changing Social Attitudes
  • Changing Federal and State Oversight
  • The Opportunity to Educate

“The tragedy of Mr. Hoffman’s death will inevitably be revisited by another celebrity death in the future. We will engage once again in the flurry of media stories which typically have a limited lifespan. Ultimately, we need to work effectively to change America’s perceptions about the safety and danger of prescription opioids, the danger of heroin (which is obviously not an FDA approved drug), and the value of prevention and early intervention in providing access to care. Mr. Hoffman’s death is a stark reminder of the dangers of using heroin. It is not, nor has ever been, a safe drug. The user simply does not know what the drug has been cut with or its potency.

Many people who have worked in the addiction treatment community for many years know that heroin has been adulterated with all sorts of dangerous chemicals which can lead to death. We need to continually educate the public about these issues and work with patient advocates and public policy officials to ensure that the message is consistent and sticks.”

http://www.aatod.org/news/message-from-aatod-regarding-the-death-of-philip-seymour-hoffman/

Source: The American Association for the Treatment of Opioid Dependence – February 11, 2014

Wider Use of Antidote Could Lower Overdose Deaths by Nearly 50%

“Distributing naloxone and training people to use it can cut the death rates from overdose nearly in half, according to a new study.

The new study, published in the BMJ, followed the expansion of Overdose Education and Naloxone Distribution (OEND) programs in Massachusetts.  The programs were offered at emergency rooms, primary care centers, rehabilitation centers, support groups for families of addicted people and other places that might attract those at risk.

The study involved 2912 people in 19 different Massachusetts communities — each of which had had at least 5 opioid overdose deaths between 2004 and 2006.  The participants were trained to recognize overdose, call 911 and administer naloxone using a nasal inhaler.  If the naloxone didn’t work, they were instructed to try another dose and perform rescue breathing until help arrived.

During that time, 153 naloxone-based rescues were reported for which there was data on outcomes, and in 98% of those cases, the drug revived the victim.

There are still practical barriers however, to widely distributing naloxone and implementing more OEND type programs. Advocates have argued that the medication should be made available over-the-counter since it has little potential for abuse and is nontoxic. The Centers for Disease Control (CDC), the director of the National Institute on Drug Abuse and even the drug czar’s office support making it more widely available, and unlike the case with needle exchange programs, there has been no organized opposition to OEND. But the Food and Drug Administration (FDA) has no precedent for allowing over-the-counter sales of such a drug: naloxone is a generic medication approved in an injectable form. Without a company to submit an application for its use in the intranasal version, the agency isn’t likely to OK over-the-counter sales.”

http://healthland.time.com/2013/02/05/wider-use-of-antidote-could-lower-overdose-deaths-from-by-nearly-50/

Source: HealthlandTime.com – February 5, 2014

Open Access Journal Article: Advancing Service Integration in Opioid Treatment Programs for the Care and Treatment of Hepatitis C Infection

liverABSTRACT

It is estimated that approximately 200 million people globally are infected with the hepatitis C virus and that roughly half of these people live in Asia. Without treatment, it is estimated that roughly twenty percent of those infected with hepatitis C virus progress to chronic liver disease, then subsequently, end-stage liver disease. Thus, access to hepatitis C testing and subsequent care and treatment of chronic hepatitis C infection are essential to address the global burden of disease.

In the United States, the Center for Disease Control and Prevention estimates that 60% of new cases of hepatitis infection are due to injection drug use. Opioid Treatment Programs (OTP’s) dispense methadone and buprenorphine under specific federal regulations to injection drug users diagnosed with opioid dependence. OTPs are developing comprehensive care and treatment model programs that integrate general medical and infectious disease-related medical care with substance abuse and mental health services. Integrating hepatitis care services and treatment in the substance abuse treatment settings fosters access to care for patients with hepatitis C infection, many who otherwise would not receive needed care and treatment.

