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These Scientific Advances Could be the Solution to the Opioid Overdose Epidemic DEVLOPING A Cur

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Short Answers to Hard Questions About the Opioid Crisis Q & A

FROM PAIN PILLS TO HEROIN ADDICT EX-AREA MAN NOW FOCISED ON HELPING OTHERS

It’s never too late Task force working to solve Louisiana’s opioid crisis

Demise on the Rise Opioid usage up, and so are fatal overdoses

Letting Go of Shame Ashamed about drug problem? Don’t be.

Precription for Disaster Louisiana’s Opioid Epidemic

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Task force working to solve Louisiana's opioid crisis In 2009, Cayce Badeaux McDaniel had just nished college at the University of Louisiana at Lafayette and was living what people would consider a normal life. ings were going ne. It all changed when she broke her neck in a car wreck — an injury that would send her into a spiral of addiction to painkillers. "Before I even knew it, I was buying it o the street. I was using benzos, and then I used alcohol – basically anything that would make me feel dierent than I did," McDaniel said.

For the next ve years it was a cycle of drugs, car accidents, arrests.

She describes the time as: "Pain and sorrow and disappointment after disappointment of my family and of everybody around me who truly loved me."

"We've got so many people dying because of drug use," said Dr. Rochelle Head-Dunham, executive and medical director of the Metropolitan Human Services District. "It is absolutely an epidemic." A new task force, formally called the Commission on Preventing Opioid Abuse, is working to come up with a set of recommendations for short-term and long-term eorts that can be made to address prescription opioid and

Today, she's in recovery and serves as an addiction counselor herself.

But McDaniel's addiction story is a familiar one in Louisiana, a state that has been hit particularly hard by a national opioid crisis that health leaders say is largely driven by the abuse of prescription painkillers. Louisiana has the seventh-highest opioid pain reliever-prescribing rate in the country, and the drug overdose rate outpaces the national average.

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heroin abuse and addiction in Louisiana. e 38-member task force, created during the legislative session earlier this year, includes representatives from the medical, pharmaceutical, insurance and law enforcement communities, among others. "It's a signicant issue and it's something that needs to be addressed," said state Rep. Helena Moreno, a New Orleans Democrat who has emerged as a key voice in addressing opioid issues in the Legislature. "We are losing too many lives to opioid abuse." Head-Dunham said that drug usage tends to go through cycles. Whereas a decade ago methamphetamine was considered an epidemic, the cycle has turned to opioids.

"is is where we are," she said.

She said that there is a common thread for many people suering from opioid addiction: Often it begins with pain medications for legitimate ailments.

When users aren't able to get more prescriptions for the painkillers that they crave, they turn to illicit drugs like heroin or get their pills illicitly. At the same time, opioid addicts also build tolerance to the drugs and then increase their usage. It escalates to the point where they go to deadly limits to satisfy their cravings and stave o withdrawal symptoms. "It's a vicious cycle that the person gets into," Head-Dunham said.

-Dr. James Hussey, assistant secretary of LDH's Oce of Behavioral Health

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The opioid crisis is devastating American families and communities, claiming the lives of more than 91 people in America each day. Last month the Director of the National Institutes of Health, Dr. Francis Collins and I announced that we would leverage partnerships between NIH and private industry as well as regulatory agencies to cut the time it takes to develop new treatments in half to help end this crisis. Those include new medications to treat opioid addiction, new overdose-reversal and overdose-prevention tools and effective, safer pain medications. These Scientific Advances Could be the Solution to the Opioid Overdose Epidemic DEVLOPING A Cur

buprenorphine

methadone

naltrexone

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New and improved medications In one or two years, we can anticipate new formulations of the existing addiction medications buprenorphine, methadone, and naltrexone. This includes long-lasting “depot” injections so people who do not live close to a treatment facility can take advantage of these effective medications and better comply with their treatment. Vaccines, which bind to opioids in the bloodstream to prevent them from reaching the brain, are another innovative new tool that will take longer to develop. In addition, NIH remains committed to studying new and effective ways behavioral therapies can support adherence to medications and promote sustained recovery.

