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One Region Is Being Hit Hardest by U.S. Opioid Crisis

By Dennis Thompson        
       HealthDay Reporter

FRIDAY, Oct. 25, 2019 (HealthDay News) — More people die from drug overdoses in the northeastern U.S. than other regions, making it a major hotbed of the nation’s opioid epidemic, a new federal report says.

Fueled mainly by fentanyl and heroin, overdose (OD) deaths are soaring in an area that runs east from Minnesota and Illinois and north from West Virginia and Virginia, according to the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS).

In that area, the fentanyl OD death rate varied from 12.4 to 22.5 deaths for every 100,000 people, government data for 2017 showed.

By comparison, the fentanyl overdose death rate for the Southwest and West Coast of the United States is about 1.5 per 100,000 people.

In much of the country west of the Mississippi, most drug ODs are actually due to methamphetamine.

“We tend to think all the U.S. is the same, and clearly it is not,” said lead researcher Dr. Holly Hedegaard, an NCHS epidemiologist. “There are differences across the country in terms of the drugs that are contributing to overdose deaths.”

For this study, Hedegaard and her colleagues investigated regional differences in drug OD deaths that occurred in 2017 in the United States.

The researchers found that most overdose deaths east of the Mississippi River were linked to the opioid crisis, involving drugs such as fentanyl, heroin and prescription painkillers (for example, OxyContin).

Meth claimed the most lives in the West, however.

“It’s important to recognize those [regionall]differences, particularly when we’re thinking about effective prevention programs,” Hedegaard said. “What might work in one region won’t necessarily work somewhere else.”

Fentanyl was the leading cause of OD deaths nationwide in 2017, accounting for about two out of every five fatal overdoses, the report said.

The New England states were hardest hit, with 22.5 fentanyl OD deaths per 100,000 people, the researchers found.

The Mid-Atlantic states were next worst, with 17.5 deaths per 100,000 people chalked up to fentanyl. These states include West Virginia, Virginia, Maryland, Pennsylvania and Delaware, as well as the District of Columbia.

Continued

The opioid epidemic is also taking a toll on southern states, where the fentanyl overdose death rate was 9.1 per 100,000 people, according to the report.

Fatal overdoses due to heroin followed roughly the same pattern, concentrated in the Northeast but also occurring at greater frequency in the South.

Pat Aussem is director of clinical content and development at the Center on Addiction, in New York City. She said, “This report highlights the inroads fentanyl has made, particularly east of the Mississippi, contributing to overdose deaths as people using substances either seek or unwittingly consume it in heroin, counterfeit pills or cocaine.”  

Aussem stressed that “education about the risks of fentanyl and the distribution of naloxone [to counter an overdose] beyond people who use opioids is essential.”

On the other hand, methamphetamine claims more lives in the western United States.

The southwestern region of California, Nevada, Arizona and Hawaii led the nation in meth overdose deaths, with 5.2 for every 100,000 people.

The region encompassing Colorado, Montana, Utah, Wyoming and the Dakotas had a meth OD rate of 4.9 per 100,000 people. The Pacific Northwest states of Alaska, Washington, Oregon and Idaho had a meth death rate of 4.8 per 100,000 people, the findings showed.

“With purity rates upward of 90% and relatively low prices, methamphetamine use —  and in turn, overdose deaths — continues to be prevalent in the West, although it’s making inroads in other areas of the country,” Aussem said.

These overdose numbers closely track drug seizure data kept by the U.S. Drug Enforcement Administration, Hedegaard said. This shows that ODs tend to follow the availability of drugs in specific regions, and how supplies move across the country.

“While understanding geographic differences is important, we can’t lose sight that our country has an addiction problem,” Aussem said. “Access to evidence-based, affordable care is essential. We must also catch the problem further upstream, screening people, including our youth, to protect against addiction and loss of life.”

The new study was published Oct. 25 in the CDC’s  National Vital Statistics Reports.

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Sources

SOURCES: Holly Hedegaard, M.D., M.S.P.H., epidemiologist, U.S. National Center for Health Statistics, Hyattsville, Md.; Pat Aussem, M.A., M.B.A., director of clinical content and development, Center on Addiction, New York City; Oct. 25, 2019,National Vital Statistics Reports

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Johnson & Johnson Settles Opioid Suit in Ohio

With a federal trial pending, the pharmaceutical giant Johnson & Johnson agreed Wednesday to pay two Ohio counties more than $ 20 million for its role in the ongoing opioid crisis.

The settlement comes on the heels of a $ 572 million settlement the company was ordered to pay New Brunswick, N.J., for marketing opioids in the state, the Associated Press reported.

The federal lawsuit is scheduled to start in less than three weeks, and four companies have already settled. But companies are still facing 2,000 lawsuits for their part in the opioid epidemic.

In the Ohio settlement, Johnson & Johnson’s subsidiary Janssen Pharmaceutical agrees to pay Cuyahoga and Summit counties $ 10 million without admitting liability. The settlement also calls for the company to pay $ 5 million in legal expenses and give $ 5.4 million to nonprofits that fight the epidemic in northeastern Ohio, the AP reported.

Drugmakers Endo, Allergan and Mallinckrodt have also settled with these Ohio counties. Purdue Pharma has made a preliminary settlement to cover all its lawsuits, but half the states involved say they will oppose the settlement in bankruptcy court.

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Beating Opioid Addiction Can Be Tough, Here’s What Helps

THURSDAY, Sept. 26, 2019 — A constant barrage of news on America’s opioid epidemic stokes feelings of hopelessness, and with good reason: Every day, more than 130 people are dying from overdoses, according to government statistics.

