Archive for September, 2017

Our one-on-one interview with NBA superstar, Hawks owner Grant Hill

Posted on: September 26th, 2017 by sobrietyresources No Comments

By David Heitz


Weekend warriors who shoot hoops with their pals are at risk of becoming heroin addicts.

It’s actually not a National Enquirer statement.

By now we know that professional athletes pay an incredible price over time for their sports prowess. Injuries lead to opioids. Some become addicted to opioids.

We hear about it more often at the college or even the middle school level.

And we hear about it most often in football. But it happens in basketball (any sport, quite frankly), too.

“Basketball is a contact sport, football is a collision sport,” legendary NBA superstar Grant Hill said in a one-on-one interview with SobrietyResources.org.

So why don’t we have a better deal to offer athletes who get injured? More than just addictive, harsh opioids for treating their pain?

Actually, we do.

And its spokesperson is the picture of health even after 11 surgeries during his two-decade long career of NBA superstardom.


Grant Hill gives away his youthful secret

Looking good, feeling good and doing good comes naturally for Grant Hill. Why? Opioids haven’t ravaged his body, even after 11 – yes, 11 – surgeries.

Hill dribbled down home courts for Detroit, Orlando, Phoenix and Los Angeles before becoming co-owner of the Hawks.


How Hill has kept such an incredible grip on life

The miracle for Hill is that he did not become addicted to opioids or even have to suffer their ill effects. Hill does not proclaim to be an ironman hero in that regard. Like many people, they made him extremely ill and did not bring relief.

He had no choice but to seek alternative methods as he sustained injury, after injury, after injury.

While incoming NBA players are trained on the essentials of good health, Hill said they don’t get a lecture on opioid addiction. One wonders how much of a lesson they get from coaching staffs in high school or college.

“It’s not discussed from the ‘git-go’ (the words the interviewer posed), but more discussion overall about good health,” Hill explained. “Nutrition, training, listening to your body. If your body talks, you have to listen.

Sometimes, you have to learn how to listen,” Hill said.


Much more than a former player turned TV sports host

Today, Hill is helping others on the court find pain relief and avoid opioid addiction.

The Hawks franchise, in conjunction with Emory Healthcare, recently opened a new sports medicine center in the Atlanta suburb of Brookhaven. It serves as the Hawks’ primary training site.

It offers cutting-edge approaches for managing pain whether it be from surgery or injury.

“I was just there yesterday, and there is such an emphasis on managing pain, I’m almost jealous,” Hill said.  “We didn’t have it when I played.”

Hawks Principal Owner Tony Ressler explained in an NBA news release.

“It is a privilege to be partnering with a local institution that is a world leader in the medical field and that also shares our vision and passion for excellence.  In addition, we are proud that this facility will go beyond benefitting just our players, but will also be a valuable sports medicine resource available to the entire community.”

From analyzing players’ sweat for nutritional analysis to using 3D technology called “motion capture,” Hill intends to keep his Hawks flying high and healthy.

Said Dr. Jonathan S. Lewin, president, CEO and chairman of the board of Emory Healthcare: “Delivering on-site care not only will enable us to provide faster care to Hawks players, but also will enhance our ability to conduct sports performance research and translate what we learn to all athletes both professional and recreational.”

It sounds like the Star Trek sick bay. From the news release:

 

“A fully dedicated recovery area including cryotherapy, sensory deprivation tanks and in-ground hydrotherapy will also be on-site. Additionally, all non-sports orthopedic specialties will be located two blocks away at The Emory Orthopedics & Spine Center.”

 

Hill said it gives his players a choice when it comes to pain management after a surgery or injury.

“Hopefully you can avoid surgery,” Hill said. “But we need to have a healthy conversation about what’s happening in sports, including our ‘Weekend Warriors,’ and have a dialogue with surgeons about our options.


What is the United States of Non-Dependence Report?

Cleverly named but equally as important, this report highlights important information that far too many Americans seem to be tuning out on the evening news.

The report’s findings:

● Enough opioids were prescribed in 2016 to provide every man, woman and child with 36 pills
● Surgery-related overprescribing results in 3.3 billion unused pills available for potential diversion or abuse
● A 10% reduction in opioid prescribing could save $830 million annually in drug costs alone and make 332 million less pills available for diversion and abuse

Surgeons generally know whether a patient may be at risk for opioid addiction based on algorithms usually provided by insurance companies and the like, Sethi explained.

A hybrid of opioid and non-opioid options can be used when appropriate, Sethi said.

 


Exparel is what kept Grant Hill healthy on the court

Hill’s youthful looks could be considered a modern-day Oil of Olay for professional athletes. Picture it: A dose of a kind of “mega-Novocain.”

It’s called Exparel, and it’s how Hill has found relief.

There are plenty of non-opioid pain options, even for – the doctor himself said it – shoulder replacement.

“If you would have asked me could you could get a shoulder replacement without opioids five years ago, I would have said, no,” explained Dr. Paul Sethi, Hill’s surgeon. “Now? In 50 percent of cases, it won’t require any pills.”

Sethi explained a pain reliever called Exparel has evolved quite a bit since first becoming available. It is gaining credibility as a viable option to opioids for sports injury-related surgeries, he said, and even is being used on children.

Sethi is renowned for repairing elbows, knees and shoulders at Orthopedics & Neurosurgery Specialists. His groundbreaking research regularly is published in medical journals.


Bookmark PlanAgainstPain.com as a resource

Hill is helping spread the word about a new website that explains alterative pain management methods. It’s important for people to understand, Dr. Sethi said, that pain is subjective. It’s why it can be a tricky call when prescribing opioids.

Pain is personal, no two people experience it the same way,” the website explains. “Your doctors will develop a pain management plan based on your particular needs, which is why it’s important to discuss pain treatment options.

“There are many types of treatment plans — some with drugs and some without, and some pain treatments administered during surgery — that can be used together or separately to provide relief based on your specific needs, so discuss your choices with your medical team.”

From 1994 to 2013, Grant Hill became a basketball icon. Today, he’s host of “NBA TV’s NBA Inside Stuff.” He’s a millionaire and has a beautiful wife and children.

“Have a game plan,” Hill advised athletes of all kinds when it comes to being prepare for an inevitable painful injury.

“Be aware of what’s available.”

#OneLessPill

Share your story, with that hashtag, of why you would like to pour your opioid painkillers down the drain.

For more information, go to planagainstpain.com.

 

Fentanyl: Growing Use and Abuse

Posted on: September 26th, 2017 by sobrietyresources No Comments

Written by Lindsey Carnick

Fentanyl is an opioid analgesic drug. Opioid analgesics are incredibly potent substances that act on the central nervous system to drastically reduce the user’s perception of pain, in addition to creating a feeling of sedation and sometimes euphoria. Morphine, the medical precursor to fentanyl, and its deadly street drug counterpart heroin, are both derived from the opium plant. All three substances work on the same receptor sites in the brain. The CDC estimates that heroin-related overdose deaths have quadrupled since 2010, and the overdose rate from 2014 to 2015 increased by almost 21% to nearly 13,000 individuals; and fentanyl’s potency ranges from between fifty to a hundred times that of heroin.

Fentanyl is synthetically produced in laboratories (not from the Opium plant) and is available by prescription under three individual brand names. Fentanyl became available in a transdermal patch form in the 1990s, and was frequently prescribed for cancer patients. It has been increasingly prescribed as a pain management medication for surgical patients and patients with severe chronic pain who have developed a tolerance to other opioid medications due to prolonged use, or those who have acute breakthrough pain episodes that are otherwise not responsive to less aggressive medication therapies.

At low to moderate doses, opiates reduce the user’s perception of pain, induce drowsiness, and can create mild euphoria. Nonlethal side effects include nausea, vomiting, constipation, dizziness, and sedation. Physical and psychological dependence, as well as tolerance (needing more of the substance to achieve the same effects) are also common side effects of opioid use. All opioid substances are potentially lethal due to their impact on the central nervous system. Central nervous system depression is dangerous because it inhibits brain activity and subsequently slows the vital, automatic functions of the body such as breathing and heartrate, increasing the risk of coma and death. Fentanyl’s potency makes its potential for deadly physiological effects significantly higher than other opiates, particularly because users may not be aware of how much stronger fentanyl is than other opioid substances they may have used previously.

The development of newer and stronger pain management medications such as Fentanyl is both a result and a catalyst of a population that has an increasingly lower and lower threshold for pain tolerance. This is due in large part to overprescribing of opiate medications by a range of medical professionals from dentists to surgeons. Many of whom are largely unaware of substantial addictive and tolerance potentials of these substances. Opiate medications have resulted in a widely decreased pain tolerance in tandem with an increased tolerance (lack of response) to previously effective drugs, necessitating the development of stronger substances for the management of the same initial presenting problem.

Fentanyl has become increasingly attractive to individuals struggling with a number of opiate-misuse and dependency-related issues. Because of its potency, fentanyl users require less of the substance to achieve the desired result. Like any other substance of this strength, fentanyl is also extremely attractive to illicit street drug manufacturers, who use it to maintain the potency (and therefore the profit margin) of the drugs they are selling. Additionally, the strength of drugs cut with a substance as strong as fentanyl increases the likelihood that the purchasers of illicit drugs will be highly motivated to acquire more, often regardless of cost.

