NCADD-SD News & Blog

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Illicit Fentanyl Use Linked to Cases of Amnesia

Illicit Fentanyl Use Linked to Cases of Amnesia

More than a dozen people who used fentanyl, either alone or in combination with stimulants, have suffered severe memory loss, researchers from West Virginia University report.

These cases involved severe short-term memory loss, HealthDay reports.

Imaging scans revealed the patients had lesions on the hippocampus, a region of the brain associated with memory. The patients did not recovery quickly, and may never fully regain their short-term memory, according to lead researcher Marc Haut.

“They all have difficulty learning new information, and it’s pretty dense,” Haut said. “Every day is pretty much a new day for them, and sometimes within a day they can’t maintain information they’ve learned.” He added, “Based upon the imaging, I would be surprised if they didn’t have at least some significant memory problems permanently.”

The findings are published in the Annals of Internal Medicine

Original linkOriginal author: Ezra
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Nurse Practitioners and Physician Assistants Now Eligible to Prescribe Buprenorphine

Nurse Practitioners and Physician Assistants Now Eligible to Prescribe Buprenorphine

Nurse practitioners and physician assistants will now be eligible to prescribe and dispense the opioid addiction treatment buprenorphine from their office, Reuters reports.

The Drug Enforcement Administration said the change will make it easier for residents of underserved areas to receive treatment for opioid addiction.

The new rule is a result of the Comprehensive Addiction and Recovery Act (CARA), passed in 2016.

The law expanded access to substance use treatment services and overdose reversal medications by extending the privilege of prescribing buprenorphine in office-based settings to qualifying nurse practitioners and physician assistants. CARA requires that nurse practitioners and physician assistants complete 24 hours of training to be eligible to prescribe buprenorphine.

“This action reflects this work and the ongoing need to further expand access to the most effective treatment for opioid use disorder,” David Fiellin, Professor of Medicine, Emergency Medicine and Public Health at Yale School of Medicine, told Reuters.

Original linkOriginal author: Ezra
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Trump Plans to Slash Drug Policy Office Budget

Trump Plans to Slash Drug Policy Office Budget

The Trump Administration is planning to cut more than $340 million from the budget of the White House Office of National Drug Control Policy (ONDCP), CBS News reports.

The administration will eliminate the agency’s grant-making capabilities, according to the article. Two grant programs–the High Intensity Drug Trafficking Areas (HIDTA) and Drug-Free Communities (DFC)–would be relocated to, and managed by, the Department of Justice and Department of Health and Human Services.

According to a spokesperson from the White House Office of Management and Budget, the administration’s 2019 budget is not final.

HIDTA provides assistance to federal, state, local, and tribal law enforcement agencies operating in areas determined to be critical drug-trafficking regions of the United States. DFC is the largest drug prevention program in the U.S.

Original linkOriginal author: Ezra
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New Report Finds That Using E-Cigarettes May Lead Youth to Start Smoking, Adults to Stop Smoking

New Report Finds That Using E-Cigarettes May Lead Youth to Start Smoking, Adults to Stop Smoking

A new congressionally mandated report from the National Academies of Sciences, Engineering, and Medicine takes a comprehensive look at evidence on the human health effects of e-cigarettes. Although the research base is limited given the relatively short time e-cigarettes have been used, the committee that conducted the study identified and examined over 800 peer-reviewed scientific studies, reaching dozens of conclusions about a range of health impacts.

Evidence suggests that while e-cigarettes are not without health risks, they are likely to be far less harmful than conventional cigarettes, the report says. They contain fewer numbers and lower levels of toxic substances than conventional cigarettes, and using e-cigarettes may help adults who smoke conventional cigarettes quit smoking. However, their long-term health effects are not yet clear. Among youth -- who use e-cigarettes at higher rates than adults do -- there is substantial evidence that e-cigarette use increases the risk of transitioning to smoking conventional cigarettes.

E-cigarettes are a diverse group of products containing a heating element that produces an aerosol from a liquid that users can inhale via a mouthpiece, and include a range of devices such as “cig-a-likes,” vape tank systems, and vape mods. Millions of Americans use e-cigarettes, and e-cigarette use is generally greatest among young adults and decreases with age. Use varies substantially across demographic groups, including age, gender, race, and ethnicity. For example, among youth and adults, use is typically greater among males than females.

Whether e-cigarettes have an overall positive or negative impact on public health is currently unknown, the report says. More and better research on e-cigarettes’ short- and long-term effects on health and on their relationship to conventional smoking is needed to answer that question with clarity.

