Archive for the ‘Drug Abuse’ Category

Skyrocketing price of the “life-saving antidote” for the opioid epidemic in New York State; have the drug companies gone too far?

March 12, 2017

 Figure 3-page-001(https://www1.nyc.gov/site/doh/about/press/pr2016/pr102-16.page)        

Data from the Center for Disease Control (CDC) shows a fourfold rise in overdose deaths related to prescription opioids in the United States since 2000 (figure 1). In New York State (NYS), opioid related hospital admissions peaked in 2014 (figure 2), prompting implementation of policies to address these concerns. One of the major executions by the NYS Department of Health was issuance of a standing order authorizing licensed pharmacists to dispense naloxone, an opioid antidote, to persons without needing a prescription.

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Figure 2

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Source: https://www.osc.state.ny.us/press/releases/june16/heroin_and_opioids.pdf

Naloxone counteracts the dangerous effects of opioids with minimal or no adverse events if mistakenly administered to persons not suffering an overdose. The demand for naloxone has significantly increased now that the State has requested widespread availability for the public to administer naloxone in cases of suspected overdose. However, the rising costs of naloxone have made it difficult to meet these demands. The injectable version of the drug has increased significantly over the past few years. The price for naloxone nasal spray in the CVS chain’s New York stores is up to $110 for people who buy it without a prescription and insurance. An auto-injector version of naloxone called Evzio, that works like Epi-pen, is $2,250 for a single-dose injector.

Increasing access to naloxone for the public is inadequate if prices continue to rise. The State and the manufacturers of these products are our stakeholders. These parties may reduce costs by increasing manufacturers, and offering consistent prices and discounts. Pushback from the manufacturers to lower prices thrives in that they are limited in number and have raised costs to meet rising demand. The community may argue that increasing the availability of antidotes may promote drug overdose. Thus we appeal for an alliance between the state and the manufacturers to reduce prices of these life-saving medications to curtail the opioid epidemic.

Written by Asma Akter, Elan Gorshein, Nidhi Madan

Averting a Crisis: Legalization of Needle Exchange Programs in Virginia

March 12, 2017
ACT UP march for syringe exchange

CREDIT: KAYTEE RIEK VIA FLICKR

In February 2017, Virginia governor Terry McAuliffe signed legislation that legalizes syringe access programs in the state. Needle exchange programs provide anyone needing a clean needle with a place to exchange their used needle for a sterile needle at no cost. These programs can also offer HIV testing and counseling, alcohol swabs, and male and female condoms, among other resources that vary by organization.

According to the approved bill, these programs will only be implemented in regions meeting certain criteria created from information such as overdose rates, number of Hepatitis C cases, and morbidity data. Thanks to several federal and private funds, these programs will not take away from the state’s general funds.

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CREDIT: SPENCER PLATT/GETTY IMAGES

There has been controversy regarding whether needle exchange programs are helpful or detrimental. In 2011, Archbishop Francis Chullikat spoke on behalf of the Catholic Church at the United Nations in opposition of harm-reduction programs. The Catholic Church believes that people dealing with drug addictions should be given tools and assistance to break free from their addiction as opposed to measures that allow them to “continue” in their cyclic, addictive behavior. On the other hand, the CDC and NIH both advocate that needle exchange programs play a role in preventing HIV transmission and other health problems among people who inject drugs.

A needle exchange program in Virginia is important for preventing an HIV outbreak, considering an outbreak like this has happened in Indiana and the number of HIV cases rose from a typical 5 cases a year to 200 cases in 2015. It is important for local government officials and residents to voice their support for needle exchange programs to ensure the continuity and growth of such programs. A needle exchange program can be the difference between a public health crisis and a public health victory.

Pushing for the Federal Standardization of Prescription Drug Monitoring Programs

March 11, 2017

In 2012, the Centers for Disease Control and Prevention declared prescription drug abuse an epidemic in the United States as the number of unintentional opioid overdoses had increased by 75% since 1999. These trends went hand in hand with increases in opioid prescriptions. In response, 49 states developed Prescription Drug Monitoring Programs (PDMP) to track prescriptions of regulated substances – databases providers can check before writing prescriptions.

