Author: Justin Mckibben
In Philadelphia, there have been nearly 800 fentanyl overdoses this year.
According to figures released by the US Centers for Disease Control and Prevention (CDC) a sharp rise in drug overdose deaths, which many attribute in part to fentanyl, is causing a drop in American life expectancy.
As 2018 begins, many are afraid of what the future may bring concerning more deadly drugs reaching the streets, overdoses, and deaths. One area, in particular, is the streets of Philadelphia. Now, many in the area are pointing out that heroin is no longer the poison most popular on the illicit market. Fentanyl in Philadelphia is now the main ingredient in the drug problem.
How Fentanyl in Philadelphia is Changing the Scene
Patrick Trainor is a special agent with the Philadelphia division of the Drug Enforcement Administration (DEA). Trainor has kept an eye on the Kensington neighborhood for two decades. When talking about the drastic impact the lethal synthetic opioid has brought to the heroin market, he states,
“Fentanyl has drastically changed the landscape… Sixty-four percent of fatals in Philadelphia County are fentanyl-related. There’s no dope out here now, it’s all fentanyl. Even the old timers are scared of it.”
In areas like Emerald Street, AKA Emerald City, even drug users carry Narcan regularly.
Dangers and Death
Even addicts who are now content with using fentanyl are aware of the risks. But many say that compared to heroin, fentanyl’s rush is intense and immediate.
It is painful to use because it burns the vein. Some choose to chance the elevated risk of abscesses by injecting under the skin. This practice is said to reduce the risk of overdose and prolong the high. Yet, overdoses come almost instantaneously. Beyond that, the comedown of fentanyl is said to be abrupt, and the withdrawal period is a long and difficult one.
Tolerance for the drug builds quickly; dependence on the drug is rapid and pretty much unavoidable. Even those revived by Narcan can fall back into overdose due to the immense strength of the drug.
A lot of the issues related to fentanyl in Philadelphia can be connected to how it hit the street in the first place. According to interviews with drug users in the Kensington area, when fentanyl first started flooding the market the dealers didn’t know how to handle it, and the users didn’t even know about it. They had no idea about the risks of the drug, and overdoses were everywhere.
But then the dealers caught on when customers started dying all over, and so they changed the way they cut the drug in order to keep their consumers. Trainor himself notes,
“You’re paying the same for something that’s roughly 100 times more powerful, so why would you buy heroin? The demand is for the most powerful thing they can get. Heroin will never be able to compete with fentanyl. It just can’t.”
There is no wonder why fentanyl in Philadelphia has become the dealers choice, the economics of fentanyl trafficking are easy to understand.
Unlike with heroin, there is no need to wait for the poppy harvest to start production. To yield a kilo of fentanyl, the chemicals one would need cost less than $5,000. At $55,000-$60,000 per kilo delivered, fentanyl is the about the same price as heroin but earns traffickers far more once it is cut and packaged for the street.
Each kilo of fentanyl can be cut out to approximately 330,000 doses, according to Trainor. A single kilo is enough to kill half of the counties residents.
Two factors make fentanyl in Philadelphia such a difficult drug to get ahead of:
No dominant trafficker
With drug problems in the past, a substance coming into any area would probably be controlled by a single, relatively predictable trafficker or trafficking family, but not with fentanyl.
This incredibly powerful and potentially life-threatening drug is coming from China, ordered over the dark web, or coming up from Mexico. It isn’t being shipped in through the typical channels, and thus law enforcement has found it increasingly difficult to track.
It is easy to modify
Fentanyl is a synthetic drug, therefore it is pretty simple to change the formula. Every time traffickers make subtle changes to the chemical ingredients of their batch, the DEA analysts struggle to adapt and catch on before the recipe has been changed again.
“It used to be just fentanyl but now we’ve noticed eight different analogs in this area and around 40 nationally. Our chemists estimate there could be 200 additional variants.”
