Resource: Medications to Treat Opioid Use Disorder

nih-nida-logoThis is an overview of a great page on the National Institute on Drug Abuse’s website, which has quite a few links and research around medications for opioid’s.

An estimated 2.1 million people in the United States had a substance use disorder related to prescription opioid pain medicines in 2016.1 However, only a fraction of people with prescription opioid use disorders receive specialty treatment (17.5 percent in 2016).1 Overdose deaths linked to these medicines were five times higher in 2016 than 1999.2 There is now also a rise in heroin use and heroin use disorder as some people shift from prescription opioids to their cheaper street relative; 626,000 people had a heroin use disorder in 2016, and more than 15,000 Americans died of a heroin overdose in 2016.1,3 Besides overdose, consequences of the opioid crisis include a rising incidence of infants born dependent on opioids because their mothers used these substances during pregnancy4,5 and increased spread of infectious diseases, including HIV and hepatitis C (HCV), as was seen in 2015 in southern Indiana.6

Effective prevention and treatment strategies exist for opioid misuse and use disorder but are highly underutilized across the United States. An initiative of the Secretary of Health and Human Services (HHS)7 began in 2015 to address the complex problem of prescription opioid and heroin use. In 2017, HHS announced five priorities for addressing the opioid crisis:

  1. improving access to treatment and recovery services
  2. promoting use of overdose-reversing drugs
  3. strengthening our understanding of the epidemic through better public health surveillance
  4. providing support for cutting-edge research on pain and addiction
  5. advancing better practices for pain management

Effective medications exist to treat opioid use disorder: methadone, buprenorphine, and naltrexone. These medications could help many people recover from opioid use disorder, but they remain highly underutilized. Fewer than half of private-sector treatment programs offer medications for opioid use disorders, and of patients in those programs who might benefit, only a third actually receive it.9 Overcoming the misunderstandings and other barriers that prevent wider adoption of these treatments is crucial for tackling the problem of opioid use disorder and the epidemic of opioid overdose in the United States.

For more go here.

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The A Way Program turns 2 this month

AWO LogoThe Lake County Opioid Initiative (LCOI) is proud to announce that the Waukegan Police Department and the Lake Zurich Police Department have been added as entry points for the Lake County Opioid Initiative’s ‘A Way Out’ (AWO) Program. With these additions, there are now a total of thirteen ‘A Way Out’ police entry points across Lake County.
“The City of Waukegan is very grateful for the opportunity to join this program.  This will be another tool that the Waukegan Police Department will have to combat the opioid crisis and further assist our residents and their families in mitigating the direct and indirect effects of opioid abuse,” said Wayne Walles, Waukegan Police Chief.

395 participants have accessed treatment via the ‘A Way Out’ Program

The eleven police departments currently participating in the program include:

  • Deerfield Police Department
  • Fox Lake Police Department
  • Grayslake Police Department
  • Gurnee Police Department
  • Lake County Sheriff’s Office, Sheriff’s Marine Unit, Sheriff’s Highway Patrol
  • Lake Forest Police Department
  • Libertyville Police Department
  • Mundelein Police Department
  • Round Lake Beach Police Department
  • Round Lake Park Police Department
  • Zion Police Department

‘A Way Out’ is a program developed by the Lake County Opioid Initiative to create additional treatment access points, reduce crime, reduce substance-related harms, and re-frame the role law enforcement plays in community safety. Through the program, people seeking help for their substance use can go to one of the police entry points and request help. The police work with the Lake County Health Department to find appropriate treatment for the individual. Substance use is a public health problem, and this program addresses it as such.

The current participating police departments have helped 395 individuals access treatment since ‘A Way Out’s’ inception on June 1, 2016. The total number of individuals helped into a treatment provider by year are:

  • 60 individuals in 2016
  • 209 individuals in 2017
  • 96 individuals up to May 2018

AWO’s largest residential and outpatient treatment providers are: Gateway Lake Villa, the Lake County Health Department, Chicago Behavioral Health Hospital, and NICASA Behavioral Health Services. Furthermore, AWO is averaging just over 15 participants per month – with September 2017 being the largest served month as 34 participants accessed treatment.

  • Approximately, 78% of AWO’s total placement is to residential treatment programs
  • The average age of the participant is 32.5 years old.

“The Lake Zurich Police Department is looking forward to being able to offer treatment options to those who need them through the ‘A Way Out’ program. This is a vital community care-taking function that the Department is committed to,” said Steve Husak, Lake Zurich Police Department.

The Lake County Opioid Initiative is committed to developing, implementing, evaluating and sustaining a multi-strategy county-wide effort to prevent opioid abuse, addiction, overdose, and death.

