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  1. 03/18/2018 08:01 am ET Updated 26 minutes ago From America’s Warriors To Victims Of Its Opioid Epidemic “All they want is pain relief.” By Erin Schumaker and Anna Almendrala JI SUB JEONG/HUFFPOST When Cpl. Darin Adams got back from serving in Iraq in 2009, he suffered from sharply painful back spasms ― a lingering symptom of an injury from falling off a ladder in the armory during his second deployment. After the fall, it didn’t occur to him to take off any time to rest, and he resumed carrying his 75-pound rucksack the next day. By the time Adams, now 32, returned home, the pain was so bad that he sometimes couldn’t sleep at night or walk more than a few steps around the house. He took ibuprofen to ward off the pain, but his back spasms worsened until 2012, when the pain became so severe that he couldn’t get out of bed some mornings. Finally a doctor at the Veterans Administration put him on a low-dose opioid, which he began taking almost every day. Adams worked as a manager at Walmart, which included lifting heavy boxes. He said if he hadn’t been taking opioids, it would have been impossible to do his job. SCOTT OLSON VIA GETTY IMAGES Retired Army Sgt. Noah Galloway of Birmingham, Alabama, arrives at Afghanistan’s Bagram Airfield on March 12, 2014. Galloway lost an arm and a leg to an explosion in Iraq in 2005. He was one of five wounded soldiers visiting Afghanistan with the Troops First Operation Proper Exit program, which brings wounded servicemen back to Iraq and Afghanistan to help them come to terms with their injuries. Adams is one of the thousands of Iraq War vets who came home with chronic pain. Saddled with injuries that veterans from previous wars would never have survived, 60 percent of military members who fought in the Middle East were returning with chronic pain, a significantly higher rate than older veterans getting care from the VA. And their timing couldn’t have been worse: By 2005, two years into the Iraq War, 10 million Americans were taking prescription opioids for long-term pain relief. But as prescription rates grew, so too did rates of overdose, accidental death and use of illicit opioids. A dangerous pattern of pain, prescription and misuse was emerging among veterans. They were encountering serious harm overseas, receiving liberal amounts of prescription painkillers for their injuries and then bringing dangerous coping strategies back home with them. A 2013 study on veterans who served after 9/11 illustrates this cycle well. “Joel” suffered serious injuries after a roadside bomb exploded near his tank. During his recovery program, the doctor prescribed hundreds of pills at a time, even though Joel had serious risk factors for addiction. “They were giving me pain pills, I was getting Percocet, Vicodin. I was getting fucking OxyContin, Oxycodone. If I fucking wanted it, they would give it to me, no doubt about it,” Joel told the study researchers. “I used to get like 460 at a time!” Joel continued. “[I told my doctor,] `Look I’m a heavy drinker,′ and he was like, ’Well, just take one before you start drinking, about an hour before you start, and then don’t take anymore after that until the morning.” Opioid prescription in the Veterans Administration health system skyrocketed 270 percent from 2001 to 2012. VA patients were twice as likely as other Americans to die of accidental opioid overdoses, according to a 2011 study, and another study found that 13 percent of all veterans taking opioids had an opioid-use disorder ― about 68,000 people. By 2012, the VA had already started to look critically at their doctors who had been excessively prescribing opioids. So by the time soldiers like Adams sought treatment, the VA was asking them to take mandatory classes at the VA pain clinic, and he spoke with a specialist about the dangers of opioid addiction. A year later, Adams appealed to the VA to approve surgery on his pinched nerve, which was causing his muscle spasms. But for the VA to sign off on the surgery, Adams had to do six months of physical therapy first. In the end, physical therapy paid off. The more stretches and exercise Adams did, the less he needed his daily painkiller. By the end of the six-month waiting period, he had reduced his opioid use to one pill a month. By medical standards, Adams’ decrease in the use of opioids is a success story. But his success was hard fought. For many other veterans who were prescribed opioids after returning from Iraq and Afghanistan, the daily pressure to live pain- and opioid-free is a continuing struggle. “I guess I’m a unicorn,” Adams said, recounting that he just followed his doctor’s instructions closely. “It was successful for me, but it’s not successful, unfortunately, for everyone.” DARIN ADAMS Darin Adams and future wife Laura Tull at her parents’ house in Waterloo, Iowa. (2006) By 2005, two years into the Iraq War, 10 million Americans were taking prescription opioids for long-term pain relief. From 1999 to 2010, prescription opioids sold to hospitals, pharmacies and