Opioid Abuse

The opioid crisis has been called the worst drug epidemic in American history. it has already killed thousands and scarred millions more. Over the last few years, there has been a rise in affirmative litigation by municipalities that is, proactive suits that seek to vindicate some public interest, not merely the municipality's corporate interests. This article examines the recent wave of lawsuits by cities and counties against the opioid industry. Municipalities face unique challenges in bringing suits. Relative to individual opioid users, municipalities face a complex task when attempting to prove injury and causation for their harms. And unlike states or nations, municipalities lack inherit authority to bring suits on behalf of their residents. The Article first explains the basics of municipal affirmative litigation, including its history, major cases, criticisms, and benefits. it then describes the origins of the opioid crisis and the pharma industry's complicity in exacerbating it. Next, it examines some of the major obstacles to municipal suits: standing , statutes of limitations, and preemption. Lastly, it describes the five theories most commonly employed in municipal affirmative litigation: (1) public nuisance, (2) Racketeer influenced and Corrupt Organizations Act (RiCO), (3) negligence, (4) state consumer protection laws, and (5) unjust enrichment. For each theory, it considers potential drawbacks to employing the theory, analogies that may predict its viability, and past opioid cases where it has been tested.

Sydney’s Medically Supervised Injecting Centre in Kings Cross has been a major national and global example of successful harm reduction in relation to illicit drug use ever since it opened its doors 18 years ago. However, since then Sydney has undergone significant transformations as a city, including gentrification of the inner Sydney suburbs where the injecting centre operates and expansions to its Western and South Western suburbs where many of its injecting drug-using population reside. Furthermore, Australia is seeing growing public health concerns about steady increases in opioid overdose deaths worth comparing to the opioid crisis in the United States. Using data from the National Coronial Information System, we explore the distribution of overdose deaths across Sydney and in doing so make the case for the establishment of a second medically supervised injecting centre in Sydney’s outer suburbs.

Pain management in the general practice setting often defaults to the use of analgesic drugs, frequently opioids. This short article applies guideline recommendations that could be used by General Practitioners in prescribing opioids for people with chronic noncancer pain (CNCP).

Objective: Emerging data are demonstrating that tamper-resistant opioids may play an important role in changing prescription opioid abuse behaviors. This study was a chart review to examine if the reformulation of OxyContin ® into a version with tamper-resistant properties (OxyNEO ®) had an impact on oxycodone-positive urine drug screens (UDSs) in opioid-dependent patients receiving methadone maintenance therapy (MMT). Design: The historical element of this study examined 250 eligible charts from patients on MMT who had data during the time periods when only OxyContin was available (baseline period), during the transition to OxyNEO, and when only OxyNEO was available. The prospective element included an exploratory questionnaire regarding retrospective opioid use. Setting: The study was conducted at three methadone clinics, in Oshawa, Peterborough, and Scarborough in Ontario, Canada. Participants: Male and female patients were eligible if they had a diagnosis of opioid dependency, received MMT, and had at least one oxycodone-positive UDS during the baseline period. Intervention: This was a noninterventional study. Main outcome measure: The main outcome was the number of oxycodone-positive UDSs. Results: The results demonstrated a marked reduction in oxycodone-positive UDSs that showed stepwise, statistically significant decreases during the transition and post-OxyContin periods relative to baseline. While the oxycodone-positive UDS results were decreasing, morphine-related-positive UDSs remained relatively stable during the same periods. There were no significant gender differences noted. Conclusions: The introduction of OxyNEO was associated with a statistically significant reduction in oxycodone exposure in a population of methadone-maintained patients.

Documento técnico del Ministerio de Salud y Protección Social de Colombia que orienta la respuesta de los servicios de salud que atienden a personas con trastornos por consumo de sustancias psicoactivas y dependencia a opioides que requieren mantenimiento con metadona.

Por otra parte menciona los elementos que se requiere para articular los servicios sociales y de salud en el país.

