Tag Archives: opioid abuse

The Negative Impact of Opioid Drugs Upon Children and Young Adults

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

In early November 2016, a conference held at Xavier University in Ohio drawing hundreds of doctors, nurses, social workers, and addiction specialists began releasing shocking (though unsurprising) data related to the prescription opioid and heroin epidemic’s negative impact on children and teenagers. The findings indicate what many in healthcare already knew: we are at risk of creating a generation of children whose lives are fundamentally altered for the worse by addiction.

In the past few months, HEAL Blog has doggedly followed the unrelenting opioid-fueled devastation in the state of Ohio, and we have frequently brought to the fore the plight of children whose lives are have been put at risk due to their caretakers’ substance addiction and abuse. What we haven’t yet really covered has been the growing risk posed to children and teens whose access to opioids is made possible by their caretakers.

A study released in the Journal of the American Medical Association (JAMA) Pediatrics showed a 165% increase in opioid poisonings in children from 1997 to 2012 (Luthra, 2016). The rate of toddlers hospitalized more than doubled, and teens were found to be increasingly at risk of overdose (both intentional and unintentional) because they gained access to their parents’ prescription opioids without their knowledge. Both of these issues point to the need to better address overprescribing of opioid drugs, as well as to better stress the need for safer storage of prescription drugs.

Roughly 1 in 10 high school students admit to taking prescription opioid drugs for nonmedical reasons (McCabe, West, Boyd, 2013; Luthra, 2016), and roughly 40% say they got those drugs from their own prior prescriptions (Fortuna, Robbins, Caiola, Joynt, Halterman, 2016). This suggests that (1.) parents are not properly securing their own prescriptions and (2.) parents are not properly monitoring their children’s use and disposal of prescriptions. These suppositions raise questions about whether or not parents whose children or teens overdose should (or do) face negligence charges.

Prescribing guidelines continue to be tightened, as the U.S. Centers for Disease Control & Prevention (CDC) and the U.S. Food & Drug Administration (FDA) have both attempted to get physicians to limit prescriptions to shorter periods, and there is little evidence that imposing penalties upon people who fail to properly store or dispose of medications will have any appreciable impact on the adult behaviors. The concern, however, is whether or not those penalties will result in lower levels of abuse and poisoning on the part of children and teens.

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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 Opioid Epidemic Grows As Death Toll Mounts

By: Marcus J. Hopkins, Blogger

Two weeks ago, police in East Liverpool, Ohio, made global news after posting an arrest scene photo of a four-year-old child in his car seat, while with his grandmother and her boyfriend sat in the front seats, overdosed on heroin. The image has served as both a poignant reminder of the often overlooked consequences of opioid and heroin addiction and as a point of controversy for addiction and child advocates.

Map of Ohio, showing East Liverpool

Photo Source: Google Maps

The East Liverpool police posted the photo in an effort to bring attention to the havoc that opioid and heroin abuse wreaks on not only the user, but on the lives of the people around them. Both overdose victims received doses of naloxone – a fast acting drug that reverses the effects of opioid drugs – at the scene, an act which very like saved their lives. The driver, James Acord (47), was sentenced to 360 days in jail after pleading ‘No Contest’ to charges of child endangerment and operating a vehicle under the influence. the boy’s grandmother, Rhonda Pesak (50), who was awarded custody of the child on July 25, 2016, was sentenced to 180 days in jail after withdrawing her initial ‘Not Guilty’ plea to a charge of child endangerment, and reentering a plea of ‘No Contest.’

The child has since been relocated to live with his great aunt and uncle in South Carolina. His mother initially lost custody of him in December 2012 – four-and-a-half months before he was birth – as a result of her addiction to crack. Custody had initially been awarded to his great grandparents, and custody battles for the boy have involved his birth parents, a grandmother, two great aunts, and a friend, spanning four different states. Essentially, this boy’s life has been negatively impacted by drug addictions of some sort since before he was born.

Addiction advocates have criticized the East Liverpool police for “shaming” people who use drugs; child advocates have criticized the city for failing to obscure the identity of the child, which was done after the images were posted by news agencies. East Liverpool Service-Safety Director, Brian Allen, responded with the following statement:

If we hadn’t, Rhonda Pasek would have received a slap on the wrist and that little boy would have gone back to her – that’s not going to happen now. I doubt she will see that child again (Gould & Graham, 2016).

