How To Win America’s Fight Against The Opioid Epidemi

Every day, an astonishing 115 Americans die from opioid overdoses, according to a 2017 report from the Center for Disease Control and Prevention. Approximately half of these deaths are due to the misuse or abuse of prescription opioid painkillers (such as Vicodin, Oxycontin, and morphine). Beyond that, increasingly, deaths come from overdoses of the illicit drugs heroin and fentanyl, which are often used after people become addicted to or misuse prescription opioids.

Each day, more than 1000 people are sent to the emergency room for prescription opioid misuse. In many of these cases, opioids were used along with alcohol or medications meant to treat anxiety or seizures (such as Xanax, Ativan, and Valium). When people ingest such mixtures, they face a heightened risk of injury or death as their breathing slows or stops.

Effective treatments exist. But as treatment for over-dosing is increasingly available, treatment for addiction is still not accessible to many of those who need it. Access to effective treatments for opioid addiction is the missing piece in America’s unsteady fight against the opioid epidemic.

Success in Fighting the Opioid Epidemic

Gains in the fight against the opioid epidemic have been made on several fronts. The physicians and nurse practitioners who prescribe America’s medications are being trained to be more judicious in their use of opioids to treat pain. They are also learning to consider, whenever possible, non-opioid medications and other treatments that don’t come from a pharmacy at all. National guidelines have been established for methods of relieving surgical, cancer-related, and chronic pain without opioids. Taken together, all these efforts are saving lives and reducing the volume of prescription opioids that can be diverted to illicit uses.

Similarly, emergency first responders and trained laypeople now have tools to help prevent deaths from opioid overdoses. Lives have been saved in many communities by the administration of naloxone – a medication which blocks the effects of opioids on breathing centers and reverses overdoses.

But what happens after emergencies – or to prevent them? Treatments for addiction can reduce the likelihood that people addicted to opioids will overdose and die. And such treatments are vital because, like any other chronic illness such as diabetes or heart disease, untreated addiction becomes more severe and resistant to treatment over time.

The Missing Piece – Access

What most of America is sorely missing, however, is sufficient access to the addiction treatments that are the most effective – and not enough efforts are currently underway to increase such access. Currently, the best estimates suggest that only one out of every ten patients seeking drug abuse treatment can actually get into a program. To sharply reduce U.S. opioid deaths, proven forms of treatment should be readily available, on demand, to all who need them. Policymakers, civic leaders, patient advocates, and journalists, should consider the following steps:

  • Treatment and reimbursements should be evidence-based. Research shows that the most effective approach is medication-assisted therapy (MAT), where patients are given methadone, buprenorphine, or naltrexone, alongside therapy to combat addiction. Too many private payers pay for treatments based on mistaken ideas. For example, detoxification is known to be highly ineffective against opioid addiction, yet it is widely practiced and reimbursed.
  • Insurance and other reimbursement systems need to acknowledge that addiction is a chronic disease that almost never goes into remission after a one-time treatment. Treatment for addiction needs to be ongoing and long-term, just like treatments for diabetes or heart disease. But currently most health insurance companies will only cover one treatment episode or a fixed number of treatment days per year.
  • Early, intensive treatment is the most effective and less costly over time. Currently, most insurance companies will only cover outpatient treatment for opioid addiction, and will only reimburse intensive inpatient treatment if the first effort fails. Evidence shows that in many cases, the opposite approach would work better: start with intensive treatment rather than with minor steps that allow time for the disease to progress.
  • Many opioid addicts could be treated within America’s current primary care systems. Two effective medications, buprenorphine and naltrexone, can be prescribed by primary care providers. With appropriate waivers, for instance, a physician can treat up to 100 patients with buprenorphine.
  • Medications need to be supplemented with therapy. Because most primary care clinicians do not have the resources or practice partners to provide the therapies patients need in addition to medications, they often limit the number of addicts they treat or avoid treating them altogether. The answer lies in making behavioral health providers more readily available to work with primary care providers, who could then prescribe effective medications more readily.
  • Patients brought to hospitals for opioid addiction and overdose should be enrolled in therapy and other treatment on the spot. Many patients with opioid addiction end up in hospitals and emergency rooms. The current approach is to stabilize them medically and then tell them, as they are discharged, to seek further treatments. But many do not follow up or have adequate access to the help they need. A better approach would be to start treatment while addicts in crisis are at the hospital – and directly transfer them to an addiction treatment facility upon discharge.
  • Jails and prisons are other places where opioid addicts need treatment. Efforts to bring medication-assisted therapy to the incarcerated could mitigate the larger opioid crisis – and also reduce the rate at which ex-inmates commit new offenses and cycle back to prison.

The bottom line is clear: Increasing access to proven treatments for all addicts who need them would save and improve countless lives, and effectively counter America’s current opioid crisis.

Read more in Peggy Compton and Andrew B. Kanouse, “The Epidemic of Prescription Opioid Abuse, the Subsequent Rising Prevalence of Heroin Use, and the Federal Response” Journal of Pain and Palliative Care Pharmacotherapy 29, no. 2 (2015): 102-114.

How to Support Someone Going Through Heroin Detox

Going through heroin detox can be a grueling experience. Before the individual enters a heroin detox treatment program, they have already started going through some horrible withdrawal symptoms. By the time they are ready to enter a treatment program, their body has endured a tremendous amount of strain and pain, and their psyche has taken a toil making them very vulnerable to relapse if not cared for appropriately.

