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Harm Reduction: Experts Call for Urgent Action as Fentanyl-Related Overdose Death Toll Climbs

More than 120 medical experts, public health departments, and drug user health advocates have called on the federal government to take more aggressive steps to deal with a wave of overdose deaths caused by heroin cut with fentanyl, an opioid pain medication 50 to 80 times stronger than heroin. The call came in an open letter to US Health and Human Services Secretary Mike Leavitt drawn up by the Harm Reduction Coalition, a national health and human rights advocacy group working to reduce drug-related harm.

https://stopthedrugwar.org/files/fentanyl.jpg
fentanyl
The ongoing epidemic -- Drug War Chronicle reported on it in June -- has killed more than 750 injection drug users this year from Chicago to the East Coast. Chicago, Detroit, and Philadelphia all have around 200 fatalities.

The actual number of deaths may be far higher because many jurisdictions near these large cities may lack the resources and expertise to monitor overdose trends. "This wave of overdose deaths poses an acute public health emergency and immediate threat to the lives of opiate users, while highlighting persistent weaknesses in health officials' response to the increasing epidemic of both legal and illegal opiate overdose," said Dr. Sharon Stancliff, medical director for the Harm Reduction Coalition.

The letter makes five recommendations, calling on Secretary Leavitt to ensure that:

  1. The Centers for Disease Control (CDC) create surveillance systems to monitor overdose trends and threats.
  2. The National Institute of Drug Abuse (NIDA) provide emergency funds for research projects to answer urgent questions that will allow jurisdictions to immediately and effectively address the overdose epidemic.
  3. The Substance Abuse and Mental Health Services Administration (SAMHSA) rapidly replicate existing overdose prevention programs, and fully fund them.
  4. The Drug Enforcement Administration (DEA) inform CDC of levels of purity and presence of fentanyl and other hazardous contaminants in local drug supplies so CDC can notify the public.
  5. The Department of Health and Human Services (HHS) prepare an emergency report of the current overdose epidemic for Congress. This report should make emergency recommendations for prevention measures including: Supporting community-based responses to overdose, including the use of naloxone, a legal medication that reverses opioid overdoses, by users and their loved ones; improving police and emergency medical services responses to overdoses; and enhancing the availability of substance abuse treatment.

"A client told us she watched her friend die in front of her and there was nothing she could do," said Corey Davis, legal services coordinator at Prevention Point Philadelphia. "If she had naloxone and was trained to use it, she could have saved her friend's life. We've lost a lot of our people due to fentanyl. This has to stop."

