lakecountyopioidinitiative

As 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

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.

Everett, WA needle cleanup behind a Home Depot.

From the Boston Globe, October 30, 2017—One 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.

The opioid epidemic has been fueled by soaring numbers of prescriptions written for pain medication. And often, those prescriptions are written by dentists.

“We’re in the pain business,” says Paul Moore, a dentist and pharmacologist at University of Pittsburgh School of Dental Medicine. “People come to see us when they’re in pain. Or after we’ve treated them, they leave in pain.”

Indeed, 12 percent of prescriptions for immediate-release opioids are written by dentists. In 2012, dentists ranked fourth among medical specialties for their opioid prescribing rates, according to data from QuintilesIMS. It has made dentists targets for people “doctor shopping” in order to get opioids.

How Dentists Compare With Other Specialties In Prescribing Opioids

“I have dentures,” said Shawn Bishop, who is recovering from an opioid addiction at Hope House, a treatment center in Boston. “I had went to get some legitimate work done. And I got some Percocet. I realized that by going to another dentist, I could get some more Percocets.”

Bishop, now 59, recounts the times he teamed up with others to play dentists for their opioid pills.

“He would look at our teeth or Mark’s teeth in particular,” Bishop said. “He would look at his teeth and say, ‘Yeah, we need to take this one, this one, and this one.’ And Mark will always say, ‘Well, I can’t do it today. Can we make an appointment for next week?’ And then the doctor will say, ‘Yeah, I need to write a prescription of Percocets.’ He kept bad teeth and toothaches just so he can do that, you know?”

For Bishop and his friends, the enterprise of getting opioid pain pills from dentists grew so routine that, he says, he became a professional at it.

“It was almost like they knew their part to play and we knew ours,” he said. “It was like actors in a little sketch there.”

Massachusetts has taken the lead in trying to reduce opioid prescription abuse. Last year, Gov. Charlie Baker’s office passed a law to prevent drug misuse. Dental schools in the state are also required to teach a set of core competencies that their students are required to meet before graduating. Students will have to demonstrate that they know how to consider nonopioid treatment options.

“At least at the medical school, the dental school, nursing school and pharmacy school level, you don’t graduate from those places without having studied this stuff and understanding both the positives and the negatives associated with using it,” Baker says. “In addition to that, making sure as a condition of relicensure, you’re getting everyone who is writing prescriptions as part of that process.”

Now, after decades of criticizing health care providers for undertreating pain and not prescribing enough pain medication, the pendulum is swinging back. Some dentists are getting back up to speed about alternatives to opioids.

“For most dental pains, the nonsteroidal anti-inflammatory drugs (NSAIDS) —that’s Advil, Aleve, Naproxen — those agents are every bit as effective as one Vicodin or one Percocet,” Moore says. “That’s been shown over and over and over again.”

Third-year students at the Harvard School of Dental Medicine learn how to trim crowns and prep a tooth for a crown. They’re also learning to deal with the aftereffects, studying alternatives to opioids for pain relief.

This next generation of dentists is not only learning about how to prescribe opioids appropriately, but also about how to think about pain differently. At the Harvard School of Dental Medicine, students are learning how to approach pain a world away from opioids.

“You can approach it from opioid therapy, you can approach it from different neuropathy drugs, you can approach from stretching exercises to meditation,” says Kellie Moore, a fourth-year dental student at Harvard. “And just kind of like, exhausting all the options.”

Leaning on different methods of pain treatment can yield mixed success, she says: what works with one patient might not work for another.

Dental students are also rethinking what the goal of treating pain is. “On a scale of 0 to 10, with 10 being the worst, if we can get you to a 4 or 5, could you live with that and still function daily?” says Sam Lee, a fourth-year dental student. “If the answer is yes, then I think it’s important to the patient understand that that’s what we’re going to try to maintain as the new normal for them.”

Mannequin patients are stationed at the Harvard School of Dental Medicine’s Preclinical Lab, ready to have their teeth restored with crowns by a class of third-year dental students.

David Keith, an oral surgeon at Massachusetts General Hospital, agrees. “I think it does us a disservice, making us and the patients assume that they should have a total smiley face and a zero level of pain,” he said. “That’s not the real world. So we take a tooth out. We do a dental implant. You’re going to be sore for a few days, but that doesn’t mean you can’t go to work.”

The changing definition of pain is part of a larger change in the profession of dentistry. And Jeff Shaefer, an orofacial pain specialist who teaches at the Harvard School of Dental Medicine, says the role of the dentist is changing as a direct result of the opioid crisis.

“Dentistry is part of the problem and I think that hurts — that we’ve been overprescribing medication,” he says. “Having a standard regimen to give every patient is not appropriate.”

Nationally, the profession of dentistry is starting to change as well. This summer, the Commission on Dental Accreditation, which sets accreditation standards for all dental schools, ordered all graduates to be competent in accessing for substance use disorder.

But currently practicing dentists may not be so eager for a change to their profession. Keith, who regularly gives lectures to dentists in the state, has heard their complaints.

“There is a reluctance to add that, as there is reluctance to check blood pressure or check a list of medication their patients are on because it adds time to the day,” he said.

http://www.npr.org/sections/health-shots/2017/09/08/549218604/dental-schools-add-an-urgent-lesson-think-twice-about-prescribing-opioids

Notes for the table

• “Non-physician prescribers” include nurse practitioners and physician assistants.
• “General practice” includes specialists in osteopathic medicine, general practice and preventive medicine.
• “Surgery” includes specialists in general, orthopedic, plastic, cardiothoracic, vascular, colorectal, spinal and neurologic.
• “All others” includes specialists in cardiology, critical care, dermatology, endocrinology, gastroenterology, geriatrics, hematology, infectious disease, neurology, obstetrics and gynecology, oncology, otolaryngology, palliative care, pathology, pediatrics, podiatry, psychiatry, pulmonology, radiology, rheumatology, urology and veterinary.