Tag: opioid epidemic

A DEFENSE-LINKED CONTRACTOR TOOK OVER A SUCCESSFUL CDC ANTI-OVERDOSE INITIATIVE. IT IMPLODED IN A DAY.

A GROUNDBREAKING Centers for Disease Control and Prevention initiative to support harm-reduction groups across the country fell apart this month after the program came under the control of a federal contractor that has done no public health work for the government.

The National Harm Reduction Technical Assistance Center, or TA Center, was founded in 2019 as a coalition of harm-reduction groups partnered with the CDC to offer training, funding, and guidance to those working to reduce overdose deaths. Its success rested on the deep experience and the trust community members had for the three main partner organizations, which included the National Alliance of State and Territorial AIDS Directors, or NASTAD; the National Harm Reduction Coalition, or NHRC; the University of Washington’s Supporting Harm Reduction Programs; and a handful of other groups.

This month, the TA Center ceased functioning as it had for more than three years: Instead of a partnership, the project would be administered as a federal contract. And the CDC gave the sole-source contract to the Florida-based firm H2 PCI, a relatively new federal contractor with close links to the defense industry and the murky world of military special operations.

H2 PCI entered negotiations with the primary partners in the center to make them subcontractors but did not send proposed subcontracts to the groups until early November. Rushed by deadlines, those talks broke down in late November, according to Laura Guzman, executive director of NHRC.

As the H2 PCI contract went into effect on December 1, the primary partner organizations that had made the TA Center a success parted ways with the project, Guzman told The Intercept.

“From the beginning, it was clear that they had zero experience in the public health field and absolutely zero experience in harm reduction,” Guzman said. “It would be really challenging to work with a contractor who has zero understanding of our world.”

Advocates fear the takeover could wash away the years of painstaking work of building up the TA Center and sever its vital connection to on-the-ground harm reduction providers, making it harder for them to serve the people who rely on them for clean needles, naloxone, and other services, according to Maya Doe-Simkins, a veteran harm reductionist who has worked closely with the program.

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OxyContin’s Reformulation Linked to Rising Suicides by Children

In 2010, Purdue Pharma replaced the original version of OxyContin, an extended-release oxycodone pill, with a reformulated product that was much harder to crush for snorting or injection. The idea was to deter nonmedical use, and the hope was that the reformulation would reduce addiction and opioid-related deaths. That is not how things worked out.

The reformulation of OxyContin was instead associated with an increase in deaths involving illicit opioids and, ultimately, an overall increase in fatal drug overdoses. Researchers identified that pattern by looking at the relationship between pre-2010 rates of OxyContin misuse, as measured by surveys, and subsequent overdose trends. They found that death rates rose fastest in states where reformulation would have had the biggest impact. A new study by RAND Corporation senior economist David Powell extends those findings by showing that the reformulation of OxyContin also was associated with rising suicides among children and teenagers.

The root cause of such perverse effects was the substitution that occurred after the old version of OxyContin was retired. Nonmedical users turned to black-market alternatives that were more dangerous because their potency was highly variable and unpredictable—a hazard that was compounded by the emergence of illicit fentanyl as a heroin booster and substitute. The fallout from the reformulation of OxyContin is one example of a broader tendency: Interventions aimed at reducing the harm caused by substance abuse frequently have the opposite effect.

From 1988 to 2010, Powell notes in the journal Demography, the suicide rate among 10-to-17-year-olds fell by 36 percent. That drop was “followed by eight consecutive years of increases—resulting in an 83% increase in child suicide rates.” Based on interstate differences in nonmedical use of OxyContin prior to 2010, Powell estimates that “the reformulation of OxyContin can explain 49% of the rise in child suicides.”

Since “the evidence suggests that children’s illicit opioid use did not increase,” Powell says, it looks like “the illicit opioid crisis engendered higher suicide propensities by increasing suicidal risk factors for children,” such as child neglect and “alter[ed] household living arrangements.” He notes a prior study that found “states more
affected by reformulation experienced faster growth in rates of child physical abuse
and neglect starting in 2011.” And he suggests the suicide rate may also have been boosted by “parental death and incarceration” associated with the shift from legally produced pharmaceuticals to illicit drugs.