doctors’ offices nearly quadrupled, according to the U.S. Centers for Disease Control and Prevention, while the amount of pain Americans reported stayed the same. So when vets started coming back complaining of chronic pain, their doctors ― largely employees of the Veterans Administration ― provided them with opioids just as they would any patient. Opioid painkillers appeared to be effective at treating pain, were quick to prescribe and, unlike the morphine drips of yore, were simple to administer by pill. Best of all, according to pharmaceutical representatives, they weren’t addictive. Doctors’ beliefs about opioids’ efficacy were similarly misguided. Not only do opioids present serious risks, including addiction and overdose, they’re not even an effective medicine for chronic pain relief. A recent study by VA researchers in Minneapolis found that over-the-counter pain relievers like Tylenol and ibuprofen, neither of which contains opioids, are slightly more effective chronic pain treatments than opioids. The medical community at large was lulled into a false sense of security about prescribing opioids until 2011, explained Louis Celli, the national director of veterans affairs and rehabilitation at the American Legion, a nonprofit veterans organization. “This drug is extremely addictive,” Celli said. “There was less concern in the beginning, until this national epidemic took hold.” Another constellation of factors made veterans more susceptible to opioid addiction. Men who enlist in the army are twice as likely as other Americans to have been sexually abused as children and to have grown up in an environment that included domestic violence and substance abuse. Moreover, 1 in 5 soldiers who volunteer to join the Army had disorders such as intermittent explosive disorder, post-traumatic stress disorder or attention deficit hyperactivity disorder before enlisting, which all increase one’s risk of addiction. If the opioid epidemic were factored into the Iraq and Afghanistan body counts, that count would be staggeringly high. Many men and women who enlist are predisposed for substance abuse issues even before they’re issued uniforms. When soldiers from the Iraq and Afghanistan wars returned home, many had gruesome injuries that would have killed soldiers in past generations who didn’t have access to the same medical technologies. And now opioids were considered to be a safe and non-addictive first line treatment and were extensively prescribed to these returning soldiers. Worst of all, insufficient research about treating veterans addicted to high-dose pills means that today’s best practices for treating veterans addicted to opioids are based on weak data. In this science-free environment, tapering off high-dosage opioids is akin to an act of faith. THE WASHINGTON POST VIA GETTY IMAGES OxyContin is among the opioids often prescribed to veterans with long-term pain. In an effort to lower the risk of overdose and death among veterans taking opioids, the VA has taken incremental steps to lower new prescriptions, help veterans taper off existing medications, allow different centers within the VA to share data on opioid prescriptions for individual patients and be more transparent about how many opioids are being prescribed. Consequently, change on opioids has come swiftly. From 2012 to 2017, opioid prescriptions are down 41 percent among patients, and the decrease is spread out across 99 percent of the VA’s facilities. Veterans who seek treatment after these shifts on opioids are benefiting from additional education on addiction risk, an emphasis on non-pharmaceutical or non-opioid therapies, and opioid prescriptions with lower doses. In contrast, no other medical system in the U.S. releases comprehensive data on opioid prescriptions, and while almost all states now have databases that can track opioid prescriptions and flag patients for strange activity, most states don’t require doctors to check the database before issuing a prescription to a patient. VA doctors, on the other hand, are required to check the database before starting new patients on opioids. Dr. Kenneth Goldberg, chief of staff and acting director of the Durham VA Healthcare System in North Carolina, is not Adams’ doctor, but he said that his story is an example of what the VA is doing right when it comes to opioid prescription. “We want to get them on the lowest possible dose that we can,” Goldberg said. “One pill a month was his number. It’s not zero, but it’s definitely better than where it was.” While the VA has continued to implement wide-ranging new policies that have resulted in steep cuts to their prescription rates, others who work closely with veterans say that these efforts have left some veterans scrambling for ways to manage their pain and may even be pushing them toward illicit drugs. A 2017 study on Afghanistan and Iraq war veterans who had overdosed found that the transition to illicit, risky drugs like heroin was driven in part by the growing scarcity of prescription opioids, said Alex Bennett, a program director of the Opioid