Opioid commission member: Our work is a ‘sham’

“The Trump administration has extended the opioid public health emergency issued by President Trump, days before that declaration was set to expire.
In October, President Trump announced in the White House’s East Room that he was declaring the opioid epidemic a national public health emergency. The move was without precedent, as such declarations had in the past been reserved for natural disasters and the outbreak of infectious diseases.
But the emergency orders only last for 90 days, so it would have expired Tuesday. On Friday, Health and Human Services (HHS) acting Secretary Eric Hargan signed an extension for another 90 days, effective Wednesday….
The declaration didn’t free up millions of dollars or include a request to Congress for more money. In 2016, Congress approved $1 billion over two years to combat the opioid epidemic. Advocates and Democrats say more is needed to make the public health emergency effective.
An HHS spokesperson said in December that the president wasn’t sending a formal request to Congress for the opioid emergency funding, but expected lawmakers to commit the “necessary resources” to combat the crisis “now and into the future.” (A)

“In New Hampshire, which President Trump has called a “drug-infested den,” the opioid crisis is almost a statewide obsession…
Researchers at Dartmouth College in Hanover, N.H., have been studying the issue to try to understand why the state’s opioid problem is so dire.
One big reason, they say, is the proximity to an abundant drug supply in neighboring Massachusetts, the center of drug distribution networks that traffic opioids throughout New England.
Another, they say, is New Hampshire’s low per capita spending on services to help drug users break free from addiction. Nationally, the state, which has no income or sales tax, ranks at the bottom in availability of treatment programs. The fire departments’ safe stations are one effort to fill that void.
The researchers also noted that the state has pockets of “economic degradation,” especially in rural areas where jobs are few, and that may contribute to the problem.
Beyond that, the researchers say, doctors here have long prescribed “significantly higher rates” of opioid pain relievers, almost twice the national average. When the government cracked down on legal painkillers, New Hampshire residents were primed to seek out illegal street drugs.
“This is a kind of perfect storm,” says Lisa A. Marsch, a professor of psychiatry and health policy at Dartmouth’s Geisel School of Medicine and the study’s principal investigator.” (B)

“Accidental deaths in the United States rose significantly in 2016, becoming the third-leading cause of fatalities for the first time in more than a century – a trend fueled by the steep rise in opioid overdoses, the National Safety Council reports.
Accidents — defined by the council as unintentional, preventable injuries — claimed a record 161,374 lives in 2016, a 10 percent increase over 2015. They include motor vehicle crashes, falls, drowning, chocking and poisoning, a category that encompasses accidental overdoses.
NSC said in a statement, “The unprecedented spike [in accidental deaths] has been fueled by the opioid crisis. Unintentional opioid overdose deaths totaled 37,814 from drugs including prescription opioid pain relievers, heroin, and illicitly-made fentanyl.”
By comparison, motor vehicle deaths were at 40,327 in 2016, a 6.8 percent increase from the previous year. Deaths related to falls were also up by nearly 4 percent and drownings and fire-related deaths saw slight increases from 2015, up 5.1 percent and 3.2 percent, respectively. The only category to show a decline was choking deaths, which were down 4.4 percent.” (C)

“Tom Petty, the chart-topping singer and songwriter, died in October from an accidental drug overdose as a result of mixing medications that included opioids, the medical examiner-coroner for the county of Los Angeles announced on Friday, ending the mystery surrounding his sudden death last year.
The coroner, Jonathan Lucas, said that Mr. Petty’s system showed traces of the drugs fentanyl, oxycodone, temazepam, alprazolam, citalopram, acetyl fentanyl and despropionyl fentanyl…
In a statement posted to Mr. Petty’s Facebook page on Friday, his wife, Dana, and daughter, Adria, wrote that Mr. Petty suffered from “many serious ailments including emphysema, knee problems and most significantly a fractured hip,” but that he continued to tour, worsening his conditions. “On the day he died he was informed his hip had graduated to a full on break and it is our feeling that the pain was simply unbearable and was the cause for his over use of medication,” the statement said.
They said: “We knew before the report was shared with us that he was prescribed various pain medications for a multitude of issues including Fentanyl patches and we feel confident that this was, as the coroner found, an unfortunate accident.”” (D)

