Healthcare Providers Helped Bring About the Opioid Epidemic; Now It’s Time to Help End It

Some programs already in place, many more needed

By Toby Cosgrove., M.D.

Cleveland Clinic president and CEO

Too many of the stories we hear about opioid-related deaths start the same way – with a patient prescribed a pain medication for an injury or medical procedure.

The stories then progress to street drugs like heroin or fentanyl, leading all too often to death. In 2016, about 60,000 Americans died of opioid abuse, an American death toll greater than the whole of the Vietnam War.

This has to stop and healthcare providers have a key role in turning the tide. One of the most sobering statistics, from a physician’s point of view, is that over 75 percent of opioid and heroin deaths begin with a prescription pain killer. The healthcare industry bears some responsibility.

That’s not to say that patients aren’t in legitimate pain. They are, maybe as many as 100 million by some estimates. But we as healthcare providers have to approach pain differently, smarter.

Declaring the opioid crisis a National Public Health Emergency is a good first step. But we in healthcare can’t wait for Washington. We have approaches at our disposal that can effect very real change.

Better policies have shown to make a difference quickly. In just the past few months, we’ve:

• Reduced the number of opioid prescriptions exceeding 3 days by 50 percent in our emergency departments, simply through education and communication.
• Reduced the number of patients receiving opioids by one-third in a group of colorectal surgery patients.
• Hired a full-time Doctor of Pharmacy, who as a pain-management specialist can improve prescribing practices and clinical care.
• Designated every hospital unit with “pain champions,” who are conversant with alternative pain strategies.

What it boils down to is this: healthcare providers have to make this a priority and we have to give physicians the tools they need to effect change.

Essentially, we can attack the opioid epidemic in four ways: giving healthcare providers the prescribing tools and resources they need; insisting on team engagement among hospital departments; tracking prescribing data and demanding accountability; and sharing information with other hospitals in the region.

Our electronic medical records system has been an indispensable tool. It has allowed us to connect directly to the Ohio Automated Rx Reporting System (OARRS); now, a physician can see a patient’s history of controlled substances within seconds while formulating a treatment plan. Also, our patient-provider agreements and consents are stored electronically so anyone who cares for that patient can see it, review it and update it as appropriate.

At the same time, we can use the electronic medical record to gather data so that we truly understand current practice – What type of patients are being prescribed narcotics? Which departments prescribe opioids most often? – then use that data to standardize care across the system.

Here are a few more approaches we’re using at Cleveland Clinic:

A Twist on “Just Say No”: Saying “no” to patients who are seeking narcotics for pain relief is difficult. That’s why we’ve instituted training courses for physicians on how to decline opioid requests from patients, with an emphasis on being compassionate. These are difficult conversations and the stakes are high. We must help our physicians navigate this by giving them the skills, strategy and practice to show empathy while managing emotion, setting boundaries and employing de-escalation tactics when needed.

Getting Back on TREK: Back pain strikes about 31 million Americans at some point during their lives. All too often, the first-line treatment is surgery or pain killers. At Cleveland Clinic, we are offering a different approach. Back on TREK (Transform Restore Empower Knowledge) is a pilot program treating patients with chronic low back pain (with or without leg pain), with the goal of restoring function through non-surgical treatment approaches and providing patients with tools to manage their pain without narcotics. The program utilizes a combined treatment approach of psychologically informed physical therapy; pain neuroscience education and behavioral medicine sessions utilizing cognitive behavioral therapy and psychological education techniques. More than 60 percent of patients showed significant improvement in pain and disability; over half demonstrated significant reduction in fatigue, pain interference, and overall physical health.

Painless mastectomy: An experimental drug, Exparel, is a local, time-released anesthetic used after a mastectomy to help patients with the worst of the pain — the first four days — so patients can avoid opioids.

Narcotic-free colorectal surgery: A program at Cleveland Clinic Akron General replaces narcotics with pre-surgical pain management, peripheral nerve blocks during procedure, and encouragement for the patient to get out of bed and move around within 4 to 6 hours of getting to the recovery floor. Of 80 patients in the program, one-third avoided narcotics. As a result, readmission rates and surgical costs dropped, hospital stays were shortened by 50 percent, risk of complications were reduced, and recovery improved with less pain.

New “ERAS” of recovery: Several medical centers, including Cleveland Clinic, have been developing the concept of “fast-track” or “enhanced” recovery after surgery. Recently, comprehensive research has indicated that an ERAS (“Enhanced Recovery After Surgery”) methodology that permits patients to eat before surgery, limits opioids by prescribing alternate medications, and encourages regular walking reduces complication rates and accelerates recovery after surgery. ERAS can reduce blood clots, nausea, infection, muscle atrophy, hospital stay and more. Patients are also given a post-operative nutrition plan to accelerate recovery, and physicians are using multi-modal analgesia, limiting the use of narcotics.

The good news is that the fight against the opioid epidemic is moving in the right direction. Everyone – hospitals, physicians, lawmakers, law enforcement and the general public – see this as the national emergency that it is.

By leveraging the tools at our disposal – or by creating new tools – we can save lives.

