Archive for March, 2016

Heroin Epidemic Increasingly Seeps Into Public View

Posted on: March 25th, 2016 by sobrietyresources


Christ Church Cambridge in Cambridge, Mass., closed its bathrooms to public access in 2012 after several people overdosed there. Credit Kieran Kesner for The New York Times

CAMBRIDGE, Mass. — In Philadelphia last spring, a man riding a city bus at rush hour injected heroin into his hand, in full view of other passengers, including one who captured the scene on video.

In Cincinnati, a woman died in January after she and her husband overdosed in their baby’s room at Cincinnati Children’s Hospital Medical Center. The husband was found unconscious with a gun in his pocket, a syringe in his arm and needles strewn around the sink.

Here in Cambridge a few years ago, after several people overdosed in the bathrooms of a historic church, church officials reluctantly closed the bathrooms to the public.

“We weren’t medically equipped or educated to handle overdoses, and we were desperately afraid we were going to have something happen that was way out of our reach,” said the Rev. Joseph O. Robinson, rector of the church, Christ Church Cambridge.

With heroin cheap and widely available on city streets throughout the country, users are making their buys and shooting up as soon as they can, often in public places. Police officers are routinely finding drug users — unconscious or dead — in cars, in the bathrooms of fast-food restaurants, on mass transit and in parks, hospitals and libraries.

The visibility of drug users may be partly attributed to the nature of the epidemic, which has grown largely out of dependence on legal opioid painkillers and has spread to white, urban, suburban and rural areas.

The church, which opened in 1761, had kept the bathrooms open to accommodate the homeless people around Harvard Square. Credit Kieran Kesner for The New York Times

Nationally, 125 people a day die from drug overdoses, 78 of them from heroin and painkillers, and many more are revived, brought back from the brink of death — often in full public view. The police in Upper Darby, Pa., have even posted a video of another man shooting heroin on a public bus, and then being revived by Narcan, which reverses the effects of a heroin overdose, to demonstrate the drug’s effectiveness.

Some addicts even seek out towns where emergency medical workers carry Narcan, “knowing if they do overdose, there’s a good likelihood that when police respond, they’ll be able to administer Narcan,” said Special Agent Timothy Desmond, a spokesman for the New England region of the Drug Enforcement Administration.

In Linthicum, Md., Brian Knighton, a wrestler known as Axl Rotten in Extreme Championship Wrestling, died last month after overdosing in a McDonald’s bathroom.

In Cincinnati in 2014, an Indiana couple overdosed on heroin at a McDonald’s, collapsing in front of their children in the restaurant’s play area.

In Niagara Falls, N.Y., a man was accused in October of leaving a 5-year-old boy unattended in a Dairy Queen while he went to the bathroom; he was later found on the floor with a syringe in his arm.

In Johnstown, Pa., a man overdosed on heroin on Feb. 19 in a bathroom at the Cambria County Library.

“Users need the fix as quickly as they can get it,” said Edward James Walsh, chief of police in Taunton, Mass., a city 40 miles south of here that has been plagued with heroin overdoses in recent years. “The physical and psychological need is so great for an addict that they will use it at the earliest opportunity.”

That reality has taxed law enforcement and city services across the country, and has stretched the tolerance of businesses that allow unfettered access to their bathrooms. Legal liability is an increasing worry.

How the Epidemic of Drug Overdose Deaths Ripples Across America

“Overdosing has become an issue of great societal concern,” said Martin W. Healy, chief legal counsel for the Massachusetts Bar Association. “I’m not aware of any seminal cases so far, but this is likely to be a developing area of the law.”

After shooting up in public places, people often leave behind dirty needles, posing a health hazard. In response, some groups have called for supervised injection facilities, like those in Canada and Europe, where people can inject themselves under medical supervision. The goal is to keep them from overdosing and to curb infectious diseases. Such facilities are illegal in this country, although the mayor of Ithaca, N.Y., recently suggested opening one.

