Alcohol, Opioids, & other Substance Disorders

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Re: Alcohol, Opioids, & other Substance Disorders

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Doctors More Likely to Prescribe Opioids to Covid ‘Long Haulers,’ Raising Addiction Fears

4/28/21


https://khn.org/news/article/doctors-mo ... ion-fears/


Covid survivors are at risk from a possible second pandemic, this time of opioid addiction, given the high rate of painkillers being prescribed to these patients, health experts say.

A new study in Nature found alarmingly high rates of opioid use among covid survivors with lingering symptoms at Veterans Health Administration facilities. About 10% of covid survivors develop “long covid,” struggling with often disabling health problems even six months or longer after a diagnosis.

For every 1,000 long-covid patients, known as “long haulers,” who were treated at a Veterans Affairs facility, doctors wrote nine more prescriptions for opioids than they otherwise would have, along with 22 additional prescriptions for benzodiazepines, which include Xanax and other addictive pills used to treat anxiety.

Although previous studies have found many covid survivors experience persistent health problems, the new article is the first to show they’re using more addictive medications, said Dr. Ziyad Al-Aly, the paper’s lead author.

He’s concerned that even an apparently small increase in the inappropriate use of addictive pain pills will lead to a resurgence of the prescription opioid crisis, given the large number of covid survivors. More than 3 million of the 31 million Americans infected with covid develop long-term symptoms, which can include fatigue, shortness of breath, depression, anxiety and memory problems known as “brain fog.”

The new study also found many patients have significant muscle and bone pain.

The frequent use of opioids was surprising, given concerns about their potential for addiction, said Al-Aly, chief of research and education service at the VA St. Louis Health Care System.

“Physicians now are supposed to shy away from prescribing opioids,” said Al-Aly, who studied more than 73,000 patients in the VA system. When Al-Aly saw the number of opioids prescriptions, he said, he thought to himself, “Is this really happening all over again?”

Doctors need to act now, before “it’s too late to do something,” Al-Aly said. “We must act now and ensure that people are getting the care they need. We do not want this to balloon into a suicide crisis or another opioid epidemic.”

As more doctors became aware of their addictive potential, new opioid prescriptions fell, by more than half since 2012. But U.S. doctors still prescribe far more of the drugs — which include OxyContin, Vicodin and codeine — than physicians in other countries, said Dr. Andrew Kolodny, medical director of opioid policy research at Brandeis University.

Some patients who became addicted to prescription painkillers switched to heroin, either because it was cheaper or because they could no longer obtain opioids from their doctors. Overdose deaths surged in recent years as drug dealers began spiking heroin with a powerful synthetic opioid called fentanyl.

More than 88,000 Americans died from overdoses during the 12 months ending in August 2020, according to the Centers for Disease Control and Prevention. Health experts now advise doctors to avoid prescribing opioids for long periods.

The new study “suggests to me that many clinicians still don’t get it,” Kolodny said. “Many clinicians are under the false impression that opioids are appropriate for chronic pain patients.”

Hospitalized covid patients often receive a lot of medication to control pain and anxiety, especially in intensive care units, said Dr. Greg Martin, president of the Society of Critical Care Medicine. Patients placed on ventilators, for example, are often sedated to make them more comfortable.

Martin said he’s concerned by the study’s findings, which suggest patients are unnecessarily continuing medications after leaving the hospital.

“I worry that covid-19 patients, especially those who are severely and critically ill, receive a lot of medications during the hospitalization, and because they have persistent symptoms, the medications are continued after hospital discharge,” Martin said.

While some covid patients are experiencing muscle and bone pain for the first time, others say the illness has intensified their preexisting pain.

Rachael Sunshine Burnett has suffered from chronic pain in her back and feet for 20 years, ever since an accident at a warehouse where she once worked. But Burnett, who first was diagnosed with covid in April 2020, said the pain soon became 10 times worse and spread to the area between her shoulders and spine. Although she was already taking long-acting OxyContin twice a day, her doctor prescribed an additional opioid called oxycodone, which relieves pain immediately. She was reinfected with covid in December.

“It’s been a horrible, horrible year,” said Burnett, 43, of Coxsackie, New York.

Doctors should recognize that pain can be a part of long covid, Martin said. “We need to find the proper non-narcotic treatment for it, just like we do with other forms of chronic pain,” he said.

The CDC recommends a number of alternatives to opioids — from physical therapy to biofeedback, over-the-counter anti-inflammatories, antidepressants and anti-seizure drugs that also relieve nerve pain.

The country also needs an overall strategy to cope with the wave of post-covid complications, Al-Aly said

“It’s better to be prepared than to be caught off guard years from now, when doctors realize … ‘Oh, we have a resurgence in opioids,’” Al-Aly said.

Al-Aly noted that his study may not capture the full complexity of post-covid patient needs. Although women make up the majority of long-covid patients in most studies, most patients in the VA system are men.

The study of VA patients makes it “abundantly clear that we are not prepared to meet the needs of 3 million Americans with long covid,” said Dr. Eric Topol, founder and director of the Scripps Research Translational Institute. “We desperately need an intervention that will effectively treat these individuals.”

Al-Aly said covid survivors may need care for years.

