Vermont Opioid Epidemic

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

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

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

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

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

Let’s look at the numbers

National Heroin/Opioid Statistics

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

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

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

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

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

Vermont Opioid Statistics

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

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

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

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

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

How is Vermont Preventing Prescription Opioid Misuse?

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

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

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

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

Beyond the Initiation Point

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

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

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

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

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

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

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

Conclusion

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

Treating Drugs With Drugs: Heroin Addiction Treatment With Marijuana

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

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

Why Medical Marijuana?

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

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

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

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

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

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

What are the prescribers saying and doing?

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

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

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

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

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

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

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

So many questions with so few answers

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

Need for a cure

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

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

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

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

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

In conclusion

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

responding-to-the-heroin-epidemic

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

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

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

Fentanyl & Carfentanil Deadly for Law Enforcement

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

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

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

Near Deadly Exposure for Law Enforcement

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

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

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

Conclusion (or lack thereof)

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

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

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

Opioids: An American Mass Murderer

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

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

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

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

From Prescriptions to Needles

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

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

A Bottle for Every Adult

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

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

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

OxyContin, and how the Medical Community was Duped

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

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

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

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

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

The OxyContin Crisis: Precursor to the Modern Epidemic

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

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

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

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

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

Then, in 2007, it all came crashing down.

Caught in a Lie

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

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

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

The Epidemic Continues

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

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

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

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

In Conclusion

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

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

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

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

DEA Orders Production Cut for Opioids in 2017

Each year, the Drug Enforcement Agency (DEA) sets regulations on the amounts of controlled drugs that are allowed to be manufactured. Over the past three years, the DEA allowed 25% more opioid production than usual. The year 2014 set the record for deaths from drug overdoses, and over 60% of them involved opioids. Citing a decline in demand, the DEA earlier this month has ordered opioid manufacturers to cut production by 25% or more, starting next year.

When setting regulations on the amount of a drug to be produced, the DEA must take into account medical usage, scientific usage, export needs, industrial requirements, and also a reserve stock. The majority of the cuts will be made to this reserve stock, and the cuts will affect almost all Schedule II opioids.  (All drugs are divided into Schedules, according to the Food and Drug Administration. Schedule II opioids include oxycodone, fentanyl, hydrocodone, and morphine, among others. For a complete list of Schedules, click here).

The DEA has reported that the demand for opioids has decreased. This is based on sales data represented by the number of prescriptions written by those registered with the agency. However, the current opioid epidemic in America was not overlooked. In its press release, the DEA stated “The 2015 National Survey on Drug Use and Health (NSDUH) released last month found 6.5 million Americans over the age of 12 used controlled prescription medicines non-medically during the past month, second only to marijuana and more than past-month users of cocaine, heroin, and hallucinogens combined.”

Details on the Opioid Production Cuts

In 1970, Congress passed the Controlled Substances Act (CSA), which established a federal drug policy. The CSA created regulations for the manufacture, importation, distribution, possession and use of almost all substances. The CSA also created the Schedule system and the Aggregate Production Quota (APQ), which is what’s being cut next year. The DEA establishes an APQ for over 250 different Schedule I and II substances each year, according to the press report.

For next year, the reserve stocks of most Schedule II opioids will be cut, meaning a 25% reduction, but in the case of hydrocodone and a few other unnamed opioids, the cuts will be 33%. According to the press report, “The purpose of quotas are to provide for the adequate and uninterrupted supply for legitimate medical need of the types of schedule I and II controlled substances that have a potential for abuse, while limiting the amounts available to prevent diversion.” This ‘diversion’ of substances with a ‘potential for abuse’ currently has America in an opioid epidemic.

Just because of Demand Reduction?

Hopefully these production cuts can make a difference. Although a reduction in demand was cited as the main reason for production cuts, the DEA knows we are in an epidemic. In a June press release, Administrator Chuck Rosenberg said, “We tend to overuse words such as ‘unprecedented’ and ‘horrific,’ but the death and destruction connected to heroin and opioids is indeed unprecedented and horrific. The problem is enormous and growing, and all of our citizens need to wake up to these facts.” According to the DEA’s own 2016 National Heroin Threat Assessment Summary, the number of heroin users has recently tripled, and so has the number of heroin deaths.

The following graph, published in 2014 by the National Institute on Drug Abuse, brings up two important points. One is that yes, there is a reduction in the number of prescriptions written from 2012 to 2013, but two is that there is an absurd number of prescriptions being written regardless.

opioid-prescriptions-written

Perhaps this is why in July of this year, six US Senators co-wrote a letter to the DEA calling for stricter limits to be placed on opioid pills. In the text of the letter were some alleged facts regarding the APQs for opioids over the last 22 years. “Between 1993 and 2015, DEA allowed aggregate production quotas for oxycodone to increase 39-fold, hydrocodone to increase 12-fold, hydromorphone to increase 23-fold, and fentanyl to increase 25-fold.” While it would be bold to say the DEA is at fault, it is hard to look past the fact that 14 billion opioid pills dispensed per year in this country.

Also hard to look past are the facts that the pharmaceutical companies are pushing for the prescription of opioids, and that medical institutions have been over-prescribing opioids for years now.

