Dirty Jobs: Pharmaceuticals Collection Program

Wall Street Journal: Obama Administration Loosens Controls on Medication to Ease Opioid Cravings

wall-street-journal-logo-940x350In an effort to expand treatment for opioid addiction, the Obama administration is loosening strict controls of a medication doctors prescribe to ease cravings for heroin and other opioid drugs.

The Department of Health and Human Services says it will now allow doctors to prescribe the medication, called buprenorphine, to 275 patients at a time, up from 100 previously.

The limits were put in place to try to keep tight control of the medication, which addicts sometimes buy and sell on the black market because it prevents painful withdrawal symptoms from heroin and other drugs. Federal officials believed that keeping a tight lid on prescribing would thwart this black-market trade.

To read the rest of the article go here.

The Expansion of Medication-Assisted Treatment (MAT) Services

Health Department Takes the Next Step to Address the Regional Opioid Crisis: The Expansion of Medication-Assisted Treatment (MAT) Services

255-high20def20lchd20logoTo address the growing number of Lake County residents struggling with opioid addictions, the Lake County Health Department/Community Health Center is doubling the capacity of its Medication-Assisted Treatment program. It is expanding treatment to 200 people struggling with opioid addictions through a grant of $325,000 from the Health Resources and Services Administration.

“The expansion of our MAT program is an essential next step in the regional effort to address the opioid epidemic, which has had a devastating impact on local families and their communities,” said Mark Pfister, the Health Department’s interim Executive Director.  “The expansion of this program is imperative to helping people change addictive behaviors for the long-term.”

The population of residents in need of substance abuse services has substantially increased in Lake County in alignment with national trends. In 1998, the county had 30 deaths that were attributed to substance abuse.  By 2010, that number had more than tripled to 92. Opioid related deaths in 2008 were 47 and increased in 2015 to 58. Heroin-related deaths in 2008 were 30 and increased in 2015 to 42. 

For decades, the Lake County Health Department/Community Health Center has been the primary provider of substance abuse services for residents in the county. Its services include screening brief intervention and referral to treatment (SBIRT), in-patient detox and rehabilitation services, outpatient substance abuse counseling, medication-assisted treatment and women’s residential services. It established an Outpatient Substance Abuse program in the 1970s to address a growing population of residents with substance abuse concerns. The program provided both drug-free treatment as well as medication-assisted treatment (MAT) using methadone and Suboxone to treat opioid addiction.

In 2014 the Health Department, in concert with the Lake County Opioid Initiative (LCOI), began an initiative to save people who had overdosed on opioids.  The Health Department’s actions included:

  • Instructing law enforcement officers on how to administer naloxone, a drug that temporarily reverses the effect of an opioid to people who had overdosed, using a train the trainer approach.
  • Securing a donation of $1.4 million of auto-injectable naloxone from Virginia-based kaléo, enough for police officers across Lake County to carry the product in their squad cars. The first save occurred on Christmas day of 2014 and since then there have been more than 90 lives saved. Officers of 39 local police departments as well as the Sheriff’s Office now carry naloxone in their cars.
  • Providing free naloxone training to patients and friends and family members of patients, and to nurses in school settings.

In addition to the increase of treatment slots for the MAT program, the Substance Abuse Program (SAP) at 3004 Grand Avenue in Waukegan has been designated as a Federally Qualified Health Center (FQHC) allowing the Health Department to bill for the services it provides. This is critical to supporting the long term sustainability of the program. The 3004 location will become the Health Department’s ninth health center. Through the HRSA grant and the FQHC designation, the program will be able to:

  • Provide prescriptions for methadone, Suboxone and Vivitrol along with primary care, substance abuse counseling and supportive services
  • Increase medical provider hours
  • Add substance abuse counselors
  • Add a licensed clinical social worker to act as a care manager

The Health Department will continue to provide information and training to providers and members of law enforcement as it increases its prevention efforts in response to this public health crisis. Continuing to educate providers will be critical in curbing the increase in addiction locally, regionally, and nationally.  Countywide collaborations continue to help address the immediate needs of residents and will continue to help shape the agency’s response.  The expansion of MAT would not be possible without partnerships, especially the Health Department’s collaboration with the Lake County Opioid Initiative, Nicasa, and others.  To inquire about registering for the MAT program, call: (847) 377-8120.

