Tag Archives: opioids

Naloxone: The Price of Life

naloxoneIt’s likely that you may remember Martin Shkreli, the CEO of Turing Pharmaceuticals, who caught the public’s attention and widespread criticism when he unabashedly raised the price of Daraprim by 5000 percent. The drug is used for treating the deadly AIDS virus. The average cost of treatment rose from around $1,130 to over $63,000, with each tablet costing $750. While it may seem unconscionable to most that a company could unethically put people’s lives at risk by hiking the price of a potentially lifesaving drug to the point of unaffordability, sadly Mr. Shkreli decision to raise the price of Daraprim is not unique when it comes to pharmaceutical companies and lifesaving treatments. Which brings us to the main focus of today’s post—the opioid overdose reversal drug naloxone.

Stemming the Tide

If you have been following the ongoing story of the United States government’s policy changes for addressing the deadly opioid epidemic, then you have probably heard the calls from lawmakers on both sides of the aisle to get a handle on the situation—a scourge stealing the lives of over 70 Americans every day. Multiple government agencies, including the U.S. Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC) and the National Institute on Drug Abuse (NIDA) for instance, at the behest of Senators, Congressman and the White House—are working to make it more difficult to abuse prescription drugs and develop the most effective treatments for treating substance use disorders. The agencies are imploring doctors to write prescriptions with discretion, only relying on drugs like oxycodone when it’s absolutely necessary. Recently, a bill was put forward in the Senate that would impose a 1 cent tax on every milligram of active opioid ingredient in a prescription painkiller; the money generated from the tax would be used for expanding access to substance use disorder treatment. What’s more, the U.S. Senate overwhelmingly voted in favor (94-1) of the Comprehensive Addiction and Recovery Act (CARA) in March of 2016. The legislation is meant to cover a number of different facets relative to the opioid epidemic, which include:
    • Expanding Prevention and Educational Efforts
    • Expanding Access to Unwanted Prescription Drug Disposal Sites
    • Strengthening Prescription Drug Monitoring Programs
    • Expanding Access to Naloxone

The Price of Life

It is a sad truth that a number of people will die from an opioid overdose every day; however, there are many who will also be saved by naloxone, otherwise known as Narcan. If administered in a timely manner, the drug can reverse the potentially fatal depression of the central nervous system and respiratory system caused by an opioid overdose. In recent years, and with each month that passes, more law enforcement officials and other first responders have been trained to administer the drug. States and municipalities have begun to make it easier for addicts and their loved ones to gain access to naloxone without a prescription, due to the fact that they are often present at the time of an overdose, and time is of the essence. The drug is a necessity, and with demand comes dreams of profit. In fact, the price of certain forms of naloxone has increased exponentially in the past two years, according to Politico. The year 2014 saw more opioid overdose deaths (28,000), more than any other year during the course of this epidemic. Truven Health Analytics reports that since that year:
      • Kaleo Pharma’s auto-inject version went from $575 to $3,750 per two-dose package.
      • Two injections of Amphastar’s naloxone doubled in price ($66) by the end of 2014.
      • Two vials of Hospira's generic cost $1.84 in 2005, rising to $31.66 by 2014.
If the price of the drug keeps rising, it will be hard for not only patients, but first responders to afford to equip themselves with this vital medication and people who could have been saved may lose their life. Hopefully, steps will be taken to subsidize the ever growing costs of the drug.

Opiate and Heroin Rehab at PACE

Opiate and heroin addiction treatment options include psychosocial approaches, pharmacological treatment, therapeutic groups, 12-Step recovery, as well as individual and experiential therapy. Our addiction treatment staff also lead psychoeducational groups that cover the disease model of addiction, emotional management tools, relapse prevention techniques, boundaries and healthy relationships, and general life skills that help smooth the transition of clients from active addiction into life.

