Thursday, September 22, 2016

Rethinking Drug-Free School Zones

drug-free school zones
In the 1980’s, at the height of the “crack” cocaine epidemic in the United States, drug-free school zones were created to deter people from dealing narcotics in and around the area. Such laws were considered to be common sense measures in an effort to combat what was, at the time, the most serious drug related problem until being eclipsed by the opioid epidemic we face today.

As you might expect, a number of concerns have been raised over the years about policies that by and large affect minorities. Just like mandatory minimum sentences and zero-tolerance substance rules, draconian “war on drugs” policies mainly impact people of color. Such laws were one of the major contributors to our penal institutions being filled with nonviolent drug offenders.

With the nation facing the most serious drug epidemic in history, states have begun to rethink their drug-free school zone policies, some shrinking in size while others grow, Stateline reports. In an attempt to reduce prison populations comprised mostly of nonviolent drug offenders, some states are reducing the size of their school zones, including:
  • Delaware
  • Indiana
  • Kentucky
  • Utah
On the other hand, some other states’ responses to the opioid epidemic are to increase the size of their drug-free school zones, according to the article. People found in possession of even small quantities of drugs near schools, parks and playgrounds face serious penalties. Drug offender punishments, more times than not, do not match the severity of the crime. Those states including:
  • Arkansas
  • Hawaii
  • Texas
It is important to point out that increasing the size and scope of drug-free zones could have the unintended effect of making entire cities within the proximity. The Prison Policy Initiative, a nonpartisan research and advocacy group, conducted a study in 2014 showing that 92 percent of the residents of Bridgeport, Connecticut (roughly 148,000) lived in a drug-free school zone.

“You’re increasing the penalties for crime for an entire city,” said Aleks Kajstura, the author of the study. “You’re no longer steering people away from these specially protected zones. There’s nowhere for them to go.” 

This is a subject that is likely to be debated for years to come as lawmakers wrestle with policies that make the most sense. To be sure, nobody wants drug dealers conducting business near places of learning or child activity, but if policies are disproportionately affecting minorities who typically are not selling drugs to minors, but happen to be near a school–exceptions need to be or perhaps should be considered. It seems this conversation has been started, we will continue to follow the story-line on drug-free school zones in America.

Wednesday, September 21, 2016

Prescription Opioid and Heroin Epidemic Awareness Week

It is important to point out that there is a difference between drug use and drug abuse, albeit a fine line. And, in many cases users are often unaware that they have crossed the invisible boundary between taking a prescription narcotic as prescribed and using the drug in unintended ways. However, it is worth pointing out that once someone moves from use to abuse, dependence has likely set in and breaking free from habit forming narcotics, such as opioids, is extremely difficult.

For nearly two decades Americans have formed an unhealthy relationship and over reliance on prescription painkillers. While the reasons for the ubiquitous prescription opioid use in the United States are varied and subject for debate, it is crucial that effective measures are taken to tailor prescribing practices. The Substance Abuse and Mental Health Services Administration (SAMHSA) released a report that showed that 35 percent of American adults were prescribed painkillers in 2015, The Washington Post reports. When the organization accounted for Americans acquiring prescription opioids from friends, relatives or drug dealers—the figure rose to 38 percent.

If you find it startling to learn that one-third of adults in this country were prescribed opioids, despite multi-agency efforts urging doctors to adopt more discriminatory prescribing practices, rest assured you are not alone. Is it possible that that many people’s pain required the use of highly addictive and potentially deadly narcotics? Sure, but it is also highly unlikely. Thus reaffirming the belief that we have become far too accustomed, as a nation, to having instant pain relief from any level of discomfort.

In 2015, more adults took prescription painkillers than used tobacco products, according to the article. The number of opioids used was greater, even when combining cigarettes, smokeless tobacco and cigars together. The findings come from SAMHSA's annual National Survey on Drug Use and Health.

It is important to talk about the extraordinary prescription opioid use rates in the U.S., and just about everyone can see that our relationship with opioids is untenable and has been for quite some time. Yet, it seems like many doctors are still practicing as if it is business as usual. Many physicians are resistant to having addiction training, being given prescribing guidelines and using prescription drug monitoring programs. Even though as many as 78 Americans overdose on opioids every day in America.

The SAMHSA report could not have been released at a better time, considering that the President has proclaimed this Prescription Opioid and Heroin Epidemic Awareness Week. Throughout the course of the week, the administration is announcing new initiatives and calling on Congress to provide $1.1 billion to fund the efforts.

