1 in 5 deaths in young adults is opioid related

 A few statistics from a new study of opioid deaths in the US (see link)

According to a new study published in the journal JAMA Network Open by researchers from St Michaels Hospital in Toronto, Canada, the opioid problem in the United States has been getting far worse in the last 3 years. The percentage of all opiate deaths — that accounts for heroin, painkillers, and more — has increased 292%. 
1.68 million people died in 2016 alone, according to the research, with most deaths happening between the ages of 24 and 35. 

• For the 24 to 35 age bracket, 1 in 5 (20%) deaths were due to opioid use, up from just 4% in 2001. 
• 1,681,359 years of life were lost (the average age of American life is 78.4 years, as per the 2012 census)
• Perhaps most shocking of all, opioids accounted for 12.5% of the deaths between ages 15 to 24. 
• 67.5% of opioid deaths were men, with the median age of 40 years old. 

How truly awful it is.....

Alternative methods can help stem nation's opioid crisis

The New York State Psychological Association's Division on Addictions has written a paper that provides a road map for helping the millions of Americans who are addicted to opioids and preventing new individuals from emerging into the misery of opioid addiction. Here are seven ideas from the paper that would have a profound impact on the opioid epidemic.

1. Require prescriber and patient education about the risks of opioid-based pain medications.

2. Require health-care providers to provide referrals to substance use treatment for opioid-overdose survivors and patients coming out of emergency department visits, rehabilitation centers and detoxification facilities.

3. Offer referrals for evidence-based interventions for pain management that do not involve opioids.

4. Provide evidence-based training and education about substance misuse for medical and mental health professionals and students.

5. Integrate medical, psychological and social interventions.

6. Address opioid use in individuals who are in and transitioning out of the criminal justice system.

7. Respect the importance of a harm reduction framework for the entire continuum of care.

https://www.timesunion.com/opinion/article/Alternative-methods-can-help-stem-nation-s-opioid-12967395.php

Which piece of advice above you may find most helpful to fight with the opioid epidemic?

Do you agree with "a solution to the opioid epidemic is attainable, but it will only be realized when policymakers and caregivers in government, health care, education, law enforcement and other arenas work together to create a comprehensive approach that reduces the frequency of opioid overdose and death"?

Voters Demanding Solutions

As we approach the 2018 midterm elections an increasing issue for voters is solutions to the opioid crisis. This article in Reuters outlines how the the citizens of Binghampton, NY are pressing candidates to offer solutions to the crisis. Many even say the Democratic candidate can flip the previously red county if they offer the best solutions to the opioid crisis.

With what we have learned in class what do you think the voters want to hear in order for them to change their party allegiance in the midterm elections to address the opioid crisis?

https://www.reuters.com/article/us-usa-election-opioids/voters-in-opioid-plagued-districts-demand-solutions-from-candidates-idUSKCN1J11BE

As Opioid Crisis Grows, Medical Schools Bolster Addiction Training

UCSF's School of Medicine started the program of addiction training last year, partially in response to the growing need to treat opioid addiction in California and beyond. The program is designed to give doctors extensive training in addiction medicine at the beginning of their careers. It is part of a broader shift by medical schools around the country to adapt to the opioid crisis by better incorporating addiction medicine — historically a field within psychiatry — into overall medical training.

Read story of Snyder: https://www.sfchronicle.com/business/article/As-opioid-crisis-grows-medical-schools-bolster-12963095.php

Do you think this program is helpful? Do you think such program should be implemented by other medical schools?

The Possibilities of Medical Marijuana being able to combat the Opioid Crisis

As we discussed in prior weeks, medical marijuana can potentially be a large scale substitute for opioid prescription. This article examines Illinois potentially looking at the option of increasing medical marijuana in the state as a means for combating the opioid epidemic.

Do you think medical marijuana is a solution for minimizing opioid use? Do you think in the current political climate that government officials would legalize medical marijuana if it means reducing opioid deaths?

http://www.sj-r.com/news/20180603/can-medical-marijuana-help-combat-illinois-opioid-crisis

Who caused the opium war?

As introduced in the early post, between 1839 and 1842 British forces a war on behalf of drug traffickers, which opened up the lucrative China trade to British merchants. This post may answer the question, W.

Chinese-made silk, tea, porcelain were very popular in the European market. The British people hoped that China can open up trade. However, Qing emperors were sensitive to their outsider status. The British exports of wool, cashmere and other industrial products were not popular in China. The Qian long emperor even believed that China was a vast country with abundant resources, and there is no need to trade with the UK.  

On the other hand, the foreign merchants chafed against high port taxes (at 20%), pay-offs to innumerable official. 

Besides, in the 18th century, the UK implemented the gold standard monetary policy, while the Qing Dynasty used silver as the currency. Sold by silver but bought by gold made British merchants benefit from the impaired. 

Therefore, British merchants therefore smuggled opium to China to balance their interests.

Suggested reading: http://www.scmp.com/culture/books/article/2097701/who-caused-opium-war-british-merchants-canton-argues-new-book

Do you now think Britain used opiates as a weapon to defeat China?

Opiates in golden triangle

Golden triangle in southeast Asia, including Thailand, Laos, and Myanmar, was responsible for producing over half of the world's opium as recently as the 1990s. The opiate problems in Laos, for example, are severe:

1. Although the government has proved its ability to locate and destroy poppy fields, but its dedication to disbursing aid—such as might motivate the erstwhile growers to pursue other livelihoods—is more questionable. UNODC believes that less than 10% of the villages declared opium-free have received funds promised for growing alternative crops. The effects of this failure were exacerbated by the global financial crisis. Weaker demand led to a fall in farm-gate prices for legal crops, while higher input costs raised prices for household goods. As standards of living declined, the reasons to return to poppies grew stronger.