In Boston, where pedestrians step over drug users who are nodding off on a stretch of Massachusetts Avenue known as Methadone Mile, an organization for the homeless has planned what it calls a safe space, where users could ride out their high under supervision; it would not allow actual injection on site.

New England has been a cradle of the heroin epidemic. Middlesex County, which encompasses Cambridge, a city of 107,000 just west of Boston, has the highest number of overdose deaths from heroin and prescription pain pills in Massachusetts. From 2000 to 2014, Middlesex, which also includes the city of Lowell, a major heroin hotbed, had 1,634 opioid deaths.

No one keeps track of how many deaths occur in public spaces, but law enforcement officials agree the number is high.

“We quite frequently see folks using public areas,” said Robert C. Haas, the Cambridge police commissioner.

It was the fear of someone dying in their bathrooms that led officials at Christ Church Cambridge to close public access to them in 2012. By doing so, the church did not experience the kind of tragic scenes that are occurring around the country, but the decision was difficult.

The City of Cambridge spent $400,000 to buy and install Harvard Square’s first free-standing public toilet, which opened this month. Credit Kieran Kesner for The New York Times

The church, which opened in 1761 and has a long history of social activism, had kept the bathrooms open to accommodate the homeless people around Harvard Square. But addicts were also using them. Closing them after decades of serving the public represented “a retreat from our ministry,” Mr. Robinson said. But in consultation with the Cambridge police, the church reluctantly concluded that leaving the bathrooms open only enabled drug users.

Because there were no free-standing public toilets in Harvard Square, a popular shopping, culture and dining destination that is visited by eight million tourists a year, the absence of the church bathrooms was felt right away.

“Almost immediately, we began receiving calls saying, basically, ‘What the hell just happened?’ ” said Denise Jillson, executive director of the Harvard Square Business Association. “They were saying, ‘Our doorways and alleyways have become public urinals, and people are defecating everywhere.’ ”

After a campaign by business owners and local activists for a public toilet — which included stickers that read “I Love Toilets” and “Where Would Jesus Go?” — the City of Cambridge spent $400,000 to buy and install Harvard Square’s first free-standing public toilet. It was unveiled on Feb. 12. Free to use and open 24 hours a day, it sits in a kiosk on a busy traffic island between the stately brick buildings of Harvard Yard and the weathered headstones in the Old Burying Ground, which dates to 1635.

The kiosk, called the Portland Loo and made in Oregon, was designed specifically to discourage drug use. It has slanted slats at the bottom that allow the police — or anyone — to peer in and see if someone has passed out on the concrete floor. It has no heat, air conditioning or noise insulation, all meant to foil anyone from getting too comfortable inside. The hand-washing faucet is outside, and an attendant cleans four times a day.

The outcome pleased Mr. Robinson, who said the anguishing decision to close the church bathrooms had “led to a broader response to the needs of the homeless in our neighborhood.”

While the new toilet may improve life for some in Harvard Square, many restaurants, parking lots and other public spaces here and elsewhere remain potential sites for drug activity.

“Until we get a handle on the drug problem,” said Capt. Timothy Crowley of the Lowell Police Department, “I think this is an issue we’ll be dealing with for a long time.”

Correction: March 8, 2016

An article on Monday about heroin addicts who use the drug in public places misstated the number of people who die each day from overdoses of heroin and painkillers. It is 78 — not 125, which is the total number of deaths daily from all drug overdoses.

Recovery Czar and CDC Director Discuss Federal and State Actions to Address Opioid Epidemic

Posted on: March 25th, 2016 by sobrietyresources

During the press conference, CDC Director Frieden called the opiate epidemic “unprecedented.”

By John Lavitt 03/23/16

On Tuesday afternoon, the White House held a conference call with reporters to discuss federal and state actions to address the opioid epidemic, led by Michael Botticelli, director of the Office of National Drug Control Policy (ONDCP), and Dr. Tom Frieden, director of the Centers for Disease Control and Prevention (CDC).

