opioid crisis

RECENT POSTS

Op-Ed: A Few Things You May Not Know About The Senate Opioid Bill

By State Sen. John Keenan, of Quincy 

In the midst of an opioid addiction crisis that has claimed over 1,200 deaths in 2014 and thousands more in the preceding decade, the state Senate has passed a bill intended to help prevent opioid addiction. There’s more to it than most have realized.

You’ve probably read about the proposed expansion of so-called Screening, Brief Intervention and Referral to Treatment (SBIRT) programs in public schools — a proposal initially deemed controversial, with people believing it involved blood samples and lab testing. Even my mother called to report her concerns, and conveyed that my 88-year-old aunt was also opposed. For the record, the Senate bill does not include any drug testing. It does include a verbal survey and assessment, of students, to gain a better understanding of trends and risks among youth.

Continue reading

No Blame, No Shame: Treating Heroin Addiction As A Chronic Condition

Ever heard of a diabetic patient who ate a large muffin before having a blood glucose test, was scolded for giving in to temptation, and then told to just say no to carbs?

How about a cardiac patient who has a worrisome stress test and is shown the door when she admits to eating a few Big Macs?

That kind of response is all too familiar for patients whose brains have been altered by heroin or other opiates.

“We blame patients for their disease,” says Dr. Sarah Wakeman. “We also kick people out of treatment for having symptoms of their disease with addiction, which would honestly be malpractice if we did that with other conditions.”

Wakeman runs the Substance Use Disorders Initiative at Massachusetts General Hospital, where treating addiction as a chronic condition, like diabetes or asthma or high blood pressure, is the norm.

Patients are screened using questions that determine if they are at risk for addiction. There’s an assessment. Then Wakeman and her patients work on lifestyle changes, decide what medication will help break the addiction, and meet frequently to monitor progress. Continue reading

Related:

The Face Of Opioid Addiction: Vinnie, A ‘Regular’ Guy From Revere

In this 2013 file photo, a recovering heroin addict holds a demonstration dose of the medication Suboxone. (M. Spencer Green/AP)

In this 2013 file photo, a recovering heroin addict holds a demonstration dose of the medication Suboxone. (M. Spencer Green/AP)

Correction: An earlier version of this story said that approximately 100 Americans died each day from opioid overdoses in 2013. In fact, this number refers to all drug overdoses in that year, and opioid related overdoses, including deaths involving prescription opioids and heroin, accounted for two-thirds of the total, or approximately 67 deaths each day. 

By Dr. Annie Brewster
Guest Contributor

Want a glimpse of what opioid addiction really looks like?

Meet Vinnie: a self-described “regular” guy from Revere, Mass., and a recovering drug addict.

Toothless, and 60, Vinnie was prescribed opioids — Oxycodone, Oxycontin, Dilaudid, among others — for a chronic pain condition. Though he says he never intended to abuse these medications, Vinnie became an addict, taking painkillers for 28 years as his doctors kept prescribing higher and higher doses to manage his pain. Listen to his story here:

Vinnie stopped caring about anything except opioids, and finding his next dose of medication.

Vinnie, from Revere, is a recovering drug addict.

Vinnie, from Revere, is a recovering drug addict.

His marriage fell apart. He missed opportunities to spend time with his only daughter as she grew up. He became estranged from friends. He stopped taking care of his body and lost his teeth, gained 100 pounds, and developed diabetes, heart disease and arthritis. He fundamentally lost his will to live and contemplated suicide.

Ultimately, it was a pharmacist who put a stop to Vinnie’s opioid use by refusing to fill his prescription. After his initial panic, this abrupt end to the drugs led Vinnie to connect to a new doctor, an addiction specialist. His new regimen included a slow tapering of the narcotics and the initiation of Suboxone therapy.

The state and nation are in the midst of an escalating opioid crisis — it’s estimated that 67 Americans died each day from opioid overdoses in 2013, and the number of deaths from drug overdoses was three times that of the combined deaths from car accidents and homicides in that same year.

Just this week Massachusetts Gov. Charlie Baker enlisted medical schools to provide more addiction-related training to medical students. Against this backdrop, Vinnie’s story shows the harsh reality of addiction as well as a path to recovery.

How to fix it? It’s clear that a multifaceted approach is needed, as outlined in an extensive report put out by Gov. Baker’s Opioid Working Group in June.

