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.

READ MORE

 

Woman lost 2 sons in one night to opioids; fighting the crisis is now her life’s work

Everything just kind of seemed like a blur that day,” Becky Savage said. “Your mind is not really meant to process something that extreme.” The day Savage is describing is June 14, 2015.

The Indiana mom’s two oldest sons, Nick and Jack, were celebrating at high school graduation parties the night before. The boys came home about 12:30 a.m. and checked in with their mom, who had been waiting up.

The next morning, as Savage was picking up laundry in Jack’s room, she noticed that he wasn’t stirring as she tried to wake him.
“He was unresponsive. I called 911, and I remember hollering for Nick, for him to come up, and how he never came.”

Nick, her eldest son, was downstairs sleeping in the basement with friends.

The first responders arrived and tried to resuscitate Jack, and then Savage noticed one of them going downstairs to the basement.

“I had no idea at that point what they were doing in our basement. And then I remember one of them coming up and asking for a coroner. That’s the last thing that I remember that day.”

WATCH THE VIDEO

Worried about your alcohol consumption? Sober moms share their advice

If you think alcohol may be affecting your life or serving as a crutch, it’s time to get curious about your behavior. That’s one of several tips from three women who decided to stop drinking. “I want the women who are watching to know that we are never alone. There needs to be no shame attached to this,” mother and psychotherapist Kelley Kitley told Megyn Kelly.

WATCH THE VIDEO

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.

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.

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!”

 

 

 

 

 

 

CVS Limits Opioid Prescriptions to 7 Days

(CNN) In a new effort to tackle the deadly opioid addiction crisis in the United States, pharmacy giant CVS announced Friday that it will limit opioid prescriptions to seven days for certain conditions. This restriction will apply to patients who are new to pain therapy.

The new pharmacy program will also limit the daily dosage of pain pills based on their strength and will require use of immediate-release formulations before extended-release opioids — intended for severe, long-term pain treatment — are dispensed. The changes will roll out February 1 and cover all commercial, health plan, employer and Medicaid clients.

CVS, which manages medications for nearly 90 million plan members, is one of the largest pharmaceutical chains in the US, with approximately 9,600 CVS Pharmacy stores and more than 1,100 walk-in medical clinics.

“With a presence in nearly 10,000 communities across the country, we see firsthand the impact of the alarming and rapidly growing epidemic of opioid addiction and misuse,” said Larry J. Merlo, president and CEO of CVS Health.

Sales of prescription opioids quadruple from 1999 to 2014

From 1999 to 2014, sales of prescription opioids in the US almost quadrupled, according to the US Centers for Disease Control and Prevention, yet there has been no change in pain reported by Americans.

CVS said its pharmacists will counsel patients with opioid prescriptions about the risk of dependence and addiction based on CDC guidelines. These educational sessions will also emphasize the importance of keeping medications secure in the home and proper disposal of unused medications.
To help patients wanting to follow these guidelines, the company will almost double the number of drug disposal units in its Medication Disposal for Safer Communities Program from 800 to 1,550 kiosks. This expansion will begin this fall with locations in Florida, Massachusetts, North Carolina, Pennsylvania, South Carolina and the District of Columbia.

These moves put CVS’s pharmacy program more in line with the CDC’s opioid prescribing guidelines. Express Scripts, the country’s largest pharmacy benefits manager, has similar limits in place.

An ‘impactful’ move?

“I think it’s going to be helpful. I think it’s going to be impactful,” said Dr. Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing, who saw the announcement as more than a public relations move. “It will be expensive. … This will be a real administrative burden” for CVS, he said.
Studies have found that longer prescription durations, as well as higher dosages, increase the likelihood of chronic use. CVS’s steps are meant to curb not just potential long-term opioid use but also potential opioid misuse.

“There are millions of prescription bottles sitting in our bathroom cabinets and on our bedroom nightstands right now, including far too many prescription opioids that ultimately are used non-medically,” said Dr. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness.

“We’ve been watching the epidemic get worse, hidden in plain sight, for far too long, and these types of policies are necessary to reduce the incredible oversupply of prescription opioids,” Alexander said.

Balancing patients’ needs

The American Academy of Pain Medicine “supports any initiative that would help limit the effects of over prescribing medications or leading to excessive unused medicines that could lead to harm to a patient or family members or their community,” said Dr. Steven Stanos, president of the academy.

Stanos worries that CVS’s recommendations could be interpreted too rigidly and affect patients. “We would want it to balance the needs of the patient and doesn’t intrude on the relationship between the patient and the physician and how they made that decision,” Stanos said.

