Man Silhouette Drinking

A Landmark Study on the Origins of Alcoholism

For Markus Heilig, the years of dead ends were starting to grate. A seasoned psychiatrist, Heilig joined the National Institutes of Health in 2004 with grand ambitions of finding new ways to treat addiction and alcoholism. “It was the age of the neuroscience revolution, and all this new tech gave us many ways of manipulating animal brains,” he recalls. By studying addictive behavior in laboratory rats and mice, he would pinpoint crucial genes, molecules, and brain regions that could be targeted to curtail the equivalent behaviors in people.

It wasn’t to be. The insights from rodent studies repeatedly proved to be irrelevant. Many researchers and pharmaceutical companies became disillusioned. “We cured alcoholism in every rat we ever tried,” says Heilig, who is now at Linköping University in Sweden. “And at the end of every paper, we wrote: This will lead to an exciting treatment. But everything we took from these animal models to the clinic failed. We needed to go back to the drawing board.”

Heilig doesn’t buy that mice and rats have nothing to teach us about addiction. It’s more that researchers have been studying them in the wrong way. Typically, they’ll let the animals self-administer drugs by pressing a lever, which they almost always learn to do. That should have been a red flag. When humans regularly drink alcohol, only 15 percent or so become dependent on the stuff. Why them and not the other 85 percent? That’s the crucial question, and you won’t answer it with an experiment in which every rodent becomes addicted.

Man Holding Glass of Alcohol

Eric Augier, who recently joined Heilig’s team, tried a different approach—one pioneered in his former laboratory to study cocaine addiction. After training rats to self-administer alcohol, he offered them some sugary water, too. This better mimics real life, in which drugs exist simultaneously with other pleasurable substances. Given a choice between booze and nectar, most rats chose the latter. But not all of them: Of the 32 rats that Augier first tested, four ignored the sugar and kept on shooting themselves up with alcohol.

“Four rats is laughable,” says Heilig, referring to the study’s small size, “but 620 rats later, no one’s laughing.” Augier repeated the experiment with more rats of various breeds, and always got the same results. Consistently, 15 percent of them choose alcohol over sugar—the same number as the proportion of human drinkers who progress to alcoholism.

Those alcohol-preferring rats showed other hallmarks of human addiction, too. They spend more effort to get a sip of alcohol than their sugar-preferring peers, and they kept on drinking even when their booze supply was spiked with an intensely bitter chemical or paired with an electric shock. “That was striking to me, as a clinician,” says Heilig. “Embedded in the criteria for diagnosing alcoholism is that people continue to take drugs despite good knowledge of the fact that it will harm or kill them.”

Many lab studies treat animals as if they were identical, and any variation in their behavior is just unhelpful noise. But in Augier’s work, the variation is the important bit. It’s what points to the interesting underlying biology. “This is a really good study,” says Michael Taffe, a neuroscientist at the Scripps Research Institute who studies drug addiction. “Since only a minority of humans experience a transition to addiction, [an approach] such as this is most likely to identify the specific genetic variants that convey risk.”

That is exactly what the team did next. They compared the alcohol-preferring and sugar-preferring rats and looked for differences in the genes that were active in their brains. They focused on six regions that are thought to be involved in addiction, and found no differences in five. “But in the sixth, we did,” says Heilig. “And it made me smile because I started out doing my Ph.D. on the amygdala.”

The amygdala is an almond-shaped region that sits deep within the brain, and is heavily involved in processing emotions. When Augier looked at the amygdala of alcoholic rats, he found signs of unusually low activity in several genes, all of which are linked to a chemical called gaba.

Gaba is a molecular red light: Certain neurons make and release it to stop their neighbors from firing. Once that’s done, the gaba-making neurons use an enzyme called GAT3 to pump the molecule back into themselves, so they can reuse it. But in the amygdala of alcohol-preferring rats, the gene that makes GAT3 is much less active, and makes just half the usual levels of the pump. Gaba accumulates around the neighboring neurons, making them abnormally inactive.

The consequences of this are unclear, but Heilig thinks that all this extra gaba hampers the rats’ ability to deal with fear and stress. They are naturally more anxious, which might explain their vulnerability to alcohol. He predicts it will take another five years of work to fully close this loop. But for now, his team have definitely shown that GAT3—the gaba-recycling pump—is important. They took rats that prefer sugar and deliberately reduced the levels of GAT3 in their amygdala. This simple procedure was enough to convert those resilient rodents into addiction-prone, alcohol-preferring 15-percenters.

