Opioids in the News

Dear Readers,

Today I’m simply re-posting recent articles — written by others — directly related to the opioid epidemic, which is the subject of my recently published novel.

New readers are signing up almost daily to receive this blog, and many are medical students or political science majors interested in the topics and the accompanying research. Perhaps this will help.

Look for original pieces arriving in the next few days.

First, from the St. Louis Post-Dispatch 4/3/17:

Social change and economic disappointment create an epidemic of ‘deaths by despair’

st louis pd deaths per 100kScreen Shot 2017-04-11 at 2.34.51 PM.png

Two years ago, Princeton University economists Anne Case and Angus Deaton disclosed a shocking finding: Between 1999 and 2014, middle-aged (45-54) white Americans with a high school education or less died at a rate never before seen in a modern industrialized society.

Alone among every other demographic group they studied, this group’s life expectancy was shrinking. The group’s annual mortality rate jumped from 281 per 100,000 to 415 per 100,000 during the 15 years studied.

Big reasons: Striking increases in the number of suicides, drug overdoses and liver disease caused by alcohol poisoning. Case and Deaton called them “deaths by despair.”

Now the two scholars have returned to try to explain why this is happening. In a report published by the Brookings Institution, they suggest that while income inequality and wage stagnation may play a background role, a lifetime of “cumulative disadvantage” catches up with this demographic.

They are the slice of the population who hit the job market as low-skill jobs were being mechanized, computerized and globalized. They grew into adulthood as cohesion-building social institutions like marriage, family and churches became weaker. Often they didn’t have spouses, pastors, work buddies or kids to back them up.

They did have opioid painkillers, which Case and Deaton say “added fuel to the flames, making the epidemic much worse than it otherwise would have been.” They cite a study from the Boston Federal Reserve that found that among men not in the labor force, nearly half are taking pain medication, most often by prescription.

Case is a professor of economics and public affairs; Deaton, her husband, was the 2015 Nobel laureate in economics. They admit their research is not a “smoking gun,” but it has ominous implications:

“This account, which fits much of the data, has the profoundly negative implication that policies, even ones that successfully improve earnings and jobs, or redistribute income, will take many years to reverse the mortality and morbidity increase, and that those in midlife now are likely to do much worse in old age than those currently older than 65.”

Obviously the same forces affecting low-income middle-aged whites also affect poor educated middle-aged blacks and Hispanics. But mortality rates are decreasing among those groups and they don’t suffer high rates of deaths by despair. The authors speculate that expectations may be higher among whites, leading to greater disappointment when things don’t work out.

Many of these folks put their faith in Republican promises of help, and the GOP owes them something. Addressing opioid addiction is a place to start. So is keeping the social safety net intact. GOP politicians can boast about bringing back jobs and passing right-to-work laws, but voters must hold them accountable if they make things worse for the people the corporate economy has left behind.

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Dallas Morning News 4/6/17

At the heart of our opioid crisis: the doctors who overprescribe them

President Donald Trump held a “listening session” about opioids and drug abuse at the White House last week. The gathering included former addicts, parents of children who had overdosed, top federal officials and others. Trump vowed to make drug treatment more widely available — a worthwhile goal with bipartisan appeal. He also spoke of strengthening law enforcement and dismantling drug cartels.

But there is a cheaper, low-risk tactic for curbing some opioid misuse that was neglected: changing doctors’ prescribing habits and better educating patients. A recent study found that for every 48 patients who receive an opioid prescription in the emergency room, one will likely become a long-term user. A more cautious approach to prescribing could save lives.

Across the United States, health care professionals wrote 249 million prescriptions for opioid pain medicines in 2013. In 2015, about 22,000 Americans died after overdosing on some form of opioid drug, legal or illicit, according to the Centers for Disease Control and Prevention. Of those deaths, 15,000 were attributed to prescription opioid overdoses. In fiscal 2015, Texas pharmacies dispensed almost 7 million prescriptions for the opioid painkillers hydrocodone or oxycodone alone.