Big Pharma wants Big Opioid Numbers

According to the Associated Press and the Center for Public Integrity, opioid medicine manufacturers employ lobbyists and spend millions to “help kill or weaken measures aimed at stemming the tide of prescription opioids.” As a matter of fact, over the past decade, nearly $900 million has been spent advocating and lobbying for pharmaceutical companies, versus the $4 million spent on opioid limiting. Also over the last decade, the opioid industry has contributed to 7,100 state-level political candidates, has averaged 1,350 lobbyists in all fifty states, and has used the Pain Care Forum to influence opioid regulations on the federal level.

Dr. Andrew Kolodny, the founder of Physicians for Responsible Opioid Prescribing, says, “The opioid lobby has been doing everything it can to preserve the status quo of aggressive prescribing. They are reaping enormous profits from aggressive prescribing.” Evidence suggests he’s right. Actually, in 2007, Purdue Pharma, creators of Oxycontin, pled guilty to charges of misbranding and of misleading regulators, doctors, and patients. The dangerously addictive quality of the drug was criminally misrepresented, and Purdue Pharma paid $34.5 million in fines.

The lead lobbyist for Purdue Pharma is also part of the Pain Care Forum.

Doctors Prescribe too many Opioids

According to a national survey, 99% of doctors prescribe opioid medicines for longer than the recommended three-day period. 23% of doctors prescribe a month’s worth of them. Also, 74% of doctors consider morphine and/or oxycodone (both opioids) to be the most effective pain treatment medicines, but National Safety Council (NSC) research suggests the most effective pain treatment meds to be over-the-counter.

Something else 99% of doctors have done is seen a patient who was seeking pills for recreation or seen evidence of drug abuse in a patient, but only 38% of doctors refer such patients to get help. A mere 5% treat the abuse themselves. As published by the NSC, other findings among doctors include:

  • 71% of doctors prescribe opioids for chronic back pain, and 55% prescribe them for dental pain – neither of which is appropriate in most cases.
  • 67% of doctors are, in part, basing their prescribing decisions on patient expectations; however, a National Safety Council poll in 2015 showed 50% of patients were more likely to visit their doctor again if he or she offered alternatives to opioids.
  • 84% of doctors screen for prior opioid abuse, but only 32% screen for a family history of addiction – also a strong indicator of potential abuse.

Aetna and other big Insurance Companies have started putting these companies on “Super-Presciber” Watchlists.

Opioid Epidemic

It’s rather doubtful that any conspiracies are occurring, and it’s highly doubtful that the DEA and big pharma do not care about the skyrocketing number of opioid-related deaths. Regardless, though, we are amidst an opioid epidemic, and much more has to be done before we are in the clear.

An estimated 36 million people worldwide abuse opioids, with over 2 million of them here in the US. Up to half a million Americans abuse heroin. The correlation between non-heroin opioid abuse and heroin abuse is astounding.

The Substance Abuse and Mental Health Services Administration published in 2013 findings that show the “heroin incidence rate was 19 times higher among those who reported prior nonmedical pain reliever (NMPR) use than among those who did not.” (For the record, NMPR abuse is a fancier way of saying opioid pill abuse). Furthermore, 80% of heroin users had previously abused other opioids, whereas only 1% of opioid pill abusers had previously done heroin. It seems Schedule II opioids are a gateway drug to heroin.

Also, as seen in the following graph, the heroin incidence rate itself has been steadily rising for over ten years:

heroin-usage

Drug overdose is the number one cause of accidental fatality in America, and opioid-related deaths are fueling this disaster. The sale of prescription pills quadrupled from 1999 to 2010, and hit record numbers in 2014. Prescription pill overdose and death also quadrupled over this time, and also hit a record number in 2014. Surely this is no coincidence.

What is being done?

Aside from cutting production of opioids by up to 33% next year, the DEA also instituted its 360 Strategy last year to help combat the opioid epidemic. The strategy is comprised of three initiatives, together designed to “not only fight drug traffickers but also to make communities resilient to their return.” The three initiatives are:

  • To coordinate enforcement actions that target drug traffickers and suppliers
  • To advocate responsible prescribing methods by an increase in awareness of the heroin and prescription drug epidemic among manufacturers, wholesalers, medical institutions and pharmaceutical companies
  • To empower communities with whatever necessary to combat the epidemic

Head of Philadelphia’s DEA division Gary Tuggle says, “DEA’s 360 Strategy recognizes that we need to utilize every community resource possible to reach young people and attack the heroin and prescription drug epidemic at multiple levels.”

Earlier this year, the Centers for Disease Control (CDC) issued its 2016 Guideline for Prescribing Opioids for Chronic Pain. Adherence to this guideline ensures “safer and more effective chronic pain treatment.” According to the text of the guideline, 20% of patients with non-cancer pain symptoms receive an opioid prescription. In 2012 alone, nearly 260 million opioid prescriptions were written in the US, which was the approximate number of adults living in the US at the time.

Making the new CDC guideline most necessary is the fact that “rates of opioid prescribing vary greatly across states in ways that cannot be explained by the underlying health status of the population, highlighting the lack of consensus among clinicians on how to use opioid pain medication.”

So essentially, the big pharmaceutical companies push for more opioids to be purchased by medical professionals, who in turn over-prescribe opioids, which then leads to opioid dependence in patients. This vicious cycle needs to be cut off somewhere, and hopefully the production cuts for 2017 are a good start.