Se hace un estudio del arte frente a una reorganización de los servicios de atención a personas con trastornos conductuales compulsivos, que generan dependencia y la dependencia química a psicoactivos, para demostrar que es un sofisma, que el perfil de los usuarios ha cambiado en España, en general y en Galicia, en particular.

The major opioids are a therapeutic group whose main indication is the treatment of intense pain, both acute pain, mainly postoperative pain and chronic oncologic pain. However, the debate continues on whether major opioids are suitable for the treatment of chronic non-oncologic pain (NCD), since efficacy in these cases (including neuropathic pain) has only been demonstrated in short-term trials. In contrast, evidence of long-term use is limited, and evidence of increased risk of serious harm (overdose, opioid abuse, fractures, myocardial infarction, and sexual dysfunction) is evident. In this sense it is important to remember what these medicines contribute to the management of pain.

Este es un documento técnico del Ministerio de Salud y Protección Social de Colombia  y es una aproximación al perfil de la población que accede a servicios de salud que ofertan tratamiento de mantenimiento con metadona, conocidos en el país como programas de mantenimiento con metadona, así como reconocer las necesidades en salud que permitan fortalecer la integridad de la atención.
De otra parte, se hace un reconocimiento de las características de estos programas y aporta a la identificación de la oferta del tratamiento en el país en contraste con lineamientos disponibles para este tratamiento y recomendaciones de las guías disponibles.
Este documento pretende incentivar a los diferentes actores del Sistema General de Seguridad Social en Salud a fortalecer sus procesos de atención y favorecer el acceso al tratamiento en el marco de la garantía del derecho a la salud.

In 2017, drug overdoses became the leading cause of accidental death in the United States, with opioids driving this epidemic. Over the last two decades, there have been nearly half a million deaths attributable to opioids—half of these deaths occurred in the last three years, and one quarter in 2017 alone. The opioid epidemic is particularly virulent in correctional facilities. In fact, opioid overdoses are the leading cause of premature mortality among recently incarcerated persons, accounting for one-quarter of all deaths among this population. The high mortality rates among prisoners with opioid use disorder (OUD) is a direct result of the institutional practice of forcing drug abstinence on inmates. The body’s reduced tolerance for opioids, combined with potential exposure to highly potent synthetic opioids, makes opioid addicts particularly susceptible to suffering a fatal overdose in the first two weeks following incarceration.

An extremely effective method for treating OUD and preventing overdose fatalities is medication-assisted treatment (MAT), which medical literature describes as the gold standard of OUD treatment. MAT combines FDA-approved medications with some form of counseling to provide a more holistic approach to the treatment of OUD. The scarce research examining the use of MAT in correctional settings have yielded up to seventy-five percent reductions in post-release overdoses, along with sharp reductions in relapse and recidivism. Despite the life-saving potential of MAT, less than one percent of U.S. correctional facilities currently offer this treatment modality to inmates with OUD.

This paper questions the constitutionality of denying prisoners with OUD access to MAT. In particular, it argues that denying prisoners with OUD access to MAT amounts to deliberate indifference to a serious medical need, and rises to the level of cruel and unusual punishment under the Eighth Amendment.

The rate of Neonatal Abstinence Syndrome (NAS) has drastically increased over the past decade. The average hospital expense per NAS patient has tripled, while the number of babies born to opioid-dependent mothers has increased to 5 in 1000 births. Current treatment options are limited to opioid replacement and tapering. Consequently, we examined the efficacy of prenatal, low-dose and short-term vigabatrin (γ-vinyl GABA, GVG) exposure for attenuating these symptoms as well as the metabolic changes observed in the brains of these animals upon reaching adolescence. Pregnant Sprague-Dawley rats were treated in one of four ways: 1) saline; 2) morphine alone; 3) morphine+GVG at 25 mg/kg; 4) morphine+GVG at 50 mg/kg. Morphine was administered throughout gestation, while GVG administration occurred only during the last 5 days of gestation. On post-natal day 1, naloxone-induced withdrawal behaviours were recorded in order to obtain a gross behaviour score. Approximately 28 days following birth, 18 FDG microPET scans were obtained on these same animals (Groups 1, 2, and 4). Morphine-treated neonates demonstrated significantly higher withdrawal scores than saline controls. However, GVG at 50 but not 25 mg/kg/day significantly attenuated them. Upon reaching adolescence, morphine treated animals showed regionally specific changes in 18 FDG uptake. Again, prenatal GVG exposure blocked them. These data demonstrate that low-dose, short-term prenatal GVG administration blocks naloxone-induced withdrawal in neonates. Taken together, these preliminary findings suggest that GVG may provide an alternative and long-lasting pharmacologic approach for the management of neonatal and adolescent symptoms associated with NAS.

