Who’s responsible for the opioid epidemic? Doctors or pharmaceutical companies?

Dr. Barry Schultz is serving 157 years in prison after he prescribed enough opioids for a prosecutor to call him one of Florida’s, “most notorious drug dealers.” In his only interview, Schultz says he’s a scapegoat.

In the annals of 60 Minutes, we have rarely come across a doctor like Florida physician Barry Schultz. Prosecutors say he wantonly prescribed and sold massive quantities of highly addictive opioids. In July, Schultz was sentenced to 157 years for his role in fueling the most devastating public health crisis of the 21 century. Last year more Americans died of drug overdoses than in the entire Vietnam War. While Schultz ended up in jail, Mallinckrodt, the pharmaceutical company that flooded Florida with hundreds of millions of oxycodone pills, paid a relatively small penalty. The question now being debated in Congress and in federal court is: who is responsible for the opioid epidemic? The doctors who prescribed the pills or the opioid manufacturers and distributors who supplied them?

Dr. Barry Schultz is an inmate at Florida State Prison, where he will likely be incarcerated until the day he dies.

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Dr. Sanjay Gupta on how alcohol affects memory

The question of whether alcohol affects memory hangs over the current Supreme Court confirmation battle. Here with some answers is Dr. Sanjay Gupta:

I love the brain. It’s one of the reasons I became a neurosurgeon. One of the most fascinating functions of the brain is how it creates memories. We spend a lot of time talking about doing things that can improve our memory, but probably not enough time discussing the things that make our memory worse.

For example, alcohol.

Truth is: When it comes to alcohol and memory, people assume a lot of things – and a lot of those assumptions are wrong.

Much of the research comes from eyewitnesses to crime who are then questioned shortly after. One study last year showed that in this situation mild- to moderately-intoxicated people had very similar recall as sober people.

Now, there is a thing known as “blackout drunk.” That is not the same as “passed out drunk.” Someone who is blacked-out drunk may still be talking and walking. But they might be totally amnestic to the event, meaning they have no memory of it.

The biggest culprit is not necessarily how much you drank, but how quickly they drank it – the binge drinker.

With memory and alcohol you also have to consider how much time has passed. While a mild- to moderately-intoxicated person can remember things pretty well in the short term, their long term memories are much more difficult to retrieve.

And to understand why, it helps to understand how memory works. You take in sensory information – see, hear, feel – and that almost immediately gets transferred to short-term memory. From there, short-term memories get encoded into long-term memory.

It’s this last phase where alcohol seems to have the most impact. For someone who’s intoxicated, that encoding into long-term memory often doesn’t occur very well, or at all. And that is why days later someone may have a hard time remembering something that was so vivid earlier, but can’t retrieve the memory from the long-term stores, because the memories were never there in the first place.

If you want to improve your memory, the best things you can really do: pay attention when something is happening; that helps a lot. And don’t forget sleep, because it’s when you sleep that your body consolidates and transfers your short-term memories to long-term memoriesm the kind you’ll have for the rest of your life.

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No One Is Immune to Addiction

Addiction touches nearly every family. It’s time to talk about it openly and without fear.

Nothing safeguards you against addiction — not a loving family, not wealth, not faith, not age, not intelligence, wisdom nor willpower. Addiction can overcome anybody and, once it has you in its steely grip, it can cost you your health, your family, your home, your livelihood and even your life.

Jamie Daniels paid that ultimate price, dead at 23 from an opiate overdose while he was in the midst of a recovery program. His mother, Lisa Daniels of West Bloomfield, has been left “broken,” she says, “and the only thing that will partially repair me is to know that people like Jamie, young people struggling with addiction, get the help they need. They’ve got to be able to speak up and get help without being shunned, without fear of being labeled an addict for the rest of their lives.”

The alternative — silence — only exacerbates the problem. “I didn’t tell anybody,” Daniels says. “None of my friends knew what was going on. None of my family knew. We didn’t share what Jamie was going through. Now it’s time to stop that. If we had, maybe Jamie would be alive today.”

JAMIE’S STORY

Jamie had struggled with an addiction to prescription medication. With great effort, his family worked tirelessly to get him help, but it was always “one step forward, three steps back,” Daniels says.

