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Support, Don't Punish: How You Can Help End the War on Drugs

June 16, 2014

Support, Don't Punish: How You Can Help End the War on Drugs
Open Society Foundations

June 26 is the United Nations' International Day against Drug Abuse and Illicit Trafficking. Around the world, some governments use the UN's position against drugs to justify policies that include beatings and executions for drug-related offences.

In response, last year demonstrations took place on June 26 in 41 cities around the world—including in London, Paris, Kiev, Tbilisi, Oslo, Mexico City, Jakarta, Bangkok, Kuala Lumpur, Kathmandu, and Nairobi. The aim was to appeal to governments to reform draconian drug laws—which have resulted in mass incarceration, health epidemics, and violence—and to prioritize the public health and human rights of people who use drugs.

Since then, thousands more have taken to social media to share photos as part of this campaign calling on governments to reform drug laws, known as "Support. Don't Punish."

This year, the campaign will be even bigger. Visit supportdontpunish.org to find out how you can organize or participate in demonstrations in your city.

The Changing Face of Heroin Use in the United States

May 29, 2014

A new study published in JAMA Psychiatry highlights a dramatic shift in heroin use over the few past decades. The study found that over the past several years there has been a shift in heroin abuse from low-income urban areas with large minority populations to more affluent suburban and rural areas with primarily white populations. Also of note are the shifts in gender and average age of heroin users, with a larger percentage of female users and a higher average age among all users in the 2000s compared to the 1960s. Below you can read a Washington Post article summarizing the study and the full study can be accessed in full on the JAMA Psychiatry website.

The dramatic shift in heroin use in the past 50 years: Whiter, more suburban
The Washington Post - May 28, 2014

There are plenty of recent signs of heroin's move away from cities into the suburbs and rural areas. Vermont Gov. Peter Shumlin (D) even devoted his entire 2014 state of the state address to what he labeled a "full-blown heroin crisis" after the state saw treatment for the drug increase by 250 percent since 2000.

Now a new study in JAMA Psychiatry underscores just how dramatically heroin abuse has shifted away from predominately minority men living in cities. Compared to 50 years ago, heroin users today are older, live in nonurban areas, and are almost evenly male and female. Perhaps most strikingly, these users probably came to heroin after taking a prescription opioid, the study shows.

Theodore Cicero, vice chairman of research at the Washington University School of Medicine, analyzed survey responses of patients in a treatment program spanning 150 publicly and privately funded centers across the country. Some participated in further interviews for the study.

The shifting demographics are quite dramatic, according to Cicero's research:

  • While 82.8 percent of heroin users in the 1960s were men, about an equal rate of men and women are now seeking treatment.
  • The rate of heroin users seeking treatment who are white increased from just above 40 percent in the 1960s to 90.3 percent by 2010.
  • And the mean age of those seeking treatment increased from 16.5 years old in the 1960s to 22.9 years old in 2010.

How people come to use heroin has also greatly changed. In the 1960s, more than 80 percent said heroin was the start of their opioid use. In the 2000s, though, that had reversed dramatically, with 75 percent reporting they used a prescription opioid before turning to heroin.

Early data from the current decade shows that trend is starting to reverse, with heroin becoming more and more the first opioid of abuse. People who had past or current opioid use but indicated heroin was their primary drug overwhelming said they preferred the high heroin gave them (98.1 percent), and that the drug was cheaper and easier to obtain (94 percent) than prescription opioids.

Continue reading at The Washington Post...

Suboxone Treatment Directory

May, 19 2014

Suboxone Treatment Directory

Today we are launching the the Suboxone Treatment Directory. The directory is based off the listings in the Buprenorphine Physician and Treatment Program Locator maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA). As many of the listings there are out-of-date, during the past few months I have carefully combed through the entries to try and remove those that no longer exist and correct instances where contact information has changed.

The directory includes listings for both treatment programs and physicians who prescribe buprenorphine (Suboxone, Subutex) to individuals addicted to an opiate drug for the purpose of maintenance therapy or detoxification. The listings are grouped by state and include contact information for each physician or treatment program, including the address, phone number, and website if applicable.

All treatment programs and physicians listed in this directory offer treatment with buprenorphine. Some locations may offer other mental health or addictions services in addition to buprenorphine treatment. A minority of the programs listed in the directory may only utilize buprenorphine in inpatient detoxes and do not offer an outpatient buprenorphine maintenance program.

