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Statement from The NIH Director on Combating the Opioid Crisis with Scientific Solutions

Statement from The NIH Director on Combating the Opioid Crisis with Scientific Solutions

Opioid misuse and addiction is an urgent and rapidly evolving public health crisis.

An estimated 2 million Americans are addicted to opioids, and approximately 25 million suffer daily from chronic pain. The urgency and scale of this crisis calls for innovative scientific solutions, from prevention to intervention and treatment. Today, the President declared America's opioid crisis a public health emergency.

The National Institutes of Health is committed to bringing the full power of the biomedical research enterprise to bear on this crisis. That effort ranges from basic science of the complex neurological pathways involved in pain and addiction, to services and implementation science to develop and test treatment models, to integrating behavioral interventions with medication-assisted therapy, to forging strategic partnerships to advance safer, non-addictive treatments for pain.

In 2016, NIH spent $483 million on pain research ranging from cell and molecular mechanisms of acute and chronic pain, to safe, effective therapy development, to large scale clinical trials. Just this week, NIH issued the Federal Pain Research Strategy to prioritize funding in support of effective solutions to chronic pain. The belief that people with pain would not become addicted to opioid medications was promoted 20 years ago in the medical community, but sadly has contributed to an over-reliance on opioid medications, and to the current addiction and overdose crisis. While there are other approved medications and non-medication strategies that can be used to treat chronic pain, their effectiveness in many chronic pain conditions is limited and the medications come with their own side effects. There is a pressing need for potent alternative treatments for chronic pain that are non-addictive.

In support of the Administration's efforts to provide concrete and rapid response to address America's opioid crisis, NIH is pursuing formal partnerships with more than 30 biopharmaceutical companies and academic research centers to develop:

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SAMHSA Reaffirms Efforts to Address the Public Health Emergency on the Opioid Crisis

SAMHSA Reaffirms Efforts to Address the Public Health Emergency on the Opioid Crisis

President Trump’s declaration of the opioid crisis as a public health emergency reaffirms the role of the Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) as leaders in solving one of America’s most pressing public health issues.

The President recently appointed Dr. Elinore F. McCance-Katz as the first Assistant Secretary for Mental Health and Substance Use, underscoring the urgency of the issue.

“SAMHSA looks forward to continuing its role in helping American communities fight the opioid crisis through evidence-based programs in prevention, treatment, and recovery services,” said Dr. McCance-Katz. “The announcement today by President Trump reflects our commitment to this cause and inspires us to redouble our efforts on behalf of all who have suffered the effects of opioid addiction.”

HHS is implementing five specific strategies that are guiding SAMHSA’s response. The comprehensive, evidenced-based Opioid Strategy aims to:

Improve access to treatment and recovery services to prevent the health, social, and economic consequences associated with opioid addiction and to enable individuals to achieve long-term recovery;Target the availability and distribution of these drugs, and ensure the broad provision of overdose-reversing drugs to save lives;Strengthen public health data reporting and collection to improve the timeliness and specificity of data and to inform a real-time public health response as the epidemic evolves;Support cutting-edge research that advances our understanding of pain and addiction, leads to the development of new treatments, and identifies effective public health interventions to reduce opioid-related health harms; andAdvance the practice of pain management to enable access to high-quality, evidence-based pain care that reduces the burden of pain for individuals, families, and society while also reducing the inappropriate use of opioids and opioid-related harms.

Over the past 15 years, communities across our nation have been devastated by increasing prescription and illicit opioid abuse, addiction, and overdose. In 2016, over 11 million Americans misused prescription opioids, nearly 1 million used heroin, and 2.1 million had an opioid use disorder due to prescription opioids or heroin. Since 2013, the introduction of illegally produced fentanyl has made the problem worse. The Trump Administration is committed to bringing everything the federal government has to bear on this health crisis.

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29% of College Students Think ADHD Drugs Help School Performance

29% of College Students Think ADHD Drugs Help School Performance

A survey of college students finds 29 percent mistakenly think drugs used to treat attention deficit hyperactivity disorder (ADHD) increase school performance.

An additional 38 percent are unsure of the drugs’ effects on school performance, HealthDay reports.

There is no evidence that stimulant medications such as Ritalin and Adderall are effective study aids, the article notes. The survey included almost 7,300 students, none of whom had been diagnosed with ADHD.

The belief that stimulant drugs increase school performance was especially high among students who misused the drugs. Among the 11 percent of students who said they had used stimulant medication for non-medical reasons in the past six months, almost two-thirds believed the drugs would boost their grades.

The findings appear in the journal Addictive Behaviors.