The conference highlighted President Obama’s request earlier this year for $1.1 billion in new funding, most of which would go directly to U.S. states with the goal of ensuring that every American has access to treatment.

“Under the Affordable Care Act, substance abuse disorder benefits are comparable to medical and surgical benefits,” ONDCP Director Botticelli said in his remarks. The question is whether there are enough resources available to provide the extent of the medication-assisted treatment (MAT) services required to stem the tide of opioid abuse.

Given the number of Americans who now have health insurance, shouldn’t MAT be available to them all? A problem in many states, however, is that such services are useless without the trained doctors and addiction treatment specialists needed to provide them.

Since the start of the 21st century, a four-fold increase in prescribing opioids has resulted in a four-fold increase in overdose deaths due to these drugs. In the majority of states, a lack of prescriber training combined with failed prescription drug monitoring programs remain an ongoing problem. CDC Director Frieden assured that, “We are working with the states to optimize their prescription drug monitoring programs.”

Botticelli discussed the different types of federal initiatives launched to help states address opioid abuse, along with the number of states presently employing these initiatives.

As the list below reveals, the numbers are frightening:

  1. Requiring opioid prescribing training

Only 14 states have enacted such educational legislation.

  1. Establishing a prescription drug monitoring program (PDMP)

Although 49 states have established a PDMP to collect and analyze prescribing and dispensing data from pharmacists and doctors, only 22 work in real time. Only eight states require doctors to consult the PDMP before prescribing opioids.

  1. Legalizing syringe services programs (SSP)

At least 33 states have either authorized SSPs, decreased barriers to the distribution of clean needles, or altogether removed syringes from the list of drug paraphernalia. On the other hand, other states have created additional barriers to these services by prohibiting them.

  1. Permitting distribution of naloxone by pharmacists and third party prescriptions of naloxone 

Thirty-nine states now allow prescribers and pharmacists to dispense naloxone to a person who is close to someone at risk.

  1. Supporting law enforcement and public health partnerships 

Only 15 states have established a network of public health and law enforcement partnerships through the ONDCP’s High Intensity Drug Trafficking Areas.

Although progress has been made, so much more needs to be done to turn the tide of the opioid epidemic. When asked if they had a model to predict when this would happen, Frieden admitted, “What is happening is unprecedented. There is no effective model to predict the outcomes.”

Considering the number of disparate elements involved, Frieden admitted that the challenge is great. This is why the Obama administration has made combatting the opioid epidemic a top priority. In order to accomplish this goal, Congress must approve the funding requested by the administration.

Can a Vaccine Cure Heroin Addiction?

Posted on: March 21st, 2016 by sobrietyresources

Vaccines that make it impossible for addicts to get high could be hugely helpful in stopping the opiate epidemic.

03/18/2016 09:06 pm by Alexandra Ossola

Every time heroin addicts shoot up, they’re taking their lives in their hands. That’s not just because heroin itself is dangerous; increasingly, the drug is combined with fentanyl, a synthetic drug often used in conjunction with anesthesia.

Fentanyl is up to 50 times more potent than heroin, which also makes it more lethal—the drug is fueling a public health crisis in New Orleans and has caused thousands of overdoses in Chicago, New England, and Canada. For those that try to quit the habit, the path to recovery is littered with failure; 40 to 60 percent of people seeking treatment for drug addiction relapse, often within the first year.

But what if a recovering addict could physically no longer get high? A treatment that makes an addict immune to a drug’s effects would decrease the motivation to seek the drug.

That could be possible with drug vaccines, treatments that train the immune system to attack drug molecules before they affect the brain. Scientists have been experimenting with vaccines for various drugs for years; last month, researchers published a study about an experimental fentanyl vaccine, the first of its kind. And while vaccines can’t be the only treatment for the opioid epidemic, they might be one of the few options that can truly help addicts recover—if the vaccines can make it to the clinic.