Detroit Deaths From Fentanyl-Laced Heroin Could Be Reduced By Medical Treatment

Press Release Source: Reckitt Benckiser Pharmaceuticals Inc. Detroit Deaths from Fentanyl-Laced Heroin Overdoses Could Be Reduced by Medical Treatment Tuesday October 3, 7:30 am ET Physician training sessions will increase patient access to medical office-based treatment for opioid addiction DETROIT, Oct. 3 /PRNewswire/ -- A recent string of opioid overdoses and deaths in Detroit and elsewhere in Wayne County highlights the devastation of a dangerous new illegal drug mixture: the combination of heroin with fentanyl, a powerful opioid painkiller used in anesthesia and to treat cancer pain. According to the Medical Examiner's office, so far there have been at least 122 fatal overdoses in the Detroit area attributable to heroin laced with fentanyl, while several times this many have occurred nationwide. ADVERTISEMENT "Fentanyl-related overdoses in the Detroit area serve as a tragic reminder that there is a need for better patient access to aggressive and effective medical treatment for opioid addiction," said Mark Menestrina, MD, addiction medicine physician at Brighton Hospital. "Opioid addiction is a chronic disease that can afflict anyone and needs to be treated much like we treat other chronic conditions. Medical treatment is oftentimes prescribed in the privacy of a doctor's office, creating a confidential, convenient, and respectful atmosphere. Currently, there are not enough certified doctors in Detroit available to handle the increasing number of people seeking help for opioid addiction. It is critical that office-based medical treatment become more widely available in order to contain this crisis and prevent more deaths throughout the greater metropolitan Detroit area." Addiction to opioids, which includes heroin as well as the prescription painkillers oxycodone, hydrocodone, fentanyl, and morphine, is a growing public health problem that affects people from all walks of life. In Michigan, misuse of prescription opioid painkillers continues to be a major problem and, in Detroit, heroin remains widely available, according to a report by the U.S. Drug Enforcement Administration (DEA). And as evidenced by the current surge in fentanyl-heroin use, drug dealers are targeting this mixture in the Detroit area. The recent problems in Detroit and throughout Michigan reflect a national public health crisis -- according to the most recent National Survey on Drug Use and Health (2006), published last month by the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 4.7 million people currently misuse prescription pain relievers, second only to marijuana use. Among young adults, nonmedical use of prescription drugs increased from 5.4 percent in 2002 to 6.3 percent in 2005. In addition, in terms of new users, in 2005 more people 12 years and older -- 2.2 million -- misused opioid painkillers for the first time than any other drug, including marijuana and cocaine. Many people do not fully understand the danger of misusing opioid painkillers such as fentanyl. A recent national survey on the public's perceptions of opioid addiction, Prescription Painkiller/Heroin Addiction and Treatment, revealed that nearly half of the U.S. public does not know that misusing prescription opioid painkillers is as harmful to the body, and fully as addictive, as heroin abuse. Physician Certification Training Available at Sessions and Online Any doctor may become certified to treat opioid dependence in his or her private office using an FDA-approved medicine called buprenorphine. Many patients prefer the privacy, convenience, and discretion that office-based treatment offers. According to Dr. Menestrina, access to buprenorphine treatment for patients addicted to opioids is vital to reduce the number of deaths due to drug overdoses. Doctors will find information about becoming certified to treat with buprenorphine at http://www.docoptin.com. Additionally, information about online and CD-ROM training options may be obtained from 1-877-782-6966. "An increase in the number of doctors certified to treat opioid addiction is an important step in the fight against the problem we're facing in Detroit," said Dr. Menestrina. "It is unfortunate that patients seeking buprenorphine treatment are turned away simply because not enough doctors are certified to prescribe this medication. This is especially upsetting considering the great success I have seen in my practice with buprenorphine. I strongly urge other physicians to learn about this treatment option and seriously consider becoming certified to treat the exceedingly high number of chemically dependent individuals in the Detroit area." Resources for Opioid Dependence and Its Treatment Addiction to opioids is defined as a long-term brain disease by the World Health Organization (WHO) and the National Institute on Drug Abuse (NIDA). It is a treatable medical condition that is caused by changes in the chemistry of the brain. This dependence can start with use of medicine that a doctor prescribes for serious pain but that a person continues to use after the medical need for pain relief has passed. Or it may begin as recreational drug use that spins out of control. Individuals who need more information about opioid dependence and its treatment, either for themselves or for someone they are concerned about, have several options. Educational materials on opioid dependence are available to answer questions about this often-misunderstood disease and the treatments that are available for it. To receive a free educational Resource Kit on these topics, visit http://www.turntohelp.com or call 1-866-455-TURN, both provided by Reckitt Benckiser Pharmaceuticals. Additionally, the non-profit patient advocacy group NAABT -- National Alliance of Advocates for Buprenorphine Treatment -- is dedicated to helping educate the public on opioid dependence and treatment in a private doctor's office. NAABT now offers a nationwide confidential matching service to pair individuals seeking buprenorphine treatment with available doctors. "Increasingly more people are contacting NAABT for information on opioid dependence and treatment and for help finding doctors who can prescribe buprenorphine," said Timothy Lepak, president of NAABT. "This is a disease that does not discriminate. It affects people from all walks of life and all socioeconomic and demographic levels." For more information on Detroit-area physicians who can prescribe medicine to treat opioid dependence in a private medical office, visit http://naabt.org. SAMHSA's Web site also provides a physician locator and other valuable information at http://buprenorphine.samhsa.gov. In the United States, buprenorphine is marketed as Suboxone® (buprenorphine HCl/naloxone HCl dihydrate) C-III Sublingual Tablets and Subutex® (buprenorphine HCl) C-III Sublingual Tablets, the only controlled medications under the Drug Addiction Treatment Act of 2000 approved by the FDA for treatment of opioid dependence in a doctor's office. Suboxone and Subutex are manufactured by Reckitt Benckiser Pharmaceuticals. About Reckitt Benckiser Pharmaceuticals Inc. Reckitt Benckiser Pharmaceuticals Inc. is a specialty pharmaceutical company that manufactures and markets Suboxone® (buprenorphine HCl/naloxone HCl dihydrate [2 mg/0.5 mg and 8 mg/2 mg]) C-III Sublingual Tablets and Subutex® (buprenorphine HCl [2 mg and 8 mg]) C-III Sublingual Tablets, formulations of buprenorphine used to treat opioid dependence. Suboxone and Subutex are the only controlled medications under the Drug Addiction Treatment Act of 2000 approved by the FDA for office-based treatment of opioid dependence. Reckitt Benckiser Pharmaceuticals Inc. is committed to expanding access to medical therapies for patients suffering from the chronic, relapsing brain disease of opioid dependence. For more information, visit http://www.suboxone.com or http://www.opioiddependence.com. Reckitt Benckiser Pharmaceuticals Inc. is a wholly-owned subsidiary of Reckitt Benckiser PLC, a publicly traded UK firm. Important Safety Information Intravenous use of buprenorphine, usually in combination with benzodiazepines or other CNS depressants has been associated with significant respiratory depression and death. Suboxone® and Subutex® have potential for abuse and produces dependence of the opioid type with a milder withdrawal syndrome than full agonists. Cytolytic hepatitis and hepatitis with jaundice have been observed in the addicted population receiving buprenorphine. There are no adequate and well-controlled studies of Suboxone or Subutex (a pregnancy category C medication) in pregnancy. Due caution should be exercised when driving cars or operating machinery. The most commonly reported adverse events with Suboxone have included headache (36%, placebo 22%), withdrawal syndrome (25%, placebo 37%), pain (22%, placebo 19%), nausea (15%, placebo 11%), insomnia (14%, placebo 16%), sweating (14%, placebo 10%). See full prescribing information for complete information. Suboxone and Subutex are registered trademarks of Reckitt Benckiser Pharmaceuticals Inc. Media Contact: Cory Tromblee 617-761-6715 [email protected]
Localização: 
Detroit, MI
United States

