Will Opioid Litigation Take its Toll on Pharma Companies?

Indrajit Bandyopadhyay

ZacksAugust 30, 2019   The recent verdict by an Ohio district court against J&J JNJ, related to its involvement in the abuse of its opioid-based drugs, has brought the rising litigation-related liabilities of several other large pharma companies into focus. There are thousands of pending lawsuits in several states, which may run into billions of dollars in penalties or settlements and significantly impact the companies’ margins going forward.

The U.S. Opioid Epidemic  

read more>>>https://finance.yahoo.com/news/opioid-litigation-toll-pharma-companies-120012609.html

Advancements in Opiate Withdrawal Treatment

By Anna Woodward  

New trends in drug abuse across the nation have caused law enforcement and the healthcare industry to combine their efforts in combatting the problem. Narcotics, such as oxycontin, hydrocodone, and heroin, have led the nation into a crisis of opioid addiction. Due to their debilitating physical and mental withdrawal symptoms, medical providers over the years have sought out various methods to alleviate the effects. One current model uses the drug Suboxone and is being praised by both doctors and patients due to the relatively high success rates and low risks. To understand the evolution of opiate withdrawal treatment, it's important to know the causes behind the changes.

The Pharmacy to Street Pipeline

In recent years, painkiller prescriptions have been on the rise across the nation. According to one audit, between 1991 and 2013, figures have almost tripled, going from 76 million prescriptions to nearly 207 million. Patients report that the use of heroin is a dangerous but viable replacement because it is cheaper and more accessible. Furthermore, the addition of other, more powerful opioids such as fentanyl and carfentanil have appeared on the streets. Simply put, the rise in prescriptions and the development of other opioids have driven up the amount of abuse.

Comparative Risks of Maintenance

Methadone maintenance therapy was once a standard medical approach to the problem of addiction. This type of therapy gives patients a structured dosing protocol in an outpatient setting. As a form of opiate withdrawal treatment, methadone allows individuals to slowly taper their doses until they are ready to stop taking it. However, some risks do exist. The drug has the potential for abuse and has led to overdose deaths. While methadone is meant as a safer substitute for more harmful narcotics, users report that the withdrawal symptoms are harsher and more prolonged when methadone is not taken correctly.

Advancements in Pharmacology and Awareness

Suboxone, the current leader in opiate withdrawal treatment, is the combination of two chemicals: buprenorphine, a synthetic, and naloxone which acts as a blocker. Due to the unique chemical structure, suboxone does not produce the "high" associated with other opioids. It instead alleviates the withdrawal symptoms by attaching to the necessary pain receptors while allowing other receptors to rejuvenate, therefore working to decrease detox symptoms. Also, suboxone's ceiling effect lessens the risk of overdose and abuse. Naloxone blocks opiate's effects on the body, in turn removing the patient's option of a return to their illicit drug of choice.

The New Hope

Throughout the years, opiate withdrawal treatment has changed to meet the demands of trends in drug abuse. Law enforcement agencies are helping to direct individuals towards treatment while doctors and medical centers are providing psychotherapy, 12-step group participation, and low-risk chemical management. What was once a dark time for the addict can now be full of hope because of these new methods of treatment.

When considering opiate withdrawal treatment, patients can learn more about at http://rhealthmatters.com/.

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Study Identifies Factors Leading to Discontinuation of Treatment for Opioid Addiction

By Barbara Odozi   

Earlier considered as a scourge specific to military veterans, opioid addiction has today spread to each section of the society. Surprisingly, the crisis has largely engulfed teenagers, women or older adults. Addiction to opioids, including heroin, morphine and prescription pain pills, has led to severe physical and mental health problems among Americans, apart from creating a burgeoning and dangerous black market of illegal drugs on the streets.

Results from the 2015 National Survey on Drug Use and Health (NSDUH) revealed that of the 20.5 million people aged 12 years or older who were diagnosed with substance use disorders, 2 million were addicted to prescription pain relievers and nearly 591,000 were hooked on heroin.

