Supporting the development and distribution of the life-saving drug naloxone to reduce prescription opioid painkiller and heroin overdose deaths. Supporting the research, development, and approval of pain medications that are less prone to abuse. Improving surveillance to better track trends, identify communities at risk, and target prevention strategies. States can Address the strongest risk factor for heroin addiction: addiction to prescription opioid painkillers. Make prescription drug monitoring programs timely and easy to use. Providers can analyze patient prescription drug history and make informed decisions before prescribing opioid painkillers.
Increase access to substance abuse treatment services, including MAT for opioid addiction.
Work with Medicaid and other insurance companies to provide coverage for MAT. Support adoption of MAT in community settings.
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Health care providers can Follow best practices for responsible painkiller prescribing to reduce opioid painkiller addiction, the strongest risk factor for heroin addiction: Use prescription drug monitoring programs and ask patients about past or current drug and alcohol use prior to considering opioid treatment. Prescribe the lowest effective dose and only the quantity needed for each patient. Link patients with substance use disorders to effective substance abuse treatment services.
Support the use of Food and Drug Administration approved MAT options methadone, buprenorphine, and naltrexone in patients addicted to prescription opioid painkillers or heroin.
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Everyone can Learn more about the risks of using heroin and other drugs. Learn how to recognize and respond to an opioid overdose. Get help for substance abuse problems: HELP. Get Email Updates. To receive email updates about this page, enter your email address: Email Address. What's this? Hurwitz was sentenced to 25 years in prison for prescribing what prosecutors said was a dangerous amount of opioids to addicts, some of whom later re-sold their prescriptions. But at his trial , one patient who suffered from debilitating migraines said she was largely bedridden until Hurwitz began treating her.
Today’s Heroin Epidemic
This month, the Drug Enforcement Administration reclassified hydrocodone-based drugs such as Vicodin as schedule II drugs, just one level below outlawed substances like ecstasy and LSD. OxyContin was already a schedule II drug. Under the stricter classification, doctors will now only be able to prescribe the medications for a month at a time, and for no longer than three months total for any given patient. In West Virginia, law-enforcement officials have been busting unscrupulous doctors.
William Ihlenfeld, the U. Attorney for the Northern District of West Virginia, said the state is currently prosecuting a number of doctors accused of flagrant abuse of the system. The staff of another doctor, this one in Harrison County just south of Morgantown, were allegedly selling painkillers on the side.
Douglas Broderick, a New Jersey gynecologist who federal prosecutors said was feeding the painkiller addiction in West Virginia, was indicted but died before his trial. Fearful that he would be robbed, Broderick allegedly hired armed guards to protect him and his practice. West Virginia still has one of the highest painkiller prescription rates in the nation —as well as one of the highest painkiller-overdose death rates—but the death rate from pills here is slowly declining.
Between and , oxycodone-related deaths in the state decreased from to , and those from hydrocodone declined from to Two years ago, the DEA set up a tactical diversion squad in Charleston, West Virginia to fight illegal pill distribution. The crackdown on doctors might have stanched the flow of prescription pills, but it did so with a deadly externality: West Virginians have turned to heroin—a cheaper and, frequently, more accessible high.
Here you have somebody who might have had legitimate pain, [but] could no longer afford pills, so to keep the high they switched over to heroin. Efforts to disrupt the heroin incursion are complicated by the fact that West Virginians seem to be equally susceptible to the drug, regardless of wealth or education level. All neighborhoods. His ex-wife had a Percocet prescription for her back pain, but she hardly ever took the pills.
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Instead, Kevin would take five or six each day. Kevin moved to Morgantown from Florida, but within a few years he had broken up with his girlfriend and started living on the street. Eventually, he showed up at an emergency room. West Virginia is a microcosm of the national drug-abuse picture. In , the most recent year for which data are available, nationwide deaths from prescription painkillers dropped 5 percent from , but heroin overdose deaths surged by 35 percent.
With heroin, impurities and contamination can make an already dangerous drug even more deadly. The CDC has found that three out of every four new heroin users report having abused prescription painkillers prior to taking up the drug. In a high-profile recent example, the actor Philip Seymour Hoffman died after his prescription painkiller addiction led him to heroin.
Sullivan, who has been working in addiction treatment in the region since , said he rarely saw a heroin addict in his early years. Now, he sees it every day. One year-old patient has been on heroin for four years. She came from a huge family, Sullivan said, most of whom are now dead from overdoses. She had a daughter at 16 with a fellow addict, and for a time, she thought her life was simply fated to be that way.
