UPS must pay $247M for shipping untaxed cigarettes in New York – 12:39 PM 5/26/2017 | E! Brooklyn ebklyn.com: Community group votes to co-name BK Heights street after female BBridge mastermind

Community Board 2s transportation committee voted to co-name a Brooklyn Heights street for Emily Warren Roebling, who helped oversee the construction of the Brooklyn Bridge from her house in the Heights after her husband, chief engineer Washington Roebling, was stricken…

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E! Brooklyn ebklyn.com: Community group votes to co-name BK Heights street after female BBridge mastermind 7:41 AM 5/26/2017

Community group votes to co-name BK Heights street after female BBridge mastermind
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See this story at BrooklynPaper.com.

By Lauren Gill

Brooklyn Paper

Dont call it a miss-nomer!

Community Board 2s transportation committee voted to co-name a Brooklyn Heights street for Emily Warren Roebling, who helped oversee the construction of the Brooklyn Bridge from her house in the Heights after her husband, chief engineer Washington Roebling, was stricken with the bends.

E! Brooklyn ebklyn.com

 

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DEA: Made-in-China Lethal Opioid Fueling U.S. Drug Epidemic
 

mikenova shared this story .

A homemade designer version of fentanyl, the highly addictive opioid which is similar to morphine but is 50 to 100 times more potent, has been the center of drug busts across the country this month—with law enforcement pinpointing its origin from underground labs in China. The DEA says the China-U.S. supply is further fueling the country’s drug epidemic.

“This stuff is unbelievably potent. It is so powerful that even a tiny amount can kill you,” DEA spokesman Rusty Payne tells FOX Business. “China is by far the most significant manufacturer of illicit designer synthetic drugs. There is so much manufacturing of new drugs, [it’s] amazing what is coming out of China. Hundreds of [versions], including synthetic fentanyl and fentanyl-based compounds.”

Fentanyl, the opioid that killed singer Prince and is often prescribed to late-stage cancer patients, has been classified as a schedule II drug in the U.S. for decades, which makes it a felony to sell or use without a prescription. China only made the drug illegal in 2015, and at that point black market Chinese labs began increasing production of their own versions, including the one turning up recently across the country called furanyl fentanyl.

“While heroin gets harder to buy on the street or from a dealer, fentanyl comes via FedEx,” Brad Lamm, CEO of <a href=”http://Intervention.com” rel=”nofollow”>Intervention.com</a>, tells FOX Business.

Authorities say dealers across the country have been lacing heroin with the potent analog. Payne adds that Mexican drug cartels are now switching from heroin to fentanyl because of the high-profit margin.

“A kilogram of fentanyl is so much [more] lucrative for a trafficker than a kilogram of heroin, because you can mix a very small amount of fentanyl with a lot of other things and sell it on the streets and take that kilogram a lot farther. And the profits are so much greater,” he says.

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But the powder alone is deadly.

“Fentanyl is scary because if it touches your skin you can have major side effects to it, including death,” adds Payne.

The cost of counterfeit pills containing fentanyl or fentanyl-related compounds retail for $10 to $20 per pill in the U.S. (Depending on the purity of the fentanyl and the dosage).

Brooklyn District Attorney Eric Gonzalez announced this week details on a mail-order furanyl fentanyl smuggling ring bust. The operation had been bringing the drug — which has been dubbed “White China” — into the U.S from Asia. NYPD Chief of Detective Bob Boyce said that this was the first time investigators have seen this type of fentanyl in New York City.

Also this week, Cincinnati Customs and Border Protection agents said they seized 83 shipments of illegal synthetic drugs, including 36 pounds of furanyl fentanyl, from China. However, law enforcement said the six shipments of furanyl fentanyl were originally destined for Camden, New Jersey.

Meanwhile, local and state police in Boston this week recovered approximately 520 grams of a white powder that tested positive for fentanyl from behind a freezer in a restaurant basement. Suffolk County District Attorney Dan Conley called it a “major” drug seizure, but did not disclose if the drug was furanyl fentanyl, or if it was made in China.

According to the DEA, fentanyl overdose outbreaks have recently hit Ohio, New York, Pennsylvania, Michigan, Illinois, Alaska, Louisiana and Oregon. In 2015, opiates factored in 33,091 U.S. deaths, which was up more than 4,000 from the previous year, according to the U.S. Center for Disease Control and Prevention.

Payne says China has “really stepped up lately,” working hand-in-hand with the U.S. to help curb this growing problem. In January, DEA acting administrator Chuck Rosenberg was invited to China to meet with Beijing drug control officials at the invitation of the China Ministry of Public Security.

Lamm, who runs a drug and alcohol rehab center in California, warns that while the drug “makes you feel great, like the best high ever,” the potency makes it extremely easy to overdose on.

“It mellows you out to such an extent that you could potentially stop breathing,” he says.

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The opioid epidemic tightens its grip on America

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Opioid epidemic raising American heart infections

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How we are helping Michigan, and America, to fight the opioid

<a href=”http://MLive.com” rel=”nofollow”>MLive.com</a>May 22, 2017
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Trump’s budget makes it official: he’s doing little to nothing about the …

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Trump promised to end the opioid epidemic. He could be making it …

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Inside the opioid epidemic

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mikenova shared this story .

ON TUESDAY February 28th, in an address to a joint session of Congress, Donald Trump vowed to end America’s “terrible drug epidemic”. When discussing America’s social ills, Mr Trump has a tendency to exaggerate. But on the subject of drugs, the president’s characteristically dark and apocalyptic tone may well have been warranted.

In 2015 more than 52,000 Americans died of drug overdoses, according to the Centres for Disease Control and Prevention. That is an average of one death every ten minutes. Approximately 33,000 of these fatal overdoses—nearly two-thirds of them—were from opioids, including prescription painkillers and heroin. Although the absolute death toll from opioids is greatest in big cities like Chicago and Baltimore, the devastation is most concentrated in rural Appalachia, New England and the Midwest (see map). Many of the victims hail from white middle-class suburbs and rural towns.

The opioid epidemic has its roots in the explosive growth of prescription painkillers. Between 1991 and 2011, the number of opioid prescriptions (selling under brand names like Vicodin, Oxycontin, and Percocet) supplied by American retail pharmacies increased from 76m to 219m. As the number of pain pills being doled out by doctors increased, so did their potency. In 2002 one in six users took a pill more powerful than morphine. By 2012 it was one in three.

States have since cracked down on prescription opioid abuse, creating drug-monitoring programmes and arresting unscrupulous doctors. Pharmaceutical companies have reformulated their drugs to make them less prone to abuse. Unfortunately, as the supply of painkillers has dropped, many addicts have turned instead to heroin (see chart), which is cheap and plentiful. In 2014 more Americans sought treatment for heroin than for any other drug. In 2015, as total opioid deaths grew by 15%, heroin deaths increased by 23%.

To stem the tide of deadly overdoses, states rely increasingly on naloxone, a drug that reverses heroin’s effect on the brain and jump-starts breathing in addicts who have overdosed. First approved by the Food and Drug Administration in 1971, naloxone has been used by doctors and paramedics for decades. In recent years, states struggling with a surge in overdose deaths have passed laws making the drug available to police officers, firefighters and addicts’ friends and family. A recent working paper suggests that such laws—which are now on the books in 45 states and in Washington, DC—reduce opioid-related deaths by 9-11%.

