Category Archives: Prescription Drug Abuse

Med Conference: Buprenorphine Effective for Addiction Treatment

Attendees at a presentation during Hospital Medicine 2018 learned that the drug buprenorphine is appropriate to prescribe for hospitalized patients with opioid use disorders. The same medication is also effective for treating the acute pain experienced by patients being treated using buprenorphine.

Significant Increase in Drug Overdose Deaths

Dr. Anika Alvanzo, from John Hopkins Medicine, made a presentation at the conference. She referred to the significant increase in drug overdose deaths over the past 20 years. The number of fatalities jumped from three percent per year between 2006-2014 and 18 percent per year in the years 2014-2016. Dr. Alvanzo said that a large number of these deaths can be linked to increased use of synthetic opioids.

Types of Prescription Pain Medications

While some people refer to opioids to describe all types of prescription pain medications, they differ in the way they are made.

• Opiates are natural pain medications that are derived from opium. The opium is extracted from the opium poppy and is used to make medications such as morphine and codeine.
• Synthetic opioids are manufactured by humans and include methadone and fentanyl.
• Semi-synthetic opioids are a hybrid made from making chemical modifications to opiates. Drugs in this category include oxycodone, hydromorphone and buprenorphine.

Buprenorphine Availability a Bridge to Treatment for Opioid Use Disorders

Dr. Alvanzo stated during her presentation that there are currently three medications approved by the Food and Drug Administration (FDA) for treating opioid use disorder: buprenorphine, naltrexone and methadone. She went on to say that when buprenorphine is prescribed to patients on discharge from hospital, it “significantly increases” the likelihood that the patient will seek professional treatment. Approximately 75 percent of patients were in treatment one month after discharge.

The doctor urged her colleagues attending Hospital Medicine 2018 to consider getting their buprenorphine certification so that they can order the drug within the hospital and at discharge for patients. She referred to buprenorphine availability as a “bridge to treatment” for opioid use disorders patients.

Bacterial Infection Hidden Epidemic, Taking Lives in Opioid Crisis

The current opioid crisis is responsible for producing a new epidemic among teens and young adults. It’s a potentially-fatal bacterial heart infection called endocarditis.

This condition is most commonly seen in older adults. Now doctors are seeing it in much younger patients more often due to opioid drug use.

What is Endocarditis and How is is Related to Opioid Abuse?

Endocarditis is a bacterial infection of the inner lining of the heart chamber and its valves. The condition occurs when bacteria are enter the body, then are spread through the bloodstream until they attach themselves to damaged parts of the heart. It is spreading through the use of shared needles by IV drug drug users.

The clump of bacteria grows over time, and the infection can be life-threatening if it isn’t treated, according to Dr. Sarah Wakeman, the Medical Director of the Substance Use Disorder Initiative and the Addiction Consult Team at Massachusetts General Hospital.

How Infection is Spread

In a doctor’s office, clinic or hospital setting, a health care worker will swab a patient’s skin with a disinfectant to kill bacteria before administering an injection. The purpose of this step is to avoid pushing bacteria from the skin into the body with the needle. Opioid drug users who are using needles may not be taking this step, which has led to the increase in endocarditis cases.

Endocarditis Treatment Not Enough for Opioid Use Disorder Patients

Endocarditis can be treated using intravenous antibiotics over a long time. If the damage to the heart valves is severe, surgery may be recommended to replace them.

If the patient is also injecting opioids, such as heroin, treating the infection is only treating half of the problem. The opioid use disorder is still present, and the patient will go right back to using once if he doesn’t get appropriate help for the addiction.

According to a 2016 Tufts University study, hospital admissions for endocarditis due to injectable drug use increased from 3,578 in 2000 to 8,530 in 2013. The study also found that a large number of these cases involved young people aged 15-24.

Dentist Group Announces Policy to Cut Opioid Painkiller Prescriptions

The American Dental Association its members to reduce the number of opioid painkillers they are prescribing. The Association announced a new policy stating that members should “essentially eliminate” opioids from the list of remedies they have at their disposal, “if at all possible.”

Weekly Limits for Narcotics

The Association also wants to have a time limit put in place on prescriptions of no more than one week at a time. Under the new policy, dentists would be required to complete a mandatory education program that encourages use of other pain relievers.