Link to original article here: Healthcare Providers Helped Bring About the Opioid Epidemic; Now It’s Time to Help End It

Hamilton County to boost Narcan by 400 percent to fight overdose deaths

Dr. Shawn Ryan, President, Chief Medical Officer, BrightView Health, speaks during a press conference at the Hamilton County Health offices where key stakeholders unveiled a new program and pilot study to reduce and prevent opioid-related fatalities across the county. Over the next two years, they hope to increase the availability of narcan by 400%. Each box, produced by Adapt Pharma, contains two four mg doses of narcan.

Hamilton County is preparing a first-in-the-nation Narcan project with a goal of saving lives by infusing the community with the overdose antidote.

The project will bring 400 percent more doses of Narcan to a broader section of the community. New groups that will get the doses include jails, syringe exchange programs, emergency departments and faith-based groups.

The distribution of Narcan is underway, but new agencies will begin to receive it in about two months. It will take a year or two to get out all the supply, officials said.

“Opioid use disorder has become an enormous problem,” said Hamilton County Public Health Commissioner Tim Ingram. “Drug overdoses are robbing us of our future.

“We want to save lives.”

Ingram announced the initiative Thursday with others at the health department. Hamilton County and Cincinnati public health agencies, private addiction providers, hospitals and county governments are among those that have joined for the effort.

The project will cost about $550,000, Ingram said. Collaborative members, including hospitals in Hamilton County, BrightView Health, private foundations and Interact for Health, and Hamilton County commissioners contributed to that amount. . The commissioners contributed $25,000 toward an individual who will lead distribution of the medication.

Dr. Shawn Ryan, a certified addiction expert, initiated the idea. Ryan has expanded access to on-demand medication assisted treatment with his practice at BrightView Health clinics and is president of the Ohio American Society of Addiction Medicine.

Ryan said he’s alarmed by the rise in opioid overdoses, particularly by fentanyl, a synthetic that is far more potent than heroin and is rampant in the region.

Hamilton County sees an average of one opioid overdose death per day, but it can go higher, Ingram said. Ohio has about 11 overdoses deaths each day. Nationwide, the deaths number about 91 per day.

Fentanyl and related potent opioids were involved in more than half of 4,050 drug overdose deaths in Ohio last year, according to a recently released report by the Ohio Department of Health.

“It scares me,” Ryan said. “We can’t wait any longer.”

Adapt Pharma is providing the bulk of the Narcan, 25,000 doses, adding to the current supply in the county, said company spokesman Thom Duddy.

The company makes Narcan in a concentrated, four-milligram dose that has proven effective to those overdosing on fentanyl and other synthetic opioids. Narcan Nasal Spray is easy to use, which is a key reason why Adapt Pharma was asked to join the Hamilton County effort.

The county’s Narcan supply will go from about 7,000 doses to more than 30,000. It will be distributed to more locations within reach of people who are at high risk, or have a loved one at high risk, of overdosing.

Currently, Hamilton County naloxone is distributed to first responders, treatment agencies, law enforcement and community groups that provide it to the public.

Dr. Michael Lyons, of the University of Cincinnati College of Medicine, will head research for the project, tracking the distribution of Narcan and overdoses and deaths in the county.

If the influx of Narcan prevents more deaths, Ingram said, the project could become a model for communities nationwide in the fight against opioid addiction.

Public health officials stressed that addiction treatment, especially with medication, must follow overdoses and be available to those with opioid addiction.

“As has been scientifically proved, medically assisted treatment is the gold standard treatment,” said Hamilton County Commissioner Denise Driehaus, representing the county and its heroin task force.

Ingram noted that access to treatment in Hamilton County has increased, but added “we need more.”

What is naloxone?

Known also by its brand name, Narcan, naloxone is an antidote to opiate-related overdose. The non-narcotic can restore breathing in people who are overdosing from heroin or other opioids, saving lives.

Hamilton County first responders saved lives with naloxone provided by the health department almost 6,000 times from June 2016 to July 2017, Health Commissioner Tim Ingram said. They administered nearly 9,000 doses of the overdose reversal medication.

Want naloxone?

Go to a local pharmacy

Ask your doctor

Call your health department

Overdose deaths in Greater Cincinnati:

Warren County saw the largest percent increase in overdose deaths from 2015 to 2016. Last year, 58 people died of drug overdoses, up from 42 in 2015. The county’s annual overdose death rate since 2011 trails the state average.

Overdose deaths in Butler County increased from 195 in 2015 to 211 in 2016. In the last five years, the county has seen 37.9 overdose deaths annually per 100,000 residents, the second-highest in the state.

In Clermont County, the overdose death rate was 37.5 per 100,000 residents, fourth-highest in the state. Ninety-six people died of an overdose last year, down from 105 in 2015.

In Hamilton County, 318 residents died of an unintentional drug overdose in 2016, down from 335 in 2015. Since 2011, the rate of local deaths was 29.4 per 100,000 residents, 13th highest in the state.

 

 

 

 

 

Major Science Report Lays Out a Plan to Tamp Down Opioid Crisis

The National Academies report includes recommendations for federal agencies, states and medical personnel.

When the U.S. Food and Drug Administration screens new opioid drugs it should better anticipate how people might abuse them in the real world, the National Academies of Sciences, Engineering and Medicine warns in a major report issued Thursday on the country’s opioid crisis, which kills 91 people a day—often via overdoses on prescription drugs. The FDA needs to move beyond its traditional focus on clinical studies about drug effectiveness and side effects, and to seek public health data on potential abuse, the Academies advises in its 400-page proposal for targeting the deadly issue.