Two years ago, she got pregnant with her son, Cain, and decided she was tired of blowing through money and spending her days searching for her next fix. She talked to the intake staff of Chestnut Ridge on a Friday, bought enough heroin to last through the weekend, and had her first appointment on Monday. Heroin is one of the most addictive drugs , more habit-forming than cocaine, alcohol, and other common substances.
Buprenorphine alleviates the withdrawal symptoms of heroin without giving patients the same euphoric high of heroin, and without slowing respiration. Unlike some opioid-stricken areas of the country, West Virginia lacks many of the resources necessary to treat the epidemic. On Staten Island, police carry naloxone , a nasal spray that helps revive people who are in the middle of an opioid overdose.
This spring the West Virginia legislature killed a bill that would have let its emergency personnel do the same. Though Suboxone and similar drugs are readily available at clinics throughout the state, group therapy is harder to find. West Virginia has 83 mental-health shortage areas , and only about two-thirds of West Virginians are able to access mental-health treatment. Melinda Campopiano, medical officer for the Substance Abuse Mental Health Services Administration, said that there are only a few places in the country with an adequate supply of providers who can offer buprenorphine alongside therapy.
Doctors who want to offer group therapy alongside medication may need to spend hours on the phone with insurance companies in order to hash out the correct billing codes. Kesner, the man in the beginner group, said that when he was first calling around for help, all of the programs closer to his home had months-long waiting lists. One reason for the scarcity of good treatment is that Medicaid payment rates for psychologists are extremely low.
On top of that, federal restrictions limit opioid-addiction doctors to patients each, and all of the Chestnut Ridge doctors are maxed out. Even his privately insured patients struggle with reimbursement. He now takes Suboxone, works at Burger King, and lives in a shared house in Morgantown. Sitting in a quiet circle, the dozen or so people discuss their step meetings, personal issues, and medication refills.
The group therapy model is based on the effectiveness of AA, in which alcoholics gather to share stories and offer support to one another. Sarah, who has been sober for four years and comes from a middle-class family, started using Vicodin and Percocet when she was in college. Soon, heroin arrived from Detroit, and she switched drugs in order to save money. It gives patients sober friends and a place to go during the day. To commemorate the event, she composed a goodbye letter. An older man in a backward baseball cap rolled some yellow dough into a long snake. He pulled on the ends. Cumberledge made, first, a coffee table covered in drugs, and then, a shining sun.
One boyish-looking man depicted his addiction as a jackass, complete with tiny yellow droppings. A pale, melancholy woman next to me made a startling realistic marijuana pipe filled with Play-Doh pot, along with a handful of small blue pills. There are the vital signs: heart and respiratory rates and body temperature.
Sometimes blood pressure.
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These are critical in emergencies. But in day-to-day life, the normalcy of those numbers is expected.
The most common numbers are age and body weight. The U. This number has come to be massively consequential in the lives of millions of people, and to influence the movement of billions of dollars. Five years ago, the flight vanished into the Indian Ocean. Officials on land know more about why than they dare to say. This leaves little room for error, Baer noted. Number of law enforcement reports of samples that tested positive for fentanyl "fentanyl encounters" from to Carfentanil, a related tranquilizer times more powerful than heroin even skin contact can trigger an overdose , pushes the economics even farther, turning up in overdoses across the Midwest, and up and down the East Coast.
The first human poisoning with carfentanil was only reported in — a veterinarian was splashed with a dose from a dart intended to sedate an elk — so not a lot is known about human use of the drug. Unlike such synthetic opioids, heroin requires a lot of hassle for the cartels: planting poppies in fields in Mexico or Afghanistan or elsewhere , harvesting, and processing them to collect raw opium, which in turn needs chemical processing to make into morphine and then heroin, all the while dodging law enforcement and eradication efforts.
Fentanyl only takes a small lab, with raw materials typically imported from China. In , China started cracking down on exports of the drug and its chemical cousins to Mexico, the US, and Canada. As each synthetic opioid is banned, another still-legal variation on fentanyl pops up for sale. That has led to a game of outlawing new variants as soon as they appear on the market.
One kilo of heroin can make about 20, dime bags. One kilo of fentanyl might make , counterfeit pills, according to the DEA. Each pill contains 1. That means two pills could be deadly.
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Real Watson pills contain acetaminophen and hydrocodone, a less potent opioid painkiller, frequently given for back pain. Some news reports suggest the counterfeit pills that killed Prince also contained UL , a different opioid increasingly turning up in drug cocktails, as well as in cocaine and methamphetamines. The surge in fentanyl deaths and opioid addiction defies any simple solution.