Rat in Petri Dish

At this point, the team submitted their result to a journal, which agreed to publish them. Good news—but after Heilig’s long history with rat-shaped dead-ends, he wanted to do one more experiment. “Curing alcoholism in rats is not important,” he says. “What’s important is what this looks like in humans with alcohol addiction.”

As it happens, it looks much the same. Heilig’s colleagues examined postmortem tissue samples from people who had donated their brains to research, some of whom had alcohol addiction. As in the rats, they found nothing unusual in five of six brain regions. But in the amygdala, they found low levels of GAT3.

Others scientists have found connections between alcoholism, the amygdala, and gaba-related genes. But by identifying mice that are particularly vulnerable to alcoholism, Heilig’s team has begun fleshing out the details behind these somewhat hazy links. “It is a very significant study that will impact the alcohol research field deeply,” says Jun Wang from Texas A&M University. “Identifying GAT3 is not that important because alcoholism is controlled by multiple genes, but [the team’s new approach] will help to find those genes. It’s a wonderful method for modeling human alcoholism.”

There are other signs that what Heilig found is relevant to humans as well as rats. A decade ago, a French cardiologist named Olivier Ameisen claimed to have cured his own alcoholism by taking a drug called baclofen. “That was met with skepticism, and there was no basic science to support his claims,” says Heilig. But there is now: Baclofen stops neurons from releasing gaba. If individuals with alcoholism aren’t good at recycling this chemical, it might be possible to compensate by producing less of it in the first place.

But baclofen is controversial. It has been tested in several clinical trials, to mixed results. Two recent studies, which analyzed the results from these trials, concluded that the drug’s ability to treat alcoholism is only “slightly above placebo effects” and its growing use is “premature.” It can be harmful, too. People quickly build up a tolerance to it, which prompts them to seek higher doses. They can experience severe side effects, and France has seen more than 100 cases of people inadvertently poisoning themselves with baclofen. “It’s a terrible drug,” Heilig says.

Other drugs like benzodiazepines also exert their effects through gaba, but like baclofen, they’re easily abused themselves. “They’re a good alternative for alcoholism in the short term but they’re not safe in the long term,” says Lara Ray from UCLA.

But Heilig’s study suggests that other chemicals, which could influence gabalevels in more subtle ways, might help people to control their addictions. Several such substances are in development, and Heilig’s team can see if they change the choices of their alcohol-preferring rats.

“It’s just such an impressive breakthrough for the field of alcoholism, with real potential for therapies,” Ray adds.

Original article here on theatlantic.com

Main Street McArthur

New Wave Of Meth Overloads Communities In SE Ohio Struggling With Opioids

Principal Mary Ann Hale dreads weekends. By the time Fridays roll around, 74-year-old Hale, a principal at West Elementary School in McArthur, Ohio, is overcome with worry, wondering whether her students will survive the couple of days away from school.

Too many children in this part of Ohio’s Appalachian country live in unstable homes with a parent facing addiction. For years, the community has struggled with opioids. Ohio had the second-highest number of drug overdose deaths per capita in 2016, according to the Centers for Disease Control and Prevention.

But in McArthur, a close-knit village of about 2,000 in rural Vinton County, there has been a significant shift in recent months.

“They’ve moved on from the oxycodone and OxyContin,” says Hale. “Right now, the biggest problem is meth.”

Mary Ann Hale Principal

At the local ER dispatch, paramedics are observing the change firsthand. “We used to do a lot of pills, but now the problem is meth,” says Mike, a paramedic who asked to be identified only by his first name so he could speak freely. “And it’s worse because there’s no Narcan for meth,” he says, referring to the antidote that reverses an opioid overdose.

Though the opioid crisis endures in Ohio, the problem is now compounded by the resurgence of methamphetamine use, an addiction that’s even harder to treat, and can lead to troubling, violent behavior. Local officials and law enforcement are neither staffed nor funded to tackle the growing problem. For McArthur’s residents, the impact has been devastating for families across generations.

In the 2000s, the last time meth use surged across the country, people would often “cook” meth in toxic and explosive labs typically set up in bathrooms, kitchens or abandoned buildings. In response, Congress enacted the Combat Methamphetamine Epidemic Act in 2006, which regulated the sale of certain over-the-counter drugs, like pseudoephedrine, used in cooking meth. Meth use declined, seizures by law enforcement fell, and meth labs started to disappear.