Original linkOriginal author: Ezra
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Hepatitis C Spreads as a Result of Opioid Epidemic

Hepatitis C Spreads as a Result of Opioid Epidemic

New cases of hepatitis C are on the rise as a result of the nation’s opioid epidemic, according to health officials.

The Centers for Disease Control and Prevention announced earlier this year that new hepatitis C cases have almost tripled nationwide in just a few years, The Washington Post reports.

The increase is largely due to intravenous drug use among young adults.

Hepatitis C can be contracted at any point during the drug injection process, including by using a drug cooker or tourniquet with another person’s blood on it, according to Shruti Mehta of the Johns Hopkins Bloomberg School of Public Health.

Treating hepatitis C can cost tens of thousands of dollars, and is limited by insurance and Medicaid, the article notes. Treatment is mostly unavailable to people who are still using illicit drugs.

Original linkOriginal author: Ezra
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Justice Department Charges Chinese Distributors Who Sold Fentanyl to Americans Online

Justice Department Charges Chinese Distributors Who Sold Fentanyl to Americans Online

The U.S. Justice Department announced charges against two Chinese nationals who sold fentanyl online to American customers, The Washington Post reports.

The men are the first Chinese-based fentanyl manufacturers and distributors to be designated as Consolidated Priority Organization Targets, which the Justice Department considers to be among the most significant drug trafficking threats in the world.

According to the Justice Department, one of the men operated websites that sold fentanyl directly to American customers.

He also ran at least two chemical plants in China capable of producing tons of fentanyl and fentanyl analogues. The other man ran at least four fentanyl labs in China. He also advertised and sold fentanyl online.

The article notes it is unclear if the men could ever be brought to the United States to face charges.

Original linkOriginal author: Ezra
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Senators: Repeal Law That Impedes DEA’s Ability to Crack Down on Opioid Distribution

Senators: Repeal Law That Impedes DEA’s Ability to Crack Down on Opioid Distribution

Two Democratic senators have introduced legislation that would repeal a law they say hampers efforts by the Drug Enforcement Administration (DEA) to fight the opioid epidemic.

According to a report by The Washington Post and 60 Minutes, the Ensuring Patient Access and Effective Drug Enforcement Act impeded the DEA’s authority to freeze suspicious shipments of opioids in order to reduce the flow of painkillers to the black market.

CNN reports Senator Claire McCaskill of Missouri and Senator Joe Manchin of West Virginia have called for the repeal of the legislation, which was signed into law by President Obama in 2016. The law passed by unanimous consent in the Senate.

“Media reports indicate that this law has significantly affected the government’s ability to crack down on opioid distributors that are failing to meet their obligations and endangering our communities,” McCaskill said in a statement. “I’ll be introducing legislation that repeals this law and continue my work investigating the role pharmaceutical distributors played in fueling this public health crisis.”

Senator Manchin called the legislation a “horrible law that should have never passed in the first place.”

Original linkOriginal author: Ezra
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Tom Marino Withdraws Nomination as Head of ONDCP

Tom Marino Withdraws Nomination as Head of ONDCP

Representative Tom Marino of Pennsylvania announced that he is withdrawing his name from consideration as head of the White House Office of National Drug Control Policy.

His decision comes in the wake of a Washington Post and 60 Minutes joint report that concluded legislation Marino sponsored hampered efforts by the Drug Enforcement Administration (DEA) to fight the opioid epidemic.

The legislation, the Ensuring Patient Access and Effective Drug Enforcement Act, was opposed by the DEA, and supported by drug companies, NPR reports.

It changed the standard for identifying dangers of opioids to local communities from “imminent” threats to “immediate” threats. This impeded the DEA’s authority to freeze suspicious shipments of opioids in order to reduce the flow of painkillers to the black market, the article notes.

Original linkOriginal author: Ezra
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Prevalence of Illicit Drug Use is Higher in Large Metro Areas

Prevalence of Illicit Drug Use is Higher in Large Metro Areas

According to the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report (MMWR), although both metropolitan and nonmetropolitan areas experienced significant increases from 2003–2005 to 2012–2014 in self-reported past-month use of illicit drugs, the prevalence was highest for the large metropolitan areas compared with small metropolitan or nonmetropolitan areas throughout the study period.

The report goes on to note that past-month use of illicit drugs declined over the study period for the youngest respondents (aged 12–17 years).

The prevalence of past-year illicit drug use disorders among persons using illicit drugs in the past year varied by metropolitan/nonmetropolitan status and changed over time. Across both metropolitan and nonmetropolitan areas, the prevalence of past-year illicit drug use disorders declined during 2003–2014.