LA Supervisors Approve Funds for Overdose Prevention Drug

Localização: 
Los Angeles, CA
United States
Publication/Source: 
CBS 2 Los Angeles
URL: 
http://cbs2.com/topstories/local_story_255173854.html

UK Drug Deaths on the Rise, Despite Government Pledge

Localização: 
United Kingdom
Publication/Source: 
The Independent
URL: 
http://news.independent.co.uk/uk/this_britain/article1222808.ece

Surge in Heroin Deaths Leads Families of Victims to Speak Out

Localização: 
St. Louis, MO
United States
Publication/Source: 
KSDK News Channel 5
URL: 
http://www.ksdk.com/news/news_article.aspx?storyid=102639

Harm Reduction: Boston About to Move to Supply Addicts with Heroin Antidote

Boston public health authorities will likely approve a trial program providing heroin users with naloxone (brand name Narcan) next week, the Boston Globe reported Wednesday. If the Boston Public Health Commission indeed approves the program, it will join cities such as Baltimore, Chicago, and New York where authorities have already approved its distribution to drug users.

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In many locales, only paramedics or hospital emergency rooms administer the drug, which can stop a heroin overdose from turning into an overdose death. But with Boston facing a high number of heroin overdose deaths -- fatal overdoses increased 50% between 1999 and 2003 -- city health officials want to put the drug where it can do the most good most quickly: in the hands of drug users.

"The number one hope with this is to save lives," Public Health Commission executive director Joel Auerbach told the Globe. "Our paramedics have said it's a miracle drug. They've seen people who are comatose who are then revived and perfectly fine."

The trial run is expected to enroll 100 heroin users, who would have to undergo training and evaluation, as well as listen to encouragements to quit. But if they were not prepared to stop using, they would be instructed in how to administer Narcan. Then they would be given a prescription for two doses.

The proposed move comes just a week after the Office of National Drug Control Policy -- the drug czar's office -- rejected the idea as somehow encouraging drug use. "We don't want to send the message out that there is a safe way to use heroin," ONDCP spokesperson Jennifer DeVallance told the AP.

Editorial: Sometimes They Tell the Truth

David Borden, Executive Director

https://stopthedrugwar.org/files/borden12.jpg
David Borden
It's alternately refreshing or appalling to hear public officials who deal with drug policy occasionally tell the truth about it. This week reformers got to bring home some of both.

