‘Russian mafia’ from Brighton Beach charged with arson of illegal poker club in New York

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https://en.crimerussia.com/
‘Russian mafia’ from Brighton Beach charged with arson of illegal poker club in New York
https://en.crimerussia.com/
In particular, Aleksey Tsvetkov aka Pelmen, who immigrated to the United States from Ukraine in 1992, used to be an expert in debt collecting. In 2003, he was arrested by the FBI as a member of another Russian organized crime group, the Brighton Beach …

As reported by the press service of the Prosecutor’s Office of New York, all of them face various prison terms in accordance with the charges (from 17 years to life imprisonment).

‘Russian mafia’ from Brighton Beach charged with arson of illegal poker club in New York

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Four out of six suspects in the arson of a three-story building in May last year were arrested in November 2016 as part of a large-scale operation of the FBI and the New York police against the organized crime groups of immigrants from the former Soviet Union countries.

The US Prosecutor’s Office in the Eastern District of New York has unveiled an indictment on charges of arson of the 3-story residential building in the Brighton Beach/Coney Island district of New York, in which an illegal poker club was located.

The major fire occurred on the night of May 2, 2016, but its reasons have not been officially announced until now. Residents of the building were evacuated, but firemen had to rescue two people blocked by flame in an apartment on the third floor. As a result of the fire-fighting operations, several New York fire fighters suffered injuries and burns.

According to the document, six members of the so-called Russian mafia have been convicted of arson; five of them were arrested almost a year ago on suspicion of other crimes, whereas the sixth person, Viktor Zelinger, is still at large.

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Members of a transnational OCG Aleksey Tsvetkov, Leonid Gershman (Lenchik), Vyacheslav Malkeev (Steve Bart), and Librado Riviera (Macho), arrested on charges of racketeering, drug trafficking, illegal possession of firearms, illegal usury, and the organization of an underground gambling business in November 2016, are currently in custody. As reported by the CrimeRussia, the investigation was conducted by the Drug Enforcement Administration (DEA) with the assistance of other law enforcement agencies.

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Detention of members of the criminal syndicate, November 2016

It is known that exerting pressure on their victims through their relatives in the US, the crime group would extort money abroad, namely in Israel and Eastern Europe. It was reported that the majority of those detained during the police operation had previous criminal experience. In particular, Aleksey Tsvetkov aka Pelmen, who immigrated to the United States from Ukraine in 1992, used to be an expert in debt collecting. In 2003, he was arrested by the FBI as a member of another Russian organized crime group, the Brighton Beach Crew, headed by Zinovy Bari.

цветков2.jpg

Aleksey Tsvetkov

According to the prosecutor’s office, Gershman and Malkeev were the Brighton Beach gang’s ‘power hitters’ along with Tsvetkov.

As reported by the press service of the Prosecutor’s Office of New York, all of them face various prison terms in accordance with the charges (from 17 years to life imprisonment).

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The Brooklyn Bridge – Home Page – 8:41 PM 5/28/2017

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City removes swastika etched into Gravesend sidewalk – Brooklyn Daily – 11:11 PM 5/26/2017

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1. Brooklyn Photos from mikenova (1 sites)
E! Brooklyn ebklyn.com: Snakes can actually hunt in packs 2:40 PM 5/26/2017

Cuban boa

Snakes can actually hunt in packs

But you should only be scared if you live in a cave in Cuba.

Scary enough on its own.

Ger Dekker/Flickr

E! Brooklyn ebklyn.com

 

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City removes swastika etched into Gravesend sidewalk – Brooklyn Daily


Brooklyn Daily
City removes swastika etched into Gravesend sidewalk
Brooklyn Daily
Some neo-Nazi nogoodnik carved a swastika into the sidewalk on McDonald Avenue in Gravesend this week, but the city quickly removed the anti-Semitic symbol just a day after it was found. A local passerby saw the hateful sign, about three-inches wide, …

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. Mets legend Tom Seaver says pitchers should “learn to pitch” or they won’t age wellhttp://nydn.us/2rXGTtP 

3 Brooklyn federal prison guards arrested on rape, sex abuse charges. 2 were lieutenants who ran anti-rape trainings http://gothamist.com/2017/05/25/mdc_guards_rape.php 

3 Brooklyn federal prison guards arrested on rape, sex abuse charges. 2 were lieutenants who ran anti-rape trainings http://gothamist.com/2017/05/25/mdc_guards_rape.php …

The Domino Factory makeover, developed by @TwoTreesNY, gets its first food shop, via @thebridgebk: http://ow.ly/BHWG30c2LV1 pic.twitter.com/CrCyDIgXza

The Domino Factory makeover, developed by , gets its first food shop, via: http://ow.ly/BHWG30c2LV1 

 

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Russian diplomat claimed Kushner wanted backchannel: report
Russian bankers sue BuzzFeed over unverified Trump dossier
Sheepshead Bay, Brooklyn – Wikipedia
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The Awkward Language of Donald Trumps Body
Snakes can actually hunt in packs
Inmate hijacks van full of Lino Lakes prisoners and escapes
Ex-Jared Kushner employee explains why hes unqualified to hold any job
“The Germans are bad, very bad: Trumps alleged slight generates confusion, backlash
Russian Orthodox Old Believers: Keeping their faith and fighting fires in the West Siberian Plain
Jared Kushner now a focus in Russia investigation
Heres why the FBI is likely to be interested in Jared Kushners meeting with Russians
Exclusive: NSA Chief Admits Donald Trump Colluded With Russia
Its time to plan an escape route, for you and your money, from Trumpland
Sources: Comey acted on Russian intelligence he knew was fake
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opioids epidemic in america – Google Search

 

Mike Nova’s Shared NewsLinks
Russian diplomat claimed Kushner wanted backchannel: report

mikenova shared this story from National Rss Article only.

Jared Kushner wanted to create a back-channel communications link between President Trump’s transition team and the Kremlin, according to alleged discussions reported Friday.

Russian Ambassador Sergey Kislyak told other officials in Moscow that Kushner, Trump’s son-in-law and adviser, had suggested an off-the-grid way to talk after a meeting at Trump Tower that also included future — and now fired — National Security Adviser Michael Flynn, according to The Washington Post.

Friday night’s report, based off information from U.S. officials, came the same day the Post reportedthe Senate Intelligence Committee probing alleged Russian meddling in the 2016 election had requested documents from the Trump campaign

It’s the first time the Trump campaign itself has been brought into the investigations into the meddling and potential collusion that have accelerated in recent weeks — after the firing of FBI Director James Comey.

Jared Kushner scrutinized in Trump-Russia investigation: reports

Comey confirmed his agency’s investigation in March and reportedly resisted pressure from Trump to end its look at Flynn.

Flynn and former Trump campaign chair Paul Manafort are believed to be targets of the investigation, though multiple outlets reported Thursday that Kushner was considered a person of interest.

Team Trump had previously confirmed the meeting between Kushner, Flynn and Kislyak, but said it was not out of the ordinary and dismissed questions about collusion as “fake news.”

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The Post report Friday was based off of conversations Kislyak had with other Russian officials, and the Americans involved did not comment.

Ivanka Trump, Jared Kushner fail to disclose art worth millions

It is not unusual for incoming presidential administrations to meet with foreign leaders, though before the December meeting, the Kremlin had been accused of orchestrating a campaign to influence the November election.

A joint intelligence community report released in January said the effort was aimed at helping Trump.

Kushner had originally failed to report his meeting with Vladimir Putin’s man in America on his application for a security clearance, but his lawyer said the documents were submitted prematurely and his client would inform authorities in an interview.

A potential backchannel between the Trump team and the U.S.’ former Cold War foe had previously been raised by a report in April, when the Post reported controversial Blackwater founder Erik Prince, also Education Secretary Betsy DeVos’ brother, had acted as a go-between in January.

Fla. GOP operative received troves of documents from hacker

Prince reportedly acted as an envoy for Trump in a secretive meeting with unidentified emissary from Putin in the Seychelles — remote islands in the Indian Ocean — though Prince and the White House denied that he was sent by the incoming administration.

The Post reported Friday that the Kushner-Kislyak conversation in December talked about a Trump representative meeting a “Russian contact.”

Flynn’s contacts with Kislyak, which also included a phone call on the day the Obama administration announced sanctions in retaliation for the alleged interference, contributed to his swift exit from the administration in its early days.

Trump says he demanded the former general’s resignation after he misrepresented the content of his call to Vice President Pence, who told reporters that the chat did not involve talk of sanctions.

Russia probe involves current senior White House official: report

The President himself has talked about easing the economic punishments, which dragged Russia’s economy into recession after it annexed Ukraine’s Crimea in 2014. White House adviser Gary Cohn said Friday that a move softening the sanctions is unlikely.

Before the Senate Intelligence Committee asked for documents from the Trump campaign, large parts of the Russia investigation made public so far have focused on Flynn, who is also accused of not reporting money he took from Kremlin-backed broadcaster RT.

Flynn, barred from taking payments as the former head of the Defense Intelligence Agency, refused earlier this week to cooperate with subpoenas from the Senate Intelligence Committee, invoking his Fifth Amendment right to not self-incriminate.

The former general has called the cyclone of news around his activities a “witch hunt” and suggested that he would talk if given immunity.

Paul Manafort, who left Trump’s campaign after reports that he received money off-the-books while working for a pro-Kremlin party in Ukraine, has also become a focus of the investigation, and reportedly received a subpoena over the loan for a Hamptons house he received while departing from the future President.

Oleg Deripaska, a Russian oligarch close to Putin, has also said that he is willing to speak with the congressional meddling inquiries if given immunity, the New York Times reported Friday.

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Russian bankers sue BuzzFeed over unverified Trump dossier

mikenova shared this story .

NEW YORK (AP) – The owners of a Russian bank are suing BuzzFeed for publishing an uncorroborated dossier that alleged they were part of a Russian scheme to influence the 2016 U.S. presidential election.