Dentists Prescribe Most Opioids to US Teens

Dental practitioners are the leading source of opioid prescriptions for US teens, even though they write less than seven percent of opioid prescriptions in the US. During the period from 2010-2015, the most notable increase in dental prescriptions was for patients aged 11-18. The rate jumped from close to 100 per 1,000 patients to 165 per 1,000 patients. Among all age groups, the rate increased from 131 per 1,000 patients to 147 per 1,000 patients.

Other Options Shown to be Just as Effective

The number of opioid prescriptions written by dentists continues to rise even though evidence has shown that ibuprofen and acetaminophen control most dental pain effectively, according to an analysis conducted on five studies. The results were published in the Journal of the American Dental Association. These over-the-counter medications are less risky than opioids, which are addictive.

When dentists prescribe opioids, they tend to prescribe Vicodin or Percocet to relieve the short-term pain from procedures such as wisdom teeth extractions, dental implants and root canal work.

Dr. Paul Moore, Professor at the University of Pittsburgh’s School of Dentistry and the co-author of the analysis, said that the fact dentists are still prescribing opioids when other options are just as effective most of the time is “a little disturbing.”

The Association’s new policy supports requiring dentists to complete continuing education courses on limiting opioid use to retain their license. A number of states have already adopted this policy.

Hospitals Reduce Opioid Dispensing in Response to Epidemic

More hospitals are changing their policies about dispensing opioids to emergency room and surgical patients. Drugs like OxyContin, Vicodin and fentanyl, which are prescribed to temporarily provide relief for moderate to severe pain, have also caused irreparable damage. It’s difficult to determine how many people who currently have an addiction to opioids were first exposed to the drugs at a hospital, but it is often where people first encounter them.

Hospital patients aren’t the only ones who were at risk of becoming addicted to painkillers. People who were prescribed large amounts of this class of drugs would often end up with leftover pills. More than 50 percent of Americans who misuse opioids get them from friends or family members, according to the National Survey on Drug Use and Health.

Now there is an increasing number of hospitals and other medical practices that are reducing the number of pills being prescribed for pain. Doctors are saying that opioids are not the only choice for treating acute pain and that less potent options are often just as effective. In the past six months, Rush University Medical Center has given patients recovering from surgery ibuprofen, acetaminophen and gabapentin, which is used to treat nerve pain. A mild opioid medication is used to treat sharper spikes of pain and more acute pain.

Dr. Asokumar Buvanendran, a pain specialist at Rush University Medical Center, said that patients were “more satisfied” with the new protocol. It represents a trend that is hopefully leading more people away from these deadly drugs.

According to experts, opioid use skyrocketed in the 1990s when doctors started prescribing them to patients much more often. During this time, physicians were influenced in their choice to provide medicines in this class to patients by aggressive pharmaceutical company marketing tactics.

Rethinking Approach to Treating Pain

Most of the opioids were given to chronic pain patients. They were also the first choice for post-surgical pain or for patients visiting emergency rooms complaining of pain.

Doctors had the idea that drugs didn’t cause addiction; abusers were solely responsible for their own plight if they became addicted. Research has now shown that the properties of the drugs themselves change brain chemistry in users to cause the addiction.

New Opioid Prescribing Guidelines Help Doctors Make Better Decisions

Northwestern Medicine now talks to patients about the dangers of opioids before surgery. Patients are asked to bring any unused medication to follow-up appointments with their surgeon, so that the drugs can be disposed of safely.

All doctors in the state are required to enroll in a database to monitor painkillers and prescriptions that are commonly abused, a measure to seek out those who may be “doctor shopping” to get drugs. Some hospitals have similar in-house systems.

The Centers for Disease Control and Prevention has called for doctors to prescribe a maximum of seven days’ worth of opioids for patients to take home for acute pain. Many emergency departments today are only giving out 24 – 72 hours’ worth of pills.

While some chronic and severe pain patients may feel these tougher prescribing practices are prohibitive to their care, hopefully there is some comfort knowing that their inconvenience could be contributing to saving lives.

States Looking to Rewrite Drug Laws with Focus on Addiction Treatment

Legislators and other policy makers throughout the country continue their efforts to combat the drug epidemic in America, especially with regards to heroin and other opiates. For example, lawmakers in Washington are seeking to change the way the Evergreen State approaches treating opioid addiction. House Bill 2489 and its counterpart in the Senate would make significant changes to the state law to make medication-assisted therapy the treatment of choice for opioid addiction, according to reports.

