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Drug News

“It’s not just a spliff round the barbecue”

A survey of a cross-section of lawyers in the UK finds that at least 27 percent of them regularly uses recreational drugs – and dangerously strong and addictive drugs at that.

image001“And a startling 22 percent of barristers that take drugs have indulged while at their chambers’ desk or in the lavatories,” the survey said.

The survey, performed by Legal Cheek, a popular UK legal news journal, said that the favored drugs were not a bit of weed now and then.

“It’s not just a spliff round the barbecue,” said the survey. “Nearly 80 percent of users are keen on class-A gear… the survey shows they have a taste for the hard stuff.”

By ‘class-A gear’ the survey refers to the UK equivalent of Schedule 1 or 2 drugs in the U.S. – opioids, cocaine, crack, methamphetamines – all the most dangerous and addictive drugs.

“Of those currently taking drugs, almost all at least occasionally indulge in class-A. Indeed, 89 percent said they take cocaine or crack, albeit with only 9% doing the latter,” the survey said.

Another 77 percent of lawyers currently taking drugs said they were keen on Ecstasy/MDMA, while 30 percent expressed a ‘retro fondness’ for psychedelics such as LSD.

image003“But marijuana is the most popular drug for lawyers,” said the survey. “Of those currently taking drugs, 93 percent said they enjoyed a spliff. Slightly more than 40 percent go for ketamine, while nearly the same percentage opts for magic mushrooms.

“Strikingly, four lawyers said they were currently at least occasionally enjoying the delights of heroin,” the survey added.

The survey uncovered strong support among UK lawyers for the “complete decriminalization of all drugs.” This opinion of the legal profession “flies in the face of recent government moves to ban a range of so-called legal highs,” according to the survey. “Some 54 percent of lawyers said drugs should be made legal, indicating that many of those in the front line of the ‘war on drugs’ — either prosecuting or defending dealers and users — reckon the battle is lost.”

While more than one lawyer in four was currently taking drugs, the survey found that overall use is “much higher. Nearly 60 percent of lawyers said they had at some stage in their lives taken illegal drugs.”

Another finding suggests that personal wealth influences drug habits. “Perhaps because their remuneration packages are far weightier, those solicitors practicing corporate-commercial law are more likely to take drugs than their counterparts slaving away at general practices,” said the survey. Roughly 56 percent of solicitors currently taking drugs work at commercial law firms, while only 36 percent are at the lower-paying general practices.

Criminal lawyers were “leading the way” in drug abuse – more than 60 percent of those currently taking drugs. Only 22 percent were in common law practices.

image005 These findings are expected to “trigger some dismay” within the UK government, following an announcement to put before parliament the “Psychoactive Substances Bill” that proposes to “prohibit and disrupt the production, distribution, sale and supply of new psychoactive substances in the UK.”

In other words, it’s designed to crack down on what is seen as an increasing public interest in what can be called “legal highs.” The law would ban a wide range of substances, including the sale of nitrous oxide — more commonly known as “hippy crack” or “laughing gas.”

Mike Penning, Minister of State for Policing, Crime, Criminal Justice and Victims, said: “The landmark bill will fundamentally change the way we tackle new psychoactive substances — and put an end to the game of cat and mouse in which new drugs appear on the market more quickly than government can identify and ban them.”

Legal Cheek says that the professional implications for lawyers busted for doing drugs “remain vague.” Regulators apparently approach such situations on a “case-by-case approach.”

“For example,” says Legal Cheek, “the UK’s Solicitors Regulation Authority maintains that even a minor drugs conviction is likely to be considered a breach of rule 1.06 which states ‘you must not behave in a way that is likely to diminish the trust the public places in you or the profession’.

A UK legal authority told Legal Cheek that lawyers caught using drugs may be required to appear before a Solicitors Disciplinary Tribunal, and that any penalty “would largely depend on the circumstances.”

Lawyers convicted in a court of law for a drugs offence, or those reported for abusing drugs to the UK’s Bar Standards Board could get anything from a tap on the shoulder to disciplinary action.

It’s obvious from this survey that a lot of lawyers in the UK are messing around with drugs, and a lot more serious drugs than we feel comfortable with, considering that we put so much trust in our lawyers to protect our interests. What kind of defense can a lawyer put up for us if he’s just taken psychoactive drugs in the court washroom before addressing the judge or jury?

We aren’t aware of any similar survey here in the U.S. We can probably safely assume that there is a similar level of recreational drug use. If you’ve heard of any such survey of American lawyers regarding recreational drug use or any special or other treatment for drug offences in courts, by law societies or by Bar associations, we’d love to hear from you. Maybe we could do a U.S.-based blog on the topic.

Meanwhile, if you or someone you care for needs some expert help for drug or alcohol problems, don’t hesitate to call Novus today. We’ll do our best to explain all your options and help steer you to the best solution.

PICTURE CREDITS: Legal Cheek Ltd.

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When the prescription opioid painkiller Numorphan in pill form was taken off the market 36 years ago in 1979, most people working in addiction treatment breathed a sigh of relief.

Throughout the 1960s and ‘70s, Numorphan (generic name oxymorphone) was seen to be responsible for countless thousands of addictions and overdose injuries and deaths. One of the most commonly abused prescription opioids at the time, the pills were usually dissolved and injected by addicts, many of whom preferred it to heroin.

By 1979, swayed by the wave of oxymorphone addictions and deaths across the country attributable to Numorphan, the FDA and the drug’s maker, Endo Pharmaceuticals, removed Numorphan tablets from the market. The injection and suppository forms of Numorphan were allowed to stay on the market and are still in use today.

So after a deadly 20-year run – it had been approved in 1959 – the pill form of Numorphan disappeared from pharmacy shelves in drug stores and hospitals across the country. Neither the FDA nor the drug maker admitted any connection to the 20-years-long Numorphan epidemic for its removal.

