Opioid Use Now Tops Tobacco Use in the U.S.

A survey released by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) shows that more people in the U.S. use opioid painkillers than tobacco, highlighting the tragic opioid crisis gripping the country. [1]

A federal review published in the spring showed that opioid prescriptions in the U.S. decreased for the 1st time in 2 decades, which suggests that doctors are finally starting to heed warnings about the drugs’ addictive properties. However, that decrease has not translated into fewer deaths. The SAMHSA report illustrates just how widespread the problem remains.

The problem is especially severe in Tennessee, where there are more opioid prescriptions written than people actually living in the state. There are 1.18 opioid prescriptions per every resident of Tennessee. More people died from overdoses in the state in 2014 than from car crashes or shootings. [2]

Source: CDC

Nationally, 37.8% of American adults are using some type of opioid painkiller, while 31.1% of U.S. adults use tobacco problems.

According to the 2015 National Survey on Drug Use and Health (NSDUH), a division of the Department of Health and Human Services (DHHS), more than 91.8 million Americans 18 and older used prescription painkillers last year. By comparison, 75.4 million U.S. adults used tobacco products. [1]

Those numbers creep even higher when children 12 and older are included; to 97.5 million and 78.3 million, respectively. And more than 12.5% of those users admitted to misusing the painkillers.

Danny Winder, director of the Vanderbilt Center for Addiction Research in Nashville, said:

“You’d like to think that is good news and reflects a reduction of tobacco use, but unfortunately that’s not the case. It’s a particularly pernicious problem because of its prevalence…Anytime you have a substance that is legally available and has addictive properties, that’s setting up the problem.” [2]

Actually, smoking rates have declined significantly in the U.S. in the last 50 years. From 2005 to 2015, smoking among adults declined from 20.9% to, or 45.1 million, to 15.1%, or 36.5 million. In the last year alone, the overall smoking rate fell 1.7 percentage points, resulting in the lowest prevalence since the CDC began collecting data in 1965.

However, you don’t generally associate tobacco use with hard drugs, yet many people who die from heroin overdoses begin with a dependence on prescription opioids. Even in those who don’t overdose or graduate to heroin, painkiller addiction can be devastating. In 2015, approximately 40% of unemployed people in the U.S. used a prescription opioid. [2]

Another disturbing finding from the survey is that in 2014, 27.0 million people aged 12 and older had reported using an illicit drug (10.2%). This percentage in 2014 was higher than those in every year from 2002 to 2013. [1]

The 2nd most common type of illicit drug use remained nonmedical painkiller use, but the percentage of people aged 12 or older in 2014 who were current nonmedical users of pain relievers (1.6%) was lower than the percentages in most years from 2002 to 2012.

The 2014 NSDUH estimated 66.9 million people aged 12 or older were tobacco users.

Dr. Richard Soper, chief at the Center for Behavioral Wellness in Nashville, said:

“We require tobacco companies to put warning labels on tobacco products; you don’t really see that in opioid products. As long as the FDA is continuing to approve opioids, there will still be access to it. There will still be doctors writing prescriptions.” [3]

In early 2016, the U.S. Food and Drug Administration (FDA) published draft guidelines outlining testing standards for generic drugs that have been produced to be harder to crush and dissolve or snort. The agency requires that generic drug makers be able to prove that their product is bioequivalent to the name brand drug. But under the new guidelines, manufacturers will also have to prove that their generic drug has the same anti-abuse properties as its name brand equivalent.

However, this is the same agency that approved OxyContin for use in children in August 2015.

Sources:

[1] Newsmax

[2] The Tennessean

[3] The Daily Caller

CDC

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About Julie Fidler:
	Julie Fidler is a freelance writer, legal blogger, and the author of Adventures in Holy Matrimony: For Better or the Absolute Worst. She lives in Pennsylvania with her husband and two ridiculously spoiled cats. She occasionally pontificates on her blog.

The Opioid Crisis Deemed a National Emergency: So What Happens Now?

On August 10, 2017, President Donald Trump declared the opioid crisis a national emergency in a move that many speculated he wouldn’t make. Only 2 days before the announcement, Trump vowed to “win” the fight on painkillers and heroin, but stopped short of declaring an emergency. [1]

On August 8, following a meeting with Trump, Health and Human Services secretary Tom Price said that such a declaration was unnecessary, but said that all options were on the table, including a declaration of emergency. [2]

It is unclear what sparked the reversal.

Speaking at his Bedminster, New Jersey, golf club, Trump said:

“The opioid crisis is an emergency, and I’m saying officially, right now, it is an emergency. It’s a national emergency. We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis.” [1]

The President called the crisis “a serious problem the likes of which we have never had.”

