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The Vicious Attack Against Suboxone Continues

Buprenorphine, the generic name for Suboxone, is a medication used to treat opiate dependence – it helps minimize withdrawal symptoms. It’s often an essential part of a person’s recovery plan, mainly due to its accessibility. Users can attain it through a prescription from a certified doctor, rather than having to hoof it to a medication-assisted treatment program multiple times per month, like methadone requires.

Although it does have the potential to be abused, Suboxone is considered safe by most clinicians when used as prescribed. However, despite its many benefits, an increasing number of pharmacies are now refusing to fill these valid prescriptions. It begs the question: How is this happening – especially in light of a full-blown opioid epidemic sweeping the country?

Round and Round

The Suboxone uproar seemed to have started once the U.S. Drug Enforcement Administration (DEA) cracked down on both Walgreens and CVS, fining them millions after violating federal rules for dispensing controlled substances. As a result, both pharmacy giants established stricter dispensing rules, which led to thousands of complaints by Suboxone users.

And now we can add Wal-Mart to the list, with a North Wilkesboro, NC, store location recently refusing to fill buprenorphine prescriptions altogether. Reportedly, DEA agents visited the Walmart pharmacy and told them if they continued filling Suboxone prescriptions, they would be accused of collusion. In response, the Wal-Mart allegedly axed sales of all buprenorphine products. A subsequent phone call to the Wal-Mart pharmacy, placed by Dr. Jana Burson, seems to back up the claims. In her blog, Dr. Burson writes:

“I asked him if it was true that Wal-Mart no longer fills buprenorphine prescriptions, and he said yes, that’s true. I asked was that for all forms of buprenorphine, including the films, Zubsolv, generics, etc., and he said yes, all of them… Starting to feel a little riled, I asked him if he thought that decision would interfere with appropriate treatment of a potentially fatal illness; he just repeated Wal-Mart had decided not to stock buprenorphine at all.”
Interestingly enough, DEA spokesman Rusty Payne says the agency is not the one to blame with limiting access to opioid painkillers. “If something is prescribed for a legitimate medical purpose, we’re certainly not going to get in the way,” Payne told the National Pain Report. Instead, he points the finger at the doctors and pharmacists.

Bottomline: Is This Legal?

The laws that govern whether pharmacists are obligated to fill legitimate prescriptions are murky. There doesn’t seem to be a clear-cut answer, other than some saying the final decision lies within an individual pharmacist’s “professional discretion.” For instance, Title 21 of the Code of Federal Regulations states that:

“The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription.”
However, others look towards company policies for direction. Walgreens now utilizes their “Good Faith Dispensing Checklist,” which mandates staff pharmacists ask every patient a number of questions before filling a new controlled substance prescription. If the patient and the prescription don’t meet all the “good faith” criteria, the Walgreens pharmacist cannot – by company policy – fill the prescription.

Whether it’s legal or not, refusing a legitimate prescription is blocking your access to treatment. If you or someone you know are refused Suboxone, contact your prescribing physician or your treatment program case manager immediately to make sure your recovery plan isn’t compromised in any way.

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Schizophrenia risk increased with alcohol, drug abuse

There has been a wealth of research on the impact that alcohol, cannabis, and other drugs might have on the risk of developing schizophrenia and other psychiatric disorders.

However, it is a difficult area to study, and previous research has been controversial and often contradictory.

As one example, many earlier studies could not take into account co-abuse; in other words, people who abuse a number of compounds.

Dr. Stine Mai Nielsen and Prof. Merete Nordentoft, from Copenhagen University Hospital, Mental Health Center in Denmark, recently embarked on one of the largest studies of its type.

Their findings, presented at this year’s International Early Psychosis Association (IEPA) meeting in Milan, Italy, add another piece to the puzzle.

Schizophrenia and drug abuse
To dive into this question, the team of investigators used data from 3,133,968 individuals born between 1955-1999 from nationwide Danish registers. In all, they identified more than 200,000 cases of substance abuse and over 21,000 schizophrenia diagnoses.

