Dangerous New Synthetic Opioid Found in Counterfeit Painkillers

A new, dangerous designer drug has reached the United States—in the middle of a deadly viral pandemic. Isotonitazene is a synthetic opioid so novel that it has not even been banned by the authorities yet.

Barry Logan is a leading authority on forensic toxicology and chief scientist at forensic firm NMS labs. He told Vice in March that his colleagues have identified isotonitazene in samples from more than 200 deceased drug users in the midwest and northeast since August last year. “Isotonitazene is the most persistent and prevalent new opioid in the US,” said Logan.

According to USA Today, isotonitazene has been detected in the blood of people who died of overdoses in Illinois and Indiana, where it was mixed with cocaine. It was also reportedly found in Canada last year.

The new drug—deemed as potent as fentanyl—comes in a white or off-white powder form or is pressed into counterfeit opioid pills. Designer drugs always tend to be one step ahead of the law and this new synthetic is no exception. It is currently not on the US Drug Enforcement Agency’s controlled substances list simply because there hasn’t been enough time to classify it.

Bryce Pardo, an associate policy researcher at the Rand Corporation, told Vice that drug laws simply cannot cope with the seemingly endless drugs being produced by underground chemists in China. “Our drug control laws are old, and the ease of chemical innovation, cheap shipping, and the ubiquity of the internet have all stretched the applicability of these laws.”

Isotonitazene seems to have arrived in the United States following an aggressive global crackdown on illicitly made fentanyl. It represents a typical pattern in the seemingly endless “War on Drugs”: When governments focus their supply interdiction efforts on one substance, the market will start delivering alternatives.

The resurgence of methamphetamine in recent years is a good example of that pattern. While opioid misuse may have peaked nationwide, people with addiction have been switching to other substances. “Nationally, since late last year, meth has turned up in more deaths than opioid painkillers like oxycodone and hydrocodone. In 14 of the 35 states that report overdose deaths to the federal government on a monthly basis, meth is also involved in more deaths than fentanyl, by far the most potent opioid,” The New York Times reported last year. “Provisional data from the CDC shows there were about 13,000 deaths involving meth nationwide in 2018, more than twice as many as in 2015.” Now, we’re witnessing the emergence of a new synthetic opioid as well.

A focus on disrupting the supply of addictive drugs has never worked because it doesn’t address the reason for the demand. The actual misuse of drugs and alcohol is only one aspect of a substance use disorder and not necessarily the most important one. That is why Prohibition, the “War on Drugs,” and the “Just Say No” campaign all failed to achieve their objective.

Addictions are frequently driven by underlying mental health issues such as anxiety, depression, and trauma. If these issues are not addressed within a comprehensive treatment approach, sustained recovery is unlikely to happen.

Addiction cannot be reduced to substance use, it is not simply chemically caused by the presence of drugs and alcohol in the human body. Addiction is a complex biopsychosocial and spiritual disorder with many interlocking conditions and mechanisms. “By itself, nothing is addictive,” wrote Maia Szalavitz provocatively in her influential 2016 book Unbroken Brain. “Drugs can only be addictive in the context of set, setting, dose, dosing pattern, and numerous other personal, biological, and cultural variables. Addiction isn’t just taking drugs. It is a pattern of learned behavior.”

Addiction affects the body, mind, and spirit. It is a disease requiring comprehensive treatment in an integrated care environment. Recovery from addiction is also a personal quest for meaning and connection with other people, our human nature, and the entire universe.

Harmony Fights Opioid Epidemic with HOPE

More than two-thirds of drug overdose deaths in the United States in 2017 involved opioids, according to the Centers for Disease Control and Prevention, escalating an epidemic the CDC says “continues to worsen and evolve.” From 2016 to 2017, opioid-related overdose deaths increased 12 percent overall, surging among all age groups 15 and older.

The CDC report’s recommendations for curbing opioid-related overdose deaths include “increasing naloxone availability, expanding access to medication-assisted treatment, enhancing public health and public safety partnerships, and maximizing the ability of health systems to link persons to treatment and harm-reduction services.”