Mikhail Fridman, Petr Aven and German Khan of Alfa Bank filed the defamation lawsuit Friday in Manhattan. They are seeking unspecified damages from BuzzFeed, editor-in-chief Ben Smith, reporter Ken Bensinger and editors Miriam Elder and Mark Schoofs.

The dossier published Jan. 10 included explosive claims that Russians had compiled compromising information about Republican Donald Trump. Buzzfeed admitted that the allegations were unverified and “potentially unverifiable.”

The lawsuit says Buzzfeed defamed the plaintiffs by linking them to the Kremlin campaign to interfere in the U.S. election.

BuzzFeed spokesman Matt Mittenthal calls the lawsuit a “shameless attempt to bully and intimidate BuzzFeed News.”

Copyright 2017 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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The Brooklyn Bridge – 2:54 PM 5/26/2017

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The Brooklyn Bridge from mikenova (8 sites)
E! Brooklyn ebklyn.com: Snakes can actually hunt in packs 2:40 PM 5/26/2017
The Brooklyn Bridge bklyn-ny.net: UPS must pay $247M for shipping untaxed cigarettes in New York 12:39 PM 5/26/2017
The Brooklyn Bridge bklyn-ny.net: Opioids Epidemic in America Update 11:50 AM 5/26/2017
The Brooklyn Bridge bklyn-ny.net: OPIOID NATION: A look back at how opioid addiction plagued New York City 20 years ago 11:08 AM 5/26/2017
The Brooklyn Bridge bklyn-ny.net: Trump aggressively pursued government post in USSR in 1980s 10:53 AM 5/26/2017
The Brooklyn Bridge bklyn-ny.net: NYC News Student Brought Gun to Brooklyn High School: Police 10:27 AM 5/26/2017
The Brooklyn Bridge bklyn-ny.net: The Brooklyn Bridge 8:44 AM 5/26/2017
The Brooklyn Bridge bklyn-ny.net: Your Ideal Week: May 25-31, Memorial Day weekend is here 8:23 AM 5/26/2017
The Brooklyn Bridge bklyn-ny.net: Brooklyn high school student slashes teacher in eye NY Daily News New York Daily News 8:02 AM 5/26/2017
E! Brooklyn ebklyn.com: Community group votes to co-name BK Heights street after female BBridge mastermind 7:41 AM 5/26/2017
FB-RSS feed for Mike Nova: 5.9.17 – Welcome!Listen to 5.9.17 – Welcome! by Mike Nova 2 #np on #SoundCloud
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The Brooklyn Bridge bklyn-ny.net: The Brooklyn Bridge 10:25 PM 5/25/2017 | The World Web Times worldwebtimes.com: FBI homes in on Trumps son-in-law Jared Kushner in Russia probe 9:37 PM 5/25/2017
The World Web Times worldwebtimes.com: FBI homes in on Trumps son-in-law Jared Kushner in Russia probe 9:37 PM 5/25/2017
FB-RSS feed for Mike Nova: Retweeted New York Times World (@nytimesworld): Islamic terrorist groups are joining forces in the Philippines. Who are they? What do they want? And what’s next? https://t.co/luilFIUt0h https://t.co/WmGqQNI8sX
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The Brooklyn Bridge from mikenova (8 sites)
E! Brooklyn ebklyn.com: Snakes can actually hunt in packs 2:40 PM 5/26/2017

Cuban boa

Snakes can actually hunt in packs

But you should only be scared if you live in a cave in Cuba.

Scary enough on its own.

Ger Dekker/Flickr

E! Brooklyn ebklyn.com

The Brooklyn Bridge bklyn-ny.net: UPS must pay $247M for shipping untaxed cigarettes in New York 12:39 PM 5/26/2017

1. Brooklyn Photos from mikenova (1 sites) 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 by By Lauren Gill Friday May 26th, 2017 at 7:38 AM Brooklyn Paper: Full Articles 1 Share See … Continue reading“UPS must pay $247M for shipping untaxed cigarettes in New York – 12:39 PM 5/26/2017”

The Brooklyn Bridge bklyn-ny.net

The Brooklyn Bridge bklyn-ny.net: Opioids Epidemic in America Update 11:50 AM 5/26/2017

“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.” opioids epidemic in america Google Search Friday May 26th, 2017 at 11:47 … Continue reading“Opioids Epidemic in America – Update – 11:50 AM 5/26/2017”

The Brooklyn Bridge bklyn-ny.net

The Brooklyn Bridge bklyn-ny.net: OPIOID NATION: A look back at how opioid addiction plagued New York City 20 years ago 11:08 AM 5/26/2017

OPIOID NATION: A look back at how opioid addiction plagued New York City 20 years ago OPIOID NATION: A look back at how opioid addiction plagued New York City 20 years ago http://nydn.us/2qVSDOK pic.twitter.com/sektDCCV92 OPIOID NATION: A look back at how opioid addiction plagued New York City 20 years agohttp://nydn.us/2qVSDOK  pic.twitter.com/sektDCCV92 Saved Stories – 1. New … Continue reading“OPIOID NATION: A look back at how opioid addiction plagued New York City 20 years ago – 11:08 AM 5/26/2017”

The Brooklyn Bridge bklyn-ny.net

The Brooklyn Bridge bklyn-ny.net: Trump aggressively pursued government post in USSR in 1980s 10:53 AM 5/26/2017

1. Brooklyn Photos from mikenova (1 sites) 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 by By Lauren Gill Friday May 26th, 2017 at 7:38 AM Brooklyn Paper: Full Articles 1 Share See … Continue reading“Trump ‘aggressively pursued’ government post in USSR in 1980s – 10:53 AM 5/26/2017”

The Brooklyn Bridge bklyn-ny.net

The Brooklyn Bridge bklyn-ny.net: NYC News Student Brought Gun to Brooklyn High School: Police 10:27 AM 5/26/2017

1. Brooklyn Photos from mikenova (1 sites) 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 by By Lauren Gill Friday May 26th, 2017 at 7:38 AM Brooklyn Paper: Full Articles 1 Share See … Continue reading“NYC News Student Brought Gun to Brooklyn High School: Police – 10:27 AM 5/26/2017”

The Brooklyn Bridge bklyn-ny.net

The Brooklyn Bridge bklyn-ny.net: The Brooklyn Bridge 8:44 AM 5/26/2017

The Brooklyn Bridge from mikenova (8 sites) E! Brooklyn ebklyn.com: Community group votes to co-name BK Heights street after female BBridge mastermind 7:41 AM 5/26/2017 FB-RSS feed for Mike Nova: 5.9.17 – Welcome!Listen to 5.9.17 – Welcome! by Mike Nova 2 #np on #SoundCloud FB-RSS feed for Mike Nova: 5.9.17 – Welcome! by Mike Nova … Continue reading“The Brooklyn Bridge – 8:44 AM 5/26/2017”

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The Brooklyn Bridge bklyn-ny.net: Your Ideal Week: May 25-31, Memorial Day weekend is here 8:23 AM 5/26/2017

Your Ideal Week: May 25-31, Memorial Day weekend is hereby Kate Hooker Friday May 26th, 2017 at 8:20 AM Brooklyn Based 1 Share A carpet of bluebells is blooming at Brooklyn Botanic Garden. Photo: BBG Memorial Day weekend is nigh, and if you are jetting off the Hamptons, the Catskills, the Shore, or somewhere even … Continue reading“Your Ideal Week: May 25-31, Memorial Day weekend is here – 8:23 AM 5/26/2017”

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The Brooklyn Bridge bklyn-ny.net: Brooklyn high school student slashes teacher in eye NY Daily News New York Daily News 8:02 AM 5/26/2017

1. Brooklyn Photos from mikenova (1 sites) E! Brooklyn ebklyn.com: BKLYN.. #YourHometownTeam 5:56 PM 5/25/2017 BKLYN.. #YourHometownTeampic.twitter.com/LiQLCvDxWDby (@BKCyclones) Thursday May 25th, 2017 at 5:54 PM Twitter Search / Brooklynchamber 1 Share BKLYN.. #YourHometownTeam pic.twitter.com/LiQLCvDxWD E! Brooklyn ebklyn.com Feed Integration by RSS Dog.   Saved Stories – 1. New York and Brooklyn Brooklyn Nine-Nine creator: Finale … Continue reading“Brooklyn high school student slashes teacher in eye – NY Daily News – New York Daily News – 8:02 AM 5/26/2017”

The Brooklyn Bridge bklyn-ny.net

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

FB-RSS feed for Mike Nova: 5.9.17 – Welcome!Listen to 5.9.17 – Welcome! by Mike Nova 2 #np on #SoundCloud

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The Brooklyn Bridge bklyn-ny.net: The Brooklyn Bridge 10:25 PM 5/25/2017 | The World Web Times worldwebtimes.com: FBI homes in on Trumps son-in-law Jared Kushner in Russia probe 9:37 PM 5/25/2017

The Brooklyn Bridge from mikenova (8 sites) The World Web Times worldwebtimes.com: FBI homes in on Trumps son-in-law Jared Kushner in Russia probe 9:37 PM 5/25/2017 The Brooklyn Bridge bklyn-ny.net: The Brooklyn Bridge 6:44 PM 5/25/2017 The Brooklyn Bridge bklyn-ny.net: Gunman Fatally Shoots One Man, Wounds Another Outside Bushwick Houses: NYPD 6:08 PM 5/25/2017 E! … Continue reading“The Brooklyn Bridge – 10:25 PM 5/25/2017 | The World Web Times worldwebtimes.com: FBI homes in on Trumps son-in-law Jared Kushner in Russia probe 9:37 PM 5/25/2017”

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The Brooklyn Bridge bklyn-ny.net

The World Web Times worldwebtimes.com: FBI homes in on Trumps son-in-law Jared Kushner in Russia probe 9:37 PM 5/25/2017

FBI homes in on Trump’s son-in-law Jared Kushner in Russia probe http://dlvr.it/PF8Y3T 

