Mississipi Delta Medical Leaders Are Working to Restore Trust Between Minorities and Health Researchers
April 18, 2018
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STAT
Where Marijuana is Legal, Opioid Prescriptions Fall, Studies Find
April 02, 2018
As more states legalize medical and recreational marijuana, doctors may be replacing opioid prescriptions with suggestions to visit a local marijuana dispensary. Two papers published Monday in JAMA ...
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Kentucky Could Become the First State to Tax Opioid Prescriptions
March 02, 2018
Kentucky could become the first state to tax opioid prescriptions
Lawmakers in Kentucky are weighing whether to impose a new tax on opioid prescriptions, the latest effort in a string of so-far failed attempts to pull new revenue from the painkillers that helped seed a nationwide addiction crisis.
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Benzodiazepines: Our Other Drug Epidemic
February 22, 2018
Benzodiazepines: our other prescription drug epidemic
I got the call every addiction doctor dreads: A patient of mine nearly overdosed. ... and progressing to heroin by his early 20s. He had been in recovery for six months. "Was it heroin?" I asked the doctor, who was calling from the emergency department. "Not opioids," said the doctor. "Benzos ...{C}
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Most People Who Got a Flu Shot This Year Aren't Protected From the Most Common Strain
February 16, 2018
Three-quarters of people who got a flu shot this year were not protected against H3N2 flu, the viruses that have caused the lion's share of disease in what has been one of the most difficult flu seasons in years in the United States, according to new data from the Centers for Disease Control and Prevention. While…
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Maker of OxyContin to Stop Marketing Opioids to Doctors Amid Addiction Crisis
February 10, 2018
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For Chinese Fentanyl Sellers, the U.S. Mail is the "Virtually Guaranteed" Route to Not Get Caught
January 25, 2018
For Chinese fentanyl sellers, USPS is the "virtually guaranteed" route to not get caught
WASHINGTON - Hundreds of millions of dollars worth of fentanyl - and likely more - is pouring into the United States through international mail - and the federal government isn't equipped to track ...
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How Healthy Is Your State? The Disparities Are Stark
December 12, 2017
Massachusetts is the healthiest state to live this year, according to a new report from the United Health Foundation. The report ranks states on 35 factors that impact health, from vaccination levels and infant mortality rates to environmental pollution and poverty levels. The analysis also pinpoints public health challenges nationwide. One particularly troubling trend: The rate…
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The Drug Treatment Racket: Union Workers Feel Trapped as Their Benefits Are Drained
November 16, 2017
Targeted by an addiction treatment center, union workers feel trapped as their benefits are drained
They'd been promised a "spa for teachers," but were brought to a rundown, low-slung building on an unremarkable stretch of road miles from the beach. ... cards, and driver's licenses. One after another, New Jersey public school teachers arrived at the Recovery Institute of South Florida after asking their union to find them addiction or mental health ...
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Trump Opioid Panel Will Recommend Nationwide Drug Courts, Tightened Prescribing Rules
November 01, 2017
Trump opioid panel will recommend nationwide drug courts, tightened requirements for prescribers
WASHINGTON - President Trump's commission on combating the opioid epidemic plans to encourage the federal government to establish drug courts in every federal judicial district, adjust reimbursement ...
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Opioid Epidemic Shares Chilling Similarities With Past Drug Crises
October 30, 2017
Opioid epidemic shares chilling similarities with past drug crises
NEW YORK (AP) - While declaring the opioid crisis a national public health emergency Thursday, President Donald Trump said: "Nobody has seen anything like what's going on now." ... , an outcast in a society of outcasts. He is regarded as a fool by heroin addicts, as insane and violent by those using psychedelics and marijuana, and a ‘bust' by non-drug using hustlers," wrote Dr. Roger Smith ...{C}
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Are People Really Falling Ill from Touching Fentanyl? In Most Cases, Scientists Say No
August 17, 2017
Police officers hospitalized after incidental exposure to fentanyl. A Florida child fatally overdosed. In communities around the country, such headlines are stoking fears that a momentary brush with a tiny amount of fentanyl powder could prove fatal.
The synthetic opioid, blamed for increasing numbers of overdose deaths across the U.S., is 50 to 100 times more potent than morphine. But experts consulted by STAT said many of the reported incidents appear to be false alarms that run counter to scientific fact and exaggerate the risks.
The American College of Medical Toxicology recently issued a position paper concluding that, based on what’s been publicly released, none of the recent incidents involving first responders is consistent with opioid toxicity. The doctors, who reviewed a handful of cases, said they are not challenging the truthfulness of the officers involved. Rather, they are questioning whether their reports are verified cases of poisonings that carry the hallmarks of opioid exposure.
“A lot of the symptoms are nondescript, such as vague dizziness, that don’t concern opioid poisoning,” said Dr. Andrew Stolbach, a physician at Johns Hopkins Medical Center and lead author of the paper. “And in a lot of the cases, the way that they were exposed doesn’t make sense, like brushing a small amount of powder off a uniform.”
While most of the reports have involved first responders, some have involved young children, including the fatal overdose of a 10-year-old Florida boy who was found to have a mixture of heroin and fentanyl in his body. How he came in contact with opioids remains unknown, although authorities have raised the possibility that he encountered it at a community pool or walking through a neighborhood known to be a hotbed of opioid trafficking.
