America’s Heroin Epidemic

How does taking opioids make someone feel? We usually avoid asking this question when discussing recreational drug use because nobody wants to encourage drug experimentation, let alone drug addiction. When the topic is addressed, it’s easy for people to assume that only weak-minded, reckless people turn to drugs.

Sadly, not many people are prepared to understand that drug addiction, particularly heroin and opioid addiction, has risen to epidemic proportions. America’s heroin epidemic affects all of us. It could be your significant other, your neighbor or even your child. No one ever thinks that it can happen to them or someone they love. However, heroin addiction doesn’t discriminate.

Dating back to the 1990s, pharmaceutical companies claimed that patients taking certain opioid medications would not become addicted. As such, health care providers began prescribing opioids for everything from sprained ankles to post-partum pain control. With this increased rate of opioid prescriptions, it slowly became clear that these types of medications were highly addictive and often led to substance abuse issues. As addiction levels rise, so does the need to understand that opioids, legally or illegally, led the U.S. to its current heroin epidemic.

The U.S. Centers for Disease Control and Prevention, or CDC, estimates that the economic burden brought about by prescription opioid and heroin use comes in at $78.5 billion. This figure includes addiction treatment, the cost of health care, legal expenses and lost productivity.

Understanding the Epidemic

The opioid epidemic has been described as the deadliest drug crisis in American history. According to the CDC, more than 115 people die from opioid overdoses every day.

People used to think that only unemployed people from broken homes turned to heroin to escape reality. No longer is opioid use limited to low-income areas; it has transcended into all geographic areas, affecting people of all ages and ethnicities. Now, the faces of heroin addiction include veterans who cannot find work after leaving the military, moms who needed pain relief after giving birth and even people who had oral surgery.

Many people who become addicted to heroin do not have a prior history of substance misuse. Substance use disorder is not linear or predictable. Some people who were introduced to drugs through prescription pain relievers end up on heroin. Health care officials say that the ever-increasing abuse of prescribed painkillers leads users to the street when they no longer can obtain the drug legally. Unfortunately, because heroin is so addictive, it leads to increased drug-seeking behavior.

Those who misuse the drug and become addicted look for a stronger and possibly cheaper high. Heroin is both, but it is also deadly. It can be laced with other drugs that cause death. Deaths from heroin overdose doubled between 2010 and 2012. The death toll also increased dramatically in 2014 when heroin mixed with fentanyl became more common. Fentanyl, when combined with heroin, is lethal. Users can die within seconds of ingestion.

Although the issue is multifaceted, drug makers and physicians play a key role in this epidemic. After all, if there were no pharmaceutical opioids, physicians wouldn’t be able to prescribe them. That is not to say that they are responsible for another person’s substance use disorder, but the snowballing effect of prescription drug use and not being able to gain access to them has led many Americans to heroin.

Veterans and Heroin Use

Veterans have also been affected by America’s opioid epidemic. Untreated chronic pain has led many veterans to seek out pain relief on the street. After being discharged from their service, some veterans find themselves unemployed and homeless. Depression and the need to escape create the perfect backdrop for substance use disorders. According to the VA, it is estimated that 68,000 veterans are currently struggling with opioid use disorders, and when they can no longer gain access to prescription pain medication legally, they may turn to heroin.

Heroin’s Effects

Heroin can be snorted, injected or swallowed. The speed at which heroin reaches the brain depends on the method taken. Users who inject heroin can feel its high within seven to eight seconds. Astonishingly, not all first-time users experience the feeling of euphoria we hear about. Since heroin slows down the digestive tract, some users may become nauseated and vomit.

Many users report that the high they experience is similar to the feeling after a satisfying sexual encounter, only much more intense. It is this sensation that drives users back to the drug. The brain cells that are affected by heroin eventually become damaged, causing the inability to feel pleasure without heroin. In turn, these cells create the intense craving heroin users have. Unfortunately, the more that individuals take the drug, the larger amounts they need to achieve a high. Often, users become convinced that they can’t function normally without the drug.

Symptoms of Heroin Addiction

It is not surprising that an estimated 23 percent of all people who try heroin will become dependent. The brain’s receptors change almost immediately upon use, leading to an inexplicable high within minutes. Since heroin produces a downer effect, using it produces an almost instantaneous feeling of relaxation and euphoria. Similar to other kinds of opiates, heroin prohibits the brain’s ability to feel pain.