“That’s going to be a huge, significant burden on the health care system,” Al-Aly said. “Long covid will reverberate in the health system for years or even decades to come.”
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Re: Alcohol, Opioids, & other Substance Disorders

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Opioids like ‘lean’ permeate hip-hop culture, but dangers are downplayed

5/28/21


https://www.news-medical.net/news/20210 ... layed.aspx


Nykerrius Williams knows about the close relationship between hip-hop and opioid use. Williams, 27, an independent rapper from Gibsland, Louisiana, who goes by the name Young Nyke, took oxycodone pills for the first time when he was 16 and has continued patterns of misuse of those pills, as well as Lortabs, Xanax and codeine cough syrups, until recently. To him, it's part of the business.

If you ain’t rapping about being on no drugs, or you out here in the streets selling some drugs," he said of his chosen profession, "you ain’t got some of that going on — like, don’t nobody wanna hear what you talking about."

This snapshot of Williams' hip-hop life doesn't seem all that different from that of musicians of other genres for whom the mix of drugs and addiction is a recurring storyline, claiming the lives of artists like Janis Joplin, found dead of a heroin overdose in 1970, and rapper DMX, who died last month.

But drug use in the hip-hop community has an ever increasing presence that is intertwined with the music - and one with dire consequences. The catchy lyrics suggest that opioid misuse is part and parcel with fame and wealth, just a normal, and innocuous, component of that life.

Coverage on the abuse of hard drugs in the community usually focuses on tragedy surrounding certain popular rappers rather than the lyrics and the culture they create. And while public health experts take great pains, for example, to criticize and curtail the promotion of vaping to young people, little attention is paid to the dangerous effects that hip-hop is having on vulnerable listeners by normalizing popping Percocets or drinking cough syrup.

From big cities like Los Angeles to rural towns like Gibsland — population 878 — opioid misuse among some young, hopeful listeners is about emulating their favorite rap star's enviable image. For others, it is not all about the high life. It's self-medication.

"Let’s talk about pain," saidMikiel Muhammad, 38, aka King Kong Gotcha, a member of the rap trio The Opioid Era in Virginia. "The pain is so deep. They ain’t got money to go see a psychiatrist, but they got money to go get a Perc-10. They got $10, $15 for that," Gotcha said, referencing the street value of a 10-milligram Percocet tablet.

According to a February KFF report, anxiety, depression and thoughts of suicide have increased for young adults in the past year.

Artists like Young Nyke sometimes confront neighborhood and family violence, as well as a general lack of opportunities and resources in their communities — circumstances amplified by the covid pandemic. The poetic words detailing the rappers' experience offer some support. But these phrases can also be fraught.

It's not just the drug use that is worrisome, said Naa-Solo Tettey, an associate professor of public health at William Paterson University in Wayne, New Jersey. Often these songs promote using opioids while engaging in high-risk activities like unprotected sex or speeding and, while she is a hip-hop fan, "from a public health perspective, it’s just dangerous," she said.

That toxicity reaches into populations already plagued by perpetual cycles of poverty, poor health and lowered life expectancy. There is a need for "culturally relevant interventions" to educate and raise awareness within the hip-hop music audience, which Tettey's research categorizes as primarily composed of youth from "vulnerable and socially disadvantaged" groups.

It is time to turn a critical eye to how opioid misuse permeates hip-hop's lyrics, creating an entryway for Black young adults into the American opioid epidemic, said Tettey.

In 2017 that epidemic was declared a national public health emergency, with over 47,000 opioid-related overdose deaths reported. Researchers at the Centers for Disease Control and Prevention say fatal drug overdoses nationwide have surged roughly 20% during the covid pandemic, killing more than 83,000 people in 2020. Within this grim statistic the Substance Abuse and Mental Health Services Administration has found inequities.

According to a 2020 report from the Department of Health and Human Services' Office of Behavioral Health Equity and SAMHSA, attention to this crisis has focused more on white suburban and rural communities, even though Black communities are experiencing similar dramatic increases in opioid misuse and death. The report also found that synthetic opioids, like fentanyl, are affecting opioid death rates among Black people more severely than other populations.

A 2020 SAGE journal research paper found a large increase in prescription opioid overdose deaths among Black people. The paper also found the rate of death almost tripling between 1999 and 2017. In February 2018 the U.S. surgeon general tweeted a warning that trends in opioid misuse "may be a precursor to even more opioid overdose fatalities in the black community in coming years.”

"The music industry, all it does is perpetuate whatever’s going on outside," said Jarrell Gilliard, 40, explaining the pharmaceutical drug presence he's encountered and how it's reflected in popular lyrics. "How they pump these pills and all these prescribed medicines through the streets. Once the streets got ’em …" said Gilliard, whose hip-hop alias is Grunge Gallardo.

Grunge is also a member of The Opioid Era, named for their gritty, raw imagery and lyrics. Songs such as "Suboxones," "Sackler Oath" and "Overdose," which opens with a haunting 911 recording of a woman frantically pleading for help with one, contrast sharply with the pill-laced tunes of hip-hop's mainstream.

"I think that’s the most dangerous thing about it," said Richard Buskey, 42, who completes The Opioid Era trio as Ambassador Rick. "It’s a disconnect between the youth and them realizing that they’re in the same category as what they would consider a junkie or a fiend."