Establishing the truth in these cases is not just a matter of setting the record straight, but of preventing hysteria and ensuring public safety. While accidental exposure to opioids can take lives, so can undue fear of the risks. For first responders, taking extra precautions could delay lifesaving care for people suffering overdoses and distract from more pressing threats, such as a suspect at a crime scene.
“We want to prevent unintended consequences,” said Dr. Diane Calello, medical director of the New Jersey Poison Information and Education System. “If a law enforcement professional is wearing a lot of unnecessary protective gear in a situation that requires an agile response, that in and of itself is a safety issue.”
Conversely, failing to take proper precautions could also result in harm. So what’s the right balance?
STAT spoke to several toxicologists and law enforcement officials to examine the underlying science of fentanyl exposure and the extent of the risk it poses to first responders and the public.
Can fentanyl poison officers and others through incidental skin contact?
In several incidents, officers have reportedly fallen ill after a powdered form of fentanyl came in contact with their skin or clothing.
Although ingesting a pinch of fentanyl powder can be fatal, several toxicologists said contact with intact skin is extremely unlikely to cause opioid toxicity, which can occur only if the substance enters the bloodstream.
“If you have fentanyl powder on your hand for five or 10 minutes, it’s inconceivable that that would be sufficient to cause you to have an overdose,” said Dr. David Juurlink, a toxicologist at the University of Toronto.
Fentanyl cannot penetrate the skin on its own. It needs moisture. That’s why, in clinical care, patients are given fentanyl patches to aid in absorption and relieve pain. The position paper by the American College of Medical Toxicology reported that, even if a large area of the body were covered with fentanyl patches, it would take 14 minutes to transmit a therapeutic dose of 100 micrograms, let alone an overdose.
“For the fentanyl patch to work, you have to put a lot of fentanyl in the patch. It has to be moist and it has to be in contact with the skin for a long period of time, in a special liquid,” said Stolbach. “Those aren’t the conditions that are going to occur when somebody is incidentally exposed.”
One of the most widely reported incidental overdoses occurred in East Liverpool, Ohio, where officer Chris Green became ill following a traffic stop involving drugs. Green has recovered and returned to work.
The city’s police chief, John Lane, said he believes Green’s illness resulted from opioid exposure, regardless of the questions raised by toxicologists. Lane said a screening test confirmed that Green had opioids in his body, but the exact method of exposure remains unclear.
He said Green collapsed moments after he brushed a small amount of powder off his shirt at the police station, after the traffic stop was over.
“We don’t know if he brushed it off with his hand or rubbed his eye,” Lane said. “We think what may have happened is that he put on that Purel or Germ-X stuff, and that got it wet and maybe he absorbed it that way. We’re not sure. All we know is he overdosed from it.”
The medical toxicologists group specifically warns that alcohol-based hand sanitizers should never be used, because they are ineffective in removing fentanyl and may increase drug absorption. The organization said officers should take basic precautions to prevent the remote risk of poisoning through skin contact, such as wearing nitrile gloves and immediately washing with copious amounts of water if contact does occur.
Can inhaling fentanyl cause an overdose?
Toxicologists said the possibility of accidental inhalation presents a higher risk, especially in poorly ventilated spaces where public safety officials suspect fentanyl is dispersed in the air.
Calello said inhaling fentanyl — or ingesting it — puts it in contact with mucous membranes in the nose or mouth, providing the drug a way into the bloodstream, which can result in poisoning.
She added, however, that such circumstances are unlikely to arise during a traffic stop or in other open-air environments. “Handling an overdose victim is not going to entail a plume of aerosolized drug,” Calello said.
It would take prolonged exposure to a large amount of airborne fentanyl to cause an overdose, according to the medical toxicologists. Their report references safety standards for industrial workers who manufacture fentanyl. “At the highest airborne concentration encountered by workers, an unprotected individual would require nearly 200 minutes of exposure to reach a dose of 100 mcg of fentanyl,” the report states. (100 mcg, or micrograms, is enough to have a therapeutic effect but not enough to cause an overdose.)
“We would expect in an industrial fentanyl production plant there’s going to be more fentanyl in the air than there would be at any crime scene,” Hopkins’s Stolbach said.
Still, in cases where first responders suspect a high concentration of airborne opioids, the medical toxicologists group recommends that officers use a respirator, in addition to wearing water-resistant coveralls to block skin exposure.
Why are so many officers falling ill if the risks of poisoning are so low?
Toxicologists said officers may indeed be getting sick following exposure to fentanyl or other substances, but that does not necessarily mean the drugs are the cause.
The only way to confirm a case of poisoning is to conduct a urine or blood test, or to verify that symptoms were reversed by a dose of naloxone. But such evidence is lacking in many of the cases reported around the country.
“The common theme is that there is no biochemical confirmation,” Stolbach said. In most cases, the media is reporting that officers are being hospitalized, but hospitalization may just be a precaution.
Juurlink said the real culprit in these cases may be a phenomenon known as the nocebo effect, in which the mere suggestion that a substance can be harmful causes people to suffer negative effects after exposure. In medical research, for example, being informed of side effects related to a pill or procedure can bring on real-life symptoms.
