Sad Story Illustrates the Opioid Overdose Epidemic in the USA

This sad story illustrates the cost of the ongoing opioid overdose epidemic in the USA.

A 7-year-old told her bus driver she couldn’t wake her parents. Police found them dead at home.

For more than a day, the 7-year-old girl had been trying to wake her parents.

Dutifully, she got dressed in their apartment outside Pittsburgh on Monday morning and went to school, keeping her worries to herself. But on the bus ride home, McKeesport, Pa., police say, she told the driver she’d been unable to rouse the adults in her house.

Inside the home, authorities found the bodies of Christopher Dilly, 26, and Jessica Lally, 25, dead of suspected drug overdoses, according to police.

Also inside the home were three other children — 5, 3 and nine months old.

Speaking before the state legislature last week in Harrisburg, Gov. Tom Wolf (D) told lawmakers that the opioid epidemic facing Pennsylvania is “a public health crisis, the likes of which we have not before seen. Every day, we lose 10 Pennsylvanians to the disease of addiction.

Nationwide, opioids such as heroin and prescription pain relievers killed more than 28,000 people in 2014, more than any year on record, according to the Centers for Disease Control and Prevention. At least half of all opioid overdose deaths involved a prescription drug, the CDC said, adding that the number of overdose deaths involving opioids has nearly quadrupled nationwide since 1999.

The couple’s 7-year-old daughter asked the officer to sign her homework so she could turn it in at school the next day.

“That broke my heart,” Burton said. “She said, ‘I did my work.’ She pulled it out and showed it to us. It was math homework, (like) ‘Which number is greater? Which number is odd or even?’ … I told her, ‘Sweetie, you probably won’t have to go to school tomorrow. … But where you’re going is going to have everything you need.'”

The human cost of the ongoing epidemic of abuse of prescription and illegal opioids is hard to fathom. Addressing these challenges is not easy but stories like this should remind us how important it is for us to take on the task.

Related: President Obama Proposes $1.1 Billion in New Funding to Address the Prescription Opioid Abuse and Heroin Use Epidemic (Feb 2016)Heroin Use Spikes Among Those Who Abuse Prescription Painkillers (2015)Funding Drug Addiction Treatment Would Cost 1/7 the Cost of the Current Criminal System Focused Policy

The War on Drugs has been a Huge Failure with Massive Unintended Consequences

This webcast takes a look at our experience with the so-called “war on drugs.” The war on drugs has been a huge failure with massive unintended consequences. Policy needs to take into account results. We have some minor attempts to do this but overall the war on drugs has led to increasing damage as we increase the war without considering the results.

Related: Funding Drug Addiction Treatment Would Cost 1/7 the Cost of the Current Criminal System Focused PolicyReducing Harm Due to Drug Use Should be the Aim, Not WarDrug Treatment Funding Can More Than Pay For Itself With Reduced Crime Costs

President Obama Proposes $1.1 Billion in New Funding to Address the Prescription Opioid Abuse and Heroin Use Epidemic

President Obama’s Budget includes new mandatory funding to help ensure that all Americans who want treatment can get the help they need. I have posted the whole press release because if I link to it, the link will break with the next president (

Prescription drug abuse and heroin use have taken a heartbreaking toll on too many Americans and their families, while straining resources of law enforcement and treatment programs. More Americans now die every year from drug overdoses than they do in motor vehicle crashes. New data from the Centers for Disease Control and Prevention (CDC) show that opioids—a class of drugs that include prescription pain medications and heroin—were involved in 28,648 deaths in 2014. In particular, CDC found a continued sharp increase in heroin-involved deaths and an emerging increase in deaths involving synthetic opioids, such as fentanyl.

The President has made clear that addressing the opioid overdose epidemic is a priority for his Administration and has highlighted tools that are effective in reducing drug use and overdose, like evidence-based prevention programs, prescription drug monitoring, prescription drug take-back events, medication-assisted treatment and the overdose reversal drug naloxone. Under the Affordable Care Act, substance use disorder services are essential health benefits that are required to be covered by health plans in the Health Insurance Marketplace. The law also required that covered substance use disorder benefits are comparable to medical and surgical benefits.