PDMPs have become pillars of the national strategy, but their effectiveness varies by state. These differences highlight the main problem: the features of PDMPs including timeliness of data collection, who has access, requirements for use, interstate operability, and mechanisms to enforce prescriber noncompliance, also vary by state. As PDMPs are evaluated, evidence is amassed about the most effective features and must be translated into policy.

Several players including the National Alliance for Model State Drug Laws and the PDMP Training and Technical Assistance Center have synthesized and spread this information without directly proposing federal standardization. The National Council for Prescription Drug Programs issued technical proposals for the application of best practices; and grassroots NGOs such as Shatterproof have worked with individual states to make PDMPs more effective. As efforts spread, the American Medical Association has reacted against the mandatory use of PDMPs by providers, and the ACLU against the violation of patient privacy.

Another avenue should be pursued. More than half the states use federal funds to support their PDMP, the biggest program being the Harold Rogers PDMP Grant administered by the US Department of Justice’s Bureau of Justice Assistance (BJA). Grassroots NGOs should use their visibility to push the BJA to standardize PDMPs by making the most effective features of PDMPs requirements for the receipt of federal funds. The BJA must encourage states to apply evidence rather than turn their back to it.

A Questionable Solution to Maryland’s Opioid Crisis

March 11, 2017

In 2015, over 1,000 Marylanders died due to opioid-related overdoses. This week, in response to increasing opioid-related deaths, Senate Bill 868 will be heard. This bill increases the scope of the Overdose Response Program (ORP), which provides education and reduces overdose by certifying and training Marylanders to assist overdose victims.

The bill allows healthcare professionals to dispense naloxone to individuals without any of the previously required education. The intent is remove the barrier of attending an educational session for obtaining naloxone, with the hope of curbing the opioid-overdose epidemic.

While naloxone is not difficult to administer, an overdose cannot be treated by just administering naloxone once. Naloxone wears off quickly, and it is critical to call emergency medical services and understand how to initiate CPR. Allowing access to the drug without education may not improve outcomes, and may become a financial burden to those trying to help.

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Image Credit: The Harm Reduction Coalition

While the Department of Hygiene and Mental Health, the Institute for Emergency Medical Services System, and The American Pharmacists Association are invested in this bill, other associations have yet to make formal statements. The American Medical Association has a task force increasing access to naloxone, the American Society of Addiction Medicine, and the Substance Abuse and Mental Health Services Administration recommend and encourage individuals who carry naloxone to receive a comprehensive overdose-related education.

While the bill’s intention is noble, removing education is not the right way forward. There are other possibilities, including requiring healthcare professionals to provide a standardized pamphlet each time they provide or dispense naloxone – which would please all stakeholders.

Nelson Mandela said, “Education is the most powerful weapon which [we] can use to change the world.” In our attempt to save lives, Maryland should be cautious in skipping education.

Failure of Ethics or Well-Supported Medical Intervention? The Debate on Supervised Injection Sites in Ottawa, Ontario

August 19, 2016
Image obtained from www.cbc.ca, Johnathan Hayward/Canadian Press

Photo Credit: Johnathan Hayward/Canadian Press

Supervised injection sites have been the topic of fiery debates across Canada for over a decade- but now we are feeling the heat here in Ottawa. Former Conservative Health minister Tony Clement once famously referred to Vancouver’s Insite program as a “failure of ethical judgment.”  However, since the landmark Supreme Court ruling in 2011 to allow Insite to continue operating, citing its ability to save lives with no discernable negative public health impacts, discussions about creation of new supervised injection sites have cropped up in nearly every major Canadian city.

Several Ottawa Community Health Centers, including Sandy Hill, have put forth proposals for supervised injection sites. However, Ontario Health Minister Eric Hoskins has stated that he will not consider any proposals that have not first been vetted at a municipal level.  Although Ottawa Mayor Jim Watson has historically been against the facilities, a vote held by the Ottawa Board of Health in June 2016 was overwhelmingly in favor of safe injection sites, leading the Mayor to soften his stance on the issue slightly. However, several key public figures, including local law enforcement, remain opposed to the idea.

