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Research and Resources on the Opioid Epidemic

I. INTRODUCTION

“Opioids are a class of drugs that includes the illegal drug heroin; synthetic opioids such as fentanyl; and pain relieversavailable legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused (e.g., taken in a different way or in a larger quantity than prescribed, or without a doctor’s prescription). Regular use—even as prescribed by a doctor—can lead to dependence and, when misused, opioid pain relievers can lead to overdose and/or death.”

https://www.drugabuse.gov/drugs-abuse/opioids

• July 6, 2017

Oxycodone is a Schedule II narcotic. Schedules are based on risk of abuse. Any drugs that are Schedule I (drugs with high risk and no counterbalancing benefit) are banned from medical practice.

https://medshadow.org/resource/drug-classifications-schedule-ii-iii-iv-v/

• March 14, 2017

Opioid withdrawal medications include Methadone, Robaxin, clonidine, Catapres, Methadose, methocarbamol, Dolophine, Methadone Diskets, Robaxin-750, Thorazine, Catapres-TTS, chlorpromazine, and chlodiazepoxide.

https://www.drugs.com/condition/opiate-withdrawal.html

• July 5, 2017

II. CONFERENCES

ASHRM 2017 Tuesday Keynote Panel to Address National Opioid Crisis
“We all see stories daily from around our country that bring home the human toll of the opioid crisis. The ASHRM 2017 Tuesday Keynote Panel brings together healthcare providers, researchers and policymakers to make sense of where we are in containing and reversing this problem. Leaders in risk, safety and quality have a crucial role in helping their organizations implement research and policy developments, promote safe patient care and become a trusted community partner.”

https://tinyurl.com/y9wo4lnu

• October 15-18, 2017

III. ADDICTION RESOURCES

National Addiction Foundation
“National Addiction Foundation is the first non-profit concierge service developed for those who suffer from drug or alcohol addiction.”

https://nationaladdictionfoundation.org/information/addiction/

• 2017

The National Center on Addiction and Substance Abuse
“As science unlocks the complex addiction puzzle we will find new, better ways to prevent, treat and perhaps even eliminate this devastating disease. This is changing the way doctors, researchers and the public view and treat addiction and substance use. By better understanding this complex disease, we will improve health, save lives and save money”

https://www.centeronaddiction.org/

• 2017

Resources for Heroin and Opioid Addiction, Treatment and Support

http://abcnews.go.com/Health/resources-heroin-opioid-addiction-treatment-support/story?id=37352500

• March 8, 2016

National Institute on Drug Abuse (NINDA)
“The National Institute on Drug Abuse (NIDA) leads the Nation in scientific research on the health aspects of drug abuse and addiction. It supports and conducts research across a broad range of disciplines, including genetics, functional neuroimaging, social neuroscience, prevention, medication and behavioral therapies, and health services. It then disseminates the results of that research to significantly improve prevention and treatment and to inform policy as it relates to drug abuse and addiction.”

https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/resources

• December 2012

IV. BACKGROUND 

A History of Opiate Opioid Laws in the United States – NAABT
“Prior to 1890, laws concerning opiates were strictly imposed on a local city or state-by-state basis. One of the first was in San Francisco in 1875 where it became illegal to smoke opium only in opium dens. It did not ban the sale, import or use otherwise. In the next 25 years different states enacted opium laws ranging from outlawing opium dens altogether to making possession of opium, morphine and heroin without a physician’s prescription illegal.”

https://www.naabt.org/laws.cfm 

• September 9, 2016

V.    OPIOID CLAIMS AND LITIGATION

16 sue Jefferson Hospital in opioid scheme
“Sept. 13–Sixteen people on Wednesday sued Jefferson Hospital for negligence in connection with a former employee who stole painkillers intended for hospital patients and gave the patients look-alike pills not intended to treat pain.”

http://www.advisen.com/tools/fpnproc/fpns/articles_new_2/P/292299321.html?rid=292299321&list_id=2

• September 14, 2017

Enriching Lawyers Is Not the Solution to the Opioid Crisis
“Effective health care reforms must reduce the excessive costs imposed by frivolous lawsuits. Studies have shown that medical tort reform could reduce total health care premiums between 1 and 3 percent. As estimated by the American Action Forum, this could mean “roughly $15 billion” in savings from effective (but partial) medical tort reform.”

https://www.forbes.com/sites/econostats/2017/09/13/enriching-lawyers-is-not-the-solution-to-the-opioid-crisis/#11a195c02c52

• September 13, 2017

New Mexico suing opioid makers, distributors
“ALBUQUERQUE, N.M. — New Mexico is now the eighth state to sue the largest pharmaceutical opioid makers and distributors, hoping to win settlements that will fund law enforcement and treatment in a state historically ranked as hardest hit by opioid addiction and overdose.”

