Tag Archives: addiction

Research Indicates Nearly 30% of Opioid Prescriptions Lack Medical Justification

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

HEAL Blog posts frequently discuss the impact the opioid epidemic has upon the spread of HIV, Hepatitis B (HBV), and Hepatitis C (HCV). One aspect that we’ve discussed – prescribing habits – has recently received further study. According to new research published in Annals of Internal Medicine, 28.5% of opioid prescriptions have no record of either pain symptoms or pain-related conditions justifying their prescription (Scutti, 2018).

The study authors go out of their way to suggest that various causes may contribute to this lack of justification – failure to submit documentation, time constraints, clinic workflows, or complicated documentation systems (Scutti). In recent decades, doctors and nurses, alike, have complained about the complicated and seemingly never-ending amount of paperwork involved in providing even the most basic of care. Much of this is related to the Electronic Medical Record (E.M.R.) – software programs that are designed to account for virtually everything that can, does, or should occur with a patient. Recent studies indicate that doctors spend a little more than half of their work hours doing administrative work, rather than in face-to-face time with patients (Ofri, 2017).

Rx bottle with medicine on top of an Rx order

Photo Source: MedScape

Essentially, any time an insurer, new law, regulation, or threat of legal action appears, new field (or more) pops up in E.M.R. software that requires input on behalf of the doctor. So, realistically, it is possible that the justifications for at least some of the 28.5% of unjustified opioid prescriptions could just have been lost in the shuffle. Doctors are, after all, only human. Very well-trained, highly educated humans, but humans, nonetheless.

The other side of this argument, however, is that “doctors are human.” Doctors, like every human, are susceptible to poor influences – deals made with pharmaceutical companies to prescribe certain medications that highly addictive in lieu of other medications, for example. Or addiction; manipulation by patients; under the table dealing. At least once a week, I read an article about a doctor whose license is being suspended or revoked because they’ve been illicitly prescribing opioids or other narcotics in exchange for [x], or they’ve been selling them on the side. But, even those instances can’t account for all of 28.5%.

Yet another angle is that these drugs have become increasingly regulated since 2006 (the scope of the Annals study is 2006-2015). Since 2015, even more restrictions have been placed upon opioid prescribing, and in most states, this has resulted in dramatic decreases in the number of prescription per capita. In 2017, the opioid prescribing rate had fallen to the lowest it had been in 10 years (Centers for Disease Control and Prevent, 2017). But, even that comes with additional problems: patients turning to “street” sources for prescription opioids; patients moving off of opioids to heroin (often cut with fentanyl or carfentanil), because heroin is easier and cheaper to obtain; the resultant overdoses and increased risk of infection with HIV, HBV, and HCV.

There is no single solution to curbing the opioid epidemic. Doing so is going to require multiple approaches working in conjunction to defeat the problems. Outside of just prescriber education about opioid addiction and increase prescribing restrictions, we must also include and incorporate patient-focused harm reduction measures, such as increasing access to legal Syringe Services Programs (needle exchanges that also provide screening and testing for diseases and linkage to treatment programs for disease and addiction) and increasing access to addiction treatment programs by expanding the number of available beds.

For far too long, we have attempted to deal with these problems with siloed responses – just syringe exchanges; just prescribing restrictions; just prescriber education. This strategy is not working, and moreover, it is more expensive, in the long-run, to continue funding multiple single-focus initiatives that don’t work in tandem with one another, than it would be bring all of these resources and initiatives into one large effort. But, that will require cooperation and a lot of money up front; it’s far more palatable to fund smaller, less effective initiatives because the “ask” is lower on up-front costs. Realistically, though, it needs to be done.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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Ohio’s Opioid Addiction Forces Rethinking

HEAL Blog is the recipient of the ADAP Advocacy Association’s  2015-2016 ADAP Social Media Campaign of the Year Award

By: Marcus J. Hopkins, Blogger

When rescue teams arrived on the scene, they had to break out two windows in her still-running truck to get to Debra Hyde and her eight-month-old grandson. Hyde’s truck was still in “Drive” in front of a large wall of propane tanks, when rescue workers found her overdosed on heroin in the backseat of her truck.