Overdose Prevention Program at National Development and Research Institutes who authored both this paper and the 2013 study that interviewed “Joel.” If veterans can’t stretch their limited opioid prescriptions until their next refill, some supplement that prescription with street drugs. “In a place like New York City, it is roughly a dollar or two per milligram of Oxy, and a bundle of heroin can be purchased for $60, so people tend to do a cost-benefit analysis,” Bennett said. “Let’s say I have 60 Percs ― I can get rid of those, manage my pain and eat.” For instance, “Barber,” a 54-year-old Army veteran featured in Bennett’s study, explained that when the prescribed Percocets weren’t enough to get him through to the next refill, he decided to sell the pills on the street and then use that money to buy heroin, which provided more relief for the two bulging vertebral discs in his spine. “These are self-care and self-management strategies, in many ways,” Bennett said. Because of this potential pipeline to illicit drugs, as well as other concerns, Dr. Stefan Kertesz, a frontline caregiver and long-term addiction researcher who teaches at the University of Alabama at Birmingham, isn’t convinced that everyone who takes high-dosage prescription opioids should be tapered off them as much as possible. “If a patient is currently functioning OK from their point of view, [and then] if you change something that leaves them afraid they’ll function worse, that can be pretty violative,” Kertesz said. Without scientific evidence, there’s no proof that weaning veterans off high doses of opioids protects their health. And without that scientific backing, some patients may be better off staying on opioids. The existing data on tapering patients’ opioid doses is pretty bleak. A 2017 review of all tapering studies to date finds that among people who volunteer to have their opioid intake reduced, there is only low-quality evidence to suggest that their chronic pain levels and quality of life will improve once they decrease their opioid use. Keep in mind that these results are only for those who actually want to reduce their opioid consumption, said Kertesz, and doesn’t include participants like these veterans, who might feel like the VA is reducing their opioid intake against their will. “Certainly we have no solid studies on involuntary mandatory dose reductions at all,” Kertesz said. “That should trouble you, because that means we’re flying blind.” But scant high-quality evidence that tapering off opioids will make people safer doesn’t mean that we should accept the status quo, Goldberg explained. “I don’t think any patient should take any medication that’s not really helping them,” Goldberg said. This is especially because the status quo exposes veterans to opioid tolerance, overdose and death, said Dr. Chris Marx, who works alongside Goldberg as a psychiatrist at the Durham VA Medical Center. “These are not medications without risk,” she said. As for Adams, while he was skeptical about how physical therapy could help manage his back pain, he was pleasantly surprised by the results. By the end of the six-month waiting period, Adams’ back pain was so well-controlled that he decided to forgo the surgery altogether. Now he takes ibuprofen in addition to continuing his twice-a-day stretching routine. He still has an opioid prescription, but it’s for 25 pills a year — a far cry from his once-a-day routine — and he rarely uses them. “The best advice I can give to a vet is if there is an alternative treatment, such as physical therapy, give it an honest shot,” he said. “There was a period of time that I didn’t think physical therapy was working, [and] I had to go a few times before I found a physical therapist that helped me see the light.” Erin Schumaker Senior Reporter, HuffPost Anna Almendrala Senior Reporter, HuffPost https://www.huffingtonpost.com/entry/iraq-war-opioid-addiction-veterans_us_5aa17569e4b0d4f5b66eb332
  2. Senator Calls Out Big Pharma For Opposing Legal Marijuana Tom Angell A prominent Democratic U.S. senator is slamming pharmaceutical companies for opposing marijuana legalization. "To them it's competition for chronic pain, and that's outrageous because we don't have the crisis in people who take marijuana for chronic pain having overdose issues," Sen. Kirsten Gillibrand of New York said. "It's not the same thing. It's not as highly addictive as opioids are." Photo by Justin Sullivan/Getty Images "On the federal level, we really need to say it is a legal drug you can access if you need it," she said. Gillibrand, in an appearance on Good Day New York on Friday morning, was responding to a question about whether marijuana is a "gateway drug" that leads people to try more dangerous substances. "I don't see it as a gateway to opioids," she said. "What I see is the opioid industry and the drug companies that manufacture it, some of them in particular, are just trying to sell more drugs that addict patients and addict people across this country." Legalization advocates have long speculated that "Big Pharma" is