Tag Archives: opioids

Purdue Pharma Settles Yet Another Lawsuit

By: Marcus J. Hopkins, Policy Consultant

Purdue Pharma and its owners, the Sackler family, have settled yet another lawsuit, this time in Oklahoma, to the tune of nearly $275 million in a case that alleged the pharmaceutical giant and its owners actively ignited and fueled a nationwide opioid epidemic (Goldberg, 2019). The settlement allows Purdue and the Sacklers to avoid a public trial that was scheduled for the end of May.

Well…it allows them to avoid that public trial.

No sooner had the settlement been announced on Tuesday, March 26th, than the New York state Attorney General, Letitia James, filed a civil suit against not only Purdue Pharma, but eight specific members of the Sackler family, and a host of other pharmaceutical companies including manufacturers, distributers, and holding companies (Rabin, 2019).

New York State Attorney General, Letitia James

Photo Source: NY Daily News

And these are just the latest lawsuits faced by prescription opioid makers. States, counties, and municipalities around the nation are taking pages directly out of the 1990s tobacco company lawsuit playbook and applying them to a much more insidious threat: addictive pain relievers passed off as legitimate consumer medications. The charges are strikingly similar in scope, nature, and fact: these companies knowingly sold, distributed, and attempted to increase the popularity of substances they knew to be highly addictive, concealed that information from the public, and did so strictly for financial gain.

This time, however, those files these suits are not just going after the companies who knowingly profited off of the suffering and addiction of human beings; they are naming names, and specifically going after individual family members who, according to filings from a Massachusetts lawsuit that includes dozens of internal Purdue Pharma documents, directed these coverups, attempted to shift the blame onto patients, and shifted hundreds of millions of dollars out of Purdue’s coffers into their own accounts and trusts, including offshore accounts, in efforts to protect that money from being seized (Rabin).

The United States and countries around the world have been paying the price for Purdue and the Sacklers’ greed for over twenty years, despite the settlements, despite the judgments, and despite the attempts at reformulation that led prescription opioid addicts to turn to Injection Drug Use (IDU), learning how to melt down their products, filter out the coating, and inject their deadly drugs directly into their bloodstreams. And yet, the U.S. Food and Drug Administration (FDA), as well as local, state, and Federal governments, have been seemingly unable to do what is necessary and pull every prescription opioid drug off the commercial market, restricting it only to palliative usage.

Governments have been paralyzed not by the pharmaceutical companies and their owners directly, but by the “Pain Advocacy” non-profit advocacy groups these companies and their owners directly fund. A report published in 2018 found that fourteen non-profit organizations, mostly representing pain patients and specialists, received nearly $9 million from the drugmakers, while doctors affiliated with those groups received an additional $1.6 million (Perrone & Mulvihill, 2018). Whenever legislation arises that would curb prescription opioid distribution or add another layer of monitoring, these organizations rise to the challenge, going out in force to contact legislators, their largest donors, and speak at public hearings.

And their tales are often harrowing. Lawmakers will hear stories about crippling pain that renders speakers all but immobile, and how nothing had worked to relieve their unbearable pain…until prescription opioids became available for purchase by the general public with a prescription. Since then, those living with chronic pain have finally been able to function normally and live a happy life.

The reality is that these people are not functioning normally. Prescription opioid drugs work because they fundamentally change the chemistry of the brain, specifically the opioid receptors that can stop electric pulses from traveling through your nerve cells when opioids bind with the three major receptors, Mu, Kappa, and Delta. These effects, primarily controlled by the Mu-opiate receptor, are the same whether the opiates are heroin or prescription pills (Akpan & Griffin, 2017).

When these activists speak of being able to function normally, they are deluding themselves; they have become dependent upon opioid drugs in order to function, and the reason why other methods of pain relief “feel” less effective after they’ve been taking prescription opioid drugs is because their chemically altered brain wants to accept no substitutions. They are addicted…just not to the same degree as those they seek to blame for being uncaring about their pain.

