Archive for September, 2016

More U.S. babies born addicted to opiates like heroin

Posted on: September 27th, 2016 by sobrietyresources

September 26, 2016

By Lisa Rapaport

(Reuters Health) – The proportion of U.S. babies born suffering from withdrawal syndrome after exposure to heroin or prescription opiates in utero has more than doubled in less than a decade, a study suggests.

Researchers focused on what’s known as neonatal abstinence syndrome, a condition akin to withdrawal that develops when babies essentially become addicted to drugs their mothers use during pregnancy.

Nationally, the rate of neonatal abstinence syndrome involving mothers’ use of opiates – which includes heroin as well as prescription narcotics like codeine and Vicodin – surged from 2.8 cases for every 1,000 births in 2009 to 7.3 cases for every 1,000 births in 2013, the study found.

At least some of this surge in the case count is due to drug policies designed to crack down on prescription drug abuse and combat the methamphetamine epidemic, said lead study author Dr. Joshua Brown, a pharmacy researcher at the University of Kentucky in Lexington.

“The drug policies of the early 2000s were effective in reducing supply – we have seen a decrease in methamphetamine abuse and there have been reductions in some aspects of prescription drug abuse,” Brown said by email. “However, the indirect results, mainly the increase in heroin abuse, were likely not anticipated and we are just starting to see these.”

The findings of the current study add to a growing body of evidence pointing to a surge in births of babies suffering from opiate withdrawal. One report last month from the U.S. Centers for Disease Control and Prevention found an even bigger spike over a longer period, from 1.5 cases for every 1,000 births in 1999 to 6 cases per 1,000 in 2013.

CDC researchers also found wide variation in neonatal abstinence syndrome by state, ranging in 2013 from 0.7 cases for every 1,000 births in Hawaii to 33.4 cases per 1,000 in West Virginia.

“We know that certain states are harder hit by the opioid/heroin abuse epidemic, with about 10 states contributing half of all neonatal abstinence syndrome cases,” Brown said. “These states are often more rural and impoverished areas of the U.S. such as Mississippi, Alabama, and West Virginia.”

Brown and colleagues looked at Kentucky in particular. Here, the rate of neonatal abstinence syndrome climbed from 5 cases for every 1,000 births in 2008 to 21.2 cases per 1,000 births in 2014, researchers report in JAMA Pediatrics.

While the study didn’t look at health outcomes for babies born suffering from drug withdrawal, these infants often require intensive medical care. (See Reuters’ 2015 special report “Helpless and Hooked” here:

These babies may have central nervous system issues like seizures and tremors, gastrointestinal problems and feeding difficulties, breathing challenges, as well as unstable body temperatures.

Typically, they remain in the hospital for several weeks after birth and receive low doses of methadone, a medicine designed to wean addicts off heroin and prescription opiates, Brown said.

Treatment can ease withdrawal symptoms in newborns, but can’t necessarily address developmental problems these infants may have later on, said Dr. William Carey, a pediatrics researcher at pediatrics at Mayo Clinic Children’s Center in Rochester, Minnesota.

“While abuse of prescription opiates has declined, the use of illicit opiates has increased such that there may be a zero-sum game at best,” Carey, who wasn’t involved in the study, said by email. “Since maternal use of either prescription opiates or illicit opiates is associated with withdrawal in newborns, it is reasonable to think that any increase in the overall use of opiates would be linked to an increase in the rate of neonatal abstinence syndrome.”

7 overdose deaths in 1 day reported in Cleveland area

Posted on: September 27th, 2016 by sobrietyresources

Published September 25, 2016 by Associated Press

Seven people died Saturday in the Cleveland area, marking the latest outbreak of drug overdose deaths in the state.

Tests were being conducted to figure out which drugs were involved in the Saturday deaths, Cuyahoga County Medical Examiner Thomas Gilson said. Officials believe the drugs involved were either heroin or fentanyl.

“This cluster of deaths is deeply concerning,” Gilson said in a statement. “Although there is no clear link between the individuals, this number clearly raises the possibility of a very deadly drug in our community.”

He issued a warning to take extreme caution while also advising people not to use illicit drugs.

The deaths were reported across the county — in both Cleveland and its suburbs — and weren’t limited to one area, Chris Harris, a spokesman for the medical examiner, said Sunday.

The outbreak comes after 52 people died from heroin or fentanyl during August in the Cleveland area. The opioid deaths last month were the most in the county’s history, the medical examiner’s office said.