He added:

“You know when I was growing up they had the LSD and they had certain generations of drugs. There’s never been anything like what’s happened to this country over the last four or five years. And I have to say this in all fairness, this is a worldwide problem, not just a United States problem.”

Source: MPR News

Keith Humphreys, an addiction specialist at Stanford University who worked in the federal Office of National Drug Control Policy under Barack Obama, explained that 2 major actions will result from the national emergency declaration. [2]

“First, it lets states and localities that are designated disaster zones to access money in the federal Disaster Relief Fund, just like they could if they had a tornado or hurricane.”

Source: The Huffington Post

According to Humphreys, the declaration will allow states and cities to request disaster zone declarations from the White House. In turn, these localities would be able to use federal funds for drug treatment, the overdose-reversal drug Naloxone, and other tools.

Humphreys said:

“Second, declaring an emergency allows temporary waivers of many rules regarding federal programs. For example, currently Medicaid can’t reimburse drug treatment in large residential facilities (16 or more beds). That could be waived in an emergency.”

Under the Obamacare replacement proposals backed by Trump, Medicaid funds for opioid addiction treatment would have been drastically cut.

An Excuse to Keep Fighting the War on Drugs?

The United States is undoubtedly in the grip of an unparalleled drug epidemic. In 2015, opioid overdoses killed nearly 35,000 people in the U.S., according to the National Institute on Drug Abuse (NIDA). [1]

By contrast, a study published August 7, 2017, found that mortality rates were 24% higher for opioids and 22% higher for heroin than had been previously reported. [2]

However, proponents of a public health-centered approach to the crisis epidemic worry about the potential ramifications of what powers an emergency declaration would grant an administration that favors tough-on-crime law enforcement tactics.

Grant Smith of the Drug Policy Alliance said:

“We need to be cautious about the intentions of this administration. An emergency declaration can be used for good. It can help free up federal resources, help prioritize responses by the federal [government], help give the administration leverage to request legislation from Congress.”

Or, in the worst case scenario:

“…all of those things I just mentioned could be used to further the war on drugs. It could give the administration leverage to push for new sentencing legislation. Or legislation that enhances [drug] penalties or law enforcement response. It could give [Attorney General Jeff] Sessions more leverage to push the agenda that he has been pushing,” Smith warned.

In 2016, as part of the 21st Century Cures Act, Congress approved $1 billion in funding over 2 years for state grants to tackle the opioid epidemic. Nevertheless, recent federal estimates suggest opioid overdoses increased last year, even as opioid prescriptions decreased.

Sources:

[1] NBC News

[2] The Associated Press

MPR News

The Huffington Post

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About Julie Fidler:
	Julie Fidler is a freelance writer, legal blogger, and the author of Adventures in Holy Matrimony: For Better or the Absolute Worst. She lives in Pennsylvania with her husband and two ridiculously spoiled cats. She occasionally pontificates on her blog.

This 1980 Letter from Researchers Helped Fuel the Opioid Epidemic

The U.S. opioid epidemic is claiming lives at a breakneck pace. More than 52,000 Americans died of drug overdoses in 2015, according to the CDC – an average of 1 death every 10 minutes. Nearly 33,000 of those deaths involved opioids, including prescription painkillers and heroin. Now we know how the crisis began unfurling: a 101-word letter written by Boston University Medical Center researchers, published in the New England Journal of Medicine. [1] [2]

The scientists raved that “despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.” Hundreds of scholarly articles would go on to quote the researchers’ assertion. Doctors across the country would take those words as gospel truth, and prescriptions for opioids would begin to skyrocket. [2]

Dr. David Juurlink, a scientist with Sunnybrook Health Sciences Center in Toronto, Ontario, and senior author of the report, says:

“The surge in opioid prescribing we have seen over the last 20 years is due in no small measure to doctors being reassured about the safety of opioids.” [2]

Read: Even the “Safest” of Rx Opioids Highly Addictive, Say Experts

Between 1999 and 2015, prescriptions for opioids like OxyContin and Vicodin quadrupled. During that period, more than 183,000 deaths from prescription painkillers were reported in the United States.

Source: attn:

The single-paragraph letter stated that the Boston University researchers found “only four cases of reasonably well-documented addiction” in a review of 11,882 hospitalized patients treated with narcotics.

Juurlink and his colleagues found the letter was forever etched in history without anyone ever questioning or challenging the finding that addiction was rare, and without noticing that the letter had nothing to do with opioids. The fact that the study involved narcotics – not opioids, and in a hospital setting – not a take-home prescription, was glossed over in journal citations.