Lisa Daniels

She and former husband, Detroit Red Wings announcer Ken Daniels, who will be speaking about Jamie at an event March 7 at Temple Israel didn’t learn about his problem with addiction until December of his senior year at Michigan State University. A friend told his sister that Jamie was getting into stronger prescription drugs.

“He didn’t want people to know what he was going through. He was afraid if people knew, they would use it against him, even his peers,” Daniels says.

Unlike the majority of families with an addict, there was no predisposition to the disease in Daniels’ family. “I didn’t know what the signs were but, in hindsight, I realized that from the time he was young, he was often alone and said he felt like he never fit in. Maybe he was depressed. I do know that he suffered from depression for a while before his death.”

She does know that at age16, Jamie gave a self-diagnosis to a therapist as having ADD and asked for Adderall. “He did not have ADD,” Daniels says. “He eventually told me he intentionally answered the questions wrong on the ADD test. It was that easy. He was struggling with something at 16, but Adderall was not the answer; it may have been the beginning of something terrible.”

Jamie continued to take Adderall through college. His family doesn’t know when he turned to opiates. “They were easily obtainable on campus and, by the time he graduated, he couldn’t stop,” she says.

She watched him try to detox himself several times. On three occasions, he was taken to the emergency room during an acute crisis, only to be discharged hours later with no long-term plan. They finally found a therapist Jamie liked, who guided him toward getting the medical help he needed.

During his most difficult crisis to date, Jamie called his therapist who recommended he go directly to the emergency room to be admitted to a 12-day detox program.

The hospital let him out two days early. “From there, they wanted Jamie to move into a sober living facility here in Michigan, but after speaking with Jamie’s therapist, we agreed to send him to a private rehab center in Florida.”

Jamie, still under his father’s health insurance, went to Palm Beach County, Fla., for treatment. He first spent a month at the Beachway Therapy Center, then moved on to a sober living house with a strong reputation in Delray.

He was sober, attended outpatient treatment meetings and eventually got a job working as a law clerk. “At work he was doing well, but, at home on his own, he was depressed,” Daniels says.

Florida has become the nation’s recovery capital with more than 400 sober living homes in Palm Beach County alone. These homes are linked with outpatient treatment programs, doctors and labs. Some owners, realizing there is more money to be made from a relapsed individual with insurance, pay “body brokers” to lure individuals in recovery into specific sober homes with offers of gifts, or in Jamie’s case, rent covered completely by insurance. Jamie had become the victim of “patient brokering.”

Nine days after transferring to this new sober home, Jamie died of a drug overdose.

The Daniels family tried to piece together the last week of Jamie’s life. They learned the doctor this home sent him to had prescribed a new medication for his anxiety, the highly addictive Xanax. “They set him up to fail,” Daniels says.

On. Dec. 7, 2016, just four days after he was prescribed the Xanax, Jamie ingested heroin laced with fentanyl (a synthetic opioid 50 times stronger than heroin). It shocked his heart and killed him. “We don’t know how or when he got the drugs,” Daniels says. “No medications or drugs were found at the scene.”

The Daniels didn’t find out about the corrupt nature of the home Jamie was in until months after his death. However, after speaking with the insurance company and the drug task force detectives, it was determined that most of the charges from two of the three sober homes Jamie lived in were fraudulent.

Daniels estimates that the fraudulent charges to the insurance company were between $55,000 and $60,000. Approximately two weeks after Jamie’s death, they learned the owner of the last house Jamie lived in had been under investigation. Eventually, he was convicted and is now serving 27 years in prison.

Daniels wants others to be aware of this danger in the billion-dollar industry of addiction and let them know it’s not just happening in Florida. “Jamie’s ability for successfully beating his addiction was taken away from him because he was manipulated,” she says.

She adds that addiction did not define the life of her son, however. “He was a beautiful soul: loving, caring and compassionate. He loved and protected his sister, Arlyn. They were the best of friends. He called his Bubbie just to chat and always ended each phone call with ‘love you.’ He would have helped anyone at any time.”

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Clean, Sober and $41,000 Deep in Out-of-Pocket Addiction Recovery Costs

Tess Henry with her rescue dogs, in a photo taken by her mother. Ms. Henry was the subject of a recent Sunday Review essay, which generated over 400 reader comments.
Credit Patricia Mehrmann

People recovering from opioid addiction and their families discuss the financial and emotional costs of treatment.

