Opioids & Heroin Epidemic

opioid and heroin epidemicThe opioid epidemic is a serious problem in America today. In the late 1990s and early 2000s, prescription opioid drugs were touted as low-risk solutions for chronic pain and other conditions. Thousands upon thousands of people all across the country were led to assume that opioid drugs were relatively safe solutions to temporary or chronic pain, and these days, almost everyone in America knows somebody whose life has been negatively affected by these dangerous drugs.

As the use of prescription opioid drugs became more and more widespread, another equally destructive problem continued to simmer in the background: heroin abuse. In recent years, these two disparate issues have combined into a maelstrom that is ravaging the country. By learning more about the origins of the opioid epidemic, you can insulate yourself against the dangers that this mounting trend poses.

What Are Opioids?

Opioids are a class of drugs that block pain by directly interacting with pain circuits in the brain. In addition to reducing the sensation of pain, these drugs also produce a euphoric high that quickly becomes addictive. When opioid drugs are used in their prescribed concentrations, they can be effective short-term tools for fighting pain, but abusing these drugs quickly results in addiction.

The original opioid was opium, which was used in the ancient world for analgesic and recreational purposes. Opium is extracted from the bud of the poppy flower, and it is also known as the “milk of the poppy.” While opium itself isn’t widely used in the West anymore, every type of synthetic opioid is in some way derived from the substance. For instance, morphine was one of the first isolate opioids to be extracted from opium, and it is still widely used in medical settings today.

Morphine is much more powerful than normal opium, and the first signs of opioid abuse in America began with cases of morphine addiction in the mid-20th century. However, another synthetic opioid known as oxycodone rapidly supplanted morphine as the go-to drug for cases of pain that were moderate to severe. Today, oxycodone is widely known by its brand names OxyContin and Percocet, and it is one of the main drivers of the opioid epidemic.

As medical drugs like morphine and oxycodone gained popularity in the mainstream, another type of opioid steadily crept into American homes from the shadows. Known as heroin, this morphine derivative is of much lower quality than other types of opioid drugs, and since it is made by criminal drug gangs, there is no way for end users to guarantee that their supply is safe. This drug is usually cut with cheaper substances, and long-term users often inject it into their bodies with needles that may or may not be safe.

Heroin powder is white in its pure form, but most types of street heroin are brown due to additives. An even more insidious type of this drug is also available to street users: black tar heroin. It is either gummy or hard as a rock and derives its name from its black color. This type of heroin is the cheapest, but it is also more likely to be filled with pollutants than any other form of this street drug.

In recent years, however, a street drug that’s even more dangerous than heroin has made its debut. While fentanyl is used in hospitals under extreme circumstances, this drug is also manufactured in China and other countries and smuggled into the United States for illicit use. If fentanyl were just another opioid like oxycodone or morphine, it would be easier to lump this drug into the existing opioid crisis. However, fentanyl is a synthetic opioid that is much stronger than others traditionally manufactured in the pharmaceutical industry.

The Centers for Disease Control and Prevention (CDC) has estimated that fentanyl is 50 to 100 times stronger than morphine. As an abused substance, fentanyl had its debut as an incredibly potent designer drug that was mainly used by wealthy coastal elites. As prices of fentanyl have dropped, however, it has been much more widely used.

These days, it’s common to find fentanyl included in bags of street heroin. Many users are unaware of the presence of this drug in their supply, and they may choose to use their regular dose immediately upon receiving a new bag of drugs that has fentanyl in it. The results of this choice can be disastrous. Because fentanyl is so much stronger than normal heroin, it’s far easier to overdose on heroin that has been spiked with this highly potent synthetic drug.

What Is Fueling the Epidemic?

There are a number of factors that are contributing to the ongoing prevalence of the opioid epidemic in the United States. It’s possible to trace the origins of this pressing social issue back to earlier days of heroin abuse in the United States. During the waning decades of the 20th century, heroin became more and more popular throughout the country. When opium production spiked in Afghanistan in the years following 9/11, this problem only became worse.

Today, it appears that a significant amount of heroin is still coming into the U.S. from foreign countries. While cocaine and marijuana seizures on the country’s borders have decreased in recent years, heroin seizures have increased in some areas. Additionally, although there is no statistical information yet available on fentanyl seizures along the border, a U.S. citizen was recently arrested while attempting to smuggle nearly 11,500 fentanyl pills across the San Ysidro Port of Entry. Fentanyl is so powerful that a batch of pills of that size could easily poison a sizeable town.

Despite the fact that fentanyl poses such a danger to users, companies in China and other countries continue to produce this drug. In many cases, these companies often sell fentanyl directly to American citizens over the dark web. In other situations, fentanyl is smuggled into the country for illicit use. However, increased awareness of the dangers of this drug is minimizing the domestic market for fentanyl.

Historically, one of the biggest impediments to halting the opioid crisis has been domestic opioid manufacturers. For instance, the manufacturers of OxyContin, Purdue Pharma, once claimed in their official materials that their prescription opioids were safer than morphine and other types of opioid drugs. These types of misguided marketing campaigns led many doctors to believe that some opioids were safer than others. In many parts of the country, prescriptions for these drugs increased. For example, in the state of West Virginia, 110 opioid prescriptions were written for every 100 people in 2013 at the height of the opioid crisis. While certainly not all of these prescriptions were illegitimate, the sheer number of pills being prescribed made the drugs much more widely available for use.

The rise of prescription painkillers has even had a bleed-over effect into heroin abuse. According to the National Institute on Drug Abuse (NIDA), using prescription opioid drugs increases the likelihood that you will use heroin. This phenomenon is partially fueled by the fact that this drug is generally cheaper than prescription opioids, and it’s easy to find a supply of heroin even when your doctor refuses to prescribe you any more opioids.

To briefly recap, here are the most prominent reasons why the opioid crisis is still a significant problem in the United States:

  • Medical: Doctors have prescribed much higher doses of opioids than are safe for extended periods of time.
  • Smuggling: Many tons of opioids have come over the U.S. border in recent decades. These drugs continue to be smuggled into the country.
  • Plentiful supply: The dangers of opioids are becoming better known, but these drugs are still widely produced and prescribed.
  • Prescription and illicit overlap: Since both heroin and prescription opioid drugs are widely available, it’s easy for addicts to remain addicted.

What Is Being Done

In recent years, greater attention has been paid to the problems that have arisen from increased opioid drug use in the United States. The Trump Administration declared that the opioid epidemic is a Public Health Emergency in 2017. This declaration has brought more attention to the blight of opioid drugs in American communities, and members of the Trump administration have begun coordinating with local officials around the country. Alongside the highest office in the land, policymakers and medical professionals across the United States are leading a national conversation focused on how to best combat this issue in local communities that each face their own unique problems.

The greater emphasis on border security has also helped decrease the supply of opioids entering our country illegally. While keeping illicit opioids from passing through our points of entry will ultimately require the help of other nations, every border seizure of heroin or fentanyl is another batch of drugs that won’t make it into the hands of Americans who suffer from opioid addiction. The incoming Obrador administration in Mexico has promised to work with the U.S. government to fight the power of the cartels in Central and South America. In addition, better diplomatic relations with China will inevitably lead to decreased fentanyl production.

An increased public awareness of the danger that opioids pose has been the most effective measure in curbing the spread of this epidemic. While stopping the drug supply is one half of the equation when it comes to stamping out the opioid menace, education is another critical part of this initiative. An informed populace will be less likely to make decisions that are harmful, and adults who have been educated regarding the dangers of opioids will pass their knowledge down to their children. In decades past, Americans were largely unaware of the dangers that opioids posed to themselves and their communities. However, the American people have woken up to the problem and many are actively working to find a solution.

Increased prevalence of abuse-deterrent formulations (ADFs) in prescription pills has made it harder for people to abuse drugs like OxyContin and Percocet. However, ADFs aren’t present in the majority of prescription opioids, and they aren’t present in any illicit drugs like fentanyl or heroin.

If more people become aware of the dangers of opioid drugs, and if fewer opioids are made available to the populace, this fire will naturally extinguish itself. In the raging blaze that is opioid addiction, the drugs themselves are the wood and ignorance about the dangers of opiates is the oxygen. When starved of these vital components, any fire has no choice but to go out. By surrounding this problem from all sides, we are making the gradual destruction of this danger to our well-being a guaranteed inevitability.

Effects of Heroin on the Brain

inhaling heroin how it effects the brainThere’s a new and disturbing trend among heroin users that involves inhaling heroin instead of injecting, sniffing or snorting it. “Chasing the dragon” is what this method of heroin ingestion is called. It involves heating heroin in a pipe and inhaling the fumes.

Chasing the dragon has become a popular way to use heroin because it protects users from the hazards of injection. For example, shooting up, which is another name for injecting, can cause skin abscesses. Sharing needles with other users can facilitate the spread of infectious diseases like AIDS and hepatitis.

Hazards of Chasing the Dragon

Chasing the dragon has been identified as a new threat to health according to a recent study about the effects of heroin on brain function published in JAMA Neurology. According to researchers, inhalation does offer protection against the hazards of shooting up. However, it can also cause dementia, coma, irreversible brain damage and death.