“E-cigarettes cannot be simply categorized as either beneficial or harmful,” said David Eaton, chair of the committee that wrote the report, and dean and vice provost of the Graduate School of the University of Washington, Seattle. “In some circumstances, such as their use by non-smoking adolescents and young adults, their adverse effects clearly warrant concern. In other cases, such as when adult smokers use them to quit smoking, they offer an opportunity to reduce smoking-related illness.”

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Walmart to Help Customers Safely Dispose of Opioids

Walmart to Help Customers Safely Dispose of Opioids

Walmart will give customers filling opioid prescriptions a packet of powder they can use to safely dispose of leftover medication, Reuters reports.

Patients filling opioid prescriptions at Walmart or Sam’s Clubs pharmacies will receive a free packet of DisposeRx. To safely dispose of opioids, a person adds warm water and the powder to their pill bottle, which then forms a biodegradable gel around the pills.

According to a Walmart news release, “Beginning immediately, patients filling any new Class II opioid prescription at Walmart pharmacies will receive a free DisposeRx packet and opioid safety information brochure when picking up their prescription. Patients with chronic Class II opioid prescriptions will be offered a free DisposeRx packet every six months.”

Original linkOriginal author: Ezra
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Recreational marijuana legalization: Do more youth use or do youth use more?

Recreational marijuana legalization: Do more youth use or do youth use more?

What impact may legalization of recreational marijuana in Oregon have on teen marijuana use?

Recent results from an Oregon Research Institute (ORI) study indicate that the influence of legalization on youth may depend on whether they were already using at the time of legalization.

Following legalization of recreational marijuana, no significant changes in the numbers of youth who used marijuana occurred, yet increases in the frequency of use by youth who were already using marijuana were found.

For teenagers who had tried marijuana by 8th grade, the frequency of use during the following year increased 26% more for those who were in 9th grade after marijuana was legalized compared to those who were in 9th grade prior to legalization.

The research results are published online in Psychology of Addictive Behaviors.

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DEA Announces Step to Increase Opioid Addiction Treatment

DEA Announces Step to Increase Opioid Addiction Treatment

The United States Drug Enforcement Administration announced a deregulatory measure that will make it easier for residents of underserved areas to receive treatment for opioid addiction.

As published in the Federal Register, nurse practitioners and physician assistants can now become DATA-Waived qualifying practitioners, which give them authority to prescribe and dispense the opioid maintenance drug buprenorphine from their offices.

Prior to the enactment of the Drug Abuse Treatment Act of 2000, only physicians could treat opioid addicts and had to register with DEA as both physicians and operators of Narcotic Treatment Programs. Waiving this second registration prompted more physicians to offer treatment services. The Federal Register notice is available here:

This action brings DEA regulations into conformity with the Comprehensive Addiction and Recovery Act passed by Congress and signed into law in 2016. Because the vast majority of DATA-Waived physicians prior to CARA served urban areas, rural parts of the United States were underserved. This action provides more treatment options for addicts in rural parts of the country.

According to a 2017 report published by the National Rural Health Association, 90 percent of DATA-Waived physicians practice in urban counties, leaving 53 percent of rural counties without any prescribing physician and 30 million people living in counties where treatment is unavailable. As a result, rural patients seeking outpatient buprenorphine treatment must often travel long distances to access care. Rural providers of buprenorphine report a demand far beyond their capacity and say they lack the resources to adequately support themselves and patients in treatment. The NRHA report also found that, with 92 percent of substance use treatment facilities located in urban areas, rural areas offer fewer inpatient and day treatment resources.

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Supervised Injection Facilities Can Benefit People Using Intravenous Drugs

Supervised Injection Facilities Can Benefit People Using Intravenous Drugs

People who inject drugs in a facility where staff members provide clean needles and guard against overdoses say they have reduced their use of public spaces for drug use, a new study finds.

Using supervised injection facilities also has given them a greater ability to use hygienic injecting practices and provides better protection from fatal overdoses, they told authors of the study.

More than 100 supervised injection facilities operate legally in 166 cities throughout the world, Reuters reports.

There are no such facilities that are legally sanctioned in the United States. The study involved one staff member and 22 participants from one community-based organization that has successfully operated an underground facility since September 2014.

Lead author Peter Davidson of the University of California, San Diego told Reuters no one has ever overdosed in a supervised injection facility, where staff members are equipped with the opioid overdose antidote naloxone. The findings were published in the International Journal of Drug Policy.