working behind the scenes to maintain cannabis prohibition. And in 2016, Insys Therapeutics, which makes products containing fentanyl and other opioids, as well as a synthetic version of the cannabinoid THC, donated half a million dollars to help defeat a marijuana legalization measure that appeared on Arizona's ballot that year. Numerous studies have shown that legal marijuana access is associated with reduced opioid overdose rates. Research published this month, for example, concluded that "legally protected and operating medical marijuana dispensaries reduce opioid-related harms," suggesting that "some individuals may be substituting towards marijuana, reducing the quantity of opioids they consume or forgoing initiation of opiates altogether." "Marijuana is a far less addictive substance than opioids and the potential for overdosing is nearly zero,” the researchers wrote in the Journal of Health Economics. Last week, Gillibrand became the second cosponsor of far-reaching Senate legislation to remove marijuana from the Controlled Substances Act and withhold federal funding from states that have racially disproportionate enforcement of cannabis laws. “Millions of Americans’ lives have been devastated because of our broken marijuana policies, especially in communities of color and low-income communities,” she said at the time. "Legalizing marijuana is a social justice issue and a moral issue that Congress needs to address." Gillibrand is also a sponsor of far-reaching medical cannabis legislation and recently signed a letter calling for new protections for state marijuana laws to be inserted into federal spending legislation. "I think medical marijuana could be treatment for a lot of folks," she said in the interview on Friday. "A lot of veterans have told us that this is the best treatment for them. I do not see it as a gateway drug." Many political observers have speculated that Gillibrand will run for her party's presidential nomination in 2020. She and at least two other potential Democratic contenders have already endorsed marijuana legalization. Tom Angell publishes Marijuana Moment news and founded the nonprofit Marijuana Majority. Follow Tom on Twitter for breaking news and subscribe to his daily newsletter. https://www.forbes.com/sites/tomangell/2018/02/23/senator-calls-out-big-pharma-for-opposing-legal-marijuana/ NIDA says there is no gateway theory of marijuana. https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-gateway-drug
  3. Just two days after Christmas, the Lt. Governor signed SB 0274, a bill to limit opioid based pain prescriptions for people in “acute pain”. Governor Rick Snyder and Michigan Attorney Bill Schuette also are working to reduce opioid addiction, abuse and overdoses. President Obama at the National Prescription Drug Abuse and Heroin Summit made similar comments on opioids. http://legislature.mi.gov/doc.aspx?2017-SB-0274 http://www.detroitnews.com/story/news/politics/2017/12/27/calley-signs-opioid-bills/108948644/ According to Poison Control, adults aged 45–54 had the highest rate of drug overdose deaths in 2015. http://www.poison.org/poison-statistics-national Key findings Data from the National Vital Statistics System, Mortality The age-adjusted rate of drug overdose deaths in the United States in 2015 (16.3 per 100,000) was more than 2.5 times the rate in 1999 (6.1). Drug overdose death rates increased for all age groups, with the greatest percentage increase among adults aged 55–64 (from 4.2 per 100,000 in 1999 to 21.8 in 2015). In 2015, adults aged 45–54 had the highest rate (30.0). In 2015, the age-adjusted rate of drug overdose deaths among non-Hispanic white persons (21.1 per 100,000) was nearly 3.5 times the rate in 1999 (6.2). The four states with the highest age-adjusted drug overdose death rates in 2015 were West Virginia (41.5), New Hampshire (34.3), Kentucky (29.9), and Ohio (29.9). In 2015, the percentage of drug overdose deaths involving heroin (25%) was triple the percentage in 2010 (8%). Deaths from drug overdose have been identified as a significant public health burden in the United States in recent years (1–4). This report uses data from the National Vital Statistics System (NVSS) to highlight recent trends in drug overdose deaths, describing demographic and geographic patterns as well as the types of drugs involved. https://www.cdc.gov/nchs/products/databriefs/db273.htm With the current nationwide epidemic of opioid abuse, dependence, and fatalities, clinicians are being asked by federal agencies and professional societies to control their prescribing of narcotic medications for pain. Federal guidelines emphasize tapering, discontinuing, and limiting initiation of these drugs except in provision of end-of-life care. Reducing reliance on opioids, however, is a massive task. According to one estimate, more than 650 000 opioid prescriptions are dispensed each day in the United States. Unless the nation develops an increased tolerance to chronic pain, reduction in opioid prescribing leaves a vacuum that will be filled with other therapies. Enter