One of the lead researchers, neurologist Ciro Ramos-Estebanez of the University Hospitals Cleveland Medical Center in Ohio, learned in 2015 of an unusual side effect in a woman who had been inhaling heroin.

The woman had fallen into a coma caused by hydrocephalus. That’s an excessive buildup of spinal fluid in the brain. The hydrocephalus was caused by chronic inflammation of the brain, and the inflammation was caused by regular heroin inhalation. Although the woman recovered from her coma following emergency surgery to remove the trapped spinal fluid, she suffered from side effects of heroin on brain function. Her symptoms included permanent cognitive impairment.

Hydrocephalus Connected to Heroin Use: A New Phenomenon?

This was the first case of hydrocephalus that had ever been reported in connection with heroin inhalation. Because hydrocephalus is not recognized by health professionals as a side effect of heroin, Dr. Ramos-Estebanez decided to explore the issue further and to identify the reasons behind it.

Dr. Ramos-Estebanez and his team examined over 30 case studies. The reports included two incidents that had involved patients at their own hospital. Based on this study, the team came to some interesting conclusions regarding the inhalation of heroin.

Although there’s little official information about the frequency of heroin inhalation, the information available indicates that inhalation is more common than most health professionals realize. This method of ingestion is currently on the rise, and it’s quickly becoming the most popular way to use.

More than two-thirds of heroin users in India and Norway admit that they regularly inhale heroin. Available information also suggests that inhalation is becoming popular among teenagers in large urban areas east of the Mississippi. In 2014, 21 percent of all heroin-related inpatient hospital visits by teenagers between 12 and 19 years old were due to heroin inhalation. This method of drug ingestion appears to have become a global phenomenon, and it’s currently reaching epidemic proportions in the eastern United States.

Side Effects of Heroin Inhalation

The side effects of heroin inhalation range from mild to severe. There can be mild memory loss and long-term cognitive impairment at one end of the continuum. The worst-case scenario at the other end can involve killing off cells and creating spongy holes in the brain’s white matter. White matter consists of connective tissue through which brain cells communicate. Damaged white matter is associated with seizures, progressive dementia, trouble speaking, coma and death.

A Potent and Toxic High

There is growing concern that chasing the dragon will make heroin more accessible because needles and other drug paraphernalia are no longer a part of getting high; all users need is a pipe. Users also report that the intensity of the high from inhaling is much greater than with snorting or sniffing. That could account for greater interest in heroin by those who previously did not use it and increased consumption of heroin by those who do use it.

The JAMA researchers hypothesized that heating heroin to the high temperature required for inhalation changes it into a chemical that easily crosses the blood-brain barrier and reaches the brain immediately. This barrier normally screens out harmful substances. However, vaporized heroin crosses the blood-brain barrier so quickly that there’s no chance for it to be metabolized by the body into a less harmful substance before it enters the brain. The faster heroin enters the brain, the greater the high and the more addictive the drug becomes. The result is a seductively potent high that’s directly harmful to the brain.

Inhaling Heroin: An Emerging Public Health Problem

Based on the results of the study, Ramos-Estebanez said that medical professionals who treat heroin users should be aware of the practice of heroin inhalation and of the risks involved. Ramos-Estebanez calls heroin inhalation “an emerging public health problem.” However, he believes that lives can be saved if the symptoms are recognized early. In fact, researchers have already identified drugs that could prevent catastrophic brain damage if they are administered early on.

Risks Associated With Long-term Heroin Use

Regardless of the method of ingestion, the long-term effects of heroin on brain function can be catastrophic. The most notable effects are long-term changes in hormonal levels and shifts in the brain’s neuron system. These changes are not easily reversed and can cause discomfort for those trying to kick the habit. The white matter of the brain is damaged regardless of how the drug is ingested, and this damage affects decision-making, behavioral regulation and the ability to cope with stress.

Heroin quickly creates high levels of tolerance. That means the dose must be increased regularly. Heroin also causes severe physical dependence, and withdrawal symptoms occur rapidly if drug use is reduced or stopped. Within hours after the last dose, withdrawal symptoms kick in. They can include diarrhea, vomiting, repetitive movements of the legs, muscle and bone pain, restlessness, insomnia and an acute sensitivity to cold. Symptoms are most intense during the first 48 hours. In a best-case scenario, the symptoms ease off after that.

The faster heroin reaches the brain, the more intense the high and the greater the risk of developing heroin use disorder. A heroin use disorder can range from mild to severe, and the most severe form is addiction. With this chronic condition, users cannot get clean or stay clean on their own. The craving for drugs causes the user to do whatever is necessary to get heroin regardless of the consequences. Getting and using the drug consume a user’s entire life, and heroin ingestion continues even when the use of the drug causes serious and life-threatening health problems.

Subjective Effects of Heroin When Smoked, Injected, Snorted or Sniffed

Heroin converts to morphine in the brain and quickly binds to opioid receptors to produce a pleasurable sensation called a rush. The rush can be accompanied by a pleasantly warm flush, heavy extremities and a dry mouth. Depending on the dose, there may be “nodding out.” That occurs when a user vacillates between a conscious and a semi-conscious state.

Users may also experience vomiting, nausea and extreme itching. The initial rush is usually followed by slowed-down breathing and a decreased heart rate. If enough of the drug has been ingested, slowed-down breathing can lead to coma, permanent brain damage and death.

Physical Effects of Heroin on the Brain

Heroin slows down breathing by impacting neurochemical activity in the brain stem. The brain stem controls automatic body functions like heart rate, blood pressure and breathing. Heroin also impacts the limbic system, which governs emotional states, sleep and pleasure. Heroin is a pain reliever, and that pain relief is delivered via the spinal cord.

Brain Damage Caused by Heroin and Methadone

Methadone is a synthetic drug used to treat those with heroin use disorder. Patients visit a clinic and are dispensed a dose of methadone powder mixed with juice that keeps withdrawal symptoms at bay for 24 hours. Methadone maintenance, as it’s called, is thought to be safer than heroin because it’s ingested orally and administered in a clinic, and it involves neither injections nor inhalation.

Researchers in a study at the University of Edinburgh published their results in the Journal of Neuropathology and Applied Neurobiology. The study examined the effects of heroin on brain function  in 34 heroin and methadone users who had died at an average age of 26 years. Their brains were compared to the brains of 16 young adults who were not drug users but who had died young.

The researchers found that opioid users’ brains were up to three times more likely to have sustained brain damage when compared to the brains of those who did not use drugs. The drug users’ brains were similar to the brains of older people, and they had brain damage similar to that found in patients with Alzheimer’s disease. The researchers called this effect the premature aging of the brain.

The brains of deceased heroin and methadone users had damaged nerve cells in brain areas associated with memory, learning and emotional well-being compared to the brains of those who did not use heroin or methadone.

Drug users’ brains were similar to the brains of people experiencing early Alzheimer’s disease. Their brains showed “significantly higher levels of two key proteins associated with brain damage.” Heroin and methadone have also been linked to low-grade brain inflammation.

Brain Damage and Cellular Death

The researchers found that a key brain protein called Tau, which facilitates communication between brain cells, had become insoluble in certain cells. That, in turn, caused nerve cell damage and even cellular death in certain areas of the brain.

There was also an accumulated level of amyloid precursor protein. This suggested that there had been a disruption of protein transport in the brain at a cellular level. Protein buildup can cause serious nerve cell damage and death in key parts of the brain that are essential for healthy functioning.

Other Effects of Heroin on the Brain

Neurotransmitters in the brain that regulate pain, pleasurable feelings and hormonal release are all affected by heroin, methadone and morphine. Opioid drugs increase pleasure and reduce pain. These drugs stimulate the brain’s reward centers, which, in turn, creates a craving for more drugs. In healthy brains, these centers are stimulated by naturally occurring neurotransmitters. With drugs, the presence of these naturally occurring neurotransmitters is reduced or limited. That creates a dependence on drugs to provide normal levels of stimulation.

Heroin Inhalation and Asthma

Inhaling heroin can be dangerous for those with asthma. Three asthmatic patients in Britain required mechanical ventilation soon after inhaling heroin. Two patients died due to acute severe asthma after inhaling heroin. Two asthmatic patients refused to stop inhaling heroin despite the health risks.

Heroin Inhalation Thought by Users to Decrease Risk of Infectious Diseases Caused by Injection

Half of all U.S. heroin users live in New York, New Jersey and Connecticut. Up to 80 percent of users in clinics report that they no longer inject heroin. One-third of those who enter drug rehabilitation for heroin use disorder say they’re snorting, sniffing and inhaling heroin to guard against infectious diseases like AIDS.

Treatment for Heroin Use

Treatment for heroin use disorder generally involves an inpatient stay in a medical detox facility during which users are gradually weaned from the drug. After the patient is stabilized, he or she may participate in treatment modalities like education, individual and group counseling and medication.

Most recovering heroin users are encouraged to attend support group meetings like Narcotics Anonymous. Recovery also involves developing the ability to deal with the urge to use and learning techniques to reduce the effects of triggers that could lead to a relapse.

Some treatment programs even use devices to help curb withdrawal symptoms. In 2017, the FDA approved the use of an electronic stimulation device. Known as the NSS-2 Bridge, the device is placed behind the ear and helps to reduce withdrawal symptoms by sending electrical pulses to stimulate certain key nerves in the brain.

