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Millennials and Baby Boomers Hardest Hit by Opioid Epidemic

Millennials and Baby Boomers Hardest Hit by Opioid Epidemic

Millennials and Baby Boomers appear to be the age groups hardest hit by the opioid crisis, doctors at Columbia University conclude.

Millennials (people in their 20s and 30s) have higher death rates from heroin than other age groups, while Baby Boomers (those born between 1946 and 1964) have higher rates of death from both prescription opioids and heroin, the researchers report in the American Journal of Public Health.

The study found Baby Boomers were up to 27 percent more likely to die of a prescription opioid overdose, compared with people born in the late 1970s, HealthDay reports. They were up to one-third more likely to die of a heroin overdose.

Millennials were 23 percent more likely to die of a heroin overdose compared with those born in the late 1970s.

Original linkOriginal author: Ezra
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Understanding the Difference between Physical Dependence and Addiction

Understanding the Difference between Physical Dependence and Addiction

In a recent hearing before Congress, the Food and Drug Administration (FDA) Commissioner Scott Gottlieb spoke about the devastating impact of the opioid epidemic and what his agency is doing to address it.

While Dr. Gottlieb is not the first to note the massive scale of this crisis, he did bring up one often-overlooked component of its much-needed solution – distinguishing between an opioid addiction and a physical dependence on opioids. Although frequently conflated, differentiating between these two conditions is essential to break the stigma associated with what has proven to be the most effective form of opioid addiction treatment: medication-assisted treatment (MAT) – a treatment approach that combines the use of medications such as methadone and buprenorphine with behavioral counseling.

To make progress in ending the opioid epidemic and help people with addiction, families, health professionals and policymakers must understand and appreciate the important difference between physical dependence and addiction, and acknowledge that medication is an essential part of the solution to this crisis.

But What Exactly Is The Difference Between Physical Dependence And Addiction?As Dr. Gottlieb pointed out, and as described in our report, Addiction Medicine: Closing the Gap between Science and Practice, physical dependence is not the same as addiction. Physical dependence occurs when the brain adapts to the effects of a drug and develops tolerance. In other words, an individual will require more and more of the drug to achieve the initial positive effect and will rely on continued use of the drug to prevent painful and uncomfortable withdrawal symptoms.

Opioids, even when used as directed, can cause physical dependence. This can also be the case for other medications that the body and brain adjust to and come to depend on in order to maintain normal function. However, if misused -- either by taking a larger amount than prescribed, for a longer time than prescribed, or for non-medical purposes – opioids, can lead to addiction, a disease that interferes with, rather than maintains, normal functioning.

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Over 1.6 Million Could Die From Drugs, Alcohol and Suicide Over Next Decade: Report

Over 1.6 Million Could Die From Drugs, Alcohol and Suicide Over Next Decade: Report

More than 1.6 million Americans could die from drugs, alcohol and suicide over the next decade, a new report concludes.

USA Today reports the findings come from the Trust for America’s Health and the Well Being Trust.

The nonprofit group found in 2015, there were 39.7 deaths per 100,000 U.S. residents due to drugs, alcohol and suicide, compared with 23.1 deaths per 100,000 in 1999—a 72 percent increase. That number could rise to 56 deaths per 100,000 by 2025, the group said.

“We see a connection among the three epidemics,” said John Auerbach, President and CEO of the Trust for America’s Health. “They are all behavioral health-related — that is, they have a substance abuse or mental health diagnosis associated with them.”

Original linkOriginal author: Ezra
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Are Teens with Opioid Addiction Getting the Treatment They Need?

Are Teens with Opioid Addiction Getting the Treatment They Need?

Today’s opioid crisis knows no boundaries, especially when it comes to age.

The National Institute on Drug Abuse found that “prescription and over the counter drugs [including prescription opioids] are among the most commonly abused drugs by 12th graders, after alcohol, marijuana, and tobacco.” Over the past 15 years, the number of children and teens hospitalized due to opioid poisoning has nearly doubled and it has been widely cited that most adults in treatment for opioid addiction started using illicit substances before the age of 18. These statistics make it clear that there is a need to effectively identify and treat addiction to opioids among young people in order to prevent the consequences of this disease from following them into adulthood, or worse — cutting their lives short.