At a hearing in June of this year, Senator Richard Durbin (one of the six to write a letter to the DEA) pointed out that in 2014, (the year with the most drug overdoses ever), the DEA allowed enough opioid production “for every adult in America to have a one-month prescription.”

In response, DEA Administrator Chuck Rosenberg said, “I think we’re part of the problem.” Hopefully now, the DEA becomes even more a part of the solution.

World’s Most Dangerous Drug? Carfentanil makes its case

You’ve heard of Morphine. It’s an opioid painkiller administered by health professionals worldwide every day. If you’ve ever been hurt badly enough to be hospitalized, there’s a good chance you were given Morphine for the pain. Morphine is actually listed as one of the two most important opioid painkillers by the World Health Organization, making it a crucial part of a basic healthcare system.

Morphine and other opioid painkillers are involved in 40% of all drug overdoses, and Morphine itself is essentially heroin, just less refined.

You may not have heard of Fentanyl. It’s an opioid painkiller as well, used mainly for anesthesia and pain management, and it’s up to 100 times stronger than Morphine. You may have been given Fentanyl prior to a surgery, and it is often used by veterinarians on smaller animals requiring surgery. Fentanyl has also helped produce drugs to alleviate cancer pain. When used properly, it is an effective medicine.

Fentanyl patches have been killing children under 2 for over fifteen years, and starting around 2006 there has been a steady rise in the amount of deaths caused by Fentanyl.
You likely haven’t heard of Carfentanil, unless you are in the veterinary field and deal with large mammals. Carfentanil is extremely close in chemical makeup to and can be derived from Fentanyl. Similar to Morphine and Fentanyl, it too is an opioid painkiller, primarily marketed as Wildnil, for use as an anesthetic for large animals such as elephants. It’s 100 times stronger than Fentanyl, and is therefore 10,000 times stronger than Morphine, making it “one of the most potent known and the most potent commercially used opioids,” according to the US National Library of Medicine. Carfentanil is never administered to human beings.

Due to its limited medical use, the US government only allows an annual production quota of 19 grams. Ingestion of this powerful drug can cause near-automatic respiratory failure, as the entire nervous system slows down to a point where death is imminent.

Carfentanil has lately been being mixed into heroin, and bad batches have killed tens of thousands of people. An amount the size of a poppy seed can be lethal.carfentanil

A New Epidemic

Heroin use in America is an overwhelming epidemic. It’s estimated that 900,000 Americans use heroin, and it’s a fact that heroin abuse rates have skyrocketed in the past decade. 2014 set a new record for heroin overdose deaths at 10,574. Every day in the news there are sad stories of heroin running rampant and killing young people.

Carfentanil plays a major role in this current heroin-caused death spree.

Drug dealers are lacing heroin with Carfentanil all across the country and even in Canada. Those who use the laced heroin are overdosing in huge numbers. In fact, no compiled data exists yet for how many people have died in total from Carfentanil-laced heroin, likely because of how quickly this is all happening. In order to see the scope of the problem, individual episodes must be examined.

Carfentanil on the Rise

July of this year marked the essential start of the Carfentanil epidemic. Since then, strings of fatal overdoses have been reported all over North America, and continue to be reported this month. These deaths are predominantly occurring from Carfentanil-laced heroin, but the deadly effects of Carfentanil made international headlines in 2002.

Movsar Barayev, a Chechen warlord, held 912 people hostage at the Dubrovska Theater in Moscow, Russia. After a three day holdout, Russian police pumped what was called a sleeping gas into the building, effectively killing Barayev and his 40-person team, but also killing 130 of the hostages. Much controversy surrounded the subsequent investigation. It was discovered, however, that the gas was made mainly of Carfentanil. It was literally used as a chemical weapon. (This implication is further investigated below).

Now, in America, fourteen years later, Carfentanil is again making headlines.

Ohio, USA

In early July, Ohio police seized large amounts of heroin which was laced with Carfentanil. Apparently some had gotten distributed already. By the end of the month, the city of Akron alone saw 141 Carfentanil-laced heroin overdoses, ten percent of them fatal. Columbus saw ten fatal overdoses(apr link) from the concoction in just a nine-hour period. Last month, over 200 Cincinnati residents died this way in just two weeks’ time.

The state has recently been strengthening its police force and creating anti-heroin coalitions. Hamilton County coroner Dr. Sammarco told the New York Times, “We’d never seen it before. I’m really worried about this.” Another quote that drives the point home of just how bad it is in Ohio comes from Akron Police Chief Jim Nice: “Most of the deaths from heroin overdoses are coming from too much Fentanyl being cut into that.” The Fentanyl he speaks of is oftentimes Carfentanil, which remember is the 100x stronger version.

Pennsylvania, USA

In early August, a report from officials in Philadelphia said users of Carfentanil-laced heroin are “dropping like flies.” John Libonati, coroner for Mercer County, is reportedly “desperate to get that information out to the public.” Up until August, there had been 10 Carfentanil-related deaths in the county. During the first week of August there were four more. Regardless, the number of accidental overdose deaths in the county is down from last year.

Statistics can be misleading, however, and this string of fatal overdoses in a highly populated area of Pennsylvania serves as proof. Libonati credits the drop in accidental overdose deaths to “quick emergency responses, accurate diagnosing and the availability of Naloxone, and not a reduction in drug abuse.” While it is good news that this response is happening, abuse is still rampant. Libonati went on to say, “The number of calls that we and other ambulance services are getting is skyrocketing… The number of deaths may be down but usage is not. Literally every part of Mercer County is affected.”