It’s entirely possible to recover from a heroin use disorder, but it’s best not to do it by yourself. There is plenty of help available that can take you from a medically supervised detox to residency in a sober house. Treatment options include both inpatient and outpatient programs that can be long- or short-term depending on your needs.

Revolutionary Treatment: The Opiate Intervention Court of Buffalo

If someone punches his or her own face, are there assault charges? If someone eats two family-size bags of Doritos every night for a week, does he or she get brought up on abuse charges? If someone were to walk a tightrope, does the court issue an arrest warrant for reckless endangerment? The answer to all of these questions is no.

However, answer this question: If someone abuses heroin or prescription pills that don’t belong to them, are there potential charges? The answer becomes a yes, even though no crime against anyone else has been committed. Plus, criminal charges, often heavy ones, are levied against the substance abuser. Why is the answer yes here? Especially when thousands of American people are fatally overdosing on opiates every year?

The Opiate Intervention Court, which started May 1st in Buffalo, NY, is changing the answer from a yes to a no.

Not treating drug addicts like criminals, but instead treating them for the disease of addiction, seems almost like common sense. Still, the Buffalo-based program is the first of its kind in the US to do what it does. So what does it do?

A First of its Kind

In 2014, the first year that set records for deaths from opiates in America, the city of Buffalo experienced roughly 175 deaths caused either by heroin or opioid prescription drugs, both of which fall into the family of opiates. Last year, Buffalo saw 300 deaths caused by opiates. The epidemic is everywhere nationally, but obviously the big city of western New York has it worse than some.

That’s why, starting on the first of May of this year, the city of Buffalo introduced the Opiate Intervention Court. As reported by local news network WKBW in late May: “With the support of local government, law and health service officials, this new court that started at the beginning of May will work with the city’s existing Drug Court, but will offer more immediate help to those suffering from addiction.”

So, since it’s the first of its kind in America, Buffalo’s new court system is truly revolutionary. Non-violent minor drug offenders, who fill nearly half of our jails, are not criminalized. They are helped. This is because the overwhelming majority of them has no criminal background, and simply acquired a disease… opiate addiction. Some studies suggest that up to 90% of such addicts, (most of them heroin addicts – some pill addicts), began with using legally-prescribed opioid medication.

Treatment begins immediately after the arrest. First there is a screening for opiate addiction. Next comes arraignment, after which “that individual is referred to an appropriate treatment program, with counseling, guidance and the support of the justice system and community from day one,” according to WKBW.

This is vastly different even from pre-existing drug courts, which have been around for thirty years. Before Buffalo’s new method, arrest, arraignment, and even jail time on occasion all came before any kind of treatment. This is still how it’s done everywhere else. Buffalo makes it seem outdated.

For Example

Let’s make up Betty, a non-violent, 27-year-old woman whose worst criminal offense before her arrest for possession of heroin last week was a parking ticket. Two years ago she broke her foot in three different places during a cliff-jumping accident. Her doctor prescribed her OxyContin and she became addicted. The prescription ran out, was not refillable again, and she turned to something much cheaper and much more readily available: heroin.

Today, Betty is a heroin addict, but functional in society. However, at the bank one day, she is extremely high on heroin, maybe even close to an overdose, and accidentally drops her baggy of heroin on the floor. There so happens to be an on-duty police officer in the bank who sees it. Betty gets arrested.

Now, in virtually every court of law across the country, Betty would be treated as a criminal. Depending on the state on which attorney she can afford, charges could range from probation to years of hard time. Neither scenario helps Betty get sober.

Let’s say that same exact thing happened last week but in Buffalo. She would still get arrested, but things would be much different from there.

How it Works

Betty would be screened for an opiate addiction the morning of her arraignment, prior to the arraignment itself. From there, she would be placed into an inpatient treatment program, run by professional experts. Also, she would have a curfew of 8:00 PM. Also, addicts like Betty in the Opiate Intervention Court are seen every single day, for 30 to 45 days, by City Court Judge Craig Hannah himself. He and fellow City Court Judge Robert Russell, Jr. are running the new court system together.

From there, Betty’s future depends on the severity of the drug charges. As written in the Buffalo section of BizJournals: “Once a defendant is stabilized in the program, a decision will be made by the Erie County District Attorney’s Office and the defense bar on sending the offender to drug court, according to [Judge] Russell.”

Charges are adjourned while participants are in the program, and if participants are successful, charges are usually at least lessened. “We could have the option to dismiss the charges. We could have the option to give a reduced plea. We have multiple options available to use if the person successfully goes through the program,” said Buffalo District Attorney John Flynn at a press conference in late May.

As of July 10th of this year, a total of 80 participants had gone through Opiate Intervention Court, and zero had overdosed. Ten warrants had been issued for failure to appear, but this is the worst outcome thus far.

Take Ron Woods, a real person from Buffalo who recently went through the program. At age 21, he became addicted to the opioid painkillers he was prescribed alongside his cancer treatments. Once the prescription was over, Ron turned to heroin. Flash forward through over a decade of addiction, and in May of this year, Ron, now 36, was arrested on felony drug charges. He was offered participation in the Opiate Intervention Court.

Ron was interviewed by the Associated Press, was the story was published by ABC. In the story, Ron spoke about the program with candid honesty: “This 30-day thing is like being beat up and being asked to get in the ring again, and you’re required to. This court makes it amazingly easy. Normally I’d be like, ‘This is stupid,’ but for the first time I had an optimistic outlook and I wanted to get clean.”

How it Came to Be

Buffalo, as mentioned, has a pretty awful opiate problem. In the 52.5 square-mile city alone, people are dying at a rate of nearly one per day. Therefore, several Erie County officials, judges and police officer among them, decided it was time to start treating opiate addiction more humanely. The county asked the US Justice Department for some federal funding, and received a three-year $300,000 grant. This was another first. No drug court in US history had ever received a federal grant. [Why not? Who knows…]

Anyway, the money helped create the possibility of treatment for participants, and as stated previously, the experimental court system worked. As written in the ABC article: “We have an epidemic on our hands. We’ve got to start thinking outside the box here,” said Erie County District Attorney John Flynn. “And if that means coddling an individual who has a minor offense, who is not a career criminal, who’s got a serious drug problem, then I’m guilty of coddling.”

The court is ready to treat up to 200 people per year, and to have treated 80 in less than three months is well above par. Judge Hannah, the main proprietor of the system, has literally not taken a day off from work since May 1st when the court began. “Our goal is to save lives. That is our purpose. If saving lives means we got to put their criminal case on the bench for 30, 60, or 90 days, we have our partners in government who agreed to do it and we’re going to do it,” he said to WKBW.

Remember how Buffalo had 300 opiate deaths last year? Well we’re over halfway through this year, and there have been less than 70. It seems like improvement has already begun. Plus, Buffalo’s revolutionary court system has already inspired eight other US states to begin mixing treatment with justice: Alaska, Indiana, Kansas, Minnesota, North Carolina, New Jersey, Virginia, and Washington.

A revolution in the treatment of minor drug offenders may have begun.

A Beautiful Future

A quite similar program in Buffalo recently received much more than $300K. In fact, the Erie County Family Treatment Drug Court has very recently received a total of $2,125,000 to be granted over five years. The grant comes from the US Department of Health and Human Services, and shows a major national interest in what’s going on in western upstate New York.

The money is to be used to “pair the authority of the court system with compassionate, proven treatment services toward the goal of improving the family unit and advancing lifelong recovery,” according to Niagara Frontier Publications, linked above. Does this sound familiar?

DA Flynn, along with Congressman Brian Higgins and Erie County Executive Mark Poloncarz announced the grant on Monday the 17th of July. “This significant grant will go far in helping our court system support those struggling with addiction,” said Flynn. The proof comes in two parts, each to be established using grant funding:

Celebrating Families!

This program will be offered to families with one or both parents who are substance addicts. The aim is to reduce addiction, but also to reduce domestic violence, child abuse, and neglect. The program incorporates the parents and the children, and promotes health and sobriety.

Connections

This program will “integrate behavioral and medical treatment providers into wrap-around services for families.”

Drug courts, such as the Opiate Intervention Court and the Erie County Family Treatment Drug Court, use evidence-based treatment methods that reduce addiction, crime, and recidivism (return to jail after a sentence). According to the National Association of Drug Court Professionals, 75% of those who successfully complete a drug court program do not reoffend for at least two years. Also, drug court programs are 45% more successful than other sentencing options when it comes to reducing crime.

It doesn’t hurt that about $13,000 is saved per person who completes a drug court program. Out of the 3,200 drug courts nationwide, these two in Buffalo, NY are setting precedents for treatment methods. This isn’t the first time the city in western New York has achieved this.

If $300,000 helped keep 80 people alive and out of jail, imagine what $2.125 million is going to do for a city that is losing nearly one person to opiates every single day that goes by.

In Conclusion

City Court Robert Russell, who played a critical role in establishing the Opiate Intervention Court, also created America’s very first Veterans Treatment Court in 2008. Perhaps the rest of the country should be looking to Buffalo for answers. Just less than a decade ago, Buffalo gave us a drug court for veterans – one of the most-affected groups by the opioid epidemic. Now, this year, it gives us a revolutionary opiate court.