“If in a moment of panic, a person sees powder on their skin and they’ve read reports on the internet about people having overdosed, you could see how that might cause someone to at least believe they’ve had an overdose,” Juurlink said.
Indeed, some of the symptoms reportedly suffered by public safety officers, such as a racing heart, dizziness, and anxiety, are more consistent with panic than opioid poisoning. “If anything, people with opioid poisoning would have a slow heart rate,” Stolbach said.
Toxicologists said law enforcement officials should be trained to recognize the objective symptoms of opioid poisoning so they can deliver the opioid antidote naloxone when appropriate. Those symptoms would take hold within a few minutes of exposure. A person would become sleepy and lethargic and start breathing at an abnormally slow rate.
“That’s the typical progression,” Calello said. “From awake to sleepy, to asleep, to unconscious. The things that have been described in the news really are not what we typically see with patients who get opioids.”
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White Nationalists Are Flocking to Genetic Ancestry Tests, and They're Not Liking What They Find
August 17, 2017
It was a strange moment of triumph against racism: The gun-slinging white supremacist Craig Cobb, dressed up for daytime TV in a dark suit and red tie, hearing that his DNA testing revealed his ancestry to be only "86 percent European, and ... 14 percent Sub-Saharan African." The studio audience whooped and laughed and cheered. And…
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Doctor's Murder Over an Opioid Prescription Leaves Indiana City With No Easy Answers
August 10, 2017
A doctor's murder over an opioid prescription leaves an Indiana city with no easy answers
MISHAWAKA, Ind. - Dr. Todd Graham wasn't yet halfway through his workday at South Bend Orthopaedics when a new patient came into his office here complaining of chronic pain. Heeding the many warnings of health officials, he told her opioids weren't the appropriate treatment. But she was accompanied by her husband, who insisted on a prescription.…
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White House Panel Urges Trump to Declare State of Emergency Over Opioid Crisis
August 01, 2017
White House panel urges Trump to declare state of emergency over opioid crisis
WASHINGTON - The White House's commission on combating the opioid epidemic has recommended that President Trump declare a federal state of emergency to address the crisis, a potentially significant step for an administration that has repeatedly pledged to take steps to ease the epidemic. "The first and most urgent recommendation of this Commission is direct and…
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Psychiatry Group Tells Members They Can Defy 'Goldwater Rule' and Comment on Trump's Mental Health
July 25, 2017
A leading psychiatry group has told its members they should not feel bound by a longstanding rule against commenting publicly on the mental state of public figures - even the president. The statement, an email this month from the executive committee of the American Psychoanalytic Association to its 3,500 members, represents the first significant crack in…
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DEA Asked for Applications to Grow Marijuana for Research, But It Doesn't Approve Them
July 25, 2017
Almost a year after the Drug Enforcement Administration announced it would consider granting additional licenses to cultivate cannabis for research purposes — and despite drawing 25 applicants so far — the agency has yet to greenlight a new grow operation.
The DEA says it does not have a timeline to approve or deny applications and noted that it is dealing with a new review process. All applicants remain under review and none has been rejected, said Katherine Pfaff, a DEA spokeswoman.
But the lag has allowed critics of the agency to argue that the announcement was a public relations ploy and that the DEA remains dug in against marijuana research. And, they say, the signals from the Trump administration, particularly Attorney General Jeff Sessions’s embrace of a tough-on-drugs ethos, leave them doubting the agency will ever approve another grower.
“What has progressed with the DEA over the past year? Nothing,” said Rachel Gillette, an attorney at Greenspoon Marder in Colorado, who specializes in marijuana policy. “I would be surprised if we had another conversation in five years and they had granted another license.”
The DEA has been pressed to liberalize its policies on cannabis research in recent years, with scientists and others arguing that there’s a growing need for evidence-based research at a time when more people have started self-treating their diseases with marijuana. Experts warn there is little rigorous research validating marijuana as a medicine and that cannabis-based products are often unregulated.
“There are lots of constituents in marijuana besides the material that makes you happy,” said Lyle Craker, who studies medicinal plants at the University of Massachusetts, Amherst, and who has applied for a license. “We need to investigate those to gain full insight into the plant so we know what’s going on when we tell people what to use and what not to use. We need some basis.”
For decades, the only sanctioned source of marijuana available for U.S. research has been the University of Mississippi, which has an exclusive contract with the federal government. But scientists say the quantity and variety of cannabis produced there isn’t sufficient.
Many advocates for cannabis research heralded the DEA’s announcement last August that it would consider tapping new growers.
Craker submitted his application in February, after working with a nonprofit called the Multidisciplinary Association for Psychedelic Studies, and received follow-up questions from the DEA the next month. Craker responded to the questions on April 12, and he said he has not heard anything since.
“What is their policy?” Craker said. “They’re saying they’re open to research, but they don’t allow any.”
Rep. Andy Harris (R-Md.), a doctor who supports easing restrictions on marijuana research, said a pharmaceutical company in his district has also applied for a license and that he has been in touch with the DEA to check on the status of the application.
