Substance Abuse in Older Adults – Topic Overview

Many people think alcohol and drug abuse happen only to teens and younger adults. But all ages can have problems with drugs and alcohol, including older adults.

Older adults may use illegal drugs, use prescription or over-the-counter medicines in harmful ways, drink too much alcohol, or mix alcohol and medicines. Doing any of these can cause serious health problems and problems with money and the law. It also can harm relationships with family and friends.

Substance abuse in older adults may be overlooked, because:

Older adults are more likely to drink or use drugs at home rather than in public.
Older adults may not have duties that are affected by substance abuse, such as going to school or work.
Signs of abuse are similar to those found in health problems that many older adults have, such as depression and dementia.
Caregivers of older adults may be aware of the problem but may not want to talk about it.

Alcohol

Alcohol abuse is dangerous for all people, and it can be very dangerous for older adults. Older adults:1

  • Usually need less alcohol to become drunk (intoxicated) than someone younger.
  • Stay drunk longer, because their bodies process alcohol more slowly.
  • May have vision and hearing problems and slower reaction times. Alcohol can make these problems worse, which means alcohol-related falls, car crashes, and other kinds of accidents are more likely.
  • May be more likely to mix alcohol and medicine because they are taking so many medicines. Mixing alcohol with many over-the-counter and prescription medicines can be dangerous or even fatal.

In older adults, alcohol can trigger some health problems or make them worse. These health problems include high blood pressure, ulcers, liver disease, anxiety, sleep problems, and depression.1

Experts suggest that adults 65 and older have:1

  • No more than 1 standard drink camera.gif a day.
  • No more than 2 drinks on any drinking occasion, such as New Year’s Eve or weddings.

Some older adults should not drink alcohol. Women who are small may want to ask their doctors what amount of alcohol is safe for them.

Florida governor signs major bill to combat opioid epidemic

Florida Governor Rick Scott talks to the media at the end of the legislative session at the Florida State Capitol in Tallahassee, Fla., Sunday March 11, 2018. The ending of the legislative session in Florida is called Sine Die and is signaled with the ceremonial dropping of the handkerchief from the Florida House and Senate. Mark Wallheiser AP Photo

Gov. Rick Scott on Monday signed Florida’s opioid legislation into law, a move seen by many as a good first step in combating a crisis that has claimed at least 16 lives a day in the Sunshine State.

“What it does take is a pretty comprehensive approach to addressing the epidemic,” said Mark Fontaine, Executive Director for the Florida Alcohol and Drug Abuse Association. “It has education programs and helps control the measures for availability.”

The legislation includes tougher limits on most painkiller prescriptions, more money for treatment programs and requirements for physicians to check the state’s prescription database. The Republican governor and the state Legislature had made passing opioid legislation a priority of the recently concluded session.

Opioid-related deaths across Florida have jumped 35 percent from 2015 to 2016, according to the Florida Department of Law Enforcement. Opioids were identified as either the cause of death or were present in the deceased person’s body in 5,725 cases in 2016. The 2017 figures are still being compiled.

“I don’t think anyone wakes up in the morning with the goal of becoming an addict. This will make a big difference in reducing the number of addicts,” said Scott, who signed the bill at the Manatee County Sheriff’s Office in Bradenton.

Manatee County suffered the highest ratio of deaths in Florida in 2016 from fentanyl analogs — synthetic versions of fentanyl that can be 5,000 times more lethal than heroin.

House speaker Richard Corcoran, who attended the signing, said the measure is one of the first in Florida that attempts to combat the opioids crisis at the front end by limiting supplies and by doctors’ checks on the prescription database.

The new laws, which take effect July 1, also contains some of the nation’s toughest mandates on initial prescriptions for Schedule II painkillers such as Oxycontin and Fentanyl. The initial limit would be three days, but doctors could prescribe up to seven days for acute pain exceptions. It does not place medication limits for trauma cases, chronic pain, cancer and terminal illnesses.

Florida is the 25th state since 2016 that has passed legislation that imposes some limits or guidelines on opioid prescriptions. Only two others — Kentucky and Minnesota — have statutory limits of three or four days.

Fraser Cobbe, who represents the Florida Orthopedic Society, said doctors would have liked to see the limit extended to 10 days for surgeries not related to traumatic injuries, like hip and other joint replacements.

“The concern is major surgery was not addressed or focused on the human element,” Cobbe said.