Maryland, USA

In September, the Maryland Poison Center published an update concerning Carfentanil overdoses, explaining and warning people how the drug has been laced into heroin recently. The publication also reads: “Safety protocols are being developed by agencies in many Maryland jurisdictions and throughout the U.S. to minimize the risk of exposure. Many agencies are recommending that field-testing of suspected heroin be suspended.”

This means Carfentanil is so dangerous that even testing heroin laced with it could be fatal for the testers. Imagine what this drug does inside the body…

Alberta, Canada

Earlier this month, one Edmonton man and one Calgary man each died from Carfentanil-laced heroin overdoses. Alberta’s chief medical officer of health, Dr. Karen Grimsrud, issued a warning afterward: “Albertans need to know that the drug Carfentanil has made its way into our province and that it is an extremely dangerous and deadly opioid. The smallest trace of Carfentanil can be lethal and Albertans should be aware of the life-threatening dangers in using this drug.”

Over 150 Albertans have died from Fentanyl-laced heroin this year, but evidence suggests that Carfentanil may be to blame in some cases but is untraceable. Due to the extremely low amount required for a fatal overdose, Carfentanil detection requires highly-sensitive equipment only recently even being made. Alberta’s chief medical examiner, Dr. Elizabeth Brooks-Lim: “There are very few labs in North America capable of measuring Carfentanil in human blood.”

Michigan, USA

Just days ago, Wayne County chief medical examiner Carl Schmidt reported 19 fatal overdoses from Carfentanil-laced heroin. Also, the Michigan Regional Poison Control Center has reported a rise in severe opioid-related toxicity levels among patients.

Analysis of heroin samples from surrounding counties is currently underway. Only time will tell if Carfentanil has found its way into other areas of Michigan, but already there have been suspected instances in Port Huron and New Haven. Chairwoman of Governor Snyder’s commission on opiate prevention, and president of Families Against Narcotics, Judge Linda B. Davis, told USA Today, “This is really scary. It makes it more deadly than heroin already is. It is devastating communities.”

Oregon, USA

In the past two months, two Oregon residents have overdosed from Carfentanil-laced heroin. Miraculously, both people survived. Dr. Zane Horowitz, medical director of Oregon Poison Center, knows this is not usually the case. “It doesn’t take much. The first time most people use it is the last time they use it,” said the doctor to local news network NWCN.

Vancouver, Canada

A huge success for Canadian border officials in early August was also a sign of how bad the Carfentanil epidemic has gotten in North America. In Vancouver, an entire kilogram of the stuff was intercepted in the mail by the Canadian Border Services Agency. It was discovered in a package addressed to 24-year-old Calgary native Joshua Wrenn. He faces a charge of importation of a controlled substance.

The single kilogram contained enough Carfentanil to kill 50 million people, more than the number of people in all of Canada. Where the Carfentanil came from brings us to an entirely different continent: Asia.

China Sells Carfentanil, and it’s a Chemical Weapon

CBS recently reported on Chinese businesses that are willing to sell Carfentanil “openly online, for worldwide export, no questions asked,” according to the Associated Press, who investigated these Chinese businesses. Twelve different Chinese vendors were discovered to offer Carfentanil by the kilogram via their websites. China does not list Carfentanil as a controlled substance, and as a nation leads the world in synthetic drug sales. The US has pressed China to outlaw the substance. Nothing has happened yet.

The Freedom of Information Act has made it public knowledge that since its creation in 1974, the US, the UK, Russia, Israel, China, India, and the Czech Republic have all researched Carfentanil as a possible chemical weapon. It has since been banned entirely from warfare according to the Chemical Weapons Convention.

Former assistant secretary of defense for nuclear, chemical and biological defense programs Andrew Weber said, “It’s a weapon. Companies shouldn’t be just sending it to anybody.” However, if you live in the US, Canada, the UK, France, Germany, Australia or Belgium, one kilogram of death powder goes for $2,750. An email sent in September from a representative of China-based Jilin Tely Import and Export Co. to Associated Press amidst their investigation read, “We can supply Carfentanil… for sure. And it’s one of our hot sales product,” broken English and all.

Weber, in response to the ease with which the Associated Press found in ordering Carfentanil from China, said, “Countries that we are concerned about were interested in using it for offensive purposes. We are also concerned that groups like ISIS could order it commercially.” This has some terrifying implications.

China’s Stance

Fentanyl is a controlled substance in China, along with 18 other related chemical compounds. However, Carfentanil remains uncontrolled. This is rather unfortunate considering the effect China controlling a substance has on the United States.

For example, last October, China added Acetylfentanyl, a weaker version of the very-strong Fentanyl, to its controlled substance list. Six months later, Acetylfentanyl overdoses in the US were down by 60%.

The problem lies in the “freewheeling chemicals industry” of China, as CBS calls it. Here’s what happens. Vendors that produce these chemicals lie on their customs forms. This enables them to guarantee delivery of Carfentanil to countries where it is illegal. These vendors even go so far as to offer advice to buyers on how to sneak the packages past law enforcement and into their homes.