“In an effort to help curb abuse and misuse, Walmart is launching a first-of-its kind opioid disposal solution – available at no cost – in all company pharmacies.* Known as DisposeRx, the small packet contains ingredients that, according to the manufacturer, when emptied into a pill bottle with warm water, ultimately enable patients to responsibly dispose of leftover medications in their trash.
According to the Substance Abuse and Mental Health Services Administration and the National Institute of Drug Abuse, more than 65 percent of people misusing prescription opioids are getting them from family and friends, and personal prescriptions are one of the main sources of nonmedical opioid abuse. DisposeRx provides a virtually effortless way for patients to destroy leftover opioids and a way to do so without ever leaving home.
The innovative disposal solution will now be provided in addition to ongoing counseling available to Walmart patients on proper opioid use when filling an opioid prescription at any one of its 4,700 pharmacies nationwide. Now, pharmacists can also counsel patients on how to use DisposeRx and distribute an opioid awareness brochure outlining risks and helpful resources.” (E)

“Under intense pressure to combat the problem, states across the country are expanding their Medicaid programs to cover alternative treatments such as acupuncture, massage, and yoga. The effort could increase non-opioid options for low-income patients suffering from pain. But it also opens states to criticism from skeptics who say taxpayers are being forced to fund unproven treatments based on political expediency instead of sound science.
Ohio’s Medicaid department took the most dramatic step this month by extending coverage of acupuncture treatments delivered by non-medical providers for patients with low-back pain and migraines, a step likely to allow much greater access and attract new practitioners to the field.
But Ohio is not alone. Eleven other states have implemented policies to encourage beneficiaries to use alternative therapies to help manage their pain and limit reliance on opioids, according to a 2016 survey by the National Academy for State Health Policy. In addition to acupuncture, covered services include massage, yoga, chiropractic manipulation, and various forms of physical and behavioral therapy, among others.” (F)

“On the same day Chris Christie ends his rein as the Governor of New Jersey, the state welcomes new rules — crafted by his administration — that aim to put a dent in what’s considered one of the leading causes of the deadly opioid crisis.
Proposed in August, the rules that take effect Tuesday impose limits on payments and other compensation that licensed prescribers in New Jersey may accept from pharmaceutical companies.
Licensed physicians, physician assistants, dentists and other prescribers may not accept more than $10,000 per year (total from all manufacturers) for services such as speaking engagements, participation on advisory boards and consulting arrangements. Contracts entered before Tuesday do not apply. The new cap does not apply to payments related to research and education events…
“Doctors who prescribe medicine should be motivated only by what is best for their patients, and never by financial incentives heaped on them by the pharmaceutical industry,” Attorney General Chris Porrino said when the proposed rules were first announced.
The rules hold the prescribers accountable for staying within the limits, not the pharmaceutical companies, making New Jersey unique when compared to other states with caps in place.” (G)

“On his last day in office, governor signs range of healthcare legislation, including measures on his
With less than 24 hours left in office, Gov. Chris Christie signed legislation to further integrate behavioral and physical healthcare, create more checks on physicians prescribing addictive medicines, and ensure that overdose victims get information about treatment options.” (H)

“Doctors at some of the largest U.S. hospital chains admit they went overboard with opioids to make people as pain-free as possible, and now they shoulder part of the blame for the nation’s opioid crisis. In an effort to be part of the cure, they’ve begun to issue an uncomfortable warning to patients: You’re going to feel some pain.
Even for people who’ve never struggled with drug abuse, studies are finding that patients are at risk of addiction anytime they go under the knife….
“I just wanted my patient not to be in pain, thinking I was doing the right thing for them and certainly not an outlier among my colleagues,” said Mike Schlosser, M.D., chief medical officer for a division of HCA, the nation’s largest private hospital chain.
Schlosser spent a decade as a spinal surgeon putting his patients at HCA’s flagship facility in Nashville through some of the most painful procedures in medicine, like correcting back curvature. He said he genuinely wanted to soothe the hurt he caused.
“But now looking back on it, I was putting them at significant risk for developing an addiction to those medications,” he said.
Using HCA’s vast trove of data, he found that for orthopedic and back surgeries, the greatest risk isn’t infection or some other complication—it’s addiction.
So the nation’s largest private hospital chain is rolling out a new protocol prior to surgery. It includes a conversation Schlosser basically never had when he was practicing medicine.”.. (I)

