Category: Opioids

Overdose deaths due to opioids have killed more than half a million people over the past two decades. This public health crisis has worsened during the COVID-19 pandemic, with some states reporting a 30% increase in opioid overdose deaths. But there is hope for a better future:  the forthcoming state opioid settlement could help turn the tide.

As states are settling their legal cases against opioid manufacturers, pharmaceutical distributors, and pharmacies, they will hopefully be investing in evidence-based programs to prevent and treat opioid addiction. States and counties are in desperate need of increased resources to help address the current opioid epidemic and prevent future addictions.

Jurisdictions will face difficult decisions in determining how to use their settlement money.

Fortunately, an expert panel recently released a report that provides a helpful roadmap that states, cities and counties can use to guide them through this process.

Today, Shatterproof joins with public health colleagues led by the Johns Hopkins School of Public Health to announce guiding principles for the use of the opioid abatement funds. We lay out five key principles that states and localities should use when determining how to spend the money.

The most urgent principle is this: States must develop a fair and transparent process for how these settlement dollars will be spent. It is not a given that states will spend this money on evidence-based programs to prevent and treat addiction. As noted with the past tobacco settlement, only 2-3% of the dollars were spent on nicotine prevention and cessation programs.

Building and implementing a transparent process is critical to ensuring this history is not repeated with the opioid settlement.

Some states, like Colorado and New Hampshire, have enacted policy to create a special opioid abatement fund so that these dollars don’t go directly into the state’s general treasury. Other states have included a reporting mechanism in that process so that allocation amounts and outcomes can be reported back to the state. Texas came to an agreement with their counties on allocation and distribution of funds by locality.

It will be up to the states to determine these practices. Shatterproof is alerting stakeholders and elected officials so that a transparent process to allocate opioid settlement dollars can be enacted in all 50 states.

Click here to read the recommendations.

Then sign our petition urging state officials to spend settlement dollars on evidence-based addiction programs. This could be a big opportunity to get more science-based treatment and prevention programs into our communities—and to save countless lives. Together, we can make it happen.

This article appeared at ShatterProof.com – Courtney Gallo Hunter is Shatterproof’s Vice President of State Policy.

I am the mother of four, but addiction is my ever-present extra child. My grandparents died of alcoholism. My father-in-law did, too. My 43-year-old brother died of a heroin overdose in May. He became addicted after taking prescribed OxyContin following an appendectomy.

When my 13-year-old daughter needed hernia surgery as my brother was hitting rock bottom, it wasn’t the operation I feared. It was the opiates that would be part of her recovery. A 2018 study in the journal Pediatrics reported “persistent” opiate use by nearly 5 percent of patients age 13 to 21 following surgery, as compared to 0.1 percent in the nonsurgical group.

I wanted to figure out a way to help my daughter through the pain without resorting to using opiates.

Days before my daughter’s operation, our family devised a pain protocol based on what we learned from a popular TEDtalk byJohann Hari, a journalist who believes that people avoid addiction through “bonds and connections.”

He cites a study comparing two groups of rats. One group lived alone in cages, with only food, water and water laced with heroin. Those rats became addicted and quickly died. The other group lived in what Mr. Hari called “Rat Park.” They had treats, activities and interaction with other rats. They chose the plain water over the heroin water. They thrived, despite the presence of an addictive substance.

The message I took from it was that affection and connection might help reduce my daughter’s pain. If we surrounded her with comfort, maybe she wouldn’t need the drugs at all.

Our pain protocol included my daughter’s favorite movies, books and foods. We made a list of relaxing activities that build oxytocin: braiding hair, massage, cuddling and wearing cozy clothes. We listened to her fears. As a distance swimmer she could tolerate discomfort, but she was afraid of the unknown of surgical pain. We agreed to bring home whatever pain medication was prescribed, but to avoid using it if possible.

At the hospital, my daughter changed into a pink cotton gown, dotted with lambs and rainbows. I smoothed her hair as a tech struggled to pin an IV into the back of her hand.

“It hurts, Mommy,” she pleaded. “I’m scared.”

A nurse offered a thimble of liquid Xanax to help ease her anxiety. She looked to me for permission, then nodded her head yes. Moments later I witnessed a powerful transformation from fear to nonchalance. She waved goodbye as a team wheeled her bed around a corner. I thought of previous outpatient procedures my children had faced: tubes in the ears, a meniscus tear. I was never given instructions about alternative pain management and I didn’t think to ask. The difference, now, was that my brother was an addict. What if I gave my children pain pills and they became addicted too?