Cobbe said his organization is putting most of its focus on informing members about the new regulations with checking the state’s prescription database as well as the requirements for doctors to complete a 2-hour continuing education course on responsibly prescribing opioids.

The state’s Prescription Drug Monitoring Program will receive a software upgrade that should make it easier to integrate into a patient’s medical file as well as making it easier to track medication history nationwide — a move designed to prevent someone near state lines from trying to doctor shop for multiple prescriptions.

There are some critics though who think the $65 million in the state budget signed by Scott last Friday does not go far enough in properly funding law enforcement and treatment programs.

Democratic gubernatorial candidate Gwen Graham said in a statement that Scott and the Legislature must join other five other states in suing drug manufacturers and hold them more accountable.

Scott’s signing came hours before President Donald Trump spoke Monday in New Hampshire about federal steps to combat opioid addiction. Florida Attorney General Pam Bondi was a member of the president’s opioid commission.

Second high intensity drug bust results in 49 arrests in Martin County

The second high intensity drug bust in Martin County yields in 49 arrests over a two day period.

According to the Martin County Sheriff’s Office, deputies focused on a busy stretch of roadway located near Highway 710 in Indiantown the first week in March.

Deputies say out of the 49 arrests, 36 resulted in felonies, and 27 were misdemeanor charges.

The interdiction effort resulted in the seizure of unique varieties of drugs moving through the area.

These drugs included:

  • 1 gram of LSD
  • Alprazolam 34 pills
  • Adderall 1 pill
  • MDMA 26 pills
  • Oxycodone 2 pills
  • LSD 1g (70-doses)
  • Cocaine 6.8g
  • Psilocybin Mushrooms 20.8g
  • Cannabis 243g

The MCSO utilized federal and regional law enforcement including the MC Special Investigations Division, narcotics detectives, K-9 and aviation units, criminal interdiction team, marine unit, warrants, criminal investigations division, uniform road patrol, corrections department, and dispatch.

Long-awaited study finds monthly Vivitrol as effective as daily pill for opioid addiction

The largest head-to-head study to date between two leading drugs to treat opioid addiction has found them roughly equivalent — an outcome that could dramatically change prescribing habits and boost the fortunes of the newer drug, Vivitrol.

The study, sponsored by the National Institute on Drug Abuse, found that a monthly shot of naltrexone (sold as Vivitrol) is as effective as its main competitor, the daily pill of buprenorphine and naloxone (sold as Suboxone). Researchers found that about half of people with opioid addiction who took either drug remained free from relapse six months later.

Previously, there’s been a “widespread belief” that patients “don’t do as well on naltrexone as they do on buprenorphine,” said Dr. Nora Volkow, director of NIDA. “We’re hopeful this changes the prejudice.”

The finding, however, comes with a major caveat. A large number of people were unable to even start treatment with Vivitrol. That’s because participants had to thoroughly wean themselves off opioids for a period of three days before they could start taking Vivitrol, to avoid sudden symptoms of opioid withdrawal. Because of that hurdle, patients failed to start on Vivitrol at four times the rate that they did Suboxone.

Vivitrol, which received Food and Drug Administration approval in 2010 for opioid treatment, is seen as attractive option because patients only have to take it once a month, and it doesn’t contain opioids. Suboxone, by contrast, has been treated with skepticism by some physicians and officials — including former Health and Human Services Secretary Tom Price — because it’s “substituting” one opioid for another. But Vivitrol, which costs about $1,000 a shot, is also much more expensive than Suboxone, and up until now has had limited evidence showing how well it works.

Addiction experts say this study, which confirms the results of a smaller head-to-head trial recently published, offer more clarity at a time where misconceptions have clouded the public’s judgment about treatments for opioid addiction.

Costs and benefits

The research was conducted between 2014 and 2017 at eight community-based inpatient treatment facilities across the U.S. A group of 570 opioid-dependent adults — the majority of whom were white men between the ages of 25 and 45 — received one of the two medication-assisted treatments.

Over the subsequent six months, researchers both solicited self-reports of opioid use as well as weekly urine samples. Participants also reported side effects and their level of opioid craving. At the end of six months, 52 percent of those who had received Vivitrol had relapsed, compared with 56 percent of those receiving Suboxone. However, 28 percent of participants assigned to Vivitrol couldn’t make it through the detox period, as compared to 6 percent of people who quit the study before initiating Suboxone dosage. Taking into account all the participants, Suboxone had a lower rate of relapse than Vivitrol.