Getting rid of opioid addiction is tricky due to the involvement of medication. Additionally, opioid addiction recovery treatment requires long-term engagement in therapy for its success, which many fail to follow. Disengagement from treatment has become a norm in people undergoing recovery from an addiction to opioid drugs.

Until recently, a majority of people addicted to prescription pain relievers were treated with buprenorphine. However, a recent study published in the Journal of Substance Abuse Treatment has pointed out that many patients undergoing the treatment process tend to give up midway owing to various reasons, such as unemployment, belonging to a particular race or an acute hepatitis C infection.

What causes disengagement from opioid addiction treatment

According to the study by the researchers from the Boston University (BU), individuals with opioid use disorder are more likely to disengage from treatment programs if they are black or Hispanic, unemployed, or have hepatitis C. Buprenorphine - Subutex and Suboxone - is the most widely used drug for the treatment of opioid addiction due to its efficacy in reducing the rates of heroin and prescription opioid use. Additionally, it reduces the chances of "risky behaviors" that are associated with development of co-morbidities such as HIV or viral hepatitis infection.

As part of the study, the researchers evaluated more than 1,200 patients treated at office-based addiction treatment (OBAT) program between 2002 and 2014 to identify the patient-specific factors associated with retention in the treatment program for longer than one year. Factors such as age, gender, race/ethnicity, education level, employment, infection with hepatitis C virus, co-morbid psychiatric conditions, and prior or current use of drugs or alcohol were specifically evaluated.

Highlighting some important disparities in treatment outcomes (especially racial/ethnic), the study observed, "Older age, female, and co-morbid psychiatric diagnosis were associated with greater odds of treatment retention beyond one year, patients who were black or Hispanic, unemployed, and had evidence of hepatitis C viral infection were associated with decreased odds of treatment retention beyond one year."

The study plays a key role in understanding the potential of opioid agonist buprenorphine to treat opioid addiction at a time when Americans are fighting a tough battle against prescription drug abuse. The study is expected to open newer avenues of treating opioid addiction, apart from encouraging patients to complete the recovery program.

Treating opioid addiction through effective therapeutic interventions

Like any other addiction, opioid abuse is also a brain disease that needs to be treated immediately. Prescriptions for opioid medications written by doctors has resulted in unprecedented level of opioid addiction in the country. While institutions at the federal level are making efforts to address the issue by sharing guidelines on the nature and extent of prescription to physicians, it is important to identify alternate therapeutic interventions that are more effective.

If you know someone who has a problem with heroin or prescription drug addiction, you can contact Prescription Drug Addiction Help to seek guidance on various prescription drug abuse treatment centers in your vicinity. Call at our 24/7 helpline number 866-623-3847 to learn more about prescription drug treatment centers in the U.S.

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Understanding Drug Use and Addiction

Revised June 2018

Many people don't understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to. Fortunately, researchers know more than ever about how drugs affect the brain and have found treatments that can help people recover from drug addiction and lead productive lives.

What Is drug addiction?

Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug addiction is considered a "relapsing" disease—people in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug.

Learn more>>>https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction

The Role Of The Brain In Addiction

By Bhavya Nagori Sharma 

Technology has its mighty hand over every field in the world now. And since the base of technology is science, so how could medical sector not undergo changes! Neuroscience has always been an area of immense complexities and curiosities. Advances in this sector has allowed doctors to dig deeper into the brain and even study minutest of changes that happen due to substance intake.

When we talk about addiction as a brain disease, the reward system of the brain plays a very important role.

Physiologically, limbic system is the brain's reward system. Mesolimbic and mesocortical pathways (Mid-brain) have our cognitive control and functions which would be both reward related and aversion related. Reward related functions are always stronger and more motivating than aversion, hence drug abuse behavior is stronger in addicts. The reward system connects certain structures in such a way that they generate the feeling of pleasure for certain behaviors or stimulus given to the body. In day-to-day life, it is activated by healthy, life-sustaining activities like eating and socializing. But 'Drug Abuse' is another behavior that generates euphoria, which is enjoyed by the mind. And human nature is to repeat those actions that give us some definite satisfaction. The limbic system does more than just giving a reward response. For any behavior to be reinforced, it has to be first registered as pleasant to the mind and body. Limbic system in the brain recognizes our positive and negative emotions, which very well explains, how our body and mind get dependent on any psychoactive mood altering substance.