Please, the rest of America, please copycat what Buffalo is doing. The answer is right there, within the borders of a fifty-two-and-a-half square-mile city in western New York.

China to Ban Fentanyl – and Save Thousands of Lives

Nearly 80 Americans die every single day from opioid drugs. Millions are addicted, whether to hydrocodone or heroin or something in between, but most opioid addictions start with prescription drugs. Due to prescriptions being expensive, addicts often turn to street dealers for opioids. At least 75% of heroin addicts began with legal pills.

Drug dealers want profit, and the cheaper they can get their drug supply, the better. Heroin is rather expensive, and prescription opioids aren’t exactly easy to come by in bulk. That’s why Chinese fentanyl imports have skyrocketed over the last couple of years.

Fentanyl is a synthetic opioid, 50 times stronger than heroin. Also, it’s much cheaper than actual opioids, legal or not. Recently, drug dealers have been saving boatloads of money by importing from China. Production, sale, and purchase of fentanyl are illegal in all more developed countries, except for in China, where multiple companies produce and sell fentanyl through the internet, with little to no government regulation.fentanyl-100-times-stronger-than-heroin

Fentanyl is incredibly deadly. The Department of Justice and the Drug Enforcement Agency (DEA) issued a public warning last year regarding the potency and lethality of the synthetic drug. Deaths from fentanyl continue to rise dramatically across the country.

American and Mexican drug cartels buy fentanyl from China in bulk, and then either lace it into drugs or use it to create new drugs. Dealers are saving money at the cost of tens of thousands of lives. This has been going on for years. US government agents have long wondered why the Chinese government stood by, letting it happen.

Starting March 1, 2017, China will ban the production and sale of fentanyl, and more.

The Fentanyl Ban

According to CNN on February 16: “DEA spokesman Russ Baer confirmed that China made the announcement [to ban fentanyl] Wednesday night, after six months of talks between the Chinese and US governments. That included a January visit by acting DEA Administrator Chuck Rosenberg, the first DEA administrator to go to China in more than a decade, to discuss the issue.”

Four chemicals were included in the ban. Three of them are variations of fentanyl, all necessary for drug dealers to create synthetic opioids. The fourth is carfentanil, an even more powerful synthetic opioid which is used to tranquilize large mammals such as elephants. Carfentanil, too, is working its way into American street drugs, and has its own rather large body count.

Because it hasn’t begun yet, the ban’s effect remains to be seen.

However, several government officials are excited, and nobody sees this as a bad thing. Although it may not make headline news every night, the impact fentanyl has made is breathtaking. Fentanyl helps fuel the ongoing opioid crisis, the worst drug crisis in US history. Stopping the source of fentanyl will without a doubt benefit our society. First we must understand the crisis before we can discuss any potential cure.

The Fentanyl Crisis

One must fully realize how lethal fentanyl really is. ONE GRAIN of fentanyl, the size of a grain of sand, can kill a fully grown human being. Police K9 units are overdosing from just sniffing for it. Prince died from fentanyl, and he possessed controlled amounts. Now just imagine what carfentanil does to someone, 100 times more powerful than fentanyl. Here’s what it’s done to our society:

  • In 2014, there were 28,647 opioid-caused deaths in America.
  • This set the record, a 14% increase from the previous year.
  • In 2015, the number of deaths caused by opioids jumped to 33,091.
  • Nearly twice as many people die from prescription opioids than from heroin.
  • More people die from opioids than from guns and car accidents combined.
  • Totals are not yet calculated for 2016, but are expected to be higher than ever.
  • 144 Americans die every day from drug overdoses, mostly from opioids.
  • Also every day, 600 more Americans try heroin for the first time.

No corner of the country is safe from this ongoing epidemic. A quick Google search of any state followed by either the word ‘opioid’ or ‘fentanyl’ will show you the devastation. Although 2014 set a record at the time for overdose deaths, it was last year that fentanyl really began its killing spree.

Just over 8 lbs. of fentanyl was recovered by US authorities in the year 2014. While this is literally enough to kill thousands of people, authorities recovered an incredible 295 lbs. of fentanyl in just the first half of last year. That’s enough to kill two million people.

The worst part of all is how unpredictable the presence of fentanyl is in the drugs people are buying and using. A first-time user has the same odds as a lifetime user when it comes to getting a laced batch. This goes for pills and heroin alike. Proof of this comes from a recent Fox News article covering the ban in China.

The article starts with the story of Carlos Castellanos, a 23-year-old man who had been sober for 10 months until he fatally overdosed from fentanyl. “He was very happy, healthy. He had a girlfriend. He had plans to go back to college. He wanted to be an engineer. He was facilitating meetings to help other people in drug recovery. But the drugs are toxic and they’re everywhere,” said his mother.

What the Ban Means

The DEA believes the ban coming on March 1st will be crucial to reducing overdoses. Melvin Patterson, a spokesman for the agency, told Fox, “The DEA views China’s actions to be four giant steps in the right direction, steps that will ultimately lead to the reduction of numerous overdoses that have occurred throughout the United States, especially the last couple of years.”

Their optimism is rooted in the fact that since October 2015, when China began regulating 116 other synthetic chemicals, “the global supply of those substances plummeted, some as much as 60 percent,” reports Fox. We sure could use a 60% reduction in the amount of fentanyl on the streets.

Another major benefit to the ban in China will be cracking down on drug dealers. Spokesman Patterson said that tracing fentanyl recovered in the future will be easier, since China can be ruled out. “Until now, China had been an exasperatingly indecipherable key piece of the puzzle in the fight against fentanyl trafficking…” says Fox News.

Fighting the Crisis

Nearly every community has been affected in some way by the current drug crisis. Also, new laws are being passed, so money is being heaved toward curing addiction, and each and every state is fighting the crisis. However, the winner of strictest law regarding legal opioids goes to New Jersey.

“In every community it’s a concern now,” says NJ Assemblyman Declan O’Scanlon. “I cannot be too dramatic about this. This scourge knows no socioeconomic or ethnic or geographic bounds.” He has been one of the state’s most outspoken politicians for stopping the addiction crisis. O’Scanlon called the ban in China “heartening.”

He fully supports Governor Christie’s radical new law, which limits every patient’s first opioid prescription to a five-day supply. Cancer patients, chronic pain patients, and those on end-of-life care are excluded. The law also says health insurance companies must cover both inpatient and outpatient drug addiction treatment.

“We are here today to save lives,” said the NJ governor upon signing the bill. “New Jersey now leads the way first and foremost in recognizing this is a disease.” Gov. Christie said this because no other state has as strict of a policy.

It makes sense when you consider that New Jersey was home to 1,600 opioid deaths two years ago. A state full of small towns, Fox News reports NJ resident Paula DeJohn’s story in the article linked above. She owns Silverton Memorial Funeral Home, in a community named Toms River, where most people don’t make a ton of money. Over the last couple of years, Paula has noticed some significant changes at work.

“We’ve been seeing a lot of kids… it’s unbelievable. It’s primarily high school kids, but also young people in their 20s and 30s. Before it was rare to see a young person. Now it’s constant,” says Paula. This is because of the rise in opioid deaths, mostly caused by fentanyl. Recently, over just ten days, three dead school-aged victims were brought to Silverton Memorial. “Everything runs down to us,” Paula says.

She went on to say how she has friends who have been affected personally, and sees kids become addicted who she’s known her whole life. The parents do everything to try and stop it, she says.

This is why New Jersey welcomes the ban in China with open arms. Really, everyone can see how much of a positive change the ban will create. David Shirk is a fellow at the DC-based International Center for Scholars, and he spoke with Fox News (linked above) regarding the ban and its possible effects:

“Part of the epidemic isn’t about illicit supply. China’s regulations will make illicit production harder to access. For so many people addicted to opium, it starts with legal access to prescription medicines, which is abused. A lot of the problems at the end of the day contributing to addiction are social and psychological, and the fact that we don’t have a strong support system to help people deal with it.”

In Conclusion

It’s a war we seem to be losing, but nobody can say we’re not fighting. The Obama administration did more than its fair share of work to combat the epidemic, and Trump at least seems to be on board with continuing the good fight. With China banning fentanyl sales and production, cartels will be forced to revert to old methods.

This does not mean the end of opioid addiction.

However, it’s one hell of a start. This ban could very well mean the end of the fentanyl chapter in our current crisis.

New Initiatives to Help Addicts Receive Treatment through Police Departments

Many know someone who has suffered from drug abuse and addiction. When someone is stuck in that cycle of constant drug use it can seem hard for some to get themselves out of it. Now for anyone who is facing the hardship of addiction can now seek help in an unlikely place. Currently addicts can go to two police departments in Ocean County New Jersey and get the treatment they need, even if they do not have insurance.

The new program also allows the addicts to hand over their drugs while not fearing the consequences of the law. Al Della Fave, a representative of Ocean County Prosecutors office came out whit this new information recently. The Prosecutors office is leading this new initiative that will be formally known as the Heroin Addiction Response Program.

The trial program will begin by being offered two days a week, at two separate police departments. Manchester Police Department will run the program on Wednesdays and the Brick Police Department will have it on Thursdays.