Also on the drawing board are new overdose-reversal tools, including stronger and longer-acting formulations of naloxone and other compounds. These can reverse overdoses of powerful synthetic opioids like fentanyl. Other research will focus on the development of wearable devices that can detect an overdose when it is occurring and automatically intervene and signal for help. Getting funding Freeing the medical field from its reliance on addictive opioid analgesics is especially urgent, and a combination of publicly and privately funded science will help us achieve this goal. New opioid compounds that block pain without addiction or overdose risk are already being studied. Compounds targeting the body’s other pain-signaling systems, such as the endocannabinoid system, are another promising approach. We have also been funding research into high-frequency repetitive transcranial magnetic stimulation (rTMS) and related technologies that could greatly improve quality of life for chronic pain patients without using medications at all. The opioid crisis may look daunting, but there is much reason for hope. Science will find a solution — probably many solutions — to this crisis. NIH and our industry partners are committed to an “all scientific hands on deck” approach to accelerate this work to prevent overdose deaths, support long term recovery from opioid addiction, and ensure that pain treatment is not a pathway to addiction.

New opioid compounds that block

pain without addiction or overdose risk are already being studied

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How bad is it? It’s the deadliest drug crisis in American history. Drug overdoses are the leading cause of death for Americans under 50, and deaths are rising faster than ever, primarily because of opioids. Overdoses killed more people last year than guns or car accidents, and are doing so at a pace faster than the H.I.V. epidemic at its peak. In 2015, roughly 2 percent of deaths — one in 50 — in the United States were drug-related. Overdoses are merely the most visible and easily counted symptom of the problem. Over two million Americans are estimated to have a problem with opioids. According to the latest survey data, over 97 million people took prescription painkillers in 2015; of these, 12 million did so without being directed by a doctor. i Short Answers to Hard Questions About the Opioid Crisis Q & A

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Pill mills began popping up around the country as communities were flooded with prescription opioids. Over the next decade, a growing number of people grew addicted to the drugs, whether from prescriptions or from taking them recreationally. For many, what started with pills evolved into a heroin addiction. At the same time, the heroin market was changing.The price plummeted. Newly decentralized drug distribution networks pushed heroin and counterfeit pharmaceuticals into suburban and rural areas where they had never been. Everywhere the suppliers went, they found a ready and willing customer base, primed for addiction by decades of prescription opiate use. Then in 2014, fentanyl began entering the drug supply in large amounts. So shouldn’t we just stop prescribing opioids? No. Opioids are a vital component of modern medicine that have measurably improved the quality of life for millions of people, particularly cancer patients and those with acute pain. But their efficacy in treating chronic pain is less clear, especially when weighed against the risks of overdose and addiction. Though prescription opioid consumption has been decreasing in the United States since 2010 or 2011, it remains high. According to the International Narcotics Control Board, if the amount of opioids prescribed per year were averaged out over each person living in America, everyone would get about a two-week supply. (Or a three-week supply, according to the C.D.C. Different ways of measuring what counts as a daily opioid dose give different values.) Either way you count, it’s higher than anywhere else in the world. 15

So is this crisis about prescription painkillers or heroin? Both. The crisis has its roots in the overprescription of opioid painkillers, but since 2011 overdose deaths from prescription opioids have leveled off. Deaths from heroin and fentanyl, on the other hand, are rising fast. In several states where the drug crisis is particularly severe, including Rhode Island, Pennsylvania and Massachusetts, fentanyl is now involved in over half of all overdose fatalities. While heroin and fentanyl are the primary killers now, experts agree that the epidemic will not stop without halting the flow of prescription opioids that got people hooked in the first place. Why has this problem gotten so much worse in recent years? Decades of opioid overprescription, an influx of cheap heroin and the emergence of fentanyl. Addiction to opioids goes back centuries, but the current crisis really starts in the 1980s. A handful of highly influential journal articles relaxed long-standing fears among doctors about prescribing opioids for chronic pain.The pharmaceutical industry took note, and in the mid-1990s began aggressively marketing drugs like OxyContin.This aggressive and at times fraudulent marketing, combined with a new focus on patient satisfaction and the elimination of pain, sharply increased the availability of pharmaceutical narcotics.

