Archive for January, 2016

Survey Reveals How Many U.S. Adults Have Had Drug Use Disorder

Posted on: January 22nd, 2016 by sobrietyresources No Comments

By John Lavitt Friday, November 20th, 2015

A significant number of Americans have suffered from drug abuse disorder at some point in their lives.

In a survey of American adults funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), researchers found that drug use is common, but treatment is rare.

The survey revealed that 10% of adults in the United States experience a drug use disorder at some point in their lives. Usually co-occurring with a mental health disorder, the drug use disorder goes untreated over 75% of the time. The study also found that about 4% of Americans met the criteria for drug use disorder in the past year.

“Based on these findings, more than 23 million adults in the United States have struggled with problematic drug use,”said Dr. George Koob, NIAAA director. “Given these numbers, and other recent findings about the prevalence and under-treatment of alcohol use disorder in the U.S., it is vitally important that we continue our efforts to understand the underlying causes of drug and alcohol addiction, their relationship to other psychiatric conditions and the most effective forms of treatment.”

Dr. Bridget Grant of the NIAAA Laboratory of Epidemiology and Biometry conducted the NESARC study, which appears online in the Journal of the American Medical Association. Using DSM-5 criteria, more than 36,000 people were evaluated using face-to-face interviews. The interviews revealed that drug use disorder was more common among white men and Native Americans. Being single or no longer married also raises the risk level. Age, finances, and education also play a role. Younger individuals, as well as those with lower income and education levels, were at even greater risk.

Regional differences show that people living in the 13 Western-most states in the country, including Alaska and Hawaii, were more likely to go through a drug use disorder. From a psychiatric perspective, the study showed individuals with drug use disorder in the past year were 1.3 times as likely to experience clinical depression, 1.6 times as likely to have post-traumatic stress disorder (PTSD), and 1.8 times as likely to have borderline personality disorder.

The majority of people never receive any form of treatment. Nearly 14% of people who had drug use disorder in the past year—and 25% of people who have ever had a drug use disorder—went on to receive care. Less than one-third of those with severe lifetime drug use disorder ever receive any form of treatment. Such low treatment rates may reflect skepticism about the effectiveness of treatment insufficient resources. Lack of knowledge among healthcare providers and barriers related to stigma are also key factors.

“The prevalence and complexity of drug use disorders revealed in this study coupled with the lack of treatment speak to the urgent need for healthcare professionals to be trained in proper techniques to identify, assess, diagnose, and treat substance use disorders among patients in their practice,” said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse (NIDA).

 

https://www.thefix.com/survey-reveals-how-many-us-adults-have-had-drug-use-disorder

 

For Teenagers, Adult-Sized Opioid Addiction Treatment Doesn't Fit

Posted on: January 18th, 2016 by sobrietyresources No Comments

Heidi Benson Updated January 15, 2016 7:33 AM ET Published January 15, 2016 5:00 AM ET

Addicted to prescription painkillers after a high-school sports injury, Cameron Burke moved on to heroin, which was cheaper and more easily accessible. His parents tried everything, more than once sending him out of state for treatment.

“It was never enough,” Jennifer Weiss-Burke of Albuquerque, N.M., told a local TV reporter last year. “Thirty days here, 30 days there, maybe detox for five days. It was never long-term, and that’s what he needed. Recovery from heroin addiction requires long-term treatment.”

During the course of two years, Cameron would seem to recover, only to relapse. In 2011, Weiss-Burke found him dead in his room.

Weiss-Burke turned her grief into action, lobbying for state legislation that would require all medical practitioners to complete a course in addiction and pain management when their licenses are renewed, and pushing for the creation of Serenity Mesa, a long-term treatment center for youths in Albuquerque that opened its doors last year.

Although drug addiction was described as a disease as long ago as the 1700s, addiction medicine has been neglected by the medical system, according to a 2012 study by the National Center on Addiction and Substance Abuse at Columbia University.

“While a wide range of evidence-based screening, intervention, treatment and disease management tools and practices exist, they are rarely employed,” the report found.

