“For too long, conducting legitimate research on the medical benefits of marijuana was all but impossible. Kept out of the hands of doctors and scientists by an overzealous DEA, pot is still classified by the federal government as a Schedule I drug under the Controlled Substances Act—the strictest category available. This makes funding and access to research-grade, federally legal cannabis hard to come by; even in states where marijuana is legal, studies on the drug are still subject to approval by multiple boards, and samples must be procured from the only lab in the country approved to dispense research-grade marijuana.
Robert L Cook, professor of epidemiology at the University of Florida, recently announced he is leading a 400 person study to scrutinize marijuana’s effects on people living with HIV. The five year, $3.2 million study is believed to be the largest of its kind, and will look not only at marijuana’s impact on the brains of HIV patients, but also whether the drug is able to help suppress the virus. Cook will also account for the specific amount of marijuana consumed or inhaled by participants, as well as the amount of THC and cannabinoids in those doses—something he said other researchers haven’t been able to do.”
Source: Vice.com – November 16, 2017
“President Trump will instruct the Department of Health and Human Services to declare the opioid crisis a public health emergency, the administration said Thursday.
It is a major step in combating the drug epidemic and a major follow-through on a longstanding presidential promise. But White House officials were quick to caution that the administration’s response won’t end with the declaration, with a number of new rules and actions expected to be issued in the coming weeks.
As of Thursday: What does the emergency declaration entail?
What’s in It
Telemedicine: The administration said a regulatory change would allow for the prescription of “medicine commonly used for substance abuse or mental health treatment” via telemedicine. Addiction experts have said that would be a major step toward allowing individuals in rural areas with substance use disorder to access care.
Personnel: The declaration allows HHS, and states with governors who request it, to “make temporary appointments of specialists with the tools and talent needed to respond effectively” to the crisis.
Labor grants: In a move it said is “subject to available funding,” the White House will instruct the Department of Labor to issue “dislocated worker grants” to those displaced from the workforce due to the opioid crisis.
HIV/AIDS resource shifts: The administration said it would shift resources within existing programs aimed at delivering HIV/AIDS care to better serve those with both HIV/AIDS and substance use disorder.
Money: The emergency declaration relies on a public health emergency fund that, according to HHS, currently is worth only $57,000. Senior administration officials said they expected the opioid crisis to figure heavily into ongoing budget negotiations and a spending bill Congress must pass by December, but declined to specify a dollar figure.”
Source: ScientificAmerican.com – October 26, 2017
See related article: Federal money to fight opioid crisis may be going to wrong places, new report says available at: http://www.washingtonexaminer.com/federal-money-to-fight-opioid-crisis-may-be-going-to-wrong-places-new-report-says/article/2638853
See related article: Trump’s call to bolster virtual opioid treatment lacks muscle, critics say available at: https://www.politico.com/story/2017/10/26/trump-opioid-telemedicine-measure-critics-244222
See related article: Christie backs Trump decision not to declare ‘national emergency’ on opioids available at: http://www.nj.com/politics/index.ssf/2017/10/after_calling_for_it_christie_backs_trump_decision.html
“The Centers for Disease Control and Prevention (CDC) released what we usually call “the Monitoring Report.” The full name of the report is “Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data.” In addition, they published two new related fact sheets, Understanding the HIV Care Continuum and Selected National HIV Prevention and Care Outcomes in the United States.
The Monitoring Report signals that we are making progress on most of our national HIV prevention, care, and treatment goals and illustrates the impact that HIV continues to have on the lives of 1.1 million Americans who are living with the infection. It also shows us where we need to do better and re-assess our efforts, diagnose the problems, and use this information to make the changes to our policies, programs and services that are needed to turn the results around.
The reports can be accessed at: https://www.hiv.gov/blog/new-release-cdc-monitoring-report-and-nhas-indicators
Source: The Centers for Disease Control and Prevention – July 27, 2017
Heroin use in the United States was estimated to cost society more than $51 billion in 2015, according to new research at the University of Illinois at Chicago.
According to the World Drug Report 2016 from the U.N. Office on Drugs and Crime, heroin use has reached the highest level in 20 years in the U.S. and is the deadliest drug worldwide.