2.  Methamphetamine, known in Thai or Lao as yaba, is rising sharply. 

The ease and speed with which yaba factories can be assembled and relocated, combined with Laos' porous borders, makes it a cinch to evade the police. Unlike poppy plots, meth labs are not easily spotted by helicopter surveillance. So it is difficult to determine whether police are making inroads or whether factories are simply scaling up production. Nor is it possible to tell if seized pills originated in Laos or only indicted midway along their journey to markets in Europe, America and elsewhere in Asia.

Read Article: https://www.economist.com/banyan/2011/07/19/a-second-wind-from-the-golden-triangle?zid=293&ah=e50f636873b42369614615ba3c16df4a

Do you have any suggested policies to Laos government to solve the opiate problems?  Do you think if it is possible for Laos to implement "decriminalization"? 

Burning of Opium Stocks in Humen

A story just before the first opium war in the 19th century:

Daoguang eighteen years (1838) in September, Lin Zexu to the Emperor Daoguang letter, about the Western countries on China's large dumping of opium harm, if ignored, a few decades later, China will have no soldiers can resist the enemy, the Treasury will emptiness. Daoguang emperor read, was deeply moved, that is, in the same year on December 31 appointed Lin Zexu as imperial envoy, to ban opium in Guangzhou. In the process of ban on opium in Guangzhou, Lin Zexu realized that the British colonists refused to give up the evil opium trade, and plan to use force to invade China. In order to fight against opium aggression, defeated the enemy, he carried out a lot of "learning the enemy's ability to resist the enemy" military reform practice. Lin Zexu in Guangdong side of the ban on smoking, while actively preparing for the construction of the fort, he believes that "people can be used," recruiting more than 5,000 fishermen compiled sailors, defeated the British provocation. In the second half of 1839, won the battle of Kowloon and other victories.

From March 1839, Lin Zexu arrived in Guangzhou to ban opium, to October 1840 the Qing Dynasty to stop Lin Zexu Governor of the two borough duties, Lin Zexu in Guangzhou hosted a ban on anti-British military struggle for 19 months. May 18, 1839, spent 34 days, 19187 boxes of smoke collected, the total weight of 1188127 kg. June 3, which lasted 23 days in the Humen destruction of opium, under the command of Lin Zexu, declared to the world the Chinese nation will not succumb to the determination of aggression. Lin Zexu went to Guangzhou to ban smoking, in the practice of fighting with the invaders, he realized that his lack of Western knowledge, he began to consciously purposefully to collect foreign newspapers, books, translation, in order to obtain valuable information, Understanding of "Western". By analyzing foreign political, legal, military, economic, cultural and other aspects, he realized that only to learn from Western countries, China can resist foreign aggression.

Lin Zexu in Humen to destroy opium to a certain extent, to curb the spread of opium in China, in the civil society had a positive impact. Second, the ban on smoking greatly increased the awareness of the Chinese people on the harm of opium, so many people see the British trafficking in opium to the nature of China, wake up the Chinese people's patriotic consciousness. After this incident, non-smoking hero Lin Zexu by the Chinese people respect for national heroes. His honest, upright quality has also been descendants of praise. However, Lin Zexu in Humen destroyed the opium did not effectively save China in the fire and water, but accelerated the British invasion of China. The reason is that the ban on smoking directly undermines the interests of the British bourgeoisie, the British government quickly decided to launch a long-planned war of aggression against China, "Lin Zexu in the Humen destruction of opium" has also become a foreign powers launched the fuse of the Opium War. From this point of view, Lin Zexu in the Humen destruction of opium to accelerate the pace of China's semi-colonialization, to a large extent to promote the development of modern Chinese history.

Lin Zexu in the Humen destruction of opium on the one hand to wake up a lot of patriotic people of China at that time, they began to reflect on, repositioning China's position in the world, no longer think that China is "heavenly country." On the other hand, it also greatly inhibited the British opium trade in China, a heavy blow to the British bourgeoisie in China's trade plunder, showing the Chinese people's determination and awareness of smoking ban. In addition, this event has become an example of the world's anti-smoking movement, history, many countries and regions combined with their own situation to be followed to curb the proliferation of drugs. Lin Zexu led the victory of the ban on smoking, safeguarding the dignity and interests of the Chinese nation. Lin Zexu in the Humen destruction of opium is an important event in the modern history of China against imperialism, but also the feat of human history. 

This story shows how individuals fight with opiates during the most dark period when China was stuck by opiates. Historians believe that it shows the determination of the Chinese nation against foreign aggression, which has a symbolic significance for the Chinese people to fight against foreign aggression.

Fentanyl Deaths quadrupled in since 2016 in West Michigan

This article came out last night saying that West Michigan, specifically Calhoun and Kalamazoo county, have a higher rate of fentanyl overdoses than the rest of the state combined. Calhoun county Medical Director Dr. William Nettleton says death rate per 100,000 people in 2016 nearly doubled the rate of the entire state. Many public officials say the only way to combat this widespread addiction is to come together as a community.