Publication: Opioid overdose prevention and response in Canada

May 6, 2014

The Canadian Drug Policy Coalition recently released a policy brief titled Opioid Overdose Prevention and Response in Canada. Consulting with experts who work in front-line overdose prevention program across Canada, the Coalition developed this brief to identify policy changes that can save lives. The policy brief can be accessed in PDF format on the Canadian Drug Policy Coalition's website at drugpolicy.ca.

Across Canada, far too many people are dying from drug overdoses. Deaths related to overdose due to opioids, whether used medically or non-medically, have risen sharply and are now the third leading cause of accidental death in Ontario (OHRDP 2013 Environmental Scan). Drug overdose is not confined to one group of people but can affect anyone, including people taking prescribed opioids.

The tragedy is that many of these deaths could have been prevented with measures such as training, increased availability of naloxone (an emergency medication that reverses the effects of opioids,) improved efforts to encourage people to call 911 during an overdose event, and better prescribing practices. The purpose of this policy brief is to discuss the multi-jurisdictional policy barriers that hinder the scale-up of opioid overdose prevention and treatment initiatives in Canada.

This brief provides an overview of the scant available data on drug overdoses in Canada and discusses key initiatives and policy changes that could mitigate the high number of injuries and deaths amongst people who use opioids. We close by offering recommendations to both the federal and provincial governments. This brief can be used to advocate for changes to the policy context of overdose. Readers interested in implementing overdose prevention programs are directed to an emerging set of excellent Canadian resources on this issue.

-excerpt from the CDPC policy brief Opioid Overdose Prevention and Response in Canada

HHS leaders call for expanded use of medications to combat opioid overdose epidemic

April 24, 2014

A commentary published in the New England Journal of Medicine describes that the current medications used to treat opioid addiction (methadone, buprenorphine, or naltrexone) are currently underutilized in addiction treatment services and discusses ongoing efforts by major public health agencies to encourage their use. The authors of the commentary include leaders from the National Institute on Drug Abuse (NIDA), the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

HHS leaders call for expanded use of medications to combat opioid overdose epidemic
National Institute on Drug Abuse - April 24, 2014

A national response to the epidemic of prescription opioid overdose deaths was outlined yesterday in the New England Journal of Medicine by leaders of agencies in the U.S. Department of Health and Human Services. The commentary calls upon health care providers to expand their use of medications to treat opioid addiction and reduce overdose deaths, and describes a number of misperceptions that have limited access to these potentially life-saving medications. The commentary also discusses how medications can be used in combination with behavior therapies to help drug users recover and remain drug-free, and use of data-driven tracking to monitor program progress.

The commentary was authored by leaders of the National Institute on Drug Abuse (NIDA) within the National Institutes of Health, the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Medicare and Medicaid Services (CMS).

"When prescribed and monitored properly, medications such as methadone, buprenorphine, or naltrexone are safe and cost-effective components of opioid addiction treatment," said lead author and NIDA director Nora D. Volkow, M.D. "These medications can improve lives and reduce the risk of overdose, yet medication-assisted therapies are markedly underutilized."

Research has led to several medications that can be used to help treat opioid addiction, including methadone, usually administered in clinics; buprenorphine, which can be given by qualifying doctors; and naltrexone, now available in a once-a-month injectable, long-acting form. The authors stress the value of these medications and describe reasons why treatment services have been slow to utilize them. The reasons include inadequate provider education and misunderstandings about addiction medications by the public, health care providers, insurers, and patients. For example, one common, long-held misperception is that medication-assisted therapies merely replace one addiction for another – an attitude that is not backed by the science. The authors also discuss the importance of naloxone, a potentially life-saving medication that blocks the effects of opioids as a person first shows symptoms of an overdose.

The article describes how HHS agencies are collaborating with public and private stakeholders to expand access to and improve utilization of medication-assisted therapies, in tandem with other targeted approaches to reducing opioid overdoses. For example, NIDA is funding research to improve access to medication-assisted therapies, develop new medications for opioid addiction, and expand access to naloxone by exploring more user-friendly delivery systems (for example, nasal sprays). CDC is working with states to implement comprehensive strategies for overdose prevention that include medication-assisted therapies, as well as enhanced surveillance of prescriptions and clinical practices. CDC is also establishing statewide norms to provide better tools for the medical community in making prescription decisions.