According to the Centers for Disease Control (CDC), fentanyl is increasingly responsible for the drug-related overdose deaths of persons using illicitly manufactured fentanyl, heroin, or other street drugs mixed with manufactured fentanyl. Deaths in the United States due to heroin and illicit opioids (fentanyl) were six times higher (over 20,000) in 2015 than in 2002, which suggests not only increased availability and consumption of street fentanyl, but also increased use of heroin by individuals addicted to but unable to obtain synthetic opiates. These two drugs alone were responsible for more opiate-related deaths in 2015 as all other opiates combined (18,000), which only increased by two times between 2002 and 2015.

The risk of death associated with illicit fentanyl use is high, and as with other opiates, there are other devastating consequences of misuse and abuse. Addiction and dependence frequently have severe and debilitating impacts on an individuals’ physical, emotional, mental, social, and financial health. Individuals misusing fentanyl may experience severe disruption in their relationships, as acquiring the drug frequently becomes users’ sole focus and interest, and the effects of the substance make it difficult to engage in relationships in a meaningful way. Users are often unable to maintain relationships with family, friends, spouses, and colleagues, and they often become reclusive. Dishonesty due to their addiction, along with feelings of guilt and shame are often prevalent. Accompanying behaviors such as lying and manipulation to obscure the abuse are also common. Drug addiction often results in severe financial quandaries. As the user seeks to maintain the feelings the drug creates, and, because of opioid tolerance, they require increasing amounts and/or concentrations to achieve the same effect. Finding the financial resources to secure more of the drug can severely impact the individuals’ intimate relationships as well as their attention to other financial responsibilities. Legal and criminal consequences often follow opioid misuse, as users become increasingly desperate to maintain their access to the substance and may engage in illegal activity directly (possession, dealing) or indirectly (stealing) related to the substance itself.

Opioid addiction creates tremendously painful emotional and physical challenges for individuals and their families. It is often intertwined with well-intentioned attempts by medical professionals to alleviate pain and suffering. Individuals are often hard-pressed to live with chronic pain conditions, and opioid tolerance creates a quandary for those who are seeking to live productive lives in spite of very difficult circumstances that often are beyond their control. Helping individuals get clean from opioid addiction has the added challenge of re-exposing the underlying condition that may have been the initial reason for opiate use and with decreased means of addressing it.


Due to the startling upswing in heroin and illicit opioid related deaths and law enforcement encounters, as well as the increasing numbers of persons seeking addiction treatment, the dangers of fentanyl are increasingly at the forefront of a national dialogue on responsible opiate prescribing practices and the pressing need for alternative pain management therapies. Educating providers about the dependence and tolerance potentials of opiate pain medications and establishing responsible prescribing guidelines and clinical best practices has become a priority for the professional organizations governing prescribers across the healthcare spectrum, from primary care offices to operating rooms. It will take a collective and concerted effort by healthcare providers, law enforcement professionals, public policy makers, and consumers to impact the public health crisis that has arisen from the remarkable development of these powerful drugs.

Opioid overdoses shorten US life expectancy by 2½ months

Posted on: September 25th, 2017 by sobrietyresources No Comments

By Nadia Kounang, CNN
Updated 12:33 PM ET, Tue September 19, 2017

(CNN)Opioid drugs — including both legally prescribed painkillers such as oxycodone and hydrocodone, as well as illegal drugs such as heroin or illicit fentanyl — are not only killing Americans, they are shortening their overall life spans. Opioids take about 2½ months off our lives, according to a new analysis published in the medical journal JAMA.

In 2015, American life expectancy dropped for the first time since 1993. Public health officials have hypothesized that opioids reduced life expectancy for non-Hispanic white people in the United States from 2000 to 2014. Researchers have now quantified how much opioids are shortening US life spans.

The researchers noted that the number of opioid overdose deaths are probably underestimated because of gaps in how death certificates are completed.

From 2000 to 2015, death rates due to heart disease, diabetes and other key causes declined, adding 2¼ years to US life expectancy. But increases in deaths from Alzheimer’s disease, suicide and other causes offset some of those gains. On average, Americans can now expect to live 78.8 years, according to data from 2015, the most recent data available. That’s a statistically significant drop of 0.1 year, about a month, from the previous year.

Women can still expect to live longer than men — 81.2 years vs. 76.3 years — but both of those estimates were lower in 2015 than they were in 2014.

Life expectancy at age 65 remained the same in 2015. Once you’ve reached that age, you can expect to live another 19.4 years. Again, women fare slightly better: 20.6 years vs. 18 years for men.

Drug overdose deaths reach new highs
Drug overdose deaths are expected to continue to reach new record highs. The Centers for Disease Control and Prevention expects drug overdose deaths to top 64,000 in 2016 when the numbers are finalized — that’s more than the number of American troops lost during the Vietnam War. Most of these overdoses involved an opioid. Since 1999, the number of opioid-related drug deaths has more than quadrupled.

While prescription opioids like oxycodone or hydrocodone were considered to be driving factors in the increasing rates of overdose in the early part of the 2000s, heroin and illicit fentanyl have become the drivers for opioid overdose deaths in recent years. In fact, the number of overdose deaths related to fentanyl is expected to more than double, from an estimated 9,945 in 2016 to 20,145 in 2017, the CDC says. For the first time, fentanyl will be the leading cause of opioid overdose.

‘It’s a national emergency’
On the heels of the release of a draft report of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, over the summer, President Donald Trump said “The opioid crisis is an emergency, and I am saying, officially, right now, it is an emergency. It’s a national emergency.

“We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis,” he added. “It is a serious problem the likes of which we have never had.”

Yet, five weeks have passed since Trump’s statement, and the White House has yet to make any sort of formal announcement of a national emergency.

In addition, this week, New Jersey Gov. Chris Christie, a Republican who chairs the drug addiction commission, posted a letter on the White House’s website requesting an additional four weeks for the commission to complete its final report. “In the interest of submitting … sound recommendations, our research and policy development are still in progress,” wrote Christie. “Accordingly, and pursuant to the Executive Order establishing the Commission, we are seeking an additional four weeks to finalize our work.”

Many public health officials point to the over-prescribing of narcotic painkillers as one of the roots of the opioid overdose epidemic. Last year, the CDC issued prescribing guidelines for using opioids to treat chronic pain. According to a recent government report, the No. 1 reason people misuse prescription drugs is to manage pain. In an attempt to help deal with the pain issue, the Trump administration is partnering with private pharmaceutical companies to help fast-track non-opioid, non-addictive pain relief alternatives.

http://www.cnn.com/2017/09/19/health/opioids-life-expectancy-study/

Overdose, alcohol deaths cast dark shadow on American life expectancy

Posted on: September 19th, 2017 by sobrietyresources No Comments

By David Heitz

Despite medical advances, the American life expectancy dipped from 2014 to 2015 due to the nation’s opioid, alcohol crises.

Between 2000 and 2015 in the U.S., life expectancy increased overall. But from 2014 to 2015, we began to slide backward.

The data places the blame squarely at the feet of painkiller and heroin overdoses.

Previous researchers already have reported that overdoses have contributed to reducing life expectancy among non-Hispanic whites.

The harsh conclusion, directly from the research letter published Tuesday in JAMA:

“U.S. life expectancy decreased from 2014 to 2015 and is now lower than in most high-income countries, with this gap projected to increase,” the authors concluded. “These findings suggest that preventing opioid-related poisoning deaths will be important to achieving more robust increases in life expectancy once again.” (1)

It’s the first time the opioid epidemic has been framed in such a way as to directly tell white Americans, “Your children may live a shorter life than you because people are overdosing on prescription drugs and heroin,” in so many words.

Dr. Deborah Dowell of the U.S. Centers for Disease Control and Prevention led the team of researchers. They combed through government data that is assembled via death certificates.

It was a complicated task. They looked at the 12 leading causes of death, which included unintentional injuries and suicide.

The authors explained, “In ranked cause-of-death classification, drug, opioid,
and alcohol poisoning are not considered to be unique cause-of-death categories. Instead, poisoning deaths are classified as either accidental poisonings (which contribute to unintentional injuries), suicides, or homicides (ranked 16th in leading causes of death). Contributions from drug, opioid, and alcohol poisoning deaths overlap with both unintentional injury deaths and suicides and cannot be summed with these leading ranked causes of death.”

Using spreadsheets and other software, they crunched numbers to arrive at their conclusions.

Elderly and female drinkers constituting a ‘public health crisis’

The bottom line is, so many people have died from opioid overdose that it is impacting the overall life expectancy in the United States.

The authors’ research showed that average life expectancy for newborns rose two years from 2000 to 2015, to 78.8 years.

But, it would have climbed even higher had drug-poisoning deaths not tripled during the period, from 17,415 in 2000 to 52,204 in 2015. In fact, the age-adjusted death rate – a person’s chances of dying from something not related to natural causes – increased from 6.2 per 100,000 people to 16.3.