Initially, heroin users can hide the signs of their habit. Over time, family members and co-workers may start to notice the signs of drug use, which include cycles of alertness followed by falling asleep, constricted pupils, rapid behavioral changes and shortness of breath.

The above red flags are not unique to heroin. There are more definitive signs that a heroin user exhibits and these typically include possession of paraphernalia used to prepare the drug. In addition, behavioral changes become more evident as drug users sink further into the substance abuse cycle. Individuals may lie to cover up their addiction and avoid making eye contact. Speech may be incoherent. Performance at work and school may decline, resulting in unemployment or expulsion.

Long-Term Effects of Heroin Use

When someone continues to use heroin despite the deadly consequences, they can develop all kinds of health issues as follows:

Central nervous system

Heroin’s impact on a user’s brain is profound. The receptors that produce chemical signals for happiness and pleasure shrink. People who use heroin for long periods of time also show deterioration of white matter on CT scans of the brain. As such, their ability to make sound decisions and regulate their behavior is altered.

Respiratory system

Like other opiates, heroin slows respiratory function. People who use heroin may breathe much slower and shallower when they are high. If someone uses too much, they may stop breathing. The risk of cardiac arrest is one of the major health risks of heroin. Although it can occur the first time someone uses heroin, chronic users usually need to take higher doses to feel the same effect, which increases the risk of respiratory failure.

Cardiovascular system

Large doses of heroin can cause sudden death. Long-term heroin users also face a slew of other cardiovascular issues including vein damage. With each injection, the damage is done to the veins and arteries that lead to the heart. In turn, infection and abscesses can occur. According to the CDC, approximately 32 percent of heroin users in New York City suffer from a drug-induced abscess.

Digestive system

Heroin can also negatively impact the user’s digestive tract. Its sedative properties slow the movement of food and water, causing constipation and bloating. Users may not disclose these symptoms nor seek treatment, putting them at greater risk for developing intestinal blockages.

What’s Being Done

The FDA believes a multidisciplinary approach to treatment would help bridge the gap between substance use disorders and treatment. Stricter limitation of the frequency and the number of opioid prescriptions would force people to look for alternative ways of pain management, including cognitive therapy, occupational therapy, and physical therapy.

The CDC has also partnered with many states to combat both opioid addiction and heroin use. By educating the public and setting up safe zones for those who are suffering from addiction, the hope is that users will go to those safe zones to inject or use as opposed to getting high on the street.

The Opioid Crisis Response Act of 2018 marks a breakthrough in the fight against the heroin epidemic in the U.S. Federal action is intended to make people more aware of the crisis and provide resources for those who want to get clean. However, one the largest hindrances to this bill being passed are funding. If the legislation is successful, some pharmaceutical companies could be bankrupt, thus making treatment of other chronic medical conditions more difficult.

Getting Treatment

Behavioral and pharmacological treatment can be effective for heroin users. Comprehensive treatment allows users to remain abstinent and restore a level of normalcy into their lives.

Heroin users must complete a detoxification program prior to entering a long-term treatment program. During detoxification, patients may be given medications to reduce the intensity of withdrawal symptoms, which can include pain, diarrhea, nausea, and vomiting. Even though the detoxification period is not a treatment for the addiction itself, it is an effective first step.

After detox, many users manage their cravings with medication. Several medications have been approved for the treatment of heroin addiction. Since they work on the same receptors as heroin in the brain, they are considered safe and effective. They satisfy cravings while blocking opioid receptors in the brain; even if a user relapses and takes heroin, they would not experience a high, which can help them on their road to recovery.

The most common medication used for recovery is methadone. Taken orally, it is slow-acting and prevents withdrawal symptoms. If the user is not at an inpatient facility, the medication is usually dispensed through an approved outpatient treatment center on a daily basis.

Buprenorphine has also been approved for the treatment of heroin addiction. This medication is only available through certified physicians. However, it also eliminates the need for daily trips to a methadone clinic. Generic options are available, making it a more affordable treatment option.

Getting treatment for any substance use disorder may be frightening and, for some, embarrassing. People with long-standing emotional problems or chronic pain are usually at a higher risk of developing substance use disorders. However, that should never dissuade anyone from asking for help. The good news is that heroin addiction is treatable. The first step is asking for help and admitting that there is a problem. Both inpatient and intensive outpatient treatments are available for those in need.

How Long Does Heroin Stay In Your System?

What Is Heroin?