https://www.abqjournal.com/1059909/new-mexico-suing-opioid-makers-distributors.html

• September 7, 2017

Ric’s email: Opioid maker bent rules to get drug to patients, Senate report says — 2nd update
“A representative of Insys Therapeutics Inc. misled a health insurer into approving payment for a prescription of the company’s addictive fentanyl painkiller, and 14 months later the woman who received the prescription was dead at age 32 from complications related to the drug, according to a report by a U.S. Senate committee investigating the opioid crisis.”

http://www.advisen.com/tools/fpnproc/fpns/articles_new_2/P/291767383.html?rid=291767383&list_id=2

• September 6, 2017

Opioid drug crisis goes beyond a doctor
“On a single day in December 2013, Dr. Michael Kostenko – owner and sole resident physician at the Coal County Pain Clinic just outside Shady Spring – wrote 375 prescriptions totaling more than 22,000 oxycodone pills for 271 people. He collected $20,000 without seeing a single patient.”

https://tinyurl.com/ybbd2m6e

• August 27, 2017

Ric’s email Doctor Charged in Oxycodone Deaths Gets 20 Years in Prison
“Dr. Michael Kostenko, who faced 22 charges, admitted at the second day of his trial in April to one count of distribution of oxycodone that wasn’t for a legitimate medical purpose. He was sentenced Wednesday in federal court in Beckley.”

https://www.usnews.com/news/best-states/west-virginia/articles/2017-08-23/doctor-charged-in-oxycodone-deaths-gets-20-years-in-prison

• August 23, 2017

Ric’s email: Insys agrees to pay $4.45 million to resolve Illinois opioid lawsuit
“Insys Therapeutics Inc has agreed to pay $4.45 million to resolve a lawsuit by Illinois’ attorney general claiming it deceptively marketed an addictive fentanyl-based cancer pain drug for off-label uses.”

http://www.reuters.com/article/us-insys-court-idUSKCN1AY25C

• August 18, 2017

Ric’s email: South Carolina sues OxyContin maker Purdue over opioid marketing
“(Reuters) — South Carolina sued Purdue Pharma L.P. on Tuesday, becoming the latest state or local government to accuse the OxyContin maker of deceptive marketing practices that have contributed to a national opioid addiction epidemic.”

https://tinyurl.com/yanuzz39

• August 15, 2017

Ric’s email: Arizona drug company may pay Illinois $4.5M over opioid lawsuit
“Aug. 05–An Arizona drug company is preparing to spend as much as $4.5 million to potentially settle a lawsuit brought against it by Illinois Attorney General Lisa Madigan alleging the company pushed doctors to prescribe its opioid painkiller beyond its intended use.”

https://tinyurl.com/ycqnnsxv

• August 5, 2017

Ric’s email: Provinces to be kept from recouping full medical costs of OxyContin crisis
Purdue Pharma, maker of the prescription painkiller OxyContin, has agreed to pay $20-million, including $2-million to provincial health insurers, to settle the long-standing class-action suit. An Ontario court judge approved the proposed national settlement two weeks ago. Courts in three other provinces, including Nova Scotia on Tuesday, must also approve the settlement before it becomes final.”

https://tinyurl.com/y9dfdz74

https://beta.theglobeandmail.com/ece-images/131/news/national/article35840679.ece/BINARY/image.jpg

• July 31, 2017

Class action suit website
“Many victims of America’s opioid epidemic are filing lawsuits against physicians, pharmacists, and drug wholesalers. They claim that these doctors and entities caused or contributed to their addictions to prescription painkillers.”

https://www.classaction.com/opioids/lawsuit/

• 2017

Pharmacists May Be Legally Liable for Opioid Overdoses
“As the US opioid epidemic continues to soar, physicians have been held criminally responsible for patients’ overdose deaths. Now, it appears pharmacists may be next to be held legally liable.That’s the opinion of pharmacy law experts who have watched the crisis unfold during the past decade.”

http://www.medscape.com/viewarticle/882358

• June 30, 2017

A doctor prescribed so many painkillers, she’s been charged with murdering her patients, authorities say
“In total, pharmacists handed her 510 pills that day — all legal, because she had a prescription with the signature of her doctor, Regan Ganoung Nichols, scrawled at the bottom, according to a probable cause affidavit.”

https://tinyurl.com/yaxrcvq5

• June 24, 2017

Ohio’s opioid lawsuit against 5 pharma companies: 6 things to know
“COLUMBUS, Ohio — The state of Ohio sued five pharmaceutical manufacturers Wednesday, arguing the companies fraudulently marketed addictive prescription painkillers and seeking hundreds of millions of dollars to address Ohio’s opioid crisis.”

http://www.cleveland.com/metro/index.ssf/2017/05/ohios_opioid_lawsuit_against_5.html