Dr. Joshua Lee, an associate professor with New York University’s School of Medicine and a leading author of the study, which published in the Lancet on Tuesday, said the findings indicate that each drug can help certain patients, rather than one simply being better than the other.

“Both medications worked quite similarly and, therefore, both should be discussed as treatment options,” Lee told STAT. “The problem is not enough people are getting into treatment anyway, and when they do go into treatment, they don’t get any of these treatment options. Enough of the circular firing squad among the addiction treatment providers, and the war amongst all these different medications.”

But other addiction doctors said that the gap in rates of people who successfully started each treatment was an alarming sign.

“The take-home from this study is that buprenorphine [Suboxone] is more effective” than Vivitrol, said Dr. Sarah Wakeman, the medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital. She said the study confirmed what she sees at her clinical practice — that it is easier to initiate Suboxone treatment with patients, and patients stay with the treatment longer.

She also pointed out that many of the overdoses in the study occurred after detox — a phase that isn’t required if patients are given Suboxone.

Dr. Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University, agreed. “Buprenorphine outperformed naltrexone, period,” he said.

The need for evidence

One charge the study does settle is that there is a lack of evidence supporting Vivitrol’s touted effects. Alkermes, which manufactures the drug, was dinged by a number of investigative reports earlier this year highlighting the company’s expansive claims about the drug’s potential to investors and its aggressive lobbying of federal lawmakers.

Alkermes did not donate drugs to this trial. But two of study’s senior authors — Lee and Dr. John Rotrosen, a psychiatry professor at NYU’s School of Medicine — had received free drugs from Alkermes for an unrelated trial. Two other researchers involved in the study disclosed receiving either research support or consulting fees from Alkermes in the past. In a statement, Alkermes CEO Richard Pops said the “data from the study reinforce the value of [medication-assisted treatment] and the distinct differences between two important options” for opioid-use disorder.

Indivior, the company that makes Suboxone, donated drugs to this trial and “had access to periodic safety data only, with no input or review of this manuscript,” according to the study.

Volkow, for her part, believes physicians should be prescribing medication out of a series of choices. For instance, Vivitrol might be a better treatment for someone in a rural area because he or she wouldn’t have to drive as frequently to a faraway clinic; chronic pain patients might respond better to Suboxone, as it blocks pain receptors.

Ultimately, Volkow feels more long-term research and development of opioid addiction treatments — including extended-release buprenorphine — is needed now to truly know what works best for patients.

“They’re not perfect — in this trial 50 percent of the patients relapsed after six months,” Volkow said. “So it behooves us to research more and develop more medications.”

OxyContin maker stops promoting opioids, cuts sales staff

OxyContin maker Purdue Pharma LP said on Saturday that it has cut its sales force in half and will stop promoting opioids to physicians, following widespread criticism of the ways that drugmakers market addictive painkillers.

The drugmaker said it will inform doctors on Monday that its sales representatives will no longer visit physician offices to discuss its opioid products. It will now have about 200 sales representatives, Purdue said.

  • The drugmaker said it will inform doctors on Monday that its sales representatives will no longer visit physician offices to discuss its opioid products.
  • Doctors with opioid-related questions will be directed to its medical affairs department.
  • Opioids were involved in more than 42,000 overdose deaths in 2016, according to the U.S. Centers for Disease Control and Prevention.

“We have restructured and significantly reduced our commercial operation and will no longer be promoting opioids to prescribers,” the Stamford, Connecticut-based company said in a statement.

Doctors with opioid-related questions will be directed to its medical affairs department. Its sales representatives will now focus on Symproic, a drug for treating opioid-induced constipation, and other potential non-opioid products, Purdue said.

Opioids were involved in more than 42,000 overdose deaths in 2016, according to the U.S. Centers for Disease Control and Prevention.

Among other opioid producers, Endo International Plc agreed in July to pull its Opana ER painkiller after the Food and Drug Administration called for its withdrawal.

Purdue and other drugmakers have been fighting lawsuits by states, counties and cities that have accused them of pushing addictive painkillers through deceptive marketing.

The lawsuits have generally accused Purdue of downplaying OxyContin’s addiction risk and of misleading marketing that overstated the benefits of opioids for treating chronic, rather than short-term, pain.

