Showing posts with label narcotics. Show all posts
Showing posts with label narcotics. Show all posts

Sunday, 19 June 2016

Princess Health and Dangers of HIV and hepatitis from intravenous drug use reach far beyond addicts and families, threatening a wide swath of Ky.. Princessiccia

The growing use of heroin and the abuse of prescription painkillers in Kentucky also mean that the state "is being ravaged by the diseases that follow in their wake: hepatitis and HIV. These dangers also reach far beyond addicts and their families, threatening a wide swath of the population," Laura Ungar reports for The Courier-Journal.

Kentucky has one-fourth of the 220 U.S. counties that the U.S. Centers for Disease Control and Prevention had judged to be at high risk for outbreaks of HIV and hepatitis C among intravenous drug users, Ungar notes in the second installment of a three-part series on heroin in Kentucky and adjoining states.
"Acute hepatitis B rose 114 percent in Kentucky, Tennessee and West Virginia from 2009 to 2013, even as incidence remained stable nationally, according to one study," she reports. "According to another study, the rate of new hepatitis C cases among people 30 and younger more than tripled from 2006 to 2012 in Kentucky, Tennessee, Virginia and West Virginia. More recently, cases of acute hepatitis B and C in Kentucky reached 281 last year, up from 120 in 2003."

Dr. Nora Volkow, director of the National Institute on Drug Abuse, told Ungar that hepatitis C has become the top cause of death from reportable infectious diseases in the U.S., and an HIV outbreak in Austin and Scott County, Indiana, �was a wake-up call� for the country. Ungar notes, "Addicts may also be spreading both diseases without knowing it. Up to three in four people with hepatitis C, and one in eight with HIV, don�t know they have it, experts say."

Dr. William Cooke, an Austin physician "who treats dozens of patients with HIV and hepatitis, said many communities are ill-equipped to handle the threat," Ungar writes. "All over the region and nation, he said, there�s too little substance abuse treatment, too little emphasis on the poverty that often accompanies addiction and too little compassion."

Kentucky has authorized needle exchanges where addicts can get clean syringes to avoid the threat of infection from contaminated needles. "Officials say needle exchanges are an important part of a comprehensive strategy to control disease," Ungar notes. "But critics argue these programs enable drug use, and many area residents reject the idea of using public money to fund them. So the prospect of more syringe exchanges in the region remains uncertain."

Ungar gives the basics of how the diseases spread: "HIV, which can be transmitted through semen and other bodily fluids in addition to blood, is mainly spread by having unprotected vaginal or anal sex with someone who has HIV, or sharing used needles, which can harbor live viruses for up to 42 days. But it also can be transmitted to health care workers by needle sticks, or from mother to child during pregnancy, birth or breastfeeding, especially if the mom isn't taking medicine.

"Hepatitis B and C, which are caused by separate viruses, are easier to catch than HIV because there are higher levels of virus in the blood. Hepatitis B is more often contracted through sex or accidental needle sticks than hepatitis C, but both types are commonly spread by sharing tainted needles."

Thursday, 16 June 2016

Princess Health and  Painkillers appear to increase risk of deaths other than overdoses, according to new study of Medicaid patients in Tennessee. Princessiccia

Princess Health and Painkillers appear to increase risk of deaths other than overdoses, according to new study of Medicaid patients in Tennessee. Princessiccia

"Accidental overdoses aren't the only deadly risk from using powerful prescription painkillers," The Associated Press reports. "The drugs may also contribute to heart-related deaths and other fatalities, new research suggests."

A study of of more than 45,000 Medicaid patients in Tennessee from 1999 to 2012 found that "those using opioid painkillers had a 64 percent higher risk of dying within six months of starting treatment compared to patients taking other prescription pain medicine," AP reports. "Unintentional overdoses accounted for about 18 percent of the deaths among opioid users, versus 8 percent of the other patients."

"As bad as people think the problem of opioid use is, it's probably worse," said Vanderbilt University professor Wayne Ray, the lead author of the study report. "They should be a last resort and particular care should be exercised for patients who are at cardiovascular risk."