That is still not enough. Data released in recent months show that the opioid epidemic is worsening, driven largely by the rise of fentanyl, a synthetic opioid painkiller 50-100 times more powerful than morphine. In 2016 fatal overdoses increased by 26% in Connecticut, 35% in Delaware, and 39% in Maine. During the first three quarters of 2016, deadly overdoses in Maryland jumped by a whopping 62%, prompting the state’s governor to declare an official state of emergency. Mr Trump’s promise to end the scourge of opioid abuse in America is looking more challenging by the day.

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Americas Addiction to Opioids: Heroin and Prescription Drug Abuse
 

mikenova shared this story from NIDA News.

Good Morning, Madam Chair and members of the Caucus.  Thank you for inviting the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health (NIH), to participate in this important hearing and contribute what I believe will be useful insights into the growing and intertwined problems of prescription pain relievers and heroin abuse in this country.

Background

The abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that affects the health, social, and economic welfare of all societies.  It is estimated that between 26.4 million and 36 million people abuse opioids worldwide,[1] with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin.[2]   The consequences of this abuse have been devastating and are on the rise.  For example, the number of unintentional overdose deaths from prescription pain relievers has soared in the United States, more than quadrupling since 1999.  There is also growing evidence to suggest a relationship between increased non-medical use of opioid analgesics and heroin abuse in the United States.[3]  

To address the complex problem of prescription opioid and heroin abuse in this country, we must recognize and consider the special character of this phenomenon, for we are asked not only to confront the negative and growing impact of opioid abuse on health and mortality, but also to preserve the fundamental role played by prescription opioid pain relievers in healing and reducing human suffering. That is, scientific insight must strike the right balance between providing maximum relief from suffering while minimizing associated risks and adverse effects.

Abuse of Prescription Opioids: Scope and Impact

Prescription opioids are one of the three main broad categories of medications that present abuse liability, the other two being stimulants and central nervous system (CNS) depressants.

Several factors are likely to have contributed to the severity of the current prescription drug abuse problem.  They include drastic increases in the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and aggressive marketing by pharmaceutical companies.  These factors together have helped create the broad “environmental availability” of prescription medications in general and opioid analgesics in particular.

Rate of opiate prescriptions showing steady increases from 76 million in 1991 to peak of 219 million in 2011 and slight drop off to 207 million in 2013.Figure 1 – Opioid Prescriptions Dispensed by US Retail Pharmacies

IMS Health, Vector One: National, years 1991-1996, Data Extracted 2011. IMS Health, National Prescription Audit, years 1997-2013, Data Extracted 2014.

To illustrate this point, the total number of opioid pain relievers prescribed in the United States has skyrocketed in the past 25 years  (Fig. 1).[4]  The number of prescriptions for opioids (like hydrocodone and oxycodone products) have escalated from around 76 million in 1991 to nearly 207 million in 2013, with the United States their biggest consumer globally, accounting for almost 100 percent of the world total for hydrocodone (e.g., Vicodin) and 81 percent for oxycodone (e.g., Percocet).[5]

This greater availability of opioid (and other) prescribed drugs has been accompanied by alarming increases in the negative consequences related to their abuse.[6] For example, the estimated number of emergency department visits involving nonmedical use of opioid analgesics increased from 144,600 in 2004 to 305,900 in 2008;[7] treatment admissions for primary abuse of opiates other than heroin increased from one percent of all admissions in 1997 to five percent in 2007[8]; and overdose deaths due to prescription opioid pain relievers have more than tripled in the past 20 years, escalating to 16,651 deaths in the United States in 2010.[9]

In terms of abuse and mortality, opioids account for the greatest proportion of the prescription drug abuse problem.  Deaths related to prescription opioids began rising in the early part of the 21stcentury.  By 2002, death certificates listed opioid analgesic poisoning as a cause of death more commonly than heroin or cocaine.[10]

Because prescription opioids are similar to, and act on the same brain systems affected by, heroin and morphine (Fig.2), they present an intrinsic abuse and addiction liability, particularly if they are used for non-medical purposes.  They are most dangerous and addictive when taken via methods that increase their euphoric effects (the “high”), such as crushing pills and then snorting or injecting the powder, or combining the pills with alcohol or other drugs.  Also, some people taking them for their intended purpose risk dangerous adverse reactions by not taking them exactly as prescribed (e.g., taking more pills at once, or taking them more frequently or combining them with medications for which they are not being properly controlled); and it is possible for a small number of people to become addicted even when they take them as prescribed, but the extent to which this happens currently is not known.  It is estimated that more than 100 million people suffer from chronic pain in this country,[11] and for some of them, opioid therapy may be appropriate. The bulk of American patients who need relief from persistent, moderate-to-severe non-cancer pain have back pain conditions (approximately 38 million) or osteoarthritis (approximately 17 million).[12]  Even if a small percentage of this group develops substance use disorders (a subset of those already vulnerable to developing tolerance and/or clinically manageable physical dependence[13]), a large number of people could be affected.  Scientists debate the appropriateness of chronic opioid use for these conditions in light of the fact that long-term studies demonstrating that the benefits outweigh the risks have not been conducted. In June 2012, NIH and FDA held a joint meeting on this topic,[14] and now FDA is requiring companies who manufacture long-acting and extended-release opioid formulations to conduct post-marketing research on their safety.[15]

The Effects of Opioid Abuse on the Brain and Body

Opioids include drugs such as OxyContin and Vicodin that are mostly prescribed for the treatment of moderate to severe pain.  They act by attaching to specific proteins called opioid receptors, which are found on nerve cells in the brain, spinal cord, gastrointestinal tract, and other organs in the body.  When these drugs attach to their receptors, they reduce the perception of pain and can produce a sense of well-being; however, they can also produce drowsiness, mental confusion, nausea, and constipation.[16]  The effects of opioids are typically mediated by specific subtypes of opioid receptors (mu, delta, and kappa) that are activated by the body’s own (endogenous) opioid chemicals (endorphins, encephalins).   With repeated administration of opioid drugs (prescription or heroin), the production of endogenous opioids is inhibited, which accounts in part for the discomfort that ensues when the drugs are discontinued (i.e., withdrawal). Adaptations of the opioid receptors’ signaling mechanism have also been shown to contribute to withdrawal symptoms.

Opioid medications can produce a sense of well-being and pleasure because these drugs affect brain regions involved in reward. People who abuse opioids may seek to intensify their experience by taking the drug in ways other than those prescribed.  For example, extended-release oxycodone is designed to release slowly and steadily into the bloodstream after being taken orally in a pill; this minimizes the euphoric effects. People who abuse pills may crush them to snort or inject which not only increases the euphoria but also increases the risk for serious medical complications, such as respiratory arrest, coma, and addiction. When people tamper with long-acting or extended-release medicines, which typically contain higher doses because they are intended for release over long periods, the results can be particularly dangerous, as all of the medicine can be released at one time. Tampering with extended release and using by nasal, smoked, or intravenous routes produces risk both from the higher dose and from the quicker onset.

