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Archive for July 13th, 2015

The Role of Doctors in the Heroin

800px-Heroin

By Ross Parker

With the recent volume of media on the issue of the heroin epidemic, its overdoses and deaths, has come an effort to provide an easy explanation for the cause of and solution to this multifaceted problem. Much of the blame has been directed at doctors, who are charged with being either intentionally or negligently pill-happy with painkiller prescriptions. Their failures, it is charged, have made medical patients into addicts and, when the scrips became unavailable or too expensive, the patients were forced to turn to heroin and other opiates on the streets.

The tragic death of actor Phillip Seymour Hoffman who went from painkiller to heroin addiction and then to an overdose death is presented as a prime example for this explanation for the increase.

But the reasons for the current heroin upsurge are far more complex than the responsibility of a single group. Factors such as a failure of individual responsibility, insufficient education for kids, inadequate drug treatment resources, the emergence of Mexico as the dangerous big dog in shipping heroin up north, inadequate regulation and, yes, law enforcement, as well as a dozen other reasons contribute to the pandemic.

But doctors and their regulators do play an important role in this analysis and any feasible solution. It is not merely a coincidence that the country is in the midst of both a painkiller and a heroin overdose epidemic. The relationship between the two provide part of the cause.

The number of painkillers prescribed has quadrupled in recent years. Every day 44 people in the U.S. die from an overdose of painkillers. The number of deaths has skyrocketed from 4,000 to 16,000 annually. Experts from the health and law enforcement fields point to prescription drug abuse as a major cause of the epidemic. But they usually fail to add that 70% of these overdoses were by individuals other than the patient who obtained the prescription. Their access was from patients, many of whom legitimately needed the prescription, or from the street traffickers.

Which is not to say that medical profession doesn’t need to get its house in order.  Reforms need to be made even if doctors are not the only or even the primary culprit for the contagion.  It is true that a substantial percentage of physicians fail to find out about a patient’s history with controlled substances or their obtaining multiple scrips, even though this information is readily available. Plus many doctors lack the training and experience to identify opioid abusers and what alternative pain relief regimens could substitute for these drugs for patients at risk.

The February 2015 New England Journal of Medicine bemoans the absence of the use of proven medication treatment strategies both by physicians and drug treatment centers. The lack of insurance coverage, physician training, policy hindrances, and adequate resources are only part of the explanation for this failure.

Researchers of a study presented recently in the Clinical Journal of Pain found that many primary care doctors lacked an adequate knowledge base about opioid treatment and failed to appreciate the danger of diversion to non-patients. These two deficiencies often made the doctors prescribe them more often than necessary.

One part of the formula to battle this rampant epidemic is to work with doctors to strengthen the net that is supposed to limit painkillers to patients for whom there are no effective alternatives. Physicians have to receive training to be able to use an evidence-based pain management program and to be able to identify the dangers of misuse and overdoses. Checking up on drug-seeking patients should be mandatory and, if where it is not required, it should be the choice of every physician before a controlled substance is prescribed.

As was detailed in last week’s column, doctors should have the testicular tissue and foresight to make Naloxone available to family members, friends and first responders so that an addict in the throes of an overdose can get to the emergency room before his or her breathing shuts down.

[Two updates on that column: Kudos to the Macomb County Michigan Sheriffs’ Department who saved an overdosing person’s life last week because a month earlier they had the good sense to give every deputy Naloxone to use when confronted with an overdose. Second, thanks to the reader who posed the question, why isn’t Naloxone over the counter so it is readily available to first responders to provide a supply of this life-saving and harmless drug? Indeed, a good question.]

States have an important and related role in these reforms. As mentioned last week, every state should implement a mandatory Prescription Drug Monitoring Program. So far, although progress has been made in this endeavor, most states still make it voluntary by doctors and, as a result, well less than half utilize this database that tracks prescriptions and dispensing of controlled substances. In states which have recently made the program mandatory, results have been dramatic. In the last two years New York has had a 75% decline in patients seeking multiple scrips. Oregon and Tennessee have both had an immediate drop in overdoses.

There are many other fronts to this perplexing and complex battle to save lives, not the least of which is more study on why a half million people, especially young people from all socioeconomic backgrounds, are risking their lives every day for this momentary high even though they create a nightmare for their families.

One thing is clear, we need to stop stigmatizing addicts and looking for an easy fix. Only a broad based solution involving many disciplines and more resources will get the nation through this scourge.

Parker: The Role of Doctors in the Heroin Plague

Ross Parker was chief of the criminal division in the U.S. Attorney’s Office in Detroit for 8 years and worked as an AUSA for 28 in that office.

800px-Heroin

By Ross Parker

With the recent volume of media on the issue of the heroin epidemic, its overdoses and deaths, has come an effort to provide an easy explanation for the cause of and solution to this multifaceted problem. Much of the blame has been directed at doctors, who are charged with being either intentionally or negligently pill-happy with painkiller prescriptions. Their failures, it is charged, have made medical patients into addicts and, when the scrips became unavailable or too expensive, the patients were forced to turn to heroin and other opiates on the streets.