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FROMPAINPILLS TO HEROINADDICT: EX-AREA MAN NOW FOCUSED ON HELPING OTHER By: Dave Hinton

A ndrew Dewey’s life was a mess. A survivor of Hurricane Katrina in Louisiana, he moved back to Illinois in 2006 and went through a divorce. His wife left to live in Bowling Green, Ky., taking their son with him. “It spiralled me deeper and deeper, and I ended up being a drug addict and alcoholic,” Dewey, a rural Penfield native, said. The drug use all started from an opioid drug prescription to help him deal with pain from a back injury. “(My doctor) had me on a prescription drug killer with no exam, no MRI.Then he up and closed his office, and I started detoxing,” Dewey said, noting that he started on vicodin, then graduated to oxycontin and then to morphine with oxycontin.At one point he was taking 20 tablets a day as his body became immune to the drug.

Opioid addiction is both a physical and psychological addiction. - Andrew Dewey

Unable to get more pain reliever, Dewey was desperate.That’s when a friend offered to help.

“He said,‘I can make you feel better.’ It was a shot,” Dewey said.

The shot was heroin, and his battle with that drug began.

Dewey lost 100 pounds in six months. He wasn’t eating. Only using.

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“We as a society have to realize we are not going to arrest, we are not going to prosecute our way out of this problem,” Dewey said.“When you take a user and put them in the system, to me that’s like arresting a diabetic for possession of a donut.

“Heroin is different. It’s affecting blue-collar middle class families. It’s the housewife next door to you.”

According to state figures, since 2013, the number of heroin deaths has nearly doubled, and the number of prescription opioid deaths has almost quadrupled. In 2016, there were 1,889 opioid overdose deaths, an increase of 76 percent from 2013.

Today the 1984 Armstrong Township High School graduate is one of the faces of the state of Illinois’ battle against opioid drug abuse. Dewey spoke at a ceremony lastWednesday as Lt. Gov. Evelyn Sanguinetti and other state officials unveiled the State of Illinois Opioid Action Plan. Earlier in the day, Gov. Bruce Rauner signed an executive order that created the Opioid Overdose Prevention and Intervention Task Force that will look at strategies to prevent expansion of the opioid crisis, treat and promote the recovery of individuals with opioid-use disorder and reduce the number of opioid overdose deaths. Dewey, who has turned his life around with treat- ment, wants to help others who are like he used to be. He said it is important to eliminate the stigma of drug abuse and stressed the importance of prevention, treatment and ongoing support.

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Overdose deaths involving synthetic opioids have increased more than any other category of opioids. The largest increase was in the number of deaths involving fentanyl and drugs similar to fentanyl, which led to a tenfold increase in synthetic opioid overdose deaths between 2013 and 2016. Said Dewey:“I don’t think most people wake up at any point and say,‘You know what? I can’t wait to be a heroin addict.We’re having kids in high school and middle school” with addiction issues.

Heroin is the drug of choice is because it’s so cheap and readily available.

And Dewey said many times it starts with “some kind of pills.”

One reason heroin is the drug of choice is because it’s so cheap and readily available.

“It’s everywhere,”he said.“I live in a little town the size of Rantoul (Chatham). I’m well aware of at least six places at least a mile from here that have it. It’s becoming the level of problem that no town, no village is becoming immune from.” Dewey said he began treatment March 5, 2012. His step toward a new life continued when he enrolled in Lincoln Land College, Springfield. He was later asked to be the commencement speaker.