Opioid pain relievers are sometimes diverted for nonmedical use by patients or their friends, or sold in the street.  In 2012, over five percent of the U.S. population aged 12 years or older used opioid pain relievers non-medically.[17]  The public health consequences of opioid pain reliever abuse are broad and disturbing.  For example, abuse of prescription pain relievers by pregnant women can result in a number of problems in newborns, referred to as neonatal abstinence syndrome (NAS), which increased by almost 300 percent in the United States between 2000 and 2009.[18]  This increase is driven in part by the high rate of opioid prescriptions being given to pregnant women. In the United States, an estimated 14.4 percent of pregnant women are prescribed an opioid during their pregnancy.[19]

Prescription opioid abuse is not only costly in economic terms (it has been estimated that the nonmedical use of opioid pain relievers costs insurance companies up to $72.5 billion annually in health-care costs[20]) but may also be partly responsible for the steady upward trend in poisoning mortality. In 2010, there were 13,652 unintentional deaths from opioid pain reliever (82.8 percent of the 16,490 unintentional deaths from all prescription drugs),[21] and there was a five-fold increase in treatment admissions for prescription pain relievers between 2001 and 2011 (from 35,648 to 180,708, respectively).[22] In the same decade, there was a tripling of the prevalence of positive opioid tests among drivers who died within one hour of a crash.[23]

A property of opioid drugs is their tendency, when used repeatedly over time, to induce tolerance. Tolerance occurs when the person no longer responds to the drug as strongly as he or she did at first, thus necessitating a higher dose to achieve the same effect.  The establishment of tolerance hinges on the ability of abused opioids (e.g., OxyContin, morphine) to desensitize the brain’s own natural opioid system, making it less responsive over time.[24]  This tolerance contributes to the high risk of overdose during a relapse to opioid use after a period in recovery; users who do not realize they may have lost their tolerance during a period of abstinence may initially take the high dosage that they previously had used before quitting, a dosage that produces an overdose in the person who no longer has tolerance.[25]  Another contributing factor to the risk of opioid-related morbidity and mortality is the combined use of benzodiazepines (BZDs) and/or other CNS depressants, even if these agents are used appropriately. Thus, patients with chronic pain who use opioid analgesics along with BZDs (and/or alcohol) are at higher risk for overdose. Unfortunately, there are few available practice guidelines for the combined use of CNS depressants and opioid analgesics; such cases warrant much closer scrutiny and monitoring.[26] Finally, it must be noted in this context that, although more men die from drug overdoses than women, the percentage increase in deaths seen since 1999 is greater among women: Deaths from opioid pain relievers increased five-fold between 1999 and 2010 for women versus 3.6 times among men.[27]

Relationship between Prescription Opioids and Heroin Abuse

The recent trend of a switch from prescription opioids to heroin seen in some communities in our country alerts us to the complex issues surrounding opioid addiction and the intrinsic difficulties in addressing it through any single measure such as enhanced diversion control (Fig.3). Of particular concern has been the  rise in new populations of heroin users, particularly young people.

Types of opioids used to get high - see captionFigure 3 – Growing Evidence

suggests that abusers of prescription opioids are shifting to heroin as prescription drugs become less available or harder to abuse. For example, a recent increase in heroin use accompanied a downward trend in OxyContin abuse following the introduction of an abuse-deterrent formulation of that medication (dashed vertical line)

The emergence of chemical tolerance toward prescribed opioids, perhaps combined in a smaller number of cases with an increasing difficulty in obtaining these medications illegally[28], may in some instances explain the transition to abuse of heroin, which is cheaper and in some communities easier to obtain than prescription opioids.

The number of past-year heroin users in the United States nearly doubled between 2005 and 2012, from 380,000 to 670,000 (Fig. 4).[29] Heroin abuse, like prescription opioid abuse, is dangerous both because of the drug’s addictiveness and because of the high risk for overdosing.  In the case of heroin, this danger is compounded by the lack of control over the purity of the drug injected and its possible contamination with other drugs (such as fentanyl, a very potent prescription opioid that is also abused by itself).[30]  All of these factors increase the risk for overdosing, since the user can never be sure of the amount of the active drug (or drugs) being taken. In 2010, there were 2,789 fatal heroin overdoses, approximately a 50 percent increase over the relatively constant level seen during the early 2000s.[31]  What was once almost exclusively an urban problem is spreading to small towns and suburbs.  In addition, the abuse of an opioid like heroin, which is typically injected intravenously, is also linked to the transmission of human immunodeficiency virus (HIV), hepatitis (especially Hepatitis C), sexually-transmitted infections, and other blood-borne diseases, mostly through the sharing of contaminated drug paraphernalia but also through the risky sexual behavior that drug abuse may engender.

NIDA Activities to Stem the Tide of Prescription Opioid and Heroin Abuse

NIDA first launched its prescription drug abuse public health initiative in 2001.  Our evidence-based strategy calls for a comprehensive three-pronged approach consisting of (1) enhancing our understanding of pain and its management; (2) preventing overdose deaths; and (3) effectively treating opioid addiction.

Research on Pain and Next Generation Analgesics.

Although opioid medications effectively treat acute pain and help relieve chronic pain for some patients,[32] their addiction risk presents a dilemma for healthcare providers who seek to relieve suffering while preventing drug abuse and addiction.  Little is yet known about the risk for addiction among those being treated for chronic pain or about how basic pain mechanisms interact with prescription opioids to influence addiction potential.  To better understand this, NIDA launched a research initiative on “Prescription Opioid Use and Abuse in the Treatment of Pain.”  This initiative encourages a multidisciplinary approach using both human and animal studies to examine factors (including pain itself) that predispose or protect against opioid abuse and addiction.  Funded grants cover clinical neurobiology, genetics, molecular biology, prevention, treatment, and services research.  This type of information will help develop screening and diagnostic tools that physicians can use to assess the potential for prescription drug abuse in their patients.  Because opioid medications are prescribed for all ages and populations, NIDA is also encouraging research that assesses the effects of prescription opioid abuse by pregnant women, children, and adolescents, and how such abuse in these vulnerable populations might increase the lifetime risk of substance abuse and addiction.

Another important initiative pertains to the development of new approaches to treat pain.  This includes research to identify new pain relievers with reduced abuse, tolerance, and dependence risk, as well as devising alternative delivery systems and formulations for existing drugs that minimize diversion and abuse (e.g., by preventing tampering and/or releasing the drug over a longer period of time) and reduce the risk of overdose deaths. New compounds are being developed that exhibit novel properties as a result of their combined activity on two different opioid receptors (i.e., mu and delta).  Preclinical studies show that these compounds can induce strong analgesia but fail to produce tolerance or dependence.  Researchers are also getting closer to developing a new generation of non–opioid-based medications for severe pain that would circumvent the brain reward pathways, thereby greatly reducing abuse potential.  This includes compounds that work through a type of cannabinoid receptor found primarily in the peripheral nervous system.  NIDA is also exploring the use of non-medication strategies for managing pain.  An example is the use of “neurofeedback,” a novel modality of the general biofeedback approach, in which patients learn to regulate specific regions in their brains by getting feedback from real-time brain images.  This technique has shown promising results for altering the perception of pain in healthy adults and chronic pain patients and could even evolve into a powerful psychotherapeutic intervention capable of rescuing the circuits and behaviors impaired by addiction.

Developing More Effective Means for Preventing Overdose Deaths

The opioid overdose antidote naloxone has reversed more than 10,000 overdose cases between 1996 and 2010, according to CDC. [33]  For many years, naloxone was available only in an injectable formulation and was generally only carried by medical emergency personnel.  However, FDA has recently approved a new hand-held auto-injector of naloxone to reverse opioid overdose that is specifically designed to be given by family members or caregivers.  In order to expand the options for effectively and rapidly counteracting the effects of an overdose, NIDA is also supporting the development of a naloxone nasal spray—a needle-free, unit-dose, ready-to-use opioid overdose antidote that can easily be used by an overdose victim, a companion, or a wider range of first responders (e.g., police) in the event of an emergency.[34]

Research on the Treatment of Opioid Addiction

Drug abuse treatment must address the brain changes mentioned earlier, both in the short and long term.  When people addicted to opioids first quit, they undergo withdrawal symptoms, which may be severe (pain, diarrhea, nausea, vomiting, hypertension, tachycardia, seizures). Medications can be helpful in this detoxification stage, easing craving and other physical symptoms that can often trigger a relapse episode.  However, this is just the first step in treatment. Medications have also become an essential component of an ongoing treatment plan, enabling opioid-addicted persons to regain control of their health and their lives.