Now, meth is back, and not just in Ohio. Communities around the country are raising the alarm.

In 2012, 17,846 pounds of the stimulant drug were seized by law enforcement agents in the U.S. or at the border, according to U.S. Customs and Border Control. By 2017, that number had more than tripled, and much of it now comes from Mexico.

Meth Graph SE Ohio

 

“What everybody is doing now is buying the cheap Mexican meth, and not cooking anymore,” says Vinton County prosecutor Trecia Kimes-Brown.

Meth overdoses have been climbing too, though it’s harder to overdose on meth than on opioids. Overdoses involving psychostimulants, which include meth, increased from 5 percent of total overdoses in 2010 to 11 percent in 2015.

The Drug Enforcement Administration confirms that Mexican drug dealers have taken over the market for meth in the U.S. “Trafficking and usage trends in places like Ohio are on the rise,” says Cheryl Davis, a special agent and a spokesperson for the DEA.

Trying to keep up with the need

There’s only one stoplight in McArthur. A sprinkling of locally-owned shops line main street. The talk of the town in recent months has been the opening of a new grocery store, the first in many years. What they still don’t have, anywhere in the county, is a hospital or an in-patient treatment center.

Vinton County prosecutor Kimes-Brown says that it’s hard to find mental health professionals for users who end up in custody. It’s the criminal justice system, she says, that has absorbed the brunt of the drug crisis.

Vinton Cty Prosecutor

People arrested on meth charges are often transported to neighboring counties, and when there are no spaces available at a nearby jail, Kimes-Brown has to triage. She’ll call a judge and negotiate a swap: Let out someone with a misdemeanor, a lower risk to society, and let in one of her violent meth arrestees.

“I literally have to put them on the street to put this other, more violent offender in jail,” says Kimes-Brown. “That happens at least once a week.”

That has left Vinton County with an enormous bill. In 2017, a sixth of the county’s budget went toward the jail bill — about $578,000, according to county records.

The surge of meth cases has also been overwhelming for local police. It can be riskier for officers to respond to meth-related calls.

“They are more violent,” says Ryan Cain, the lead detective on counternarcotics for the county. He says in a rural county with a culture of hunting, it’s not uncommon to encounter meth users who are hallucinating — and carrying a gun.

“We actually had one guy say that a helicopter was in the backyard and people were repelling down the helicopter,” he says. “How strong their hallucinations are is wild.”

Meth can make people agitated and prone to risk-taking, says Andy Chambers, an addiction psychiatrist and researcher at the Indiana University School of Medicine in Indianapolis.

“You can develop dangerous psychotic episodes that can look like schizophrenia,” says Chambers. “The psychosis can get dangerously paranoid — hearing stuff, feeling like they’re being pursued.”

And it can make people neglectful of their lives, their families — anything but the next high. Cain says he’s seen people sell food stamps for 25 or 50 cents on the dollar and steal from family members. “They spend every dollar they got trying to get the next hit,” he says.

Layers of addiction

Counselor Amanda Lee of Health Recovery Services rehab center on McArthur’s Main Street, regularly treats patients struggling with opioid addiction — and using meth. Sometimes, she says, people turn to meth when they’re detoxing from opioids.

“People are going to meth to get off of opiates,” says Lee, whose patients tell her opioids are less available on the street these days, while meth is everywhere. “They go through withdrawal from opiates and sickness and they’re using meth to get through it.”

Amanda Lee Counselor

Lee also says when staff give patients Vivitrol treatments, one of a handful of FDA-approved medications for opioid addiction, it still leaves users craving other highs. Vivitrol is a monthly injection which blocks opioid receptors.  “The Vivitrol injection does not cover receptors in the brain for methamphetamines, so, they can still get high on meth” says Lee. She thinks Vivitrol might be driving some patients to meth.

The connection is not so clear-cut for Chambers.

“There’s a lot of urban legend that Vivitrol is causing meth addiction, but it’s not true,” says Chambers. “You’re getting people who were using meth with opiates beforehand and now the meth is prevalent. But it’s not that Vivitrol is causing meth.”

The real problem, Chambers says, is that patients’ meth addiction may be going untreated. While some patients can benefit from Vivitrol or other medication-assisted treatment for opioid use disorder, there’s not a drug that helps with meth.

