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This Week's News in Substance Use: 1/19/18

The Wrong Way to Treat Opioid Addiction, The New York Times

“Because methadone and buprenorphine are opioids themselves, it’s easy to assume that using them is 'substituting one addiction for another.' However, the pattern of taking the same dose every day at the same time means that there is no high or intoxication. Patients on maintenance doses are able to nurture a baby, drive, work and be a loving spouse.

In these patients, addiction is replaced by physical dependence. And that’s not a problem for those who have health care coverage: It’s no different from needing antidepressants or insulin. When a drug’s benefits outweigh its risks, continued use is healthy, not addictive.”

To Reduce the Risk of Opioid Addiction, Study Suggests Higher Doses but Fewer Refills, The Los Angeles Times

“It may sound counterintuitive, but providing more pain relief to patients right away might allow them to stop taking the pills sooner. And reducing the total amount of time that patients are on opioids could ultimately reduce the risk of addiction and [misuse], new research suggests.

A study published Wednesday in the BMJ finds that for every additional week a patient takes drugs like oxycodone and hydrocodone, the chance that he or she will wind up abusing the drug increases by 20%. And every time a prescription for opioid painkillers is refilled, the risk of [misuse] rises by 44%.”

Walmart Offers Product to Destroy Leftover Opioids, But Critics Say It's Unnecessary, NPR

“On Wednesday the chain rolled out a pharmacy product it says provides a safe way to get rid of extra prescription opioid drugs. It's called DisposeRx and when mixed with warm water it turns any form of opioid drug — including powders, pills, tablets, capsules, liquids or patches — into a biodegradable gel that can't be separated or converted back into a usable drug…

Dr. Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University, agrees that leftover pills do contribute to the spread of addiction but he says products like DisposeRx are unnecessary because the CDC already encourages anyone who's at the end of a prescription opioid treatment to "flush them down the toilet." No special ingredients necessary.”

Senate Republicans Are Trying to Blame Medicaid for the Opioid Epidemic, Vox

“The basic argument: Medicaid, particularly through the Obamacare-funded expansion, gave patients greater access to opioid painkillers — by linking them to doctors who could prescribe the drugs and by paying for many of the pills. Patients then misused the opioids, shared the drugs with others, or sold them on the black market. That, the claim goes, fueled the current drug overdose crisis, which led to nearly 64,000 overdose deaths in 2016.

This is not a new argument. During the debate over Obamacare repeal, some Republicans raised this claim as part of their rationale for pulling back the health care law’s insurance expansion. Online, this argument has gained more traction due to wider discussion in the blogosphere and social media.

“But this claim runs into a basic problem: the concept of time. Medicaid didn’t expand under Obamacare until 2014 — well after opioid overdose deaths started rising (in the late 1990s), after the Centers for Disease Control and Prevention in 2011 declared the crisis an epidemic, and as the crisis became more about illicit opioids, such as heroin and fentanyl, rather than conventional opioid painkillers.”

There Is More Than One Opioid Crisis, FiveThirtyEight

“The Kentucky Injury Prevention and Research Center is one of the organizations trying to put the puzzle pieces together. A partnership between the state Public Health Department and the University of Kentucky College of Public Health, the center is investigating the causes of the state’s drug overdoses to help policymakers make more educated decisions about how to tackle the crisis. That means improving the accuracy of death certificates and other available data and encouraging law enforcement groups, public health officials and other state agencies to communicate with one another better. The center started working with drug overdose mortality data in 2011 and quickly realized how limited death certificate information on how someone died and what killed them was.

The efforts that KIPRC and the state have made to improve this data have led to crucial findings, including that Kentucky’s crisis isn’t one crisis, but many. Different parts of the state are afflicted with different drugs. Northern Kentucky, for example, has a high prevalence of heroin and fentanyl — a synthetic opioid that is more deadly than heroin and other types of opioids — while in the eastern part of the state, prescription opioids are still the main concern.”

With Trump MIA on Opioids, Here Come the Lawyers, Bloomberg

“One unique aspect of American culture is that when the government won’t stop corporate wrongdoing, the plaintiff’s bar rushes in to fill the void. Without question, plaintiff’s lawyers have made a difference — many products are safer, and many corporate behaviors have changed because of lawsuits or the threat of lawsuits.

But using litigation to effect change also has its critics, who say that Congress, not the legal system, should do that kind of work; that the lawyers are motivated more by the fees than the problem; and that there are far too many lawsuits where the evidence of wrongdoing is thin. And yes, I’ve been one of those critics.”