“The idea that [the researchers] can make an effective vaccine is very cool. It’s a good accomplishment,” says Phil Skolnick, director of the Division of Pharmacotherapies and Medical Consequences of Drug Abuse at the National Institute on Drug Abuse (NIDA).

After a person injects, eats, smokes, or snorts a drug, drug molecules enter the bloodstream and eventually make their way to the brain where they bind to particular receptors on the surface of neurons. A drug vaccine would stop that process—the immune system would attack those molecules while they’re still in the blood. But the immune system doesn’t naturally assume that the molecules are invaders that need to be attacked, so it needs to be trained.

“You have to trick the body, and it requires a fair amount of trickery,” Skolnick says. In practice, that means binding molecules with a similar structure to those of the drug in question with antigens, molecules that trigger an immune response. Over time, the immune system would learn to attack drug molecules. Most vaccines so far have targeted a single compound, but it could be possible to have a polyvalent vaccine that can address several at once.

Scientists were able to demonstrate a working vaccine recently in mice. Over the course of several weeks, they gave mice a series of booster shots so that their immune systems would attack fentanyl. Then the researchers gave the vaccinated mice a lethal dose of the drug. Not only did the mice survive, they didn’t demonstrate any “high” behavior like ignoring pain. Skolnick, who wasn’t involved in the study, called it “good science” and “a great scientific accomplishment.”
The idea of drug vaccines has been around since the 1970s, says Kim Janda, a chemist at the Scripps Research Institute and an author of the fentanyl study, but it became eclipsed by other treatments like methadone. Then, starting in the mid-1990s, scientists, including Janda, started studying vaccines for cocaine that brought the concept back into fashion.

If scientists have been working on drug vaccines for so long, why aren’t any available? Part of the reason, Janda says, is that past vaccines simply haven’t worked well enough. The most promising vaccine so far has been one for nicotine addiction, called NicVax, that could help people stop smoking. It went through several rounds of clinical trials but eventually failed because it didn’t help more people quit smoking than a placebo. Janda says there are scientific reasons why NicVax didn’t work, and he’s looking to address them in his own nicotine vaccine.

The other impediment to the development of drug vaccines is that there’s not much money dedicated to it. “The problem is that pharma companies have not been terribly interested in addiction research,” Skolnick says. For the companies and organizations that hold the purse strings, addiction is still considered a “moral failure,” Janda adds, which makes them reluctant to allocate funding to treat it like a neurological disorder.

And though that attitude has started to shift, it hasn’t yet affected organizations’ funding decisions; though last month President Obama requested more than $1 billion from Congress to combat the opioid epidemic, neither Skolnick nor Janda anticipate any of that money going towards drug vaccines.

Even if scientists developed a drug vaccine that was approved by the Food and Drug Administration (FDA), it wouldn’t be a panacea for addiction. It would be unreasonable to expect that a vaccine would work in 100 percent of patients, Janda says. A drug vaccine would require booster shots over the course of several months, and some patients might not get all of them, which would limit its efficacy. It might be expensive.

Plus, in the U.S., addicts could access a number of different drugs if they wanted to get high again—a vaccinated heroin addict could still relapse with morphine or painkillers against which he’s not vaccinated, for example. And even a highly effective vaccine would need to be paired with behavioral therapy to treat the non-physical aspects of addiction, plus another drug to combat craving. “There’s no magic bullet for addiction,” Skolnick says.

Still, drug vaccines are a promising treatment option. Pre-clinical studies like Janda’s show that vaccines can truly decrease the percent of addicts that relapse. With the right formulation and more experiments, they could be a new, creative solution to combat the opioid epidemic.

Janda’s team has also developed a heroin vaccine and is working with a small biotech company called Molecular Express to bring it toward clinical trials. They’re raising money for their research now and plan to test the vaccine in non-human primates through a collaboration with Virginia Commonwealth University. He hopes to start tests in humans in the next two years, and might even look into combining it with the fentanyl vaccine, he says.

