Enough Fentanyl to Kill 26 Million People

Opioid use disorder is a treatable mental illness; those who undergo treatment and commit themselves to working a program of recovery can lead productive lives. While useful forms of treatment are available, many find it difficult to seek help due to the intense cravings typical of opioid addiction. Everything that public health officials can do, must be done, to encourage as many people as possible to seek addiction treatment—the risk of overdose death is notoriously high.

Many of you are probably aware that the likelihood of fentanyl exposure among heroin addicts is exceedingly high. With each year that passes, more and more people succumb to fentanyl exposure, an analgesic that is 100 times more potent than morphine and 50-80 times stronger than average batches of heroin. When people cut heroin with fentanyl, the result is a deadly cocktail. In fact, research shows that fentanyl-related deaths more than tripled between 2010 and 2016.

One of the reasons fentanyl is more prevalent than ever is because cartels in Mexico can synthesize the drug with ease. Drug cartels acquire the necessary precursors from Asia and then chemists south of the border manufacture the hazardous substance. Once in powder form, the drugs is either stamped into pills disguised as highly coveted OxyContin or cut into batches of heroin to boost potency. In either case, opioid users on this side of the border have no way of knowing that the drug they are about to ingest, smoke, snort, or inject contains the presence of fentanyl.

Fentanyl is Everywhere

So just how likely is it that people will come in contact with fentanyl? Highly likely! The drug made the headline once again after a Nebraska State Trooper pulled over a truck hauling 118 pounds of the deadly substance, CNN reports. The U.S. Drug Enforcement Administration (DEA) states that 2 milligrams of fentanyl is a lethal dose; a little math shows that there was enough fentanyl confiscated to kill roughly 26 million people.

"This year is going to be a banner year, a record year in a bad way, in overdose deaths in the United States," said Matthew Barden, an associate special agent with the ‎DEA.

Naloxone is a drug that can reverse the deadly symptoms of an overdose; unfortunately, fentanyl is so potent that it often doesn’t work and people die. When a fentanyl overdose is reversed, first responders often have to give victims multiple doses of the drug. Pharmacies sell naloxone under the name Narcan. Fentanyl is only going to be more prevalent in the coming years. Anyone caught in the destructive cycle of opioid use disorder should seek help immediately and begin working a program of addiction recovery.

 

Southern California Opioid Use Disorder Treatment

Celebrate Hope at Hope By The Sea can assist anyone struggling with an opioid use disorder. We can help you end the cycle of addiction, please contact us today.

Opioid Addiction Report: Declare A National Emergency

There is a good chance that you have been affected by the widespread misuse of opioid painkillers. Either yourself personally, or you have a loved one or close friend who's been touched by the disease of addiction. Right now, there are millions of Americans living with an untreated opioid use disorder. You may have heard tell that the White House appointed a Commission on Combating Drug Addiction and the Opioid Crisis. The hope is to find viable solutions to our nation’s most serious public health crisis.

Solutions are desperately needed, people are dying and many more are meeting the criteria for opioid addiction with each day that passes. Confronting this epidemic has proved to be a serious challenge. While there have been efforts to both assist addicts get help and make it harder to acquire prescription opioids, still around 142 Americans die of an overdose every day.

Last year, Congress approved and President Obama signed into law a couple piece of legislation aimed at putting an end to the epidemic. Legislation that called for funding addiction treatment services, expanding access to the opioid overdose reversal drug naloxone and training doctors to be more frugal prescribers. The Comprehensive Addiction and Recovery Act (CARA) and the 21st Century Cures Act have yet to bear quantifiable proof. Only time will tell. The current administration has placed their trust in the opioid commission to address the epidemic.

 

Opioid Crisis Report

Many addiction experts have eagerly awaited what conclusions the commission would make. This week, the Commission on Combating Drug Addiction and the Opioid Crisis released a preliminary report, according to the Associated Press. Wherein, the first order of business calls for the President to declare the opioid addiction epidemic a national emergency. Report says that roughly 142 deaths each day is "equal to September 11th event every three weeks."

“Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the Executive Branch even further to deal with this loss of life. It would also awaken every American to this simple fact: if this scourge has not found you or your family yet, without bold action by everyone, it soon will.” 