“The reality is meth has been with us for many years,” Chambers says. In fact, he says, it might be better to stop talking about an “opioid crisis” or a “meth crisis” and admit we have a “polysubstance epidemic.”

What’s underlying it he says, especially in rural areas, is a broken mental health care system.

In fact, 56 out of 88 Ohio counties have mental health care provider shortages, mostly in rural areas. This leaves about 70 percent of the population with unmet mental health care needs in Ohio, and rates are similar throughout much of the Midwest, South and Western U.S., according to data from the department of Health and Human Services.

“I’m concerned about the ongoing shortages,” says Chambers. “If you want decent mental healthcare in the U.S. you better live in the big cities.”

When home is no longer safe

Few have paid a steeper price than the children of Vinton County.

“These kids are living in these environments where they’re not being fed, they’re not being clothed properly, they’re not being sent to school, they’re being mistreated,” says county prosecutor Kimes-Brown. “They have a front row seat to all of this.”

Teachers and staff at West Elementary are often the first to notice that a child is no longer safe at home.

“They’ll just walk into the office and start crying,” says Hale, principal at West Elementary School. “They hug you and you sit down and talk with them and find out what’s going on in their secret little world.”

The staff at West Elementary School is aware of about 60 students directly affected by the drug crisis — about one sixth of their student body.

“I’ve had kids describe to me drug use they’ve seen,” says Rebecca Smallwood, the school counselor. “We had one student who performed CPR on her mom when she overdosed. We’ve had lots of kids see their parents get arrested.”

Hale says teachers must know how to read the signs in the classroom. Sometimes the clues are small but revealing. Shoes that are many sizes too small, or students who come to school without socks or underwear. Just outside the principal’s office, staff keep a storage room they refer to as “Little Walmart” stocked with underwear, shoes, T-shirts, and pants for their students.

For other kids at the school, the signs are much less ambiguous.

“[There’s] a slide in their academic behaviors, then aggression, crying, or kids talk about suicide,” says Hale. “We’ve been dealing with one of those [cases] this year. Mom’s an addict, dad went sideways when mom left, and grandma’s raising the little girl.”

This is not uncommon in Vinton County — parents, too consumed with addiction, rely on family members to step in and care for their kids. Usually, it’s the child’s grandparents.

Angela is one of those grandparents.

Her grandson, Billy, was exposed to his mother’s meth addiction early on.

(The grandmother asked NPR to refer to them as Angela and Billy to protect the family’s privacy.)

“One day, she brought him to the house. He was in diapers, he was about a year old and he had a smell to him,” Angela says. “He was beet red, like he’s been out in the sun. She had him in a meth house and the chemicals is what burned his skin, made him red.”

That part of Billy’s story is harrowing enough, but it takes an even darker turn.

While visiting his grandmother, Billy complained about pain. Angela saw signs on his body that suggested her daughter’s boyfriend sexually abused Billy.

“He did things he shouldn’t have to [Billy],” Angela says, through tears. “It did a heck of a number on him.”

Angela and her husband gained full custody of their grandson in April.

It was a difficult transition for Billy. When he started living with his grandparents, Angela says he wouldn’t talk to strangers — he wouldn’t go near men. “Even his grandpa,” Angela says, “he shied away from.”

Angela And Billy

Angela says he still won’t sleep alone.

“He sleeps on the couch and I’m there because I never know when he’s going to have his nightmares,” she says. “It’s harder on the kids than it is on anyone else.”

Smallwood says that the school is starting to see the effects of kids that have been shuffled from home to relatives or foster care. “That kind of disruption, what it does to a student forever, it’s huge. You just can’t, you can’t use enough adjectives to describe what that does.”

For kids like Billy, school is often the only place they are safe. It is where there is structure and regular meals and people who keep track of their lives from the moment they get off the school bus through the last bell of the day.

But it’s summer time now, a season most kids and teachers look forward to and relish.

At West Elementary it’s different.

“We worry,” says Principal Hale.

Original article here posted on NPR.org.

Woman looking at skyline

People in the U.S. Are Drinking More Alcohol Than Ever: Study

More Americans are drinking alcohol in general, a new study finds, but perhaps more alarming is that many more fall into the categories of high-risk drinking and alcohol use disorder (AUD). The increases were seen from the years 2001-2002 to 2012-2013 in a number of demographics. In fact, the greatest increases in alcohol use were women, minorities, older adults, and people of lower socioeconomic status. The authors point out that while the public conversation has largely been on opioids and pot in recent years, alcohol use and abuse have been quietly rising.