Joseph Coronato, who is the Ocean County Prosecutor, said that the program is an effort to try and get more addicts the treatment they need, while shifting the current model of arrest and imprison for drug addicts. Coronato went on to state that: “It is my mandate that Ocean County Law Enforcement treat all those suffering from addiction with compassion, care, and concern while providing resources to assist in their recovery,”. He went on further to say that candidates will be screened to see if they are suitable for treatment.

For the people who are selected to the program they will be heading to the New Jersey Addiction Triage Center, which is a nonprofit organization. New Jersey Addiction Triage Center is fairly new that incorporated at the end of last year and is backed by a rehabilitation center in Pennsylvania, called the Malvern Institute.

This Triage Center currently works with the Prosecutors in Monmouth and Ocean counties, to create a new diversion program that will give people who are arrested with addictions the treatment they need. The center will coordinate with rehabilitation clinics to take patients from the program, regardless of insurance. The program was designed to entice treatment centers to accept patients without insurance and in change will later be given patients with insurance that come through other diversion programs.

There is said to be about twenty-four new recovery coaches that are going to be working with the program. These coaches will be contractors through the Malvern Institute. Currently the Ocean County Prosecutor’s Office plans to fund this program through money forfeited from drug busts and has already begun funding training through this method.

The Heroin Addiction Response Program will send the participants of the program to two local New Jersey treatment centers. The two facilities said to be participating in the program are the Ocean County-based Preferred Behavioral Health Group and Integrity House, based in North Jersey with a facility in Toms River.  These two will not be the only facilities in the program as there will be other facilities used that are located in Florida, Pennsylvania and Texas.

Della Fave went on to state that anyone can participate in the program and they can be from out of the county and even out of state.

This new program came on the heels of The New England Journal of Medicine published a new report on a similar program located in Gloucester, Massachusetts. That program is called the Angel Initiative and is being touted as a model for other programs like it across the country. According to the publication it showed that only a minority of people who suffer from opioid addiction seek treatment. From 2009 to 2013, 21% of people who suffer from opioid addiction got any sort of treatment.

In 2015 The Angel Initiative started and has since helped 520 people find treatment. John Rosenthal who is a co-founder of the Police Assisted Addiction & Recovery Initiative said that many of those 520 people were from out of the area and even from out of the state. Per Rosenthal Gloucester has seen a 30 percent decrease in crime that is typically related to addiction.

Since the program in Gloucester is so new, they are tracking the progress of the patients that have entered the program. The program in Gloucester is one of only a few places to be tracking the progress of its patients, so in that regard it is fairly unique.

These types of programs are popping up all over the country and as Rosenthal puts it “are taking off like wildfire,”. There are programs like this starting in Macomb County, Michigan, and recently Manchester, Connecticut. So far Police Department-based programs with the aim to help addicts are spreading and tracking the patients will be the key in seeing if these programs are successful. Coronato, did go on to say that tracking patients in their Heroin Addiction Response Program is going to be the programs foundation as “We have to see what programs are effective,”. Overall these programs seem to be rather cost effective and are helping mend the relations between the addicts and police officers, but only time and proper tracking will tell whether or not these programs are truly effective.

 

 

Vermont Opioid Epidemic

On June 6th, 2017 Dutchess County of New York State filed a lawsuit against 11 pharmaceutical companies on several allegations regarding their production and distribution of prescription opioid painkillers. The lawsuit alleges that pharmaceutical companies have used deceitful tactics to market prescription opioid painkillers, an epidemic that has swept across the nation resulting in several deaths that only continue to increase by the year. Keep in mind, considering the date of the lawsuit, that nothing has come of the it and Dutchess County is not necessarily setting a precedent as 5 other New York State counties have filed similar lawsuits against pharmaceutical companies and individual providers. There are 62 counties in New York State.

vermont opioid epidemicAs has become the norm in a capitalist society like the United States, money is a powerful and nearly undefeated entity. How often do you see money being the driving force behind evil and selfish acts? It’s safe to assume money is the driving force behind the companies and providers turning their back on a public health crisis, even if it didn’t start that way. Addiction is a disease, as is cancer, and the former is much easier to turn your back on.

In addition to the lawsuit against pharmaceutical companies, Dutchess County has named a handful of prescribing providers alleging that they were responsible for promoting opioids for sale and distribution locally and nationally. Dutchess County Legislator, Jerry Landisi, is quoted saying “We have been fighting this war on drugs and addiction, but the enemy has been supplied by these pharmaceutical companies who have chosen to put profit ahead of patient safety.”

The problem is spreading and there does not seem to be an end in sight. Several states are seeing the devastating effects of the opioid epidemic, including Vermont. In fact, Vermont ranks ninth among the National Safety Council’s top 10 states with the highest heroin fatality rates per capita.

So, what gives them a right to blame the companies and prescribers? Is it pure ignorance? As it is for many professionally licensed providers, there are annual continuing education requirements. Any responsible doctor would take note of the rise in deaths due to prescription opioid use.

Let’s look at the numbers

National Heroin/Opioid Statistics

  • In 1999 there were 7,523 deaths due to prescription opioids
  • In 2015 there were 29,728 deaths due to prescription opioids
  • In 1999 there were 2,675 deaths due to illicit opioids
  • In 2015 there were 19,884 deaths due to illicit opioids

If you’re wondering why pharmaceutical companies and individual providers are being held accountable, the above statistics should be telling. Not only have patients become addicted to pain management medications prescribed by their doctors, they seem to be seeking out the drug after the prescription has lapsed.

To the naysayers that may point to our population growth in America, which has grown 14% between 1999 and 2015. The population growth of 14% pales in comparison to the 295% increase in prescription opioid deaths over the same time frame. If we’re aiming for population control then we have the answer.

There are some states that are considered to be doing it “right”, most notably, the state of Vermont, which is just a mere ninety miles from the center of Dutchess County, NY.

Now that we’re shifting away from the most recent lawsuit in New York, let’s see what their neighbors are up to, besides filing lawsuits.

Vermont Opioid Statistics

  • In 2010 there were 38 deaths in Vermont due to prescription opioids
  • In 2016 there were 38 deaths in Vermont due to prescription opioids

Wait, the opioid deaths did not increase 295% in Vermont? Yes, the same number of people died at the hands of prescription drugs but they must be doing something “right” in Vermont.

Before we dive into the treatment programs and legislation associated with Vermont’s success let’s widen the spectrum again briefly. On a national level, for those addicted to opioids the people closest to them are the most dangerous enablers. In 2015, a survey determined that 36% of people that misused a prescription pain reliever received the drug directly from their doctor. Another 54% of misuses were taken, bought or given to the person by a friend or relative. The remaining 10% fell into the following categories:

  • 9% bought from a drug dealer or stranger
  • 9% obtained the prescription pain reliever “some other way”

It’s not the dark alley dealer we have to worry about. It’s the people that are supposed to care about our health and well-being.

How is Vermont Preventing Prescription Opioid Misuse?

While the following list is seemingly vague, we get an idea of what programs and prevention tactics are being employed and we’ll take a close look at a couple of the programs and the elements that make them successful. Vermont reportedly has the following prevention and treatment programs in place:

  • Mandatory Prescriber Education
  • Opioid Prescribing Guidelines
  • Eliminating Pill Mills (VT doesn’t have them but also doesn’t have legislation to eliminate/prevent them)
  • Prescription Drug Monitoring Programs
  • Increased Access to Naloxone
  • Availability of Opioid Use Disorder Treatment

Particular to mandatory prescriber education and opioid prescribing guidelines, at first glance, it could seem like just more charting in an attempt to decrease liability with a smoke screen of caring for the patient. However, it seems the amount of charting that needs to occur cannot be fudged or faked as there are too many stipulations in place that call upon the doctor to be, well, a responsible doctor! For example, when prescribing an opioid painkiller the prescriber must evaluate the benefits and risks, including risk of misuse. Additionally, the provider will need to produce a diagnosis that supports prescription opioids and consider and document the possibility of a non-opioid alternative as well as a non-pharmacological treatment.

These doctor and patient education attempts will help prevent the patients from confusing the drowsy eye warning on the bottle as a “wink, wink” suggestion, much like Lucille Bluth, of the cult television show, Arrested Development.

Beyond the Initiation Point

If you’re looking for a hole in Vermont’s approach, you must read on to determine if you feel it’s a credible approach. What’s been described in the preceding section is a small part of the process, the opioid initiation stage. How should we expect doctors, especially ones that see dozens of people on weekly basis, monitor opioid use after the initial prescription?

For general practitioners that aren’t seeing improvement in their patient’s condition they must be comfortable with a referral to a pain management specialist and/or a substance abuse specialist. Mainly, don’t be so damn arrogant! Some of the risk indicators are listed below:

  • Treatment goals are not met despite escalating doses.
  • The patient’s history and/or a screening indicate high risk for misuse, abuse, diversion, addiction, or overdose.
  • The prescriber knows or suspects based upon reasonable grounds that the patient has engaged in misuse of opioids or other substances.
  • The patient obtains prescriptions from multiple prescribers and/or multiple pharmacies.
  • The patient has been prescribed multiple controlled substances

Relating back to the more charting phenomenon, it seems that a common theme within Vermont’s model is documenting their treatment of the patient. Vermont’s laws indicate that the patient must be seen within 365 days of the initial prescription, otherwise the provider will be held accountable for being in violation of a state law. The annual review of a patient’s prescription mirrors the initiation stage and what’s important about the annual requirement is that patients that are misusing or are addicted have to come back and evaluate their use themselves. That way the provider and patient are being held accountable. The annual reevaluation period has the following salient elements:

  • Reevaluation of effectiveness and safety of the pain management plan and the patient’s adherence to the treatment regimen.
  • Potential for non-opioid/non-pharmacological treatments.
  • Functional status examination of the patient.
  • Review of the Controlled Substance Treatment Agreement and Informed Consent, and any revisions to the conditions.
  • Assessment of co-morbid conditions.
  • Related actions that may prompt adjustments to treatment, including aberrant behavior, early refills, or other factors reasonably suggesting risks associated with misuse, abuse, diversion, addiction, or overdose.