Not only is their detox treatment vital; so too is the support from their loved ones, and this can be challenging especially for those who don’t understand what heroin is, what it does, and what heroin detox treatments consist of. If you have a loved one who is fighting for his or her life by trying to get off drugs and enter a heroin detox program, you can best support them by understanding what they are going through. Some basic education will help you be a great support system, and help your loved one get back onto a path of normalcy and healthy living.

What does Heroin do to the Human Body?

The impact heroin has on the human body depends on how much is injected, where the drug binds in the body (or brain), how long it sticks, how strong it is, the rate of speed it takes to bind, and what happens afterward. When heroin is used it clings to certain receptors in the brain called mu-opioids. Once it affixes, it activates these receptors causing a massive sensation of pleasure.

The human brain contains naturally produced chemicals called neurotransmitters that fuse receptors that regulate hormone-release and pain. This all takes place in “the reward center” of the brain, where dopamine is released. When natural dopamine is mixed with external opioids like heroin, that high a person experiences is amplified by massive proportions. According to the National Institute on Drug Abuse, the greatest increase in heroin use is seen in young people aged 18-25. Unfortunately, many young adults can see themselves as invincible and don’t consider the various consequences heroin can have on their health, their life, or on their mortality. When a person takes heroin, their breathing and heart rate slows down–in some cases to the point it can be life-threatening.

What Makes Heroin So Addictive?

Heroin is a very addictive opiate because it actually changes the neurochemical activity in the brain which alters the state of one’s sensation and overall feeling while creating profound degrees of physical dependence and tolerance. Opiates cause pleasure by targeting various regions of the brain and nervous system–giving instant pleasure, both physically and emotionally, on tap. An opioid like heroin alters activity in the limbic system–a part of the brain that controls emotion. Pile this on top of the fact it blocks pain signals being delivered through the spinal cord, and one experiences a state of pleasure that becomes instantly addictive.

Your Loved One’s Behavior is Still Obnoxious after Heroin Use

Supporting a loved one going through heroin detox can be challenging, as much of their bad, obnoxious behavior can still be present. Here are some things to keep in mind: repeated use of heroin causes long-term imbalances that are very difficult to reverse because of the brain’s physiology and physical structure changes.

According to a study on white matter impairment in chronic heroin dependence, W. Li and others discovered that the brain’s white matter deteriorates due to heroin use, and that one’s decision-making abilities, the capacity to regulate behavior, and how one responds to stress is affected. Therefore, if your loved one is having massive mood-swings, says inappropriate things, and acts irrationally, know that the aftermath of this drug has simply dug its talons this deep into the user, and now it is up to a heroin detox treatment to gently and lovingly reverse as much damage done as possible by bringing the person back to their normal self.

Give Support by Finding a Heroin Detox Treatment Program

One way you can support your loved one going through heroin detox treatment is to do some research in looking for the best programs available. You simply can’t lock someone in a room and slide food and water through a window, as movies like ‘Trainspotting’ would like you to think. Coming off heroin can be life-threatening and extremely painful, which is why finding the best heroin detox program is vital to your loved one’s ability to have a happy and healthy future.

Heroin detoxification treatment centers use specific drugs to shorten the timespan of opiate withdrawal syndrome. Even with these drugs, patients still experience various degrees of pain, and the road to recovery is still harsh and often hard for loved ones to witness. When looking for various heroin detox treatment centers, here are some questions worth asking:

  • What accreditations does the facility hold?
  • Are medical resources immediately available?
  • Is there a pre-admission evaluation focused on protocol?
  • What are the safety standards and guidelines?
  • Are there multiple detox options to accommodate a variety of patients?
  • How long is the inpatient care program?
  • What is the post-detox recovery care?
  • What procedures are used to make the detox more humane?

By investigating programs and learning more about why they are successful, you can be of tremendous support to your loved one by helping him or her get on the best path to a full recovery.

More Ways to Support Someone through Heroin Detox

Love and ongoing support is crucial to recovery. Here are some ways in which you can show your loving support through their journey to a bright, promising future:

Write a Letter – Writing a letter to someone expressing your love and support is good therapy for you, and it is an ideal thing for the patient to have because they can look at it whenever they need some additional motivation to get them through hard times. If the person has wronged you, avoid being judgemental or calling them out in the letter. There will be a time to confront them, but when they are focused on detoxing is not the ideal moment. Once the detox treatment is complete and the person enters the next phase of recovery, you could write a second letter praising them for making it through the detox, and then confront them on the pain they caused. This way they can deal with the reality of what they did in the next step of their treatment plan which often involves coming to terms with the past.

Build Confidence – Be their cheerleader. Let them know how you have always admired them, acknowledge what they are going through must be very difficult, and let them know you recognize their bravery for undertaking the journey. Saying things like, “I am proud of you for embarking this huge step” and “I respect you for wanting to get clean and be the best version of you” will help empower and drive the person to keep up the good work.

Trophy – A trophy is given to someone to acknowledge and honor them for being victorious. You don’t have to go out and get an actual trophy; instead, create your own “trophy concept” by giving the person a special gift as a way to honor them for being victorious thus far in their recovery. For example, if the person loves to write you could get them a fancy pen with an engraved message on it, and a leather-bound journal. Tell them the pen is their trophy for completing phase one of a very challenging task, and the journal is their platform for writing reflections, celebrating the little victories they experience every day, and writing down their game plan and goals for a fruitful future.

Emphasize Self-Care – In many cases people going through certain phases of heroin detox treatment will be so haunted by the pain they caused loved ones that they don’t focus on themselves. Let your loved one know that self-care is crucial to a full recovery. Let them know that putting themselves first is not at all selfish, but healthy and necessary to their recovery. Let them know you are there to give support, but they need to support themselves at the same time.