Although both metropolitan and nonmetropolitan areas experienced significant increases from 2003–2005 to 2012–2014 in self-reported past-month use of illicit drugs, the prevalence was highest for the large metropolitan areas compared with small metropolitan or nonmetropolitan areas throughout the study period. Notably, past-month use of illicit drugs declined over the study period for the youngest respondents (aged 12–17 years).

The prevalence of past-year illicit drug use disorders among persons using illicit drugs in the past year varied by metropolitan/nonmetropolitan status and changed over time. Across both metropolitan and nonmetropolitan areas, the prevalence of past-year illicit drug use disorders declined during 2003–2014.

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Health Effects of New “Heat-Not-Burn” Cigarettes Still Unknown

Health Effects of New “Heat-Not-Burn” Cigarettes Still Unknown

The health effects of new products known as “heat-not-burn” cigarettes are still unknown, researchers caution in a new study.

The devices mix the electronics behind e-cigarettes with the tobacco-burning properties of regular cigarettes, according to HealthDay.

The devices warm up tobacco to about 500 degrees Fahrenheit, producing an inhalable aerosol. Heat-not-burn cigarettes are not approved for sale in the United States. An application for approval was filed with the Food and Drug Administration late last year.

Researchers looked at Google searches about the devices in Japan, where they are available. They found that searches about the devices surged by more than 1,400 percent in 2015, when they were first released in Japan. Searches increased almost 3,000 percent between 2015 and 2017. There are as many as 7.5 million Google searches a month about heat-not-burn devices in Japan, the researchers report in PLOS One.

“We don’t know enough about the health implications of heat-not-burn tobacco products, and that lack of knowledge is extremely dangerous for public health,” said study lead author Theodore Caputi of the Wharton School at the University of Pennsylvania in Philadelphia.

Original linkOriginal author: Ezra
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Uber Use Cuts Drunk Driving Accidents in Some Cities

Uber Use Cuts Drunk Driving Accidents in Some Cities

Use of Uber has contributed to a decrease in drunk driving accidents in some cities but not others, according to HealthDay.

Study author Christopher Morrison of the University of Pennsylvania said the availability of public transportation is one factor that may influence Uber’s effect on drunk driving.

The findings appear in the American Journal of Epidemiology.

The study looked at car crash histories and Uber availability between 2013 and 2016 in Reno and Las Vegas, Nevada; Portland, Oregon; and San Antonio, Texas. Alcohol-involved crashes were reduced by about 60 percent in Portland, but not at all in Reno, the researchers found.

“The differences could be due to a wide range of different factors,” Morrison said. “One likely explanation is that local populations use public and private transport differently from city to city, and probably also use ride-sharing services differently from city to city.” He noted that Portland has many more public transportation options than Reno. People might choose to use these alternatives to private vehicles after drinking too much, he said.

Original linkOriginal author: Ezra
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Medicare Places Few Restrictions on Opioid Prescriptions: Study

Medicare Places Few Restrictions on Opioid Prescriptions: Study

Medicare has not put significant restrictions in place for opioid prescriptions, despite recent government guidelines that recommend such limits, according to a new study.

Yale researchers analyzed Medicare coverage for opioids. They found that in 2015, one-third of opioids were prescribed with no restrictions, such as prior authorization or setting quantity limits, HealthDay reports.

The study, published in Annals of Internal Medicine, also found a modest increase in Medicare coverage of opioids between 2006 and 2015.

In 2016, the Centers for Disease Control and Prevention issued guidelines that recommend primary care providers avoid prescribing opioid painkillers for patients with chronic pain.

The guidelines state that doctors who determine that opioid painkillers are needed should prescribe the lowest possible dose for the shortest amount of time.

Original linkOriginal author: Ezra
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Online Tool Tracks Suspected Opioid Overdoses in Real Time

Online Tool Tracks Suspected Opioid Overdoses in Real Time

A new online tool allows first responders, public safety and public health officials to track opioid overdoses in real time, NBC News reports.

Health officials say the data allows them to quickly allocate resources where they are needed.

First responders can access the tool, the Overdose Detection Mapping Application Program (ODMAP), from any mobile device or computer when they go to the scene of an overdose. They enter whether the overdose was fatal or nonfatal and whether the opioid overdose antidote naloxone was administered. The results appear on a map, which police chiefs and other officials can use to see where overdoses are being reported.

If there is a cluster of overdoses in a particular area, police and fire chiefs get e-mail alerts.