“During Prescription Opioid and Heroin Epidemic Awareness Week, we pause to remember all those we have lost to opioid use disorder, we stand with the courageous individuals in recovery, and we recognize the importance of raising awareness of this epidemic.”  -- Proclamation by President Obama, September 16, 2016

Thursday, September 15, 2016

Giving Naloxone to Opioid Patients

It could be argued that naloxone is one of the most important medications of our time, given that it has the power to reverse a potentially fatal opioid overdose. With over 70 opioid overdoses per day, most of which are the result of prescription painkillers, the need for expanded naloxone access cannot be overemphasized. More than 2 million Americans who use drugs like oxycodone or hydrocodone meet the criteria for opioid use disorder, there are another 500,000 people abusing heroin. Both of the aforementioned numbers are believed to be lower than the actual prevalence of opioid use disorder in the United States.

In the U.S. there have been a number of efforts made to expand access to naloxone, sold under the brand name Narcan. Now that the Food and Drug Administration has approved a form of the medication that can be administered through the nasal cavity, just about anyone can aid in giving an overdose victim naloxone. What’s more, in many states opioid addicts and their loved ones can acquire the drug from a pharmacy without a prescription, a trend that is expected to continue in the coming months and years. The vast majority of first responders now carry naloxone kits in their car trunks, so that the drug can be administered upon arriving at the scene of an overdose.

Even though the drug is more readily available and easier to acquire, overdoses continue to rob people of their lives. Seeing as prescription opioids lead to the most overdoses, wouldn’t it make sense to prescribe naloxone to patients who are prescribed opioid painkillers? Isn’t it better to be safe, than sorry?

It turns out that patients given opioids may want to have a safety net in case of an emergency. A new study, albeit small, found that most patients taking prescription opioids would be receptive to filling a prescription for naloxone, HealthDay reports. Of the 60 patients prescribed opioids and naloxone that were involved in the study, 82 percent filled their naloxone prescription. Three patients used naloxone to treat an overdose. The research was published in the Annals of Family Medicine.

"Physicians should absolutely consider prescribing naloxone with opioids," said study co-author Dr. Phillip Coffin. 

The findings indicate that more than one-third of the participants reported an improvement in their drug-taking behavior prior to filling the naloxone prescription, according to the article. There were some patients who said having the drug at hand changed how they dosed their opioids and how often.

"Some providers have voiced concern that prescribing naloxone to patients could result in negative patient reactions," Coffin added. "We found that this was rare. Even among the few with a negative initial reaction, all but one patient still wanted naloxone again in the future."

Tuesday, September 13, 2016

Addiction: A New Role Model

We all need role models in life. Having someone to look up to can help guide one on their course to potential success. Millions of adolescent American boys look up to professional baseball players, hoping that one day that they will be able play ball on national television. Professional athletes inspire people around the globe to hold on to their dreams, and with hard work they, too, can inspire others in the same way when they reach adulthood.

The most popular sport in the world is f├╣tbol, known in the U.S. as soccer. While the sport's popularity has steadily increased in the country over the years, men’s soccer is far less popular than the other American sports, such as baseball, basketball and football. However, when it comes to women’s soccer, the case is something altogether different, partly because the women’s team has brought home several World Cup championships and Olympic gold medals. There are a number of great professional female soccer stars in this country, some names you may be familiar with are Abby Wambach and Mia Hamm. A significant number of adolescents girls not just in this country, but around the globe, aspire to play in a World Cup one day, like Wambach and Hamm.

Abby Wambach retired recently, after helping the U.S. women’s team win gold at the 2004 and 2012 Olympics and the 2015 Women’s World Cup. At the age of 36, Wambach’s list of accomplishments is deep, including being named the FIFA World Player of the Year in 2012. Since her retirement, Abby continues to be an advocate for the sport in a number of ways, and she fights for good causes as well.

A new memoir of Wambach was released today, called Forward. As you might expect, soccer is a major point in the publication, but it turns out that the memoir makes public some information that many people did not know about the beloved soccer star. Wambach’s new book discloses that she has battled with prescription drug and alcohol abuse over the years, a problem that had a negative impact on the icon’s life, FC Yahoo reports. Her problem finally caused the retired athlete to hit a “bottom,” when she was arrested for driving under the influence in April. And like many others who have found their way to recovery, a traumatic life event is often needed.

“That night getting arrested was one of the best things that has ever happened to me. Because if I don’t get so publicly shamed and publicly humiliated, I don’t think I wake up,” said Wambach. “I think I was asleep for a lot of years. Asleep to the pleas from my family and friends, and even myself, to get help. So that night I was humiliated enough to wake up.” 

