Fentanyl Salesmen Arrested for Kickback to Doctors

An aspect of the prescription opioid epidemic that is often ignored is the role of pharmaceutical salesmen. These are people who are employed by pharmaceutical companies to travel around the country enticing doctors to prescribe their medical product. Now, it stands to reason that a physician's willingness to prescribe a drug should be based off of the drug's effectiveness at treating a specific condition—and in a perfect world that may be the case. However, doctors are often times given huge incentives to prescribe one medication over another, a practice which surely had a hand in the rampant over prescribing of drugs like OxyContin (oxycodone).

In the wake of the beloved pop star Prince’s death, attention has been redirected back to the powerful opioid analgesic fentanyl. Many Americans may have never heard of fentanyl as the drug is not commonly used outside of hospital settings. Those who had heard of the drug before may have been unaware that fentanyl is 100 time more potent than morphine. Fentanyl, while fast acting and highly effective, can cause severe respiratory depression that can be fatal; this is why it should be scarcely used except under the close supervision of doctors and nurses.

In an attempt to stem the tide of irresponsible prescribing practices, law enforcement has begun to set their sights on pharmaceutical salesmen. Recently, two former pharmaceutical salesmen were arrested from charges stemming from paying doctors to prescribe a form of fentanyl, USA Today reports. The two salesmen, who worked for Insys Therapeutics, allegedly paid two doctors in the New York-area $259,000 in kickbacks to prescribe Subsys.

Most fentanyl prescribed for take home use comes in the form a transdermal patch. The patches are adhered to one’s skin—slowly releasing the drug throughout the course of the day. Subsys, on the other hand, is sprayed under the tongue, according to the article. The spray version of fentanyl works quickly, relieving pain in just five minutes.

"You have this hyper-powerful drug marketed intensely, aggressively and shamelessly without any sense of the addictive and lethal power of what is being sold," said Arthur Caplan, the director of medical ethics at NYU Langone Medical Center in New York.

We will continue to follow the fentanyl story. Stay tuned. 

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.

Coroner's Report: Fentanyl Caused the Death of Prince

This past April, millions of people around the United States and across the globe were shocked to learn that Prince Rogers Nelson, more widely known as Prince, died at the relatively young age of 57. While it was unclear as to the cause of the pop singer's death, many were convinced that the superstar passed away from drug related issues. It probably comes as little surprise that Prince suffered from pain after decades of high energy performances, and it was widely known that he endured a hip injury that required pain medication.

Prince had been known to lead a clean life, refraining from mind altering substances over the years, which made it hard for many to believe that his death could be the result of a drug overdose. Now, two months later, the coroner's report has come out, and the cause of his death was an overdose of the powerful opioid analgesic fentanyl, CNN reports. It is likely that you have heard news reports about the drug in recent years, as fentanyl is commonly mixed with heroin to increase potency—resulting in a wave of overdoses across the united states.

Just to put the drug into perspective, fentanyl is around 80 to 100 times stronger than morphine and roughly 40 to 50 times more potent than pharmaceutical grade (100% pure) heroin. The drug is known to cause severe respiratory depression even in small doses—rife for the potential of overdose. Heroin users, more often than not, have no idea that the “dope” they are about to snort or inject is laced with fentanyl; being unaware of the presence of the powerful analgesic, users will dose themselves out as they normally would—ignorance that can prove deadly.

Authorities are still trying to determine where Prince acquired the fentanyl that led to his death, according to the article. To be sure, it could have come from only one of two places. Either a physician wrote him a prescription for fentanyl to treat his pain, or he acquired the drug through illegal channels. Fentanyl is being produced in clandestine labs, typically overseas in countries such as China where it is easy for chemists to acquire the requisite precursors. The drug is then shipped out of China, finding its way to Mexico where it is then moved north of the border.

Without a doubt it is important authorities find Prince’s source; however, where the drug came from will not bring the beloved artist back—as is the case with the thousands of Americans who lose their life in this country from prescription opioid and heroin overdoses. What’s more, Prince’s death, much like Michael Jackson's and a number of other stars' deaths in recent years, drives home the point that everyone is eligible for addiction—and all who use opioids are at risk of overdose. Every day in the United States alone, over 70 people succumb to opioid overdose deaths.

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.”

Two Types of Alcoholics

Drugs and alcohol take their toll on the human brain, which can be measured through a number of scanning techniques. When compared to the brains of people who have not had a substance use disorder, clear differences can be seen. That being said, the brain of one alcohol user may look different than another, and new research may have found that there are two types of alcoholics. Researchers from the University of Eastern Finland found that while all alcoholics share similar brain changes, some alterations are exclusive to one type of alcoholic but not another, PsychCentral reports. The findings are published in the journal Alcohol and Alcoholism.