But beyond that, a number of policy experts and advocates said they were not sure who else had applied. Pfaff, the DEA spokeswoman, said she could not discuss who has applied, or say whether they include academics, pharmaceutical companies, or growers in states with legal medicinal or recreational marijuana. It’s also unknown how many of the 25 applicants are worth serious consideration.
The DEA announcement last August came at the same time the agency ruled that marijuana would remain a Schedule 1 drug, defined as having a high potential for abuse and no medical value. Some scientists have long chafed at marijuana’s classification — which it shares with heroin and some hallucinogens — because it forces them to go through a series of security and regulatory hurdles before they’re permitted to study it.
Harris and Rep. Earl Blumenauer (D-Ore.) are planning to introduce a bill this year that would ease some restrictions on scientists seeking to study marijuana. The two congressmen, who pushed a similar bill last Congress, are seen as a bit of an odd couple: Harris is a conservative who has fought legalizing recreational marijuana, while Blumenauer is one of the legalization movement’s top advocates in Congress.
But they agree that, even as more states legalize marijuana, experts still don’t fully understand if and how cannabis can be used as a legitimate medicine, and in what ways it might be harmful. The answers to those questions will only come with more scientific research, they say.
“If Andy and I can come together on this, it indicates how strong the consensus is that we should move forward,” Blumenauer said. “I am just shocked that [the DEA is] so frozen in time at a time when everybody who has their wits about them agrees we need to make research easier.”
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Chuck Schumer Calls on FDA to Regulate Snortable Chocolate
July 10, 2017
NEW YORK - U.S. Sen. Charles Schumer is urging federal regulators to look into a "snortable chocolate" powder, saying he's worried that it could prove harmful and is being marketed like a drug.
In a letter Saturday, the New York Democrat asked the Food and Drug Administration to investigate the use of caffeine in inhalable food products such as so-called Coco Loko. It's gotten buzz in recent weeks.
Schumer, the Senate minority leader, says there are too many unanswered questions about a product pitched under the innocent-sounding name of chocolate.
"This suspect product has no clear health value," he said in a statement. "I can't think of a single parent who thinks it is a good idea for their children to be snorting over-the-counter stimulants up their noses."
Marketed as "raw cacao snuff," Coco Loko includes cacao powder, which comes from beans used in making chocolate; they contain some caffeine. Manufacturer Legal Lean Co. doesn't detail other ingredients online, but according to news reports, Coco Loko also includes common energy-drink ingredients.
It promises feelings of well-being, mental focus, ecstasy-like euphoria and a rush of "motivation that is great for partygoers to dance the night away without a crash," according to Orlando, Florida-based Legal Lean's website. It notes that the claims haven't been vetted by the FDA.
The agency has said it hasn't yet determined whether it has authority to regulate snortable chocolate.
Legal Lean Co., which sells Coco Loko online for $19.99 for a 1.25-ounce (3.5-gram) tin, did not return a call seeking comment. Founder Nick Anderson has said he didn't consult any medical professionals but believes Coco Loko is safe. He said he developed it from snortable chocolate that's circulated in Europe in recent years.
"There's really no negative publicity, so I felt we're good to go," he told ABC's "Good Morning America" on Thursday.
Doctors have said they're not certain what the effects of inhaling chocolate might be.
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New on the Streets: Gabapentin, a Drug for Nerve Pain and Another Choice for Addicts
July 06, 2017
ATHENS, Ohio - On April 5, Ciera Smith sat in a car parked on the gravel driveway of the Rural Women's Recovery Program here with a choice to make: go to jail or enter treatment for her addiction. Smith, 22, started abusing drugs when she was 18, enticed by the "good time" she and her friends…
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Calling Chris Christie! White House Opioid Crisis Commission Misses Due Date for Preliminary Report
June 28, 2017
WASHINGTON — President Trump’s commission on the opioid crisis has missed its first deadline.
The newly created panel met for the first time on June 16, just 11 days before the White House’s ambitious due date for a preliminary report meant to outline federal strategies to curb the epidemic.
An executive order that established the commission had set a 90-day deadline for the completion of that document. The deadline will come and go without a report being filed, and a commission teleconference originally scheduled for Monday evening has been rescheduled for July 17.
“It’s been pushed back for a couple of weeks,” commission member Bertha Madras, a researcher at Harvard Medical School and McLean Hospital who studies the biology of addiction, told STAT. “We need more time because it’s a massive task.”
Madras said the group has been working diligently on its report, compiling a list of federal resources and programs available to help stem the epidemic. The panel was still crafting its recommendations, she said, but overall the commission’s work was going very well.
“Right now, we’re going to have more recommendations than anyone anticipated,” she said.
Madras was named to the commission just last month, along with its chair, Gov. Chris Christie of New Jersey, and Govs. Charlie Baker of Massachusetts and Roy Cooper of North Carolina. The fifth member, former Rhode Island congressman Patrick Kennedy, is a treatment advocate who has spoken openly about his own struggle with drug abuse.
“It seemed to have been put together on a fairly brief turnaround,” said Dr. Joe Parks, the medical director of the National Council for Behavioral Health, of the first meeting, during which he delivered a brief presentation. “I was left with the impression that we were part of an initial broad information-gathering — I was given very broad opportunity to give whatever input I pleased.”