Lack of effective treatment in the teen years can blight an entire life. “When substance use disorders occur in adolescence, they affect key developmental and social transitions, and they can interfere with normal brain maturation,” the National Institute on Drug Abuse reported in 2014. “These potentially lifelong consequences make addressing adolescent drug use an urgent matter.”

The first line of defense is primary health care, according to Dr. David E. Smith, an addiction medical specialist who founded the Haight Ashbury Free Clinics in San Francisco. To increase the number of physicians trained to diagnose and treat addiction and to recognize early signs of adolescent substance use disorder, Smith would like to see addiction medicine mandatory in medical school.

“Engaging people earlier in their addiction improves their chances of recovery and overall better health,” Smith said. “Meanwhile, costs for the health care system are dramatically reduced.”

A Youth Based Approach

Deaths from heroin overdose in all age groups doubled from 2010 to 2012, according to a 2014 study from the Centers for Disease Control and Prevention.

In response, communities are seeking new strategies to treat addiction and speed access to care. That includes trying to meet the unique needs of youth after years of addiction treatments geared to adults. Serenity Mesa is one of those youth-centered efforts.

Such programs offer evidence-based treatment, types of therapy that have shown scientifically validated results. They include: Screening, Brief Intervention and Referral to Treatment (SBIRT), a preventative protocol for early detection; Motivational Interviewing, a counseling approach that guides individuals to set goals; and Functional Family Therapy (FFT), which treats teens in a family setting.

While public policy and social attitudes have begun to catch up with science, treatment for teens lags far behind. The 2012 National Survey on Drug Use and Health found that 90 percent of drug-addicted youth ages 12 to 17 get no treatment at all.

“Twenty years ago, we were just beginning to focus on evidence-based treatment for drug-involved youth,” says Dr. Holly Waldron, a senior scientist at the Oregon Research Institute who studies adolescent behavior. “Historically, interventions for addictive behaviors have included confrontational approaches, but we’ve learned that confrontation does not produce effective change in substance-abuse behavior.”

Instead, Waldron and her colleagues favor evidence-based interventions including functional family therapy and cognitive behavioral treatments for adolescent substance abuse.

“We’re actively involved in taking these treatments to community settings,” she said. “If we can connect kids to treatment, we know they’ll improve.”

Most health insurers now require proof that addiction programs use evidence-based treatment, a sign of efficacy. And since the 2010 Affordable Care Act expanded the Mental Health Parity and Addiction Equity Act, more adolescents have better access to insurance coverage.

Yet, teenagers rarely enter rehab voluntarily. “Clinicians are dependent on systems like juvenile justice and the schools to get teens connected to treatment,” Waldron said.

Making family therapy work

Some treatments for teens with substance use disorder engage the whole family. Functional Family Therapy uses a dozen or more one-hour sessions to defuse negativity, then teach skills training in family communication, parenting, problem solving and conflict management. Later sessions strengthen a family’s capacity to navigate community resources, which can prevent relapse.

Waldron is also testing the effectiveness of delivering therapy to New Mexico’s scattered rural population via videoconference. Privacy is one benefit of videoconferencing, Waldron noted. “If you live in a small town and your car is parked in the lot at the mental health clinic, everybody knows that’s your car,” she says. “In Native American communities, if you go to a tribal counselor, it’s more likely people will know your business.” So talking at home over the Internet offers greater confidentiality. “That’s important to families.”

Videoconference dynamics can be complicated, however. “It’s harder to discern over a video stream how people are responding,” Waldron said. “If they’re quiet, if they’re becoming emotional, we might not see cues.”

To compensate, “the therapist has to do verbal check-ins with each member of the family,” Waldron explained. She posed an example, meant to invite participants to describe their feelings: “I hear you being quiet. Does this topic hit close to home for you all?”

The study ran through November, and Waldron said preliminary data shows the online treatment is as effective as treatment delivered face-to-face at home. If, as Waldron expects, the final data shows measurably improved outcomes such as a decline in drug use and better family dynamics, she hopes that the results can be reproduced elsewhere.

“It will mean that it’s possible to get the best treatment to kids who would never have access otherwise,” she said.

Treating addiction with medication

At HealthRIGHT 360, a nonprofit in San Francisco created in 2011 when the Haight-Ashbury Clinic merged with the local residential center Walden House, treatment can include individual or group therapy, family therapy and mindfulness meditation. All can be used in combination with medications such as methadone.