I have sat in on and participated in more roundtables and action committees about opioid abuse in the past five years than I have HIV conferences, and the common and incredulously furious refrain I hear from Pain advocates and activists is this:

“Why is my pain not important in this conversation?!”

Every time this phrase, or some variation of it, is forcefully delivered, legislators, organizers, and public health officials and advocates all scurry to assuage the speaker:

“Of course your pain is important. We are trying to make changes that keep chronic pain sufferers in mind.”

I know I am not going to win any friends by saying this – in fact I might just lose a few – but, the cold, hard reality of the situation is this:

Your pain is not more important than the lives of your fellow citizens and pandering to your controlled addiction literally has a body count.

Drug overdose

Photo Source: whitesandstreatment.com

That’s the truth. Nobody’s pain relief should ever come at the cost of human lives, and the reality is that, by continuing to allow prescription opioids to be sold on the commercial market in order to appease the pain lobby, the U.S. and other governments, as well as pharmaceutical companies, the families who own them, the doctors who prescribe opioids, and the people who think their pain is more important are all complicit in creating an international epidemic that kills between 40,000 to 50,000 deaths annually from opioid overdoses (Centers for Disease Control and Prevention, 2018).

So, while these lawsuits against Purdue Pharma, Endo Pharmaceuticals, and the Sacklers are all well and good, nothing is going to change if we do not stop allowing these companies to settle the cases to avoid stock losses, start holding them accountable, and pull these drugs from the commercial markets. Until then, the bodies will continue to pile up, prevention, recovery, and treatment efforts will continue to be underfunded by Federal, state, and local governments, and the U.S. will continue to slide further into this epidemic with no end in sight.

Get it together, America.

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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Abuse-Deterrent Prescription Opioids Likely Worsened Both Opioid and HCV Epidemics

By: Marcus J. Hopkins, Policy Consultant

Three years ago, HEAL Blog wrote about National Public Radio’s (NPR’s) new program, “Embedded,” and their first episode, “The House,” in which reported Kelly McEvers visits Austin, Indiana, and witnesses numerous people abusing the supposedly abuse-deterrent (and now discontinued) prescription opioid drug, Opana (Endo Pharmaceuticals). In this segment, the subjects – including a former nurse – melt off the protective plastic coating and liquify the drug, strain it through mesh to remove the melted plastic, mixing in some water to dilute the drug, and injecting the drug directly into their blood streams.

“Abuse-Deterrent” drugs, including prescription opioids and prescription stimulants (e.g. – Ritalin), came about around the end of the 2000s in response to a growing number of lawsuits alleging that pharmaceutical products were becoming more powerful, more addictive, and easier to abuse. These “deterrents” consistently involved the creation of time-released medications concealed in plastic that would slowly melt inside the body and release a consistent dosage over time. At the time, these new formulations were heralded as the answer to prescription drug abuse – they were harder to abuse, which would lead to fewer people becoming addicted!

Man holding needle

Photo Source: U.S. News & World Report

Except, that didn’t happen. The drugs were already incredibly powerful and addictive, and those who previously abused the non-abuse-deterrent versions either found ways, like the one mentioned above, to get around these deterrents, or switched over to less expensive illicit drugs like heroin and methamphetamine. As with every substance addiction, once you get started, it is incredibly hard to stop, and addicts will inevitably find some way to satisfy their addictions.

These abuse-deterrent reformulations led to an increase in Injection Drug Use (IDU) which, after a brief lapse during the 1980s and 90s thanks to the HIV epidemic, has made a roaring comeback, particularly in areas hard hit by economic hardships, unemployment, and relative isolation from more urban areas. While the heroin epidemic of the 1970s was largely contained within urban settings, this new epidemic hit primarily in rural and suburban parts of the U.S. – areas where physical labor (e.g. – manufacturing and mining) led to chronic pain issues which were being addressed with these highly addictive, but highly effective prescription opioid drugs.