Alcohol poisoning also contributed negatively to the overall life expectancy during the period. In fact, alcohol poisonings during the period exploded eight-fold, from 327 to 2,354.

Those numbers may not necessarily reflect an increase in the number of American drinkers, but they do reflect a shocking, exponential increase in the number of people who literally drink themselves to death.

Recent research also showed where the spike in alcohol abuse is happening.

In an unrelated JAMA study just last month, Bridget Grant from the National Institute on Alcohol Abuse and Alcoholism and colleagues combed through epidemiological data spanning 2001-2002 to 2012-2013, Their conclusion:

“Increases in alcohol use, high-risk drinking, and DSM-IV AUD in the US population and among subgroups, especially women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged, constitute a public health crisis.

“Taken together, these findings portend increases in many chronic comorbidities in which alcohol use has a substantial role.” (2)

In other words, heart disease, liver disease and mental trouble all can arise from drinking too much. Yet it’s not the manly man downing brews with the boys making headlines in the latest research.

Nobody is immune to alcoholism, painkiller, heroin and opioid addiction, or any addiction. Nobody is to blame for it either, especially once they take that first step and admit they need help.

Statistics show groups most affected by addiction

In an accompanying editorial to the report about heavy drinking among the elderly, women and minorities, Dr. Marc Schuckit validates the research.

“The validity of the results is underscored by the impressive methodology, which at each time applied virtually identical, well-validated face-to-face interviews and analytic approaches to about 40,000 nationally representative participants 18 years and older,” he writes. (3)

The threshold for problem drinking also was high. “The concept of high-risk drinking demanded five drinks per occasion for men (four for women) at least weekly, with a standard drink defined as 14 g of ethanol, and alcohol use disorders (AUDs) were defined by DSM-5.”

DSM-5 is considered the so-called bible for mental health diagnoses.

Getting down to brass tacks:

  • The number of women diagnosed with alcohol use disorder spiked almost 84 percent during the period.
  • Among blacks, AUDs ballooned by almost 93 percent.
  • Among people ages 45 to 64, the researchers reported an 81.5 percent spike in AUDs.
  • And among those ages 65 and up, there has been almost a 107 percent increase in AUDs during the 11-year span ending in 2012.



To make matters worse. Dr. Schuckit noted, “The higher rate of alcohol problems in subgroups with lower financial resources are cause for concern for humanitarian reasons alone.

“But even if those are set aside, the absence of easier access to medical care for individuals with long-term, often severe medical problems associated with heavier drinking is likely to result in these individuals turning to emergency departments for their treatment.”

That is, they only seek help in desperation, and at great cost financially and to the soul. A hospital isn’t the most comfortable place to get sober.

Easing of stigma, shame will begin to save lives

Finally, there is the suicide factor. The wild card.

And the card is getting pulled more and more. Statistics from the aforementioned CDC study showed that death by suicide rose from 29,350 to 44,193.

Most people who suffer from alcoholism or drug addiction have something else going on, too. They may be the victim of rape or some other form of violence, or they may have suffered some other form of trauma.

Nobody wants to become addicted to drugs or alcohol. When they do, they feel so bad, they continue to medicate themselves to numb the pain. It is such an ugly and vicious cycle that once broken, a whole new person is unleashed from within.

Americans thankfully have come a very long way in how they view addiction, particularly heroin and opioid addiction.

Yet in other ways, the alcoholic and the addict both remain stigmatized. It is a paradox that it takes people dying all around us to understand that these are lives that can be saved.

The early days of HIV/AIDS are a not-so-pleasant reminder of this. When it’s your son, your mother, your husband, your partner, everything changes.

And then, the judging stops. When the judging stops, people tend to seek help.

These staggering numbers show that our country is in the grips of an addiction and alcohol “public health crisis,” to use the words of one of the researchers.

We must all issue a call to action to reach out to the addicted and those ravaged by booze, and to offer them unconditional love and support. Only then will they listen when you point them in the direction of help.

More importantly, only then will they believe their own lives are worth saving.

Bibliography

  1. Dowell, D. et al. (2017, Sept. 19). Contribution of Opioid-Involved Poisoning to the Change in Life Expectancy in the United States, 2000-2015. JAMA. Retrieved Sept.16, 2017, from http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2017.9308
  2. Grant, B. et al. (2017, September). Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry. Retrieved Sept. 16, 2017, from http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2647079
  3. Schuckit, M. et al. Remarkable increases in Alcohol Use Disorders. (2017, September). JAMA Psychiatry. Retrieved Sept. 16, 2017, from http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2647075

Heroin cut 91 lives short today: star athletes, healthcare providers, your neighbor

Posted on: September 12th, 2017 by sobrietyresources No Comments

by David Heitz

Remember when most of America thought heroin addiction only happened to people with a long history of drug abuse?

We looked at heroin addiction as though it simply was the culmination of years of experimenting with other drugs. Until recently, many of us thought it only happened to lost, impoverished souls, and in places like Skid Row.

Are you kidding?

It happens to doctors in Orange County, pilots in Los Angeles, and yes, impoverished people on Skid Row.

A soccer mom anywhere can become a heroin addict after being prescribed painkillers for a surgery. High school athletes can, too, and they do. Quite a bit, in fact.

Now our country understands that heroin actually is just a dangerous painkiller usually delivered with a needle. That Vicodin you take today after something as simple as a dental procedure can eventually lead to a needle loaded with heroin going into your vein.

Given that truth, imagine the angst of a person dependent on heroin. Many, if not most, initially received a painkiller prescription from a doctor that ultimately led them down the road to heroin.

And now we expect them to turn to the medical establishment again for help? And accept being called “an addict,” when all they were doing was following doctor’s orders, likely never warned of the risk?

For addiction to opioids like heroin, a professional rehabilitation center truly is the only safe place to seek help. Heroin addiction is a serious medical condition. Abrupt discontinuation of opioids without medical supervision can result in death.

The good news is that doctors, policymakers and even politicians are waking up to the plight of those addicted to heroin. They understand they need to do their part to help America recover from the heroin epidemic, too. They know the addicted, whose lives are in danger, are the last people to blame.

Number dying from drug overdose has quadrupled

Statistics regarding heroin addiction are so staggering, Americans largely have become numb to them. But for each number, the story of someone we know is attached, or soon will be. When the number is given a face, everything changes.

Consider this data provided by the U.S. Centers for Disease Control and Prevention (CDC):

More than four times as many people are dying of drug overdose today than in 1999. From 2000 to 2015, more than half a million people died from  overdose,        usually opioids like oxycodone, hydrocodone, heroin and methadone. (1)

The U.S. Department of Health and Human Services put the number of total deaths caused by opioids in general to more than 33,000 in an April 2017 news          release. (2)

 

“This alarming statistic is unacceptable to me,” U.S. Department of Health and Human Services Secretary Dr. Tom Price said.

The statistic was pegged to President Trump’s creation of his Commission on Combatting Drug Addiction and The Opioid Crisis. More than half a billion dollars in grants has been promised to all 50 states.

Price has dubbed the opioid epidemic as one of his department’s top three priorities.

The CDC estimates that 91 people every day die of overdose, usually from opioids like heroin. However, those are 2015 numbers. The problem now seems far more explosive than that, with some cities now recording double-digit overdose deaths every day.

Earlier this year, Louisville, Ken. recorded 40 overdoses in one day, one fatal, USA Today reported. (3) And while even one death destroys multiple lives, the others lived because naloxone kits – which bring those who overdose back from the brink – increasingly are being made available to first responders and even the general public.

Naloxone works by shutting off the receptors that allow the opioids to go to work in the brain and slow down breathing.

In a world where the heroin scourge wants to destroy lives, the good news is that America is fighting back. Saving people from heroin is anything but a lost cause.

Heroin epidemic a matter of public health

Among young adults ages 18 to 25, more than twice as many people are using heroin than 10 years ago. Most of them also are using other drugs, according to the CDC.

However, heroin use has increased among all age groups. Elderly people prescribed painkillers for bone and joint pain can even end up addicted to heroin if they know where to find it.

“Some of the greatest increases occurred in demographic groups with historically low rates of heroin use: Women, the privately insured, and people with higher incomes,” the CDC reports.

Nearly all people who use heroin use other drugs, too, according to the CDC. People who use cocaine are 15 times more likely to become addicted to heroin.

It’s an epidemic so profoundly dangerous and denigrating to our society, many are reacting out of fear-based ignorance.

Because most people addicted to heroin inject it, there is a tremendous risk of the addicted contracting chronic illnesses passed on needles. Those illnesses include HIV, Hepatitis C, and sometimes even both.

HIV is manageable with lifelong medication. Hepatitis C, a once-deadly liver disease, is now curable with the same. However, the medications for both illnesses bear a whopping financial burden.

The public health ramifications of opioid addiction go far beyond the deadly risks associated with addiction itself, such as overdose. The introduction of the needle has disastrous public health ramification.