Cuyahoga County, which has about 1.2 million residents, is on pace to record more than 500 overdose deaths from heroin or fentanyl this year, reported.

The wave of deaths around Cleveland follows outbreaks of overdoses in Akron and Cincinnati involving the animal sedative carfentanil.

Hospitals in the Cincinnati area have seen more than a dozen overdoses a day since the powerful drug used to sedate elephants was found in the area’s heroin supply about two months ago.

In one six-day span last month, there were 174 overdoses reported in Cincinnati and Hamilton County.


Many doctors don't prescribe medication for opioid addiction despite epidemic

Posted on: September 27th, 2016 by sobrietyresources

Dan Mangan | @_DanMangan

Tuesday, 20 Sep 2016 | 2:30 PM ET

This effective weapon in the fight against opioid addiction often isn’t being used.

A study released Tuesday found that doctors authorized to prescribe a drug that has shown success at curbing opioid cravings actually tend to prescribe the medication to significantly fewer patients than they potentially could — despite an ongoing painkiller overdose epidemic that kills more than 60 Americans every day.

CNBC separately has learned that fewer than 250 patients nationally have actually received a new long-acting implantable version of that drug, buprenorphine, in the two months since it has been available, even though more than 2,400 doctors have been trained in the implants.

“There seems to be, despite us being in the middle of a horrible epidemic, a missing sense of urgency in getting access for [addicted] people, and … opening up treatment pathways for people,” said Behshad Sheldon, CEO of Braeburn Pharmaceuticals, whose implantable product Probuphine was approved for use earlier this year.

The study findings and sales figures come as President Barack Obama designated this week as Prescription Opioid and Heroin Epidemic Awareness Week to focus attention on efforts to stem the rate of painkiller addiction and the resultant death toll, which has more than quadrupled since 1999.

During the time, buprenorphine, often sold under the brand name Suboxone, has become an increasingly popular tool to treat opioid addicts, by eliminating their withdrawal symptoms. About a quarter of the 2.8 million people or so people diagnosed with opioid abuse disorder take buprenorphine, typically in oral form.

But only about 2 percent of the nation’s doctors are authorized to prescribe the drug, and only about one-fifth of those waivered doctors write around 90 percent of all buprenorphine prescriptions.

The low rate of authorized doctors, and a 100-patient maximum cap on the number of patients an authorized doctor can treat, have been blamed for preventing wider use of buprenorphine, even in the face of evidence that opioid addicts are much less likely to relapse if they are placed on medication to manage their addiction.

In response to those concerns, the federal government this summer raised the maximum cap to 275 patients a single physician can treat with the drug. Since July, 1,275 practitioners have applied for and been approved for the new maximum, federal officials said Monday.

However, the Rand Corp. study released Tuesday suggested that even the doctors allowed to prescribe buprenorphine aren’t coming close to the number of patients they could be treating.

The study, published in the Journal of the American Medical Association, found that from 2010 to 2013 more than 20 percent of the doctors authorized to prescribe buprenorphine to opioid addicts were treating three or fewer patients with that drug. And fewer than 10 percent of such doctors were treating more than 75 patients.

The research also found that the median number of opioid addicted patients being treated by an authorized doctor with buprenorphine is often 11 or even fewer patients in 5 of the 7 states with the most physicians with such waivers. In California, the median number of patients was just seven for authorized doctors.

Those medians are well below the 30-patient cap that doctors initially faced when they were authorized to prescribe the medication. And it’s much lower than the 100-patient maximum that until this summer was the limit for doctors who applied for that new cap after holding a buprenorphine waiver for at least a year

“We were rather surprised to see such a large number of physicians treating relatively few patients,” said Dr. Bradley Stein, senior physician scientist at Rand, and senior author of the study. “We were really surprised that slightly more than 20 percent … are treating only three or fewer patients per month.”

“They certainly are not prescribing to what might be their capacity,” he said.

Stein said he and his fellow authors also were surprised by the study’s findings that the median duration for buprenorphine treatment per patient was just 53 days.

That was “lower than expected given clinical recommendations of maintenance treatment for up to 12 months and evidence linking longer treatments to better outcomes,” the study said.

Novice prescribers cited insufficient access to doctors with more experience prescribing buprenorphoine as well as “insufficient access to substance-abuse counseling for patients” as “barriers to treating more patients” in their own practice, Stein said.