"Prescription drug overdoses in the United States are skyrocketing. The good news is we can prevent this problem by stopping the source and treating the troubled," said co-author and CDC director Tom Frieden, M.D., M.P.H. "It is critical that states use effective prescription drug tracking programs so we can improve prescribing practices and help get those who are abusing drugs into treatment."

Continue reading at National Institute on Drug Abuse...

In Effort to Fight Overdoses, Staten Island Officers Will Soon Carry Heroin Antidote

April 18, 2014

More and more we are seeing first responders (other than paramedics) being equipped with and trained to use naloxone. In January it was reported that police in New Jersey would begin carrying naloxone in the form of a nasal spray, and yesterday it was announced that police and firefighters in the New York City borough of Staten Island will be doing the same. Putting naloxone in the hands of first responders such as police and firefighters is important, as often they are the first ones to arrive at the scene of a drug overdose.

In Effort to Fight Overdoses, Staten Island Officers Will Soon Carry Heroin Antidote
The New York Times - April 17, 2014

Police officers across Staten Island will soon be equipped with and trained to use a nasal spray that reverses the effects of a heroin or opioid pill overdose, the authorities said on Thursday.

The move, expanding a pilot program in the borough, is part of a broad national push to get the lifesaving medication, naloxone, into the hands of emergency workers amid what federal authorities have called an epidemic of opioid overdoses.

New York City paramedics, who have advanced training, have carried the drug for four decades. Now emergency medical technicians and firefighters, who, along with the police, are often the first to be dispatched to medical calls, will also carry the drug, the Fire Department said.

In recent years, the city has seen surges in the amount of heroin seized and in fatal overdoses from the drug. On Monday, the authorities seized 44 pounds of heroin, worth approximately $12 million, from two apartments in the Washington Heights neighborhood of Manhattan serving as stash houses. Deaths from heroin increased 84 percent between 2010 and 2012, and followed alarming rises in overdoses from prescription pain medications citywide in recent years.

The expansion of the pilot program into a regular part of police work on Staten Island underscored the scope of the crisis in the borough, which has seen the city's highest rates of fatal overdoses from both heroin and prescription opioid abuse. In the past few months, officers in one police precinct in northern Staten Island used naloxone to save three people in the throes of an overdose. (Because the medication only works on heroin-like drugs, a person overdosing from a non-opiate drug died despite receiving naloxone from officers.)

"The victim was snoring very loudly, what's called a death rattle," said Officer Daniel Keating, recalling his experience in February administering the drug with two other officers. After two doses, Officer Keating said, "he came to, and then the E.M.S. took over, and he survived."

At a news conference in the Richmond County district attorney's office, the police commissioner, William J. Bratton, thanked the officers for the example they provided to the borough's three other precincts. All Staten Island officers will be trained to use the drug by the end of next month, he said.

Continue reading at The New York Times...

FDA approves naloxone auto-injector device Evzio

April 6, 2014

Virginia-based Kaléo Pharma has received FDA approval for a naloxone auto-injector. Evzio can be administered by family members or caregivers to rapidly deliver naloxone to reverse an opioid overdose. Naloxone has long been used as an antidote for opioid overdoses and is often distributed to users of opioid drugs through needle exchanges and other locations in several countries worldwide. The FDA fast-tracked the approval of Evzio under its expedited priority review process which is used for drugs that treat serious medical conditions or fill an unmet medical need.

FDA approves device to combat opioid drug overdose
The Washington Post - April 3, 2014

In a move aimed at stemming the tide of deaths caused by the nation's prescription drug epidemic, the Food and Drug Administration on Thursday approved a new device that would allow family members or caregivers to administer emergency medication to combat an overdose.

The product, Evzio, rapidly delivers a dose of naloxone, a long-used antidote to overdoses of a powerful class of painkillers known as opioids, which include legal drugs such as Vicodin and OxyContin, as well as illicit drugs such as heroin. The treatment would be administered through a hand-held automatic injector that, when activated, gives spoken instructions to the user and is small enough to carry in a pocket.

Federal officials fast-tracked the approval of Evzio — the FDA reviewed its application in less than four months — saying it could play a critically important role in preventing some of the estimated 16,000 annual deaths attributed to prescription drug overdoses, a problem that has grown steadily worse over the past decade.

Opioid overdoses are marked by slowed breathing, extreme fatigue and changes in heart rate. Because victims tend to lose consciousness and fall ill quickly, allowing nearby family members or caretakers to administer naloxone rather than waiting on paramedics or doctors could mean the difference between life and death.

