Category Archives: Prescription Drug Abuse

States Expanding Access to Buprenorphine for Addiction Treatment

There 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 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.

Pain Relief Without Fear of Addiction

Compound May Offer Pain Relief Without Fear of Addiction

New research from Indiana University-Bloomington may give doctors and their patients living with pain a non-opioid option for treating severe pain.

Researchers conducted a pre-clinical study involving mice. They discovered that compounds known as PAMs (Positive Allosteric Modulators) heighten the effect of natural pain relievers the body produces internally when injured or exposed to stress. PAMs were first discussed with attendees at the 2016 Conference for the Society for Neuroscience, held in San Diego, California.

About PAM

The researchers chose a PAM that would intensify endocannabinoids. These two brain compounds (anandamide and 2-arachidonoylglycerol) specifically act on the CB1 receptor that responds to the presence of THC, the main psychoactive ingredient in marijuana. The PAM used in the study was GAT211, a molecule that coauthor Ganesh Thakur at Northeastern University created that had effects that concentrated on the brain.

The PAM increased the effects of the endocannabinoids without creating the undesired side effects associated with marijuana use. These include lowering of body temperature and clumsiness.

The pain relief achieved from PAM was more effective and lasted longer than when drugs were used that work by breaking down then metabolizing the brain’s cannabis-type compounds. Using PAM on its own means natural painkillers target the correct part of the brain as needed. The alternative is take drugs that bind to receptor sites throughout the body.

Increases the Body’s Natural Ability to Relieve Pain

Study leader Andrea G. Hohmann, a professor and chair of neuroscience at the University’s Department of Psychology and Brain Sciences, stated that the study revealed a PAM increases the body’s pain relieving ability without decreasing effectiveness over time. This is a key component of addiction; a person finds that they need to consume more of their drug of choice to experience the desired effect.

Professor Hohmann went on to say that she sees the research her team is doing as “an important step forward” in the goal to find new, non-addictive pain relievers.

The results of the study were published in the journal Biological Psychiatry.

Non-Addictive Painkillers Help Save Lives from Opioid Overdose

Continuing to find ways of providing pain relief for patients that don’t involve drugs with a high potential for abuse is of utmost importance in the battle against opioid addiction. Tens of thousands of lives are now lost each year due to overdoses and millions of people are abusing these drugs.

If you have a loved one who needs treatment help for a substance abuse problem, contact Desert Cove today for more information about our program.

Study Identifies Three Ways to Reduce Risk of Opioid Overdose in Addition to Treatment

reduce risk of opioid overdoseThere are three new helpful recommendations for doctors to follow in order to reduce deaths associated with prescription painkiller overdoses. While some of it is common sense, other parts are simple measures that can save lives. Researchers at the RAND Corporation have found that not prescribing opioids or anti-anxiety medication to patients with opioid dependence problems, ensuring that patients received psychosocial counseling and keeping up with quarterly doctor visits greatly reduced the chances of opioid-related deaths.

Researchers were able to come to these conclusions after observing the care that over 30,000 Veterans received through the VA health system. This at-risk population often sees a large amount of opioid abuse, and researchers were anxious to see what was effective within this vulnerable group. This is also the first study that has looked at developing quality measures to assure against potential opioid overdose deaths. This was important because another group of researchers have recently released data that shows the number of people dying from opioid overdoses is likely not going to reduce for several years unless some drastic changes are enacted.

These changes would be different from, or in addition to changing other prescribing habits, physician education programs about opioid abuse and prescription drug monitoring programs. It also presents another set of guidelines that can be easily checked.

“This is a very large drop in mortality and we need to conduct more research to see if these findings hold up in other patient care settings. But our initial findings suggest that these quality measures could go a long way toward improving patient outcomes among those who suffer from opioid addiction,” commented Dr. Katherine Watkins, lead author of the study.

These three recommendations have been published in the journal Drug and Alcohol Dependence, but researchers are hopeful that the information is more broadly dispensed because of the potential life-saving information to physicians everywhere.

CDC: Number of Opioid Prescriptions Falling

opioid prescriptionsAccording to the Centers for Disease Control and Prevention (CDC), the number of opioid prescriptions in the United States fell 18% between its peak in 2010 and 2015. However, it is still three times higher than it was in just 1999.

The reduction in prescriptions is partially due to the revised prescribing practices that have been recommended for physicians, as well as the general awareness campaigns brought on by the overdose epidemic. For more than a decade our nation has lost many thousands of lives each year to drugs like OxyContin, Vicodin, Percocet, Opana and many others. Unfortunately, those horrible losses are still occurring today.