Supporting a loved one going through heroin detox treatment means you also need to support yourself. If you aren’t getting enough sleep, eating right, or taking care of your own needs, you won’t be at full strength to be a strong pillar of support. Also, if you are worn down your loved one will likely notice, and enhanced guilt on their part may surface thus slowing down their recovery.

Compassion, forgiveness, and understanding–these are the tenants of supporting a loved one going through heroin withdrawal, and these core components can also be used to help you get through the emotional rollercoaster of watching from the sidelines.

Undocumented Immigration Doesn’t Worsen Drug, Alcohol Problems in U.S., Study Indicates

Despite being saddled with many factors associated with drug and alcohol problems, undocumented immigrants are not increasing the prevalence of drug and alcohol crimes and deaths in the United States, according to a new study published in the American Journal of Public Health.

Researchers led by University of Wisconsin–Madison sociology Professor Michael Light used newly developed state-level estimates of the unauthorized immigrant population to examine the relationship between undocumented immigration and drug and alcohol arrests and deaths.

Light says national debate on immigration law spurred him to begin a series of studies on undocumented immigrants and public safety and health.

“This is an area where public and political debates have far outpaced the research,” Light says. “And central to this debate is whether undocumented immigration increases drug and alcohol problems, or crime more generally. There are good theoretical reasons to think it could have increased substance abuse problems in recent decades. But the data just doesn’t show it.”

Light, who was a professor at Purdue University while he conducted the study, along with Purdue sociology Professor Brian Kelly and graduate student Ty Miller, used immigration data from the Center for Migration Studies and the Pew Research Center spanning 1990 to 2014.

They compared undocumented immigration rates to four representative measures of drug and alcohol problems: drug crimes and driving under the influence arrests collected from federal, state and municipal sources in the FBI’s Uniform Crime Reports; and drug overdose deaths and drunken driving fatalities counted by the Centers for Disease Control and Prevention’s Underlying Cause of Death database and the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System.

According to the study, rather than increasing substance abuse problems, a 1 percent increase in the proportion of the population that is undocumented is associated with 22 fewer drug arrests, 42 fewer drunken driving arrests and 0.64 fewer drug overdoses — all per 100,000 people. The frequency of drunken driving fatalities was unaffected by unauthorized immigration rates.

According to Light, one explanation for these findings could be what prior research often calls the “healthy immigrant thesis” or “Latino paradox.”

“When you look at things we think of as predictive of criminal behavior and poor health outcomes — low levels of education, few economic assets — immigrants tend to be engaging in less crime and staying healthier than we would expect,” Light says.

And yet, undocumented immigration is often stirred into debate of social ills like opioid use. It’s unquestionable that drugs are smuggled across the border between the United States and Mexico, Light says, but this does not mean drug smuggling and unauthorized immigration are one and the same.

“That just doesn’t appear to be the case,” he says. “If you want to fight the opioid epidemic or reduce drunk driving, deporting undocumented immigrants residing in the U.S. is likely not going to be the most effective policy.”

Into the Woods: On the Path to Recovery

Addiction is devastating at any age, but for parents with a teenager substance abusers, it can all but tear the family apart. Adolescence is a period prone to experimentation, but unfortunately, the desire to try new things can lead teens down a dark path that stops being fun and becomes life-threatening.

Studies demonstrate that many teenagers hold a blase attitude regarding drug use; dosomething.org — a global youth outreach program — reports that 50 percent of American high schoolers in 2013 did not find it harmful to try crack/cocaine once or twice; 40 percent reported that they believe trying heroin is not a bad or dangerous thing. In the same study, it was found that a total of 6.5 percent of American high schoolers smoke pot daily and that 54 percent of them do not see a problem with regular steroid use.

Signs and Symptoms of Teenage Drug Abuse

Teenagers who are using drugs actively usually exhibit telltale symptoms. Some of the most common include a change in friends, a careless attitude toward work and school, lower grades, changed eating and sleeping habits and strained relationships with people they were once close to.

Teenagers who struggle with drug addiction may be scared to admit their problem due to the consequences they’ll receive from their parents, but getting help as soon as possible is critical. Teens who do not seek help with their drug addiction during adolescence face psychological and developmental damage that will only hinder them the older they become. They are also more likely to engage in criminal activity that could further disrupt their life and tarnish their future; a 2012 TEDS report by the Center for Behavioral Health Statistics and Quality revealed that the primary reason for drug treatment referral was the criminal justice system; 51.2 percent of older adolescent (15–17 years old) rehab patients were admitted under court orders.

An Alternative to Rehab

While a teen substance abuser can seek help from a psychologist or traditional drug rehab, there are other options that have proven themselves to be incredibly effective in more ways than one. Wilderness therapy for drug addiction is one such option.

Wilderness rehab presents addicted teens with a new, challenging environment over a 6 to 9-week recovery program. There are many advantages to teen wilderness drug therapy that can elicit profound and life-changing results.

Control & Self-Discipline

Although the wilderness rehab programs for drug-addicted teens are incredibly regimented, the fact teenagers take such an active role in their treatment and survival outdoors leaves them with a sense of control and empowerment.

For teenagers who have problems with authority and struggle to thrive in a structured environment, wilderness camps are difficult. However, the structure that is provided throughout the duration of the course demonstrates to teens that they are capable of succeeding under a set of rules and that they don’t need drugs to tame their insecurities or fears.

Useful Life Skills

There are a lot of skills that a teenager picks up in wilderness rehab that they will continue to employ throughout their recovery and well into adulthood. Anger management, healthy emotional coping mechanisms, goal-setting, perseverance, conflict resolution, and enhanced communication skills are just several of the aspects teens explore and develop during treatment.