Wine Glass and Bottle

The study, published in the JAMA Psychiatry, looked at data from almost 80,000 participants taking part in two large-scale studies in the U.S. Participants were interviewed face-to-face and asked about their daily drinking habits. The researchers were interested in their alcohol use over a 12-month period, high-risk drinking (four or more drinks for women and five or more drinks for men on at least one day of the week), and AUD as defined by the DSM-IV, the “bible” of mental health disorders.

Almost all kinds of drinking across all demographics rose between the two time points, and some rose sharply.

  • Alcohol use rose from 65% to 73% of the adult population, which is about an 11% increase. The increase was much higher for minorities, women, seniors, and people with less education and income.
  • High-risk drinking rose from about 10% to 13% of the population, or an almost 30% increase. In minorities, women, and older people, the numbers were considerably higher.
  • People who were identified as having alcohol use disorder (AUD) increased from 9% to 13% of the population, an increase of almost 50%. For women, the increase in AUD was 84%, for Hispanic and African-American individuals it was 52% and 94%, respectively. And for older people, the increase was a whopping 105%.

In other words, people are drinking more alcohol than before, and more people are drinking alcohol than before.

The percentages clearly rose much more for certain demographics. For women, the authors write, the rise in alcohol use may be due in part to work-life balance stress. “Stress associated with pursuing a career and raising a family,” the authors write, “may lead to increases in high-risk drinking and AUD among women, results that were consistent with substantial increases in these patterns of alcohol use among married individuals and those residing in urban areas found in this study.”

For minorities, increased drinking may also have to do with stress, but a different type. “Wealth inequality between minorities and whites has widened during and after the 2008 recession,” the team points out, “possibly leading to increased stress and demoralization.”

There are major chronic health risks associated with alcohol use for all of us—heart disease, stroke, cancer, type 2 diabetes, high blood pressure, cirrhosis, and pancreatitis. And for women, breast cancer, cirrhosis of the liver, and fetal alcohol spectrum disorder are particular risks of alcohol use, especially heavy use.

Since so much of the public attention has been on prescription opioids, heroin, and even pot, the fact that alcohol is one of the most deadly drugs around may have receded into the background. The authors call the rising alcohol problem a “public health crisis that may have been overshadowed by increases in much less prevalent substance use.” There are certainly effective treatments for alcohol addiction, and they’ve gotten better over the years. But equally as important as treatments is fixing the societal problems that lead people to drink in the first place.

By Alice G. Walton

Original article here published on Forbes.com.

Forbes logo

US needs to invest ‘tens of billions or hundreds of billions’ to fight opioid epidemic

The goal of an opioid is to reduce pain, but the addictive drugs are creating pain for millions of families suffering through the crisis.

Deaths from opioid overdoses number at least 42,000 a year in the U.S., according to the Center for Disease Control.

“This is an epidemic that’s been getting worse over 10 to 20 years,” Caleb Alexander, co-director of Johns Hopkins Center for Drug Safety, told CNBC’s “On The Money” in a recent interview.

“I think it’s important that we have realistic expectations about the amount of work that it will take and the amount of coordination to turn this steamship around,” Alexander added.

President Donald Trump declared the opioid epidemic a public health emergency last fall, and he announced an initiative in March to confront the national health crisis.

“No doubt there’s a lot of efforts underway at every level to address the epidemic,” Alexander explained.

“There’s a flurry of legislation right now working its way through Congress and these legislative efforts address everything from safer packaging to better use of information to try to address the diversion of prescription opioids.”

Opioids include not just prescription drugs, like OxyContin, codeine, and morphine, but also heroin and synthetic drugs like fentanyl.

But Alexander says some progress has been made in reducing the overprescribing of the prescription painkillers, “this was one of the primary drivers of the epidemic in the first place.”

Street Sign Addiction Life

“There’s been modest declines in prescription opioid sales over the past 5 to 7 years. But we’re still way beyond the volume of opioids prescribed compared with every other country in the world. We have a long way to go before we get to the levels of opioid prescribing that we were at in the late 1990’s before this epidemic began.”

Alexander says his research is focused on identifying clinical and policy solutions to the opioid epidemic.

Beyond reducing opioid prescriptions, he sees another step as crucial in addressing the epidemic.