Agonist medications developed to treat opioid addiction work through the same receptors as the addictive drug but are safer and less likely to produce the harmful behaviors that characterize addiction, because the rate at which they enter and leave the brain is slower. The three classes that have been developed to date include (1) agonists, e.g., methadone (Dolophine or Methadose), which activate opioid receptors; (2) partial agonists, e.g., buprenorphine (Subutex, Suboxone), which also activate opioid receptors but produce a diminished response; and (3) antagonists, e.g., naltrexone (Depade, Revia, Vivitrol), which block the receptor and interfere with the rewarding effects of opioids.  Physicians can select from these options on the basis of a patient’s specific medical needs and other factors.  Research has shown methadone- and buprenorphine-containing medicines, when administered in the context of an addiction treatment program, can effectively maintain abstinence from other opioids and reduce harmful behaviors; we believe their gradual onset and long duration contribute to this ability to “stabilize” patient behavior.

Chart showing that methadone helps people stay in treatment and reduces drug use Figure 5 – Methadone Treatment Pre- and Post Release Increases Treatment Retention and Reduces Drug Use

(Findings at 12 month post-release)

Scientific research has established that medication-assisted treatment of opioid addiction is associated with decreases in the number of overdoses from heroin abuse,[35] increases retention of patients in treatment and decreases drug use, infectious disease transmission, and criminal activity. For example, studies among criminal offenders, many of whom enter the prison system with drug abuse problems, showed that methadone treatment begun in prison and continued in the community upon release extended the time parolees remained in treatment, reduced further drug use, and produced a three-fold reduction in criminal activity (Fig. 5).  Investment in medication-assisted treatment of opioid addiction also makes good economic sense.  According to a 2005 published analysis that tracked methadone patients from age 18 to 60 and included such variables as heroin use, treatment for heroin use, criminal behavior, employment, and healthcare utilization, every dollar spent on methadone treatment yields $38 in related economic benefits—seven times more than previously thought.[36]

Buprenorphine is worth highlighting in this context for its pioneering contributions to addiction treatment.  NIDA-supported basic and clinical research led to the development of this compound, which rigorous studies have shown to be effective, either alone or in combination with naloxone, in significantly reducing opiate drug abuse and cravings.

The arrival of buprenorphine represented a significant health services delivery innovation. FDA approved Subutex® (buprenorphine) and Suboxone® tablets (buprenorphine/naloxone formulation) in October 2002, making them the first medications to be eligible for prescribing under the Drug Addiction Treatment Act  of  2000. Subutex contains only buprenorphine hydrochloride. This formulation was developed as the initial product. The second medication, Suboxone, contains naloxone to guard against misuse (by initiating withdrawal if the formulation is injected).  Subutex and Suboxone are less tightly controlled than methadone because they have a lower potential for abuse and are less dangerous in an overdose.  As patients progress in their therapy, their doctor may write a prescription for a take-home supply of the medication.  To date, of the nearly 872,615 potential providers registered with the Drug Enforcement Administration (DEA), 25,021 registered physicians are authorized to prescribe these two medications. The development of buprenorphine and its authorized use in physicians’ offices gives opioid-addicted patients more medical options and extends the reach of addiction medication to remote populations.

Medication-assisted treatments remain grossly underutilized in many addiction treatment settings, where stigma and negative attitudes (based on the misconception that buprenorphine or methadone “substitute a new addiction for an old one”) persist among clinic staff and administrators.  This leads to insufficient dosing or limitations on the duration of use of these medications (when they are used at all), which often leads to treatment failure and the perception that the drugs are ineffective, further reinforcing the negative attitudes toward their use.[37]  Policy and regulatory barriers also can present obstacles.

Integrating Drug Treatment into Healthcare Settings

Medication-assisted treatment will be most effective when offered within the larger context of a high-quality delivery system that addresses opioid addiction not only with medication but also with behavioral interventions to support treatment participation and progress, infectious disease identification and treatment (especially HIV and HCV), screening and treatment of co-morbid psychiatric diseases, and overdose protection (naloxone).  NIDA’s research over the last two decades has provided us with evidence that a high quality treatment system to address opioid addiction must include all these components, yet there are currently very few systems in the United States that provide this bundle of effective services.[38]  Health care reform—with a focus on both expanding access to treatment and improving the quality of care—offers hope that we may be better able to integrate drug treatment into healthcare settings and offer comprehensive treatment services for opioid addiction.  We also are examining ways to use health care reform and the focus on health promotion and wellness to pay for and deliver prevention interventions targeted at children, adolescents, young adults, and high-risk adult populations like those with chronic pain or returning veterans.

promo for Medscape CMEs - see captionFigure 6 – Medscape’s Test-and-Teach

is one example of NIDA’s multi-platform approach to enhance a physician’s ability to properly manage pain while preventing the abuse of prescription opiods

Prevention, Education, and Outreach

Because prescription drugs are safe and effective when used properly and are broadly marketed to the public, the notion that they are also harmful and addictive when abused can be a difficult one to convey.  Thus, we need focused research to discover targeted communication strategies that effectively address this problem.  Reaching this goal may be significantly more complex and nuanced than developing and deploying effective programs for the prevention of abuse of illegal drugs, but good prevention messages based on scientific evidence will be difficult to ignore.[39]

Education is a critical component of any effort to curb the abuse of prescription medications and must target every segment of society, including doctors (Fig.6).  NIDA is advancing addiction awareness, prevention, and treatment in primary care practices, including the diagnosis of prescription drug abuse, having established four Centers of Excellence for Physician Information.  Intended to serve as national models, these Centers target physicians-in-training, including medical students and resident physicians in primary care specialties (e.g., internal medicine, family practice, and pediatrics).  NIDA has also developed, in partnership with the Office of National Drug Control Policy (ONDCP), two online continuing medical education courses on safe prescribing for pain and managing patients who abuse prescription opioids.  To date, combined, these courses have been completed over 80,000 times. Additionally, NIDA is directly reaching out to teens with its PEERx initiative, an online education program that aims to discourage prescription drug abuse among teens,[40] by providing factual information about the harmful effects of prescription drug abuse on the brain and body.

NIDA will also continue its close collaborations with ONDCP, the Substance Abuse and Mental Health Services Administration (SAMHSA), and other Federal Agencies. It will also continue to work with professional associations with a strong interest in preserving public health. For example, NIDA recently sponsored a two-day meeting in conjunction with the American Medical Association and NIH Pain Consortium, where more than 500 medical professionals, scientific researchers, and interested members of the public had a chance to dialogue about the problems of prescription opioid abuse and to learn about new areas of research.   In another important collaborative effort, NIDA, CDC, SAMHSA, and the Office of the National Coordinator for Health Information Technology reviewed eight clinical practice guidelines on the use of opioids to treat pain and developed a common set of  provider actions and associated recommendations.[41]

Conclusion

We are seeing an increase in the number of people who are dying from overdoses, predominantly after abuse of prescribed opioid analgesics. This disturbing trend appears to be associated with a growing number of prescriptions in and diversion from the legal market.