However, with recent developments, neurobiology has been able to study how addiction is related to the brain. Researchers and scientists studied the brain's reaction to different substances and discovered that drug abuse actually alters the chemical makeup of the brain, which is what causes addiction and they named it as a 'Brain Disease.'

Since the brain is placed as the epicenter of human activity, it is the initiation point of every phenomenon that occurs. Whatever we feel, experience or think, all is first registered by the brain and within lesser than nanoseconds, it commands us to act. It communicates through neurons, neurotransmitters, receptors and transporters. Yes, it is very complicated and sounds mystical too (specially to people like me who have not studied biology after high school)

How do Drugs Affect the Brain?
Psychoactive substances interrupt with the communication systems of the brain. They interfere with the way a message is transmitted and sent to its defined destination. No matter how much people say that cannabis would not be called a drug, it is a plant, but the reality remains unchanged, which is, that everything has certain chemical composition. For example, Heroin and Marijuana's chemical structure are like copies of a natural neurotransmitter. Amphetamines mimic catecholamine neurotransmitters, causing general physiological changes which prepare the body for physical activity and fight-or-flight response. So, the moment the body is intoxicated with a drug containing amphetamines or its derivatives, it starts reacting in unnatural ways by raising blood pressure, increased alertness resulting in sleeplessness, blood glucose levels. They can easily activate neurons, giving various directions to the body to react in a different way, than would a natural neurotransmitter would! Cocaine can make a person delirious, because it releases natural neurotransmitters in bulk and blocks the natural recycling process of neurotransmitters by the brain. Amphetamine causes drug tolerance very quickly and rapidly too.

Chronic addictive drug use causes alterations in the process by which information from a gene is used to synthesize a gene product- RNA or Protein. Nigrostriatal Pathway is a dopaminergic pathway that plays an extensive and unavoidable role in addiction. It comprises of Transcription Factor, which is a protein that controls what all information has to go from the DNA to the messenger RNA. Psychoactive substances block, many of the neural and behavioral alterations that are to be taken to the RNA. Altered dopamine transmission is the first thing that comes to notice in cases of drug abuse.

These have been many studies extensively done by medical science researchers on addiction. There is a wide range of chemicals that people use to reach a euphoric state. But the gist of it all is, that they play with the normal functioning of brain by altering the natural chemicals that ought to be there.

How Does the Reward System Work?
Whenever a person happens to do something that takes him to a different state of mind for a while, like reaching the oomph point in a sexually pleasurable activity, treating the taste buds with a new and a very different flavor or winning an excessive amount of money or any other valuable resource that he could use to be really rich, the brain takes it all in the same way. It activates the same gland and releases the same chemical Dopamine, which functions as a neurotransmitter, in all scenarios that seem to be pleasurable or exciting. Similarly, whenever the body receives an antibody that becomes too exciting for it like any drug, chemical or alcohol, the body releases certain amount of dopamine or cuts down its level. It is a problematic scenario is there is too much or too little of dopamine released by the brain. Drugs are addictive because they release up-to 10 times more dopamine than a natural neurotransmitter can! But when the body gets tolerant to the same drug and its amount, it can even cut down its normal release of dopamine!

The brain commands the body to engage more and more into activities that gives it pleasure. That is how drug addiction is a problem.

Shafa Home is a residential rehabilitation, de-addiction and detoxification centre, which works using Therapeutic Community and applying its unique treatment modalities in the treatment. It is the largest and the oldest rehabilitation center in India treating addiction, behavioural problems and psychiatric problems. They have multifarious therapeutic sessions that are used through the treatment. You can logon to http://www.shafahome.org to know more.

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Addiction Recovery: Collaborative Care Ensures Effective Outcomes

By Susan Navarez 

The prevailing opioid crisis in the United States has displayed time and again how ruthless addiction can become by putting massive strain on the society. An addiction, a complicated brain condition driven by substance-seeking behavior despite being aware of the harmful consequences, causes several psychological problems that remain unaddressed in primary care settings.