“Less than three months after President Donald Trump declared the U.S. opioid crisis a public health emergency, the nation’s governors are calling on his administration and Congress to provide more money and coordination for the fight against the drugs, which are killing more than 90 Americans a day.
The list of more than two dozen recommendations made Thursday by the National Governors Association is the first coordinated, bipartisan response from the nation’s governors since Trump’s October declaration.
The governors praised him for taking a first step, which included a pledge to support states’ efforts to pay for drug treatment through Medicaid, the joint federal-state health insurance program for low-income people. But the governors also called for more action…
The governors are asking for a requirement that drug prescribers undergo substance abuse training and register to use state databases that monitor prescriptions of dangerous drugs. They also seek increased access to naloxone, a drug that reverses overdoses, and asked that Medicare cover methadone treatment for senior citizens.
They said the federal government needs to do more to block illicit versions of synthetic drugs such as fentanyl from being shipped into the U.S. Last year, the Department of Justice issued indictments of two Chinese companies accused of sending fentanyl illegally into the U.S., one of several anti-opioid moves by the federal government….
The governors also called for the White House to put someone in charge of a coordinated effort on opioids…” (J)

“The opioid abuse crisis is costing Missouri about $1.4 million an hour, or enough to wipe out the economic gains produced by the state’s agriculture, mining and utility industries, according to a study released this week.
The study by the Missouri Hospital Association considered health care, lost work productivity, substance abuse treatment and other costs for the thousands of Missourians who were addicted to opioids and the 921 who died of an opioid-related overdose in 2016. Using data from the White House Council of Economic Advisers, the hospital association determined that the total cost of the opioid crisis in Missouri was more than $12 billion that year. (K)

“While most clinical efforts to mitigate the risk of opioid misuse have focused on limiting dosage levels, reducing the length of an opioid prescription actually has greater influence over the risk of misuse, according to a study published in BMJ.
For the study, researchers examined the health records of more than 568,612 privately insured patients nationwide who filled an opioid prescription postoperatively between 2008 and 2016. The patients had no history of opioid misuse prior to surgery. Researchers identified misuse in 5,906 patients via a diagnostic code indicating opioid dependence, abuse or overdose.
Analysis revealed the risk of misuse increased 20 percent with each additional week of opioid use and 44 percent with each additional prescription refill. Additionally, researchers found dosage — the amount of opioids taken over a 24-hour period — had minimal correlation to the risk of misuse when compared to prescription length. For patients taking opioids for two weeks or less, the risk of misuse was not influenced by dosage levels, even when the dose was twice as high. However, high opioid dosage did display a significant correlation to misuse in patients taking opioids for nine weeks or more.” (L)

“President Donald Trump is planning to slash the budget of the Office of National Drug Control Policy, in what marks his administration’s second attempt to gut the top office responsible for coordinating the federal response to the opioid crisis.
The plan would shift the office’s two main grant programs, the High Intensity Drug Trafficking Areas grant and the Drug Free Communities Act, to the Justice and Health and Human Services departments, respectively, multiple sources in the administration and others working with the government on the opioid crisis told POLITICO.
The move would result in a reduction of about $340 million, or 95 percent of the ONDCP’s budget. Trump administration officials say the office would still serve as the White House’s drug policy shop, while the grants would be administered by larger agencies.
The proposal is the latest in a series of actions that health policy experts contend show the Trump administration isn’t serious about addressing the opioid epidemic, despite the president’s designating the substance abuse disorder a national emergency.
Trump hasn’t appointed a permanent director or “drug czar,” to lead ONDCP or asked Congress for additional funding states say is needed to tackle the crisis. The administration has also emphasized a law-and-order approach that experts say only constitutes a narrow part of the solution — one that if overemphasized could harm more struggling patients than it helps.” (M)

“The needs and concerns of older people very rarely get any attention in discussions about the opioid problem. This needs to change, for several reasons…
Most importantly, one need not be addicted to be hurt. Older people are often drawn into the struggles of addicted children, friends, and extended family. The growing number of grandparents raising the children of addicted parents in “grandfamilies” has paralleled the growth of the epidemic, according to Generations United.
Many older people are also desperate to keep a struggling family member afloat. Too often, the result of these valiant efforts to hold a family together is older members going down with the ship. By sheltering an addicted child or grandchild in public housing, an older adult risks eviction under anti-drug use regulations from the Department of Housing and Urban Development. Their personal safety may be also be at risk; a rise in elder abuse and financial exploitation is attributed to the opioid crisis, as more adult children with addiction problems move back in with their parents.” (N)