This is at least the second time in the past month that Ohio authorities have found a grandparent or guardian overdose in a vehicle with a child. Earlier in the month, Ronda Pasek and her boyfriend were found overdosed with a child in the backseat, and she is now sentenced to a 180-day sentence for a misdemeanor charge of “child endangerment.” In both cases, the children involved were remanded to the care of child services.

Woman laying on the ground after overdosing on Heroin, with the needle on the ground nearby

Photo Source: JustThinkTwice

1,424 people died in Ohio, in 2015, as a result of drug overdoses. This has forced first responders to reconsider not only how they prepare for their jobs – Naloxone kits are essentially a “must,” these days – but, how they respond to the burgeoning epidemic that plagues their state. In Marion, OH, and across the nation, heroin has fundamentally altered the work of police and emergency-service workers. Police and paramedics are now expected to play the roles of social workers, drug-treatment specialists, and experts at connecting with kids in drug-prevention programs (as those of us who remember D.A.R.E. can attest).

Marion Police Chief, Bill Collins, told his officers to stop charging those who overdosed, while at the same time, he was making connections with religious leaders, healthcare professionals, addition treatment providers, and teachers to find ways to help better address drug addiction within his community. He followed the evidence: many addiction surveys indicate that a large number of opioid addicts became addicted to prescription pain killers after gaining access to their parents’, grandparents’, or guardians’ properly (or improperly) prescribed opioid painkillers and began using them recreationally. In addition, he noticed that many of the people who were being found overdosed had kids in local schools, which further indicated that a great place to start would be within the educational paradigm.

With these things in mind, Collins and his allies helped create the “Too Good for Drugs” campaign, that teaches age-specific strategies that students can use to resist drugs. The program won a $25,000 Ohio Department of Education grant to fund the ten-week program for 6th-12th grade students. Teachers were so passionate about the project that they volunteer to teach it. Officials are still waiting to find out if another grand to extend the program to K-5th grade students is approved.

But, beyond the fact that these functions are becoming unlisted job requirements in these fields, should law enforcement officers and other first responders be expected to fill these roles? What few people contest is that “something” needs to be done; beyond that, there’s little agreement between healthcare professionals, law enforcement organizations, and advocacy groups on exactly what that “something” is.

Do we need more treatment centers for drug addiction, both in- and out-patient? Absolutely. Do we need more qualified social workers and staffing resources to adequately address opioid and other drug addiction? Yep. Do we need to do a better job of providing these recovery and addiction services to people in more rural parts of states – areas where opioid and heroin addiction are currently hitting states hardest? There’s no doubt of that.

But, the reality is that all of these approaches, while both the “right things to do” and the best ways we currently have to address the problem, are costly and require resources that, on the state and local levels, may simply not exist. Further complicating these efforts is the seeming inability of our elected leaders at the Federal level to work together toward accomplishing mutually beneficial goals. For states currently watching their cities turn into drug dens with a body count, it really does seem like the time for them to just get it together, and get to work.
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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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In Case of Overdose, Please Spray Naloxone

By: Marcus J. Hopkins, Blogger

For the past two weeks, HEAL Blog has covered various issues related to Harm Reduction and opioid abuse, but not much attention has been given, on our part, to what happens when using injection drugs goes awry and results in an overdose. This is where two specific Harm Reduction methods – Good Samaritan laws and expanded access to the opioid antagonist, Naloxone – come into play.

Good Samaritan laws are ones that provide legal protection to people who provide reasonable assistance to people who are, or whom they believe to be, injured, ill, in peril, or otherwise incapacitated. As it relates to drug overdoses, Good Samaritan laws allow bystanders, medical professionals, or anyone, really, to treat an overdose victim using reasonable methods – such as the application of Naloxone for opioid overdoses – without fear of being later prosecuted, should the person survive and decide, for whatever reason, to sue the person who performed the life saving measure.