Tettey said that's partly because mainstream artists represent a lifestyle many young adults want for themselves, which can translate into modeling behaviors like opioid misuse.

Feeling the 'lean'


Patrick Williams, 26, an independent rapper from Orange, Texas, with the stage name PatvFoo, is no stranger to addiction.

He was 21 when he first sipped "lean" — a drink made from mixing prescription cough syrup containing the antihistamine promethazine and the opioid codeine with soda, Jolly Rancher candies and ice, served in doubled-up Styrofoam cups. "It's a variety of colors that you have," PatvFoo said, referencing the various formulations of codeine cough syrups. Purple syrup ranks as most potent. PatvFoo learned about lean through the Texas rap scene and artists like DJ Screw and then became a user.

"At first, there's a mellowing high," said Stevie Jones, 23, also known as Prophet J, an independent rapper in Louisville, Kentucky. He has similar recollections from his first time misusing codeine syrups. He and his friends drizzled some on a blunt — the slang term for a hollowed-out cigar filled with pot. "It just makes it burn slower — like, get you a little bit higher, I guess," Prophet J said.

Things can take a bad turn quickly. Although lean is one of the weaker opioids, experts say it is highly addictive, and often in a short time. "The day you go without it you get bad, bad stomach cramps. You feel like you got to just throw up all the time. You sweating. It's like you got a bad flu," PatvFoo said.

That flu-like feeling is opioid withdrawal, said Dr. Edwin C. Chapman, a Howard University College of Medicine alum who has practiced internal and addiction medicine in Washington, D.C., for more than 40 years. The symptoms range from runny nose and eyes to diarrhea and usually can be stopped with a gulp of cough syrup or lean, he said.

And there's a harsh reality in that. Whether it's Percocet pills or lean, "it’s all in the same class as heroin and fentanyl," Chapman said.

But learning that opioid use is promoted in popular music came as a revelation to Chapman. "That’s not the music that I listened to," said the 75-year-old doctor. The medical community, he said, has been focused on curbing the overprescribing of pain medication. "But it’s never talked about … that it’s being advertised overtly to young folks through music or through the media."

Indeed, abuse of lean, also known as "purple drank" and "sizzurp," has managed to evade the regulatory spotlight while remaining popular and recognizable — so much so that vaping companies distributed nicotine-containing e-liquids resembling the drink and even mimicked the slang term "double cup" in their labeling. These products triggered a 2019 Food and Drug Administration crackdown on the vaping juices. The drugs themselves, however, still pump through the streets, just like the hip-hop lyrics.

And it has altered the market, moving it beyond the street options of heroin and opioids, said hip-hop artist Buskey. "We living in the times where they're getting it out of the medicine cabinet."

Phillip Coleman, 34, a rapper in Rochester, New York, who goes by the name GodclouD, started using at age 15 after being prescribed 5-milligram tablets of Percocet following wisdom tooth extraction. That set him on a path to misusing prescription painkillers, which led to cocaine and then a heroin addiction that eventually landed him in prison.

Fortunately, Coleman was able to overcome his addictions in rehab and refocus on family and music. He cautions that people buying Percocet or other prescription pills on the street have no way of knowing if they are legitimate or "just pressed fentanyl." He said the reward for opioid addiction isn't the lifestyles of the rich and famous you see portrayed by some hip-hop artists. "You don’t get to trade in your empty bags like the box tops and get, like, a bike or whatever. Like, you don’t get no hat; you don't get no fentanyl swag," he chuckled. "Like, you just die."
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Re: Alcohol, Opioids, & other Substance Disorders

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Inflammatory process alteration accompanies opioid use disorder

6/14/21


https://medicalxpress.com/news/2021-06- ... order.html


Prevalence rates of opioid use disorder (OUD) have increased dramatically, accompanied by a surge of overdose deaths—nearly 50,000 in the U.S. in 2019. While opioid dependence has been extensively studied in preclinical models, an understanding of the biological alterations that occur in the brains of people who chronically use opioids and who are diagnosed with OUD remains limited.To address this issue, researchers from Boston University School of Medicine (BUSM) have conducted the largest transcriptomic (the study of all the RNA molecules within a cell) study to date using postmortem brains from people with OUD.

Their findings show, for the first time, a critical role for neuroinflammation as the driver of the pathological brain alterations produced by chronic opioid use. They also identify microglia (the most prominent immune cells of the central nervous system and the first to respond when something goes wrong in the brain) as the cell type responsible for many of these changes.

"Our study has yielded a number of surprising and important findings, including how two of the most critical brain regions associated with opioid dependence, the prefrontal cortex and nucleus accumbens, communicate with one another under "healthy" conditions, as well as how opioids alter fundamental brain processes contributing to opioid dependence," explained corresponding author Ryan W. Logan, Ph.D., associate professor of pharmacology & experimental therapeutics at BUSM.

To investigate the molecular changes in the human brain associated with opioid dependence, the researchers used transcriptomic and computational approaches to examine gene changes in the prefrontal cortex and nucleus accumbens and discovered changes associated with inflammation and synaptic structure/function in the brains of people who are diagnosed with OUD. "The data reveals a new mechanism by which opioids may alter the brains' structure to change synaptic plasticity, ultimately resulting in behavioral changes," said Logan.