Prescription Addiction: Made in the USA

addictionThere is a lot of information, and unfortunately, deadly misinformation about prescription opioids circulating the internet and other major media outlets. Simply put, there is a lot that the average American adult is unaware of, and what they think they know isn’t always rooted in science. In the United States, we use the vast majority of the world’s supply of prescription opioids—despite the fact that we make only 5 percent of the world’s population. While prescription opioids are abused across the globe, America has the market share of the problem. In an attempt to shed some light on both the opioid addiction crisis and potential solutions—Dr. Sanjay Gupta joins Anderson Cooper of CNN’s "Anderson Cooper 360" for a town hall special—to discuss the prescription drug abuse epidemic in the U.S. The presentation, "Prescription Addiction: Made in the USA" airs tonight, May 11, 2016, at 9 P.M. EDT. It is likely to be more than informative and eye opening for many Americans. Dr. Sanjay Gupta has a remarkable understanding about pain narcotics, addiction and how opioid addiction became a pervasive problem in the United States. The Chief Medical Correspondent wrote an op-ed published today by CNN, which covers many aspects of the epidemic. But, perhaps most intriguing is his belief that doctors were responsible for creating the scourge we face, and it will fall on doctors to spearhead efforts for ending the epidemic. Gupta writes:
The fact is, we have accepted the tall tales and Pollyannaish promises of what these medications could do for too long. As a community, we weren't skeptical enough. We didn't ask enough questions. We accepted flimsy scientific data as gospel and preached it to our patients in a chamber that echoed loudly for decades.”
He points out that while the epidemic is the result of the medical community acting on opioid prescribing recommendations they were not based on fact, doctors continue to recklessly prescribe these deadly narcotics despite knowing that the drugs should be doled out as sparsely as possible. He cites a recent study published in the Annals of Internal Medicine which showed that 91% of opioid overdose survivors managed to obtain another prescription—usually from the physician who prescribed the narcotics the patient overdosed on in the first place. Gupta calls on prescribing physicians to:
  • Engage with patients and discuss treatment with them.
  • Set realistic expectations for patients.
  • Conduct follow-up conversations with patients to gauge treatment efficacy.
“It is not too late. In order for this American-made epidemic to finally end, however, it is the American doctors who must lead the way,” writes Gupta. Remember to tune in tonight, or catch it on DEMAND, to see CNN’s "Prescription Addiction: Made in the USA" May 11, 2016, at 9 P.M. EDT. Join in the conversation and share this family and friends. If you’d like, you can view a short trailer about the town hall meeting by clicking here.