• June 16, 2017

Doctor’s Defense for Overprescribing Drugs: Blame Big Pharma
“A Long Island doctor is using a novel defense against federal prosecutors accusing him of overprescribing opioid painkillers: He’s blaming the drug manufacturers.”

http://www.law.com/sites/almstaff/2017/06/08/doctors-defense-for-overprescribing-drugs-blame-big-pharma/?slreturn=20170621175416

• June 8, 2017

Lawsuit against opioid makers, drug distributers, and doctors
“DAYTON, Ohio — The cities of Lorain and Dayton plan to file suit against pharmaceutical companies, opioid drug distributors and physicians they say are responsible for Ohio’s opioid addiction and overdose crisis.”

http://www.cleveland.com/metro/index.ssf/2017/06/dayton_lorain_to_sue_opioid_ma.html

• June 5, 2017

In the Common Pleas Court of Ross County, Ohio Civil Division
“Litigation against pharmaceutical companies in Ohio State. Includes overdosing, marketing practices, standard opioid medical practice in 1990 (short term treatment; chronic use prohibited and discourage), accusations of pharmaceutical companies using deceptive branding.”

http://www.ohioattorneygeneral.gov/Files/Briefing-Room/News-Releases/Consumer-Protection/2017-05-31-Final-Complaint-with-Sig-Page.aspx

• May 31, 2017

Meet the Plaintiffs Lawyers Signing on to Help Gov’ts Sue Big Pharma Over Opioid Epidemic
“By the end of the year, Paul Hanly Jr. predicts he will have sued pharmaceutical companies in more than half of New York’s 62 counties, alleging the drug manufacturers deceptively marketed opioid painkillers such as OxyContin and Percocet.

http://www.law.com/sites/almstaff/2017/05/23/meet-the-plaintiffs-lawyers-signing-on-to-help-govts-sue-big-pharma-over-opioid-epidemic/

• May 23, 2017

Fatal Opioid overdose results in wrongful death
“The man was on prescription opiates for five years. The physician doesn’t work for the medical system any longer, but is now the director of laboratory services for Signature Health.”

http://www.injurymedmal.com/blog/2017/04/fatal-opioid-overdose-results-in-wrongful-death-lawsuit.shtml

• May 23, 2017

Lake Hospital System sued over fatal opioid overdose
“A Parma woman has filed a wrongful death lawsuit against Lake Hospital System over her husband’s accidental drug overdose.”

http://www.news-herald.com/general-news/20170404/lake-hospital-system-sued-over-fatal-opioid-overdose

• April 4, 2017

Opioid distributors sued by West Virginia counties hit by drug crisis
“The suits are among the first of their kind in the country. They accuse the companies of creating a hazard to public health and safety by shipping inordinate quantities of opioids into the state in violation of a West Virginia law. The law was originally designed to permit the demolition of run-down buildings that posed a public nuisance and threatened the safety of a community.”

https://tinyurl.com/ydh2nssx

• March 9, 2017

Physicians’ legal duty to relieve suffering
“In 1991, a North Carolina jury awarded $15 million in compensatory and punitive damages to the family of Henry James, a nursing home patient who died a painful death from terminal metastatic prostate cancer. The jury found that a nurse’s refusal to administer the opioid analgesics necessary to relieve Mr. James’s pain, on the rationale that he would become addicted, constituted a gross departure from acceptable care.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071521/

• September 2001

VI. WHITE PAPERS

Prescription Drug Abuse and Prevention
“America is in the midst of a prescription opioid epidemic. It is estimated that 6.5 million Americans and 2.5% of the population age 12 years and older are current nonmedical users of psychotherapeutic drugs. Of these, 4.3 million, or 66.2%, reported the use of pain relievers for nonmedical purposes.”

http://www.aaoms.org/docs/govt_affairs/advocacy_white_papers/prescription_drug_abuse_prevention.pdf

• March 2017

Combatting the Opioid Abuse Epidemic: A Shared Responsibility that Requires Innovative Solutions
“Every day, the opioid abuse epidemic affects communities across America. This white paper presents McKesson’s recommendations to improve prescribing and dispensing practices towards our country’s shared goal…”

https://tinyurl.com/ycbaowly

• March 2017

White Paper: Opioid Use, Misuse, and Overdose in Women
“This report was developed as part of an initiative supported by the U.S. Department of Health and Human Services (HHS) Office on Women’s Health (OWH) to examine the prevention, treatment, and recovery issues for women who misuse, have use disorders, and/or overdose on opioids.”