While methadone can be effective in addiction recovery for adults, it is not well-suited for teens, according to Dr. Ako Jacintho, HealthRIGHT 360’s medical director.

Methadone is highly regulated and can only be administered at methadone clinics. The drug must be taken daily, so trips to and from the clinic, often far from home and work, can be especially difficult for teens. And, Jacintho noted, teens may encounter other addicts at the clinic, as well as opportunities to buy drugs.

The maintenance drug often prescribed for teens is Suboxone, a combination of buprenorphine, an opiate substitute that eliminates craving, and naloxone, which blocks euphoric effects. Suboxone doesn’t cause drowsiness, and, the equilibrium it provides can make it easier to identify and treat co-occurring disorders like depression or anxiety. The dosage is eventually tapered.

A 2014 Yale School of Medicine study showed that ongoing maintenance treatment with Suboxone is more effective than detoxification and abstinence alone.

“There is strong data on Suboxone,” Jacintho said. When combined with behavioral therapy, he says, Suboxone can reduce relapses and promote recovery. And, it can be prescribed and given by a trained and certified primary care physician — in a doctor’s office, rather than a clinic, Jacintho noted. “We get better outcomes when we change from methadone clinics to primary care.”

As education and training around addiction improve, Smith hopes more attention will be paid to the people he calls “role models of recovery.”

Vitka Eisen, CEO of HealthRIGHT 360, is one of them. She was a heroin addict from age 19 to 25, until the Haight Ashbury Free Clinic and Walden House put her back on her feet. Three college degrees later, including a doctorate in education from Harvard University, she’s proud to call herself “a 1987 Walden House graduate.”

Having been homeless during periods of her addiction, Eisen knows the difficulties teenage addicts may face.

“It’s hard for these kids to get off heroin, because they lead such challenging lives. If a kid’s using heroin, there’s a high likelihood of trauma exposure” from school, work or family life, she said. “Drugs may seem like the best thing in their life, the thing that helped them deal with how they experience the circumstances of their lives.”

The most effective treatments for teens, she says, build on the individual’s strengths while empowering them to better handle stressful circumstances.

And these treatments can gain in effectiveness when used in combination with medications such as Suboxone.

Jacintho also says there soon will be greater acceptance of integrated treatment for teens. “The data is going to show positive health outcomes,” he predicted.

Smith is cautiously optimistic, too. “Every interface with a health care professional should give a consistent message,” he said. “We care.”

This story was produced by Youth Today, the national news source for youth-service professionals, including child welfare and juvenile justice, youth development and out-of-school-time programming.

 

http://www.npr.org/sections/health-shots/2016/01/15/463046372/for-teenagers-adult-sized-opioid-addiction-treatment-doesnt-fit

 

FDA Panel Favors Approval for Drug-Oozing Addiction Implant

Posted on: January 18th, 2016 by sobrietyresources No Comments

By MATTHEW PERRONE, AP HEALTH WRITER WASHINGTON — Jan 12, 2016, 5:46 PM ET

Federal health advisers recommended approval Tuesday for an experimental implant designed to treat patients recovering from heroin and painkiller addiction.

Despite shortcomings in company studies, a majority of Food and Drug Administration advisers said the implant offers important benefits not currently available. The drug-oozing device is intended to be a safer, more reliable approach to controlling cravings and withdrawal symptoms.

“Overall the data did have some problems,” said Dr. Thomas Grieger, of the Maryland Department of Health. “But I think clearly there was no evidence of significant risk with this agent and there is evidence of significant benefit and hopefully great promise.”

The advisers voted 12-5 in favor of the device from Braeburn Pharmaceuticals. The FDA is scheduled to make its formal decision by Feb. 27.

The matchstick-size implant, dubbed Probuphine, slowly releases a low dose of buprenorphine over six months. Currently buprenorphine is available as a pill or film that dissolves under the tongue. It is considered a safer, more palatable alternative to methadone, the decades-old standard for controlling opioid addiction. Opioids are a powerful family of drugs that mimic the opium poppy, including medications like oxycodone and illicit narcotics like heroin.

