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Have You Ever Stepped on a Nail?


Ask people if they’ve ever stepped on a nail and most will say yes. It can happen to anyone, although the odds go up when lots of boards with nails in them are lying around and people are not paying attention. No one wants or expects to step on a nail. It’s a no-fault wound. Addiction is more likely to develop when lots of addictive substances are within easy reach and people are not paying attention. Some people are more susceptible than others, but it can happen to anyone. No one wants or expects to develop addiction. It’s another no-fault wound. Concern and individualized assistance are appropriate responses to no-fault wounds. Blame and judgment are not. Our responses to people with addiction ought to be like our responses to people who step on a nail. We might begin by expressing concern for the injured person and then proceed to administer the...

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Fuel the Recovery of Others—with Acceptance and Accountability


After looking the other way for far too long, people and institutions in the United States are starting to face addiction. Respect for individuals in active addiction and resources to assist them into recovery are gradually becoming the norm. Previous Addiction Medicine Updates have identified two core responsibilities, stated as calls to action, that most individuals in active addiction need to adopt in order to achieve lasting recovery. Keep Your Distance! advocates modifying routines and lifestyles to minimize the risk of resuming substance use. Ask for Help! advocates repairing and creating relationships based on honesty and mutual respect. The latest neuroscience, as well as decades of practical experience, support the relevance of these actions, which I call The Two Pillars of Recovery®. But what about everyone else? What about all those who live with, care for, and work beside people in active addiction? What actions should family, friends, healthcare providers, and...

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All About Medications for Opioid Use Disorder—In One Place


In the face of our national opioid crisis communities across the United States are taking notice and taking action. They’re proactively addressing opioid misuse, opioid addiction, and overdose deaths by distributing naloxone nasal injectors to counteract overdoses, contriving ways to move individuals treated for overdoses directly into treatment, and making treatment for opioid use disorder (OUD) more accessible. Treatment for OUD has several potential components, one of which is use of three FDA-approved OUD medications: Methadone, buprenorphine, and naltrexone. Use of medication to treat opioid addiction has been controversial since the 1960s when methadone was first shown to help individuals addicted to heroin. But controversy is being replaced with acceptance as OUD medications are increasingly recognized as a potent tool to combat the opioid crisis. Treatment Improvement Protocol (TIP) 63 released by the Substance Abuse and Mental Health Services Administration (SAMHSA) in February 2018, Medications for Opioid Use Disorder, is an...

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FDA Calls on Online Companies to Police Opioid Sales


Food and Drug Administration (FDA) Commissioner Scott Gottlieb this week called on Internet service providers and social media companies to more carefully monitor online sales of opioids. “We find offers to purchase opioids all over social media and the Internet, including Twitter, Facebook, Instagram, Reddit, Google, Yahoo and Bing,” Gottlieb said at the National Rx Drug Abuse and Heroin Summit in Atlanta. Many illicit drugs that enter the U.S. are bought and sold online, including drugs laced with fentanyl, he said. Gottlieb plans to meet with leaders of Internet companies and advocacy groups “to identify technology gaps and new solutions,” The Wall Street Journal reports. Such solutions might include search algorithms to alert potential buyers about treatment programs and the deadly risks of opioids.

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FDA to Host Meeting on Patient-Focused Drug Development for Opioid Use Disorder


The Food and Drug Administration (FDA) will host a public meeting April 17 on patient-focused drug development for opioid use disorder (OUD), in collaboration with the National Institute on Drug Abuse. The FDA is also working closely with patient advocacy and community organizations to encourage participation from people with OUD. The FDA is interested in learning patients’ perspectives on OUD, including the effects on their health and well-being that have the greatest impact on daily life, their experience using prescription medical treatments and other treatments or therapies for OUD, and challenges or barriers to accessing or using medical treatments for the disorder. The meeting will take place at FDA White Oak Campus, 10903 New Hampshire Ave., Building 31, Room 1503A (Great Room), Silver Spring, Maryland, from 10 a.m. to 4 p.m.