But then, in 2006, for some utterly inexplicable reason (well, on the surface at least) the FDA approved Endo Pharmaceutical’s application to approve the same drug all over again, but under a new trade name – Opana.

The FDA approved both Opana immediate-release and Opana ER for extended release. And then in 2011 the agency approved an “abuse-deterrent” version which, as with similar pills like abuse deterrent OxyContin, abusers are easily defeating the anti-injection properties of and are shooting up Opana like there’s no tomorrow.

The effects of Opana abuse are closer to those of morphine than of other widely abused opioids like OxyContin (extended release oxycodone). According to NYPress.com, OxyContin has “a more stimulating effect” than Opana, which can cause users to fall asleep. Like morphine, Opana’s greatest danger to abusers is the possibility of respiratory depression, the major cause of overdose death.

In addition to the ever-present risk of overdose, sharing needles among a large group of Opana abusers has been found responsible for a massive outbreak of HIV and hepatitis C infections in rural Austin, Indiana, and several Appalachian states.

The new Opana, according to a report in MedPage Today, is also associated with a blood-clotting disorder and permanent organ damage, problems that didn’t occur with injection abuse of earlier version of the drug, Numorphan, or injection of generic oxymorphone.

In addition to the tragedies associated with addiction and spread of disease, there’s another disturbing aspect of this whole Opana thing. When the FDA approved Opana, there already were dozens of other narcotic painkillers on the market. And plenty of them were already complicit in tons of cases of crime, abuse, overdose and deaths.

Why in the world would there need to be yet another opioid painkiller on the market, and one with a proven track record of destruction?

“There certainly didn’t seem to be a need for it,” said James Roberts, MD, a professor of emergency medicine at Drexel University College of Medicine in Philadelphia. As quoted in MedPage Today, Roberts added that “there are plenty of narcotics around for pain relief.”

As we’ve reported in earlier blogs and articles, the Milwaukee Journal Sentinel and MedPage Today collaborated on an investigation of oxymorphone’s “re-appearance” on the market. The investigative reporters observed a pattern of drug approvals over a decade or more, including “cozy relationships between regulators and drug company executives and the use of questionable clinical testing methods allowed by the FDA.”

Throughout the 2000s, records show, there were regular meetings of drug company execs, federal regulators and various academics involved in drug development, under the auspices of an organization funded by pain drug companies. These meetings were the subject of a 2013 Journal Sentinel/MedPage Today investigation. And Opana’s Endo Pharmaceuticals was a frequent attendee.

“The nation’s leading pharmaceutical companies paid entry fees running into the tens of thousands of dollars to attend invitation only conferences with FDA and NIH officials,” the reporters wrote. “Entry to these meetings was secured by annual fees from $20,000 to as high as $35,000. The drug companies that paid those fees were guaranteed the right to send a representative to the annual meetings.” And many of the academics invited to these closed-door meetings were offered payments of about $3,000 to attend.

The ostensible purpose of the meetings has been to come up with ways to fast-track drug trials – cutting back on almost every aspect of testing, even removing test subjects who suffer from side effects from the statistical outcomes.

Another thing: When Endo tried to get Opana approved in 2003, reports MedPage Today, the FDA said the drug didn’t appear effective enough in clinical trials. And there were safety concerns after several pain patients overdosed on the drug and had to be revived with emergency doses of naloxone.

Endo promptly removed anyone from the study who didn’t respond well to the drug, and the FDA approved it.

These approaches “essentially stack the deck in favor of the drug,” says MedPage Today. “More importantly, experts say, drugs tested that way are not likely to reflect what will happen when a drug gets on the market and is prescribed for large numbers of people.”

“It’s in fact cheating,” said Patrick McGrath, PhD, a pediatric pain expert at the Dalhousie University in Halifax, Nova Scotia.

The whole affair reeks of something resembling “pay to play” – not how the FDA is authorized to protect the American public from harm. For its part, the FDA denies any pay-to-play funny business.

But there’s no explanation to justify the approval of yet another dangerously addictive opioid painkiller into a world already awash in painkillers, a world already crushed by a prescription painkiller addiction epidemic.

Meanwhile, doctors are writing close to 800,000 Opana prescriptions a year. And Endo Pharmaceuticals is grossing an average $450 million a year.

And thousands of opioid addicts are finding plenty of Opana to go around, too.

If you or someone you care about is in trouble with drugs or alcohol, call Novus and get the help you need.

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Categories: Drug News, Painkillers #

The small and almost unknown town of Austin, Indiana – population 4,200 – is the center of the worst surge in cases of HIV and Hepatitis C in state history. And the epidemic is stemming entirely from one drug – Opana ER extended release oxymorphone – being injected with shared needles.

Although Opana ER is made in an “abuse deterrent” form, users easily have discovered how to get around that mechanism, said Dr. Jerome Adams, Indiana’s State Health Commissioner. “It’s important that we all understand that just because a drug comes in an abuse deterrent form, that doesn’t automatically make it safe.”

By April of this year, the number of confirmed cases of HIV in southeastern Indiana had climbed to 136 just since November 2014. And this is in a region that historically has seen less than 5 cases a year. Meanwhile, there were six additional preliminary cases, said CDC officials, awaiting confirmation. If positive it would bring the total to 141.

Added to the HIV, co-infection with the Hepatitis C virus (HCV) also has been diagnosed in nearly 85 percent of patients.

The number of HIV cases rang alarm bells all the way from rural Indiana to the CDC. The state’s chief medical consultant told a CDC briefing that roughly four out of five infected patients reported injection drug use, while some of the others reported partners as injection drug users.

In Scott County, where most of the current infections are, fewer than five cases of HIV per year have been reported in the past. “This is the first outbreak of its type that we have seen documented in recent years,” said Dr. Jonathan Mermin, director of the National Center for HIV/AIDS in Atlanta.

Opana ER and shared syringes – a deadly combination

The majority of cases have been linked to dissolving tablets of the prescription opioid oxymorphone (Opana ER or Extended Release) and injecting it using shared syringes.