https://www.womenshealth.gov/files/documents/white-paper-opioid-508.pdf

• December 2016

Confronting the Crisis of Opioid Addiction: An Overview of Beacon’s White Paper

https://www.fda.gov/downloads/Drugs/NewsEvents/UCM454820.pdf

• July 2015

VII. STATISTICS AND GUIDELINES

Opioid Epidemic: A State by State Look at a National Crisis

“Escalating use of prescription opioids for pain management has drastically contributed to America’s opioid epidemic.”

http://www.moveforwardpt.com/Resources/Detail/opioid-abuse-statistics-of-50-states-2

• 2017

Drug Overdose Death Data
Statistically significant data of drug overdose by state.

https://www.cdc.gov/drugoverdose/data/statedeaths.html

• December 16, 2016

Prescription Opioid Overdose Data
“In 2014, almost 2 million Americans abused or were dependent on prescription opioids.”

https://www.cdc.gov/drugoverdose/data/overdose.html

• December 16, 2016

Synthetic Opioid Data
“The death rate of synthetic opioids other than methadone, which includes drugs such as tramadol and fentanyl, increased by 72.2% from 2014 to 2015.1 Synthetic opioid death rates (other than methadone) increased across all demographics, regions, and numerous states.”

https://www.cdc.gov/drugoverdose/data/fentanyl.html

• December 16, 2016

Reported Law Enforcement Encounters Testing Positive for Fentanyl Increase Across US

“Since 2013, law enforcement encounters (drug submitted for analysis) testing positive for fentanyl reported by laboratories participating in NFLISi has sharply increased in a growing number of states. A 2015 CDC Health Alert and 2016 MMWR documented states with high or increasing numbers of fentanyl encounters also reported increases in fentanyl-involved overdose deaths. Recent investigations in Ohio and Florida provide strong evidence of an association between reported fentanyl encounters and fentanyl-involved overdose deaths due to illicitly-made fentanyl.”

https://www.cdc.gov/drugoverdose/data/fentanyl-le-reports.html

• August 24, 2016

America’s Addiction to Opioids: Heroin and Prescription Drug Abuse

“The abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that affects the health, social, and economic welfare of all societies.  It is estimated that between 26.4 million and 36 million people abuse opioids worldwide, [1] with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin.”

https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse

• May 4, 2014

Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings

“Withdrawal management (WM) refers to the medical and psychological care of patients who are experiencing withdrawal symptoms as a result of ceasing or reducing use of their drug of dependence.”

https://www.ncbi.nlm.nih.gov/books/NBK310652/

• 2009

VIII. OPIOIDS IN THE NEWS

Ric’s email: Mandatory e-prescribing, nationwide data would ‘drastically’ reduce opioids, says Oklahoma congressman
“Physicians that already feel overregulated may loathe another mandate, but some healthcare leaders have said doctors should embrace e-prescribing to reduce opioid use. Several states, including New York and Connecticut, have passed legislation mandating e-prescribing, but the approach is still relatively underutilized.”

https://tinyurl.com/y7v3thpv

• September 14, 2017

A Helpful Tool to Combat the Opioid Crisis
“The opioid crisis is so complex and so large — drug-related deaths now exceed those caused by cars, H.I.V. or guns — that there is no single solution.”

https://www.nytimes.com/2017/09/11/upshot/a-helpful-tool-to-combat-the-opioid-crisis.html

• September 11, 2017

Ric’s email: Virginia turns to data analytics to fight opioid crisis; Intermountain Healthcare EHR effort cuts prescriptions
“Virginia Governor Terry McAuliffe announced his state’s drive to stem the state’s opioid addiction problem by crunching healthcare data. The move is the latest in a series of efforts by governments and large healthcare organizations to get a handle on the problem.”

https://tinyurl.com/y9lqrz82

• August 25, 2017

Ric’s email: Dying at home in an opioid crisis: hospices grapple with stolen meds
“They sent home more painkillers for weeks. But the elderly woman, who had severe dementia and incurable breast cancer, kept calling out in pain.”

http://www.grandhaventribune.com/AppleNews/2017/08/23/Dying-at-home-in-an-opioid-crisis-hospices-grapple-with-stolen-meds.html

• August 23, 2017

Ric’s email: Study: Opioid Users Don’t See Overdose as Wakeup Call—Brush with death had little effect on subsequent use
“Turns out, even a close call with an overdose isn’t enough to deter opioid users.As described in a JAMA research letter, Julie M. Donohue, PhD, of the University of Pittsburgh, and colleagues looked at five years of claims data for Medicaid-covered patients in Pennsylvania.”

https://www.medpagetoday.com/PublicHealthPolicy/by-the-numbers/67454?xid=nl_mpt_DHE_2017-08-24&eun=g516862d0r&pos=0

• August 23, 2017

Ric’s email: BIDMC calculates impact of opioid-related ICU admissions
“The number of opioid-related admissions to intensive care has grown steadily since 2009 and costs are skyrocketing as a result, according to a new study.”