“The opioid epidemic is huge. It’s real and it’s not going away,” Janda says. “It’s a very hard addiction to break. I think whatever ways we can look at stopping it is important. And vaccines are one of the ways of looking outside the box.”


New Documentary Shows What A Humane Approach To Addiction Actually Looks Like

Posted on: March 11th, 2016 by sobrietyresources

“Frontline” goes deep into Seattle’s efforts to help drug addicts instead of punishing them.

02/23/2016 04:06 pm ET by Jason Cherkis

WASHINGTON — In the early moments of “Chasing Heroin,” a new “Frontline” documentary that will air Tuesday on PBS and online at 9 p.m. EST, a police van pulls down a Seattle alley and stops near a pair of heroin addicts. A cop gets out of the van and assures them that he means no harm.

“I gotcha,” he says, “You’re getting well. No big deal. I’m not going to jam you up.”

The officer merely wants to know who the addicts are and offer them connections to a social worker — and, maybe down the line, to treatment. Decades into the war on drugs, the exchange is jarring for what it doesn’t include: an arrest.

“Frontline” cameras spent a year chronicling not only the quiet devastation of the opioid epidemic but also the attempts of police officers and social workers, public defenders and prosecutors, to save the lives of addicted people without locking them up.

Disappointments and setbacks are frequent in “Chasing Heroin.” It’s because of these disappointments that the film achieves a clear-eyed, even vital importance, especially if you know someone struggling with addiction. The opioid epidemic may be decades in the making, but the public health solutions — specifically in the forms of medication-assisted treatment through methadone and buprenorphine — are still trying to take root and gain public acceptance.

You’ll worry about Cari Creasia, the PTA mom turned opioid addict and drug mule, and Johnny Bousquet, an addict yearning for a second chance. A single car ride to a methadone clinic will feel like a huge win. At the very least, one thing is certain: You won’t wish any of the addicts were in prison.

This past weekend, The Huffington Post did a short Q&A over email with Marcela Gaviria, the director, writer and producer of “Chasing Heroin,” in anticipation of Tuesday’s premiere. HuffPost spoke with Gaviria about her film, how it came together and what she learned from making it.

What got you interested in making “Chasing Heroin”?

I began my career at FRONTLINE reporting on the drug wars. I was born and raised in Bogota, Colombia, and had cut my teeth following the cocaine wars, so it was natural territory for me.

The heroin epidemic first came onto my radar back in 2013, after I heard about the spike of overdoses in places like New Hampshire and Vermont. I pitched this story for several years and was really pleased when I finally got the green light to pursue the story.

How did you arrive at the public health/harm-reduction storyline? Did you set out to tell that story? 

When we set out to tell this story, I kept thinking of something [Drug Enforcement Administration] Special Agent Bob Stutman told us 15 years ago while making “Drug Wars for PBS FRONTLINE. He said, “We, as a nation, should have learned the lesson a long time ago that you cannot depend on law enforcement to solve the problem.” I wanted to understand if that had changed since I last covered the drug wars. Did the drug war logic still endure? Did punitive approaches still hold sway? Were any cities embracing a decriminalization model? What was new and novel?

The best reporting that we found, to be blunt, was yours. I was very tempted to head to Kentucky and Indiana to cover the response to the HIV spike, but also wanted to try to till new territory.

Seattle and LEAD [Law Enforcement Assisted Diversion] seemed to encapsulate a shift from the old war on drugs to new ways of dealing with demand. We settled there for budgetary and logistical reasons, deciding to explore this terrain in one place.

The original idea was to find two participants in the LEAD program and follow them over time. Along the line we decided that it would be important to show a counterpoint, in drug courts, which is a more prevalent model.

One of the most compelling people that you followed was Cari. How did you find her? What drew you to her story?