One of those variants is Carfentanil. This horrifically hazardous material is a painkiller… for elephants and other large mammals! It is estimated to be up to 10,000 times stronger than morphine. Carfentanil has shown up in other areas in the past, such as Cleveland, Ohio. It is still rare for street consumption, but it has shown up along with fentanyl in Philadelphia medical examiner’s office.
Over the past three years, fentanyl-related deaths across America have increased by 540%. According to the Journal of the American Medical Association, for the first time, the majority of fatal overdoses are fentanyl-related, accounting for nearly all the increases in drug overdose deaths from 2015 to 2016. Part of facing the ongoing opioid epidemic is providing effective and comprehensive addiction treatment opportunities. As more and more people die every day from these insidious substances we have to do all that we can to help fight back. If you or someone you love is struggling with substance abuse or addiction, please call toll-free now. We want to help!
CALL NOW 1-800-951-6135
Author: Justin Mckibben
Despite the fact that over 91 people die every day from an overdose due to prescription drugs, some people still struggle to realize that prescription drug abuse is the driving force behind the current opioid epidemic. According to the American Society of Addiction Medicine (ASAM):
- 4 out of 5 heroin users started out abusing prescription pain medication
- 94% of people in treatment for opioid addiction surveyed in 2014 switched to heroin from prescription opioids.
One of the biggest issues is that powerful opioid painkillers are being overprescribed. Whether due to aggressive marketing tactics used by Big Pharma companies or the corrupt ‘pill mills’ where doctors were dishing out excessive prescriptions of potent drugs to be sold on the street, prescription opioids flooded the neighborhoods across the nation, helping create one of the worst addiction outbreaks in American history.
But it wasn’t just the fact that drugs were making it onto the streets. In general, even legitimate opioid prescriptions were astonishingly high. While too many people still think the only problem is heroin or street drugs, the facts show us that opioid painkillers were still largely overprescribed in recent years, which contributed to the current crisis.
Too ‘Legit’ to Quit
According to the National Survey on Drug Use and Health, nearly 92 million U.S. adults in 2015 were taking a legitimately prescribed opioid. That translates to 38% of the adult American population.
There were an estimated 240 million opioid prescriptions in 2015, nearly one for every adult in the general population. Even the Deputy Director of the U.S. National Institute on Drug Abuse, Dr. Wilson Compton, said,
“The proportion of adults who receive these medications in any year seemed startling to me”..”It’s an awful lot of people who take these, mostly for medical purposes, but within that, a significant percentage end up misusing them,”
So while a lot of these prescriptions were going to treating serious conditions, how many ended up on the street or being abused at home because they were overprescribed?
The same NSDUH survey found that 11.5 million people misused prescription opioids they obtained through illicit means. Overall, Dr. Compton states that these results indicate medical professionals are doing a poor job of appropriately prescribing these medications.
The trend didn’t end there. According to a new report, nearly 3 million people who had surgery in 2016 became persistent opioid users, taking the drugs 3-6 months after a procedure. The report also states that due to overprescribing, 3.3 billion pills were left unused by patients, which left them open for diversion or misuse.
Some pain management advocates insist that pain may end up being undertreated due to the rising scrutiny of opioid prescriptions. Many of these advocates say it is extremely difficult to truly know if opioids are overprescribed because pain is too hard to objectively quantify. Therefore, some patients may actually need more relief resources than others.
Yet, prescribing rates are still, at the very least, questionably high. Especially considering by most estimates that over 50% of opioid pills legitimately prescribed are unused by patients, which suggests significant overprescribing certainly exists.
4 Doctors, 6 Million Pills, 1 Year
One recent case in particular that stands out concerning overprescribing of medications is the story of a small northwestern county in Arizona where 4 doctors prescribed nearly 6 million opioid pills in a 12 month period. The data provided by the Controlled Substances Prescription Monitoring Program did not list the doctors by name, but did give detailed information about the prescriptions.
Out of all 4, the top prescribing doctor is responsible for:
- More than 20,000 opioid prescriptions
- Equaling out to over 1.9 million pills
- That comes to 7,350 pills a day
The second-place prescriber is responsible for:
- More than 15,000 prescriptions
- Equaling out to nearly 1.6 million pills
The other two doctors totally a combined 2.4 million pills prescribed.