He said that programs that offer mentoring to those doctors with less experience prescribing buprehnorphine and web-based or telephone counseling for patients might be ways to address those concerns, and increase prescription levels.

Sheldon, CEO of Braeburn Pharmaceuticals, said that when the company began offering the implantable form of buprenorphine for sale, “we expected, say, for the first month or so, that it would be be a really low number.”

But the 239 orders for Probuphine that have come in over the past two months are lower than even those expectations. And Sheldon noted that many of those orders have come from just two states, New York and California.

And “probably not even 10 percent” of the doctors who have been trained on implanting and removing Probuphine have ordered it, she said.

“There was an intensive and robust training program that you wouldn’t think people would go to unless they were going to prescribe the product,” Sheldon said.

Braeburn has hoped that Probuphine will be an attractive option for doctors who are concerned about patients giving or selling their burprenorpine to someone else, or who don’t want to argue with their patients about how much medication they should be receiving. The implant, which is placed in the upper arm, lasts six months, delivering a steady dosage of buprenorphine to the bloodstream.

Sheldon said that the relatively slow sales to date for Probuphine appear due to several factors, including doctors’ concerns about to what extent the implants will be covered by insurance companies.

“Some are being driven by waiting to see what reimbursement will be like,” Sheldon said.

Probuphine costs $4,950, compared to the $2,400 or so that buprenorphine strips would cost for the same six-month period, she said. But big insurers, both private and public, have been “very enthusiastic” about Probuphine and are willing to pay for it, she said.

“We actually have insurance companies calling us … they’re enthusiastic about a six-month implant that can’t be abused, misused or diverted,” Sheldon said. But it takes time for doctors to aware of that, according to Sheldon. “Until then, it’s our word they have to take.”

Despite the initially slow sales, Sheldon is optimistic Probuphine will become more popular. She noted that in addition to sales to physicians, Braeburn expects more business from institutions, who have expressed interest in the implants.

“It’ll be a little slow in the beginning, but then it will snowball and take off,” she predicted.

Doctors Who Treat Opioid Addiction Often See Very Few Patients

Posted on: September 22nd, 2016 by sobrietyresources

September 20, 201612:01 PM ET by Nancy Shute

Many people struggling with opioid addiction can’t find a doctor to provide medication-assisted treatment, even though it’s highly effective. One reason could be that doctors who are qualified to prescribe the medication typically treat just a handful of patients.

Researchers at the RAND Corporation looked at pharmacy records from the seven states with the most doctors approved to prescribe buprenorphine, which helps people manage cravings and avoid withdrawal. They found 3,234 doctors who had prescribed the drug, also known as Suboxone, to new patients from 2010 to 2013. The median number of patients by a doctor treated each month was 13. About half of the doctors treated 4 to 30 patients; 22 percent treated less than 4; 20 percent treated 31 to 75.

“We were really surprised,” says Dr. Bradley Stein, a psychiatrist and lead author of the study, which was published Tuesday in JAMA, the journal of the American Medical Association. “We found that only about 10 percent of doctors were what we would call heavy prescribers, with more than 75 patients a month.”

Only a fraction of the 4 million people thought to abuse prescription painkillers or heroin in the U.S. are getting medication-assisted treatment.

There’s been a big push to make it easier for doctors to prescribe buprenorphine, including new rules announced by the Obama administration in July that raised the number of patients a doctor can treat from 100 to 275. But this data suggests that those limits aren’t the only barrier to getting treatment to more people.

The researchers also were surprised to find that most patients weren’t prescribed buprenorphine for very long, even though it can be used long term. The mean length of prescribing was 53 days per patient.

“This really brought home for us the need for multiple approaches, so doctors are willing and able to prescribe buprenorphine,” Stein says.

Urban areas have typically been better equipped to provide treatment for opioid addiction, whether with methadone clinics or with buprenorphine, which people can take at home and doesn’t require people a daily clinic visit. But many people struggling with opioid addiction live in smaller cities or rural areas where physicians have little experience with treating addiction to heroin and prescription opioids.

That includes towns like Bridgton, Maine, where family physicians shied away from treating addicts until they realized that their own patients were the ones overdosing and dying.

Just taking an online course on how to prescribe buprenorphine won’t be enough for many providers, Stein says, especially since many patients with opioid addiction also have other problems that need care. “We really need to think about providing mentorship, providing consultation, providing clinical support,” Stein says.