“We have not seen an outbreak of HIV specifically associated with the injection of oral opiates previously,” Mermin said. And the Indiana State Department of Health said that the injection drug use is “a group activity in this population” – with as many as three generations of a family, along with multiple community members, all injecting together and sharing needles.

Patients have ranged in age from 18 to 57 years and are on average 35 years old. A total of nearly 55 percent are male.

Opana (oxymorphone) has a half-life of approximately 4 hours. That means dependent users begin to feel withdrawal symptoms around that time. “We have heard that folks are injecting from 4 to over 10 times a day,” one official said.

Once crushed, the Opana pills are less “dissolvable” than, for example, heroin. The anti-abuse formula renders it thick and lumpy, requiring a thicker gauge needle to inject. “That is making the sharing of needles an even higher risk activity,” said Health Commissioner Adams, “because you’re being inoculated with higher amounts of HIV virus.”

Needle exchange programs are currently illegal in Indiana, so the only recourse for addicts is to buy or steal new needles, or share used needles. In late March, Indiana Governor Mike Pence (R) signed an executive order authorizing a 30-day needle exchange program, and then was persuaded to extend the program for another 30 days. But needle exchange alone “is minimally effective,” said Adams, “so it must be part of a comprehensive response.”

Indiana has a prescription drug monitoring program that lets health officials give physicians feedback about their prescribing habits, Adams said. The state also is taking “a four-pronged approach to the outbreak” that includes the development of a ‘one-stop shop’ that provides testing, treatment, and follow-up; a needle-exchange program now being offered by the Scott County Health Department; a public awareness campaign and additional HIV testing and treatment at a local health clinic.

“This outbreak that we’re seeing in Indiana is really the tip of an iceberg of a drug abuse problem that we see in the U.S. that is putting people at very high risk for infectious diseases,” Adams said.

And the CDC has released a health advisory to alert healthcare providers and health departments of the HIV outbreak and HCV co-infection. The advisory details how to identify and prevent the spread of HIV and HCV and urges providers to refer patients with substance abuse problems for medication-assisted treatment and counseling.

The principal adverse effects of Opana (oxymorphone) are similar to other opioids. The most common are constipation, nausea, vomiting, dizziness, dry mouth and drowsiness. Of course, it’s highly addictive and can lead to dependence, withdrawal symptoms or overdose.

Here at Novus, we routinely achieve great success treating dependencies to prescription opioids such as Opana ER. If you or a loved one needs help with an opiate dependence, don’t hesitate to call Novus. We’re always here to help.

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Neuroscientists at Washington University School of Medicine in St. Louis have found a way to activate the brain’s pain-relieving mechanism using nothing but light.

Although the research is in the very, very early stages, the scientists say that some day in the future, doctors might be able to treat pain with safe, non-addicting doses of light, instead of the dangerous and addictive opioids in such wide use today.

To understand how the light idea works, we first need to know that all those opioid pills and injections we call “painkillers” are in fact not painkillers at all. They simply flip some switches in our brains and body that activate the body’s own natural pain-relieving system.

The second thing, and really the only other thing we need to know, is this really big news:

According to the research, the body’s pain-relief switches can be flipped on using something other than opioids – in this case, simple light.

How opioids work

When we take opioids, they interact with special receptors in our brains and body called “opioid receptors.” In simple terms, this causes the receptors to initiate biochemical activity in specific chemical pathways, reducing our sensitivity to pain.

So painkilling ability is not contained in the opioid painkillers – our own bodies have that ability. Opioids are just the activators – they flip the switches that turn on the body’s own painkiller system.

We’ve  called these switches “opioid receptors” because opioids have been the only substances known that so quickly and thoroughly switch on the body’s built-in painkilling system.

The question has been: What if some other substance, a non-opioid with no side effects, could be found that will flip these switches – something that is neither dangerous nor habit-forming?

That’s what the researchers at Washington University were trying to find out. And they say they’ve found a very exciting possibility.

The search for alternatives to opioids

Searching  for some other non-opioid substance that might activate the opioid receptors could take, literally, forever. You might never find anything that works. Furthermore, no one is exactly sure how these receptors even work – not in complete detail, anyway. They’re complex, and in fact do a lot more than just regulate pain.

Instead, the scientists decided to try altering the receptors themselves. Perhaps they could make the receptors sensitive to some known substance – one they could select in advance. If it worked, perhaps it could lead to better pain-killing drugs – ones with fewer side effects.

They decided to test the theory using a light-sensing protein called rhodopsin, which senses light in the eye’s retina. If they could somehow combine rhodopsin with opioid receptors, maybe  the receptors would “switch on” with light instead of needing opioids.

In the lab, the scientists were able to merge light-sensing rhodopsin into key parts of opioid receptors, creating new receptors that respond to light in exactly the same way that standard opioid receptors respond to opioids.

They injected these altered receptors into the brains of lab mice, and the results were astonishing. When the researchers shone light on the receptors that contained rhodopsin, the same cellular pathways were seen to become activated. The mice reacted to light in the same way that normal mice – and people for that matter – react to opioids.

The researchers were able to vary the animals’ response depending on the amount and type of light. Different colors, longer and shorter exposures and pulsed or steady light all produced slightly different effects.

Will light or other substances just act the same as opioids?

Opioids can create tolerance, dependence and addiction. They can interrupt normal breathing and function of the central nervous system, called overdose. There are many other side effects.

Will receptors altered to respond to light act the same as the standard ones do with opioids?

The researchers wrote that, in theory at least, receptors tuned to light may not present the same dangers. In fact, they say that someday it may be possible to activate, or deactivate, painkilling nerve cells without affecting any of the other receptors that today’s opioid painkillers trigger – the ones that potentially lead to tolerance, dependence and overdose.

And if pain patients have to have altered light-sensitive receptors injected into their bodies, how will you ever turn them off when the painful condition is healed? Or will people have to spend the rest of their lives avoiding light?