We commend the Caucus for recognizing the serious and growing challenge posed by the abuse of prescription and non-prescription opioids in this country, a problem that is exceedingly complex.  Indeed, prescription opioids, like other prescribed medications, do present health risks but they are also powerful clinical allies.  Therefore, it is imperative that we strive to achieve a balanced approach to ensure that people suffering from chronic pain can get the relief they need while minimizing the potential for negative consequences.  We support the development and implementation of multipronged, evidence-based strategies that minimize the intrinsic risks of opioid medications and make effective, long term treatments available.

References

[2] Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

[4] IMS’s National Prescription Audit (NPA) & Vector One ®: National (VONA).

[6] To clarify our terminology here, when we say “prescription drug abuse” or “nonmedical use,” this includes use of medications without a prescription, use for purposes other than for what they were prescribed, or use simply for the experience or feeling the drug can cause.

[7] Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2007: national estimates of drug-related emergency department visits.

[8] Treatment Episode Data Set (TEDS) Highlights – 2007. National Admissions to Substance Abuse Treatment Services. SAMHSA

[9] Mack, K.A. Drug-induced deaths – United States, 1999-2010. MMWR Surveill Summ. 2013 Nov 22;62 Suppl 3:161-3. CDC

[10] Paulozzi et al. Increasing deaths from opioid analgesics in the United States Pharmacoepidemiol. Drug Saf., 15 (2006), pp. 618–627

[11] Relieving Pain in AmericaExternal link, please review our disclaimer.: A Blueprint for Transforming Prevention, Care, Education, and Research. REPORT BRIEF JUNE 2011; Johannes et al. The prevalence of chronic pain in United States adults: results of an Internet-based survey. J Pain.11(11):1230-9. (2010); Gallup-Healthways Well-Being Index.

[12] De Leon Casada. Opioids for Chronic Pain: New Evidence, New Strategies, Safe Prescribing The American Journal of Medicine, 126(3s1):S3–S11. (2013)..

[13]American Academy of Pain Medicine; American Pain Society; American Society of Addiction Medicine. Definitions Related to the Use of Opioids for the Treatment of Pain. Glenview, IL, and Chevy Chase, MD: American Academy of Pain Medicine, American Pain Society, American Society of Addiction Medicine; 2001

[19] Bateman, B.T. et al. Patterns of Opioid Utilization in Pregnancy in a Large Cohort of Commercial Insurance Beneficiaries in the United States. Anesthesiology.  in press (2014)

[21] Centers for Disease Control and Prevention , National Center for Health Statistics. Multiple Cause of Death 1999-2010 on CDC WONDER Online Database, released 2012. Data are from the Multiple Cause of Death Files, 1999-2010, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.

[22] Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2001-2011. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-65, HHS Publication No. (SMA) 13-4772. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

[23] Brody and Li. Am. J. Epidemiology. 2014

[24] Williams, J. Regulation of μ-opioid receptors: desensitization, phosphorylation, internalization, and tolerance. Pharmacol Rev. 65(1):223-54. (2013).

[25] Møller et al. Acute drug-related mortality of people recently released from prisons. Public Health.  124(11):637-9. (2010); Buster et al. An increase in overdose mortality during the first 2 weeks after entering or re-entering methadone treatment in Amsterdam. Addiction. 97(8):993-1001. (2002).

[26] Paulozzi, L. Prescription drug overdoses: a review. J Safety Res. 43(4):283-9 (2012)

[27] CDC.Vital signs: overdoses of prescription opioid pain relievers and other drugs among women–United States, 1999-2010. MMWR 62(26):537-42. (2013).

[28] Slevin and Ashburn. Primary care physician opinion survey on FDA opioid risk evaluation and mitigation strategies. J Opioid Manag. 2011 Mar-Apr;7(2):109-15.

Hooten and Bruce. Beliefs and attitudes about prescribing opioids among healthcare providers seeking continuing medical education. J Opioid Manag. 7(6):417-24.(2011).

[29] Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

[30] SAMHSA advisory Bulletin 2/7/14  <a href=”http://www.samhsa.gov/newsroom/advisories/1402075426.aspx” rel=”nofollow”>http://www.samhsa.gov/newsroom/advisories/1402075426.aspx</a>).

[31] Centers for Disease Control and Prevention , National Center for Health Statistics. Multiple Cause of Death 1999-2010 on CDC WONDER Online Database, released 2012. Data are from the Multiple Cause of Death Files, 1999-2010, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.

[32] Moore, A. et al. Expect analgesic failure; pursue analgesic success BMJ. 3;346 (2013).

[33]Community-Based Opioid Overdose Prevention Programs Providing Naloxone. United States, 2010. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. MMWR. Vol 61/No.6 February 17, 2012.

[34]NIDA STTR Grantee: AntiOp, Inc., Daniel Wermerling, CEO.

[35] Schwartz, R.P. et al. Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995-2009. Am J Public Health. 103(5):917-22 (2013).

[36] Zarkin, G. Benefits and costs of methadone treatment: results from a lifetime simulation model.  Health Econ. 14(11):1133-50 (2005).

[37] Knudsen, H.K.; Abraham, A.J.; and Roman, P.M. Adoption and implementation of medications in addiction treatment programs. J Addict Med 2011; 5:21-27.

[39] Spoth et al. Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. Psychology of Addictive Behaviors 16(2):129–134, 2002.

Inside a Killer Drug Epidemic: A Look at Americas Opioid Crisis
 

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Opioid epidemic – Wikipedia
 

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The opioid epidemic (also called opioid crisis) refers to the rapid increase in the use of prescription and non-prescription opioids in the United States. Opiates are a class of analgesic drugs, including those naturally derived from opium, such as morphine and heroin, and opioids are similar synthetic and semi-synthetic drugs such as Percocet, Vicodin, OxyContin and fentanyl. According to the DEA, “overdose deaths, particularly from prescription drugs and heroin, have reached epidemic levels.”[2]:iii

In 2015 there were 52,000 American deaths from all drug overdoses. Two thirds of them, 33,000, were from opioids, compared to 16,000 in 2010 and 4,000 in 1999.[3][4] In 2016, deaths from overdoses increased over the previous year by 26% in Connecticut, 35% in Delaware, 39% in Maine, and 62% in Maryland.[5] Nearly half of all opioid overdose deaths involve a prescription opioid.[6]

The governor of Maryland declared a State of Emergency in March 2017 to combat the epidemic.[7] CDCdirector Thomas Frieden has said that “America is awash in opioids; urgent action is critical.”[8]President Donald Trump may set aside $500 million in the 2017 budget to combat opioid addiction and has launched a commission to deal with the epidemic.[9][10][11]

Overdose Deaths Involving Opioids, United States, 2000-2015 – Opioid epidemic
 

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Overdose Deaths Involving Opioids, United States, 2000-2015. Deaths per 100,000 population.