Here’s what Xu Liqun had to say, president of Hangzhou Reward Technology, a company that offers Carfentanil on its website: ““The government should impose very serious limits, but in reality in China it’s so difficult to control because if I produce 1 or 2 kilograms, how will anyone know? They cannot control you, so many products, so many labs.”

In Conclusion

This is some scary stuff. The drug used to immobilize elephants, the largest land mammals on Earth, is being put into heroin all over North America, and most of it is coming from Chinese websites that allow free sale of the stuff, even offering advice on how to sneak it past the cops and the post office.

The heroin it’s being put into is killing Americans by the tens of thousands, in all corners of the country. The worst part of all is how undetectable Carfentanil is; heroin addicts are unsuspectingly buying their own deaths. The heroin epidemic is becoming a Carfentanil epidemic, and it needs to stop.

Substance Abuse & the Elderly: A Growing Issue

Senior-Alcohol-AbuseBe prejudiced for a moment. In your mind, picture a drug addict. Picture a jobless, alcoholic man with a Xanax addiction who lives alone and can barely afford to pay his utility bills. He’s so out of touch with modern society that he doesn’t have a computer, and rarely does he receive visitors. Now you should have an image of this man in your mind. Regardless of any other feature, did you expect him to be 78 years old?

This man is not real, but the problem of substance abuse among the elderly is very real. More than 2.5 million elderly people have a substance abuse problem in this country. It is, in fact, “one of the fastest growing health problems facing the country.” However, for reasons we will explore, “our awareness, understanding and response to this health care problem is inadequate,” according to the National Council on Alcoholism and Drug Dependence.

Nearly 10% of hospital visits among the elderly are caused by substance abuse. The same goes for 14% of their trips to the emergency room and for 20% of their psychiatric hospital admissions. Widowers aged 75 and over have the highest alcoholism rate in the nation. Half of nursing home residents battle alcoholism. High rates of prescription pill abuse and misuse are common among the elderly.

There are some evidence-based reasons for why the elderly face their own substance abuse epidemic, as well as some implicit causes for why this is so. Also, some factors only serve to worsen the issue, such as living alone or the fact that doctors are less likely to refer the elderly to substance abuse recovery programs.

Reasons, Causes, and Contributing Factors

Many reasons exist, both physical and psychological, for why the elderly may turn to drugs or alcohol. The majority of these reasons are unique to the elderly age group. Certain life situations can cause the elderly to self-medicate. Another cause for elderly substance abuse regards the lifestyle of their particular generation, the baby-boomers. Also, especially regarding prescription drugs, the elderly face an over-saturation of medicine as an age group. Over one half of the elderly currently take three or more different prescription pills a day.

Let it be noted that there are essentially two types of elderly substance abusers, those who had begun abusing early and continue to in old age, and those who start abusing in old age. People over 65 who have abused drugs and/or alcohol throughout their lives are nicknamed ‘hardy survivors,’ and those who begin later in life are nicknamed ‘late onset’ substance abusers. Obviously the hardy survivors are more at risk than the late onset abusers, but substance abuse remains as deep a problem for one as it does for the other.

Reasons why the elderly may turn to substance abuse:

  • Depression due to the children being grown and gone
  • Loss of identity and/or financial hardship due to no longer working
  • Feelings of dependence due to the need for assisted-living
  • Friends are fewer and further away
  • Physical and/or mental health problems
  • Death of a longtime partner or loved one
  • Physical pains of aging, including loss of mobility
  • Boredom

These are reasons why an elderly person might continue to abuse (hardy survivors) or start to abuse (late onset) drugs and/or alcohol. People move away, jobs must be left, health is deteriorating, and loneliness occurs more often than ever. There are also more increasingly complicated factors that contribute to this growing problem.

Medically speaking, substance abuse in the elderly can be difficult for doctors to recognize and diagnose. According to the Center for Substance Abuse Treatment, “Diagnosis [of substance abuse] may be difficult because symptoms of substance abuse in older individuals sometimes mimic symptoms of other medical and behavioral disorders common among this population, such as diabetes, dementia, and depression.” If the substance abuse goes unrecognized, no treatment gets provided.

Another medical contribution to the problem stems from research done in 1982. The researchers found there was a “decline in encounter time for patients 65 years of age and older compared with those 45 through 64 years of age.” If people over sixty-five with substance abuse problems are not being diagnosed as such, and are also not being seen by doctors as long as others, it’s almost no wonder this is a growing problem.

Lastly, today’s elderly people consider substance abuse very much a private matter, and may feel great shame which leads to reclusion. The Center for Substance Abuse Treatment explains that due to this possible shame, the elderly are much less likely to seek professional help on their own. The same actually goes for the friends and family of the elderly, especially for their children. “Many relatives of older individuals with substance use disorders, particularly their adult children, are also ashamed of the problem and choose not to address it.”

The Baby-Boom Generation

If you were born between 1946 and 1964, you are considered a ‘baby-boomer.’ The baby boom was a spike in the birth rate that occurred after World War II. There were 76 million children born in America during this time, and the birth rate reached levels unseen since the 1920s. These baby-boomers, according to the Partnership for Drug-Free Kids, “had much higher rates of illicit drug use as teenagers and young adults than people born in earlier years.”