cannabis. As of August 2016, the District of Columbia and 25 states have legalized cannabis for medical use. Recreational use of cannabis has been legalized in 4 of these states and Washington, DC, and like initiatives are pending in other states. The mandated transition to limit use of opioids, paired with the current climate around liberalizing cannabis, may lead to patients’ formal and informal substitution of cannabis for opioids. Observational studies have found that state legalization of cannabis is associated with a decrease in opioid addiction and opioid-related overdose deaths https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5332546/ The Institute of Medicine in a 1999 report, the same report that the people of Michigan described when creating the MMMA, declared that cannabinoids from the marijuana plant, could be useful for patients “who have developed tolerance to opioids”. President Trump’s ONDCP task force on the opioid prescriptions crisis has recommended calling for a national emergency. Due to the interim report, President Donald J. Trump has instructed his Administration to use all appropriate emergency and other authorities to respond to the crisis caused by the opioid epidemic. 8-10-2017 In Medical Marijuana states, overdoses on opioid prescription painkillers are reduced by 25%. Using data on all prescriptions filled by Medicare Part D enrollees from 2010 to 2013, we found that the use of prescription drugs for which marijuana could serve as a clinical alternative fell significantly, once a medical marijuana law was implemented. The CDC has declared opioid prescription overdoses an epidemic. https://www.cdc.gov/drugoverdose/epidemic/index.html President Trump has a plan to limit opioid prescriptions. President Obama and President Trump have instructed the FDA and DEA to limit opioid based prescription painkillers. http://jamanetwork.com/journals/jama/fullarticle/2503508 April 19, 2016 CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 Deborah Dowell, MD, MPH. Tamara M. Haegerich, PhD. Roger Chou, MD. JAMA. 2016;315(15):1624-1645. doi:10.1001/jama.2016.1464 https://beta.theglobeandmail.com/news/national/among-veterans-opioid-prescription-requests-down-in-step-with-rise-in-medical-pot/article30285591/ Of course medical marijuana can be used as a painkiller in the states with working medical marijuana laws. What about the people who don’t know about medical marijuana? Unfortunately, the limits, burdens and tightening of the rules for doctors and pharmacists to prescribe and dispense pain medication have caused patients’ quality of life to drop. Due to these new rules, patients have been dropped by physicians, denied prescriptions at pharmacies and have been forced to turn to heroin just to attain pain relief. Thousands of people have signed this petition to have some of these rules rescinded so they can get their medications back, to no avail. The reports detailing denials of pain medications were posted to the change.org petition. The reports are heartbreaking. These patients need a replacement therapy after they have been denied prescription opioid analgesics by their physicians and pharmacists. https://www.change.org/p/congress-ease-the-dea-s-grip-on-doctors-allowing-chronic-pain-patients-to-get-the-medications-we-need Marijuana can prevent the intensity and amount of migraines. Marijuana is also useful as an adjunct therapy to opioid prescriptions because it allows the patient to use fewer opioids to achieve the same pain relief. Physician Guide to Cannabis-Assisted Opioid Reduction Prepared by Adrianne Wilson-Poe, Ph.D. Distributed by Congressman Earl Blumenauer
  4. A lot of people are going to be in a lot of pain. The suicide rate will rise with these new unscientific regulations. http://legislature.mi.gov/doc.aspx?2017-SB-0274 Sec. 7333b. (1) Beginning July 1, 2018, if a prescriber is treating a patient for acute pain, the prescriber shall not prescribe the patient more than a 7-day supply of an opioid within a 7-day period. (2) As used in this section, “acute pain” means pain that is the normal, predicted physiological response to a noxious chemical or a thermal or mechanical stimulus and is typically associated with invasive procedures, trauma, and disease and usually lasts for a limited amount of time. http://www.detroitnews.com/story/news/politics/2017/12/27/calley-signs-opioid-bills/108948644/ Lansing — Lt. Gov. Brian Calley signed a 10-bill package Wednesday aimed at reducing Michigan’s rapidly growing opioid addiction by requiring doctors and the state to better track and control the flow of opioid-based prescription drugs. Calley signed six bills that will collectively require doctors to use a new online prescription tracking state database, set up a legitimate doctor-patient relationship and limit the number of pills dispensed in a given seven-day period. It comes as the number of heroin and prescription opioid overdose deaths in Michigan has doubled during the past five years. Health and addiction experts have long urged the medical industry to adopt new