Many unknowns remain, and the questions are fascinating. Hopefully more research will tell us in more detail what the future might hold. The goal is pain control without side effects or dangers. Perhaps science can answer this need and bring an end to the scourge of opioid addiction and accidental death.

Meanwhile, here at Novus, we’re busy dealing with the real world of today – the seemingly endless problems of opioid painkiller use and abuse. And the message is this: Don’t hesitate to pick up that phone and call us if you or someone you care about is troubled by drugs or alcohol. We’re the experts, and we’ll do our level best to answer all your questions and get you the help you need.

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It’s apparently no coincidence that the states ranking lowest for a sense of wellbeing among its citizens are also the states with the highest consumption of mood-altering drugs.

A nationwide Gallup poll, called “The State of the States” poll, has found that Kentuckians, Rhode Islanders and West Virginians consume the most mood-altering drugs, both prescription and illicit, in the nation.

And another Gallup poll has found that the least happy and satisfied people in the nation live – guess where: West Virginia and Kentucky and to a lesser extent, Rhode Island.

Anyone with an interest in drug use and abuse, drug addiction and treatment, should pay attention to these two polls. They reveal a lot about why people get caught up in drugs and alcohol. And they may help point the way to a faster, more successful recovery.

Every drug and alcohol user has his or her own reasons for consuming more than is considered healthy. But the Gallup polls suggest that each person’s story likely includes some of the common depression and lack of fulfillment that is widespread in each state.

And when more people all around you are using so many drugs and alcohol, a tacit sort of agreement about it can begin to filter into the community. The whole take-a-pill-or-smoke-a-joint-when-you’re-feeling-down thing takes on a sort of legitimacy. It breeds and spreads and becomes “the norm.”

Gallup’s “State of the States” survey polled 450 residents from each of the 50 states. It asked how often they took mood-altering drugs or medication, including prescription drugs, “to help them relax” – that is, try to make the rest of your crappy day a little better than it usually is.

West Virginians reported using such substances the most – 28 percent said they took drugs to relax almost every day. Rhode Islanders were next, at 25.9 percent, and Kentuckians were third with 24.5 percent. Alaskans reported the least drug use with only 13.5 percent.

The other Gallup poll found West Virginia and Kentucky two of the lowest-ranking states in terms of a simple sense of wellbeing.

“It’s no coincidence that drug use was inversely proportionate to the wellbeing score,” said lead researcher Dan Witters. In other words, the worse you feel about yourself and life the more drugs you reach for on a daily basis. Witters said that these feelings “increase the chances of drug use.” He pointed to such factors as obesity or even poor workplace performance contributing to a feelings of depression, a sense of low self-esteem and generalized stress – all of which can lead to drug use as compensation.

When a quarter of the population can’t – or won’t try to – get through a day without some sort of chemical assistance, there’s definitely something wrong going on. Whatever that is, these states are also among the highest in the nation for heroin and prescription opioid addictions and overdose deaths, marijuana use among teenagers, and alcoholism.

And when there’s a lot of agreement that taking drugs is an okay thing to do, you tend to see an escalation of it. And before long, it leads to dangerous drug abuse and all the tragic results that go along with that.

According to a Medical Daily report, the Gallup wellbeing survey noted that the keys to more wellbeing are found in “a variety of health, workplace and societal factors, from obesity status to the development of disease, and workplace performance to crime rates.”

Gallup defined the “five elements of wellbeing” as purpose, social, financial, community, and physical health. “States and local communities can use wellbeing concepts and the five elements as focal points in designing initiatives to improve wellbeing,” the Gallup poll said. “It’s likely that if people have a sense of wellbeing in these areas, they’d be less likely to use drugs.”

Here at Novus, we are frequently reminded of the complex personal battles being waged (and won) by our patients, and how these issues relate to the larger areas of their lives – often close to those “five elements” as seen by the Gallup pollsters.

If you or anyone you care for is using mood-altering substances to “relax and just get through the day” don’t hesitate to call us. We’ll do our best to answer your questions and see that you get the best and most appropriate help available.

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Categories: Drug Facts, Drug News #

Florida parents are warned: Dangerous ‘designer drugs’ are on the streets

Two synthetic “designer drugs” are killing people, or driving them to insane behavior, or both, according to reports in the media and from federal law enforcement. But instead of scaring people off because of their unpredictable and dangerous effects, the drugs are gaining in popularity among recreational drug abusers, especially teens and young adults.

The Drug Enforcement Agency (DEA), poison control centers and police forces are warning parents to be especially on the lookout for strange behavior from their kids. The effects of the newer crop of synthetic drugs are usually LSD-like, can be seriously dangerous and their side effects can last for days, perhaps longer. It’s been shown that some people can experience recurring LSD trips even years after taking the drug, and these drugs may cause the same effects.

Two notorious synthetic drugs are called “N-Bomb” and “flakka.” They’re both powerful hallucinogens that lead to extremely dangerous and violent activity. Emergency hospital admissions for synthetic drugs are rising across the country, and treatment usually involves having to manage “extreme agitation” while trying to prevent life-threatening organ damage. These drugs are, quite literally, dangerous poisons.

N-bomb has been marketed as “legal” or “natural” LSD for a few years, and it’s blamed for at least 19 deaths and possibly as many as 30, says the DEA. It was named a “Schedule 1” highly dangerous drug last November and is now illegal. N-bomb mimics the effects of LSD, but in much more erratic and unpredictable (and more dangerous) ways.

Patients admitted to emergency wards for N-bomb poisoning “require heavy sedation to calm aggression and violence as well as external cooling measures to treat hyperthermia, or overheating of the body,” according to a report in Medical Daily.

N-Bomb, is a relatively new synthetic drug from the “NBOMe” class of drugs, from whence it got its street name. NBOMes were originally developed for psychiatric drug purposes to map serotonin receptors in the brain. Today they’re one of the most frequently abused designer psychoactive substances. N-Bomb is sold as blotter paper, powder or liquid that can be ingested, snorted, or inserted rectally or vaginally, says the DEA.