Tess Henry’s family paid $12,000 for 30 days of rehab from opioid addiction. She had done two more cycles of treatment without achieving sobriety. So her family agreed to pay $20,000 for 28 days of more rehab. But they never got the chance.

A few days after assuring her mother that she planned to fly to Virginia to resume treatment, Ms. Henry was murdered.

The tragic end of Ms. Henry’s six-year struggle to recover from an opioid addiction that began with a prescription for cough syrup was chronicled last week in The New York Times by Beth Macy, a journalist who covers the opioid crisis.

It takes eight years, and four to five attempts at treatment, for the average person addicted to opioids to achieve one year of remission, according to John Kelly, a researcher and professor of psychiatry at Harvard Medical School, whom Ms. Macy cited in her Sunday Review essay.

Some people manage to achieve recovery through free 12-step programs, while others spend hundreds of thousands of dollars.

Ms. Henry’s story prompted readers to share with us in our comments section their own struggles with recovery or the struggles of their family members.

Here is a selection of the comments that cite costs — in out-of-pocket expenses, as well as in time, insurance payouts and human patience — of recovery. They are condensed and lightly edited.

‘I’m lucky it didn’t cost me more’

$25,000 for Suboxone, $16,000 of doctor appointments, $200,000 paid by insurance

I abused opiates for four years. I quit one-time and have been sober for five years. I’ve been on Suboxone [a drug that helps prevent opioid withdrawal symptoms] for five years as well. Luckily I make enough money to spend $400/month on Suboxone. I also moved 1,500 miles away from where I bought OxyContin when I quit, went to a $100,000 rehab on private insurance, and then stayed for 10 more months working as a nighttime janitor and going to A.A. like 10 times a week.

Recovering from opiates has cost me over $25,000 for Suboxone, $16,000 of doctor appointments, and it’s cost my insurance about $200,000. It cost me five years of my life. I’m lucky it didn’t cost me more.

Demi Lovato is Awake, With Family Following Apparent Drug Overdose

Pop star Demi Lovato is recovering in a hospital Wednesday following an apparent drug overdose at her Hollywood Hills home. The 25-year-old has been open about her struggles with drug and alcohol addiction, hinting recently of a relapse in her song “Sober.” A representative for Lovato says she is “awake and with her family.” NBC’s Natalie Morales reports for TODAY.

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Investigation Shows How Florida Sparked U.S. Heroin Crisis

A Palm Beach Post investigation has uncovered Florida’s role in igniting the country’s heroin epidemic in 2011.

The Palm Beach Post traced the origins of the heroin crisis, driving down the “Oxy Express” highways, which users and dealers used to load up on oxycodone pills.

The state’s repeated failure to control its own prescription drug problem would eventually lead to more addicts turning to heroin not only on Florida, but in other states around the country.

WLRN’s Christine DiMattei fills in for Tom Hudson as host of The Florida Roundup. She sat down with Pat Beall, investigative reporter at The Palm Beach Post, to explore the so-called “Oxy Express.”

WLRN: To connect the dots, you and your team traveled to what’s become known as the “Oxy Express.” What is that and where is it exactly?

PAT BEALL: The Oxy Express was the nickname given to a stretch of roadways from South Florida – specifically Palm Beach and Broward Counties – all through the Appalachians. It was an area where people would drive down, van loads of people, load up on drugs here in Palm Beach County through our pill mills and then drive back to the Appalachians and sell or use the same drugs.

There were plenty of people along the way who told you flatly that this story is unprovable. Epidemiologists particularly who were among those that said that available data alone could never definitively prove this oxycodone-to-heroin transition. Much less Florida’s role in this. What was the first tip you got that launched this whole thing? And what was your reaction to that tip?

P.B.: I really wasn’t paying attention. I think that pretty much sums it up. It was in early 2012, and I had been doing a story about online drug sales. In speaking to a couple of treatment counselors locally in Palm Beach County, I was told, Listen the crack down on prescription pills and pill mills isn’t driving people to online drug sales; it’s driving them to heroin. I really couldn’t buy that. I couldn’t buy it because I think I had at that time something of the same skewed perception that people had about who a heroin user would be. And why would anybody who was using pills jump to a street drug? So it took a little time for me to wrap my head around that.