Opioid Withdrawal and Loperamide is Dangerous

opioid withdrawalAnyone who has abused and/or been addicted to opioid narcotics has experienced withdrawal symptoms at one time or another. They can tell you first hand, with the utmost clarity, the hell that is opioid withdrawal and that they would have done just about anything to ease their pain. For those who detoxification was not intentional, their withdrawal is usually the result of running out of drugs or money to purchase more of their drug of choice. People undergoing opioid withdrawal are most commonly outside of a medical setting, which means that they lack access to the drug typically prescribed to mitigate their symptoms, such as Suboxone (buprenorphine) or Ativan (lorazepam). The U.S. National Library of Medicine reports that early symptoms of opioid withdrawal include: agitation, anxiety, muscle aches, increased tearing, insomnia, runny nose, sweating and yawning. Late symptoms of withdrawal include: abdominal cramping, diarrhea, dilated pupils, goose bumps, nausea and vomiting. Clearly, the majority of the symptoms listed above make for an unpleasant time, especially when you consider that some of the symptoms can continue for several weeks. While the behavior is not new, in the wake of the American opioid epidemic a number of opioid addicts have turned to the over the counter (OTC) antidiarrheal drug loperamide (Imodium) to ease their withdrawal symptoms, NPR reports. While it may seem like a harmless practice, in very high doses loperamide fatally disrupts the heart's rhythm. At 10 times the box recommended dose the drug can ease withdrawal discomfort, but in larger doses loperamide can actually create euphoric effects similar to opioid narcotics. At this point you may be wondering how a commonly used OTC medication can cause an opioid-like high and still be purchased without a prescription. Keeping the conversation as “clean’ as possible, a common side effect of opioid narcotics is constipation, a side effect that people experiencing diarrhea would appreciate. It just so happens that loperamide is a opioid-receptor agonist and acts on μ-opioid receptors, but unlike other opioid drugs, loperamide is mostly prevented from entering the blood stream and crossing the blood brain barrier essentially preventing euphoria from occurring, according to a study titled “Poor Man's Methadone: A Case Report of Loperamide Toxicity” published in the American Journal of Forensic Medicine & Pathology. The research showed that in very high doses, loperamide is able to cross the blood-brain barrier gaining access to the central opioid receptors in the brain, causing euphoria and respiratory depression. Until recently, it was fairly uncommon for people to abuse the drug, but with more people than ever abusing opioids in our country, there has been a spike in hospital cases involving loperamide, which at one time was classified as Schedule II of the Controlled Substances Act 1970, transferred to Schedule V in 1977 and then decontrolled in 1982.
Because of its low cost, ease of accessibility and legal status, it's a drug that is very, very ripe for abuse," says William Eggleston, a doctor of pharmacy and fellow in clinical toxicology at the Upstate New York Poison Center, which is affiliated with SUNY Upstate Medical University. "At the Upstate New York Poison Center, we have had a sevenfold increase in calls related to loperamide use and misuse over the last four years."
Eggleston and his co-authors, whose new study was published the Annals of Emergency Medicine, believe that loperamide should be restricted; much like pseudoephedrine was in the wake of the American methamphetamine crisis. If taken in recommended doses, such drugs are relatively harmless, but they carry a high potential for abuse. If you, or a loved one, struggles with opioid addiction, stay clear of OTC medications that people claim will help with withdrawal symptoms. The safest course one can take is contacting a licensed addiction rehabilitation center, such as PACE Recovery Center. We can get you the help you need, and aid you in getting on the road to recovery.

FBI Film About Opioid Addiction

addictionThere is no question, the opioid epidemic in the United States is both unprecedented and insidious; however, if there is a silver lining to be found it is that the crisis has forced an evolution to occur regarding how we, as a nation, both view and talk about addiction. For years, addiction experts have said that addiction does not discriminate - an assertion that was hard for many lawmakers to accept; however, in the wake of the scourge of opioid addiction affecting practically every demographic throughout the nation for well over a decade - we are now seeing a paradigm shift with how lawmakers believe we should handle this calamity. It has become clear that we cannot arrest this epidemic away, as we tried to do during the 1980’s through the ‘90s with the cocaine problem in America. The use of draconian drug laws to combat addiction focused more on the symptoms of addiction and did little to address the disease of addiction. Addiction cannot be treated with steel bars, solutions can only be found with evidence-based, scientifically accepted methods of substance use disorder treatment. With 44 people dying from overdoses every day, there is a great need for expanded access to both the life saving opioid overdose reversal drug naloxone and to substance use disorder treatment services. In recent months, there has been an inter-agency push to get those struggling with addiction the help they need without fear of prosecution. Overdose survivors do not need to fear be arrested, and are actually being directed to rehabilitation services. In fact, the President is asking Congress for $1.1 billion to expand access to addiction treatment services; in some places, addicts who would like help have to wait up to a month to get a bed at treatment centers. While making treatment more available is huge and has the potential to save thousands of lives, there is also a need for more in the way of prevention through education. Recently, both the Drug Enforcement Administration (DEA) and the Federal Bureau of Investigation (FBI) joined forces to make a film about the opioid epidemic - aimed at youth, The Washington Post reports. The goal is to prevent adolescents from abusing prescription opioids, which is strongly believed to be the link to beginning heroin use. The film: "Chasing the Dragon: The Life of an Opiate Addict" was produced at the insistence of James Comey, the current Director of the FBI. “You will see in ‘Chasing the Dragon’ opioid abusers that have traveled a remarkably dangerous and self-destructive path,” said Acting DEA Administrator Chuck Rosenberg. “I hope this will be a wakeup call for folks. Please pay close attention to this horrific epidemic. Help reverse it. Save a life. Save a friend. Save a loved one.” We hope that you will watch Chasing the Dragon below: If you are having trouble watching the film, please click here.

