Thursday, February 5, 2015

Home / Join Together / Commentary: Abuse-Deterrent Opioids: Who Needs Them, and at What Cost?


Commentary: Abuse-Deterrent Opioids: Who Needs Them, and at What Cost?
February 4th, 2015/


Ending prescription drug abuse is not easy. It’s a complex problem, and solving it is going to take a complex solution made up of many components. One such component capturing the spotlight recently is the development and marketing of so-called “abuse-deterrent formulations” (ADFs) of extended-release/long-acting (ER/LA) opioid pain relievers. Policymakers are touting these medications as being so important that they are willing to consider legislation requiring that ADFs be used for all ER/LA opioid prescriptions. What many of those policymakers apparently haven’t considered, however, is how much this is going to cost, and who is going to bear that cost.

First, let me just say this about the term “abuse-deterrent”: it’s a misnomer. Currently approved ADFs are designed either to make it hard for people to crush, cut or otherwise alter the pills obtained from the pharmacy (e.g., OxyContin®, Hysingla®) or with a sequestered opioid antagonist that is released if the product is altered, rendering the opioid totally ineffective if it is ingested (e.g., Targiniq®, Embeda®). Other ADF mechanisms are envisioned in the draft guidance issued by the U.S. Food and Drug Administration (FDA) in 2013, but the common theme for all of them is an attempt to discourage people from altering the medication to snort, inject, smoke or otherwise ingest it by an unintended route. Doing this with an ER/LA opioid is dangerous because the medication in it is intended to be released over 12 to 24 hours, but when altered and taken by another route, the entire dose of the drug hits the bloodstream immediately, increasing the risk of overdose exponentially. ADFs deter this kind of abuse; but what they don’t deter is the most common form of abuse: swallowing more of the intact medication than is intended. In a sense, the “ADF” acronym really ought to stand for “alteration-deterrent formulation.”

Altering ER/LA opioids is a behavior most often seen among those who have a long history of abusing drugs. It is a behavior that is very rarely seen in people with pain who are prescribed these medications by their healthcare providers. As one panelist observed at a recent FDA meeting about ADFs, it’s a little odd that we’re designing these medications to protect people who shouldn’t be using them in the first place, rather than designing them to benefit those who SHOULD be using them. Requiring universal use of ADFs, which is the track on which the policy train is currently gathering speed, unquestionably would benefit the public health and reduce fatal overdoses involving prescription opioids. From that standpoint, such policies make a great deal of sense, and should be supported.

Unfortunately, it’s not that easy. Because these are new medications, the companies who make them have development costs to recoup, which is why the government grants them patent protection to exclusively market these new ADFs for several years. Like all such monopolistic situations, the result is a new product with a much higher price tag than the older products being replaced. This leads to another consideration: If the vast majority of people who are prescribed ER/LA opioids don’t alter them, why should they have to pay considerably more for medications designed to protect someone else? And, if some of these medications have older (cheaper) non-ADF versions on the market, why shouldn’t they be able to use these and save some money?

Clearly, if we want to encourage wide-spread adoption of ADF opioid pain relievers (and I think we certainly do), we need to take the necessary steps to make them affordable. That is why many pain management advocates support legislation that requires the use of ADFs in most instances, but only when coupled with a provision that third-party payers (insurance companies, Medicare, Medicaid, etc.) cover them so that patients’ out-of-pocket cost is as low as possible. Massachusetts did just that in a law it passed last year, and we at the Academy are advocating for similar provisions in bills that are now popping up in many state legislatures.

As is the case with every policy addressing prescription drug abuse, ADFs are not THE solution to the problem, but they are A solution – another vital piece in the policy puzzle we have to put together to end this complex public health crisis and save precious lives.

Dartmouth Says It Will Ban Hard Liquor on Campus
February 4th, 2015/


Dartmouth College has announced it will ban hard liquor on campus in an effort to reduce alcohol-related incidents. Hard liquor will no longer be served at events open to the public, and penalties for underage students found in possession of hard alcohol will increase in severity, according to The New York Times.

Colleges and universities across the country have been dealing with alcohol-related problems including sexual assaults, fraternity hazing and hospitalizations, the article notes. Few other colleges, except for ones with religious affiliations, ban hard liquor. It is unlikely other institutions will follow the lead of Dartmouth, despite its Ivy League affiliation, the newspaper states.

“I think you’re going to continue to see smaller efforts to step up enforcement, but not a lot of big statements like this,” said Kevin Kruger, President of Naspa, a national association of student affairs professionals in Washington. Kruger said while hard alcohol is particularly destructive, the core of the problem is that for many college students, “they’re under 21 and it’s illegal to drink, period.”