At times, it is quite challenging to determine the best treatment approach for an individual with a mental disorder, to say the least. Such a perplexing problem oftentimes becomes the key reason behind the overstretched rehabilitation process. The inadequacy in tackling mental disorders witnessed alongside addiction in primary care settings may result in poor access to care, discontentment with quality, noncompliance with prescribed medications, etc.

With a growing need to address not only mental disorders but also substance use disorders (SUDs), the interventions based on collaborative care in primary care settings can enhance the scope of holistic recovery from both the disorders. Being a patient-centered approach, the primary elements of collaborative care include population-based care, measurement-based care, evidence-based treatment and accountable care.

Considering the fact that patients with psychiatric disorders significantly benefit from collaborative care, the approach appears promising for the treatment of a co-occurring addiction.

Strengths of collaborative care model

The principal features of collaborative care include regular follow-up, medication-assisted treatment (MAT), psychosocial interventions, adherence to medicine regimen, case management, etc. Therefore, individuals with SUDs significantly benefit from systematic approach of the collaborative care model.

For instance, when a mental health specialist works in conjunction with the primary care provider, it significantly increases the resources to treat the patient by providing adequate counseling and education. In addition, the frequent interaction between the patients' case manager and the primary care provider keeps both parties updated on the patients' progress in terms of treatment. This assists in alerting them about any kind of gaps, relapses, insignificant improvement in symptoms or if remission is yet to be achieved. As a result, the focus during the entire treatment remains on the patient.

Despite being somewhat rudimentary compared to the sophisticated rehabilitation process, the tools of measurement-based care, such as urine drug screening tests, play a key role in increasing focus on each patient. Moreover, the measurement-based interventions are invaluable because:

• They approach every case uniquely, focusing the treatment at an individual level.
• They assist in identifying individuals at risk of developing a relapse.
• They offer a way to measure treatment success across different clinical settings.

To boost the scope of recovery and strengthen adherence to treatment under the collaborative care model, every patient undergoes a biopsychosocial assessment that provides crucial insight into which relapse-prevention strategies are likely to prevail.

Some of the other measures, such as setting up treatment dates, promoting participation in the 12-step groups and determining the symptoms of mental disorders, make it possible to provide the much-needed care that supports the primary care provider's prescription and aims at preventing a relapse.

The collaborative care model has redefined treatment approaches to psychiatric disorders and substance abuse. It has also demonstrated success in overcoming the stigma and myths surrounding mental disorders and addiction that otherwise demotivate patients and result in poor adherence of treatment. In addition, the collaborative care model ensures the overall holistic rehabilitation of patients.

Seek professional help

Despite numerous clinical trials and extensive research on the advantages of integrated care in primary settings, it has not been incorporated across the primary care settings. It has displayed significant success in treating both mental disorders and SUDs under one roof with the least cost burden on patients. To lead an addiction-free life, it is essential to undergo an effective treatment based on the collaborative care model. It assists in overcoming not just the problem of addiction but also co-occurring disorders and diminishes the scope of a relapse.

If you or your loved one is battling an addiction to any substance, it is advisable to seek help. Sovereign Addiction Services is a trusted organization for services related to mental health, addiction and dual diagnosis. Our state-of-the-art addiction treatment centers in California and other states specialize in delivering evidence-based intervention plans that increase the scope of holistic recovery. Call at our 24/7 helpline number 855-683-9756 to know more about our substance abuse treatment centers.

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Should Opioid Medicine Be Available In Public Places in Maine? [POLL]

Celeste

April 14, 2019

According to WGME, Maine Governor, Janet Mills is proposing a plan that would make the opioid reversal drug, Naloxone, available in public locations.

Just like fire boxes and defibrillators, "Naloxboxes" might become the next life saver to be found in public places for general access. There were about 300 deaths in Maine during the first nine months of 2018 as the nation battles the opioid epidemic.