Original linkOriginal author: Ezra
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Those Arrested For Pot Number More That All Violent Crimes

Those Arrested For Pot Number More That All Violent Crimes

In 2016 more people were arrested for marijuana possession than for all crimes the FBI classifies as violent, according to 2016 crime data released by the agency.

Marijuana possession arrests edged up slightly in 2016, a year in which voters in four states approved recreational marijuana initiatives and voters in three others approved medical marijuana measures.

The article in the Washington Post noted that marijuana possession remains one of the single largest arrest categories in the United States, accounting for over 5 percent of all arrests last year.

More than one in 20 arrests involved a marijuana possession charge, amounting to more than one marijuana possession arrest every minute.

The FBI’s report goes on to note that overall, in 2016, roughly 1.5 million people were arrested for drug-related offenses, up slightly year-over-year. Advocates for a more public health-centered approach to drug use say numbers like these show the drug war never really went away.

Original linkOriginal author: Ezra
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Scientists Develop Portable, Rapid Urine Test for Amphetamines

Scientists Develop Portable, Rapid Urine Test for Amphetamines

Korean scientists have developed a portable, quick urine test for amphetamines, HealthDay reports.

“Breathalyzers are effective at catching drunk drivers on the spot, thereby preventing accidents,” researcher Ilha Hwang said. “We hope that our sensor may have a similar effect with people who abuse amphetamines.”

The test uses a wireless sensor and smartphone app, and can detect amphetamines in a drop of urine within seconds, the researchers report in the journal Chem. The device costs about $50 to produce.

“Conventional drug detection generally use techniques that require long operation time, sophisticated experimental procedures, and expensive equipment with well-trained professional operators,” co-senior author Joon Hak Oh said in a news release. “Moreover, they are not usually portable. Our method is a new type of drug sensor that can solve all these problems at once.”

Further testing in clinical settings is needed before the device can be marketed, Oh said.

Original linkOriginal author: Ezra
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FDA Requires Makers of Fast-Acting Opioids to Pay for Doctor Training

FDA Requires Makers of Fast-Acting Opioids to Pay for Doctor Training

The Food and Drug Administration (FDA) announced it will require makers of fast-acting opioids to fund voluntary training for healthcare professionals who prescribe the drugs, according to Reuters.

The training will include education on safe prescribing practices and non-opioid alternatives.

The FDA informed 74 manufacturers of immediate-release opioids that they will have to fund training for doctors, nurses and pharmacists.

Companies that make extended-release and long-acting formulations of opioids already must pay for training of healthcare professionals. The FDA is also considering some type of mandatory education on opioids, the article notes.

According to the FDA, approximately 160 million prescriptions a year – about 90 percent of all opioid pain medications prescribed in the United States – are for fast-acting formulations.

Original linkOriginal author: Ezra
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Cigna Will Stop Covering OxyContin in Effort to Reduce Inappropriate Use

Cigna Will Stop Covering OxyContin in Effort to Reduce Inappropriate Use

Health insurer Cigna announced this week it will stop covering the prescription opioid OxyContin in an effort to reduce inappropriate use of the drug. Instead it will cover an equivalent drug less vulnerable to being misused.

The alternate drug is Xtampza ER, made by Collegium Pharmaceutical Inc. Xtampza ER cannot be made more fast-acting through cutting or crushing, Cigna said.

The change will go into effect January 1, 2018, Reuters reports.

Patients who have started using OxyContin for hospice care or cancer treatments will continue to have the medication covered next year.

“Our focus is on helping customers get the most value from their medications – this means obtaining effective pain relief while also guarding against opioid misuse. We continually evaluate the clinical effectiveness, affordability and safety of all our covered medications as these characteristics can change over time, and we make adjustments that we believe will provide better overall value for those we serve,” Cigna Chief Pharmacy Officer Jon Maesner, Pharm.D. said in a news release.

Original linkOriginal author: Ezra
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Hospital Treatment Rates for Heroin Surge While Rates for Prescription Opioids Drop

Hospital Treatment Rates for Heroin Surge While Rates for Prescription Opioids Drop

Hospital treatment rates for heroin rose more than 31 percent between 2008 and 2014, while treatment rates for prescription opioids have declined, according to a new study.

Hospital discharge rates for prescription opioid poisonings decreased each year by about 5 percent between 2010 and 2014, the study found.

Lead researcher Tina Hernandez-Boussard of Stanford University said the results provide evidence that people addicted to prescription opioids are turning to heroin because it is cheaper and easier to get, HealthDay reports.

“I’m cautiously optimistic that prescribing clinicians are positively reacting to the opioid crisis and therefore prescription opioids are contributing less to the overall drug epidemic,” Dr. Hernandez –Boussard said in a news release.