The report in the Journal of the American Medical Association noted that opioids can slow breathing and worsen the disrupted breathing associated with sleep apnea, which could lead to irregular heartbeats, heart attacks or sudden death.

The patients in the study "were prescribed drugs for chronic pain not caused by cancer but from other ailments including persistent backaches and arthritis," AP reports. "Half received long-acting opioids including controlled-release oxycodone, methadone and fentanyl skin patches. . . . There were 185 deaths among opioid users, versus 87 among other patients. The researchers calculated that for every 145 patients on an opioid drug, there was one excess death versus deaths among those on other painkillers. The two groups were similar in age, medical conditions, risks for heart problems and other characteristics that could have contributed to the outcomes."

Tuesday, 14 June 2016

Princess Health and Potent fentanyl, mixed with heroin, drives 14.7 percent increase in fatal drug overdoses in Kentucky from 2014 to 2015. Princessiccia

The number of drug-overdose fatalities in Kentucky rose almost 15 percent in 2015, driven by a 247 percent jump in deaths involving fentanyl, a highly potent opioid that some traffickers are mixing with heroin, the Kentucky Office of Drug Control Policy said Tuesday.

The office counted 1,248 fatal overdoses in Kentucky last year, up 14.7 percent from the 1,088 reported in 2014. Fentanyl was a factor in more than a third: 420, up from 121.

"Heroin was detected in 28 percent of cases, consistent with the previous year," the Justice and Public Safety Cabinet said in a press release. "However, as a total, heroin-related deaths increased in 2015, largely because the drug is being laced with fentanyl."

�The introduction of illicit fentanyl into the heroin trade is producing devastating results,� Van Ingram, director of the office, said in the release. �Whether it�s manufactured to resemble heroin or a prescription pill, the cartels have made an already dangerous situation worse.�

Gov. Matt Bevin said, �I am heartbroken for the Commonwealth. More than three families a day are shattered by this epidemic of untimely death. This is unacceptable and will be vigorously addressed with every resource at our disposal.�

The report by Ingram's office listed the eight counties with the most fatal overdoses per person from 2012 to 2015. All were in Eastern Kentucky or Northern Kentucky. Here are the counties, with the number of deaths per 10,000 people: Leslie, 6.86; Bell, 6.12; Gallatin, 5.26; Knott, 4.87; Wolfe, 4.83; Floyd, 4.76; Campbell, 4.72 per 100,000 and Kenton, 4.63 per 10,000.

Counties with big percentage increases in fatal overdoses from 2014 to 2015 included Bell, from 11 to 20; Boyd, from 13 to 24; Butler, from none to eight; Harlan, from six to 10; Kenton, from 71 to 112; and Rowan, from five to 12.

Counties with large decreases included Bullitt, from 22 to 11; Grant, 13 to 6; Russell, from 13 to 7; Laurel, 18 to 10; Leslie, from nine to five; McCracken, 20 to 10; and Marshall, from 12 to fewer than five. The report does not list specific numbers for a county in years when the county had fewer than five fatal overdoses.

The figures above are based on where the death occurred. Based on the residence of the overdose victim, some counties ranked higher; for example, Powell County had 5.84 overdose deaths per 10,000 people, and Russell County had 4.95. This map shows rates based on the county where the overdose victims resided; note that it shows the death rate per 100,000 people, not 10,000 (a figure closer to the population of most counties). Click on the image for a larger version.

Wednesday, 25 May 2016

Princess Health and Kentucky is the only truly Appalachian state to have put a brake on fatal overdoses from narcotics. Princessiccia

Kentucky is the only truly Appalachian state to have put a brake on fatal drug overdoses, report Rich Lord and Adam Smeltz of the Pittsburgh Post-Gazette as part of a series in the about the deadly epidemic of prescription painkillers in the region.

A chart with the series' story about Kentucky shows that fatal drug overdoses were less numerous in the state in 2013 than in 2012, when the General Assembly cracked down on "pill mills," and that while fatal overdoses rose in 2014, they were still not as numerous as in 2012. Official numbers for 2015 are expected soon, and may rise because of the spread of heroin.