Read more here>>>https://wblm.com/should-opioid-medicine-be-available-in-public-places-in-maine-poll/?trackback=fbshare_mobile&fbclid=IwAR3A9I8w19pJPUFTtV3vrmEOSz_Pz-rW5enwS2e19JyPoN_1tA0-77W58hE

Role of Family in Addiction Recovery

By Bhavya Nagori Sharma  |   Submitted On March 06, 2018

We all are aware of the life and living cycle of a human being. Between birth and death, there is a lot that happens which shapes our identity. There are certain traits which are inbuilt or inherited and then there are some characters that we build as we go through certain states and situations, which add-on to our identity at various points of time. Now my question here is- What do you identify your first identity as?

Birth; your name given by your family; schooling on the basis of parents' name; college on the basis of your parents' name and your marks; your resume requires' your family details; your bio-data for marriage needs your family details. So everywhere, the family stands first, which makes it your first identity.

The reason I am quoting this point is that family has its role everywhere. Even in addiction, it has its unequivocal involvement. Addiction is known as a Family Disease. It cannot be denied that family has its significant role to play in enabling addiction and ending it as well.

Once an addict has been treated and has started his journey of recovery, your role as family does not just end there. Rather it is just the beginning and you have to make sure that your loved one takes it to a long way. Without your knowledge and support, it is not going to be possible. There are certain definite steps that you as a family need to take, so that your whole family can enjoy a sober and happy recovery life.

Be Alert and On the Watch

Do not commit the same mistakes again. Having your emotions attached with someone might not be something that you can control, but a sure measure that can be taken is to keep them under your control.

You should not get over-emotional whenever your recovering addict is trying to get you in his trap. You must keep in mind, all the things he did previously. If there is an excess of any behavior, which you think, was previously used, to go for using substance, you must immediately get aware of it and take a tough step. You will have to let go your gullible nature and be more sagacious.

Be alert about his routine and daily activities. Trust him in what he is doing, but not so blindly that he would take you for a ride. Know that he is not supposed to take you for granted. Have all your questions answered about any kind of deviations that you see or hear of in a clear manner.

Always discuss whatever move he wants to make and then considering its practicality and profitability, you can decide to finance or support it. But do not get too much defensive and doubtful about his capability. That is a tough job, right?

Do Not Leave Him Free

'Empty mind is devil's workshop'. You must have been hearing this since your childhood. So when you leave him without any work or engagement in the family, he would drag himself to drugs/alcohol and maybe utilize his pent-up energy in using it in newer ways. Understand the line of his privacy and his alibis to use drugs in private, hiding from you. Show your full involvement in his talks and tasks. Make sure that he does not take anything casually. If he loses his sincerity and starts frittering away time, he would lose his awareness, which might turn out to be a reason for relapse. In treatment, they are taught many unwritten philosophies, such as No Free Meals and Being Aware Is Being Alive. They must practice them and for practicing them you need to be their role models too. Also, make sure that his circadian rhythm does not change, i.e. his sleep cycle and even eating habits remain healthy.

Be Emotionally Available

Always be emotionally available to him. There are times when we all feel low. Apparently, those who become addicts, their coping mechanism is automated towards drugs and alcohol or self harm only. So, whenever you see that your loved one is getting sad and negative about life, or has chosen the silent corner for himself for a persistent time period, you need to intervene. Cook for him and ask him to help, play good music, go out for a nice lunch or dinner, refresh some childhood memories. There are many things to do together. Treatment does not get over with the addict getting out of the rehabilitation center. Don't take him lightly ever. He needs the feeling of love and belonging, more than anybody else needs. And at the same time, don't commit this mistake of asking him to consume a little bit of alcohol or smoke once a while at social gatherings, thinking that might uplift his mood and you are keeping an eye on him, so he won't go out of control. An addict can never settle at peanuts. He would get back to the same intensity again.

