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Nearly as easy as reordering laundry detergent from Amazon, non-prescription opioids can be bought online and shipped directly to your doorstep. The frightening reality is that it is cheap and some of the synthetic formulations can be up to eight times more potent than morphine. The death toll from opioids purchased through an internet pharmacy is estimated to be 50 and rising. It is without a doubt that the United States is currently in the throes of a drug crisis and the dangerousness of continuing to allow these highly addictive drugs to be readily available via the internet is underscored by two recent deaths in Utah. Ryan Ainsworth, and his friend Grant Seaver, both 13 years old, attended junior high school together in Park City, Utah.1 According to the Washington Post, in September 2016 the two boys died within 48 hours of one another owing to acute drug intoxication from a synthetic opioid known as: U-47700. Also known as “pink” or “pinky,” the boys acquired U-47700 online from Shanghai and had it shipped to a friend’s house. At the time of the boys’ deaths, it was legal in the United States for them to own U-47700. According to data from the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS), nearly 19,000 deaths were attributable to an overdose of prescription pain medication.2 This number surpassed the more than 10,500 deaths attributable to heroin overdose that same year. Some of these destructive impacts that opioid abuse has on public health and safety across the United States is attributable to the overprescribing habits of health care providers. In fact, among other grave findings from the 2014 White House Summit, it was noted that in 2012, health care providers in the United States wrote 259 million prescriptions for pain medication.3 To put this number in perspective, it would be enough to provide every adult in America with a bottle of pills. The overprescribing habits of physicians, unfortunately, is not the only problem when it comes to the opioid epidemic, as opioid medications are readily available online through overseas websites – without even having a prescription.4 The list of drugs available is ever-growing and includes U-47700, as well as multiple forms of fentanyl, which is an opioid drug whose potency is estimated to be more than 50 times that of morphine. The emergence of new synthetic forms of opioids is occurring so rapidly that neither state nor federal enforcement can keep up.5 As regulators place bans on opioids that emerge in popularity among its users, new forms of the drug appear on the market to replace them. Foreign laboratories respond to every ban by chemically modifying the drug’s formula just enough to deem the drug legal in the United States. A large portion of these foreign drugs are considered legal for the purpose of research and have not yet undergone approval for use as medical treatment. According to the Drug Enforcement Administration (DEA), most of the synthetic drugs ending up in the United States originated in China. Usually, these Chinese laboratories will rely on patent records available online, as well as information from scientific journals to create the compounds. At this time, both state and federal regulators are unable to come up with an ideal solution to control these new and dangerous drugs from entering the country. One problem in keeping up with continuing development of new opioid drugs is that there is no uniform clearinghouse for crime laboratories, law enforcement authorities, health care professionals, and medical examiners to share information that they acquire on these new drugs. It has been suggested by the National Governors Association (NGA) that the El Paso Intelligence Center, which is a division of the Department of Homeland Security (DHS) that is responsible for collecting and analyzing information on the identification of drug traffickers, would serve as a first step in initializing this type of clearinghouse. It is clear that state and federal officials must identify a more effective method of pinpointing new versions of opioid drugs as they find their way into the country. As has been done in the past with several types of fentanyl, this would allow the United States federal government to demand that China cease production of the drug. The opioid epidemic in the United States has grown exponentially, while the race to turn the tide against it continues to lag behind.   References  1 Guarino B. Synthetic opioid nicknamed ‘pink’ blamed for deaths of two 13-year-old Utah boys. The Washington Post. Nov 2016. Accessed from: https://www.washingtonpost.com/news/morning-mix/wp/2016/11/04/synthetic-opioid-nicknamed-pink-blamed-for-deaths-of-two-13-year-old-utah-boys/?utm_term=.2842c69823af. 2 Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2014 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2014, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed from: http://wonder.cdc.gov/mcd-icd10.html. 3 Centers for Disease Control and Prevention. CDC Vital Signs. Opioid painkillers prescribing: where you live makes a difference. July 2014. Accessed from: http://www.cdc.gov/vitalsigns/opioid-prescribing/. 4 Paoli L, Greenfield VA & Reuter P. Change is possible: The history of the international drug control regime and implications for future policymaking. Subst Use Misuse. 2012;47(8-9):923-35. 5 Wood D. Drug Diversion. Aust Prescr. 2015;38(5):164-6....