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LSD And Psilocybin Could Be Powerful Treatments For Pain—Without Opioids’ Dwindling Effects Over Time, Study Says

LSD and psilocybin could offer promising therapeutic potential for the treatment of chronic pain “on a mechanistic and experiential level,” according to a newly published literature review that highlights scientific findings happening as part of the “psychedelic renaissance”—a recent thawing of stigma and opposition into psychedelics research after decades of prohibition.

What’s more, authors note, the pain-relieving effects of LSD and psilocybin seem to increase with repeated treatment, unlike opioids, which display “decreased therapeutic effect” over time.

The narrative review, published last month in the South African Medical Journal, charts both the history of the two substances as well as scientists’ emerging understanding of their methods of action. It notes that the drugs seem not just to reduce pain but also better manage the experience of pain.

“Recent neuroimaging studies combined with small sample interventions with classic psychedelic agents,” authors wrote, “may point towards a possible means of improving the treatment of chronic pain on a mechanistic and experiential level.”

Classic psychedelics, the literature review explains, are those that bind to the central nervous system’s 5-HT2A receptors. They include both LSD and psilocybin.

The way psilocybin binds to receptors in the central nervous system “has similar effects to LSD on cognition, emotional processing, self-awareness and the perception of pain,” says the literature review, “which underpins its potential therapeutic benefit in treating people suffering with pain. Numerous small trials of LSD and psilocybin for chronic pain have already shown a good safety profile, with minimal physical dependence, withdrawal syndrome, or compulsive drug seeking compared with other analgesic agents.”

While the two drugs are part of the same family of alkaloids, their history is, of course, much different. The review describes explains that LSD was first synthesized in 1938, meaning humans have used it for less than a century. Psilocybin’s use stretches back thousands of years. In the modern U.S., psilocybin use was popularized in the late 1950s, while LSD grew to prominence in the ’60s and ’70s.

While there have been no reports of direct mortality from either substance and no withdrawal following chronic use, the study says, “the use of psilocybin in clinical research ended at the same time as LSD research as the Controlled Substances Act was enforced.”

Associations with counterculture and anti-government sentiment meant LSD and psilocybin research was abandoned, authors wrote. “From 1977 until the early 2000s, no more LSD research was published, despite overwhelming evidence pointing towards therapeutic benefit.”

Prior research had indicated LSD might be useful in treating depression, pain, and physical suffering in cancer patients and others. Among seven patients with phantom limb pain, participants treated with LSD reduced their analgesic requirements, and two patients’ pain was resolved.

During what the review refers to as the modern “psychedelic renaissance” or “the new wave of psychedelic research,” studies have found that psilocybin or LSD may help reduce cluster headaches, end-of-life depression in cancer patients and chronic pain.

In a pain study, a small sample of patients who self-medicate with the psychedelics “revealed a decrease in the experience of pain during the psychedelic session and for up to 5 days after treatment, before their pain returned to baseline.”

“The most exciting revelation from these interviews relates to the lasting psychological and emotional effect the psychedelics had on those interviewed,” the review says. “They describe increased resilience, body-self-awareness and psychological flexibility and psychological flexibility, which led to feelings of acceptance, agency and hope.”

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US States With Medical Cannabis Access See Decline in Nonmedical Opioid Prescriptions

Medical cannabis legalization is associated with a decrease in the frequency of nonmedical prescription opioid use, according to a Rutgers study.

The study, published in the International Journal of Mental Health and Addiction, examined data from a nationally representative survey of adults who reported nonmedical prescription opioid use – or using prescription medications without a prescription or in a manner other than prescribed.

According to the study, when states implement medical cannabis laws, there is a 0.5 to 1.5 percentage point decrease in regular to frequent (up to or greater than once per week on average) nonmedical prescription opioid use among people who reported using opioids in the previous year. However, these reductions were concentrated in people who met diagnostic criteria for cannabis addiction.

Still, the pros of legalizing marijuana to address risky opioid use should be considered alongside the cons, according to Hillary Samples, faculty member at the Center for Pharmacoepidemiology and Treatment Science in the Rutgers Institute for Health, Health Care Policy and Aging Research and lead author of the study.