Original linkOriginal author: Ezra
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Senate Report: Medicaid Contributing to Opioid Crisis

Senate Report: Medicaid Contributing to Opioid Crisis

Medicaid is contributing to the nation’s opioid crisis by establishing incentives that make it profitable to abuse and sell opioids, a report by Republicans on the Senate Homeland Security and Governmental Affairs Committee concludes.

The report notes that at least 1,072 people have been convicted or charged nationwide since 2010 for improperly using Medicaid to obtain prescription opioids, some of which were then resold on the nation’s streets. “The number of criminal defendants increased 18 percent in the four years after Medicaid expanded, 2014-2017, compared to the four years prior to Medicaid expansion,” the report states.

The committee’s top Democrat, Claire McCaskill of Missouri, said Medicaid expansion is not to blame for the opioid epidemic, USA Today reports.

“This idea that Medicaid expansion is fueling the rise in opioid deaths is total hogwash,” McCaskill said. “It is not supported by the facts. And I am concerned that this committee is using taxpayer dollars to push out this misinformation to advance a political agenda.”

Original linkOriginal author: Ezra
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Move to Lower Legal Blood Alcohol Levels to Reduce Drunk Driving Deaths

Move to Lower Legal Blood Alcohol Levels to Reduce Drunk Driving Deaths

A new report calls for lowering legal blood alcohol levels to reduce drunk driving deaths.

The National Academies of Sciences, Engineering, and Medicine report recommends lowering legal blood alcohol levels for drivers from 0.08 to 0.05 percent blood alcohol concentration (BAC), according to HealthDay.

The report also calls for increasing alcohol taxes significantly, strengthening policies to prevent illegal alcohol sales to people under 21 and to already-intoxicated adults, enacting all-offender ignition interlock laws, and providing effective treatment for offenders when needed.

“Strong evidence from the U.S. and other countries, such as Canada, shows that individuals convicted of alcohol-impaired driving who have ignition interlocks installed on their vehicles are less likely than others to be rearrested for alcohol-related driving or to crash while the device is installed,” the report states. “Therefore, all states should enact laws to require ignition interlocks — breath alcohol analyzers connected to the ignition system of a vehicle — for all offenders with a BAC above the limit set by state law.”

Original linkOriginal author: Ezra
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Opioid Overdoses Fuel Rise in Accidental Deaths

Opioid Overdoses Fuel Rise in Accidental Deaths

Opioid overdoses are fueling a sharp increase in accidental deaths in the United States, according to a new report by the National Safety Council (NSC).

The group found accidental deaths became the third-leading cause of fatalities in 2016 for the first time in more than a century, NPR reports.

Accidents accounted for 161,374 deaths that year, up 10 percent from 2015. Common causes of accidental deaths include motor vehicle crashes, falls, drowning, choking and poisoning—a category that includes accidental overdoses.

In a statement, NSC said, “The unprecedented spike [in accidental deaths] has been fueled by the opioid crisis. Unintentional opioid overdose deaths totaled 37,814 from drugs including prescription opioid pain relievers, heroin, and illicitly-made fentanyl.”

Original linkOriginal author: Ezra
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Getting to Zero Alcohol-Impaired Driving Fatalities Through a Comprehensive Approach

Getting to Zero Alcohol-Impaired Driving Fatalities Through a Comprehensive Approach

Alcohol-impaired driving remains the deadliest and costliest danger on U.S. roads today.

Every day in the United States, 29 people die in an alcohol-impaired driving crash—one death every 49 minutes. After decades of progress, alcohol-impaired driving fatality rates plateaued and have increased for the past two years—making it a persistent public health and safety problem.

Each alcohol-impaired driving crash represents a failure of the system.

A coordinated, systematic, multi-level approach spanning multiple sectors is needed to accelerate change.

With support from the National Highway Traffic Safety Administration, the National Academies of Sciences, Engineering, and Medicine convened a committee to help identify promising strategies to reduce deaths caused by alcohol-impaired driving in the United States.

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NCADD and Facing Addiction Have Merged

NCADD and Facing Addiction Have Merged

Today, Facing Addiction and the National Council on Alcoholism and Drug Dependence (NCADD) are proud to announce a definitive agreement to merge our organizations – creating a national leader in the effort to turn the tide on the addiction epidemic.