Let’s go back to the pill mill crisis. You’ve traced the beginnings of this problem to the rogue pain management clinics in Florida – back when the pill mills were a thriving business in South Florida. How did they get the prescription meds in the first place?

P.B.: Florida failed to regulate pill mills, and it really went back many years. There was a problem in Florida that was pretty obvious starting in 2002-2003 with prescription pills. Florida just did nothing. Other states adopted prescription-monitoring programs. Other states cracked down on their own pill mill activity and rogue doctors. We didn’t. So that allowed not only pill mills to thrive and illicit opioids to be transported across state lines, it also provided this incredible window of time that gave addiction time to take root and grow.

David Cassidy claimed he didn’t have dementia — he just lied about getting sober

A few weeks before his death in November, David Cassidy confessed that the sudden decline in his health was brought on by alcohol abuse — not dementia, as he previously claimed.

The revelation comes courtesy of A&E Networks, which is airing a two-hour documentary next week originally intended to chronicle the onetime teen idol as he recorded a tribute record to his late father, Jack Cassidy. Instead, David Cassidy fell gravely ill and struggled with what he first said was the onset of dementia.

The truth was just as bad. After becoming ill and being hospitalized during production, Cassidy was told that he had liver disease, which would ultimately become multiple organ failure.

“The head doctor at the hospital, she said, ‘I believe that your dementia was directly related to your alcoholism,’” Cassidy told A&E producer Saralena Weinfield in a taped phone call from a Fort Lauderdale, Fla., hospital.

“I did it to myself, man. I did it to myself, to cover up the sadness and the emptiness,” he said.

Cassidy explained that after a few days where he was unconscious and near death, his memory came back.

“That’s such a blessing,” he told the producer, beginning to laugh as if he were telling a wry joke. “That means I’m cognizant of my surroundings, that I’m alive and it’s daytime and I know what day of the week it is. There is no sign of me having dementia at this stage of my life. It was complete alcohol poisoning. And the fact is, I lied about my drinking.”

After he was arrested for DUI in 2014 — his wife filed for divorce the next week — Cassidy was sentenced to rehab and put on probation. In early February 2017, he told People that he was suffering from dementia and would stop touring to focus on his private life.

The former star of “The Partridge Family” died soon after at age 67 from organ failure, including his liver and kidneys.

Although Their Introductions as Treatment are Different, Two Top Medications for Opioid Addiction are Equally Effective

With opioid addiction officially declared a public health emergency in the U.S., medical intervention to treat the illness is increasingly important in responding to the epidemic. Now, a new study concludes that two of the top medications available for outpatient, office-based treatment, once initiated, are equally safe and effective in curtailing opioid use, relapse, treatment drop-out and overdose.

Researchers in the Departments of Psychiatry and Population Health at NYU School of Medicine, who led the study sponsored by the National Institute on Drug Abuse (NIDA) and published online November 14, 2017 in The Lancet, conclude that extended-release naltrexone (an opioid antagonist marketed as Vivitrol) demonstrated similar safety and clinical effectiveness to more commonly prescribed buprenorphine-naloxone (an opioid agonist marketed both generically and as Suboxone).

However, the study also points out differences that have previously been known: Patients being treated with naltrexone must detoxify before it can be administered. (This is commonly referred to as the “detox hurdle.”) On the other hand, buprenorphine allows individuals to transition relatively seamlessly from opioid use to medication maintenance without needing to detoxify.

Agonist (buprenorphine) and antagonist (naltrexone) treatment are pharmacologically, conceptually and logistically near-opposites — allowing patients, families and providers to choose an approach in line with their goals and preferences. Among the differences:

  • Agonists activate opioid receptors, have opioid-like effects, and maintain physical dependence on opioids, while antagonists have no effects on their own and block the effects of opioids
  • Agonists can be started while a patient is still opioid dependent or detoxifying, but antagonists only can be administered after full detoxification to avoid opioid withdrawals
  • When discontinued, agonists are associated with withdrawal symptoms; antagonists are not
  • Agonists have abuse potential and diversion risks; antagonists do not
  • There are differences in prescribing regulations and community acceptance between the two forms of treatment

Despite these differences, the researchers say, until now there had been no comparative data on the effectiveness of both treatments. “As the epidemic has escalated, and hundreds of people in the U.S. and elsewhere are dying every day, there is an increased urgency to provide immediate and effective medical treatment,” says John Rotrosen, MD, professor in the Department of Psychiatry at NYU School of Medicine and the study’s senior author. “Our findings should dispel some commonly held misconceptions and help patients choose between these different approaches to treatment.”