“There might be some benefits to allowing legal access to medical cannabis in the context of opioid-related harms, ”Samples said. “However, from a policy perspective, there are much more effective interventions to address the ongoing overdose crisis, such as increasing access to treatment for opioid addiction.”

According to the Centers for Disease Control and Prevention, the rate of drug overdose deaths rose more than 14 percent from 2020 to 2021 in the United States. To understand approaches to mitigate this crisis, researchers have examined whether cannabis serves as an alternative to opioid use as cannabis might help with pain and symptoms of opioid withdrawal.

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After Xi Jinping visit to San Francisco, city falling back into drug use and homelessness: business owner

With the Asia-Pacific Economic Cooperation (APEC) conference over and done with in San Francisco, some business owners are complaining that the city is reverting into a den for homelessness and drug use. 

Restaurant owner Tony Pankaew said in a local media interview.that San Francisco rushed to clean up the city for Chinese President Xi Jinping and other foreign dignitaries for APEC.

“They cleaned up the people, they cleaned up the streets,” he told CBS News Bay Area. “They made the city look good and look impressive for the foreigners, for the politicians.”

“Now they have started to come back,” Pankaew said. “Slowly but surely. [In] a couple weeks [the city] will be back to where [it was] before.” 

Pankaew said he was hopeful that things will turn around in San Francisco, adding that a new skating rink near his business might attract more people, and therefore more business. 

Gov. Gavin Newsom, D-Calif., was criticized on social media after admitting that San Francisco timed a massive cleanup effort ahead of the summit.

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Marijuana And Opioids Are ‘Equally Efficacious’ In Reducing Pain, With Cannabis Offering Additional ‘Holistic’ Benefits, Study Shows

Medical marijuana and opioids are “equally efficacious” at mitigating pain intensity in patients with chronic pain, according to a new study in the Journal of Cannabis Research—but cannabis also provided more “holistic” relief, such as by improving sleep, focus and emotional wellbeing.

Researchers said their findings support the hypothesis that medical cannabis (MC) “alleviates pain through holistically altering the pain experience” rather than “only targeting pain intensity.”

“The results of the present study support the hypothesis that the effects of MC on pain experience are more holistic than those of opioids,” their report says. “MC may alleviate pain through affecting a broad range of pain-related experience experiential factors such as relaxation, improved sleep and mood, being able not to react to the pain, as well as a sense of control.”

The nine-person Finnish team, led by Åbo Akademi University psychology professor Jussi Jylkkä, looked at a sample of 201 chronic pain patients, 40 of whom used medical marijuana and 161 of whom used opioids to treat pain. There was some crossover, with about 45 percent of medical marijuana patients reporting also using opioids for their pain and about 4.3 percent of opioid users having used medical cannabis.

Subjects completed retrospective surveys on the “positive and negative phenomenological effects of the medicine,” and researchers then compared scores from the two groups.

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Medical Marijuana Legalization Led To Reduction In Frequent Use Of Nonmedical Prescription Opioids, Study Finds

Legalizing medical marijuana is associated with a “lower frequency” of nonprescribed pharmaceutical opioid use, according to a study published this month in the International Journal of Mental Health and Addiction.

While the decrease was rather small—between about 0.6 percent and 1.5 percent for regular to frequent opioid use—and was concentrated in people who met diagnostic criteria for cannabis use disorder, the researchers said it could signal “substitution effects with partial replacement of opioids by cannabis.”

The research team, from the schools of public health at Rutgers and Columbia universities as well as the University of Arizona’s School of Government and Public Policy, said the results highlight “the importance of identifying tradeoffs of cannabis legalization as an intervention to reduce opioid-related harms.”

The study used national survey data from 2004 to 2014 to examine nonmedical prescription opioid (NMPO) use—specifically, prescription opioids used without a prescription or in a manner other than prescribed.

Despite the decrease in regular and frequent opioid use, the study also found that medical cannabis legalization (MCL) was associated with a 2.1 percent increase in the occasional use of nonmedical prescription opioids, defined as between once and 12 times per year.