Inspired by decades of advocacy, led largely by NCADD in partnership with many NCADD Affiliates from around the country, Facing Addiction formed an unparalleled, coalition that launched on October 4, 2015, with a historic concert and rally on the National Mall in Washington, DC. On that day, an unprecedented group of entertainers, politicians, advocates, and “everyday Americans” came together to tell the country that we must unify our voices to turn the tide against addiction.

Since that historic event, Facing Addiction has quickly become a leading voice in the effort to turn the tide against addiction in our country. They have now forged a coalition of some 750 Action Network partners reaching more than 35 million people connected to this cause.

Facing Addiction was selected to be the exclusive co-sponsor to launch the United States Surgeon General’s historic report, titled Facing Addiction in America, which was unveiled at a major event at Paramount Studios in Los Angeles on November 17, 2016.

Today, Facing Addiction and the National Council on Alcoholism and Drug Dependence (NCADD) are proud to announce a definitive agreement to merge our organizations – creating a national leader in the effort to turn the tide on the addiction epidemic.

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Increase in Opioid Overdoses Leads to Rise in Organ Donations

Increase in Opioid Overdoses Leads to Rise in Organ Donations

The increase in fatal opioid overdoses has led to a rise in organ donations, according to CNN.

The United Network for Organ sharing, which manages the nation’s organ transplant network, says early data indicates a record number of deceased organ donors in 2017, for the fifth year in a row. There were more than 10,000 deceased organ donors last year—a 3 percent increase from 2016. More than 1,300 of those donors died from drug overdoses.

“About 40 percent of the increase (in the past five years) tracks back to the drug intoxication issue,” said Dr. David Klassen, the network’s Chief Medical Officer. In the past five years, the number of donors who died of drug overdoses increased 144 percent, while the number of deceased organ donors overall rose 24 percent.

Klassen said people who died of overdoses are usually good candidates for organ donation. “They tend to be younger and tend not to have the burdens of diseases associated with aging,” he said. He added that while the drugs may cause people to stop breathing or their hearts to stop, they don’t necessarily harm the organs.

Original linkOriginal author: Ezra
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Study Looks at Role of Medication-Assisted Treatment Started in the ER

Study Looks at Role of Medication-Assisted Treatment Started in the ER

A new study will assess whether starting medication-assisted treatment in the emergency room within hours of an opioid overdose will prevent people from relapsing after they recover.

Researchers at Virginia Tech, Carilion Clinic and Inova Fairfax Hospital received a $1 million grant to conduct the study, The Roanoke Times reports.

Participants treated for opioid overdoses in the emergency room will be asked if they want to participate in the study. If they consent, they will receive an injection of Sublocade, an extended-release form of buprenorphine, a drug that reduces opioid cravings.

Sublocade was approved by the Food and Drug Administration in November. It is the first ever buprenorphine injection for the treatment of moderate-to-severe opioid use disorder in adult patients.

Original linkOriginal author: Ezra
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Federal Officials Suspend Database of Programs to Treat Addiction and Mental Illness

Federal Officials Suspend Database of Programs to Treat Addiction and Mental Illness

Health officials have suspended a database of programs that help prevent and treat addiction and mental illness, The Washington Post reports.

The National Registry of Evidence-based Programs and Practices, run by the Substance Abuse and Mental Health Services Administration, was suspended in September. No new postings have been added since then.

The database includes hundreds of programs that have been evaluated by an independent contractor and found scientifically valid.

Addiction and mental health specialists say they rely on the database to find appropriate and effective treatments, the article notes. Officials would not say why the database was suspended. They confirmed the contract for running the database will be taken over by a new entity, which they said is working closely with other parts of the agency to “institute an even more scientifically rigorous approach to better inform the identification and implementation of evidence-based programs and practices.”

Original linkOriginal author: Ezra
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APA Releases New Practice Guideline on AUD Pharmacotherapy

APA Releases New Practice Guideline on AUD Pharmacotherapy

The American Psychiatric Association (APA) recently released a new practice guideline for the pharmacological treatment of alcohol use disorder (AUD). Despite the high prevalence of AUD and its significant public health consequences, patients with this disorder remain undertreated.

The guideline aims to increase physician and public knowledge on the effectiveness and risks of the five medications that may be used for the treatment of AUD: acamprosate, disulfiram, gabapentin, naltrexone, and topiramate.