"For years, the lack of a lay-friendly delivery system has made it difficult to make naloxone broadly available to the public and to foster its use in non-medical settings, where it is often most urgently needed," FDA Commissioner Margaret A. Hamburg told reporters Thursday, calling Evzio "an extremely important innovation that will save lives."

Regulators warned that Evzio should not be considered a substitute for medical care, that it works only temporarily to reverse overdose effects, and that it can trigger opioid withdrawal symptoms, including nausea, vomiting, sweating, uncontrollable trembling, and increased heart rate and blood pressure.

Still, the approval of Evzio will for the first time allow people with no medical knowledge to inject the drug into a patient's muscle or under the skin during an emergency by walking them through each step verbally, much like an automated defibrillator.

Family members or caregivers will need to get a prescription for the product ahead of time. But doing so would allow them to have a portable dose of naloxone in an easy-to-use injector about the size of a credit card and the thickness of a cellphone.

"This is an important milestone for the millions of patients taking opioids who are trying to balance pain management with the safe use of opioids, as well as those who are struggling with abuse," Eric Edwards, chief medical officer of Kaleo, the maker of Evzio, told reporters Thursday. "What we've realized is that opioid overdoses do not discriminate...We want to make sure this product is made available to all who could benefit from it."

Continue reading at The Washington Post...

AIDS: Crimean drug users at risk, says NGO

March 21, 2014

Russia's annexation of Crimea could mean losing access to life-saving services for Crimean drug users. Approximately 800 Crimeans currently rely on opioid substitution therapy (OST) such as methadone maintenance treatment, treatments which are prohibited under Russian drug laws. Individuals who depend on OST would have to face harsh withdrawal symptoms if the therapy was to be discontinued abruptly, and many of these individuals are likely to relapse back into using illicit opiates such as heroin.

Russia's repressive drug laws and punitive approach to people who use drugs has meant that Russia now experiences one of the highest rates of new HIV infections in the world. Nearly 80 percent of all HIV cases in the country are due to injection drug use. The Ukraine provides HIV prevention services such as clean needle exchanges, condoms, and rapid testing and counseling for HIV and other STDs. With over 14,000 injection drug users in Crimea, cutting off these life-saving services would mean putting thousands of lives at risk.

AIDS: Crimean drug users at risk, says NGO
AFP - March 20, 2014

More than 14,000 injecting drug users in Crimea risk being cut off from life-saving treatment and services prohibited in Russia, an NGO working to halt HIV spread warned on Thursday.

Most immediately at risk are about 800 Crimeans who depend on opioid substitute therapy (OST), the International HIV/AIDS Alliance said in a statement highlighting a hidden health consequence of the political crisis.

People on OST receive synthetic drug substitutes which are safer than the heroin they replace and are administered under medical supervision, curbing HIV infection through needle-sharing.

"This treatment is prohibited in Russia and current stocks of methadone and buprenorphine on the Crimean peninsula will only last for another few weeks at most," said the alliance.

"With the blocking of highways that connect Crimea to the mainland, getting medical supplies through is challenging and there are concerns that a major public health crisis will arise as a result."

Once treatment is cut off, OST recipients will go into withdrawal and many are likely to revert to their old, unsafe drug habits, the British-based group said.

Contrary to Ukraine, where drug addicts have access to HIV prevention services like clean needle exchanges, condom distribution and HIV-testing, Russia takes a punitive approach to drug use that the alliance claimed was responsible for one of the highest rates of new HIV infections in the world.

"Injecting drug users represent nearly 80 percent of all HIV cases in the country," said the statement.

OST has been available in Crimea for almost a decade under the political control of Ukraine, which saw the number of new HIV cases among people who inject drugs drop from 7,127 in 2006 to 5,847 last year.

Andriy Klepikov, executive direct of the alliance's Ukraine branch, urged Crimean authorities to intervene.

"Any interruption to harm reduction programming is a disaster for health, human rights and the HIV epidemic in the region," he said.

"We urge the authorities in Crimea to step in and ensure that critical supply chains are not disrupted and lives not put at risk as a result of territorial politicking."

Continue reading at AFP...

Holder: Heroin an urgent 'public health crisis'

March 10, 2014

In his weekly video message, Attorney General Eric Holder called the rise in overdose deaths involving heroin and prescription opiates an "urgent public health crisis." This article from ABC News quotes that between 2006 and 2010, the number of overdose deaths involving heroin increased by 45 percent. The attorney general also supports wider access to naloxone and has urged all first responders to have the medication on hand.