Naloxone is a medication often used by first responders because it can rapidly reverse opioid overdose. It is an opioid antagonist—it binds to opioid receptors and can reverse and block the effects of other opioids. It can quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain relievers.

Medication-assisted treatment (MAT) is used to decrease opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission. Medications used for the treatment of opioid use disorder are buprenorphine (Suboxone, Subutex), methadone, and extended release naltrexone (Vivitrol). Some of these drugs are controversial in the recovery community because they are themselves opioids.

The National Institute on Drug Abuse, a US government research institute, clarifies that contrary to what some critics say, “methadone and buprenorphine DO NOT substitute one addiction for another. When someone is treated for an opioid addiction, the dosage of medication used does not get them high–it helps reduce opioid cravings and withdrawal. These medications restore balance to the brain circuits affected by addiction, allowing the patient’s brain to heal while working toward recovery.”

The use of these medications should always be combined with behavioral counseling with the ultimate aim of ceasing all substance misuse.

HOPE – Harmony’s Opioid Programming Experience

Harmony has provided all clients with medication-assisted treatment for many years. This combination of education, counseling, and the use of medication in early recovery is part of the Harmony philosophy. HOPE expands MAT to include medications that alter the physical response to opioids, reduce cravings, and give the patient time to heal from the psychological, social, and spiritual wounds of addiction.

“It’s important to remember that MAT is only a small part of the picture,” says Harmony’s medical director Christopher Reveley. “That is why we call it ‘medication-assisted’ treatment, because by itself it is not the treatment. Used alone it has a low probability of being successful.”

At Harmony, HOPE begins with thorough medical and psychological evaluations. Collaboration with the patient, members of the interdisciplinary team and, when appropriate, family and referral sources, determine the most effective treatment plan. All HOPE clients are invited to participate in weekly support groups led by a professional addiction counselor. These groups address the unique challenges of early opioid recovery, including uncomfortable physical and psychological symptoms, cravings, and strategies to avoid relapse. In this setting, clients support each other and are educated about the process of recovery.

Medication-assisted therapy may help stabilize the patient for these challenges in early recovery. “It gives people an opportunity to step out of the chaos of addiction and consider other ways of being,” says Dr. Reveley. “I never felt that buprenorphine was meant as a lifelong or even long-term solution.” Although there may be exceptions. It all depends on the individual needs of the patient. Reveley remembers a patient who had been on methadone for 46 years. “He tried to taper off a dozen times and relapsed to heroin use every single time. His family was initially very opposed to him being on methadone but eventually they told him ‘this is working, your life depends on it.’ So there are people on either end of the bell curve but in most cases buprenorphine is only a small but important part of the solution.”

Buprenorphine can be an important tool, especially in early recovery from opioid use disorder. The medication offers patients the opportunity to start living a “normal” life, far removed from the drug culture lifestyle they may have been immersed in while using heroin and other opioids. People are dying every day from opioid overdoses, especially in the age of the fentanyl scourge. Buprenorphine may provide the buffer that enables them to launch into sustained recovery. It is a buffer that can save people with addiction from a potentially lethal overdose.

Harmony has been treating addiction for 49 years and HOPE is now offered to all Harmony clients with opioid use disorders. The program involves enhanced medical, counseling, and case management services specifically tailored to meet these clients’ unique needs.

The Harmony care team works closely with clients who choose to include buprenorphine in their treatment strategy. This will typically involve full participation in HOPE and a recommendation for participation in Harmony’s Transitional Care Program (TCP), an intensive, 90 day intensive outpatient program coupled with monitored sober living and medication management by Harmony providers. When clinically indicated or to accommodate client preference, Harmony’s case managers may refer clients to other programs with similar services.

If you or someone you know is struggling with opioid use disorder and needs help, call Harmony at 970-432-8075 and one of our admissions specialists can discuss next steps.

A Vaccine for Heroin?

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The American prescription opioid epidemic has affected millions of Americans and their loved ones. Efforts to curb painkiller abuse had the unintended effect of leading to a scourge of heroin use – as the drug is often times cheaper, stronger and easier to acquire in the wake of prescription opioid crackdowns. Heroin abuse has become a major public health concern in both urban and rural America, due to the rise in both addiction and overdose death rates. While there is help available in the forms of treatment and 12-Step recovery, relapse rates are particularly high among opioid addicts.