Samuel Ball, president and CEO of the National Center on Addiction and Substance Abuse, said:

“The real opioid problem we have now has been created by free prescribing of opioids to outpatients. More than 80 percent of the subsequent articles did not mention the patients were in the hospital.” [2]

A review of medical literature revealed 608 separate mentions of the letter, the report states. Close to three out of four articles cited the letter as evidence that narcotic painkiller addiction is a rarity. This, Juurlink says, suggests that few of the researchers who cited the article ever actually read it.

“Anyone who goes and pulls that original paper will see there’s nothing much to it. There was a mass uncritical citation of this letter. This letter effectively spawned hundreds of publications telling doctors and nurses that addiction was rare. When you hear something that frequently, you come to believe it’s true.” [2]

Read: Major Drug Distributors Flooded West Virginia with Millions of Pain Pills

Source: Charleston Gazette-Mail

Let that sink in. A supposedly scientific paper that had no supporting evidence convinced the nation’s doctors that patients could take opioids for extended periods of time with no risk of addiction.

One citation read:

“This pain population with no abuse history is literally at no risk for addiction.” [4]

Another read:

“There have been studies suggesting that addiction rarely evolves in the setting of painful conditions.” [3]

Oh, and get this one:

“Fear of addiction may lead to reluctance by the physician to prescribe. However, there is no evidence that this occurs when prescribing opioids for pain.” [4]

Ball says the letter was heavily cited as proof of opioids’ safety throughout the late 20^th century and early 21^st century. His best guess is that well-meaning researchers and pain specialists were driven by two powerful forces: the desire to ease suffering, and the fact that opioids were promoted “by companies with money to make if only they can get doctors to prescribe their pills.” [2]

Read: Drug Companies Fought to Delay CDC’s New Opioid Guidelines

Dr. Robert Glatter, an emergency physician with Lenox Hill Hospital in New York City, says:

“It’s clear that the pharmaceutical industry capitalized on poorly substantiated research and conclusions regarding risks of addiction to sell a campaign of influence to physicians and other health care providers.” [2]

Dr. Hershel Jick, a drug specialist at Boston University Medical Center, and a graduate student, agrees.

“I’m essentially mortified that that letter to the editor was used as an excuse to do what these drug companies did. They used this letter to spread the word that these drugs were not very addictive.” [3]

Sources:

[1] The Economist

[2] Health Day

[3] Associated Press

[4] Los Angeles Times

attn:

Charleston Gazette-Mail

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About Julie Fidler:
	Julie Fidler is a freelance writer, legal blogger, and the author of Adventures in Holy Matrimony: For Better or the Absolute Worst. She lives in Pennsylvania with her husband and two ridiculously spoiled cats. She occasionally pontificates on her blog.

Commission to Trump: Declare National Emergency over Opioid Epidemic

President Trump’s opioid commission has urged him to declare a national state of emergency over America’s burgeoning opioid crisis. The recommendation comes from a preliminary draft of the commission’s report. [2]

By declaring an emergency, Trump’s cabinet would be able to take action, and Congress would be forced to fund potential solutions to the epidemic.

Drug overdoses likely killed more people in 2016 than the entire Vietnam War. The previous year, opioid overdoses claimed the lives of more people than car crashes, gun violence, and HIV/AIDs combined, when the AIDS epidemic was at its height in 1995.

The commission says in the report:

“With approximately 142 Americans dying every day, America is enduring a death toll equal to September 11th every three weeks. After September 11th, our President and our nation banded together to use every tool at our disposal to prevent any further American deaths.

Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the Executive Branch even further to deal with this loss of life.”

Read: UN Says It Will Monitor the Fentanyl Market

The lawmakers made several other recommendations, including:

• Grant waiver approvals for all 50 states to get rid of treatment barriers in the Medicaid program that exclude the federal Institutes for Mental Diseases.

• Mandate education initiatives with the assistance of medical and dental schools, and by amending the Controlled Substances Act, to require that prescribers receive better training about the treatment of pain and addiction.

• Provide federal support for state-based prescription drug monitoring programs. This will allow doctors to closely monitor a patient’s prescription drug history, to spot patients who might be doctor shopping for more opioids, or if a patient has a history of abusing drugs.

• Provide more funding for research into non-opioid painkillers.

• Boost efforts to block illegal fentanyl shipments.