In addition to the ‘A Way Out’ program, the Lake County Opioid Initiative has launched other programs to help support citizens impacted by the opioid epidemic. The Police Naloxone Program has saved 262 lives since December 25, 2014. Text-A-Tip, a digital crisis intervention service, has received a total of 17,039 texts since September 30, 2015. Finally, the Lake County Opioid Initiative has collaborated with community leaders to bring prevention education information to parents and students. In the year 2018, a total of five opioid/heroin prevention education programs have been conducted across Lake County.

LCOI also supports a network of prescription disposal boxes in Lake County. Partnerships include: Solid Waste Agency of Lake County (SWALCO); municipal law enforcement, the Lake County Sheriff’s Office, the Lake County State’s Attorney’s Office, the Lake County Health Department, the Lake County Opioid Initiative, and the Lake County Underage Drinking and Drug Prevention Task Force. In the year 2017, over 13,000 pounds of unwanted/unused prescription drugs were collected.

To raise funds to continue accessibility of these programs, the Lake County Opioid Initiative will be hosting its first annual ‘Save a Life’ fundraising event at the Double-Tree by Hilton in Mundelein, IL on September 14, 2018 at 6:30pm.

For more information regarding the ‘A Way Out’ program, please visit www.awayoutlc.org.

Joint State’s Attorneys Letter to the Editor

dh-logo-252x50As state’s attorneys working to counter the devastating effects of opioids in our communities, we appreciated the recent visit of U.S. Surgeon General Jerome Adams to Sugar Grove. We agree with him that the availability of naloxone — the antidote to an opioid overdose — is a key tool to save lives.

In addition, as law enforcement officials, we are committed to aggressively pursuing drug dealers and cartels, promoting drug drop-off programs where people can safely get rid of their old prescriptions, and taking action in court against pharmaceutical companies that have lied about the exceptionally addictive nature of their opioid products.

We also believe that it is time to open up a new front in this fight to save lives. There are two sides of this problem: supply and demand. The above measures focus on opioid supply — but we need to be equally aggressive in reducing demand.

That effort has to start in early childhood. A new report by Fight Crime: Invest in Kids — an organization of which we are all members — has released a report showing that home visiting programs for new and expecting parents can reduce traumatic experiences for children. That, in turn, can reduce the likelihood that children will misuse or become addicted to both prescription and illicit opioids once they become teens or adults.

It is our hope that these voluntary “parent-coaching” programs for at-risk parents — and similar, prevention-oriented early childhood efforts — will be fully funded and protected in the state budget that Illinois leaders are assembling. Investing in prevention oriented programs now will pay dividends in the future. Prevention, starting in kids’ earliest years of life, must be an essential component in our strategies to overcome the grave outcomes of opioid dependency.

Robert Berlin, DuPage County State’s Attorney
Joseph McMahon, Kane County State’s Attorney
Michael Nerheim, Lake County State’s Attorney

Video

Some Drug Disposal coverage from WBBM

To see the video click the link below.

Fighting The Opioid Epidemic At Drop-Off Sites

Drug Disposal Day this Saturday

We’re deeply concerned by the opioid crisis that has impacted families in every corner of the United States. We started by thinking about how to bring Google’s technical expertise to help families combat the epidemic.

Research by the federal government has shown that prescription drug abuse is a large driver of opioid addiction, and that the majority of abused prescription drugs are obtained from family or friends, often from a home medicine cabinet. The U.S. Drug Enforcement Administration (DEA) has found that one way that Americans can help prevent drug abuse and addiction is to properly dispose of unneeded or expired prescription drugs. Yet many people aren’t aware of, or can’t easily find, prescription drug disposal programs in their communities.

Using Google Maps API, our team worked with the DEA to create a locator tool for the National Prescription Drug Take Back Day this Saturday, April 28. The locator tool can help anyone find a place near them to safely dispose of leftover prescription medications.

For the map and the rest of the article click here.

Surgeon general urges Americans to carry overdose antidote

downloadThe nation’s chief doctor wants more Americans to start carrying the overdose antidote naloxone to help combat the nation’s opioid crisis and save lives.

U.S. Surgeon General Dr. Jerome Adams is expected to speak about the new public health advisory Thursday morning at the National Rx Drug Abuse & Heroin Summit in Atlanta.

In a news release, Adams said he hopes those who are at risk — as well as their friends and family members — will keep the antidote on hand and learn how to use it.

“Each day we lose 115 Americans to an opioid overdose — that’s one person every 12.5 minutes,” Adams said in a statement. “It is time to make sure more people have access to this lifesaving medication, because 77 percent of opioid overdose deaths occur outside of a medical setting and more than half occur at home.”

More than 42,000 Americans suffered fatal opioid overdoses in 2016, his statement said.