Consider Scott County, Indiana, where one wave of a drug shared by multiple people with one needle created the most alarming HIV/Hepatitis C infection ripple effect the country ever has seen.

In an exclusive interview with the website HIV Equal last year, that state’s director of public health declined to state the cost associated with the epidemic. Indiana did participate in Medicaid expansion, and most of the 190 people infected with HIV in the community of 4,000 are insured under the state-funded Healthy Indiana program. (4)

Two years ago, the Indiana News and Tribune estimated the cost at least $58 million and growing. (5)

For those addicted to heroin who also have contracted these diseases – and there are many – so much hope lies where there once was just fear. The fact that people with these illnesses can now live normal lifespans gives even more reason to recover and reclaim one’s life.

Without treatment, heroin leads addicted to the grave

There is only one ending for people addicted to heroin who don’t seek help. It’s a reality as sure as death itself. Every time someone ends up in the ER due to overdose, there’s a chance they may never come out alive.

An even more shocking reality is that parents of college-aged students may never know their child ended up in an emergency room due to overdose. That’s because of HIPAA privacy laws.

For the parent of a child who perhaps just went off to college, and stumbled upon painkillers being mixed with booze at parties, this is a very real and very difficult situation. The slope is slippery, and no parent wants to think their child is becoming a drug addict. Such thoughts, unfortunately, are pushed aside far too often when parents suspect something isn’t right when junior comes home for holiday break.

And the reason parents push such thoughts aside are the same reasons the addicts themselves push them aside.

Nobody wants to think themselves or a loved one are facing a life and death situation for which they need treatment.

And nobody wants their friends or family to know they are going into rehab, or that someone they love needs drug treatment. The stigma is too great.

And yet the stigma of addiction, and the failure of the loved ones of the addicted to confront it, is why nearly 100 people per day continue to die of overdose.

It’s a cycle that ends the very second addicted people admit they need treatment, and their loved ones support them on their path to recovery.

Bibliography

1. Drug overdose deaths in the United States continue to increase in 2015. (2017, Aug. 30). U.S. Centers for Disease Control and Prevention. Retrieved Sept. 9, 2017, from https://www.cdc.gov/drugoverdose/epidemic/index.html
2. Trump Administration awards grants to states to combat opioid crisis. (2017, April 19). U.S. Department of Health and Human Services. Retrieved Sept. 9, 2017, from https://www.hhs.gov/about/news/2017/04/19/trump-administration-awards-grants-states-combat-opioid-crisis.html
3. One day, 1 city: 43 overdoses, 1 death. (2017, Feb. 10). USA Today. Retrieved Sept. 9, 2017, from https://www.usatoday.com/story/news/nation-now/2017/02/10/heroin-epidemic-overdoses/97745102/
4. Heitz, David. (2016, April 13). Indiana Department of Public Health spokesperson gives HIV Equal’s David Heitz exclusive interview. HIV Equal. Retrieved Sept. 9, 2017, from http://www.hivequal.org/hiv-equal-online/exclusive-hiv-equal-s-david-heitz-interviews-indiana-public-affairs-about-hiv-emergency-needle-exchange-program
5. Hayden, Maureen. (2015, Dec. 17). HIV Outbreak Costs State $58 million. Indiana News and Tribune. Retrieved Sept. 9, 2017, from http://www.newsandtribune.com/news/hiv-outbreak-costs-state-million/article_189054a4-a45f-11e5-964a-c39db793576d.html

To Grow Market Share, A Drug Maker Pitches Its Product to Judges

Posted on: September 7th, 2017 by sobrietyresources No Comments

Philip Kirby says he first used heroin during a stint in a halfway house a few years ago, when he was 21 years old. He quickly formed a habit.
“You can’t really dabble in it,” he says.

Late last year, Kirby was driving with drugs and a syringe in his car when he got pulled over. He went to jail for a few months on a separate charge before entering a drug court program in Hamilton County, Ind., north of Indianapolis. But before Kirby started, he says the court pressured him to get a shot of a drug called Vivitrol.

Vivitrol is a monthly injection of naltrexone, which blocks opioid receptors in the brain. It’s one of three medications approved by the Food and Drug Administration for treating opioid addiction. While it’s effective in some people, it’s not for everyone. Patients have to be ready to be opioid-free, and some patients won’t do well on it. It can also have side effects, which Kirby says he experienced.

“I had sinus problems, chest problems for the whole month I was on it,” Kirby says. “I couldn’t shake it.”

He says he also got a rash — another possible reaction to Vivitrol, according to the product’s warnings. Months after he had the shot, he still had white splotches on his arms, which he attributed to the drug. But even with those symptoms, Kirby says the court urged him to stick with the medication for a couple of more months. “They were way too pushy about it,” he says.

More than 130,000 Americans will go through drug courts this year, according to the National Association of Drug Court Professionals. Drug courts are designed to allow some people whose crimes stem from addiction to get treatment instead of jail time. But the treatment that is offered varies from court to court and is entirely at the judge’s discretion.

Some courts offer participants a full range of evidence-based treatment, including medication-assisted treatment. Others don’t allow addiction medications at all. And some permit just one: Vivitrol.

Prime targets for marketing
One reason for this preference is that Alkermes, the drug’s manufacturer, is doing something nearly unheard of for a pharmaceutical company: It is marketing directly to drug court judges and other officials.

The strategy capitalizes on a market primed to prefer their product. Judges, prosecutors and other criminal justice officials can be suspicious of the other FDA-approved addiction medications, buprenorphine and methadone, because they are themselves opioids. Alkermes promotes its product as “nonaddictive.”

The argument worked for Judge Lewis Gregory, who heads the city court in Greenwood, Ind. About a year and a half ago, Gregory didn’t allow participants to start on addiction medications while in the program. “We were failing miserably with the heroin population,” he says.

At the time, Gregory was only familiar with buprenorphine and methadone. Both are opioid medications that can prevent withdrawals, reduce cravings and ultimately help people maintain a stable recovery. When they are properly prescribed and administered, patients don’t get a euphoric feeling or a “high.”

Buprenorphine and methadone have been the standard of care for opioid addiction for years, but because they’re opioids, it is possible to misuse them. They’re also sold illegally on the street.

“I was certainly not going to do a medication-assisted treatment program with drugs which people use to get high,” Gregory says, adding that he would not order someone to stop buprenorphine treatment if it were legally prescribed by a physician, a situation he rarely sees.

Then he received some Vivitrol literature in the mail and a phone call from an Alkermes sales representative. “So we ended up meeting in the early part of 2016, and she began educating me a bit,” he says.

Six months later, his court began a Vivitrol program, permitting some participants to use the drug. A sales representative sometimes sits in on the court’s treatment team meetings, Gregory says.

Many treatment specialists say allowing judges and other criminal justice officials with no medical training to exert influence over medical decisions is problematic. The power makes them prime targets for Vivitrol marketing, they say.
“You would think it would be more appropriate to go after physicians,” says Basia Andraka-Christou, who researches drug courts at the Fairbanks School of Public Health at Indiana University.

“What this is implying is that the judges in these cases are actually making a lot of the medical decisions, and that should be very concerning to everyone,” she says.

Adriane Fugh-Berman, who researches pharmaceutical marketing at Georgetown University, says she has not heard of another drug company going after judges. She says it’s not just unique — it’s inappropriate and could ultimately be damaging to patients. “They’re not health care providers. They don’t know data. They don’t know research,” she says.

A company strategy
The drug court Kirby went through doesn’t allow medications other than Vivitrol for treating addiction. In fact, NPR and Side Effects Public Media have identified at least eight courts out of the several dozen in Indiana that say they only allow Vivitrol treatment.

NPR and Side Effects Public Media have learned that Alkermes sales reps have also marketed the drug to court officials in Missouri and Ohio. A report from ProPublica found that extensive marketing is leading judges to favor Vivitrol around the country.

The company is open about this part of its sales strategy. At an investor event last year, policy director Jeff Harris said drug courts are a huge market for Vivitrol.

“We’re making progress but still just barely scratching the surface on the need that exists across the country,” Harris said in a presentation. “There are over 3,000 counties in the United States, and there are over 3,000 drug courts.”
A shot of Vivitrol costs about $1,000, making it pricier than the other addiction treatments. In many cases, the drug is paid for through Medicaid or other public funds. And marketing to criminal justice settings seems to have paid off for the company, whose earnings have grown significantly since its introduction. Vivitrol sales reached $209 million in 2016 — up from just $30 million in 2011. Sales have continued to climb this year.

Alkermes goes beyond marketing to judges. It also lobbies state and national policymakers to write laws that favor Vivitrol — and in some cases, hamper access to other addiction medications. The company has said it supports the use of all medications for addiction, but in practice, it doesn’t.

The company supported one law in Indiana that encourages the use of Vivitrol in drug courts. Signed in 2015, the bill allows judges to require medication as a condition of participating in a drug court, and the language specifically highlights Vivitrol treatment.

Alkermes declined repeated interview requests. In a written statement, the company defended the practice of marketing in criminal justice settings by noting that judges don’t actually prescribe their product.