Encouraging wider availability of naloxone is definitely a step in the right direction. But with the continued widespread abuse of prescription opioids and large increases in the amount of heroin overdoses, how much more evidence is needed before the U.S. government realizes that the law enforcement-centered approach of the war on the drugs has been a failure? You can read the full article below and on the ABC News website.

Holder: Heroin an urgent 'public health crisis'
ABC News - March 10, 2014

Attorney General Eric Holder on Monday called the increase in heroin-related deaths an "urgent and growing public health crisis" and said first responders should carry with them a drug that can reverse the effects of an overdose.

The video message posted on the Justice Department's website reflects the federal government's concern about the growing prevalence of heroin and prescription painkillers. The number of overdose deaths involving heroin increased by 45 percent between 2006 and 2010, according to White House Office of National Drug Control Policy.

"Addiction to heroin and other opiates, including certain prescription pain-killers, is impacting the lives of Americans in every state, in every region, and from every background and walk of life — and all too often, with deadly results," Holder said in the message.

His public support for an antidote that could be used to rescue overdosing drug users mirrors the position of the White House drug policy office, which has also urged all first responders to have the medication on hand. At least 17 states and the District of Columbia allow naloxone — commonly known by the brand name Narcan — to be distributed to the public, and bills are pending in some states to increase access to it.

Advocates say Narcan, which comes in a spray and injectable form, has the potential to save many lives if administered within a certain window. But critics fear that making the antidote too accessible could encourage drug use.

Holder said law enforcement is combating the overdose problem, including by cutting off the supply chain that illicitly furnishes prescription painkillers to drug addicts. But he said more work is needed to prevent and treat drug addiction.

"Confronting this crisis will require a combination of enforcement and treatment. The Justice Department is committed to both," he said.

Bill Piper, director of national affairs for the Drug Policy Alliance, a group that advocates against what it sees as "the excesses" of the war on drugs, said in addition to promoting broader access to Narcan, the Justice Department should also back better education about heroin abuse and promote "Good Samaritan" laws that protect from prosecution individuals who call police to report an overdose.

Continue reading at ABC News...

Heroin laced with fentanyl blamed for dozens of U.S. deaths

February 19, 2014

heroin stamp bag fentanyl laced

News agencies are reporting that fentanyl-laced heroin is behind the deaths of over 80 heroin users on the East Coast of the United States in the past month. The spiked heroin is being sold in several states including Maryland, Rhode Island, New Jersey, and Pennysylvania. Fentanyl is an extremely potent opioid with medical doses measured in micrograms (one thousandths of a milligram), meaning even a tiny amount can be fatal even for experienced heroin users. Heroin is often sold in stamp bags — small glassine bags which are branded with different stamps for different batches of heroin. According to Monroe News, heroin found in stamp bags bearing the stamps 'Bud Light,' 'Theraflu,' and 'Income Tax' has tested positive for fentanyl.

Heroin laced with fentanyl blamed for dozens of U.S. deaths
UPI - February 17, 2014

Heroin laced with the synthetic opiate fentanyl is being blamed by officials for more than 80 deaths across the United States in recent weeks.

Officials say there have been at least 37 deaths in Maryland and 25 in Rhode Island, TheAlmagest.com medical news website reported Sunday. Another 22 deaths were reported in southwestern Pennsylvania, the (Jamestown, N.Y.) Post-Journal reported.

Fentanyl, a narcotic used to control chronic pain, is about 80 times more powerful than morphine, doctors say. Ellen Unterwald, director of the Center for Substance Abuse Research at the Temple University School of Medicine, says even a small amount of fentanyl can be fatal.

The Post-Journal noted the Pennsylvania Health Department warned its local medical providers about the recent increase in fentanyl-related deaths.

"This product is being sold as heroin ... and produces an extremely potent opioid effect including coma and respiratory depression," the statement reads. "[This] can overcome the tolerance of chronic opioid abusers."

Michelle Spahn of the Drug Enforcement Agency's Buffalo office told the newspaper authorities can't tell if the fentanyl is pharmaceutical grade or being made clandestinely somewhere in the United States, Canada or Mexico.

The DEA said a fentanyl epidemic between April 2005 and March 2007 left 1,013 overdose deaths in its wake, the newspaper said.

Continue reading at UPI...