Don’t Wait for a Sign

If you suspect your teenager is addicted to drugs or you are a teen struggling with drug abuse, don’t avoid seeking outside help. Because of all the doubt and fear involved in sending a teen off to rehab, it’s not uncommon for people to try and figure things out at home instead of seeking professional treatment.

Consider wilderness rehab programs and other types of drug therapy now. Doing so in the midst of addiction can help stop it from spiraling even further out of control and put teens back on the path toward a productive, healthy life.

Recovering Addicts Share 3 Surprising Benefits of Sobriety

People working to overcome their substance abuse issues are fighting the battle of a lifetime. It’s not just about rebuilding a healthier life that doesn’t revolve around an addiction — it’s also about learning how to find joy in the simplest details life has to offer.

Through our discussions with people in recovery, we learned that maintaining a positive perspective in your sobriety is a wonderful tool for staying focused on living a fulfilling, drug- and alcohol-free life. And our conversations showed us that there are plenty of ways to stay inspired — many that the people we spoke with never even thought about until they were on the path to recovery!

“We help each other when we’re down and we’re happy for each other when something good happens.” So says Zach, who reached a year of sobriety in June with help from the Treehouse in Texas. Zach and other recovering addicts spoke to me about some of the positives that come with life in recovery, and it turns out that some pretty inspiring stories commonly emerge from the dark experiences of addiction.

1. You can inspire others.

You can inspire others with your story. While you may not have ever considered your life to be inspirational, the fact is that what you’ve accomplished through recovery can show others trying to get to where you are that they can do it too.

I spoke with a number of recovering addicts from various facilities around the country, and I heard time and time again that they learned more from their peers than from trained professionals. That help that you can give to others is a feeling like no other, and can work wonders for your self-esteem.

“I loved seeing people’s faces light up while I was helping them in treatment, and I liked being able to understand what others were going through,” Zach told me. He now hopes to become a licensed substance abuse counselor.

“I want to go on and get my education so I can help others the way the people at the Treehouse helped me. I want to give back to those people,” he added. “By helping just one person, you’re really helping a whole family. If I can make an impact on just one person’s life, I’m fine with that. I just want to do what I can to give back and pass on what’s been given to me.”

2. It becomes easier to open up to people.

Another benefit of sobriety is that you’ll likely find it easier to open up to people than you did while you were using. Wendy said she shares her story as often as she can in the hopes that it will help others.“A lot of people are in denial. I’m not afraid to tell people my whole story, including that I relapsed,” she told me. “That’s probably the best thing that happened to me because it made me realize that I had a drinking problem [in addition to a drug problem].”

3. You’ll find yourself in a better mood more often.

People often think about drugs and alcohol as a way to put themselves in a better mood as they take a break from their problems, but in reality, sobriety will give you a more positive attitude than dangerous substances ever will.

“It’s very rare I’m in a bad mood now, because I’ve learned how to turn my bad mood around,” Wendy said, recalling a time when she came home from work with  groceries, but didn’t get any assistance from her significant other carrying them into the house. She admitted she was perturbed at first, but added, “I sat in my car for a few minutes and thought, ‘Really? Is this something to be mad about?’

“Now instead of letting myself be overwhelmed by negative thoughts, things just disappear,” she explained. “Things aren’t as bad as we make them. We tend to make huge deals of things that are really just tiny specks on the spectrum.”

While it may feel easier to turn to drugs or alcohol to try to cope with your problems, the reality is that you’ll get far more benefits from remaining sober with the right perspective.

The Presidential Policy Series: Combatting Drug Abuse

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The Presidential Policy Series has been exploring where the Democratic and Republican nominees, Hillary Clinton and Donald Trump stand on a variety of healthcare policy issues. We examine how already the presidential nominees plan to address our country’s largest healthcare epidemic—addiction.

Across the country from small, rural towns to large cities, drug abuse has been on the rise. The most recent National Survey on Drug Use and Health in 2013 estimated that approximately 22.7 million Americans needed treatment for a drug or alcohol problem, yet only 11% of these people were able to actually receive treatment. Nearly eight out of nine people who are struggling with addiction fail to gain access to the care they need. It’s a frightening statistic, especially as 7,800 individuals above the age of 12 try a new drug every single day.

While drug use has long been an issue, it has gotten worse in recent years. More people died from drug overdoses in 2014 than in any other year on record. The majority of those drug overdoses were the result of opioids, prescription painkillers, or heroin.

What policy proposals have the two candidates announced to address America’s drug epidemic?

A ‘Bold Plan’ to Tackle Drugs

Hillary Clinton is proposing a “bold plan” to prevent, treat, and support recovery from drug abuse. As part of her plan, Secretary Clinton vows to launch a $10 billion initiative that will work with state and local governments to focus on prevention and educate communities on how to intervene early to prevent addiction. She has also announced new initiatives to work with providers to aid prevention and ensure that opioid painkillers are being administered more appropriately by requiring new training and monitoring programs.

For those suffering from addiction, Clinton wants to expand inpatient and outpatient services, increase the number of specialty-trained providers, and ensure insurance is not a barrier to receiving treatment. She also plans to make naloxone, the rescue drug for opioid overdose, accessible to every first responder. Finally, she plans to increase investment in programs that divert people to rehabilitation instead of prison for low-level and non-violent drug offenses.