Outside experts have been largely impressed by the commission and its direction, if not the pace of work.
“I had a good hour with Governor Christie, and I have to say he was extremely impressive, extremely knowledgeable,” said Gary Mendell, who as the CEO of the addiction treatment advocacy group Shatterproof was invited to testify before the commission at its first meeting. “He seemed very focused on wanting to do the right thing.”
But Mendell and others who appeared at the first hearing were adamant that the pending health care legislation would be a major setback for the recovery community if it became law.
At the same time, Mendell said, while those invited to testify implored the White House not to pursue legislation that could hamper treatment access, they recognized that Christie’s commission is a non-legislative body with little influence over Republicans on the Hill.
Despite forceful rhetoric on the issue from Trump while on the campaign trail, the White House has struggled to avoid contradictions between the commission’s work and its own agenda.
In April, Trump celebrated the House’s passage of a bill that detractors say would sharply reduce access to addiction treatment in two ways: a roughly $800 billion cut in planned Medicaid spending over the coming decade, and deregulation that could allow insurers in some states not to cover some basic health services, including addiction treatment.
In May, a leaked memo suggested the Trump administration would seek to effectively eliminate the White House’s drug control policy office, reducing its funding from $388 million to $24 million. The administration backtracked on the cuts following bipartisan outrage.
And on Monday, top Trump lieutenant Kellyanne Conway found herself facing demands for an apology after she suggested the two requisite tools for ending the crisis were funding and “a four-letter word called will.”
When asked about the deadline, the White House forwarded questions to the Office of National Drug Control Policy, which forwarded questions to Christie’s office, which did not respond to requests for comment.
The commission has not changed its goal of submitting a final report to Trump by Oct. 1.
Andrew Joseph contributed reporting.
An earlier version of this story stated that Trump’s draft budget envisioned effectively eliminating the White House’s drug control policy office. The proposal was made in a memo that was leaked, before the budget proposal was released.
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Senate Health Care Bill is a Disaster for Dealing With the Opioid Crisis
June 22, 2017
WASHINGTON — The health care bill unveiled by Senate Republicans on Thursday includes funding to help tackle the nation’s opioid crisis — but dramatically less than the amount sought by two GOP senators and recovery advocates.
Sens. Rob Portman (Ohio) and Shelley Moore Capito (W.Va.) at one point had requested $45 billion over the course of a decade to keep the battle against opioids on the nation’s front burner. The bill instead would allocate only $2 billion, all in 2018.
“Well, they did say there’s some opioid funding,” Capito said as she emerged from the meeting in which GOP leadership walked through the bill with members. But, she added, the number falls far short of what she wanted.
The massive influx of money would have at least partially helped make up for the Senate’s proposed rollback of Medicaid, which pays for roughly half of addiction treatment in many states. In West Virginia, it funds nearly 45 percent of addiction treatment costs. In Ohio, the figure is 49.5 percent.
While the opioid epidemic is not limited to that pair’s states, most other Republicans did not join the call for including a major opioid epidemic funding stream through their health bill.
“I think it’s not unreasonable to think carefully about how much money you can add to the system all at once,” said Sen. Roy Blunt (R-Mo.), who chairs the Senate’s health appropriations subcommittee. “We tripled the money two years ago, then doubled the tripling. So we’re in a fairly fast trajectory, and I don’t know how much money you can effectively spend here.”
Blunt, however, acknowledged Capito and Portman’s expertise on the issue and maintained that funding addiction treatment was a priority for his subcommittee and for Congress in general.
Some advocates for the recovery community suggested the proposal for $45 billion in funding overlooked the complicated spiral in health issues that can be brought on by addiction. The additional funding, for instance, wouldn’t help cover treatment for conditions that are common among those struggling with addiction and that would otherwise be covered by Medicaid.
Senate drafters of the bill, by not including the new funding, could give either Capito or Portman — both of whom hail from Medicaid expansion states and have shown resistance to major cuts to the program — a sturdier stack of reasons to vote no. They could also use their resistance as leverage with Senate Majority Leader Mitch McConnell.
Or, in the outcome that worries those combating the opioid crisis the most, the issue could simply fizzle.
“The proposed $45 billion was not going to come close to being sufficient to address the epidemic that’s ravaging our country and taking more lives every day,” said Gary Mendell, the CEO of the addiction-focused nonprofit Shatterproof. “Shatterproof will continue to pressure senators to vote no on this bill that would have devastating effects for Americans with substance use disorders.”
The bill’s elimination of the Affordable Care Act’s essential health benefits provision, which largely mandated that insurers cover mental health and substance abuse treatment, was also cause for concern for stakeholders in combating the crisis.
“Eliminating requirements for coverage of key benefits, including mental health and substance use disorders and other patient protections that are part of the Affordable Care Act, will have detrimental impacts for millions,” Dr. Altha Stewart, the president-elect of the American Psychiatric Association, said in a statement.
The White House, which has said it sees efforts to address the opioid epidemic as a priority, did not immediately respond to a request for comment.
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To Better Treat the Opioid Crisis, Call in the Journalists?
June 15, 2017
One of the privileges of being a health care provider these days is having access to innovative technologies designed to help save lives. My colleagues and I were recently surprised to discover a powerful tool that could be useful in our line of work: journalists.