This may serve as a national model for highly cost-efficient healthcare that has a measurable outcome of improved public health with reduced hepatitis C prevalence.

http://www.scirp.org/journal/PaperInformation.aspx?PaperID=42589#.Uul-AJtALzZ

Source: International Journal of Clinical Medicine – January 2014

International Journal of Drug Policy Celebrates its 25th Anniversary – 25 Free Downloads Available from Past Issues

Articles of interest related to opioid dependence and addiction include:

  • Gender sameness and difference in recovery from heroin dependence: A qualitative exploration – September 2013
  • Interventions to prevent HIV and Hepatitis C in people who inject drugs: A review of reviews to assess evidence of effectiveness – August 2013
  • What has been achieved in HIV prevention, treatment and care for people who inject drugs, 2010–2012? A review of the six highest burden countries – October 2013
  •  
  • Syringe access, syringe sharing, and police encounters among people who inject drugs in New York City: A community-level perspective – August 2013
  • “I felt like a superhero”: The experience of responding to drug overdose among individuals trained in overdose prevention – August 2013
  • Brief overdose education can significantly increase accurate recognition of opioid overdose among heroin users – June 2013
  • Does informing people who inject drugs of their hepatitis C status influence their injecting behaviour? Analysis of the Networks II study – December 2013

http://www.ijdp.org/issues?issue_key=S0955-3959(13)X0007-6

Source: International Journal of Drug Policy – January 2014

Barriers to HCV Care Include Lack of Physical Symptoms, Treatment Side Effects

“Barriers to hepatitis C care for patients enrolled in opioid substitution treatment included the perception of being physically well and concerns about adverse effects associated with interferon-based hepatitis C virus treatment, according to results from the ETHOS study.

“Integrating treatment for hepatitis C within settings that provide treatment for drug dependence minimizes some of the barriers for clients wishing to undertake hepatitis C treatment,” study researcher Carla Treloar, PhD, deputy director of the Centre for Social Research in Health at the University of New South Wales, Australia, told Infectious Disease News. “However, treatment remains an unattractive option for some patients. Providing ways for those without hepatitis C symptoms to be assessed for liver damage may be important to open up alternative conversations about hepatitis C care.”

http://www.healio.com/infectious-disease/hepatitis-resource-center-2013/barriers-to-hcv-care-include-lack-of-physical-symptoms-treatment-side-effects

Source: Healio.com – December 11, 2013

Heroin Addiction Warps Brain’s Ability to Change

brain“In a study of heroin abusers’ post-mortem brains, longer duration of heroin use was associated with changes in the shape and packaging of DNA in the brain in the ventral and dorsal striatum, areas of the brain associated with drug addiction, according to Yasmin Hurd, PhD, of the Icahn School of Medicine at Mount Sinai Hospital in New York, N.Y., and colleagues.

The DNA of these patients’ brains became more “open” to gene expression and overactive, which may mean that a treatment that helps “close” this gap and reduce over activity may help temper addiction, Hurd told MedPage Today during an oral presentation at the Society for Neuroscience meeting.”

http://www.medpagetoday.com/MeetingCoverage/SFN/42901

Source: MedPageToday.com – November 14, 2013

Federal Register Notice: Removal of the Prohibition to Use Addictive Drugs in the Maintenance Treatment of Substance Dependence in TRICARE Beneficiaries

military“The Department of Defense (DoD) published this final rule to remove the exclusion of drug maintenance programs and allow TRICARE coverage of the substitution of a therapeutic drug, with addictive potential, for a drug of addiction when medically necessary and appropriate as part of a comprehensive treatment plan for an individual with substance use dependence. The current regulation prohibits coverage of drug maintenance programs where one addictive substance is substituted for another.

The final rule allows TRICARE to cover, as part of otherwise authorized treatment of substance use disorder, utilization of a specific category of psychoactive agent when medically necessary and appropriate. Removal of the exclusion is based on recognition of the accumulated medical evidence supporting the use of certain pharmacotherapies as one component in the continuum of opioid treatment services. Medication assisted treatment, to include drug maintenance involving substitution of a therapeutic drug with addiction potential, for a drug of addiction, is now generally accepted by qualified professionals to be reasonable and adequate as a component in the safe and effective treatment of substance use disorders treatment services, and thus appropriate for inclusion as a component in the TRICARE authorized substance use disorder treatment for beneficiaries.”

https://www.federalregister.gov/articles/2013/10/22/2013-24232/tricare-removal-of-the-prohibition-to-use-addictive-drugs-in-the-maintenance-treatment-of-substance

Source: FederalRegister.com – October 22, 2013

Naloxone Nasal Spray on Development Fast Track as Emergency Treatment for Opioid Overdose

“AntiOp, Inc., a Kentucky company says its nasal spray could save the lives of thousands of narcotic pain medication and heroin overdose victims and that the Food and Drug Administration (FDA) has specified the final research requirements necessary for approval of the drug. AntiOp, Inc. says, its naloxone nasal spray could be on the market in about 18 months.