https://tinyurl.com/ycqojmkk

• August 14, 2017

Ric’s email: Lawmakers advocate for mandated e-prescribing as the opioid epidemic becomes a national emergency
“Representatives from Massachusetts and Oklahoma are urging Congress to pass a bill that would mandate electronic prescribing for any provider participating in Medicare, arguing the requirement is a necessary step to curb opioid abuse.”

https://tinyurl.com/y7j6e8af

• August 14, 2017

Ric’s email: Opioid Overdose ICU Admissions Increasing—Overdose patients are sicker, ICU death rate increasing
“Deaths associated with opioid overdoses in hospital intensive care units nearly doubled over a seven-year period from 2009 and 2015, and the costs of treating overdose victims in the ICU has skyrocketed, researchers report.”

https://www.medpagetoday.com/Psychiatry/Addictions/67240?xid=nl_mpt_DHE_2017-08-14&eun=g516862d0r&pos=0

• August 13, 2017

Ric’s email: How medical schools are responding to the opioid epidemic
“Nearly 2 million Americans abused or were dependent on prescription opioids in 2014, according to the CDC. From 1999 to 2015, more than 180,000 people died from overdoses related to prescription opioids. In light of the ongoing epidemic, Managed Healthcare Executive set out to discover what medical schools are doing to address the situation.”

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/how-medical-schools-are-responding-opioid-epidemic

• August 12, 2017

Ric’s email: Hospital Impact—PBMs are worsening the opioid epidemic
“For Americans younger than 50, the leading cause of death used to be injuries caused by accidents. Now, the biggest killer isn’t car crashes or ladder falls—it’s drug overdoses.” “Overdose deaths surged by 15% from 2015 to 2016, the largest annual increase in American history. Overdoses have pushed up death rates among all racial and ethnic groups.”

https://tinyurl.com/y8esgtjt

• August 3, 2017

Ric’s email: Study: Many patients prescribed more opioids than they use
“Most patients don’t use all of the pills in their opioid prescriptions, but they also don’t often dispose of their leftovers properly, according to a new study.” “Researchers at Johns Hopkins reviewed a number of prior studies on opioid prescribing and found that between 67% and 92% of patients did not use an entire opioid prescription, but still held onto the leftover medications, putting them at greater risk for misuse, according to data published in JAMA Surgery.”

https://tinyurl.com/yaodubcb

• August 2, 2017

Ric’s email: White House opioid commission calls for data sharing between state and federal PDMPs by next year
“A White House-appointed commission tasked with addressing the country’s opioid addiction crisis wants state and federal prescription drug monitoring programs (PDMPs) to be completely interoperable in less than 12 months.”

https://tinyurl.com/yd2jcr6w

• August 1, 2017

Ric’s email: Jury convicts South Philly doctor of conspiracy to sell opioids
“July 27–Azad Khan signed progress notes for hundreds of patients at the South Philadelphia drug-treatment clinic, indicating he had performed a physical exam on each and had provided drug-treatment counseling.” “The reality, according to federal prosecutors: Khan was not examining or counseling the patients, but was part of an illegal ‘assembly-line’ scheme to sell opioids.”

https://tinyurl.com/y8jznx92 

• July 27, 2017

Ric’s email: Opioid Overdoses: Prosecution Risk and the Need for Naloxone

“There were more than 47,000 fatal drug overdoses in the United States during 2014, with roughly two thirds of those deaths linked to opioids.[1] Synthetic opioids, such as fentanyl, are involved in the mortality rates.”

http://www.medscape.com/viewarticle/883080

• July 26, 2017

Ric’s email: ‘Comes close to malpractice:’ Barriers keep effective treatment away from South Carolina opioid addicts
“White and black, poor and upper class, teenage boys and middle-age women, high school dropouts and doctoral degrees. The opioid epidemic hasn’t discriminated.”

http://www.postandcourier.com/content/tncms/live/

• July 24, 2017

Ric’s email: Fair Game: Hard Questions for a Company at the Center of the Opioid Crisis
“The immense pay packages bestowed on corporate chieftains are often said to reflect feats of management that enrich company shareholders. An executive’s masterly performance justifies the compensation, in other words.”

https://www.nytimes.com/2017/07/21/business/mckesson-opioid-packaging.html

• July 21, 2017

Ric’s email: Workers’ comp seeks to move away from opioids, surgery for lower-back injuries
“The Bureau of Workers’ Compensation’s board of directors has approved a rule that discourages surgery and opioid use in favor more conservative therapy for lower-back injuries. That includes physical therapy, chiropractic care and rest, anti-inflammatories, ice and other nonsurgical treatments. The new rule requires workers to undergo at least 60 days of comprehensive conservative care before considering surgery as an option.”