I am part of an interdisciplinary team that focuses on finding better ways to identify, intervene, and treat substance misuse/abuse. We were approached by The GroundTruth Project, a nonprofit journalism organization, which was seeking underwriting from the Northwell Health Foundation, which is affiliated with my employer, Northwell Health. The journalists wanted to create a five-part podcast series on the problem of opioid and heroin addiction and requested access to our team. It also wanted the opportunity for various reporters to be a “fly on the wall” during physician-patient encounters. The one stipulation: In the spirit of true journalism, my colleagues and I would have absolutely no editorial control of the finished product.
We certainly understood the reporters’ and editors’ interest in this project: Opioid abuse represents a major health care crisis, and our organization has been proactive in creating and piloting potential solutions to better address the epidemic.
But it certainly wasn’t a small ask. We aren’t used to having reporters observing us as we work, and we were nervous that if we gave up editorial control we could run the risk of being inaccurately represented. Even so, we agreed to this intriguing proposition. High-quality journalism, we thought, might be able to shed light on the pressing problem of opioid abuse by uncovering deeper truths, highlighting things we just weren’t seeing, and exploring varying perspectives, all of which could help us better address the crisis and improve our approach with patients.
Right from the get-go, we were in the thick of the two-month-long reporting process. Various teams of reporters and sound engineers recorded interviews with members of our team and the Northwell Health Opioid Management Steering Committee. They shadowed clinicians as they went about their work. With help from the Northwell public relations team, they interviewed a patient and his psychiatrist. We also invited the journalists to observe a training session for medical office assistants, nurses, and health coaches on our Screening, Brief Intervention, and Referral to Treatment (SBIRT) service, which helps identify patients whose alcohol, drug, or tobacco use may be interfering with their health before it becomes a lifelong addiction. That piqued the journalists’ interest about our focused educational efforts on substance abuse underway at the Hofstra Northwell School of Medicine.
The focus of the series was on the stories of providers, patients, and family members, as well as the steps we were taking to address any gaps in clinical care and clinical training.
Even though my colleagues and I know quite a bit about the opioid and heroin crisis, since we deal with it firsthand as health care providers, participating in the project gave us a clearer understanding of the epidemic. In our state, New York, more than 110,000 residents are treated daily in the Office of Alcoholism and Substance Abuse Services system. It monitors a statewide network of certified treatment providers that operate more than 1,100 programs. That includes the direct operation of 12 addiction treatment centers, which provide inpatient rehabilitation services to more than 10,000 persons per year. Some states have even more difficult struggles, particularly Ohio and West Virginia. This epidemic is truly nationwide.
Our hope, when we first agreed to participate in this project, was that it would provide additional perspectives and serve as a learning opportunity for our team and other Northwell clinicians. The final product, “The Fix: Treating New York’s Opioid Crisis,” certainly delivered on that promise.
When we treat patients, most of us are laser focused on giving them the best care possible and sometimes saving them from life-threatening afflictions. We often don’t create opportunities for our patients to feel comfortable discussing their use of alcohol or drugs, which can constrain the flow of relevant information that can better inform clinical delivery and care plans. As we see the daily escalation of the opioid crisis in our communities, it is evident that there is no “face” to addiction. It can affect homemakers, students, lawyers, health care professionals, and construction workers. The podcast highlights this as folks from all walks of life share their accounts of addiction and how they could have been addressed, prevented, and better treated.
The project also brought to light a fundamental problem with clinicians’ skill sets related to substance misuse: In the current landscape of clinical education and training, the average physician receives just four hours of instruction related directly to addressing substance use. The same is true for most other health professionals. As a result, few feel comfortable talking with patients about substance abuse and addiction. And talk we must. To meet the challenges of the opioid epidemic, we need to become accustomed to asking patients about substance use as naturally and comfortably as we discuss blood pressure, blood sugar, and weight.
Much remains to be done for the country to overcome the opioid epidemic. Policies must change, patient-centered treatment models need to be developed, and the hardships that drive millions of Americans to feel hopeless must be met and conquered.
We try to teach every young doctor that you can’t really care for a patient unless you care about him or her as a whole person. What better way to show and grow this basic empathy than by learning how to have meaningful, sometimes difficult, and absolutely necessary conversations about substance use and abuse?
Participating in the podcast, developed in the spirit of neutrality and objectivity, helped us validate this commitment. We’re grateful to The GroundTruth Project for this insightful look at the many facets of the opioid epidemic as we work to stand up as a community and offer solutions to address it.
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Move Over Hippocrates: Harm Reduction as the New Paradigm for Health Care
June 01, 2017
The concept of "First, do no harm," which is embedded in the oath that kicks off the careers of most new doctors in America, has become something of a surrogate for the practice of medicine. But it's something of a false promise. Doctors routinely cause their patients harm. The oath we should be taking is, "Help…
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Marijuana Compound Helps Stop Epileptic Seizures
May 26, 2017
For the first time, scientists have demonstrated that a component of cannabis reduces seizures in children with a rare form of epilepsy, marking a significant step in efforts to use marijuana and its derivatives to treat serious medical conditions.