Data was analyzed using a range of statistical measures; they also controlled for a number of factors including gender, urbanity, other psychiatric diagnoses, co-abuse, parents’ immigration to Denmark, parents’ economic status, and psychiatric history.

The team found that abuse of any substance increased the risk of developing schizophrenia. The increased risks were as follows:

Cannabis: 5.2 times
Alcohol: 3.4 times
Hallucinogenic drugs: 1.9 times
Sedatives: 1.7 times
Amphetamines: 1.24 times
Other substances: 2.8 times.

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Editorial: Drugs. Addiction. Regret. Excuses.


When we were in elementary school, a police officer or two stood in the front of our classroom and told us drugs were bad. They did this on a weekly basis as part of the Drug Abuse Resistance Education, or D.A.R.E. program. We wrote our D.A.R.E. essays to complete the program and proudly received our D.A.R.E. graduation certificates, confident we would never do drugs and our friends would never do drugs.

Drugs were bad.

We never thought we or someone we knew would be addicted to drugs. This once naive thought now seems ridiculous given that an estimated 2.1 million people in the United States struggle with a drug addiction. Often this is because these substances are easy to obtain by way of a friend or a prescription.

America as a country is grappling with the heroin epidemic, and more than 3,500 people in Pennsylvania have died from an opioid overdose in the past year. Two of those deaths were the parents of a 7-year-old girl in Pittsburgh, who spent a day trying to “wake up” her parents after they overdosed.

This is just one of the real-world consequences of drugs, but it is extreme. It also seems somewhat irrelevant to us as college students because we aren’t in the “real world” just yet.

When we were in elementary school taking D.A.R.E. classes, drugs were bad. Maybe we still think they are bad. But chances are we know someone who does cocaine at every date party. We’ve seen the empty Adderall pills that litter the cubicles of Farchild-Martindale library during exams.

The national heroin epidemic receives attention because of the large-scale of the issue, the smaller-scale drug issues sometimes go unnoticed or ignored. While it may not be an epidemic, we seem to ignore the everyday drug use in our own school. This may be because we compartmentalize our lives in such a way that we’ve convinced ourselves what we do in college won’t hurt us later on in life.

We rationalize that it’s fine to take some Addy to study for an exam now, but we won’t take one when we have a real job. We only smoke when we’re drunk. We only do coke to have a good time on some weekends.

Heroin use on our campus is not nearly as prevalent as cocaine use or Adderall use, and it may not even be used at all. While heroin is still widely considered to be dangerous, Adderall and coke are less stigmatized than when we took D.A.R.E. in fifth grade. Coke is now a party drug and Adderall is a study drug — both have a particular purpose that play into the work hard, play hard mentality on campus.

Sure, not all of these items are addictive. Not everyone who uses them will become an addict. But these foreign substances are harmful when we become slaves to their effects.

There is a problem if you are putting something into your body and you cannot stop.

Drug addiction is terrifying. Everything else aside, our bodies are not made to be completely dependent on any one foreign substance. The health habits developed in our 20s will set the course for the rest of our lives. It’s not possible to completely overhaul our lifestyles the second we put on a brown cap and gown to graduate.

Anything can be addictive if you let it rule your life. When you can’t relax or have fun or focus without a drug, it becomes an addiction.

The desire to compartmentalize our lives is natural. Grade school was one time of our lives, high school was another and college is a third. While this breakdown of our lives may be important for remembering experiences, it is hazardous to think our actions in college will not affect our health in the future.

Addiction is bad.


These states are struggling with a drug addiction-fueled crisis in foster care


The nation’s drug-addiction epidemic is driving a dramatic increase in the number of children entering foster care, forcing many states to take urgent steps to care for neglected children.

Several states, such as New Hampshire and Vermont, have either changed laws to make it possible to pull children out of homes where parents are addicted, or have made room in the budget to hire more social workers to deal with the emerging crisis.

Other states, such as Alaska, Kansas and Ohio, have issued emergency pleas for more people to become foster parents and take neglected children, many of them infants, into their homes.