No one-size-fits-all solution
Drug court judges interviewed for this story say they don’t mandate Vivitrol treatment, and that people can say no.

“We encourage it, but we never force anybody,” says Judge Gail Bardach of the Hamilton County, Ind., drug court, where Philip Kirby was a participant.

But facing potential jail time and court officials who really believe in Vivitrol, participants say getting the shot doesn’t always feel like a choice.
“They made it seem like they were forcing it upon me, like I couldn’t come into the program until I got it,” Kirby says.

For some patients, Vivitrol does help. Jeremy Templin went through the Hamilton County drug court program a few years ago after he was arrested for theft. He said the decision to go on Vivitrol seemed like it was made without him, but he credits his recovery, in large part, to the drug.

“I don’t know what it would have been like without it, but I know that I did have it, and here I am today,” he says. “I’m still alive.”

But Vivitrol is far from a one-size-fits-all solution. It’s not ideal for patients who are dealing with chronic pain on top of their addiction, or for pregnant women. It’s expensive. Furthermore, relapse rates for all kinds of opioid addiction treatment are high, and after a period of not using, tolerance for opioids is low. Treatment with Vivitrol, which contains no opioid ingredients, could make someone more likely to overdose if they relapse, addiction specialists warn.

Dan Mistak, an attorney with Community Oriented Correctional Health Services, says courts should allow all medication options and let doctors make treatment decisions — including whether someone should use medication in their recovery.
“We rely on outside experts all the time in the judicial system. We don’t ask a judge to come in and be an expert in arson,” for example, he says. “This is a responsibility that a judge doesn’t want.”

The federal government and the National Association of Drug Court Professionalsagree that courts should allow all three FDA-approved opioid addiction medication options.

“Especially with this exploding opioid use epidemic, we have to make available, as much as we can, whatever interventions are out there that are likely to be effective,” says Terrence Walton, chief operating officer for the NADCP, which lists Alkermes as one of its biggest donors.

For some judges, limited access to buprenorphine and methadone shapes their decisions about what to allow in drug court programs. The medications are heavily regulated, and many communities lack providers who can prescribe and dispense the drugs. Judge Bardach says she would consider allowing participants to use methadone if there were a provider closer to the court.

A need for regulation?
Currently, there is no regulatory agency that can ensure that judges follow best practices.

“There are not that many ways to leverage accountability over these courts,” says Christine Mehta, a researcher at Physicians for Human Rights. Mehta recently authored a report on drug courts, focusing on three states. “Really the key is attaching restrictions and requirements to funding,” she says.
The federal government has put some requirements in place for courts receiving grants from the Bureau of Justice Assistance. They have to show that they “will not deny any eligible client access to the program because of their use of FDA-approved medications for the treatment of substance use disorders.” But only about 200 of the more than 3,000 drug courts nationwide operate with help from a BJA grant.
The Substance Abuse and Mental Health Services Administration has similar grant-making guidelines in place, but it currently funds only 172 courts.
Mehta says states and counties need to implement similar requirements and work to educate drug court officials about all addiction medication options. She argues that until drug courts allow all of the medications, they’re not fulfilling their promise.

“If drug courts say that they provide access to treatment instead of prison, they are inherently violating that by saying, ‘Well, we only provide Vivitrol,’ ” she says.

Mehta says Alkermes’ marketing would be less effective if judges were compelled to follow best practices.

Georgetown researcher Fugh-Berman thinks that pharmaceutical companies like Alkermes should be barred from marketing to court officials and lawmakers.
“It would be great if the [FDA] went after this,” she says. “I think it does fall under their jurisdiction, but I wouldn’t rely on that being enough.” She says Congress could pass a law preventing such marketing, as well.

Philip Kirby says his probation officer finally relented when he lifted his shirt and showed that his rash was covering his whole body.

That rash has since cleared up, but it has left a pattern of white spots on his arms.

“I don’t know if they’ll go away,” he says. “I hope they go away eventually.”
He says he wishes he’d never taken Vivitrol in the first place.
http://www.npr.org/sections/health-shots/2017/08/03/540029500/to-grow-market-share-a-drugmaker-pitches-its-product-to-judges

Heard on Morning Edition

Here, Heroin Spares No One, Not Even the Sheriff’s Wife

Posted on: September 5th, 2017 by sobrietyresources No Comments

(CNN)Robert Leahy was sitting on his couch, watching TV, when his wife, Gretchen, walked through the front door.

It was about 10 p.m. She’d left for the grocery store hours earlier. Now, she “bumbled” about the room, Leahy says, incoherent and vacant. He’d seen her like this before.

“What the f**k are you doing?” he asked. “You’re high.”

After the initial shock wore off, Leahy was angry and embarrassed. He worried about his reputation and what his colleagues at the Clermont County Sheriff’s Office would think. He’d been a law enforcement officer for more than a decade, and now he was married to a heroin addict.

He needed to save himself and their young son. He had done all he could to save her.

Just weeks earlier, Gretchen had returned home to Madeira, Ohio, from Crossroads Centre Antigua, an addiction treatment facility founded by musician Eric Clapton. It was one of a handful of times she’d received treatment for opiate addiction in the past five years. Leahy says he spent more than $16,000 — nearly all of their life savings — to cover the cost.

And now she was high again.

On September 7, 2005, Leahy filed for divorce and a temporary restraining order. At the time, the US opioid epidemic was in its early stages. Abuse of prescription painkillers was a growing, if hidden, problem, and heroin addiction had yet to ravage rural and suburban America. That would soon change. Nearly 15,000 Americans — 500 from Ohio alone — died of an opioid overdose in 2005. In 2015, those numbers soared to 33,000 and 2,700 deaths, respectively.

At first, Leahy could not understand why his wife had let herself become an addict, why she had made that choice. But as he watched her struggle for years to stay clean, his knowledge of addiction matured. He began to see it as a disease in need of treatment and compassion.

More than a decade later, as Ohio grapples with one of the deadliest drug epidemics in American history, the state’s criminal justice system has undergone a similar transformation. Local officers and judges know that they can no longer treat all addicts like criminals. To stop an epidemic, they have to think like medical professionals.

‘This is a mass fatality crisis’
On July 31, the White House’s Commission on Combating Drug Addiction and the Opioid Crisis released an interim report asking President Donald Trump to declare the opioid epidemic a national health emergency.
Ohio has been one of the states hit hardest by the crisis. Last year, 86% of overdose deaths in the state involved an opioid. In Montgomery County, the situation is particularly dire. Local officials say that more than 800 people will probably die from an opiate overdose there this year, more than double last year’s record of 349 opioid deaths.
Law enforcement officials say the county’s location has made it an ideal distribution hub for Mexican drug cartels. Interstates 70 and 75, two major arteries that crisscross the nation, intersect in the northeast corner of the region. Officials say the cartels ship their product directly to Dayton, less than a 10-minute drive from the intersection. Then, local dealers hop onto one of the “heroin highways” and circulate opioids throughout the country.


A morgue in Montgomery County, Ohio, fills nearly every night with bodies from the heroin epidemic.

Most nights, the freezer in Montgomery County’s morgue is stacked floor-to-ceiling with bodies. Dr. Kent Harshbarger, the coroner whose office services more than 30 counties, estimates that 60% to 70% of these corpses are the result of an opioid overdose.

“What’s most challenging is seeing the same story repeated over and over again,” he said. “It seems, from my perspective, inevitable.”

Since last year, to deal with the surge in overdose deaths, Harshbarger has hired six part-time coroners, two autopsy technicians and three field investigators. He also extended some of the staff’s workday by three hours so they had time to perform more autopsies and remodeled the morgue freezer to fit more bodies.

Several times in 2015 and 2016, the office was overwhelmed, and he had to house some of the corpses in mobile morgues — trucks with refrigerated trailers. The state purchased the trucks in the mid-2000s with a grant from the Department of Homeland Security. They were intended to be used in the field to store bodies after a mass-casualty event like a plane crash or a terrorist attack. Harshbarger says the current crisis is not so different.

“Staff is overwhelmed,” he said. “This is a mass fatality crisis.”

What started as a heroin epidemic quickly turned even deadlier. Experts say the spike in overdose deaths in Montgomery, and in many places across the country, is largely due to heroin’s opiate cousins: fentanyl and its more potent analogues like carfentanil. Fentanyl is a synthetic opioid 50 to 100 times stronger than heroin. Carfentanil, originally designed as a large-animal tranquilizer, is 5,000 times more potent than heroin.

Montgomery County Sheriff Phil Plummer says that when addicts think they’re purchasing heroin, they’re more likely buying one of these synthetic opioids.
“We need to quit calling it a heroin epidemic; this is fentanyl.” he said. “It’s really not a heroin issue anymore.”

The numbers back him up. In 2016, 251 of the 349 opioid-related overdose deaths in the county involved only fentanyl or carfentanil, with no heroin present, and an additional 34 involved heroin laced with fentanyl.