At least 14 states have sued privately held Purdue. Alabama Attorney General Steve Marshall filed a lawsuit on Tuesday accusing Purdue of deceptively marketing prescription opioids.

Purdue is also facing a federal investigation by the U.S. Attorney’s Office in Connecticut.

Purdue has denied the allegations in the various lawsuits. It has said its drugs are approved by the U.S. Food and Drug Administration and account for only 2 percent of all opioid prescriptions.

Purdue and three executives pleaded guilty in 2007 to federal charges related to the misbranding of OxyContin and agreed to pay $634.5 million to resolve a U.S. Justice Department probe.

That year, Purdue also reached a $19.5-million settlement with 26 states and the District of Columbia. It agreed in 2015 to pay $24 million to resolve a lawsuit by Kentucky.

U.S. President Donald Trump has drawn criticism for his response to the opioid crisis. He has yet to declare it a national emergency as he pledged to do in August following a recommendation by a presidential commission.

Major heroin, fentanyl dealers arrested in St. Lucie County, sheriff’s office says

FORT PIERCE, Fla. – The St. Lucie County Sheriff’s Office and multiple federal agencies held a news conference Friday morning to announced the results of a seven-month drug investigation,

Officials said they investigated heroin and fentanyl dealers, which resulted in more than 40 arrests.

St. Lucie County Sheriff Ken Mascara singled out four people as primary dealers: Cybil Green, her boyfriend Johnny Lewis, his son Rodney Stevens and his girlfriend Latoya Felder.

The sheriff said Green utilized her juvenile children to package drugs for sale.

They called the investigation “Operation Big Mi-steak” because the sheriff said Green was selling drugs from a Steak ‘n Shake where she worked off Okeechobee Road near the Florida Turnpike.

The sheriff’s office said the following drugs were confiscated: 50 grams of fentanyl, 4 grams of heroin, 220 grams or almost half a pound of powder cocaine, 9 grams of crack cocaine, 1 gram of Molly, 11.5 grams of crystal meth, 80 pounds of marijuana, 23 marijuana plants, 16 liquid ounces of THC oil, 1,000 milligrams of cannabis oil, 71 caplets of carfentanyl, 2 vials of testosterone, 10 Xanax pills, and various drug paraphernalia.

In addition, investigators said they seized 25 firearms.

Following the arrests of the suspected dealers, officials said they noticed a drop in overdoses in the community.

Questioning A Doctor’s Prescription For A Sore Knee: 90 Percocets

by Michelle Andrews

Doctors often prescribe more opioid painkillers than necessary following surgery, for a variety of reasons.

Doctors often prescribe more opioid painkillers than necessary following surgery, for a variety of reasons.

I recently hobbled to the drugstore to pick up painkillers after minor outpatient knee surgery, only to discover that the pharmacist hadn’t yet filled the prescription. My doctor’s order of 90 generic Percocet exceeded the number my insurer would approve, he said. I left a short time later with a bottle containing a smaller number.

When I got home and opened the package to take a pill, I discovered that there were 42 inside.

Talk about using a shotgun to kill a mosquito. I was stiff and sore after the orthopedist fished out a couple of loose pieces of bone and cartilage from my left knee. But on a pain scale of 0 to 10, I was a 4, tops. I probably could have gotten by with a much less potent drug than a painkiller like Percocet, which contains a combination of the opioid oxycodone and the pain reliever acetaminophen, the active ingredient found in over-the-counter Tylenol.

When I went in for my follow-up appointment a week after surgery, I asked my orthopedist about those 90 pills.

“If you had real surgery, like a knee replacement, you wouldn’t think it was so many,” he said. He told me the electronic prescribing system sets the default at 90. So when he types in a prescription for Percocet, that is the quantity the system orders.

Such standard orders can be overridden, but that is an extra step for a busy physician and takes time.

As public health officials grapple with how to slow the growing opioid epidemic — which claims 91 lives each day, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.

While patients today are often given opioids to manage postoperative pain, a large supply of pills may open the door to opioid misuse, either by the patients themselves or others in the family or community who can access the leftovers.

Post-surgical prescriptions for 45, 60 or 90 pills are “incredibly common,” says Dr. Chad Brummett, an anesthesiologist and pain physician at the University of Michigan Medical School.

Last year, the Centers for Disease Control and Prevention released a general guideline saying that clinicians who prescribe opioids to treat acute pain should use the lowest effective dose and limit the duration to no longer than seven days.