What do you think W Michigan can do to reduce fentanyl OD's? Do you find it surprising that W Michigan has so many more OD's than the rest of the state?

http://wwmt.com/news/local/opioid-deaths-involving-fentanyl-quadrupled-in-two-years

PIcture of old opium den

Titled "Smokers in Old Kolkata 1945."  (see link)

Thoughts?

The Opium War

The blogs that I will post this week would serve as preview materials for the next week's class. We are going to discuss the opium war in China in the 19th century.

Between 1839 and 1842 British forces fought a war on behalf of drug traffickers. Their victory opened up the lucrative China trade to British merchants. This was all done with the full blessing of the British government.

https://www.nam.ac.uk/explore/opium-war-1839-1842
This article gives a brief introduction on the root, process and consequence of the first Opium War.

Any thoughts?
Do you think opiates were used as a weapon to defeat China? The article said "the British believed the Chinese had always been uncooperative", do you believe it is true?

The Great American Fraud

From the first paragraph on an expose on opioid addiction and the role of advertising:

GULLIBLE America will spend this year some seventy-five millions of dollars in the purchase of patent medicines. In consideration of this sum it will swallow huge quantities of alcohol, an appalling amount of opiates and narcotics, a wide assortment of varied drugs ranging from powerful and dangerous heart depressants to insidious liver stimulants; and, in excess of all other ingredients, undiluted fraud. For fraud, exploited by the skilfulest of advertising bunco men, is the basis of the trade. Should the newspapers, the magazines and the medical journals refuse their pages to this class of advertisement, the patent medicine business in five years would be as scandalously historic as the South Sea Bubble, and the nation would be the richer not only in lives and money, but in drunkards and drug-fiends saved. 

 The article documents the complicit behavior of the medical profession and media with the producers of "opioid" drugs.   Nothing we haven't talked about in class this quarter, perhaps.  And yet, the series that this paragraph came from was first published in 1905.  Thoughts?

Purdue Pharma knew about opioid addiction....?

This article was recently posted on the NY Times about the origins of the opioid epidemic. Meier outlines that early on Purdue Pharma executives knew that Oxy was being crushed, snorted and ultimately abused. However, they continued to push the drug as less addictive than substitutes.

Since we have recently been discussing consequences for executives who wrongfully acted, what type of punishment (if any) should be handed out to the Purdue Pharma executives?

https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxycontin.html

Fentanyl Seized in Nebraska

http://www.savannahnow.com/news/20180527/inside-semi-truck-in-nebraska-troopers-found-enough-fentanyl-to-kill-26-million-people

-118 pounds of pure fentanyl that was worth about $20 million in the street would have possibly been able to kill about 26 million people. 26 million people.... Wow

-If you would take a guess, how many of these shipments are being delivered in a week?

Opioids in the water

From the BBC:

The finding suggests "a lot of people" are taking oxycodone in the Puget Sound, researchers say.
Scientists used mussels as a way to test pollution in Seattle's waters and discovered high enough oxycodone levels for the shellfish to test positive.  Mussels do not metabolise opioids, but some fish can become addicted.

The mussels were placed in the bay to test for pollutants.  I wonder what is in the Great Lakes?

Purdue’s superhero - Rudy Giuliani

https://www.theguardian.com/us-news/2018/may/22/rudy-giuliani-opioid-epidemic-oxycontin-purdue-pharma

“The former New York mayor also secured an agreement that greatly restricted further prosecution of the pharmaceutical company and kept its senior executives out of prison.”

-I am surprised on the deal Purdue received which avoided criminal conviction in a way. Rudy Giuliani was really Purdue’s savor.

-What is your thought on the deal they achieved?

Medication-Assisted Treatment

https://drugfree.org/parent-blog/medication-assisted-treatment/

I did not know anti-craving medications such as Naltrexone, Buprenorphine and Methadone existed.

-Have you heard about these anti-craving medications? If so, what is your input on it?

Do you think it is helpful? Should we consider this as a reliable option for treatment?

Opioid Addiction Advertisement

https://www.adweek.com/brand-marketing/a-teen-wrote-and-co-directed-this-powerful-psa-about-the-rapid-spiral-of-opioid-addiction/

I think this is a good advertisement that helps bring awareness to the crisis and I could definitely see this video being shared on different news outlets.

What did you think about the ad overall?

Fed Conducts National Survey

https://www.npr.org/2018/05/23/613854559/opioid-crisis-takes-a-toll-on-economic-outlook-for-many-americans-fed-says


The Fed conducted a national survey and for the first time they included questions regarding opioid addiction.
If economists are realizing the impact that opioid abuse and addiction are having on the economy, what would you consider to be the next step to try to address these trends in regards to trying to improve financial stability?

CEO’s of Valeant and Philidor are convicted

https://www.courthousenews.com/former-valeant-philidor-executives-convicted-of-fraud/

Both CEO”s were charged with : “one count of conspiracy to commit honest services wire fraud;

one count of honest services wire fraud; one count of conspiring to violate the Travel Act;

and one count of conspiring to commit money laundering.

The charges together carry a maximum sentence of 65 years in prison.”

-Do you think it is a fair indictment?

The U.S. Attorney Berman described the CEO of Valeant as the “fox guarding the henhouse.”  

While it was Tanner the one who provoked significant risks, it was thanks to the company’s own financing,
personnel and supervision department who further continued this fraud.

-Do you think the CEO had to go down in order for the company to remain active?