Photo credit: M-J Milloy, TML Daily Newspaper

Photo credit: M-J Milloy, TML Daily Newspaper

Scientific literature from Insite, as well as from 90 other cities around the world with supervised injection sites, is consistently demonstrative of the benefits of these centers. Safe injection sites reduce deaths related to overdose, reduce new transmission of blood-borne diseases such as HIV and Hepatitis C, reduce health care costs, and increase likelihood of addicts seeking definitive treatment for their addiction. There has been no evidence to support the idea that they increase crime or violence. These statistics should hit home for us in Ottawa, as the 2012 Toronto and Ottawa Supervised Consumption Assessment Study (TOSCA) demonstrated that Ottawa has one of the highest rates of HIV and Hepatitis C among IV drug users in Canada, and rates of opioid overdose continue to climb.

As the final City Council decision approaches, these coming weeks represent a critical time for the future of supervised injection sites in Ottawa. Safe injection sites save lives, and now is the time to loudly advocate on their behalf. In this situation, withholding a scientifically and economically sound intervention from those struggling with addiction would be the true failure of ethics.

HHS’s New Rule: Raising the Patient Limit on Buprenorphine

August 15, 2016

The Department of Health and Human Services (HHS) has proposed a rule in March 2016 that would allow certified practitioners to prescribe buprenorphine (an opioid) to as many as 275 patients per physician in order to treat opioid use disorder.  In the past, SAMHSA proposed that certified physicians could prescribe buprenorphine for Medication-Assisted Treatment (MAT) for up to 30 patients initially, and up to 100 patients after one year.

The evidence-based MAT, buprenorphine or Suboxone, was under-utilized previously, and many practitioners were limited in their ability to assist patients in need of treatment due to the restriction. Centers for Disease Control and Prevention (CDC) guidelines advise caution in using opioid drug therapy to combat the problem and provide specific treatment guidelines to certified physicians while the SAMHSA rule expands patient access to medication assisted treatment. American Society of Addiction Medicine (ASAM)  and American Psychiatric Association (APA) applaud this policy change and call it ‘long overdue’ as an important step to help combat the current epidemic of opioid addiction and overdose deaths. Buprenorphine drug satisfies cravings without the euphoria that drives drug-seeking behavior.

The abuse and addiction to opioids, such as heroin, is reportedly increasing all over the USA. In 2013, an estimated 289,000 people in the US used heroin. The mortality from unintentional prescription opioid overdose has been quadrupled from 1999 to 2014, and deaths related to heroin have escalated 39% between 2012 and 2013. In Maryland, the number of heroin-related deaths more than doubled between 2010 and 2014. Approximately, 86% of all intoxication deaths that occurred in Maryland in 2014 were opioid-related.

An increase in patient cap will permit certified physicians to give patients greater access to buprenorphine. Approximately 2 million who are dependent on heroin and in favor of seeking treatment will benefit from this new rule. In July 2016, Congress has passed the Comprehensive Addiction Recovery Act (CARA) which not only expands access to buprenorphine to certified physicians but also to nurses and physician assistants to be able to prescribe buprenorphine.

Although it is hard to predict how successful of an outcome this rule will generate, the outlook thus far has been optimistic.

The Agony of Ecstasy: Amend the Illicit Drug Anti-proliferation Act

March 4, 2016

By refusing to amend the Illicit Drug Anti-Proliferation Act, Congress continues to stand in the way of harm-reduction services as the number of drug-related deaths continues to mount in the night life and music communities.

What is the Illicit Drug Anti-Proliferation Act?

In 2003, the Illicit Drug Anti-Proliferation Act (Read the full text here.) was passed by Congress in an effort to combat deaths due to ‘club’ drugs, such as MDMA. This act states that organizers of an event where controlled substances are suspected to be present can be charged with a felony for contributing to drug use, punishable by up to 20 years imprisonment, a fine of up to $500,000, and can have their venue seized by law enforcement.