I sat in on several sessions of King County drug court to find possible participants. I was looking for someone who had begun abusing opioids and then moved on to heroin, so that I could tell the backstory of the opioid epidemic. But the few characters I was drawn to in drug court actually dropped out of the program before I started filming. So, in speaking to the team that runs program for alternatives, they suggested I contact Cari Creasia. And once I heard the details of her life story — from soccer mom to drug house junkie — I couldn’t resist.

In the film, you show how the LEAD program works and how it sometimes doesn’t work, especially when addicts have to wait for treatment or are turned away from treatment. Why aren’t doctors certified to prescribe buprenorphine incorporated into the LEAD program more? Is there a shortage of certified doctors in Seattle?

This is interesting territory, and I wanted to do more on it, but ultimately decided the best way to broach it in the film was through the providers in each character’s life. I think there is an overall shortage of buprenorphine-certified doctors in the country, but [I] don’t think Seattle is unusual in any particular way.

I’m curious about what you think of the criticism mentioned in the film that the media is paying attention to the epidemic because it’s mostly affecting white people? And that the harm-reduction approach is only becoming mainstream because there are white addicts? In my own reporting on the subject, I’ve found that addicts still have an incredibly difficult time accessing services and that the more punitive approaches still hold sway in a lot of communities. I think you found that as well with the town that rejected the methadone clinic. And you touch on this with the segment on drug courts.

I think it’s clear that we are starting to see a shift in that cities are increasingly willing to embrace harm-reduction approaches — from the Angel program in Gloucester, Massachusetts, to LEAD, which is being replicated in more than 30 cities now. I do agree with former Attorney General Eric Holder that when things affect a majority community, politicians pay greater attention and are more willing to try new approaches.

That said, you’re right, many communities are still not turning the corner. It’s true of Bremerton and true of many drug courts in Washington state that do not offer medication-assisted treatment.

After spending a year with LEAD, how do you think it could be improved?

You can’t ask LEAD to be responsible for improving the services that they divert their clients to, but it’s clearly a flaw in the system. I also think they could work on finding ways to help their clients find jobs once they are in recovery. It’s very hard for someone like Johnny Bousquet to stay clean if he can’t become [a] productive member of society.

What surprised you most while working on the film?

I was shocked by the lack of availability of services and by the difficulties people have accessing treatment. Too much is stacked against an addict in recovery.

What do you think parents who are struggling with addicted children need to know?

What’s upsetting to realize is that there is no Consumer Reports for addiction treatment. It’s so hard to figure out what to do and where to send your kid.

Having spent a year covering his story, I’ve come away believing methadone and Suboxone are important options in the road to sobriety, and there is still too much stigma attached to using those medications.

What’s the scene in the film that still haunts you?

It’s hard to choose one scene, but this is definitely one of the most emotionally intense films I’ve ever worked on. I really grew to care for the people I profiled. And I think I’ll always be haunted by worry for them. Perhaps in five years’ time I can come back and film them again and see how things are working out for them.

As far as scenes, it’s hard to forget Kristina shooting up as she carries on about her future life. I still am touched every time Dr. Capp chokes up when he talks about Johnny’s desire to do anything to get clean.

What do you want viewers to take away from the documentary? 

I hope they realize that this epidemic is not unlike the AIDS epidemic of the 1980s. Then, as a nation, we rallied to come up with solutions. We aren’t doing enough now. Access to treatment is inadequate. Services stink. Relapse rates are way too high. There aren’t enough studies to tell us what works and what doesn’t work. Over half a million people have died from opiate overdoses in the last 15 years. We clearly can do better.

What do you think needs to change in our public policy in dealing with the heroin epidemic?

The Obama administration is reviewing the restrictions on prescribing for medication-assisted treatment, and relaxing those rules would be a good start. We could also require insurance plans to include coverage for more than 30 days of inpatient treatment. That’s clearly not enough time to get someone clean. And access to medication-assisted treatment should not be denied.

This interview has been edited for length and clarity.

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