“We need to better identify and treat people with opioid addiction. This is a treatable condition, just like diabetes or high cholesterol and yet the vast majority of people with opioid use disorder are not enrolled and seeking care.”

Alexander added: “The statistics are stunning. More than 2.1 million Americans have an opioid use disorder or opioid addiction” and he says the country needs to “invest tens of billions or hundreds of billions of dollars” to shore up the treatment system.

He said patients should be able to access medications that “we know work to help reduce the cravings for further opioids.”

With treatment, Alexander said “they can return to normal healthy productive lives in recovery.”

Original article here on CNBC.com.

Pride Parade basic logo

BrightView is Part of Cincinnati Pride Parade This Saturday June 23rd, 2018

Join us this Saturday June 23rd! BrightView is an official sponsor for this year’s Cincinnati Pride Parade and Festival.  We will be walking in the parade and will also have a tent at Sawyer Point where we will be distributing Narcan.

Where: Sawyer Point & Yeatman’s Cove
When: Sat, Jun 23, 2018 11:00 am to 9:00 pm
Click on the colorful image directly below for a link to Cincinnati Pride official website and
see map below for parade route.
Pride Parade Logo
Pride Parade Map

 

Informative & Interactive Web Page Explaining The Opioid Crisis in Chapters

This powerfully visual interactive web page allows you to explore the opioid epidemic as if you were reading a book, with Chapter 1 being the introduction to the epidemic, or “Understanding the Crisis.”  Chapter 2: “From Understanding to Collaboration”; analyzing the data and joining forces with various partners to bring the most effective evidence-based care to life. Chapter 3: “Using Data”; how fact-based insights are helping experts to understand and treat the epidemic. Chapter 4 offers you insight into the personal lives of several people recovering from addiction, how it started for them and how far they’ve come.  Chapter 5: “Hope for the Future”; the conclusion discussing the tools we have to tackle this crisis and how we all have a stake in this and do not have to go at this alone.  Through partnership and collaboration, things can get better.

Link to web page here:  thewashingtonpost.com

 

 

Cinci skyline

Hamilton County: Huge Narcan Influx, Treatment Boost Contributes to OD Death Drop

A massive influx of naloxone and concerted efforts to get addiction treatment quickly to those who ask for it appear to be contributing to a decline in the overdose death toll in Hamilton County.

“We have plummeting mortality rates, increased treatment,” said Dr. Shawn Ryan, founder of BrightView Treatment Centers and an active member of the Hamilton County Heroin Coalition.

There are more “preliminary, positive results” of a countywide program rolled out last fall to attack the area’s opioid epidemic.

The concept, embraced by public and private health officials, government entities, first responders and others, was to boost lives saved by inundating the region with the opioid overdose antidote Narcan and respond quickly to people asking for addiction treatment.

It may seem like a no-brainer for other medical conditions, but for addiction, such immediate treatment has been lacking for years.

Narcan Nasal Spray

“I am cautiously optimistic that we are definitely headed in the right direction,” said Hamilton County Health Commissioner Tim Ingram. “It’s everyone working together.”

“This is a complicated issue,” Ingram added. “It’s a journey, although it feels like a race.”

Here’s a breakdown of what’s happened since the effort started in Hamilton County:

  • In seven months, since a Narcan Distribution Collaborative formed under Hamilton County Public Health, the county has had a 375 percent increase in naloxone kits handed out.
  • In the first five months of 2018 compared to the previous year, there was a 34 percent drop in deaths, Hamilton County coroner’s reports show.
  • Hamilton County has had a greater than 50 percent increase in treatment of patients with opioid addiction, comparing 2016 to 2017, according to the Hamilton County Mental Health and Recovery Services Board.
  • There’s been a 33 percent drop in medic runs for overdose in the past six months compared to the previous six, Hamilton County Public Health surveillance data show.
  • In that same period, Hamilton County has seen a 36 percent decrease in overdose visits to emergency rooms, the health department surveillance data also show.

The University of Cincinnati is heading the tracking and research on the Hamilton County project. Its work is not yet complete.

Mortality is still “far above” the baseline of these deaths prior to the opioid epidemic, Ryan said.

But Ryan, president of the Ohio chapter of the American Society on Addiction Medicine, said he noted that if progress continues, the Hamilton County plan could end up as a model for other communities.

