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Friday, February 24, 2017

Safely Storing Prescription Opioids

If you are one of the millions of Americans who watched the Super Bowl, you likely saw public service announcements addressing prescription opioids and overdose. It’s a topic of vital concern for public health officials, considering that many teenagers and young adults begin using opioids they get from a friend or family member. Sometimes the pills are acquired right out of mom and dad’s medical cabinet.

Prescription opioid and heroin abuse is one of the most serious public health crisis this country has ever faced. Every day, nearly a hundred people succumb to an overdose. Naturally, efforts to reduce deaths have come from many Federal agencies and organizations. Reigning in opioid prescribing practices has been priority, with many attributing the opioid addiction epidemic to overprescribing.

Of course, “reigning in” does not mean the end of prescribing drugs, such as OxyContin or Percocet. It means, encouraging doctors to utilize alternative forms of pain management. Turning to opioids when nothing else proves effective. On top of that, prescribers have been advised to take advantage of prescription drug monitoring programs (PDMPs) to combat patient “doctor shopping.” That is, seeing multiple doctors to get multiple prescriptions for the same type of drugs.

On the other side of the prescription opioid problem in America, is the public; who have been entreated to safely dispose of unused medication and to keep prescription narcotics locked up. The latter of which is ever important in keeping potentially deadly drugs out of the hands of young people. You may think that medicine cabinet drug diversion is relatively rare, or that PSAs about keeping one’s prescriptions opioids locked up may be common sense, in the wake of epidemic raging throughout the country. It’s not!

In fact, one of the Super Bowl PSAs pointed out that while Americans are typically good about keeping their firearms locked up, teenagers are more likely to lose their life from an overdose than a bullet. Please take a moment to watch the PSA below:

If you are having trouble watching, please click here.

The PSA could not have been presented at a more opportune time, considering the new research out of Johns Hopkins Bloomberg School of Public Health. Researchers conducted a survey which found that 70 percent of prescription opioids in homes with children are not stored safely, according to a press release. The findings were published in the journal Pediatrics.

"Our work shines a light on the pervasiveness of unsafely stored opioids in American homes with children," says study lead author Eileen McDonald, MS, faculty with the Johns Hopkins Center for Injury Research and Policy. "Unsafely stored opioids can contribute to accidental ingestions among younger children and pilfering by older children, especially high school students. We know that teens who use these drugs recreationally frequently get them from homes where they are easily accessible, increasing their risk for addiction and overdose." 

The end of the American opioid epidemic rests on more than just changing prescribing practices, it requires that the public do their part to ensure the safety of young people who are susceptible to both addiction and overdose. If you have prescription opioids in your household, please understand the gravity of this issue.

Tuesday, February 21, 2017

OxyContin Age Restriction in California

A couple of years ago, the United States Food and Drug Administration (FDA) made the controversial decision to approve OxyContin ® (oxycodone) for people as young as 11-years of age. The decision to lower the age restriction on prescribing the powerful opioid came about, despite the fact that the country had been, was and would continue to be in the grips of deadly opioid addiction epidemic.

Advocates of the OxyContin for kids 11 to 16 ruling said that it would help the small number of children with serious illnesses, whose pain could not be managed with other forms of pain medicine. Critics said that the drug would likely be prescribed to young people with moderate pain, as well—putting them at risk of developing opioid addiction.

To be sure, a child battling cancer should be given access to medicines that are effective. However, as Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing, pointing out in 2015 the FDA approved OxyContin for children without deferring to an advisory panel who could debate the risks and benefits of such a decision, USA Today reported. When you consider that teenagers are at a greater risk of addiction than adults with fully developed brains, the risks were likely greater than the benefits.

Opioids of any kind carry the risk of dependence and addiction. Of course, the stronger the narcotic the more intense the euphoria, and perhaps with it—a greater likelihood of someone wanting to come back for more. OxyContin, sold generically as oxycodone, is an apex prescription painkiller. The strong narcotic acts quickly, and wears off faster than advertised. It does not contain nonnarcotic space fillers like acetaminophen, which is commonly found in other prescription opioids.