New research published in Health Affairs this month found evidence that supports what those of us on the ground have been saying for years: abuse-deterrent drugs were making the problem worse. Not only did they increase the number of people switching from prescription opioids to heroin, they also led to an increase in new Acute Hepatitis C (HCV) infections as a result of IDU.

This study looked specifically at the 2010 reformulation of OxyContin (Purdue Pharma). Between 2010 and 2015, there was a more than 40% drop in the abuse of OxyContin. Prior to this reformulation, HCV infection rates were comparable between above- and below-median misuse states (meaning literal states, and not the state of using the drugs); beginning in 2011 – the first full year after the reformulation hit the market – the gap between those states began to widen (Powell, et al, 2019). States with above-median misuse of OxyContin saw a 222% increase in HCV infections after the reformulation, while states with below-median misuse of OxyContin saw only a 75% increase over the same period. The researchers found that much of the increased infection rate was caused by people switching from the harder-to-abuse, move expensive reformulation over to cheaper and easier to procure heroin, which has a higher rate of injection than reformulated OxyContin.

Essentially, those states that had a high rate of OxyContin abuse saw massive increases in HCV infection rates, while those with a low rate of abuse still saw an increase, but ones that were significantly lower.

Does this mean that efforts to prevent prescription opioid abuse should be halted? Absolutely not! What it does mean is that our governments – Federal, state, and local – need to stop treating health crises as isolated incidences that can be solved with a single strategy. As with every healthcare-related issue, there is no singular “cause” that can be solved with a singular “cure.” Every action taken – whether that be decreasing access to prescription opioid drugs or closing Syringe Exchange Services programs – has both positive and negative consequences and combating health issues will always require multi-pronged approaches to anticipate and deal with those issues.

Moreover, outside of just “healthcare” responses, such as increasing access to clean syringes, changing HIV/Viral Hepatitis testing protocols to be universal, or increasing access to Medication-Assisted Treatment, addressing healthcare issue also requires additional changes, such as increasing access to job placement/training services, affordable housing assistance, and other wraparound services that can help reduce the conditions that often increase the likelihood that someone will begin abusing pharmaceutical/illicit drugs.

The researchers also reached this conclusion, so…it is not just Marcus being crazy and radical.

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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Opioids Drive Hepatitis C Infections in New CDC Data

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

The Centers for Disease Control and Prevention (CDC) has released new data that estimate that approximately 2.4 million adults are living with Hepatitis C (HCV) in the United States (Hofmeister, et al., 2018). This estimate was reached by analyzing 2013-2016 data from the National Health and Nutrition Examination Survey to estimate the prevalence of HCV in the non-institutionalized population in combination with literature reviews and population size estimation approaches to estimate the HCV prevalence and population sizes for incarcerated people, unsheltered homeless people, active-duty military personnel, and nursing home residents (Hofmeister).

Photo of the CDC Headquarters

Source: George Mason University

These data represent the latest effort by the CDC to more accurately reflect the severity of the HCV epidemic in the United States. The accuracy of this estimate has been significantly hampered by the failure of the CDC to classify HCV as a mandatorily reportable condition (like HIV). Instead, the CDC has left up to individual states whether or not they consider HCV a reportable condition, which has led to a range of wildly varying approaches from no reporting whatsoever, to incredibly detailed reporting that goes down to the county and/or jurisdictional level. These variations have led to certain states providing no functional data about the incidence or prevalence of this deadly virus in their states.

One of the primary drivers of new HCV infections has been the prescription opioid and heroin epidemic that extends into virtually every corner of the U.S.:

Earlier CDC research found that new hepatitis C cases tripled between 2010 and 2016. Most were traced to injection-drug use among younger adults addicted to heroin and other opioids. Adults under 40 have the highest rate of new infections (Norton, 2018).

In states where Injection Drug Use (IDU) is highly prevalent (suburban and rural areas of New England, the Midwest, and Appalachia), IDU accounts for a significant percentage of new HCV infections – in West Virginia and Massachusetts – the states with the second- and first-highest rates of HCV infection respectively – evidence suggests that it is the leading risk factor identified in HCV incidence reporting.