But amid the harrowing stories, there’s some good news: It is possible to recover from an opioid addiction.

That’s the primary message from a study published recently in the Journal of Addiction Medicine, in which an estimated 1.2 million American adults reported recovering from an opioid addiction.

While the research demonstrated that an opioid problem can be overcome, it also showed that the road to recovery is likely to be long and challenging. It will also require more resources than it takes to kick an alcohol problem.

“It can take up to five years of continuous remission before the risk of symptoms drops to levels seen in the general population,” said study lead author Lauren Hoffman, a research fellow at Massachusetts General Hospital’s Recovery Research Institute and Harvard Medical School.

Using data from the 2017 National Recovery Survey, Hoffman and her team analyzed treatment and recovery services used by U.S. adults who had resolved opioid problems compared to those who had overcome an alcohol problem. Results showed stark differences between the two groups’ recovery route.

By mid-recovery (between one and five years), individuals who had resolved an opioid problem were four times more likely to have used pharmacotherapies (drugs to prevent cravings or relapse such as methadone or buprenorphine), two-and-a-half times more likely to use formal addiction treatment (such as cognitive behavioral therapy), and around two times more likely to use recovery support services and mutual help organizations than adults in mid-recovery from an alcohol problem.

Mid-recovery, adults recovering from opioid abuse also were more likely than those battling alcohol issues to report low self-esteem. During early recovery, the groups didn’t exhibit these differences.

The study “implies that perhaps those who have an opioid problem might need to utilize more services or utilize services for a longer period of time to maintain recovery and achieve recovery durations beyond one year,” Hoffman observed.

The findings don’t come as a surprise to some addiction experts.

“Once you are dependent on opioids, you are more likely to fall into the category of having a more severe problem,” said Frederick Muench, president of the Center on Addiction.

The study, he said, reinforces the need to incentivize recovery supports over long periods of time. This isn’t something the U.S. treatment system historically has advocated for, explained Muench. “Ongoing support isn’t necessarily covered by insurance,” he said.

Treatment services’ prohibitive costs and scarcity, especially in rural areas, have long been blamed as the primary obstacles standing in the way of recovery from opioid dependence. But Muench points to some positive trends. Notably, they include recent federal funding increases allocated to medication treatment for drug recovery, as well as recognition by the medical community of addiction medicine as an official subspecialty of preventive medicine.

As policymakers become more aware of the need to adequately address opioid use, the stigma that opioid users feel may simultaneously decline. That would be another step in the right direction for recovery, experts believe.

“Individuals with opioid use disorder are less likely to disclose their recovery status,” said Hoffman. Unlike alcohol use, which is more widely accepted, she sees the shroud of secrecy and stigma surrounding the use of opioids as detrimental, making countless individuals afraid to reach out for help. Knowing that there is hope for opioid users may spur them to seek outside assistance, she added.

For these reasons, professionals in the addiction field applauded Hoffman and her team for addressing recovery as part of their research.

“We mostly focus on the mortality of opioid users. Of course, it’s devastating. But we need to pay attention to the fact that people can recover,” said Dr. Wilson Compton, deputy director of the U.S. National Institute on Drug Abuse.

The new research may have put opioid recovery on the map. But for Hoffman, it spurs new inquiries.

“Recovery doesn’t look the same for everyone. It’s going to vary by substance, at the very least,” she suggested. “Those who suffer from an opioid problem might need prolonged clinical care or additional recovery support to maintain recovery in the long term.”

More information

There’s more on fighting drug addiction at the U.S. National Institute on Drug Abuse.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

Drugs.com – Daily MedNews

Opioid Prescriptions for Eye Surgery Patients Surge

THURSDAY, Sept. 19, 2019 — Though eye surgery has gotten easier for patients, the percentage who filled an opioid prescription after an eye operation tripled between 2000 and 2014, a new study reports.

“This really is surprising, given that there have been tremendous strides in the past decade to reduce the invasiveness and recovery time for these procedures,” said senior study author Dr. Brian VanderBeek. “We would have expected rates to go down, not up.”

VanderBeek is an assistant professor of ophthalmology at the University of Pennsylvania in Philadelphia.

For the study, his team tracked filled opioid prescriptions among more than 2.4 million patients who had “incisional” eye surgery in the United States between 2000 and 2016.

In 2000-2001, across six different ocular subspecialties, 1.2% of patients undergoing cataract surgery or other types of incisional eye surgeries filled an opioid prescription afterward.

But by 2014, that figure rose to 2.5% of patients. The uptick eased in 2015 to 2.2%, and then again in 2016 to 2.1%, according to the report published in the Sept. 19 issue of JAMA Ophthalmology.

Eye surgery patients in the Northeast were least likely to fill an opioid prescription; those in the Mountain states were most likely to do so. Odds were highest among black patients, men and those without a college degree, the findings showed.

After accounting for other factors, opioid prescriptions tripled during the study period across all of the eye procedures in the study, the researchers found.

VanderBeek pointed out that the procedures are unrelated to one another, yet the rise in prescription rates among them was nearly identical. That suggests something other than surgery-related pain is driving the increase, he said.

The findings dovetail with a nationwide opioid epidemic that resulted in more than 47,000 deaths in 2017 alone.

Still, compared with patients who undergo other types of surgery, prescription of opioids among eye surgery patients remains very low, the study authors stressed.