The President’s FY 2017 Budget takes a two-pronged approach to address this epidemic. First, it includes $1 billion in new mandatory funding over two years to expand access to treatment for prescription drug abuse and heroin use. This funding will boost efforts to help individuals with an opioid use disorder seek treatment, successfully complete treatment, and sustain recovery. This funding includes:

  • $920 million to support cooperative agreements with States to expand access to medication-assisted treatment for opioid use disorders. States will receive funds based on the severity of the epidemic and on the strength of their strategy to respond to it. States can use these funds to expand treatment capacity and make services more affordable.
  • $50 million in National Health Service Corps funding to expand access to substance use treatment providers. This funding will help support approximately 700 providers able to provide substance use disorder treatment services, including medication-assisted treatment, in areas across the country most in need of behavioral health providers.
  • $30 million to evaluate the effectiveness of treatment programs employing medication-assisted treatment under real-world conditions and help identify opportunities to improve treatment for patients with opioid use disorders.

This investment, combined with other efforts underway to reduce barriers to treatment for substance use disorders, will help ensure that every American who wants treatment can access it and get the help they need.

Second, the President’s Budget includes approximately $500 million — an increase of more than $90 million — to continue and build on current efforts across the Departments of Justice (DOJ) and Health and Human Services (HHS) to expand state-level prescription drug overdose prevention strategies, increase the availability of medication-assisted treatment programs, improve access to the overdose-reversal drug naloxone, and support targeted enforcement activities. A portion of this funding is directed specifically to rural areas, where rates of overdose and opioid use are particularly high. To help further expand access to treatment, the Budget includes an HHS pilot project for nurse practitioners and physician assistants to prescribe buprenorphine for opioid use disorder treatment, where allowed by state law.

Building on Actions to Address the Opioid Epidemic

In October 2015, the President announced a number of new public and private sector actions to address this issue, including a Presidential Memorandum on prescriber training and opioid use disorder treatment. He also announced a commitment by more than 40 provider groups that more than 540,000 health care providers will complete training on appropriate opioid prescribing in the next two years. After just over three months, these groups reported that more than 66,000 providers have completed prescriber training to date, putting them on target to meet their goal.

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Cocaine addiction: Scientists discover ‘back door’ into the brain

Individuals addicted to cocaine may have difficulty in controlling their addiction because of a previously-unknown ‘back door’ into the brain, circumventing their self-control, suggests a new study led by the University of Cambridge.

A second study from the team suggests that a drug used to treat paracetamol overdose may be able to help individuals who want to break their addiction and stop their damaging cocaine seeking habits.

Although both studies were carried out in rats, the researchers believe the findings will be relevant to humans.

Cocaine is a stimulant drug that can lead to addiction when taken repeatedly. Quitting can be extremely difficult for some people: around four in ten individuals who relapse report having experienced a craving for the drug – however, this means that six out of ten people have relapsed for reasons other than ‘needing’ the drug.

“Most people who use cocaine do so initially in search of a hedonic ‘high’,” explains Dr David Belin from the Department of Pharmacology at the University of Cambridge. “In some individuals, though, frequent use leads to addiction, where use of the drug is no longer voluntary, but ultimately becomes a compulsion. We wanted to understand why this should be the case.”

Drug-taking causes a release in the brain of the chemical dopamine, which helps provide the ‘high’ experienced by the user. Initially the drug taking is volitional – in other words, it is the individual’s choice to take the drug – but over time, this becomes habitual, beyond their control.

Previous research by Professor Barry Everitt from the Department of Psychology at Cambridge showed that when rats were allowed to self-administer cocaine, dopamine-related activity occurred initially in an area of the brain known as the nucleus accumbens, which plays a significant role driving ‘goal-directed’ behaviour, as the rats sought out the drug. However, if the rats were given cocaine over an extended period, this activity transferred to the dorsolateral striatum, which plays an important role in habitual behaviour, suggesting that the rats were no longer in control, but rather were responding automatically, having developed a drug-taking habit.

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Almost everything we think we know about addiction is wrong

Almost everything we think we know about addiction is wrong.

Addiction is just one symptom of the crisis of disconnection that is happening all around us.

The opposite of addiction is not sobriety. The opposite of addiction is connection.

In the video they talk about one of the things we posted about earlier (in The Causes of Drug Addiction are Complex): the conditions of addiction expedients that form the basis of our understanding are questionable.

The claim made in the video is that psychology is much more the cause of addiction than chemistry. There certainly is plenty of evidence suggesting psychology is very important.

The video makes the claim it is largely about a “crisis of disconnection.” That if we don’t make strong interpersonal connections we will seek solace in the form of something that distracts us (drugs or something else).