By the numbers!

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DEA Increasingly Alarmed Over Illicit Fentanyl and Other Synthetic Drugs

DEA Increasingly Alarmed Over Illicit Fentanyl and Other Synthetic Drugs - Join Together News Service from the Partnership for Drug-Free Kids

The Drug Enforcement Administration (DEA) has become increasingly alarmed over the proliferation of illicit fentanyl and other synthetic drugs, the acting head of the agency told a Senate committee Tuesday.

DEA Acting Administrator Chuck Rosenberg told the Senate Judiciary Committee synthetic drugs pose an unprecedented threat for overdoses and deaths, especially among young people in the United States, Reuters reports.

“The yearly market for illegal non-medical prescription pain relievers is over 11 million people, and if fentanyl is introduced into even a small portion of that overall market, there is a likelihood that overdoses will increase,” Rosenberg said in his testimony to the committee. “Fentanyl and fentanyl derivatives represent the deadly convergence of the synthetic drug threat and current national opioid epidemic.”

Last week the Midwest Medical Examiner’s Office announced that toxicology tests concluded Prince died from an accidental fentanyl overdose. The office did not specify how the drug was taken, or if it was prescribed or illegally made. Fentanyl is an opioid legally prescribed for cancer treatment. It can be made illicitly, and is 25 to 50 times more potent than heroin.

Rosenberg told the Senate committee the DEA is also concerned about synthetic cannabinoids and their byproducts (sometimes sold under brand names such as “K2” or “Spice”). He noted synthetic drug producers modify chemical formulas in search of new psychoactive substances. “Once a new drug is formulated, the Internet and social media are used to market its arrival on the scene, allowing for its fast adoption and use,” he said. Each newly designed drug must be banned separately through a process Rosenberg called “clunky and cumbersome.”

Lake County Opioid Initiative Launches Countywide Substance Abuse Treatment Access Program Through Police Departments

Chief Quote Black“A Way Out” gives individuals an opportunity to seek treatment and recovery; this program has the potential to save and change lives,”  says Lake County, Ill. State’s Attorney Mike Nerheim, who has made the issue his top priority since taking office in 2012.

Today, Law Enforcement officials, health care providers, impacted community members and Cofounders of the Lake County Opioid Initiative (LCOI) announced the launch of the Lake County Opioid Initiative’s “A Way Out” program. This innovative program gives individuals the opportunity to avoid entering the criminal justice system or more importantly, another chance at living a healthy life.

AWOLogo“A Way Out” is a Lake County, Illinois Law Enforcement Assisted Diversion pilot program, designed to fast-track users to substance abuse programs and services. It is available 24 hours a day, 7 days a week at participating police departments across Lake County and it ensures no criminal charges will be sought for those that may be in possession of narcotics or paraphernalia, as long as assistance is sought out by the prospective program participant.

“A Way Out” was developed by the Lake County Opioid Initiative to create additional treatment access points, reduce crime, reduce substance-related harms, re-frame the role law enforcement plays in community safety, and unite the community. For far too long, substance abuse has been stigmatized. Substance abuse is a public health problem that needs to be addressed as such. Lake County Opioid Initiative is committed to developing innovative ways to create positive change in our community as it relates to substance abuse and mental health.

“As an individual in recovery who has been in and out of the criminal justice system, drug court saved my life. But, if I were offered the opportunity to get help before I entered the system, many of the stresses I face today would be off my shoulders so I could focus on recovery,” said Kevin Kaminski who is in recovery.  

Program Overview

By taking advantage of “ A Way Out”, participants and their loved ones are given the opportunity to end the destructive cycle that substance abuse, dependency or addiction has caused in their lives. Participants are given the chance to avoid the biological, psychological and environmental harms and are set on a direct course to recovery. The only requirement of participants is their self-motivation to seek recovery.

The program is set up so that participants will NOT be criminally charged. There is no need to fear arrest or prosecution for seeking participation in this program.