What are the effects of this act?

This act has proven to be ineffective as stories of deaths at music events due to drug use continue to emerge. The Drug Abuse Warning network recently reported that national ED visits due to MDMA toxicity increased 120% between 2004 and 2011 while levels of MDMA use have remained relatively constant.

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Past Month Ecstasy Use among People Aged 12 or Older, by Age Group: Percentages, 2002-2014. Figure produced by 2014 Drug Use report sponsored by HHS
Source: http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm

 

One victim of this act was 19 year-old Shelly Goldsmith, a student at the University of Virginia, who died of dehydration and heatstroke after consuming MDMA at a rave in Washington D.C. Shelley collapsed while attempting to make her way through the hot, crowded venue to the bar to buy a bottle of water.  The current act discourages venues from distributing free water to prevent heat stroke or any other harm-reduction services, else they face federal prosecution for suspicion of contributing to drug use.

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Shelley Goldsmith died at 19 years old from heatstroke after ingesting MDMA at an Electronic Dance Music concert where no free water was available, is seen here posing with Vice President Joe Biden, who authored the Anti Illicit Drug Proliferation Act
Source: https://www.amendtheraveact.org/

Advocates such as Shelley’s mother, Dede Goldsmith, have spoken to Congress on the importance of harm reduction and educating the public on safe drug use.  Senator Tim Kaine has recently announced that he intends to propose an amendment to current law which will allow venues to provide harm-reduction services without bearing the risk of legal consequences.

Unfortunately, the bill is unlikely to easily pass. Most members of Congress are nervous about appearing ‘soft’ on drug policies and will need to be shown that harm-reduction is the will of the people and that passing this amendment will save lives.

What can we do to show Congress how important this amendment is?

  • Sign the Petition! Send Congress a message that the American people want to stop the unnecessary deaths: Petition: https://www.amendtheraveact.org/sign-the-petition/
  • Donate! The organization, ATRA (AmendTheRaveAct.org) creates and distributes campaign materials to educate the public on the harms caused by this amendment
  • Speak out! By explaining the benefit of harm reduction, and the differences between harm-reduction and the promotion of drug use, you can help turn the tide of public opinion against using an abstinence only strategy to reduce drug related-deaths.

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Epidemic of opioid overdose deaths in the U.S.A.

March 4, 2016
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Drug deaths have surged in nearly every U.S. county, reaching a new peak in 2014 (NYTimes.com: How the Epidemic of Drug Overdose Deaths Ripples Across America)

According to the Centers for Disease Control (CDC), there has been a 200% increase in the rate of opioid related overdose deaths since 2000 in the United States. We believe that the prescribing practices and protocols for identifying patients most at risk of developing an opioid dependence need to be improved. By identifying and improving the structure of the current practice of prescribing pain killers, perhaps there will be a decline in those who continue on to illicit heroin use and ultimately, a decline in the number of opioid overdose deaths in the United States.

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On February 12, 2015, a bill was introduced to the Senate under the title, S.524 – Comprehensive Addiction and Recovery Act that directly addressed this issue. This bill directs the Department of Health and Human Services to convene a Pain Management Best Practices Inter-Agency Task force to develop best practices for pain management and prescribing pain medication, and a strategy for disseminating such best practices. This legislation will expand, though enhanced grant programs, prevention and education efforts, expand access to the overdose-reversing drug Naloxone, support alternative treatment in lieu of incarceration, strengthen the Prescription Drug Monitoring Program and support expansion of the use of evidence-based treatment medications.

The bill would help channel further funding and improvement of standing programs such as Alliance of States with Prescription Drug Monitoring Programs, the Substance Abuse and Mental Health Services Administration (SAMHSA), and Department of Justice – Office of Justice Programs.