“We’re definitely in a crisis, and we don’t see an end in sight any time soon,” said Angela Sausser, executive director of the Public Children Services Association of Ohio, a coalition of public child safety agencies in the state.

In many states in the East and parts of the Midwest, addiction to opioid painkillers and heroin is helping to drive the crisis in foster care. In other parts of the Midwest and in the West, abuse of methamphetamines is. Regardless of the source, states are scrambling to deal with the fallout on children:

In Georgia, where substance abuse is involved 40 percent of the time when children are removed from their family, the system is so overburdened that state child welfare officials have partnered with local churches to help foster families with everything from doing laundry to buying a crib.

In Ohio, where more than 9,900 children are in foster care and nearly half of those taken into custody last year had a parent using drugs, case workers are having a hard time placing children with relatives. By the time the children get to foster care, they report, many of the adults in their extended family are addicted to opiates, too.

In California, agencies in San Diego and Orange County have issued calls for people to become foster parents and take in neglected children.

In Massachusetts, where 9,500 children are in foster care, the opioid epidemic has hit “every socioeconomic situation and every city,” and the foster care system was ill-prepared to deal with it, said the state’s child advocate, Maria Moissades.

“For everyone, the crisis happened so quickly, there was no time to gear up,” said Moissades, whose agency ensures that children receive timely services and makes policy recommendations to better serve children in need. “No one knew it was going to be as big.”

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Saving future generations from prescription drug abuse


One of America’s most devastating health care crises often begins in the most benign of locations — home medicine cabinets.

Our nation is becoming increasingly aware of the growing number of hospitalizations and casualties tied to prescription drug abuse. This problem is particularly acute among young adults. In 2014, according to the National Institute on Drug Abuse, nearly five individuals between the ages of 18 and 24 died every day, on average, from prescription drug overdoses. For every death, there were nearly 120 emergency room visits. The ease with which these young men and women get their hands on painkilling medications is particularly concerning. More than six out of 10 acquired the pills without ever having to leave home.

One source of this problem is easy to see. When we’re prescribed opioids after knee surgery or a root canal, for example, it is common for some pills to be left in the bottle when we feel better and no longer need them. But those drugs, all too often, stay in our medicine cabinet, or on top of a bedroom dresser or in the kitchen. Unused and often forgotten medications left where anyone can access them pose a serious health threat.
A Johns Hopkins School of Public Health study found that more than half of Americans who are prescribed opioids have leftover pills. A majority of those individuals don’t know or are not informed how to safely store or dispose of them. Clearly, we — and by “we,” I mean a broad coalition of governmental policymakers, community leaders, law enforcement and the healthcare industry — need to build upon existing efforts to do a better job of providing patients and families a safe, environmentally responsible way to dispose of unused medications.

At Mallinckrodt, we are dedicated to providing safe and effective medications for patients, and we are committed to working with policymakers, law enforcement officials and the industry to address the complex issues of opioid addiction and abuse.

This year alone, we have purchased and are donating more than one million drug deactivation and disposal pouches to community groups, law enforcement, schools, patients and families. These systems deactivate prescription drugs and make the chemical compounds in the pills safe for landfills. The pouches also are biodegradable. We’re working with community leaders and organizations to distribute these pouches where they can have the most benefit.

We are also committed to raising public awareness of the critical role of responsible drug disposal in the fight against prescription drug abuse.

While effective, this is just one step. Additional actions need to be taken. The pharmaceutical industry needs to continue its work on tamper-resistant and abuse-deterrent drug delivery technologies, while lawmakers and regulators craft the standards that will enable their adoption. We must improve the integration of state and federal prescription drug monitoring programs and share best practices for detecting suspicious drug orders at the manufacturing and supply chain stages.

We should enhance drug take-back and addiction rehabilitation programs, while doing a better job overall of educating patients, healthcare providers and the public about the dangers of prescription drug abuse. And, we should consider the use of alternatives to opioids when medically appropriate. Mallinckrodt is committed to these types of efforts and encourages others to take action as well.