The findings are published in Health Affairs.

Original linkOriginal author: Ezra
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Survey Results Shed Light on Substance Use Initiation Trends

Survey Results Shed Light on Substance Use Initiation Trends

Illicit drug use initiation was highest for marijuana in 2016, followed by prescription pain relievers, tranquilizers and stimulants, according to national data.

A recent article in Healio.com – Psychiatric Annals referenced these findings.

“Whether someone engages in substance use is associated with several risk factors that are typically correlated with an increased likelihood of substance use (eg, perception of low risk of harm from using a substance, easy availability of substances) and protective factors that are typically associated with a decreased likelihood of substance use (eg, exposure to prevention messages),” Rachel N. Lipari, PhD, of the Substance Abuse and Mental Health Services Administration, and colleagues wrote.

To determine risk, protective factors and estimates for substance use initiation, researchers analyzed data from the 2016 National Survey on Drug Use and Health (NSDUH) for individuals aged 12 years and older. More than four out of five individuals perceived great risk for harm from weekly use of cocaine, heroin or lysergic acid diethylamide (LSD), while roughly one-third of individuals perceived great risk for harm from weekly marijuana use.

Overall, 68.3% of individuals perceived great risk for harm from consuming four or five alcoholic drinks nearly every day and 72.8% perceived great risk for harm from smoking one or more packs of cigarettes per day.Perception of risk varied across age groups. Approximately two out of five youths aged 12 to 17 years perceived great risk from weekly marijuana use compared with one out of six young adults aged 18 to 25 years. Individuals who never used marijuana or cocaine were more likely to report greater perceived risk for harm from use.

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Study Highlights Unmet Treatment Needs Among Adults With Mental Health and Substance Use Disorders

Study Highlights Unmet Treatment Needs Among Adults With Mental Health and Substance Use Disorders

Despite current treatment guidelines, fewer than 10 percent of adults with co-occurring mental health and substance use disorders receive treatment for both disorders, and more than 50 percent do not receive treatment for either disorder.

The findings highlight a large gap between the prevalence of co-occurring disorders and treatment rates among U.S. adults and the need to identify effective approaches to increasing treatment for those with these conditions.

An analysis of data from U.S. adults with both a mental health disorder and a substance use disorder indicates that only 9.1 percent of those adults received both types of care over the past year, and 52.5 percent received neither mental health care nor substance use treatment.

The study, based on data collected from the 2008-2014 National Survey on Drug Use and Health, reports that 3.3 percent of the adult U.S. population, or some 7.7 million individuals, suffers from both a mental health and substance use disorder. Those adults with co-occurring disorders who did receive both types of treatment tend to have more serious psychiatric problems and accompanying physical ailments and were more likely to be involved with the criminal justice system compared to individuals who did not receive both types of care.

The primary reasons for not seeking care were inability to afford treatment, lack of knowledge about where to get care, and a low perceived need among those with both disorders.

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NIAAA Alcohol Treatment Navigator Helps Find Quality Treatment of Alcohol Use Disorder

NIAAA Alcohol Treatment Navigator Helps Find Quality Treatment of Alcohol Use Disorder

Described as a “game-changer” by individuals in the alcohol treatment community!

An important new online resource is now available to help people recognize and find high quality treatment for alcohol use disorder (AUD), which affects more than 15 million adults in the United States. The NIAAA Alcohol Treatment Navigator helps individuals and their loved ones negotiate the often-complicated process of choosing treatment for alcohol misuse by telling them what they need to know, and what they need to do, to recognize and choose quality care.

The landmark Navigator website is comprehensive, yet easy-to-use -- guiding users through a step-by-step process to find highly-qualified treatment professionals. It helps create informed consumers by describing AUD and the various treatment options available, explaining the importance of “evidence-based” practices, providing tips on how to recognize five signs of quality care, and recommending specific steps to find quality treatment, including 10 questions to ask potential providers. It also features online directories of treatment providers, with instructions on how to use the directories, and a downloadable toolkit to help organize and simplify the search process.

In development for more than two years, the Navigator is based on decades of scientific research on clinical interventions and health services, with input from treatment providers, researchers, people seeking treatment, and their families. Individuals can use this comprehensive resource to better understand treatment options; families can get information that will empower them to help an adult loved one; and health professionals can use it as a tool to share with patients/clients who need a referral.

The NIAAA Alcohol Treatment Navigator: https://AlcoholTreatment.niaaa.nih.gov

Original linkOriginal author: Ezra
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