FDA Approves Naloxone Nasal Spray

naloxoneThere is little debate regarding the insidious nature of opioid addiction, a scourge that has been tearing American families apart for over a decade. The prescription opioid painkiller epidemic stems from a change in modalities with doctors and how they manage a patient’s pain. Gauging a patient’s pain is no easy task because pain intensity is subjective. Doctors are required to treat a person’s pain adequately, which has resulted in rampant overprescribing and a subsequent rise in addiction rates. After a decade and a half of overprescribing opioids, both federal and state governments had had enough. In more recent years, practically every state implemented prescription drug monitoring programs (PDMP) to track patients who fill multiple prescriptions of the same types of drugs. Before such programs were put in place, patients could visit multiple doctors in a week complaining of the same ailment - giving them the ability to accumulate more pills than any one person could use in a month. The medications, often paid for by state assistance programs, were then resold at inflated prices to those who would abuse the drugs. Government crackdowns on prescription opioid abuse made it more difficult for addicts to acquire drugs, such as oxycodone (OxyContin ®), due to scarcity and heightened pricing. Curbing painkiller abuse had an unintended consequence, addicts left with few options turned to heroin - a cheaper and often more potent substance. In the last decade, heroin use more than doubled among young adults ages 18–25, and 45% of people who used heroin were also addicted to prescription opioids, according to the U.S. Centers for Disease Control and Prevention (CDC). Opioids, whether by prescription or bought on the street in the form of heroin, are not just highly addictive, misuse can result in a fatal overdose. The CDC reports that 44 people die every day from an overdose. Thankfully, if an overdose victim is discovered in time, their life can be spared. The drug naloxone hydrochloride has life saving potential, reversing the effects of a prescription opioid or heroin overdose. Until recently, naloxone was only approved for use in the form of injection by the U.S. Food and Drug Administration (FDA). Naloxone injections, while effective, requires the administrator to be proficient in giving injections - ruling out the majority of people who are first to discover an overdose victim. This week, the FDA announced the approval of a nasal spray version of naloxone, which first responders say is easier to use, according to an FDA news release. Naloxone nasal kits eliminate the risk of a contaminated needle prick. While unapproved, many first responders, such as EMTs and police officers, used naloxone with nasal spray adapters; now, the nasal spray devices will meet the FDA’s high standards for safety, efficacy and quality. What’s more, the nasal spray does not require extensive training to administer, meaning that a mother, father or even child can save the life of a loved one. A number of states and municipalities have lighten the restrictions on who can have access to the life saving drug, hopefully the new approval will convince other states to follow suit. The majority of overdose victims are discovered by a friend or family member. With overdoses, time is of the essence, the sooner naloxone is administered - the greater the chance of saving a life.
Combating the opioid abuse epidemic is a top priority for the FDA,” said Stephen Ostroff, M.D., acting commissioner, Food and Drug Administration. “We cannot stand by while Americans are dying. While naloxone will not solve the underlying problems of the opioid epidemic, we are speeding to review new formulations that will ultimately save lives that might otherwise be lost to drug addiction and overdose.”
___________________________________________________________________________ If you are or a loved one is struggling with prescription opioids or heroin, please contact Pace Recovery Center.