Brett Favre Opens Up About Painkiller Dependency

https://syndication.bleacherreport.com/amp/2777311-brett-favre-says-he-went-to-rehab-3-times-once-took-14-vicodin.amp.html

I know I’ve already blogged for today, but this popped up on my phone this morning and I feel it’s something that definitely pertains to this class. Brett Favre, one of the greatest quarterbacks to ever play in the NFL, opened up today about his dependence on alcohol and painkillers. According to the article, he went to rehab 3 different times in his career, and once took 14 Vicodin pills at once (to put this into perspective, a month’s prescription of Vicodin is 30 pills).

This also reminded me of the Chris Heron story we watched in class. I think painkiller addiction is something that is much more prevalent in sports than we hear about, and is definitely swept under the rug in certain cases. What is everyone’s reaction to this?

Esteemed Lawyer Sues Big Pharma

https://www.independent.co.uk/news/world/americas/us-opioid-crisis-mike-moore-big-pharma-tobacco-suing-lawyer-mississippi-a8362346.html?amp

According to this article by Independent, esteemed Mississippi lawyer Mike Moore is the primary lawyer for Mississippi in the lawsuit from my first post, in regards to multiple states suing Purdue Pharma. Moore is most well known for a case he was a part of in the 1990s, specifically for holding tobacco companies accountable for making false claims about cigarettes in their marketing campaigns.

Personally, I’m glad that someone who has experience with holding companies who market addictive products falsely accountable will be representing Mississippi in court. What are your thoughts on this?

New York Looks North: Supervised Heroin Sites

https://www.nytimes.com/2018/05/21/nyregion/opioid-crisis-compels-new-york-to-look-north-for-answers.html

"As Mayor Bill de Blasio has come out in support of supervised injection centers in New York, his stance has been shaped by Caanada. The country has been a pioneer; its first supervised injection facility, where heroin can be used under supervision, opened in Vancouver in 2003. A decade of political and legal wrangling followed, culminating with the Canadian Supreme Court ruling in favor of the approach in 2011."

Canada pioneered these supervised injection centers, they seem to support a mantra of "Don't do it alone." New York and San Francisco are currently trying to launch these sites as early as this summer. In an era where we are facing this massive surge of deaths from opioids, do you think this approach could help? I have questioned the legality of this before, but do you think federal authorities in the U.S. would step in to interfere with these sites? 

Anti-Drug Video from the ‘50s

https://m.youtube.com/watch?v=F4HPk20gDMc

This is an anti-drug video from the 50s. I thought it was interesting. Responses could answer the following: What is your biggest takeaway? What audience do you think this video was trying to reach? If you watched something like this and knew nothing else about the issue, how would you view drug addicts? Who do you think was responsible for pushing videos/messages like this to the public?

Deadly Prescription “Super Pills”

https://nypost.com/2018/05/20/schumer-deadly-super-pills-are-making-opioid-epidemic-even-worse/amp/

This New York Post article discusses a new OxyContin brand “Super Pill” that has been being prescribed by doctors recently. According to the article, the drug “has the dosage power of 24 Vicodin tablets in one swallow.”

I personally found this short article pretty shocking. It seems to me as if this drug being released and prescribed major step backwards in trying to aleviate the Opioid Crisis. What are your thoughts on this?

Surprising Heroin Facts

https://www.rollingstone.com/culture/features/opioid-crisis-what-people-dont-know-about-heroin-w520478

This Rolling Stone article discusses some heroin facts that are either misconceived or simply not public knowledge. The highlights include: Heroin can either be sold as powder or tar based, with a rare amount of it actually being in pill form. Symptoms that are typically associated with heroin use (dilated pupils, profuse sweating, scratching, etc) are actually typically symptoms of  heroin withdrawals. Heroin use rose in the 1960s, after soldiers returned from the Vietnam War having been exposed to opium, and that kickstarted the “War on Drugs.” Heroin abusers often overdose on purpose, so that they can be prescribed Naloxone, a drug which counteracts the withdrawl symptoms but gives users a similar rush.

What is your reaction to these facts? Do any of these surprise you?

Virginia Expands Medicaid Coverage For Treatment Centers

https://www.vox.com/policy-and-politics/2018/5/10/17256572/opioid-epidemic-virginia-medicaid-expansion-arts
   
Addiction treatment centers are notoriously underpaid;Virginia is using Medicaid to boost their reimbursement rates.

"What Virginia did was use the big health plan it has control over — Medicaid, which covers low-income people — to boost reimbursement rates to addiction treatment providers. The state started the program, the Addiction and Recovery Treatment Services (ARTS), in April 2017. After the program went into effect, the percent of Medicaid members with an opioid use disorder who received treatment went up by 29 percent from April to December 2017 compared to the same period the previous year. At the same time, emergency department visits related to opioid use disorders went down by 31 percent... Under ARTS, access to evidence-based anti-addiction medications like buprenorphine is financially incentivized with higher rates."

Any thoughts? Do we think this is effective? Should more states be doing this?

Opioid Crisis Takes Toll on NH Families

This article talks more about how parents who become addicts lose their children to foster care (a topic brought up last week). It is a big issue in New Hampshire, who is amongst the top 3 states that have been hurt the most by this crisis.

http://www.wmur.com/article/ongoing-opioid-crisis-takes-toll-on-nh-families/20734120

“Last year, 688 children were put into foster care in New Hampshire; 67 percent of them were placed because of family substance abuse. The number of terminated parental rights cases increased 63 percent in the past year. O'Neill said she believes courts are backlogged, and with a shortage of DCYF caseworkers and attorneys, the system is struggling.”