Jake G. Rascoff, a student who edits The Dartmouth Review, predicted the new rule will have a negative effect. “It will increase the incidence of surreptitious binge drinking and increase the risk of binge drinking off campus, which will lead to drunk driving,” he said.

Several other colleges, including Bowdoin, Bates and Colby in Maine, also have hard-alcohol bans. Some institutions, including Stanford, Swarthmore and Colgate, ban hard alcohol in certain places, and at certain types of events. Brown recently announced it is reviewing its alcohol policy after reports of sexual assaults at two fraternity parties.

Some schools have strong alcohol policies but do not strictly enforce them. At many colleges, fraternities own their houses and the land beneath them, allowing them to operate outside of college policy.



Moms-

Please join me in welcoming the a.mazing Nicole Montalbano as our guest expert for “In The Rooms,” on Thursday, Feb 5, at 7 PM ET. Nicole is the brilliant and beautiful daughter of our founder, Barbara Theodosiou. Nicole is currently a senior at Florida State University. She has recently been admitted into the Physician Assistant Program at Barry University in South Florida.

Nicole will be presenting for us her point of view as the sibling of Daniel, who suffers fro...m the disease of addiction. Most of us remember the path that led Barbara to create “The Addict’s Mom,” but allow me to remind you. When Barbara learned that two of her sons were addicted to drugs, she was devastated, as all of us are. She felt desperate and alone, convinced that no one could ever understand her heartbreak and pain as a mother of a child (children) who is battling addiction. So, certain that there were others who felt as she did, Barbara founded our wonderful TAM as a safe forum to “Share Without Shame” the tragedies, small victories, and grief as mothers’ of children with drug addiction. Of course, under Barbara’s excellent guidance, TAM has grown to include initiatives in education, advocacy, the legal system, and most recently, scholarships for treatment. Nicole was very young, at age 12, when the tragedy of addiction entered her house.


Nicole has written a very poignant memoir of her experiences with her beloved brother. As a guest on “In The Rooms,” Nicole will share her memoir, and her special insight as Daniel’s sister. We will invite her to suggest coping strategies for families, especially the siblings, when addiction becomes part of their daily lives. We will ask her to share with us what she would have done differently, and what is her most difficult obstacle to overcome. She can discuss the stigma, the pain of watching Daniel’s downward spiral, and her own healing process. I would also like to ask Nicole how Daniel’s tragic journey has affected her own life choices in relationships and career goals. Then you, the viewers, will have the o.pportunity to ask questions of Nicole.

Nicole Montalbano is a very brave young lady. With the example set by her mother, Barbara, it is no wonder that Nicole is able to “Share Without Shame” her journey, hand-in-hand with her family, on the devastating path that is addiction.

Please join us online at: www.intherooms.com (you will need to download Google Chrome or Firefox ) 
Further instructions how to access can be found in our files section on In the Rooms.


http://myemail.constantcontact.com/PRE-FESTIVAL-MEET---GREETS.html?soid=1102906894456&aid=aHBLL87hQx0

http://myemail.constantcontact.com/PRE-FESTIVAL-MEET---GREETS.html?soid=1102906894456&aid=aHBLL87hQx0

Wednesday, February 4, 2015

February 4 CHAP 46 v 1 TWELVE STEPPING WITH STRENGTH FROM THE PSALM



God is our refuge and strength,a very present help in trouble.   (GODS BIG BOOK)



STEP 11. Sought through prayer and meditation to improve our conscious contact with God praying only for knowledge of His will for us and the power to carry that out .
After fourteen years of living clean ,I can honestly say that the Psalm is true . There is no denying ,that God is real ! He picked me up cleaned me up and continually holds me up .  Recovery is not a one man show ! Starting with steps one through twelve reveal and  maintain and insist on the presence of GOD with us and for us .Before God and the twelve steps , I was strung out ,homeless ,depressed , suicidal , paralyzed with fear and angry at the world and I very much hated the ones who loved me most. Now when troubles come instead of preparing to do war with the world or getting higher that a kite , I  find a quiet place and talk it out with the GOD of the universe , my Father my helper my friend .






Psalm 147:3   “He heals the brokenhearted and binds up their wounds.
                        (GODS BIG BOOK)    By Joseph Dickerson 


February 3, 2015 Volume 2., No. 24








Breaking News! Will He Pass ... a UA?