Three hours later the surgeon breezed through the waiting room doors. The hernia was deeper than expected, he reported, and she would be in considerable pain tomorrow.

In the recovery room, my daughter lay propped up in bed, sucking on a frozen rocket pop. “Mama,” she said drowsily. “I’m all done.” She battled to keep her heavy eyelids open. The ice pop melted upright in her hand.

I thought of my brother, nodding off on a family ski vacation; in a parked car waiting for an oil change; during a children’s egg hunt on Easter Sunday.

While my daughter slept, a discharge nurse told me how to change her dressing and watch for fever. Then she explained how to “stay on top” of the pain with a prescription for 44 Oxycodone tablets. My jaw tightened.

“I don’t want to give this to her,” I said, shaking my head at my own memories.

The busy hallway went silent, except for the alarm of an empty IV drip.

“This is like heroin to me,” I said. “My brother is addicted.”

The nurse looked away. “My daughter too,” she said, and began to cry. “She won’t stop. I had to kick her out.”

We exchanged the mournful words of opiate families: “It’s everywhere.”

“Is this all for me?” she asked quietly. She collapsed, smiling, into the stack of duvets on the sofa.

The anesthesia kept the edge off the initial pain. My daughter dozed while we watched episodes of “MasterChef Junior.” That night, my husband carried her to bed, then I slept beside her, alternating Tylenol and ibuprofen. In the morning, I inquired about her discomfort, hoping she wouldn’t ask for a pill.

“It’s just annoying,” she said.

“Annoying like you’re suffering?” I asked.

“Annoying like can I have ice cream for breakfast?”

“Coming right up,” I said. I offered her our specialty of the house: mint chip and a side of Advil. That day, nestled in our sofa oasis, we nibbled from a wooden bowl of buttered popcorn mixed with M&Ms. While surviving all three “High School Musicals,” I stroked her skin, smoothed her hair and praised her bravery. We played Uno, and worked on a puzzle. Greeting cards and balloon bouquets came in from friends and teachers. The principal called. Not once did she complain of intolerable pain.

She winced gingerly when she wanted to flip sides on the couch. We assisted her so that she wouldn’t use her abdominal muscles.

The discharge nurse had told us that walking would speed recovery, so we pretended her stuffed animals were babies and carried them on laps around the first floor of our house.

By day three, she didn’t even want the over-the-counter medication.

“I’m good,” she said. “I don’t need it.”

I felt a mixture of relief and rage. Why were we sent home with so many pills? Without my brother’s experience, I might have given all of them to her.

Her recovery was so quick that it became hard to keep her quiet. On day four I found her teetering on the back of the sofa, arms wide, like she was walking a tightrope.

“Have you lost your mind?” I snapped. “Get down from there!”

“Mom, I’m training,” she protested. “Pain doesn’t bother me so I’m practicing for the military. I made the sofa into an obstacle course.”

As I tucked her back under a blanket, I thought of the twists, turns and pressures my children will inevitably face in their adult lives. My daughter’s resilience has given me reason to hope. Together we are defying our family heritage.

This article first appeared here at the NYTimes.com
Jennie Burke is a writer who lives in Baltimore.

Addiction Recovery Bulletin

A working paper published by the National Bureau of Economic Research (NBER) argues that the decades-long U.S. opioid crisis is “a unique product of specific policies and features of the U.S. health care market” that remain in effect.

“Without the opioid epidemic, American life expectancy would not have declined in recent years,” the paper stated. “In turn, the epidemic was sparked by the development and marketing of a new generation of prescription opioids and provider behavior [that] is still helping to drive it.”

In December 1995, the FDA approved a new opioid known as Oxycodone. Subsequently, according to the National Institute on Drug Abuse (NIDA), “pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and health care providers began to prescribe them at greater rates.” A blizzard of prescriptions followed.

An estimated 21-29% of patients who are prescribed opioids for chronic pain end up misusing them, according to NIDA, while 8-12% develop an opioid use disorder.

Tens of millions of Americans became addicted to prescription opioids and tens of thousands died of overdoes in the two decades that followed. In recent years, the overdose crisis accelerated after synthetic opioids like fentanyl began flooding the U.S.

A lot of the problem has to do with regulation’

The pharmaceutical industry’s opportunism — enabled by the backing of politicians and federal regulators — along with the emerging medical consensus that opioids were highly effective for pain management, led to opioids taking hold in American society.

Furthermore, money pouring in from Big Pharma and a green light from D.C. provided American doctors with a financial incentive to prescribe more opioids.