Addiction, more times than not, will continue unchecked for years before a person makes the choice to seek help, and change their ways. So many people who have problems with drugs or alcohol are able to function in professional settings, and in Wambach’s case, perform remarkable sporting feats. Because of this, many people will continue to abuse mind altering substances, saying to themselves ‘I pay the bills and feed my family, how bad could I be?’ It is a line of thinking that keeps people trapped in the cycle of addiction for far too long.

“I was stubborn and I was in denial,” Wambach said. “I didn’t want to face the truth.” 

Well, now Wambach is facing the truth and has been sober since April, according to the article. Hopefully, her addiction and new found recovery will inspire adolescent girls who are struggling with drugs and alcohol—find the courage to reach out for help. Even in retirement, she can be a role model for mental health issues that affect millions of young people around the globe.

If your teenage daughter has been struggling with drugs and/or alcohol, please contact Cottonwood  Tucson. Our 90-day Sweetwater Program for teen girls ages 13 - 17 was created to help girls and their families recover from addiction.

Friday, September 9, 2016

Opioid Epidemic: A Call to Action

opioid epidemic
When people talk about the American opioid epidemic today, much of the discussion is in regard to the rise of heroin use across the country in recent years. Additionally, powerful opioid analgesics, such as fentanyl and carfentanil, have been finding their way into batches of heroin—making a dangerous drug even more dangerous. It is a trend that has led to a spike in overdose deaths, as heroin users are using the deadly admixtures without any knowledge of the presence of the powerful analogs.

To be sure, heroin and heroin mixed with drugs like fentanyl are worth having a conversation about, especially with regard to preventing people from using such cocktails. However, it is important that we do not lose sight of the root of the opioid epidemic, prescription painkillers. It is widely agreed upon that the rise in heroin abuse is directly tied to more than a decade of over prescribing opioid analgesics to patients with practically any level of pain.

Pain patients across the country were given, and continue to be prescribed drugs like OxyContin (oxycodone) and Vicodin (hydrocodone). In many cases, even patients who survive an overdose on prescription opioids, still continue to receive the drugs that nearly killed them after the fact. And despite these alarming prescribing practices, primary care physicians are—by and large—resistant to being instructed on how to prescribe safely, undergoing opioid addiction training and using prescription drug monitoring programs.

Here are some of the numbers from the U.S. Centers for Disease Control and Prevention (CDC):
  • As many as 1 in 4 patients receiving long-term opioid therapy (in primary care settings) struggle with opioid addiction.
  • There was a 300 percent increase in opioid prescription sales since 1999, without an overall change in reported patient pain.
  • In 2013 alone, 249 million opioid prescriptions were written in the United States—enough to give every American adult a bottle of opioids.
If you have been following this blog, or the national news, then it is likely that you are aware of some the efforts made by both lawmakers and health experts to end the crisis we face. You are probably also aware that without doctors doing their part, it is fairly unlikely that the problem will go away on its own. Recently, in an attempt to encourage, or rather plead with doctors to change their ways, U.S. Surgeon General Vivek H. Murthy, M.D., M.B.A. wrote a letter to his fellow physicians. You can read the letter in full below:

Dear Colleague,

I am asking for your help to solve an urgent health crisis facing America: the opioid epidemic. Everywhere I travel, I see communities devastated by opioid overdoses. I meet families too ashamed to seek treatment for addiction. And I will never forget my own patient whose opioid use disorder began with a course of morphine after a routine procedure.

It is important to recognize that we arrived at this place on a path paved with good intentions. Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely. This coincided with heavy marketing of opioids to doctors. Many of us were even taught – incorrectly – that opioids are not addictive when prescribed for legitimate pain.

The results have been devastating. Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed. Now, nearly 2 million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C.

I know solving this problem will not be easy. We often struggle to balance reducing our patients’ pain with increasing their risk of opioid addiction. But, as clinicians, we have the unique power to help end this epidemic. As cynical as times may seem, the public still looks to our profession for hope during difficult moments. This is one of those times.

That is why I am asking you to pledge your commitment to turn the tide on the opioid crisis. Please take the pledge. Together, we will build a national movement of clinicians to do three things:

First, we will educate ourselves to treat pain safely and effectively. A good place to start is the TurnTheTideRx pocket guide with the CDC Opioid Prescribing Guideline. Second, we will screen our patients for opioid use disorder and provide or connect them with evidence-based treatment. Third, we can shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing.

Years from now, I want us to look back and know that, in the face of a crisis that threatened our nation, it was our profession that stepped up and led the way. I know we can succeed because health care is more than an occupation to us. It is a calling rooted in empathy, science, and service to humanity. These values unite us. They remain our greatest strength.

Thank you for your leadership.

                                                  Vivek H. Murthy, M.D., M.B.A.
                                                  19th U.S. Surgeon General
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