The four doctors in question are located in Mohave County, which as of 2016 is home to approximately only 205,249 people. That comes out to about a 30 opioid supply for every single person in that county.
Now while pain may be hard to objectively quantify, these numbers are obviously unsettling. Even the executive director of the Arizona Board of Pharmacy, Kam Gandhi, could not explain why or how these four physicians were able to issue so many opioid pills.
A spokesperson for Attorney General Mark Brnovich declined to specify exactly what actions are being taken by his office concerning this development. However, according to AZ Central Doug Skvarla, who directs the Controlled Substances Prescription Monitoring Program, said that information has been passed on to Brnovich’s office for “an open investigation.”
Illicit Use of Prescriptions
There are plenty other issues with opioid prescriptions being taken advantage of all over the United States. Pain management advocates often argue that the problem isn’t about opioid prescriptions; it’s the people that misuse and divert the medications. In other words, that the people abusing opioids frequently don’t have a legitimate prescription. A lot of opioid pills being abused are obtained illicitly.
Many people won’t use their whole prescription. Many will actually give pills to a loved one who doesn’t have their own pain treatment. Or they will sell their remaining pills. Pill mills and ‘doctor shopping’ allowed for the even worse spread of excessive opioid prescriptions. Like in Illinois, where one individual received 73 prescriptions for opioid drugs from 11 different prescribers and filed them at 20 different pharmacies. In some cases, the individual filled prescriptions at multiple pharmacies in one day.
There is absolutely a high demand on the illegal drug market for prescription opioid painkillers. As a former addict who spent over 7 years using, buying and selling opioid medications on the street, I can say there is plenty of ways to get these drugs without a prescription.
However, if we back-track a little bit, how did so many potent medications get onto the streets if there is no overprescribing?
Feeling the Pain
Pain management is absolutely necessary. There must be resources and effective medications available for those suffering from serious medical conditions or recovering from life-altering procedures. There is no denying that we have to provide effective pain relief options for patients who desperately need it. So, of course, this is a difficult conversation to have, because many people can take these medications are directed and be fine when they are gone. Some people require long-term pain treatment, but it does not result in a severe addiction.
Still, the fact is that if these medications weren’t being prescribed more than medically necessary, they would have never flooded the underground drug marketplace as rapidly and as abundantly as they did. Between doctors overprescribing (sometimes for kickbacks), patients working the system and manipulating physicians, and the aggressive marketing tactics of Big Pharma going unchecked, there are plenty of elements at play.
Undoubtedly when we examine the opioid epidemic we cannot ignore any contribution. We have to make efforts to combat the spread of heroin addiction. There has to be an intensive effort to deal with the incredibly deadly synthetic opioids like fentanyl and carfentanil, and people also have to acknowledge their own choices and do their part to move forward. It might be a difficult and painful process, but it is necessary.
Still, overprescribing of opioid medications cannot be ignored. We should explore all options concerning prescription monitoring programs, enforce current regulations of drug distribution, and develop innovations in pain management therapy.
According to one report, even just a 10% reduction in surgery-related opioid prescribing would reduce:
- The number of excess post-surgical pills available for diversion or misuse by 332 million
- The annual number of patients who go on to persistent opioid use after surgery by 300,000
- Annual drug costs by $830 million
Not only can we do better to treat those suffering from chronic and severe pain, but we can do better to make sure these potent and habit-forming medications don’t end up in the wrong place. For those who abuse prescription opioids, or who have found themselves using heroin, we need to provide safe and effective treatment options. Palm Partners Recovery Center has been treating people struggling with drug dependence and substance use disorder for decades, focusing on holistic and comprehensive care. If you or someone you love is struggling, please call toll-free now.
CALL NOW 1-800-951-6135
Author: Justin Mckibben
Earlier this week we talked about a story that shook things up in politics as a former DEA agent threw some serious accusations at the Big Pharma industry, Congress and a number of key officials for their involvement in policies some believe helped create the enduring opioid crisis in America. Among those accused of tipping the scales in favor of Big Pharma and stripping power away from those charged with regulating the industry was Republican Representative Tom Marino.