Medication-assisted treatment is supposed to include counseling, and that can be hard to find, especially in rural areas. “So we may need to think about telehealth or online counseling,” Stein says. “We may need to be creative to have people receive effective treatment, no matter where they live.”

Treatment can work, “People can recover. They go on to live incredibly productive lives. And we want to have the high-quality treatment to get them there.”

Why Ohio Police Released Photos of a Suspected Heroin Overdose – but Didn't Blur a Child's Face

Posted on: September 15th, 2016 by sobrietyresources

People Magazine September 12, 2016

The city of East Liverpool, Ohio, stunned many last week when it released two photos showing two adult unconscious from a suspected heroin overdose with a 4-year-old boy sitting behind them.  “We feel it necessary to show the other side of this horrible drug,” the city wrote in a post Thursday accompanying the photos. “We feel we need to be a voice for the children caught up in this horrible mess.”  The decision to publicize those images was difficult, local authorities tell PEOPLE. But “we feel fully justified and vindicated in what we did,” says Brian Allen, the city’s director of public service and safety.  He says that for every negative reaction to the post – which has been shared more than 28,000 times on Facebook – there are four positive ones.  On Friday, for example, Allen says a man approached him at lunch, shook his hand and said that he’d lost his own son to heroin earlier this year – and that if those photos were available then, the man said, he would have been more involved with his son and prevented his death.  “Shed the light of day on this,” one user wrote about the post, in a comment typical of a frequent reaction. “The disease thrives in darkness and dies in the light.”  Allen says the city has posted on Facebook about drug raids and suspected dealers, but not drug overdoses. This time was different: “We felt that image was so powerful that it had to be told the way it was,” he says.  He says he’s seen many overdose scenes, “and none of them carried the message that this one did.”  Allen says the hope was that such a post would kick-start a community discussion about drugs, which might spread to the rest of the state and even the country.  What’s more, he says, East Liverpool would like more financial support from the governor to put more police officers on the ground and build an in-patient treatment center for addicts.  Allen says they’ve yet to hear from the governor since the post went up, but he has a feeling they will soon.

Photographing an Alleged Crime Scene

Allen says the suspected overdose took place Wednesday, when an East Liverpool officer witnessed the couple’s car allegedly driving erratically behind a school bus carrying children.  The officer pulled the car over and had to turn it off himself, Allen says, to prevent it from rolling forward. There were still schoolchildren gathered around, he says.  Officers tended to the suspects and the boy while another officer photographed the car, per protocol, as a potential crime scene, Allen says. At no point did responding officers think the images might later be widely distributed, he adds.  Then on Thursday, the driver, James Acord, pleaded guilty to his charges and was sentenced to the maximum jail time, Allen says. Local media had been requesting records from the incident and the city learned it would have to release them all following the guilty plea, Allen says – including the crime scene images.  (Allen says the woman beside Acord in the car, Rhonda Pasek, the boy’s grandmother, pleaded not guilty to her charges and will next appear in court Wednesday. The boy was placed in the custody of county children services, and PEOPLE has not been able to reach Acord or Pasek for comment.)  The city soon decided to post about the incident on its Facebook page, Allen says. He wrote the post.  “We take a very direct approach to dealing with our drug problem,” he says, adding, “When you look at the expression on [the boy’s] face, someone needs to step in and help. And we felt that’s what we were doing.”

Why Didn’t They Blur the Child’s Face?

Allen says that one of the biggest criticisms of the city’s post – why they chose not to blur the child or crop him out of the images – stems from a misunderstanding of the law. He says that, legally, the city could not alter the photos as public records.  “I can’t pick and choose what I want the public to see,” he says.  The state’s attorney general, Mike DeWine, affirmed his support for East Liverpool’s post in a statement to PEOPLE. “Tragically, these scenes are not that unusual,” he said. “The face of substance abuse, particularly heroin, is as familiar as the faces of our families, our neighbors, our co-workers, and our friends.  “Families are being torn apart in Ohio by heroin, and, as shown in these images, innocent children are the victims.”  And while Allen says the city “extensively” considered the possible after-effects of the child being in those photos and identified via his relationship with Pasek, he notes that the boy’s name has not been released and that he is not from East Liverpool, which minimizes the chance he’ll face a stigma in daily life.  Allen says much less consideration was given to the reaction from Acord and Pasek, but that “I never wanted to shame anybody. None of us did.”  He says the photos’ release may help accomplish a big picture goal of building a county treatment center – so when Acord is released from jail, he’ll have somewhere he might go.  “I completely agree you can’t shame an addict into getting help,” Allen says. “But I can shame the government into providing help.”