“The FDA has been very encouraging of our approach,” said AntiOp founder and CEO Dr. Daniel Wermeling. “Once we file a new drug application, they plan to complete a priority review of our product, which usually takes about six months.”

Naloxone is already stocked in thousands of emergency rooms, ambulances and post-surgery recovery rooms but in an injectable form. It must be administered intravenously or as a shot into muscle or under the skin. Because many heroin abusers carry hepatitis or the HIV virus, the risk of infection to medical personnel is high. Some emergency responders use atomizers to convert the injectable form of naloxone to a nasal spray. Wermeling and others believe a nasal spray version of naloxone will prove to be effective, safer and easier to administer than the current injection-based approach.”

http://www.fortmilltimes.com/2013/09/20/2970640/naloxone-nasal-spray-on-development.html

Source: FortMillTimes.com – September 20, 2013

Blog: Street-Obtained Buprenorphine: Drug of Abuse, or Proof of Limited Access?

for sale sign“In a recent article from the journal Addictive Behaviors, researchers discovered that buprenorphine was rarely, if ever, used by IV drug users to get high. In fact, the vast majority of people who reported acquiring the medication from an illicit source did so with the expressed purpose of avoiding withdrawal symptoms. This seems to contradict the common misconception that heroin users “get high” on Suboxone, therefore we should promote abstinence-based treatment. To the contrary, studies like this one could be interpreted as evidence there is not enough access to these medications – if there were, people wouldn’t be forced to seek the drugs from street dealers or friends.”

The table on the Knowledge and Use of Buprenorphine among 602 Injection Drug Users in Baltimore, Maryland can be accessed at: http://mattsub.blogspot.com/2013/08/street-obtained-buprenorphine-drug-of.html

The article abstract is available at: http://www.sciencedirect.com/science/article/pii/S0306460313002232

Source: – Substance Matters: Science and Addiction – August 24, 2013

Legal Interventions to Reduce Overdose Mortality: Naloxone Access and Overdose Good Samaritan Laws

“Opioid overdose is typically reversible through the timely administration of the drug naloxone and the provision of emergency care. However, access to naloxone and other emergency treatment is often limited by laws and that pre-date the overdose epidemic. In an attempt to reverse this unprecedented increase in preventable overdose deaths, a number of states have recently amended those laws to increase access to emergency care and treatment for opiate overdose.”

The Network for Public Health Law has published an update on access to naloxone by state and Good Samaritan laws.

http://www.networkforphl.org/_asset/qz5pvn/network-naloxone-10-4.pdf

Source: Network for Public Health Law – May, 2013

How to Make Drug Courts Work

Pg8_law“Drug courts have made a surprisingly small contribution to the crime reduction that has occurred over the past twenty years. They process only a small fraction of drug-involved offenders within the criminal justice system, and an even smaller fraction of offenders who commit serious crimes. Most chronic cocaine, heroin and methamphetamine users who reach court will end up in jail or prison, often for minor crimes.

Drug courts could be more helpful in reducing crime and incarceration, but only if they become more ambitious and less risk-averse by taking in populations likely to serve real time.”

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/04/26/how-to-make-drug-courts-work/

Source: WashingtonPost.com – April 26, 2013

Studies – Advance Knowledge of HIV Impact on Hepatitis C Infection and Genes That May Thwart HCV

Infectious disease experts at Johns Hopkins have found that among people infected with the hepatitis C virus (HCV), co-infection with HIV, speeds damage and scarring of liver tissue by almost a decade.

In a second study of HCV infection, the Johns Hopkins research team participated in the discovery of two genetic mutations that make it more likely that patients’ immune systems can rid the body of HCV. Both studies are described in articles published online in February ahead of print in the journal Annals of Internal Medicine.