Drawing on a multisite sample of 40 persons who sell, share, or use diverted buprenorphine to manage opioid use disorder, in this study we describe why individuals seek to obtain buprenorphine outside of formal treatment contexts, and between-site variation regarding their motives and means. Findings indicate that both the provision and purchase of diverted buprenorphine support user-defined risk minimization strategies to avoid withdrawal, reduce heroin use, and satiate opioid cravings in periods of lowered tolerance. We also found that a subset of the sample used buprenorphine recreationally, and that it functioned to extend or augment illicit drug use careers. Implications of the findings are discussed in light of federal and state drug control and treatment policies.

The neurobiology of Chronic Low Back Pain is described as well as how this process of pain perception can have profound effects on human emotions and upon pain perception. The treatment of chronic low back pain by opiates further complicates this picture of human emotions experienced with chronic low back pain as well as the complication of addiction and the altering of pain perception.  Some legal and ethical issues are discussed such as how a United States Supreme Court ruling essentially opened the gates of the current opioid crisis that affects many people with chronic low back pain.

To explore the demographic patterns of hospitalizations related to prescription opioid overdose (POD) and evaluate the mortality risk of association in POD inpatients. Methodology We conducted a cross-sectional study using the Nationwide Inpatient Sample of 184,711 POD inpatients. A binomial logistic regression model was used to evaluate the odds ratio (OR) of association for mortality risk due to comorbidities (substance use disorders (SUD) and medical complications) in POD inpatients. Results POD inpatients were majorly females (54.1%), older adults aged 51-75 years (48.5%), whites (81.5%), and from lower household income quartet (32.8%). The most prevalent comorbid SUD among POD inpatients was alcohol (15.7%), followed by cannabis (5.7%), cocaine (4.2%), and amphetamine (1.8%). Comorbid alcohol use disorders had a minimally increased association with mortality but were not statistically significant (OR = 1.036; P = 0.438). POD in patients with cardiac arrest had the highest risk of mortality (OR = 103.423; P < 0.001), followed by shock (OR = 15.367; P < 0.001), coma (OR = 13.427; P < 0.001), and respiratory failure (OR = 12.051; P < 0.001). Conclusions Our study indicates that the hospitalizations related to POD were more prevalent among females, elders between 51 and 75 years of age, whites, and those in the lower household income quartet. The prevalence of prescription opioid use and the hospitalization related to POD remains a significant public health issue. POD inpatients with medical complications were at a higher risk of mortality than with comorbid SUD.

The argument from inductive risk claims that judgments about the moral severity of errors are relevant to decisions about what should count as sufficient evidence for accepting claims. While this idea has been explored in connection with evidence required for the approval of pharmaceuticals, the role of inductive risk in the post-approval process has been largely neglected. In this article, we examine the ethics of inductive risk in connection with revisions to the product monograph for OxyContin in Canada, which understates the risks of addiction and abuse associated with this drug. Using the concept of inductive risk, we consider what evidence should have been sufficient for Health Canada (HC) to revise the product monograph for OxyContin. Given the stakes involved, we argue that a less strict standard of evidence would have been appropriate, yet HC in fact took the opposite course, insisting upon a higher standard of evidence than it normally requires. In addition to providing a novel perspective on the opioid crisis in Canada, this article contributes to existing philosophical work by demonstrating that inductive risks in the post-approval stage are important and linked to pre-approval inductive risks.