Heroin is a controlled substance in the United States, and the USDA classifies it as a Class-1 highly addictive drug. It is a plant-based but heavily manufactured and altered opioid drug derived from the poppy flower. Heroin is processed and cut with other substances before it gets to the consumer. Users of the drug typically smoke, snort or inject it intravenously. The immediate effects are feelings of euphoria and sedation.

Health Impacts of Heroin in Your System

Opiate addiction is a significant problem around the world and in recent years, opioid abuse has been on the climb, leading to numerous cases of overdose. These types of drugs have a negative impact on energy levels and sex drive as well as the weight and functions of major organs such as the liver and kidneys.

Most significant, however, is the effect of opiates on brain function. As this drug is used for its effects on brain chemistry, it can cause changes to the way your brain operates and how it sends and receives signals.

In fact, the biggest danger of heroin abuse results from the drug’s ability to block or alter signals in your brain that control important bodily functions. Emergencies from opioid abuse often stem from breathing difficulties associated with overdose. The reason for this is that heroin can change the chemistry of the brain stem and cause depressed breathing.

Parts of your brain control the basic functions of your body, such as breathing and the beating of your heart, so that you don’t have to think about it. Heroin can alter and interrupt these signals that are telling your body to do what it needs to do to survive.

Drug Testing in the USA

In the United States, drug testing is used in many different types of situations. This is a common reason people may ask how long drugs will stay in your system. Many employers require pre-hire drug testing, and some also perform random drug tests on their employees.

Types of Tests

There are several ways to test for opiates and other drugs in the human body. Depending on the type of test performed, heroin can show up on the tests results whether a person has used recently or been abstinent for some time. Here’s a closer look at some of the tests currently in use:

Blood

Blood tests are one of the best ways to test for substances in the body, such as prescription or illegal drugs. This is not the most common type of drug test used, however. Blood testing is sometimes used by law enforcement, but it’s most commonly utilized in emergency medicine. In fact, blood testing is rarely used for legal issues and more often for medical diagnostic purposes.

The invasive nature of this test has raised constitutional issues. Of course, blood testing involves taking blood from a person’s body, and this requires either consent or due process of law, including a court order. While blood tests are great for medical purposes to determine what is going on in the body right now, they are not ideal for detecting prior opioid use because opiates may not be picked up in the bloodstream if it’s only been a few hours after use.

Urine

The most common type of drug test used in the United States is the urinalysis test. This is the preferred method for employment testing and probation and parole testing. This is because it is a fast and reliable form of testing that is also far cheaper to perform than blood and hair tests. Additionally, there are fewer legal and constitutional concerns when using urinalysis.

Hair

Hair testing is not especially common, but it does have a significant history of use in the U.S., primarily in the court systems. This method does have one benefit over other methods: While blood and urine tests have a more limited time frame to work in, hair testing can detect drugs months after their use.

Saliva

Testing of oral fluid is another somewhat common testing method for illegal and prescription drugs. This method involves using a cheek swab to collect a sample of saliva and other oral fluids. The test works much the same as a blood or urine test and detects the same content as other forms of testing.

The issue with saliva testing is that it can be a less reliable method due to medical conditions or drug side effects that may cause dry mouth. If a good sample can’t be collected, then the test will fail. In certain instances, the very drug being tested for can cause side effects that will negate the saliva test. This type of test isn’t typically the first choice when it comes to heroin detection.

Understanding Half-life

In science, half-life refers to the time it takes for a substance to be reduced by half, either by decay or through elimination within the human body. In medicine, half-life is used in formulas to determine proper doses and duration for treatment. For example, an antibiotic would have to be administered at a certain dose and frequency to ensure that antibodies remain present long enough to effectively fight the bacteria or infection.

The half-life of a drug determines how long the substance will be present and detectable in your body. If you are not a chemistry person, the concept can seem confusing, but it is fairly simple. Essentially, different substances take longer to clear from your body than others.

On one hand, there is the time it takes for the substance to be cleared to the extent that you no longer feel the effects of the drug, and on the other hand, the time it takes for it to not be detectable by tests. As an example, you could take a medication for pain and at the end of its half-life, you may feel your pain return and no longer feel the effects of the drug. However, a blood test would still show the presence of pain medication.

Variables to How Long Heroin Will Stay in Your System

 

When people ask how long a particular drug will remain in their system, it is not a simple answer that is the same for everyone. The best answer is always going to be a range because not all people are the same and not all drug mixtures are the same. Below are some of the many factors to take into consideration when asking how long a drug will be detectable in your system.