Researchers think they can cure cocaine addiction by erasing memories

Posted on: September 7th, 2016 by sobrietyresources

By Lindsay Dodgson 09/07/16

A new therapy could treat drug addicts by erasing their memories.

The experimental treatment, developed by researchers at Cardiff University and published in the journal eLife, can wipe clean the memories associated with taking cocaine, which is one of the main reasons users find the drug so addicting.

Cocaine produces a buildup of the neurochemical dopamine in the brain, which causes the user to feel euphoric and compulsive. This is because of its impact on the limbic system, which is an area of interconnected regions in the brain responsible for pleasure and motivation.

New memories made when high on cocaine are therefore intense and filled with enjoyment, leading the user to seek out these feelings again and again. The researchers therefore scoured clinical trials for an approved substance that interfered with the brain chemistry in that area.

The team found that when cocaine-dependent mice were given a dose of a certain molecule called PD325901, they acted as if they had never been addicted or ever taken it at all, because the pathways in the brain that associated pleasure with drug use had been blocked.

“We collected all available molecules which block this pathway, awaiting clinical trial, and we tested them in animal models for cocaine addiction,” lead researcher Professor Riccardo Brambilla told Business Insider. “We found one molecule which actually does the job very nicely.”

The treatment also appeared to not interfere with general memory function of the animals, which Professor Brambilla points out would be a major side effect in human studies.

“Obviously patients who are people might make the situation slightly more complex,” he said. “If we have a protocol for patients where we only administer the drug once or twice, it would minimise the potential side effects.”

Cocaine addiction is a relatively narrow problem, affecting 2-3% of the general population in the UK, but Professor Brambilla and his team are now looking into the effect of their molecule on legal drugs such as alcohol and nicotine.

Alcohol Dependence Linked to Lack of Enzyme, Study Finds

Posted on: September 6th, 2016 by sobrietyresources

The research findings may lead to new therapies to curb excessive drinking. 

By Kelly Burch 09/01/16

Researchers in Sweden say the lack of an important enzyme in the brain may inhibit impulse control, contributing to alcoholism.

Whether or not you’re a drinker, we all know that alcohol dulls one’s ability to control impulses. Scientists have hypothesized that impaired function in the frontal lobe of the brain was partially to blame for alcohol dependence, since the frontal lobe has been known to affect decision-making and impulsivity.

However, this is the first time scientists have discovered a specific molecule that can explain the impairment, according to the International Business Times. In research published in the journal Molecular Psychiatry, researchers showed that when the enzyme, PRDM2, was switched off in the nerve cells of rats, the animals were more prone to developing a dependence on alcohol.

Enzymes are molecules that catalyze reactions in living organisms and cells. Researchers had a theory that PRDM2 affected impulse control in the nerve cells in the brain’s frontal lobe. To prove this, they disrupted PRDM2 production in the brains of rats that were already alcohol dependent. The change made the rats more likely to consume more alcohol, even if doing so had unpleasant physical affects. Rats who had been dependent in the past, but were not currently dependent, were more likely to relapse when the enzyme was reduced.

Researchers believe that PRDM2 affects how impulse control signals are sent through the brain. “PRDM2 controls the expression of several genes that are necessary for effective signaling between nerve cells,” lead author Markus Heilig told the Times. “When too little enzyme is produced, no effective signals are sent from the cells that are supposed to stop the impulse.”

To be sure that reduced amounts of PRDM2 was a cause—rather than a consequence—of alcohol dependence, the researchers repeated the study on rats that were not alcohol dependent. That population also showed less impulse control after PRDM2 production was stopped in the brains.

The researchers hope that in the long term, understanding the precise brain chemistry surrounding addiction will help innovators develop better treatments for drug and alcohol dependence. In the short term, however, head researcher Heilig said the study showed that addiction has a biological basis, and should not be stigmatized.

“We see how a single molecular manipulation gives rise to important characteristics of an addictive illness,” he said. “Over the long term, we want to contribute to developing effective medicines, but over the short term the important thing, perhaps, is to do away with the stigmatization of alcoholism.”


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