“People have blamed all sorts of things, heroin from Mexico and fentanyl from China and economic decline and so on and so forth,” Dr. Janet Currie, a professor of economics and public affairs at Princeton University and one of the co-authors of the paper, told Yahoo Finance. “But really the issue is that a whole lot of people got addicted because they were prescribed pain medications which aren’t prescribed in the same way in other countries. They’re much more controlled.”

Opioids are prescribed and abused in the U.S. at a significantly higher rate than any other country.

“If you recognize that a lot of the problem has to do with regulation… most other countries, when they do allow opioid prescription, they don’t know how high doses of opioid prescriptions are but we do,” Currie said. “Most other countries don’t allow advertising medications direct-to-consumers but we do. There’s a whole list of things like that which have made things worse.”

‘The economic impact is also quite substantial’

Some research indicates a strong correlation between workforce participation and overdose rates. And last year, while testifying before the House Financial Services Committee, Federal Reserve Chair Jerome Powell spoke of adverse effects on the workforce.

Originally posted on Yahoo.com here

U.S. states claimed they are owed $2.2 trillion to address harm from OxyContin maker Purdue Pharma LP’s alleged role in America’s opioid epidemic, accusing the drugmaker in new filings of pushing prescription painkillers on doctors and patients while playing down the risks of abuse and overdose.

In filings made as part of Purdue’s bankruptcy proceedings that were disclosed on Monday, the states said Purdue, backed by the wealthy Sackler family, contributed to a public health crisis that has claimed the lives of roughly 450,000 people since 1999 and caused strains on healthcare and criminal justice systems. The filings cited more than 200,000 deaths in the U.S. tied directly to prescription opioids between 1999 and 2016.

In large states such as California and New York, claims alone totaled more than $192 billion and $165 billion, respectively. Forty-nine U.S. states, Washington, D.C. and various territories are making the claims. Oklahoma settled litigation with Purdue last year.

Purdue filed for bankruptcy in 2019 under pressure from more than 2,600 lawsuits brought by cities, counties, states, Native American tribes, hospitals and others. The lawsuits said the company, and in some cases the Sacklers, used deceptive marketing and took other improper steps to flood communities with prescription opioids.

The company and family have denied the allegations and pledged to help combat the opioid epidemic, including by providing addiction treatment drugs and overdose reversal medications under development.

In response to the state claims, Purdue said it continues to work toward resolving litigation and emerging from bankruptcy, and that it is typical for claims from various creditors to be “filed in amounts substantially larger than what is ultimately allowed by the court.”

Sackler representatives did not immediately respond to requests for comment.

Purdue and the Sacklers have pointed to fentanyl and heroin as more significant culprits in the opioid crisis. States in their filings, though, pointed to National Institute on Drug Abuse research estimating that about 80% of heroin abusers previously took prescription opioids.

In addition to the assertions from states, Purdue faces claims exceeding $18 billion from the U.S. Justice Department on account of potential penalties resulting from criminal and civil investigations.

In filings tied to Purdue’s bankruptcy case, federal prosecutors said Purdue contributed to false claims being made to federal healthcare insurance programs by allowing doctors to write medically unnecessary opioid prescriptions that were at times tainted by illegal kickbacks, according to a person familiar with the matter.

The Justice Department claims also included possible penalties arising from allegations that Purdue violated the U.S. Food, Drug and Cosmetic Act and violations of federal conspiracy and anti-kickback laws, the person said.

The Justice Department has declined to comment on the claims.

Claims from states and federal prosecutors are being processed after being filed just before a July 30 deadline set by a U.S. bankruptcy judge. While they will collectively exceed trillions of dollars, the filings are in many cases placeholders as opposed to roadmaps for how much money Purdue will ultimately pay its creditors, the bulk of which are U.S., state and local governments.

Purdue is only worth a bit more than $2 billion if liquidated. The company values a proposal to settle litigation, which includes providing addiction treatment and overdose-reversing drugs, at more than $10 billion. The Sacklers would contribute $3 billion and cede control of Purdue, with the company becoming a trust run on behalf of plaintiffs.

From Reuters.com

In April, Rob Camidge was released from a short stint in jail and right into a pandemic. A recovering heroin addict with long stints of sobriety, Camidge knew the routine that helped to keep him clean: Working. Going to the gym. And three times a week, visiting an outpatient program where his urine was tested.

Now, due to COVID-19, there was no work. The gym was closed. And his recovery program moved online, sans drug tests. Narcotics Anonymous meetings via Zoom “don’t feel real,” he said. “There’s nothing like talking to someone across from you, looking from eye to eye.”