According to the researchers, inflammation in the brain is related to several psychiatric disorders and neurological disorders including neurodegeneration and aging-related brain diseases. "Our findings highlight the potential role for activation of specific inflammatory pathways in the brain and their interplay in brain processes related to cognition, impulsivity, risk-taking and substance use," he added.

The researcher believe this this work offers a new context for neuroinflammatory actions in the human brain that may explain how opioids produce circuit dysfunction. In addition, it may provide new insights into potential targets for therapeutic development in treating people suffering with opioid dependence.
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Re: Alcohol, Opioids, & other Substance Disorders

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Opioid overdoses spiked during the COVID-19 pandemic, data show

6/15/21


https://medicalxpress.com/news/2021-06- ... demic.html


Since the first diagnosed case of COVID-19 in the United States on Jan. 20, 2020, news about infection rates, deaths and pandemic-driven economic hardships has been part of our daily lives.

But there is a knowledge gap in how COVID-19 has affected a public health crisis that existed before the pandemic: the opioid epidemic. Prior to 2020, an average of 128 Americans died every day from an opioid overdose. That trend accelerated during the COVID-19 pandemic, according to the Centers for Disease Control and Prevention.

We are a team of health and environment geography researchers. When social distancing began in March 2020, addiction treatment experts were concerned that shutdowns might result in a spike in opioid overdose and deaths. In our latest research in the Journal of Drug Issues, we take a closer look at these trends by examining opioid overdoses in Pennsylvania prior to and following the statewide stay-at-home order.

Our findings suggest that this public health response to COVID-19 has had unintended consequences for opioid use and misuse.

History of the opioid epidemic

Opioid misuse has been a major U.S. health threat for over two decades, largely affecting rural areas and white populations. However, a recent shift in the drugs involved, from prescription opioids to illegally manufactured drugs such as fentanyl, has resulted in an expansion of the epidemic in urban areas and among other racial and ethnic groups.

From 1999 to 2013, increasing death rates from drug abuse, primarily for those from 45 to 54 years of age, contributed to the first decline in life expectancy for white non-Hispanic Americans in decades.

There was a modest national decline in overdose mortality from prescription opioids from 2017 to 2019, but the COVID-19 pandemic has upended many of these advances. As one of our public health partners explained to us, "We were making progress until COVID-19 hit."

We believe this presents an urgent need for research on the relationships between COVID-19 policy responses and patterns of opioid use and misuse.

Opioid use increases during the pandemic

Pennsylvania has been among the states hardest hit by the opioid epidemic. It had one of the highest rates of death due to drug overdose in 2018, with 65%, a total of 2,866 fatalities, involving opioids.

The state's stay-at-home order, implemented on April 1, 2020, mandated that residents stay within their homes whenever possible, practice social distancing and wear masks when outside the home. All schools shifted to remote learning, and most businesses were required to operate remotely or close. Only essential services were allowed to continue operating in person.

In the following months, the public's overall cooperation with these mandates contributed to measurable declines in coronavirus infection rates. To learn how these mandates also affected people's use of opioids, we assessed data from the Pennsylvania Overdose Information Network for changes in monthly incidents of opioid-related overdose before and after April 1, 2020. We also examined the change by gender, age, race, drug class and doses of naloxone administered. (Naloxone is a drug widely used to reverse the effects of overdose.)

Our analysis of both fatal and nonfatal cases of opioid-related overdose from January 2019 through July 2020 revealed statistically significant increases in overdose incidents for both men and women, among whites and Blacks, and across several age groups, most notably the 30-39 and 40-49 groups, following April 1. This means there was an acceleration of overdoses within some of the populations most affected by opioids prior to the COVID-19 pandemic. But there were also uneven increases among other groups, such as Black people.

We found statistically significant increases in overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids and carfentanil. This is consistent with previous research on the main opioid classes contributing to increases in drug overdose and death. The results also affirm that heroin and synthetic opioids such as fentanyl are now the major threats in the epidemic.

When a pandemic and an epidemic collide

While we found significant change in opioid overdoses during the COVID-19 pandemic, the findings say less about some of the driving factors. To better understand these, we have been interviewing public health providers since December 2020.

Among the important factors they highlight as contributing to increased opioid use are pandemic-driven economic hardship, social isolation and the disruption of in-person treatment and support services.

From March to April 2020, unemployment rates in Pennsylvania shot up from 5% to approximately 16%, resulting in a peak of more than 725,000 unemployment claims filed in April. As workplace shutdowns made it harder to pay for housing, food and other needs, and the opportunities for in-person support disappeared, some people turned to drugs, including opioids.

People in the early stages of treatment or recovery from opioid addiction may be particularly vulnerable to relapse, suggested one of our public health partners. "They might be working in industries that are closed down, so they have financial problems … [and] they have their addiction issues on top of that, and now they can't like go to meetings, and they can't make those connections." (Under our clearance with Penn State for doing research with human subjects, our public health informants are kept anonymous.)

An addiction treatment counselor told us that especially for those with past or present opioid use problems, or histories of mental health issues, "It's not a good thing to be alone in your own thoughts. And so, once everybody was kind of locked down … the depression and anxiety hit."

Another counselor also pointed to depression, anxiety and isolation as driving increased opioid misuse. The pandemic "just spun everything out of control," they said. "Overdoses up, everything up, everything."