Browns QB Johnny Manziel Stumbles... Into Rehab 

Johnny Manziel entered treatment, adviser Brad Beckworth told ESPN.com on Monday. Manziel is expected to be in rehab at least a few weeks, but the amount of time depends largely on what doctors recommend. The quarterback is voluntarily entering treatment as a direct result of his lifestyle away from the field, and he informed people in his circle last week that he wants to "figure out his value system."



It's a Thin Thin Line 
I'm Not Addicted - I'm Dependent 
by Brittany Patterson 

Prescription drug addiction can be characterized by behaviors like:

- Getting high on prescription drugs like OxyContin or Lortab takes 
priority over eating
- If you go too long between getting high you can't sleep or think of anything except how to get the next pill...






Future Mutes Coming To Rehab?

Smartphone Addiction Time-bomb 
'ready to explode' 

A third of internet users now access online content on mobile phones - up from just 10% two years ago - and internet users are expected to surpass PC users by next year. Counsellors now fear internet addiction, fueled by 24/7 access via mobile phones, will be the next wave of compulsive disorders that they will be treating. They are already hearing concerns expressed by parents of young adults and children about excessive use of smartphones to the point where they are no longer speaking or communicating without using technology.



Do The Math - That's What Counts VIDEO 
Addiction Treatment Goes Public: AAC's Recovery-Center Empire VIDEO 

American Addiction Centers is run by Michael Cartwright, a former drug addict and alcoholic who says he's been sober for 23 years. The company's IPO underwriters estimate there are 8,100 substance-abuse treatment enterprises across America, operating 16,700 clinics and centers. These include famous nonprofits such as the Hazelden Betty Ford Foundation, as well as Narconon International, an addiction treatment organization with ties to Scientology. At the high end, Malibu centers like Promises and Cliffside charge the Lindsay Lohans of the world as much as $112,000 per month for spa-like accommodations and services.






Get well at New Method Wellness





Check out the Waismann Method






There's Always Something

Facebook Activates Same Brain Areas As Drugs; How Social Media Sites Hook You 

As for their actual brain, the brain scans showed that high-scoring participants experienced greater activation of their amygdala and striatum, the two brain regions involved in impulsive behavior. These patterns are on par with those who are addicted to cocaine.



Massachusetts Hope 
Senator Says His Top Priority 
Is Curbing Opiate Addiction 

Viriato M. deMacedo's top priority was to spur the local economy, but, as he said, things change and the number one priority in his new job is to bring an end to the region's heroin epidemic. "It's a tall order, but I'm committed to do anything I can," he said. CONTINUED @ CapeNews.com






Click here for Biosound Therapy







Check out Loma Linda University 






Truly Good Samaritans

Overdose Victims Saved by Workers 
From Nearby Offices 

Several people are being hailed as heroes after police said they pulled two men who had overdosed on heroin out of a burning car in a busy shopping plaza on Thursday afternoon. -"I didn't think about it," said Michalides, 33, of Manchester. "I saw the car on fire, saw someone inside, and had to get them out." "At that point I started administering CPR to him, probably for about seven or eight minutes, with a woman from the Geico office helping, and revived him until Manchester fire could get here with oxygen."



Good Question VIDEO 
Liver Transplant Ethics: 
Should Alcoholics Be Sober First? VIDEO 

"
I believe that if doctors have a patient whose life they can save and they have a donor who's willing to give, that they have an obligation [to save their life]," she said in an interview on CBC Radio's As It Happens. In an interview on CBC Radio's Metro Morning on Wednesday, Levy said last year more than 100 people died while waiting for a transplant.







Twelve Promises: Rewards of Recovery







Brandi's Wish 






ABROAD:

Couple Kills Alcoholic Son, Hacks Body 

An elderly couple, fed up with their 27-year-old alcoholic son, bludgeoned him to death and chopped the body using a stone-cutter. They even dumped the parts in a forest near their home and had their house painted to remove any trace of the crime. Nand Kishore and Asha Devi, who are both in their 60s, have been arrested. 



Investigative Audio Report AUDIO 
'Scars Of Teen Drug Treatment' AUDIO 

While Barker received state and federal funding, as well as judicial praise, teenagers suffered horrific abuses that a Senate report compared to North Korean brainwashing. Barker eventually fell out of favor, and the Seed closed - only to be reborn as Straight Inc. With many of the same staffers and even harsher sessions, it expanded to multiple states. Of course it had the backing of Nancy Reagan.CONTINUED @ HuffingtonPost.com





His House & Her Creation Treatment





Bridges To Recovery 






Now Eat This

FDA Approves Drug For Binge-Eating 


Standard treatment for binge eating and other eating disorders usually involves counseling and psychotherapy. Some doctors also prescribe antidepressants to try and curb eating disorders, though they are not approved for that use. The Food and Drug Administration approved Vyvanse in 2007 as a once-a-day pill for ADHD. Friday the agency cleared the drug for adults who compulsively overeat. Serious adverse events associated with Vyvanse can include psychiatric problems like hallucinations and mania as well as heart complications.