Braeburn Pharmaceuticals and Camurus AB (STO:CAMX) have announced that they received very positive early outcome findings from their pivotal phase III randomized clinical trial of an injectable treatment for opioid dependency. Opioid addiction is a rapidly growing epidemic in America. In 2013, the twelve-month and lifetime prevalence of nonmedical prescription opioid use disorder according to the DSM-V were 0.9% and 2.1%, respectively.1 The death tolls from abuse of these substance has increased at an alarming rate. Drug overdose is now the leading cause of accidental death in the US, with fatality rates from overdose exceeding 55,000 in 2015 alone.2 Opioid addiction accounts for a large portion of this toll, with more than 20,000 overdose deaths being related to prescription pain relievers and nearly 13,000 overdose deaths being related to heroin.3 Buprenorphine is an approved medication for treating adult patients with opioid use disorder and has shown much promise in its effectiveness.4 For the phase III randomized, double-blind, active-controlled, parallel group, multi-center, intervention trial, 428 adult patients with an opioid use disorder agreed to participate and were enrolled. The goals of this late phase study were to assess the safety and efficacy of weekly and monthly subcutaneous injections of buprenorphine (CAM2038) for treating adult outpatients with opioid use disorder. Analysis of the primary outcome data, though it has not yet been published, revealed that CAM2038 achieved statistical non-inferiority when compared to the daily sublingual buprenorphine/naloxone. Moreover, there were very few serious adverse events reported during the study and the two treatment groups demonstrated comparable safety profiles. A full analysis of the outcome data is expected to be released in April 2017. Given these significant findings, it is likely that CAM2038 injectable buprenorphine products will provide effective new solutions for both patients and physicians. This is particularly important in populations of patients with substance use disorders, given the well know difficulty with treatment compliance and their constantly evolving needs as they progress through the stages of recovery. In terms of buprenorphine, specifically, the current standard of care involves daily administration of sublingual buprenorphine. Findings from this study demonstrated that once-weekly and once-monthly CAM2038 injectable buprenorphine products are superior for treating adults with opioid use disorder and, together with another recently approved Probuphine 6-month buprenorphine implant, have the power to transform the current treatment for opioid addictions. Moreover, the FDA has been noted as granting an expedited designation to the CAM2038 subcutaneous injection application for release on the market.   References 1 Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, Jung J et al. Nonmedical prescription opioid use disorder in the United States. J Clin Psychiatry. 2016;77(6):772-780. 2 Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2015 on CDC WONDER Online Database. Accessed at http://wonder.cdc.gov/ucd-icd10.html. 3 National Institute on Drug Abuse. Drug Facts: Heroin. 2014; Bethesda, MD: National Institute on Drug Abuse. Accessed at http://www.drugabuse.gov/publications/drugfacts/heroin. 4 Stein BD, Sorbero M, Dick AW et al. Physician capacity to treat opioid use disorder with buprenorphine-assisted treatment. JAMA. 2016;316(11):1211-1212....

Opioid Abuse: Now A True Public Health Concern Within The US Pediatric Population   The use of opioids dates back to more than 2,300 years ago. Within the last twenty years, however, there have been significant increases in the number of prescriptions written for the drug.1 While there are many appropriate medical uses for opioid drugs, the increase in medical usage has been followed by an increase in cases of opioid abuse, addiction, and fatalities related to opioid toxicity.1,2   Adults are not the only ones affected by the recent opioid crisis. In fact, addiction researchers are now suggesting that the number of children and adolescents who are hospitalized due to an opioid overdose has more than doubled over the last 16 years.   In a study, recently published in JAMA, scientists conducted a retrospective analysis of hospital discharge records between the years of 1997 and 2012 from patients 1 to 19 years of age, who had been hospitalized due to a suspected opioid poisoning.3 For adolescents between the ages of 15 and 19, poisonings that were likely due to heroin were also identified.   Findings from this retrospective study revealed that, in 2012, 3.71 out of every 100,000 children aged 19 years and younger had been hospitalized for a primary opioid overdose. This was compared to the hospitalization rates in 1997, which revealed that 1.4 of every 100,000 children age 19 years and younger had been hospitalized for a primary opioid poisoning.3   The findings from adolescents between the ages of 15 and 19 years were even more staggering. In this sample, hospitalization rates were 10.17 per 100,000 in 2012, compared to 3.69 per 100,000 in 1997. Nonetheless, the greatest spike in hospitalization rates due to opioid toxicity were found among children below the age of four. In this group, the rate of hospitalization was 2.62 per 100,000 in 2012, which was up from 0.86 per 100,000 in 1997.3   BETTER PREVENTION PROGRAMS FOR CHILDREN AND ADOLESCENTS IS KEY   The reasons behind pediatric abuse and misuse of opioid drugs is multifactorial.4 Among very young children, it is more likely that the child accidentally swallows their parent’s medication; however, among older children and adolescents, researchers suggest that opioid overdoses are more likely due to an underlying drug abuse problem or a suicide attempt. While this study has many limitations, it highlights a major epidemic in the US that needs to be addressed. In fact, according to the Centers for Disease Control and Prevention, in 2014, more individuals died from drug overdoses than in any other year on record. Moreover, of these deaths, more than 6 in every 10 were found to be related to an opioid.5   Many suggest that opioid abuse will continue to be a persistent problem for our nation’s youth and it is believed that more prevention programs may be the best shot at helping our at-risk teens.     References 1 Gugelmann HM, Nelson LS. The prescription opioid epidemic: Repercussions on pediatric emergency medicine. Clin Pediatr Emerg Med. 2012;13(4):260-268. 2 Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical overdose deaths, United States, 2010. JAMA. 2013;309(7):657-659. 3 Gaither JR, Leventhal JM, Ryan SA. National Trends in Hospitalizations for Opioid Poisonings Among Children and Adolescents, 1997 to 2012. JAMA. 2016;Epub ahead of print. 4 Compton WM, Volkow ND. Major increases in opioid analgesic abuse in the United States: Concerns and strategies. Drug Alcohol Depend. 2006;81(2):103-107. 5 Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in Drug and Opioid Overdose Deaths – United States, 2000-2014. MMWR. 2016;64(50):1378-82....