Naloxone, itself, is referred to as an “opioid antagonist” – a drug medication that counteracts life-threatening depression of the central nervous system and respiratory system, allowing the overdose patient to breathe normally. It’s also a nonscheduled (i.e. – non-addictive) prescription medication (Harm Reduction Coalition, n.d.), meaning that there is no chance of becoming addicted to the drug. It can be delivered via injection into the muscle, vein, or under the skin, or, more commonly, by nasal spray. The latter application, under the product name “Narcan,” is the generally preferred method of treating overdose victims.

RESPOND to an OPIOID OVERDOSE! You can save a life! [Naloxone Kit]

Photo Source: Washington.edu

When discussing “expanding access to Naloxone,” we’re speaking of more than simply making it more readily available; we’re also discussing how it can be procured, not only by medical emergency personnel and authority figures, but by minimally trained people, which can include essentially anyone, from family members to neighbors to your local postal worker. In fact, CVS pharmacy locations have made Narcan available without a prescription (over the counter, essentially) in 22 states (Thurston, 2016), allowing virtually anyone to procure the overdose cure with minimal hassle, and minimal cost.

Cost is, of course, an issue that must be dealt with, whenever we speak of medical treatments. While Naloxone is relatively inexpensive – depending on the location, between $20-$40 a shot (and in some cases, $6/dose with rebates) – the increased and increasing demand for the drug has cause some drug manufacturers – Amphastar Pharmaceuticals, in particular – to increase their prices to meet the cost of production, raw materials, and labor. Amphastar makes the naloxone most widely used by health departments and police, and is currently the only manufacturer that makes naloxone in a dosage that can be administered nasally (All Things Considered, 2015).

Naloxone, however, is not a panacea, for all its potential live-saving benefits. While the increased availability of Naloxone does translate into more overdose victims being saved, it may not be able to keep up with the increase in opioid and heroin abuse. In Louisville, KY, for example, 40 people in the metro area have died from a drug overdose as of March 21st, 2016, whereas that number was 31 in 2016 (Mora, 2016). While these numbers will, of course, fluctuate from year to year, Jefferson County (where Louisville is located) has the highest overdose rate in the state; Kentucky, as a whole, has the third highest rate in the nation.

In addition to the concerns about increasing opioid abuse levels, areas that are hardest hit by opioid addiction (and thus require larger amounts of Naloxone) may find themselves unable to keep up with the cost of treating patients. Opioid addiction and overdose rates continue to soar in suburban and rural areas, where financial resources may already be taxed by the basic functions of governance. Rural areas, in particular, face significant issues outside of just the cost of procuring doses – reaching and delivering naloxone to far flung overdose patients requires additional resources, both in terms of human and transportation resources.

While the increased access to Naloxone and Good Samaritan laws protecting those who use it are undoubtedly a good thing, they are only two parts of the Harm Reduction stratagem. Without additional efforts, such as Doctor Shopping Laws, Mandatory Prescription Drug Monitoring Programs, and Federally- and state-funded recovery services, we will continue to struggle with the growing opioid and heroin abuse epidemic. As Louisville city councilman stated, “I don’t think we’ve seen the worst of our heroin or opioid problem; I think we’re still in an upward trajectory” (Mora).

References:

All Things Considered. (2015, September 10). Price Soars For Key Weapon Against Heroin Overdoses. National Public Radio: All Things Considered. Retrieved from: http://www.npr.org/sections/health-shots/2015/09/10/439219409/naloxone-price-soars-key-weapon-against-heroin-overdoses

Harm Reduction Coaliation. (n.d.). Understanding Naloxone. New York, NY: Harm Reduction Coalition. Retrieved from: http://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/understanding-naloxone/

Mora, C. (2016, April 04). Opioid overdose deaths increase, despite naloxone prevalence. Louisville, KY: WLKY News. Retrieved from: http://www.wlky.com/news/opioid-overdose-deaths-increase-despite-naloxone-prevalence/38859616