One question is whether states like Pennsylvania will continue to support telehealth in the future. While the transition from in-person to telehealth services has increased access to treatment for some, it has raised challenges for populations like the rural and elderly. As one provider explained, "it's really hard for that [rural] population out there" to utilize telehealth services due to limited internet and broadband connection. In other words, flexible modes of addiction treatment might work for some but not others.

The goal of our research is not to criticize efforts to mitigate the spread of COVID-19. Without the mandatory stay-at-home order in Pennsylvania, both infection and death rates would have been worse. However, our research shows that such measures have had unintended consequences for those struggling with addiction and emphasizes the importance of taking a holistic approach to public health as policymakers work to confront both COVID-19 and the addiction crisis in America.
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Re: Alcohol, Opioids, & other Substance Disorders

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Fentanyl Overdose Deaths in San Diego Spiked More than 200% During Pandemic

Last year’s increased isolation conflated an already alarming problem – a prevalence of a very lucrative and very dangerous drug: Fentanyl

6/16/21


https://www.nbcsandiego.com/news/local/ ... c/2633123/


“I remember the instance a buddy put down a shot glass in front of me and poured a shot in it,” recalled Manning about one night in high school, just a few weeks after coming home from rehab. “And there was probably eight of us, and everyone just stopped and looked at me. And I instantly said out loud, ‘It was going to happen eventually,’ and just threw it back. And then it was off to the races again.”

And for a while, Manning got away with it.

“Yeah, I put on a good show,” Manning said. “I was able to make it look like I was drinking socially when really I was drinking to blackout every weekend and then mixing in different pharmaceuticals.”

The show ended when Manning's addiction to heroin left him homeless, and in and out of jail.

“About 50% of the clients we serve at Shoreline Recovery Center come with opioid use disorder diagnoses,” said Kate Judd, the Program Director for Shoreline Recovery Center. “It’s a significant margin of our population.”

It's an addiction Judd knows firsthand.

"I’ve struggled with addiction since I was about 15,” Judd said.

The former basketball player suffered an injury that got her hooked on painkillers for eight to 10 years.

"What made them so addicting to me was they were easy to hide,” Judd said.

And hiding an addiction gets a lot easier when you're isolated, which is why Judd and Manning say they're not surprised overdoses spiked in 2020.

“As soon as you get stuck in your own apartment by yourself that anxiety,” Manning said. “That depression is going to start running. I need to escape from that so I’m going to do more of the drugs I’m already doing.”

Last year’s increased isolation conflated an already alarming problem – a prevalence of a very lucrative and very dangerous drug: Fentanyl.

"It’s just a high, high possibility of overdose with this particular substance,” said DEA Special Agent Michael Wasser.

Fentanyl is a synthetic chemical compound that’s much cheaper and easier to make than heroine – but 20 times as potent. Imagine one-fifth of the amount of powder in a packet of artificial sweetener – that’s how little fentanyl it takes to kill someone.

NBC 7 Investigates analyzed county data and uncovered fentanyl deaths rocketed by more than 200% in 2020. We are now on pace to surpass 1,000 deaths this year - to put that in perspective, 151 San Diegans died from fentanyl in 2019.

"Those numbers are just not sustainable,” Wasser said. “Something has to hit home enough to where people have to notice."

For Manning, the threat of a prison sentence motivated him to get clean.

“I had no idea how sick I was,” Manning said. “It had nothing to do with the substances. It was the way that I was interacting with the world. My mental health, anxieties and depressions, shame and guilt."

Sober for nearly three years now, Manning wants those struggling with addiction to know it's never too late.

“I found meaning in everything,” says Manning. “I found purpose in life. I found direction. And, and I’m not giving it up. It’s not going to happen.”

You can't underestimate San Diego's role in the problem on a national level. The state of California only accounts for 10% of the border with Mexico but claims the majority of fentanyl seizures at the border.

Border seizures increased by 142% from 2019 to 2020. Just like the number of fentanyl deaths, seizures during the first five months of this year have already surpassed all of 2019.

If you are struggling with addiction or know someone who is, the hotline below is from SAMHSA – a taxpayer-funded, national, 24/7 treatment locator and helpline organization.

You can call 800-662-HELP (4357) or you can visit, https://findtreatment.gov
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Re: Alcohol, Opioids, & other Substance Disorders

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Local Support Groups Raise Awareness on Narcan as Opioid Overdose Numbers Rise

Cherish Burtson is two and a half years sober-- she founded her own support group and is working to help save the lives of people struggling with substance abuse

6/27/21

https://www.nbcsandiego.com/news/local/ ... e/2642001/


According to county data, an average of three people die from a drug overdose every day in San Diego.

“Not everyone can just stop doing drugs,” said Cherish Burtson, SD Harm Reduction founder. “It’s not that simple.”

Burtson knows it first hand.

“When I was in my early 20’s, I was introduced to heroin by some friends,” said Burtson. “I was kind of going through a bad period with my mental health at that time and just gradually over time I got hooked on it.”

Today, Burtson is two and a half years sober. She’s founded her own support group and is working to help save the lives of people struggling with substance abuse.

“If we can support each other and if people who use drugs can support each other more then that can make a big difference,” said Burtson.