Of the aforementioned elements, especially within the one year mark, what sticks out the most the requirement to assess for comorbidity. Yes, the patient may have come with back pain due to recent surgery however, he or she may have developed an addiction over time, especially due to the vulnerability a physical ailment can create. Those suffering from an injury or that are in recovery cannot always participate in regular activities, may be bed ridden at times and feel alienated from their social group. All of those elements could result in depressive symptoms, which put someone at much higher risk to misuse or abuse drugs.

As indicated earlier, addiction is a disease and must be recognized and treated as such. While Vermont is seeing their most significant decrease in prescription opioid misuse in the 18 to 25 age range, the Substance Use and Mental Health Services Administration found that the rates for mental illness and substance use disorders were the highest (35.1%) for people in the same age range.

Conclusion

While the opioid epidemic is alive and well, it’s a welcome sight to see Vermont attempting to increase their treatment capacity to deter the effects to their residents. Much like the tobacco industry’s settlement with 46 states in 1998, the wave of lawsuits may force the pharmaceutical companies to take more responsibility for ignoring or downplaying the addictive nature of opioids. In the tobacco settlement the tobacco industry agreed to make ongoing payments to the 46 states involved to fund anti-smoking campaigns and public health programs. With the current climate of healthcare and the increasing cost, a similar settlement could be applied to the opioid epidemic. In the meantime, other states should be following in the footsteps of Vermont because, just like tobacco, much of the damage is already done. The patients are hooked. What makes this even worse is that many of those hooked started with trying to get help. We’ve learned quite a bit since the time period of doctors recommending smoking. Let’s not be so naive again.

Treating Drugs With Drugs: Heroin Addiction Treatment With Marijuana

The lesser of two evils. Fighting fire with fire. Throwing a Band-Aid at the problem? If you find yourself scratching your head in concern right now, you likely are not alone. Many of us may recall a time in school, out in the community, through the news, or various other sources when marijuana was referred to as the “gateway drug.” Ultimately suggesting the use of marijuana will open the flood doors and lead to the use of more and worse drugs. Now, we are seeing the very same drug being used as a way of treatment for heroin addiction. Believe it or not, some treatment facilities are even going as far as saying marijuana is a cure for heroin addiction. The adhesive on Band-Aids isn’t super glue and even super glue does not last forever.

While this claim has gained attention countrywide, there are still experts in the addiction field that are highly skeptical. Dr. Mark Willenbring for example, a psychiatrist who provides treatment to addicts (and formerly oversaw research at the National Institute for Alcohol Abuse and Alcoholism), believes that alternative approaches are needed for traditional drug treatment, but not this – stating “the concept on its face is absurd.” Dr. Willenbring, further states “I’m not prone to making exaggerated or unqualified statements and in this case I don’t need to make any: It doesn’t work.” — “Like trying to cure alcoholism with Valium.” Common sense should tell us substituting one drug for another doesn’t bring a solution. It develops yet another layer to the addiction. If the goal is ultimately to be drug-free, how is adding another drug to the mix an effective means of treatment?

Why Medical Marijuana?

The zeitgeist contradicting Dr. Willenbring’s perspective is that medical marijuana has reportedly become a less harmful way to treat certain diseases and ailments including but not limited to multiple sclerosis, arthritis, epilepsy, glaucoma, HIV, chronic pain, Alzheimer’s and various forms of cancer.

To complicate matters further, medical marijuana is now being used to treat substance use disorders. A 2014 study conducted by the Journal of the American Medical Association found that the death rates for opiate overdoses were significantly lower in states with medical marijuana as compared to states that continue to outlaw marijuana.

Let’s look at the other side of the coin…

Wait – isn’t marijuana still considered a drug? Therefore, medical professionals are essentially treating one form of substance use disorder with a different substance? Yes. Marijuana is still considered a Schedule 1 drug by the federal government. Why is this important? Well, Schedule 1 drugs are drugs that according to the United States Drug Enforcement Agency have certain characteristics which includes drugs or other substances that have a high potential for abuse. More notably, among the drugs considered to be a Schedule 1 drug is heroin. That’s right, we are now being told that marijuana – a drug with the same classification and the drug for which we are trying to cure an addiction to – heroin – is supposed to be a solution.

heroin-use-is-a-part-of-a-larger-substance-abuse-problem

As shown in the above image, the Centers for Disease Control and Prevention found that those addicted to marijuana are three times more likely to become addicted to heroin. Haven’t we learned from past attempts to treat drug use with additional drugs that put us at risk for comorbid addiction? The late 19th and early 20th centuries were characterized by using morphine to treat alcohol addiction. The next “solution” was to treat all the morphine addicts with, wait for it, heroin! Additional renditions of using drugs to treat drugs continue to occur, with an eerie feel that we’re in a Simpson’s episode, blindly following Seymour Skinner’s philosophy on extinguishing invasive species.

What are the prescribers saying and doing?

Several states are authorized to dispense medical marijuana to treat opioid addiction however, there are opposing points of view. While it’s possible that close monitoring of a program using medical marijuana to treat heroin addiction, the ongoing concern is that we’re just creating a second addiction which will eventually be super ceded by the harder drug, heroin.  This suggests that long-term monitoring with significant attempts to ensure accountability for heroin addicts will be necessary for successful prescription of medical marijuana.

While there is data that suggests using medical marijuana as an effective harm reduction approach in reducing opioid overdose mortality, do we want to continue using addictive drugs to treat drug addiction considering the aforementioned failed attempts? The Yale Journal of Biology and Medicine suggests using the following prevention techniques to curb our populations’ initial and current involvement with illicit and prescribed drugs:

  • Education
  • Targeting high-risk populations
  • Targeting those with a history of substance use disorders
  • Involve immediate and extended family members
  • Propaganda discouraging the sharing of prescription opioids
  • Encourage appropriate disposal of unused and expired opioids
  • Medication take back days
  • Prescription monitoring programs
  • Increase prescriber use of pain contracts

To drug, or not to drug: is it even a question?

There’s significant history suggesting that using addictive substances to treat substance use disorders is highly (no pun intended) unsuccessful. An argument can be made that marijuana is the least of its preceding evils (i.e. morphine, OxyContin, hydrocodone). Despite marijuana being excused as much less harmful drug, by the buyers and sellers, an argument can be made that marijuana can be debilitating and increase the risk of harm to the user and those around him or her.

Should we prescribe to this new school of thought, how can we actually determine that medical marijuana is a solution? Will states be willing to install an infrastructure that sanctions those in receipt of medical marijuana so they can have a license to operate a motor vehicle while under the influence? How does one get to work if they smoked three hours before a shift starts? What if that employee needs the marijuana to control his or her chronic pain at their place of employment? How does that affect those in rural areas that don’t have access to public transportation? Are we contradicting the ‘buzzed driving is impaired driving’ campaign? These are important questions that seemingly have not been answered yet.

We all undoubtedly want to find the solution for drug addiction – especially when it comes to heroin as it has claimed so many lives. But at what cost? Normalizing drug use has a history of being a slippery slope. Operating a motor vehicle is just one of the seemingly infinite variables that will need to be addressed and we’re doing it on whim with an absence of years of conclusive studies and evidence.

So many questions with so few answers

If we’re betting on history and lobbying against prescribing addictive drugs to treat drug addiction, something’s got to give. Between 2001 and 2015, the rate of opioid overdose fatalities quadrupled. What’s interesting is that many longitudinal studies on marijuana use are tainted because the people being studied are often combining marijuana with other illicit drugs, including heroin. The studies are further skewed by the increasing THC content in marijuana over the last couple of decades. So, we’re trying to study marijuana use but its historical cautionary slogan of it being a gateway drug is becoming true to those that are trying to push it through legislation. Follow the money! Taxes in states with legal medical marijuana are much lower than their counterparts.

Need for a cure

Not only have the heroin-related overdoses deaths quadrupled over a fifteen year period but individuals using heroin are likely to also be abusing multiple other substances, including cocaine and prescription opioid pain relievers. It is estimated that nearly all people who use heroin also use at least one other drug. Based on this information alone – yes we are in desperate need for a cure.