Unfortunately, young people are not receiving the opioid use disorder (OUD) treatment path most strongly recommended by the American Academy of Pediatrics: medication-assisted treatment (MAT). While MAT, which relies on medications to regulate the body’s response to opioids, in combination with counseling and detoxification, has been shown more effective in helping young people sustain their addiction recovery than detoxification and counseling alone, it is highly underutilized due to stigma and barriers in the healthcare system.

Boston University Medical Center researchers found that, “only one in four [young adults ages 13 to 25 diagnosed with OUD]… are receiving potentially life-saving medications for addiction treatment.” These numbers become even more troubling when you take a deeper dive; fewer than 1 in 10 teens aged 16 – 17 and 1 in 50 teens aged 13 – 15 received the addiction treatment medications that could have a significant impact on the success of their recovery.

This disparity can be attributed, in part, to the fact that less than three percent of all U.S. physicians have obtained the waivers necessary to prescribe buprenorphine – one of the few medications used in MAT – and of those physicians, only one percent are pediatricians. Additionally, some physicians may refrain from offering MAT to their adolescent patients because there is a lack of data showing the long-term impact it has on this age group. A lack of data also explains why the Food and Drug Administration (FDA) has only approved buprenorphine for use by those aged 16 and older, despite a demonstrated need for effective, evidence-based addiction treatment options for younger teens.

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Kellyanne Conway Will Oversee White House Response to Opioid Epidemic

Kellyanne Conway Will Oversee White House Response to Opioid Epidemic

White House counselor Kellyanne Conway will lead the White House response to the opioid epidemic, U.S. Attorney Jeff Sessions announced.

Sessions said Conway will be charged with helping change the perception about opioids and reducing addictions and deaths, Newsweek reports.

Conway, a lawyer, has no formal experience in drug policy or law enforcement, the article notes.

Before working for the Trump Administration, she had her own polling company.

Conway has promoted prevention programs as a way to combat drug use. In October, Conway told Fox News, “The best way to stop people from dying from overdoses and drug abuse is by not starting in the first place. That’s a big core message for our youth.”

Original linkOriginal author: Ezra
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60 Percent of People Who Die From Opioid Overdose Suffer Chronic Pain

60 Percent of People Who Die From Opioid Overdose Suffer Chronic Pain

A study of people who die from opioid overdoses found just over 60 percent suffer from chronic pain, HealthDay reports.

Many also struggle with anxiety or depression, the researchers report in the American Journal of Psychiatry.

The study included medical records of more than 13,000 adults who died from an opioid overdose between 2001 and 2007.

“The frequent occurrence of treated chronic pain and mental health conditions among overdose decedents underscores the importance of offering substance use treatment services in clinics that treat patients with chronic pain and mental health problems,” said lead investigator Dr. Mark Olfson of Columbia University Medical Center.

Original linkOriginal author: Ezra
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Significant Inequalities Between Mental and Physical Health Payments Uncovered

Significant Inequalities Between  Mental and Physical Health Payments Uncovered

Medical and surgical healthcare providers are receiving significantly higher payments from insurers than addiction and mental health practitioners for the same types of services, finds a groundbreaking, independent report published by Milliman, Inc. and released by a coalition of America’s leading mental health and addiction advocacy organizations including the Legal Action Center.

In the Milliman report, commissioned by the Bowman Family Foundation, researchers found that along with payment disparities, which occur in 46 out of 50 states, “out-of-network” use of addiction and mental health treatment providers by consumers is extremely high when compared to medical and surgical providers.

This perfect storm of factors reveals that patients are being forced into more costly out-of-network care, and can mean that treatment is abandoned altogether.

When taken together, the analysis paints a stark picture of restricted access to affordable and much-needed addiction and mental health care in an era of escalating suicide rates and opioid overdose deaths. Further, these disparities point to potential violations of federal and state parity laws, which require insurance companies to treat diseases of the brain, such as clinical depression and opioid addiction, the same way they treat illnesses of the body, such as cancer and heart disease.

One of the most dramatic disparities outlined in the report is the low reimbursements paid to behavioral health providers when compared to physical health providers – a factor likely influencing network access and overall practitioner shortages.

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SAVE THE DATE: Join us December 14 for a Twitter Chat about Women and Alcohol

SAVE THE DATE:  Join us December 14 for a Twitter Chat about Women and Alcohol

Why are drinking guidelines different for women than men? How do the health effects of heavy drinking differ? Where can women turn for help if they have an alcohol problem?