Any comment would suffice. If you’re feeling it, you can answer: Did this provide any surprising stats/info? Are there any entities you think are in a position to help?

San Francisco Special Medical Team

https://www.sfchronicle.com/bayarea/article/SF-mayor-s-bold-plan-to-treat-heroin-addicts-on-12920781.php

This article discusses a proposal the mayor of San Francisco had to create a special medical team for the city, whose chief purpose is to drive around the city and provide heroin addicts with a medication which severely reduces the withdrawal symptoms of heroin. The drug is called buprenorphine, and it is faster acting and more effective than methadone.

I personally feel that this is a great step towards helping addicts get through their addiction and on the path to leading a normal life. Do you think that this medical team will be effective? Should this be something implemented in all big cities?

Pharma-Doctor Dinner Dates

https://www.google.com/amp/s/www.vox.com/platform/amp/science-and-health/2018/5/15/17355722/opioid-epidemic-doctor-pharma-insys

This article is based around a study that was conducted involving pharmaceutical companies buying doctors expensive dinners. There was found to be a strong correlation between big pharmaceutical companies taking doctors out for expensive dinner dates and those same doctors prescribing more opioids than their counterparts who hadn’t been wined and dined.

What’s your reaction to this? Do you feel that there should be laws in place to prevent this? Or should it be on the hospitals who employ these doctors?

Opioid Abuse in Public Bathrooms

http://www.chicagotribune.com/news/ct-met-public-bathrooms-opioid-overdose-20180510-story.html

This article talks about how common it is for people to use opioids in public bathrooms. It is dangerous and usually, the business where these fatal incidents occur  face liability issues:

"Just this month, Cook County sheriff’s officers revived a man who allegedly overdosed in the bathroom of the Skokie courthouse, while another man died of a suspected overdose in the restroom of a Downers Grove Starbucks. Experts say the seclusion afforded by these spaces makes them dangerous, especially as fentanyl has increased the potency of heroin to unpredictably strong levels... Researchers in the late 1990s examined hundreds of heroin deaths in San Francisco and discovered that 5 percent took place in restrooms."

Do you feel these businesses should be held responsible? Should they start developing rules/codes to reduce/prevent this from happening? Any other thoughts are encouraged.

Roseanne Gets Caught Up in Opioid Crisis

https://www.washingtonpost.com/news/reliable-source/wp/2018/05/16/roseanne-gets-caught-up-in-the-opioid-crisis/?noredirect=on&utm_term=.2f3be3c4389f

To be clear, this is the fictional Roseanne, she isn’t actually addicted to pills. In the rebooting of the popular ABC series ‘Roseanne,’ the story line involves her taking Vicodin for her sore knee. She eventually becomes addicted, hides pills around the house, and takes them in secrecy.

“Since its politically steeped premiere, ABC’s “Roseanne” reboot has been promising an upcoming opioid story line. As regular, everyday, Main Street-dwelling Americans, it made sense that the Conners would be touched by the prescription drug epidemic that’s dominating headlines. The only question was: Which member of the clan would be a statistic?”

What do you all think of this? We talked a lot about different ways that we should be talking about this as a community. Should our entertainment industry be utilized in sparking conversations about this crisis? Any other thoughts??

Purdue Pharma Lawsuit

https://www.google.com/amp/amp.timeinc.net/fortune/2018/05/16/oxycontin-purdue-pharma-lawsuit-tennessee-florida-opioid-epidemic

This article discusses a recent lawsuit brought up against Purdue Pharma and other big Pharma companies by the states of Tennessee, Florida, North Carolina, Texas, Nevada, and North Dakota for falsely claiming prescription opioids as not addictive.

A direct quote from Robert Josephson, a Purdue representative, in regards to the lawsuit stated, “We are disappointed that after months of good faith negotiations working toward a meaningful resolution to help these states address the opioid crisis, this group of attorneys general have unilaterally decided to pursue a costly and protracted litigation process.”

Mike Papantonio, a Florida-based lawyer representing the plaintiffs, also made a statement in regards to the trial, which was, “You can’t accomplish anything in terms of getting companies to admit they are responsible without filing lawsuits. There won’t be any closure on this without litigation.”

How do you personally feel about this issue? Do you think that settling out of court would be the most effective way of making policy changes towards improving the Opioid Crisis? Or do you feel there needs to be a lengthy litigation to hold the pharmaceutical companies accountable?

Michigan has the 4th biggest drug problem in the US

I know I'm not supposed to be blogging this week, but I thought this was interesting to share.


https://www.wxyz.com/news/michigan-has-the-4th-biggest-drug-problem-in-the-us-report-finds

Detox Now

http://wsbt.com/news/local/detox-now-is-la-porte-countys-newest-tool-in-combating-opioid-crisis

This article discusses the Detox Now program that is being implemented in LaPorte County, Indiana.  It was made possible by a $633,000 grant from the Health Care Foundation of LaPorte County aims to eliminate those barriers to wellness like funding and transportation. The program is free to all LaPorte County residents and provides people with access to treatment and recovery without the fear of getting in trouble.  If someone has drugs on them when they come in for help, law enforcement just destroys it without making an arrest.

I think that programs like these will go a long way with making a tangible impact on the lives of those affected by the crisis.  Understanding what addicts are going through and offering them help no matter how low they are is important. I think federal funding should be allocated towards replicating programs like Detox Now in communities across the country.