“Whenever you have an epidemic, I think it’s reasonable to ask what you can do to curb it,” VanderBeek said in a university news release.

“Even if eye surgeries are a minor source of the problem, if we can limit some of the exposure to opioids, in light of the national emergency, we are obligated to do what we can. We don’t want people to be in pain, but we also don’t want to continue to fuel the problem if we can avoid it,” he added.

More information

For more about the opioid epidemic, visit the U.S. Department of Health and Human Services.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

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Purdue Files for Bankruptcy Over Opioid Crisis Suits, With Many States Objecting

MONDAY, Sept. 16, 2019 — OxyContin maker Purdue Pharma has filed for Chapter 11 bankruptcy, touching off what could be a fierce battle by dozens of states hoping to recoup billions spent fighting the opioid crisis.

As reported by The New York Times, there are over 2,600 pending federal and state lawsuits lodged against Purdue, and the pharmaceutical giant has proposed a resolution to most of them as part of its bankruptcy filing. The move was approved Sunday night by Purdue’s board of directors.

However, one group of 26 states has refused to settle with Purdue under the proposed arrangement. That sets the stage for lengthy legal battles between the states, Purdue Pharma and the wealthy Sackler family that owns the company, the Times said.

The first legal fight could occur as early as this week in White Plains, N.Y., the newspaper added.

In a statement, Purdue Chairman Steve Miller said the company’s proposed settlement “will dedicate all of the assets and resources of Purdue for the benefit of the American public. This settlement framework avoids wasting hundreds of millions of dollars and years on protracted litigation, and instead will provide billions of dollars and critical resources to communities across the country trying to cope with the opioid crisis.”

Purdue hopes to restructure following bankruptcy, and in the process trigger an automatic halt to civil litigation against it over the opioid epidemic, the Times said.

The settlement requires the dissolution of Purdue Pharma and the formation of a new “public benefit trust” that would continue to sell OxyContin, the firm’s blockbuster opioid.

Proceeds from the new company would be used to pay the plaintiffs in the lawsuit and combat the opioid epidemic through research and the development of new medicines to treat addiction. Purdue also would donate drugs under development for addiction treatment and overdose reversal.

In its filing, Purdue claims the company is valued at $ 10 billion. However, states opposed to the plan say that number is speculative and could take years to realize. And they add that the Sacklers still plan to run another pharmaceutical business, a British company called Mundipharma, until it is sold off. Finally, the states contend that settling the lawsuits through the continued sale of Oxycontin helps the Sackler family itself avoid any monetary penalty.

In a statement, the Sackler family said it had “deep compassion for the victims of the opioid crisis,” the Times reported. “We are hopeful that in time, those parties who are not yet supportive will ultimately shift their focus to the critical resources that the settlement provides to people and problems that need them.”

The Chapter 11 filing comes just one day after New York Attorney General Letitia James announced evidence of almost a billion dollars in previously undisclosed wire transfers from Purdue to private accounts held by Sackler family members.

In a statement released earlier this month about the proposed bankruptcy settlement, Connecticut Attorney General William Tong said that, “I cannot speak to other states or divulge confidential negotiations, but Connecticut has not agreed to any settlement. The scope and scale of the pain, death and destruction that Purdue and the Sacklers have caused far exceeds anything that has been offered thus far.”

More than 200,000 people have died from prescription opioid overdoses since 1999, according to federal statistics. Another 200,000 have died due to overdoses from illicit opioids such as heroin and fentanyl.

More information

The U.S. Centers for Disease Control and Prevention have more about the opioid epidemic.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

Drugs.com – Daily MedNews

Could CBD be the Answer for Those Suffering from Opioid Withdrawal?

What is this CBD thing everyone’s talking about?

CBD is short for cannabidiol, which is a naturally-occurring chemical compound that is found in the cannabis sativa plant.  CBD is extracted from the cannabis sativa plant and converted into certain industrial products – – such as CBD oils, hemp clothing, edibles, topicals, pet foods, etc.  Hemp is taking the world by storm as a healthy, natural alternative to things like medicine and clothing.  Growth of the hemp plant requires no pesticides, and it actually eliminates carbon dioxide from the air.

Is CBD the same thing as Marijuana?

The short answer is no.  CBD is a chemical compound that can be found in marijuana, yes.  However, the hemp plant contains much higher levels of CBD than the marijuana plant does.  For this reason, it is the hemp plant from which CBD is extracted.  What are the differences between the marijuana plant and the hemp plant? 

The hemp plant is similar to marijuana because they both come from the cannabis sativa plant.  Marijuana is the dried flower of the female cannabis plant, and it can come from two different species – – cannabis sativa and cannabis indica.  Hemp only comes from the cannabis sativa species.  Hemp leaves tend to be shiny and slim compared to bushy and thick marijuana leaves. 

( Marijuana plant on the left, Hemp plant on the right )

However, the main difference is the simple fact that CBD does not get you high.  The chemical compound that produces psychoactive effects, and therefore gets you high, is tetrahydrocannabinol (THC).  While the marijuana plant contains high levels of THC, the hemp plant contains approximately .3% THC.  Remember that CBD is mainly extracted from the hemp plant, which does not contain enough THC to get you high. 

If CBD doesn’t get you high, why is it so popular?

It has only been legal to buy since 2018

Everyone wants to get their hands on CBD.  Retail shops are opening up everywhere to take advantage of the legalization of hemp products.  Consumers are buying CBD like crazy.  Business is booming in the hemp industry!