Of course, we know that Tom Marino was President Donald Trump’s top nominee to be the nation’s drug czar.
Now, after withdrawing from the nomination to head the White House Office of National Drug Control Policy, Tom Marino says he is proud of his role in writing a 2016 law that many critics say paved the way for the current epidemic.
The Tom Marino Factor
What kind of role did Tom Marino have in the creation of the Ensuring Patient Access and Effective Drug Enforcement Act? Why is it that so many are up in arms about the bill in the first place?
To recap- Pennsylvania Congressman Tom Marino and Congresswoman Marsha Blackburn of Tennessee introduced a bill to the House. It was advertised to officials as a way to ensure that patients had access to the pain medication they needed. In a statement released by Marino’s office, he claims the law would help “facilitate a balanced solution” by ensuring access to certain medications while allowing the Drug Enforcement Administration to prevent the sale and abuse of prescription drugs.
In essence, Tom Marino was supposedly pushing for a way to let pain management patients still get the useful medications they needed, without impeding on the process of curbing abuse.
But that isn’t how everyone sees it, especially after the 60 Minutes story.
Why it Matters
According to the opposition, the bill ultimately did little else besides weaken the DEA and the government’s authority to stop companies from distributing opioids in suspicious shipments.
For years prior to the passage of the “Marino Bill” some big-time drug distributors were getting fined thousands of dollars for repeatedly ignoring DEA warnings to shut down suspicious sales of hundreds of millions of pills. These companies were racking up billions of dollars in sales while turning a blind eye to obnoxious overprescribing of dangerous drugs.
Back then the DEA was able to immediately prevent drugs from reaching the street by freezing suspicious shipments. If the DEA judged that the drugs posed an “imminent danger” to a community, they could take action to prevent the flood of powerful narcotic medications from overwhelming the area.
However, the Tom Marino bill is argued to make it virtually impossible for the DEA to freeze suspicious narcotic shipments from the companies. Now, the agency is required to demonstrate that a drug distributor’s actions represent “a substantial likelihood of an immediate threat,” which officials say is far more difficult criteria to meet. The report against the Tom Marino bill even cited internal DEA and Justice Department documents and an independent assessment by the DEA’s chief administrative law judge.
The DEA even fought the bill, according to people within the agency, but in 2015 the law gained momentum again when the Justice Department named a new chief of the DEA- Chuck Rosenberg. After some reluctance, the report on 60 Minutes that included exclusive insight from Joseph T. Rannazzisi states the DEA ultimately took a deal they did not want.
Champion for Big Pharma
Marino disputed that, calling the reports “false accusations and unfair reporting.”
Tom Marino spent years pushing versions of this bill through Congress. He argued that it was to put an overly-aggressive DEA in check and protect drug companies from what he believed was unfair or misguided federal interference. In other words, he spent a lot of time fighting for Big Pharma’s ability to send millions of pills to communities that didn’t have half the population to justify them. All because the DEA was being aggressive?
The irony here is that the same people who pushed so hard for drug distributors ability to traffic obscene among of pills without the pesky DEA would probably be the same people demanding mandatory minimums for low-level drug offenders on the streets.
And again, many are still suspicious of those involved in pushing for this kind of legislation because of their connections to Big Pharma industry. The Post reports that the drug industry worked behind the scenes with lobbyists and key members of Congress, including Tom Marino.
Some reports indicate the Big Pharma industry poured more than a million dollars into election campaigns, including Marino’s, who received nearly $100,000 in campaign contributions from political action committees supporting the drug industry.
Utah Republican Senator Orrin Hatch calls the report “complete baloney” after it gained serious momentum earlier in the week.
Why are we not surprised? Because Hatch himself has received hundreds of thousands in donations from Big Pharma companies and health contributors over the years.