Age

Your age has a lot to do with your metabolism and the way your body processes substances you take in. An older person with a slower metabolism may show the presence of a drug longer than a younger person with a fast metabolism. Additionally, a person who has not yet reached full maturity may process the drug at a different rate than an adult. This is one reason that addiction in youth is of particular concern.

Weight

It stands to reason that weight would be a factor in the half-life of heroin and other drugs. Doses for medication are often based on weight. The reason for this is that the dose may need to be larger to have the intended effect on a larger person while a smaller person may get stronger effects from a drug at a smaller dose.

Body Fat

Body fat plays a role in how your body metabolizes what you put into it and how it breaks substances down. Excessive body fat impacts circulation, digestion, and liver and kidney function.

Hydration

Hydration plays a key role in removing toxins from your body. Good hydration is very effective in reducing the duration of time that drugs can be detected in urine. Using water to clean the urine is so effective that many people will drink large quantities of water in an attempt to pass a drug test. However, many tests will count clear urine as an automatic fail on the assumption that the subject was trying to falsify the results.

Drug Quality

This is one of the biggest variables in determining both the effect of the drug and how long it remains in your system. The fact that heroin is an illegal drug means that supplies are not checked for quality or held to an FDA standard. When using black market products, there is little way to know the purity and strength of the drug itself.

As drugs like cocaine and heroin are cut with other substances, the actual volume of the drug can vary. Think of it in the same way as proof in alcohol terminology. A 4% ABV will have a different effect on your body than a 90% grain alcohol. Similarly, heroin of low purity will break down in your body faster than a higher concentration.

Health Factors

One individual may process heroin in a different way depending on personal health issues. A diabetic, for example, will break things down in the body in different ways and at different rates. A person with blood and circulation issues may also take longer to clear the drug from their body.

Use History

The effect of a particular drug can have a lot to do with a person’s history of use. Consider that a dose for a first-time user may have a much stronger impact than the same dose for someone who has dealt with addiction for many years. One component of drug abuse is the perceived need for more and more as time goes on. Unfortunately, this is what leads to many overdoses.

While a lifelong user may process the drug differently, the bigger issue is their likely increased dosage. If a person is consuming higher and higher amounts to try and get a certain high, the volume in their body will likely take longer to process through the system.

How Long Does Heroin Stay in Your System?

Taking all of the above into account, we are talking about a drug with a very short half-life. In most cases, it will be undetectable in urine after only a couple of days. Blood and saliva tests are especially poor testing methods for heroin. In fact, testing blood and oral fluids may yield a negative result within only five to six hours of taking the drug. The most effective test available for detecting drug use over time is hair follicle testing, which has been reported to detect heroin in the body for up to three months after the last use.

So, when considering how long the drug stays in your system, the answer really depends on the test. You can think of two days and up to three months as the two extremes. However, most tests will only be able to detect heroin in your system for a period of two to seven days.

Heroin Withdrawal Symptoms & Detox

heroin withdrawalAbuse of heroin is a real and pressing problem in the United States. According to the National Institute on Drug Abuse, the number of people reported to abuse heroin has been on the rise since 2007. It’s reached 948 thousand Americans in 2016, and the heroin abuse epidemic shows no signs of slowing down.

It’s what can be expected, considering that the opioid abuse crisis in the U.S. is also in full swing. However, that doesn’t mean that nothing can be done. To be able to recognize the signs and symptoms of heroin abuse and help people around you, you should know what heroin withdrawal looks like and how it manifests. Here’s everything you need to know about heroin withdrawal and abuse:

Why People Turn to Heroin

Heroin is classified as a Schedule I drug which has no medical purpose or application, but is highly addictive and has a lot of potential for abuse. Similarly to prescription opioids, heroin suppresses some central nervous system functions like heart rate, respiration, temperature regulation, and blood pressure. Acting on opioid receptors in our brain; the heroin also causes a rush of pleasure much like when prescription opioids are abused.

However, heroin is a cheaper alternative to prescription opioids such as Vicodin, OxyContin, and others. They might be a gateway into drug abuse, as they’re prescription medications whose use doesn’t carry such a stigma as the use of street drugs do, but many prescription opioid abusers eventually turn to heroin. It’s usually easier to obtain since prescription painkillers are becoming harder to attain. According to CNN, once measures have been taken to make prescription opioids harder to abuse, the use of heroin almost doubled.