Photo published for FBI homes in on Trump’s son-in-law Jared Kushner in Russia probe

FBI homes in on Trump’s son-in-law Jared Kushner in Russia probe

A series of meetings between a Russian banker, the Russian ambassador and Kushner are raising eyebrows at the FBI

salon.com

The World Web Times worldwebtimes.com

FB-RSS feed for Mike Nova: Retweeted New York Times World (@nytimesworld): Islamic terrorist groups are joining forces in the Philippines. Who are they? What do they want? And what’s next? https://t.co/luilFIUt0h https://t.co/WmGqQNI8sX

Retweeted New York Times World (@nytimesworld):

Islamic terrorist groups are joining forces in the Philippines. Who are they? What do they want? And what’s next? https://t.co/luilFIUt0h https://t.co/WmGqQNI8sX

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FB-RSS feed for Mike Nova: Retweeted Salon (@Salon):FBI homes in on Trumps son-in-law Jared Kushner in Russia probe

Retweeted Salon (@Salon):

FBI homes in on Trumps son-in-law Jared Kushner in Russia probe

FBI homes in on Trumps son-in-law Jared Kushner in Russia probe

A series of meetings between a Russian banker, the Russian ambassador and Kushner are raising eyebrows at the FBI

FB-RSS feed for Mike Nova

FB-RSS feed for Mike Nova: Retweeted Eyewitness News (@ABC7NY):’Unadoptable’ dog saved from euthanasia by Ohio police department: https://t.co/XcAnOL8THR https://t.co/VXYRfOCLA7

Retweeted Eyewitness News (@ABC7NY):

‘Unadoptable’ dog saved from euthanasia by Ohio police department: https://t.co/XcAnOL8THR https://t.co/VXYRfOCLA7

Eyewitness News (@ABC7NY) posted a photo on Twitter

Get the whole picture – and other photos from Eyewitness News

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FB-RSS feed for Mike Nova: Retweeted CNN International (@cnni): Members of the British Royal Air Force are sending a message to ISIS in a storied way — scrawled on a bomb https://t.co/Y5782TJ77g https://t.co/b2Jb34MXnI

Retweeted CNN International (@cnni):

Members of the British Royal Air Force are sending a message to ISIS in a storied way — scrawled on a bomb https://t.co/Y5782TJ77g https://t.co/b2Jb34MXnI

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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

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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…

1. Brooklyn Photos from mikenova (1 sites)
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
1 Share

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

 

Saved Stories – 1. New York and Brooklyn
Thieves in Construction Gear Steal $800K from Court Street Jeweler: NYPD
Police are searching for a group of men they say stole more than $800K as well as jewelry from a Court St. jeweler. http://brooklyn.news12.com/story/35524183/police-men-dressed-as-construction-workers-rob-jeweler 
UPS must pay $247M for shipping untaxed cigarettes in New York http://nydn.us/2rXWVUf pic.twitter.com/ndEzweHPD5
.@lsarsour commencement speech at draws fire. Opponents call on CUNY to rescind invitation http://www.brooklyneagle.com/articles/2017/5/25/sarsour-commencement-speech-draws-fire pic.twitter.com/lzBUCfu3yB
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US durable goods orders fell for first time in 5 months
US growth in Q1 revised up to 1.2 pct. but still weak
.@BMadden1954 Mets legend Tom Seaver says pitchers should “learn to pitch” or they won’t age well http://nydn.us/2rXGTtP pic.twitter.com/tat1fVbI3D
3 Brooklyn federal prison guards arrested on rape, sex abuse charges. 2 were lieutenants who ran anti-rape trainings http://gothamist.com/2017/05/25/mdc_guards_rape.php 
The Domino Factory makeover, developed by @TwoTreesNY, gets its first food shop, via @thebridgebk: http://ow.ly/BHWG30c2LV1 pic.twitter.com/CrCyDIgXza
At least 26 Coptic Christians killed in Egypt by masked gunmen
Local pols, residents question approval process for Two Bridges waterfront skyscrapers
Air Force morgue worker accused of offering to show Astronaut John Glenns dead body  http://nydn.us/2qn3O0o pic.twitter.com/jjOEEg2ejR
No L Train Service Again This Weekend
Short Report: 2017 Chevrolet Malibu Premier
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Fire damages Artichoke Basille’s Pizza in East Village
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Trump ‘aggressively pursued’ government post in USSR in 1980s
Off-duty NYPD cop arrested for selling drugs in Queens

 

Saved Stories – 1. New York and Brooklyn
Thieves in Construction Gear Steal $800K from Court Street Jeweler: NYPD

Thieves dressed in construction gear left a shop employee bloodied in the Thursday robbery, police said.
Police are searching for a group of men they say stole more than $800K as well as jewelry from a Court St. jeweler. http://brooklyn.news12.com/story/35524183/police-men-dressed-as-construction-workers-rob-jeweler 
 

Police are searching for a group of men they say stole more than $800K as well as jewelry from a Court St. jeweler. http://brooklyn.news12.com/story/35524183/police-men-dressed-as-construction-workers-rob-jeweler …

UPS must pay $247M for shipping untaxed cigarettes in New York http://nydn.us/2rXWVUf pic.twitter.com/ndEzweHPD5
 

UPS must pay $247M for shipping untaxed cigarettes in New York http://nydn.us/2rXWVUf 

.@lsarsour commencement speech at draws fire. Opponents call on CUNY to rescind invitation http://www.brooklyneagle.com/articles/2017/5/25/sarsour-commencement-speech-draws-fire pic.twitter.com/lzBUCfu3yB
 

. commencement speech at draws fire. Opponents call on CUNY to rescind invitationhttp://www.brooklyneagle.com/articles/2017/5/25/sarsour-commencement-speech-draws-fire …

OPIOID NATION: A look back at how opioid addiction plagued New York City 20 years ago http://nydn.us/2qVSDOK pic.twitter.com/sektDCCV92
 

OPIOID NATION: A look back at how opioid addiction plagued New York City 20 years agohttp://nydn.us/2qVSDOK 

US durable goods orders fell for first time in 5 months

US orders for long-lasting manufactured goods fell in April for the first time in 5 months.
US growth in Q1 revised up to 1.2 pct. but still weak

US economy grew at modest 1.2 percent rate in Q1, better than first believed but well below Trump goal.
.@BMadden1954 Mets legend Tom Seaver says pitchers should “learn to pitch” or they won’t age well http://nydn.us/2rXGTtP pic.twitter.com/tat1fVbI3D
 

. Mets legend Tom Seaver says pitchers should “learn to pitch” or they won’t age wellhttp://nydn.us/2rXGTtP 

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

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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 Epidemic in America – Update – 11:50 AM 5/26/2017

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“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.”
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Daily chart: America’s opioid epidemic is worsening

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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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America’s Addiction to Opioids: Heroin and Prescription Drug Abuse

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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 21st century.  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.

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OPIOID NATION: A look back at how opioid addiction plagued New York City 20 years ago http://nydn.us/2qVSDOK pic.twitter.com/sektDCCV92

OPIOID NATION: A look back at how opioid addiction plagued New York City 20 years agohttp://nydn.us/2qVSDOK 

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Story image for opioids epidemic in america from New York Post

The opioid epidemic tightens its grip on America

New York PostMay 20, 2017
These are just two snapshots from the plague of our time — America’s opioid epidemic. The slide into addiction is well documented: Users …

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Opioid epidemic raising American heart infections

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The opioid epidemic in the U.S. has given rise to some major heart problems amongst the people. A study was conducted last year which said …

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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
Understanding the crisis requires talking to Americans who are on the … Michigan has done admirable work against this epidemic of opioid …

Story image for opioids epidemic in america from Vox

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Tens of thousands of people will likely die of drug overdoses under President Donald Trump’s watch, as America’s horrific opioid epidemic …
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Story image for opioids epidemic in america from Vox

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

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Donald Trump didn’t mince words about it on the campaign trail: He said he would, as president, “end the opioid epidemic in America,” arguing …

Story image for opioids epidemic in america from The Epoch Times

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America’s opioid epidemic may be even deadlier and more widespread than previously thought, as a number of opioid-related deaths are …

Story image for opioids epidemic in america from The Economist

Inside the opioid epidemic

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THEY have America in a deadly grip. In 2015, the most recent year for which full statistics are available, 33,091 Americans died from opioid …
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Daily chart: America’s opioid epidemic is worsening

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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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America’s Addiction to Opioids: Heroin and Prescription Drug Abuse

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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 21st century.  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.

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Inside a Killer Drug Epidemic: A Look at America’s 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]CDC director 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]CDC director 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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A look back at how opioid addiction plagued the city 20 years ago

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One look at the front page of Sunday’s Daily News — the arm, the needle, the headline, “Opioid Nation” — took me back to a summer afternoon 20 years ago. That was the day I met Gloria Colon.

Daily News reporter Linda Yglesias and I had gone to the Hunts Point section of the Bronx for a story about an outreach effort to supply clean needles and condoms to a notorious gathering place for heroin-addicted prostitutes. Gloria was one of them.

I can still see her as I saw her then — a frail, painfully thin woman stumbling down an industrial, pocked-marked sidewalk, barely alive. Her body — all five feet and 90 pounds of it — was an emaciated ruin, with fresh wounds overlapping old ones on scarred, scabbed flesh. She had no teeth, only ill-fitting, chipped-top dentures once given to her by a john who happened to be a dentist.

When I introduced myself, she answered in a shrill, rasping voice, but there was remarkable warmth and kindness in it too. I asked if we could hang out with her to document what her life was like, and she agreed.

A Desperate Life: One woman’s struggle with heroin addiction

She led us through a mangled chain-link fence to a “shooting gallery” that was littered with broken glass, dirty needles, garbage and human waste — a place just like the one I saw in the Daily News last Sunday.

She cooked her fix, tightened her purse strap around her arm and wiped away blood as she probed for a vein. Finally, she found one, and for a moment, as the heroin took hold, she steadied herself against a wall.