Stronger Borders to Decrease Drug Availability

To date, Donald Trump has expressed no discernable, coherent policy around resolving the drug crisis. He has mostly focused his attention on calls for tighter border security; one of the side effects, ostensibly, being a reduction in the availability of drugs that are being illegally smuggled into the country. To our knowledge, his only stated position on prescription drug reform has been a liberalization of pharmaceutical overseas imports, which we will cover in the next article in the series.

Traditionally, the GOP has supported stricter drug legislation with many legislators at the national level opposing the legalization of marijuana and speaking out against the improper prescription of painkillers, which often leads to the opioid abuse. Many Republicans support in-school education programs targeted at preventing and delaying substance abuse among children and adolescents. Unlike Democrats, who have come out strongly against the War on Drugs, the GOP continues to support harsher penalties, such as jail time and mandatory minimums, to deter drug use.

The growing drug epidemic across the United States is a serious domestic issue that the next President will have to address. In our opinion, opioid and prescription drug abuse is one of the most troubling drug crises our nation has ever faced and poses a more insidious threat than drugs illegally smuggled across our borders. Healthify encourages continued, bi-partisan efforts to educate, prevent, and delay drug consumption among children and seek to promote greater access to rehabilitation and treatment for substance abusers.

The Rising Danger of Fentanyl Abuse

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In recent years, the United States and Canada has seen an increase in fentanyl related overdoses. Fentanyl is a pharmaceutical drug classified as an opiate. It is a whitish powder that can be found in the form of tablets, in capsules, and cut with other drugs. The drug’s infamous potency and accessibility has attracted many buyers and sellers.

Fentanyl was first used as an anesthetic during operating procedures.  It is currently being used to treat pain symptoms from a variety of medical conditions. Fentanyl produces a feeling euphoria and a sense of well-being, the effects can last up to 6 hours. A primary cause of addiction is the high tolerance after the first use. This leads to higher doses constantly needed to reproduce the initial high. The discomfort from ‘coming down’ is another leading factor in addiction, users will avoid withdrawal symptoms by simply dosing again. Other side effects include weight loss, hallucinations, shaking and sweating.

Opioids are the leading category in overdoses and fentanyl is steadily rising with people looking for drugs that are more accessible and more potent. Fentanyl has the same high inducing effects as morphine, only stronger. “Fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent” according to the National Institute on Drug Abuse. Like any synthetic drug the potency is only an estimate but could easily be more as a result the likelihood of death is also higher. In Sacramento county 53 fentanyl related overdoses resulted in 12 deaths. Fentanyl, along with other prescriptions, can cause noticeable impairment that puts others at risk, particularly while driving. Drug dealers aren’t sure of the potency and users have no way to tell what they are consuming. Most fentanyl seized has been illicitly created.

For producers, fentanyl is relatively inexpensive to make. A kilo of fentanyl can be made for cheaper than it takes to produce a kilo of heroin. Fentanyl from China and Mexico has been found in the United States, with similar cases in Canada, both pharmaceutical grade and illicit. Fentanyl’s strength allows for the sale of smaller quantities to more people since the drug is highly addictive it results in a consistent demand. It can also be bought and sold over the internet on black market websites, it is a lucrative business for drug dealers.

Non-illicitly created fentanyl is sold from people with prescriptions or by those with access to the drug. According to Drug Abuse, “Because Fentanyl is frequently administered in a hospital setting, people with easier access to the drug (those working in or around a healthcare setting) may fall prey to fentanyl addiction.” Since it is accessible and prescribed to patients, law enforcement have found it difficult to prevent abuse.

Most labs and law enforcement are not equipped to detect fentanyl since its use is still gaining momentum. During 2013-2014, the CDC found there were over 400 percent more cases of fentanyl use than the previous year. With a high estimate for unreported cases, its various forms and mixture with other drugs make it difficult to be detected. It has been found mixed with heroin, OxyContin, and cocaine.

Withdrawal from fentanyl is non-lethal but it has similar painful withdrawal symptoms as other drugs in its category. Its potency make users particularly vulnerable to relapse. Support groups, clinics, and medication is available for fentanyl users to overcome addiction. Unfortunately, fentanyl related incidents are expected to increase in the next few years.

HHS announces new actions to combat opioid epidemic

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U.S. Health and Human Services (HHS) Secretary Sylvia M. Burwell today announced several new actions the department is taking to combat the nation’s opioid epidemic.

The actions include expanding access to buprenorphine, a medication to treat opioid use disorder, a proposal to eliminate any potential financial incentive for doctors to prescribe opioids based on patient experience survey questions, and a requirement for Indian Health Service prescribers and pharmacists to check state Prescription Drug Monitoring Program (PDMP) databases before prescribing or dispensing opioids for pain. In addition, the department is launching more than a dozen new scientific studies on opioid misuse and pain treatment and soliciting feedback to improve and expand prescriber education and training programs.

“The opioid epidemic is one of the most pressing public health issues in the United States. More Americans now die from drug overdoses than car crashes, and these overdoses have hit families from every walk of life and across our entire nation,” said Secretary Burwell . “At HHS, we are helping to lead the nationwide effort to address the opioid epidemic by taking a targeted approach focused on prevention, treatment, and intervention. These actions build on this approach. However, if we truly want to turn the tide on this epidemic, Congress should approve the President’s $1.1 billion budget request for this work.”

The actions announced today build on the HHS Opioid Initiative, which was launched in March 2015 and is focused on three key priorities: 1) improving opioid prescribing practices; 2) expanding access to medication-assisted treatment (MAT) for opioid use disorder; and 3) increasing the use of naloxone to reverse opioid overdoses. They also build on the National Pain Strategy, the federal government’s first coordinated plan to reduce the burden of chronic pain in the U.S.