Flakka is all over South Florida and is spreading like wildfire

The other drug, called flakka, is so new it hasn’t been assigned to a drug schedule. It can’t be seized as an illegal substance yet, and sellers can’t be busted for drug dealing. Flakka is made from the same type of chemicals that are used to make “bath salts,” a notoriously dangerous hallucinogenic with potentially fatal side effects.

Drug cops say flakka looks a little like crack cocaine or meth and has a unique “sweaty” odor.  It is actually a form of crystal meth, usually made in overseas labs and sold over the Internet. Flakka can be swallowed, snorted, injected, smoked and easily concealed in electronic cigarettes or a vaporizer. It’s being sold on the streets of South Florida and spreading northwards. It’s in Texas and Ohio too, and cops say it’s only a matter of time before it spreads across the country.

A report in the Miami Herald, quoting from a police report last week, says a Miami man high on flakka proclaimed himself Thor, the Norse God of War, attacked a police officer and attempted to have sexual relations with a tree. The man was first seen running naked through a Brevard County community. The man was acting completely crazy and at first could not be subdued. When an officer tried to use a Taser, the guy pulled the electric probes out of his body and just punched the officer and tried to stab him with the cop’s badge. It took enormous effort to subdue the crazed victim of flakka psychosis.

Medical Daily reports that a man ran out of his Miami house last month after smoking some flakka, stripped his clothes off and screamed violently while police chased him. It took five officers to bring the man down. Police said he exhibited the same kind of super-strength that users of crystal meth often have. He was suffering from the hallucinations and paranoid delusions so often seen in people high on flakka.

CBS news reported recently that a man stoned on flakka was arrested for trying to break down a police station door, another man high on flakka was found naked and armed with a gun on a rooftop, and a third man, trying to climb a fence, slipped and impaled himself with a foot-long spike. This is a dangerous and terrible drug.

Jim Hall, an epidemiologist at the Center for Applied Research on Substance Use and Health Disparities at Nova Southeastern University, describes flakka as creating a “bizarre high” which will probably “sweep the nation if it isn’t stopped.”

“We’re starting to see a rash of cases of a syndrome referred to as ‘excited delirium,’” Hall told CBS News recently. “This is where the body goes into hyperthermia, generally a temperature of 105 degrees. The individual becomes psychotic. They often rip off their clothes and run out into the street violently and have an adrenaline-like strength, and police are called and it takes four or five officers to restrain them. Then, once they are restrained, if they don’t receive immediate medical attention they can die.”

Similar effects are caused by another new drug in Florida and elsewhere called butane hash oil, also known as BHO or Budder. People put it in room vaporizers and become intensely high, with unpredictable results. Budder is the active marijuana ingredient, THC, mixed with other harmful chemicals. And police say its use is increasing.

DEA says N-bomb revenues are helping finance terrorists

N-bomb, which has already caused many deaths, may be helping finance terrorists. The DEA says it’s been acting on credible reports that revenues from synthetic drugs like N-bomb are ending up in the pockets of terrorists and criminal organizations in the Middle East. A DEA crackdown has led to 200 warrants, 120 arrests and the seizure of $20 million in cash.

“[N-bomb] is a dangerous drug, it is potentially deadly, and parents, law enforcement, first responders, and physicians need to be aware of its existence and its effects,” says Dr. Donna Seger, professor of clinical medicine and medical director of the Tennessee Poison Center. “The recreational use of synthetic (designer) psychoactive substances with stimulant, euphoric, and/or hallucinogenic properties has risen dramatically in recent years.”

Seger adds that the quality control of these street drugs is nonexistent. Misjudging a dose could lead to significant toxicity, with such symptoms as hypertension, rapid or irregular heartbeat, hyperthermia, dilated pupils, agitation, aggressive behavior, delirium, hallucinations, seizures, and even renal failure or coma.

Here at Novus, we help patients overcome dependence and addiction to alcohol and drugs of all kinds. We don’t see people on synthetic designer drugs as a rule, but their capacity to create dependence and addiction has already begun to surface here and there across the country.

If you or someone you know has been experimenting with synthetic drugs like N-bomb or flakka, we strongly urge you to confront this problem right away. These are very dangerous drugs because their side effects are extremely unpredictable and are potentially lethal.

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Categories: Drug Facts #

A troubled Marine who overdosed and died in a VA psych ward is only one of many cases of overdose in recent years. But the VA assured the committee in March that the rampant opioid prescribing has begun to ease off and other measures are being taken.

The Veteran’s Affairs has come under the gun after a damning report by the Center for Investigative Reporting on opioid prescribing at a VA hospital in Wisconsin found a 14-fold increase in oxycodone pills prescribed.

The Center found opioid painkillers prescribed at the Tomah VA Medical Center soared from 50,000 hydrocodone pills in 2004 to 712,000 pills in 2012. There was apparently no significant increase in the number of patients – just in the number of oxycodone pills prescribed per patient.

Veterans also told a reporter that opioid use was so rampant at the hospital that the soldiers gave the place the nickname “Candy Land.”

When a 35-year-old Marine Corps veteran died of an opioid overdose while in the hospital’s psych ward last August, it was only the latest in a long string of heartbreaks for veteran’s families going back many years.

Numerous reports from the VA Inspector General (IG) over the past five years say veterans are dying from medication overdoses across the country. Whistleblowers have also alerted the IG several times about dangerous opioid and benzodiazapine prescribing practices – a particularly deadly cocktail.

Tests not being done, leaving patients at risk

Yet in spite of the deaths, whistleblower warnings and the IG’s official reports, routine drug tests to monitor narcotics uses and abuses are still not being performed in the nation’s VA hospitals or among the many thousands of outpatients receiving medications.