UIC pharmacoeconomists led by Simon Pickard and Ruixuan Jiang created a cost-analytic model to determine how heroin impacts society using several variables: number of imprisoned heroin users and their crimes; treatment costs of heroin abuse; chronic infectious diseases contracted through heroin abuse (HIV, Hepatitis B and C, and tuberculosis), and cost of their treatments; cost of treating newborns with medical conditions associated with heroin; lost productivity at work; and heroin overdose deaths.
The study, published in the journal PLOS ONE, found that heroin users are less productive than others due to premature death; spend more time away from work due to seeking treatment for drug dependence and for drug-related hospitalizations, and have high rates of work absenteeism and unemployment.
On average, the societal cost per heroin user per year is $50,799. An estimated 1 million people are active heroin users in the United States, putting the total societal cost at approximately $51 billion, said Pickard, professor of pharmacy systems, outcomes and policy.”
Source: Eurekalert.org – June 8, 2017
“The toll of addiction is staggering. Approximately one in seven people who try addictive substances will get hooked, and the abuse of illicit drugs costs the economy $193 billion each year in healthcare, crime prevention, and loss of productivity, according to the National Institute on Drug Abuse.
Researchers are working on vaccines that block drugs from reaching the brain, preventing addicts from getting high. These vaccines could help people in recovery stay clean, but they’re not likely to become part of the standard childhood immunizations lineup.
Among the anti-heroin vaccines being tested, one coaxes the immune system to attack heroin and helps eliminate it from the body so effectively that it can neutralize lethal levels of the drug in animals.
A second anti-heroin vaccine, developed at the Walter Reed Army Institute of Research in Silver Springs, Maryland, goes after two closely linked problems: It keeps heroin from reaching the brain while also preventing HIV infection.”
Source: WRCBRV.com – April 24, 2017
By Barbara Goodheart, ELS
How different are women from men, when it comes to using—and misusing—opioids?
More different than you might think, it turns out, according to CDC Vital Signs, a publication of the Centers for Disease Control and Prevention. Women are more likely than men to have chronic pain, and to use prescription opioids for longer periods, in higher doses. They also tend to become physically dependent on opioids more easily than men, even after using smaller amounts for shorter periods.
The outcomes of opioid use and misuse reflect women’s greater susceptibility. Between 1999 and 2010, overdose deaths from prescription pain killers increased 237% among men, but the rise was far higher among women—more than 400%.
The situation with heroin usage is similar. CDC Vital Signs indicates that between 2002 and 2013, heroin use rose 50% among men, but it increased 100% among women. These examples are from a new 35-page report, White Paper: Opioid Use, Misuse, and Overdose in Women, published in December by the Office on Women’s Health (OWH), U.S. Department of Health and Human Services (HHS).
This article summarizes the White Paper and highlights important data about women and opioid use and misuse.
Overview: The HHS White Paper
Contents. The White Paper opens with a description of the opioid epidemic and the three areas of the HHS Opioid Initiative (see table), then moves on to prevention and treatment of opioid use disorders (OUDs).
|HHS Opioid Initiative
In addition to citing data, the White Paper highlights factors involved in a woman’s path to opioid misuse, among them life experiences, biological and social influences, geography, and demographic characteristics.
Purpose. The White Paper was commissioned to educate enrolled participants in advance of a September 2016 HHS-OWH national meeting. The goal of the meeting was to prepare participants to understand the impact of the opioid epidemic on women, across age, race, geography, and income, and to issue a post-meeting report on possible solutions to some of the problems discussed in the White Paper.
Underlying Psychological Differences in Women Lead to Riskier Behavior
Why do women behave differently from men when it comes to opioids? Psychological differences, such as women’s more intense opioid cravings, account for some of the riskier behavior. While both sexes are susceptible to psychological and emotional distress, a key difference exists: these distresses are actual risk factors for hazardous prescription opioid use in women, and only in women, studies show; men react to these distresses in other ways.
SAMHSA data (2015) reveal that 4% of females ages 12 and older misused prescription pain relievers during the previous year. Because misuse often leads to involvement of the health care system, it’s not surprising that, CDC data show, every three minutes another woman visits an emergency department because of prescription painkiller misuse.