Actions that are part of today’s announcement include the:

Buprenorphine Final Rule

Expanding access to MAT is one of the three foundational priorities of the HHS Opioid Initiative, and buprenorphine is one of the drugs frequently used for MAT.  The rule finalized today by the Substance Abuse and Mental Health Services Administration (SAMHSA) allows practitioners who have had a waiver to prescribe buprenorphine for up to 100 patients for a year or more, to now obtain a waiver to treat up to 275 patients.  Practitioners are eligible to obtain the waiver if they have additional credentialing in addiction medicine or addiction psychiatry from a specialty medical board and/or professional society, or practice in a qualified setting as described in the rule.

HCAHPS Proposal

Many clinicians report feeling pressure to overprescribe opioids because scores on the HCAHPS survey pain management questions are tied to Medicare payments to hospitals.  But those payments currently have a very limited connection to the pain management questions on the HCAHPS survey.  In order to mitigate even the perception that there is financial pressure to overprescribe opioids, the Centers for Medicare and Medicaid Services (CMS) is proposing to remove the HCAHPS survey pain management questions from the hospital payment scoring calculation. This means that hospitals would continue to use the questions to survey patients about their in-patient pain management experience, but these questions would not affect the level of payment hospitals receive.

IHS PDMP Policy

While many Indian Health Service (IHS) clinicians already utilize PDMP databases, IHS will now require its opioid prescribers and pharmacists to check their state PDMP database prior to prescribing or dispensing any opioid for more than seven days.  The new policy is effective immediately for more than 1,200 IHS clinicians working in IHS federally operated facilities who are authorized to prescribe opioids.  Checking a PDMP database before prescribing an opioid helps to improve appropriate pain management care, identify patients who may have an opioid misuse problem, and prevent diversion of drugs. This policy builds on IHS efforts to reduce the health consequences associated with opioid use disorder. As a part of this work, IHS announced that it would train hundreds of Bureau of Indian Affairs law enforcement officers on how to use naloxone, and provide them with the life-saving, opioid overdose-reversing drug.

New Research Priorities

Research  on opioids conducted and funded by HHS helps the department better track and understand the epidemic,  support the development of new pain and addiction treatments, identify evidence-based clinical practices to advance pain management, reduce opioid misuse and overdose, and improve opioid use disorder treatment – all areas of research that are critical to our national response to the opioid epidemic. HHS will launch more than a dozen new scientific studies on opioid misuse and pain treatment to help fill knowledge gaps and further improve our ability to fight this epidemic. As part of this announcement, the department released a report and inventory on the opioid misuse and pain treatment research being conducted or funded by its agencies in order to provide policy-makers, researchers, and other stakeholders with the full scope of HHS activities in this area. The report will also help these stakeholders and external funders of research avoid unnecessarily duplicating research that is currently underway. For more information, download the HHS infographic on the department’s research priorities.

Prescriber Training RFI

HHS is actively working to stem the overprescribing of opioids in a number of ways, including by providing prescribers with access to the tools and education they need to make informed decisions.  In particular, HHS has developed a number of activities that support opioid prescriber education.  This request for information seeks comment on current HHS prescriber education and training programs and proposals that would augment ongoing HHS activities.

For more information on other actions HHS has taken to address the opioid epidemic, download the department’s new Opioid Epidemic fact sheet.

Understanding Substance Abuse, Addiction and Treatment

Illicit-Drugs

Substance abuse can include alcohol, tobacco, marijuana, and other drugs, and is prevalent in all ages. For adolescents, the top three most abused substances are alcohol, marijuana, and tobacco in that order. At the end of 2014, it was found that around 2.8 million older adults in the US abused alcohol and there was a 3.3 percent increase in illicit drug use among older adults between 2002 and 2013.

Now clearly, drug or alcohol use is different than abuse or addiction. Typically substance abuse has three criteria: tolerance, withdrawal, and continued use even when there is negative consequences. The withdrawal seems to be a key factor in that many people build up a tolerance and continue drinking even after having had negative effects, but not everyone has withdrawals, which is the separation between use and abuse. Another difference is that those abusing substances or with addictions often need treatment to overcome their excessive use and dependency.

There are countless substances out there but the big ones are alcohol, tobacco, illicit drugs, and other drugs such as caffeine and misused prescription drugs.

Alcohol

Excessive alcohol consumption is a leading cause of death, killing more than three million people each year worldwide. Still, excessive use is not the same as alcohol abuse or addiction. According to the Center for Disease Control and Prevention (CDC) defines ‘alcohol abuse’ as “a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work,” which is different than alcoholism–defined as a chronic disease. About 17.6 million Americans either abuse alcohol or are dependent on alcohol. Although this number seems small relative to the US population, it is actually close to 1 in 12 adults in the US. But keep in mind that it isn’t just adults using alcohol, many underage persons are as well.

Many states are considering changes to their alcohol sales laws; hopefully these changes will lessen the amount of alcohol accessible to underage persons. It will also limit the amount of alcohol-related crimes. However, some of the law changes being proposed seem to be more relaxed about alcohol sales instead such as not asking for ID for people who look older than 40 and allowing sales on Sunday–many states currently have laws prohibiting alcohol sales on Sunday.

Tobacco

Tobacco is another highly addictive drug. Action on Smoking & Health (ash.org) has a very extensive list of tobacco statistics for the US and world. Some of the more glaring statistics are that over twenty percent of deaths in the United States are from tobacco, there are currently 1.1 billion tobacco users worldwide–which is terrifying because tobacco kills up to fifty percent of its users, and that there are over 4000 chemicals in tobacco, 250 of which are known to be harmful to humans.

