The US Opioid Crisis is Expanding and Worse Among Young People

MedicalResearch.com Interview with:
Joshua Barocas, MD Assistant Professor of Medicine Section of Infectious Diseases Boston Medical Center / Boston University School of Medicine Joshua Barocas, MD

Assistant Professor of Medicine
Section of Infectious Diseases
Boston Medical Center / Boston University School of Medicine 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Massachusetts has been particularly hard hit by the opioid epidemic despite lower opioid prescribing rates, near universal health insurance, and availability of opioid treatment. That said, it is difficult to estimate the population with or at-risk for opioid use disorder. It is generally a highly stigmatized disease and typical methods to estimate of opioid use disorder relay on contact with the healthcare system and/or patient reporting.

We used a unique and powerful methodology coupled with a first-in-the-nation linked database in Massachusetts to obtain both an accurate count of people with opioid use disorder who are known to the healthcare system and estimate the number who are out there but not yet known to the system.

We found that more than 275,000 people – or 4.6 percent of people over the age of 11 in Massachusetts– have opioid use disorder, a figure nearly four times higher than previous estimates based on national data. In 2011 and 2012, the prevalence of opioid use disorder in Massachusetts for those over the age of 11 was 2.72 percent and 2.87 percent, respectively. That increased to 3.87 percent in 2013, and even more, to 4.6 percent in 2015. Those between the ages of 11 and 25 experienced the greatest increase in prevalence of all age groups. The number of “known” persons increased throughout the study period – from 63,989 in 2011 to 75,431 in 2012, and 93,878 in 2013 to 119,160 in 2015.  Continue reading

Fentanyl Strips Can Prevent Opioid Overdoses

MedicalResearch.com Interview with:
"150826-fentanyl-factory-underground-illicit.jpg" by r. nial bradshaw is licensed under CC BY 2.0
Jon Zibbell, PhD,
Senior public health scientist
Behavioral Health Research Division
RTI International
Research Triangle Park, NC, 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: For the first time in 2016, U.S. overdose deaths involving illicitly-manufactured fentanyl surpassed deaths from heroin and prescription deaths.

Fentanyl is an extremely potent synthetic opioid, and an illicitly-manufactured form of the drug is regularly being mixed with heroin and often sold to unwitting consumers. Fentanyl is 50 times more potent than heroin and its illicitly-manufactured version is extremely difficult to discern when mixed with heroin. Harm reduction organizations have started to distribute FTS and people consuming street-purchased opioids are using them to test drugs for fentanyl. Our objective was to assess whether this point-of-use form of drug checking was influencing people’s drug use behavior. The study was self-funded by the research institute RTI International.

Our findings show that consumers who tested street opioids with fentanyl test strips were five times more likely to engage in safer drug use behavior when the test comes back positive. The study was conducted among a group of 125 people who inject drugs in Greensboro, North Carolina.

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Most Opioid Overdose Patients Can Be Discharged After Brief ER Visit

MedicalResearch.com Interview with:

Frank Scheuermeyer MD MHSc Clinical Associate Professor Department of Emergency Medicine St Paul’s Hospital and the University of British Columbia

Dr. Scheuermeyer

Frank Scheuermeyer MD MHSc
Clinical Associate Professor
Department of Emergency Medicine
St Paul’s Hospital and the University of British Columbia 

MedicalResearch.com: What is the background for this study?

Response: Mortality from the opioid epidemic is dramatically increasing and a main culprit appears to be illicit fentanyl. Current research states that patients with presumed fentanyl overdoses are at high risk of deterioration and death, and require prolonged emergency department stays or hospital admission to ensure a safe outcome.

Our inner-city hospital adopted a protocol initially developed for patients with heroin overdose, modified it to account for the greater potency of fentanyl, and studied 1009 consecutive patients who arrived with an overdose.