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Addiction is an illness and should be addressed as a public health issue, instead of being dealt with as a crime. Funds should be made available to educate the public, improve naloxone availability, and towards research to develop medications for treatment of opioid addiction. We also believe physicians need to be part of the solution and strengthening the Prescription Drug Monitoring Program will help curb over-prescribing. Support the Comprehensive Addiction and Recovery Act by reaching out to your local representatives!

Say No to Marijuana legalization in MA

March 3, 2016

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This year, Massachusetts is debating on a House Bill 1561 to legalize recreational marijuana. Such bill permits residents to buy marijuana at certain dispensary and grow marijuana for personal use. The bill also places taxes on Marijuana sales. The use of marijuana is associated with poor cognitive function, drug addiction, and respiratory illnesses. In 2012, Colorado was one of the states that legalized recreational marijuana use. From the Colorado experience, such legislation led to an increase in marijuana related traffic fatalities and emergency admission from marijuana use. Between 2011 to 2013, there was a 57% increase in emergency room visit for marijuana related conditions. Toxicology report indicated that driving under the influence from marijuana rose 16% from 2011 to 2013 (http://www.rmhidta.org/html/august%202014%20legalization%20of%20mj%20in%20colorado%20the%20impact.pdf). Furthermore fatal traffic accidents from being under the influence due to marijuana rose 92% from 2010 to 2014 (https://www.coloradopotguide.com/media/2987/2015-hidta.pdf). In additional, the use of marijuana can lead to addiction to the drug. Massachusetts is facing a signficant drug addiction problem with 1099 death in 2014 from opioid overdose (http://www.mass.gov/eohhs/docs/dph/quality/drugcontrol/county-level-pmp/data-brief-overdose-deaths-ma-residents-january-2016.pdf), and by legalizing marijuana, this problem may get much worse and will require more resources to treat patients.

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Legalizing marijuana caused multiple significant health concerns. This mistake should not be repeat in MA, a state that already has a big opioid crisis. Some proponents of this bill indicated economic benefits from taxes, but the social costs from addiction and life lost are outweighed such economic benefits. Please vote “No” for this bill. Lets your state official know that your concern today!!!

Support preventive and sustainable networks for behavioral and mental health in Maryland

March 2, 2016

pic7Over 177,000 children and adults in Maryland are dependent on the public behavioral health system.   More than 1 million inhabitants of Maryland are currently experiencing some sort of mental illness. Of the 24 counties in Maryland, there are only three counties that provide fully functional, 24 hours, 7 days a week service to their constituents.

Two key bills have been introduced in both the house and senate of the Maryland General Assembly: “Behavioral Health Community Providers – Keep the Door Open Act” and “Department of Health and Mental Hygiene – Clinical Crisis Walk-In Services and Mobile Crisis Teams – Strategic Plan”.  These two bills are essential to provide a preventive and sustainable network in mental and behavioral health services for Marylanders.

“Behavioral Health Community Providers – Keep the Door Open Act” (SB497/HB595)

  • Community behavior health providers provide regular and reliable mental health and substance use treatment to Marylanders in need.
  • SB497/HB595 promotes increased access to behavioral health community providers by providing reimbursement increases for these providers.

 

“Department of Health and Mental Hygiene – Clinical Crisis Walk-In Services and Mobile Crisis Teams – Strategic Plan”(SB551/HB682)

 

  • Access to crisis response services have been shown to reduce  crisis events related to mental health and substance use.  
  • SB551/HB682 promotes greater access to crisis response systems by improving walk-in and mobile crisis services.

 

 

 

The upcoming hearings in the house of delegates will provide an opportunity for caretakers, parents, children, community advocates, and organizations to rally in support of preventive and sustainable networks of services for mental and behavioral health in Maryland.  Register for the rally today!

Let your legislators know you support SB497/HB595 and SB551/HB682.   Call, write and/or e-mail.

Support preventive and sustainable networks for behavioral and mental health in Maryland n the 2016 election! Are YOU ready?

Image credits: Most of the images were created by the author.  Other pictures are courtesy of NAMI Maryland, Pinterest and Maryland Health Department.