Although cigarette smoking has declined in adolescents recently, it is still around. Many start trying tobacco at a young age, which is a factor on becoming a regular smoker later in life, especially if their parents or peers smoke as well.

Illicit Drugs and Other Drugs

Other drugs that lead to addiction and abuse are not often thought of as “doing drugs” or even drugs in general. Prescription drug abuse is the next most abused substance by American teenagers other than marijuana and alcohol. These drugs are often obtained from taking a relative’s prescribed drugs without them knowing. Along with prescription drugs, many teens are also using cough syrups as means to get high.

The most popular drug–even though most don’t realize it is a drug–is caffeine.Dr. Harold Urschel, author of Healing the Addicted Brain, said:

“Caffeine is quite addictive in the sense that it is a psychoactive substance. It stimulates certain chemical systems in the brain and this keeps you awake. If you use it on a daily basis, you develop a tolerance, just as you would to pain pills or other drugs. After a while, you need more and more to produce the same effects. Unfortunately, along with waking you up, caffeine also makes you agitated, irritated, and anxious – and those effects increase along with your daily dosage of caffeine. You get acclimated to caffeine’s wake-up aspect, but never to its agitation, irritation, and anxiety aspects.”

Not many people consider or think of caffeine as a drug when in fact it holds the properties of drugs and can become addicting in the sense that some people “can’t function without coffee” or other forms of caffeine.

Treating Addiction

Other than the obvious health issues that come along with substance abuse, there are other problems caused by drug use including overcrowded prisons. Because of the excessive amounts of people either committing crimes as a result of drug use or crimes related to the possession or use of drugs, one suggestion to stop overcrowded prisons is re-evaluating prison sentences for drug-related offenses. But instead of putting a band-aid on the issue, what if there were more efforts into treating these offenders before they get to the point of incarceration?

“Ours is an honorable profession. We serve people who have incredible resilience and drive.” –Jim LaPierre (substance abuse counselor)

The type of treatment used for substance abuse or addiction with the most success varies with each individual. Not only does any given treatment not work the same for any two clients, but each client has a different background and chemical makeup. Kathleen Farkas of the Case Western Reserve University Mandel School of Applied Social Sciences said that “those who have problems with alcohol and other drugs, the age of onset of the problem is important for diagnosis as well as for treatment planning,” saying that some have been dependent on the substance for most of their lives while others began late in life.

 

Why Aren’t We Talking About Sexual Assault On Campus?

By Leah Greenidge, Rosedad Francois, Valerie Jean-louis, Farah Robles

As children, we embark on various journeys in life from attending our 8th grade dance, making the cheer-leading team or making the varsity sports team in high school. Then, if fortunate enough, its surviving the hectic and often stressful 4 years of college in hopes of obtaining your degree. With this journey comes many obstacles and sadly sexual assault on campus can be one of the harsher obstacles in life someone may experience with many long-term and devastating effects.

Students found guilty of sexual assault on campuses have a high probability of receiving no consequences for their actions. It is usually the victim that has to endure the shame, feelings of embarrassment and anger which may change their outlook on life. Victims are either too scared to report or feel as if they some how caused the events to happen. Most survivors suffer high rates of Posttraumatic Stress Disorder (PTSD), depression, and co-occurring drug/alcohol abuse. Due to under-reporting, it is believed that 1 in every 5 women will be sexually assaulted while in college.

According to an article in Mother Jones,

The NIJ-funded study also examined the circumstances and risk factors surrounding sexual assault on campus, including the role of alcohol and fraternities. Nearly 60 percent of campus sexual-assault victims were under the influence of booze or drugs when they were attacked; one-fourth said their assailant was a frat member. Read Full Article

campusSA-chart

To make our campuses safer, change needs to happen with school policies and practices to prevent these assaults from happening. Across all demographics, rapists and sex offenders are too often escape paying for their crimes and are free to assault again. Sexual assault in general is a subject that people keep on “the hush hush”, but we need to start talking about sexual assault on campus in order to create a safe environment for students to excel.

We are students passionate about empowering people, and we’ve started this campaign to give a voice to those who don’t have one #‎outofyourshadow

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Dangers Of Alcohol Use In College

Many young people in college give themselves to partying and drinking alcohol, and it is very common for most college students to drink heavily on weekends. It has become part of the college culture, but what are the dangers of partying this way? What if you are one who has decided that you want to stay away from alcohol altogether? How do you do it?

The Dangers

shotsSome of the dangers of drinking heavily and partying while in college is the potential for your grades to slump. If you are focusing all your energy on partying and drinking on the weekends then are you spending adequate time studying and doing homework? Also, many students party on Sunday nights despite the fact that they have to be at school on Monday. Showing up to class with a hangover is not fun nor is it helpful.

Since there is so much drinking going on in colleges, due to new found freedom and the ample resource, there is also a lot of pregnancies that happen as well as the transmission of STD’s. When you are under the influence of alcohol your inhibitions are lowered and you do things that you wouldn’t normally do. Many college students practice unsafe sex simply because they are under the influence of alcohol and they don’t think straight enough to use protection or not have sex altogether. Students and people in general become careless when intoxication happens.

Learn more stats about college drinking here at www.niaaa.nih.gov

How to Stay Away

If you are one of the rare ones who would like to stay away from alcohol altogether while at college, then you will have a battle ahead of you to fight. Though it is not the easiest to stay away from alcohol while in college, it is possible.