prescription opioid standards. Many heroin addicts start out using legal painkillers first, and even people who take such drugs as directed by a doctor can still wind up addicted. Calley and other public officials have called for legislation to stop “pill mills,” or unscrupulous doctors who authorize too many prescription painkillers and end up feeding addiction. “It’s now claiming more lives than car accidents each year,” Calley said at a Wednesday press conference. In 2015, 1,275 people died from heroin and opioid-related overdoses — 884 were caused by prescription opioids and another 391 from heroin, according to the most recent data from the state Department of Health and Human Services. By comparison, 963 people died in car accidents in 2015, according to the Michigan State Police. The 2015 heroin and prescription opioid overdose deaths represented a nearly 100 percent increase over the 639 deaths in 2010 — 195 from heroin overdoses and another 444 from prescription opioid overdoses. “This will make a huge difference. It’s about earlier detection and prevention,” Calley said about the legislation. “We’ve done a lot of great work to try and save lives after a person becomes addicted,” said the lieutenant governor, who chairs Gov. Rick Snyder’s task force on opioids. “What we’re doing now is the work to prevent the addiction from happening in the first place and to detect it earlier in the process and get ahead of this epidemic.” In overall Michigan drug poisonings, 1,981 people died in 2015, according to the state, a 12 percent rise from the 1,745 fatalities from the year before. What legislation does One of the bills Calley signed Wednesday was by Sen. Tanya Schuitmaker, R-Lawton, and requires that doctors review a patient’s history on a new online database called MAPS before prescribing opioids. The measure was recommended by Snyder’s task force. Calley said Schuitmaker’s bill is “very central to making progress in the fight against the addiction epidemic that has swept across this state and across the nation.” He also praised a bill from state Rep. Andy Schor, D-Lansing, for expanding treatment options for Medicaid recipients in need of opioid addiction help. Lawmakers need to keep working to expand treatment, “but it seems like there’s never enough,” Calley said. “At the end of the day, the most important aspect for whether a person recovers, the first thing is wanting to get better. And there’s so much more awareness today; there’s so much more acceptance among people to seek treatment than what we saw a few years ago. That makes me hopeful that we can turn this around.” A related bill from Sen. Dale Zorn, R-Ida, requires the state to record opioid prescriptions in MAPS in an effort to keep tabs on doctors who prescribe too much. It’s also meant to help doctors know when patients are hopping from office to office to get too many pills. According to the report, every state except Missouri has a prescription drug tracking system for pills. MAPS came online in 2002 but experienced a major upgrade in April that lawmakers and health professionals hailed as a cornerstone of the state’s opioid epidemic battle. The legislation Calley signed Wednesday also would stop a prescriber other than veterinarians from distributing opioids without first looking into a patient’s prescription history on MAPS. Other bills would require a “bona fide” patient-doctor relationship before a doctor could prescribe opioids and limit the supply of opioids. Legislation signed last year by Snyder allotted $2.5 million for a new cloud-based database and did not require doctors to check the system before prescribing addictive painkillers to patients. Although some in the industry say the system could help fight the state’s opioid-abuse epidemic, the Michigan State Medical Society has voiced strong concerns that requiring use of the new system would be time consuming and add more work for doctors. As of Tuesday, 24,639 licensed doctors and pharmacists have voluntarily signed up to use the state’s drug tracking database and more than 4,000 nurses or office managers on behalf of licensed medical professionals, according to the Department of Licensing and Regulatory Affairs. Blue Cross Blue Shield of Michigan CEO Daniel Loepp in a Wednesday statement called the package “a strong step forward that strengthens Michigan’s efforts to reduce addiction and abuse.” According to Poison Control, adults aged 45–54 had the highest rate of drug overdose deaths in 2015. http://www.poison.org/poison-statistics-national Key findings Data from the National Vital Statistics System, Mortality The age-adjusted rate of drug overdose deaths in the United States in 2015 (16.3 per 100,000) was more than 2.5 times the rate in 1999 (6.1). Drug overdose death rates increased for all age groups, with the greatest percentage increase among adults aged 55–64 (from 4.2 per 100,000 in 1999 to 21.8 in 2015). In 2015, adults aged 45–54 had the highest rate (30.0). In 2015, the age-adjusted rate of drug overdose deaths among non-Hispanic white persons (21.1 per 