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Drug News

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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Last November, 60 percent of the citizens of California voted “Yes” on the controversial Proposition 47, also known as the Safe Neighborhoods and Schools Act, which reduces non-violent drug-related crimes from felonies to misdemeanors.

The new law affects “non-serious, nonviolent crimes” unless the defendant has prior convictions for murder, rape, certain sex offenses or certain gun crimes.

Also, anyone already serving a sentence now can be re-sentenced. That means defendants in drug treatment as a result of a Drug Court sentence can now walk out of treatment without finishing it and not suffer the consequence of a felony conviction on their record. Until now, Drug Court-ordered treatments had to be completed to have the felony conviction scrubbed.

The effects of Prop. 47 are being felt throughout most of the state. And in Southern California’s affluent Orange County (OC), the new law is creating a massive stir. Since the vote was enacted, OC officials say admissions at government-funded treatment centers have dropped significantly. They blame Prop. 47, which has effectively neutered Drug Court magistrates who can no longer entice many drug offenders to enter treatment with the reward of a scrubbed felony conviction when they graduate.

And in spite of the fact that the county just added another $1.7 million to its already generous $9.4-million public detox and rehab fund, Court officials say they’re “bracing for a big drop in applicants.”

Paul Shapiro, the OC’s Superior Court coordinator of collaborative courts, told the OCRegister that Drug Court was averaging about 50 evaluations each month during 2014 until Prop. 47 passed in November. Since then, Shapiro said, there were only 25 evaluations in November, and this dropped to 15 in December. Shapiro said there’s still some hope that the decline will let up or reverse.

But other professionals told the paper that if addicts are referred to the program, they may decline treatment because there’s no threat of a felony record. Without that motivation to enter treatment, “a lot of people will just wait until they hit another barrier,” said Cathy Stills, executive director of a treatment center called Hope House. “This might be an overdose, a car crash, or something more serious.”

Proponents of Prop 47 say there are other means and methods to encourage drug dependent offenders to enter treatment than “threatening them with a felony.” They should be treated like any other drug addict with life problems, and dealt with on a personal level, they say.

But Superior Court Judge Matthew Anderson, who’s been presiding over the Drug Court program for 15 years, says otherwise. According to the OCRegister, Anderson dismissed the notion that society needs to readjust how it helps addicts. He said Drug Court already did that when it was introduced nationally more than 20 years ago. “We’ve been dealing with drug addiction for decades, and before drug courts came into being, the criminal justice system was struggling mightily,” Anderson said.

Anderson pointed to the Drug Court’s successes: Of the 1,911 people who’ve graduated since it began in Orange County in 1995, 28.8 percent were arrested again – far lower than the 74.4 percent recidivism rate cited for those who didn’t complete drug court. “It’s unfortunate that a program as prominent and successful as Drug Court could be placed at risk here,” Anderson told the OCRegister.

It seems that Southern California is the most natural region for something like Prop. 47 to pass. And that’s especially true in Orange County, the home of Disneyland, the World Series-winning Anaheim Angels, the Stanley Cup-winning Anaheim Ducks and a whole slew of Fortune 500 companies.

OC is also home to more than 3 million Southern Californians who appear to enjoy a generally higher standard of living than many of their 4 million neighbors just to the north in the City of Los Angeles. Orange County denizens tend to think they have everything a little better than their fellow citizens to the north – things like less urban blight and lower unemployment, better jobs and housing and newer, better schools for their more-privileged kids.

Orange County and Los Angeles County together make up the Los Angeles metropolitan area. With a population of 10 million, it’s the second-largest metropolitan area in the US, after the New York metropolitan area with 24 million residents. And even when Orange County and Los Angeles County are combined with their three neighboring counties – San Bernardino, Riverside, and Ventura counties, which makes up what’s known as Greater Los Angeles, totaling over 18 million people – Southern California still comes in behind New York as far as population goes.

If you drive the 50 or so miles of colorful coastal highway from Long Beach in L.A. south to San Clemente, where OC ends and San Diego begins, you pass through a half dozen or so of the wealthiest beach communities in the country – Seal Beach, Huntington Beach, Costa Mesa, Newport Beach, Laguna Beach, Dana Point (famous for surfing) and at the southernmost point, San Clemente, where President Richard Nixon’s ‘Western White House’ entertained world leaders, and where the former President lived after his retirement. Nixon was an OC boy himself, born and raised in Yorba Linda.

Yet in recent years, in spite of being perceived as a Mecca for the privileged Southern California lifestyle, OC has been plagued by a rising tide of drugs and addiction. Like the rest of America, the county has had to cope with the soaring crime rates and overdose deaths and other family tragedies that accompany widespread drug abuse.