The commission included several recommendations in their report, including:

• Enforcing mental health parity laws, ensuring people get the coverage they need for addiction treatment.
• Equipping “all” law enforcement officers with naloxone.
• Funding federal agencies to develop fentanyl detection sensors.
• Increasing the use of opioid addiction medications, such as buprenorphine.
• Require doctors and other people working in the medical field to get buprenorphine prescribing waivers.
• Facilitate state prescription drug monitoring programs data sharing nationally by July 1, 2018.

The commissioner stated that it will release another report later this fall.

 

Addiction Treatment

Opioid addiction is difficult to recover from, but it is possible. The process usually begins with detox to help you get through the withdrawal process, the pain of which often leads to immediate relapse without assistance. Then followed by residential addiction treatment to teach you how a life in recovery can be achieved, teaching you skills and providing tools to help achieve success. After treatment, a continued program of spiritual maintenance is how one holds on to their recovery for years to come.

If you are ready to take the journey of addiction recovery, please contact Celebrate Hope at Hope by The Sea today.

1 Million Heroin Users in America

Grim news was printed this week, courtesy of The New York Times. And, once again opioids are at the center of the discussion. Preliminary data compiled by the newspaper indicates that drug overdose deaths in America probably exceeded 59,000 last year. Unless something drastic is done soon, this is a trend that will likely continue in the coming years.

People are dying. Opioid use disorder, or opioid addiction is the root of the problem. Yet, in 2017, nearly twenty years into the 21st Century, millions of Americans still struggle to access addiction treatment services. Even when they want help. In rural America, the closest addiction treatment center is sometimes hundreds of miles away. Given that fact that many opioid addicts are at the lower end of the socioeconomic scale, the likelihood of traveling such distances for help is slim to none.

In addition to a lack of treatment options, many addicts still have hard time getting naloxone, the opioid overdose reversal drug that has saved thousands of American lives, and will continue to do so. But, getting the drug without a prescription is still not possible in certain places. Even if one can acquire it, affording the medicine is a whole different story. Perhaps you've heard the news about ever-increasing naloxone prices. Wherever you find demand, you find greed.

 

An Epidemic That Costs Billions

Prescription opioids are still a problem, to be sure. Yet, heroin use has steadily increased in recent years. What’s more, the mixing of heroin and fentanyl has become a common occurrence. Users who don’t know their heroin was mixed with the deadly painkiller are at great risk of overdose death. There are an estimated 1 million people actively using heroin in America today, according to a University of Illinois at Chicago press release. All told, heroin use in the United States costs society $51 billion in 2015. The costs are tied to:

• Addiction Treatment
• Heroin-related Crime
• Imprisonment
• Treating Chronic Infectious Diseases
• Treating Newborns with Neonatal Abstinence Syndrome (NAS)
• Overdose Deaths
• Lost Job Productivity

“The downstream effects of heroin use, such as the spread of infectious diseases and increased incarceration due to actions associated with heroin use, compounded by their associated costs, would continue to increase the societal burden of heroin use disorder,” said UIC pharmacoeconomists, Simon Pickard.

 

The Greatest Cost Is Life

Loss of productivity pales in comparison to the staggering death toll that could be reduced by increasing access to addiction treatment services. The longer one goes without treatment, the greater the chance of an overdose. If you are struggling with addiction to any form of opioids, please contact Celebrate Hope at Hope By The Sea today.

Our highly-trained staff specializes in the treatment of opioid use disorder. The opioid addiction epidemic is the most serious drug crisis the world has ever seen, and putting an end to it starts with treatment.

Reversing Overdose Has A Heavy Price

In a perfect world, opioid addicts would have free-access to the lifesaving drug naloxone. The drug can reverse the deadly effects of an opioid overdose, and one could argue that doctors should co-prescribe naloxone when they write an opioid prescription and community outreach programs should handout naloxone free to heroin addicts who cannot afford to buy it from a pharmacy. Sadly, that is not the world we live in, but some lawmakers in the United States have been fighting to expand access to the miracle drug, which has proved difficult because of price.