There are two types of alcoholics, anxiety-prone (Type I) and impulsive (Type II) based on Cloninger’s typology, according to the article. The researchers looked at post-mortem brains from both types of alcoholics and a control group.

“From the viewpoint of the study setting, this division was made in order to highlight the wide spectrum of people suffering from alcohol dependence. The reality, of course, is far more diverse, and not every alcoholic fits into one of these categories,” said Olli Kärkkäinen, M.Sc. (Pharm).

Typically, Type I alcoholics are more prone to anxiety and are more likely to become dependent on alcohol later in life, the article reports. On the other hand, Type II alcoholics usually become dependent on alcohol when they are younger and show greater impulsivity and antisocial behavior. In Type I alcoholic brains, the researchers found:

• Changes in the endocannabinoid system, which modulates stress responses.
• Increased Docosahexaenoylethanolamide levels in the amygdala, possibly linked to their anxiety prone nature.

With Type II alcoholic brains, the researchers found elevated levels of AMPA receptors in the anterior cingulate cortex, according to the article. That part of the brain has a hand in learning and the regulation of behavior, which could explain the impulsive nature of Type II alcoholics.

“These findings enhance our understanding of changes in the brain that make people prone to alcoholism and that are caused by long-term use. Such information is useful for developing new drug therapies for alcoholism, and for targeting existing treatments at patients who will benefit the most,” said Kärkkäinen, the study findings were part of his doctoral thesis.

Exercise Creates New Dopamine Receptors

Addiction recovery requires a lot of hard work; years of living in the grips of the disease can be a hard break. It is often said that the easiest part of recovery is putting down the drink or drug, the hard part is not picking them back up. Eternal vigilance is needed if long term recovery is to be achieved. Drugs and alcohol take a heavy toll on the brain; in a sense they change the wiring - one’s neurochemical receptors can diminish over time. The effect that drugs have on the brain from greater and prolonged use can affect one’s ability to abstain from use in recovery.

Fortunately, the human brain has an extraordinary ability to repair the damage done by substance use, and there are things that can be done to speed up the process. Researchers at the University of California Los Angeles (UCLA) found that exercise can help those in recovery from methamphetamine addiction, UPI reports. The UCLA team’s research indicates that exercise aids the brain in adding new dopamine receptors, diminishing one’s cravings for meth. The findings were published in the journal Neuropsychopharmacology.

"We know that deficits in the striatal dopamine system are hallmark features of substance-use disorders and are caused by molecular adaptations to repeated drug exposure and, likely, also reflect a genetic predisposition," said Dr. Edythe London, professor of psychiatry and molecular and medical pharmacology at UCLA, in a press release. 

The study involved 19 people; the researchers asked 10 of the participants to exercise three times a week for an hour and to do resistance training for eight weeks, according to the article. The other nine members of the study were asked to not exercise, but were given health education training. PET scans were performed to find how many dopamine receptors were present in the reward system part of the brain - known as the striatum. After eight weeks, the exercising group had a 15 percent increase in dopamine receptors, compared to just 4 percent in the non-exercising group.

"Although this is a small study, it's a very encouraging finding," said London. "The results demonstrate that methamphetamine-associated damages to the dopamine system of the brain are reversible in human subjects, and that recovery of the dopamine system after chronic drug use can be facilitated with exercise training." 

At Celebrate Hope clients are encouraged to exercise and/or do yoga, as we believe that recovery requires healing both mind and body. Please contact us to begin the journey of recovery.

Being Charlie: Addiction and Homelessness

Hollywood often paints inaccurate pictures of addiction, usually the result of writers who themselves have never struggled with the disease. While it is good that such movies spark conversations about addiction, helping break the stigma of the insidious illness, it is always nice to see films that were written by those who walked the lonely road.

Every adult in America has probably seen a Rob Reiner film, such as WHEN HARRY MET SALLY… You may even know something about the acclaimed director's life. You may not know that Reiner’s son Nick began his battle with addiction in his early teens, according to People. Nick Reiner was sent to his first addiction treatment center when he was about 15 years of age. The center would be the first of 17 such facilities that he would check into, and he is only 22 years old.

Nick’s story is like so many others who began using drugs and alcohol at a young age. He bounced in and out of treatment centers, found recovery and relapse - eventually winding up homeless living on the streets. Now sober, he decided to write a film that resembles his own experiences, according to the article.

Being Charlie, directed by Rob Reiner, is the story of the son of a famous former actor who is running for governor. Along the way, Charlie who is trying to find recovery, refuses to go back to rehab and finds himself homeless. "It's not my life," says Nick Reiner but he adds "I went to a lot of these places, so I had a lot of these stories."

"I was homeless in Maine. I was homeless in New Jersey. I was homeless in Texas," says Nick. "I spent nights on the street. I spent weeks on the street. It was not fun." 

Please take a moment to watch the trailer below:




If you are having trouble viewing the trailer, please click here.