More than 2.5 million Americans are addicted to opioids, according to federal estimates. But less than half are receiving medication-based treatment to help control the problem.

Braeburn executives told panelists Tuesday that its implant could help reduce cases of relapse among chronic drug abusers. Many recovering addicts struggle to stick with their daily medication, putting them at risk of returning to illicit drug use and overdosing.

But panelists questioned whether Braeburn’s studies accurately predict Probuphine’s success. They cited shortcomings in the company’s research including missing urine samples from some study participants. Additionally, many patients received additional drug therapy to control their cravings and symptoms, clouding the picture of the implant’s performance.

Ultimately, most panelists said they were swayed by an FDA analysis showing that Probuphine was at least as effective in avoiding relapse as older treatments.

Dr. Rajesh Narendran, of the University of Pittsburgh, said prescribing instructions for the device must be “crystal clear” about which patients should receive it. Braeburn only studied the drug in patients who were already stabilized on low-to-medium doses of buprenorphine.

The FDA previously rejected Probuphine in April 2012, judging the drug’s dose was too low to reliably help the broad range of opioid-addicted patients.

Another concern raised Tuesday involved the complex surgical procedure needed to put in and remove the rod-like implants, which are inserted under the skin of the arm. According to an FDA review, problems like bleeding and infection were more frequent with Probuphine than with contraceptive implants that use similar drug-releasing technology.

Braeburn CEO Behshad Sheldon said Tuesday the company would aim to train 1,500 physicians to perform the procedure in the initial six weeks after launch.

“The few, current options are not enough to address the tremendous needs of the vast population dealing with this complex disease,” Behshad said in a statement. Princeton, N.J.-based Braeburn licensed the U.S. rights to Probuphine from its original developer, Titan Pharmaceuticals.

Heroin and opioid painkillers caused 28,650 fatal overdoses in 2014, the highest number on record in the U.S. Despite those numbers, experts say buprenorphine remains underused due to federal caps on prescribing, gaps in insurance and a lack of acceptance by doctors.

Along with increasing compliance, Probuphine has the potential to address other problems with the oral buprenorphine, including illegal diversion and accidental poisoning in children.

 

http://abcnews.go.com/Business/wireStory/addiction-implant-faces-scrutiny-federal-panel-36248720

Holistic approach to treating addiction improves recovery

Posted on: January 18th, 2016 by sobrietyresources No Comments

By Lana Bandoim 2016-01-11 20:07

An addiction to alcohol can have a devastating impact on your family, friends, work and home. Although treatment programs provide hope, it is important to understand the value of a holistic approach to improve the chances of recovery. A holistic approach refers to programs that treat the mind, body and spirit. These programs recognize that addiction is influenced by multiple factors, so it requires a versatile plan.

Holistic approach

Researchers have investigated the holistic approach to treating addiction and have found that it can benefit the individual. A study, published in the Journal of Psychoactive Drugs, reveals that treatment centers that focus on a holistic program can help people improve their self-esteem and self-confidence as they recover from addiction. People who are allowed to express their feelings are more likely to find long-term wellness.

Treatment settings

One of the key aspects of a holistic approach to addiction is the setting of the treatment center. A location that is beautiful and serene can help you find peace as you focus on recovery. For example, Beachway.com embraces this concept by using a facility in Delray Beach that offers a beautiful setting. Your environment affects your body, mind and spirit, so it is important to find a calm location that encourages recovery. A gorgeous beach or lush forest can help you reconnect with nature and reinvent your soul.

A holistic treatment program understands that addiction has to be approached from multiple angles. The best treatments combine several strategies and create a customized plan for each individual. This means that a program may include medication, counseling, group therapy, meditation, yoga and other treatments. There is usually a mix of conventional and alternative strategies that fit each person who is seeking help.

One of the reasons why people prefer the holistic treatments is because they offer an integrated answer and do not feel as oppressive. Treatment programs often include fun activities and relaxing excursions that help you discover yourself. You may spend several hours at the beach or enjoy a yoga class. You may also have a picnic outdoors or get a relaxing massage. All of these activities are designed to help you recover and move past your addiction.