It’s a sentiment echoed by Dr. Patrice Harris, chairwoman of the American Medical Association’s opioids task force. “When patients seek physician help for an opioid use disorder — or need comprehensive care for chronic pain — one-size-fits-all limits, such as blanket prior authorization protocols, may cause delays in care that could severely harm patients,” she said.

CVS said its guidelines are flexible and recognize that there maybe situations that require more than a seven-day prescription or a higher-dose opioid. For times like those, physicians will be able to seek exceptions.

CVS is also committing $2 million to federally qualified community health centers that provide medication-assisted treatment and other addiction recovery services.

The President’s opioid commission says that about 142 Americans die every day from a drug overdose, equal to the death toll from the September 11 attacks every three weeks. Most of those overdoses are from opioids.

Though there were over 30,000 fatal overdoses from opioid drugs in 2015, public health experts believe that for every fatal overdose, there are 30 non-fatal overdoses. That would mean over 900,000 overdoses in 2015 alone.

According to the CDC, drug overdoses are the leading cause of unintentional death in the US.

Faces of an Epidemic: Stories of the Victims of America’s Opioid Crisis

Faces of an Epidemic: Stories of the Victims of America’s Opioid Crisis — and the Fight to Save Lives

By @stevehelling and

Jack and Hunt Freeman were Texas brothers with a lot going for them. Hunt, 26, was a charismatic salesman at a Harley Davidson shop; Jack, 29, worked as a golf assistant at an upscale country club.

But the two also liked to party with alcohol and recreational drugs — first using marijuana and cocaine in high school and, later, moving on to heroin.

The brothers entered rehab multiple times, but neither could stay clean for long. On Valentine’s Day, Hunt fatally overdosed, sending Jack into a drug-fueled tailspin.

Three months later he overdosed, too.

“I wouldn’t want anyone to go through what we’ve been through,” their mother, Kim Freeman, tells PEOPLE in this week’s issue in a special report on the opioid crisis in America.

“To lose two children,” Freeman says, “is unimaginable.”

Heroin and other opioids are claiming lives throughout the U.S. at a staggering rate. According to the Centers for Disease Control, drug overdoses now kill more Americans than either guns or car accidents: 52,000 in 2015 alone, the most recent year for which statistics are available.

One person dies of an overdose every 10 minutes.

The vast majority of those deaths, approximately 80 percent, have taken place in white communities. Experts suggest this is in part because white Americans generally have better access to health care and are more likely to be prescribed narcotics, and research shows that four in five heroin users first abused prescription pills.

People become addicted to drugs such as OxyContin, Percocet and Vicodin while being treated for a medical condition and then seek out more pills — or heroin — on the street when their prescription runs out.

“This problem of addiction truly does start in the medicine cabinet,” Russ Baer, a special agent for the Drug Enforcement Administration, tells PEOPLE. “It starts with the misuse and abuse of prescription opioid painkillers.”

A few of the people who overdosed on opioids in America (left to right, starting from top left): Katie Golden, 17; Garrett Moody, 27; Alison Collins, 22; Clyde Henderson, 62; Jacklyn Mastromauro, 29; Robert Mapps, 22; William Godwin II, 47; Samantha Roser, 23; Wolf Schinzel Sr., 47; Analicia Sutherland, 21; Ethan Beck, 26; Constance Crawford, 24; Ashley Nunnally, 26; Richard Cosner, 30; Celeste Tumminello, 25; Bryan Clay, 27; Jessica Caruso, 36 and Jack Freeman, 29.

What addiction is not, according to one retired police commander, is “a character flaw.”

The death rate from overdoses of heroin and prescription painkillers has more than quadrupled since 1999, prompting thousands of Americans to take action, including Philadelphia librarian Chera Kowalski and Stop the Heroin co-founder Bill Schmincke.

Kowalski, 33, was raised by parents who faced their own struggles with heroin. After witnessing an overdose on library property, she was trained, along with 25 other staffers, to administer Narcan, a nasal spray used for the emergency treatment of opioid overdoses.

In the past year she says she has saved six lives — providing six more chances for recovery.

“Once we can tell the Narcan works, there’s a huge sense of relief,” she says. “It provides me with hope that if they live, they have the opportunity to seek treatment, because long-term recovery is possible.”

Schmincke, 52, of Egg Harbor Township, New Jersey, began the nonprofit Stop the Heroin with his wife, Tammy, after watching son Steven spiral from occasional marijuana use into a severe opioid addiction that landed him in rehab several times.

“He was a good kid; the drugs just got him,” Schmincke says.

“We’re about awareness now,” he says of their organization, which helps people transition from rehab to sober living. “We’d like to bring light to people who don’t understand addiction. They think these people out there are junkies and drug addicts, which they’re not. They’re in the grasp of a demon.”