Heroin Withdrawal

As with other opioids, the symptoms of heroin withdrawal peak at one to three days after the last dose, but they can start as early as 6 or 12 hours after it. After one week, the symptoms begin to subside, but then the post-acute withdrawal syndrome follows. The symptoms that characterize the post-acute withdrawal stage are mostly psychological or emotional, but they can last years as the brain chemistry is returning to its normal state.

When it comes to acute heroin withdrawal symptoms, they can be very severe, depending on the amount of drug that’s been taken and how often. Some of the symptoms include:

  • Sweating
  • Shaking
  • Agitation and nervousness,
  • Nausea and abdominal pain
  • Drug cravings
  • Depression
  • Muscle spasms

Once withdrawal occurs, heroin addicts may use medical detox to soothe them, which is medication and therapy that helps alleviate the severity of the withdrawal symptoms. However, more often than not the solution for withdrawal is to wait until the symptoms abate.

The Range of Heroin Withdrawal Symptoms

Not everyone experiences the same withdrawal symptoms — there is a range of them based on how dependent the brain is to heroin. It means that the length of the abuse of heroin, the way in which it was abused, the doses that were taken, and the frequency in which they were taken, all affect the severity of withdrawal. As the abuse of heroin causes intoxicating effects like euphoria, the withdrawal symptoms will often cause the user to experience the opposite. Slowed heart rate will become rapid during withdrawal, and elation and sedation will turn into anxiety and a lower mood in most cases.

Mild withdrawal symptoms generally happen to those people who haven’t spent the past few months or years abusing heroin frequently and in massive doses. They include:

  • Yawning
  • A runny nose and tearing
  • Chills and sweats
  • Nausea and abdominal cramps.

Any of the milder symptoms above may coincide with moderate withdrawal symptoms depending on how much and how often heroin was abused. These include:

  • Diarrhea
  • Vomiting
  • Trouble concentrating
  • Agitation
  • Restlessness
  • Goosebumps
  • Fatigue
  • Tremors

The most severe heroin withdrawal symptoms may consist of a few that are life-threatening if there are certain complications. Severe heroin withdrawal symptoms include:

  • Depression
  • Difficulty feeling pleasure
  • Drug cravings
  • Insomnia
  • Anxiety
  • Hypertension
  • Rapid heart rate
  • Impaired respiration
  • Muscle spasms

Owing to some complications that these symptoms can cause and how dangerous it is to quit heroin outright, it’s usually advised to go through medical detox where the user has proper support of both medical and mental health experts who can keep the users safe through the process of quitting heroin.

How Does Medical Detox Work?

Detox can help manage the withdrawal symptoms by incorporating medications and therapy to help lessen the brain’s immediate dependence on heroin. Since it is a short-acting drug that starts affecting the user fast but also leaves the bloodstream quickly, it’s crucial to start detox before heroin exits the user’s system completely. Withdrawal can begin as soon as 6-12 hours since the last dose, but it usually takes heroin anywhere between 5-10 days to entirely leave the system, depending on how addicted the user is.

As part of medical detox, it’s also essential to monitor the user’s vital signs that might be affected by heroin withdrawal. These are primarily heart rate and breathing, but also temperature levels and blood pressure. During withdrawal and detox, it’s imperative to keep those who are going through it safe from withdrawal-related harm.

Some of the medications used during detox may include symptom-specific remedies to battle nausea, depression, and convulsions. In some cases, heroin can be replaced with a longer-acting opioid such as buprenorphine, naltrexone or methadone. Buprenorphine is the one used most often, as it has the lowest abuse potential and it can help suppress drug craving symptoms which helps those going through post-acute withdrawal syndrome to stay clean.

Even though heroin withdrawal is usually not life-threatening, it’s still extremely uncomfortable and dangerous to go through. Abruptly quitting heroin is not advisable, and those who want to stop and stay off the drugs should seek professional medical help. A detox is a viable option, and buprenorphine therapy can be very beneficial if administered correctly. Those addicted to heroin don’t have to walk the road to recovery alone.

How to Use Narcan to Reverse an Overdose

how to use narcanWhile prolonged opioid addiction is a terrible scourge in our country, one of the worst aspects of the opioid epidemic is how easy it is to overdose on these drugs. With the introduction of Chinese-made fentanyl into the illicit American market, it’s easier to overdose on opioids than ever before. However, the effects of opioid overdose can be reversed with the aid of a drug that was developed to save the lives of people who have fallen into the trap of heavy opioid use.