[1]

The opioid epidemic (also called opioid crisis) refers to the rapid increase in the use of prescription and non-prescription opioids in the United States. Opiates are a class of analgesic drugs, including those naturally derived from opium, such as morphine and heroin, and opioids are similar synthetic and semi-synthetic drugs such as Percocet, Vicodin, OxyContin and fentanyl. According to the DEA, “overdose deaths, particularly from prescription drugs and heroin, have reached epidemic levels.”[2]:iii

In 2015 there were 52,000 American deaths from all drug overdoses. Two thirds of them, 33,000, were from opioids, compared to 16,000 in 2010 and 4,000 in 1999.[3][4] In 2016, deaths from overdoses increased over the previous year by 26% in Connecticut, 35% in Delaware, 39% in Maine, and 62% in Maryland.[5] Nearly half of all opioid overdose deaths involve a prescription opioid.[6]

The governor of Maryland declared a State of Emergency in March 2017 to combat the epidemic.[7] CDCdirector Thomas Frieden has said that “America is awash in opioids; urgent action is critical.”[8]President Donald Trump may set aside $500 million in the 2017 budget to combat opioid addiction and has launched a commission to deal with the epidemic.[9][10][11]

Background[edit]

Main causes and effects[edit]

Opioid addiction has mostly been an American problem. Between 1991 and 2011, prescriptions of painkillers in the U.S. grew from 76 million to 219 million per year. Among the opioid pills prescribed are Percocet, Vicodin, Oxycodone or OxyContin. Along with that increase in volume, the potency of the opioids also increased. By 2002, one in six drug users were being prescribed drugs more powerful than morphine; by 2012 the ratio had doubled to one in three.[5]

In the late 1990s many Americans were diagnosed with chronic pain, estimated to affect around 100 million people or a third of the US population. This led to a push by drug companies and the federal government to expand the use of painkiller opioids.[5] But when some patients continue to take the medication beyond what a doctor prescribes, whether to minimize pain or to enjoy the euphoric feelings it gives, it can mark the beginning stages of a deadly addiction. Over time, tolerance develops and a person needs to use more to get the same effect. Dependence, or addiction, occurs when a person relies on the drug to prevent withdrawal symptoms.[12]

Opiate self-injection paraphernalia

To remedy that growth, in 2010 the government began cracking down on pharmacists and doctors who were over-prescribing opioid pain killers. But this led to the unintended consequence of users turning to illegal heroin, an even more addictive drug, as a substitute.[5] Some addicted patients were also being denied opioid prescriptions as doctors tried to cut back painkiller drug abuse.[13] A 2017 survey in Utah found that about 80 percent of heroin users started with prescription drugs.[14]

In Maine, new laws were imposed which capped the maximum daily strength of prescribed opioids and which limited prescriptions to seven days. But some doctors were then concerned that patients would turn to using street drugs like heroin to extend their use of painkillers.[13] Heroin is significantly more potent and cheaper than prescription opioids. As a result, by 2015 while deaths from prescription opioids had increased by 15% nationwide, for heroin users it had increased 23%.[5][15]

Despite the increased use of painkillers, however, there has been no change in the amount of pain reported in the U.S.[16][17] Nonetheless, the current opioid epidemic has become the worst drug crisis in American history. More than 33,000 people died from overdosing in 2015, nearly equal to the number of deaths from car crashes, with deaths from heroin alone more than from gun homicides.[18] It is also leaving thousands of children suddenly needing foster care after their parents have died from an overdose.[19]

Fentanyl[edit]

There have always been drug addicts in need of help, but the scale of the present wave of heroin and opioid abuse is unprecedented. In Maryland, the first six months of 2015 saw 121 fentanyl deaths. In the first six months of 2016, the figure rose to 446.

Christopher Caldwell,
senior editor The Weekly Standard[13]

Fentanyl, a newer synthetic opioid painkiller, is 50 to 100 times more potent than morphine and 30 to 50 times more potent than heroin,[13] with only 2 mg becoming a lethal dose.[20] Fentanyl-laced heroin has become a big problem for major cities, including Philadelphia, Detroit and Chicago.[21] As a result, its use has caused a spike in deaths among users of heroin and prescription painkillers, while becoming easier to obtain and conceal. Some arrested or hospitalized users are surprised to find that what they thought was heroin was actually fentanyl.[13] According to CDC director Thomas Frieden:

As overdose deaths involving heroin more than quadrupled since 2010, what was a slow stream of illicit fentanyl, a synthetic opioid 50 to 100 times stronger than morphine, is now a flood, with the amount of the powerful drug seized by law enforcement increasing dramatically. America is awash in opioids; urgent action is critical.[8]

According to the Centers for Disease Control and Prevention (CDC), death rates from synthetic opioids, including fentanyl, increased over 72% from 2014 to 2015.[12] In addition, it reports that the total deaths from opioid overdoses may be under-counted, since they do not include deaths that are associated with synthetic opioids that are used as pain relievers. The CDC now presumes that a large proportion of the increase in deaths is due to illegally-made fentanyl; as the cause of overdose deaths do not distinguish pharmaceutical fentanyl from illegally-made fentanyl, the actual death rate could therefore be much higher than reported.[22]

Those taking fentanyl-laced heroin are more likely to overdose because they don’t know they also are ingesting the more powerful drug.[23] In March 2017, New Jersey police arrested a person possessing nearly 31 pounds (14 kg) of fentanyl (14 kg would yield 7 million lethal doses.)[24][25] Among those who died from overdosing on fentanyl is singer Prince.[25][26]

Fentanyl has surpassed heroin as a killer in several locales: the CDC identified 998 fatal fentanyl overdoses in Ohio in all of 2014, which is the same number of deaths for the first five months of 2015.[27] In Cleveland, a person was caught selling blue fentanyl pills disguised to look like doses of the milder opioid painkiller, oxycodone.[27] The U.S. attorney for Ohio stated:

One of the truly terrifying things is the pills are pressed and dyed to look like oxycodone. If you are using oxycodone and take fentanyl not knowing it is fentanyl, that is an overdose waiting to happen. Each of those pills is a potential overdose death.[27]

While Mexican cartels are a main source of heroin smuggled into the U.S., for fentanyl, Chinese suppliers provide both raw fentanyl and the machinery necessary for its production, according to medical publication STAT.[27] In British Columbia, police discovered a lab making 100,000 fentanyl pills each month, which they were shipping to Calgary, Alberta. 90 people in Calgary overdosed on the drug in 2015.[27] In Southern California, a home-operated drug lab with six pill presses was uncovered by federal agents; each machine was capable of producing thousands of pills an hour.[27]

Earlier decades[edit]

In the early 1900’s WWI veterans were returning. At this point in time, there were very few options to help relieve pain. Doctors mainly turned to morphine. [28] Opioids soon became known as the wonder drug. They were being used for even minor things such as cough relief. No one knew of their addictivness until around 1920, and not too long after heroin was deemed to be an illegal drug. [28]Again in the mid 1900’s (around WWII), doctors were using opioids in lieu of surgery. This made the prescriptions that were made for opioids skyrocket. [28]

In the 1950s, while heroin addiction was known among jazz musicians, it was still fairly unknown by average Americans, many of whom saw it as a frightening condition.[13] That fear extended into the 1960s and 1970s, although it became common to hear or read about drugs such as marijuana and psychedelics, which were widely used at rock concerts like Woodstock.[13] But heroin and opioid addiction began to make the news when famous people such as Janis Joplin, John Belushi, Jim Morrison and Lenny Bruce, whom most people didn’t know were addicted, died from overdoses.