One way to combat the heroin epidemic is to educate yourself and the ones you love on the risk factors associated with the addiction. The following are some risks of those most at risk of heroin addiction:

  • People who are addicted to prescription opioid pain relievers
  • People who are addicted to cocaine
  • People without insurance or enrolled in Medicaid
  • Non-Hispanic whites
  • Males
  • People who are addicted to marijuana and alcohol
  • People living in a large metropolitan area
  • 18 to 25 year olds

Do any of the above apply to you or someone you love? The risks are not limited to these situations as the Centers for Disease Control and Prevention has found that some of the largest increases actually occurred groups with historically low rates of heroin use. These demographic groups include women, the privately insured and people with higher incomes. It appears there are no bounds when it comes to the heroin epidemic.

Perhaps most notably, as it relates to the current subject matter, one of the risks associated with heroin addiction is in fact people who are addicted to marijuana and alcohol. Based on this alone, how are doctors considering using a drug that increases an individual’s risk to become addicted to heroin as a cure?

In conclusion

While it is quite clear that there is a need for a cure for heroin addiction and other substance use disorders, it is not as clear that medical marijuana is the solution. Since there is no time to lose as heroin addiction is truly a life threatening disorder, instead of relying on this new treatment with medical marijuana which has very little scientific backing, there are multiple other treatment and prevention options available to you or someone you love.

responding-to-the-heroin-epidemic

Below are some options which may be the right fit for you or someone you love:

  • Medications. There are several medications which aided individuals who are trying to combat their addiction. These medications have been well-researched and also are FDA-approved.
  • Therapy and support groups. This option may suit you or someone you love as well. No one treatment is the right treatment for everyone. Speaking with a professional will help find the right treatment plan for the individual and may just be the missing piece to the puzzle to aid in recovery.
  • Call SAMHSA 24-hour national helpline. If you are not sure where to start, please pick up the phone. The helpline is always available to you or someone you love and it is an invaluable resource as something as simple as reaching out may just save a life.

Most importantly, whatever treatment is right for you, the time for treatment is now. Don’t waste anymore of your life – get help before it is too late.

Drug Cartels Use Lethal Substitute to Save Money

A warning has been issued by both the Department of Justice and the Drug Enforcement Administration to both police and anyone who purchases drugs off the street about fentanyl, an extremely powerful opioid 50-100 times stronger than morphine. A few grains the size of table salt crystals can kill a full grown human being. Drug cartels from Tijuana, Mexico to all over the US are selling fentanyl disguised as both OxyContin and heroin, according to NBC.

Fentanyl is so lethal that simply handling it is causing major concern among law enforcement. Two New Jersey police officers almost passed out recently, simply from sealing a bag of the stuff during a bust, as reported in the NBC article. Now imagine injecting or snorting fentanyl. That’s how numerous people are dying lately.

From the Far East to a Coffin

It all starts in China, where multiple companies produce and sell fentanyl through the internet. The near impossibility of regulating the large amount of such companies makes for easy access to fentanyl. Therefore, drug cartels in North and South America are importing it from China, and due to its bland white appearance, disguising it as heroin and/or OxyContin, both powerful opioids. Hence the warning from both the DOJ and the DEA.

Assistant US Attorney Sherri Hobson said, “I see this as an experienced prosecutor as like a death sentence for someone who thinks that they’re buying oxy but really they are buying fentanyl because it’s cheaper.” DEA spokeswoman Amy Roderick added to the conversation, saying “It’s extremely profitable for the cartels… They aren’t having to harvest the poppy plants… not having to manufacture that paste into heroin. They are literally just getting a chemical from China.”

More than 50 overdoses in Sacramento, twelve of them fatal, occurred recently due to users buying fentanyl when they believed it to be OxyContin. On the opposite coast, fentanyl has killed more than 100 people every year since 2014 in Erie County, NY. Famous singer Prince died this year in his Minnesota home, reportedly from fentanyl, and a hydrocodone bottle found in his home tested positive for fentanyl, according to CNN. George Marquardt of Kansas is now known as the ‘Walter White of Wichita,’ after it was discovered he had been mass producing fentanyl (among other drugs) for decades, selling them to anyone with the money. In May of this year, Alaska State Troopers reported a spike in deaths caused by fentanyl-laced heroin. No part of the country is safe from this epidemic.

In Conclusion

Last month alone, US authorities seized over 70 pounds of fentanyl, along with some 6,000 counterfeit prescription pills. That’s more than enough to kill the entire population of North America and Japan combined. If that doesn’t hit you like a ton of bricks, then you are literally immune to a ton of bricks.

If eleven SWAT officers experienced “lightheadedness, nausea, sore throats and headaches” just from busting a fentanyl-selling residence in Hartford, Connecticut last month, then surely fentanyl injection and/or inhalation is far worse. The DEA, recognizing how potent fentanyl is, told the Washington Post “…it represents an unusual hazard for law enforcement.”

Imagine now the hazard it represents for those addicted to opioids. Please, if you or a loved one is struggling with an opioids addiction, be careful. Enroll in an addiction treatment facility, or at the very least, seek help from your loved ones. If you are an opioid user, for God’s sake be careful. Every crystal of fentanyl out there (and it is out there) is a death sentence waiting to happen.

No high is good enough to die for.

Fentanyl & Carfentanil Deadly for Law Enforcement

It’s a well-established fact that fentanyl and carfentanil, two of the most deadly opioids known to man, are killing people by the thousands. Fentanyl is an opioid medication used for surgery and chronic pain, and it is 50-100 times more powerful than morphine. Carfentanil, its stronger cousin, is up to 100 times more powerful than fentanyl, and is used to tranquilize large mammals such as elephants.

Both substances are being masked as prescription pills or heroin by drug dealers on the street, and both substances are so deadly that even a few grains can kill. Overdoses from the substances have risen as much as 500% over the last few years according to the CDC. No part of the country is safe. From Alaska to Maine, Hawaii to Florida and all states in between, America is in the midst of a fentanyl/carfentanil crisis.

“Fentanyl is being sold as heroin in virtually every corner of our country… a very small amount ingested or absorbed through your skin can kill you,” said DEA Deputy Administrator Jack Riley to Law Enforcement Product News. Riley said this as part of a warning from the DEA to all US law enforcement, a warning about the dangers of being exposed to fentanyl or carfentanil during drug busts.

Near Deadly Exposure for Law Enforcement

These two drugs are so deadly, that as part of the warning issued by the DEA, a video was released, and it is available to view here.

Deputy Administrator Riley is the spokesperson, and his message is clear. Fentanyl exposure can be deadly. Riley urges all officers to “transport it directly to a laboratory, where it can be safely handled and tested.” He says not to field test it, and to never bring it back to the office. Here’s why:

  • Recently in New Jersey, two officers survived a powder blast of fentanyl to their faces. Investigator Kallen and Detective Price of the Atlantic County Task Force were sealing a bag of confiscated fentanyl when a cloud of the powder came out of the bag and the officers inhaled it. “I felt like my body was shutting down,” said Det. Price. “I thought that was it. I thought I was dying.” Inv. Kallen added, “You actually felt like you were dying. It was the most bizarre feeling that I never ever would want to feel again.”
  • In Hartford, CT last month, eleven SWAT team officers were exposed to a cloud of fentanyl being blown about the crime scene. Several of the officers experienced lightheadedness, nausea, sore throats and/or headaches. The entire team was taken to the hospital.
  • All over the country, law enforcement officers as well as firefighters are now carrying Naloxone, an anti-overdose drug. Well, now, because of the fentanyl crisis, officers in places such as Vancouver, Canada and St. Louis, MO, are carrying it for themselves. Exposure to the drug can be so deadly so quick, that the anti-overdose drug may have to be administered to an exposed officer.

Conclusion (or lack thereof)

As if it’s not bad enough fentanyl is killing drug users and putting law enforcement at risk, police dogs sniffing for drugs are being exposed as well. The invasion of fentanyl (and carfentanil – even deadlier but less commonly found) has made being a cop even harder and riskier of a job.

Fentanyl and carfentanil are so hazardous, officers must wear the same suits worn by scientists avoiding the Ebola virus when handling them. These are full-body, level A hazmat suits. Imagine what damage these drugs do to the human body, able to kill in less than three minutes.

130 people die every day from opioid overdoses in this country. Remove fentanyl and carfentanil from the equation and that number goes down.

Opioids: An American Mass Murderer

This country has a serious opioid addiction problem. The number of fatal overdoses from both prescription painkillers and heroin an hour died from an opioid overdose that year. Approximately 2.35 million Americans had diagnosable opioid addictions in America, according to the Substance Abuse and Mental Health Services Administration. Popular painkillers such as OxyContin, Vicodin and Percocet all are opioids and heroin is a stronger, more refined opioid.

Three facts, when all considered together, point to how America got this way. One is that over the course of the last two decades or so, pharmaceutical companies have aggressively promoted opioid painkillers. Two is that this push worked, because the number of prescriptions for opioids written every year is simply outrageous. (See section below titled A Bottle for Every Adult). Three is that 75% of heroin addicts begin with prescription painkillers, whether taken legally or recreationally.

No part of the country is safe from this epidemic. Everywhere you turn, there are horrifying news stories about opioid overdoses and how opioid addiction is rampant. In Oregon, over half of overdoses involve prescription painkillers, and the state sees more than 500 people overdose every year. Republican presidential nominee Donald Trump, in a speech given on September 29th in Bedford, New Hampshire, told the crowd “They said the biggest single problem they have up here is heroin. More than any place, this state, I’ve never seen anything like it…” said Trump.