This drug is commonly known as Narcan, and it serves as a ray of hope for overdose victims and their loved ones. Instead of having to stand idly by or rely on dangerous anti-overdose drugs like adrenochrome, people who are confronted with the terrifying situation of dealing with an overdose can now use a safe and effective drug to save a life.

What Is Narcan?

Narcan is a brand name of naloxone, a drug that was developed to stop the physiological process of an overdose in the human body. If naloxone is administered in time, it reverses or blocks the effects of opioids.

An overdose is dangerous because opioids bind to the nerve cells that control respiration. Naloxone chemically displaces these opioid molecules, allowing the victim of overdose to quickly begin breathing again. The drug is a significant improvement on previous forms of anti-overdose drugs, which mainly sent a jolt designed to shock the body out of failed respiration or cardiac arrest.

Naloxone is administered in a variety of different ways, and it may be possible for you to store this drug in your home or place of work in case of emergency. If this course of action isn’t possible, most hospitals and addiction recovery clinics keep various forms of naloxone on hand at all times.

What to Do in the Event of an Overdose

Before you learn how to use drugs like Narcan, it’s important to understand that there are other actions you should take if you or another person ingests a toxic dose of opioids. While naloxone provides a lifeline for people who have ingested dangerous levels of opioids, administering this drug isn’t the only thing that you should do in this critical situation.

Call for Help

Before you do anything else, it’s important to call 911. That way, emergency services will be alerted to the situation and will start heading toward your location. If you need to leave the person on their own while you make the call, you’ll need to put them in recovery position first. This position is achieved when the person’s arm is crossed under their neck and one leg is placed over the other with the knee bent. When an overdosing person is put in this position, it is assured that they will not choke.

Use Naloxone

After you call 911, you’ll need to administer naloxone if you have it. If you don’t have any naloxone on hand, you’ll need to wait for EMTs to arrive on the scene. Since there are no known effects of naloxone if a person isn’t overdosing, there’s no reason to be cautious when using this substance. If the person isn’t having an overdose, naloxone won’t have any effect.

Help the Person Breathe

In many cases, opioid overdose causes trouble with respiration. If the person is having trouble breathing, you can conduct rescue breathing. Pinch the person’s nostrils closed, and breathe into their mouth once every five seconds until their breathing normalizes.

Provide Comfort

Once you’ve administered naloxone and helped the person start breathing again, there’s not much more you can do until EMTs arrive. Make sure that the person stays in the recovery position, and comfort them as much as possible. If the person is conscious, they may be confused or in a panic. They may also want to use drugs. It’s your job to restrain and pacify them until medical professionals arrive.

Suggest Treatment

After paramedics have arrived and the person’s condition has stabilized, it’s time to address the issues that caused this situation to occur in the first place. Do everything you can to keep the person from using drugs, and suggest that it might be time to detox under the careful supervision of a qualified inpatient addiction treatment center.

How Is Naloxone Applied?

Naloxone comes in a number of different forms, and each is administered differently. These different administration techniques have various benefits and detractors. You should be aware of each administration route before you decide which type of naloxone to have on hand in case of emergencies. Here is some basic information on the different forms that naloxone may take:

Hypodermic injection:

Traditional hypodermic injection remains one of the most popular routes of administration for naloxone. In most cases, naloxone injections are applied to the thigh or arm, and they can be administered through clothing. In some cases, naloxone will come in small packages that you’ll need to pour into a hypodermic syringe, but it’s much more common to encounter injectable naloxone in packages that fit directly into syringes. Single-use syringes with naloxone already inserted are also available.

Before stocking up on injectable naloxone, talk with your pharmacist about the recommended dose. In most cases, naloxone is injected in a dose of 0.4mg/ml. With this amount, a second dose is sometimes needed.

If you plan to administer naloxone with a hypodermic syringe, it’s important to receive professional injection training first. Injecting lifesaving drugs like naloxone isn’t as easy as it may seem. Adequate training will make sure that you don’t harm the overdosing person.

Autoinjection:

If you want to inject naloxone easily and safely, you should definitely learn about the benefits of autoinjection. A pharmaceutical brand called Evzio was approved to make an autoinjector with naloxone in 2014. This marked the first time that an autoinjector had been approved outside of clinical settings. This autoinjector is much easier to use than a traditional hypodermic needle, and it looks like a small box with instructions and an LED indicator on the side. It administers a single, calculated dose of naloxone with a retractable needle, and it doesn’t require any assembly or technical knowledge to be used.