You can find “A Way Out” in just a few easy steps:

  1. Locate a participating police department
  2. Walk in through the main doors
  3. Tell an officer that you are requesting help

“The Lake County Opioid Initiative, First Responders, and Hospitals are doing an extraordinary job of saving the lives of overdose victims in Lake County. The need to connect these individuals and their families and loved ones to treatment and support services is imperative! A Way Out is an innovative program connecting those struggling with a substance use disorder to the treatment they need. Most importantly, they are “intercepted” before they have initial or continued criminal justice system involvement. Because addiction is a chronic disease, people can’t simply stop using drugs for a few days and be cured,” said Bruce Johnson, CEO of Nicasa Behavioral Health Services. “Addiction is a complex but treatable disease that affects both brain function and behavior. It is important to note that no single treatment is right for everyone and people need to have quick access to culturally competent treatment. Most patients will need long-term or repeated behavioral health care therapies combined with medication assisted treatment to stop using and recover their lives. Treatment should include both primary care and mental health services as needed. Staying in treatment long enough is extremely critical. Service providers throughout Lake County can help and they have local as well as nationwide referral networks to connect individuals to treatment.”

Statewide, Illinois has been significantly impacted by the opioid epidemic. A statewide assessment reported that heroin accounted for 54% of drug-related fatalities in 2014 and 55% between January and October 2015. In addition, Lake County has had a total of 83 overdose reversals via Naloxone administration by law enforcement since Christmas Day 2014. The numbers are certainly staggering and concerning. As a result, the Lake County Opioid Initiative has been actively working to reduce overdose deaths and combat addiction.

The Center for Disease Control reported that more persons died from drug overdoses in the United States in 2014 than during any previous year on record. From 2000 to 2014 nearly 500,000 people in the United States have died from drug overdoses. In 2014, there were approximately one and a half times more drug overdose deaths in the United States than deaths from motor vehicle crashes. Opioids, primarily prescription pain relievers and heroin, are the main drugs associated with overdose deaths. In 2014, opioids were involved in 28,647 deaths, or 61% of all drug overdose deaths; the rate of opioid overdoses has tripled since 2000. The 2014 data demonstrate that the United States’ opioid overdose epidemic includes two distinct but interrelated trends: a 15-year increase in overdose deaths involving prescription opioid pain relievers and a recent surge in illicit opioid overdose deaths, driven largely by heroin.

“We are in the midst of an epidemic, here and across the nation.  Far too many lives have been lost and far too many families have been devastated.  This program seeks to help people get the treatment that they seek, without entering the criminal justice system,” said Lake County State’s Attorney Michael G. Nerheim.  “I am confident that it will save lives, reduce crime, and make our community safer.  Beyond that, it is simply the right thing to do.”

The Lake County Opioid Initiative Co-Founders would like to thank the LCOI task force members as well as our partners for the “A Way Out” Program:

  • Advocate Condell Medical Center
  • Advocate Good Shepherd Hospital
  • Northwestern Memorial Health Care (Lake Forest/Grayslake)
  • Vista Health Systems
  • Gateway Foundation Lake Villa
  • Nicasa Behavioral Health Services
  • Lake County Health Department
  • Live4Lali
  • LEAD (Leading Efforts Against Drugs)
  • Lake County State’s Attorney’s Office
  • Phase one participating Police Departments: Grayslake, Gurnee, Libertyville, Mundelein, Lake Forest, Round Lake Beach and Round Lake Park

“We’ve been hard at work in Congress on legislation to help people struggling with addiction, and we’ve made huge progress passing our bipartisan bill Lali’s Law,” Rep. Dold said. “As important, though, is making sure that local resources are available to those who need them.  ‘A Way Out’ will save lives by giving those in-need access to treatment and a chance at recovery.”

Important FAQ’s

Who is not eligible to participate in “ A Way Out?”

We do not discriminate against any individuals who want to participate in “A Way Out”. However, if you have a warrant out for your arrest or are currently being charged with a crime in Lake County, we cannot permit participation. The police department will look into your case and determine the appropriate course of action.

How does/should substance use disorder treatment work?

Please review the National Institute on Drug Abuse’s Principles of Effective Treatment, for information on a recommended approach to the treatment process, and NIDA’s overview on Types of Treatment. We are committed to upholding evidence-based models of treatment through “A Way Out.”

Will anyone know about my participation in “ A Way Out”?

No. This program maintains 100% confidentiality and waivers are signed to uphold this promise.