The refreshing truth-telling came from Great Britain, where a Parliamentary Committee harshly tore into the official drug classification scheme used in the Misuse of Drugs Act, and the agency that is responsible for maintaining it. Many of the rankings seemed to have resulted from "knee-jerk responses to media storms," the committee charged, with no consistency and "no solid evidence to back-up the view that classification had a deterrent effect." "The current classification system is riddled with anomalies and clearly not fit for its purpose," the chairman said. "From what we have seen, the Home Office and ACMD approach to classification seems to have been based on ad hockery and conservatism." (See two articles below in this issue to read all about it.)

Gotta like that! But now for one that I don't like -- not at all. In Philadelphia, one of the cities suffering under the crisis of fentanyl-laced heroin and the resulting wave of often fatal overdoses, the harm reduction program Prevention Point Philadelphia, partnering with a local physician, has begun to help distribute naloxone, a medication that if used soon enough during an overdose can save the victim's life.

Naloxone distribution is a type of program known as "harm reduction," the idea of which is that since we know some people are going to use drugs regardless of how we fight them, there are things that can be done to help them save their lives and the lives of others -- even before they stop using drugs, for that matter even if they never stop using drugs. Needle exchange programs are another example of harm reduction at work.

The drug czar's office reacted to the PPP venture with criticism. If heroin users have a chance of surviving an overdose, the reasoning went, it is "disinhibiting" to the objective of getting addicts to just stop using the stuff. "We don't want to send the message out that there is a safe way to use heroin," an ONDCP spokesperson said. But "dead addicts don't recover," as the common mantra in the harm reduction field goes.

While the drug czar's position is dead wrong about this -- deadly wrong, in fact -- the comment seems a fairly truthful explanation of the horrible way that many drug warriors think. It is a direct corollary of the spokesperson's comment that it is better to have people who could be saved instead die, in order to dissuade others from using drugs -- better to make sure that drugs kill -- so that everyone will be sure that drugs do kill. But the dead from overdoses are definitely (and permanently) dead, whereas those who, through the withholding of livesaving assistance to some, are thereby saved from death through their own choices, may or may not exist.

Those who oppose harm reduction are in effect supporting "harm intensification" instead -- a deliberate attempt through policy to increase the dangers of drugs -- at a cost of lives, and in my view of morality too.

But that is what prohibition is truly about, harm intensification on a global scale. Hence the need for legalization instead -- so morally defunct ideas like those expressed this week by the drug czar's office can be laid to rest and their ghastly consequences finally be made to cease.

Harm Reduction: Drug Czar's Office Opposes Letting Heroin Users Have Easy Access to Overdose Antidote

When heroin users around Philadelphia started overdosing on junk laced with fentanyl, a powerful synthetic opiate, a local harm reduction group began working with a sympathetic physician to provide addicts prescriptions to naloxone (brand name Narcan). The Office of National Drug Control Policy thinks that's a bad idea.

In many cities, paramedics carry Narcan with them, but by the time they arrive on the scene, it can be too late, explained Casey Cook, executive director of Prevention Point Philadelphia, the group that runs the city's needle exchange program. "If people have to rely on paramedics, more often than not, the overdose is going to be fatal, just because of the amount of time for people to get there," she told the Associated Press in an interview last Friday.

But the drug czar's office is worried that providing addicts with the means to survive an overdose would prove "disinhibiting," much the same way social conservatives argue that providing teenagers with condoms to prevent pregnancy and disease "disinhibits" them from remaining abstinent. ONDCP doesn't want to appear to condone drug use. "We don't want to send the message out that there is a safe way to use heroin," said Jennifer DeVallance, an ONDCP spokesperson told the AP.

There were some 16,000 drug-related deaths reported in 2002, the vast majority of them involving either heroin or prescription opiates, and at least 400 people have died in the wave of fentanyl-related heroin ODs in the past few months. Better they should die than people think heroin is safe, huh?

Prosecutor Says Dangerous Heroin Now in Cape May County (New Jersey)

Localização: 
United States
Publication/Source: 
Press of Atlantic City
URL: 
http://www.pressofatlanticcity.com/news/local/capemay/story/6583660p-6430459c.html

Opiate Painkiller ODs Now Top Those for Cocaine, Heroin

Localização: 
United States
Publication/Source: 
Forbes
URL: 
http://www.forbes.com/forbeslife/health/feeds/hscout/2006/07/24/hscout533964.html

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