The company that sponsored the Phase 3 trial, GW Pharmaceuticals, had already announced some of the results, but researchers said the full peer-reviewed study, published Wednesday in the New England Journal of Medicine, validated the importance of the research. They also pointed out that the drug, cannabidiol, helped some patients more than others and was associated with a range of sometimes severe side effects, a significant finding because some families have been treating their children on their own in states where recreational marijuana use is legal.
“We now have solid, rigorous scientific evidence that in this specific syndrome, cannabidiol is effective at reducing seizures,” said Dr. Orrin Devinsky, a neurologist at New York University Langone Medical Center and an author of the new study. But, he added, “This is not a panacea.”
Cannabidiol, which GW has branded as Epidiolex, is a non-hallucinogenic component of marijuana that can be purified and administered in oil.
For the trial, researchers enrolled 120 children from 2 to 18 years old with Dravet syndrome, a rare genetic form of epilepsy that kills up to 20 percent of patients by the time they are 20. There are no drugs approved specifically for Dravet.
During the study, the patients stayed on their normal treatment regimen, and half of them also received cannabidiol while the remainder were given a placebo. Over a 14-week treatment period, the median number of convulsive seizures in the cannabidiol group decreased from 12.4 to 5.9 per month; for the placebo group, the number went from 14.9 to 14.1.
In the cannabidiol group, 43 percent of patients had their number of seizures cut in half or more, compared with 27 percent in the placebo group. And 5 percent of patients taking cannabidiol saw their seizures disappear, compared with none in the placebo group.
Common side effects seen in the cannabidiol group included vomiting, fatigue, fever, drowsiness, and diarrhea. Eight patients in the group withdrew from the trial because of the severity of the side effects.
In an editorial published with the study, Dr. Samuel Berkovic of the University of Melbourne called the trial “welcome” and “the beginning of solid evidence for the use of cannabinoids in epilepsy.” But he noted that it needs to be replicated and that other studies will be required to know if cannabinoids — the different components of cannabis — can help with other forms of epilepsy and to treat adults.
As desperate families have sought to treat their children with cannabis or cannabidiol on their own, experts have cautioned that it can be risky. Researchers don’t know, for example, how cannabidiol will interact with other medications, and they know even less about how adding THC — a hallucinogenic cannabinoid — to the mix might affect children with epileptic syndromes. They also don’t know the long-term effects of taking cannabidiol.
“We just have to be humble,” Devinsky said. “People have jumped to the idea that cannabis-based products are natural and therefore they work well, and all these anecdotes support that. There’s a lot of belief, and not a lot of science.”
The latest study was a randomized, double-blind, placebo-controlled trial, considered the gold standard form of research. Experts say that these types of trials are the only way to determine if cannabinoids are truly effective at treating diseases.
“The data to me are persuasive,” said Dr. Igor Grant, of the Center for Medicinal Cannabis Research at the University of California, San Diego, who was not involved with the study. “They do show that not everyone gets well, and that’s an important point. But there were substantially better outcomes in the cannabidiol group.”
GW has also announced the results of two Phase 3 trials for cannabidiol in another form of epilepsy called Lennox-Gastaut syndrome, the full data from which have not been published. The company plans to ask the Food and Drug Administration this year to approve Epidiolex for both syndromes.
“We do see it as profoundly important that patients suffering from these difficult-to-treat conditions have access to an FDA-approved medication, which is manufactured to the standards that medicines are meant to be manufactured to, where the safety profile is well-characterized, and where the dosing is well understood,” GW CEO Justin Gover said in an interview.
An FDA approval of Epidiolex could also lead to a change in US drug policy. Cannabis is classified as a Schedule I drug, defined as having a high potential for abuse and no medical value. But an approval would signify that cannabis — or at least cannabidiol — does have a medical use.
The Drug Enforcement Administration could reschedule only cannabidiol and leave cannabis generally at Schedule I. But some scientists who complain that the scheduling makes valid research on cannabis burdensome — they have to get special approval and meet security protocols to study cannabis — hope that the potential of cannabidiol as a medicine could push the DEA to reschedule cannabis itself.
For now, researchers are not sure why some children saw better responses to cannabidiol than others, or even how the drug reduces seizures. But they said this study will likely lead to others exploring those questions and if cannabidiol or other cannabinoids can help with other conditions.
“It’s really a welcome development that they had a well-controlled trial, it’s a big step forward,” said Ivan Soltesz, a neuroscientist at Stanford University, who was not involved with the study. But, he said, “it’s a little bit of a mystery about how it actually works.”