There is no medical explanation for the rise in opioid use. Sales of prescription opioids nearly quadrupled from 1999 to 2014, even though Americans don’t report having more pain now. Prescribing rates vary widely among states, even though health conditions don’t. Even among doctors working in the same emergency room, some prescribe opioids much more frequently than others.

some states have more opioid

The federal government — along with some states and professional associations — has produced extensive prescribing guidelines. Opioid medications are not the preferred option for managing chronic pain; doctors and patients should try other approaches first and carefully weigh risks before starting prescription opioids. For acute pain, such as after surgery, doctors should prescribe the lowest possible dose of opioid for the shortest duration. Prescribers must be especially careful with older adults because opioid painkillers can put seniors at higher risks of falls and fractures.

Pharmacists and patients have an important role. In Texas, lawmakers are considering a bill, SB 316, which tightens the state’s prescription drug monitoring program. The bill would make it easier for pharmacists and regulators to quickly spot patients who fill multiple prescriptions for addictive medications and doctors who prescribe inappropriately.

And the public can help, too. How do most people who misuse prescription pain medications get them? One large study showed that about half obtained them free from friends or relatives. So, if you have pain pills left over from surgery or dental work, drop them in the toilet. Really. These medications are so dangerous when misused that the FDA recommends flushing them down the sink or the toilet if you can’t find an official drug take-back event. That will keep everybody in your home — you and your friends, relatives, kids and pets — safe.

What you can do

April 29 is National Prescription Drug Take Back Day, which aims to provide a safe, convenient and responsible means of disposing of prescription drugs, while providing education about the potential for abuse and medications. To find a drop-off location near you or to learn more about the program, visit dea.gov or call 800-882-9539.

(Verify the original piece)

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Associated Press 3-10-17:

Workers comp programs fight addiction among injured workers

This article is protected, but the link is worth reading!

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Fourth, the Kingsport Times-News 7/3/16:

Endless prescription: Suboxone, Subutex plaguing region

Suboxone. Subutex.

For many, they mean nothing. But they are at the heart of a disturbing trend which has seen people move to the area just to obtain them, caused doctors to leave other jobs to prescribe them and left hundreds of drug addicts with an endless prescription.

It is a problem law enforcement has seen explode in the last five years.

“We routinely arrest people for drug offenses and find them in possession of both buprenorphine (Suboxone or Subutex) and some other powerful narcotic (heroin, opiate-based pain pills, etc.) that buprenorphine is supposed to be weaning them off of. This phenomenon directly contradicts their intended purpose,” said Kingsport Police Department Public Information Officer Tom Patton.

“In an ideal world, buprenorphine could arguably serve a legitimate purpose. But we do not live in an ideal world, and we are probably seeing more harm than good out of these drugs at this point.”

The intended use of buprenorphine, the main ingredient in Suboxone and Subutex, is to help people addicted to pain pills achieve sobriety by providing an alternative to their drug of choice. Counseling and therapy are supposed to be provided along with the prescription.

Over time, the dosage should be reduced gradually until the patient is completely drug free.

That is not happening.

“I started going to a doctor in 2006 or 2007, somewhere around there,” said a Suboxone patient who wished to remain anonymous. “The first time you take it and the second time you take it, it feels great. Then it just turns into maintenance.”

He said he is disappointed because he was told by a healthcare professional that a tapering off would occur, but never did.

The patient, who is currently homeless, said he spends $160 a week to visit a doctor and fill his prescription. He readily admits he could spend that money on an apartment if he were not on Suboxone.

It is a cash-only business because his doctor, like many buprenorphine prescribers, does not accept insurance.

And cash only not only applies to patients, but to everyone, including law enforcement agencies that buy the drug for use as health maintenance for prisoners.

“All clinics do cash only,” said Christy Frazier, the health administrator for the Sullivan County Jail. “The ones I worked with here only take cash, even from us.”