To stem the tide of overdose deaths, the sheriff’s office is spearheading a new program called Get Recovery Options Working, or GROW. As part of the initiative, a sheriff’s deputy, a social worker, a medic and a member of the clergy visit a home where an overdose occurred within the past week. Together, they provide literature about Cornerstone Project, a local drug treatment facility, and talk to family members about how to best help their loved one, and if the individual is willing, the deputy will drive him or her to treatment that day.

“We just stop and tell them, ‘We love you and we care for you, we want to seek help for you,'” Sheriff Plummer said. “And we’re having tremendous success with that.”

Since the program started on January 1, GROW has reached out to 162 people who have overdosed, 57 of whom have entered treatment at Cornerstone Project, Plummer says. More than half of those who entered Cornerstone because of the initiative are still in treatment, says Cornerstone Project Community Outreach Manager Wendie Jackson.

A stopgap


By 2014, Leahy had climbed the ranks to chief deputy in the Clermont County Sheriff’s Office. That year, drug overdose deaths were also steadily climbing in the county, from 56 in 2013 to 68 by year’s end. It was the sixth year in a row the number of overdose deaths had risen.

Leahy recognized the trend and had an idea. He’d heard about law enforcement agencies in other parts of the country equipping their officers with a drug called naloxone, also known by the brand name Narcan. Administered as a nasal spray, the drug could reverse the effects of an opioid overdose and was easy to use. Leahy lobbied Sheriff A.J. “Tim” Rodenberg and volunteered to lead the initiative.

Rodenberg, Leahy says, was receptive but not convinced. He needed more information. The topic would be controversial, he told Leahy. Some in the community would, of course, think it’s a good idea, but others would consider it a waste of taxpayer money.

Leahy called other sheriff’s offices in the north of the state that were using Narcan and learned about the success they were having in saving lives.
He told Rodenberg what he’d heard and laid out the pros and cons of buying Narcan. Then, Leahy decided to speak from personal experience. He didn’t bring up Gretchen by name, but “I think he realized some of the decisions that I made, or the things I pushed along, were related to that.”

Leahy and Gretchen still shared custody of their son, but he says she was rarely around. She would stay clean for a few weeks — periods he calls “flashes of brilliance.” Each time, he hoped she’d turned a corner. But really, he was just waiting for her to relapse. If she overdosed, he would want the responding officer to have all the tools available to revive her, so she’d have the chance to fight another day.

“How can you get people into recovery if you can’t save their lives?” Leahy asked Rodenberg. Within months, the deputies were equipped with Narcan.

‘The challenge is to keep them alive’
In Montgomery County, the average opioid user is a 38-year-old white man, according to data collected by the sheriff’s office. But officials say the number of young addicts in the area has increased exponentially over the past five years.
County Juvenile Court Judge Anthony Capizzi estimates that nearly a quarter of the young defendants in his courtroom are addicted to either opiate painkillers or heroin.

“I have jurisdiction over children until they reach 21,” Capizzi said. “The challenge for me right now is to keep them alive that long.”
Capizzi presides over the county’s Juvenile Treatment Court. The young people in his courtroom have substance abuse issues and often, as a result, lengthy criminal histories. Capizzi puts the vast majority into some kind of treatment program; detention centers are the last resort.



Three and a half years ago, Rachel Chaffin walked into Capizzi’s courtroom. She was one of the first young defendants addicted to heroin that he’d seen in his 13 years behind the bench in Montgomery.

Chaffin was 15 years old. She had been captain of the JV cheerleading squad in high school and dreamed of one day cheering on the sidelines for the Dallas Cowboys. But growing up, her life was chaotic and unstable. Her family often teetered on the edge of homelessness. In December 2013, Chaffin got pregnant.

“I was 14. I was freaking out,” she said. “I ended up having a miscarriage.”

A drug dealer in her neighborhood later asked her whether she wanted to be a “tester” for his product and check the quality of the dope. She was scared but took the leap, fueled by a depression that consumed her after her miscarriage.
“Once I started doing it,” she said, “I didn’t want to stop.”

She landed in front of Capizzi after multiple felony and misdemeanor charges. Eventually, the judge removed her from her mother’s custody because she continued to use and put her in foster care. For the next three years, she bounced from group home to foster home, sometimes clean, sometimes not. She overdosed, and was revived by Narcan, three times.

Now 18, Chaffin eventually found a good foster home and graduated high school with a 4.0 GPA. She says she’s been clean since March, when she relapsed after another miscarriage. She says she struggles every day to stay clean, but when she feels weak, she remembers what a counselor told her during a recent stay in rehab.
“My counselor said, ‘I want you to picture your mom coming to the morgue to identify your body,'” she said. “That just broke me. I can’t picture putting my mom through so much.”

Before there’s no hope


In 2013, the Clermont County Sheriff’s Office collaborated with local mental health officials to open the Community Alternative Sentencing Center inside the local jail. The voluntary program offers people who have been convicted of a misdemeanor and have a substance abuse issue the opportunity to serve their sentences in a wing of the jail that is separated from the general population. Nearly 40% of the participants at any given time were once addicted to opioids.

The center is operated by Greater Cincinnati Behavior Health Services. The participants — or “clients,” as staff refer to them — receive group therapy and drug rehabilitation treatment, such as participating in Narcotics Anonymous.

In 2016, the voters of Clermont County elected Leahy sheriff. He says he never had aspirations for the position, but in 2015, Rodenberg told Leahy he was retiring and wanted Leahy to be his successor. Leahy ran unopposed. Now, he was in charge of a program he’d help shepherd for years.

Alternative Sentencing Center clients technically are not inmates, and there are no correctional officers in that wing of the jail. The clients are on probation, and as part of that, they’ve agreed to complete their treatment. But if a client leaves the program early, he is in violation of his probation.

Leahy says these programs can help people before they’re burglarizing homes or robbing people to feed their habit — before they’re burdened with a rap sheet full of felonies. Once a person reaches that point, they often believe there’s no hope. Leahy saw Gretchen fall into a similar abyss, and it took her years to claw her way out.

“If you can catch people in the early stages, where their life is starting to go south but it’s not totally out of control,” he said, “there’s a chance for them.”
He doesn’t want people to mistake his compassion for weakness. Those who commit felonies, he says, deserve to be in jail. But most people with substance abuse issues are better served in treatment, he says.

So far, the program has helped men exclusively, but in the fall, Leahy and GCBHS will open a women’s version in another wing of the jail. The Clermont jail now houses between 90 and 100 female inmates, nearly double the number a decade ago, Leahy says. Virtually the entire increase in population, he says, can be attributed to the crisis. Opioid overdoses have increased 2000% in Clermont County since 2007.

Both the Narcan and Alternative Sentencing Center programs seem to be paying off. Overdose deaths in Clermont County decreased from 94 in 2015 to 83 in 2016.

“Is it too early to tell? Well, I think by the end of 2017, if we can get two or three years in a row with those numbers trending down,” Leahy said, “I think people will realize and say, ‘I think somebody’s doing something that’s working.’ ”

Leahy says he speaks with Gretchen only occasionally now. There’s no ill will, but since their son has grown, there’s also no need. Gretchen says she’s been sober for three years, and Leahy gives her the benefit of the doubt. Not that he would ever ask. She doesn’t owe him any explanation, he says.

In some ways, he has a more clear-eyed view of her disease than even she does. Gretchen is still wracked with guilt from the years lost with their son and for driving her husband away.

“I think that was half of my issue. Every time I would get clean, I couldn’t let go of that guilt, shame,” she said. “And I still struggle with that to this day.”
But Leahy sees it differently. He says that the programs weren’t in place to save her, that law enforcement didn’t understand what they were dealing with yet. He’s learned that the addiction chose her, not the other way around.

“There is no rhyme or reason,” he says. “This is one of those deals, it’s kind of like fighting cancer. Your first heaviest, hardest hit is going to give you the best opportunity.”

http://www.cnn.com/2017/08/06/health/ohio-heroin-opioid-crisis-morgue-full/index.html

Story By Poppy Harlow
Article By Zach Wasser

US Drug Overdose Deaths Reach New Record High

Posted on: September 4th, 2017 by sobrietyresources No Comments


(CNN)The latest government numbers reported find that drug overdose deaths in 2016 continued to climb despite ongoing efforts to stem the the overdose epidemic.
According to the National Center for Health Statistics, estimates for the first nine months of 2016 were higher than the first nine months of the previous year, which had already reached an all time high of 52,404. Of those, more than 33,000 were attributed to opioid drugs including legal prescription painkillers as well as illicit drugs like heroin and street fentanyl.

Broken down into quarters, the third quarter of 2016, saw all drug overdose deaths peak at 19.9 cases for every 100,000 people, compared to the 16.7 in the same period last year. The first two quarters of 2016 also saw the number of overdose deaths climb from 16.3 deaths for every 100,000 people in the first quarter of 2015 to 18.9 in the first quarter of 2016, and 16.2 deaths in the second quarter of 2015 to 19.3 in the second quarter of 2016. However, the US Centers for Disease Control and Prevention, which publishes the national data, noted that the first two quarters were not significantly different from the same time frame in 2015. The CDC’s annual numbers on drug overdose deaths are usually about a year behind in reporting.