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Schools Confront Sudden Increase in Easily Concealed Vaping Devices


Middle schools and high schools are struggling to cope with a sudden increase in students using easily concealed vaping devices called Juul, which resembles a flash drive. Officials at schools across the country say they are concerned these devices are creating a new generation of young people addicted to nicotine, The New York Times reports. Pods in vaping devices have a higher concentration of nicotine than do individual cigarettes, the article notes. Vaping devices come in flavors such as fruit or mint. Because they don’t produce a noticeable plume of smoke, some students use them in class. “I’m afraid that we’re going to be hooking a new generation of kids on nicotine, with potentially unknown risks,” said Dr. Mark L. Rubinstein, a professor of pediatrics at the University of California, San Francisco. “With cigarettes, we’ve been studying them for many years, we have a pretty good idea of what the risks...

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Nerve Pain Medication Gabapentin Linked With Increasing Overdose Deaths


Public health officials say the nerve pain medication gabapentin is being found in an increasing number of overdose deaths, according to CBS News. Gabapentin is a non-narcotic drug used to treat seizures and pain associated with shingles. Doctors have been prescribing it for a growing number of other conditions, as a way to offer pain relief without opioids. A study published last year found that for people who use heroin, the combination of opioids with gabapentin potentially increases the risk of overdose death. “Unfortunately, we now need to worry about it because people are abusing it,” Dr. James Patrick Murphy, a pain and addiction specialist in Kentucky, told the Louisville Courier-Journal. “Alone, it’s not something that will stop your breathing or your heart,” he said. “But if you take it along with a drug like heroin or fentanyl, together it might be enough to make you stop breathing and put you...

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More Americans Should Carry Naloxone: Surgeon General


U.S. Surgeon General Jerome Adams released a public health advisory Thursday urging more Americans to carry the opioid overdose antidote naloxone, NPR reports. Naloxone is already carried by many first responders, such as EMTs and police officers. The Surgeon General is recommending that more people, including people at risk for an opioid overdose, as well as their family and friends, also keep naloxone nearby. “For patients currently taking high doses of opioids as prescribed for pain, individuals misusing prescription opioids, individuals using illicit opioids such as heroin or fentanyl, health care practitioners, family and friends of people who have an opioid use disorder, and community members who come into contact with people at risk for opioid overdose, knowing how to use naloxone and keeping it within reach can save a life,” he said in a statement.

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NIH Announces the HEAL Initiative


In April 2018, NIH launched the HEAL (Helping to End Addiction Long-term) Initiative, an aggressive, trans-agency effort to speed scientific solutions to stem the national opioid public health crisis. This Initiative will build on extensive, well-established NIH research, including basic science of the complex neurological pathways involved in pain and addiction, implementation science to develop and test treatment models, and research to integrate behavioral interventions with Medication-Assisted Treatment (MAT) for opioid use disorder (OUD). Successes from this research include the development of the nasal form of naloxone, the most commonly used nasal spray for reversing opioid overdose, the development of buprenorphine for the treatment of opioid use disorder, and evidence for the use of nondrug and mind/body techniques such as yoga, tai chi, acupuncture, and mindfulness meditation to help patients control and manage pain. Over the past year, NIH has worked with experts from public and private organizations to identify the...

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Opioid Overdoses Clustered in Poor Areas With Few Job Opportunities


Opioid overdoses are clustered in poor areas with few job opportunities, according to a new study. Researchers found the opioid overdose death rate varied widely by county. Rates were highest in poorer counties and those with high levels of family distress, as well as areas dependent on mining. Some rural counties, especially in Appalachia, have the highest opioid overdose death rates in the nation, the study found. “The drug epidemic is a pressing concern among policymakers, but the media portrayal of the drug overdose epidemic has largely been that it is a national crisis, with the common refrain that ‘addiction does not discriminate,'” lead author Shannon Monnat of Syracuse University in New York told HealthDay. “Failure to consider the substantial geographic variation in drug-related mortality rates may lead to failure to target the hardest-hit areas.” The findings are published in the American Journal of Preventive Medicine.

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