Attacking the problem of prescription drug abuse requires a sustained, multi-faceted effort. By taking both common sense and innovative steps to make opioids less accessible for non-medical uses, we can reduce the number of ER cases and tragic, unnecessary deaths. We must eliminate the possibility that prescription drug abuse, misuse or diversion begins in the home medicine cabinet.

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Combined effort under way to battle drug addiction

AS HALLOWEEN approaches, we prepare ourselves to see people in scary masks. But we all understand that those costumed faces aren’t real.

What is real is a very scary face that’s too often masked from the public. It destroys families and sometimes results in death.

We’re talking about drug addiction – a problem that affects people from all walks of life today.

Mercer County has seen several deaths due to drug overdoses – often related to heroin – in the past year alone. And across the state there are reportedly 10 deaths due to the drug crisis every day.

That’s right: every day.

But there is hope thanks to a number of efforts to fight the problem. For example, The Herald recently reported:

• Pennsylvania Gov. Tom Wolf is pushing the General Assembly to act on anti-drug bills. One includes setting up a prescription drug database that notes when a patient is prescribed opioids. Too often these drugs can lead to addiction and some people even move on to illegal drugs to get their “fix.” This is one time we agree that “Big Brother” should be watching.

• Mercer County is setting up a mobile medical office that offers a periodic shot of Vivitrol, which blocks the receptors in the body that give heroin users a high. Deaths from heroin use have risen sharply in the past year because the drug is mixed with other toxic chemicals. The Vivitrol treatments, when combined with therapy, can hopefully provide a cure to the addiction.

• Local emergency crews are being equipped with the drug Narcan which can save a person’s life when he or she is dying from a opioid overdose.

• Seminars developed by the Mercer County Behavior Health Commission and others provided information on the drug problem and included speakers such as counselors, members of law enforcement, religious leaders and medical personnel.

• Plans are in the works to open a detox center in Farrell. Currently the closest facilities for in-patient treatment are some 50 miles away or more. Mercer County Coroner John A. Libonati, who reported 18 local overdose deaths since the start of the year, said, “It’s desperately needed.”

Just recently in Sharon, emergency personnel administered the drug Narcan to a man who had wrecked his car and was unresponsive. It saved his life. But the severity of the crisis was made extremely clear because the man was driving with his 3-year-old child strapped in the backseat.

Luckily the child suffered only minor injuries. But it demonstrates that a person’s drug addiction sadly can have adverse effects on his family and friends.

We carry stories on men and women who are arrested for burglaries or robberies, people who claim they committed crimes to satisfy the need for drugs. Victims are often mentally scarred. But an even bigger fear is that a person high on drugs might injure or kill a victim during a crime.

It is gratifying to see the coordinated effort on state, county and local levels to battle the growing crisis of drug use.

Maybe the combined assault on the problem will bring positive results – and fewer needless deaths of local men and women.
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Obama and Macklemore to talk about drug abuse

President Barack Obama will share his experience with substance use in an opioid crisis documentary with Macklemore that will premiere worldwide at the White House this afternoon and on MTV next week, the New York-based cable company announced Tuesday.
The president and the Grammy Award-winning artist will both be featured in the premiere of “Prescription For Change: Ending America’s Opioid Crisis,” an hour-long documentary that addresses the ongoing opioid addiction epidemic in America.
“The centerpiece of the doc is a frank conversation between Grammy-Award winning artist Macklemore and President Barack Obama, in which the two openly share their own experiences with substance use as they discuss the scourge and stigma of addiction,” MTV said in a statement. “‘Prescription for Change’ also highlights the societal forces that have contributed to the opioid crisis, as it follows the journeys of three young women in recovery.”
Macklemore, the documentary’s executive producer, said it will highlight “some of the things we need to do to address this epidemic.”
“I’m one of millions of Americans who has struggled with addiction and abused pain killers, and if it weren’t for treatment and recovery I wouldn’t be here today,” he said in the statement.
While MTV will premiere the documentary next Tuesday at 9 p.m., its world premiere will occur at the White House, which is hosting a “South by South Lawn” festival. Ana Marie Cox, MTV News’ senior political correspondent, will moderate a discussion with Macklemore, National Drug Control Policy Director Michael Botticelli and others.
“Prescription for Change” is one of three documentaries MTV Docs, a new filmmaking initiative that seeks to “capture the artists and audiences that inspire MTV,” plans to release this year.