In 2014, the Farm Bill was passed by the federal government, legalizing hemp use for research – – this was a good first step, but it was the Farm Bill’s revision in 2018 that really changed the game.  In 2018, the Farm Bill was revised, and hemp products were suddenly legal to buy and sell on a federal level. 

CBD is a member of the cannabis sativa species

Let’s be honest.  CBD is extremely popular for the same reason it is still illegal in some states – – It’s close relationship with marijuana.  CBD and marijuana are sort of like brothers.  CBD is the brother that gets good grades in school and goes to church every Sunday.  Marijuana is the brother that hangs out with a wild bunch and sometimes gets into trouble.  However, both brothers have good hearts.

Our country has been divided on the legalization of marijuana issue for some time now.   In 1988, only 24 percent of United States citizens supported legalization. Oh, how the tide has changed since then.  In the last 30 years, we have seen the stigma associated with smoking marijuana almost completely disappear.  Medical marijuana is being prescribed by doctors in 22 states, and weed is being legally-smoked for recreational purposes in 10 states!  In 2018, nearly 70% of Americans approve legalization.

( Original infographic available at https://disa.com/map-of-marijuana-legality-by-state )

CBD is proven to have many health benefits

Studies show that CBD has many health benefits.  We know that CBD affects the human body by attaching itself to receptors in the human endocannabinoid system.  Most scientists say that this reaction results in positive effects.  Some scientists still say that CBD causes negative effects.  Just like with legalization, we seem to be split on the matter.  However, just like with legalization, the tide is shifting towards conclusive scientific evidence, conveying CBD as a healthy alternative medicine.   CBD has been said to improve the following conditions:

  • Anxiety
  • Depression
  • Nausea and Vomiting 
  • Acne
  • Crohn’s Disease
  • Diabetes
  • Severe Pain
  • Glaucoma
  • Insomnia
  • Mood Swings
  • Loss of Appetite
  • Parkinson’s Disease
  • Muscle Spasms
  • Stress
  • Epilepsy
  • & More!

However, what we don’t talk about very often, is how CBD can relieve opiate withdrawal symptoms. This could be huge!

The Opiate Epidemic

 In 2017, we saw 70,000 drug overdose deaths. A large majority of these deaths have been attributed to synthetic opiates.  We all know somebody that has been affected by this.  Whether we’ve lost a loved one, or we know somebody that’s lost a loved one, we have all been affected.  The Opiate Epidemic has plagued the entire United States, along with the rest of the world.  The afore-mentioned death rate shrunk by 5% in 2018 – – the same year that CBD became legal to buy and sell.  Is there a correlation between the two?  Well, that’s hard to say. 

What’s Not Hard to Say

Pharmaceutical companies are not your friend!  Need proof?  Just turn on the news!  Over the last year, the Feds have been indicting and arresting former top officials of pharmaceutical companies.  The charge – – distributing deadly opiates to the masses for profit.  These are the same pharmaceutical companies that created methadone and suboxone, the two most popular forms of treatment for opiate addiction.  Both of these treatments have a long list of negative side effects and are addictive.  Yet, the government prefers these treatments over kratom and CBD – – two naturally-occurring medicines that are known to help relieve opiate withdrawal symptoms.  It makes no sense!

Opiate Withdrawal Symptoms

  • Anxiety
  • Muscle Aches
  • Trouble Sleeping
  • Muscle Spasms
  • Abdominal Cramping
  • Digestive Issues
  • Diarrhea
  • Low Appetite
  • Rapid Heart Beat
  • Nausea and Vomiting
  • Lacrination (tearing up of the eyes)
  • High Blood Pressure
  • Runny Nose
  • Chills
  • Excessive Sweating

If you refer back to the health benefits of CBD, you’ll notice that CBD provides relief for many of the symptoms of opiate withdrawals. 

Talk to your Doctor

Opiate addiction is different for different people.  Withdrawal treatment drugs like suboxone and methadone save thousands of lives every year.  However, they are not meant to be permanent solutions.  It is beneficial for anyone taking suboxone or methadone to have a plan for getting off of these drugs.  Some addicts don’t even have access to suboxone and methadone.  Luckily, there are natural alternatives – – Kratom and CBD.  Talk to your doctor.  Bring up CBD as an alternative to your current treatment.  CBD could provide the relief that you’ve been looking for!

Shane Dwyer
Author: Shane Dwyer
Shane Dwyer is a cannabis advocate who isn’t afraid to tell the world about it! You can find his views, rants, and tips published regularly at The 420 Times.

Marijuana & Cannabis News – The 420 Times

Too Few U.S. Opioid Users Are Getting OD Antidote

TUESDAY, Aug. 6, 2019 — Naloxone can reverse an opioid overdose, but far too little of the lifesaving drug is used where it is needed the most, a new U.S. government report shows.

“Too many people in our country and in our communities are still dying from opioid-related overdoses,” said Dr. Anne Schuchat, principal deputy director at the U.S. Centers for Disease Control and Prevention. “We must and can do a better job of getting naloxone in the hands of people who really need it, and those likely to be nearby when an overdose occurs.”

The new CDC report finds that too few doctors are prescribing naloxone as recommended to patients taking high-dose opioids or opioids plus benzodiazepines (such as Valium and Xanax), or to those with a substance use disorder.

If every patient with a high-dose opioid prescription were offered naloxone (brand names Evzio and Narcan), nearly 9 million more naloxone prescriptions would have been dispensed in 2018, according to the CDC’s Aug. 6 Vital Signs report.