First, you should let your friends know where you stand. A true friend won’t try and tempt you into doing something you don’t want to do. Instead of going to bars or parties where you know there will be drinking, go to coffee shops or places where there is “dry” entertainment. Check out theatre productions, museums, or movies. Get creative. There are a ton of other options

Find people who share the same desire as you do to stay sober and away from alcohol. Together you can have parties and things together while still staying in your right mind. You can have fun apart from using a substance.

There is no doubt that alcohol can be used safely and responsibly, but it is also true that a lot of alcohol abuse happens on college campuses. There are a lot of dangers that come with binge drinking in college so be smart and drink responsibly if you decide that you do want to drink. If you are not interested in drinking then you have to be proactive in finding friends who share the same desire and you have to figure out what hobbies you will take part in. Just because you don’t drink alcohol in college doesn’t mean that your social life has to be over. It is what you make of it.

The Ever-Present Problem of Teen Drug Use

This year it seems every discussion has been centered around a different former child star or teen idol who has become involved in yet another drug or alcohol-related crime, incident, or even full on meltdown. Whether it was the untimely death of Cory Monteith, Lindsay Lohan’s legal trouble, or Amanda Bynes involuntary committal, drugs and/or alcohol abuse were at the center.

Lindsay Lohan in court with attorney Shawn Holley
Lindsay Lohan in court with attorney Shawn Holley

Sadly, these sort of news stories are neither new nor unique. Although their drug rehab stints receive far more attention, drug addiction is not limited to former child stars. Teen drug abuse is a widespread problem that has become woven into the fibers of our society.  Unfortunately, it does not seem to be going away anytime soon.

The War on Drugs

Throughout the ‘80s and the ‘90s, there was a great push to reduce drug and alcohol use amongst teenagers. Programs such as D.A.R.E. and the “Just Say No” campaign from Nancy Reagan became  well-known and part of popular culture. However, these programs are largely considered failures.

After considerable research and feedback from students, data suggests the best deterrents to teen drug use is parental involvement and peer support groups. Implementing new initiatives such as the “keepin’ it REAL” program encourages positive lifestyles that include a drug and alcohol free culture coming from their peers instead of authoritative figures disguised as catchphrases.

The Legacy

Overall, have we seen a long term drop in teen drug and alcohol use? Unfortunately, it seems that the answer is no. Illegal drug use has remained steady, perhaps dropped slightly, but alcohol use is just as prevalent as ever, and there has been a rise in prescription drug abuse among teens. In fact, a recent CNN article stated that about 47 percent of teenagers have admitted to using illegal drugs. Furthermore, in one survey, 39 percent of teenagers admitted to drinking regularly, and the number who drink occasionally is even higher.

A Solution?

So why is it that this is one problem that we simply cannot eradicate? Part of the problem is that drugs and alcohol are inherently linked with teen pop culture. Pop artists sing about taking drugs, movies are filled with teenagers at parties with alcohol, and everything around teenagers tells them that these substances are necessary in order to have a good time and live a glamorous life. So perhaps part one of getting our kids away from drugs and alcohol, is to get them away from our kids.

Changing an entire culture is a tricky and a near impossible task. However, a more realistic goal might be to identify ways to increase children’s self-esteem when they are young as well as prepare them pitfalls of drug use and peer pressure. Teaching our kids about the ins and outs of drug use, and helping them to understand their long term effects, can be the most important thing that we as parents can do. This in turn means that, in order to help teach kids, we first have to educate parents.

Teenagers are not exactly well known for listening to their parents, but if their parents make an effort to educate about the dangers from a young age, it can make a real difference when the time comes to make their own decision. We cannot possibly hope to eradicate drug and alcohol abuse among all teenagers, but if we are going to make an impact, we will have to do it one teenager at a time.

“Crack Babies” and Poverty: Finding the Right Target

The inspiration for this article is the result of a recently published article: “‘Crack baby’ study ends with unexpected but clear result.” Having worked in child welfare long enough to remember and experience first hand the so-called ‘crack babies’, this caught my attention immediately.

The article is a summary of a study that followed children exposed to cocaine in utero, the ‘crack babies’ as they came to be known, in the late 1980’s and early 1990’s.  I held some of these babies, placed them in foster care, and accompanied them on visits to doctors.

My colleagues and I discussed their future, cautioned foster parents about what to expect, and advised the courts on their progress. I took the calls from distraught foster parents at wits’ end who were struggling to care for infants who would stiffen like a board and whose cries were louder, longer, and much more ‘ear piercing’ than a ‘normal’ baby cry. Thankfully most of these foster parents were completely committed to caring for the children and were calling mainly to vent because confidentiality prevented them from sharing their frustrations with others outside of the child welfare system.

crack cocaineWe told the foster parents what the doctors were telling us, “we don’t know what to expect”. We feared the worst, a lifetime of intellectual delays and medical challenges, and hoped for the best, that they would outgrow the trauma of exposure to cocaine during their early development. Over time, we saw infants grow into toddlers and young children who had some challenges but for the most part, seemed to overcome the early exposure.

The study referenced above sought out evidence, more than the anecdotal evidence such as that my colleagues and I had collected, regarding the future of ‘crack babies’. They found some unanticipated results. Perhaps most significant is summed up in this quote, Poverty is a more powerful influence on the outcome of inner-city children than gestational exposure to cocaine”. Yes, they are suggesting that poverty is more damaging to children than cocaine.

While this is just one study with a moderate sample size (over 200 children were followed), there are compelling reasons to pay attention. This was a longitudinal study spanning 25 years, what many consider the ‘gold standard’ for identifying cause and effect in social science research. The researchers were thorough in examining the many factors that might influence findings.

The most important message here is the influence of poverty on children. This suggests that we should be doing everything possible to address the issue of poverty especially as it impacts children and families.

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