Treatments for Opioid Dependency

Medication-assisted therapy is one type of treatment where people dependent on the drugs are prescribed substitute medications such as buprenorphine or methadone to keep withdrawal symptoms under control while providing supportive counseling and other services.

Many studies have shown that the incorporation of such medication can be beneficial, although most treatment specialists still recommend only short-term usage, as continuing to take the drugs for years results in its own dependency. However, used for stabilization and then a tapering process bolstered by intensive treatment can improve early relapse rates for many users.

Offering Many Forms of Treatment

The deputy chief medical officer for the Washington Health Care Authority, Charissa Fotinos, pointed out that updating the state treatment guidelines would help to put across the message that addiction is not a moral failing on the part of those affected. It may not encourage more people to seek help, but it will change the tone of the conversation for those who do reach out for assistance.

Opioid users themselves stated in a survey they were very interested in medications to help them reduce their drug use. They are interested in obtaining the most effective treatment for their addiction, according to the University of Washington’s Alcohol and Drug Abuse Institute, which conducted the survey of needle exchange clients.

The bill will change the current language, and it includes directions to expand access to treatment options across the state. Many of these expanded treatment provisions hinge on funding that will be provided in Governor Jay Inslee’s new budget.

The new bill and the funding would work together to create a “hub and spoke” treatment network in areas of Washington. Six pilot sites are operating in the western part of the state with federal funding received last fall.

Under this treatment model, clients are referred to a central hub to get started on their treatment. Once they are stabilized, they can get ongoing care, including counseling and medication, from a mobile provider or a clinic located closer to their home.

Buprenorphine for Addiction Treatment

States Expanding Access to Buprenorphine for Addiction Treatment

Buprenorphine for Addiction TreatmentThere continues to be a high demand for medication-assisted treatment (MAT) for opioid addiction. To date, however, states like Ohio only haveabout two percent of doctors that have completed the training necessary to prescribe or dispense buprenorphine. This is the main ingredient in the addiction treatment drug Suboxone, and other similar medications.

Plan to Double Healthcare Professionals Providing Buprenorphine

The state is planning to double the number of healthcare professionals certified to provide Suboxone (and other addiction treatment medications) to patients over the next 18 months. The federal government has provided $26 million in grant funding under the 21st Century Cares Act so that more healthcare providers can get training. Under existing law, doctors, as well as nurse practitioners and physician assistants (PAs) can dispense buprenorphine.

Waiver to Treat Patients for Opioid Addiction

Under the Drug Addiction Treatment Act of 2000 (Data 2000), doctors can apply for a waiver allowing them to treat patients with buprenorphine in their office, clinic, a community hospital or “any other setting where they are qualified to practice.” To qualify for a physician waiver, a doctor must be:

• Licensed under state law
• Registered with the DEA (Drug Enforcement Administration) to dispense controlled substances
• Agree to treat a maximum of 30 MAT patients during the first year
• Qualify to treat MAT patients, either by training or by professional certification

A doctor who has completed at least eight hours of classroom training focused on treating and managing patients with opioid use disorders can qualify for a waiver. The new training program for medical professionals is 1.5 days of classroom instruction, and participants are expected to continue their education through online courses and seminars.

Medication-Assisted Treatment Growing in the United States

The National Institutes of Health Studies says that MAT is a very effective method for treating opioid addiction. Studies conducted in 2014 revealed improved long-term recovery rates over traditional treatment methods, though it often takes finding the perfect balance for each individual as to how long they stay on the medication. Ideally, they would work toward being off of it in 2 years or less, and many people seek to use Suboxone for short-term tapering to simply ease opiate withdrawal symptoms.

Opioids for ER Patients

Over-the-Counter Pain Relievers as Effective as Opioids for ER Patients

For a number of patients, their first introduction to opioid pain medications occurs when they seek treatment in an Emergency Room (ER). Since doctors have more than one option for treating pain, what would happen if they offered over-the-counter pain medications instead of these strong, potentially addictive drugs instead?

A new study looked at what would happen if doctors took this approach to patients who visited the ER for treatment of sprains and broken bones. The results found that pain relievers sold under brand names as Tylenol and Motrin were as effective as opioids for treating severe pain.