Grandparents Raising Grandchildren

https://www.cbsnews.com/news/opioid-epidemic-leaving-grandparents-to-raise-grandchildren/

This article discusses how the opioid crisis affects families and in some cases shifts guardianship to older siblings or grandparents.  It is heartbreaking what some of this children are exposed to at such a young age and how quickly that are forced to grow up. This exchange between Bill Whitaker and nine-year-old Cheyenne Nunn is hard to read:

Bill Whitaker: Did you have enough food?

Cheyenne Nunn: Sometimes but not always. I hid it under my bed.

Bill Whitaker: What would you hide?

Cheyenne Nunn: Top Ramen. Something easy to cook.

Bill Whitaker: How old were you?

Cheyenne Nunn: Five, six.

Bill Whitaker: How did you know to step up and take care of your little sister and cook?

Cheyenne Nunn: I knew that she needed it. So I decided to be what -- something I'm not.

Bill Whitaker: Which is?

Cheyenne Nunn: A grownup.

Bill Whitaker: You decided to be a grownup?

Cheyenne Nunn: Yea, I tried to be a grownup for Lilah.

Can you guys think of any types of resources that can be put into place so that five-year-olds don't have to be grownups? Also, I take my hat off to the grandparents who are willing to start over and become parents again. It's easy to say we all would do the same if the time came, but it's much harder to actually be willing to sacrifice retirement to change diapers.

Bona Fide Prescriber-Patient Relationship

We have learned that from our readings and discussions that the Midwest has been hit especially hard by the crisis.  Because of this, I wanted to know what Michigan was doing as far as legislation to combat the rampant opioid abuse.  I found a couple of websites that mentioned a "Bona fide relationship" bill.  The bill requires that a licensed provider may not prescribe a controlled substance listed in schedules 2 to 5 unless the prescriber is in a bona fide prescriber-patient relationship with the patient being prescribed the controlled substance.  

A bonafide relationship was originally defined as follows:

"The bill defines a bona fide prescriber-patient relationship as a treatment or counseling relationship between a prescriber and a patient in which both of the following are present:

· The prescriber has reviewed the patient's relevant medical or clinical records and completed a full assessment of the patient's medical history and current medical condition, including a relevant medical evaluation of the patient conducted in person or via telehealth.

· The prescriber has created and maintained records of the patient's condition in accordance with medically accepted standards."

(The full summary of the bill can be found here: https://www.legislature.mi.gov/documents/2017-2018/billanalysis/House/htm/2017-HLA-0270-32A56060.htm)

The bill was initially slated to go into effect on March 31st of this year, but has since been tentatively postponed until March 31, 2019. The date was postponed due to concerns raised by the Michigan State Medical Society (MSMS), over the definition of a "bonafide relationship". One major concern that they have with the bill in its original state, is that it severely restricts the ability to provide quality care to established patients in emergent situations, when another prescriber is providing care when the primary prescriber is unavailable.

What do you guys think about this bill? Do you think that it will help reduce the number of people abusing opioids? Is it easily enforceable? Should other states adopt similar legislation?

Children of the Opioid Crisis

https://www.nytimes.com/2018/05/09/magazine/children-of-the-opioid-epidemic.html

This article profiles a number of women who are attempting to beat addiction for themselves and for their children. The article states that the young-adult population has been hardest hit, proportionately, with nearly 400,000 adults ages 18 to 25 suffering from addiction to prescription painkillers (the vast majority) or heroin. I did not realize that our age demographic makes up about a quarter of the total number of people battling opioid addiction in this country.  An interesting part of the article was the discussion of the standard of care for pregnant women addicted to opioids. Here is a key excerpt:


"The standard of care for a pregnant women addicted to opioids is medication-assisted treatment: a long-acting opioid substitute — traditionally methadone — that binds to the body’s opioid receptors to prevent withdrawal symptoms, usually without causing the euphoric sensations that commandeer the brain’s dopamine system into a relentless quest for more. Pregnant women on methadone or buprenorphine (a newer opioid-replacement drug) are more likely to bring their pregnancies to term, ensuring higher birth weights and better health for their babies...Women stabilized on medication-assisted treatment are in far less danger of relapsing, overdosing or contracting H.I.V., hepatitis C or other infections common among those who inject drugs. They experience less maternal stress, which has been shown to negatively impact the fetus’s epigenetics, or gene expression."


However, Methadone and buprenorphine are still opioids, and a fetus that is adapted to them is still at risk for withdrawal syndrome after birth. The author discusses how pregnant women addicted to opioids have not been a part of the attitude shift within this country of addiction being viewed as a mental illness. Instead, they are the subject of harsh punishments, due to the fact that their children are born with withdrawal syndrome. What do you guys think about mothers who are addicted during pregnancy being charged with child abuse? Do you think that these punishments will discourage pregnant women who are addicted from seeking help?

Opioid Distributor Apologizes

https://www.usatoday.com/story/news/politics/2018/05/08/drug-crisis-distributor-apologizes-large-opioid-shipments/589760002/

This article was published yesterday and talks about the role opioid distributors have played in the epidemic happening in West Virginia.  A top executive at one of these distribution companies apologized on Tuesday for "his company's failure to stop sending painkillers to two West Virginia pharmacies", but later said that he doesn't think that his company's actions contributed to the epidemic.  For a bit of context, these two pharmacies that Cardinal Health shipped pills to, are the focus of a congressional investigation.