But more detailed guidance is necessary, clinicians say.

“There really aren’t clear guidelines, especially for surgery and dentistry,” Brummett says. “It’s often based on what their chief resident taught them along the way or an event in their career that made them prescribe a certain amount.”

Or, as in my case, an automated program that makes prescribing more pills simpler than prescribing fewer.

Brummett is co-director of a Michigan program that has released recommendations for post-surgical opioid prescribing for a growing list of procedures.

To determine the extent to which surgery may lead to longer-term opioid use, Brummett and his colleagues examined the insurance claims of more than 36,000 adults who had surgery in 2013 or 2014 for which they received an opioid prescription. None of the patients had prescriptions for opioids during the prior year.

The study, published online in JAMA Surgery in June, found that three to six months after surgery, roughly 6 percent of patients were still using opioids, having filled at least one new prescription for the drug. The figures were similar whether they had major or minor surgery. By comparison, the rate of opioid use for a control group that did not have surgery was just 0.4 percent.

Some insurers and state regulators have stepped in to limit opioid prescriptions. Insurers routinely monitor doctors’ prescribing patterns and limit the quantity of pills or the dosage of opioid prescriptions.

At least two dozen states have passed laws or rules in just the past few years aimed at regulating the use of opioids.

Last year in my state of New York, Gov. Andrew Cuomo signed legislation that reduced the initial opioid prescription limit for acute pain from 30 days to no more than a seven-day supply.

As my experience demonstrated, however, a seven-day limit (those 42 pills in my case) can still result in patients receiving many more pills than they need. (For those who find themselves in a similar situation with excess pills, there is a safe and proper way to dispose of them.)

Still, some worry that all this focus on overprescribing may scare physicians away from prescribing opioids at all, even when appropriate.

“That’s my concern, that people are so afraid of things and taking it to such an extreme that patient care suffers,” says Dr. Edward Michna, an anesthesiologist and pain management physician at Brigham and Women’s Hospital in Boston. Michna is on the board of the American Pain Society, a research and education group for pain management professionals. Michna has been a paid consultant to numerous pharmaceutical companies, some of which manufacture narcotics.

But other doctors say that one of the reasons doctors call in orders for lots of pills is convenience.

“When you land on the front lines, you hear, ‘I like to write for 30 or 60 pills because that way they won’t call in the middle of the night’ ” for a refill, says Dr. Martin Makary, a professor of surgery and health policy at Johns Hopkins School of Medicine.

Makary is spearheading a consortium of Hopkins clinicians and patients that provides specific guidelines for post-surgical opioid use. The program, part of a larger effort to identify areas of overtreatment in health care, also identifies outlier prescribers nationwide to encourage them to change their prescribing habits.

The Hopkins group doesn’t have an opioid recommendation for my surgery. The closest procedure on their website is arthroscopic surgery to partially remove a torn piece of cartilage in the knee called the meniscus. The post-surgical opioid recommendation following that surgery: 12 tablets.

Rehab that puts alcoholic pilots back in the cockpit

The words CLEARED FOR TAKEOFF are welcomed by air travelers in a hurry. They’re even more welcomed by airline pilots who once feared they’d never fly again. Our Cover Story is reported by Tony Dokoupil:

Many alcoholics can tell you the exact moment they hit rock bottom. Former airline Captain Lyle Prouse hit his at 30,000 feet.

On March 8, 1990, he was at the controls of Northwest Flight 650, Fargo to Minneapolis, with 58 people aboard, and after a night of heavy drinking on a layover, he was drunk.

“I think on the tab were 14 rum and cokes for me,” Prouse said. “And depending on the testimony you listen to, the figure goes up to 18 or 19. I don’t know.”

His blood-alcohol content that morning was at least 0.13 percent: Too drunk to drive, and more than triple the limit for flying.

Dokoupil asked, “Did you have any doubts about getting on that plane?”

“No. I mean, I wouldn’t fly the airplane if I thought I was gonna die.”

The plane landed safely, but Prouse and his crew were arrested, and became the first commercial airline pilots convicted of flying while intoxicated. Prouse was sentenced to 16 months in federal prison.

“No other pilot in all of American commercial aviation damaged the profession like I did,” he said. “That was a knife in my heart. That hurt.”

Lyle Prouse’s career was a longshot from Day One: Raised by alcoholic parents, he joined the Marines and fought his way from a ground unit into a fighter jet, and a decorated career. Somewhere along the way, though, he became an alcoholic himself.