The FDA had asked for the report, and its release comes as several states are suing pharmaceutical companies over allegations that they downplayed the addictive nature of certain prescription painkillers and helped fuel the current crisis. “The focus of the request from the FDA was for advice on what they could do to evaluate [opioids] more completely before approving them for use,” says Stanford University anesthesiology professor David Clark, a member of the Academies committee that drafted the report. A key recommendation, Clark says, is for “the FDA to move beyond its standard matrix of considerations for drug safety and—at least for opioids—move into a more public health–centered matrix of considerations which could help us predict what might happen for people beyond the intended recipient of the drug.”

The 18-member committee, which worked on the report for more than a year, identified specific steps that states, federal agencies and medical providers should take to stem the tide of abuse of substances including heroin, fentanyl and prescription drugs—even as they ensure pain patients have access to legal relief. Any policy that aims to restrict lawful access to prescription opioids would drive some people toward the illegal market, the report warns. Instead it urges states, regulators and public health agencies to work toward universal access to evidence-based interventions for substance abuse, including treatment programs and full coverage of medications approved to fight addiction. The report calls for expanding access to the overdose antidote naloxone to laypeople, and also says jurisdictions should explicitly authorize syringe exchange as well as their sale or distribution. “Reducing the scope of the epidemic of opioid addiction is my highest immediate priority as commissioner,” the FDA’s Scott Gottlieb said in an e-mailed statement. “I was encouraged to see that many of [the Academies’] recommendations for the FDA are in areas where we’ve made new commitments.”

The Academies’ report also recommends increasing the FDA’s formal reevaluations of opioid approval decisions, in order to ensure that the drugs’ benefits still outweigh the risks. It advises the FDA and other federal health agencies to improve their data tracking on pain and opioid use, and to invest more money in research for a clearer picture of the opioid epidemic—and for potential ways to combat it, such as programs that track prescribing and dispensing information.

Officials battling the crisis on the ground applauded some of the Academies’ findings. “The report is in line with the work we are already doing in Baltimore City,” says Leana Wen, the city’s public health commissioner. “We have had needle exchange programs for over 20 years, and we also have a very aggressive naloxone program.” The report focuses on improving research and regulatory actions before a prescription drug hits the market, Wen notes. “All these are important, but I continue to emphasize what I see on the frontlines—a need for increased access to treatment that is evidence-based and well established.” With naloxone’s price rising and a shortage of substance abuse treatment beds, these are crucial needs, she says.

The report also says states should take specific actions, such as creating more year-round programs in which pharmacies or other establishments take back unused prescription painkillers—so they do not sit around patients’ houses, where they might be abused or stolen. (According to the National Institute on Drug Abuse, nearly half of young people who inject heroin abused prescription opioids first.) “The concerns on this point are more impetus rather than obstacle,” Clark says. “It is not uncommon to have drug take-back programs through churches, pharmacies, universities, and public interest groups and community organizations. But none of those organizations are set up to do that kind of thing on an ongoing basis.” Some pharmacies have already moved in this direction by setting up drop boxes to dispose of old drugs when someone comes in to fill a new prescription, he adds.

The President’s Commission on Combating Drug Addiction and the Opioid Crisis, chaired by New Jersey Gov. Chris Christie, also aims to come up with concrete recommendations. It was scheduled to release an interim report last month but has not done so, and now expects to put the report out at the end of this month, around its next meeting. “The Commission is continuing to look at how the administration can best address this unprecedented crisis and will be releasing its [final] report in October,” Richard Baum, acting director of the Office of National Drug Control Policy, told Scientific American in an e-mailed statement. “The Trump administration is committed to addressing the opioid epidemic,” Baum wrote, and in just six months it has “sent nearly $500 million to the states to address the epidemic locally, begun work on the president’s first National Drug Control Strategy and established the President’s Commission on Combating Drug Addiction and the Opioid Crisis.” (The latest version of the Senate health care bill, released Thursday, also would include $45 billion to help support substance abuse treatment.)

Addressing the opioid epidemic requires action in the medical and patient community as well, the Academies’ committee says. It advises states to create better pain education materials for medical schools, medical licensing boards and the public. States and the federal government should also work in concert to help boost access to medication for addiction—and to make sure patients can afford it, the report says. Managing the opioid crisis is a balancing act requiring trade-offs when it comes to restricting the lawful opioid supply, influencing prescriber practices, cutting demand and reducing harm, the committee members wrote. Yet they add that their proposal should, “leave adequate space for responsible prescribing and reasonable access for patients and physicians who believe an opioid is medically necessary.”

Article by: Dina Fine Maron on July 13, 2017

Link to article here: Major Science Report Lays Out a Plan to Tamp Down Opioid Crisis

Lives Lost: One story of opioid recovery

Lisa is alive today because of new tactics in the fight against opioid addiction.

CANTON, OH Every morning, Lisa dissolves a pill under her tongue. She doesn’t mind the flavor: chalky, like children’s aspirin, with a hint of orange.

The pill is Suboxone, a medication that helps Lisa control her cravings for opioids. After years of abusing prescription pills and heroin, and surviving more than a dozen overdoses, she has been sober four months and counting.

Her bills are paid. There is food in the refrigerator. She spends time with her children.

“I’m happy, actually,” Lisa said. “This is the best things have been in a long, long time.”