Holding Big Pharma accountable for their contribution to the opioid epidemic has become an increasingly popular cause. Lawyers and politicians at all levels have been pushing to put a spotlight on the shady side of the pharmaceutical industry. Now it seems that spotlight may extend more and more to exposing the politics that allow these issues to spread.
Another crucial element to putting an end to the opioid epidemic is providing safe and effective treatment for those who need help the most. A lot of people are still out there suffering because of prescription drug abuse or other dangerous substances. But we want to help. If you or someone you love is struggling, please call toll-free now.
CALL NOW 1-800-951-6135
While the entire country has been impacted by this ongoing issue, more options for prevention and treatment have become paramount to changing the tides. Just this week Rick Scott, the governor of the state of Florida, proposed a strategy for fighting the opioid epidemic that has gained a lot of attention. Scott has decided to ask local lawmakers to impose a three-day limit on opioid prescriptions during the upcoming legislative session. This latest development is one new piece of recent initiatives to combat the opioid crisis.
Florida Governor Opioid Initiatives
During two press conferences on Tuesday, the Florida Governor announced a pushback on an abundance of opioid prescriptions, while also introducing other ideas for fighting addiction.
One of the initiatives Rick Scott is pushing is to require all health-care professionals who prescribe controlled substances to participate in the Florida Prescription Drug Monitoring Program, also known as the PDMP. This database involves health-care professionals to report important information on patients receiving powerful narcotic medications, including:
- Name of the doctor
- Patient name
- Prescription information after the prescription is filled
But this is not the last of Florida Governor Scott’s opioid initiatives. His office also plans to seek additional reforms such as:
- Fight unlicensed pain management clinics
- Requiring education on responsible opioid prescribing
- Creating more opportunities for federal grants
Scott apparently plans to put some more investments toward helping those already struggling. He is also pushing for more than $50 million for services including:
Part of this initiative is also boosting up the budget of the Florida Violent Crime and Drug Control Council.
At the moment the finer details of the Florida Governor’s proposals are not yet available. However, what it does tell us is that Scott is not ignoring the contribution Big Pharma makes in this current crisis. What we can tell from this outline is that Rick Scott says he is aiming to address prescription opioid pain medication, recognizing it as a key source of the growing problem.
Why 3 Days?
It has been reported time and time again that we should be paying attention to how powerful opioid medications impact rising addiction rates. Now the Centers for Disease Control and Prevention (CDC) has released a recent study showing how quickly someone could get hooked on these kinds of drugs. In this study it is shown:
- After three days of use, about 6% of patients were still using opioids a year later.
- Five days into use, about 10% of patients were still using opioids a year later.
- After 11 days of use, it jumps to 25% of patients still taking opioids a year later.
So it would seem that between 3-5 days, the chances of continued use almost doubled. Then between 5-11 days the chances of use more than doubled. This development may have helped inspire the idea to limit prescriptions to 3 days.
Back in March, Bradley Martin of the CDC, one of the study authors, told Vox magazine:
“There’s nothing magical about five days versus six days, but with each day your risk of dependency increases fairly dramatically,”
So while day 5 and day 6 may not be a dramatic leap over the edge, some may see this proposed limit as an attempt to at least slow a process down.
The Opposing Argument
The Florida Governor will probably face strong criticism, or at least skepticism, from crowds such as:
The opposition is still very real. This isn’t even the first time Florida lawmakers have seen something like this brought to the table. Just last year Florida legislatures quietly rejected an effort last year to impose a five-day cap on opioid prescriptions for acute pain.
Legislatures and doctors are the only concerns Florida Governor may have to tangle with in order to push this idea through. Other potential obstacles standing against this proposal include:
- Additional out-of-pocket co-pays that patients will incur
- The ability of patients with chronic pain and terminal illnesses to refill prescriptions
The Florida Society of Interventional Pain Physicians will discuss caps on prescriptions during a board meeting today. Dr. Sanford Silverman is a past president of the Florida Society of Interventional Pain Physicians. In regards to the 3 day limit he stated:
“We don’t think the cap is reasonable since it is a completely arbitrary number,”
“A better idea would be to mandate usage of the PDMP prior to writing an opioid for acute pain.”