If one were looking to buy naloxone, they can expect to pay upwards of $150 for two doses. Certainly, you cannot put a price tag on life, but if you can’t afford the naloxone kit you may lose yours. Lawmakers have received a lot of pressure from addiction experts to reign in the ever-increasing price of the lifesaving drug. This week, experts called on the government to act in The New England Journal of Medicine, according to HealthDay. The experts write:

“Naloxone’s price increase is part of an overall trend of increasing prescription-drug prices for both new brand-name drugs and old, off-patent generics. Public frustration with rising drug prices has led to a number of recent policy proposals, including Vermont’s new legislation requiring companies to justify price increases, California’s attempt to constrain drug payments, and the recently proposed and bipartisan-supported Fair Accountability and Innovative Research Drug Pricing Act. None of the federal or state initiatives expanding naloxone’s availability, however, address the drug’s rising cost.” 

Part of the issue is that there are limited options. An increase in demand for the drug has the expected effect of drug makers seeing an opportunity to increase profit, regardless of the deadly consequence of people being unable to afford the drug. Here are the numbers:

• Hospira (a Pfizer Inc. company) charges $142 for a 10-pack of naloxone —a 129 percent increase since 2012.
• Amphastar's 1 milligram version of naloxone costs around $40—a 95 percent increase since September 2014.
• A two-dose package of Evzio (naloxone) costs $4,500, a more than 500 percent increase over two years.

“The challenge is as the price goes up for naloxone, it becomes less accessible for patients,” said study lead author, Ravi Gupta, a fourth-year Yale medical student. "Taking action now is essential to ensuring that this lifesaving drug is available to patients and communities."

The Naloxone Yo-Yo Effect

It could easily be argued that naloxone, the lifesaving overdose reversal drug sold under the brand name Narcan, is one of the most important drugs ever produced. If it's administered in a timely manner, the life of an opioid addict can be spared from what would have otherwise resulted in an overdose death.

In the United States, practically every first-responder has been trained to administer the drug, in response to the staggering overdose death rates linked to the epidemic plaguing America. Additionally, a number of states have taken certain actions, making it much easier for addicts and their families to acquire the ever important drug—in many cases a prescription is not required for obtaining the miracle drug.

While the United States has the highest overdose death rates in the world, after decades of over prescribing painkillers and a burgeoning heroin market, our neighbors from the North have hardly been spared. In fact, between November 17-23, there were nearly 500 overdoses that required paramedics in the greater British Columbia (B.C.) area, CTV reports. Situations that would usually be considered routine, involving naloxone treatment. However, it turns out that addicts have begun mixing naloxone with their heroin in an attempt to protect oneself from an overdose.

Obviously, the method is far from the right course of action. The act of using an opioid, followed by naloxone, is being called “yo-yoing” or the “yo-yo” effect, according to the article. Heroin causes feelings of euphoria; naloxone reverses those effects by essentially starting a process of drug withdrawal—a real up and down experience. One that is far from pain-free.

In B.C. paramedics are arriving at the scene of overdoses and seeing empty vials of the overdose reversal drug, the article reports. Addicts are getting a false sense of safety from yo-yoing, but Paramedic Sophia Parkinson says that a person who uses naloxone needs to be followed up with by medical personnel, as the effects of the antidote can be fleeting.

Please take a moment to watch a short video on the Yo-Yo Effect:


If you are having trouble watching, please click here.

Naloxone Without a Prescription

In the United States, we face a grave and serious situation with regard to both prescription opioids and heroin use. For far too long an unprecedented number of Americans have been able to access prescription opioids, even in situations where an alternative treatment could be utilized. In the wake of widespread over prescribing, an old drug reemerged on the scene—heroin.

Historically, heroin was thought to be a drug found only in heavily populated urban environments—used primarily among the poor and those of ethnic descent. While there may have been some truth to that idea in the past, it is far from reality today; Americans affected the most by illicit heroin and prescription opioid abuse reside in rural parts of the country—the Appalachian region strongly considered to be the epicenter of the American opioid epidemic.

If you have been following the media reports on this subject, it is likely that you have read about the efforts being made to mitigate the crisis. Efforts include:

• Expanding Access to Addiction Treatment
• Offering Treatment Instead of Jail Time
• Utilizing Prescription Drug Monitoring Programs
• Making It Easier to Acquire Naloxone

By and large, there has been widespread support on both sides of the political spectrum for expanding access to the lifesaving opioid overdose reversal drug naloxone—sold under the brand name Narcan. Thousands of American lives have been saved by the miracle drug, prompting lawmakers, health experts and those who work in the field of addiction to call for legislation which would make it easier for the friends and families of addicts to acquire naloxone.

