This Week's News in Substance Use: 5/4/18

SUD news 5/3/18

The Hard-to-Trace Ingredient Behind Skyrocketing Cocaine Deaths , The Atlantic

“In the United States, more people are dying because of synthetic drugs like fentanyl than because of heroin or prescribed painkillers. While, to many, the opioid crisis has been synonymous with heroin and prescription pills, a report published Tuesday in JAMA Psychiatry builds the case that the class of synthetic drug is increasingly making its way into other drugs like cocaine and leading to overdoses. From 2010 to 2016, more and more overdose deaths have been found to be caused, at least in part, by drugs like fentanyl.”

New Front on Opioid Litigation: Suits Over Rising Premiums , The Wall Street Journal

“The opioid epidemic has unfairly increased health insurance costs across the board, not just for those suffering from addiction, plaintiffs allege in five proposed class-action lawsuits filed Wednesday.

“The suits, brought on behalf of people and businesses who have paid for health insurance in California, Illinois, Massachusetts, New Jersey and New York since 1996, represent a new front in litigation seeking to hold corporations accountable for the opioid crisis.”

Even More Doctors Are Cutting Back On Opioid Painkillers , BuzzFeed

“Around 7 in 10 doctors have cut back on their prescriptions of opioid painkillers or stopped prescribing them entirely in the last two years, according to a new nationwide survey.

The survey, conducted by the SERMO physician network for BuzzFeed News, points to an increase since 2016, when SERMO found about 6 in 10 doctors in its network reported cutting back.

“’Doctors have been feeling uneasy about prescribing opioids for a long time and now they are seeing a chance to move away from them,’ family physician Eriko Onishi of the Oregon Health and Science University told BuzzFeed News. Insurance companies and Medicare are pushing to cut opioid prescriptions, she noted, following the CDC recommendations to make opioids a last-choice option for pain patients.

“’I’ve changed my own practice,’ Onishi said. ‘These are hard conversations to have with patients — to tell them that opioids are not really helping your pain.’”

Questions Raised About Study of Device to Ease Opioid Withdrawal , NPR

“Innovative Health Solutions, the device maker, has marketed the Bridge for opioid withdrawal for more than a year, even before it had clearance for that use from the Food and Drug Administration. Then, last November, the Versailles, Ind.-based company got that, too. Citing the study, the FDA allowed the Bridge to be promoted for opioid withdrawal.

“Indiana State Sen. Jim Merritt, a Republican who is known for sponsoring legislation addressing the opioid crisis, held an effusive press conference after the FDA gave its OK to the Bridge. ‘People will detox,’ he told reporters. ‘They will withdraw from drugs if it's a simpler process, and this is it.’

“But some addiction specialists aren't persuaded by the evidence behind the device. The study informing the agency's decision didn't randomly compare the experience of patients treated with the device with others who got a sham treatment. Andy Chambers, an addiction psychiatrist in Indianapolis, said there's no way to know if the $595 device works, or if patients and providers simply believe that it does.”

The Pain Hustlers , The New York Times Magazine

“That points to a major vulnerability in policing the opioid crisis: Doctors have a great deal of power. The F.D.A. regulates drug makers but not practitioners, who enjoy a wide latitude in prescribing that pharmaceutical companies can easily exploit. A respected doctor who advocates eloquently for wider prescribing can quickly become a ‘key opinion leader’; invited out on the lucrative lecture circuit. And any doctor who exercises a free hand with opioids can attract a flood of pain patients and income. Fellow doctors rarely blow the whistle, and some state medical boards exercise timid oversight, allowing unethical doctors to continue to operate. An assistant district attorney coping with opioids in upstate New York told me that it’s easy to identify a pill-mill doctor, but ‘it can take five years to get to that guy.’ In the meantime, drug manufacturers are still seeing revenue, and that doctor is still seeing patients, one after another, day after day.”

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