100,000) was nearly 3.5 times the rate in 1999 (6.2). The four states with the highest age-adjusted drug overdose death rates in 2015 were West Virginia (41.5), New Hampshire (34.3), Kentucky (29.9), and Ohio (29.9). In 2015, the percentage of drug overdose deaths involving heroin (25%) was triple the percentage in 2010 (8%). Deaths from drug overdose have been identified as a significant public health burden in the United States in recent years (1–4). This report uses data from the National Vital Statistics System (NVSS) to highlight recent trends in drug overdose deaths, describing demographic and geographic patterns as well as the types of drugs involved. https://www.cdc.gov/nchs/products/databriefs/db273.htm With the current nationwide epidemic of opioid abuse, dependence, and fatalities, clinicians are being asked by federal agencies and professional societies to control their prescribing of narcotic medications for pain. Federal guidelines emphasize tapering, discontinuing, and limiting initiation of these drugs except in provision of end-of-life care. Reducing reliance on opioids, however, is a massive task. According to one estimate, more than 650 000 opioid prescriptions are dispensed each day in the United States. Unless the nation develops an increased tolerance to chronic pain, reduction in opioid prescribing leaves a vacuum that will be filled with other therapies. Enter cannabis. As of August 2016, the District of Columbia and 25 states have legalized cannabis for medical use. Recreational use of cannabis has been legalized in 4 of these states and Washington, DC, and like initiatives are pending in other states. The mandated transition to limit use of opioids, paired with the current climate around liberalizing cannabis, may lead to patients’ formal and informal substitution of cannabis for opioids. Observational studies have found that state legalization of cannabis is associated with a decrease in opioid addiction and opioid-related overdose deaths https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5332546/ The Institute of Medicine in a 1999 report, the same report that the people of Michigan described when creating the MMMA, declared that cannabinoids from the marijuana plant, could be useful for patients “who have developed tolerance to opioids”. All of the currently available analgesic (pain-relieving) drugs have limited efficacy for some types of pain. Some are limited by dose-related side effects and some by the development of tolerance or dependence. A cannabinoid, or other analgesic, could potentially be useful under any of the following circumstances: • There is a medical condition for which it is more effective than any currently available medication. • It has a broad clinical spectrum of efficacy and a unique side effect profile. • It has synergistic interactions with other analgesics. • It exhibits "side effects" that are considered useful in some clinical situations. • Its efficacy is enhanced in patients who have developed tolerance to opioids. President Trump’s ONDCP task force on the opioid prescriptions crisis has recommended calling for a national emergency. The first and most urgent recommendation of this Commission is direct and completely within your control. Declare a national emergency under either the Public Health Service Act or the Stafford Act. With approximately 142 Americans dying every day, America is enduring a death toll equal to September 11th every three weeks. Due to the interim report, President Donald J. Trump has instructed his Administration to use all appropriate emergency and other authorities to respond to the crisis caused by the opioid epidemic. 8-10-2017 In Medical Marijuana states, overdoses on opioid prescription painkillers are reduced by 25%. Conclusions and Relevance Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates." Using data on all prescriptions filled by Medicare Part D enrollees from 2010 to 2013, we found that the use of prescription drugs for which marijuana could serve as a clinical alternative fell significantly, once a medical marijuana law was implemented. The CDC has declared opioid prescription overdoses an epidemic. Drug overdose deaths and opioid-involved deaths continue to increase in the United States. The majority of drug overdose deaths (more than six out of ten) involve an opioid. Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled. From 2000 to 2015 more than half a million people died from drug overdoses. Americans die every day from an opioid overdose. https://www.cdc.gov/drugoverdose/epidemic/index.html President Obama at the National Prescription Drug Abuse and Heroin Summit made similar comments on opioids. It's important to recognize that today we are seeing more people killed because of opioid overdose than traffic accidents. President Trump has a plan to limit opioid prescriptions. Reduce the amount of Schedule II opioids (drugs like oxycodone, methadone and fentanyl) that can be made and sold in the U.S. President Obama and President Trump have instructed the FDA and DEA to limit opioid based prescription painkillers. http://jamanetwork.com/journals/jama/fullarticle/2503508 April 19, 2016 CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 Deborah Dowell, MD, MPH. Tamara M. Haegerich, PhD. Roger Chou, MD. JAMA. 2016;315(15):1624-1645. doi:10.1001/jama.2016.1464 Governor Rick Snyder and Michigan Attorney Bill Schuette also are working to reduce opioid addiction, abuse and overdoses. Fewer Canadian veterans have sought prescription opioids and tranquillizers in recent years, while at the same time prescriptions for medical marijuana have skyrocketed. It is not clear whether the two are related, but the trend echoes what researchers have found in U.S. states with medical-cannabis laws. New data provided to The Globe and Mail by Veterans Affairs Canada show that over the past four years, the number of veterans prescribed benzodiazepines – with brands such as Xanax, Ativan and Valium – had decreased nearly 30 per cent. Opioid prescriptions also shrank almost 17 per cent during that same period. https://beta.theglobeandmail.com/news/national/among-veterans-opioid-prescription-requests-down-in-step-with-rise-in-medical-pot/article30285591/ Of course medical marijuana can be used as a painkiller in the states with working medical marijuana laws. What about the people who don't know about medical marijuana? Unfortunately, the limits, burdens and tightening of the rules for doctors and pharmacists to prescribe and dispense pain medication have caused patients’ quality of life to drop. Due to these new rules, patients have been dropped by physicians, denied prescriptions at pharmacies and have been forced to turn to heroin just to attain pain relief. Thousands of people have signed this petition to have some of these rules rescinded so they can get their medications back, to no avail. The reports detailing denials of pain medications were posted to the change.org petition. The reports are heartbreaking. These patients need a replacement therapy after they have been denied prescription opioid analgesics by their physicians and pharmacists. David Jasko Hackensack, NJ Apr 27, 2017 “Tired of being treated as a "drug seeker," when pain medications are requested. Since I have been in chronic pain, 9 of 10 doctors have refused pain medication, leaving me unable to walk 90% of the time.“ Sharron Rishling Las Vegas, NV Apr 27, 2017 “My daughter had had this terrible pain disease CRPS (Chronic Reflex Pain Syndrome) which is disabilitating. She is totally disabled and they are not letting her have her pain medication.“ nathan luse Wyoming, MI May 14, 2017 “I have chronic lower back pain, and chronic pain in my feet, pain meds got taken away, and there is no surgery to fix me. shots have zero effect, had a specialist notarized this. only thing that works and gets me out of bed is medication. Been cut-off since december.” Susan Pare Otisville, MI Feb 1, 2017 “I have been in severe, chronic pain of one form or another since I was two years old. I will be 64+ later this year. There has been almost no time in that period where I have been free of pain. I recall having to beg my doctor to prescribe more than 15 days of Vicodin at a time and that had to last me SIX MONTHS. Granted this was 20 years ago, but suddenly it is like living that time all over again. Surely there must be a happy medium between me and the neighborhood dealer.” Ariel G Baraga, MI Jan 28, 2017 Signing this because I deal with pain everyday that doctors do not help because they think I'm a drug seeking addict. Deborah Palomarios Onaway, MI Jan 2, 2017 I have severe pain. I have had 4 back surgeries. The last two I was only given 10 days of pain meds then no more. Its barbaric! Scott Behler Ann Arbor, MI Dec 18, 2016 Dealing with chronic pain for the last 19 years. I am a restaurant manager by career, and often am walking, standing, for 12 hours a day. Had the ability to manage my pain, and be successful in my position until about a year ago, when my doctor of many years cut me way back, and every time I see him now, directs me to see a different orthopedic or pain management clinic, who continually suggest additional surgeries (I've already had 7 of them, one more painful and longer recovery time than the next), or more injections ( I've had multiple spinal, steroid, cortisone, synvisk, etc., that have worked for very short periods). I understand the issues with recreational usage problems, but let the people who are in legitimate pain and need them to survive get them! Sad when some of us chronic pain patients start thinking about finding street drugs such as heroin just to be able to live a somewhat "normal" life. I've also heard of chronic pain patients that just give up and commit suicide. This is something that my faith would forever restrict me from doing, but I can understand giving up on life because what kind of life is it when you are continually suffering? https://www.change.org/p/congress-ease-the-dea-s-grip-on-doctors-allowing-chronic-pain-patients-to-get-the-medications-we-need
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