Women with a substance use disorder are at increased risk of injection drug use, which can lead to viral hepatitis or to HIV. From 2010 to 2014, new cases of hepatitis C among women rose more than 260%—with substance use in part responsible. Younger women risk transmitting the infection to their infants—yet many, serving as caregivers and lacking childcare options, find it difficult to arrange for treatment for their disorder.
Preventing OUDs and Overdoses in Women
Few data exist on preventive measures for women, and studies tend to involve substances other than opioids. The tendency of women to quickly become physically dependent on opioids, mentioned earlier, involves several physiological differences that exist between men and women: metabolic rate, hormone levels, and percentages of body fat. With the risk of opioid-related harm higher in women, investigators see screening and early intervention as key steps in helping to protect women from OUDs and overdoses.
The HHS Opioid Initiative
Opioid Prescribing Practices
Between 2008 and 2012, more than one-third of Medicaid-enrolled women aged 18-44 and more than one-fourth of privately insured women in the same age group were prescribed opioids.
Expanding Naloxone Use in Women
Naloxone offers potentially life-saving treatment, but is under-used in women. A 2016 study found that men were almost three times more likely than women to be given naloxone in resuscitation efforts. With a nasal spray and an auto-injector formulation now available, perhaps more women who need naloxone will be able to obtain it.
The White Paper notes: “Given the trends in increased heroin use among women, increased availability and usage of naloxone may soon be that much more critical to prevent death from overdose among women.”
MAT for Women
Despite “overwhelmingly positive” evidence that MAT is effective, and a recommendation from the CDC that patients with an OUD be offered MAT, each year only 20% of adults—men and women—with an OUD receive MAT. The barriers: cost, access, and stigma.
Many women with an OUD lack the financial and child-care resources available to other women. Even those who can find affordable treatment and decide to enter a program may have problems arranging for child care.
In response to the increasing impact of the opioid crisis on women, the HHS OWH held a national meeting on September 29-30, 2016. The meeting convened a national conversation on how best to address some of the problems described in the White Paper. AT Forum will check with HHS OWH later regarding its findings and recommendations, and, if appropriate, will publish a follow-up article.
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AAFP Supports Turn the Tide Rx Campaign to End Opioid Abuse. August 9, 2016. American Academy of Family Physicians Web site. http://www.aafp.org/news/health-of-the-public/20160809turntide.html. Accessed April 12, 2017.
Anson P. Post-Surgical Pain Guidelines Reduce Use of Opioids. Pain News Network Web site. February 18, 2016. https://www.painnewsnetwork.org/stories/2016/2/18/guidelines-for-post-surgical-pain-discourage-use-of-opioids. Accessed April 12, 2017.
CDC Vital Signs citing National Survey on Drug Use and Health 2002-2013. http://www.cdc.gov/vitalsigns/heroin/index.html#modalIdString_CDCImage_0. Accessed April 12, 2017.
Center for Substance Abuse Treatment. Chapter 13 – Medication-Assisted Treatment for Opioid Addiction During Pregnancy. In: Center for Substance Abuse Treatment. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Rockville, MD: Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 43.) http://www.ncbi.nlm.nih.gov/books/NBK64148/# 6.
Chou, R. et al. Management of Postoperative Pain: A Clinical Practice Guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. February 2016, Volume 17, Issue 2, Pages 131-157. http://www.jpain.org/article/S1526-5900%2815%2900995-5/fulltext#back-bib18. Accessed April 12, 2017.
Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49. doi: http://dx.doi.org/10.15585/mmwr.rr6501e1.
Substance Abuse and Mental Health Services Administration. Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders. Treatment Improvement Protocol (TIP) Series 54. HHS Publication No. (SMA) 12-4671. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.
“The U.S. prescription drug abuse epidemic has increased the risk of HIV outbreaks in rural and suburban communities, where up to now the virus has posed little threat, warns a new case study.
Needle-sharing among prescription drug addicts created an outbreak in rural Scott County, Ind. Public health officials report HIV infected 181 people there between November 2014 and November 2015.