The recent news that Medicaid was expanded by voter ballot initiatives in Idaho, Nebraska, and Utah brings some hope that people living with HCV in those states will gain access to curative treatment. That said, even with Medicaid programs paying for treatment, it is both far cheaper, and more effective to prevent infection, rather than to play “Recovery Medic.” This can be effectively accomplished by establishing (and adequately funding) Syringe Services Programs (SSPs) which have been shown to reduce the number of new infectious disease infections and increase access to and utilization of drug abuse recovery services. Unfortunately, according to a 2017 CDC study, only three U.S. states have laws that “support full access” to both SSPs and HCV treatment (Norton).

For those of us in the HCV data game, these data are of little surprise. While this latest CDC estimate is down from the previous one, there are factors to consider when looking at this decrease: the introduction of HCV Direct-Acting Antivirals has decreased the number of people living with HCV as access to these medications has increase and people who wereliving with HCV have died in greater number as their disease ravaged their livers and other bodily organs. Essentially, people either got cured, or they died (Norton).

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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Rural America Continue to Struggle with Opioid Addiction

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 1999, the Centers for Disease Control and Prevention (CDC) reported that drug overdose deaths were higher in metropolitan (urban) areas than in non-metropolitan (suburban/rural) areas – a rate of 6.4 vs. 4.0 (per 100,000). In 2015, that trend has reversed, with non-metropolitan overdose deaths more than quadrupled in number with a rate of 17.0, while metropolitan areas had a rate of 16.2 (CDC, 2017).

From these data we can surmise a few things:

  1. The population in the U.S. did not decrease from 1999 (279 million) to 2015 (321 million);
  2. Despite this population increase (+42 million), the total number of drug overdose deaths has increased exponentially;
Medical technician counting needles.

Photo Source: Daily Beast

So, what changed during this period? According to the American Society of Addiction Medicine, from 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel:

  • The overdose death rate in 2008 was nearly four times the 1999 rate;
  • Sales of prescription pain relievers in 2010 were four times those in 1999;
  • Substance use disorder treatment admission rate in 2009 was six times the 1999 rate
  • In 2012, 259 million prescriptions were written for opioids – more than enough to give every American adult their own bottle

Along with these sobering (as it were) statistics, four out of five heroin users started out abusing prescription painkillers. Also, 276,000 adolescents aged 12-17-years-old were current non-medical users (abusers) of prescription pain relievers, with 122,000 having an addition to prescription pain relievers. 21,000 adolescents had used heroin in the past year, and an estimated 5,000 were current heroin users (American Society of Addiction Medicine, 2016)

Essentially, as the rate of prescribing opioids increased over time, so too have the rates of addiction and overdose deaths. That said, the opioid prescribing rate has declined from 2012-2017 and is currently at the lowest level in ten years, from 259 million in 2012 to 191 million in 2017.

Even with this decline, reversing the damage already done is going to take at least a generation to fix, particularly when it comes to adequately addressing opioid and heroin addiction (inclusive of treatment, recovery, and relapses). Moreover, there are vast disagreements in how we, as communities, counties, states, and a nation, should best go about dealing with these issues.

Despite the fact that we have hard scientific data and evidence that certain measures work better than others (e.g. – Harm Reduction measures like Syringe Services Programs (SSPs) and Medication-Assisted Treatment (MAT)), it is difficult to convince elected officials to legalize, authorize, and fund these measures. This is largely due to long-standing, albeit factually inaccurate, objections that SSPs are essentially “enabling” or “condoning” drug use and abuse.

One small town in Washington state – Stanwood – has decided to approach their burgeoning opioid addiction problem like they would a natural disaster, the same way they would mobilize and respond to a landslide or flu epidemic:

…the response to the opioid epidemic is run out of a special emergency operations center, a lot like during the Oso landslide, where representatives from across local government meet every two weeks, including people in charge of everything from firetrucks to the dump (Boiko-Weyrauch, 2018).