But her story is about more than a pill. Lisa is alive and in recovery because Stark County embraced new techniques to fight an opioid epidemic that has killed hundreds locally and thousands across the state.

Medication-assisted treatment, outreach by police officers, the wide-spread use of overdose-reversing naloxone and peer support all played a role in Lisa’s story.

Lisa is 51 years old and lives in Canton. She agreed to speak with The Canton Repository on the condition her last name not be used because of concerns regarding her past associates.

Lisa almost didn’t make it to this point. By her own count, she overdosed at least nine times that landed her in a hospital. That number doesn’t include the dozen or so times her teenage son waited anxiously at her side to blast overdose-reversing naloxone up her nose.

“He saved my life more times than I know,” she said.

Lisa started smoking marijuana when she was 13 years old. In her 20s, she started using methamphetamine, cocaine and prescription pills. Vicodin was the first opioid she tried. Her mother gave her the pill to ease a headache.

“That was the miracle cure for hangovers after that,” Lisa said.

Sometime later, a pain management doctor prescribed Lisa opioids such as Percocet, Vicodin and OxyContin for migraines and pain related to scar tissue. The doctor didn’t ask about her past drug use, she said.

Lisa had a medicine cabinet full of opioids, but she would blow through a month’s worth of pills in a few weeks. The first pain management doctor ultimately dropped Lisa after she got an opioid prescription from a dentist. She found another clinic, but authorities shut it down.

Drugs such as heroin, cocaine or opioid painkillers flood the brain with dopamine, causing a feeling of pleasure. Food, sex and exercise also release dopamine, but can’t compete with surge from the drugs.

Over time, drug use depletes the amount of dopamine in the brain. Addiction takes hold and the brain’s structure changes.

“They have to seek substances to fill that gap,” said Dr. Jamesetta Lewis, of Mercy Medical Center’s Pain Management Center. “That’s when an addiction develops. They have to get more and more substances to bridge that dopamine gap the brain can’t fill itself.”

Unable to get pills, Lisa used heroin. That was about eight years ago. Heroin was cheaper than pills and stronger. She used every day. When she heard about someone overdosing, she’d try to buy the same stuff.

“I never cared if I died,” Lisa said. “I never cared. I just didn’t care. And if I was going to die, that was the way to do it because it was completely painless. You just go to sleep.”

Addiction consumed her life and hurt those closest to her. Her adult daughter started using opioids. Lisa’s teenage son worried every time he left the house or went to school that he’d return to find her dead or in jail. At night he skipped sleep to make sure she didn’t die.

“Growing up seeing your family do that, it does something to you,” he said.

Ready for help

Two Canton Police narcotics officers knocked on Lisa’s door one day this winter.

Detective Mike Rastetter and a supervisor were checking complaints about drug activity at Lisa’s home. They knew Lisa from all the times she had overdosed.

“She looked skin and bones,” Rastetter said. “She looked really bad.”

Lisa was sick from withdrawal and desperate when they knocked. What she didn’t know at the time was that the department had told officers to look for ways to help people addicted to drugs get treatment.

Lisa told the detectives she was going to die if she didn’t get help. They started making calls. About four hours later, Lisa was in a detox bed at the Crisis Intervention & Recovery Center.

“We were fortunate enough that day that it was available,” Rastetter said.

Medication-assisted treatment

Addiction treatment can take different forms. After a week of detox, Lisa went to CommQuest Services’ Regional Center For Opiate Recovery in Massillon, which opened in 2015 specifically to treat opioid addiction. Since then, it has received 2,500 unduplicated referrals from more than 20 counties.

“We talk about recovery being a process of learning to enjoy life and repairing the damage you did while you were using and improving the overall quality of your life,” said CommQuest President and CEO Keith Hochadel.

Lisa’s treatment plan combined counseling and 12-step meetings with daily doses of Suboxone, a combination of naloxone and buprenorphine, an opioid. Suboxone reduces the euphoria and cravings associated with opioids so a patient can focus on recovery.

The thought of getting high is always in her mind, Lisa said, but she counts to 20 and thinks about something else and the craving passes.

“I can function every day,” Lisa said. “I function.”

Starting this month, Stark Mental Health and Addiction Recovery will use two-thirds of a $741,000 federal and local funding package to expand treatment with Suboxone and Vivitrol, a medication that blocks an opioid from making the user high.

But the local treatment community has realized that treating addiction involves more than medication and counseling sessions. Men and women in recovery need help to rebuild their lives and the best guide can be a person who has walked the same road.

Rebuilding lives

When Lisa started at ReCOR, she had to go to Massillon every day to get her dose of Suboxone. She couldn’t drive and everyone she knew who had a car was using drugs. She was able to get a ride with a peer supporter from Stark County TASC.

Peer supporters are individuals in recovery who are trained to help others addicted to drugs or alcohol.

“You actually know what they’re talking about,” said Nicole Osborne, who oversees TASC’s peer supporters. “You actually know where they’re coming from. You didn’t just read it in a book in school.”

Three times a week peer supporters from TASC visit individuals detoxing at the Crisis Center. Rides to treatment appointments are just some of the help they offer.

People addicted to alcohol or drugs put everything else in their lives on hold, Osborne said.