These ideas are explored further in Johann Hari’s book about drugs and addiction: Chasing the Scream.

Related: Drug Addictions Often Disappear Over Time, even without treatmentMethods to Treat AddictionFunding Drug Addiction Treatment Would Cost 1/7 the Cost of the Current Criminal System Focused PolicyCombination Strategy to Treat Alcohol Dependence

Drug Addictions Often Disappear Over Time

This article includes links to many research studies, some linked to below, for the rest go to the full article.

Most People With Addiction Simply Grow Out of It by Maia Szalavitz

By age 35, half of all people who qualified for active alcoholism or addiction diagnoses during their teens and 20s no longer do.

The average cocaine addiction lasts four years, the average marijuana addiction lasts six years, and the average alcohol addiction is resolved within 15 years. Heroin addictions tend to last as long as alcoholism, but prescription opioid problems, on average, last five years. In these large samples, which are drawn from the general population, only a quarter of people who recover have ever sought assistance in doing so (including via 12-step programs). This actually makes addictions the psychiatric disorder with the highest odds of recovery.

If you start drinking or taking drugs with peers before age 18, you have a 25% chance of becoming addicted, but if your use starts later, the odds drop to 4%. Very few people without a prior history of addiction get hooked later in life, even if they are exposed to drugs like opioid painkillers.

These results can give people hope when they, or loved ones, are suffering from an addiction. Treatment helps sometimes but also fails quite often. Even in the case where things are not looking good, there is hope that eventually things may run there course.

Of course, there is a risk, sadly, that before the addiction ends tragedy will strike. So hopefully we can keep researching methods to better treat addiction. But if things are failing (especially for one you love) there may be light at the end of the dark tunnel.

Related: The Success Rate of AA is Only 5-10%How Effective is Drug Addiction Treatment?What Does the Evidence of Treating Alcoholism Show?Combination Strategy to Treat Alcohol Dependence

The Success Rate of AA is Only 5-10%

The treatment of drug addiction continues to be difficult. Even finding data on success rates is hard. And analyzing that data is difficult (the data is not straight forward and leaves open many possible questions or criticisms). This study calls into question the effectiveness of a 12-step recovery method to treat addiction.

With Sobering Science, Doctor Debunks 12-Step Recovery

There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent. Most people don’t seem to know that because it’s not widely publicized. … There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine.

It’s not only that AA has a 5 to 10 percent success rate; if it was successful and was neutral the rest of the time, we’d say OK. But it’s harmful to the 90 percent who don’t do well. And it’s harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. AA is never wrong, according to AA. If you fail in AA, it’s you that’s failed.

The reason that the 5 to 10 percent do well in AA actually doesn’t have to do with the 12 steps themselves, it has to do with the camaraderie. It’s a supportive organization with people who are on the whole kind to you and it gives you a structure. Some people can make a lot of use of that. And to its credit, AA describes itself as a brotherhood, rather than a treatment.

image of the Sober Truth book cover

Dr. Lance Dodes has written a book looking at the data behind the results of AA. The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.

Related: Looking at the Evidence of Treating AlcoholismHow Effective is Drug Addiction Treatment?, NIH studyImproving Addiction Treatment with The University of Wisconsin, MadisonMethods Used to Treat Addiction

The Death of Philip Seymour Hoffman Highlights the Increased Use of Heroin

We lost a great actor with the death of Philip Seymour Hoffman. Once again the danger of drug use has resulted in the loss of life. He sought treatment for his addiction but failed to avoid an untimely death.

photo of Philip Seymour Hoffman by Jean Jacques Georges

Philip Seymour Hoffman at the Paris premiere of The Ides of March in 2011 by photo by Jean Jacques Georges

Hoffman death puts focus on heroin’s comeback

Hoffman, 46, was found on the bathroom floor of his New York City apartment with a syringe in his left arm and glassine bags usually associated with heroin. Police say they are investigating substances found in the apartment to determine which drugs were present, but Hoffman has been open about his drug use, which included prescription pills and heroin, and his decades-long struggle to stay sober.

As authorities crack down on clinics that prescribe pain pills by the thousands and pharmaceutical companies change their formulas so the pills are more difficult to abuse, opiate addicts are turning to cheaper and more-plentiful heroin.