As a result, abusers can ingest more OxyContin pills than they can say another common opioid, Percocet. Without the risk of acetaminophen toxicity which can lead to liver failure, oxy-abusers can use more without putting their liver at risk. What’s more, the implementation abuse-deterrent features inside OxyContin, are not that great at deterring abuse. With a little ingenuity, such features can be skirted.

Keeping all of that in mind, is it wise decision to allow oxycodone to be prescribed to teens? One Californian Senator would answer that question with an emphatic, No! California Senator Anthony Portantino (D-La Cañada Flintridge) has introduced Senate Bill 419, which would prohibit writing oxycodone prescriptions for anyone under the age of 21, The Los Angeles Times reports. Senator Portantino believes that SB419 would keep young people from being exposed to such an addictive drug, at such an early age.

“The abuse of this drug is a national epidemic and we need to protect our children from being prescribed this highly addictive substance," said Sen. Portantino in a statement. "Lawmakers, regulators and medical professionals have been wrestling with how best to control this synthetic heroin and I’m saying, while we’re looking for solutions, let’s make sure we keep it away from our most vulnerable population."

Friday, February 17, 2017

Alcohol-Withdrawal Treated With Electroacupuncture

Even though America is in the grips of a deadly opioid addiction epidemic, it is vital that we remember that more people abuse alcohol than any other drug. While opioids can easily lead to a deadly overdose, heavy alcohol use typically kills people slowly. It is fair to say that opioid overdose deaths are considered to be more headline worthy, compared to the slow death associated with alcohol use (excluding alcohol poisoning and car wrecks).

Losing sight of alcohol use disorder (AUD) in the United States can’t be allowed. To put it in perspective, it is estimated that some 2 million Americans abuse opioids of any kind. When you compare that figure to the rates of AUD in the U.S., the difference is staggering. The 2015 National Survey on Drug Use and Health (NSDUH) report showed that 15.1 million adults ages 18 and older had AUD. What’s more, an estimated 88,000 people die from alcohol-related causes annually, compared to the 20,101 overdose deaths related to prescription pain relievers and 12,990 overdose deaths related to heroin in 2015.

For the sake of discussion, let’s assume for the moment that 88,000 people actually died from alcohol related causes in 2015. And between prescription opioids and heroin, there were 33,091 overdose deaths. Simple arithmetic will reveal that nearly 55,000 more Americans died from alcohol, than opioids in 2015. Clearly, the need to reignite the dialogue about alcohol abuse is crucial

It is well understood that the surest way of reducing the number of deaths related to either alcohol or opioids is intervention. Addiction treatment can help break the cycle of addiction, and continued recovery maintenance can mitigate the risk of relapse. But, either way, relapse rates are exceedingly high. Research scientists continue to look for ways to lessen people’s risk of relapse. When it comes to alcohol, it is no easy task.

Unlike opioids, alcohol can be found easily and acquired inexpensively. Many who attempt to detox from alcohol find it too difficult without assistance. Without such help, relapse typically happens within the first week of withdrawal. There are drugs, like Vivitrol for instance, which can help alcoholics fight the cravings that lead to relapse. On the other hand, the pain of alcohol-withdrawal is often cited as being one of the leading causes of relapse. Naturally, that pain should not be treated with another potentially habit-forming drug.

New research suggests that electroacupuncture (EA), a combination of acupuncture with electrical stimulation) could be useful for alcohol-withdrawal pain reduction, Newswise reports. EA treatment may even reduce other alcohol-withdrawal symptoms. The findings were published in Alcoholism: Clinical and Experimental Research.

The study indicates that EA can reduce hyperalgesia (hypersensitivity to pain) in rats experiencing alcohol withdrawal, according to the article. If human tests are effective, electroacupuncture could help people succeed at long-term recovery.

Thursday, February 16, 2017

New Fathers With Depression

Bringing life into the world is a major event, one often associated with joy. After all, childbirth or adopting a baby is one of the prerequisites for building a loving family. While having a child is often an important part of a happy life, sometimes it can have the opposite effect on one’s psychological well-being.

There is a good chance that you are familiar with pre- and postpartum depression in mothers. You may also be aware that mothers whose depression goes untreated can put both the baby and mother at risk. New fathers need to aware of the emotional state of their partner both during and after a pregnancy. If abnormal behavior appears, intervention may be needed.