When she meets a new client, she asks the woman about her “life to-do list,” the things she’s avoided or ignored for months or years. That can be getting a driver’s license, finding a home, clearing up arrest warrants or getting a job.

“You need the basics of life,” Osborne said. “You need to know where you’re going to sleep that night. It’s hard to even think about being sober or not using drugs if you don’t have a place to live or no food.”

Peer supporters also link clients to others who can help them stay sober.

Lisa said teaming with a peer supporter removed any excuses she might have had for not going to treatment.

“You don’t have a reason to say, ‘I can’t do it,’” she said.

Police outreach

Lisa is drug-tested regularly in the ReCOR program and said she goes to 12-step meetings almost daily.

Rastetter stops and checks on Lisa and her family about once a month. Right now he’s trying to find her a job.

The 11-year Canton police veteran said he never thought his job would include navigating the maze of addiction services, insurance and housing assistance. Finding local resources on the fly is a challenge, he said, but it’s getting better.

“It’s worth a chance,” Rastetter said. “If we save two or three people’s lives and they get off heroin, then it’s worth it. It really is.”

Lisa is one of about five people the police have helped get into detox, and the department is trying to assist more.

Taking a cue from communities such as Mansfield, Akron and Green, Canton police started a Recovery Response Team in late June. The team includes police, a caseworker from TASC and a Crisis Center nurse. Every week, the team visits individuals who recently overdosed.

“The jails are not equipped to deal with addiction recovery, and I think that looking at this from a health care standpoint and as a health care crisis is very important,” said Lt. John Gabbard, who oversees the initiative.

The police will still pursue drug dealers, but Gabbard asked for patience from residents who might not understand the new approach toward individuals using drugs.

“Give us a chance to convince you that taking the long-term approach of getting them help will be more beneficial to the neighborhood than trying to evict them into someone else’s neighborhood and not dealing with that problem,” Gabbard said.

Looking forward

Now that Lisa’s life isn’t ruled by a daily hustle for drugs, she has a lot of things she wants to do.

She wants to get a job and more furniture for her home. She wants to drive again. She wants to spend time with her family, including her daughter who is now in recovery.

Her plan is to “do things and make memories,” Lisa said. “Ones that I can remember and ones where everybody’s happy.

Relapse is always a risk, and with opioids, the consequence of one slip can be fatal.

“The thought’s always there in your head and it’s a struggle every day, but there is hope at the end of the tunnel,” Lisa said. “But you have to really want it.”

Her kids were proud of her recovery.

“Not everyone is as lucky as her to where you can OD as many times as she did and be alive to this day,” her son said.

Article written by: Shane Hoover, Cantonrep.com staff writer

Link to original article here: Lives Lost: One story of opioid recovery

BrightView’s president, Dr. Ryan, is the featured speaker in this podcast where they interview experts about addiction and addiction education. Listen at the 1:30 minute mark!

The Cover2 Podcast is an ongoing series of interviews with people who are making a difference in the fight against opioid addiction.  The Cover2 Podcast seeks to raise awareness and to connect users.

Click here for: Podcast – Dr. Shawn Ryan, MD, MBA, ABEM

Rise In Hospital Visits For Opioids Spotlight The Epidemic

The latest government numbers on opioid-related hospitalizations paint a picture of a country in a drug-related crisis. Between 2005 to 2014, emergency room visits stemming from opioid use rose 99 percent and inpatient stays jumped 64 percent, according to the Agency for Healthcare Research and Quality.

In 2014 alone, opioid-related hospitalizations totaled 1.27 million.

The spike in hospital visits was driven largely by people ages 25 to 44. The report by the Rockville, Maryland-based agency also noted gender differences in the way men and women used hospital services.

Women were more likely to have inpatient stays, while men were more likely to visit the ER in 2014.  “Our data tell us what is going on. They tell us what the facts are. But they don’t give us the underlying reasons for what we’re seeing here,” Anne Elixhauser, co-author of the report and senior research scientist at AHRQ, told the Washington Post.

“It is no surprise that opioid-related hospitalizations rose significantly during that time period,” Dr. Peter Friedmann, associate dean for research at the University of Massachusetts Medical School and chief research officer at the nonprofit Baystate Health, told HuffPost.

“The surge of opioid use disorder and opioid-related overdose deaths that started in the late ’90s continues unabated in most of the U.S. Overdose deaths are the tip of the iceberg,” Friedmann said.

A U.S. Centers for Disease Control and Prevention report published in June found that between 2010 to 2015, North Carolina hospitals saw a 12-fold increase in patients suffering from endocarditis, an infection of the heart, that was linked to drug dependence.

“As the U.S. opioid epidemic continues to grow, hospitalizations for infectious complications associated with injection drug use are likely to increase,” the report said.

The AHRQ report follows a New York Times Upshot analysis of data from health agencies around the country that estimated drug overdose deaths will top 59,000 in 2016. That’s up from 52,404 overdose deaths in 2015, a 19 percent increase that would be the largest such jump in U.S. history.

According to the Times, the numbers are expected to rise again in 2017.

Link to the original article with informative video here:

Rise In Hospital Visits For Opioids Spotlight The Epidemic

By Erin Shumaker 6/20/2017

Too Many Opioids After Cesarean Delivery

Doctors may be overprescribing opioids to women who have had cesarean sections.