“Our report has good news and bad news related to both opioid prescribing and co-prescribing of naloxone,” Schuchat said during a Tuesday media briefing on the findings.

“We are making progress in reducing high-dose opioid prescribing, but there is still too much and we are seeing significant increases in pharmacy prescriptions for naloxone, but there is much room for improvement, missed opportunities remain,” she noted.

While there was an overall increase in naloxone dispensing from 2012 to 2018, there were wide variations in naloxone dispensing in pharmacies, despite similarities in state laws.

More needs to be done to increase naloxone access at the local level, according to the report.

The investigators found that rural counties had the lowest dispensing rates in 2018; primary care providers wrote only 1.5 naloxone prescriptions per 100 high-dose opioid prescriptions (an opioid overdose risk factor); and more than half of naloxone prescriptions required a co-pay. Co-pays can keep some patients from accessing the meds.

The report said that the number of naloxone prescriptions dispensed doubled from 2017 to 2018; only one naloxone prescription is dispensed for every 70 high-dose opioid prescriptions; and 71% of Medicare prescriptions for naloxone required a co-pay, compared to 42% for commercial insurance.

In addition, rural counties were nearly three times more likely to have low rates of naloxone-dispensing than metropolitan counties, and naloxone dispensing is 25 times greater in the highest-dispensing counties than the lowest-dispensing counties.

In 2017, over 47,000 Americans died of opioid overdoses. For years, naloxone has been used by emergency medical services, first responders and community-based overdose prevention programs. Meanwhile, efforts are being made to boost access to naloxone through prescribing and pharmacy-based distribution.

CDC director Dr. Robert Redfield said in an agency news release: “It is clear from the data that there is still much needed education around the important role naloxone plays in reducing overdose deaths. The time is now to ensure all individuals who are prescribed high-dose opioids also receive naloxone as a potential lifesaving intervention.”

In addition, Redfield said, “As we aggressively confront what is the public health crisis of our time, CDC will continue to stress with health care providers the benefit of making this overdose-reversing medicine available to patients.”

More information

The U.S. National Library of Medicine has more on naloxone.

© 2019 HealthDay. All rights reserved.

Posted: August 2019

Drugs.com – Daily MedNews

Some Drug Abusers Use Relatives to ‘Opioid Shop’

By Robert Preidt

HealthDay Reporter

FRIDAY, May 10, 2019 (HealthDay News) — People who are thwarted in their attempts to “shop around” for prescription opioid painkillers at doctors’ offices and pharmacies may try to get the drugs via relatives as a last resort, researchers report.

Some people who misuse opioids go to numerous prescribers and fill prescriptions at multiple pharmacies to avoid detection. But states are cracking down on such “shopping,” forcing them to find other ways of getting the drugs.

The new study suggests some try to get opioids from family members who are prescribed the painkillers. University of Michigan researchers said it’s the first study to examine doctor and pharmacy shopping within families.

For every 200 U.S. patients prescribed opioids in 2016, one had a family member who shopped for opioids, the study found.

The findings underscore the need to reduce the number of opioids available for such diversion by limiting unnecessary prescribing, according to authors of the study published May 10 in the journal JAMA Network Open.

The researchers analyzed 1.4 million opioid prescriptions in 2016 for 554,000 people and relatives covered under the same private family insurance plan.

Of those prescriptions, 0.6% (1 out of 167) were filled by a patient with a family member who met the criteria for opioid shopping — they had received prescriptions from four or more sources and filled them at four or more pharmacies in the past year.

That percentage means that 1.2 million of the 210 million opioid prescriptions in the United States in 2016 may have been dispensed to people who had family members who shopped for opioids, said lead author Dr. Kao-Ping Chua and colleagues.

When researchers defined opioid shopping as getting prescriptions from at least three sources and filling them at three or more pharmacies, 1.9% of opioid prescriptions met that criteria.

For opioid prescriptions to children, 0.2% were filled when the child, doctor and pharmacy met opioid shopping criteria, the study found.

And 0.7% of opioid prescriptions to kids went to those with a family member who met pharmacy shopping criteria. Though researchers can’t be sure from their data, they suspect the adults were often the children’s parents.

Continued

“This apparent doctor and pharmacy shopping behavior in children is likely driven by an adult family member, since children can’t obtain opioid prescriptions from multiple prescribers and fill them at multiple pharmacies on their own,” Chua said in a university news release. He’s a pediatrician and health care researcher at Michigan.

To prevent people who shop for opioids from misusing family members’ medicine, Chua said doctors should not prescribe more doses than patients need, and should order over-the-counter painkillers when possible.

WebMD News from HealthDay

Sources

SOURCE: University of Michigan, news release, May 10, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Many Drug Abusers Use Family Members to ‘Opioid Shop’

FRIDAY, May 10, 2019 — People who are thwarted in their attempts to “shop around” for prescription opioid painkillers at doctors’ offices and pharmacies may try to get the drugs via relatives as a last resort, researchers report.

Some people who misuse opioids go to numerous prescribers and fill prescriptions at multiple pharmacies to avoid detection. But states are cracking down on such “shopping,” forcing them to find other ways of getting the drugs.

The new study suggests some try to get opioids from family members who are prescribed the painkillers. University of Michigan researchers said it’s the first study to examine doctor and pharmacy shopping within families.

For every 200 U.S. patients prescribed opioids in 2016, one had a family member who shopped for opioids, the study found.

The findings underscore the need to reduce the number of opioids available for such diversion by limiting unnecessary prescribing, according to authors of the study published May 10 in the journal JAMA Network Open.