Other states have created caps on prescriptions, although some may not seem as strict as the 3 day rule.
- Massachusetts limits the supply to seven days.
- New Jersey set it so that first-time prescriptions for acute pain cannot exceed a five-day supply. Also, patients being treated for cancer or under hospice care are exempt.
- Ohio caps distinguish between patients with chronic pain and those with acute pain.
At the end of the day, similar strategies may not be left up to the lawmakers. If pharmacies decide to impose their own limits on certain prescription drugs the Florida Governor might not have to push very hard to get the limits he is looking for.
CVS announced Friday that the company plans to:
- Limit the daily dosage of pain pills based on their strength
- Require the use of quick-release painkillers before extended-release opioids are dispensed
- Limit opioid prescriptions to seven days for certain conditions
This restriction will specifically apply to patients who are new to pain therapy.
Only time will tell how far Florida Governor Rick Scott’s new pitch will go, but it seems one thing people can agree on is that the opioid crisis does require some new approaches to prevention.
With more prevention we may be able to slow down the rising rates of opioid addiction. Meanwhile, the need for safe and effective treatment still means a lot for helping those already suffering. Real treatment resources matter. If you or someone you love is struggling, please call toll-free now. We want to help.
CALL NOW 1-800-951-6135
Author: Justin Mckibben
The Center for Disease Control and Prevention (CDC) announced on September 5th it would be allocating more than $28.6 million in funding to assist dozens of states, not to mention the District of Columbia, with overcoming the issues they face concerning opioid abuse, addiction, overdose and opioid related death. Many states are still struggling to make headway in the uphill battle. Thanks to the CDC fighting opioids with such a large contribution people in these areas have a better chance of gaining access to crucial resources.
It All Adds Up
The Omnibus Appropriations Bill in 2017 added funding for fighting the opioid epidemic with a $103 million dollar contribution. Combined with this new money from the CDC there will be even more support for things such as:
Addiction prevention programs
Drug monitoring programs
Improved toxicology testing for medical examiners/coroners
This isn’t the first time this year the CDC has dropped a big sum into the opioid outbreak.
Just a few months back in July the CDC fighting opioids led to a $12 million pledge to state overdose prevention efforts. This contribution was made as part of the plan from the Department of Health and Human Services’ (DHHS) in response to the nationwide opioid epidemic.
Who Gets the Money?
So which states are receiving funding through this latest pledge, and why? This money is being distributed out to various states that participate in the CDC’s Overdose Prevention in States Program (OPiS). The OPiS program includes 3 unique programs designed for prevention efforts:
Prescription Drug Overdose: Prevention for States (PfS)
This program will provide $19.3 million in funding to 27 states to expand various of their prevention programs, which also use community outreach.
Data-Driven Prevention Initiative (DDPI)
$4.6 million will go through DDPI to 12 states and Washington, D.C. for similar programs. Other states getting funds through the DDPI include:
Enhanced State Opioid Overdose Surveillance (ESOOS)
Across the country around $4.7 million will go to medical examiners and coroners in 32 states and D.C. to track and prevent overdoses. The top 5 states on the list of highest rates of overdose death will receive funding, which includes:
-as well as-
How is CDC Fighting Opioids?
Not only is the OPiS program a big portion of the plan to fight opioids from the DHHS, but there are 4 other key components to these efforts.
Naloxone expansion programs
Improving public health data related to opioid crisis
Advancing practices for pain management
Greater research and support on addiction and pain
DHHS Secretary Tom Price states that the funding expansion was made possible through legislation signed by the Trump administration earlier this year. He insists it is an important part of committing help to states combating opioid addiction and overdose.
Many are hopeful that this will be the beginning of a trend for allocating funds toward more resources for CDC fighting opioids and the damage they cause across America. Advocates are still hopeful to receive more support, but for now there is at least some hope that something is being done. As far as each individual, recovery begins with taking advantage of any opportunity in front of you to do better. If you or someone you love is struggling with substance abuse or addiction, please call toll-free now.
CALL NOW 1-800-951-6135