Yet, there is a growing body of research indicating that an eye should be kept on expectant and new fathers, as well. Studies have shown that fathers are at risk of developing symptoms of depression before and after birth, which can lead to all kinds of problems.

A study published in the Journal of Child Psychology and Psychiatry found that a father's depressive symptoms can have an impact on the mother and child, CNN reported. The lead researcher in the 2008 study, Dr. Michael Weitzman, professor of pediatrics and environmental medicine at the New York University School of Medicine, points out that new fathers suffering from depression can result in added stress, depression or increased use of alcohol or smoking for the mother.

You may think that prenatal and postpartum depression in fathers is rare. However, when researchers analyzed data on 3,523 men in New Zealand who participated in the Growing Up In New Zealand study, they found that such cases were not all that rare, Fox6 reports. The study was published in the journal JAMA Psychiatry.

The researchers found that elevated prenatal depression symptoms were found among 82 fathers (2.3 percent), and elevated postnatal depression symptoms were found among 153 (4.3 percent).

“The rates of antenatal and postnatal paternal depression that we found are consistent with previous similar studies in other countries including the US,” said Lisa Underwood, a research fellow at the University of Auckland in New Zealand and lead author of the study. She adds: “Our key message applies worldwide: Pregnancy and the postnatal period are key opportunities to engage with expectant and new fathers to discuss depression symptoms and provide support.”

Friday, February 10, 2017

Alcoholic Liver Disease Transplant Waiting List

One of the few things that money can’t buy you in the United States is a new organ. If you are in need of a new organ, you are typically put on a list of recipients and pray for your number to be called. Unfortunately, the rules for being eligible for an organ transplant are not written in stone, open for subjective interpretation by health professionals on organ transplant committees. For most, many in need of a new organ that may not seem like a big deal, but for those with a history of substance abuse it can be fatal.

Millions of Americans consume alcohol in unhealthy ways. Problematic drinking can lead to organ damage that cannot be repaired, such as alcoholic cirrhosis, a severe form of Alcoholic Liver Disease (ALD). Without a liver transplant, death is no longer a question of if. Naturally, there are those who feel that self-inflicted damage of the liver should disqualify alcoholics from receiving a transplant. However, the “you made your bed, now sleep in it” approach to alcoholics in need of a new liver is unethical.

Some alcoholics are given a second chance, being placed on the donor list and eventually receiving a liver. But it is not common. A sad reality that is partly the result of demand being greater than supply, and partly due to what is known as the “six-month rule”—an informal policy used at most of the 140 or so transplant centers in the United States. All ALD patients are required to show that they can abstain from alcohol for six months before they are given a spot on the register, The Chicago Tribune reports.

Only 7,127 (about half of those in need of a liver) people received liver transplants nationwide in 2015, according to Anne Paschke of the nonprofit United Network for Organ Sharing. Even if ALD patients were allowed to get on the list immediately after being diagnosed, they will still have to wait a long period of time for a liver, often too long. Liver disease progresses rapidly, and you can die from it in a matter of months. Being forced to wait six-months just to get on the waiting list is often a death sentence. Sander Florman, director of the Recanati/Miller Transplantation Institute at Mount Sinai Hospital in New York says:

"We try really hard to not make decisions based on personal feelings. Having said that, we are doctors - humans - and we take care of our individual patients - humans - case by case, and we try to balance organ shortage with always opting to save lives." He added: "The six-month practice has been generally accepted but is not based on hard data, and I believe should be seen as more of a guideline than a policy - because life and death is at stake. As a result, it is hard to draw a firm line in the sand. If someone has been sober, is in a program, committed to remain in a program and has social supports, it is very hard to justify six months as an absolute and any different from 5 1/2 months - or other amount of time - if they will die without transplant." 

Requiring patients to prove that an organ will not be wasted on them does make sense in number of ways. With such a shortage of organs to go around, mitigating the risk of a patient returning to alcohol after a transplant should be of the utmost importance. But without clear cut rules based off of science, it is easy to see how some patients might fall through the cracks.

Jackie Brafford, a registered nurse from Virginia has been sober four (4) months on her own accord at the time of her ALD diagnosis, according to the article. She was told that she would have to wait six months to get on the list. Bradford died 5 weeks later.