The National Council on Alcoholism and Drug Dependence (NCADD) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) are partnering for a Twitter Chat on women and alcohol. Bring your questions for NCADD and NIAAA experts as we discuss what women need to know about alcohol and their health.

Date: Thursday, December, 14, 1:00-2:00 pm ETHashtag: #FAQWomenDrinkingNCADD Expert: Julie Dostal, PhD, Executive Director, LEAF Council on Alcoholism and Addictions, Oneonta, NY and NCADD Board MemberNIAAA Expert: Deidra Roach, MD, NIAAA Medical Project OfficerOriginal linkOriginal author: Ezra
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SAMHSA Releases Resource on Preventing Opioid Overdose

SAMHSA Releases Resource on Preventing Opioid Overdose

The Substance Abuse and Mental Health Services Administration (SAMHSA) recently released a resource titled “Preventing Opioid Overdose: Understanding Good Samaritan Laws”.

This resource provides an overview of this overdose prevention strategy, including the aims of these laws and types of protections they can offer.

Overdose Good Samaritan laws are policies that provide legal protections for individuals who call for emergency assistance (such as 9-1-1) in the event of a drug overdose. This may include protection from arrest and/or prosecution for crimes related to drug possession, drug paraphernalia possession, and other crimes. These laws are designed to encourage people to summon emergency assistance if they experience or witness a drug overdose.

As of July 2017, 40 states and the District of Columbia have instituted Good Samaritan laws. Yet, lack of awareness and understanding of the protections these laws provide, as well as concerns about their limitations, may be limiting their effectiveness in encouraging overdose bystanders to call for help. These barriers may also prevent the criminal justice system from fully observing them.

The resource further outlines some of the obstacles that prevent overdose bystanders and the criminal justice system from applying their state’s Good Samaritan laws, and steps prevention practitioners can take to raise awareness of these laws among various target populations.

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Cost of Opioid Crisis Estimated at $504 Billion by the Council of Economic Advisers

Cost of Opioid Crisis Estimated at $504 Billion by the Council of Economic Advisers

The Council of Economic Advisers (CEA) recently announced that the opioid drug problem has reached crisis levels in the United States—in 2015, over 33,000 Americans died of a drug overdose involving opioids.

CEA finds that previous estimates of the economic cost of the opioid crisis greatly understate it by undervaluing the most important component of the loss—fatalities resulting from overdoses.

The CEA report estimates the economic cost of these deaths using conventional economic estimates for valuing life routinely used by U.S. Federal agencies. It also adjusts for underreporting of opioids in overdose deaths, includes heroin-related fatalities, and incorporates nonfatal costs of opioid misuse.

CEA estimates that in 2015, the economic cost of the opioid crisis was $504.0 billion, or 2.8 percent of GDP that year. This is over six times larger than the most recently estimated economic cost of the epidemic.

Copy of the full report is available here.

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Separating Side Effects Could Hold Key for Safer Opioids

Separating Side Effects Could Hold Key for Safer Opioids

NIH-funded scientists may have revealed brain functions in pre-clinical research that widen the safety margin for opioid pain relief without overdose

Opioid pain relievers can be extremely effective in relieving pain, but can carry a high risk of addiction and ultimately overdose when breathing is suppressed and stops. Scientists have discovered a way to separate these two effects -- pain relief and breathing -- opening a window of opportunity to make effective pain medications without the risk of respiratory failure. The research, published today in Cell, was funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

Opioid medications suppress pain by binding to specific receptors (proteins) in the brain; these same receptors also produce respiratory suppression. However, the way these receptors act to regulate pain and breathing may be fundamentally different. Studies using mouse genetic models suggest that avoiding one particular signaling pathway led to more favorable responses to morphine (pain relief without respiration effects). The investigators then explored if they could make drugs that would turn on the pathways associated with pain relief and avoid the pathways associated with respiratory suppression.

"We are pleased to have uncovered a potential new mechanism to create safer alternatives to opioid medications, ones that would be far less likely to cause the side effects that lead to overdose deaths associated with the misuse of opioids," said NIDA Director Nora D. Volkow, M.D. "We are excited that basic research on how opioid drugs work in the brain has led to this novel approach, and that we continue to make critical progress in this area."