And according to the reports, doctors are even prescribing medications to patients they have not even seen in person. Although this is a violation of written VA policy, one would think it’s a violation of basic ethical medical practice anywhere.

And just a couple of weeks ago, a former pharmacist at the Tomah VA told the committee she was “discouraged by higher-ups” from performing drug tests, in contravention of VA guidelines.

Noelle Johnson, who was fired from that facility and now is employed as a VA pain management specialist in Des Moines, said pharmacists at Tomah were discouraged from testing patients for drug use for fear of what “prescribing physicians might learn.”

Johnson said she was told that if the tests were negative, it could indicate the patient wasn’t taking their meds and were instead maybe selling them. And if the tests were strongly positive, it could “suggest overuse or abuse” and the VA could be held liable “when something unfortunate happened.”

“I believe that this is the point of urine drug testing, to substantiate use and misuse of high-risk medications for the safety of veterans and the public,” Johnson told the committee. “What happened to the doctors’ oath of ‘First Do No Harm?’”

VA is taking steps, says spokesperson

Dr. Carolyn Clancy, the VA’s interim Under Secretary for Health, told the committee that the VA has gotten the message and is taking steps to remedy the situation. Clancy said that the best way to curtail prescription drug abuse and overdose is to avoid prescribing addictive medications like fentanyl, hydrocodone or oxycodone. She said that several VA programs are in place and already working to reduce the number of prescriptions and subsequent “accidental deaths.”

“Chronic pain management is challenging for veterans and clinicians,” Clancy told the Committee. “Opioids are an effective treatment but their use requires constant vigilance to minimize risk and adverse effects.”

Clancy said a program to educate physicians on the VA’s narcotics prescription guidelines was introduced in three areas in 2013 and has been adopted by about a third of the VA’s health regions. It’s already bringing about reductions in the number of prescriptions, and also beefing up appropriate testing and tracking of patients, she said, and the VA will expand the program to include all its medical centers.

Another program, Clancy said, is called the Opioid Safety Initiative, also started in 2013, and is also helping reduce the numbers of opiate prescriptions. Since 2012, the number of patients receiving opioids has declined by 13 percent, she said, and those using opioids and benzodiazepines together — a cocktail that can have fatal consequences if taken incorrectly — has dropped by 24 percent.

Clancy also told the Veteran’s Affairs Committee about VA’s Overdose Education and Naloxone Distribution program (OEND) which provides emergency kits containing the opioid overdose antidote drug naloxone to veterans on high doses of opiates or who use multiple medications to manage pain.

Naloxone program saving lives

Since its introduction last May, she said, more than 2,400 kits have been provided to such veterans, their families or friends. And at least 41 veterans have been rescued from overdoses since the OEND program began.

Naloxone instantly reverses the respiratory depression that kills the victims of opioid overdose. It’s administered by nasal spray or injection, and is easy enough for anyone with a few minutes of instruction to use. It’s normally carried in ambulances, is used at all ERs, and is carried by many police forces across the country, since cops are very often on the scene of overdoses even before the EMT people.

The overuse of opiates for pain management and the resulting widespread dependencies, abuses and addictions to these highly addictive medications is not just a VA problem. Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, recently called the overprescribing of opioids “a national epidemic.”

Frieden said the prescribing practices of America’s physicians is the primary source of the epidemic. But the VA’s physicians went to all the same med schools as the rest of America’s doctors. So we shouldn’t expect anything different at the VA.

The Institute of Medicine says a hundred million Americans are suffering from chronic pain on any given day. Yet medical schools devote less than two days – maybe 8 to 10 hours tops – to  the treatment and management of pain, including chronic pain. There are only a few thousand actual certified pain specialists in the entire country – just a drop in the bucket.

Senator says he’s “angered and disgusted”

Ranking committee member Sen. Richard Blumenthal (D-CT) said he is “angered and disgusted” that so little appears to have been accomplished to address overprescribing since the committee’s last session on the same topic.

“I want this hearing to be different, to produce action,” Blumenthal said. “This epidemic has been with us for years and years and that’s one reason for my anger and astonishment that the VA system isn’t better than it is.”

Here at Novus, we’re also looking forward to a time when opioid prescribing in and out of the military is under control. Meanwhile we’re here 24/7 helping people who have fallen victim to prescription opioids. If you or someone you care about is suffering from the addictive effects of prescription pain meds, don’t hesitate to give us a call. We’re always here to help.

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Categories: Drug Facts, Drug Overdose #

The number of babies born in Florida dependent on opioids like heroin and hydrocodone has increased more than 10-fold since 1995, says a new report from the Centers for Disease Control and Prevention (CDC). And the soaring 10-fold increase “far exceeds the three-fold increase observed nationally,” the report said.

The CDC added that only 10 percent of the mothers who used opioids during pregnancy received, or were even referred for, treatment for drug dependencies.

Babies exposed to addictive prescription or illicit drugs taken by a mother during pregnancy can suffer a wide range of physiologic and neurobehavioral side effects. The condition, called Neonatal Abstinence Syndrome (NAS), is terribly sickening and painful for newborns, and can be life threatening if not treated correctly.

CDC was helping Florida streamline patient information system

In February 2014, the Florida Department of Health asked the CDC to help assess the accuracy and validity of the state’s hospital inpatient discharge data linked to birth and infant death certificates. The state wanted to know if the information could correctly monitor NAS in the state, and if it accurately describes the characteristics of infants with NAS and their mothers.

This new CDC report only focuses on the second objective – describing maternal and infant characteristics.

The CDC studied the data for 242 confirmed cases of NAS during a 2-year period (2010–2011) identified in just three Florida hospitals. The conclusions were extrapolated to apply to the whole state.

97 percent of NAS babies had to be admitted to ICU

“Infants with NAS experienced serious medical complications with 97.1 percent being admitted to an intensive care unit,” the report states, “and had prolonged hospital stays for a mean duration of 26.1 days.”