The First National Public Opinion Research On Opioids

opioidsThe unprecedented spike in prescription opioid use in America has raised a number of questions with regard to how the country found itself in the grips of an epidemic. Certainly, most people who experience pain which requires an analgesic of some kind; the pain goes away and they stop taking the prescription. On the other hand, many people continue using prescription opioids long after the pain dissipates, resulting in dependence and/or addiction. Many Americans understand that the country is in the midst of a prescription drug crisis, with thousands of overdoses every year and even more people in need of addiction treatment. Some people will use prescription opioids that were prescribed for someone else, despite having the knowledge that opioids are dangerous and addictive. A new study, which may be the first national public opinion research on opioids, has found that in the past year more than one in four Americans took a prescription opioid, ScienceDaily reports. What’s more, fifty-eight percent of those surveyed say they understand that opioid abuse is major public health problem. The study was conducted by researchers at Johns Hopkins Bloomberg School of Public Health.
"This study shows that many Americans have had direct experience using prescription pain relievers and a sizable share have misused or abused these medications themselves or have close friends or family members who have done so," says study leader Colleen L. Barry, PhD, MPP, an associate professor in the Department of Health Policy and Management at the Bloomberg School. "The seriousness of the issue has become salient with the American public."
The findings indicate that the American public may be in a unique position to pass bills that could combat the opioid epidemic, according to the article. The public could support:
  • Better medical training for safely controlling pain and treating addiction.
  • Curbing “doctor shopping” (seeing multiple doctors for the same drugs).
  • Requiring pharmacists to check identification.
"We think this is the perfect time to work on passing policies that can truly impact the crisis of prescription pain reliever abuse," says study co-author Emma E. "Beth" McGinty, PhD, MS, an assistant professor in the Department of Health Policy and Management at the Bloomberg School. "The issue has not yet been highly politicized like some public health issues such as the Affordable Care Act, gun violence or needle exchanges, so we may have an opportunity to stem this epidemic."
The findings were published in the journal Addiction. ___________________________________________________________________________ If you are or a loved one is abusing opioids, please contact Pace Recovery Center.

Drug and Alcohol Use in America Compared to Europe

drug-useExcessive alcohol and illicit drug use are problems that every industrialized country struggles with, albeit they all go about it in different ways. While many argue about which measures are most effective from one country to the next, it turns out that some countries are doing better in the fight against addiction. So, how does the United States compare to the rest of the western world? The easy answer is, ‘not that well’! Using data from the United Nations, a group of treatment professionals worked to create a series of maps to compare drug and alcohol use in the United States to European countries. The findings showed that Americans overwhelmingly lead the way in opioid and amphetamine-type stimulant use. The United States has the most people in substance use disorder treatment and we have the highest rate of overdose deaths per year. prevalence-of-opioid-use-once-year-past-year Interestingly, the U.S. did not even make the top five when it came to the availability of substance abuse treatment. America tied with Spain for the most cocaine used, and we came in second (per capita) for marijuana use. However, with Amsterdam considered to be a marijuana mecca, the Netherlands failed to make the top five. The data gathered showed that America is in the top five for almost every national measure of drug abuse. Europe, on the other hand, has a long history with alcohol which may be why countries in the EU top the charts for alcohol use in the last year. America, did not make the top five for once, sitting somewhere in the middle. Norwegians came in first, with the most alcohol consumed per capita; with the stereotypical hard-drinking Irish ranking fifth. This data and mapping help experts determine what policies are working, and which are not. It should help us develop more effective measures going forward. ___________________________________________________________________________ If you or a loved one is living with addiction, please contact Pace Recovery Center.

House Unanimously Passed Bills Aimed at Opioid Abuse

opioidsLawmakers in Massachusetts continue to spearhead an operation against the opioid epidemic devastating major cities and small towns across the nation. Massachusetts is a state that has felt the overwhelming effects of this crisis, a scourge unprecedented in our times. Lead by U.S. Rep. Joseph P. Kennedy III and U.S. Rep. Katherine Clark, the U.S. House of Representatives unanimously passed two bills devised to combat the insidious effects of opioid abuse, the Boston Herald reports. Kennedy said the unanimous support “speaks to the breadth and depth of the opiate abuse epidemic.” The bill that Kennedy co-sponsored reinstates federal funding to states prescription drug monitoring programs (PDMPs). Monitoring programs deter “doctor shoppers,” people who go to multiple doctors every month for the same types of prescriptions. While PDMPs exist in 49 states, the need for a nationwide system is necessary. The funding will also be used for drug screening and substance use disorder treatment, according to the article.
There are few people in this country who have been spared the heartbreak of watching a loved one, neighbor or friend fall victim to opiate addiction,” said Kennedy. “It’s an epidemic striking red states and blue states, small towns and big cities, neighborhoods rich and poor.”
Clark’s bill, if passed by the Senate, creates uniform standards for diagnosing and treating neonatal abstinence syndrome (NAS). The syndrome occurs when fetuses are exposed to opioids, after birth they experience withdrawal symptoms which require extra medical care. The bill would become the first law to address newborns exposed to opioid use, the article reports.
Right now there is no standard for treatment with NAS,” Clark told the Herald. “This problem leads to long stays in the NICU and hundreds of millions in Medicaid dollars.”
___________________________________________________________________________ If you or a loved one suffers from opioid addiction, please contact Pace Recovery Center.