In Colorado, a golden retriever nearly died from consuming heroin thrown over a fence into a dog daycare, presumably by someone being chased by police. This September, 28 opioid overdoses occurred in the city of Huntington, West Virginia in a four-hour span. Even in Hawaii drug overdose deaths rose 83% from 2006 to 2014, creating the island chain’s own opioid epidemic. Every corner of the country is being affected.

From Prescriptions to Needles

Three out of every four heroin addicts began with prescription pills, as mentioned previously. Some used the pills recreationally and graduated to heroin, but many others simply substituted heroin for the painkiller they were legally prescribed. In a 2014 report by Al Jazeera on opioid addiction, several members of a heroin treatment center were interviewed. One unnamed man’s story is eye-opening: “I was hurting so bad that I ended up punching a four-by-four, breaking… three fingers… to get pain meds from my doctor. I’d do that several times.”

At that point in the interview, another man speaks up, stating how he’s heard of people deliberately taking a baseball bat to their wrists just to get more opioids from their doctors. Several of the people being interviewed chime in, saying how heroin is much cheaper than the prescriptions fueling their addictions.

A Bottle for Every Adult

There are far too many painkillers floating around this country. Vivek Murthy is America’s current Surgeon General, and he is well aware of America’s opioid epidemic. Just a couple of months ago, every doctor in America received this letter from Murthy, explaining how the nation is in crisis regarding opioids, and recommending more careful prescribing methods. During a speech on the topic, Murthy revealed an astonishing truth regarding prescriptions in the US. “We have currently nearly 250 million prescriptions for opioids written every year. That’s enough for every adult in America to have a bottle of pills and then some.”

More opioid prescriptions are written annually in America than there are people in Canada, Italy and Japan combined. However, it wasn’t always like this. In fact, starting with the drug war in the 60s and 70s, doctors became more and more skeptical of prescribing opioids. The term ‘opiophobia’ was even coined in the early-to-mid 1990s, referring “to a phenomenon in which exaggerated concern about the risks associated with opioids prevent appropriate medical use of opioid analgesics,” according to the Pain & Policy Studies Group.

It was in the late 90s that big pharmaceutical companies began excessively pushing opioid medication, especially the company Purdue with their drug OxyContin. From here, the story of how big pharma, the medical industry, and the pure nature of addiction created an epidemic begins.

OxyContin, and how the Medical Community was Duped

Part of the opiophobia was exaggerated, due to the drug war being waged by the country, but a part of it was also based in truth. Doctors were fearful of prescribing opioids because they thought it would lead to addiction. Originally, these opioid medications were reserved for patients with severe pain, say, from cancer or another life-threatening disease. However, with the push from companies like Purdue Pharma, opioid medication not only began to get prescribed again, it began to be given to patients for all types of pain, not just severe chronic pain.

OxyContin first hit the market in 1996. The opioid was heavily marketed by Purdue. As a part of the sales pitch, Purdue manufactured hats, swing music CDs, and even a gorilla plush toy. HBO Last Week Tonight host John Oliver can be seen with this plush toy during a segment the show did on the opioid epidemic recently. Purdue even went so far as to make promotional videos for OxyContin, clips of which can also be seen in the Last Week Tonight episode. It gets worse from here.

Purdue’s first promotional video for the opioid was released in 1998, called I Got My Life Back. The film featured seven people whose lives had changed for the better due to an OxyContin prescription. One charming grandmother says in the video that her relationship with her grandchildren has grown because of the drug’s pain-relieving effects.

Another promotional film released by Purdue around this time was called From One Patient to Another, and one particular claim made in the video is bewildering. The narrator says, “Less than 1% of patients taking opioids actually become addicted.” Not only has time and science proven this to be completely untrue, the source of the claim is shoddy at best. Taken from a letter to the editor of the New England Journal of Medicine by the Boston Collaborative Drug Surveillance Program (BCDSP), the ‘fact’ is not peer-reviewed and only regards one hospital’s findings. The BCDSP simply observed 11,882 patients over time, finding “four cases of reasonably well documented addiction in patients who had no history of addiction.”

Through these widely publicized videos, Purdue Pharma told doctors nationwide that opioids are not addicting, and based its information on one research team’s letter to the editor of a medical journal. They also told the American public that pain can be relieved (and life can be better) with a prescription for OxyContin.

The OxyContin Crisis: Precursor to the Modern Epidemic

The advertising worked. In its first year on the market, OxyContin yielded $45 million in sales for Purdue. They had a hot item, and seemingly every doctor wanted in. The crisis began to form once people began getting addicted to OxyContin.

In 2001, an article was published by the Associated Press regarding OxyContin abuse in Appalachia (a multi-state region on the eastern seaboard). The article tells the story of multiple West Virginian young adults losing the battle with OxyContin. One 18-year-old girl shot herself in the head when she couldn’t find more. Some girls in the area were prostituting themselves for the drug. Kristen Rutledge, interviewed in the article, says she would lie to her father and say drug dealers were threatening her, in order to get more money for OxyContin, which her and her friends called ‘hillbilly heroin.’

It’s not Addiction, it’s just Pseudo-addiction

Around this time, OxyContin-related deaths and overdoses were springing up across the country. In 2002, the New York Times reported how OxyContin deaths were higher than previously thought in 32 US states. Of course, Purdue Pharma became aware of this spreading crisis, and in another highly publicized video, the company’s own Dr. Alan Spanos explained what was really going on: “Pseudo-addiction is when a patient is looking like a drug addict because they’re pursuing pain relief,” said Spanos. “It’s relief-seeking behavior mistaken as drug addiction.”

Doctors with a lot of patients and not a lot of time were attracted to the idea of a non-addictive painkiller. By 2000, OxyContin sales rose to $1.1 billion and over 6 million prescriptions were being written annually. For the first half of the decade, doctors handed out OxyContin like candy to people with all degrees of pain, and more and more people became addicted.

Then, in 2007, it all came crashing down.

Caught in a Lie

In Guilty Plea, OxyContin Maker to Pay $600 Million read the headline of the New York Times business section on May 10, 2007. The article explains how Purdue Pharma misbranded their drug OxyContin, pleading to “criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused.” The total amount of all fines paid was $634.5 million, which is an awful lot for what is essentially false advertising. Obviously an incredible amount of damage was already done.

Purdue was not the only pharmaceutical company to be exposed for such wrongdoing. The next year, Cephalon, Inc. was brought up on charges of promoting drugs for uses unapproved by the Federal Drug Administration. They had to pay $444 million in fines and also enter into a corporate integrity agreement to disclose their payments to physicians.

The most shocking instance of a pharmaceutical company lying to the public involves Insys and their fentanyl-based product Subsys. A former manager and a former sales rep were both arrested on anti-kickback charges. “The two former Insys employees are accused of making payments to doctors as part of what officials call a ‘sham’ educational program to prescribe millions of dollars’ worth of the fentanyl spray to patients,” according to the article by HG. This is scary stuff,

The Epidemic Continues

Zoom ahead to the year 2008. Two of the seven people featured in Purdue Pharma’s 1998 promotional video died from opioid abuse, and a third claimed that losing her health insurance saved her life. When she had the insurance, OxyContin was being delivered to her. “I lost my house. Oh yeah, I’ve lost cars. I lost a lot,” she said in an interview. Once the insurance was gone, so was the drug, and she believes that saved her life. The level of irony is unbelievable.

Still the drug continued to flourish. By 2010, OxyContin single-handedly accounted for 30% of the painkiller market. The year 2014 set the all-time high for drug overdoses in the US, and opioids played a major role.

The Centers for Disease Control (CDC) has recently issued a guideline for the safe prescribing of opioid painkillers for patients with chronic pain. The CDC first recommends using non-opioid therapies, attempting to avoid opioids altogether. However, because opioid medications are the perfect solution for those who actually need them, the CDC recognizes that these non-opioid therapies will not work for everyone. If opioids become necessary, the CDC recommends doctors “start low and go slow.” This means prescribing a lower dosage and for less time.

Dr. Anna Lembke of Stanford University believes these guidelines are not applicable to the whole country. “It’s easy to say ‘use non-opioid alternatives,’ but in a lot of rural areas, patients don’t have access to things like physical therapy and mindfulness meditation, and insurance companies won’t pay for it.” Her point is valid. In a country with 250 million opioid prescriptions, her point becomes truth.

In Conclusion

Opioid medication suppliers are in no hurry to slow their sales down. In fact, a new drug is currently being marketed that counteracts the constipation associated with opioid medication use. (It was even advertised during this year’s Superbowl). There will likely be no shortage of opioid painkillers in America anytime soon. However, simply removing the drug from existence would create more problems than it would solve. Many people legitimately rely on opioid medications for a pain-free life.

What we need is more funding to treatment centers, and more availability of Naloxone, an anti-overdose drug that saves thousands of lives. Substance abuse treatment facilities only reach 10% of those that need treatment. For those already addicted, Naloxone can save their lives. In many cases, it already is.

In a documentary called Death by Fentanyl, a Revere, Massachusetts fireman is interviewed about Naloxone. What he says actually says it all. “We tend to have more overdoses than we do fires, so it’s a piece of equipment we can’t go without now.”

What we can go without is a nation plagued by opioid addiction.