Researchers tracked prescriptions and pill use in 179 women discharged from an academic medical center after cesarean delivery. On average, they left the hospital with a prescription for the equivalent of 30 pills containing 5 milligrams of oxycodone or hydrocodone. Then, using interviews, the scientists tracked how much of the medicine they used during the two weeks after discharge. The study is in Obstetrics & Gynecology.

Those in the top quarter of opioid use after discharge had consumed more than twice as much of the medicine while they were hospitalized. They were also more likely to have smoked during pregnancy and to have public health insurance, but they did not differ from the others in education, body mass index, history of depression and other characteristics.

Certified nurse-midwives prescribed 50 percent less medicine over all than doctors. Most women used the pills for about eight days, and 75 percent had unused medicine at the end of the two weeks.

“About a quarter of the women used all their pills and still reported they had pain,” said the lead author, Dr. Sarah S. Osmundson, an assistant professor of obstetrics at Vanderbilt University, “so it’s not so simple as ‘just use less.’ We need to figure out how to individualize opioids, as opposed to giving all patients the same prescription.”

By NICHOLAS BAKALAR

JUNE 14, 2017

Link to article here: Too Many Opioids After Cesarean Delivery

The opioid epidemic in Ohio is so bad, a church is handing out Narcan

This CNN article talks about this past weekend’s festival that BrightView’s non profit partner, The BrightView Foundation, was happy to assist with distributing 48 of the 70 Narcan kits to the community.

(CNN) A few months ago, Jeremy Bouer says, he found an overdose victim in front of his church in Cincinnati. A week later, he encountered another at a nearby McDonald’s. Then another in his neighborhood.

 

That’s when Bouer took action.

Bouer works at Holy Family Church, and during its annual family festival over the weekend, the parish handed out Narcan kits to the congregation.

Working with the state attorney general’s office, the church distributed 70 kits of the opioid overdose antidote.

“This 70 packs of Narcan, that is 70 lives,” Bouer told CNN affiliate WLWT. “I can’t wait to hear stories and testimonies of people being saved from the packs that are being served from our festival.”

Overdose-related deaths have been on the rise all over the nation. And Ohio’s been particularly hard-hit.

Dealers have been cutting heroin with the synthetic fentanyl to give it a boost and stretch their supply or give a bigger kick, according to the Drug Enforcement Administration. Fentanyl is 50 to 100 times more potent than morphine and 30 to 50 times more potent than heroin. Just a quarter of a milligram can kill someone.

Narcan counteracts the effects of opioids and can reverse an overdose. It’s been used by hospitals and emergency responders for years, and there are efforts to expand access across the country. But some say it’s not a permanent solution.

“I think it is ridiculous,” Nicole Bellamo, a neighborhood resident, told WLWT about the church’s effort. “For one, really? At a festival? For two, they are doing them nothing but a favor so they can overdose again and again and again.” 

Another resident, Jerri Grundy, said she’s happy to see the church giving back in new ways.

“These people need help from somewhere,” she said. “If the doctors are not going to help them, maybe it is the church or the Lord can help.”

By Paige Levin, CNN 6/13/2017

Link to article here: CNN.com

Drug Deaths in America Are Rising Faster Than Ever

New data compiled from hundreds of health agencies reveals the extent of the drug overdose epidemic last year.

AKRON, Ohio — Drug overdose deaths in 2016 most likely exceeded 59,000, the largest annual jump ever recorded in the United States, according to preliminary data compiled by The New York Times.

The death count is the latest consequence of an escalating public health crisis: opioid addiction, now made more deadly by an influx of illicitly manufactured fentanyl and similar drugs. Drug overdoses are now the leading cause of death among Americans under 50.

Although the data is preliminary, the Times’s best estimate is that deaths rose 19 percent over the 52,404 recorded in 2015. And all evidence suggests the problem has continued to worsen in 2017.   

Because drug deaths take a long time to certify, the Centers for Disease Control and Prevention will not be able to calculate final numbers until December. The Times compiled estimates for 2016 from hundreds of state health departments and county coroners and medical examiners. Together they represent data from states and counties that accounted for 76 percent of overdose deaths in 2015. They are a first look at the extent of the drug overdose epidemic last year, a detailed accounting of a modern plague.

The initial data points to large increases in drug overdose deaths in states along the East Coast, particularly Maryland, Florida, Pennsylvania and Maine. In Ohio, which filed a lawsuit last week accusing five drug companies of abetting the opioid epidemic, we estimate overdose deaths increased by more than 25 percent in 2016.

“Heroin is the devil’s drug, man. It is,” Cliff Parker said, sitting on a bench in Grace Park in Akron. Mr. Parker, 24, graduated from high school not too far from here, in nearby Copley, where he was a multisport athlete. In his senior year, he was a varsity wrestler and earned a scholarship to the University of Akron. Like his friends and teammates, he started using prescription painkillers at parties. It was fun, he said. By the time it stopped being fun, it was too late. Pills soon turned to heroin, and his life began slipping away from him.

Mr. Parker’s story is familiar in the Akron area. From a distance, it would be easy to paint Akron — “Rubber Capital of the World” — as a stereotypical example of Rust Belt decay. But that’s far from a complete picture. While manufacturing jobs have declined and the recovery from the 2008 recession has been slow, unemployment in Summit County, where Akron sits, is roughly in line with the United States as a whole. The Goodyear factories have been retooled into technology centers for research and polymer science. The city has begun to rebuild. But deaths from drug overdose here have skyrocketed.