Thurston, J. (2016, March 31). CVS locations in Vermont to sell naloxone without prescription. Colchester, VT: WPTZ New Channel 5. Retrieved from: http://www.wptz.com/news/cvs-locations-in-vermont-to-sell-naloxone-without-prescription/38762902

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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President Obama Proposes $1.1 Billion in New Funding for Prescription Opioid & Heroin Epidemic

By: Marcus J. Hopkins, Blogger

Last week, the Obama Administration announced that the President is proposing $1.1 billion in new funding to address the prescription opioid abuse and heroin use epidemic that is currently sweeping our nation’s rural and suburban areas. The funds are earmarked to spend $920 million to expand access to medication-assisted treatment efforts, $50 million in National Health Service Corps funding to expand access to substance use treatment providers, and $30 million to evaluate the effectiveness of medication-assisted treatment programs under real-world conditions.

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President Barack Obama and others listen to Charleston Police Chief Brent Webster, foreground, during an event at Charleston, W.Va., where Obama hosted a community discussion on prescription drug and heroin abuse, Oct. 21, 2015. Photo Source: VOA News

If I sound dismissive of this effort, it’s because there are some strings attached to this proposal that makes it yet another example of how little people understand the severity of the issue and the difficulties associated with trying to address it in a rural setting. The $920 million will be allocated to states based on the “…severity of the epidemic and on the strength of their strategy to respond to it.”

The last part of that is the kicker – really, How Do You Solve a Problem Like Maria? One of the most difficult barriers to overcome in the hard-hit Appalachian Mountain Region is one of access; there simply are too few places for people with any health condition to turn.

For the past few years, the state of West Virginia has been besieged by budgetary, economic, and employment woes. In a state where the per capita income is $22,966, it’s hardly surprising that financial issues abound. Those issues are further compounded by a dearth of private and public services available across the state. We have food deserts (areas where there are no grocers or markets providing fresh foods), healthcare deserts, utility deserts – if a map of all the available services were created of West Virginia, it would resemble an actual desert, replete with a handful of oases where these services are available.

Despite the state’s efforts to combat a nearly two-decade-long opioid abuse and heroin use epidemic in the state, the fact of the matter is that there just aren’t enough physical resources – literally, buildings in place – with the capacity to serve as treatment hubs. More troubling is a proposal by the current Republican legislature to combine county health departments into nine multi-county districts, essentially forcing residents from dozens of already underserved counties to have to travel even further to get to a single health department facility. The report suggests potential savings of $12.5 million or more to the state…but doesn’t bother to take into account issues of accessibility, affordability, or the impact that this would have on one of the least healthy states in the nation.

While additional funds are always appreciated, if past precedent is indicative of anything in West Virginia, it’s that Federally-allocated, but state-administered funds for state improvements rarely go very far in a state beset by geographic and economic hardships that have been allowed to go unaddressed for decades, intransigence and failure to adapt being the name of the game in the state. How is West Virginia – the state with the highest rate of opioid overdoses in the nation – supposed to compete for these funds when the state’s legislators are actively attempting to cut healthcare costs at the expense of healthcare access? If we are to receive funds based on the strength of our plans to confront this healthcare crisis, how will it look when, rather than expanding access, we are going about shrinking it?

This additional funding proposal has the potential to be a game changer…in states with legislatures who actively seek to expand access. To be honest, I am somewhat concerned by the caveat that these funds are designed to support medication-assisted treatment efforts. Even if they are effective in reducing dependency on opioid drugs, it seems ironic that addiction to one type of drug should be addressed by the use of another type of drug. Perhaps this proposal needs a bit more work, and a lot more focus on proven harm reduction efforts, such a accessible and legal syringe exchange programs, accessible treatment and rehabilitation centers, and more attention paid on the prescribing side of the issue.

Overall, I thank the President for his consideration, and welcome him to expand his thinking to include other types of treatment.
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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

 

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