Of these five, naltrexone and acamprosate have the best available evidence related to their benefits, and both have minimal side effects. As such, they should be considered the preferred pharmacological options for patients with moderate to severe AUD who want to reduce drinking or achieve abstinence. However, acamprosate should be avoided in patients with significant renal impairment, and naltrexone should be avoided in patients with acute hepatitis or liver failure, or in patients currently taking opioids or who may be expected to take opioids.Disulfiram, gabapentin and topiramate are also options for treatment of AUD but should typically be considered after trying naltrexone and acamprosate, unless the patient has a strong preference for one of these medications. Disulfiram is a special case as it does cause a series of adverse reactions if alcohol is consumed within 12 to 24 hours of taking the medication; the reactions include elevated heart rate, flushed skin, headache, nausea, and vomiting. Therefore, disulfiram is suggested only to patients who wish to achieve abstinence from drinking. Patients taking topiramate are at an increased risk of cognitive dysfunction, dizziness, and loss of appetite, whereas patients taking gabapentin may experience fatigue, insomnia, and headache.

While the guideline focuses specifically on evidence-based pharmacological treatments for AUD, it also includes recommendations and suggestions related to psychiatric evaluation of patients with AUD and developing a person-centered treatment plan. Evidence-based psychotherapeutic treatments for alcohol use disorder also play a major role in treatment and peer support groups such as Alcoholics Anonymous, and other 12-step programs can be helpful for many patients. However, specific recommendations related to these treatments are outside the scope of this guideline.

The full guideline, executive summary, and related materials are available here.

 

Original linkOriginal author: Ezra
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Need for Multiple Naloxone Doses on the Rise

Need for Multiple Naloxone Doses on the Rise

The percentage of people treated for a drug overdose who need more than one dose of the opioid overdose antidote naloxone is on the rise, a new study suggests.

Researchers from the Centers for Disease Control and Prevention (CDC) analyzed data from the National Emergency Medical Services Information System, and found the percentage of patients receiving multiple naloxone doses among emergency medical service (EMS) responders increased from 14.5 percent in 2012 to 18.2 percent in 2015, which represents a 26 percent increase in four years.

“We found there were 31,000 cases in which two or more naloxone doses were needed in 2015 in a prehospital setting,” said lead author Mark Faul, PhD, Senior Health Scientist at the CDC. “Of those, 4,000 cases required three doses, 1,600 required four doses, 615 required five doses and 200 cases required six or more doses.” He noted that not all people requiring multiple naloxone doses were successfully revived.

The study was published in Prehospital Emergency Care.

Dr. Faul discussed the results at the recent annual meeting of the American Public Health Association.

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Association Found Between Non-Cigarette Tobacco Product Use and Future Cigarette Smoking Among Teens

Association Found Between Non-Cigarette Tobacco Product Use and Future Cigarette Smoking Among Teens

According to the National Institute on Drug Abuse (NIDA), some teens who use e-cigarettes and other non-cigarette tobacco products report smoking cigarettes one year later, based on recent research funded by institutes within the National Institutes of Health and the Food and Drug Administration.

The research is based on data from the participants of the nationally representative Population Assessment of Tobacco and Health (PATH) study.

The researchers studied cigarette-smoking initiation among more than 10,000 participants in the PATH study. When first interviewed at ages 12-17, roughly half of the group reported that they had used e-cigs, hookah, snuff, or other non-cigarette tobacco products, but never cigarettes; the rest said they had always been completely tobacco-free.

When re-interviewed one year later, 4.6 percent of the group reported that they had now smoked a cigarette. Adjusted for other smoking risk factors, those who initially reported having used a non-cigarette tobacco product were twice as likely to have smoked cigarettes during the past 30 days, and those who had used more than one type of product were nearly four times as likely.

Original linkOriginal author: Ezra
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Sessions Allows More Aggressive Enforcement of Federal Laws Against Marijuana

Sessions Allows More Aggressive Enforcement of Federal Laws Against Marijuana

Attorney General Jeff Sessions has rescinded a policy that discouraged prosecutors from enforcing federal laws against marijuana in states that have decriminalized the drug, The New York Times reports.

In a statement, Sessions said that his memo to United States attorneys directs them “to use previously established prosecutorial principles that provide them all the necessary tools to disrupt criminal organizations, tackle the growing drug crisis, and thwart violent crime across our country.”

While marijuana remains illegal under federal law, the drug has been at least partly legalized—including for medicinal use—in 29 states and the District of Columbia. California began allowing the sale of recreational marijuana on January 1.

Sessions’ move is likely to increase the confusion about whether it is legal to buy, sell or possess marijuana in states where federal and state law conflict, the article notes.

Original linkOriginal author: Ezra
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