 

In 2016, Summit County had 312 drug deaths, according to Gary Guenther, the county medical examiner’s chief investigator — a 46 percent increase from 2015 and more than triple the 99 cases that went through the medical examiner’s office just two years before. There were so many last year, Mr. Guenther said, that on three separate occasions the county had to request refrigerated trailers to store the bodies because they’d run out of space in the morgue.It’s not unique to Akron. Coroners’ offices throughout the state are being overwhelmed.

 

Drug overdose deaths in six Ohio counties, 2010 to 2017

Totals for 2017 assume that overdose deaths continue at the same rate through the remainder of the year. Source: Butler County Coroner’s Office; Cuyahoga County Medical Examiner’s Office; Hamilton County Coroner; Montgomery County Alcohol, Drug Addiction & Mental Health Service; Montgomery County Sheriff’s Office; Summit County Department of the Medical Examiner

 

In some Ohio counties, deaths from heroin have virtually disappeared. Instead, the culprit is fentanyl or one of its many analogues. In Montgomery County, home to Dayton, of the 100 drug overdose deaths recorded in January and February, only three people tested positive for heroin; 99 tested positive for fentanyl or an analogues.

Fentanyl isn’t new. But over the past three years, it has been popping up in drug seizures across the country.

Most of the time, it’s sold on the street as heroin, or drug traffickers use it to make cheap counterfeit prescription opioids. Fentanyls are showing up in cocaine as well, contributing to an increase in cocaine-related overdoses.

The most deadly of the fentanyl analogues is carfentanil, an elephant tranquilizer 5,000 times stronger than heroin. An amount smaller than a few grains of salt can be a lethal dose.

“July 5th, 2016 — that’s the day carfentanil hit the streets of Akron,” said Capt. Michael Shearer, the commander of the Narcotics Unit for the Akron Police Department. On that day, 17 people overdosed and one person died in a span of nine hours. Over the next six months, the county medical examiner recorded 140 overdose deaths of people testing positive for carfentanil. Just three years earlier, there were fewer than a hundred drug overdose deaths of any kind for the entire year.

This exponential growth in overdose deaths in 2016 didn’t extend to all parts of the country. In some states in the western half of the U.S., our data suggests deaths may have leveled off or even declined. According to Dr. Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco, and an expert in heroin use in the United States, this geographic variation may reflect a historical divide in the nation’s heroin market between the powdered heroin generally found east of the Mississippi River and the Mexican black tar heroin found to the west.

 This divide may have kept deaths down in the West for now, but according to Dr. Ciccarone, there is little evidence of differences in the severity of opioid addiction or heroin use. If drug traffickers begin to shift production and distribution in the West from black tar to powdered heroin in large quantities, fentanyl will most likely come along with it, and deaths will rise.

Drug overdose deaths in Philadelphia and San Francisco Drug overdose deaths since 1980 have surged in Philadelphia despite a shrinking population; most heroin there is powdered. They have remained relatively flat in San Francisco, where most heroin is black tar.

First responders are finding that, with fentanyl and carfentanil, the overdoses can be so severe that multiple doses of naloxone — the anti-overdose medication that often goes by the brand name Narcan — are needed to pull people out. In Warren County in Ohio, Doyle Burke, the chief investigator at the county coroner’s office, has been watching the number of drug deaths rise as the effectiveness of Narcan falls. “E.M.S. crews are hitting them with 12, 13, 14 hits of Narcan with no effect,” said Mr. Burke, likening a shot of Narcan to “a squirt gun in a house fire.”

Early data from 2017 suggests that drug overdose deaths will continue to rise this year. It’s the only aspect of American health, said Dr. Tom Frieden, the former director of the C.D.C., that is getting significantly worse. Over two million Americans are estimated to be dependent on opioids, and an additional 95 million used prescription painkillers in the past year — more than used tobacco. “This epidemic, it’s got no face,” said Chris Eisele, the president of the Warren County Fire Chiefs’ Association and fire chief of Deerfield Township. The Narcotics Anonymous meetings here are populated by lawyers, accountants, young adults and teenagers who described comfortable middle-class upbringings.

 Back in Akron, Mr. Parker has been clean for seven months, though he is still living on the streets. The ground of the park is littered with discarded needles, and many among the homeless here are current or former heroin users. Like most recovering from addiction, Mr. Parker needed several tries to get clean — six, by his count. The severity of opioid withdrawal means users rarely get clean unless they are determined and have treatment readily available. “No one wants their family to find them face down with a needle in their arm,” Mr. Parker said. “But no one stops until they’re ready.”

About the data

Our count of drug overdoses for 2016 is an estimate. A precise number of drug overdose deaths will not be available until December.

As the chief of the Mortality Statistics Branch of the National Center for Health Statistics at the C.D.C., Robert Anderson oversees the collection and codification of the nation’s mortality data. He noted that toxicology results, which are necessary to assign a cause of death, can take three to six months or longer. “It’s frustrating, because we really do want to track this stuff,” he said, describing how timely data on cause of death would let public health workers allocate resources in the right places.

To come up with our count, we contacted state health departments in all 50 states, in addition to the District of Columbia, asking for their statistics on drug overdose deaths among residents. In states that didn’t have numbers available, we turned to county medical examiners and coroners’ offices. In some cases, partial results were extrapolated through the end of the year to get estimates for 2016.