English Debates VIDEO 
Cutting Edge Debates And Talks From The World's Leading Thinkers VIDEO 

Docs in the Dock
Despite the recent bad press, most of us still think doctor knows best. Yet with medical intervention now the third biggest killer after heart disease and cancer, is it time to call a halt to our trust? Should we end the monopoly on prescription? Would this give us ownership over our own health, or risk lives and return us to Victorian quackery? Theme One Can we trust doctors? Theme Two Ending the drugs monopoly. The Pitch Pharmaceutical companies target doctors. 






Consider Milestones Ranch in Malibu





Detox With Dignity Now 






Walking The Walk ... For Over 20 Years

How One Man Helped 10,000 People With Serious Drug Problems Recovery 

Howard Josepher and Exponents, the organization he founded 20 years ago have some answers. Howard and Exponents have helped more than 10,000 people with serious drug problems. Mr. Josepher knows about substance abuse on a personal level. He struggled with heroin addiction and spent some time behind bars. Over the last two decades, Howard built a dynamic organization made up of staff who have also struggled with addiction, incarceration and HIV. 



Eyes On The Prize 
Former Top 100 Recruit Noah Cottrill Kicked Addiction, Thriving in NAIA 

That was rock bottom," Cottrill said. "I was arrested in a vehicle with people I should not have been with. I take full responsibility for that, but that was my rock bottom. I said 'no more' and I called my brother and my family and I told them what was going on." Cottrill left the state and entered the Brighton Center for Recovery in Michigan. He spent 30 days there. He had no computer, no cell phone, no basketball. "I had to work on myself off the court before I could even think about lacing up the shoes again."









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This Would Be A Cool

California May Increase Smoking Age To 21 

Tobacco companies know that people are more likely to become addicted to smoking if they start at a young age. We can no longer afford to sit on the sidelines while Big Tobacco markets to our kids and gets another generation of young people hooked on a product that will ultimately kill them. - Ed Hernandez California Senator and bill sponsor.



Harm Reduction 
What Facebook Addiction Looks Like 
in the Brain 

For many Facebook users, the urge to like a kitten video or snoop on a high-school flame is almost irresistible. As it turns out, this type of "Facebook addiction" may show up in the brain: A new study found that the brains of people who report compulsive urges to use the social networking site show some brain patterns similar to those found in drug addicts.






Fallen Hero Returns Triumphantly

Ex-Fresno State Hoops star Ex-Addict, 
Chris Herren, Returns to Fresno To Teach 

With each interview and every speech, Chris Herren reopens deep wounds. They are dark memories from which most would rather move on and forget. Alcohol and drug experimentation turned into addiction, near-death overdoses and arrests that overshadowed a promising basketball career that had shined brightest while he was at Fresno State Herren, a star at Fresno State from 1996-1999 under future Hall of Fame coach Jerry Tarkanian and who then played a couple of seasons in the NBA, knows some might already know of his story. 



OPINION 
Dartmouth's Semi-Serious 
New Rules on Alcohol 

"Hello. My name is Gene, and I'm an alcoholic." This is the way I have begun countless 12-step meetings. And today, I celebrate nine years of sobriety, without so much as a sip of communion wine. The decision to seek treatment for alcoholism nine years ago was one of the best, most rewarding decisions of my life. Indeed, it saved my life, pure and simple. Alcoholism is a progressive disease that only gets worse, never better.






Finally, The Implant Step VIDEO

Helping Addicts Stay Sober with Implant VIDEO 

The surgeon cut a flap in Mark's abdomen and implanted a dissolvable tablet of naltrexone that blocks the euphoric receptors in the brain that give an addict or alcoholic that high. The naltrexone implant lasts anywhere from six to 12 months depending on a patient's metabolism. Dan Markel is the CEO and founder of the company that makes the implant. He says while the FDA approved the use of naltrexone in pill form. Doctors have had trouble getting patients to comply. 3 months after Mark got the implant he's making progress. CONTINUED @ ABC30.com


They Are The Future - The Future is NOW 







...