“Our pilots are just like all people; they have some of the same shortcomings that any of us could have,” said Peggy Gilligan, the former FAA administrator in charge of safety. She says a drinking problem is not necessarily the end of a pilot’s career.

“There are lots of things that initially might disqualify you from being a pilot, but with proper care and treatment, with proper rehabilitation, you can return to the flight deck,” she said.

And in fact, for decades, the FAA has been doing exactly that: quietly sending pilots diagnosed as substance abusers back to work.

It’s called the Human Intervention Motivation Study, or HIMS. And before you panic, consider this: it may be one of the most successful rehab programs ever.

Eighty percent of pilots who enter the program do not relapse at all. And of those that do relapse, most relapse only once.

Dokoupil asked, “There’s never been an issue with a pilot undergoing treatment while flying?”

“That’s right,” said Gilligan.

“Why aren’t you screaming this good news from every rooftop in Washington, D.C.?”

“That’s a really good question!” she laughed.

Right now, under the HIMS program, there are upwards of 1,300 pilots flying with a special medical license for addiction.

Since the mid-1970s, 6,000 pilots have been treated and returned to the cockpit … pilots like Captain Dana Archibald, whose career nearly crashed in the late 1990s when he missed a flight after a drunken binge.

“I just stopped showing up for work,” he said.

“You’re just telling your boss that you got the flu?” asked Dokoupil.

“I would tell him every story in the book, because I’m an alcoholic. I’d tell ’em anything they wanted to hear, just so I wouldn’t get in trouble.”

In another era, addicted pilots would be fired or forced to keep their addictions a secret. The FAA says that’s all changed.

“What we don’t want, to this day, are pilots who hide something that could present a risk,” Gilligan said.

Of course, addiction isn’t just a pilot’s problem; millions of Americans are struggling with addiction. Most of the people who need treatment are not in it, and relapse is common. But for airline pilots, those rules don’t seem to apply.

Dr. Lynn Hankes, who ran an addiction treatment center in South Miami. He says the airline pilots he treated were more likely to get sober, and stay that way.

A member of the general public, he notes, is three times more likely to have a relapse than a pilot.

Why? “Because they don’t have the system in place,” Dr. Hankes said.

For pilots, that system means a month or so in an FAA-approved rehab facility, then monitoring and drug tests. And if the FAA clears them to fly again, the treatment usually continues for at least three years.

It’s not foolproof, but it works.

“Since the inception of the HIMS program, in the last 43 years there has never been even one, not a single commercial passenger-carrying airline incident or accident, that has been alcohol- or drug-related,” Dr. Hankes said. “That’s the proof in the pudding.”

“If the general public had a HIMS-style program available to them, do you think relapse rates would fall as low as they are for pilots?” Dokoupil asked.

“Well, that’s the big question. There’s a key element missing in the general public, and that is, we don’t have the leverage.”

“Everybody is afraid of losing something.”

“Yeah, but it’s very easy to hide out there in the general public. If you threaten a pilot with taking away his wings, it’s like threatening a doctor with taking away his stethoscope. That’s a lot of leverage. If they want to get back to the cockpit or the operating room, they gotta jump through the hoops.”

And jump they do: Similar programs have been used successfully by doctors and flight attendants, and now police and fire departments are interested, too.

For pilots, it’s about a lot more than just winning back their wings.

Dana Archibald told Dokoupil that, were it not for the HIMS program, “I certainly wouldn’t be a pilot, but more importantly, I don’t know if I’d be alive.”

Archibald is now a full-time 737 captain with a major airline flying out of Miami.

And the Lyle Prouse story ends far differently than he ever could have hoped. After his arrest, he was a broken man on the verge of suicide.

“I lost the will to live,” he said. “And I thought I was too tough for that.”

“How close do you think you came to taking your own life?” Dokoupil asked.

“I was within an eyelash. I was not romancing the idea or considering the idea — I was within an eyelash of executing the idea.”

But after he got out of prison, he was placed into the HIMS program, and in 1993 — against all odds — he was re-hired by Northwest Airlines.

Five years later, Prouse retired honorably as the captain of a 747.

“I’ve gotten to live out more miracles than anybody I know,” he said.

What are the miracles? “That I flew again. That my wife stayed with me. That my kids still love me. That I got sober. That I didn’t die like my parents did.