Can my loved one(s) join me in the process? 

Yes. We provide waivers for you to sign indicating specific details of your loved one’s involvement in your treatment plan based entirely on your preference.

If I become an “A Way Out” participant and relapse after completing treatment, will I be kicked out of the program?

No. Relapse or lapses in sobriety can be part of the recovery process. We do not view them as failures, only indicators that more treatment may be required. According to the National Institute on Drug Abuse, “Relapse rates (i.e., how often symptoms recur) for people with addiction and other substance use disorders are similar to relapse rates for other well-understood chronic medical illnesses such as diabetes, hypertension, and asthma, which also have both physiological and behavioral components. Treatment of chronic diseases involves changing deeply imbedded behaviors, and relapse does not mean treatment has failed. For a person recovering from addiction, lapsing back to drug use indicates that treatment needs to be reinstated or adjusted or that another treatment should be tried.”

For program details, participating police departments, and FAQ’s please visit AWayOutLC.org.

America’s opioid addiction: ‘I ended up selling all my valuable stuff to buy pills’

theguardianlogoOn the outskirts of Kingsport, Tennessee, Kim, a therapist, faces a small group of people sitting in folding chairs. She’s helping them rid their life of illegal drugs.

The attendees are all white and working class, self-described “dirt poor”, and none with college degrees. They have come to spend hours talking of past and present pains, offer each other support, and pee in a cup. If they pass the test, they will get their weekly prescription of Suboxone, an FDA-approved narcotic for opioid addiction treatment. Or as it is called on the streets, “fake heroin”.

Kingsport is where the Appalachians cross into eastern Tennessee. It’s a factory town cut in two by train lines and surrounded by hills. The few parts that are flat are stuffed with shopping malls, themselves filled with franchises. On maps, the area is mostly colored green for national forest, or brown for the hills. But on maps showing drug overdoses in the US it is dark red, the color used for the most deaths.

For the rest of the story go here.

Former FDA head: Opioid epidemic one of “great mistakes of modern medicine”

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Doctor David Kessler, who ran the FDA from 1990 to 1997, doesn’t hold back when talking about the explosion in opioid use in the last two decades.

“This has been one of the great mistakes of modern medicine,” said Kessler, who went on to say opioid addiction in the U.S. amounts to an epidemic. “FDA has responsibility, the pharmaceutical companies have responsibility, physicians have responsibility. We didn’t see these drugs for what they truly are,” Dr. Kessler said.

From 1999 to 2014, sales of opioids quadrupled in the U.S. — and so did the number of opioid-related overdose deaths, reports CBS News’ Jim Axelrod.

“There was a notion that pain was the fifth vital sign, you wanted to relieve pain, that that was essential. You dosed until the pain was alleviated,” Kessler explained.

That, said Kessler, was a costly mistake. Seventy-eight people now die each day from overdosing on painkillers. But the CDC didn’t issue prescription guidelines until this past March. They recommended doctors try over-the-counter pain medications before prescribing more limited quantities of opioids — but did not mandate they do so.

But are the guidelines strong enough? “We’ll see,” said Kessler. “This is an American condition. This is an American disease.”

In the 21 years since OxyContin first came on the market, it has generated more than $35 billion in sales.

“The inappropriate promotion of drugs contributed significantly to this epidemic,” Kessler said. “Because drug companies took a small piece, a sliver of science and widely promoted it as not being addictive. That was false.”

While pill mills are among the most visible signs of the epidemic, Kessler said two-thirds of painkiller prescriptions are written by well-intentioned physicians trying to do right by their patients.

“Everybody has to do better. The CDC guidelines need to be implemented. Pharmaceutical companies need not over-promote. Doctors need to prescribe more wisely in a more limited way.”

“But it’s going to take a societal shift, it’s bigger than any one of those steps, in order to change this epidemic.”

When asked about his responsibility as the head of the FDA, he said the epidemic took hold after he left the agency in 1997, but does admit he should have pushed for stricter prescription practices when he was still in charge.