“They wanted me to tell my story from addiction to that date,” Dewey said.

It is a story of hope.

From there he enrolled in classes at the University of Illinois at Springfield, where he earned a bache- lor’s degree in psychology and is now working toward a master’s degree in clinical mental health counseling. Dewey said in April, the U.S.Attorney’s Office in Springfield was working to assemble community residents to work toward combating the opioid crisis.They approached one of Dewey’s professors, who pointed them to Dewey.

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Mike Emery, the re-entry outreach law enforce- ment coordinator for the U.S.Attorney’s Office of Central Illinois, said Dewey’s story is so impactful that it needs to be heard. It took “a lot of courage” for Dewey to get up in front of a room full of people and tell his story, Emery said.“Andrew was fantastic on both counts as a speaker and making his point. I know for a fact that his talk made an impact. “I worked for law enforcement for 33 years. I needed to hear what Andrew had to say.When I was active in law ... that’s all I did was enforce the law, make the arrest and not see the end result of people having the addiction.”

Dewey’s goal:“I knew from day one when I walked out in 2012 (having completed treatment) that this was what I was going to do. I had a goal in mind at that time — that if I can just save one person, all of it’s worth it. I think in the bigger picture, that’s what sometimes we do looking out at the problem, is forget these are people.We want to stigmatize, demonize, but this is a person.”

Heroin is different. It’s affecting blue-collar middle class families. it’s the housewife next door to you.

There is a relationship between opioid prescription drugs and illegal substances, Dewey said.

“I think that heroin is a substance of choice because it is an opioid. (Addicts) can’t break that cycle of addiction without treatment,” Emery said. “Andrew is a perfect example of having the strength to break that addiction. It’s a horrible struggle.”

Opioid addiction is both a physical and psychologi- cal addiction, according to Dewey.

“It’s the sensors in the brain that are calling for the addiction of the opioids,” he said.“It’s breaking down that mental barrier.You do that by backing off a little bit at a time.” A full-time grad student who is raising a son, Dewey works at NPR radio in a graduate assistant program that helps pay his college bills. He also works two days a week as an intern at Gateway Addiction Treatment Center.

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Prescription for disaster: Louisiana ’ opioid epidemic

very time RoyOMartin has to replace an employee, it shells out at least $25,000 to hire and train someone new. And in recent years, the Alexandria-based lumber company has increasingly spent more to replace lost workers as a national epidemic has infiltrated the Louisiana workforce, driving up turnover and absenteeism rates, while decreasing productivity. President and CEO Roy O. Martin III decided last fall that he had to speak out. Along with the company’s medical director, Martin penned a letter to physicians in central Louisiana, pleading with them for help. “Over the years, we have had several employees who never returned to work after a surgery because of prescription drug dependency,” Martin wrote, asking doctors to heed the medical director’s recommendation and limit painkiller prescriptions. “I hope we can work collectively to stem the growth of the opioid epidemic.”

As the use and abuse of prescription painkillers has skyrocketed across the nation—and predominantly so in the Bayou State—Martin’s letter reflects a growing concern among businesses over the well-being of the workforce, and the costly strain of increased turnover rates and prescription drug costs, which is RoyOMartin’s fastest-growing expense.

In recent years, Louisiana has seen an alarming rise in opioid-related overdoses and become one of just eight states with more opioid prescriptions than residents. The severity of the issue prompted the state to pass legislation in June aimed at curbing the epidemic. Less has been said, however, about an area where Louisiana’s opioid abuse also

rises above the rest: its workforce. The Workers’ Compensation Research Institute reports 85% of injured workers in Louisiana on pain medication received opioids from 2012 to 2014. What’s worse, one in six received opioids on a long-term basis, making Louisiana No. 1 among 25 study states for long-term use. The impact on workers and employers is “quite literally an epidemic,” says Jim Patterson, Louisiana Association of Business and Industry vice president of government affairs. He adds the issue has been known and talked about among the business community, but not broadly enough.