In partnership with A New Path, another local support group, Burtson hosted a free community training on Narcan. Around 50 people showed up at the training.

For support groups like A New Path and SD Harm Reduction now it is more important than ever to train on and provide a Narcan kit to every San Diego resident.

If you are interested in scheduling a free training on Narcan call 619 670-1184 or email anewpath.org.

“We want Narcan to be in everyone's medicine cabinet,” said April Ella, director of operations for naloxone distribution at A New Path. “It should be like fire extinguishers. It’s absolutely necessary for people to learn how to use Narcan and to learn how to recognize and respond to an overdose.”

Since 2012, Ella and her team at a new path have trained over 8,000 people and have recorded 1,982 overdose reversals.
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Several states legalize Fentanyl test strips to help save lives

Fentanyl is 50 to 100 times more potent than morphine

6/26/21


https://www.foxnews.com/us/states-legal ... est-strips


Across the country, more states are beginning to legalize drug testing strips that can detect the presence of the potent opioid Fentanyl to avoid deadly overdoses.

According to the National Institute on Drug Abuse, Fentanyl is 50 to 100 times more potent than morphine and is typically used to manage severe pain specifically after a surgery. While it’s legally prescribed, it’s also being sold and distributed on the black market.

Sonoran Prevention Works in Arizona, helps families affected by drugs and sees thousands of people each year. "A deadly dose of Fentanyl is not very much at all, it's a couple of granules…and because it's showing up in drugs and people don't know it, because it's not regulated in any capacity, and because it's so strong and potent it is accidentally being mixed into drugs, or it's really easy to accidentally put too much in a drug," said Haley Coles, Executive Director of the organization.

Arizona is the latest state to legalize these Fentanyl testing strips, allowing users to see if their drugs have been laced with lethal doses. Governor Doug Ducey signed the legislation on May 19th and it will take effect 90 days after the legislative session ends.

Sonoran Prevention Works say they've been ahead of the game, by handing out more than 20,000 strips over the last three years. Helping save lives, even when they weren’t legal. "Now that it is not some illegal thing and it's not going to be an underground activity, our hope is that more and more entities will start distributing these and making them available," said Coles.

For now, these strips will only be available online or from a drug prevention group. Coles says they give them out for free to anyone who needs them. Advocates are hoping they’ll become more accessible at local pharmacies one day.

"It's definitely a stepping stone," said Coles. "To have people have access to the strips is really important because then they have the option of testing what's in their drugs, but we don't think that this is going to solve the whole problem, because still not everybody is going to have access to them."

Natalie Nelson volunteers at the organization, she also uses the test strips herself.

"I actually would not be here speaking with you today if it weren't for the Fentanyl testing strips because Xanax is a huge drug in Arizona that Fentanyl is in, and it's very sad, and a lot of the times that I would buy Xanax, there would be Fentanyl in it," said Nelson.

Out of all the times she has tested her anxiety medications with the strips, ten times they’ve come back as positive for Fentanyl.

"Once I tested them, I would take a picture of it and send it to the person that I got it from. Usually they have no idea, because they're getting it from whoever. Then they stop selling it, which is awesome because that reduces the risk of a lot of people overdosing," said Coles.

Nelson, 22, has lost 5 people to Fentanyl overdoses this month alone. She’s even helped save lives in the past by using drug-reversal injections like Naloxone, something the organization also distributes to people in need.

Some states consider these test strips "illegal drug paraphernalia," but several including Colorado, Rhode Island, Maryland, New Mexico, and now Arizona have made efforts to decriminalize them, with the intent to save lives.

Nationwide the number of opioid overdoses is growing. The most recent stats from 2019 show that number, mainly caused from Fentanyl, reached over 36,359.

Advocates ultimately want users to seek professional treatment but until someone is ready, this is a way to help. Nelson hopes more will be done to combat mental health across the country to address drug issues in the first place.

"I noticed that a lot of people, that I interact with that use drugs frequently are actually self-medicating for an underlying mental health disorder, and they're trying to cope, because they either don't have the resources to get help, they don't know how to get the resources, they don't know where to start. They just want to, you know, cope with it," said Nelson.

"These people who are just human beings, just like everybody else, are demonized in the community and it just always made me so sad to see that. The shame and guilt that these people hold just because they use a substance, it’s very sad to see and I wanted to become an advocate for those people. I want to essentially become sort of like a voice, and be part of this safe haven that we have here, for people that use drugs," said Nelson.

Along with the test strips, Sonoran Prevention Works also helped pass a bill to legalize clean needle exchange programs. Allowing people to dispose of dirty needles for free.

"In Arizona, there's no standard free place for people to dispose of their syringes. when people call into the state, they're told to put them in the trash," said Coles.

"The more syringe service programs we have, the more places, we will have for people to dispose of those syringes. What's important about the law to is it protects people who are traveling with their used syringes from being arrested with those used syringes if they can prove that they are a member of a program, and that is how we're able to incentivize people to come back to bring their syringes to us."
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Re: Alcohol, Opioids, & other Substance Disorders

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Study reflects shortcomings in how the U.S. handles care for people with opioid addiction

7/23/21


https://www.news-medical.net/news/20210 ... ction.aspx


As opioid overdose deaths rose during the COVID-19 pandemic, people seeking treatment for opioid addiction had to wait nearly twice as long to begin methadone treatment in the United States than in Canada, a new Yale study has shown.