Timing and rehabilitation

In general, many treatment programs for addiction last 30 days. However, an individual’s special situation and needs may require a treatment program that is longer or shorter. In a facility that embraces the holistic approach, timing is flexible. A study from the Archives of General Psychiatry reveals that the length of a treatment program has a direct impact on the success of recovery, and those who spent more time in a program were more likely to avoid a relapse.

Treating the entire person

A key component of the holistic approach is the idea that treatment should involve the entire person. This means that the person’s body, mind and spirit have to be addressed together. This approach helps with both withdrawal and relapse because it does not ignore an essential part of the addiction process. The goal is to recover and avoid addiction in the future, so coping strategies have to be in place.

 Customized treatments

If you or a loved one is considering an addiction recovery program, then you may want to look for one that uses a holistic approach. Programs that use a combination of nutrition, medication, counseling, therapy, recuperation and activities have a greater chance of success. A person who is mentally, physically and emotionally strong is more likely to overcome an addiction and avoid setbacks. In addition, the uniqueness of each individual is recognized with this approach, so treatments can be customized.

 

http://www.emaxhealth.com/12410/holistic-approach-treating-addiction-improves-recovery

From Addiction Battles to Chart-Topping Success: Natalie Cole's Bright Life in the Spotlight

Posted on: January 13th, 2016 by sobrietyresources No Comments

BY MARIA YAGODA 01/01/2016 AT 04:50 PM EST

With a father like jazz legend Nat King Cole, Natalie Cole was always going to have an extraordinary life.  The nine-time Grammy-award-winning singer, who died on Thursday at 65 due to complications from ongoing health issues, had a life of extreme ups and downs, from decades-long battles with addiction to chart-topping success.  One of five children, Cole grew up singing songs with her father in one of the most exclusive neighborhoods of Los Angeles, Hancock Park. In her autobiography, Angel on My Shoulder, she describes her father singing “gibberish” songs to her and her siblings.  “I cherish those memories, and I love the fact that when he was home, he was just being Dad. He really spent what has become known as quality time with us,” she wrote. “The flip side of that was that he was gone for weeks, sometimes months, at a time. When you make your living as a singer, you have to go where the gigs are.”

While she loved to perform, singing had not yet become a passion.  The first time she was onstage with her father, in the summer of 1957 at the Cal-Neva Lodge in Lake Tahoe, she had wandered out from behind the curtain, just 7 years old and very confused. (The audience loved it.)

When her father took her to freshman year at Northfield School for Girls, a boarding school in Northfield, Massachusetts, in 1964, it was the last time she saw her father relaxed and happy – when she returned for Christmas, he was skeletal, having developed advanced lung cancer as a longtime heavy smoker. He died in February 1965 at age 45.  “My dad was so much fun. I just wish he could be here. That’s the hardest part of this,” she told PEOPLE in 2008, after she was diagnosed with Hepatitis C. “I think of him every time I sing. My father led by example. He wasn’t much of a talker – he walked life. That means a lot to me.”
 

Discovering Drugs

Cole enrolled at the University of Massachusetts at Amherst in 1968 to study child psychology. After dating a boy named Jimmy, she began singing and rehearsing with his band – and also experimenting with drugs. As a senior, she began taking LSD, once almost jumping off a dorm high-rise because she was so high she thought she could fly.  It was then that her lifelong battle with addiction truly began.  “People often ask me why I got into drugs. I think they were just waiting to happen, a culmination of not having resolved things. My father’s death was the beginning – it wasn’t till years later that I was able to understand that I was still grieving, and that as ‘the daughter of,’ I was still walking in his shadow,” she wrote in her memoir.  She began routinely snorting heroin, which left her feeling sleepy and warm, rather than violently ill. As she got hooked, she dabbled in extricating welfare checks out of mailboxes and check fraud.
 

A Singing Career on the Rise

While still a student in Massachusetts, she started playing gigs in New York, where she moved after graduating. As her drug use increased, her career took off – she signed a contract with Capitol Records in 1975.  Her first chart-topping single, “This Will Be,” won her two Grammys. Her second album, Natalie, went gold. After a friend overdosed that year, the singer decided to quit heroin. It was the same year she met producer-songwriter Marvin Yancy, whom she married in 1976, and they moved into a Beverly Hills home. She had her first son (and only child), Robert, a year later.