The name of this group is the Multi-Agency Coordination group (MAC group), and has seven big, overarching goals which are broken up into manageable steps, like distributing needle cleanup kits and training schoolteachers to recognize trauma and addiction. Police officers enter illegal homeless encampments in wooded areas not to arrest them, but to help link them to drug treatment and housing resources, as well as to provide other assistance, such as food, coffee, and transportation to and from appointments (Boike-Weyrauch).

This approach to policing the opioid epidemic is slowly becoming more popular, but again, convincing states, counties, and local municipalities to adopt this strategy is incredibly difficult due to the long-standing opposition against the use of public resources for these purposes. The concept of treating addiction as a disease, rather than as a crime to be punished isn’t an easy pill to swallow for those who believe that only the individual is responsible for dealing with their health issues; who have abandoned the concept that addressing the welfare, health, and safety of all citizens will lead to greater results than leaving people to their own devices.

As part of the Community Access National Network’s ongoing research, we provide state-by-state analysis of various Harm Reduction measures (e.g. – SSPs, Naloxone Access, and Provider Education Requirements) in our monthly publication, the HIV/HCV Co-Infection Watch. Our October edition can be found here: http://www.tiicann.org/co-infection-watch.html

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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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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Who Funds the Opioid Epidemic (and the Subsequent HCV Epidemic)

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

Senator Claire McCaskill (D-MO) is planning to introduce a bill into the Senate that would require drug makers to report payments that are made to nonprofit organizations and patient advocacy groups (Silverman, 2018). This is an issue that HEAL Blog, as well as the Community Access National Network’s HIV/HCV Co-Infection Watch publication, has repeatedly brought up in our reporting.

Sen. Claire McCaskill

Photo Source: The Washington Free Beacon

State and Federal lawmakers have been attempting to place prescribing and use restrictions on prescription opioid drugs for the better part of two decades. There is a natural opposition that state and Federal lawmakers face from opioid manufacturing pharmaceutical companies, such as Purdue Pharma, maker of OxyContin, the first prescription opioid drug made available and marketed to average consumers rather than for use in palliative care and severe injury. But, that’s not where the pressure on lawmakers ends.

Purdue Pharma logo

Photo Source: Purdue Pharma

Where McCaskill’s proposal comes into play goes back much further, with pharmaceutical companies creating and funding nonprofit organizations to advocate for a single issue: Pain. Pain Advocates, since the late-1980s, have been actively lobbying Congress, the U.S. Food & Drug Administration (FDA), and state legislatures to push for easier access to these powerful drugs. Every time a legislator or the FDA attempts to reign in what was once virtually unfettered access to

Opioid drugs work by binding to opioid receptors in the brain, spinal cord, and other areas of the body and reducing the sending of pain messages to the brain, thereby reducing the feeling of pain. For Pain Advocates who claim to represent patients whose levels of daily or regular pain leave them unable to function normally, these drugs have been seen as necessary for their survival. What drug manufacturers who fought for easy access to these drugs failed to mention (despite knowing from their own research) is that opioid drugs are highly addictive.

I’ve personally encountered several pain advocates whose opposition to my advocacy for opioid prescribing restrictions in the state of West Virginia has been boiled down to this line of thinking: “How am I supposed to be a functional human being without these prescriptions?” In a state like West Virginia, which has the highest rate of drug overdose deaths in the nation (52 per 100,000) and potentially the highest rate of Hepatitis C (HCV) in the nation (7.2 per 100,000), this comes across to me as them really saying, “My pain is more important than the preventable spread of disease or others’ lives.”