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Mind-altering ketamine becomes new pain treatment, despite little research or regulation

As U.S. doctors scale back their use of opioid painkillers, a new option for hard-to-treat pain is taking root: ketamine, the decades-old surgical drug that is now a trendy psychedelic therapy.

Prescriptions for ketamine have soared in recent years, driven by for-profit clinics and telehealth services offering the medication as a treatment for pain, depression, anxiety and other conditions. The generic drug can be purchased cheaply and prescribed by most physicians and some nurses, regardless of their training.

With limited research on its effectiveness against pain, some experts worry the U.S. may be repeating mistakes that gave rise to the opioid crisis: overprescribing a questionable drug that carries significant safety and abuse risks.

“There’s a paucity of options for pain and so there’s a tendency to just grab the next thing that can make a difference,” said Dr. Padma Gulur, a Duke University pain specialist who is studying ketamine’s use. “A medical journal will publish a few papers saying, ‘Oh, look, this is doing good things,’ and then there’s rampant off-label use, without necessarily the science behind it.”

When Gulur and her colleagues tracked 300 patients receiving ketamine at Duke, more than a third of them reported significant side effects that required professional attention, such as hallucinations, troubling thoughts and visual disturbances.

Ketamine also didn’t result in lower rates of opioid prescribing in the months following treatment, a common goal of therapy, according to Gulur. Her research is under review for medical journal publication.

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How Iron-Clad Is the Iron Law of Prohibition?

IN LATE MAY 2023, at the National Institute of Standards and Technology in Gaithersburg, Maryland, Edward Sisco opened a package of swabs taken from used syringes and empty bags. Sisco, a research chemist, ran the samples through a mass spectrometer, a device about the size of a washing machine, and got back a chemical profile.

Sisco receives these swabs from needle exchanges in Maryland and four other states, to track what drugs people are using. Those drugs range from illicitly manufactured fentanyl, an opioid that has largely replaced heroin; benzodiazepines, a class of drugs used to treat anxiety; and 20 different cutting agents and adulterants, such as caffeine, quinine, and mannitol. The surveillance system, which the federal agency piloted in October 2021, also frequently turn up drugs that are contaminating the illicit drug supply in the U.S. Among these are xylazine, a veterinary sedative that goes by the street name tranq, short for tranquilizer; clickbait headlines sometimes refer to xylazine as a “zombie drug” because it causes necrotizing wounds, skin ulcers and knocks people out. Last year, Sisco found another animal tranquilizer, medetomidine, in a small percentage of samples. Xylazine has never been approved for use in humans, and neither sedative is a typical opioid, which complicates the use of antidotes, such as naloxone, to reverse overdoses.

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Epstein Victim Who Testified Against Ghislaine Maxwell Has Died—and Her Family Wants Answers

Carolyn Andriano, a victim of sex-trafficker Jeffrey Epstein whose testimony was crucial to putting away his accomplice Ghislaine Maxwell, has died.

There was no obituary or funeral service after she died earlier this year, and police in West Palm Beach, Florida, opened an investigation into her death. After The Daily Beast reached out for comment, police spokesman Mike Jachles told us that the investigation was concluding and that Carolyn died of an accidental overdose.

The 36-year-old mother-of-five had planned to start a new chapter in North Carolina, at a new house with a fireplace and half-acre lot with a chicken coop. Carolyn and her husband, John Pitts, had purchased the property just weeks before she was found unresponsive in a West Palm Beach hotel room on May 23.

Before her death, “she was ecstatic,” Carolyn’s mother, Dorothy Groenert, told The Daily Beast. “She was all set up for a whole new lifestyle.”

Groenert says Carolyn’s death came as a shock because she was working on building a new life and texted her recently about being free of drugs and alcohol.

The way Groenert sees it, some things about her daughter’s overdose don’t make sense, and she wants cops to investigate further.

Jachles, however, said that Carolyn’s case would officially be closed this week. Officers on the scene took a statement from Pitts, who told them that Carolyn had been using drugs, and Carolyn’s brother, who rushed to the hotel after Pitts texted Groenert that Carolyn had died. Pitts tried to administer CPR and “was given directions over the phone with 911,” Jachles said.

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