Despite the positive streak, drugs drew her back in. This time, the substance was cocaine, which her and her husband began taking excessively.  The cocaine, and her enormous success, put strains on their marriage, leading to their ultimate divorce – which Cole called the biggest regret of her life. Her addiction also affected her career, as she increasingly blew off concert dates and gave lackluster performances.
 

A Wake-Up Call

1982 was a wake-up call; Cole realized she had become a negligent mother, once even taking Robbie with her to go pick up drugs, which she put in his diaper bag for safe transport. Her family – and everyone who cared about her – were begging her to go to rehab.  In 1983, Cole’s agent, business manager and attorney went to her Beverly Hills home and persuaded her to check into the Hazelden rehab clinic outside Minneapolis – which she said was the best thing she ever did.  “They all came to my house like the undertakers – they were all in dark suits and they were very serious and very sober,” she said in 2014 of the intervention. “They looked at me and they said, ‘We just know you’re going to die.'”

After six months in rehab, she began the process of rebuilding her life, moving with Robbie, “nearly broke,” to a Studio City townhouse. In 1985, she released her 12th album, “Dangerous,” which only sold 150,000 copies. While performing a concert in Dallas that year, she learned that her first husband, Marvin, had had a stroke and died, another blow during an incredibly difficult year.

After getting her career back on track with the album Everlasting, Cole remarried in 1989, to record producer Andre Fischer, even though she said her mother’s bad feeling about him ended up being correct. All the same, it broke her heart that her father couldn’t be at the wedding.
 

An Unforgettable Musical Triumph

Her desire for closure with her father led her to attempt to do his music, she wrote in her memoir, even though she admitted to spending the first part of her career rebelling against it. Her Unforgettable album, which features a virtual ‘duet’ with her father, was a tribute to him.  Cole won six Grammys, including Record of the Year, though her husband, Fischer, became increasingly resentful. Their marriage began to fall apart around 1992, just as her brother, Kelly, fell victim to AIDS. And in 1995, her attorney called her to tell her that her mother, Maria Cole, was suing Capitol Records and all her children to take control over revenues from Nat’s estate.  When she finally split up with Andre, longtime friend Whitney Houston called her to say that she’d never liked him. (Houston had never stopped calling him “Tick-Tick-Boom,” her way of reminding Cole that he was trouble.)  Cole’s professional success continued despite personal setbacks; her duet with her father, “When I Fall in Love,” won a Grammy in 1997. Yet she soon found herself in yet another toxic relationship.

“It took some sound advice from my own son, twenty-plus years my junior, to break the pattern. One day he said, ‘Mom, why don’t you take a break from dating for a while?’ It was the best advice my angel could ever give me,” she wrote in her 2000 memoir.

 

An Alarming Diagnosis

In 2008, Cole was diagnosed with hepatitis C. Chemotherapy treatments left her weak, and she soon developed serious kidney problems, which required dialysis three times a week.  “My life crumbled before my eyes. I never had symptoms. I didn’t know anything about it. Would I still have a career? Was I going to die? How long did I have? I was devastated,” she told PEOPLE in 2008. “I had to let it sink in for six weeks while they ran more tests.”  In 2009, she received a life-saving kidney transplant, but woke to learn that her sister, Cookie, who had been battling lung cancer, had died that day.  “This was a very joyous moment where I’ve got new life. It was also a very sorrowful moment, where my sister had gone on, and the family that donated the kidney had lost their daughter as well,” Cole told AARP The Magazine in 2009. “My first reaction was that I wished I were back on dialysis to have my sister,” she said. “These two people had left this earth – and I was here. Why? I feel like I don’t deserve it.”  Cole’s mother, Maria, died three years later at 89, following a brief battle with cancer.  “Our mom was in a class all by herself. She epitomized class, elegance, and truly defined what it is to be a real lady,” said Cole and her siblings, Timolin and Casey Cole, in a statement.