Don't be Scared

Do not ignore his anger and over that, do not be scared of it. Don't be scared of the self harm threats he would be driveling before you. If he is losing his calm over petty matters and snapping at everything you say, beware then. For it indicates that he is again going to use his substance. If you become submissive, which is what he wants, you will lose this battle with addiction. You have to practice Tough Love. Forget about what he used to do earlier when his wishes were not fulfilled. You do not have to be his Jinn again. He knows when to rub the lamp, but you need to decide whether your emotions have to come out or not, even if he is trying to be forceful. The moment you give-in and hand over your emotional control to him, he would relapse. No anger, no threats of self harm, no abuses shall work on you. You need to be stronger than him. Not all the time do you have to be pleasant with him and specially for his irrational demands and behaviors. Don't let him overpower you. Identify when is he trying to do that. He cannot raise his unnecessary demands, financial/fake emotional/unimportant medical needs over your necessities and routine. He would be testing your patience most of the times. He would be trying to see if he still has control over you, so don't give-in his tactics. Let him know that no drama would work in your house and on you.

Addictive behavior can be spotted in any phase of life. Those behaviors would be leading to relapse. For example, excessive shopping, which you might take as being normal to pamper self once a while; but if you see a large amount of money being wasted on shopping, you need to beware again. Spending too much of time on phone, internet, movies, and preferring to be isolated for long hours. Even eating too much is a sign of approaching relapse. These are just actions that a recovering addict takes as substitutes of his substance and to find his temporary solace. You can always call the rehab for help and continue going to Family Association Meetings. But being a family member of a recovering addict, Never Give Up.

Shafa Home is India's first and largest rehabilitation center, treating addiction, behavioral problems, psychiatric patients with their Unique Treatment Modalities in Therapeutic Community setting. They were the first ones to establish the concept of Therapeutic Community in India. They are one of the board members of the Asian Federation of Therapeutic Communities. They hold Family Association Meeting every second and fourth Saturdays to psycho-educate and keep the family members aware regarding various topics such as Myths regarding Addiction, How to Keep Recovery An Ongoing Deal and a lot more. You can visit their website http://www.shafahome.org for more information or call 01165866515

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Drug use remains prevalent inside Maine State Prison

By Stephen Betts, BDN Staff • November 30, 2012 5:01 pm...

WARREN, Maine — Drug use remains common within the Maine State Prison although the state said it has taken steps to stem the flow of illegal substances and diverted prescriptions into the maximum security facility.

Thirty-eight inmates were charged with drug crimes last year and thus far in 2012, another 26 prisoners have been indicted for trafficking in prison contraband, namely drugs, at the Maine State Prison. In the October grand jury session alone, 12 inmates were charged with drug offenses within prison walls.

read more here>>>https://bangordailynews.com/2012/11/30/news/midcoast/drug-use-remains-prevalent-inside-maine-state-prison/

Drug Use by State: 2018’s Problem Areas

May 14, 2018  |  John S Kiernan, Senior Writer & Editor

Drug abuse has a long and storied history in the United States, and we’ve been “at war” with it since 1971 under the Nixon administration. But no matter who is in office, the federal drug budget continues to increase. It’s moved from $23.8 billion in 2013 to almost $27.5 billion in 2017.

The current administration seems to be taking a hardline approach to drug use. President Donald Trump and Attorney General Jeff Sessions have advocated for strict sentences for drug-related offenses, even as far as the death penalty in some cases.

Given the uncertain future and lack of significant progress to date, it’s fair to wonder where drug abuse is most pronounced and which areas are most at risk in the current political climate. This report attempts to answer those questions by comparing the 50 states and the District of Columbia across 20 key metrics, ranging from arrest and overdose rates to opioid prescriptions and meth-lab incidents per capita. Continue reading for the complete findings, commentary from a panel of researchers and a full description of the methodology used.

read more here>>>https://wallethub.com/edu/drug-use-by-state/35150/

Substance Abuse

If you or someone you know is struggling with alcohol and/or drug use, call 211 to get help today. We offer information and referrals to a number of substance use prevention programs from outpatient treatment facilities to hospitalization options. We can refer you to local support groups, relapse prevention services, continuing care programs, and supportive services such as child care, transportation, and parenting skills development. 211 can also provide referrals to services that address problem gambling for yourself or someone you know.

For those dealing with opiate addiction, 211 Maine in partnership with the Maine Department of Health and Human Services, provides a toll-free statewide information and referral Opiate Helpline where you can speak with a specialist to identify treatment options and other resources in your area.

read more here>>>https://211maine.org/substance/