As the rate of new HCV infections continues to rise, in some states like WV, exponentially, is that opioid drug abuse is directly tied to this meteoric increase. In a report from the National Institutes of Health’s (NIH’s) National Institute on Drug Abuse, data indicate that the incidence of heroin initiation (beginning to use) was 19 times higher among those who reported prior nonmedical pain reliever use than among those who did not. Further, a separate study cited by the NIH found that 86% of young, urban heroin injectors had used opioid pain relievers nonmedically prior to using heroin, and that their introduction into nonmedical use was characterized by three main sources of opioids: family, friends, and personal prescriptions (National Institute on Drug Abuse, 2018).

Next week, we’ll take a deeper look at how opioid diversion from legitimate prescriptions can potentially lead to addictions that can increase the risk of acquiring Hepatitis and HIV as a result of Injection Drug Use.

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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Young Adults Most at Risk of Hepatitis C Infection Via Injection Drug Use

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

Statistical analyses from around the country don’t lie: our nation’s young adults are driving the Hepatitis C (HCV) epidemic in the United States, and prescription opioids and heroin are the primary risk factor. These data, released by the U.S. Centers for Disease Control and Prevention (CDC) in December 2017, indicate that adults aged 18-39 saw a 400% increase in HCV, 817% increase in admissions for injection of prescription opioids, and a 600% increase in admissions for heroin injection (CDC, 2017). This analysis was made by compiling data from the CDC’s hepatitis surveillance system and from the Substance Abuse and Mental Health Services Administration (SAMHSA) national database that tracks admissions to substance use disorder treatment facilities in all 50 U.S. states from 2004 to 2014.

Photo of the CDC Headquarters

Source: George Mason University

The findings “…indicate a more widespread problem than previous studies have shown,” researchers led by the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) wrote (Connor Roche, 2018). The largest increases were among persons aged 18-29 and 30-39 (400% and 325%, respectively), non-Hispanic Whites, and Hispanics (Zibbell, et al, 2018). Admissions for both men and women attributed to Any Opioid Injection Drug Use (IDU) increased significantly, as did admissions for heroin IDU, and Prescription Opioid Analgesics (POA). Amontg non-Hispanic Whites, admissions for Any Opioid IDU increased 134% over the 11-year period (Zibbell).

What makes this frustrating as an advocate for both HCV and for Harm Reduction measures is the pushback from Conservative and Libertarian organizations and “think tanks” who consistently claim that there is no “opioid epidemic;” that the only real problem we have is heroin and fentanyl (Singer, 2018). The Cato Institute – one such Libertarian organization (founded as the Charles Koch Foundation in 1974) – has consistently misrepresented data about the opioid epidemic in America by focusing only on overdose statistics. Even the statistics they cite – “Digging deeper into that number shows over 20,000 of those deaths were due to the powerful drug fentanyl, more than 15,000 were caused by heroin, and roughly 14,500 were caused by prescription opioids” – come with some caveat that portends to excuse their galling lack of accuracy.

The purpose of the Cato Institute and Mr. Singer’s positions is to attempt to persuade “rational” people that prescription opioids aren’t the real problem, and any efforts to restrict or regulate the dosages, supply days, or “well-meaning, hardworking” healthcare providers who prescribe prescription opioids is obviously absurd. Why, any rational human being would never abuse prescription opioids, and the people who do are the ones at fault; not those innocent physicians who prescribe the highly addictive substances. (/sarcasm)

Counter to the alternate reality created by Mr. Singer, where addiction to the effects of opioids just magically appears, and can’t possibly be related to prescription drugs, that isn’t how addiction works, nor do any of the surrounded data – drug abuse statistics, treatment facility admission records, and HIV/HCV infection data – support his nonsensical claim.

These findings from the CDC should be concerning to Americans. These problems are going to get far worse, before they get better, particularly if people who are addicted lose access to government-, employer-based, and/or privately-funded healthcare coverage. With the removal of the Individual Mandate from the Affordable Care Act in 2017, analysts consistently predict that chaos will ensure within the health insurance marketplaces, which will inevitably result in fewer people having access to affordable healthcare, an increase in unpaid medical and emergent care expenses, and increased prices for everyone.

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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