“I just came back from a pilot reunion at Northwest. And I get an email from one of the gals. She said, ‘You’re a very loved and respected member of the Northwest Family.’ I didn’t have that in 1990.”

Prouse added, “I suppose without sounding preachy or evangelistic, the only thing I can attribute it to is God’s grace.”

Dokoupil said, “What’s that saying? ‘God watches over –‘”

“‘Fools and drunks’? Something like that. Well, I certainly earned that!”

 

 

 

 

 

 

FDA chief warns about kratom to treat opioid addiction; will seek more regulatory power

Citing 36 deaths, the Food and Drug Administration chief warned  consumers Tuesday not to use the herbal supplement kratom to ease opioid withdrawal and announce plans to step its regulatory oversight to combat the opioid epidemic.

The FDA public health advisory on kratom follows the Drug Enforcement Administration’s reversal or at least delay of plans to classify kratom as a controlled substance on the same level as heroin and LSD.

FDA commissioner Scott Gottlieb says the FDA plans to work with the DEA to determine how kratom should be classified.

Ktatom

Mitragyna speciosa, is a tropical evergreen tree in the coffee family native to Southeast Asia in the Indochina and Malaysia phytochoria

Kratom, a plant grown naturally in countries including Thailand and Malaysia, is widely sold in smoke shops and other locations as a powder that can be used in tea to slow the effects of opioid withdrawal. But it has addictive properties of its own, FDA says. public health advisory related to the FDA’s mounting concerns regarding risks associated with the use of kratom.

The FDA says kratom carries similar risks of abuse, addiction and in some cases, death, as opioids. It is also often used recreationally for its euphoric effects.

Along with opioid withdrawal, kratom is also believed to relieve fatigue, pain, cough and diarrhea. Anita Gupta, an osteopathic anesthesiologist and licensed pharmacist, has expressed concern about an increase in the use of kratom among her chronic pain patients.

Kratom users and advocates were “dismayed to learn of the DEA’s plan to classify kratom as a Schedule 1 substance – the same classification as LSD and heroin – despite anecdotal and scientific evidence indicating kratom could be an effective opioid alternative,” says Walter Prozialeck, chairman of the pharmacology department at Midwestern University Chicago College of Osteopathic Medicine.

As an active “drug”, kratom certainly has potential for causing harmful effects and can, itself be addictive,” Prozialeck, who co-authored a December 2016 study on kratom in the Journal of the American Osteopathic Association.  “However, overwhelming evidence indicates kratom is far less dangerous than classic opioids.”

 Studies from Asia indicate kratom, in its pure form, has not been linked to any deaths in that part of the world, says Prozialieck. He blames a “lack of quality control in western countries including the U.S., which can lead to dangerous alterations of kratom or the addition of other drugs.

“The therapeutic potential of kratom is real, but more research is urgently needed to evaluate its safety and efficacy,” he added. “One of my concerns is that a total ban will likely stifle such research.”

Because kratom is unregulated, “you never know the real strength, ingredients, or how it’s prepared,” agrees Chris Barth, who used the medication Suboxone to recover from a pain pill addiction a decade ago.

“Limited access and or lack of knowledge of approved treatments is what’s probably driving this.” says Barth. “It’s probably easier to ‘do it yourself’ with kratom ordered over the internet than find — if it’s available — and pay for FDA approved, doctor supervised treatment.”

Gottlieb also told his agency’s criminal investigations staff that he may ask Congress for more authority and resources to fight the opioid epidemic, according to remarks prepared for delivery Tuesday afternoon.

Gottlieb also says in the remarks that a new working group with Customs and Border Patrol is working on stepped-up enforcement at entry points for illegal narcotics.

The fact Gottlieb is speaking to the investigations staff is significant because “if they find people here who are opening the gates to these drugs, there may be opportunities for the FDA to investigate at a high level,” says Joshua Sharfstein, former principal deputy FDA commissioner in the Obama administration.

Importers, organized crime or others in the supply chain could be part of conspiracies to distribute illegal opioids, Sharfstein says.

FDA is already using import alerts and other authority to stop foreign, unapproved and misbranded drugs at the border to keep kratom shipments from entering the United States. Hundreds of shipments have already been detained and many are seized.

Still, more than 340 million packages reach the U.S. every year.