“It was the largest outbreak that has occurred in the U.S. since the introduction of HIV treatment,” said lead author Dr. Philip Peters, a medical officer with the Division of HIV/AIDS Prevention at the U.S. Centers for Disease Control and Prevention. “And it occurred in a poor and rural community. We have not seen HIV outbreaks in these types of communities before.”
Many of the infected people had crushed and cooked down the extended-release form of the opioid pain pill oxymorphone (Opana ER). The result was an injectable slurry, which increased potency and dodged drug-making technologies intended to prevent abuse, Peters said.
But the dose created by this process proved too powerful.”
Source: ConsumerHealthDay.com – July 20, 2016
“Research published in the online edition of the Journal of Acquired Immune Deficiency Syndromes has identified the jurisdictions in the United States especially vulnerable to the rapid spread of HIV or HCV due to unsafe injecting drug use. A total of 220 counties in 26 states had a high level of vulnerability, with factors associated with unsafe injecting including high rates of death due to drug overdose, unemployment and poverty.
“We have developed a model to identify US counties potentially vulnerable to rapid spread of HIV, if introduced, and new or continuing high numbers of HCV infections among PWID [people who inject drugs],” comment the authors. “Jurisdictions identified as at-risk might use potentially informative local data that were not available nationally and take action.”
Source: AidsMap.com – June 21, 2016
By Alison Knopf
Five years ago, the U.S. Equal Employment Opportunity Commission (EEOC) ordered Hussey Copper to pay $85,000 because the Leetsdale, Pennsylvania-based company refused to hire a job applicant who was in methadone maintenance treatment.
Donald Teaford was offered a job as a production laborer, but the offer was rescinded—and this was illegal. The offer was conditional upon Mr. Teaford’s passing a medical examination, during which the company doctor learned that he was receiving methadone as part of treatment. The company mistakenly concluded this meant he was a safety risk, according to the EEOC. Mr. Teaford was qualified for the job, and had no adverse effects from methadone. The treatment program provided the company physician with documentation of Teaford’s successful participation.
The Americans with Disabilities Act (ADA) is the federal law protecting people like Mr.Teaford, and it’s important for everyone involved in methadone treatment to know about it. “Methadone treatment is one of the most monitored and regulated medical treatments in the United States,” said District Director Spencer H. Lewis, Jr., of the EEOC’s Philadelphia District Office, in announcing the decision on February 11, 2011. That office oversees Pennsylvania, Delaware, West Virginia, Maryland, and parts of New Jersey and Ohio. “This case should remind all employers that the ADA requires employers to make individualized assessments about an individual’s ability to do the job, instead of acting out of speculative fears or biases,” said Mr. Lewis.
The EEOC first tried to reach a pre-litigation settlement with the company, but was unable to, after which it filed suit. In addition to the $85,000 monetary award to Mr. Teaford, Hussey Copper was to hire him as a mason utility laborer. Furthermore, Hussey Copper was then under a five-year consent decree enjoining it from further engaging in any employment practice that discriminates based on disability, and also requires workplace education on disability rights.
“We are pleased that in addition to the monetary relief and the injunctive relief that will benefit all company employees and applicants, Hussey Copper will also hire Mr. Teaford,” said Attorney Debra Lawrence at the time. “He now has the opportunity to earn a living performing a job for which he is well qualified.”
Legal Action Center Advice
Today, the same is true, and MMT patients should take heed of their rights, according to the Legal Action Center, a public interest law firm based in New York. “When you’re applying for a job, you don’t have to tell them anything” about HIV, hepatitis, or substance use disorders, including your status as a patient,” Sally Friedman, legal director, told AT Forum.
You are not required to answer questions about treatment in a job interview; such questions can be part of a medical examination, but a medical examination can be performed only after a job offer has been made, with the offer contingent upon the medical examination. If you are applying to be a food service worker and you have hepatitis A, the job offer can be rescinded. But in most cases, if you are in treatment (whether with a medication or not), you cannot be denied the job, as long as you are not using illegal drugs. A drug test for illegal drugs is not a medical exam, and you can be given a drug test before you get a job offer.