In both countries during the pandemic, about one in 10 methadone clinics were not accepting new patients and a third of those cited COVID-19 as the reason, according to research published July 23 in the journal JAMA Network Open.

An estimated 90,000 people in the United States died from drug overdoses last year.

" We missed opportunities to save lives."

- Paul Joudrey, assistant professor of internal medicine at Yale School of Medicine and corresponding author of the paper

The findings highlight shortcomings providing prompt access to people seeking treatment for opioid addiction, the authors say.

Methadone has been used to prevent overdose deaths for decades, but the treatment remains highly regulated and difficult to access within the United States. In response to the rise in overdose deaths, however, Canada and its provinces relaxed regulations on methadone treatment.

For the study, the authors wanted to evaluate how timely treatment access compared between the countries during the pandemic. It has been shown that the faster people who seek help can access medication, the more likely they are to start treatment.

"How fast can you connect them to the medication is crucial," said Joudrey, who specializes in addiction medicine. "Delays as short as one day can reduce rates of treatment entry. It's important that addiction treatment systems are flexible to provide care quickly when patients are ready."

For the study, a team led by Joudrey and E. Jennifer Edelman, associate professor of general medicine and of public health, contacted methadone clinics in 13 states and the District of Columbia in the U.S. and three Canadian provinces with the highest rate of opioid overdose deaths. Posing as patients requesting methadone treatment, they asked whether clinics were accepting new patients and requested the first available appointment.

They found that slightly less than 90% of clinics of both countries accepted new patients during the pandemic. About a third of clinics who did not accept new patients cited COVID-19 as the reason. And they found that wait times for medication in the U.S. were much longer - 3.5 to 4.1 days compared with 1.9 days at Canadian clinics.

The findings reflect shortcomings in how the U.S. handles care for people with opioid addiction, Joudrey said. In both nations, clinics with an open access model -- where patients can present for treatment without a prior appointment -- provided timelier treatment access. But in the U.S., only about 30% of clinics offered open access, compared with 59% in Canada.

Also, the United States is hampered by many federal, state, and local regulations which make opening new clinics more difficult. This has helped create a methadone treatment shortage, Joudrey said.

"Regulation carries a heavy burden," he said.

Source:


Yale University
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Re: Alcohol, Opioids, & other Substance Disorders

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Researchers identify four themes as key contributors to diseases of despair in Pennsylvania

7/23/21


https://www.news-medical.net/news/20210 ... vania.aspx


Financial instability, lack of infrastructure, a deteriorating sense of community and family fragmentation are key contributors to diseases of despair in Pennsylvania communities, according to Penn State College of Medicine and Highmark Health researchers. The researchers conducted four focus groups in Pennsylvania communities identified as having high rates of despair-related illnesses.

Diseases of despair are medical diagnoses involving alcohol-related disorders, substance-related disorders and suicidal thoughts and behavior. Princeton economists Anne Case and Angus Deaton proposed the concept of deaths of despair in 2015 after observing a decline in life expectancy of middle-aged white men and women between 1999 and 2015 -- the first such decline since the flu pandemic of 1918. They theorized that this decline is associated with the social and economic downturn in rural communities and small towns over the last several decades, leading to feelings of despair and loss of hope for the future.

" The crisis in recent years has broadened past this initial demographic that Case and Deaton established, and we are now seeing rising excess mortality in other groups of working-class Americans, including people of color."

- Daniel George, associate professor of humanities and public health sciences, Penn State College of Medicine

George is a researcher with a Penn State Clinical and Translational Science Institute project looking at diseases of despair in Pennsylvania.

The first phase of this project analyzed Highmark Health insurance claims and found that the rate of diagnoses related to diseases of despair -- alcohol-related disorders, substance-related disorders and suicidal thoughts and behaviors -- increased significantly in the past decade.

"Nearly one in 20 people in the study sample of 12 million people were diagnosed with a disease of despair in our earlier research," Emily Brignone, Highmark Health, said. "Following Case and Deaton's findings, we saw the most substantial percentage increase in disease of despair diagnoses among men ages 35 to 74, followed by women ages 55 to 74 and 18 to 34. The issue is one of great importance that we are proud to be addressing with Penn State."

Using the data from the first study, the researchers then identified hotspots in Pennsylvania with a high rate of diagnoses related to diseases of despair for the second phase of the project. A disease of despair rate was determined by dividing the number of unique members with a qualifying diagnosis during that year by the total number of members. Researchers selected communities in Dauphin and Lebanon counties and conducted focus groups through existing community partnerships. Researchers report their results in the journal JAMA Network Open.

"Most of the research on deaths and diseases of despair have been at the epidemiological level; in other words, looking at large data sets and trying to identify patterns over time," George said. "There has been less done qualitatively - basically exploring the perceptions and beliefs of people who are affected by diseases of despair, trying to understand what is happening on the ground."

Four focus groups included a total of 60 participants. Focus group members were both residents and community health workers who interact with those affected by diseases of despair. The research team analyzed transcripts of the focus groups to identify themes.

The first theme researchers identified was the role of financial instability and how United States domestic policy contributes to self-harming behavior.