“Given that massive volume, it’s estimated that only a small percentage of the illicit drugs smuggled through the (international mail are being intercepted,” Gottlieb said.

While it’s very important to strengthen border enforcement, “the challenge is akin to pushing the tide back into the ocean,” says Sharfstein.

Gottlieb, who did two previous stints at the FDA, has publicly expressed misgivings about how long it took the agency to truly address the crisis.

What Doctors Facing the Opioid Crisis Need Next

By Alice Park

How do you confront an epidemic that has claimed more lives than the HIV/AIDS crisis at its peak? How do you counteract a system that incentivizes the flow of prescription painkillers from doctors to patients and ends up getting 3 million Americans addicted each year? And how do you reverse surging demand for prescription opioids’ illegal substitutes, which are more damaging and toxic but far cheaper and easier to obtain?

You could start by declaring a national public health emergency. That’s what President Trump did on Oct. 26, creating a 90-day window during which federal agencies–from the Food and Drug Administration, which regulates prescription drugs; to the Department of Health and Human Services, which oversees guidelines for treating addiction; to the Department of Justice, which is responsible for prosecuting illegal pill makers and drug dealers; to the National Institutes of Health, which studies how people first get addicted–must shift parts of their existing budgets to address the crisis. After 90 days, the President can renew the emergency status to extend the intensified response.

This is a move in the right direction. But Trump’s order did not make additional funding immediately available, leading those on the front lines of the epidemic to ask what, exactly, it will mean. “Unfortunately, nothing,” says Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center and former director of National Drug Control Policy in the Obama Administration. “There are no new grant dollars, no new policy initiatives.”

Days after Trump’s declaration, his official White House commission on the crisis issued its final report, which called for many of the initiatives that are backed by experts like Botticelli. The findings make it clear that current strategies and funding are far from adequate.

“What we need is something like the Ryan White Care Act,” says Dr. Sarah Wakeman, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital. In 1990, Congress passed the act to provide funding for HIV patients who could not afford basic medical care and anti-HIV drugs. With $2.3 billion at its disposal, the fund currently provides care to more than half of all people infected with the virus in the U.S.

For the opioid epidemic, such additional funding would allow more people to receive medication-assisted treatment (MAT), which mimics opioids but has less addictive potential and can wean addicts off their dependence. Studies show that people given medications like methadone or buprenorphine are less likely to overdose or relapse.

Mandating that all health insurers cover substance-use-disorder treatment–as the Affordable Care Act does–would expand access to the medications and help reduce the stigma and controversy surrounding the practice of using drugs to treat drug addiction. But the Trump Administration’s reform efforts threaten to remove such coverage, most of which comes in the form of expanded Medicaid benefits. “If that’s taken away, then we’re back to square one,” says Cheryle Herr, clinical director for the Family Recovery Center in Liverpool, Ohio, which has been hit hard by the epidemic. “Our people are going to die.”

This is a move in the right direction. But Trump’s order did not make additional funding immediately available, leading those on the front lines of the epidemic to ask what, exactly, it will mean. “Unfortunately, nothing,” says Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center and former director of National Drug Control Policy in the Obama Administration. “There are no new grant dollars, no new policy initiatives.”

Days after Trump’s declaration, his official White House commission on the crisis issued its final report, which called for many of the initiatives that are backed by experts like Botticelli. The findings make it clear that current strategies and funding are far from adequate.

“What we need is something like the Ryan White Care Act,” says Dr. Sarah Wakeman, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital. In 1990, Congress passed the act to provide funding for HIV patients who could not afford basic medical care and anti-HIV drugs. With $2.3 billion at its disposal, the fund currently provides care to more than half of all people infected with the virus in the U.S.

For the opioid epidemic, such additional funding would allow more people to receive medication-assisted treatment (MAT), which mimics opioids but has less addictive potential and can wean addicts off their dependence. Studies show that people given medications like methadone or buprenorphine are less likely to overdose or relapse.

Mandating that all health insurers cover substance-use-disorder treatment–as the Affordable Care Act does–would expand access to the medications and help reduce the stigma and controversy surrounding the practice of using drugs to treat drug addiction. But the Trump Administration’s reform efforts threaten to remove such coverage, most of which comes in the form of expanded Medicaid benefits. “If that’s taken away, then we’re back to square one,” says Cheryle Herr, clinical director for the Family Recovery Center in Liverpool, Ohio, which has been hit hard by the epidemic. “Our people are going to die.”