The rate of Neonatal Abstinence Syndrome (NAS) has drastically increased over the past decade. The average hospital expense per NAS patient has tripled, while the number of babies born to opioid-dependent mothers has increased to 5 in 1000 births. Current treatment options are limited to opioid replacement and tapering. Consequently, we examined the efficacy of prenatal, low-dose and short-term vigabatrin (γ-vinyl GABA, GVG) exposure for attenuating these symptoms as well as the metabolic changes observed in the brains of these animals upon reaching adolescence. Pregnant Sprague-Dawley rats were treated in one of four ways: 1) saline; 2) morphine alone; 3) morphine+GVG at 25 mg/kg; 4) morphine+GVG at 50 mg/kg. Morphine was administered throughout gestation, while GVG administration occurred only during the last 5 days of gestation. On post-natal day 1, naloxone-induced withdrawal behaviours were recorded in order to obtain a gross behaviour score. Approximately 28 days following bir...

Prescription opioid overdose deaths continued to increase sharply over the last two decades. It is important to understand the adverse effects of misuse of prescription opioids on the individual's mental health and U.S. communities. To address this problem, an empirical analysis is conducted to estimate the factors that impact which have impact on the mental disorder related mortality. A county level panel data from 2009 to 2016 for 3134 counties is employed to estimate the link between the misuse of prescription opioid, economic indicators and the mental disorders related mortality. An economic model is created as a function of economics factors, medical factors and availability of mental health services, and demographic factors. This empirical analysis is conducted separately for rural and urban areas and Northeast, South, East, and West regions in the Unites States (U.S.) to involve the changes by geographic variation. The results show that the number of mental disorders related deaths are positively associated with the U.S. opioid prescription rate. The results also find that an increase in the county unemployment rate results in an increase in the mental disorders related mortality per 100,000 people in each county. The findings are mostly hold with both the fixed effect approach and count data approach.

The non-medical use of pharmaceutical opioids is associated with a range of negative health consequences, including the development of dependence, emergency room presentations and overdose deaths. Drawing on life history data from a broader qualitative study of the non-medical use of painkillers, this brief report presents two cases of transitions from recreational or non-medical pharmaceutical opioid use to intravenous heroin use by young adults in Australia. Although our study was not designed to assess whether recreational oxycodone use is causally linked to transitions to intravenous use, polyopioid use places individuals at high risk for progression to heroin and injecting. Our first case, Jake, used a range of analgesics before he transitioned to intravenous use, and the first drug he injected was methadone. Our second case, Emma, engaged in a broad spectrum of polydrug use, involving a range of opioid preparations, as well as benzodiazepines, cannabis and alcohol. Both cases ...

Introduction: The non-medical use of pharmaceutical opioids is associated with a range of negative health consequences including the development of dependence, emergency room presentations and overdose deaths.
Methods: Drawing on life history data from a broader qualitative study of the non-medical use of painkillers, this brief report presents two cases of transitions from recreational or non-medical pharmaceutical opioids use to intravenous heroin use by young adults in Australia.
Results: While our study was not designed to assess whether recreational oxycodone use is causally linked to transitions to intravenous use, poly-opioid use places individuals at high risk for progression to heroin and injecting. Our first case, Jake, used a range of analgesics before he transitioned to intravenous use and the first drug he injected was methadone. Our second case, Emma, engaged in a broad spectrum of polydrug use, involving a range of opioid preparations, as well as benzodiazepines, cannabis and alcohol. Both cases transitioned from oral to intravenous pharmaceutical opioids use and subsequent intravenous heroin use.
Discussion: These cases represent the first documented reports of transitions from the non-medical or recreational use of oxycodone to intravenous heroin use in Australia. As such, they represent an important starting point for the examination of pharmaceutical opioids as a pathway to injecting drug use among young Australians and highlight the need for further research designed to identify pharmaceutical opioids users at risk of transitions to injecting and to develop interventions designed to prevent or delay these transitions.