The series also credited a crackdown by the Kentucky Board of Medical Licensure, which "took disciplinary action for prescribing irregularities against 135 of the state�s roughly 10,600 doctors" from 2011 to 2015. "The board also moved against 33 doctors during that time for abusing narcotics themselves."

"Getting tough on doctors works," Lord wrote in the series' main story. The state story reported, "Kentucky�s per-capita opioid consumption -- though still seventh in the nation -- dropped by a steepest-in-Appalachia 12.5 percent from 2012 to 2014, according to IMS Health Inc.," Lord and Smeltz report. "Kentucky is the only state, among the seven studied by the Pittsburgh Post-Gazette, in which fatal overdoses have plateaued. Elsewhere, they have climbed relentlessly."

The story quotes Kerry B. Harvey, U.S. attorney for the eastern half of Kentucky: �In much of Eastern Kentucky, the workforce is engaged in difficult, manual labor,� like mining, farming and logging, �so people would injure themselves and be prescribed these very potent narcotics, because the medical profession changed the way it looked at prescribing these kinds of narcotics for pain.� The drugs dulled the �sense of hopelessness� people had about the area�s economy, �and so for whatever reason, this sort of culture of addiction took hold.�

"Harvey said that as physicians have gone to jail, and others have faced board discipline, the painkiller business model has adapted. . . . Now the doctors take insurance, and bill the insurer or the government not just for the office visit, but for the MRI, urine screen and back brace they use to justify the addictive narcotic." Harvey said, �So instead of a cash business, in many cases now the taxpayers or the insurance companies pay. The result is the same. We end up with our communities flooded with these very potent prescription narcotics.�

Thursday, 19 May 2016

Princess Health and At forum on opioid abuse in Corbin, people say they need more treatment services, community education and coalitions. Princessiccia

Image from Lauren Osborne, WYMT-TV Mountain News
By Melissa Patrick
Kentucky Health News

CORBIN, Ky. � After a day of learning and talking about opioid prevention, treatment and mobilization, people at a forum in Corbin agreed on three things: Access to substance abuse and mental health services remains a huge barrier in southeastern Kentucky; more community education is needed; and drug-prevention programs should form coalitions to better use their limited resources.

Substance abuse affects almost every family in Kentucky, and four Kentuckians die every day from a drug overdose. That was part of the opening message from Dr. Allen Brenzel, medical director of the state Department for Behavioral Health, Development and Intellectual Disabilities.

"This is, in my opinion, one of the most pressing health-care issues facing our commonwealth today," Brenzel said. "If 1,000 people a year were dying from measles in the state of Kentucky, think about the public response that we would have. ... We would be on red-alert, we would have a complete, public-health, massive intervention to solve that problem."

Van Ingram, executive director at the Governor's Office of Drug Control Policy, said that next year's drug overdose report, which will be released in a few weeks, will show the problem is getting worse.

About 125 people, most of them health-care providers, attended the "Cumberland River Forum on Opioid Use Disorders: A Time for Community Action" May 17 at the Corbin Technology Center. It was sponsored by The Kentucky Cabinet for Health and Family Services, the Hazelden Betty Ford Foundation, and Cumberland River Behavioral Health. Similar forums were held in Lexington May 16 and Louisville May 13.

John Tilley
John Tilley, secretary of the Kentucky Cabinet for Justice and Public Safety, said he hoped the forum would "light a fire under this community" to talk to their neighbors and friends, community leaders and legislators about the value of treatment over incarceration for substance abuse and mental health issues.

Tilley, who chaired the House Judiciary Committee when he was a state representative from Hopkinsville, acknowledged that some abusers should be in prison, but said society must distinguish between "who we are mad at and who we are afraid of. ... I promise you the way to get out of this mess is not to over-criminalize addiction and mental illness."

Tilley said "The solution is right before our eyes," using for treatment some of the billions of dollars now used to incarcerate drug users.

Tim Feeley, deputy secretary for the CHFS and a former legislator from Oldham County, agreed: "We are not going to incarcerate our way out of this." He said the state needs more treatment programs and said the cabinet was fully committed to addressing the state's addiction problems to the best of its abilities.