The commission warns in the report that “If this scourge has not found you or your family yet, without bold action by everyone, it soon will.” [2]

They go on:

“You, Mr. president, are the only person who can bring this type of intensity to the emergency and we believe you have the will to do so and to do so immediately. Our citizens are dying. We must act boldly to stop it.”

The Commission on Combating Drug Addiction and the Opioid Crisis is chaired by New Jersey Gov. Chris Christie (R), Massachusetts Gov. Charlie Baker (R), North Carolina Gov. Roy Cooper (D), former Rep. Patrick Kennedy (D), and Dr. Bertha Madras.

Sources:

[1] Vox

[2] USA Today

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About Julie Fidler:
	Julie Fidler is a freelance writer, legal blogger, and the author of Adventures in Holy Matrimony: For Better or the Absolute Worst. She lives in Pennsylvania with her husband and two ridiculously spoiled cats. She occasionally pontificates on her blog.

Fewer Dying from 3 of the 5 Leading Causes of Death in the U.S.

A study published online in the CDC’s Morbidity and Mortality Weekly Report says that fewer people are dying from 3 of the 5 leading causes of death in the United States – heart disease, cancer, and stroke. [1] [2]

Potentially preventable deaths from asthma, bronchitis, emphysema, and other chronic lower respiratory diseases didn’t budge, though.

But, eh, more people died from unintentional injuries, mainly caused by falls and by overdoses from both prescription and illegal drugs.

Former CDC Director Tom Frieden said in a statement:

“Fewer Americans are dying young from preventable causes of death. Tragically, deaths from overdose are increasing because of the opioid epidemic, and there are still large differences between states in all preventable causes of death, indicating that many more lives can be saved through use of prevention and treatment available today.” [3]

The rates of death from each cause vary geographically. Where people live is generally a good indicator of the health problems they face, their access to and use of social services, and public health efforts. Deaths from all leading causes are highest in the South.

Macarena C. García, DrPH, from the Center for Surveillance, Epidemiology and Laboratory Services at the Centers for Disease Control and Prevention (CDC), wrote:

Source: NIDA

“Public health officials can use the decreases observed as benchmarks for improving population health, while using observed increases to direct targeted efforts to reduce the number of potentially preventable deaths.

Specifically, given the reported increase in potentially preventable deaths from unintentional injuries, these findings might inform the selection and implementation of evidence-based interventions to prevent deaths from injuries such as falls and drug overdoses, based on epidemiologic burden.” [2]

For the study, Garcia and her team analyzed mortality data from the National Vital Statistic System, using the same model as that used in a 2010 analysis to allow for comparison.

Overall, the 5 top causes of death in the U.S. – heart disease, cancer, chronic lower respiratory disease (CLRD), stroke, and unintentional injuries – increased from 2010 to 2014, which was consistent with population increases. But the rate of heart disease, cancer, and stroke deaths increased more slowly than the population grew.

Of those who died of heart disease, cancer, CLRD, stroke, and unintentional injuries, the CDC estimates that 15% of the cancer deaths, 30% of the heart disease deaths, 36% of the CLRD deaths, and 28% of the stroke deaths were preventable. A whopping 43% of the unintentional deaths were preventable. [3]

Potentially preventable cancer deaths fell 25% from 2010-2014, driven by a 12% decrease in the age-adjusted death rate from lung cancer. The authors of the study credit the decline in cancer deaths to prevention, early detection, and treatment.

There was an 11% decrease in potentially preventable deaths from stroke and a 4% decrease in potentially preventable deaths from heart disease. The researchers wrote that the reduction in both causes of death is attributable to improved quality of care and a drop in risk factors, including better blood pressure control among people who have hypertension.

In comparison, potentially preventable deaths caused by accidents increased 23%. Those caused by CLRD rose1%, which the CDC said was not considered statistically significant. [3]

Overdose deaths involving prescription opioids have quadrupled since 1999, the CDC said. Nearly two million Americans abused or were addicted to prescription opioids in 2014, and more than 14,000 people died from overdoses involving those drugs.

Source:

[1] Medscape

[2] CDC

[3] Fox News

National Institute on Drug Abuse (NIDA)

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Pantera lead singer Phil Anselmo talks about his opiate and heroin use

NEW ORLEANS (INTELLIHUB) — The lead singer of the popular 90’s metal band Pantera, Phil Anselmo, gave a powerful speech at Loyola University New Orleans in 2009 where he conveyed to the audience his life on painkillers and heroin.

Anselmo told the audience how he climbed the ladder of painkillers until he eventually got hooked on Soma’s then heroin.

The rockstar said that Soma should be taken off the market because it’s dangerous in the sense that you will eventually migrate to full blown heroin use.

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