Epidemic’s impact may be underestimated
Another report earlier this week in the American Journal of Preventive Medicine found that the number of drug overdoses involving opioids between 2008-2014 was likely underestimated by 24%. When looking at overdose deaths involving heroin, the percent of overdose deaths were underestimated by 22%. These differences are likely attributed to the growing use of synthetic opioids like street fentanyl that medical examiners and health departments may not have included initially on death certificates. Experts have previously said the reported numbers of deaths were underestimated, but this is the first study to quantify just how much.

All these numbers seem to indicate a worsening trend in the drug overdose epidemic, which public health experts have been concerned about. The introduction of illicit fentanyl and other designer opioids like U-4770, more commonly known as Pink, which have sometimes been found cut into heroin and other drugs have unknowingly exacerbated an already troubling epidemic.

Just last week, President Trump’s commission on the opioid epidemic issued a report calling on the President to declare the drug overdose crisis a national emergency.

“Our citizens are dying. We must act boldly to stop it,” the commission, headed by New Jersey Gov. Chris Christie, said in an interim report. “The first and most urgent recommendation of this Commission is direct and completely within your control. Declare a national emergency.”

On Tuesday, President Trump is set to meet with Health and Human Services Secretary Tom Price to discuss the opioid epidemic.

By Nadia Kounang

http://www.cnn.com/2017/08/08/health/drug-overdose-rates-2016-study/index.html

It May Soon Be Possible To Immunize People Against Opioid Addiction

Posted on: September 2nd, 2017 by sobrietyresources No Comments

The opioid epidemic is spreading like a disease, so it’s fitting that the next major development in fighting it could be a vaccine. Researchers reporting at the 254th National Meeting & Exposition of the American Chemical Society (ACS) say they’ve made significant progress toward developing a vaccine against the effects of the synthetic opioid fentanyl and heroin.

Fentanyl mixed with other opioids, like heroin, has proven an especially deadly combination. According to the CDC, death rates in 2015 for synthetic opioids, including fentanyl, increased 72.2%, the highest on record. All indications are that rates for 2016 and 2017 will be much higher.


“There is an urgent need to discover effective medications to treat substance use disorders. Increasingly, drug users are turning to opioids and powerful synthetic versions of these drugs that can sometimes be as much as 100 times more potent than heroin,” says Kim D. Janda, Ph.D., head of the vaccine research team.

Unlike viral particles, opioid molecules are too small to be detected by the human body’s immune system, so the researchers found a way of linking opioid molecules to larger molecules that the immune system will identify. In response, the body produces antibodies that bind to the opioid molecules and prevent them from attaching to opioid receptors. This is different than current opioid preventatives like methadone, which block opioid receptors directly. The team reports that they’ve had success with this method against fentanyl and also against a combination of fentanyl and heroin (pre-clinical success of the process in rhesus monkeys was shown in a paper published in June in the Journal of the American Medical Society).

The team also reports that they’ve made progress developing a vaccine against a potent amphetamine combination drug called captagon, a major problem in the Middle East, showing that the vaccine theory is potentially applicable to a range of drug addictions.

While not yet ready for testing in humans, the current research is setting the stage for clinical trials for what could eventually be a major weapon against a problem that’s claiming more lives every year.

By David Disalvo

https://www.forbes.com/sites/daviddisalvo/2017/08/21/the-key-to-fighting-the-opioid-epidemic-could-be-a-vaccine/#156c1b254479

The Opioid Epidemic’s Biggest Culprit Isn’t Heroine Anymore – It’s Something Deadlier

Posted on: September 1st, 2017 by sobrietyresources No Comments

Andrew*, an HVAC engineer, looks better than your average 37-year-old, college-educated man from Canton, OH. Clean-shaven, wearing a fitted maroon polo shirt and black dress pants. Athletic. Energetic. Flirtatious.

He sits on the patio of a local restaurant, sipping his cocktail, skimming the menu at the kind of place you take your kids to after soccer practice.
“Yesterday I had one glass of wine, today I had two. Tomorrow, I don’t know,” Andrew says, both hands cupped around a sweaty vodka-soda with lime. “But it’s not heroin.”

But it wasn’t heroin two weeks earlier, either, when the husband and father of three woke up on the floor of his sober-living house to six men shaking him. They told him it took two doses of Narcan, an opioid blocker, to revive him after he overdosed on carfentanil for the sixth time this year.

It wasn’t heroin, because if you ask drug users, people in recovery, medical personnel, and law enforcement, they’ll tell you that drug has all but dried up in the state of Ohio, a state leading the country in fatal opioid overdoses, according to the Centers For Disease Control.

If it were heroin, it would’ve been made from morphine, which is derived from naturally occurring opium.

Carfentanil — a synthetic form of fentanyl — is generally used to sedate very large animals, like elephants, and it’s 10,000 times stronger than morphine. It’s the new drug of choice for those manufacturing and selling illicit drugs in the Buckeye State, which was home to a record-setting 4,149 accidental deaths due to fatal overdoses in 2016.

Fentanyl itself is another popular option. The drug is “50 to 100 times more potent” than morphine, according to the National Institute on Drug Abuse. Oftentimes, drug users don’t realize they aren’t getting quite what they bargained for until it’s too late.

Andrew noticed the switch about six months ago, when he started “falling out” — or losing consciousness — after doses he had previously considered normal.
“I was shooting up all day, every day,” he said, as he stretched out his arms to show dark bruises where his veins had collapsed under his skin. And then finally, one day, he overdosed.

The casual observer probably would never know that Andrew was battling opioid addiction at this very moment, but the crisis that’s hit America hard doesn’t discriminate.

Drug overdose deaths have now become the leading cause of accidental deaths in the US with 52,404 fatalities in 2015, according to the American Society of Addiction Medicine; 33,091 of those deaths, which equates to more than six out of 10, involved an opioid.

And it’s getting worse. While official numbers aren’t in yet, a New York Times preliminary report has the total number of drug overdose deaths for 2016 at more than 59,000, which it described as “the largest annual jump ever recorded in the United States.”

Addiction started for Andrew in 2009, when he started taking his mother’s oxycodone, which she had been prescribed after a medical procedure — he says because he “didn’t want her taking all of that.” He also had a longstanding Adderall prescription added to the mix.

His opioid and Adderall abuse went undetected by his wife until the Summer of 2016, when she noticed he was running out of the ADHD drug before the end of the month. After she made a call to his doctor, his prescription was revoked, and Andrew turned to cocaine. The way he tells it, his wife got fed up, took their kids, and left him, and one week later, he was shooting up heroin.

What Can We Do to Stop the Epidemic?

It’s not that uncommon of a story, and it can happen to anybody. President Donald Trump addressed that issue in his press briefing from New Jersey on Aug. 8. “Nobody is safe from this epidemic that threatens young and old, rich and poor, urban and rural communities,” he said. “Everybody is threatened.”
But what’s debatable is Trump’s view that amping up incarceration is the answer to the problem. In the same briefing, he pledged to increase federal drug prosecutions and implied he’d fight to lengthen sentences for convicted federal drug offenders. This is in stark contrast to the Obama administration’s approach to dealing with drug users.

Two days later, Trump told reporters in New Jersey, “The opioid crisis is an emergency, and I’m saying officially, right now, it is an emergency. We’re going to draw it up and we’re going to make it a national emergency. It is a serious problem, the likes of which we have never had.”

What methods the Trump administration will ultimately employ to combat the epidemic aren’t exactly certain at this time.

What we do know is that his comments about “upping federal prosecutions” were made despite a preliminary report issued on July 31 by his Commission on Combating Drug Addiction and the Opioid Crisis. The report almost exclusively recommended addressing shortcomings in access to treatment for addicts, along with prescription drug reform and stopping the influx of synthetic opioids (like fentanyl and carfentanil) from other countries, like China.

That approach is more in line with what people who are living in the throes of the epidemic think would be helpful.

Incarceration Doesn’t Work For Everyone
One of those people is Tugg Massa, 42, from Akron, OH. He’s a recovering addict and founder of Akron Say No to Dope, a nonprofit organization that serves Summit County, where as many as 250 people died last year from drug overdoses. Those deaths were largely attributed to the introduction of carfentanil in the area in June and July of 2016, according to Ohio.com.

Both fentanyl and carfentanil are a whole lot cheaper on the street than morphine and heroin, he explained, which is why they’re being cut with anything and everything people use to get high — usually unbeknownst to the drug user.
“It’s not like it was when I was growing up,” Tugg said. “Not to glorify drug use of any kind, but it’s a lot more dangerous now. It’s not heroin. Heroin won’t even get the people out there using drugs high anymore because this fentanyl and carfentanil are so strong.”

He knows what he’s talking about, as someone who used drugs for 27 years. Tugg’s been sober since Oct. 10, 2012, the day he was arrested for illegal manufacturing of methamphetamines.

When Tugg got caught, he was making meth to support his own opioid habit. He spent two years in prison for that charge, where, despite his surroundings, he got clean and earned his GED.

“It was difficult,” he said of his time there. “There’s a lot of drugs in prison. I had a drug dealer on one side of my cell and a drug dealer in the other cell next to me.”