Some of the numbers from this article are staggering:

• between 2007 and 2012, distributors sent more than 780 million hydrocodone and oxycodone into West Virginia, which roughly equals 433 pills for every man, woman and child in the state, congressional investigators say. During that time, 1,728 West Virginians fatally overdosed on those two drugs.
• Investigators discovered that a single pharmacy in Mount Gay-Shamrock, population 1,779, received more than 16.5 million hydrocodone and oxycodone pills between 2006 and 2016. In nearby Williamson, population 2,900, distributors sent almost 21 million opioids to two pharmacies during that same period.

Looking at these numbers, I just don't see how pharmaceutical distributors can say that they did not contribute to the epidemic in some way. Do you guys think that it is the responsibility of these companies to stop sending to pharmacies that may be problematic? Or is it the responsibility of the government to put regulation in place to prevent these companies from flooding communities with painkillers?

Despite opioid crisis, Louisiana may cut drug treatment options

The final article I am posting shows that despite the increasing awareness that laypeople have of the opioid crisis, some states are failing to recognize this and are slashing funds that are meant to go for treatment centers. One example is Louisiana.

The latest state budget proposal, passed by the Louisiana House, scraps $47 million worth of state and federal funding that pays for outpatient drug and alcohol treatment programs for adults enrolled in Medicaid. In January, 4,600 people were using services paid for with this money that would no longer be available, according to the Louisiana Department of Health. 

It could be worse. The original budget proposal considered by lawmakers completely eliminated drug and alcohol treatment for adults with Medicaid after July 1. It scrapped all inpatient and outpatient substance abuse treatment funding -- a total of $74 million from state and federal sources.

Do you think that there can be other solutions that can alleviate the impacts of these cuts? What would happen if, let's say, insurance acknowledge that there are other treatments that are needed beyond Naxolone and start covering therapy? Would this be a good solution? 

Walmart to restrict selling opioids at their pharmacies

I know it is not my turn to post, however I just saw this on CNBC about Walmart restricting opioid sales at their pharmacies. I thought it was interesting and wanted to share it with you all!



https://www.cnbc.com/2018/05/07/walmart-to-restrict-opioid-dispensing-at-its-pharmacies.html

Opioid Epidemic Largely Skips Campuses

It seems that the Opioid crisis is hitting people of all races and gender, but people with higher levels of education are less likely to be hit by the crisis:

Individuals with less education are more likely to develop an addiction to opioids, recent research has found. This is for a few reasons: people with low education levels have fewer job opportunities, leaving them more vulnerable to depression and addiction; they usually work in areas with higher risks of workplace injuries, making opioid painkiller use more likely; and they have fewer resources to combat drug addiction, like money for rehabilitation.

Many campuses are giving Naloxone to security officials, and most of those who have had to use it are in community colleges. 

https://www.insidehighered.com/news/2018/05/07/colleges-prepare-treat-opioid-misuse-see-few-cases


Have you guys heard about the Opioid epidemic on college campuses? What about at K? Had you guys heard about the epidemic impacting K at all?

Return of cocaine complicates heroin crisis

This is an interesting Op-ed written by a doctor who finds that many of his patients have traces of cocaine in their body. The addition to cocaine to opioids seems to speed up the process of addiction and to cause more deaths:

The link is: https://www.theday.com/op-edguest-opinions/20180506/return-of-cocaine-complicates-heroin-crisis

Here are some passages:

Not all of these drug interactions are by accident. Drug combinations are intentionally used by some. Speedballing, a well-known practice among drug users, consists of cocaine mixed with opioids − used intravenously to get high.

Cocaine, a central nervous system stimulant, and opioids, a depressant, are co-administered to get an intense high and to counter the side effects of each other. This Russian roulette may be an exciting practice for some, but a misjudgment can easily lead to a fatal overdose.

A cocaine overdose can cause extremely high blood pressure, strokes, heart attacks and death. There is only a limited window of time to intervene medically to save lives in these cases, and no known drug can reverse these overdoses.

A few years ago there was hope for a cocaine vaccine, but that project has not yet yielded any empirical results. Currently, only cognitive behavioral therapy and contingency management are effective treatments for cocaine use disorders.

While most of the media and healthcare policy attention is focused on the opioid epidemic, this emerging cocaine problem is going mostly unnoticed.

Ethnic minorities are especially vulnerable to opioid-laced cocaine deaths. Those who are not ready to quit drugs should practice harm-reduction strategies such as needle exchange programs, using the test dose of the drug before injecting and keeping Naloxone handy to avoid accidental overdose.

Do you guys have policy suggestions for this issue beyond access to Naloxone and needle exchange programs? 

Kanye West addicted to Opioids

I don't necessarily expect comments on this post...but I just came across this video (that Kanye posted on his own twitter feed) and thought I would share:

http://www.tmz.com/2018/05/01/kanye-west-opioids-liposuction/

NYC Mayor Plans to Open Safe Drug Injection Centers to Combat Opioid Crisis

I thought this article was interesting, especially because the author of our first book argued that one of the solutions to ending the stigma and the Opioid Crisis is to create centers where addicts can inject under supervision.

http://insider.foxnews.com/2018/05/05/bill-de-blasio-open-safe-drug-injection-centers-combat-opioid-crisis

"New York City Mayor Bill de Blasio revealed on Thursday his plan to open four supervised drug injection facilities to help combat the nation's ongoing opioid epidemic.

According to the New York Post, the sites are places where people can safely inject heroin, and then receive help from professionals about changing their drug habits to hopefully overturn them.

Medical professionals will also supervise those at the injection centers and can administer an overdose antidote if needed."