Scientists continue to develop new methods intended to give addicts the best shot at successful recovery, and believe it or not, in the near future there may be a vaccine available that will prevent people from getting high if they use. Research was published last month that dealt with developing a vaccine that would prevent people from getting high if they use the powerful opioid narcotic fentanyl – an analgesic that is 80 to 100 times more potent than morphine, and 50 times stronger than heroin.

What’s more, clandestine laboratories are manufacturing fentanyl which is then being mixed with heroin to make it more potent. Heroin users are often unaware of the presence of fentanyl, an ignorance that can prove fatal. Admixtures of heroin fentanyl can severely depress respiratory function, which can result in death.

Working with mice, researchers were able to inject the animals with booster shots that would train their immune systems to attack the fentanyl molecules in the bloodstream before the drug crossed the blood-brain barrier resulting in euphoria or potential overdose, The Daily Beast reports. Additionally, when the researchers injected the mice with lethal doses of fentanyl, the mice survived.

“The idea that [the researchers] can make an effective vaccine is very cool. It’s a good accomplishment,” says Phil Skolnick, director of the Division of Pharmacotherapies and Medical Consequences of Drug Abuse at the National Institute on Drug Abuse (NIDA), who was not involved in the study. “You have to trick the body, and it requires a fair amount of trickery.”

If the human clinical trials are successful, it could eventually lead to the development of a heroin vaccine. The vaccines would be specific to particular drug molecules. If people in recovery from heroin addiction are vaccinated, it could significantly deter relapse because the user would know that they will not experience the desired euphoric affect.

Until such time, the best opportunity of successful recovery rests on effective, evidence-based addiction treatment programs. If you are battling with prescription opioid and/or heroin addiction, please contact Harmony Foundation to begin the journey of recovery.

Senate Votes On Comprehensive Addiction and Recovery Act

CARA

With presidential candidates crisscrossing the country discussing how to handle the prescription opioid and heroin epidemic, lawmakers in D.C. are also hard at work to combat the problem as well. It is no secret that democrats and republicans often disagree about major issues; one thing lawmakers from both sides of the aisle can agree on is that something needs to be done – sooner rather than later.

This week, the Senate voted in favor (86-3) of the Comprehensive Addiction and Recovery Act (CARA), a bill which would give federal grants to states and local governments to help fund the fight against our nation’s crippling health crisis, USA Today reports. If a final vote on the bill’s passage is in favor, it will give the Attorneys General the power to fund improvements in:

  • Prescription Drug Monitoring Programs
  • Addiction Treatment
  • Prevention
  • Education

CARA was sponsored by Sheldon Whitehouse of Rhode Island, a Democrat, and Rob Portman of Ohio, a Republican, according to the article. A bill which would put at least $80 million towards treatment, prevention and recovery. While the bill’s support is definitely a step in the right direction, the bill would not actually fully fund $725 million needed to accomplish everything that its sponsors intended. Unfortunately, an effort to add $600 million in emergency funding to the bill was blocked last week.

One of the states affected the most by the opioid crisis is New Hampshire. While a small state, they are losing lives every day to overdoses. The effort to garner the additional funding was led by Senator Jeanne Shaheen, D-N.H.

“There is simply no excuse for Congress providing emergency funding for the Ebola and swine flu epidemics, while ignoring an opioid crisis that’s killing a person a day in the Granite State,” said Shaheen.

If you are struggling with opioid addiction, please contact Harmony Foundation. We can help you build the foundation for sustained addiction recovery.

New FDA Commissioner Supports Abuse-Deterrent Opioids

abuse-deterrent-opioids

It does not matter how someone uses prescription opioids, they can be dangerous and potentially lead to a deadly overdose. However, it could easily be argued that the greatest risk is associated with intravenous (IV) use; opioid addicts will crush their pills, mix the powder with water and inject. In order to combat the use of opioid narcotics in unintended ways, pressure was put on pharmaceutical companies to develop formulations of their painkillers that are harder to abuse – known as abuse-deterrent opioids.