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Marijuana Dispensaries Have Ability To Reduce Opioid Overdoses and Substance Abuse

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: David Powell  PhD Economist; Core Faculty, Pardee RAND Graduate School RAND, Santa Monica     MedicalResearch.com:  What is the background for this study?  What are the main findings?   Response: There has been some research suggesting that the adoption of state medical marijuana laws leads to reductions in prescriptions for opioid analgesics among certain populations and opioid-related overdoses overall.  However, medical marijuana laws are very different across states and they have changed over time as well.  We wanted to understand what components of a medical marijuana law could potentially lead to reductions in overdoses and substance abuse.  We focused specifically on the role of dispensaries, given their importance in providing access to medical marijuana, and tested for different effects in states with and without legally-protected and operational dispensaries.  We found that dispensaries are critical to reduce opioid-related overdoses and substance abuse.  We also found evidence that more recently-adopting states have experienced smaller reductions in overdoses and opioid substance abuse, potentially because the more recent adopters tend to enforce more stringent guidelines for dispensaries than the early adopters.   MedicalResearch.com: What should readers take away from your report?  Response: We find that the introduction of medical marijuana dispensaries has the potential to reduce opioid-related harms quite significantly.  More broadly, it also suggests that, when we think about the opioid crisis, improving access to pain management alternatives may be a useful mechanism for reducing dependence on opioids.        MedicalResearch.com: What recommendations do you have for future research as a result of this work?  Response: During most of the time period that we studied, prescription opioids were driving the opioid crisis, but it has recently transitioned to the point where heroin and illicit synthetic opioids are playing more prominent roles.  We are hesitant to suggest that medical marijuana access will have the same scope in a climate in which synthetic opioids and heroin are the primary substances of abuse.  Future work could do more to explore the potential of different types of medical marijuana laws to reduce overdoses related to these substances.        Citations: Do medical marijuana laws reduce addictions and deaths related to pain killers? ☆ •David Powella, , ,  •	Rosalie Liccardo Paculaa, b,  Mireille Jacobsonb  RAND, Santa Monica, United States  NBER Cambridge, MA, United StatesUniversity of California, Irvine, United States Received 14 November 2015, Revised 15 August 2017, Accepted 30 December 2017, Available online 3 February 2018  Journal of Health Economics Volume 58, March 2018, Pages 29–42  https://doi.org/10.1016/j.jhealeco.2017.12.007     The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Dr. Powell

David Powell  PhD
Economist; Core Faculty, Pardee RAND Graduate School
RAND, Santa Monica 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been some research suggesting that the adoption of state medical marijuana laws leads to reductions in prescriptions for opioid analgesics among certain populations and opioid-related overdoses overall.  However, medical marijuana laws are very different across states and they have changed over time as well.  We wanted to understand what components of a medical marijuana law could potentially lead to reductions in overdoses and substance abuse.  We focused specifically on the role of dispensaries, given their importance in providing access to medical marijuana, and tested for different effects in states with and without legally-protected and operational dispensaries.

We found that dispensaries are critical to reduce opioid-related overdoses and substance abuse.  We also found evidence that more recently-adopting states have experienced smaller reductions in overdoses and opioid substance abuse, potentially because the more recent adopters tend to enforce more stringent guidelines for dispensaries than the early adopters.   Continue reading

Vancouver Study: 100% of Opioid-Users Tested Positive for Fentanyl

MedicalResearch.com Interview with:
“Drugs” by Ben Harvey is licensed under CC BY 2.0William G. Honer, MD, FRCPC, FCAHS

Jack Bell Chair in Schizophrenia
Professor and Head, Department of Psychiatry
University of British Columbia
Vancouver, BC

MedicalResearch.com: What is the background for this study?

Response: The Province of British Columbia, Canada, has experienced a tremendous increase in the number of opioid related overdoses and deaths. In 2012, there were 269 drug overdose deaths, five years later in 2017 the overdose deaths are predicted to have increased 500%. Toxicology studies of deaths, and examination of seized drugs indicate fentanyl is the major cause.