In recent years, the number of people abusing prescription pain pills has dropped steadily as heroin use increased. The number of people 12 and older who regularly abuse OxyContin dropped from 566,000 in 2010 to 358,000 in 2012, the National Survey on Drug Use and Health reported in December. The number of regular heroin users soared from 239,000 in 2010 to 335,000 in 2012, the survey found.

The tragedy caused by the abuse of drugs damages millions every day. We have to do a better job of reducing the damage done to society due to the abuse of drugs. Celebrities shine a light on the problem but it is a widespread problem that has an immense impact throughout society.

Related: Russell brand’s testimony on dealing with drug addictionPrescription painkillers kill more every year in usa than heroin and cocaine combined Eminem’s ‘relapse’ explores his drug addition and rehabilitation

The Causes of Drug Addiction are Complex

image of comic panels from rat addiction experiment

Comic panels, by Stuart McMillen, of the rat park drug addiction experiment, see the full comic.

The causes of drug addiction are not simple. Like many medical issues they are a complex interaction of factors.

Drug addiction: The complex truth by Tom Stafford

Many studies have shown rats and monkeys will neglect food and drink in favour of pressing levers to obtain morphine (the lab form of heroin). With the right experimental set up, some rats will self-administer drugs until they die. At first glance it looks like a simple case of the laboratory animals losing control of their actions to the drugs they need. It’s easy to see in this a frightening scientific fable about the power of these drugs to rob us of our free will.

But there is more to the real scientific story, even if it isn’t widely talked about. The results of a set of little-known experiments carried out more than 30 years ago paint a very different picture, and illustrate how easy it is for neuroscience to be twisted to pander to popular anxieties. The vital missing evidence is a series of studies carried out in the late 1970s in what has become known as “Rat Park”. Canadian psychologist Bruce Alexander, at the Simon Fraser University in British Columbia, Canada, suspected that the preference of rats to morphine over water in previous experiments might be affected by their housing conditions.

Rats are smart, social creatures. Living in a small cage on their own is a form of sensory deprivation. Rat Park was what neuroscientists would call an enriched environment, or – if you prefer to look at it this way – a non-deprived one. In Alexander’s tests, rats reared in cages drank as much as 20 times more morphine than those brought up in Rat Park.

As the article notes more research is needed, but there should be more research into the importance of social environment on drug abuse and drug abuse treatment.

Related: Methods to treat addictionHow effective is drug addiction treatment in the USA?Prescription drug abuse in the USALooking at the evidence of treating alcoholism

What Should Society Do About Drug Addicts That Are Not Seeking Treatment?

What to do about drug addicts that are not interested in treatment (yet?) is open to debate. Strict law enforcement would say that the government shouldn’t provide any support to those that are taking illegal action (taking drugs they can’t legally take). And that argument makes some sense. The biggest problem with it is the results of such policies have not been very effective. Society suffers. Should society suffer because taking action to reduce burdens on society can be seen as taking it easy on criminals?

Denmark offers rooms monitored by nurses for drug addicts to use, and crime seems to have been reduced:

Year on year, burglaries in the wider area are down by about 3%, theft from vehicles and violence down about 5%, and possession of weapons also down. “From the police perspective, I can see the benefits,” said Orye. “It feels calmer.”

Critics say that such rooms make it easier for drug users to abuse themselves and send the wrong message. Only five people using Copenhagen’s room have been put on treatment since October.

Petersen, like many others using the room or floating around the courtyard outside, said that she does not want and would never seek treatment. But every day that she comes here to inject she meets health professionals, social workers and people offering treatment in case she suddenly want to rise from rock bottom, say the room’s staff. Petersen might change her mind one day, said Nanna Gotfredsen, a lawyer who campaigned for the room.

Michael Olsen, a local resident who was a key figure in persuading authorities to accept the idea of a consumption room, said that he felt moved to champion the cause when he found addicts taking drugs in his bins, and women urinating in a phone box because all the toilets in the area had been sealed to stop addicts injecting there.

The best strategies for society are not obvious. The last 50 years have not been a very successful period for society dealing with the problems caused by drug addiction. Hopefully we can experiment and find solutions that are better.

I do think we have moved toward more support for treatment for those seeking help to overcome drug addiction and to stay clean. Moving more in that direction seems wise to me.

Related: UK Drug Policy Commission Recommends Decriminalizing Drug UseRussell Brand’s Testimony on Dealing with Drug AddictionHow Effective is Drug Addiction Treatment?2012 National Drug Control Strategy for the USA