“The FDA says it has taken “significant steps to confront the staggering human and economic toll created by opioid abuse and addiction, including strengthening drug warnings, taking action against companies for misleading promotion and taking important measures to enhance the safe and appropriate use.”
But from the 1995 approval of Oxycontin to belated 2013 restrictions on popular painkillers like Vicodin, Kolodny and others say the FDA has squandered one opportunity after another to curb rampant prescribing and the wave of addiction that followed.
West Virginia Sen. Joe Manchin, whose state has the highest opioid death rate in the nation, sums up the FDA’s lumbering response in two words: “Absolutely criminal.”
The FDA’s new commissioner, Dr. Scott Gottlieb, doesn’t go that far. But he acknowledges that the agency, where he was a deputy from 2005 to 2007, did not do all it could.
The 1995 approval of OxyContin led to what many see as the biggest public health catastrophe in the nation. George Frey / Reuters
“I don’t know that we could have stopped it,” said Gottlieb, who has made opioids the top priority of his seven-month tenure, in an interview with NBC News.”
“I think that there were opportunities probably years ago to take steps that might have allowed us to get ahead of it more than we are now. I think a lot of people didn’t do what they needed to do in the past or we wouldn’t be in the situation we’re in right now.”
The situation is undeniably grim: more than 300,000 deaths from prescription and illegal opioids since 2000, a drug-dependent baby born every 25 minutes, and life expectancy in the U.S. down for the second year in a row.” (O)

“The Trump administration could help improve the treatment of substance use disorder by following the recommendations of its own Commission on Combating Drug Addiction and the Opioid Crisis.
One recommendation urged federal agencies to analyze the quality of the various types of addiction treatment. This would give patients confidence that they are receiving treatments proven to work. It would also provide a framework for medical providers to turn to when helping their patients decide the best treatment options for their situations.
While every patient’s situation is unique and should be evaluated on an individual basis, research shows that long-term treatment with FDA-approved medications is the most effective form of treatment for those with opioid addictions. The FDA has approved three medications for this treatment: methadone, buprenorphine, and naltrexone. All three significantly increase the likelihood that individuals can recover to live healthy lives.
There are, however, significant differences in how each medication works and which one is best for which patient. Providing access to all three medications is essential — as is the case for many other diseases, the right medication and treatment plan should be focused on the patient….
The medical community must also step up. More physicians, nurse practitioners, and physician assistants need to get the proper training to offer patients with substance use disorders effective medications to quell them.
Just as with cancer or diabetes or other chronic conditions, the public, private, and medical sectors have the power to save the lives of those struggling with addiction. But their efforts won’t pay off until we use every clinical tool available to us. Payers need to cover and properly reimburse all three types of medication for addiction treatment — the Trump administration can provide incentives to do that. Treatment programs need to support, offer, and fully explain their benefits — the government can issue guidelines that encourage this. Clinicians need to get on board with evidence-based treatment options. And patients need to be empowered to ask for treatment without fear of shame and stigma, and be fully assured that they are receiving the right care and advice.
To effectively fight this deadly epidemic, we need everyone to play a role and do what they can to save lives.” (P)

“”Everyone is willing to tolerate the intolerable — and not do anything about it,” said former Democratic Rep. Patrick Kennedy, who was one of six members appointed to the bipartisan commission in March. “I’m as cynical as I’ve ever been about this stuff.”
President Donald Trump declared the opioid epidemic a 90-day public health emergency in October, but did not make any new funding available. In November the president said he would donate his third quarter salary to the Department of Health and Human Services to help fight the crisis.
Critics say the declaration did virtually nothing to change the status quo and that overdose deaths have continued to mount in the months since. The public health emergency declaration was, in fact, set to expire on January 23, but as the government was headed toward a shut down on Friday, Acting Secretary of the Department of Health and Human Services Eric Hargan renewed the national public health emergency for another 90 days.
“This and the administration’s other efforts to address the epidemic are tantamount to reshuffling chairs on the Titanic,” said Kennedy. “The emergency declaration has accomplished little because there’s no funding behind it. You can’t expect to stem the tide of a public health crisis that is claiming over 64,000 lives per year without putting your money where your mouth is.”” (Q)