In other words, many, if not most of those 242 newborns spent nearly a month in the hospital being weaned off the addictive drugs. And the story would be the same at any of the rest of the state’s several hundred hospitals. The cost of such treatment can reach six figures for each infant.

“The findings of this investigation underscore the important public health problem of NAS,” the CDC said, “and add to current knowledge on the characteristics of these mothers and infants.”

Partly as a result of the CDC study, as of June 2014, NAS became a mandatory reportable condition in Florida – that is, diagnosed cases must by law be reported to the Florida Department of Health.

Mothers involved in cases of NAS need intervention

As to the lack of care offered or provided to drug-using mothers, the CDC says intervention should be increased, not just for NAS mothers but for all women of child-bearing age. Such intervention is needed to:

  • Increase the number and use of community resources available to drug-abusing and drug-dependent women of reproductive age
  • Improve drug addiction counseling and rehabilitation referral and documentation policies, and
  • Link women to these resources before or earlier in pregnancy.

Only 1 percent of mothers used heroin, 99 percent prescription drugs

Once again, more evidence of America’s appalling abuse of prescription drugs: Over 99 percent of drug-exposed mothers were using prescription drugs, not street drugs like heroin.

While the whole country is up in arms about “the heroin epidemic,” less than 1 percent of NAS mothers had used heroin during pregnancy. Here’s the whole drug-use-while-pregnant picture:

  • Less than 1 percent of mothers were reported to have used heroin during pregnancy
  • Approximately 82 percent of mothers were using one or more prescription opioids, such as oxycodone, morphine, hydrocodone, hydromorphone, tramadol or meperidine
  • 59.9 percent were using methadone and 3.7 percent using buprenorphine – both drugs commonly used for treatment of opioid dependence
  • 40.5 percent were using benzodiazepines such as Xanax, Klonopin, Lorazepam / Ativan and Valium (diazepam)
  • After benzos came tobacco at 39.7 percent, marijuana at 24.4 percent and cocaine at 14.1percent
  • Reasons reported for opioid use included illicit (nonmedical) at 55 percent, drug abuse treatment at 41.3 percent and chronic pain treatment at 21.5 percent
  • The reason for opioid use during pregnancy was unknown for 10.3 percent of NAS mothers
  • Only 10.3 percent of mothers apparently received or were referred for drug addiction rehabilitation or counseling during the infant’s birth hospitalization.

Over 99 percent of NAS was from opioids

  1. Nearly all infants with NAS – 99.6 percent – were exposed to opioids in utero, which definitely highlights the widespread issue of opioid use in women of childbearing age.
  2. Women face many barriers in accessing any type of substance abuse treatment, which might also be reflected in the finding that only 10.3 percent of mothers of infants with NAS received or were referred for drug addiction rehabilitation or counseling during their infant’s birth hospitalization, despite a high percentage of mothers with positive urine toxicology screen results.
  3. Because abstinent detoxification during pregnancy is dangerous to the fetus, medication assistance is recommended as the standard of care for pregnant women with opioid addiction.
  4. Comprehensive medication assistance coupled with correct prenatal care reduces the usual complications associated with untreated opioid use disorder.

Bottom line, even one baby born dependent on drugs is one too many. Here at Novus, we deeply care about the situation, and take care to help all our female patients of child-bearing age understand the vital need for all pregnancies to be drug-free of any addictive or other toxic substances.

If you know a woman of child-bearing age who is dependent on opioids, please help them to come off these drugs before pregnancy occurs.  Have them call Novus, or contact us yourself and we will help.

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Categories: Drug Facts, Opiods, Painkillers #

Zohydro ER, the extended release hydrocodone prescription painkiller that caused a firestorm when the FDA approved it over a year ago, has finally been released in a new abuse-resistant formulation.

An extended release painkiller contains 5 or 6 times as much opioid as a single-dose pill. It’s intended to be released slowly over many hours after you take it.

But addicts want to get all that opioid in a single hit by crushing it into a powder and snorting it, or mixing it in a liquid and shooting it up with a syringe.

The new Zohydro ER is made using something called BeadTek technology, which is designed to deter abuse “without changing the release properties of hydrocodone when Zohydro ER is used as intended,” says the announcement from the pill’s maker, Zoegenix, Inc., of San Diego, CA.

The company claims that, when the new pill is crushed and mixed into a liquid or solvent, the BeadTek technology turns it into a viscous gel that’s impossible to use in a syringe.

The product label won’t include the abuse-deterrence claim until later in the year after the company finishes “Human Abuse Liability studies” of the pill’s new abuse-deterrent properties and submits the results to the FDA. These findings will affect the wording for the label.

Original FDA approval ignited a firestorm

Zohydro ER, the first pure hydrocodone extended release pill ever, with no abuse deterrence at all, was asking the FDA for approval to bring it to market.

We already knew that hydrocodone was the most abused prescription opioid in America – even mixed, as it always was with acetaminophen in drugs like Lortab, Norco and Vicodin.

Also, the country had already endured the horrors unleashed by Purdue Pharma’s OxyContin – a pure oxycodone extended release painkiller that triggered a decade of addictions, overdose deaths and ruined lives across the country.

Purdue Pharma had come out with an anti-abuse version of OxyContin back in 2012, and it was seen as making a difference. Well actually, sending most addicts on to heroin or over to the various other painkillers like hydrocodone, hydromorphone and others.

But now, here came Zohydro ER, pure hydrocodone with no built-in deterrence. It looked to everyone concerned like OxyContin all over again.

The FDA’s approval of the original Zohydro ER ignited a firestorm of adverse reaction in the media, letters to the FDA from institutions all over the country, even demands that the head of the FDA resign. Criticism came not just from the public, but also from a wide cross-section of the medical profession. The consensus was that Zohydro ER offered nothing but more danger of abuse and deaths from overdose, since there was no real need seen for more opioid painkillers.