The researchers analyzed 1.4 million opioid prescriptions in 2016 for 554,000 people and relatives covered under the same private family insurance plan.

Of those prescriptions, 0.6% (1 out of 167) were filled by a patient with a family member who met the criteria for opioid shopping — they had received prescriptions from four or more sources and filled them at four or more pharmacies in the past year.

That percentage means that 1.2 million of the 210 million opioid prescriptions in the United States in 2016 may have been dispensed to people who had family members who shopped for opioids, said lead author Dr. Kao-Ping Chua and colleagues.

When researchers defined opioid shopping as getting prescriptions from at least three sources and filling them at three or more pharmacies, 1.9% of opioid prescriptions met that criteria.

For opioid prescriptions to children, 0.2% were filled when the child, doctor and pharmacy met opioid shopping criteria, the study found.

And 0.7% of opioid prescriptions to kids went to those with a family member who met pharmacy shopping criteria. Though researchers can’t be sure from their data, they suspect the adults were often the children’s parents.

“This apparent doctor and pharmacy shopping behavior in children is likely driven by an adult family member, since children can’t obtain opioid prescriptions from multiple prescribers and fill them at multiple pharmacies on their own,” Chua said in a university news release. He’s a pediatrician and health care researcher at Michigan.

To prevent people who shop for opioids from misusing family members’ medicine, Chua said doctors should not prescribe more doses than patients need, and should order over-the-counter painkillers when possible.

More information

The U.S. Centers for Disease Control and Prevention has more on prescription opioids.

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Posted: May 2019

Drugs.com – Daily MedNews

Poor, Minorities Get Less Help For Opioid Addiction

By Robert Preidt

HealthDay Reporter

WEDNESDAY, May 8, 2019 (HealthDay News) — When it comes to opioid addiction treatments, money and race matter, researchers say.

White, wealthy Americans are much more likely to receive medication for their addiction than minorities and the poor, the new study found.

Racial and financial differences have only grown wider as the opioid crisis in the United States has worsened, even though opioid addiction rates are similar among whites and blacks, according to Dr. Pooja Lagisetty, an assistant professor of internal medicine at the University of Michigan, and her colleagues.

The new analysis of 2012 to 2015 data found that for every appointment where a black patient received a prescription for the opioid addiction medication buprenorphine, there were 35 such appointments for white patients.

There was a large increase in the overall number of buprenorphine prescriptions written at outpatient clinic visits over the previous decade, but a decrease in the percentage of those visits where the patients were black, the investigators found.

The percentage of those visits paid for by cash or private insurance grew far faster than the percentage paid by Medicaid, which covers low-income people, and Medicare, which covers people with disabilities and adults over age 65, the findings showed.

Between 2012 and 2015, patients paid cash for nearly 40% of outpatient visits where buprenorphine prescriptions were written, while private insurance covered the cost of 34% of the visits, a significant increase from just under 20% a decade earlier.

Medicare and Medicaid, which provide medical coverage to 30% of all Americans, accounted for just 19% of such visits, according to the researchers.

For patients who pay cash, a single prescription of buprenorphine can cost several hundred dollars, the study authors noted in a university news release.

More than 2.3 million Americans have an opioid use disorder, but less than half are receiving medications approved to treat the disorder. Medication is the only treatment that has years of evidence showing it can help patients recover from opioid addiction.

In the early 2000s, just 0.04% of all outpatient visits in the United States included a prescription for buprenorphine. That rose to 0.36% by the mid-2010s, or about 13.4 million visits.

Continued

The study was published May 8 in JAMA Psychiatry.

The differences in rates of buprenorphine prescriptions at clinic visits suggests inequalities in access, Lagisetty noted.

“We shouldn’t see differences this large, given that people of color have similar rates of opioid use disorder,” she said.

“As the number of Americans with opioid use disorder grows, we need to increase access to treatment for black and low-income populations, and be thoughtful about how we reach all those who could benefit from this treatment,” Lagisetty added.

“Cash-only buprenorphine clinics have proliferated in recent years, which may be expanding access for those with the means to pay in certain regions. But the high costs may be prohibitive for those who cannot afford to pay. In addition, we know that patients do better when they remain on the medication long-term. Paying hundreds of dollars per month can be a major barrier to staying engaged in care,” Lagisetty said.

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SOURCE: University of Michigan, news release, May 8, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Amid Opioid Crisis, Cocaine, Meth Deaths Soar

By E.J. Mundell

HealthDay Reporter

THURSDAY, May 2, 2019 (HealthDay News) — As the United States battles an ongoing epidemic of opioid abuse and deaths, new data shows that fatalities tied to cocaine and methamphetamines are also surging.

In fact, of the more than 70,000 lives lost to drug overdoses in 2017, “nearly a third involved cocaine, psychostimulants or both,” reports a team led by researcher Mbabazi Kariisa, of the U.S. Centers for Disease Control and Prevention.

Psychostimulants include drugs such as methamphetamines (meth), the “club drug” MDMA, Ritalin, and even caffeine.

National vital statistics data on causes of death found that in 2017, 1 in 5 drug overdose deaths (nearly 14,000 cases) involved cocaine, representing “a 34.4% increase from 2016,” Kariisa and colleagues reported.

Similarly, nearly 15% of all fatal drug ODs for 2017 (about 10,000 cases) involved psychostimulants, a jump upwards of 37% over the previous year.

These numbers reflect a recent, troubling trend: The CDC team noted that between 2015 and 2016, rates of drug overdose deaths involving cocaine, psychostimulants or both had already risen by 42.4%.