https://tinyurl.com/y8qssbnj

• July 21, 2017

Ric’s email: Doctor helped fuel drug crisis, AG alleges
“He allegedly made it worth the trip, writing painkiller prescriptions two to five at a time and renewing them every month. In 2016 alone, according to New Jersey’s attorney general, Craig Gialanella wrote 413 prescriptions for approximately 50,000 pills in the names of 30 people from Atlantic County.”“The pharmacist looked closer and found Patterson himself was using multiple dates of birth to avoid being flagged in the state’s Prescription Monitoring Program, an oversight tool meant to uncover overprescription, authorities claim.”

https://tinyurl.com/ya8gv4rf

• July 21, 2017

Two Leading Online Black Markets Are Shut Down by Authorities
“AlphaBay grew into a business with 200,000 users and 40,000 vendors — or 10 times the size of Silk Road — the Justice Department said Thursday. The site recently come under scrutiny because many of its vendors sell synthetic opioids, like fentanyl, which play a central role in the nationwide overdose epidemic.” “On Thursday, Dream Market had 57,000 listings for drugs and 4,000 listings for opioids.”

https://www.nytimes.com/2017/07/20/business/dealbook/alphabay-dark-web-opioids.html

• July 20, 2017

Opioid prime suspect in youth death
“Opioid drugs come in many forms, some more powerful than others. Fentanyl is a particularly powerful opioid that alters the perception of pain and is 50 to 100 times more potent than the opioid morphine. The first fentanyl formulation was approved by the U.S. Food and Drug Administration (FDA) in 1968. Especially in recent years, misuse and illicit manufacturing of the drug has become an important contributor to the opioid epidemic.”

http://abcnews.go.com/Health/fentanyl-opioid-suspected-10-year-olds-death/story?id=48723374

• July 19, 2017

A Tide of Opioid-Dependent Newborns Forces Doctors to Rethink Treatment
“From 2003 to 2012, the last year for which statistics are available, the number of babies born dependent on drugs grew nearly fivefold in the United States. Opioids are the main culprit, and states like Kentucky are particularly hard-hit: 15 of every 1,000 infants here are born dependent on opioids.”

https://www.nytimes.com/2017/07/13/health/opioid-addiction-babies.html

• July 13, 2017

Opioid addiction rates continue to skyrocket
“The BCBS analysis found that longer-duration prescriptions were associated with higher incidences of opioid use disorder. A CDC study from earlier this year found that an opioid prescription lasting for eight or more days increased the likelihood of using the drug a year later to 13.5%. A prescription of 31 days or more increased chances of long-term opioid use to 29.9%.”

http://www.cnn.com/2017/06/29/health/opioid-addiction-rates-increase-500/index.html

• June 29, 2017

Feds investigate dozens of thefts of opioids, other drugs at VA facilities
“WASHINGTON — Federal authorities are investigating dozens of new cases of possible opioid and other drug theft by employees at Veterans Affairs hospitals, a sign the problem isn’t going away as more prescriptions disappear.” “The immense pay packages bestowed on corporate chieftains are often said to reflect feats of management that enrich company shareholders. An executive’s masterly performance justifies the compensation, in other words.”

http://www.pennlive.com/nation-world/2017/05/feds_investigate_dozens_of_the.html

• May 29, 2017

Ric’s email: How a little-known patent sparked Canada’s opioid crisis
“OxyContin wasn’t merely a commercial success because it was effective at killing pain – it was also highly addictive. Patients who were prescribed the seemingly benign pills for everyday conditions, such as back pain, were becoming hopelessly dependent upon them, unable to break their habit and requiring stronger and stronger doses as time went on. Increasingly, people were dying.”

https://www.theglobeandmail.com/news/investigations/oxycontin/article33448409/

• May 19, 2017

Dentists Work To Ease Patients’ Pain With Fewer Opioids
“Dentists have long been frequent prescribers of immediate-release opioids like Vicodin and Percocet for the pain from tooth extractions. That’s a lot of pills and teeth; annually more than 3.5 million people, mainly young adults, have their wisdom teeth removed.”

http://www.npr.org/sections/health-shots/2017/02/26/513865623/dentists-work-to-ease-patients-pain-with-fewer-opioids

• February 26, 2017

Amid Opioid Overdoses, Ohio Coroner’s Office Runs Out of Room for Bodies
“Addiction is so entrenched and widespread that police officials say there are now third and fourth generations of prescription drug abusers. These days, hospitals in Cincinnati require drug testing of new mothers and infants because of a surge in newborns exposed to addictive drugs.”

https://www.nytimes.com/2017/02/02/us/ohio-overdose-deaths-coroners-office.html?_r=0