How the pathways split following receptor activation is referred to as biased signaling. The study showed that as the degree of bias (divergence) increased, so too did the ability of an opioid to reduce pain in mice without affecting breathing. Similarly, compounds that favor the breathing pathway produced more respiratory side effects at lower doses. Ultimately, opioids with a larger divergence (bias factor) had a larger margin of safety, or therapeutic window, opening up an opportunity for medication intervention.

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Some Experts Question Opioid Commission’s Marijuana Warning

Some Experts Question Opioid Commission’s Marijuana Warning

The chair of President Trump’s Opioid Commission warned about the dangers of marijuana, in a letter accompanying the release of the commission’s final report.

Some experts are questioning the commission’s view that marijuana could further fuel the opioid crisis.

New Jersey Governor Chris Christie, the chair of the commission, warned against legalizing marijuana in the midst of the opioid epidemic.

One researcher, Dr. Chinazo Cunningham, a professor of medicine at the Albert Einstein College of Medicine, told CNN she is surprised to see negative language about marijuana in the opioid report. “Research that examines pain and marijuana shows that marijuana use significantly reduces pain,” she said. “In addition, the majority of studies examining marijuana and opioids show that marijuana use is associated with less opioid use and less opioid-related deaths.”

Dr. Cunningham is conducting the first long-term study to test whether medical marijuana reduces opioid use among adults with chronic pain, including those with HIV.

Original linkOriginal author: Ezra
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Long-Acting and Daily Medications to Treat Opioid Addiction Found Equally Effective

Long-Acting and Daily Medications to Treat Opioid Addiction Found Equally Effective

A new study finds a long-acting medication and a short-term drug that must be taken daily are equally effective in treating opioid addiction.

Researchers at NYU Langone Health found extended-release naltrexone (Vivitrol) was as safe and effective as more commonly prescribed buprenorphine-naloxone (Suboxone) in curtailing opioid use, relapse, treatment drop-out, and overdose.

The study, which was sponsored by the National Institute on Drug Abuse, was published in The Lancet.

The study is the first major head-to-head comparison of the treatments, according to The Washington Post. Researchers found each treatment had disadvantages. Short-acting medicines must be taken daily for years or even a lifetime. Naltrexone, which is given as a monthly injection, cannot be started until a person is fully detoxified from opioids—which more than 25 percent of the study subjects failed to do.

More than half of the study subjects relapsed at least once, regardless of which treatment they received.

Original linkOriginal author: Ezra
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DEA Rule Allows Criminal Prosecution for Fentanyl Trafficking

DEA Rule Allows Criminal Prosecution for Fentanyl Trafficking

The Drug Enforcement Administration (DEA) will classify illicit versions of fentanyl at the same level as heroin, Reuters reports.

The action will make it easier for federal prosecutors and agents to prosecute traffickers of all forms of fentanyl-related substances, the agency said.

Legally prescribed fentanyl is classified as a Schedule II drug, which means it is highly addictive but has a medical purpose.

The new DEA order classifies illicit fentanyl as a Schedule I drug, along with heroin. Schedule I drugs are considered addictive, with no medicinal purpose.

The DEA order will last up to two years, with a possibility of a one-year extension if certain conditions are met. In a statement, Attorney General Jeff Sessions said, “By scheduling all fentanyls, we empower our law enforcement officers and prosecutors to take swift and necessary action against those spreading these deadly poisons. I also urge the many members of Congress who clearly share our concern and alarm over fentanyl’s role in our opioid overdose epidemic to do their part by permanently scheduling these lethal substances.”

Original linkOriginal author: Ezra
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Teens Dependent on Marijuana and Alcohol Struggle with Success Later in Life

Teens Dependent on Marijuana and Alcohol Struggle with Success Later in Life

Teens who are dependent on marijuana and alcohol struggle to achieve hallmarks of adult success, such as graduating from college, getting married, having a full-time job and earning a good salary, a new study finds.

Researchers at the University of Connecticut tracked 1,165 study participants, starting at age 12.

They checked in on them at two-year intervals, until they were between 25 and 34 years old, HealthDay reports. Most of the participants had a grandparent, parent, aunt or uncle with an alcohol problem. Marijuana and alcohol dependence appeared to have a more severe effect on young men.

“Parents should try to delay their children’s onset of use as much as possible,” said researcher Victor Hesselbrock. “If you can push regular use back well into adolescence, the kids do a lot better.”