Her siblings, along with Cole’s son Robert Yancy, would eventually pay tribute to Natalie herself, in a heartfelt statement released shortly after her death.  “It is with heavy hearts that we bring to you all the news of our Mother and sister’s passing. Natalie fought a fierce, courageous battle, dying how she lived. With dignity, strength and honor,” her family said. “Our beloved Mother and sister will be greatly missed and remain UNFORGETTABLE in our hearts forever.”

 

http://www.people.com/article/natalie-cole-life-addiction-chart-topping-success

WITH HEROIN USE ON THE RISE, CALLS FOR FLORIDA TO ESTABLISH A NEEDLE EXCHANGE

Posted on: January 13th, 2016 by sobrietyresources No Comments

BY JESS SWANSON WEDNESDAY, DECEMBER 30, 2015

By 10 a.m. Wednesday, November 11, the health professionals in white coats and green scrubs have already filed into Jackson Health System’s $2 billion medical complex north of downtown Miami. But across NW 17th Street, scores of homeless individuals half-asleep on the sidewalk pull tarps and cardboard over their eyes as the sun rises higher overhead. A few people nervously pace, counting coins in their palms as they try to scrounge about $4 each for their morning fix.

South Florida’s heroin epidemic is especially pronounced here. Used, uncapped needles are sprinkled in the bushes and empty lots. It’s all too common for low-income intravenous drug users, desperate for a fix, to pick these off the ground or share needles with others, who may harbor infections. The consequences can be fatal.

“Oh, it’ll catch up with you eventually,” warns Jose DeLemos, a tall, scraggly man who walks with a limp. “It always does.”

He should know, because until 41 days ago, the 52-year-old recovering heroin addict was curled up on this block too. He contracted HIV from using dirty needles — a problem that might have been prevented had legislators passed a needle-exchange bill when it was first introduced.

For the past three legislative sessions, medical professionals have been working with state legislators to try to pass a bill — the Infectious Disease Elimination Act — that would establish a needle exchange program at the University of Miami’s Miller School of Medicine, adjacent to Jackson Hospital. (In earlier versions of the bill, it would be run through Florida’s Department of Health.) Anyone could bring in a dirty needle and exchange it for a clean one. Staff would examine injection sites for infection and provide pamphlets about drug treatment centers. There are 194 similar programs in America. This bill would create the first one in Florida.

Proponents of needle exchange concede that such a program would not stop users from being addicted. But they insist it would drastically halt the spread of infections, route drug users into rehab, and save taxpayers millions of dollars. Still, in medicine, the idea of “harm reduction” can be controversial. Critics say giving away needles enables and encourages drug use.

But drug use is already rampant. The Centers for Disease Control and Prevention found that heroin use increased significantly across all demographics after Florida’s pill mills shuttered in 2011. According to the National Institute on Drug Abuse, there were 15 heroin-related deaths in Miami in 2011. By 2014, that number had soared to 60. There are an estimated 10,500 intravenous drug users in Miami-Dade.

These users are at high risk of contracting HIV; it’s estimated that one-third of all HIV cases are acquired by injecting drugs. Statistics for 2014 from the Department of Health show there were 26,445 people living with HIV/AIDS in Miami-Dade and 17,214 in Broward.

“I try to tell as many people my story as I can,” DeLemos says, “to scare them so they think of me whenever they want to pick up a needle.”

DeLemos, a soft-spoken giant, was born in the Dominican Republic. In 1968, he moved with his mother, father, and sister to Newark, New Jersey. He grew up in a working-class family, was a decent student, and hung out with good kids. The first time he tried drugs was with his cousin. Cocaine. He was 17 and hated it.

After high school, DeLemos attended the Culinary Institute of America in Hyde Park, New York. In 1984, he moved to Orlando for a job at Disney World as a sous chef. He fell in love with a kind woman, and for the next 17 years, life was good. Then, in 2005, a nasty breakup sent him on a downward spiral.

A heartbroken DeLemos fled to Miami for a change. He snorted cocaine and dabbled in crack. Then he started snorting heroin to calm him down. “My friend told me that I was doing it wrong and wasting it,” he says. “I was scared to mainline it, but he showed me how to do it.” The sensation of doing heroin “was pure love.”