Besides, he was isolated from his friends and family on the Jersey Shore—and idle. “I can’t do what I normally do,” he said. “So what I know best is getting high.” And without in-person drug screenings, he figured “no one knows, the only person who knows is me…It’s only going to be this one time.”

Camidge got what he calls “the stinkin’ thinkin’” and began using heroin again in June before finally getting into a rehabilitation program. He’s now clean, living at a halfway house in Newark. And he’s finding a semblance of stability at a nonprofit for the formerly incarcerated called the New Jersey Reentry Corporation, where those who have dealt with incarceration and addiction are pouring into their offices, telling stories about how the recent pandemic worsened the health emergency that was already here: opioid addiction.

Early government data from throughout the region show a spike in suspected drug overdose deaths since the lockdown began in March. Deaths in New Jersey were up 15 percent from March to June, compared to the same period last year. In 2019 overdose deaths in New Jersey totaled 3,021—a slight decrease from the year before. But any progress appears to be wiped away in 2020. There were 309 deaths in May alone, compared to 248 in May 2019.

Queens saw a 56 percent spike in overdose deaths during the first five months of the year. In Staten Island, the 58 overdose fatalities so far this year represent an increase from 49 at this time last year (though a spokesperson from the district attorney’s office said the numbers are preliminary and could change).

Another indicator: Emergency Medical Technicians in New York City administered naloxone, the drug used to revive those who overdose on heroin, 23 percent more often than last year, according to NY1. Unlike in New Jersey, which maintains an online overdose tracker, neither the state or city health departments in New York said it had public data about overdose deaths in 2020.

Nationally, a White House drug policy office analysis showed an 11.4 percent increase in fatalities during the first four months of the year, while a New York Times analysis estimated the increase to be 13 percent.

When the coronavirus epidemic first began to take hold in March, President Trump presaged the problem. “You will see drugs being used like nobody has ever used them before,” he said. “And people are going to be dying all over the place from drug addiction, because you would have people that had a wonderful job at a restaurant, or even owned a restaurant.”

Those struggling in recovery and the network of people who work with them describe myriad reasons for the spike in overdose deaths during COVID:

• A pause in drug screenings at outpatient facilities meant that those in recovery weren’t being held as accountable for staying off drugs.
• In-patient drug treatment facilities halted or limited in-take to preserve social distance. The New York State Office of Addiction Services and Support even advised that admissions be reduced.
• Group therapy sessions could no longer be held, leading to therapy via Zoom—which requires that patients have a video-enabled device. Such sessions also lack the human interaction many struggling with addiction require.
• Quarantine-imposed social isolation and separation from friends and family not only exacerbated some of the mental health challenges associated with addiction, but it led some heroin-addicted people to use alone, with no one there to revive them with naloxone or call 9-1-1 if they overdosed.
• Government offices were closed, so those leaving prison on drug charges had a harder time accessing housing, food and other public benefits, leading to a sense of desperation that can trigger relapses.
• Many doctors’ offices, where suboxone is prescribed to help people get off heroin, closed.
• The economic crisis has made jobs and affordable housing scarcer, especially for those re-entering the community.
• Fentanyl, an opioid far deadlier than heroin, is becoming increasingly common on the streets.

Jim McGreevey, former governor of New Jersey and now the chairman of the New Jersey Reentry Corporation, has spent much of the last 16 years since he left office ministering to prisoners and running nonprofits that assist those leaving incarceration.

“Some people suffer COVID watching Netflix; other people suffer COVID being out in the street worrying about how they’re going to eat, where they’re going to sleep,” McGreevey said to a group gathered at the nonprofit’s facility in Paterson on a recent Monday morning. “The stack is already against [those struggling with addiction] on so many levels, but COVID just made it worse, COVID made it almost insufferable.”

And yet, as the need increases to help the formerly incarcerated with addiction recovery, government support is in peril. McGreevey laid off 10 percent of his staff due to state budget cuts, and without more funds, he said his Paterson office could close this fall.

“We’ll spend a fortune to keep people locked up in prison, but we don’t do much to help people when they come out of prison in terms of addiction treatment, in terms of employment,” he said.

Budget cuts are playing out similarly in New York, where lawmakers are alarmed by a possible 31 percent reduction in drug treatment funding. Advocates for drug treatment say the federal government needs to provide emergency relief to mental health and addiction services, but little has been appropriated.

The irony of COVID is it prompted officials to release scores of incarcerated people—like those held on drug crimes—in order to prevent the spread of the virus behind bars. But without jobs or treatment programs waiting for them, they weren’t necessarily better off on the outside.