"One of the main findings was that financial distress is at the heart of it," George said. "It is something that has been driving instability in people's lives and increases the risk for drug abuse and escape through drugs and drink. People identified jobs with full benefits and a living wage not being as available as they used to be and people having to choose groceries over medical care and their anti-anxiety medications."

The second theme that researchers identified was a lack of infrastructure, especially in rural communities.

"Focus group participants noted a lack of public transportation that could help people get to their jobs or to their health care appointments, and the role that played in compounding distress in people's lives," George said. "They also identified failures in our school systems that were resulting in schools not preparing kids to have trades or skills to make them competitive in a 21st-century economy."

The third theme that researchers identified was a deteriorating sense of community. Participants discussed fragmentation over the last several decades that has led to rising isolation and distrust, and a lack of neighborly support. These trends have been worsened, in part, by social media.

"There was a really interesting perception that there has just been a general decline in the community," George said. "There is more loneliness, more alienation, a loss of trust among people, less neighborly interactions. People talked about just feeling an absence of actual human connection online with technology and electronic devices, and that it has taken the place of tangible, real human connection-- and that that compounds loneliness."

The final theme researchers identified was the fragmentation of the family.

"There is more pressure on two-earner families, and that was leading to kids being less bio-psychosocially developed and leaving home at greater risk for despair-related behaviors," George said.

Researchers will next consider potential solutions, including the role of health care facilities in identifying despair-related risk factors, partnerships with community organizations that work with those most at risk and the use of big data analysis and machine learning to identify at-risk communities and guide state-level policy changes. Focus group attendees shared their beliefs that more needed to be done at the local and state levels to address the causes of despair, including non-profit initiatives, peer support, infrastructure building, economic development and rebuilding a sense of community as well as social safety nets.

"A key message is really that we do not want to blame the victims here," George said. "Despair is something that is an indictment of the way that we have organized our society rather than a personal failing or an individuated sense of despair that somebody may feel. People are responding to objectively worsening material circumstances in their lives. What we are trying to do with the diseases of despair construct is essentially create a parameter whereby we can measure it, study it, try to understand what is going on and then address root causes."

Source:

Penn State
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Re: Alcohol, Opioids, & other Substance Disorders

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Physical pain induces relapse of alcohol consumption, research shows

7/27/21


https://www.news-medical.net/news/20210 ... shows.aspx


The study has also shown changes in an area of the brain related to motivation for drug intake, and in a second experiment they have shown that the kappa-type opioid receptor (a protein) is key to causing these animals to relapse.

Research by the Department of Pharmacy and Pharmaceutical Technology and Parasitology of the University of Valencia (UV) has shown in a preclinical experiment with rats that physical pain induces relapsing with alcohol consumption. The study, published in journal PAIN, has also shown changes in an area of the brain related to motivation for drug intake, and in a second experiment they have shown that the kappa-type opioid receptor (a protein) is key to causing these animals to relapse.

Several studies have emphasised that suffering physical pain can trigger relapses in alcohol consumption and that it can be a key reason for initiating a compulsive consumption that leads to addiction. Along the same lines, the UV research group led by Lucía Hipólito has shown in a study that pain induces relapse when it develops during alcohol withdrawal in female rats.

"We have discovered one of the neurobiological bases that can explain the relationship between the relapse of alcohol consumption and physical pain, thanks to alterations that occur in the kappa opioid receptors in the nucleus accumbens, an area of the brain closely related to the motivation for taking drugs", explains the researcher.

The study has also concluded that this increase in alcohol consumption is related to anxiety or depression. This negative affective state induced by forced abstinence from alcoholic beverages causes it, in combination with pain, to become stronger and persist after reintroducing addiction in female rats. This is how the research team has shown that aggravation due to anxiety pain is a key factor in the increase in alcohol intake after a period of abstinence. As Hipólito indicates, "it can be said that pain increases the effects of not ingesting alcohol or accelerates those that can lead to a relapse".

In a second line of research, the authors -among them Jesús Lorente, Javier Cuitavi and Yolanda Campos, also from the same research group- have not only studied these alterations, but have also verified that when they blocked the opioid receptor kappa with a drug, called Norbinaltrophimine, relapse does not occur. Thus, the author states that they have studied the functionality of the drug for these cases, but it could have uses for other pathologies.

" The problem is that they are causing some adverse effects in the early stages of clinical research that are difficult to manage. Our research group is now focused on how we could improve the pharmaceutical form, that is, how to administer it to avoid its side effects."

- Lucía Hipólito, Researcher

On the other hand, Hipólito also points out the interest of the differences based on the sex of the rats, since the results have only been verified in females. In observational clinical studies, although there are women, their presence is usually lower than that of men, causing the representative sample to often not be valid. "We believe that there may be some bias when studying the events that can lead people to relapse, because there are studies that show that men tend to enter treatment programs more than women. Luckily now, interesting data are being published about this in terms of gender, but it is still too early for the sample to be equitable", argues the researcher.

Source:


Asociación RUVID

Journal reference:


Lorente, J.D., et al. (2021) Kappa opioid receptor blockade in NAc shell prevents sex-dependent alcohol deprivation effect induced by inflammatory pain. Pain. doi.org/10.1097/j.pain.0000000000002332.
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