Statistics suggest that baby-boomers continued patterns of substance abuse with them through time. Approximately 3 million baby-boomers have a diagnosable substance abuse problem. Up to 25% of them binge drink alcohol, with nearly 10% of them alcoholics. Alcohol is the most commonly abused substance among the baby-boomers, and among the elderly, but is by no means the sole substance of choice.

For the first time ever, both the accidental drug overdose rate and the opioid abuse hospitalization rate are higher for baby-boomers than for those currently aged 25 – 44. According to The Wall Street Journal, between 1990 and 2010 “the rate of death by accidental drug overdose for people between ages 45 and 64 increased eleven-fold.” Annually, a drug abuse survey is conducted by the U.S. Dept. of Health and Human Services. In 2012, the survey showed that less than 20% of those aged 65 and over had ever used illicit drugs, but for those aged 64 and under, nearly half had used them.

What this all means is that baby-boomers as a generation contribute greatly to the present issue of elderly substance abuse. This notion was summarized well by Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse: “As the baby boomers have aged and brought their habits with them into middle age, and now into older adult groups, we are seeing marked increases in overdose deaths.”

The baby-boomers are not the only ones to blame. A large portion of current baby-boomers do not even qualify as elderly. On the same token, there are members of the elderly who abuse substances but are not baby-boomers. One might argue that the biggest contributor to elderly substance abuse outside of the baby-boomers is prescription pill abuse and misuse.

 

Prescription Pills and the Elderly

prescription pillsThe elderly consume almost one-third of prescription pills in America, yet only make up 13% of the population. Putting that into real numbers, approximately 4 billion prescriptions are written each year in our country, which has a population of 319 million. Essentially this means that the 41.5 million elderly people in this country receive 1.2 billion prescriptions per year. That’s 29 prescriptions a year for every single elderly person in America. Granted, not all of the prescriptions written for the elderly are abused for recreational purposes. However, let’s take this further…

Studies have shown up to 23% of all prescriptions given to the elderly are benzodiazepines. This class of drugs is known to be sedative, hypnotic (sleep-inducing), and muscle-relaxant. The most common benzodiazepine is Valium. Well over 10 million people report abusing Valium per year, making it the third most abused tranquilizer in the US. The number of hospital visits involving benzodiazepines increased six-fold between 1999 and 2011.

Abusing prescription pills isn’t the only way they can be damaging to the elderly. Misuse of a legal drug occurs when the medical directions are not followed. Misuse could mean taking too many pills at once, and could also mean taking the right amount of pills but too frequently. Misuse can be committed voluntarily or by accident. According to the Center for Applied Research Solutions, the elderly “are particularly vulnerable to prescription drug misuse.” You may recall from previously in this text that the elderly are seen for less time by doctors than any other age group. This may be resulting in the elderly being misinformed on the pills they have. This and several other factors make prescription pill abuse and misuse (as well as other illicit drug/alcohol abuse) especially dangerous for the elderly.

Substance Abuse is More Dangerous for the Elderly

As we age, our minds and bodies tend to fail us slowly. Because of this, the dangers elderly people face when abusing substances are greater than they are for other demographics. Specific dangers exist for those over 65 who engage in drug and/or alcohol abuse.

  • The elderly are much less likely to be referred to a specialist by family, friends, or medical professionals.
  • Substance abuse is not often detected among the elderly. This is due to living alone more commonly than others, being less willing to share this information with others, or because the effects of aging are similar to those of substance abuse.
  • Older people take multiple medications at once more often than other people do. This is rather dangerous because of possible adverse effects from misuse or from mixing these drugs with alcohol.
  • It is all too easy for an addicted elderly person to assume they are too far gone to change, that they don’t have enough reason to quit.
  • Tolerance decreases with age. This means what might have been a normal amount to an elderly person at one time could actually cause overdose.
  • Enzymes in the liver that process alcohol decrease in volume as people get older. This means alcohol abuse among the elderly can cause liver diseases more rapidly.
  • Intoxication often leads to falling down or making other poor decisions, which can be sufficiently more dangerous for an elderly person.
  • Less responsibility and fewer commitments means less holding back from abusing among the elderly. Job loss and parenting are not concerns for them.
  • Due to natural aging processes, the elderly are simply much more affected by substance abuse than those under 65.

In Conclusion

Unfortunately, it is predicted that the number of elderly people with substance abuse issues is rising. Part of this is population-based, since those aged 65-70 are the part of the populous growing the fastest. However, a large part of this remains due to a lack of knowledge. Elderly substance abuse is known as a ‘hidden dilemma.’

Said best by the US National Library of Medicine, substance abuse among the elderly will only cease when further means of prevention are instilled into the medical community. The quote:

“Studies have shown that intentional abuse of prescription drugs is increasing among all age groups. As the number of persons 65 years of age and older skyrockets with the aging of the baby boomers, experts predict that prescription drug abuse among the elderly also will rise significantly. Efforts to increase awareness of drug abuse among elderly patients, caregivers, and health care practitioners, as well as research into how best to prevent and treat the elderly drug abuser, will be necessary to thwart what could become a significant public health problem.”