Treating Acute Pain Without Opioids

The study involved 411 adult patients who sought treatment in two Emergency Rooms in New York City. All of them received ibuprofen (the main ingredient in Motrin) and acetaminophen (the main ingredient in Tylenol) or one of three opioid drugs: codeine, oxycodone or hydrocodone. All patients received standard doses, and none were told which medication was being administered.

The patients rated their pain levels on a score of 1-10 before being given their pain medication and again two hours later. The researchers found that for an average patient, the pain levels dropped from a 9/10 to approximately 5/10. There was little difference reported between the two groups.

Dr. Andrew Chang, Professor of Emergency Room Medicine at Albany Medical College in New York State, explained that ibuprofen and acetaminophen affect different pain receptors in the body. He went on to say that using them together may be especially effective.

These results dispute the standard ER practice used for treating acute pain. It could lead to changes that could help prevent new patients from being given opioids, which have such a high potential for abuse.

Although the study didn’t continue to follow the patients after they left the hospital, it is likely that the pain relief continued while taking the OTC remedies.

Study Has Potential to Help Opioid Crisis

Over two million people in the US are addicted to prescription painkillers or heroin. According to experts, changes in how ER doctors prescribe drugs could potentially put a dent in the current opioid crisis and help save lives.

Long-term opioid use often starts after patients are introduced to the drugs in an acute pain treatment situation. Emergency Rooms have given them to patients more often in recent years, although more states have limited the number of pills that can be given out. According to previous studies, approximately one-third of ER patients received an opioid painkiller during their visit. Approximately 20 percent of ER patients leave the hospital with a prescription for an opioid pain medication.

opioid epidemic

Addiction Expert Explains Three Main Groups of Opioid Epidemic

For the average person reading news stories or listening to the situation being discussed on the air, it seems as though the situation is mainly about young people who have moved from a prescription opioid dependency to a heroin addiction and that fentanyl is causing many of the overdose deaths. Popular news stories imply that efforts to stop people from becoming addicted to prescription drugs have not helped, but only made the issue worse.

This is one part of the opioid crisis but it isn’t the full story. As Andrew Kolodny, the co-director of opioid policy research at Brandeis University Heller School for Social Policy and Management pointed out, there are three opioid epidemics impacting North America.

The Three Opioid Epidemics in North America

1. Longtime Addicts

This, according to Kolodny, is the smallest group. Most of them are between the ages of 50-70 and started using heroin in the 1970s and 1980s. They lost a number of their friends to addiction. Fentanyl is responsible for killing off people in this group, due to the heroin supply being “laced” with this powerful pain reliever.

2. Young Rural and Suburban Users

The second group is the middle one, and is between 20-40 years of age. This is the group that gets most of the press coverage. They are people who are being found dead of an overdose, often with needles still in stuck in their arm.

In many instances, the road to addiction starts out with prescription opioids. The person may have started taking medications prescribed for someone else. They may have originally been prescribed the pain medication, but started using it more often than as directed. When their supply ran out, they turned to buying pills on the street.

At some point the cravings for pills increased. The cost was high and heroin could satisfy the cravings at a cheaper price. Switching from pills to heroin wasn’t anything new, according to Kolodny. Again, when dealers started adding fentanyl to their heroin supply around 2011 because it was a cheap filler, the number of overdose victims skyrocketed.

3. Middle-Aged and Senior Adults

The largest group, which has remained mostly under the popular press’ radar, is made up of people in their mid-40s through to their 80s. Their deaths due to opioid abuse are under-reported.

People in this age group may have been taking pain medications prescribed by their primary care doctors for several years. When they pass away from heart disease or another cause, no one wants to think of their long-term opioid use as being a contributing factor. Families also don’t think to ask whether their loved one may not have been using their opioid medication appropriately, whether there was an interaction with other medications (over the counter or herbal supplements included). They wouldn’t ask whether alcohol use and opioids may have been an issue.

The fact there are three sub-groups among this epidemic is why the number of overdose deaths have continued to rise. This isn’t a typical substance abuse problem, as the number of lives lost have actually reduced the average life expectancy in America.

To solve this problem Kolodny suggests investing money in building a new treatment system at an estimated cost of $60 billion. Although there are a ton of addiction programs doing great things, the system as a whole isn’t slowing the number of deaths, so more must be done.

injection treatment for opioid addiction

Monthly Injection Treatment for Opioid Addiction Approved by FDA

The FDA (US Food and Drug Administration) has approved a monthly treatment for addiction that is the first of its kind. The new option can be used for those struggling with substance abuse issues stemming from an addiction to narcotics such as prescription painkillers or heroin.