Back Pain, Anxiety, and Depression – Opioid Abuse

A large percentage of people who seek treatment for substance or alcohol use disorder also have other mental health disorders on board, such as depression or anxiety. When this is the case, it is referred to as having a co-occurring disorder, and successful recovery hinges on treating both. What’s more, people’s depression or anxiety may play a part in people forming an addiction. In fact, new research suggests that people living with high levels of depression or anxiety, and experience chronic lower back pain, are significantly more prone to developing a problem with prescription opioids, Medical News Today reports. People with chronic lower back pain and high levels of depression or anxiety were 75 percent more likely to abuse opioids than people with low levels, and their back pain was less likely to improve. The researchers involved in the study examined 55 patients with chronic lower back, as well as major or minor levels of anxiety or depression, according to the article. Over the course of 6-months, the patients were given oral forms of morphine, oxycodone or a placebo. The patient's pain levels and the amount of drugs taken were recorded daily. There was 50 percent less improvement and 75 percent more opioid abuse among patients who had high levels of depression or anxiety, compared with patients with low levels. The findings suggest that doctors treating patients with lower back pain, who show symptoms of mental illness, should make sure that the mental illness is being treated rather than "refusing to prescribe opioids," according to lead researcher Prof. Ajay Wasan, at the University of Pittsburgh School of Medicine. This may reduce the likelihood of opioid abuse and reduce pain. “High levels of depression and anxiety are common in patients with chronic lower back pain,” Wasan said in a news release. “Learning that we are able to better predict treatment success or failure by identifying patients with these conditions is significant. This is particularly important for controlled substances such as opioids, where if not prescribed judiciously, patients are exposed to unnecessary risks and a real chance of harm, including addiction or serious side effects.” The study is published in Anesthesiology. ___________________________________________________________________________ If you or a loved one is struggling with opioid addiction and depression or anxiety, please contact Pace Recovery Center.

Physicians Have Misconceptions About Opioids

doctorPhysicians who understand the nature of addiction are crucial in the fight against prescription opioid abuse. Unfortunately, a new survey indicates that many doctors have misconceptions about current opioids on the market and lack an understanding of opioid abuse, PsychCentral reports. The findings come from a nationally representative sample of 1,000 primary care physicians. The new survey, conducted by researchers at Johns Hopkins Bloomberg School of Public Health, showed that almost half of internists, family physicians and general practitioners believe that abuse-deterrent pills are less addictive than traditional opioid medications. The researchers contend that this error in reasoning may be contributing to the prescription opioid epidemic plaguing the country. While abuse-deterrent formulations may make it more difficult for addicts to tamper with pills to be used in unintended ways, such drugs are in no way less addictive than their forerunners.
“Physicians and patients may mistakenly view these medicines as safe in one form and dangerous in another, but these products are addictive no matter how you take them,” study leader G. Caleb Alexander, MD, said in a news release. “If doctors and patients fail to understand this, they may believe opioids are safer than is actually the case and prescribe them more readily than they should.”
The research showed that one-third of the physicians thought that the majority of prescription drug abuse occurs by means of injecting or snorting the medications, rather than orally, according to the article. However, a number of studies show that most prescription drug abuse occurs via oral use.
“Doctors continue to overestimate the effectiveness of prescription pain medications and underestimate their risks, and that’s why we are facing such a public health crisis,” Alexander said.
The findings were published in the Clinical Journal of Pain.