Why have coke, meth and the like become even more deadly? According to the researchers, in many cases, deaths also involved the use of opioids, including super-potent drugs such as fentanyl.

“Nearly three-quarters of cocaine-involved deaths in 2017 also involved opioids,” they reported, as did about half of deaths involving psychostimulants such as meth. Synthetic opioids — fentanyl, most prominently — often played a key and deadly role.

An emergency physician on the front line of the drug overdose epidemic wasn’t surprised by the numbers.

“While much attention continues to focus on addressing opioid abuse and misuse, it’s vital that we don’t ignore the dangers that cocaine and other psychostimulants present,” said Dr. Robert Glatter, who practices at Lenox Hill Hospital in New York City.

In many cases, drug abusers may not even know that the substances they are using are laced with fentanyl or other drugs, he added. The trend “could be partly related to people unaware of the tainted product they were using,” Glatter said.

Continued

But even used alone, cocaine raises a person’s odds for death, he said.

“Cocaine use elevates blood pressure, weakens the heart muscle, promotes formation of plaque in the coronary arteries, thereby increasing the risk of heart attack,” Glatter explained. “It also may precipitate a stroke by virtue of its effects on plaque formation in blood vessels that supply the brain.”

The CDC team found that some demographics are being hit harder by the resurgence of cocaine and psychostimulant abuse than others.

When it comes to gender and age, the upward trend in fatalities was most pronounced for young women aged 15 to 24, although young men were similarly affected. Cocaine-related deaths were most common in the Midwest, while the West had the highest rate of fatal overdoses involving psychostimulants, the CDC researchers said.

The data suggests an increasingly complex “poly-substance landscape” of drug abuse across America, Kariisa’s group said.

“Drug overdoses continue to evolve along with emerging threats, changes in the drug supply, mixing of substances with or without the user’s knowledge, and poly-substance abuse,” they wrote. More can and must be done to provide addicts with “tailored and effective prevention and response strategies” to help curb these trends, the researchers said.

The new report was published in the May 3 issue of the CDC journal Morbidity and Mortality Weekly Report.

WebMD News from HealthDay

Sources

SOURCES: Robert Glatter, M.D., emergency physician, Lenox Hill Hospital, New York City; May 3, 2019,Morbidity and Mortality Weekly Report

Copyright © 2013-2018 HealthDay. All rights reserved.

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Another Cost of the Opioid Epidemic: Billions of Dollars in Lost Taxes

TUESDAY, April 16, 2019 — Opioid abuse-related job losses have cost U.S. federal and state governments tens of billions of dollars in lost tax revenue, a new study claims.

Penn State researchers analyzed data from the U.S. National Survey on Drug Use and Health along with estimates of declines in the U.S. labor force due to the opioid epidemic.

Between 2000 and 2016, federal tax losses due to opioid-related reductions in the labor force totaled $ 26 billion, researchers estimated. State governments lost an estimated $ 11.8 billion in tax revenue over that period.

The federal hit was entirely due to lost income tax revenue, while states also lost sales tax revenue, according to the study.

Pennsylvania was among states taking the biggest hit — a $ 638.2 million tax revenue loss.

“This is a cost that was maybe not thought about as explicitly before, and a cost that governments could potentially try to recoup,” said Joel Segel, an assistant professor of health policy and administration at Penn State.

“Instead of focusing on the cost of treating people with opioid use disorder, you could think about it in terms of a potential benefit to getting people healthy, back on their feet, and back in the workforce,” he added in a university news release.

In 2016, nearly 2.1 million Americans had an opioid use disorder, and about 64,000 died of opioid overdoses, previous research has found.

Segel noted those studies have focused on substance abuse treatment and other medical costs associated with the epidemic.

These new findings help show the value of treating people with opioid addiction and should be considered when treatment programs are being evaluated, according to Segel.

“Not only are treatment programs beneficial to the individual and to society, but if you’re thinking about the total cost of these treatment programs, future earnings from tax revenue could help offset a piece of that,” he said.

The study was recently published in the journal Medical Care.

More information

The U.S. Centers for Disease Control and Prevention has more on opioids.

© 2019 HealthDay. All rights reserved.

Posted: April 2019

Drugs.com – Daily MedNews

FDA: Don’t Suddenly Stop Taking Your Rx Opioid

By EJ Mundell

HealthDay Reporter

WEDNESDAY, April 10, 2019 (HealthDay News) — Because of the danger of “serious harm” to patients, the U.S. Food and Drug Administration is advising doctors not to suddenly stop patients from taking opioid painkillers, or drastically lower the dose.

In a statement released Tuesday, the agency said it is adding a warning about sudden discontinuation of use to the prescribing information of opioid painkillers such as OxyContin (oxycodone), Vicodin (hydrocodone), morphine and other drugs.

“Rapid discontinuation can result in uncontrolled pain or withdrawal symptoms,” the agency explained. “In turn, these symptoms can lead patients to seek other sources of opioid pain medicines, which may be confused with drug-seeking for abuse. Patients may attempt to treat their pain or withdrawal symptoms with illicit opioids, such as heroin, and other substances.”

The new guideline is meant to help doctors allow patients who no longer require an opioid to safely wean themselves off the drug — cutting their risk for withdrawal symptoms.

The United States is currently in the grip of an epidemic of opioid abuse and addiction. According to 2017 statistics from the National Institute on Drug Abuse, more than 1.7 million people in the United States are thought to have opioid use disorder and more than 47,000 died from an opioid overdose.