The tragic death of actor Phillip Seymour Hoffman who went from painkiller to heroin addiction and then to an overdose death is presented as a prime example for this explanation for the increase.

But the reasons for the current heroin upsurge are far more complex than the responsibility of a single group. Factors such as a failure of individual responsibility, insufficient education for kids, inadequate drug treatment resources, the emergence of Mexico as the dangerous big dog in shipping heroin up north, inadequate regulation and, yes, law enforcement, as well as a dozen other reasons contribute to the pandemic.

But doctors and their regulators do play an important role in this analysis and any feasible solution. It is not merely a coincidence that the country is in the midst of both a painkiller and a heroin overdose epidemic. The relationship between the two provide part of the cause.

The number of painkillers prescribed has quadrupled in recent years. Every day 44 people in the U.S. die from an overdose of painkillers. The number of deaths has skyrocketed from 4,000 to 16,000 annually. Experts from the health and law enforcement fields point to prescription drug abuse as a major cause of the epidemic. But they usually fail to add that 70% of these overdoses were by individuals other than the patient who obtained the prescription. Their access was from patients, many of whom legitimately needed the prescription, or from the street traffickers.

Which is not to say that medical profession doesn’t need to get its house in order.  Reforms need to be made even if doctors are not the only or even the primary culprit for the contagion.  It is true that a substantial percentage of physicians fail to find out about a patient’s history with controlled substances or their obtaining multiple scrips, even though this information is readily available. Plus many doctors lack the training and experience to identify opioid abusers and what alternative pain relief regimens could substitute for these drugs for patients at risk.

The February 2015 New England Journal of Medicine bemoans the absence of the use of proven medication treatment strategies both by physicians and drug treatment centers. The lack of insurance coverage, physician training, policy hindrances, and adequate resources are only part of the explanation for this failure.

Researchers of a study presented recently in the Clinical Journal of Pain found that many primary care doctors lacked an adequate knowledge base about opioid treatment and failed to appreciate the danger of diversion to non-patients. These two deficiencies often made the doctors prescribe them more often than necessary.

Read more »

DEA Head: 43,000 People Die a Year from Opiate Overdoses

Gov. Haley: FBI’s Background Check Failed to Raise Red Flags Before Gun Purchase

Dylann Roof

Dylann Roof

By Steve Neavling
ticklethewire.com

The racist man accused of shooting nine people at Emanuel AME church in Charleston was barred from buying a firearm but still was able to make a purchase because the FBI’s background check raised no red flags, NBC News reports. 

FBI officials acknowledged that Dylann Roof should have been prevented from buying a gun because he acknowledged he had possessed drugs during a previous arrest.

South Carolina Gov. Nikki Haley blamed the error on the FBI background checks.

“When the FBI called us, we were told that it was an FBI issue, that it was not a state issue,” she said.

Haley raised many questions.

“When someone has a charge filed against them, it should go into a database, and it should be shown immediately to anyone’s that looking at it,” she said. “I would be more interested in what went wrong. Why are they dealing with paperwork and not dealing with technology?”

FBI-Assembled ‘Hybrid Task Force’ to Tackle Violent Crime in St. Louis

st. louis mapBy Steve Neavling
ticklethewire.com

This isn’t your normal task force.

In fact, the FBI is calling it the Hybrid Task Force, and its goal is to pursue drug dealers and violent criminals, KMOX reports. 

“The task force has two focuses,” St. Louis Police Chief Sam Dotson said. “One is an interdiction piece that long term investigation to try and interrupt some of the drugs that are coming to town. And the other is a more rapid response to violence.”

Dotson credited the FBI for assembling the resources to make the team possible.

The members come from an impressive array of agencies – FBI, DEA, ATF, U.S. Attorney’s Office and several local prosecutors.

The task force all be formally introduced on July 20.

Mexican Drug Lord ‘El Chap’ Guzman Escapes Prison through Mile-Long Tunnel

guzmanBy Steve Neavling
ticklethewire.com

Mexico’s most notorious drug lord has escaped from prison again.

Joaquin “El Chapo” Guzman was last seen stepping into a shower when he escaped from a maximum-security prison through a tunnel.

What authorities discovered was baffling – a lighted tunnel that stretched nearly a mile long from the prison to a half-built house, CNN reports. 

Mexican President Enrique Peña Nieto said a manhunt was underway and that he was “deeply troubled.”

“This represents, without a doubt, an affront to the Mexican state, but also I am confident that the institutions of the Mexican state, particularly those in charge of public safety, are at the level, with the strength and determination, to recapture this criminal,” Peña Nieto said.

Guzma, who has run a deadly drug trafficking ring, escaped from prison in a laundry cart in 2001.