Not only did the FDA approve Zohydro ER as-is in the face of all this criticism, it did so against the direct recommendation of its own medical, scientific and research advisory committee to disapprove the drug and keep it off the market.

DEA classifies hydrocodone as even more dangerous

Last year, not too long after the FDA approved the original Zohydro ER and after more than a decade of hemming and hawing, the Drug Enforcement Administration (DEA) finally rescheduled hydrocodone-containing meds as Schedule II drugs, up from Schedule III.

In plain English, this meant it was finally acknowledged that hydrocodone is just as dangerous as oxycodone, which has always been Schedule II.

We at Novus were pleased to report on the DEA rescheduling of hydrocodone, since we see the harm that hydrocodone has brought to so many of our patients. Hydrocodone is among the top killer drugs in America.

And believe it or not, 99 percent of all hydrocodone is consumed right here in America. The rest of the world just isn’t interested, because there are plenty of other prescription opioids to choose from. And many, if not most pain management specialists, even here in America, question the need for more.

Also, late last year, Purdue Pharma came out with its own anti-abuse hydrocodone extended release painkiller, with the company’s abuse-resistance technology built in. Called Hysingla ER, it’s abuse-deterrent technology “discourages” chewing, crushing, snorting or injecting.

Even a legitimate prescription can lead to hydrocodone dependence

Let’s not forget that there are many medical patients who take legitimate, doctor-ordered hydrocodone or other opioids for pain, who then become dependent on the drugs – abuse-resistant or not. These people need to be carefully weaned off those drugs, but some of them actually become addicted.

So here we are, in a country awash in prescription opioid painkillers (there are dozens) and countless thousands of prescription opioid painkiller addicts, and we have not one, but two new ones. And doctors often find themselves stuck between a rock and a hard place – wanting to help their patients, but at the same time wanting to avoid over-medicating with seriously addictive painkillers.

There is a movement afoot among pain specialists and researchers to find solutions for mild and moderate pain other than opioids and opiates. Some approaches are already being used, but it’s rough going when the American public is demanding opioids, and nearly all regular doctors know very little about alternatives. Perhaps this will be the subject of a future blog.

Meanwhile, here at Novus, we’re known far and wide for our medical breakthroughs in opioid detoxification, including hydrocodone. Our proprietary opioid detox protocols result in much more comfortable detox experiences for our patients, and even improves patients’ overall health. Patients often remark as they’re leaving, “I haven’t felt this good in years, even before I got into trouble with (substance abuse).”

If you or someone you care for has a problem with opioid dependence or addiction, don’t hesitate to call us. We are always here to help.

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crying-baby The rate of babies being born in Canada’s province of Ontario suffering from opioid withdrawal has soared to more than 15 times what it was 20 years ago.

Newborn withdrawal, called neonatal abstinence syndrome (NAS), grew in Ontario from about 0.3 per 1,000 live births in 1992 to 4.3 per 1,000 in 2011 – in all, nearly 3,100 infants born suffering the same frightful withdrawal symptoms that adult addicts go through when kicking opioid dependence.

And newborn babies don’t have whatever tiny bit of comfort there might be in at least knowing why they’re in so much pain and that it will eventually be over.

Two major facts point at a most disturbing situation:

  • Nearly all the mothers were dependent on prescription opioids like oxycodone, hydrocodone and morphine from their physicians, not street drugs like heroin or illicit opioid painkillers.
  • Most of the increase occurred in just the past 5 years – over 1,900 babies, 2/3 of the total 3,100.

The past 5 years has seen negative publicity at an all-time high about the dangers of overprescribing opioid pain killers. Canadians should have expected their doctors to back off from the unhealthy rates of prescribing opioids that occurred through the 1990s and early 2000s. But it appears some Canadian doctors didn’t get the memo, as the saying goes.

The research, published in the Canadian Medical Association Journal, says women were prescribed opioids both before and during pregnancy. Principal researcher Dr. Suzanne Turner, a physician at St. Michael’s Hospital in Toronto who specializes in providing obstetrical care for women with addictions, said the study suggests that many women were prescribed opioid painkillers to treat pain prior to or during their pregnancies, and then at some point a dependence or an addiction was identified and they were switched to methadone.

Current medical opinion holds that methadone withdrawal is a little easier on newborns. Although switching one dependence (painkillers) for another (methadone) hardly sounds like treatment for most people. But in the case of pregnancy, an opioid- dependent mother-to-be must not attempt to detox because it is dangerous to the fetus.

“That’s really important because we know that methadone is actually good in [such a] pregnancy because it stabilizes mom, and babies are more likely to be born at term and at high birth weight and healthy.”

Of course, Turner’s use of the term “healthy” doesn’t mean that these newborns don’t face a week or two of methadone withdrawal hell, unless they are carefully weaned from a replacement drug such as morphine.

“The concern to me is how do we address the fact that they were prescribed opiates prior to pregnancy and is there something we can do at that stage to prevent the transition to addiction and then requiring methadone,” she asked. “This is a treatable condition. If the babies get morphine, which is typically the standard of care, they’re not in withdrawal and then we slowly wean them off that dose of morphine over time.”

Addiction to prescription opioids now exceeds heroin addiction as the most common reason to offer methadone as a “treatment.” Turner says that preventing addiction by using alternative pain-relief therapies when possible would pay dividends for both mothers and their babies. “It speaks to the fact that doctors need to be aware there is the risk of addiction if women are prescribed opiates prior to pregnancy, and if they’re of child-bearing age, those risks should be assessed.”

Turner added that doctors and other caregivers need to counsel women that using any opioid during pregnancy can lead to NAS. She said this is especially important information for women with addictions because of the uncommonly high risk of unplanned pregnancies.

Here at Novus, we deal with opioid/opiate painkiller dependencies and addictions on a daily basis. If you or someone you care for needs help with opioid dependence, don’t hesitate to call us. We’ll help you find the right solution for your situation.

Image courtesy of arztsamui at FreeDigitalPhotos.net

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