Naloxone can restore a person’s breathing after it is injected or sprayed in the nostrils, quickly bringing overdose victims back from near-death.

The drug, which, is often referred to by the brand name Narcan, is available over the counter in most states and is regularly used by first responders across the country. A two-dose pack of Narcan is among many options available and the drug is increasingly covered by insurance, according to The Network for Public Health Law, a nonprofit that helps government agencies. As of July 2017, all 50 states have passed laws improving naloxone access, the nonprofit said.

Maine’s Republican Gov. Paul LePage has been one of the most outspoken opponents of the push, arguing that naloxone doesn’t treat addiction and merely discourages people from seeking treatment by essentially offering a safety net if they do overdose.

Proponents, however, argue that greater access to naloxone doesn’t draw people to illegal drug use or foster an addiction.

“To manage opioid addiction and prevent future overdoses, increased naloxone availability must occur in conjunction with expanded access to evidence-based treatment for opioid use disorder,” Adams said in a statement.

Adams’ recommendation for more people to possess naloxone comes a month after Philadelphia’s health department urged residents to do the same.

Prior to his current role, Adams had been Indiana’s health commissioner, where he promoted needle-exchange programs aimed at stemming the spread of diseases among intravenous drug users.

Mike Nerheim on the Opioid Crisis

wbez

Last week, Morning Shift looked at the opioid crisis inside Chicago, specifically how it’s affecting communities of color. Today we’re moving farther out from the city to the “collar counties”. Today we talk with the state’s attorneys from DuPage and Lake counties to find out how the epidemic is affecting those areas, and what’s being done to stem the tide of addiction, overdoses, and deaths.

To listen to the show (20 Minutes)
Click the show logo.

morning shift

SHOW GUESTS were:
Mike Nerheim, State’s Attorney for Lake County
Robert Berlin, State’s Attorney for DuPage County

Walmart, Jewel-Osco take steps to help curb opioid epidemic

Easier disposal of drugs,  over-the-counter sale of OD antidote offered

By Corilyn Shropshire and Lauren Zumbach Chicago Tribune

Walmart and Jewel-Osco are joining the list of retailers making efforts to address the nation’s opioid epidemic.

The world’s largest retailer said it wants to limit abuse of prescription opioids by making it easier for patients to dispose of leftover drugs. Meanwhile, Jewel-Osco is making opioid overdose antidote Narcan available to buy over the counter, the company announced Tuesday.

Walmart pharmacies will provide patients free packets of a product that when combined with leftover medications and warm water in a pill bottle forms a biodegradable gel that can be safely tossed in the trash, as the drugs can’t be extracted for abuse, according to manufacturer DisposeRx. All patients filling new opioid prescriptions at Walmart will receive a packet of DisposeRx when picking up their medications, Walmart said. Patients with chronic prescriptions will be offered one every six months, and existing patients can request a packet at any time at Walmart and Sam’s Club pharmacies.

To reduce the risk of misuse or accidental exposure, the U.S. Food and Drug Administration recommends patients dispose of unneeded medications through official take-back programs. When that’s not an option, the agency recommends flushing certain medicines, including opioids, down the toilet, saying the benefits of getting rid of the drugs outweigh any potential environmental risks.

Walmart believes its solution is easier because “it can all happen responsibly at home,” said Marybeth Hays, executive vice president of consumables and health and wellness at Walmart U.S.

At Jewel-Osco, Narcan, the brand name for nasal spray naloxone, can be bought without a prescription for $157.69 to reverse the effects of opioid overdose. The drug will be dispensed by pharmacists at the patient’s request.

Walmart said it will have naloxone for behind-the-counter sale or dispensing by a pharmacist in all states where it’s legally able to do so, including Illinois, this month. Walgreens and CVS began stocking naloxone in the fall.

The Centers for Disease Control and Prevention and the American Medical Association have recommended doctors consider co-prescribing opioids and naloxone under certain circumstances, such as when patients have a history of substance abuse or also use certain other sedatives.

Narcan is a concentrated naloxone nasal spray that competes with opioids to bind with the same receptors in the brain. It normally reverses the effects of opioid overdose in two to three minutes.

In 2016, 1,946 people died after overdosing on opioids in Illinois, according to the state.

crshropshire@chicagotribune.com

lzumbach@chicagotribune.com

This is what the opioid crisis looks like.

needles.jpgEverett, WA needle cleanup behind a Home Depot.

10 percent revived by Narcan in Mass. died within year, study says

envizo

From the Boston Globe, October 30, 2017One in 10 Massachusetts residents who were revived from an overdose by a fast-acting antidote went on to die within a year, according to research providing stark evidence that merely reversing overdoses will not end the opioid crisis. The study, presented Monday at a medical conference, tracked what happened to thousands of people who received the overdose rescue drug naloxone, commonly known by the brand name Narcan.