“Super-Prescribers” are being Placed on Aetna Watchlist

Picture a bottle of opioid pills, such as oxycodone. Now think about 280 million bottles of opioid pills. That’s how many are given to patients annually. The actual number of pills given out per year is in the billions. In a society all too familiar with substance abuse, it seems no wonder we are in the midst of an opioid-abuse epidemic. Due to the epidemic, Aetna, a very large American health care company, has begun notifying those doctors who prescribe the most opioid pills (super-prescribers); they notified 951 of them in fact.Aetna Watchlist Super-Prescribers

The Facts

The near-thousand doctors notified made up the top 1% of opioid prescribers, now being called super-prescribers. Over 8.5 million insurance claims were analyzed, and only doctors who had prescribed opioids a dozen or more times were included. Had these doctors prescribed at the average rate, nearly 1.5 million less opioid pills would be in public hands. Granted, the vast majority of the patients given opioids needed them medically, but still, plenty of the drugs end up in an abuser’s hands. Not to mention, doctors who routinely prescribe large amounts of opioids were excluded.

Aetna sent the same message to each and every doctor: “You have been identified as falling within the top 1 percent of opioid prescribers within your specialty.” This simple sentence is not a warning so much as a strong suggestion to ensure all opioid prescriptions are necessary. High refill rates may be needed in some cases, but without a doubt some refill rates could stand to be curbed or even ended. 14,838 people died from opioid overdoses in the year 2014 alone.

The Reasons

Harold Paz is the chief medical officer of Aetna. Speaking to the Washington Post, but really speaking to the doctors on the Aetna watchlist, Paz said, “We’re asking you to look at your practice…and identify if the way you’re prescribing narcotics is best practice. And if it’s not, here’s an opportunity to improve.” Nothing criminal is suspected of happening.

This is simply a major step being taken by an insurance provider to help try and end the opioid crisis. According to a recently published article by Journal of the American Medical Association, almost 60% of us leave our leftover prescriptions at home once done with them, and 20% of us give them away. This game of telephone with drugs needs to stop. Please if you’re reading this, do not share your prescription pills and in fact keep them well hidden. If you no longer need them find out how to properly dispose of your excess drugs.

Aetna is not alone in this battle. Other insurance companies have launched similar campaigns to help stop the abuse. Consumers for Affordable Health Care believes lowering the opioid prescription rate will even benefit the insurance companies themselves. This is because the medicine is expensive but also because overdoses lead to other diagnoses that are also expensive. Yes, it may also be about money with the insurance companies, but nevertheless the morals are in the right place.

Cigna, another rather large insurance provider, currently has programs to reduce opioid prescriptions. Their goal is to lower the rate by 25%. Anthem, another insurance company, launched the Pharmacy Home Program, which aims to reduce the amount of people who attempt to receive multiple prescriptions from multiple doctors and therefore receive multiple bottles of pills. This is known as “doctor shopping” and is punishable by law.

The Hope

We can only pray that somehow the opioid abuse problem in America stops. This is a good thing that Aetna and other insurance companies are doing, but it will not stop the problem by itself. Education on drug abuse at early ages and a whole lot of human help is required, but it is not impossible.

Homeless, Addicted, Incarcerated – Breaking the Cycle

Homeless

Homelessness is an epidemic on its own. On any given night, over 630,000 people in the US are homeless. For obvious reasons, the homeless suffer from a multitude of issues, including hunger, sleeplessness, harassment, and hypothermia in seasonal areas. Sadly, one quarter of all homeless people are children. Over 55,000 are veterans. An astonishing ninety percent of homeless women “are victims of severe physical or sexual abuse, and escaping that abuse is a leading cause of their homelessness.” Other reasons for becoming homeless include mental illness, depression, and job loss. (One in five homeless people exhibit symptoms of mental illness).homeless

Many of our nation’s homeless people start out leading a normal American life. In fact, the vast majority of the homeless have recently held jobs. A study was conducted in New York City at the Franklin Avenue shelter that showed only one percent of homeless people report having never held a job. However, up to 75% of homeless people were shown to have a drug and/or alcohol addiction. Oftentimes drug abuse is the reason for the downfall.

Addicted

Another common infliction faced by the homeless is drug and/or alcohol addiction. The single leading cause of death among the homeless for many years was HIV, but recently drug overdoses have surpassed HIV as the leading cause. A study conducted in Boston showed drug overdoses to be the leading cause of death among the homeless, even more frequent than cancer, heart disease or HIV. More than four out of five homeless overdose deaths are from opioids.

Even beyond the use of illicit drugs, a reported 73% of the homeless are addicted to nicotine, which is over three times higher than the rate for non-homeless people. Also, because of the large amount of health problems the homeless face, along with the fact that healthcare is not readily available, many turn to illicit drugs as a method of self-medication.

Incarcerated

According to the US Department of Justice, “a significant proportion” of the 600,000+ people who are released from incarceration “were homeless when they were incarcerated.” Up to half of the homeless on the streets were previously incarcerated, and let’s not even discuss recidivism rates. (Over three-quarters of people arrested and released get arrested within five years).

It’s not a secret that homelessness and incarceration have a relationship. Studies show incarceration to be 4-6 times more likely for the homeless population.

The Cycle, and Breaking it

Among many programs implemented to combat the cycle of homelessness, addiction, and incarceration, one in Sacramento, CA named the Clean & Sober Program serves as a great example of the effect such programs can have. The initiatives of the Clean & Sober Program are to assist those homeless people “who want to further their education or strengthen their family relationships,” and to provide resident housing from $0 to $275, dependent on the situation. Traditional 12-step recovery programs are also offered.