For individuals recovering from drug or alcohol addiction, moment by moment tracking of their progress can be an essential component in their efforts towards sobriety. This population is one that the startup, pala·linq, is targeting to help with their new app, WeConnect. WeConnect offers a support platform, in app form, that features several functions that serve to support recovery from drug or alcohol addiction, including:   Regular notifications that are context-specific in order to promote open communication within support groups Personalized dashboard view that provides support for structuring daily activities that are the most beneficial for the recovering addict’s wellbeing, including regular reminders to engage in prayer or meditation Ongoing progress reports on attendance at recovery meetings, utilizing geofencing to discourage dishonest reporting   The app also features an “SOS” button that the addict may utilize during periods of feeling particularly down, low, hopeless/helpless, or just simply in need of urgent support. This “SOS” button instantly sends a message to pre-selected contacts requesting for them to reach out to the recovering addict for support.   The startup’s co-founder, Daniela Tudor, described that the purpose of developing WeConnect was to lessen the feeling of isolation that recovering addicts commonly struggle with, which is believed to be linked to high rates of relapse. Tudor actually developed the idea herself while in rehab for addiction. Following completion of her rehabilitation program, Tudor realized that she wanted a way to stay in contact with those who had supported her through the recovery program -- these were the people who she felt would be the ones to really help her stay on track once she left the program.   Rewards are also an important element of WeConnect. These rewards allow recovering addicts to earn things like coupons for coffee or free yoga sessions. Tudor emphasizes that they only offer rewards that will help the individual’s progress toward sobriety.   An important feature of WeConnect’s platform is its privacy. Unlike other, more socially-based, recovery- or wellness-support applications available, there is no way for users to search for other users. The only way to add a contact within the application itself is if the user has the person’s email and phone number. Even then, the WeConnect user must confirm that they would like them as part of their network. Tudor emphasizes that the app is compliant with all HIPAA regulations.   WeConnect also offers benefits to providers who are working with recovering addicts. The applications platform offers a feature that provides data on the recovering addict’s progress to individuals who are involved in their care during recovery.   At this time, WeConnect is in beta testing and many have begun using the app across inpatient rehabilitation and treatment centers in Arizona, California, and Washington. These teams are working together to collect data on the application and whether it can have beneficial impacts on relapse rates of those recovering from addiction. After that, the startup hopes to present their application to insurance companies....