The study was presented at the annual meeting of the American Public Health Association.

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Millions of Dollars Needed for Trump’s Anti-Opioid Ad Campaign, Advocates Say

Millions of Dollars Needed for Trump’s Anti-Opioid Ad Campaign, Advocates Say

The anti-drug ad campaign advocated by President Trump’s opioid commission will need millions of dollars in funding, advocates tell The Hill.

It is not clear how such a campaign would be funded, the article notes.

New Jersey Governor Chris Christie, who chaired the commission, said the campaign should be paid for by the federal government, with private sector partners. The report, released recently, included 56 recommendations, including an aggressive multimedia campaign to fight the opioid epidemic.

An ad campaign must be part of a more comprehensive approach that includes strengthening treatment and changing opioid prescribing patterns, advocates say.

In order to be effective, a campaign must be based on evaluations of what has been effective in the past, and must frequently test the ad’s message with the target audience, they note. “We’ve learned a lot about how to communicate about these issues in the past three decades or so. There’s a lot of really good science on this right now,” said Marcia Lee Taylor, Chief Policy Officer of the Partnership for Drug-Free Kids.

Original linkOriginal author: Ezra
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Combo of Acetaminophen and Ibuprofen as Effective as Opioids for Acute Pain

Combo of Acetaminophen and Ibuprofen as Effective as Opioids for Acute Pain

A study of patients who went to the emergency room suffering from acute pain found those given a combination of ibuprofen and acetaminophen reported as much pain relief as those who were given opioids.

The 416 patients in the study had acute pain in their shoulders, arms, hips or legs, the Los Angeles Times reports.

About 20 percent of the patients had a bone fracture, the researchers wrote in the Journal of the American Medical Association. Other patients had injuries such as a sprained ankle or dislocated shoulder.

Patients were assigned to one of four groups. One group received a combination ibuprofen/acetaminophen tablet (containing the medications found in Advil and Tylenol. The other groups received a drug containing a prescription opioid, such as Percocet (a combination of oxycodone and acetaminophen), Vicodin (hydrocodone and acetaminophen) or Tylenol No. 3 (codeine and acetaminophen).

Patients were asked to rate their pain when they arrived at the hospital and two hours after they received their medication. Those who took the acetaminophen/ibuprofen tablet reported pain relief similar to those who received an opioid.

Original linkOriginal author: Ezra
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Drug Overdose Deaths Rose More Than 17 Percent Last Year: CDC

Drug Overdose Deaths Rose More Than 17 Percent Last Year: CDC

 Drug overdose deaths increased more than 17 percent between 2015 and 2016, according to a new report by the Centers for Disease Control and Prevention (CDC).

The overdose death rate rose to almost 20 people per 100,000, up from 16.3 per 100,000 the previous year, The New York Times reports.

Drug overdoses are now the leading cause of death for Americans under age 50, the CDC found.

Recently, these deaths have been driven by overdoses of fentanyl and other synthetic opioids, according to Dr. Robert Anderson, Chief of the CDC mortality statistics branch. “The main message is the drug rate went up a lot again, and of course we’re worried about it,” he said.

Original linkOriginal author: Ezra
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Hospitals Overwhelmed With Treating Diseases Resulting From IV Drug Use

Hospitals Overwhelmed With Treating Diseases Resulting From IV Drug Use

Hospitals are struggling to deal with an overwhelming number of cases of diseases that result from intravenous opioid use, including hepatitis C, endocarditis and the antibiotic-resistant infection MRSA.

Hepatitis C is the most common infectious disease that affects people with opioid use disorder, USA Today reports.

Reported cases of the disease almost tripled between 2010 and 2015.

Endocarditis—a condition in which the heart’s inner lining is inflamed—is a side effect of opioid addiction. Hospitalizations for endocarditis rose almost 50 percent from 2002 to 2012, at an average cost of $50,000 per patient.

MRSA is the second most common co-occurring condition with opioid use disorder, the article notes. The cost of treating the infection is about $60,000 per patient.

Original linkOriginal author: Ezra
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Provide Feedback on the President's Commission Recommendations

commission-on-addiction-image

The Addiction Policy Forum is coordinating a response to the President's Commission Recommendations on Combatting Drug Addiction and the Opioid Crisis. You can read the final report here.

You can help the Addiction Policy Forum by completing their survey by clicking the button below and giving your views.

Take the Survey

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