5 weeks ago, I probably would've thought that the logic behind these centers is completely flawed and they make no sense. But little by little, it seems as if these centers may alleviate some of the stigma, spark conversation around addiction, and hopefully help addicts seek treatment.

 What do you all think in regard to building these centers?

LA sues 9 drug companies

LA has filed a civil lawsuit against 9 big drug manufacturers... what do you guys think? To me, it seems as if these lawsuits are coming in a bit late, and they are civil, so I don't think like they will have much impact since the companies can easily pay pretty much any fine. 

Does this change your perception of who is a victim of the Opioid Addiction? A lot of what we read seemed to focus on medium-sized cities and suburban areas, but now it seems as if the crisis is affecting major cities. 

Here is the links and some quotes:

http://www.latimes.com/local/lanow/la-me-ln-opioid-city-lawsuit-20180503-story.html

City Atty. Mike Feuer said that prescription drug manufacturers and distributors encouraged doctors to prescribe potent painkillers for chronic, long-term pain and downplayed the addictive nature of the drugs. The drugmakers also failed to report suspicious sales, he said.

"I will not let Los Angeles become the next West Virginia or Ohio when it comes to the devastating effects of the opioid crisis," he said at a City Hall news conference.

L.A.'s civil lawsuit names Purdue Pharma, Janssen Pharmaceuticals, Endo Pharmaceuticals, Cephalon, Insys Therapeutics and Mallinckrodt. The complaint alleges that the companies borrowed from the "tobacco industry's playbook" by using false and deceptive marketing and business practices to boost opioid sales.

The firms sought to "shift the way in which doctors and patients think about pain, specifically, to encourage the use of opioids to treat ... the masses who suffer from common chronic pain conditions," the suit says.

Latinos are hit especially hard by the Opioid crisis

I thought that this article was interesting. When talking about the victims of the Opioid Crisis, we have focused mainly on white families. But new studies show that Latinos are also hit very hard by the epidemic because of factors such as the lack of bilingual treatment programs and because there's a fear of being deported if one calls for help. 

Here's the link to the article: 

http://www.wbur.org/commonhealth/2018/05/03/latino-opioid-overdose-deaths

What do you all think? Should there be specific policies that help Latinos in particular? We tend to perceive them as the dealers, but it's interesting that many are in fact victims of the crisis.

Medical Marijuana may not help as much as we thought

Yesterday in class we talked about how Medical Marijuana may be used as a substitute for Opioids to combat abuse...However, new research shows, as in the case of Colorado, that states with legalized medical weed is not leading to less overdose deaths.

The link below explains this new research:

https://www.vox.com/policy-and-politics/2018/4/30/17302692/opioid-epidemic-medical-marijuana-painkiller

"[T]he best review of the research to date about marijuana’s health effects, from the National Academies of Sciences, Engineering, and Medicine, found that there’s “conclusive evidence” for marijuana as a treatment for chronic pain. At the same time, there’s evidence questioning whether opioids really are more effective at treating chronic pain compared to alternative treatments, suggesting that there’s a lot of room to substitute marijuana, at least for some patients.

One potential wrinkle: We already have a lot of non-opioid pain treatments. As Stanford University pain specialist Sean Mackey previously told me, there are 200-plus non-opioid pain medications, not to mention nonpharmacological approaches. So marijuana isn’t providing something entirely new here if it’s used for pain treatment.

Perhaps the most compelling evidence to date, though, comes from a recent study by David Powell and Rosalie Pacula of the RAND Corporation and Mireille Jacobson of the University of California Irvine, who looked at how medical marijuana legalization — particularly in states with the most access to medicinal cannabis — affected opioid-related deaths. They concluded, “These findings suggest that broader access to medical marijuana facilitates substitution of marijuana for powerful and addictive opioids.”

What are your thoughts? Does the logic behind the argument made work seem reasonable?

Women increasingly affected by opioid epidemic

This article talks about the rising numbers of women being affected by the opioid epidemic. "Historically, women experience more pain-related diseases and have an increased sensitivity to the perception of pain. With a higher prevalence of painful conditions such as fibromyalgia, irritable bowel syndrome, osteoporosis and joint inflammation, women are often prescribed opioid treatments to help reduce uncomfortable symptoms." Making more women susceptible to opioid abuse. 

With this in mind, and talking about alternative treatments for pain that don't involve opioids. Do you all think women are exempt from this because of their higher prevalence for pain especially in certain conditions, like after birth? An along with that how can doctors help to lower the chances of opioid abuse among women suffering from painful conditions?

https://www.mansfieldnewsjournal.com/story/opinion/columnists/2018/04/21/guest-column-women-increasingly-affected-opioid-epidemic/515652002/

Len Bias' Impact on the Drug War

Len Bias was supposed to be the next Celtics Legend when he was drafted in 1986. Two days after he was drafted, he died of a cocaine overdose. His death led to widespread fear, leading to law changes that lead to many low-level drug offenders, mostly young and black, going to jail. Termed the Len Bias case, at least in the book, this was another dark period in the drug war. Check out this article on it:
https://www.nbcnews.com/news/us-news/30-years-after-basketball-star-len-bias-death-its-drug-n593731

Increasing the punishment for drug offenses has proven to be an ineffective way to combat drug crisis. Yet, Donald Trump has recently said publically that we should start to consider the death penalty for dealers. Why is there still this disconnect? What needs to happen to change this mindset, or will it never change? Thoughts?

Poll on who is most to blame for opioid crisis

Thoughts?