But simply cutting a patient off from his or her prescription opioid may not be helpful, the FDA warned doctors.

Instead, “create a patient-specific plan to gradually taper the dose of the opioid and ensure ongoing monitoring and support, as needed, to avoid serious withdrawal symptoms, worsening of the patient’s pain, or psychological distress,” the agency advised.

And for patients, you “should not suddenly stop taking your medicine without first discussing with your health care professional a plan for how to slowly decrease the dose of the opioid and continue to manage your pain,” the FDA said. If pain, withdrawal symptoms or mood changes still occur, reach out to your doctor for help.

WebMD News from HealthDay

Sources

SOURCE: U.S. Food and Drug Administration, statement, April 9, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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CDC Clarifies Opioid Guidelines for Severe Pain

By Amy Norton

HealthDay Reporter

TUESDAY, April 9, 2019 (HealthDay News) — People with severe pain from cancer or sickle cell anemia should not be denied coverage for opioid painkillers, a new clarification on federal guidelines states.

In the wake of the national opioid epidemic, various medical societies had encouraged doctors to rein in prescriptions for the powerful painkillers.

In 2016, the U.S. Centers for Disease Control and Prevention published guidelines that said for most patients seen by primary care doctors, opioids should be a last resort.

But there has been an unintended consequence: Some insurers have refused to pay for prescriptions for patients with cancer or sickle cell anemia, or for cancer survivors with complicated chronic pain conditions.

The new clarification was issued in a letter from the CDC to three medical societies who’d brought the insurance problem to the agency’s attention — the American Society of Hematology, the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network.

The letter, released Tuesday, stresses that the guidelines weren’t intended for patients undergoing cancer treatment.

Beyond that, the letter says, the guidelines weren’t designed to “deny any patients who suffer with chronic pain” the option of opioid medications.

Dr. Deepika Darbari, who is with the hematology society, treats young patients with sickle cell anemia at Children’s National, in Washington, D.C. She said she’s come up against the insurance barrier herself — namely, plans that refused to pay for IV opioids for patients hospitalized with severe pain episodes.

And they’ve cited the CDC guidelines as the reason, Darbari said.

Sickle cell anemia is an inherited disease that causes red blood cells to be crescent-shaped, rather than disc-shaped. The cells also become “sticky” and prone to clotting. Because of poor blood circulation, patients can suffer periodic pain “crises.”

Over time, Darbari explained, sickle cell anemia can cause chronic pain by damaging organs and joints throughout the body.

Patients can first try other pain relievers, like acetaminophen (Tylenol) and ibuprofen (Motrin, Advil), along with nondrug therapies, according to Darbari.

But, she said, some need oral opioids, like Vicodin or OxyContin. And for severe pain episodes, patients may need to be hospitalized and given IV opioids.

Continued

The CDC agreed that managing sickle cell pain is complicated. The agency stated in its letter that treatment decisions — and reimbursement — should be based on medical guidelines created specifically for the disease.

Then there is the issue of cancer survivors who suffer lasting pain related to their treatment.

The CDC guidelines specifically said they do not apply to cancer patients undergoing “active treatment.”

“But where does that leave cancer survivors?” said Judith Paice, the lead author of ASCO’s guidelines on treating survivors’ pain.

More and more people are surviving cancer, Paice said — and that means more people living with aftereffects of treatment, which can include chronic pain. Some cancer treatments damage the nerves, for example, leaving people with a form of pain called neuropathy.

Another example, Paice said, relates to the aromatase inhibitors that breast cancer survivors may take for years to cut the risk of recurrence. They can cause chronic joint and muscle pain.

“We have many different options for addressing pain in cancer survivors, and opioids are one,” Paice said.

The CDC guidelines, she noted, were aimed at primary care doctors treating more common problems like lower back pain. Complex pain conditions, like those in cancer survivors, are different, Paice said.

In its letter, the CDC acknowledged that pain in cancer survivors is “unique,” and that guidelines from groups like ASCO offer “useful guidance” on treatment.

Commenting on the letter, the trade group America’s Health Insurance Plans (AHIP) said that health insurance policies have “always” recognized that patients under active cancer treatment do not fall under the CDC guidelines.

Beyond that, the AHIP said, “health insurance providers cover comprehensive, effective approaches to pain management that include evidence-based treatments, more cautious opioid prescribing, and careful patient monitoring.”

The CDC’s letter will be publicly available online, and Darbari said that doctors and patients can cite it if they run into problems with insurance coverage.

Paice called the letter “a beginning.” But she also said the problem is broader: Even when patients are not denied coverage, insurers put up cumbersome prior authorization requirements for opioids — even for refills.

Continued

“That can leave chronic pain patients without any medicine,” she said.

Paice said she reminds patients not to wait until their pills are almost gone to get a refill — since they may face delays.

WebMD News from HealthDay

Sources

SOURCES: Deepika Darbari, M.D., hematologist, Children’s National Health System, and member, American Society of Hematology, Washington, D.C.; Judith Paice, Ph.D., R.N., research professor and director, cancer pain program, Northwestern University Feinberg School of Medicine, Chicago, and lead author,Management of Chronic Pain in Survivors of Adult Cancers Guideline, American Society of Clinical Oncology; Cathryn Donaldson, director, communications, America’s Health Insurance Plans, Washington, D.C.; April 9, 2019, letter from the U.S. Centers for Disease Control and Prevention

Copyright © 2013-2018 HealthDay. All rights reserved.

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