While noting the difficulty of making predictions, Mr. Anderson reviewed The Times’s estimates and said they seemed reasonable. The overdose death rate reported by the N.C.H.S. provisional estimates for the first half of 2016 would imply a total of 59,779 overdose deaths, if the death rate remains flat through the second half of the year. Based on our reporting, we believe this rate increased.

While the process in each state varies slightly, death certificates are usually first filled out by a coroner, medical examiner or attending physician. These death certificates are then collected by state health departments and sent to the N.C.H.S., which assigns what’s called an ICD-10 code to each death. This code specifies the underlying cause of death, and it’s what determines whether a death is classified as a drug overdose.

Sometimes, the cases are straightforward; other times, it’s not so easy. The people in charge of coding each death — called nosologists — have to differentiate between deaths due to drug overdose and those due to the long-term effects of drug abuse, which get a different code. (There were 2,573 such deaths in 2015.) When alcohol and drugs are both present, they must specify which of the two was the underlying cause. If it’s alcohol, it’s not a “drug overdose” under the commonly used definition. Ideally, every medical examiner, coroner and attending physician would fill out death certificates with perfect consistency, but there are often variations from jurisdiction to jurisdiction that can introduce inconsistencies to the data.

These inconsistencies are part of the reason there is a delay in drug death reporting, and among the reasons we can still only estimate the number of drug overdoses in 2016. Since we compiled our data from state health departments and county coroners and medical examiners directly, the deaths have not yet been assigned ICD-10 codes by the N.C.H.S. — that is, the official underlying cause of death has not yet been categorized. In addition, the mortality data in official statistics focuses on deaths among residents. But county coroners typically count up whichever deaths come through their office, regardless of residency. When there were large discrepancies between the 2015 counts from the C.D.C. and the state or county, we used the percent change from 2015 to calculate our 2016 estimate.

We can say with confidence that drug deaths rose a great deal in 2016, but it is hard to say precisely how many died or in which places drug deaths rose most steeply. Because of the delay associated with toxicology reports and inconsistencies in the reported data, our exact estimate — 62,497 total drug overdose deaths — could vary from the true number by several thousand.

 

Full article with citations can be found here:

Drug Deaths in America Are Rising Faster Than Ever

Written by: Josh Katz, June 5th 2017

GOP bill would devastate efforts to end the opioid epidemic

BrightView’s President Dr. Shawn Ryan is co-author of this striking contribution about the potential newly proposed health care bill and how families and individuals suffering from opioid addiction will be among the hardest hit.

Of the many emotions evoked by House passage of the American Health Care Act, the Republican bill to repeal and replace the Affordable Care Act (aka Obamacare), sadness and fear were among the most pervasive. While the legislation reduces the benefits and increases the coverage costs for almost every demographic of our country, families and individuals suffering from opioid addiction will be among the hardest hit. In places like Ohio that are being ravaged by addiction, that is unacceptable.

In 2015, 52,000 Americans died from overdoses; that’s 144 a day. The opioid and prescription drug epidemic is clearly a national crisis. Entire communities are collapsing because of a lack of resources to push back against the rising tide.

Congressman Tim Ryan, is a Democrat who has been representing Ohio’s 13th District since 2002. He is a member of the House Appropriations Committee. 

Last year, Congress took some concrete steps towards fighting back. Last July, the Comprehensive Addiction and Recovery Act was signed into law, creating a comprehensive framework to address substance use disorder and key resources for communities. Congress also passed the 21st Century CURES Act, which included $1 billion for states to help with the local response to this ongoing epidemic. While these programs are positive efforts to confront this crisis, the Affordable Care Act has played a central role in getting people the treatment they need.

The Affordable Care Act made it possible for Americans suffering from substance use disorder to get access to quality treatment – many for the first time in their lives. Through the inclusion of substance use disorder treatment as an essential health benefit, the extension of the parity law to the small group and individual market, and the expansion of Medicaid, millions of Americans were able to gain the coverage they desperately needed to treat addiction. The House Republican health care bill, on the other hand, would not only roll back these advancements, but it could rip health coverage away from the 2.8 million Americans still struggling with addiction.

Shawn A. Ryan is the president and CMO of BrightView Addiction Treatment, an assistant professor in the Department of Emergency Medicine at the University of Cincinnati, president of the Ohio Society of Addiction Medicine and chair of Payer Relations for the American Society of Addiction Medicine. er a caption

Our country is suffering. We should be moving forward, not backward. We fully recognize that passage of this legislation might make political sense to some, but doing so is leaving behind millions of Americans most in need. This epidemic is costing our nation $700 billion in health, crime and lost productivity, but that is nothing compared to the toll it is taking on our communities. These men and women are not strangers – they are our friends and neighbors, our brothers and sisters. There is a reason over 435 addiction and mental health groups nationwide have spoken out against this House Republican health care bill: it’s because it would leave people in need without coverage or access to care.

This legislation still needs to pass the Senate before it can be signed into law by President Trump. We urge the Senate to do the right thing and toss out this bill. It is dangerous and short-sighted, and it would be devastating for our nation’s struggle to end the opioid and prescription drug epidemic that is ravaging every corner of the United States of America.

Link to article here: GOP bill would devastate efforts to end the opioid epidemic