LINK to the Original Story

Lali’s Law Unanimously Passes House Committee

EP-160229739U.S. Congressman Robert Dold’s (IL-10) bipartisan legislation Lali’s Law today was unanimously approved by the Energy and Commerce Committee of the U.S. House of Representatives. The bill will now head to the House Floor for a vote on passage. Lali’s Law will increase access to the life-saving antidote naloxone throughout the United States. Lali’s Law is named after Alex Laliberte, a Buffalo Grove, Ill. resident and Stevenson High School graduate, who passed away seven years ago from a drug overdose.

“Since we introduced Lali’s Law in February, I’ve been sharing Alex’s story with everybody in Congress, and everyone I’ve talked to recognizes that we must do more to prevent a repeat of this tragedy,” Rep. Dold said. “Getting this bipartisan bill passed unanimously by the committee is a major step toward ensuring that Alex’s lasting legacy includes helping others get a second chance at recovery and saving their families from heartbreak. I’m hopeful that Congress can put aside partisan differences and take action as soon as possible to save lives by passing Lali’s Law.”

Laliberte played sports at Stevenson High School, did well in school and cared about his friends and family, but during his sophomore year of college he began being hospitalized for a mysterious illness. Unknown to his family and doctors, Laliberte had an addiction to prescription drugs and was being hospitalized for his withdrawal. He would stay in the hospital until his symptoms subsided only to leave the hospital and repeat the cycle. Laliberte continued this pattern until he died of an opioid/benzodiazepine overdose a few days before his final exams.

Laliberte’s family, who has since founded substance use and overdose awareness and advocacy organization Live4Lali, partnered with Rep. Dold to introduce Lali’s Law. Chelsea Laliberte, Laliberte’s sister and Live4Lali Executive Director, applauded the progress.

“Alex was a beautiful person with the highest hopes for a productive future. Our lack of education on opioids and harm reduction majorly contributed to his early death. If we had known about naloxone and if it were available then, Alex and thousands of others may still be here for another chance at recovery,” Chelsea Laliberte said. “It’s simple – no one deserves to die from something so preventable as a drug overdose. Knowledge, availability and access is critical. Since Congressman Dold walked into our office to get trained, he has been a champion for this cause. We couldn’t be prouder to partner with such a knowledgable advocate.”

Between 2001 and 2014, there was a three-fold increase in prescription drug overdoses and a six-fold increase in heroin overdoses in the United States. Heroin now takes a life every three days in Chicago’s collar counties and takes more than one life every day in Cook County. Naloxone, however, has proven to be hugely successful as a life-saving antidote. When used, naloxone helps restore breathing that has been stopped by an overdose. In Lake County, Ill., 74 lives have been saved with naloxone since a new program developed by the Lake County Opioid Initiative was introduced equipping first responders with the overdose antidote. With increased access, the World Health Organization predicts naloxone could save another 20,000 lives every year.

“In a little over a year, naloxone has been used by Lake County law enforcement 74 times to save an overdose victim,” Lake County State’s Attorney Mike Nerheim said. “The bottom line is that this product saves lives. The more available it is, the more lives will be saved. The only way to overcome this epidemic is to help ensure that those that struggle with addiction are provided access to quality treatment.”

Lali’s Law creates a grant program that will help states increase access to naloxone. The primary purpose of the grant is to fund state programs that allow pharmacists to distribute naloxone without a prescription. Many states use these programs to allow local law enforcement officers to carry and use naloxone, similar to the Lake County, Ill. program. The bill has significant bipartisan support and was introduced with the help of Congresswoman Katherine Clark (MA-5).

In 2015, the Illinois General Assembly passed a provision also named Lali’s Law in memory of Alex Laliberte. The state bill built upon Illinois’s existing naloxone access law to explicitly authorize trained pharmacists to prescribe anti-overdose drugs to users and family members of those at risk of a fatal overdose. Any layperson over the age of 18 can now be trained to administer and carry naloxone. The bill also provided criminal immunity for healthcare professionals who prescribe naloxone and improved first responder access to naloxone. The intent of the federal Lali’s Law is to give Illinois officials, as well as public health officials in other states, the opportunity to use federal grants to fund changes authorized as part of the state-level Lali’s Law and similar legislation passed elsewhere in the country that will increase access to naloxone.

Rep. Dold is a co-chair of the Suburban Anti-Heroin Task Force and also member of the Congressional Bipartisan Task Force to Combat the Heroin Epidemic.