• February 2, 2017

Opioids Prescribed to Ohio Patients Decrease by 162 Million Doses Since 2012 Report Shows Continued Progress in Promoting Responsible Opioid Prescribing

https://tinyurl.com/y8xyqx48

• January 25, 2017

Ric’s email: After patient death, N.J. attorney general seeks to suspend doctor who prescribed fentanyl 10 Ways to Halt Drug Diversion by Healthcare Workers
“The New Jersey attorney general is seeking to suspend the medical license of a doctor who prescribed the powerful painkiller fentanyl to a patient who later fatally overdosed.”

https://www.statnews.com/2016/10/17/fentanyl-doctor-suspension/

• October 17, 2016

How Doctors Wrote The Script For An Epidemic
“Some wrote thousands of prescriptions for OxyContin, even though, in 2007, Purdue Pharma agreed to pay $600 million to settle criminal charges that it lied when it called that opioid ‘less addictive.’ They prescribed powerful narcotics for everything from migraines to sunburn, according to the state medical board documents, ignoring the White House’s 2011 declaration of a ‘prescription drug abuse crisis.’”

https://newsinteractive.post-gazette.com/overdosed/

• May 22, 2016

A Controversial Court Decision about Painkiller Prescription

“The FBI shut down Mountain Medical Center in 2010. During their investigation of the clinic, they found ample evidence of over prescription and improperly prescribing controlled substances.”

http://lighthouserecoveryinstitute.com/a-controversial-court-decision-about-painkiller-prescription/

• July 22, 2015

IX. DIVERSION/RECOGNITION/PREVENTION

Diversion of Drugs Within Health Care Facilities, a Multiple-Victim Crime: Patterns of Diversion, Scope, Consequences, Detection, and Prevention
“We believe that all health care facilities should have systems in place to deter controlled substance diversion and to promptly identify diversion and intervene when it is occurring. Such systems are multifaceted and require close cooperation between multiple stakeholders including, but not limited to, departments of pharmacy, safety and security, anesthesiology, nursing, legal counsel, and human resources…. diversion can occur at any point along a long supply chain.” “In the United States in 2010, nearly 4 billion retail prescriptions were filled, with sales totaling $307 billion. The medication most often prescribed, 131.2 million times, was the opioid hydrocodone combined with acetaminophen.3 The opioid oxycodone combined with acetaminophen was prescribed 31.9 million times.” “The most common drugs diverted from the health care facility setting are opioids.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538481/

• July 2017

10 Ways to Halt Drug Diversion by Healthcare Workers
“1. Have a zero-tolerance policy, 2. Make friends with law enforcement agencies, 3. Employ a 24-hour diversion hotline, 4. Assemble a team like the Mayo’s D-DIRT, 5. Employ a waste retrieval system, 6. Throw out assumptions about healthcare workers who divert drugs, 7. Know and keep track of areas, 8. Report it, 9. Make sure hospital leaders understand, 10. Offer treatment once an employee is caught and terminated.”

http://www.healthleadersmedia.com/quality/10-ways-halt-drug-diversion-healthcare-workers#

• September 2, 2016

Medication Theft In Nursing Homes Is Potentially A Really Big Problem
“The healthcare industry is aware of the serious implications of widespread ‘drug diversion.’ (‘Drug diversion’ is a nice way to say ‘stealing medication from sick people’.)” “The most widely abused prescription drugs are oxycodone and morphine derivatives.”

http://www.coluccio-law.com/medication-theft-nursing-homes-potentially-really-big-problem/

• 2014

A plan for drug diversion
“Shift-to-shift counting alone will not suffice in identification of diversion.” “A good, solid system will have policies and procedures to address screening, ongoing monitoring (including the ability to recognize the signs of an impaired worker), documentation reconciliation, auditing, handling reports for suspicion of diversion, investigation steps, involvement of other people/entities (i.e. pharmacy consultant, police, State Licensing Board, State Agency, Medical Director, families, etc.), billing concerns, etc. It may also be helpful to educate all nurse managers on identification and auditing.” ‘Sue LaGrange, RN, BSN, NHA, is the director of education at Pathway Health.’”

http://www.mcknights.com/guest-columns/a-plan-for-drug-diversion/article/376753/

• October 13, 2014

X. ADDICTION/RECOGNITION/PREVENTION

Preventing Opioid Abuse
“A 2016 study by Baker and colleagues notes that there is significant variability in the amount of opioids prescribed, and the most commonly dispensed opioid was hydrocodone (78 percent), followed by oxycodone (15.4 percent). Interestingly, a 2015 study in the American Journal of Preventive Medicine reported a decrease in the rate of prescribing opioids (-5.7 percent), perhaps indicating that more advanced practice nurses are becoming aware of the addiction issue.”

http://canpweb.org/news-room/connections-newsletter/connections-2016-editions/connections-october-2016/preventing-opioid-abuse/