During and after the Vietnam war, heroin addiction grew when addicted soldiers returned from Vietnam, where heroin was easily bought. It also increased within low-income housing projects during the same time period.”The Nixon White House panicked,” writes political editor Christopher Caldwell.[13] In 1971 some congressmen released an explosive report on the growing heroin epidemic among U.S. servicemen in Vietnam; it found that ten to fifteen percent of the servicemen were addicted to heroin, which led President Nixon to declare drug abuse “public enemy number one”.[29]By 1973 there were 1.5 overdose deaths per 100,000 people.[13]

Then followed the crack epidemic from cocaine in the mid to late 1980s. The death rate was worse, reaching almost 2 per 100,000. In 1982, Vice President George H. W. Bush and his aides began pushing for the involvement of the CIA and U.S. military in drug interdiction efforts.[30]

In comparison, the present opioid epidemic is killing 10.3 people per 100,000. In some states it is far worse: over 30 per 100,000 in New Hampshire and over 40 in West Virginia.[13] And with the ongoing opioid epidemic, opinions about drug abuse have changed.[13] The arguments about heroin and opioid use, once supported by strong moral codes, whether social, cultural, or legal, have become weaker.[13]

Demographics[edit]

Opioid addiction is also now a serious problem outside the U.S., mostly among young adults.[31] The majority of deaths worldwide from overdoses were from either medically prescribed opioids or illegal heroin. In Europe, prescription opioids accounted for three-quarter of overdose deaths among those between ages 15 and 39.[31] Some now worry that the epidemic could become a worldwide pandemic if not curtailed.[16]

That concern not only relates to the drugs themselves, but to the fact that in many countries doctors are less trained about drug addiction, both about its causes or treatment.[16] Silvia Martins, an epidemiologist at Columbia University, explains:

Once pharmaceuticals start targeting other countries and make people feel like opioids are safe, we might see a spike [in opioid abuse]. It worked here. Why wouldn’t it work elsewhere?[16]

Prescription drug abuse among teenagers in Canada, Australia, and Europe were at rates comparable to U.S. teenagers.[16] In the Middle East countries of Lebanon and Saudi Arabia, and in parts of China, surveys found that one in ten students had used prescription painkillers for non-medical purposes. Similar high rates of non-medical use were found among the young throughout Europe, including Spain and the United Kingdom.[16]

In the U.S., addiction and overdose victims are mostly white and working-class. Geographically, those living in rural areas of the country have been the hardest hit as a percentage of the national population.[32] Although more affluent areas, such as Palm Beach County Florida, have seen overdose deaths increase by 91 percent since 2015.[33]

There has also been a difference in the number of prescriptions written by doctors in different states. In Hawaii, doctors wrote about 52 prescriptions for every 100 people, whereas in Alabama, they wrote almost 143 prescriptions per 100 people. Researchers suspect that the variation results from a lack of consensus among doctors in different states about how much pain medication to prescribe. Nor does a higher rate of prescription drug use lead to better health outcomes or patient satisfaction, according to studies.[3]

Recent governmental measures[edit]

As the number of opioid prescriptions between 1991 and 2011 rose by 300%, drug cartels began flooding the United States with heroin. For opioid users, it made heroin cheaper, more potent, and often easier to acquire than prescription medications. That easier accessibility became one of the main factors leading many to using heroin.[3]

Mexican transnational criminal organizations are the main suppliers of heroin to the U.S. Heroin production in Mexico has increased by over 600% in four years, from an estimated 8 metric tons in 2005 to 50 metric tons in 2009.[3] And between 2010 and 2014, the amount seized at the border more than doubled.[35] According to the DEA, smugglers and distributors “profit primarily by putting drugs on the street and have become crucial to the Mexican cartels.”[2]:3

  • In July 2016, the governors of most U.S. states and territories entered into a formal “Compact to Fight Opioid Addiction.” They agreed that collective action would be needed to end the opioid crisis, and they would coordinate their responses across all levels of government and the private sector, including opioid manufacturers and doctors.[36]
  • In Maryland, as an urgent response to the crisis, Governor Larry Hogan, on March 1, 2017, declared a State of Emergency to combat the rapid increase in overdoses. The declaration would increase and speed up coordination between the state and local jurisdictions.[37] In 2016 approximately 2,000 people in the state had died from opioid overdoses.[38]
  • In March 2017, Delaware, which has the 12th highest overdose death rate in the country, introduced bills to both limit doctors’ ability to over-prescribe painkillers and improve access to treatment. In 2015 228 people died from overdose, which increased 35%—to 308—in 2016.[39]
  • A similar plan was begun in Michigan the same month, with the state introducing its Michigan Automated Prescription System (MAPS), which would let doctors check to see when and what painkillers have already been prescribed to a patient, and thereby help keep addicts from switching doctors to get a fresh supply of drugs.[40][41]
  • Utah is trying to pass a law that would allow relatives to petition a court to mandate substance- use treatment for adults.[14]

Local governments are also becoming involved in trying to control their opioid crisis. Officials in Everett, Washington filed a lawsuit against the manufacturer of OxyContin, a leading opioid pain medication, claiming the manufacturer was negligent for allowing drugs to be illegally trafficked to residents and failing to prevent it. The city wants the company to pay the costs of handling the crisis.[42]

The U.S. Surgeon General has listed some statistics which describe the extent of the problem:[17]

  • 78 Americans die every day from an opioid overdose.
  • In 2014, more than 10 million people in the United States reported using prescription opioids for nonmedical reasons, and close to 2 million people older than 12 years met diagnostic criteria for a substance use disorder involving prescription opioids.
  • There has been a quadrupling of prescriptions for opioids since 1999, but there has not been an overall change in the amount of pain that Americans report.
  • As many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with addiction.

In 2011, the Obama administration released a white paper describing the administration’s plan to deal with the crisis. The administration’s concerns about addiction and accidental overdosing have been echoed by numerous other medical and government advisory groups around the world.[43][44][45]

Monitoring of prescriptions[edit]

As of April 2017, Prescription Drug Monitoring Programs (PDMP) exist in every state.[46] PDMPs allow pharmacists and prescribers to access patients’ prescription histories to identify suspicious use. However, a survey of US physicians published in 2015 found only 53% of doctors used these programs, while 22% were not aware these programs were available.[47] The Centers for Disease Control and Prevention (CDC) was tasked with esbtablishing and publishing a new guideline, and was heavily lobbied.[48] [49]

In 2016, the CDC published its Guideline for Prescribing Opioids for Chronic Pain, recommending opioids only be used when benefits for pain and function are expected to outweigh risks, and then used at the lowest effective dosage, with avoidance of concurrent opioid and benzodiazepine use whenever possible.[50] Silvia Martins, an epidemiologist at Columbia University, has suggested getting out more information about the risks:

The greater “social acceptance” for using these medications (versus illegal substances) and the misconception that they are “safe” may be contributing factors to their misuse. Hence, a major target for intervention is the general public, including parents and youth, who must be better informed about the negative consequences of sharing with others medications prescribed for their own ailments. Equally important is the improved training of medical practitioners and their staff to better recognize patients at potential risk of developing nonmedical use, and to consider potential alternative treatments as well as closely monitor the medications they dispense to these patients.[31]

See also[edit]

Further reading[edit]

  • “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health” (2016)[51]

References[edit]