William Hacker
Kentucky has moved away from treating mental health and substance abuse issues criminally, said Dr. William Hacker, chair of Shaping Our Appalachian Region's Health and Wellness Advisory Committee and former state health commissioner. He said other successful anti-drug efforts include grassroots advocacy groups, the online prescription-drug tracking program, needle-exchange programs, a move toward medication assisted treatments for opioid addiction, and the SMARTS initiative, which provides addiction care for pregnant and parenting women for up to two years.

Hacker also mentioned Operation UNITE, a Kentucky non-profit created by U.S. Rep. Hal Rogers that leads education, treatment and law enforcement initiatives in 32 counties in Southern and Eastern Kentucky. UNITE has held a national drug abuse conferences for the past five years, with this year's summit in Atlanta including President Barack Obama. The acronym stands for Unlawful Narcotics Investigations, Treatment and Education.

A former pediatrician in Corbin, Hacker also noted that SOAR recently held a Substance Abuse Roundtable to discuss research and emerging opportunities associated with substance abuse and intravenous drug use in Appalachian Kentucky. He said SOAR works to create a network across the region to share best practices and money opportunities and to create community level empowerment.

"Substance abuse is not a failure of moral character, it is a disease," Hacker said. "Don't give up. Never give up."

At the end of the meeting, the attendees broke into groups that represented schools, community leaders, health-care professionals, parents and the faith community to discuss what actions they could take to address opioid abuse in their communities.

Most groups reported that lack of access to substance abuse and mental health treatment is a barrier in their communities. And while it was noted that some communities offer more services than others, several groups said they did not have enough counselors to support medication-assisted therapies or enough doctors willing to prescribe it. Lack of transportation was also mentioned as a barrier toward getting treatment in several groups.

Also, most groups said community members often aren't aware of the resources, so more community education is needed. They listed schools, churches and county Extension offices as possible sources of education, and noted that a community resource website would be helpful. They also said parents would benefit from a class to learn how to talk to their children about drugs.

The groups agreed that all sectors of the community were needed to combat substance abuse and suggested that drug prevention programs in each community should form coalitions to better use resources and information.

Saturday, 7 May 2016

Princess Health and In many people, OxyContin doesn't give 12-hour pain relief as advertised, and that can cause an addiction problem. Princessiccia

Oxycontin tablets (Los Angeles Times photo by Liz Baylen)
Why have so many people become addicted to the painkiller OxyContin? We know about the overselling of the drug by its manufacturer, Purdue Pharma, which cost the company $635 million in 2007 to settle an investigation by the Department of Justice. Now the Los Angeles Times reports on another big reason, which the settlement didn't address: In many people, OxyContin doesn't last as long as advertised, and "Patients can experience excruciating symptoms of withdrawal, including an intense craving for the drug," Harriet Ryan, Lisa Girion and Scott Glover report.

Purdue Pharma "launched OxyContin two decades ago with a bold marketing claim: One dose relieves pain for 12 hours, more than twice as long as generic medications," the writers report. "On the strength of that promise, OxyContin became America�s bestselling painkiller, and Purdue reaped $31 billion in revenue."

However, the Times reports, "Even before OxyContin went on the market, clinical trials showed many patients weren�t getting 12 hours of relief," as the company claimed. "Since the drug�s debut in 1996, the company has been confronted with additional evidence, including complaints from doctors, reports from its own sales reps and independent research. The company has held fast to the claim of 12-hour relief, in part to protect its revenue. OxyContin�s market dominance and its high price � up to hundreds of dollars per bottle � hinge on its 12-hour duration. Without that, it offers little advantage over less expensive painkillers."

In the late 1990s, when doctors began telling patients to take OxyContin at shorter intervals, "Purdue executives mobilized hundreds of sales reps to [refocus' physicians on 12-hour dosing. Anything shorter 'needs to be nipped in the bud. NOW!!' one manager wrote to her staff," the Times reports. "Purdue tells doctors to prescribe stronger doses, not more frequent ones, when patients complain that OxyContin doesn�t last 12 hours. That approach creates risks of its own. Research shows that the more potent the dose of an opioid such as OxyContin, the greater the possibility of overdose and death. More than half of long-term OxyContin users are on doses that public-health officials consider dangerously high, according to an analysis of nationwide prescription data conducted for The Times."