The cycle is no secret to the white house either. Last year, President Obama took action to assist the incarcerated with rehabilitation and reintegration into society. Among the steps taken were allocating $8.7 million to rehabilitation programs designed to reduce recidivism, allocating up to $8 million in grants for education for the incarcerated, and working to remove the question of past incarceration on job applications.

Steps are indeed being taken in the right direction, but until we either end homelessness or drug addiction, we will likely have both.

Heroin Overdose: A Picture of Abuse

I can describe a cactus. I can tell you about its thick, bulbous leaves, and how they’re covered in spines. I can explain how the cactus has dry, tannish spots on its leaves, and how tall the cactus is. I can literally read the dictionary definition of ‘cactus’ to you, but if you have never seen a cactus, all of my words are useless. Take a look at one, though, and you know exactly what a cactus looks like, no words required.

Sometimes a picture says it all.

Such is the case with this couple from Ohio. Both are passed out from heroin use, inside a vehicle, with a small child in the rear seat. The story makes you cringe, but it’s a story that needs to be heard.

heroin overdose ohio

What Happened?

Last Wednesday in East Liverpool, Ohio, James Acord was pulled over by Officer Kevin Thompson. Acord was driving erratically and weaving in and out of traffic. He told Officer Thompson he was bringing his girlfriend, Rhonda Pasek, to a nearby hospital. She was passed out in the passenger seat. An affidavit from the arrest says Acord’s head was “bobbing back and forth,” and that “his speech was almost unintelligible.” Immediately after speaking to the officer, Acord fell unconscious himself. That was when Officer Thompson noticed a little boy in back of the car.

Rhonda Pasek’s 4-year-old son was in the back seat, witnessing his mother and her boyfriend overdose on heroin before his very eyes.

Officer Thompson noticed Pasek turning blue and called emergency medical technicians to the scene. The technicians administered Narcan, a powerful anti-overdose drug, to Pasek, possibly saving her life.

Acord pled guilty to the charges of operating a vehicle while impaired as well as endangering the welfare of a child. He was sentenced to one year in jail, had his driver’s license revoked for three years, and was fined $475. Pasek pled non-guilty to the charges of endangering the welfare of a child, disorderly conduct, and public intoxication, and has a bond set for $150,000.

Setting an Example

The pictures of them unconscious in the vehicle were taken by the arresting officer. Less than a week after the incident, the city of East Liverpool decided to publish the pictures on the city Facebook page. Their reason for doing so, (from the page):

We feel it necessary to show the other side of this horrible drug. We feel we need to be a voice for the children caught up in this horrible mess. This child can’t speak for himself but we are hopeful his story can convince another user to think twice about injecting this poison while having a child in their custody.

The pictures are graphic, but they reveal so much about the heroin epidemic that has swept our country. Heroin addiction is so awful that couples with children are passing out behind the wheel. These two were made examples by a state that knows firsthand how terrible the heroin epidemic can be.

Ohio has a Heroin Problem

“We are well aware that some may be offended by these images and for that we are truly sorry, but it is time that the non drug using public sees what we are now dealing with on a daily basis.” This was published along with the pictures on the East Liverpool Facebook page. The city speaks from experience.

Heroin overdoses rose by over 70% in Ohio from 2012 to 2013. The following year, they rose by 300%. Ohio had the second most drug overdose deaths of all fifty states in 2014. The Centers for Disease Control (CDC) called Ohio’s heroin problem “an emerging threat to public health and safety.” As of this year, 18 Ohio residents die per week of heroin. 92% of those imprisoned in Ohio have a history of drug addiction. The Ohio State Bar Association (OSBA) website sums it up well: “Heroin addiction is an epidemic in Ohio, affecting countless individuals and families.”

The OSBA site also deals with some legislation recently passed in Ohio to combat the problem. The Attorney General’s Office has established a Heroin Unit for prosecution support and extending education. A plethora of laws have been passed recently to further criminalize heroin dealers. The site says the state “is mounting a vigorous fight against heroin.” Casey’s Law was passed in 2012, strengthening the rehabilitation process for heroin addicts by allowing for court-ordered involuntary drug treatment by request. The Ohio Automated Rx Reporting System requires those receiving opioid-based prescriptions to undergo a patient review process.

Countless more legislation is being tossed at the heroin epidemic in Ohio. Unfortunately, Ohio is not alone in this fight. The heroin epidemic is national, not contained within any state’s borders. Although Ohio has it bad, America has it bad, and the numbers prove it.

America has a Heroin Problem

Current estimates show there to be about 900,000 heroin users in America, with 586,000 of them addicted. Approximately 10,000 people die from heroin overdoses a year. To put that in perspective, by the time you finish watching a two-hour movie, three people will have fatally overdosed on heroin. The people overdosing are not suicidal maniacs running around with multiple needles in their arms, either. The CDC determined 81% of drug overdose deaths to be unintentional. Regardless of what the picture on the East Liverpool website may look like, and regardless of what you may have in your mind as an image of a heroin addict, these are real people, most of them young, and they need help. The average of an American heroin addict is 23.

We part with more words posted alongside the picture of James Acord and Rhonda Pasek on the East Liverpool Facebook page: “The poison known as heroin has taken a strong grip on many communities not just ours, the difference is we are willing to fight this problem until it’s gone and if that means we offend a few people along the way we are prepared to deal with that.”