“Our latest study results suggest that HIV might promote aging and disease progression in people with HCV,” says infectious disease specialist and senior investigator, David L. Thomas, M.D., M.P.H. Thomas, who is the Stanhope Bayne-Jones Professor and director of infectious diseases at the Johns Hopkins University School of Medicine and a professor at the university’s Bloomberg School of Public Health, says that among 1,176 study participants, those co-infected with HCV and HIV showed the same severity of liver fibrosis and cirrhosis as those who were infected only with HCV but were 9.2 years older. All study participants were current and former intravenous drug users from Baltimore whose health and disease progression were being monitored with bi-monthly check-ups and liver tissue samples taken from 2006 to 2011.

The United States Centers for Disease Control and Prevention estimates that a quarter of the 3.2 million Americans chronically infected with HCV are also infected with HIV.

Thomas says the findings may help physicians predict the people who are most likely to self-recover from exposure to HCV, and those who will most likely require aggressive treatment right away.

The press release can be accessed at:
http://www.eurekalert.org/pub_releases/2013-03/jhm-sak030413.php

Free access to the articles is available for a limited time at: http://annals.org/onlineFirst.aspx

Source: – John Hopkins Medicine – March 4, 2013

Patient Dilemma: Treat Hepatitis C Now or Hold Out?

“Being diagnosed with a potentially fatal disease usually triggers immediate treatment. But a growing number of people infected with hepatitis C are putting off therapy, choosing instead to roll the dice and wait for a new generation of drugs to become available.

The new drugs, which could begin hitting pharmacies in a year or two, promise to cure hepatitis C more effectively and with far fewer harsh side effects than the current regimen of medications. The disease, which attacks the liver, often progresses slowly, giving certain patients leeway in when to seek treatment. And doctors regularly monitor these patients to check if the disease has significantly worsened. Up to four million Americans are estimated to be infected with the hepatitis C virus.”

http://online.wsj.com/article/SB10001424127887323293704578330712442353712.html

Source: – WallStreetJournal.com – March 4, 2013

Target ‘Super-spreaders’ to Stop Hepatitis C

Each intravenous drug user contracting Hepatitis C is likely to infect around 20 other people with the virus, half of these transmissions occurring in the first two years after the user is first infected, a new study estimates.

The work, led by researchers from Oxford University, suggests that early diagnosis and treatment of Hepatitis C in intravenous drug users could prevent many transmissions by limiting the impact of these ‘super-spreaders’ (a highly infectious person who spreads a disease to many other people).

Working out ‘who has infected who’ in fast-spreading diseases such as influenza is often relatively straightforward, but in slow-spreading diseases such as Hepatitis C and HIV, where instances of transmission are spread over months or years, it is extremely difficult. The new approach, developed by a team from Oxford University, University of Athens and Imperial College London, combines epidemiological surveillance and molecular data to describe in detail, for the first time, how Hepatitis C spreads in a population.

http://www.ox.ac.uk/media/news_stories/2013/130201.html

Source: University of Oxford – February 1, 2013

The December 2012 issue of Heroin Addiction and Related Clinical Problems is Now Available Online

Heroin Addiction and Related Clinical Problems, the official journal of EUROPAD (European Opiate Addiction Treatment Association), is a peer-reviewed publication for professionals wanting to stay informed of research and opinion on opioid misuse treatment in Europe and around the world. A particular emphasis is on medication-assisted treatments for opioid addiction. Articles in this issue include:

  • Quality of Care Provided to Patients Receiving Opioid Maintenance Treatment in Europe: Results from the EQUATOR analysis
  • Outcomes of opioid-dependence treatment across Europe: identifying opportunities for improvement
  • Assessing the current state of public-health-related outcomes in opioid dependence across Europe: data from the EQUATOR analysis
  • Barriers to treatment access and informed patient choice in the treatment of opioid
    dependence in Europe
  • Aggressive behaviour and heroin addiction
  • Post-traumatic stress spectrum and maladaptive behaviour (drug abuse included) after catastrophic events: L’Aquila 2009 earthquake as case study

The PDF file is available for download at: http://atforum.com/documents/HeroinDecember2012.pdf

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