Mexican Drug Cartels Profit from Exporting Heroin to United States
February 3rd, 2015/



Mexican drug cartels are increasing their profits by exporting more heroin to the United States, the Associated Press reports. They are refining opium paste into high-grade white heroin, and using distribution routes they built for cocaine and marijuana.

The Mexican opium trade is now worth many billions of dollars, the article notes. Farmers who plant poppies in Mexico told the AP all of their product is exported, most of it by the Sinaloa Cartel.

The Drug Enforcement Administration estimates Mexico produced almost half of the heroin found in the United States in 2014, up from 39 percent in 2008. Afghanistan produces more heroin, but sends most of it to Asia and Europe.

Between 2013 and 2014, opium paste seizures in Mexico grew 500 percent, while poppy field eradications increased 47 percent and seizures of processed heroin rose 42 percent.

Last year, U.S. law enforcement agents seized 2,181 kilograms of heroin coming from Mexico, almost triple the amount confiscated in 2009.

Heroin addiction in the United States is growing as more people who became addicted to prescription painkillers are looking for a cheaper alternative, the AP notes. Heroin overdose deaths increased 39 percent from 2012 to 2013, according to a recent report by the Centers for Disease Control and Prevention. The report found 8,257 Americans died of a heroin overdose in 2013.

The amount of marijuana seized by U.S. officers along the Mexican border has decreased 37 percent since 2011. In the past few years, American marijuana users have been choosing more potent, higher-grade varieties grown in the United States.

White House 2016 Budget Increases Funding for Programs to Fight Prescription Drug Abuse
February 3rd, 2015/


The Obama Administration’s 2016 budget proposal includes increased funding for programs designed to fight prescription drug abuse, according to The Hill.

The budget would increase funds for programs at the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention and other agencies. The budget also would increase funding for states to expand their prescription drug monitoring program.

Under the budget, more funding would go toward expanding use of the opioid overdose antidote naloxone by first responders. “Every day, more than 100 people die as a result of drug overdose, and more than 6,700 are treated in emergency departments,” the budget summary stated. “Abuse of prescription and illicit drugs, such as heroin, is an urgent public health concern.”

Last week the Clinton Foundation announced it has negotiated a lower price for a device that delivers naloxone. The device, called Evzio, will be available at a lower price to institutions that can distribute naloxone more widely, such as police departments and universities.

The high cost of naloxone has prevented its widespread use. In some cases, prices for the drug have increased by 50 percent or more. Naloxone reverses the effects of an overdose of heroin or opioid painkillers.

The antidote has long been used by emergency rooms and paramedics. Recently, the World Health Organization said increasing the availability of naloxone could prevent more than 20,000 deaths in the United States annually. Naloxone works quickly, without side effects. A growing number of states have passed laws increasing access to the antidote.

NY Attorney General Accuses Major Retailers of Selling Fraudulent Herbal Supplements
February 3rd, 2015/


The New York State Attorney General on Monday accused four major retailers of selling adulterated and/or mislabeled dietary supplements. GNC, Target, Walgreens and Walmart were told to stop selling the products in the state, The New York Times reports.

State authorities said they had conducted tests on products including echinacea, ginseng and St. John’s wort. They found many products did not contain any of the herbs listed on the label. In many cases, pills labeled medicinal herbs mostly consisted of powdered rice, houseplants and asparagus, the article notes. Some pills contained substances that could be dangerous for people with allergies. For example, one product sold at Walmart as ginko bilboa contained wheat, even though the label said the product contained no wheat or gluten. Some GNC products had pills that contained powdered legumes, the class of plants that includes peanuts and soybeans.

Dietary supplements are exempt from the strict regulatory oversight required for prescription medications, the article notes. The move by New York Attorney General Eric Schneiderman was the first time a law enforcement agency had threatened large retail and drugstore chains with legal action for selling what he called deliberately misleading herbal products.

“This investigation makes one thing abundantly clear: the old adage ‘buyer beware’ may be especially true for consumers of herbal supplements,” Schneiderman said in a news release. “The DNA test results seem to confirm long-standing questions about the herbal supplement industry. Mislabeling, contamination, and false advertising are illegal. They also pose unacceptable risks to New York families—especially those with allergies to hidden ingredients.”

Walgreens said it would remove the products from its shelves nationwide, while Walmart said it would “take appropriate action.” GNC said it would cooperate with the Attorney General “in all appropriate ways,” but said it stood behind the quality and purity of its products. Target did not respond to the newspaper’s requests for comment.