(A) HHS extends Trump’s emergency declaration for opioids, by Rachel Roubein, https://www.statnews.com/2018/01/16/right-to-try-legislation-patients/
(B) How a ‘Perfect Storm’ in New Hampshire Has Fueled an Opioid Crisis, by KATHARINE Q. SEELYEJAN. 21, 2018, https://www.nytimes.com/2018/01/21/us/new-hampshire-opioids-epidemic.html
(C) Opioid Crisis Blamed For Sharp Increase In Accidental Deaths In U.S., by SCOTT NEUMAN, https://www.npr.org/sections/thetwo-way/2018/01/17/578518297/opioid-crisis-blamed-for-sharp-increase-in-accidental-deaths-in-u-s
(D) Tom Petty Died From Accidental Drug Overdose Involving Opioids, Coroner Says, by JOE COSCARELLI, https://www.nytimes.com/2018/01/19/arts/music/tom-petty-cause-death-opioid-overdose.html
(E) Walmart Launches Groundbreaking Disposal Solution to Aid in Fight Against Opioid Abuse and Misuse, https://news.walmart.com/2018/01/17/walmart-launches-groundbreaking-disposal-solution-to-aid-in-fight-against-opioid-abuse-and-misuse?utm_source=STAT+Newsletters&utm_campaign=d99329d601-MR&utm_medium=email&utm_term=0_8cab1d7961-d99329d601-150519373
(F) As the opioid crisis grows, states are opening Medicaid to alternative medicine, by CASEY ROSS, https://www.statnews.com/2018/01/17/medicaid-opioids-alternative-medicine/?utm_source=STAT+Newsletters&utm_campaign=d99329d601-MR&utm_medium=email&utm_term=0_8cab1d7961-d99329d601-150519373
(G) New rules cap payments from drug makers to doctors, by Dino Flammia, http://nj1015.com/new-rules-cap-payments-from-drug-makers-to-doctors/
(H) AMONG CHRISTIE’S FINAL TASKS: MORE LAWS TO HELP IN FIGHT AGAINST ADDICTION, by LILO H. STAINTON, http://www.njspotlight.com/stories/18/01/16/among-christie-s-final-tasks-more-laws-to-help-in-fight-against-addiction/
(I) Banding together to stop opioid addiction where it often starts—in hospitals, by Blake Farmer, https://www.fiercehealthcare.com/healthcare/banding-together-to-stop-opioid-addiction-where-it-often-starts-hospitals?mkt_tok=eyJpIjoiT0RjMk56UXpZMlUwT0RnMCIsInQiOiJOSG9PSVk1XC9IZ0JuR3N3eEFwbElmSXlWZkQ0aHprVVFTbTNkVjBIVmNKUGpKcXROZDV3cTdZXC90TDFqVCt2RFBUeUFodDhsS3QwMER2bktyWmNCUU5hdno5ZndKVjdBUXBoU1l2bUhXcitjN2M1S09mbE9aWmc2d3ZaOGRYOGVoIn0%3D&mrkid=654508
(J) Governors Ask Trump and Congress to Do More for Fight Against Opioids, by GEOFF MULVIHILL, http://time.com/5108758/governors-trump-congress-opioids/
(K) $1.4 million an hour: That’s how much this problem costs Missouri, by ANDY MARSO, http://www.kansascity.com/news/business/health-care/article195464299.html
(L) Risk of opioid misuse jumps 44% with each refill, study finds, by Brian Zimmerman, https://www.beckershospitalreview.com/opioids/risk-of-opioid-misuse-jumps-44-with-each-refill-study-finds.html
(M) Trump again targets drug policy office, proposing 95 percent budget cut, bySARAH KARLIN-SMITH and BRIANNA EHLEY, https://www.politico.com/story/2018/01/18/trump-targets-drug-policy-office-297422
(N) Beyond Addiction: How Older People are Forgotten in the Opioid Crisis, http://www.latimes.com/business/hiltzik/la-fi-hiltzik-medicaid-opioid-20180117-story.html
(O) Can commissioner Scott Gottlieb undo FDA missteps in opioid crisis?, by CYNTHIA MCFADDEN, BRENDA BRESLAUER and TRACY CONNOR, https://www.nbcnews.com/storyline/americas-heroin-epidemic/can-commissioner-scott-gottlieb-undo-fda-missteps-opioid-crisis-n838636
(P) Follow the evidence to treat opioid addiction, by SARAH E. WAKEMAN and GARY MENDELL, https://www.statnews.com/2018/01/22/opioid-addiction-treatment-access/
(Q) Opioid commission member: Our work is a ‘sham’, by Wayne Drash and Nadia Kounang, https://www.cnn.com/2018/01/23/health/patrick-kennedy-opioid-commission-sham/index.html