The rise of ‘grandfamilies’: Opioid crisis requires more Hoosier grandparents to raise children..

“When President Trump announced in early August, following a presidential commission’s recommendations, that the opioid crisis was a “national emergency,… he called it “a serious problem the likes of which we have never had.”
A month has now passed, and that urgent talk has yet to translate into urgent action. While the president’s aides say they are pursuing an expedited process, it remains to be seen how and by what mechanism Mr. Trump plans to direct government resources.” (A)

“This is a triple epidemic with rising waves of deaths due to separate types of opioids each building on top of the prior wave. The first wave of prescription opioid mortality began in the 1990s. The second wave, due to heroin, began around 2010 with heroin-related overdose deaths tripling since then. Now synthetic opioid-related overdoses, including those due to illicitly manufactured fentanyl and fentanyl analogues, are causing the third wave with these overdose deaths doubling between 2013 and 2014 .” (B)

“Nationwide in 2013, an average of 5.8 babies per 1,000 births were diagnosed with NAS. (neonatal abstinence syndrome) In Sullivan County in 2013, the rate was 54 per 1,000 and Northeast Tennessee registered 41 per 1,000….
Treating NAS babies is expensive due to lengthy stays in neonatal intensive care units. An average NAS baby costs around $65,000 to treat and the care of about 78 percent of NAS babies is charged to state Medicaid programs.
In the U.S., a third of reproductive-aged women filled a prescription for an opioid medication, and between 14 percent and 22 percent of women filled an opioid medication prescription during pregnancy.” (C)

“Drug overdoses killed roughly 64,000 people in the United States last year, according to the first governmental account of nationwide drug deaths to cover all of 2016. It’s a staggering rise of more than 22 percent over the 52,404 drug deaths recorded the previous year — and even higher than The New York Times’s estimate in June, which was based on earlier preliminary data.
Drug overdoses are expected to remain the leading cause of death for Americans under 50, as synthetic opioids — primarily fentanyl and its analogues — continue to push the death count higher. Drug deaths involving fentanyl more than doubled from 2015 to 2016, accompanied by an upturn in deaths involving cocaine and methamphetamines. Together they add up to an epidemic of drug overdoses that is killing people at a faster rate than the H.I.V. epidemic at its peak.” (D)

“Opioid use by American men may account for one-fifth of the decline in their participation in the U.S. labor force, according to a study by Princeton University economist Alan Krueger…
Krueger’s study linked county prescription rates to labor force data from the past 15 years, concluding that regional differences in prescription rates were due to variations in medical practices, not health conditions. In previous research, he found that nearly half of men in their prime worker ages not in the labor force take prescription painkillers daily.” (E)

“How easy is it for millennials to get their hands on the very drugs fueling today’s opioid crisis? Easier than you might think. According to a new national poll released by the American Psychiatric Association, 46 percent of millennials surveyed said illicitly obtaining such drugs would be a cinch in their neighborhoods — a far higher number than other adults questioned.
With stats like that, it’s no wonder so many health experts now warn pain sufferers — including millennials — to first consider drug-free, non-invasive options like chiropractic care to avoid the risk of getting hooked on potentially lethal painkillers like OxyContin.” (F)

“After years of rising opioid mortality, opioid deaths in most New York counties fell between 2015 and 2016, according to new numbers from the New York State Department of Health.
Excluding New York City, which is counted separately and where opioid deaths rose during the same period, there were 1,238 opioid deaths in New York state last year, compared to 1,520 deaths the year before. Overdose deaths take time to confirm, and it’s possible the new report’s numbers could change, but the apparent improvement comes amid growing use of the overdose reversal drug naloxone ― lending credence to the public health theory that increased access to naloxone helps prevent opioid deaths.” (G)

“Gov. Christie announced a new rule prohibiting prescribers from accepting “lavish meals and uncapped compensation for speaking engagements, consulting work, and other services from drug companies. The proposed rule, submitted to the Office of Administrative Law yesterday, will target the unnecessary prescription of prescription painkillers.
According to the Governor’s announcement, New Jersey doctors collected $69 million from drug companies and device manufacturers last year. He cited growing concerns that drug company money influences prescribing habits, especially when it comes to opioids. According to the Governor’s office, two-thirds of the $69 million received by New Jersey doctors went to just 300 physicians, with 39 each having received at least $200,000.” (H)