In the five days that followed the posting of the photograph, East Liverpool, a city of only 11,000 people, saw seven more overdoses and one death from heroin. But, this is just a small vignette of a much larger portrait. On Friday, September 09, Ohio authorities reported at least 21 overdoses in a single day in Akron, OH, bringing the total number of overdose deaths, this year, to 112 in the city. At least 24 people were hospitalized for overdoses, last month, while attending a music festival in the state (Karimi, 2016). In July, along, Akron police reported more than 90 overdoses and eight deaths (Las Vegas Review-Journal, 2016).

Ohio’s recently enacted Good Samaritan law offers immunity from prosecution to people trying to get help for someone overdosing on drugs or overdose victims, themselves, who seek assistance. The law, which went into effect, this month, covers people calling 911, contacting a police officer, or taking an overdose victim to a medical facility for up to two times; upon the third time, they would become subject to prosecution. This law, sign by current Ohio Governor, John Kasich, was passed in an effort to provide those offering assistance to overdose victims some measure of protection in the face of Ohio’s clear opioid and heroin abuse epidemic.

HEAL Blog will continue covering the epidemic in the coming weeks with more information and updates as they become available.
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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.

 

References:

 

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Prescribing Data Paints a Sobering Picture

By: Marcus J. Hopkins

Whenever I speak to colleagues in the medical profession about my work with Hepatitis C (HCV) and coverage data, I inevitably begin citing some of the grim statistics related to the disease: recent spikes in new HCV diagnoses indicate that poorer people between the ages of 13-35 are the new face of the disease; the most effective drugs to treat the virus cost more for twelve weeks of treatment than most Americans make in a single year; that opioid prescription drug and heroin abusers are likelier than virtually any other population to contract HCV; how the disease is largely un- or under-reported, because states lack the funds to adequately monitor and track the disease.

Bar Chart

Photo Source: kngac.ac.in

That I am familiar with the topic and can speak with some authority on the matter is clear, but what I am consistently asked by physicians, specifically, is why I believe we should make testing compulsory for those who are not Baby Boomers, the conventional wisdom being that this population, because they are likelier to have received blood transfusions prior to 1990, are high on the list o potential candidates for HCV. As I try to explain that, the new face of the disease is quickly becoming Injection Drug Users (IDUs) who are younger, whiter, and poorer, I find myself met with consternation. How can I possibly think that compulsory – and potentially costly – blanket screening would produce a net positive result?

My experience comes from having lived during and through the AIDS epidemic of the 1980s and 90s. As a kid and teenager growing up during the age of Comprehensive Sex Education, the constant mantra was “Get tested, get tested, get tested.” The campaign knew that teenagers and young adults were going to have sex with one another, and getting tested was one of the best ways to prevent the spread of HIV; by knowing your status, you could protect yourself and others with whom you might come in contact. These messages were blasted all over the media, in schools, in health classes, in science classes, on television shows, on the radio, in popular music – and, for the most part, this tactic was effective. New infections have largely plateaued over the past twenty years, or so, at roughly 50k annually in the U.S. That these types of marketing and policies directed toward HCV could produce similar results is, to me, a no-brainer.

Despite our differences on testing policies, a constant refrain I hear, especially from Appalachian physicians, is one detailing the woes of opioid drug abuse. “We see more people in the ER for drug abuse-related issues, than for virtually any other reason,” a nighttime ER nurse relayed to me, while collecting a throat culture to check for flu. “How these people get ahold of so many pills is beyond me!”

I hear that, a lot – doctors and nurses who seem simply flummoxed as to how patients come by these prescription drugs, considering the high number of opioid pain relievers prescribed in WV (137.6 for every 100 West Virginians) (Centers for Disease Control and Prevention, 2014). I’m told stories about how boring and pointless are the mandatory opioid educational courses, when they’re not a part of the problem; why should they have to take them, and waste their time on something that’s not really in their wheelhouse?

This might be the biggest disconnect that I encounter – how the behaviors of medical personal and prescribing physicians as they relate to opioid prescription drugs may be driving the increase in new drug abuse-related HCV infections. When a healthcare professional focuses only on the behaviors of patients, without acknowledging that their own role in providing their patients with access to these highly addictive drugs, it is a reminder of just how vital, and yet seemingly unheeded, those mandatory opioid education courses are. Their tacit assertion that common drug dealers, and not themselves, are the crux of the problem demonstrates how badly they need those courses.