• 2016

State orders nursing homes to stock overdose-reversing drug, better train staff

“Massachusetts regulators are ordering nursing homes to begin stocking the overdose-reversing drug naloxone and to make sure that staff members are trained to care for residents battling addictions, further evidence of the extent of the state’s opioid crisis. The issue of substance abuse in nursing homes came into sharp focus this year when the Globe reported that state inspectors declared patients in at least two facilities in ‘immediate jeopardy’ because of serious violations, including lack of substance abuse treatment and inadequate staff training.”

https://www.bostonglobe.com/metro/2016/11/29/nursing-homes-urged-stock-overdose-antidote-train-staff-addiction-care/fTVxhig5Qo0NvhVUztESLM/story.html

• November 30, 2016

How do we decrease addiction to opioids but still treat millions with chronic pain?
“As highlighted in the surgeon general’s report released this week, ‘Facing Addiction in America,’ we are now beginning to translate rhetoric into national initiatives that target community-based education, treatment centers, and interventions to stop the distribution of opioids and to implement effective treatment and prevention programs….The surgeon general’s recommendations represent a major step forward in our fight against this deadly scourge. Like most epidemics, the immediate call to arms by our federal agencies is focused on helping those who are currently affected by opioid addiction and implementing steps to minimize the risk for addiction and death in vulnerable populations.”

https://www.statnews.com/2016/11/18/opioids-addiction-chronic-pain/

• November 18, 2016

Prevention and Intervention Strategies to Decrease Misuse of Prescription Pain Medication
“Every 19 minutes, someone in the United States dies from an unintentional prescription drug overdose. One major contributing factor to the rise in such deaths is the increased use of opioid analgesics. This policy statement recommends legislative and educational strategies to combat misuse of prescription pain medications. Legislation needs to address physical and mental status examination laws, doctor shopping laws, tamper-resistant prescription form requirements, regulation of pain management clinics, prescription drug monitoring laws, prescription drug overdose emergency response immunity, and access to naloxone. Education must be required for health care prescribers and for the general public. Community education efforts could focus on safe storage, use, and disposal of prescription medications. Pain medication prescription prescribers must be educated on identification and treatment of pain, alternative modalities, substance abuse screening, and mental illness assessments and treatment for vulnerable populations.”

https://tinyurl.com/zrn5gjb

• November 3, 2015

XI. OPIOIDS IN NEW MEXICO

Under Scrutiny, New Mexico Opioid Prescriptions Taper Off
“SANTA FE, N.M. (AP) — The number of people receiving opioid pain medication prescriptions or risky overlapping prescriptions has shown a notable decline in New Mexico since the state ordered doctors to check a database that can indicate whether a patient may be receiving narcotics from multiple sources, according to newly released statistics New Mexico has strengthened its prescription monitoring program in response to a surge in its drug overdose death rate in 2014, when the state ranked second only to West Virginia.”

https://www.usnews.com/news/best-states/new-mexico/articles/2017-06-23/under-scrutiny-new-mexico-opioid-prescriptions-taper-off

• June 23, 2017

Opioid prescribers forced to confront ‘doctor shopping’
“Eighteen states have adopted comprehensive mandates in the past four years requiring doctors who prescribe opioids and other controlled substances to check databases that show whether their patients are getting drugs elsewhere. About 13 other states have weaker mandates that cover more limited circumstances, according to a recent review by the Pew Charitable Trusts and Brandeis University.”

https://tinyurl.com/ybmffth2

• January 14, 2017

NM joins 41 states in lawsuit against drug maker
“ALBUQUERQUE, N.M. — New Mexico and 41 other states are suing the manufacturer of a drug used to treat addiction to heroin and prescription painkillers that cost the state’s Medicaid program $9.3 million in 2015. The lawsuit alleges that the pharmaceutical company Indivior Inc. artificially inflated the price of Suboxone by illegally blocking competitors from introducing cheaper generic drugs. New Mexico Attorney General Hector Balderas said Indivior conspired with MonoSol Rx to switch Suboxone from a tablet version to a dissolvable film to prevent or delay other companies from entering the market. Both companies have denied the allegations.”

https://www.abqjournal.com/908478/nm-joins-41-states-in-lawsuit-against-drug-maker.html

• December 13, 2016

Native American leaders meet with feds as opioid epidemic continues in New Mexico
“For years, the northern New Mexico city of Española and northern Rio Arriba County have had some of the nation’s highest heroin-related death rates.”

http://www.foxnews.com/world/2016/09/21/native-american-leaders-meet-with-feds-as-opioid-epidemic-continues-in-new.html

• September 21, 2016

References:

Pendulum, 4600B Montgomery Blvd. Suite 204, Albuquerque, NM, 87109, 888-815-8250, www.WeArePendulum.com