These indirect measures suggest widespread exposure to fentanyl in opioid users, however direct studies of the extent of exposure of opioid users to fentanyl in the community are lacking. We carried out a community-based, longitudinal study using fentanyl testing in urine samples from volunteer participants. (It is called the “Hotel Study” since many of the participants live, or have lived in single room occupancy hotels)  Continue reading

Half Of People Who Died of Opioid Overdoses Tested Positive For Fentanyl

MedicalResearch.com Interview with:
“no drugs” by Anderson Mancini is licensed under CC BY 2.0
Julie K. O’Donnell, PhD
Division of Unintentional Injury Prevention
National Center for Injury Prevention and Control
CDC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The opioid overdose epidemic has killed over 300,000 Americans from 1999 to 2015—including 33,091 in 2015. Over this time, the epidemic has evolved from being primarily driven by prescription opioids to increasingly being driven by illicit opioids. The first wave of the epidemic began in 1999 with a steep increase in deaths involving prescription opioids, such as hydrocodone, oxycodone, and morphine. The second wave began in 2010 with rapid increases in overdose deaths involving heroin. The third wave of the epidemic began in 2013, with significant increases in overdose deaths involving synthetic opioids—particularly those involving illicitly-manufactured fentanyl (IMF), which are commonly laced into heroin products. Most recently, the IMF market continues to evolve, with an ever-widening array of illicitly manufactured fentanyl analogs being distributed.

This report indicates that over half of people in 10 states who died of opioid overdoses tested positive for fentanyl during the second half of 2016. The report found that out of a total of 5,152 opioid overdose deaths, almost 3,000 tested positive for fentanyl, and over 700 tested positive for drugs that have similar chemical structures to fentanyl (fentanyl analogs) – including the extremely potent fentanyl analog, carfentanil, which is used to sedate large animals.

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Fentanyl Laced Heroin Contributing To Spike In Heroin Overdoses in Miami-Dade County

MedicalResearch.com Interview with:
Alexander Diaz Bode

M.D. Candidate
University of Miami Leonard M. Miller School of Medicine
Miami, FL

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our country is in the midst of an opiate epidemic. This is particularly evident in the emergency department (ED), which continues to see an alarmingly large number heroin overdose. With the shutdown of “pill-mills”, where opioid prescriptions would be prescribed indiscriminately, Florida has seen particularly large increases in opiate use and overdose. In Miami, we noticed that during the summer of 2016, there was a disproportionate increase in heroin overdose being treated at our hospital relative to previous years. Our recently published study showed that fentanyl or fentanyl analog laced heroin likely contributed to this massive spike in heroin overdose observed during the summer of 2016.

Fentanyl and its synthetic analogs are opioid receptor agonists that bind with hundreds of times higher affinity than diamorphine, aka heroin. Naloxone, better known by the brand name Narcan®, is used to reverse heroin overdose in the ED. This drug works by competitively inhibiting the opioid receptor, effectively “knocking off” the bound heroin. Using naloxone dosing as a surrogate marker of heroin purity, our study found that during the investigated spike there was a disproportionate increase in the amount of naloxone used in our ED to reverse overdose relative to the increase in opiate overdose. This indicated that a stronger opioid receptor agonist, such as fentanyl or fentanyl analogs, likely was involved in the massive spike in overdose observed during the summer of 2016.

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Fentanyl for Pain: Intranasal Use in the Out-of-Hospital Setting

Morten Sejer Hansen Department of Anaesthesia 4231 Centre of Head and Orthopaedics, Rigshospitalet Copenhagen University Hospital, Copenhagen, DenmarkMedicalResearch.com Interview with:
Dr. Morten Sejer Hansen
Department of Anaesthesia 4231
Centre of Head and Orthopaedics, Rigshospitalet
Copenhagen University Hospital, Copenhagen, Denmark


MedicalResearch.com: What are the main findings of the study?

Answer: Out-of-hospital administration of intranasal fentanyl in doses of 50 and 100 microgram appears to be safe and well tolerated, with a low incidence of side effects

Secondly, intranasal fentanyl appeared effective in a wide range of patients, although no firm conclusions on analgesic efficacy can be provided due to the lack of a placebo control.
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