“That’s where prescription drug monitoring programs come in. They collect data from pharmacies to track what prescriptions for controlled substances patients have filled. The databases can be used to assess whether patients are getting more opioids than they can safely use. In addition, they can be used to tell if patients are getting other drugs, like a benzodiazepine, that are dangerous to use in combination with an opioid.
According to research summarized by the Leonard Davis Institute of Health Economics at the University of Pennsylvania, prescription drug monitoring programs can help reduce the amount or strength of opioids prescribed and dispensed. When physicians or dentists check the database and see a worrisome pattern of dispensed opioids, they can deny or change a prescription, screen for an opioid or other substance use disorder, and even counsel the patient to seek other forms of pain management or addiction treatment, if warranted.” (I)

“In 2016, the American College Health Association issued new guidelines for prescribing opioids, particularly in rural settings where students can not have access to specialized pain clinics.
‘We do very little prescribing’ “There is little evidence that opioid prescription pain medication is useful outside the treatment of cancer-related pain,” says the ACHA report. Armed with new data, some forward-looking colleges are taking a novel approach to provide support systems for students who are in recovery.
Dr. David McBride, director of the health center at the University of Maryland, said the school “sees very little” opioid use. “And we do very little prescribing,” he told NBC News. “Occasionally we prescribe in small quantities for pain.”…
Recovery dorms can be found at, among others, Augsburg College in Minnesota, Ohio State University, Baylor University in Texas, George Washington University in Washington, D.C. and Rutgers, the state university of New Jersey. (J)

“Maryland officials also have identified four strategies to:
— Raise and maintain the conversation surrounding opioid abuse to reduce stigma. — Focus energy toward a balanced approach that includes prevention, protection and recovery. — Use data to build and evaluate programs and projects. — Persevere toward long-term expectations.
Likewise, there are four ultimate goals, including prevention, access to treatment, enforcement, through police and courts, and reducing the number of overdoses. (K)

“Salt Lake City-based Intermountain Healthcare aims to achieve a 40 percent reduction in the number of opioids prescribed for acute pain systemwide by the end of 2018. “Intermountain announced the goal Tuesday, making it the first health system to formally make such a specific and substantial pledge for opioid prescription reduction.
1. To achieve the reduction, Intermountain has already trained about 2,500 prescribers in opioid reduction strategies. The system plans to extend this training to each of its 22 hospitals and 180 clinics throughout Utah and Idaho.
2. The system will also provide new tools and policies to help prescribers reduce the number of opioids prescribed by 5 million tablets annually. (L)

On July 26, at the annual shareholder meeting of McKesson, the nation’s largest distributor of pharmaceuticals, including opioid drugs, shareholders refused to approve the company’s generous executive-compensation plan after the International Brotherhood of Teamsters—which holds stock in McKesson—campaigned against it, citing the company’s “role in fueling the prescription opioid epidemic.” McKesson rejected that characterization, and denied that it had any such role. Calling the opioid, heroin, and fentanyl epidemic “complicated,” Jennifer Nelson, a spokesperson for McKesson, told me that “in our view, it is not to be laid at the feet of distributors.” The Teamsters, she charged, were trying to use the addiction crisis to their advantage in their ongoing labor dispute with the company involving the union’s efforts to represent workers at a McKesson distribution center in Florida.” (M)

“Dentists as a profession rank 4th among medical specialties for opioid prescriptions. Many of these prescriptions, historically, are written out to patients following wisdom tooth extraction, impacting children and young adults at ages when their brains are still developing and thus highly susceptible to addiction response. Patients also commonly received prescription opioids when treated at pain clinics and following surgical dental procedures. Though other medical professions also contribute to the volume of prescription opioid use and abuse in today’s society, dentists as a profession have the incredible power and knowledge to make the needed difference in response to this tragedy. (N)

“Nationally, the question becomes what this all means; such declarations of “national emergency” typically target national disasters or contagious diseases and end at a certain time. But there is no sign the epidemic is slowing down. And so the country asks: What is the administration going to do? How does the president intend to define “victory”?
Here’s hoping the president will, early in the process, identify specific goals to avoid the mission creep often associated with government programs. The alternative is the government attempting — and failing — to solve every facet of a complex challenge. A poorly executed emergency declaration creates false expectations in the public sphere, increases pressure for funding and allows political grandstanders to assume a leadership role.” (O)

Combatting this epidemic starts with conversations at home around kitchen tables, in classrooms, and on practice fields. Education is our best tool to help people stay off of drugs. We should each take responsibility for teaching our kids the dangers of heroin and opioid use and be on the lookout for signs that our kids are using drugs. Schools, libraries and police departments can aid in this effort by providing materials and training for these difficult discussions. It also means keeping an eye on the medications our family members are prescribed and taking unused medications to an approved take-back program. State and local governments can help by expanding drug takeback programs and getting the word out on programs that already exist. (P)