What the Study Examined

The clinical trial took place from 2014 to 2017 at eight community treatment programs affiliated with NIDA’s Clinical Trials Network across the U.S. The patient cohort involved 570 opioid dependent adults, approximately two-thirds of whom were men and 82% primarily using heroin. They were recruited during admission for detoxification and randomly assigned to two study groups for up to 24 weeks of treatment. One group received a monthly injection of naltrexone initiated after completing detoxification, and the other self-administered a daily oral dose of buprenorphine initiated as early as possible after randomization.

Among those treated, 24-week relapse rates were similar — 52% for naltrexone and 55.6% for buprenorphine, as were other measures of opioid use. In addition, craving for opioids was lower with naltrexone, though by the end of 24 weeks, the buprenorphine group had caught up. Other than mild to moderate injection site reactions with naltrexone, adverse events, including fatal and non-fatal overdoses, were similar across the two study groups.

The study also examined the detox hurdle — a critical point of initiation for active users (though a non-issue for those who are already fully detoxed). Approximately 25% of participants assigned to the naltrexone group were unable to complete detox and get a first dose of naltrexone — though for those assigned to naltrexone later in the detox process, the hurdle wasn’t so insurmountable. In contrast, only 6%, of patients were unable to start buprenorphine.

The study could have immediate implications for how the U.S. responds to a crisis that has already claimed 300,000 lives since 2000, according to the U.S. Centers for Disease Control and Prevention.

“Both medications are effective treatments for opioid use disorders versus counseling-only approaches or compared to placebo,” says Joshua D. Lee, MD, MSc, associate professor in the Departments of Medicine and Population Health at NYU School of Medicine and the study’s lead author. “What is now clear is how similar the outcomes are for those initiating treatment with either medication.”

The researchers also point out that the study sheds light on the likelihood that those dropping out of detox will rapidly relapse. “Patients wanting naltrexone, but who are unable to complete detox,” Lee adds, “should be encouraged to start an agonist-based treatment like buprenorphine.”

A smaller (total cohort of 159 patients) and shorter (up to 12 weeks of treatment) parallel study conducted in Norway over the same period found naltrexone and buprenorphine to be equally effective in retaining patients in treatment and reducing opioid use. However, all participants in that study were randomized late in detox so there was no “hurdle” to clear. Prior to these two studies, the field had no comparative effectiveness data. An earlier multi-site clinical trial led by NYU School of Medicine found in 2016 that extended-release Naltrexone was effective at preventing opioid relapse in criminal justice offenders.

Opioid Epidemic Leaving grandparents to Raise Grandchildren

A million children now live with their grandparents primarily due to their parents’ addictions, increasingly because of opioids.

The growing opioid crisis has been declared a public health emergency. It’s sparked a parallel crisis you rarely hear about: the impact on children neglected by addicted parents. More than one million American children now live with grandparents, primarily because of their parent’s addiction to opioids and other drugs: heroin, crack, meth and alcohol. Grandparents are putting off retirement and plowing through savings to rescue their grandchildren from dangerous situations.

To see how widespread this is, we went to one of the healthiest states in the country, Utah. Tonight, we’ll introduce you to a few families around Salt Lake City, and meet children, raised in the wreckage of the opioid crisis, getting a chance at a normal life.

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The Controlled Substances Bill is Florida’s response to opioid abuse.

This website provides basic information pertaining to CS/CS/HB 21, the Controlled Substances Bill, and the upcoming changes for prescribers and dispensers. Signed by the Governor on March 19, 2018 with an effective date of July 1, 2018, the law addresses opioid abuse by establishing prescribing limits, requiring continuing education on controlled substance prescribing, expanding required use of Florida’s Prescription Drug Monitoring Program, EFORCSE, and more.

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