The autoinjector can be used through clothes, and all you need to do to administer a dose of Evzio is hold the end of the box next to the overdosing person and press the button. This handy overdose tool even comes equipped with a recorded voice that gives you instructions from the moment that you begin administration. This voice will let you know when it’s time to remove the autoinjector.

Nasal spray:

Narcan, which is one of the most prominent manufacturers of naloxone, makes a nasal spray that delivers the drug through the nasal membranes. This nasal spray is approved by the FDA, and it provides one of the easiest ways to apply naloxone.

To use this spray, simply insert the nozzle of the Narcan administrator into one of the overdosing person’s nostrils. Then, press down on the applicator with your thumb to administer this lifesaving drug. Each package of Narcan comes with two pre-filled applicators, but you shouldn’t need to use more than one in the case of an overdose. You only need to apply Narcan to one nostril.

Nasal atomizer:

While this administration method isn’t as popular as the others, Luer-lock makes a nasal atomizer device that contains naloxone. This device has a number of different parts, and the nosepiece is usually only available at pharmacies with a prescription. In some cases, however, it is possible to buy the nosepiece from medical supply companies.

This nasal atomizer is relatively complicated, and you probably won’t know how to use it unless you’re a trained medical professional. Since the Narcan nasal spray and the Evzio autoinjector are much easier to use, they are the administration methods that people without medical training should choose.

Who Is Qualified to Administer Naloxone in an Emergency?

Qualification requirements depend on the type of naloxone that is being administered. In general, hypodermic needles and atomizers are too complicated to be used by anyone except for a paramedic. However, autoinjectors and nasal sprays are easy enough for anyone to use without any medical training.

As you decide which type of naloxone that you should keep on hand, keep in mind that the laws in your state may have an impact on your ability to possess naloxone. Some states have made it illegal to possess naloxone unless you are a certified medical professional, and other states may only allow possession of certain forms of naloxone. In your state, it may be possible to purchase the drug at a pharmacy without a prescription, but you should check the Prescription Drug Abuse Policy System website to learn about your state’s laws before you proceed.

Does This Anti-overdose Drug Have Any Side-Effects?

Naloxone does not appear to have any effect on people who are not overdosing on opioids. If you accidentally administer naloxone when you aren’t overdosing, you should have nothing to worry about. In the case of people who are overdosing, the only direct effect of naloxone is the unbinding of opioid molecules from the nervous system.

When naloxone forcibly removes opioids from the system of an overdosing person, they almost immediately enter into the withdrawal process. While opioid withdrawals are uncomfortable at best, they can also be life-threatening. Even if you administer naloxone yourself in a person’s home environment, it’s still important to seek out medical attention immediately to ensure that the person is safely guided through the detoxification process.

How Much Does Narcan Cost?

The cost to buy a dose of naloxone depends on your state of residence and your insurance plan. With the correct insurance, a dose of Narcan nasal spray currently costs about $20 to $40. This cost is extraordinarily low when compared with what can happen without the drug.

Before you purchase Narcan or a similar naloxone product, you should get in touch with your insurance company to see if they cover the cost. If your insurance doesn’t cover the cost of naloxone, you can get in touch with your local pharmacy to learn retail prices for this drug. You should also keep in mind that the manufacturers of Evzio offer a cost-assistance program to help you with your purchase.

Where Do You Get This Drug?

In most states, you can purchase naloxone without a prescription. To learn about the process of purchasing naloxone in your home state, you should call a local pharmacy and speak with a pharmacist or a pharmacy technician. Most pharmacies stock naloxone, and even if they can’t offer this anti-overdose drug without a prescription, they can help you learn about the process you’ll need to follow to be approved for one.

What Are the Next Steps?

After you’ve successfully administered naloxone and the overdosing person is in the recovery process, it can seem like your work is over. However, both you and the overdosing person have some important decisions to make that will determine their health and well-being going forward. An overdose is, by far, the clearest sign that a person needs help. You should make sure that he or she enrolls in an inpatient addiction clinic as quickly as possible.

While hospitals provide services to help in the detoxification process, addiction clinics offer the most comprehensive services available when it comes to getting and staying clean. Whatever you do, it’s important to make sure that the person knows that you are there to help with whatever they may need to overcome their addiction.

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.