Frazier said in just one week, approximately 75 percent of those coming into the jail had abused Suboxone or Subutex. She said at least two inmates told her they moved to Northeast Tennessee for the express purpose of obtaining the drugs.

Sullivan County District Attorney General Barry Staubus said almost every single drug case before a recent grand jury involved the selling of Suboxone or Subutex.

“It’s a real danger to the community,” he said. “I attribute that to overprescribing.”

Patients are not the only ones getting in on the act. Doctors are reportedly leaving their current work to start prescribing buprenorphine.

“Greed is taking over,” said Dr. Randy Jessee, senior vice president of specialty services for Frontier Health. “We are hearing stories about doctors quitting their ER work, quitting their practice and going into the Suboxone business.”

According to the Department of Substance Abuse and Mental Health, there are 94 buprenorphine prescribers in the greater metro areas of Johnson City, Kingsport and Bristol. And that number could be an underestimate because prescribers decide whether they want to be listed in the DSAMH locator, according to the 2015 DSAMH “Medication-Assisted Treatment Substance Use Tool Guide.”

It would never be obvious to anyone driving around town that so many buprenorphine prescribers exist. There is a reason why.

Many of the clinics or prescribers do not advertise the prescribing of Suboxone or Subutex. They also have unassuming names, calling themselves a rehabilitation center or family treatment center. Many users find out by word of mouth.

The Suboxone patient who talked to the Times-News was handed a card directing him to a clinic by a friend nearly 10 years ago.

“My friend at work gave me a card that was $25 off the first visit,” he said. “At my first visit, he (the prescriber) gave us cards to give out. We were pretty much advertising for them.”

He said he’s gone from being able to see the doctor at any time to having to wait up to two hours for a visit. Suboxone and Subutex are being prescribed so much in the area that pharmacies are either running out or reaching their federal limit on buprenorphine.

The patient said he’s had to drive to every Walgreens to try to get his prescription filled, only to be declined. Many smaller pharmacies refuse to accept new patients who are being prescribed Suboxone.

Once someone is given a prescription for these drugs, it becomes very hard to stop using them without tapering off because the withdrawal symptoms are worse than with regular opioids.

The Suboxone patient is stressed out because he was robbed of some cash and his entire prescription four days ago. He has not had Suboxone in three days and is starting to feel the effects. He has experienced withdrawal before and is not looking forward to going through it again.

“I feel like I woke up with the flu,” he said. “For 11 or 12 days, I feel really, really bad. Then I won’t feel right for about 30 days.”

He said he is currently $35 short for his next doctor’s appointment, meaning he needs to find the money so he can get his prescription. That means borrowing money from someone, usually with the promise of giving a pill or two in return.

Subutex is more popular on the street than Suboxone because it does not contain the overdose drug Naloxone. Users can take Subutex and get higher than they could with Suboxone.

Suboxone is going for about $25 to $30 per dose on the street while Subutex is selling for between $40 and $70.

The Tennessee General Assembly passed a bill in 2015 that said only pregnant women and those allergic to Naloxone can get it. Frazier said this had led to women getting pregnant on purpose just to obtain Subutex.

Subutex and Suboxone use on the street has become a huge problem and many blame the prescribers. The patient interviewed by the Times-News called it legal drug dealing.

“We’re giving doctors the money instead of drug lords,” Frazier said.

(Verify the original piece)

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And last, from ClarksvilleNow.com, December 2016, which pertains to the characters and situations in Jellybeaners:

Tennessee sets new record in drug overdose deaths in 2015

This page is protected, but the link and information will open eyes.

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Thanks for subscribing to Gene Scott Books, and please forward any pertinent opioid information to [email protected] you feel may help our readers.

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About the Author Gene Scott, a retired English and reading teacher, was born and raised on the prairie of Western Illinois, and has lived in Johnson City, Tennessee for thirty years with his much better half, Lana.

2 comments

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