And if you tune in to Southern California radio or TV news you’re going to hear this sprawling, ethnically diverse region called “The Southland” – fabled home to countless millionaires whose handsome, smiling faces you see every day on TV and in the movies. Southern California breeds a feeling, an attitude, that you’re in the best of all possible places – the best opportunities, best weather, best beaches, best surfing and, of course, wall-to-wall movie stars.

Two things are clear from all this. First, higher living standards, great surfing and movies stars offer no protection from the negative personal and societal effects of drug and alcohol abuse. In fact, in some way, actually encourage drug abuse.

And second, since Prop 47 has passed, the people of OC and the entire state of California need to come up with something pretty quick to deal with the soaring numbers of law-breaking drug offenders, something as effective as Drug Court, or hopefully, even better.

Meanwhile, here at Novus Medical Detox Center, we’re still hard at work helping our patients recover their lives after falling prey to drugs and alcohol. And according to the smiles on their faces and what they tell us, we’re doing one heck of a good job. If you or anyone you care for is having a problem with drugs or alcohol, don’t hesitate to give us a call. We’re always here to help.

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Categories: Drug News, Drug Overdose #

Emergency responders such as police, ambulance and ER personnel, and the city, state and county administrators that pay their bills, aren’t happy with a recent price jump for nasal naloxone – the widely-used, life-saving drug that can reverse an opioid overdose in a matter of seconds.

Amphastar Pharmaceuticals, Inc., the only U.S. maker of naloxone in convenient single-dose nasal delivery cartridges, has suddenly more than doubled the wholesale price, averaging $13 to $15 per cartridge to as high as $30 to $35.

The company is now impressing Wall Street, according to the financial news, and its shareholders are delighted with the company‘s rising stock values. But the price hikes are causing a big problem for the legions of emergency personnel from coast to coast who depend on nasal naloxone to save lives.

State, county and city health departments are traditionally under-budgeted. But with the recent recession and unemployment rates these past few years, the squeeze has gotten worse than ever. And the price increases are making it especially difficult for the many non-profits across the country that provide nasal naloxone kits to addicts and their families. These street-level, store-front groups are under even tighter financial constraints these days, and they’re on the front lines helping saving lives every day too.

New York’s Attorney General Eric T. Schneiderman wrote a 2-page letter to the Amphastar’s CEO demanding an explanation for what he called the “unacceptable” rise in prices.

Chuck Wexler, the executive director of the Police Executive Research Forum that has urged putting naloxone into every police officers’ hands, told the New York Times that because it’s not an incremental increase, there’s “clearly something going on.”

And Dr. Phillip O. Coffin, director of substance abuse research at the San Francisco Department of Public Health, told the Times that the price hikes “will decrease access” to naloxone.

Naloxone has been around since back in the 1960s and has been a useful but little-known player in the ER. That’s where most overdose victims – the ones who are lucky enough to arrive alive – get another chance at life and hopefully, a new decision to get clean, all thanks to naloxone.

In more recent years, naloxone has been made available in many constituencies to all emergency responders, usually financed by state and local health care and law enforcement budgets. Naloxone kits are also offered to the general public, such as heroin and painkiller addicts and their friends and families, in some places even without a prescription.

In 2011, says the CDC, there were 16,917 prescription opioid deaths and 4,397 heroin overdose deaths – over 20,000 in all. This colossal annual death rate, which dwarfs every kind and type of epidemic since the world-wide 1917 influenza pandemic , will only increase until more funding, not less, is made available for safe and effective opioid medical detox and long-term treatment facilities.

Most heroin and opioid overdose victims who are pulled back from death’s door by the use of a nasal or injected dose of naloxone turn right around and go back to their dangerous habits. After all, they’re addicts, right? And naloxone is only emergency medicine, not heroin detox, not rehab, not addiction treatment by any stretch.

But once you’ve saved a life with naloxone, the seriousness, the impact of that event isn’t lost on the just-saved addict. It should open the door to at least a new discussion, if not a focused intervention, that might lead to treatment and recovery.

Saving a life, any life, is not just worthwhile but essential. And naloxone provides that opportunity hundreds of times a day across America. It seems ethically wrong on every level to deny anyone another chance at life when it is so easily, quickly and inexpensively possible.

Only time will tell if the soaring naloxone prices result in killing more Americans because of a board-room decision to make a killing on the stock market.

If you or someone you care for suffers from an opioid dependence or addiction, please call Novus right away. We’re here to help, and will try to answer all your questions about opioid detox and essential long-term treatment.

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Categories: Drug Facts, Drug Overdose, Heroin #