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The Way We Talk About Drug ‘Abuse’ Is Harmful — And It Needs To Change

Substance use disorder is a medical circumstance ― a brain disease that can be targeted and treated. But when we use words like “junkie” and “crackhead,” we frame the issue in moral terms, suggesting that people with substance use disorders simply lack the willpower to get better.

And that’s not helpful for anyone.

That’s the contention of Michael Botticelli, the director of the White House Office of National Drug Control Policy, which is working to change the way Americans talk about addiction.

The problem with much of the existing language in this area is that it carries judgmental connotations. That can increase the stigma associated with substance use disorders, and end up driving people away from the treatment they need. You don’t want to seek help from someone you feel is looking down on you.

“Commonly used terms can imply, or even explicitly convey, that individuals with [substance use disorders] are morally at fault for their disease,” Botticelli wrote in an essay published Tuesday in The Journal of the American Medical Association.

Pejorative terms like “junkie,” Botticelli wrote, describe people “solely through the lens of their addiction or their implied personal failings. These word choices matter.”

ONDCP’s guidance draft, called “Changing the Language of Addiction,” encourages the adoption of various new phrases to replace older terminology that may perpetuate stigma.

Instead of using words like “abuse,” “dependence” or “drug habit,” the guidance recommends the term “substance use disorder.” Alternatively, one could talk about the “misuse” or “unhealthy/harmful use” of a substance.

“Science shows that a substance use disorder is a chronic brain disease,” the draft guidance reads. “’Substance use disorder’ is the clinically accurate term.”

The guidance also recommends using person-first language to describe people with addiction, as is standard for describing other individuals with chronic conditions or disabilities (e.g., “person with autism” rather than “autistic person”). For example, the term “person with a substance use disorder” would be preferred over terms like “abuser,” “addict” or “alcoholic,” all of which can lead to negative perceptions about the very people they describe.

Much of the vocabulary ONDCP endorses is studiously neutral. The terms “clean” and “dirty,” the office says, should be abandoned when describing a “person in recovery” who may or may not be currently using substances. ONDCP recommends instead using terms like “negative” and “positive,” a reference to one’s toxicology results, or else describing a person in recovery as either “currently using substances” or “not currently using substances.”

For people with substance use disorders who use medication as part of their treatment, ONDCP recommends saying “medication assisted treatment” instead of “drug replacement” or “drug substitution” ― terms that can imply that medication merely “substitutes” for one drug, or addiction, for another.

“The basic message is that words matter,” said Dr. Howard Koh, professor at Harvard’s T. H. Chan School of Public Health and the Harvard Kennedy School and co-author of the JAMA essay. “The stigma associated with addiction can discourage people from coming forward to seek treatment… [and] millions of people who need treatment are not receiving it. Reasons for not seeking treatment include the fear of negative reactions from neighbors, community members and employers.”

Although questions of word choice might seem beside the point when dealing with life-and-death matters like drugs and disease, Botticelli and Koh’s call for more accurate and humane language is rooted in science.

One recent study found that even a group of mental health professionals with significant experience working with people with substance use disorders were more likely to view a patient as personally culpable for their drug use ― and more likely to conclude that the patient should somehow be punished ― when the person was merely described as a “substance abuser” rather than a “person with substance use disorder.” In another study comparing the use of the same two terms, mental health professionals were found to view quote-unquote “substance abusers” as engaging in “willful misconduct,” representing a “greater social threat” and deserving of punishment.

Writing at JAMA, Botticelli and Koh say that it’s common for the language around health issues to evolve as our understanding of those issues becomes more sophisticated. They note that people with mental illness used to be labeled “lunatics,” and patients in the early days of AIDS were described as having “gay-related immune deficiency” ― language that obscures the reality that AIDS has nothing to do with sexuality, and that mental illness can affect anyone.