What followed, though, was not the slump into oblivion seen in other addicts. It was an explosion of rage — at her need to smoke crack just to jolt herself awake, at her need to prostitute herself to support her 10-bag a day habit. As Linda wrote in our story: “Every moment of her life is an act of desperation: Converging demons of drugs and johns and violence have turned her into predator and prey.” She wanted out.

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Gloria’s story ran on the front page of Sunday, July 27, 1997. Headlined “A Desperate Life,” the eight-page chronicle of Gloria’s life on the streets hit New Yorkers hard. They could no longer look away. Gloria was not a nameless statistic— she was someone’s daughter, mother or sister.

One Day at a Time: A former heroin addict’s fight for recovery

In the days that followed, the paper was showered with calls and letters from sympathetic readers filled with compassion. Drug treatment programs, religious organizations and private citizens extended offers of help. Phoenix House was one of seven area rehab centers that put its staff on standby in case Gloria made it off the streets. “A Desperate Life” became part of the lesson plan for incarcerated women at Rikers Island. Parents used it as a cautionary tale for their children.

It’s the only story I’ve done that I know saved lives. One of them was Gloria’s.

I will never forget her horror when she saw the story herself for the first time. It was her mirror. “This will either be my way out or my obit,” she said.

Gloria entered rehab shortly after publication. She spent months in Phoenix House, the 50-year-old drug-treatment facility, battling her demons and fighting through her addiction. When we visited her there, the managing director, Loretta Hinton, told us, “I haven’t seen that kind of abuse of anyone’s body in 20 years.”

Here’s who to contact if you’re struggling with opioid addiction

“A hundred times I’ve thought about leaving,” Gloria told us then. “But I take ‘A Desperate Life’ out of my drawer to make myself remember.”

She and her fellow addicts called their group “chrysalis,” a hopeful image of butterflies in gestation.

And on Sunday, Nov. 30, 1997, the Daily News was able to celebrate her successful metamorphosis in “A New Life,” another eight-page special report, this one a story of recovery.

Gloria was luckier than some others at Phoenix House: She had the love and support of a devoted family behind her. They cheered her on, and the city cheered her on.

How NYC’s opioid epidemic plays out in the Bronx

And, of course, I cheered her on too. By then we had developed a deep and lasting bond of friendship.

Her delightfully squeaky voice on the other end of the telephone always sounded like music to me during our many late-night phone calls, and the family barbeques she invited me to were filled with love, laughter and dancing.

On the 4th of July 2009, Gloria messaged me: “Girl how are you? We have to talk and by the way I am still clean and sober. [I]am living and working in the bx. You would never believe what I do 4 a living…substance abuse counselor! Please call me.”

Gloria died on January 9, 2015, five days after her 51st birthday. She was 33 when I met her. During those eighteen additional years that her body allowed her to live, she gave others the courage to save themselves from addiction, and she got the chance to raise her beautiful daughter, who had been taken from her as a one-year-old.

NYC mother’s loss echoes national heroin addiction crisis

Gloria emerged from her chrysalis as one of the strongest and most inspirational people I have ever known. She had her setbacks, as all of us do, but she never gave up. And nobody ever gave up on her.

“Now I’m really doing the most desperate thing,” she said once. “Living.”

I feel privileged to have known her. I will miss her dearly.

Susan Watts has been an award-winning photojournalist in New York City for more than 20 years. Since 1995, she’s been a staff photographer at the Daily News covering local, national and international news stories.

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OPIOID NATION: A look back at how opioid addiction plagued New York City 20 years ago – 11:08 AM 5/26/2017

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OPIOID NATION: A look back at how opioid addiction plagued New York City 20 years ago

OPIOID NATION: A look back at how opioid addiction plagued New York City 20 years ago http://nydn.us/2qVSDOK pic.twitter.com/sektDCCV92

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Trump ‘aggressively pursued’ government post in USSR in 1980s
 

mikenova shared this story from Politics Rss Article only.

Donald Trump, in the mid-1980s, aggressively pursued an official government post to the USSR, according to a Nobel Peace Prize winner with whom Trump interacted at the time.

“He already had Russia mania in 1986, 31 years ago,” asserts Bernard Lown, a Boston-area cardiologist known for inventing the defibrillator and sharing the 1985 Nobel Peace Prize with a top Soviet physician in recognition of their efforts to promote denuclearization.

Lown, now 95 and retired in Newton, Mass., tells The Hollywood Reporter that Trump sought and secured a meeting with him in 1986 to solicit information about Mikhail Gorbachev. (Gorbachev had become the USSR’s head of state — and met with Lown — the year before.)

During this meeting, Lown says, the fast-rising businessman disclosed that he would be reaching out to then-president Ronald Reagan to try to secure an official post to the USSR in order to negotiate a nuclear disarmament deal on behalf of the United States, a job for which Trump felt he was the only one fit.

“He said to me, ‘I hear you met with Gorbachev, and you had a long interview with him, and you’re a doctor, so you have a good assessment of who he is,'” Lown recalls.

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“So I asked, ‘Why would you want to know?’ And he responded, ‘I intend to call my good friend Ronnie,’ meaning Reagan, ‘to make me a plenipotentiary ambassador for the United States with Gorbachev.’ Those are the words he used. And he said he would go to Moscow and he’d sit down with Gorbachev, and then he took his thumb and he hit the desk and he said, ‘And within one hour the Cold War would be over!’ I sat there dumbfounded. ‘Who is this self-inflated individual? Is he sane or what?'”

The White House did not respond to a request for comment.

Lithuania-born Lown, who today is professor of cardiology emeritus at the Harvard School of Public Health, had been the subject of considerable media attention shortly before he first heard the name Trump.

In October 1985, he and Yevgeny I. Chazov, the personal physician of the Kremlin’s senior leadership (including Gorbachev), were chosen to share the Nobel Peace Prize on behalf of International Physicians for the Prevention of Nuclear War, a group they co-founded in 1980 that had grown to include more than 150,000 members in 49 countries.

And in December 1985, shortly after collecting their Nobel medals in Oslo, Lown joined Chazov for a meeting at the Kremlin with Gorbachev, who unexpectedly had come into power that March, making Lown one of the first Westerners to spend time with him.

It wasn’t long after Lown returned to the United States that he learned about Trump. “I get a call from New York and it was a Wall Street broker who was a friend of Trump’s,” Lown recalls, declining to name the individual.

“He says, ‘Trump would like to see you,’ and I said, ‘Who is Trump?’ I had no idea.”

He continues, “This fellow was a member of the board of the Lown Cardiovascular Research Foundation, this Wall Street fellow, and he knew that we were short on funds for the research that I outlined and that we had to do in the following few years. He says, ‘Here’s somebody who might be a source of [FUNDING]. Why don’t you meet him? He wants to talk to you — he asked me to arrange it.’ So I came into New York and went to Trump Tower and met him for lunch.”

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Lown says it quickly became apparent that Trump had an agenda of his own. “I was sitting there in this glass bubble, overlooking New York, and feeling, ‘What am I doing here?'” he recalls. “He seemed totally disjointed.”

“I talked to [TRUMP]extensively about my experience with Gorbachev,” Lown recalls. “I talked for about 20 minutes or so, about how I thought Gorbachev behaved, blah, blah, and he sat there, sort of listening. He was fidgeting and I realized he had a short attention span.”

Lown emphasizes that the whole situation felt strange.

“I thought there was another agenda, perhaps, but I didn’t know what that was,” he says. “I was not sure about his motivation for why he was doing it. But it puts together sort of a continuum that began way back in ’86, with his fixation on Russia — the Soviet Union, then.”

Trump and Lown never spoke again.

Though the lengths to which Trump went to learn about Gorbachev and to secure an official post from the Americans never have been revealed, Trump’s interest in “making a deal” with the Soviets was widely reported — and mocked — at the time.

In an April 8, 1984 profile in The New York Times, Trump revealed that concern about a nuclear holocaust had plagued him since his uncle, the groundbreaking nuclear physicist Dr. John Trump, first spoke to him about it 15 years earlier.

“His greatest dream is to personally do something about the problem,” wrote the Times’ William E. Geist (NBC anchor Willie Geist’s father), “and, characteristically, Donald Trump thinks he has an answer to nuclear armament: Let him negotiate arms agreements — he who can talk people into selling $100 million properties to him for $13 million.”

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Geist continued, somewhat snarkily, “The idea that he would ever be allowed to go into a room alone and negotiate for the United States, let alone be successful in disarming the world, seems the naive musing of an optimistic, deluded young man who has never lost at anything he has tried. But he believes that through years of making his views known and through supporting candidates who share his views, it could happen someday.”

Trump expounded on these ambitions in a November 15, 1984 Washington Post profile at the urging, he said, of his mentor and lawyer Roy Cohn, who was best known as Joseph McCarthy’s chief counsel during the Army-McCarthy hearings.

The Post’s Lois Romano asked Trump for specifics about how he would approach a U.S.-Soviet deal, and recounted how he demurred (using terms familiar to those who followed the 2016 presidential campaign): “‘I wouldn’t want to make my opinions public,’ he says. ‘I’d rather keep those thoughts to myself or save them for whoever else is chosen… It’s something that somebody should do that knows how to negotiate and not the kind of representatives that I have seen in the past.’ He could learn about missiles, quickly, he says. ‘It would take an hour-and-a-half to learn everything there is to learn about missiles… I think I know most of it anyway. You’re talking about just getting updated on a situation.'”

In Ron Rosenbaum’s November 1985 profile of Trump in Manhattan, Inc. magazine (later republished as part of the 1987 book Manhattan Passions: True Tales of Power, Wealth and Excess), Trump discussed his obsession with brokering this ultimate deal, stating, “Nothing matters as much to me now.”