Until a job has been offered, there can be no questions about disability, no requirement for an HIV test, and no questions about substance use disorders (SUDs) (past or current). However, an employer may conduct drug tests before a job offer, and may condition hiring on results showing no illegal drug use.
Patients who are on methadone, buprenorphine, or any other drug that will show up in a drug test, should give the lab a letter from the physician verifying prescriptions or participation in a methadone program, or both, and make sure the tester documents the prescribed medications, according to the Legal Action Center. In addition, the employer can require this test—or the conditional medical exam—only if everyone offered that position must take the same test or exam.
During the job interview, employers may ask whether applicants drink alcohol or currently use illegal drugs, but they can’t ask how much or how often, because this could show a protected disability.
There is no reason not to hire someone with HIV or hepatitis B or C—bloodborne diseases that can be transmitted via needle sharing. “The only defense the employer has is if the employee poses a direct threat to the health and safety of others,” said Ms. Friedman. This can happen with hepatitis A, which is transmitted orally, and therefore food service employers can legally refuse to hire someone with hepatitis A. But it does not apply to HIV, or to hepatitis B or C.
There is also confusion about the job applicant’s right to privacy, which is limited. Asked about the status of the information, she explained: “People think it’s private, especially HIV, because there are privacy laws. But privacy laws don’t mean you don’t have to tell anybody.” However, employers aren’t allowed to share the information. “Employers are required to maintain the confidentiality of information they get from a medical exam,” said Ms. Friedman. “They only need to share it with supervisors if the employee needs reasonable accommodation.
“The bottom line advice we always give is that you must be truthful,” she said. “If the employer finds out later that you lied, they can legitimately not hire you, or can even fire you.”
The Legal Action Center has a presentation on these issues. AT Forum adapted the section below, consisting of examples, for opioid treatment programs (OTPs).
Illegal discrimination based on a disability: Doctor’s office refuses to treat a man for his broken leg because he is in a methadone maintenance program.
Legal actions: An employer fires an employee who caused an accident in the workplace because he was under the influence of alcohol or drugs; An employer fires an employee because her addiction results in repeated no-shows at work.
Who is protected by the federal Americans with Disabilities Act (ADA): people with disabilities, people with a history or record of a disability, or people who are regarded as having a disability. A disability is a physical or mental impairment that substantially limits one or more major life activities, a history or record of such an impairment, or being regarded as having such an impairment. Examples of major life activities include working.
A current SUD involving illegal use of drugs is not a disability under the ADA. A past SUD involving illegal use of drugs is a disability if it substantially limits one or more major life activities. The method of recovery is irrelevant to proving disability.
Example: Claire was in a car crash two years ago and became dependent on narcotic pain medication. One year ago, she entered a methadone program. She has not used any drugs illegally since she began treatment. Claire is protected by the ADA even though her dependence on methadone does not substantially limit any major life activity. The reason is that she has a record of a disability (a SUD) which is why she is currently in methadone treatment. Presumably, others perceive Claire as having an impairment (SUD) due to her treatment in a methadone program. Therefore, Claire is protected by federal anti-discrimination law.
Example: Mitchell has been in a methadone maintenance program for 6 years. He has a commercial driver’s license, a clean driving record, and no history of arrests. Mitchell applies to be an interstate truck driver, and reveals that he is prescribed methadone. The trucking company turns him down. This was legal because the federal Department of Transportation regulations disqualify people from having an interstate license if they are taking methadone.
Example: Chris is in methadone maintenance treatment for opioid addiction. He applies for a job that would involve operating dangerous machinery, and tells the employer about his methadone treatment. The employer refuses to hire Chris, because he says he’s sure Chris’s methadone must make him sleepy, which would be dangerous when operating heavy machinery. This is not legal, because the employer’s decision is based on speculation–-he has not looked for objective medical evidence (e.g., speaking with Chris’s prescribing physician, or asking Chris himself about side effects of his medication). There is ample literature stating that methadone, when used properly pursuant to prescription, does not impair.
The bottom line: Methadone patients do have rights, as do people with HIV or hepatitis. “Various government agencies are willing to help you enforce your rights, and the EEOC has regional offices throughout the country,” said Ms. Friedman.