“It’s kind of a dirty little secret in the workplace. We are overdue in trying to address the problem of the overprescription of opioids.” PATTERSON Brought to you by: businessreport.com

Employers often turn a blind eye to prescription painkiller abuse, brushing it off as a personal matter, says Dr. Luke Lee, medical director of Baton Rouge-based Prime Occupational Medicine. But, as a medical provider serving companies across south Louisiana, Lee knows the widespread nature of opioid abuse in the workforce makes it an employment issue as well as a societal one. “The opioid crisis is just as bad as the press portrays, if not more so,” Lee says. “Based on my 20-plus years of reviewing workplace drug screens, illegal use of opioids at work increased by more than 200% over the last five years.”

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A drug or alcohol problem isn’t something to be ashamed about—it’s something to get help for, period.

A problem with drugs or alcohol can lead to other problems in a person’s life, such as problems with health, relationships, work, and school. Another problem for this list is shame.

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Letting Go of Shame Ashamed about a drug problem? Don’t be.

More than feeling guilty

Shame and secrets We were reminded of this when we heard about the death of Nelsan Ellis, the talented actor from the TV series “True Blood” and, more recently, the series “Elementary.” Nelsan didn’t reveal to the public that he had a problem with drugs and alcohol. After he died in July from complications while he was trying to withdraw from an alcohol use disorder, his family publicly revealed that he “was ashamed of his addiction.” They said that Nelsan “would want his life to serve as a cautionary tale…to help others.” The truth is, addiction is a disease. A person with an addiction can’t “just stop” taking drugs. A drug or alcohol problem isn’t something to be ashamed about—it’s something to get help for, period. One place to start is the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You don’t have to be thinking about suicide to call the Lifeline—anyone with a problem can call. It’s free, private, and confidential.

When a person feels shame, they feel guilty, embarrassed, and small. They don’t just feel bad because they did something wrong; they feel like who they are is wrong. Shame hurts. Shame can lead a person to hate themselves, feel hopeless or worthless, or even have self-destructive thoughts. In some ways, it can make a drug or alcohol problem even worse—especially if it makes the person too embarrassed to get help.

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Although local law enforcement said met amphetamine is still the drug of choice for many in north Alabama, opioid and heroin usage are up. As a result, fatal overdose numbers have increased. Opioids, which include prescription drugs such as oxycodone, fentanyl and morphine, accounted for 44 percent of overdose deaths in Alabama in 2016, a 13 percent increase since 2011, according to the state Center for Health Statistics. Most of these drugs are acquired through legal prescriptions, said acting State Health Officer Scott Harris. “You go see a physician, you get a prescription, you get it refilled, and you have this addiction problem. Some of it is not legal, but a lot of it is,” Harris said. Opioids are prescribed more widely in Alabama than in any other state, according to a July 31 report from the Centers for Disease Control and Prevention. For every 100 people in Alabama, there were 121 prescriptions for opioid painkillers written in 2016, according to CDC statistics.

D e m i s e on the Rise Opioid usage up, and so are fatal overdoses

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“There’s no DARE class that could have come through a high school and tell you (the dangers) of opioids. Nobody knew where it would take you and the road it would lead you down,” said David Wilbourn, resident manager at His Way Recovery Center in Huntsville, referring to a K-12 substance abuse prevention program. Fatal opioid overdoses in Alabama have more than doubled, from 155 in 2011 to 324 in 2016, according to a 2017 Center for Health Statistics report. “Nobody knew how powerful those things were,” said Wilbourn, who’s also a board member for Not One More Alabama, a Huntsville-based organization hoping to educate people about opioids and provide support for those trying to stop using. The power of opioids has been underestimated, Wilbourn said.