Soon, his heroin habit would cost him as much as $800 a day. He quit his job and turned to credit card fraud. He was arrested 19 times. In 2010, he tried to detox on his own. He lasted ten days. By 2011, DeLemos gave up on a normal life. He moved out of cheap motels and started sleeping in Pine Heights Park, behind Jackson’s health district.

A county ordinance prohibits the sale of syringes to any person without a prescription, and at a cost of $18 for a box of 100, DeLemos could barely have afforded to buy enough needles to satiate his habit anyway. On the streets, dealers would sell clean insulin syringes they pilfered from diabetics for $3, but gathering enough money for a clean needle was an afterthought. DeLemos cooked heroin with collected rainwater in unsterilized Coca-Cola cans.

Like dozens of other addicts who hang out by the public hospital, DeLemos’ life operated on a tragic rhythm: using dirty needles, inevitably contracting diseases, roaming across the street for treatment, and then winding up back on the sidewalk or in jail on possession charges.

Since 2011, DeLemos has been grappling with abscesses and infections. He nearly lost his left leg. He flatlined when an infection spread through his blood and to his heart. In 2013, he was diagnosed with HIV. He takes three medications for treatment.

His medical costs are passed on to taxpayers, as most injection drug users who contract diseases rely primarily on Medicare or Medicaid. The estimated cost of a hospital stay for an injection drug user averages $4,449. The lifetime cost of treating an HIV-positive person is more than $600,000. Care of indigents at Jackson costs nearly $500 million a year.

As DeLemos cycled through the hospital, he ran into Dr. Hansel Tookes, a 34-year-old medical resident specializing in infectious diseases. Tookes has done extensive research studying how injecting drugs spreads disease. In 2009, he and a team scoured Miami’s streets, interviewing users and tallying the used syringes on the ground. The study found that 95 percent of users dump their used needles onto the street, and the number found on the street in Miami is eight times higher than in San Francisco, where there is a needle-exchange program.

“The research is out there. Needle-exchange programs like the ones in San Francisco work,” Tookes says. “And it’s so much more than getting a clean needle — there are people working there who will examine any abscesses and make sure they aren’t infected. It prevents these common infections from getting worse.”

In 2012, Tookes began working closely with legislators to craft the Infectious Disease Elimination Act, which would have made needle exchanges legal in Florida (otherwise, possessing needles without a prescription could be a misdemeanor charge of possessing drug paraphernalia) and dictated they be supervised and funded by the Department of Health . It didn’t pass. The following year, Tookes tried again. It was promising, since it passed quickly through committees but was tied up in a 9-8 vote in the House committee, and the session ended before it could pass.

Tookes tried again. In 2013, the bill passed three Senate committees but got blocked in the House by Rep. Michael Bileca, a Republican from South Miami and chair of the government appropriations committee, who refused to hear it (and had voted against it the year prior). This year, Tookes and his colleagues published a cost-analysis study that found a needle-exchange program would save Jackson $11.4 million.

Bileca, who was a Jackson Health System board member until resigning in 2014, did not return calls seeking comment.

Rep. Katie Edwards of Broward, who sponsored the bill, is optimistic that the fourth legislative session is the charm. She has reintroduced the bill, with some tweaks. This one specifies that a single pilot program would be set up at the University of Miami and would be paid for privately by grants and donations. Because it would no longer rely on government funding, the bill does not go through Bileca’s committee. It has so far passed one committee in the House and two in the Senate, and Edwards hopes it will make it to a vote when the Legislature convenes in 2016.

“For the good of a city, where more than one out of every 100 people has HIV, where we have an explosive drug epidemic,” Tookes says, “let’s hope 2016 is the year the Legislature helps us do what’s best for Miami.”

“It is just unfortunate that Florida has to experience such a severe heroin epidemic for policymakers to respond,” Edwards says.

For DeLemos, who was diagnosed with HIV as the bill was killed over and over, it’s too late.

“I think all the time where I might be if there [had been] a needle exchange for me to go to,” he says. “I’ll tell my story to as many people as it takes to bring needle exchange here and keep this from happening to anyone else.”

 

 

http://www.miaminewtimes.com/news/with-heroin-use-on-the-rise-calls-for-florida-to-establish-a-needle-exchange-8139123

 

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