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Experts Say Trump's Deteriorating Speech Could Be Sign of Early Dementia
May 23, 2017
It was the kind of utterance that makes professional transcribers question their career choice: " … there is no collusion between certainly myself and my campaign, but I can always speak for myself - and the Russians, zero." When President Trump offered that response to a question at a press conference last week, it was the…
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This Strung-Out Dope Pusher Peddled Pills for Big Pharma
May 05, 2017
Sales executive for opioid maker was addicted to the drug he promoted
As a district sales manager for Insys Therapeutics, Jeffrey Pearlman led a team that aggressively pushed doctors to widely prescribe the company's highly addictive opioid painkiller Subsys. He even threatened to stop paying a nurse speaking fees if she didn't help boost sales of the drug, emails show. All the while, Pearlman held a secret: He…
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Latest Lethal Opioid Threat: Gray Death
May 05, 2017
A dangerous mix of opioids called ‘gray death' is causing overdoses in parts of the US
COLUMBUS, Ohio - It's being called "gray death" - a new and dangerous opioid combo that underscores the ever-changing nature of the U.S. addiction crisis. Investigators who nicknamed the mixture have detected it or recorded overdoses blamed on it in Alabama, Georgia and Ohio. The drug looks like concrete mix and varies in consistency from a…
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Taylor Wilson's Parents Fought for 41 Days to Get Their Daughter Treatment, But They Couldn't Stop Another Overdose
March 17, 2017
Taylor Wilson's parents fought for 41 days to get their daughter treatment. They couldn't stop another overdose
HUNTINGTON, W.Va. - The white car had stopped in the middle of the highway. The driver was slumped behind the wheel, her breaths faint and few. Her head was bobbing, chin to chest; her pupils were the size of a pinpoint. The car was strewn with syringes. Paramedics inserted a needle of naloxone, an opioid antidote,…
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Will Trump Kill The Drug Czar's Office?
February 23, 2017
WASHINGTON — With the US opioid crisis the subject of increased political focus, advocates in the recovery community had been quietly hoping President Trump might elevate the White House “drug czar” to his Cabinet. Now they are mobilizing to ensure the drug czar’s office won’t be eliminated entirely.
A recent report that the White House may propose axing the White House Office of National Drug Control Policy has sparked a scramble among leaders in the recovery community and among law enforcement. The National Fraternal Order of Police has already prepared a letter to Trump urging him to reject any proposal to eliminate the office. Advocates in the recovery community have drafted their own letter expressing support for the office.
The Office of National Drug Control Policy — established nearly 30 years ago and charged with coordinating drug policies across US agencies — has long been a proposed target for cuts by staff at the Office of Management and Budget seeking ways to reduce the White House budget. There is also some evidence that, even as the office’s budget has increased, drug use in America has been stable or even gone up.
Opponents of efforts to eliminate the office have argued that any savings would be minimal because so much of its funding goes to other agencies and to programs that would likely continue in its absence. Some have pushed to have the drug czar made a member of the Cabinet again, as was the case under Bill Clinton and George W. Bush.
The White House declined to comment on its plans or the recent report in the New York Times.
Trump has been vocal about his desire to address the US opioid crisis, a position highlighted by the National Fraternal Order of Police in its letter to the president.
“The ONDCP plays a vital role in coordinating a national strategy to fight drug trafficking and reduce illegal drug use,” the group’s president, Chuck Canterbury, wrote in the letter, a copy of which was obtained by STAT. “Without the ONDCP to help law enforcement agencies at every level to work together, we would have no way to set and coordinate a national strategy.”
If the White House does propose eliminating the Office of National Drug Control Policy, it would likely do so when it releases its budget blueprint in mid-March. But it would also likely face opposition on Capitol Hill, from the recovery community, and from law enforcement — a powerful triumvirate, as the crisis has become one of the most politically potent health issues in the country.
Some are skeptical it will come to that, given how often the issue has arisen in the past.
“That was a pretty perennial topic,” said David Murray, who worked in the office under George W. Bush and Barack Obama and is now a senior fellow at the Hudson Institute. He said he believed it was “premature” to know the Trump administration’s intentions.
A Senate Republican aide following addiction issues closely also expressed skepticism.
“I have a hard time seeing this get off the ground,” said the aide, who spoke on the condition of anonymity.
Created in 1988, the office is seen by some as an artifact of the “war on drugs,” which doesn’t reflect the changing paradigm that casts drug addiction as a public health issue as much as a criminal justice problem.
Obama notably appointed somebody with a history of substance abuse, Michael Botticelli, to be his second ONDCP director. But he had also demoted the positionfrom his cabinet in 2009, a move that Murray said “weakened the office” and that recovery advocates want to reverse.
The argument for keeping the office, as advanced by Murray and the national police group, is that it provides a clearinghouse for the anti-addiction efforts that span dozens of federal, state, and local agencies. Its director, as Murray put it, “expresses the president’s leadership” on the issue.
“There is no single place that spans across such a wide horizon,” Murray said, from public health to national security.
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Hospitals Are Training ER Docs to Resist Prescribing Opioids
January 23, 2017
Learning to say no: Hospitals train emergency doctors to resist prescribing opioids
Dr. Phillip Chang's emergency room epiphany started with a wreck. A patient admitted to the trauma unit of the University of Kentucky Albert B. Chandler Hospital was prescribed opioid painkillers for injuries he sustained in a nasty car crash. Within days, the patient returned for more pills, the first of many trips to multiple doctors."This guy…
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A Supplement Maker Tried to Silence This Harvard Doctor - and Put Academic Freedom on Trial
January 10, 2017
The dietary supplements had ominous names, like Black Widow and Yellow Scorpion. They contained an illegal and potentially dangerous molecule, similar in structure to amphetamines. But when a Harvard researcher dared to point that out, in a scientific, peer-reviewed study and in media interviews, the supplement maker sued him for libel and slander. STAT has conducted…
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