Wilbourn said he was addicted to heroin and Oxycontin until January 2015. He said he started using Oxycontin his junior year of high school, leading to his eventual heroin addiction and abuse. He said some people have a sense of false security about using opioids because they think doctor-prescribed substances are safe. “There’s no DARE class that could have come through a high school and tell you (the dangers) of opioids.” Meth is still the No. 1 drug threat statewide, according to the Center for Health Statistics report, mainly because it’s cheap and made with common household products, said Morgan County Circuit Judge Glenn Thompson.

Meth and crack deaths seldom stem from overdoses but rather from associated violence or organ failure, said Barry Matson, executive director of the Alabama Office of Prosecution Services. Local officials and activists agree deaths by opioids likely are caused by a lack of education about the dangers of such drugs. Lawrence County Coroner Greg Randolph said many overdoses are accidental, mainly because of the strength of the drugs. “The problem with opioids is the more they (users) take, the more they want,” Randolph said. “We used to see overdoses in mainly young people, but I see it in older people as well.They just don’t realize how powerful the drugs are.” Randolph said first responders are called to an overdose-related incident nearly every week in Lawrence County. >>>

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>>>

“People think that if it came from a doctor, it must be safe,” he said. “If a doctor tells you to use something, you’re going to do it.” Last month, Harris said he didn’t know a more important issue facing the state than the opioid crisis. He was speaking to a group of state health and policy leaders charged with finding fixes to the problem. Harris, who is from Decatur, also leads the Morgan County Health Department. His medical background, which began 30 years ago, is in HIV. “The number of (opioid) overdoses are outpacing the HIV deaths we saw back in the day,” Harris told the Alabama Opioid Overdose and Addiction Council. A few days later, Harris announced a grant providing 1,200 doses of the lifesaving antidote naloxone for first responders statewide to help prevent opioid overdose deaths.The grant is paying for 600 kits, each holding two doses of the drug. Naloxone allows for the temporary reversal of an overdose, giving enough time for emergency medical personnel to arrive, said the state Department of Public Health. Both Decatur Fire and Rescue and the Decatur Police Department carry naloxone in the form of a nasal spray.

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In August, U.S. Attorney General Jeff Sessions said the Justice Department would dispatch 12 federal prosecutors to cities ravaged by addiction who would focus exclusively on investigating health care fraud and opioid scams.The Northern District of Alabama is included in the pilot program. Huntsville doctor Shelinder Aggarwal pleaded guilty to illegally distributing a controlled substance and health care fraud and was sentenced to 15 years in prison in February. He also had to forfeit $6.7 million and a clinic. “We wanted to send prosecutors where there is significant prescription opioid abuse and health-care fraud, and where there are sufficient resources to support additional cases being brought,” said Justice Department spokeswoman Lauren Ehrsam.The department used three criteria to determine the target areas: • State opioid prescription rates • The number of outlier opioid physicians in the area who are prescribing prescription opioids far in excess of their peers after their specialty and other factors are taken into account; • State prescription opioid overdose rates. In 42 Alabama counties, including Morgan and Lawrence, more than 112 prescriptions for opioid painkillers were written for every 100 people in the county in 2016, according to the CDC. In three Alabama counties, Walker, Franklin and Colbert, more than 200 prescriptions for opioids were written for every 100 people in 2016, according to the CDC. Though more people are likely seeing their friends and family impacted by opioid addiction, state Rep. Johnny Mack Morrow, D-Red Bay, said they don’t know what to do about it. Morrow helped organize a town hall on the crisis.The event was held Wednesday at the University of North Alabama. Harris, Libell, state Attorney General Steve Marshall and the commissioner of the Alabama Department of Mental Health, Lynn Beshear, were among the scheduled participants who fielded questions about the government’s role in the epidemic. Though Wilbourn said he is glad lawmakers are paying attention to the issue and listening to the public, he said people shouldn’t wait on new legislation to start a movement. “We as individuals and a community can’t wait around and let lawmakers do something. We have to take ownership of this,” he said.

“We as individuals and a community can’t wait around and let lawmakers do something. We have to take ownership of this.”

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