Given the high correlative relationship between prescription drug abuse (and its potential, and perhaps eventual, path to heroin) and HCV infections, one might be led to think that the best place to stem the problem would be with the providers of the vice. Of course, a one-solution course of action will never be enough to effectively, or even adequately, combat the problem; multiple angles must be attacked in order to win the war against HCV, and unless we put forth adequate funding, staffing, and physical resources to fight these battles, we will likely fail to win the war.

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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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Opioid Prescription Abuse – Data vs. Addiction

By: Marcus J. Hopkins, Blogger

Every so often, I get the opportunity to speak with the hospice nurses who provide care services for my grandfather, and when they discover the focus of my research, I consistently hear the same thing – we have a huge problem with opioid addiction, abuse, and heroin usage in the state of West Virginia. Because their jobs specifically focus on providing hospice care, they’re not too engaged with the HCV aspect of the issue, but they have horror stories about relatives, friends, and neighbors looting their patients’ supply of opioid prescription drugs (from OxyContin to morphine) and either using it themselves or selling it on the street. But, the consensus is the same – this opioid epidemic is way out of control, and there doesn’t seem to be anyone doing anything about it.

This aspect – the “doing something about…” – is, perhaps, the most contentious issue within the opioid abuse conversation: what’s going to work, what is working, and who’s going to pay for it. These questions plague not only the people on the ground dealing with the fallout from opioid abuse, but the legislators tasked with combating a burgeoning problem. Additional concerns are raised about how to best cope with the growing addiction to opioid drugs, and frankly, there are simply no easy or cheap solutions to the problem.

Photo of opioid prescription drugs and an IU needle spread across money.

Photo Source: ReinventingAging.org

Tensions are further increased when “no nonsense”-style elected officials in the vein of Maine’s Paul LePage go off the rails talking about drug pushers coming to impregnate their white girls and bringing back the guillotine to deal with them. While this type of fast and loose language plays well with a certain segment of [mostly conservative] constituents, it plays a harmful role in demonizing not the repercussions of drug abuse and addiction, but the people who are involved. This creates (and reinforces) a social stigma, which research suggests serves as an internal barrier to seeking addiction treatment.

Two of the most successful legislative harm reduction strategies are Prescription Drug Monitoring Programs (PDMPs) that collect, analyze, and monitor electronically transmitted prescribing and dispensing data and Doctor Shopping Laws that attempt to prevent patients from seeking multiple prescriptions from multiple physicians for controlled substances.

PDMPs are highly effective tools for monitoring the rate of prescriptions being issues by physicians, as well as for tracking which patients receive those medications. Unfortunately, many states with those laws do not make reporting to PDMPs mandatory, which leaves it up to the physicians and pharmacists in those states whether or not they will participate. If there is less than an optimal participation rate, the purpose of monitoring the issue is not being served.

Doctor Shopping Laws are designed to penalize patients who visit multiple doctors in order to increase their on-hand supply of controlled substances (most frequently, opioid drugs). They make it illegal for patients to procure or attempt to procure controlled substances by fraud, deceit, misrepresentation, or subterfuge, and the penalties for getting caught vary by state. But, again – these laws only work if physicians and pharmacists are participating.

Another interesting aspect in relation to those harm reduction methods is how those laws affect law abiding citizens. There are concerns that these laws create a hostile environment, in which physicians are less likely to prescribe medically necessary medications for fear of violating state law. This could potentially leave patients in the lurch when trying to obtain a prescription to for valid use as prescribed. Should those patients be unable to receive a prescription from one physician, they may run the risk of running afoul of doctor shopping laws if they go to another physician in seek of help. While these scenarios are, at this point, purely anecdotal, it raises a serious concern about access to necessary treatment methods.

Sadly, this is one of the prices we must potentially pay if we wish to legitimately attempt to conquer our nation’s issues with opioid addiction. The consequence of making these drugs more difficult to obtain is that people who legitimately need them face the same hurdles as those attempting to procure them illegally. Good policy is, however, made when there is data and research to back up the initiative, whereas bad policy is often made when we cave to arguments of Pathos – stories, inspirational quotes, and vivid, emotional appeals.
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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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