Nearly all were successfully revived, but a high percentage later died, most likely because their underlying substance-use disorder went untreated, said Dr. Scott G. Weiner, the study’s lead author and an emergency medicine physician at Brigham and Women’s Hospital. “Naloxone is just a Band-Aid,” Weiner said. “It’s not the cure.” In Massachusetts, state and local health officials have worked to make naloxone widely available, training thousands of laypeople in its use and getting the drug into the hands of first responders around the state.

But Weiner, who directs the Brigham Comprehensive Opioid Response and Education Program, said his research shows that “it’s not going to work if we just give naloxone. We need to get them to the next step.” Hospitals should provide medications to treat addictions and immediate links to ongoing care in the community, but few do, he said.

Dr. Kevin P. Hill, director of the Division of Addiction Psychiatry at Beth Israel Deaconess Medical Center, who was not involved with the study, called the findings important but not surprising. “I might see 10 of these people a day. The fact that one of them isn’t going to be here a year from now says the situation is dire,” Hill said. “What this study shows is that the window of opportunity may only be open for a short period of time. Once somebody has had an overdose, the clock is ticking.”

Weiner presented a summary of his study, which has not been published in a medical journal, at the annual conference of the American College of Emergency Physicians in Washington, D.C. To conduct the study, Weiner and colleagues delved into a trove of data collected by the Massachusetts Department of Health, which enabled them to connect ambulance, hospital, and death records. They examined what became of 12,192 people who were administered naloxone by emergency medical services in the state between July 1, 2013, and Dec. 31, 2015.

Naloxone initially saved most lives; only 6.5 percent died the day they received the medication. But among those who survived the first day, 9.9 percent died within a year. Their median age was 54. Among those who died, nearly 40 percent did so outside of the hospital and more than half passed away in the first month.

The researchers had no information on people who were saved with naloxone by a friend or relative or who declined transport to the hospital after treatment by ambulance crews, and thus may have underestimated the death rate, Weiner said.

‘Once somebody has had an overdose, the clock is ticking.’ Said Dr. Kevin Hill, of Beth Israel Deaconess Medical Center “This study highlights the grim reality that individuals who survive a non-fatal overdose have a shockingly high mortality rate at one year,” Dr. Sarah Wakeman, medical director of the Substance Use Disorder Initiative at Massachusetts General Hospital, wrote in an e-mail.

Wakeman, who was not involved with the study, said that other data from the state show that people who started taking the addiction treatments methadone or buprenorphine after surviving an overdose were half as likely to die as those who did not receive the medications. But only 5 percent of overdose survivors receive those medications, which quiet the cravings for opioids and can pave the way to long-term recovery. “The most tragic aspect to me is the fact that we have this life-saving treatment and yet for logistical and ideological reasons it is not widely available to our most vulnerable community members,” Wakeman wrote. “There is no reason we should have delays in starting life-saving medication.”

At Mass. General, Wakeman said, people who come to the emergency department after an overdose are walked over to the hospital’s Bridge Clinic, where they receive a prescription for buprenorphine, commonly known by the trade name Suboxone. Both the Brigham and Beth Israel are working to make buprenorphine readily available to emergency room patients but face challenges in educating emergency room clinicians and making connections to treatment programs in the community.

“It’s not an easy thing to do,” Weiner said. “People are coming in at all hours. To have these services available right then and there is very important.” A sweeping state law passed last year to address the opioid crisis included a provision requiring hospitals to assess patients who come to the emergency room after an overdose and help connect them to a program. But a Globe survey of hospitals in July found that most patients declined even to be assessed.

Weiner said the law has been ineffective because hospitals rely on social workers instead of recovery coaches, who have firsthand experience with addiction and stay with patients through the often hours-long process of finding a treatment spot. Some patients are merely handed a list of numbers to call.

“That’s not doing anybody a service,” Weiner said. “This is a brain disease. Some people aren’t organized to do this. . . . You need to meet people where they are.”

At the annual conference of the American College of Emergency Physicians, Brigham researchers also presented a separate naloxone-related study. Dr. Scott A. Goldberg, an emergency medicine physician at the Brigham, and colleagues found that untrained bystanders are willing and able to administer naloxone to strangers. In a daylong experiment in Cambridge’s Central Square, researchers asked passersby to participate in a mock overdose rescue on a mannequin. Of the 50 who completed the experiment, only one failed to properly administer the drug by squirting it in the mannequin’s nostril. That person held the device upside down.

“We were really surprised that almost all were able to do this,” Goldberg said. “These are preliminary results,” he added. “By the same token the results were really strong and very encouraging.” After additional study, Goldberg hopes that lock boxes containing naloxone will be routinely placed in public places where overdoses frequently occur.