Although he successfully overcame his addiction while incarcerated, he feels strongly that being locked up is not for everyone. Instead, Tugg is a major advocate for drug court, where people get the option of undergoing treatment in lieu of conviction. That means if they make it through a 12-month program, their convictions are dropped.

Treatment Is Crucial — When the Timing Is Right
Sheriff Steve Leahy of Clermont County, OH, generally agrees with Tugg about the need for more access to treatment, but also says it needs to be worked hand in hand with the judicial system.

“You can’t throw everybody’s ass in jail,” he said. “But what you also can’t do is hug your way out of it.”

Sheriff Leahy speaks from experience as both a member of law enforcement and someone who has witnessed firsthand a loved one’s battle against opioid addiction. His ex-wife’s struggles gave him valuable insight into what might work in his community.

He points out that some people simply aren’t responsive to treatment, possibly because they’re not ready for it at that point in their addiction.
“I think there are just some people who do need to be in jail or incarcerated. Maybe because they’re selling as a pusher or they are committing crimes and burglaries and other felonies,” he said. “You have to protect the community at large. Also, with the same breath, sometimes the only way to protect an individual from themselves is by having them locked up until you can get them to a point of treatment.”

Whatever they’re doing in Clermont County seems to be working. The death toll skyrocketed to 94 in 2015, placing Clermont at the top of the state for accidental overdose deaths, according to Leeann Watson, associate director of Clermont County’s Mental Health Recovery Board. That figure was up from 68 in 2014 and 56 in 2013, said Watson, who is also cochair of the opiate task force. But in 2016, the number dropped slightly to 82 deaths.

One tool that Leahy believes in is his county’s community alternative sentencing program, which people can choose to participate in while they are incarcerated.
The program is administered in a wing of the county jail dedicated exclusively to those who have volunteered for treatment. It’s an opportunity for convicted drug offenders who are ready to tackle sobriety to make the best use of their time.
“You have to have the buy-in of the court system, which includes the probation department and other mental health and addiction specialists,” Leahy said. “It’s kind of a multipronged attack.”

Court Programs Can’t Help When Drugs Don’t Show Up on Tests
Andrew, who was placed on probation in January after officers found a needle in his car when he got pulled over for speeding, hasn’t had to face a choice like those convicted in Sheriff Leahy’s jurisdiction yet.

Not after trying out replacement drug therapy with Suboxone and methadone; not after attending treatment facilities in both Mexico and Florida; not after witnessing two people die from opioid overdoses in his own home on two separate occasions. And not even after his own latest overdose.

When his sober-living housemates revived him just two weeks ago, the police were called and he was taken to the hospital.

If he had tested positive for drugs at the hospital, he would’ve been kicked out of the sober-living house and sent to jail for violating probation.
The crazy thing is, his drug test came back negative.
“I’ve been given a lot of grace,” he says.
“Grace” for Andrew, this time, came in the form of a standard urine test that didn’t detect the particular concoction of street opioids that shut down his system.

Yes, you read that right. The standard drug tests administered at many hospitals that treat overdose victims don’t pick up carfentanil and the street versions of fentanyl that are killing people in record numbers.

“You have to know what you’re looking for,” said Dr. Barry Sample, senior director of Science and Technology at Quest Diagnostics.

Dr. Allison Chambliss, assistant professor of Clinical Pathology at the Keck School of Medicine of USC, elaborated, “Fentanyl and carfentanil are structurally distinct from the other major opioids, and so do not get detected up by the routine urine opioid drug screens out there that are designed to pick up morphine, codeine, and heroin.”

Even if you might have an idea what you’re looking for, oftentimes the proper tests simply aren’t run — either because they’re too expensive or the facility where the victim is being treated doesn’t have the proper equipment.

Usually it’s only large reference and specialty toxicology labs that have the tools required to carry out these kinds of tests, even though they could be run on urine or blood samples, just like more general opioid tests, Chambliss said.

In Andrew’s case, the standard test was apparently run, and it came back negative for opioids. He was released from the hospital and was able to go back to the sober-living facility with no probation violation recorded.

Even after that close of a call, where he narrowly escaped losing his liberty — and his life — he admits, “I still can’t promise I’ll never use opioids again. It’s too good.”

“Ready” and “Rock Bottom” Look Different For Everyone
Tugg pointed out that in his ministry of recovering addicts, “They have to come to me. I can’t go chasing people down.”

He shared Sheriff Leahy’s sentiment that drug users have to be ready on their own, which many addicts describe as their “rock bottom” moment. For him, it was a letter from his daughter while he was in prison, asking him, “Who do you think you are?”

Rock bottom for Jessica*, 26, from Los Angeles looked very different.
Having used drugs since the age of 13, Jessica became addicted to opioids at 16 after trading away cocaine for “tar” and not realizing that it was, in fact, heroin.

At one of her worst moments, she was homeless, on the street, doing whatever was necessary to score drugs. At another, an obsessed partner held her against her will for half a year.

Jessica says her captor forbid her from speaking to anyone else, eating, showering, or even using the bathroom outside of his presence. She finally convinced this man that her going to treatment would be better for their relationship, which is how she escaped that situation.

“When I got to treatment, I had to learn how to form sentences again. I couldn’t speak. I didn’t know how to raise my head and look somebody in the eye,” she said. “Even just eating was a big thing. I didn’t know how to do that anymore. I had to learn how to stop asking permission for things, which was really hard. That’s something that I still struggle with today.”

But even being held against her will wasn’t what brought her to the realization that she needed to get clean.

Her epiphany came in 2012 at the age of 21, when she had “everything” in every materialistic sense of the word. She was living with a wealthy man — who supported her $400-a-day heroin habit — in a beautiful home in Southern California. She said it was hitting an emotional bottom that finally did her drug use in over a period of four months when she was trying to overdose every single day.

“It was a feeling of desperation that was something I hadn’t felt before,” she said. “That true desperation of, ‘I have everything in the world, but I am nothing,’ that’s what was different this time than all the other times. I finally realized that I as a person had no self-worth.”

“I would be looking in the mirror at myself, because I was an IV user, and I would shoot in my neck, so I would have to be in front of a mirror. I’d be standing in front of a mirror, looking myself in the eyes as I’m injecting my neck with heroin trying to die,” she said. “Praying that you don’t wake up this time, that is the scariest feeling in the whole world,” she said.

Today, she’s five years sober and has been working for the last two and half years at a sober treatment facility in Texas, which she credits with helping to maintain her sobriety.

The Street View of How to Fight the Opioid Crisis
It’s unclear exactly what will happen to the wide-scale handling of this epidemic nationwide, if and when the opioid crisis is officially declared a national emergency, but Jessica and the other people we interviewed for this story have a wish list.

Sheriff Leahy, Jessica, and Tugg all agree that more in-house treatment facilities are crucial in this fight.

“When someone is ready to get off of drugs, we need to address that right then,” Tugg said. “We need more beds. No wait time.”

Jessica noted that in addition to more beds, facilities need more time.
“Long-term treatment is what’s working. The 30-day treatment centers are not long enough. You can’t work through all the trauma that you’ve caused to yourself as an addict. Your first week, you’re detoxing. Your second, third week, you might be going to groups and start having emotions again, and your fourth and fifth week, you’re planning your discharge already. So you’ve really only gotten a week of actual treatment,” she said.

“Starting to form new habits takes a long time. You can’t learn that in 30 days, which is why I stayed in treatment for a year and a half,” Jessica said. “A lot of treatment centers are only 30 days, which is why they’re always full because people, they’ll go in, 30 days, get out, relapse, and go back in. The long-term places are getting people and holding them and really turning them back out to be productive members of society.”

From a law enforcement perspective, Leahy would also like to see funds available for “one or two more” directed patrol officers, meaning members of law enforcement who are assigned a specific task for a particular purpose. In his community, that purpose would be to have more of a presence to help stop the flow of drugs across jurisdictional lines.

“And maybe a reinstitution of D.A.R.E. or something similar to that,” Leahy said. “We can do whatever we’re doing now, but we’ve got to get to the young people.”
At the federal level, Trump alluded during his press briefing to the fact that he’s talking with China about “certain forms of man-made drugs that come in.”
That prospect got Tugg excited.

“We need to put sanctions on China. If they’re not going to regulate what they’re sending over here, then there should be sanctions against them,” he said. “The fentanyl and carfentanil that’s going around, they can get it right through the mail from China and get it dropped off right at their house.”

Andrew says he got his last batch of opioids from his housemate, who is connected with one of the major drug cartels in Mexico. He won’t say how it arrived in Ohio.
We asked what advice he would give — after everything he’s experienced — to someone who was considering trying opioids for the first time today.

“I would say, ‘Pull out your phone and look up epitaph, because you’re gonna want to know what that word means,'” he says. “And then tell everyone you love that you love them. And then flip a quarter. Because there’s a 50/50 chance you’re gonna die.”

*Names have been changed to protect the identities of these sources.

by Stephanie Haney

https://www.popsugar.com/news/What-Fentanyl-43913253

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