Critics of such efforts argue that harder-to-abuse painkillers are merely a band-aid, and have little effect on the opioid epidemic. While the new formulations are more difficult to use, addicts often find their way around tamper resistors and/or turn heroin as a cheaper, stronger alternative. Nevertheless, such arguments can easily be countered with ‘anything is better than nothing.’

The U.S. Food and Drug Administration (FDA) has a new commissioner who has vowed to support abuse-deterrent opioid efforts, the Associated Press reports. Dr. Robert Califf told a panel of FDA advisers that he is pledging to do “everything possible under our authority to prevent abuse, save lives and treat dependence.”

The new commissioner’s declaration is just one facet of an interagency effort to end the American opioid epidemic. However, Califf made clear that the FDA alone cannot resolve the current crisis, according to the article. Since 2010, Califf’s agency has approved five abuse-deterrent opioids, and there is reportedly another 20 such drugs in development. FDA Commissioner Califf plans to work with outside advisers and he has a comprehensive plan for addressing the prescription opioid scourge, which claims as many as 44 lives per day.

He stated that the agency will add more cautionary warning labels to the opioid narcotics prescribed the most, the article reports. What’s more, the FDA will encourage the safe disposal of unused medications, which will prevent narcotics from ending up in the wrong hands.

“What we can do is work with prescribers, professional associations, patient advocates and state and local partners — essentially the entire country — to encourage safe use and disposal of opioid medications,” said Califf. 

If you or a loved one struggles with prescription opioid and/or heroin addiction, please contact Harmony Foundation. We have been helping people break the cycle of addiction for decades, teaching people about the resources needed for a living a life on the road of recovery.

Poll: Heroin Addiction Is A Serious Problem

One of the major concerns being voiced by voters is the prescription opioid epidemic, and the scourge that followed in its wake now being referred to as having reached epidemic proportions. With each day that passes with the nation continuing to struggle with how to curb the opioid crisis in America, more people are being affected – even if they themselves are not the ones addicted to opioid narcotics. In fact, a new poll shows that more than one-third of respondents know someone who has struggled with prescription opioid or heroin addiction, The Huffington Post reports. The findings come from an online poll conducted between January 20-22, and involved 1,000 completed interviews.

The new HuffPost/YouGov poll showed that nearly half of respondents (49 percent) view heroin use as a serious national problem, and 87 percent say that the heroin problem is at least a somewhat serious problem. Interestingly, when respondents were asked who should be held responsible for the heroin problem in America, almost the majority said an equal share of fault falls on:

  • Drug Users
  • Drug Dealers
  • Government
  • Law Enforcement

Who is to be held to account for the problem is somewhat irrelevant, what is important is how we, as a nation, plan to address the crisis. Greater access to addiction treatment services needs to be made available; many addicts who are in need of help often need to wait long periods of time to receive the help they so desperately require. What’s more, making clean needles and the life saving drug naloxone more readily available will not only stop the spread of infectious disease – it will save thousands of lives.

Fortunately, the President will ask congress for $1.1 billion dollars next week to fund addiction treatment services across the country, USA Today reports. Funding such programs is a clear sign that America no longer agrees with the idea that addiction can be swept under the rug through arrests, and subsequent jailing. Treatment is our best fight against addiction.

If you or a loved a one is suffering from opioid addiction, please contact Harmony Foundation. Harmony is one of the longest running, most successful, treatment programs in the world, our experienced addiction treatment team can help you begin the journey of recovery.

Motivational Interviewing Combats Opioid Abuse

motivational-interviewing

It is safe to say that prescription opioid addiction, like any substance with the potential for addiction, does not discriminate. The nation has seen opioids take the lives of thousands of people for over a decade, yet patients continue to be prescribed the drugs at unprecedented levels. Part of the problem is that pain needs to be managed, and the drugs that work best happen to be highly addictive. If misused, opioids like oxycodone or hydrocodone can be life threatening.