Alcohol use disorder is a form of mental illness. Left untreated, alcohol will wreak havoc on the mind and body. Punishing people with mental illness by enforcing arbitrary wait times, just to get a spot on a waiting list, is unethical.

Tuesday, February 7, 2017

Skyrocketing Naloxone Price In America

opioid overdose
How much is a life worth to one person? How much is it worth to a company concerned with bottom-line and profit shares? The answer to both questions will probably vary, depending on who you ask. And surely, any attempt to quantify the value of a life will probably come up short. But the question needs to be asked considering a trend occurring in the pharmaceutical industry, involving staggering price hikes on life-saving drugs. A trend which seems to have first caught the public's eye in 2015 with the price hike on an AIDS treatment.

Who can forget when Martin Shkreli, CEO of Turing Pharmaceuticals, raised the price of toxoplasmosis treatment drug Daraprim from $13.50 per pill to $750 per pill (a 5,000 percent increase). Cases like the price hike on Daraprim, are not, in fact, unique. In recent years, there has been a growing demand for the life-saving opioid overdose reversal drug naloxone, sold under the brand name of Narcan and Evzio. And, as a result the pharmaceutical companies that manufacture the miracle drugs have been steadily, egregiously raising prices.

In order to ensure that health agencies and police departments can afford to buy naloxone, the Attorney General of Ohio made an agreement with Adapt Pharma (makers of Narcan) to freeze the Public Interest Price for one year at $75 for two 4 mg doses of the drug. It was a clear sign that “big pharma” understood the importance of keeping naloxone affordable. However, some companies have different ideas about affordability all together.

The makers of the naloxone auto-injector Evzio, Kaleo, increased the price for two doses from $690 in 2014 to $4,500 in 2017, Forbes reports. Kaleo’s Evzio features a talking component which talks the average person through administering the drug to an overdose victim.

"There's absolutely nothing that warrants them charging what they're charging," said Leo Beletsky, associate professor of law and health sciences at Northeastern University, to Philly.com

As you can probably imagine, the reason for raising the price is not based on the price of making the product or the medication. There has been a price increase on naloxone, doubling to $150 for a 10cc vial, according to the article. However, the price hikes are not in-line with what it cost to make the drug. Eliza Wheeler of San Francisco’s Harm Reduction Coalition, a nonprofit that works to combat overdoses and has received donations of Evzio, says:

“I might have $10,000 to spend on naloxone for a year, to supply a whole city. If I have 10 grand to spend, I certainly can’t buy two Evzios.”

Friday, February 3, 2017

Heroin Addiction Treated With Deep Brain Stimulation

When thinking of mental health disorders and electricity, grim pictures of psychiatric wards and electroconvulsive therapy (ECT) probably come to mind. Who can forget the scenes in One Flew Over the Cuckoo's Nest (1975), et. al.? While such representations are often grossly inaccurate, in the procedure's infancy horrible atrocities were in fact subjected upon patients. We often form our opinions about certain things based on how they appear on the silver screen, but much of the time they are not accurate representations, leading to people viewing things that can actually help patients as being barbaric.

There are number of different medical procedures conducted today that involve the use of electrotherapy. Patients suffering from certain mental health disorders have benefited from the use of ECT—where all other treatments have failed. In recent years, movement disorders and neuropsychiatric disorders, like Parkinson's, have been treated with deep brain stimulation (DBS). The procedure involves the implantation of neurostimulators in the brain, which send electrical impulses to certain targets, according to the History of Deep Brain Stimulation.

deep brain stimulation

DBS is now being researched for the treatment of a number of disorders, such as PTSD and major depression, as well as addiction. In fact, a new animal study has found that DBS significantly reduced the urge to use heroin in standard rat models of addiction, The Scripps Research Institute (TSRI) News. The findings are especially important given that relapse rates among heroin addicts are especially high. The findings were published in the journal Neuropsychopharmacology.

Researchers implanted electrodes into the subthalamic nucleus region of the brain, according to the article. The same region which is targeted with Parkinson patients, and DBS can modulate abnormal muscle activity in some patients. However, researchers have found that targeting the subthalamic nucleus can also modulate compulsive behaviors like gambling, shopping and the compulsion to use certain drugs (i.e. cocaine).