If you think about it, it makes perfect sense. Time is of the utmost importance when it comes to an opioid overdose. Friends and family are, more often than not, the ones who are present—having naloxone on hand can better ensure a positive outcome. The good news is that states are jumping on board, and now practically every state has some form of legislation allowing people to buy naloxone without a prescription, Fox News reports.

"This saves lives, doesn't seem to have any negative impact that we can identify, therefore it should be available," said Dr. Corey Waller of the American Society of Addiction Medicine.

Is W-18 Too Powerful for Naloxone?

Over the last few years there have been a number of deadly cases of heroin laced with fentanyl overdoses. Fentanyl is a powerful opioid analgesic, typically used in a hospital setting for either surgery or the most severe pain. The drug is roughly 80 to 100 times more powerful than morphine and around 40 to 50 times more potent than pharmaceutical grade heroin, according to the Centers for Disease Control and Prevention (CDC). With potency like this, it is easy to see that mixing fentanyl and heroin together is a sure recipe for disaster.

Fentanyl is now being produced in clandestine labs in China, shipped to Mexico and mixed with inferior grades of heroin to increase potency. Heroin users in the United States are often times unaware of the deadly admixture when they use, so they do not adjust their dosage accordingly—overdose often ensues. You might find yourself wondering if there could be a more deadly amalgamation. The answer to that question, unfortunately, is yes.

A drug that could be as many as 10,000 times more potent than morphine is possibly being mixed with heroin in the Philadelphia area, The Philadelphia Inquirer reports. The drug, known as W-18, may be too powerful for the opioid overdose drug naloxone to reverse. The Drug Enforcement Administration (DEA) has released a bulletin warning of the dangers associated with mixing W-18 with other drugs, such as heroin. The agency pointed out that a microscopic dose of W-18 could be fatal.

Recently, anesthesiologist Anita Gupta, who works as a pharmacist and pain specialist at Drexel University College of Medicine, began seeing cases of overdose where patients didn’t have the typical response when naloxone was administered. Gupta’s suspicion for the atypical response was the presence of W-18.

“The symptoms were worse than we were used to seeing,” said Gupta. “We were getting patients with symptoms of near-death, and often required multiple doses of the antidote naloxone.”

Over The Counter Naloxone

It cannot be stressed enough; there is need for greater access to the life saving opioid overdose reversal drug naloxone in the United States, especially when you consider that the Center for Disease Control and Prevention (CDC) reports that 44 people die every day from an overdose. In recent years, there has been call from both addiction experts and lawmakers for expanded access to naloxone, sold under the brand name Narcan. The drug was recently approved by the Food and Drug Administration (FDA) to be used in nasal spray form, which makes it easier for people without any medical knowledge to administer the miracle drug.

The World Health Organization (WHO) has stated that expanded naloxone access could save more than 20,000 lives per year in the United States. It is estimated that the drug saved 10,000 lives between 2006 and 2010.

In a number of states and cities across the country, naloxone can now be acquired without a prescription. This means that both opioid users and their families can purchase the drug with little effort, and more lives will be saved. CVS pharmacies in 13 states are preparing to offer naloxone over the counter, EMS 1 reports. With the rise in heroin use across the country, a byproduct of the prescription opioid epidemic, the likelihood of overdose rates increasing is great.

"Over 44,000 people die from accidental drug overdoses every year in the United States and most of those deaths are from opioids, including controlled substance pain medication and illegal drugs such as heroin." said Tom Davis, vice president of pharmacy professional practices at CVS/pharmacy. "Naloxone is a safe and effective antidote to opioid overdoses and by providing access to this medication in our pharmacies without a prescription in more states, we can help save lives." 

The states where naloxone will be offered over the counter include:

• Arkansas
• California
• Minnesota
• Mississippi
• Montana
• New Jersey
• North Dakota
• Ohio
• Pennsylvania
• South Carolina
• Tennessee
• Utah
• Wisconsin

Please take a moment to watch a short video on the subject below:


Having trouble watching the video? Please click here.

If you or a loved one is battling opioid addiction, please contact Celebrate Hope at Hope by The Sea. We can help you learn how to live free from addiction and begin your journey of recovery.