Unlike the typical stereotypes that often accompany heroin addiction, prescription opioid addicts are often: professionals, mothers, students, productive members of society. Addiction typically stems from an injury that required the use of painkillers. While most people can use a prescription opioid until the pain goes away, there is a large number people who become dependent on such drugs and what was once a method of pain management can quickly become an addiction.

Faced with a prescription opioid addiction epidemic, federal agencies and lawmakers have made it more difficult for prescription opioids to be acquired and abused. In turn, people dependent on the drugs have been forced to look to the street, many of which opt for heroin as a cheaper and stronger opioid.

The American Society of Addiction Medicine (ASAM) reports that prescription opioids:

  • Are abused by 1.9 million Americans.
  • Cause nearly two deaths every hour from overdose or respiratory depression.
  • Almost 75 percent of opioid addiction patients switch to heroin.

The nation’s opioid epidemic happens to coincide with the “Baby Boomers” meeting old age or on the cusp. Naturally, the generation is requiring more frequent medical attention, many of which require pain management. It is believed that more than half of patients being treated for chronic pain misuse their medication at some time, ScienceDaily reports. Fortunately, new research suggests that motivational interviewing (MI), a form of behavioral counseling developed to treat alcohol abuse, may be effective in fighting prescription opioid abuse among aging adults.

“Older adults are at high risk for complications resulting from prescription opioid misuse,” says Chang, PhD, RN, associate professor and interim associate dean for research and scholarship in the University of Buffalo School of Nursing. “As the baby boomer generation ages and more patients are prescribed opioids, abuse is likely to become an even greater problem.”

MI promotes a patient’s desire to change behaviors that may be problematic by:

  • Expressing empathy for what they are going through.
  • Using non-confrontational dialogue
  • Creating a divergence between actual and desired behavior.

Patients 50 years of age and older who had chronic pain and were rated at risk for opioid misuse were examined by researchers, according to the article. The participants underwent MI for one month with counselors, and later received a one month follow-up test. Participants reported an increase in confidence, self-efficacy and motivation to change behavior, and a decline in depression, anxiety and the intensity of chronic pain.

“The Effect of Motivational Interviewing on Prescription Opioid Adherence Among Older Adults With Chronic Pain,” was published in a recent issue of Perspectives in Psychiatric Care.

Reforms to Curb the Prescription Opioid Epidemic

opioids

Statistics about the prescription opioid epidemic in America are grim to say the least. While efforts to curb the crisis in recent years have proven somewhat effective, people continue to lose their lives every day from prescription opioid overdoses. The U.S. Centers for Disease Control and Prevention (CDC) found that more than 16,000 people died from prescription opioid overdoses in 2013. Since 1999, opioid sales have increased 300 percent and the number of overdoses has quadrupled. Every day, 44 people lose their life to prescription opioid overdoses.

With most problems, it is best to look at the source when attempting to find solutions. The reality is that many physicians are not trained in pain management, yet general practitioners write the bulk of prescriptions for opioids. There is a great need for medical students to be trained in proper prescribing practices, spotting signs of abuse, and addiction medicine. Doing so will reduce overprescribing, help addicts find help and ultimately save lives.

Researchers at Johns Hopkins Bloomberg School of Public Health have issued recommendations designed to mitigate the prescription opioid epidemic, ScienceDaily reports. The new report was created by professionals from medicine, pharmacy, injury prevention and law.

The report calls for:

  • Medical students and physicians to be trained.
  • Prescriptions to be dispensed and monitored.
  • First responders to be equipped with naloxone.
  • People with addiction to be identified and treated.

“What’s important about these recommendations is that they cover the entire supply chain, from training doctors to working with pharmacies and the pharmaceuticals themselves, as well as reducing demand by mobilizing communities and treating people addicted to opioids,” says Andrea Gielen, ScD, ScM director of the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School and one of the report’s signatories. “Not only are the recommendations comprehensive, they were developed with input from a wide range of stakeholders, and wherever possible draw from evidence-based research.”

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If you are or a loved one is abusing prescription drugs, please contact Harmony Foundation to begin the journey of recovery. Harmony is a state-of-the-art, affordable, residential addiction treatment program located in the Rocky Mountains.