In the new study, rats were allowed to self-administer heroin for 12 hours per day over a two-week period, the article reports. The rats were then forced to abstain from the drug for a two-week period and then it would be restored again. After the abstinence period, rats who did not undergo DBS rapidly re-escalated their intake, whereas those that did have the DBS exhibited low intake of the drug. When the researchers turned off the DBS, those rats re-escalated their intake like the others.

“It has been very difficult to reduce heroin-seeking and -taking in an animal model because heroin is such an addictive drug, but the results here are very impressive,” said the study’s principal investigator Olivier George, an associate professor in TSRI’s Committee on the Neurobiology of Addictive Disorders. “This is the type of preclinical evidence that one needs, in order to start testing this strategy in humans.”

Thursday, February 2, 2017

Addiction Treatment Insurance Coverage


A Little History 

Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA): requires health insurers and group health plans to provide the same level of benefits for mental and/or substance use treatment and services that they provide for medical/surgical care.

Patient Protection and Affordable Care Act of 2010 (PPACA): commonly referred to as the Affordable Care Act (ACA) or “Obamacare,” further expands the MHPAEA’s requirements by ensuring that qualified plans offered on the Health Insurance Marketplace cover many behavioral health treatments and services.

Comprehensive Addiction and Recovery Act of 2016 (CARA): established a comprehensive, coordinated, balanced strategy through enhanced grant programs that would expand addiction prevention, education, treatment and recovery efforts.

21st Century Cures Act of 2016: has many primary objectives, not the least of which is giving grants to states worth $1 billion over the next two years for drug abuse prevention and addiction treatment programs.

Addiction Treatment Coverage 

Above we listed, and briefly explained some vital pieces of legislation that have helped millions of Americans, not just people living with the disease of addiction. The first two acts allowed for millions of previously uninsured Americans to get coverage; while the latter two legislative acts include provisions to address the opioid addiction epidemic. Both CARA and the Cures Act are still in their infancy, so it is hard to measure their efficacy at this point, but early data is positive. However, both bills were widely hailed by health professionals, addiction experts and lawmakers on both sides of the aisle of democracy as crucial steps in the effort to end the epidemic.

If you have been following the news in the last couple weeks and beyond, you are likely aware of the fact that many lawmakers throughout the land are not huge fans of the ACA. Critics have fought tooth and nail to repeal and/or replace the ACA since it was signed into law. While such efforts were unsuccessful, with a new President and a push to repeal the ACA recommenced, there is a chance that the end of Obamacare is in sight. Or, at the very least, such efforts will make it more difficult for the ACA to achieve the goals laid out in the legislation. So, what does that mean for people living with the disease of addiction and the future of the American opioid epidemic?

The former Director of the White House’s Office of National Drug Control Policy, Michael Botticelli, believes that if efforts to repeal the ACA are successful it could mean the loss of hard fought ground gained towards mitigating the insidious effects of the epidemic, The Huffington Post reports. The ACA has helped states hardest hit by the epidemic, such as Vermont and Maryland, fund diversion programs and helped treatment facilities better integrate primary and mental health care.

“Our response to this opioid epidemic has largely been focusing on ‘How do we narrow that treatment gap?’” said Botticelli. “And certainly one of the biggest contributors to narrowing that treatment gap is making sure that people get insurance coverage and have adequate insurance coverage for substance use disorders... We know that care and coverage has been essential to dealing with the epidemic.” He added: “I think there’s ample evidence to suggest that those states that have been significantly burdened by the opioid epidemic will be more significantly impacted because of any potential repeal of the ACA.” 

Please take a moment to watch a short video on the subject:

If you are having trouble watching, please click here.

Moving Forward 

At this point it is difficult to tell where all of this will lead. Although, it is important to keep in mind that, no matter what one’s thoughts are on any of the aforementioned bills, lives have been saved because of those legislative acts. And, if the ACA is repealed or replaced, hopefully mental health and addiction treatment will still be a major focus point. Treatment, and access to addiction treatment, will continue to be the most effective measure against opioid addiction in America. Saving both lives and families.

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