He coyly suggested that he already was “dealing at a very high level on this,” hinting at connections in Washington and at the White House, and that negotiators like him were needed: “There’s a vast difference between somebody who’s been consistently successful and somebody who’s been working for a relatively small amount of money in governmental service for many years, in many cases because the private sector, who have seen these people indirectly, didn’t choose to hire these people, any of them, because it didn’t find them to be particularly capable.”

By December 1985, Trump’s infatuation with negotiating a deal between the Americans and the Soviets was so widely known that The New York Times’ George Vecsey proclaimed, “People used to titter when Donald Trump said he wanted to broker a nuclear-arms reduction… If the United States gave Donald Trump an official title and let him loose on the arms race, he might lay off on his threat to darken the western sky of Manhattan with his personal Brasilia North. Make peace, not skyscrapers, that’s the general idea.”

It wasn’t long after the Trump-Lown meeting in 1986 that Trump made his first trip to the Soviet Union: In July 1987, he traveled to Moscow and met with Gorbachev.

“The ostensible subject of their meeting was the possible development of luxury hotels in the Soviet Union by Mr. Trump,” The New York Times wrote at the time. “But Mr. Trump’s calls for nuclear disarmament were also well-known to the Russians.” (Trump told Playboy three years later, “Generally, these guys are much tougher and smarter than our representatives.”)

In the fall of 1987, Trump, a registered Republican who had made large contributions to Democrats as well, hinted that he might make a run for the presidency in 1988 — but for which party it wasn’t clear.

That Sept. 2, he took out a full-page advertisement in three major newspapers criticizing the Reagan Administration’s foreign policy under the headline, “There’s nothing wrong with America’s Foreign Defense Policy that a little backbone can’t cure.” Asked why he had done so, his spokesperson said, “There is absolutely no plan to run for mayor, governor or United States senator. He will not comment about the Presidency.” A month later, though, he did: ”I’m not running for anything,” he told The New York Times, while adding, ”I believe that if I did run for President, I’d win.”

Trump went on to give a series of political speeches that fall, some of which, according to the Times, touched on “speeding up nuclear disarmament negotiations with the Soviet Union.”

In December 1987, Gorbachev made an historic three-day trip to the U.S. for a summit with Reagan that included a White House state dinner. There, in a receiving line, was Trump, whom Gorbachev had met in Moscow just five months earlier.

Trump subsequently recounted their conversation to The Washington Post: “They want to have a great hotel, and they want me to be the one to do it.”

Trump didn’t run for president in 1988. A Trump hotel never was built in the Soviet Union, which collapsed in 1991. But Trump’s interactions with Russia were only just beginning.

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Trump ‘aggressively pursued’ government post in USSR in 1980s – 10:53 AM 5/26/2017

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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.

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Trump ‘aggressively pursued’ government post in USSR in 1980s

mikenova shared this story from Politics Rss Article only.

Donald Trump, in the mid-1980s, aggressively pursued an official government post to the USSR, according to a Nobel Peace Prize winner with whom Trump interacted at the time.

“He already had Russia mania in 1986, 31 years ago,” asserts Bernard Lown, a Boston-area cardiologist known for inventing the defibrillator and sharing the 1985 Nobel Peace Prize with a top Soviet physician in recognition of their efforts to promote denuclearization.

Lown, now 95 and retired in Newton, Mass., tells The Hollywood Reporter that Trump sought and secured a meeting with him in 1986 to solicit information about Mikhail Gorbachev. (Gorbachev had become the USSR’s head of state — and met with Lown — the year before.)

During this meeting, Lown says, the fast-rising businessman disclosed that he would be reaching out to then-president Ronald Reagan to try to secure an official post to the USSR in order to negotiate a nuclear disarmament deal on behalf of the United States, a job for which Trump felt he was the only one fit.

“He said to me, ‘I hear you met with Gorbachev, and you had a long interview with him, and you’re a doctor, so you have a good assessment of who he is,'” Lown recalls.

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“So I asked, ‘Why would you want to know?’ And he responded, ‘I intend to call my good friend Ronnie,’ meaning Reagan, ‘to make me a plenipotentiary ambassador for the United States with Gorbachev.’ Those are the words he used. And he said he would go to Moscow and he’d sit down with Gorbachev, and then he took his thumb and he hit the desk and he said, ‘And within one hour the Cold War would be over!’ I sat there dumbfounded. ‘Who is this self-inflated individual? Is he sane or what?'”

The White House did not respond to a request for comment.

Lithuania-born Lown, who today is professor of cardiology emeritus at the Harvard School of Public Health, had been the subject of considerable media attention shortly before he first heard the name Trump.

In October 1985, he and Yevgeny I. Chazov, the personal physician of the Kremlin’s senior leadership (including Gorbachev), were chosen to share the Nobel Peace Prize on behalf of International Physicians for the Prevention of Nuclear War, a group they co-founded in 1980 that had grown to include more than 150,000 members in 49 countries.

And in December 1985, shortly after collecting their Nobel medals in Oslo, Lown joined Chazov for a meeting at the Kremlin with Gorbachev, who unexpectedly had come into power that March, making Lown one of the first Westerners to spend time with him.

It wasn’t long after Lown returned to the United States that he learned about Trump. “I get a call from New York and it was a Wall Street broker who was a friend of Trump’s,” Lown recalls, declining to name the individual.

“He says, ‘Trump would like to see you,’ and I said, ‘Who is Trump?’ I had no idea.”

He continues, “This fellow was a member of the board of the Lown Cardiovascular Research Foundation, this Wall Street fellow, and he knew that we were short on funds for the research that I outlined and that we had to do in the following few years. He says, ‘Here’s somebody who might be a source of [FUNDING]. Why don’t you meet him? He wants to talk to you — he asked me to arrange it.’ So I came into New York and went to Trump Tower and met him for lunch.”

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Lown says it quickly became apparent that Trump had an agenda of his own. “I was sitting there in this glass bubble, overlooking New York, and feeling, ‘What am I doing here?'” he recalls. “He seemed totally disjointed.”

“I talked to [TRUMP]extensively about my experience with Gorbachev,” Lown recalls. “I talked for about 20 minutes or so, about how I thought Gorbachev behaved, blah, blah, and he sat there, sort of listening. He was fidgeting and I realized he had a short attention span.”

Lown emphasizes that the whole situation felt strange.

“I thought there was another agenda, perhaps, but I didn’t know what that was,” he says. “I was not sure about his motivation for why he was doing it. But it puts together sort of a continuum that began way back in ’86, with his fixation on Russia — the Soviet Union, then.”

Trump and Lown never spoke again.

Though the lengths to which Trump went to learn about Gorbachev and to secure an official post from the Americans never have been revealed, Trump’s interest in “making a deal” with the Soviets was widely reported — and mocked — at the time.

In an April 8, 1984 profile in The New York Times, Trump revealed that concern about a nuclear holocaust had plagued him since his uncle, the groundbreaking nuclear physicist Dr. John Trump, first spoke to him about it 15 years earlier.

“His greatest dream is to personally do something about the problem,” wrote the Times’ William E. Geist (NBC anchor Willie Geist’s father), “and, characteristically, Donald Trump thinks he has an answer to nuclear armament: Let him negotiate arms agreements — he who can talk people into selling $100 million properties to him for $13 million.”

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Geist continued, somewhat snarkily, “The idea that he would ever be allowed to go into a room alone and negotiate for the United States, let alone be successful in disarming the world, seems the naive musing of an optimistic, deluded young man who has never lost at anything he has tried. But he believes that through years of making his views known and through supporting candidates who share his views, it could happen someday.”

Trump expounded on these ambitions in a November 15, 1984 Washington Post profile at the urging, he said, of his mentor and lawyer Roy Cohn, who was best known as Joseph McCarthy’s chief counsel during the Army-McCarthy hearings.

The Post’s Lois Romano asked Trump for specifics about how he would approach a U.S.-Soviet deal, and recounted how he demurred (using terms familiar to those who followed the 2016 presidential campaign): “‘I wouldn’t want to make my opinions public,’ he says. ‘I’d rather keep those thoughts to myself or save them for whoever else is chosen… It’s something that somebody should do that knows how to negotiate and not the kind of representatives that I have seen in the past.’ He could learn about missiles, quickly, he says. ‘It would take an hour-and-a-half to learn everything there is to learn about missiles… I think I know most of it anyway. You’re talking about just getting updated on a situation.'”

In Ron Rosenbaum’s November 1985 profile of Trump in Manhattan, Inc. magazine (later republished as part of the 1987 book Manhattan Passions: True Tales of Power, Wealth and Excess), Trump discussed his obsession with brokering this ultimate deal, stating, “Nothing matters as much to me now.”

He coyly suggested that he already was “dealing at a very high level on this,” hinting at connections in Washington and at the White House, and that negotiators like him were needed: “There’s a vast difference between somebody who’s been consistently successful and somebody who’s been working for a relatively small amount of money in governmental service for many years, in many cases because the private sector, who have seen these people indirectly, didn’t choose to hire these people, any of them, because it didn’t find them to be particularly capable.”

By December 1985, Trump’s infatuation with negotiating a deal between the Americans and the Soviets was so widely known that The New York Times’ George Vecsey proclaimed, “People used to titter when Donald Trump said he wanted to broker a nuclear-arms reduction… If the United States gave Donald Trump an official title and let him loose on the arms race, he might lay off on his threat to darken the western sky of Manhattan with his personal Brasilia North. Make peace, not skyscrapers, that’s the general idea.”

It wasn’t long after the Trump-Lown meeting in 1986 that Trump made his first trip to the Soviet Union: In July 1987, he traveled to Moscow and met with Gorbachev.

“The ostensible subject of their meeting was the possible development of luxury hotels in the Soviet Union by Mr. Trump,” The New York Times wrote at the time. “But Mr. Trump’s calls for nuclear disarmament were also well-known to the Russians.” (Trump told Playboy three years later, “Generally, these guys are much tougher and smarter than our representatives.”)

In the fall of 1987, Trump, a registered Republican who had made large contributions to Democrats as well, hinted that he might make a run for the presidency in 1988 — but for which party it wasn’t clear.