While there are still some counties around the nation that have shown increased activity in this regard, there are also additional good news reports, such as the number of prescriptions with high doses dropping by 41% since 2010.

It is still unclear what kind of impact this reduction will have on current and future opioid abusers. While there will still be thousands of people who die each year, hopefully that number continues to go down as well.

“We do know that when you start people on prescription opioids, the risk of unintended consequences and illicit use goes up. But our staff has done intensive analyses to see whether changing policies for prescription drugs shifts people into illicit use, and the answer is no,” explained Dr. Anne Schuchat, acting director of CDC, in response to the suggestion that limiting the number of pills being prescribed will drive abusers to seek out street drugs like heroin.

The painkiller epidemic is one area where it seems that cutting down the supply will have an effect on the demand, eventually. This is encouraging news for the continued efforts to help save lives from prescription drug addiction of all kinds, not just opioids. These and other forms of interventions are often necessary when it comes to

Study Cites Benzo Use as Cause for Brain Changes

benzo useA new research study has shown that benzodiazepines, such as Xanax, Valium, Ativan and Klonopin, actually change the structure of the brain. This discovery could lead to further research regarding benzodiazepine addiction that can be explained by altered brain chemistry.

The study, which will be published in the August edition of Psychiatry Neuroimaging, shows that long term use of benzodiazepines can change the caudate in the brain. The caudate is responsible for the reward system, a function of the brain that is often linked to addiction.

The study, which was conducted in Finland, gathered data from MRI scans of 38 people diagnosed with schizophrenia. The MRIs were taken when the subjects were 34-years-old and then again when they were 43-years-old. Comparing the MRIs showed distinct changes in the brains of those that were using benzodiazepines. In order for a study to be valid, researchers have to take into account age, illness, and medication dose, yet even with these adjustments, benzodiazepines still seem to have a major effect on the brain.

Because this is the first study that has analyzed the potential of benzodiazepines to change the structure of the brain, researchers are anxious to further their understanding of this new development.

“There is a need for understanding the mechanisms behind antipsychotic – and benzodiazepine – related structural and functional changes in the brain. Further studies should also focus on how medication-related structural alterations correspond to cognition and functioning,” explained the authors of the study. They also understand that there will need to be a more large-scale population to gather enough data to back up their initial findings more thoroughly.

However, the study is interesting because it may answer questions about the potential for benzodiazepine addiction. Medications like Xanax or Valium are highly addictive and oftentimes abused by people who do not have their own prescription for the drug. Traditionally prescribed to those that suffer from anxiety disorders, these drugs are oftentimes sold on the street to people looking for the high that benzodiazepines can provide.

It can also garner further insight into how to treat benzo addictions in terms of helping to rehabilitate the brain and repair lost function from the drugs.

Anti-Seizure Medications Linked to Opioid Overdose Deaths

Anti-Seizure Medications Opioid OverdoseNew research indicates that one of the factors in the increase in the opiate-related deaths includes another class of prescription drugs. It was found that a recent rise in the number of prescriptions for the nerve medications pregabalin (Lyrica) and gabapentin (Neurontin) has directly correlated to the rise in opiate overdose deaths in some areas. Further investigation has shown that, in addition to opiates, users are also abusing the anti-seizure medication, causing an increase in accidental overdoses.

Drug users have discovered the calming effects of anti-seizure medication and are incorporating these drugs into their daily use. This particular study focused on parts of England, where the numbers show that there were about a million prescription for the two drugs in 2004, but that number soared in 2015, with a total of 10.5 million prescriptions written for pregabalin and gabapentin.

This discovery, which appears in the latest issue of the journal Addiction, illustrates two things. One is that addicts will continue to seek out drugs that they feel enhance the euphoria brought about by their drugs of choice, and that the medical community needs to evolve with the trends. This means that drugs that previously weren’t considered as having a high potential for abuse now need to be policed more thoroughly, and prescriptions for these types of drugs need to remain checked in order to prevent abuse or misuse.

“Poly-drug use is very common amongst drug users. We need more multi-disciplinary studies like ours which seek to combine evidence from laboratory experiments on how drug act, with accounts of what users experience and information on the pattern of drug use and drug harms – in order to make health care workers and drug users aware of the dangers of combining specific drugs,” asserted Graeme Henderson, Professor of Pharmacology and Neuroscience of the University of Bristol.

One possible solution to avoiding the combining of opiates and anti-seizure medication is that medical professionals increase their screening for abuse and prescribe non-addictive alternatives to patients that are in need of anti-seizure medication. This could help prevent future abuse and help save the life of someone who might be showing signs of mixing the two drugs.