More than 7 million Americans have abused OxyContin in the last 20 years, according to the National Survey on Drug Use and Health, and a disproportionate number have been in Appalachia and Eastern Kentucky, where the drug has been called "hillbilly heroin." OxyContin "is widely blamed for setting off the nation�s prescription opioid epidemic, which has claimed more than 190,000 lives from overdoses involving OxyContin and other painkillers since 1999," the Times reports.

Purdue Pharma issued statement calling the Times story �long on anecdotes and short on facts� and said it was based on a �long-discredited theory.� Times spokeswoman Hillary Manning replied, �Our editors see nothing in Purdue�s statement that casts doubt on our reporting or our findings.� For details, click here.

Tuesday, 3 May 2016

Princess Health and Prescription drug addiction not only comes at a personal cost to individuals, but also at an enormous cost to employers. Princessiccia

By Melissa Patrick
Kentucky Health News

With nearly one of three opioid prescriptions being abused, employers are not only subsidizing the cost of these drugs, they are also paying for the fallout that results from the abuse, according to a new study.

"The personal impact that opioid painkiller abuse takes on individuals, their friends, and family is absolutely tragic,� Kristin Torres Mowat, senior vice president of health plan and strategic data operations for Castlight Health, the health-information firm that led the study, said in a news release. �This crisis is also having a significant impact on the nation�s employers, both in the form of direct and indirect costs. From higher spending on healthcare, to lost productivity, to the dangers associated with employees abusing medications in the workplace: these are aspects of the crisis that are too often overlooked in the current discussion.�

The study, titled "The Opioid Crisis in America's Workforce," looked at anonymous claims data from nearly a million employer-based health insurance claims between 2011 and 2015, defining abuse as those who received more than a 90-day supply of opioid prescriptions and received prescriptions from four or more providers. It excluded claims that had cancer, palliative care or convalescence care diagnoses.

Graph from "The Opioid Crisis in America's Workforce" report
The study found that 22 of the top 25 cities that abuse opioids are in the rural South. Henderson was the only Kentucky town on this list, as part of the Evansville, Ind., metropolitan area, which had a 7.8 percent opioid abuse rate.

Kentucky ranks fourth in the nation for painkiller prescriptions, at about 130 prescriptions for every 100 people, Christine Vestal reports for Stateline.

So why aren't more Kentucky towns on the list? "Anywhere with a ZIP code is included," Castlight spokeswoman Cynthia Cowen said in an email. "However, in less populated regions, showing the abuse rates may inadvertently lead to patient identification."

The Castlight study also found that on average, 4.5 percent of Americans who get narcotic painkiller prescriptions are abusers, and account for nearly one-third (32 percent) of total opioid prescriptions and 40 percent of opioid prescription spending.

And the cost to employers is huge, estimated at $10 billion annually for absenteeism and poor work productivity, says the report. In 2015, the study found that employers spent nearly twice as much ($19,450) in medical expenses on opioid abusers annually than on non-abusers ($10,853), a difference of $8,597.

The study offered some additional insights, including: baby boomers are nearly four times more likely to abuse opioids than Millennials; poorer people are twice as likely to abuse opioids as rich ones; states with medical marijuana laws have a lower opioid abuse rate than those that don't; patients with a behavioral health diagnosis of any kind are three times more likely to abuse opioids than those without one; and opioid abusers have twice as many pain-related conditions as non-abusers.

The federal Centers for Disease Control and Prevention has called this issue a public-health crisis and has asked doctors to change the way they prescribe opioids, by only prescribing them for three to seven days at the lowest possible effective dose.

According to the CDC, nearly 2 million Americans are abusing prescription opioids, resulting in 16,000 deaths per year. In 2014, the latest data available, 1,087 Kentuckians died of overdoses, according to the Kentucky Office of Drug Control Policy.

The report suggests that employers have a role to play in addressing this through the use of data and analytics to determine prescribing trends that can then help them better understand what their employers needs are as they relate to opioid use and abuse, and then to guide them to appropriate benefit programs to prevent or treat their addictions.