The Obama Administration announced policy changes on July 6th, 2016 that will permit certain physicians to treat up to 275 patients suffering from opioid addiction with buprenorphine (Suboxone) [1,2]. This change is expected to be in place later this year. Under the current system, physicians that prescribe buprenorphine are only able to treat 100 patients in their practice [1].   Opioid addiction to drugs such as prescription painkillers, morphine, and heroin has become a global health issue that affects individuals regardless of health, social, or economic status [3]. Estimates have revealed that between 26.4 million and 36 million people around the world abuse opioids [3]. Estimates reveal that approximately 2.1 million people in the U.S. suffer from substance use disorders attributed to prescription opioid painkillers and another 467,000 individuals are addicted to heroin [3]. The effects of opioid addiction are overwhelming, with the number of unintentional deaths quadrupling since 1999 [3].   New Mexico, in particular, has the highest rate of unintentional drug over-dose deaths in the United States, with rates being almost double the national rate [4]. Many of these deaths occur in rural areas within the State that may not have sufficient treatment facilities, including Rio Arriba, Taos, and San Miguel. One of the main issues in New Mexico is getting more physicians certified in addiction treatment [1].   Treatment with buprenorphine has gained popularity over the past few years compared to its counterpart, Methadone. There is less stigma associated with buprenorphine use as it can be prescribed by a certified physician and the prescription can be filled at a pharmacy in sublingual film, as opposed to Methadone, that is administered in a Methadone clinic [5]. Other benefits of buprenorphine include a longer half-life and shorter titration period compared to Methadone. Buprenorphine helps to reduce cravings and prevent withdrawal symptoms [5].   This policy change is a vital component to help fight the current opioid addiction epidemic in the U.S. [2]. President Obama is requesting that Congress pass the Opioid and Heroin Abuse Crisis Investment Act to the tune of $1.16 billion. This act is set to expand treatment services, prescribing programs, drug monitoring programs and improve residential substance abuse treatment [1].   References   Rule change to let doctors treat more opioid addicts. The Santa Fe New Mexican. 2016. Available at: http://www.santafenewmexican.com/news/health_and_science/rule-change-to-let-doctors-treat-more-opioid-addicts/article_bc1a83c0-d3f3-5989-b7b1-76d4ea406492.html. Accessed August 10, 2016. Proposed patient limit raised to 275. ASAM applauds important action to help close addiction treatment gap. Asamorg. 2016. Available at: http://www.asam.org/magazine/read/article/2016/07/06/asam-applauds-important-action-to-help-close-addiction-treatment-gap.-proposed-patient-limit-raised-to-275. Accessed August 10, 2016. America’s Addiction to Opioids: Heroin and Prescription Drug Abuse. Drugabusegov. 2014. Available at: https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse. Accessed August 10, 2016. Greenfield B, Owens M, Ley D. Opioid use in Albuquerque, New Mexico: a needs assessment of recent changes and treatment availability. Addict Sci Clin Pract. 2014;9(1):10. doi:10.1186/1940-0640-9-10. Platt A. Suboxone: A Harm Reduction Approach. J Alcohol Drug Depend. 2014;02(05). doi:10.4172/2329-6488.1000e118.  ...

Increase in Naloxone For New Mexico Residents   A new law, signed by Gov. Susana Martinez, is allowing New Mexico pharmacists to dispense naloxone, a drug that reverses opioid overdose, without a prescription [1].   According to the State Department of Health, in the first quarter of 2016, pharmacists in New Mexico dispensed almost five times the amount of naloxone (Brand name: Narcan) as they did in the same quarter in 2015 [1]. From January 1, 2016 to March 31, 2016 thirty-five pharmacies submitted 285 claims to Medicaid for naloxone, which was increased from 59 claims during the same quarter in 2015 [1]. It should be noted that these thirty-five pharmacies only account for a small fraction of approximately 300 pharmacies statewide [1]. While the figures for naloxone claims are up, they still underwhelming compared to the 1.75 million opioid drug prescriptions that New Mexico physicians wrote in 2015 [1]   The new law intends to make naloxone available to anyone, including users of prescription opioids and those that may witness an opioid overdose. Dr. Michael Landen, State Epidemiologist, states that the goal is to have all pharmacies stock naloxone [1]. Pharmacies throughout the state are being encouraged to dispense naloxone to all patients with a prescription for opioids [1]. Additionally, the state is encouraging physicians to prescribe naloxone to all patients with an opioid prescription [1]   Deaths due to drug overdose have become a public health crisis in the United States [2] and New Mexico’s drug overdose death rate was the second highest in the country in 2014, with 536 New Mexico resident deaths being due to drug overdose, which was up 19% from the previous year [1]. Legal, prescription opioid medications were responsible for approximately 50% of the deaths, and 154 deaths were due to heroin overdose [1].   Administration of naloxone provides a means of preventing opioid-related deaths [3]. CVS and Walgreens pharmacies throughout New Mexico have recently announced their plan to stock and dispense naloxone. Further, some Albertsons and Smiths Food and Drug stores currently stock naloxone and the state is currently negotiating with Walmart to stock and dispense the drug. Preventing opioid-related deaths should become a primary focus of pharmacists throughout the country [3].     References   Uyttebrouck O. Updated: More NM residents get naloxone. Abqjournalcom. 2016. Available at: http://www.abqjournal.com/787112/pharmacists-giving-more-nm-residents-naloxone.html?utm_source=abqjournal.com&utm_medium=related+posts+-+crime&utm_campaign=related+pos. Accessed July 7, 2016. Wermeling D. Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access. Therapeutic Advances in Drug Safety. 2015;6(1):20-31. doi:10.1177/2042098614564776. Bailey A, Wermeling D. Naloxone for Opioid Overdose Prevention: Pharmacists' Role in Community-Based Practice Settings. Annals of Pharmacotherapy. 2014;48(5):601-606. doi:10.1177/1060028014523730. ...