One element, relevant to Vinnie, is consideration of one of several medications available to treat opioid addiction, including methadone, buprenorphine and naltrexone. Currently, these medications are underused, partly because they are controversial. Continue reading

Baker Announces Plan To Combat Opioid Addiction Epidemic

Gov. Charlie Baker announces recommendations of his Opioid Working Group along with Attorney General Maura Healey, second from left, and Health and Human Services Secretary Marylou Sudders, left, at the State House. (Jesse Costa/WBUR)

Gov. Charlie Baker announces recommendations of his Opioid Working Group along with Attorney General Maura Healey, second from left, and Health and Human Services Secretary Marylou Sudders, left, at the State House. (Jesse Costa/WBUR)

One person living in Plymouth County will die today from an overdose of heroin or another opiate. Gov. Charlie Baker says that sobering average, from just one county, offers a glimpse into the opioid epidemic that rages through every community in Massachusetts.

To combat this epidemic, Baker released a plan of attack. It includes 65 recommendations, drawn from a task force of experts who heard from 1,100 people this winter and spring, many of whom crowded into public hearings to tell their stories.

“Opioid addiction is a health care issue that knows no boundaries across age, race, class or demographics,” Baker said during a press conference Monday. “From the Berkshires, to Boston, to Cape Cod, too many people have heart-wrenching stories of loved ones or friends who have battled with addiction and in some cases lost their lives. Opioid abuse is stealing the livelihood of our children, our siblings, relatives and friends, one person at a time.”

The recommendations include more education for doctors, young people, those at risk for addiction and their family members about the dangers of pain killers. The state will look to add 100 treatment and recovery beds by this time next year. Pharmacists will be required to add pain prescriptions to a statewide database within 24 hours, much more quickly than the current seven days, which Massachusetts is working to connect to databases in other states.

“This is a complicated issue so there’s not going to be a simple fix,” said Health and Human Services Secretary Marylou Sudders.

Continue reading

Related:

Report Finds Stark Gaps In Mass. Addiction Care

The math is simple and starkly clear.

There are 868 detox beds in Massachusetts, where patients go to break the cycle of addiction. They stay on average one week. Coming out, they hit one of the many hurdles explained in a report out this week from the Center for Health Information and Analysis on access to substance abuse treatment in the state.

There are only 297 beds in facilities where patients can have two weeks to become stable. There are 331 beds in four-week programs.

As the table below shows, there are almost four times as many men and women coming out of detox, with its one-week average, as there are from a two- or four-week program.

From the CHIA report on Access to Substance Use Disorder Treatment in Massachusetts

From the CHIA report on Access to Substance Use Disorder Treatment in Massachusetts

Patients who can’t get into a residential program right away describe a spin cycle, where they detox and relapse, detox and relapse. Some seek programs in other states with shorter wait times.

Continue reading

Lazarus Effect: Witnessing A Life Saved By Narcan, Opioid Antidote

An educational pamphlet and samples of naloxone, a drug used to counter the effects of opiate overdose, are displayed at a fire station in Taunton. (Elise Amendola/AP)

An educational pamphlet and samples of naloxone, a drug used to counter the effects of opiate overdose, are displayed at a fire station in Taunton. (Elise Amendola/AP)

More than two and a half times as many people die from opioid overdoses as from car accidents in Massachusetts, Gov. Charlie Baker said last week. He has appointed a task force to address the problem and held community discussions around the state.

Among measures under discussion: expanding still further the access to Narcan, a drug that, when given promptly, can counteract the effects of an overdose. Its use to reverse heroin overdoses is already up 250 percent in the first quarter of this year compared to a year ago, WBUR’s Martha Bebinger reports today. Here, a report from a medical staffer who recently saw Narcan work for the first time.

By Harold du Four
Guest contributor

“Help! Someone please help! Stay with us, Matthew, stay with us!”

The cries were coming from the parking area. In response, the charge nurse and I charged out the front doors of the Dimock Center in Roxbury, the community health center where I oversee the detox unit.

It didn’t take long to recognize the source of that distress call: a mother who had just driven from south of the city with her son, who was now slumped over in the back of their gray, two-door convertible. He was in the throes of an overdose, barely breathing, his lips so blue they were almost black.

I knew what had likely happened: The mother had been seeking to check Matthew (not his real name) in to our detox unit. While she had focused on driving into the city to seek help, her son had focused on one last hit. A half-used hypodermic needle lay on the seat next to him, having fallen from his now limp forearm, marked by the vein track scarring that bespeaks a personal history of chronic use.

While my colleague attempted to help him by loosening his winter clothing, trying to wake him, goading his sternum for signs of life, I rushed back into the detox unit to grab a Narcan kit — a naloxone nasal spray that reverses the effects of heroin and some opiate-based prescription drugs.

After quickly assembling the device, I handed it over to my colleague, a nurse with more than 25 years of experience working in the field. She then reached in to carefully – yet confidently – apply a single spray to each nostril of the young man’s nose. Mucus drained slowly down her hand. I punched in 911 on my cell phone.

The mother’s pleas to save her son became more pronounced now; my heart ached for her as she begged, “Stay with us, Matt.” We were doing all we could — but would it be enough? Continue reading