American Medicine Chest Challenge

AMCC

It is rare these days when reading a newspaper or magazine to not come across a story about the prescription opioid and heroin epidemic that is devastating families across the country. The scourge of opioid use is unprecedented in modern times, and health organizations and lawmakers continue to search for effective solutions to the problem. Every day, 44 people in the U.S. die from prescription opioid overdoses, according to the Centers for Disease Control and Prevention (CDC).

Keeping prescription opioids out of the hands of teenagers and young adults is ever important; exposure to such drugs can result in addiction and/or overdose. For over a decade, the Drug Enforcement Administration (DEA) has held the National Prescription Drug Take-Back Day. On such days, individuals can safely dispose of unused and unwanted medications that may otherwise end up in the wrong hands. On September 26, 2015, the agency reported that its take-back sites collected more than 350 tons (702,365 pounds) of unneeded medications.

The DEA is not alone; other organizations are hard at work to reduce prescription drug misuse as well. On Saturday, November 14 the American Medicine Chest Challenge (AMCC) will hold the sixth-annual National Day of Awareness and Safe Disposal, according to a news release. The initiative is calling on Americans to safely dispose of their unwanted medications at more than 1,500 Rx permanent collection sites throughout the country.

You can find a directory of collection sites on the AMCC website or download the organizations free app: AMCC Rx Drop. The AMCC also provides prescription drug abuse prevention information on their website.

Families are being called upon to take the 5-Step American Medicine Chest Challenge:

(1) Take inventory of their prescription and over-the-counter medicine
(2) Secure their medicine
(3) Dispose of unused, unwanted, and expired medicine in their home or at an AMCC disposal site
(4) Take their medicine(s) exactly as prescribed
(5) Talk to their children about the dangers of prescription drug abuse
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If you are or a loved one is abusing prescription opioids, please contact Harmony Foundation to begin the journey of recovery. Harmony is a state-of-the-art, affordable, residential addiction treatment program located in the Rocky Mountains.

Addiction and recovery news provided by Harmony Foundation.

Doctors and Pharmacists Fight Against Addiction

opioid-addiction

It’s no secret that doctors and pharmacists played a large role in the prescription opioid crisis that has been raging in the United States for over a decade. So it stands to reason that the doctors and pharmacists have a responsibility to help correct the problem.

In Massachusetts, a state which has witnessed firsthand the effects of the opioid crisis in America, U.S. Attorney General Loretta Lynch told a group of physicians and pharmacists that their assistance to law enforcement is crucial for curbing prescription opioid and heroin abuse, the Associated Press reports. U.S. Attorney Carmen Ortiz and Massachusetts Attorney General Maura Healey were also in attendance.

On Friday, at the Massachusetts Medical Society, Lynch credited the state’s medical community and commended the efforts of the Department of Justice in the fight against opioid abuse, according to the article. Lynch stated:

“I applaud you for leading a truly comprehensive campaign to reduce prescription drug abuse in the Commonwealth – and I want you to know that the Department of Justice and the entire Obama Administration, is standing with you in this fight. Through the tireless efforts of our Drug Enforcement Administration (DEA) – under the leadership of Acting Administrator [Chuck] Rosenberg – we are making major strides on all four of the action areas identified in the White House Prescription Drug Abuse Prevention Plan, which President Obama discussed in his weekly address just a few days ago: enforcement, disposal, monitoring and education.”

Lynch also spoke on the value of safely disposing of unused or unwanted prescription narcotics. She points out that opioid addiction often originated inside the family medicine cabinet.

“We also know, as you do, that opioid addiction often begins not with a law-breaking doctor, but with a family medicine cabinet. That’s why we are working to ensure that unused, unwanted and expired medications are responsibly discarded and taken out of circulation. In the last five years, the DEA has held ten National Take Back Days – most recently this past Saturday – when the public is encouraged to bring excess prescription drugs to thousands of designated sites across the country for safe and secure disposal.”

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If you are or a loved one is abusing opioids, please contact Harmony Foundation to begin the journey of recovery. Harmony is a state-of-the-art, affordable, residential addiction treatment program located in the Rocky Mountains.

Addiction and recovery news provided by Harmony Foundation.