That Sept. 2, he took out a full-page advertisement in three major newspapers criticizing the Reagan Administration’s foreign policy under the headline, “There’s nothing wrong with America’s Foreign Defense Policy that a little backbone can’t cure.” Asked why he had done so, his spokesperson said, “There is absolutely no plan to run for mayor, governor or United States senator. He will not comment about the Presidency.” A month later, though, he did: ”I’m not running for anything,” he told The New York Times, while adding, ”I believe that if I did run for President, I’d win.”

Trump went on to give a series of political speeches that fall, some of which, according to the Times, touched on “speeding up nuclear disarmament negotiations with the Soviet Union.”

In December 1987, Gorbachev made an historic three-day trip to the U.S. for a summit with Reagan that included a White House state dinner. There, in a receiving line, was Trump, whom Gorbachev had met in Moscow just five months earlier.

Trump subsequently recounted their conversation to The Washington Post: “They want to have a great hotel, and they want me to be the one to do it.”

Trump didn’t run for president in 1988. A Trump hotel never was built in the Soviet Union, which collapsed in 1991. But Trump’s interactions with Russia were only just beginning.

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Plates of Cake/Hans Chew/Rosali/Dark Tea Union Pool Sat May 27 Brooklyn Local News

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Plates of Cake/Hans Chew/Rosali/Dark Tea – Union Pool Sat May 27

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What Mussolini and Democrats Have in Common: Neo-Fascism is in Fashion

mikenova shared this story from Observer.

“You’re a fascist!” Today this is a label as commonly hurled as it is poorly understood. President Donald Trump, that progressive New York guy, is a fascist, we’re told. Then there’s the Antifa (“anti-fascist action”) movement, which “fights” the F-threat by committing violence in the streets like Brownshirts. Well played.

The Online Etymology Dictionary, generally sober in its rendering of information, amusingly writes of “fascism” that it was applied to certain groups’ ideology from 1923 and has been “applied to everyone since the internet.” In reality, however, the term’s misapplication didn’t start with the virtual world but with virtual history. Yet since I’m fairly sure at least a few of us aren’t fascists, let’s examine what the ideology is, starting with what it isn’t.

Authentic fascism never had, contrary to popular belief, a racial agenda. Its primary founding father, Italian dictator Benito Mussolini, said in 1932, “Race? It is a feeling, not a reality. Ninety-five percent, at least. Nothing will ever make me believe that biologically pure races can be shown to exist today… National pride has no need of the delirium of race.”

The fascists considered racialism destructive of one of their chief aims: national unity. In fact, when Mussolini deferred to Adolf Hitler and enacted some anti-Jewish laws (strictly speaking, these weren’t “racial” laws, but reflected their spirit) just prior to WWII, they were often decried as anti-fascist.

A Creature of the Right?

Mussolini had always been a socialist. He’d actually been the chief editor of the Italian Socialist Party’s newspaper Avanti! (in Italian, “Forward!” which, interestingly, became one of Barack Obama’s slogans). He was expelled at WWI’s start—but not for rejecting socialist dogma. Rather, while the party opposed the war, Mussolini was among a group of dissident leftists who wanted to fight Germany and Austria-Hungary to, you might say, “make the world safe for socialism.”

While a spurned child of the ideology, one of its progeny he remained. At the 1914 Milan Socialist Party meeting where his expulsion was announced, he shouted, “You cannot get rid of me because I am and always will be a socialist. You hate me because you still love me.” And he perhaps had a point. Vladimir Lenin said before a delegation of Italian socialists in 1922, “What a waste that we lost Mussolini. He is a first-rate man who would have led our party to power in Italy.”

Writer George Bernard Shaw, a Fabian Society socialist, might have seconded this endorsement. He once said of the dictator, “Mussolini was further to the left in his political opinions than any of his socialist rivals.” UC Berkeley Professor of Political Science Emeritus Anthony James Gregor, known for research on fascism and Marxism, has called Mussolini “a Marxist ‘heretic.’”

Having said this, there’s debate and confusion over whether Mussolini (and Hitler) was left or right largely because the terms themselves are confusing—and relative. Originating with the French Revolution in 1789, the designations were born because monarchists sat on the right side in the National Assembly, while republicans (that is, those endeavoring to create a republic) occupied the left. Of course, rightists today don’t espouse monarchism, and American leftists fight republicans—at least the capital “R” variety.

Noting that “right” and “left” correspond with “conservative” and “liberal,” also consider that while 1950s American conservatives were staunchly anti-communist, a conservative in the Soviet Union was a communist. And today, European “conservatives” are far more “liberal” than ours.

The explanation is that the only consistent definitions of “conservative” and “liberal” are, respectively, a “desire to maintain the status quo” and a “desire to change it;” thus, as the status quo varies from time to time and place to place, so do the actual beliefs represented by the two political terms.

So the first question is not whether fascism is left or right (in fact, its adherents called it “the Third Way”), which can be a distraction. Before we can place it anywhere on any political spectrum, we must ask: What are actual fascist beliefs?

The ideology, again, was birthed at WWI’s inception when the Italian left split over involvement in the conflict. Mussolini then became the primary founder of fascism, whose name largely derives from the fasces, a “bundle of rods containing an axe with the blade projecting” that would be carried before a Roman magistrate and which symbolized power. But what kind of power was Mussolini’s focus?

Well, as the dictator described fascism, “All within the state, nothing outside the state, nothing against the state.” Does this sound more like American traditionalists, with their focus on small government, or the Democrats, who seek to unconstitutionally centralize and aggregate ever more power?

Mussolini also once said, “I declare that henceforth capital and labor shall have equal rights and duties as brothers in the fascist family.” Is this reminiscent of American conservatives and their emphasis on economic freedom or the class warfare and regulatory tyranny of our left?

The Italian additionally stated in 1924, “God does not exist—religion in science is an absurdity, in practice an immorality and in men a disease.” Does this sound more like a party known for its “Christian Right” or one whose standard bearer once derided Middle America for clinging to “religion”?

The sad reality is that a neo-fascism is in fashion today, but not because of Trump. Rather, by growing government, empowering it to regulate most everything and allowing “crony capitalism,” we get ever closer to Mussolini’s ideal, “All within the state, nothing outside the state, nothing against the state.”

And the dictator certainly agreed. Praising Democrat icon Franklin Roosevelt’s 1933 book Looking Forward, he wrote, “Reminiscent of Fascism is the principle that the state no longer leaves the economy to its own devices… Without question, the mood accompanying this [New Deal] sea change resembles that of Fascism.”

Whether we view Mussolini as a man of the “left” or just a man who left sanity, the similarities between fascism’s founding father and our liberals should make them just a tad nervous. It certainly had this effect on one of them, late leftist activist and politician Tom Hayden.

During a radio appearance on “The Chip Wood Show” years ago, Hayden was accused by a caller of being a “communist agitator.” The host defended him, saying that Hayden had no problem with business remaining in private hands as long as the government guaranteed things were done “fairly.” Hayden agreed, providing several examples of how the state must ensure goods and services are distributed equitably.

Wood related their conversation’s denouement in 2010. He told Hayden, “‘What you’ve described isn’t communism or socialism. …Isn’t the system you want—where ownership remains in private hands, but its use is controlled by government—actually a form of fascism?’”

“There was a stunned silence as I continued, ‘In fact, Tom, isn’t it fair to say that the economic system you want to impose on us in the United States is actually classical fascism, as practiced in Hitler’s Germany and Mussolini’s Italy?’”

Hayden’s response? “Click.” He’d hung up the phone. And that’s what happens when you’re hung up on an ideology that may not be quite as “liberal” as you’d like to fancy.

Your Ideal Week: May 25-31, Memorial Day weekend is here

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A carpet of bluebells is blooming at Brooklyn Botanic Garden. Photo: BBG Memorial Day weekend is nigh, and if you are jetting off the Hamptons, the Catskills, the Shore, or somewhere even more exotic, well, good for you, lucky duck! The rest of us will be here holding down the fort, but dont feel too bad for us because there is–as always–a lot to do around these parts over the course of the next week. On Friday night, lace up your skates and get ready to do the hustle at Lola Stars Dreamland Roller Disco, which is doing Saturday Night Fever-themed version of its popular skate night at the LeFrak Center in Prospect Park from 7:30-10pm. After selling out a Friday night show at Kings Theater, Nick Cave & The Bad Seeds have added a second night on Saturday and there are still tickets available. If you happened to catch them… Read MoreThe post Your Ideal Week: May 25-31, Memorial Day weekend is here appeared first on Brooklyn Based.

I have several different accents; The Brooklyn accent, Long Island accent, and the Northern NY accent. #NYBot

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I have several different accents; The Brooklyn accent, Long Island accent, and the Northern NY accent.

This #MemorialDayWknd enjoy ALL day access to @AviatorSports’ most popular activities & games. Find more here: http://aviatorsports.com/things-to-do/day-pass pic.twitter.com/mEszTYaAE2

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This enjoy ALL day access to ‘ most popular activities & games. Find more here: http://aviatorsports.com/things-to-do/day-pass …

The deadline to enter the Greenest Block in Brooklyn contest coming up fast, only one week away. More info:

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The deadline to enter the Greenest Block in Brooklyn contest coming up fast, only one week away. More info:

Deadline to enter Greenest Block in Brooklyn contest coming up fast

This weekend brings the unofficial start of summer, meaning its time for organizations and civic groups to enter the 23rd Annual Greenest Block in…

Photo – Thursday’s Front Page:Navy Divers: http://ow.ly/jA5630c1g4p1 Hotel: http://ow.ly/xROA30c1gErJehovah’s Witnesses: http://ow.ly/BZ6l30c1gj4

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Thursday’s Front Page:

Navy Divers: http://ow.ly/jA5630c1g4p
1 Hotel: http://ow.ly/xROA30c1gEr
Jehovah’s Witnesses: http://ow.ly/BZ6l30c1gj4

Report: Jehovah’s Witnesses line up a buyer for 74 Adams St. in DUMBO http://www.brooklyneagle.com/articles/2017/5/24/report-jehovahs-witnesses-line-buyer-74-adams-st-dumbo

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Report: Jehovah’s Witnesses line up a buyer for 74 Adams St. in DUMBO http://www.brooklyneagle.com/articles/2017/5/24/report-jehovahs-witnesses-line-buyer-74-adams-st-dumbo

Report: Jehovah’s Witnesses line up a buyer for 74 Adams St. in DUMBO

Going, going, gone.