In all of these examples, Botticelli and Koh argue, “stigma and discrimination can arise when patients are labeled, linked to undesirable characteristics, or placed in categories to separate ‘us’ from ‘them.’”

“Changing the language can reduce stigma that isolates people and remove barriers that hold too many people back from receiving the treatment they need and deserve,” Koh told The Huffington Post. “Such changes, when combined with education and policy improvements, could foster a healthier future for our society.”

ONDCP’s guidance is a working draft, and the agency is currently seeking public comment on the document.

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5 Babies Show the Sobering Reality of What It’s Like to Be Born Addicted to Drugs

5 Babies Show the Sobering Reality of What It’s Like to Be Born Addicted to Drugs

Every 25 minutes, a baby is born addicted to opiates, according to the National Institute of Drug Abuse (NIDA).
The withdrawals these babies have are heartbreaking, and their condition has a name: neonatal abstinence syndrome (NAS). The cause of NAS is a mother who abuses drugs while pregnant, passing that addiction down to her child.
Side effects of NAS include tremors, seizures, vomiting, hyperactive reflexes, high-pitched crying and more.
Here are five babies whose lives were forever changed by drugs, before they were even born:
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Rate of drug-dependent newborns in Beaver County up nearly 400 percent since 2000

Rate of drug-dependent newborns in Beaver County up nearly 400 percent since 2000

The rate of babies born drug dependent in Beaver County has increased by 388 percent over the past 15 years, according to statewide analysis of hospital data released Tuesday.
The research, conducted by the Pennsylvania Health Care Cost Containment Council, showed that 21 of every 1,000 births were marked for substance-related neonatal stays in Beaver County during federal fiscal year 2015. The county rate in 2000 was 4.3 per 1,000 births.
Lawrence County had an even higher rate of drug-dependent newborns based on hospital stays in 2015 than Allegheny, Beaver or Butler counties, at 42.5 per 1,000 babies.
The rate of babies born drug dependent statewide over the same period increased by about 250 percent.
“Unfortunately, this has become a reality of life,” said Dr. Neil Capretto, medical director at Gateway Rehab. “We have this epidemic, and there are thousands of young women in our community of childbearing age who are in addiction and they will get pregnant at times. Sometimes, planned, sometimes not planned. … I would just encourage them to seek medical help and get involved with a maternal addiction program that can help, that will be good for their health and the health of their baby.”
One such program is the Pregnancy Recovery Center at Magee Women’s Hospital of UPMC in Pittsburgh, which opened in 2014.
Dr. Michael England, director at the center, said the program serves about 150 expectant and postpartum mothers who have substance abuse disorders, particularly with opioids.
Many of those mothers are treated with methadone or buprenorphine, but many wait to come forward because of stigma attached to drug addiction.
That’s the case with many who come to Heritage Valley Beaver hospital to give birth, said pediatrician Dr. James Scibilia.
“This is a really complicated problem. It’s not as simple as just patients coming in who have drug addiction, because a lot of these people don’t want to seek medical care because they’re either afraid or they are addicts using drugs in the community and they don’t want to be identified as being addicted,” Scibilia said. “So a lot of them come without really being either identified or without having enough prenatal care to really provide them with services.”
Heritage Valley delivers about 1,300 babies per year.
Long-term effects of babies born drug-dependent aren’t clear, like it is with smoking or drinking alcohol while pregnant, Capretto said.
“Probably the greatest negative effect on the baby is if the mother doesn’t get stability in her life after the pregnancy,” he said. “In other words, she doesn’t get proper treatment for addiction or relapses back into the addiction. It becomes very hard for that mother to provide good parenting.”
The rate of substance-related maternal stays has also been on the rise over the past 15 years. It has increased by 123 percent in Beaver County, from 19.5 per 1,000 hospital stays in federal fiscal year 2000 to 43.6 per 1,000 hospital stays in 2015.
The rate for substance-related stays for Lawrence County mothers in 2015 was comparable to most surrounding counties, at 43.4 per 1,000 maternal hospital stays.
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