Sublocade, from Indivior Plc, is buprenorphine given by injection. The drug reduces the sensations of withdrawal symptoms in addiction patients. Administering the drug monthly could help patients comply to the treatment schedule, compared to other versions currently available such as daily oral doses in the form of pills or dissolving strips.

Effort to Reduce Stigmas Around Drugs

Approving the new drug treatment product is part of the Administration’s plan to reduce stigmas surrounding this class of medications. Buprenorphine is a synthetic opioid, and critics have expressed their opposition to medication assisted treatment (MAT). Instead, they favor changing users’ behavior to combat the current opioid crisis.

The FDA and other federal agencies are supporting MAT, which involves administering drugs and providing counseling to those affected. The White House referred to the situation as a “public health emergency” in October.

The FDA commissioner, Scott Gottlieb, released a statement recently that said the FDA is “committed to expanding access to treatments that can help people pursue lives of sobriety.”

New Medication Available Early in 2018

According to reports, Sublocade will be made available to patients early in 2018, according to Indivior. The National Institute on Drug Abuse reports that in 2016, drug overdoses were responsible for taking the lives of more than 64,000 Americans. This figure includes overdoses caused by prescription drugs, such as fentanyl and OxyContin, and illicit ones like heroin. Clients who receive medication assisted treatment for drug addiction reduce their risk of death from all causes in half, according to the FDA, making this option a valuable one.

Mr Gottlieb stated that the FDA is currently working on guidelines that will get further treatment options for treating opioid addiction into the market more rapidly.

post-surgical painkiller addiction

Should Hospitals be Accountable for Post-Surgical Painkiller Addiction?

Patients checking into a hospital for surgery is a very common occurrence. After their procedure, they want and expect to be given enough pain medication to be kept comfortable while they recover.

Often, the pain medication given by the surgeon and other medical providers is an opioid. They are prescribed for severe pain and are considered effective at providing temporary relief. The problem is that a number of doctors are prescribing these powerful painkillers without understanding how quickly patients can develop a dependency and thus start to experience withdrawal symptoms. When patients ask about how to taper off the medication when they are recovered from their surgery, they are often not getting enough information or accurate instructions.

Post-Surgical Opioid Dependency

Some doctors and hospital administrators are now asking the question, If some patients are becoming addicted to opioids starting with a stay in a hospital for surgery or another procedure, should the hospital be held responsible? Is the addiction a medical error in the same category as an infection acquired in hospital?

At least three physician/executives with the Hospital Corporation of America have argued that the answer should be, “Yes.” Drs. Michael Schlosser, Ravi Chari and Jonathan Perlin have stated that since this type of addiction arises during a hospital stay and is a “high-cost and high-volume condition,” and that it can often be avoided by implementing and applying new guidelines for patient care.

The doctors say that although it would be difficult for hospitals to monitor all the patients being given opioid pain medications in the weeks and months after their release, hospitals should have a system in place to try. The issue of long-term opioid use as a hospital-acquired condition opens the door for standards of care to be put in place to help patients manage their pain and protect them from coming to future harm.

Holding Hospitals Responsible May Have Financial Impact

Compensation and bonus structures at many hospitals are tied to patient satisfaction surveys, and that has been cited as one reason for doctors to continue over-prescribing drugs in an effort to keep patients happier. Less painkillers initially may mean that more patients experience some additional discomfort, and even though they may be saving lives from potential addiction, the doctors could wind up getting lower reviews and thus less pay.

Majority of Surgical Patients Have Drugs Left Over

Studies have revealed that the majority of patients (between 67-92 percent) have painkillers left over after surgery. Approximately 10 percent of patients need what is described as “intense pain management,” but it is difficult for physicians to identify which patients need this level of pain relief.

There are no set guidelines for what types of opioids should be prescribed after surgery, the typical dose that should be prescribe or how long patients should take them. In 2016, the Centers for Disease Control (CDC) released prescribing guidelines for opioids for chronic pain patients, but they only addressed acute pain briefly.

A new study published in September found that the optimal time for opioid use after surgery is between four and nine days.