“Monica Slonaker, a Kokomo resident, knows well the challenges faced by grandparents thrust back into the role of day-to-day caregiver; it’s been roughly three-and-a-half years since she took in her own grandchildren. The two girls, her son’s daughters, now ages 3 and 7, were recently adopted by Slonaker and her husband, Bill – a situation, driven by opioid and alcohol abuse, that’s become commonplace across Indiana….
Then, one day, the mother showed up, dropped off the girls and “pretty much left them,” said Monica…And since the girls were dropped off at Slonaker’s home, the judicial system has determined that their father – Slonaker’s son, who suffers from alcoholism – and mother are not fit to maintain custody.
Adoption was determined to be the best option. Needless to say, it has changed the Slonakers’ lives.” (Q)

(A) A Month Has Passed Since Trump Declared an Opioid Emergency. What Next?, by By MAGGIE HABERMAN, https://www.nytimes.com/2017/09/10/us/politics/trump-opioid-emergency.html
(B) The Latest Jaw-Dropping Numbers From the Opioid Crisis, by JULIA LURIE, http://www.motherjones.com/politics/2017/09/the-latest-jaw-dropping-numbers-from-the-opioid-crisis/
(C) A HELLISH START, Babies born addicted are collateral damage of opioid crisis, by DAVID MCGEE, http://www.heraldcourier.com/news/addicted_at_birth/babies-born-addicted-are-collateral-damage-of-opioid-crisis/article_6bb6d5ec-b47b-5906-8203-c6daea1f6689.html
(D) Fentanyl Overtakes Heroin as Leading Cause of U.S. Drug Deaths, by JOSH KATZ , https://www.nytimes.com/interactive/2017/09/02/upshot/fentanyl-drug-overdose-deaths.html?_r=0
(E) Opioid use responsible for 20 percent of drop in American men from labor force, study finds, by Angel Phillip, http://www.chicagotribune.com/business/ct-opioid-use-labor-force-20170907-story.html
(F) How Millennials view the opioid crisis, http://www.philasun.com/health/millennials-view-opioid-crisis/
(G) In New York State, A Glimmer Of Good News About The Opioid Crisis, by Erin Schumaker, http://www.huffingtonpost.com/entry/new-york-opioid-crisis_us_59a94fb6e4b0dfaafcef8c26
(H) NJHA Newslink Today, September 1, 2017 Vol. 13 No. 170
(I) A Helpful Tool to Combat the Opioid Crisis, by Austin Frakt, https://www.nytimes.com/2017/09/11/upshot/a-helpful-tool-to-combat-the-opioid-crisis.html
(J) Opioid Crisis: How America’s Colleges Are Reacting to the Epidemic, by SUSAN DONALDSON JAMES, https://www.nbcnews.com/feature/college-game-plan/opioid-crisis-how-america-s-colleges-are-reacting-epidemic-n797696
(K) Official: State Needs Support to Fight Opioid Crisis, by TAMELA BAKER, https://www.usnews.com/news/best-states/maryland/articles/2017-09-01/official-state-needs-support-to-fight-opioid-crisis
(L) Intermountain to cut opioid prescriptions 40% by end of 2018: 5 things to know, by Brian Zimmerman, http://www.beckershospitalreview.com/opioids/intermountain-to-cut-opioid-prescriptions-40-by-end-of-2018-5-things-to-know.html
(M) When a Company Is Making Money From the Opioid Crisis, by BRIAN ALEXANDER, https://www.theatlantic.com/business/archive/2017/09/opioid-crisis-responsibility-profits/538938/
(N) You Are a Part of the Solution: Remedying the Opioid Crisis, Mirissa D. Price http://www.huffingtonpost.com/entry/you-are-a-part-of-the-solution-remedying-the-opioid_us_59b334cbe4b0d0c16bb52cba
(O) Defining ‘victory’ in the opioid crisis, by Robert L. Ehrlich Jr., Jim Pettit, http://www.baltimoresun.com/news/opinion/oped/bs-ed-op-0913-opioid-emergency-20170912-story.html
(P) It’s time for new approaches to the opioid and heroin crisis, by SEAN PATRICK MALONEY, http://thehill.com/opinion/healthcare/350325-its-time-for-new-approaches-to-the-opioid-and-heroin-crisis
(Q) The rise of ‘grandfamilies’: Opioid crisis requires more Hoosier grandparents to raise children, by George Myers Kokomo, http://www.kokomotribune.com/news/local_news/the-rise-of-grandfamilies-opioid-crisis-requires-more-hoosier-grandparents/article_0f4285e6-8f51-11e7-8421-f35a3787df2e.html