The Jehovah’s Witnesses have found a buyer for one of their last Brooklyn properties, The Real Deal has reported.

Fleet Week NY: U.S. Navy divers swim with stingrays at New York Aquarium

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Fleet Week NY: U.S. Navy divers swim with stingrays at New York Aquarium

‘We do our part to keep the ships ready to fight at a moments notice’

This weekend, the Navy divers will perform tricks and showcase their skills in Times Square inside a portable tank.

PHOTOS: #Brooklyn Heights Library comes down, section by section. Stone friezes have been removed. #Libraries #NYC http://www.brooklyneagle.com/articles/2017/5/24/brooklyn-heights-library-comes-down-section-photos pic.twitter.com/fzRaoWuc8c

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PHOTOS: Heights Library comes down, section by section. Stone friezes have been removed. http://www.brooklyneagle.com/articles/2017/5/24/brooklyn-heights-library-comes-down-section-photos …

Shopkeeper injured in violent jewelry store robbery on Court Street in #Brooklyn Heights. Perp fled down subway. http://www.brooklyneagle.com/articles/2017/5/25/shopkeeper-injured-violent-jewelry-store-robbery-court-street-brooklyn-heights pic.twitter.com/lr1vpRkYA4

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Shopkeeper injured in violent jewelry store robbery on Court Street in Heights. Perp fled down subway. http://www.brooklyneagle.com/articles/2017/5/25/shopkeeper-injured-violent-jewelry-store-robbery-court-street-brooklyn-heights …

The deadline to enter the Greenest Block in Brooklyn contest coming up fast, only one week away. More info: http://www.brooklyneagle.com/articles/2017/5/25/deadline-enter-greenest-block-brooklyn-contest-coming-fast pic.twitter.com/688zyxpoZd

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The deadline to enter the Greenest Block in Brooklyn contest coming up fast, only one week away. More info: http://www.brooklyneagle.com/articles/2017/5/25/deadline-enter-greenest-block-brooklyn-contest-coming-fast …

.@FleetWeekNYC : US Marine Corps host 1st Marine Day in #Brooklyn Sat. 5K w/ Marines, robot display, martial arts… http://www.brooklyneagle.com/articles/2017/5/23/fleet-week-new-york-2017-kicks-parade-ships pic.twitter.com/BXFE86D8mZ

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. : US Marine Corps host 1st Marine Day in Sat. 5K w/ Marines, robot display, martial arts… http://www.brooklyneagle.com/articles/2017/5/23/fleet-week-new-york-2017-kicks-parade-ships …

Norwegian Ridgites march in 17th of May Parade

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By Caroline Spivack

Brooklyn Daily

They were decked out in red, white, and blue — but not for the country you’d think.

An army of Norwegian Ridgites took to Third Avenue for the 65th-annual Norwegian Day parade on May 21. Once a bastion of Scandinavian culture, Bay Ridge’s Nordic community has since dwindled, but every year the parade draws out Norwegians eager to show off their pride for the land of the midnight sun, said one marcher.

“It’s a wonderful celebration that lets us share our traditions,” said Ridgite Anna Pederson, who marched in the parade in a traditional folk costume — known as a bunad — from the Bergen region of Norway, with her 4-year-old grand daughter. “It’s so exciting to see everyone so excited for Norwegian culture, and it’s a great way for me to expose the little one to her roots.”

Hundreds donned Viking garb and traditional Norwegian clothes, which differs depending on what part of the country folks hail from, for the procession that celebrates the signing of Norway’s constitution on May 17, 1814.

The parade is officially known as the 17th of May Parade but is traditionally held on the nearest Sunday. The vibrant march kicked off at Third Avenue and First Street whence it winded its way down to Lief Erikson Park.

Kristen Johnson, who was crowned Miss Norway in April, cruised along the thoroughfare greeting locals who lined the main street. Viking ships sailed behind her, along with a crew of marching bands, accordionists, and bagpipe players.

“I just loved it. There’s not enough events like these that celebrate our culture and to have this in our own backyard is just so cool,” said Bay Ridgite Maria Hagan, whose family is originally from Oslo and initially settled in Sunset Park, where thousands of Scandinavians emigrated stretching back to the 1890s.

And many of those Norwegians moved up to Bay Ridge by the mid-20th Century, which is why the procession is so crucial not only for its historic importance but for keeping the Norwegian traditions alive in Southern Brooklyn.

“It’s a really important celebration for our history,” said Hagan. “But I also think it’s great that people have managed to keep this parade going for so long because it keeps the culture alive in Bay Ridge.”

Reach reporter Caroline Spivack at cspivack@cnglocal.com or by calling (718) 260–2523. Follow her on Twitter @carolinespivack.

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Mystery solved! Russian billionaires yacht cant dock because it is illegal

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By Caroline Spivack

Brooklyn Daily

A yacht owned by a Russian oligarch that has floated in Gravesend Bay for more than a month — and drifted there throughout President Trump’s first visit to the city since taking office — is sitting idle because it is illegal for the vessel to dock.

The massive German-made ship Le Grand Bleu is owned by Russian-born billionaire and oil tycoon Eugene Shvidler — who became a U.S. citizen in 1994 — flies Bermuda’s flag. And because the vessel is not a U.S.-flagged ship, was not constructed in the U.S., and is not crewed exclusively by U.S. citizens, federal law prohibits the boat from directly sailing from one American port to the next.

The Merchant Marine Act of 1920, also known as the Jones Act, regulates maritime commerce on domestic waters and solely allows U.S. ships to sail from one local port to the next with ease. Originally intended to promote U.S. shipping, it is a law that has since rocked the boat for those who man foreign flagged ships to avoid steep U.S. taxes or sidestep regulations, according to maritime lawyer Jim Walker.

Shvidler’s ship set sail from Florida on April 13 and cast anchor in Gravesend Bay on April 16, where it has and will remain for as long as he’s in town, unless he wants to incur a hefty fine for docking in New York Harbor or run the risk of the government towing away his football field-length vessel.

Penalties for pulling up to a pier in violation of the Jones Act vary with the value of the merchandise the boat is carrying or of the cost of transportation — whichever tallies up to a higher sum — but can easily soar into the millions. In fact, in April the Department of Justice slapped an Alsakan company a whopping $10 million fine for using a Chinese ship to transport gear from the Gulf of Mexico to Alaska — the fee is the largest in history of the Jones Act.

It is possible to get a waiver, but only in extreme circumstances where it is considered necessary in the interest of national defense. For the Exxon Valdez spill in 1989, for instance, waivers were granted for foreign-flag oil skimming barges to help clean the mess until U.S. vessels could replace the ships.

But Shivdler can — and probably has — take his speedboat out for a spin and set foot in the city for a tamer $300 fee.

Le Grand Bleu was given to Shivdler in 2006 by his business partner and fellow billionaire Roman Abramovich who is pal to Russian President Valdamir Putin. The vessel comes complete with a 65-person crew, helicopter, aquarium, and speedboat.

It’s unclear how long Shivdler plans to anchor in the bay and what business has brought him to New York, and we could not reach him for comment or even to get a free tour of the yacht.

Reach reporter Caroline Spivack at cspivack@cnglocal.com or by calling (718) 260–2523. Follow her on Twitter @carolinespivack.

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Time to relax in the Ridge

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By Caroline Spivack

Brooklyn Daily

Bay Ridge is gearing up to stay put!

Memorial Day weekend is here, and we suggest spending your extra-long break from work on a leisurely staycation right here in Brooklyn’s best neighborhood, where there are plenty of sights and new spots to visit.

Kick off your weekend with a relaxing stroll along Fifth Avenue for the Storefront Art Walk (Fifth Avenue between 68th and 83rd streets), featuring the work of 15 painters, photographers, craftsmen, and others artists, who have spruced up the window fronts of stores along the commercial corridor. Among the installations you’ll find comic book-inspired sketches, razor wire sculptures, and whimsical window murals.

After you’ve sated your appetite for culture, tour a few new-to-the-nabe joints and satisfy your hunger for good grub. Third Avenue has a collection of new spots that offer something for everyone in your crew.

Stroll over the Georgian Dream Cafe (8309 Third Ave. between 83rd and 84th streets) for a cozy space with Eastern European comfort food including khinkali, known as Georgian dumplings, and a bubbling cheese bread topped with runny egg called acharuli khachapuri that is perfect for sharing. Or sink your teeth into some souvlaki at the Blue Door Souvlakia (8413 Third Ave. between 85th and 84th), which has an atmosphere that will make you think you’re kicking back on the Greek island of Santorini. Then satisfy your post-meal sweet tooth with a smoothie or fruit bowl at the funky health food joint Baya Bowls (9417 Third Ave. between 94th and 95th), which serves cleverly named treats like the “Acai-U-Later” smoothie, the “Bella Nutella” shake, and — our personal favorite — the “Kale Mary.”

Finally, cap your weekend with a cruise on one of the city’s new ferries for a nautical view of your favorite nabe. Venture just north of Bay Ridge to Sunset Park’s Brooklyn Army Terminal (80 58th St. at First Avenue), where a mere $2.75 will score you a 45-minute spin to the Rockaways, complete with a cruise parallel to the Ridge and up close and personal view of the Verrazano–Narrows Bridge.

Reach reporter Caroline Spivack at cspivack@cnglocal.com or by calling (718) 260–2523. Follow her on Twitter @carolinespivack.