  1. Jump up ^ Data Overview. Drug Overdose. CDC Injury Center. Centers for Disease Control and Prevention.
  2. ^ Jump up to: a b “2015 National Drug Threat Assessment Summary”, DEA, Oct. 2015
  3. ^ Jump up to: a b c d “How Bad is the Opioid Epidemic?”, PBS, Feb. 23, 2016
  4. Jump up ^ “America’s Addiction to Opioids: Heroin and Prescription Drug Abuse”, National Institute on Drug Abuse (NIDA), May 14, 2014
  5. ^ Jump up to: a b c d e “America’s opioid epidemic is worsening”, the Economist (U.K.) March 6, 2017
  6. Jump up ^ Opioid Overdose, CDC
  7. Jump up ^ Turque, B. Maryland governor declares state of emergency for opioid crisis. The Washington Post. March 1, 2017. Accessed May 5, 2017
  8. ^ Jump up to: a b “CDC Chief Frieden: How to end America’s growing opioid epidemic”, Fox News, Dec. 17, 2016
  9. Jump up ^ “Opioid Epidemic: Trump to Set Up Commission on Addiction Crisis”, NBC News, March 29, 2017
  10. Jump up ^ “It’s time to ‘Trump’ opioid addiction in the United States”, The Hill, Feb. 27, 2017
  11. Jump up ^ “President Trump Hosts an Opioid and Drug Abuse Listening Session”, Real Clear Politics, March 29, 2017
  12. ^ Jump up to: a b “Why opioid overdose deaths seem to happen in spurts”, CNN, Feb. 8, 2017
  13. ^ Jump up to: a b c d e f g h i j k l Caldwell, Christoper. “American Carnage: The New Landscape of Opioid Addiction”, First Things, April 2017
  14. ^ Jump up to: a b “Poll: Many Utahns know people who seek treatment for opioid addiction, but barriers remain”, The Salt Lake Tribune, April 3, 2017
  15. Jump up ^ “Overdose Death Rates”, NIDA, Jan. 2017
  16. ^ Jump up to: a b c d e f “The opioid epidemic could turn into a pandemic if we’re not careful”, Washington Post, Feb. 9, 2017
  17. ^ Jump up to: a b “Opioids: Extent of the issue”, U.S. Surgeon General
  18. Jump up ^ “Heroin deaths surpass gun homicides for the first time, CDC data shows”, Washington Post, Dec. 8, 2016, Retrieved 2017-05-08
  19. Jump up ^ “The Children of the Opioid Crisis”, Wall Street Journal, Dec. 15, 2016
  20. Jump up ^ “Fentanyl drug profile”, The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
  21. Jump up ^ “Orlando man pleads guilty to selling heroin mixed with fentanyl”, <a href=”http://Orlando.com” rel=”nofollow”>Orlando.com</a>, March 20, 2017
  22. Jump up ^ “Opioid Data Analysis”, Centers for Disease Control and Prevention (CDC)
  23. Jump up ^ “Coroner: Franklin County fentanyl deaths hit ‘unprecedented’ rate of one per day”, The Columbus Dispatch, March 16, 2017
  24. Jump up ^ “State, feds seize 14 kilos of dangerous opioid fentanyl in N.J.”, <a href=”http://NJ.com” rel=”nofollow”>NJ.com</a>, March 17, 2017
  25. ^ Jump up to: a b “Prince’s Autopsy Result Highlights Dangers of Opioid Painkiller Fentanyl”, ABC News, June 2, 2016
  26. Jump up ^ “Documents highlight Prince’s struggle with opioid addiction”, Seattle Times, April 17, 2017
  27. ^ Jump up to: a b c d e f “‘Truly terrifying’: Chinese suppliers flood US and Canada with deadly fentanyl”, STAT, April 5, 2016
  28. ^ Jump up to: a b c Moghe, Sonia. “Opioids: From ‘wonder drug’ to abuse epidemic”. CNN. Retrieved 11 April 2017. 
  29. Jump up ^ WGBH educational foundation. Interview with Dr. Robert Dupoint. <a href=”http://PBS.org” rel=”nofollow”>PBS.org</a> (February 18, 1970)
  30. Jump up ^ Scott, Peter Dale; Marshall, Jonathan. Cocaine Politics: Drugs, Armies, and the CIA in Central America, Berkeley, CA: University of California Press (1991) p. 2
  31. ^ Jump up to: a b c “Nonmedical use of prescription drugs in adolescents and young adults: not just a Western phenomenon”, World Psychiatry, Jan. 26, 2017
  32. Jump up ^ Sullivan, Andrew.“The Opioid Epidemic Is This Generation’s AIDS Crisis”, New York Magazine, March 16, 2017
  33. Jump up ^ “Patient brokering exacerbates opioid crisis in Florida”, South Bend Tribune, April 2, 2017
  34. Jump up ^ “Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012”, CDC, July 4, 2014
  35. Jump up ^ “Heroin Production in Mexico and U.S. Policy”, Congressional Research Service report, March 3, 2016
  36. Jump up ^ “A Compact to Fight Opioid Addiction”, National Governors Assoc., July 13, 2016
  37. Jump up ^ “Hogan-Rutherford Administration Declares State of Emergency, Announces Major Funding to Combat Heroin and Opioid Crisis in Maryland”, Maryland.gov, March 1, 2017
  38. Jump up ^ “Gov. Hogan Announces Opioid Epidemic State Of Emergency”, CBS Baltimore, March 1, 2017
  39. Jump up ^ “Delaware lawmakers tackle opioid addiction epidemic”, Newsworks, March 23, 2017
  40. Jump up ^ “Governor Snyder rolls out plan to fight opioid addiction”, WILX, March 23, 2017
  41. Jump up ^ “Snyder: Efforts to stop opioid abuse aren’t working”, Michigan Radio, March 23, 2017
  42. Jump up ^ “U.S. City Sues OxyContin Maker For Contributing To Opioid Crisis”, NPR, Feb. 3, 2017
  43. Jump up ^ “Tackling the Opioid Public Health Crisis”, College of Physicians and Surgeons of Ontario
  44. Jump up ^ “First Do No Harm: Responding to Canada’s Prescription Drug Crisis”, Canadian Centre on Substance Abuse, March 2013
  45. Jump up ^ “UK: Task Force offers ideas for opioid addiction solutions”. <a href=”http://Delhidailynews.com” rel=”nofollow”>Delhidailynews.com</a>. 2014-06-11. Retrieved 2016-01-07. 
  46. Jump up ^ Missouri is final state to pass PDMP program; US News & World Report; April 13, 2017
  47. Jump up ^ Rutkow Lainie; et al. (2015). “Most primary care physicians are aware of prescription drug monitoring programs, but many find the data difficult to access”. Health Affairs. 34 (3): 484–492. doi:10.1377/hlthaff.2014.1085. 
  48. Jump up ^ Matthew Perrone, Associated Press. “Painkiller politics: Effort to curb prescribing under fire”. <a href=”http://Philly.com” rel=”nofollow”>Philly.com</a>. Retrieved 2016-01-07. 
  49. Jump up ^ Ghorayshi, Azeen. “Missouri Is The Only State In The US Where Doctors Have No Idea What Prescriptions People Are Getting”. BuzzFeed. Retrieved 11 April 2017. 
  50. Jump up ^ Dowell, Deborah; Haegerich, Tamara; Chou, Roger (March 15, 2016). “CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016”. JAMA. 315: 1624–45. doi:10.1001/jama.2016.1464. PMID 26977696. Retrieved March 18, 2016. 
  51. Jump up ^ “Facing Addiction in America”, U.S. Surgeon General (2016)
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opioids – Google Search
 

mikenova shared this story .

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opioids – Google Search
 

mikenova shared this story .

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opioids – Google Search
 

mikenova shared this story .

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opioids – Google Search
 

mikenova shared this story .

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opioids – Google Search
 

mikenova shared this story .

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mikenova shared this story .

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