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Light showers: Park gets lit with Umbrella Project dance

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By Julianne Cuba

Brooklyn Daily

Go dancing with the stars!

A sea of strangers will come together to light up Brooklyn Bridge Park with images of exploding stars and solar eclipses on June 3, as part of the World Science Festival. For the “Umbrella Project,” the dance group Pilobolus will distribute several hundred brightly-lit umbrellas and encourage people into cosmic formations, creating colorful images filmed from above and projected onto a giant screen. The crowd and the music will come together for a beautiful dance under the stars, said the group’s executive producer.

“They feel out the images together and it becomes this kind of wonderful, soothing, imaginative rave as you’re moving around in the music and looking up at these images,” said Itamar Kubovy.

The World Science Festival event will begin with star-gazing and an appearance by Bill Nye the Science Guy at 7 pm, followed by the “Umbrella Project.” Pilobolus has experimented with a wide range of patterns for the project before, but for this night it will focus on images of the sky, said Kubovy.

“Let’s try to makes shapes and images of things related to astronomy and science,” he said.

The umbrellas have three buttons that will light them up in red, yellow, and blue — or any combination of those colors. After a short video explaining how the umbrellas work, people usually start by creating small, simple patterns, and then grow into more elaborate designs, said Kubovy.

“They just start walking around looking up at the screen. They start to understand what is the relationship between their button pushing and moving around,” he said. “I think once we start to create a pattern — geometric lines, circles with concentric bands and rings around them — then try to create a shape that is referencing an object.”

It’s amazing to see how a crowd works together to turn a sea of of glowing umbrellas into recognizable shapes, said Kubovy.

“Getting people to build something together in great numbers, 200 people, making a beautiful image — a moon, astronomical concepts or images, eclipses — effectively reflecting the lights back to the stars, with some kind of empathy as a group of people.”

The project will prevail in clear skies or in rain — after all, everyone will already have a shield from the raindrops, said Kubovy.

“You have an umbrella, if it rains,” he said. “It’s amazing, it even becomes more intimate, everyone’s under a tent, their own little tent.”

Those who want to see more of Pilobolus can see five of the company’s newest collaborations on July 6 in Prospect Park, when the group performs for the Bric Celebrate Brooklyn Festival.

“The Umbrella Project” at Brooklyn Bridge Park, Pier 1 (enter at Furman Street and Old Fulton Street in Dumbo, www.brooklynbridgepark.org). June 3 at 8:30 pm. Free.

Reach reporter Julianne Cuba at (718) 260–4577 or by e-mail at jcuba@cnglocal.com. Follow her on Twitter @julcuba.

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Sacrifices remembered: Bay Ridgites honor the fallen at Fort Hamilton

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By Caroline Spivack

Brooklyn Daily

It was the wreath they could do.

Service members at Fort Hamilton held a wreath-laying ceremony in honor of those in law enforcement who were killed or disabled in the line of duty. The rite was held during National Police Week to commemorate the profound sacrifice service members give to protect their communities, said the director of the emergency services department at Fort Hamilton.

“It was important for the Fort Hamilton Department of Emergency Services to have a memorial ceremony to recognize those who paid the ultimate sacrifice and to show a sign of solidarity with federal, state, and other law enforcement services,” said Michael Canter, the lead organizer behind the event.

Family members and colleagues came out to show their gratitude to three men in particular who died on the job: Deon Taylor, James McNaughton, and Joseph Lemm.

A trio of photographs of the men were placed near the lush wreath.

Fort Hamilton pulled out all the stops for the event with “Taps” on the horn, a line of speakers who offered personal and professional testimonies, and a bittersweet cake that celebrated local and federal law enforcement.

Reach reporter Caroline Spivack at cspivack@cnglocal.com or by calling (718) 260–2523. Follow her on Twitter @carolinespivack.

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Stepping up: Poly junior lift Blue Devils to semi win

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By Laura Amato

Brooklyn Daily

He just kept throwing.

Poly Prep junior pitcher Ethan Ehrenberg didn’t worry about how tired he was, or if anyone got on base, he simply kept throwing, and lifted the Blue Devils to a 3–0 victory over Riverdale in the Ivy League semis on Tuesday. He tossed a complete game, striking out four, walking three and giving up just three hits.

“It felt great,” Ehrenberg said. “The important thing was just to get to the championship game for our seniors. They all want it and we want it for them. We’re just really happy to come out here and get this win.”

Ehrenberg was dominant on the mound, but he almost didn’t get the chance to pitch. Poly was originally slated to play on Monday, and planned to pitch senior ace Oliver McCarthy, but a rainout that day led to a change of plans. Suddenly, the Blue Devils were forced to start Ehrenberg, but Poly Prep coach Matt Roventini insisted the team’s mindset stayed the same.

“We knew with Ethan on the mound, we’d still be exceptionally confident,” Roventini said. “It didn’t concern us that we didn’t have Oli to start. We had Ethan and he’s done exactly what he’s done all year, which is pound the strike zone and give us a chance. You can tell he wasn’t fazed by the moment at all.”

Ehrenberg kept Riverdale on its heels for most of the postseason tilt, but got into a jam in the top of the fifth, putting two runners on with no outs. He didn’t panic, though, just kept throwing strikes until a 1-6-3 double play got the Blue Devils out of the inning.

“[Bryan Padilla is] a great shortstop, so I knew all I had to do was get it, just throw it over the bag and he’d make the play,” Ehrenberg said. “That was a huge moment for us.”

The play was enough to take some of the wind out of Riverdale’s sails, and jumpstart a late Poly rally at the plate. The Blue Devils padded their lead in the bottom of the frame, adding two runs, and effectively seizing the game’s momentum.

“I think that moment changed the dynamic of the game,” Roventini said. “All the sudden a little more energy, a little more pep in our step and our bats come alive. Once we got the three [runs], we felt pretty comfortable.” Poly got production from its entire lineup, but the bottom of order grabbed a bit more of the spotlight, with the seventh, eighth and ninth hitters scoring all three runs.

“The majority of the pitches were early fastballs and I think that’s what led to the success,” said senior second baseman Nic Mulitz, who went 2-for-3 and stole three bases. “They weren’t going to blow by us, so we knew that swinging early, getting up on that fastball early in the count was vital to us getting on base.”

Seven out of nine Poly hitters reached base in the victory and the Blue Devils out-hit Riverdale eight to three. It’s another solid showing for a squad that now is looking to clinch yet another state championship. Winning is a tradition at Poly, but the Blue Devils aren’t getting too far ahead of themselves. Much like Ehrenberg, they’re just going to go out there and do their jobs.

“We’re used to being in this spot,” Mulitz said. “We know we need to come out on top and that’s what we’ve been doing recently. It’s not that different for us.”

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Back again: Poly softball rolls to another championship berth

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Photo by Sean Murphy

Brooklyn Daily

The outcome was never really in doubt.

The Poly Prep softball team cruised to a 7–1 victory over Horace Mann in the Ivy League semifinals on May 23, securing yet another championship berth for the squad.

“Overall, our team performance was really great,” said Blue Devils senior centerfielder Morgan O’Mara. “We came out here ready to win. This whole season we’ve been really working towards a championship so we couldn’t be more excited to be there now.”

Poly Prep jumped out to a 3–0 lead in the bottom of the second inning. They padded their lead with one more in the fourth, but Horace Mann managed to get on the board in the top of the fifth inning, making it a three-run game. That was, however, all the Lions would be able to muster.

The Blue Devils added another run in the bottom of the frame and then two more in the next to effectively wrap up the game and steal away any momentum from Horace Mann.

The game was all about senior Ava O’Mara. She was both the starting pitcher and the lead-off hitter for Poly Prep and she was nothing short of dominant in both roles.

O’Mara silenced the Lions’ batters with a complete game, allowing only three hits and just one run, striking out four, and walking only two. She says she expects nothing less of herself whenever she takes the mound.

“My job is just to focus on the batter, pitch my game, hit my corners, hit my spots,” O’Mara said. “Horace Mann is a good hitting team. They’ve hit before when we faced them two other times so it’s really about working ahead in the count, and those first pitch strikes are important.”

O’Mara also hit her stride at the plate. In four at-bats, she stroked two hits, stole three bases, scored three runs, and was able to get on base in every single at-bat. Offensively, she wasn’t alone, getting support from first baseman Nova Stoller, catcher Jane Malafronte, third baseman Chase Behar, and twin sister Morgan as Poly came out swinging from the beginning.

Despite her team’s strong performance against Horace Mann, head coach Mildred Piscopo hopes the team can do better when they face off against Fieldston in the state championship game.

“We didn’t swing the bats as well as I know that we can so I’m hoping we that we can pick it up for tomorrow,” Piscopo said. “We just have to relax when we get up to bat and just try to have some fun and not try to press and do too much.”

The title tilt will mark the third championship match-up between Fieldston and Poly Prep, so Ava O’Mara suspects that relaxation might be a little tough for some of these Blue Devils. Still, she says, the team has high hopes, and after taking down Fieldston last year, Poly is hoping for a repeat performance this spring.

“There’s a lot of nerves and you gotta find a way to cope with those nerves and play our game,” Ava said. “Every coach in the league has said we’re the better team so it’s just about playing like it.”

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Max & Murphy: Is a Healthy Discussion of NYCs Transit Crisis Finally on Track?

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City Hall You must be this tall to ride this ride. You could feel it building for months. Long delays

LGBTQ Group Holds Dance Party At DiPietros Office

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From the Morning Memo: Western New York Assemblyman David DiPietro got the Pence treatment Thursday evening from a group of

In tour of the Bronx, de Blasios biggest challenger is himself

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Man dies after being shot 7 times in Brooklyn

mikenova shared this story from Brooklyn News.

Police on the scene on Moore St. near Humbolt St. in Brooklyn where a man was shot seven times – he later died at the hospital. A 29-year-old man has died after being shot seven times during a clash in Brooklyn, officials said Wednesday.


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