The treatment plan was initiated through Mercy Health’s Cincinnati psychologist Navdeep Kang, who’s since been named an Obama Foundation fellow for his leadership. It’s the Mercy Health Addiction Treatment Collaborative, comprised of its hospitals and more than a dozen treatment clinics with matching protocol and goals.

“It is not sufficient to revive someone from an overdose,” Kang said. “That is the first and necessary step. But then an immediate, compassionate conversation about entry into treatment must follow – with treatment available on demand to capitalize on opportunities when prospective patients want to enter recovery.”

That’s something that’s been lacking across the country, experts say. And is life-threatening. If someone with heroin or fentanyl addiction is turned away or made to wait days or weeks for treatment, the relapsing condition is likely to pull them right back into drug use.

Hamilton County’s newer collaboratives along with several long-standing programs providing naloxone and linking people to treatment have helped boost the response to the opioid crisis, Ryan said.

Narcan Nasal Spray with BV Logo

He initiated the idea of the huge Narcan effort locally. It was a first-in-the-nation effort, the heroin coalition leaders said. And with that new accessibility and the other preliminary results of the work being done, Ryan said, “We are wildly exceeding our expectations.”

Still, he did not want to overstate early results.

“We are just now getting things going in the right direction and we still have a long way to go to overcome this crisis,” Ryan said. “That is going to continue to take substantial work and funding for the next several years, along with significant and sustained efforts by all partners in the community.”

Ending the opioid crisis will take numerous steps from all corners, Ingram said.

“This is about keeping people alive until we can get them treatment,” the health commissioner said, “and educating children and adults about this serious, chronic disease, opioid addiction.”

Original article here on cincinnati.com.

Drug on Lab Table

A New Study Shows Stigma is Hurting our Response to the Opioid Epidemic

When it comes to combating opioid misuse and addiction, needle exchanges and safe injection sites have decades of evidence behind them. Yet a new study published in Preventive Medicine found that a majority of Americans oppose both — and stigmatizing attitudes toward people with addiction appear to be to blame.

For the study, researchers conducted a survey of more than 1,000 Americans asking about their attitudes on needle exchanges, safe injection sites, and addiction more broadly. They found that about 39 percent of Americans support needle exchanges, while around 29 percent back safe injection sites.

The survey also measured respondents’ stigmatizing attitudes toward addiction, putting together a composite of questions — whether they’d be willing to have a person who is using opioids marry into their family or start working closely with them on a job, and their overall feelings of people who use opioids.

Psychiatrist comforting patient

The researchers concluded: “Individuals with higher stigma toward people who use opioids were less likely to support legalization of safe consumption sites … or syringe services programs.”

Needle exchanges are places where someone can dispose of used syringes, which are used to inject drugs, and obtain sterile syringes. The idea is that although you can’t stop everyone from using drugs, you can at least minimize the harms of drug use. The decades of research into such programs is clear: They combat the spread of bloodborne diseases like hepatitis C and HIV, cut down on the number of needles thrown out in public spaces, and link more people to treatment — all without enabling more drug use.

Safe injection sites, meanwhile, provide a place for people to use drugs under medical supervision in case anything goes wrong — like, say, an overdose. Drawing on more than a decade of studies, the European Monitoring Centre for Drugs and Drug Addiction in 2017 concluded that safe injection sites led to “safer use for clients” and “wider health and public order benefits.” Among those benefits: reductions in risky behavior that can lead to HIV or hepatitis C transmission, drops in drug-related deaths and emergency service call-outs related to overdoses, and greater uptake in drug addiction treatment, including highly effective medications for opioid addiction.

Yet despite the preponderance of empirical evidence supporting needle exchanges and safe injection sites, stigma holds back these policies. This is something I’ve seen time and time again in my reporting on the opioid epidemic. For example, when I asked the architects of Vermont’s “hub and spoke” system — which integrates addiction treatment into the rest of health care — what the biggest hurdles were to implementation, the barriers were not so much money or lack of evidence, but stigma.

John Brooklyn, a chief architect of the hub-and-spoke system, referred to perceptions of evidence-based anti-addiction medications like buprenorphine as an example: “It’s now 14 years after buprenorphine’s been approved [by the Food and Drug Administration], and you still have an awful lot of docs — you even have our [former] secretary of health and human services — who [say] medication-assisted treatment is just a crutch.”

Or consider one of the emails I received in response to a story on opioids: “Darwin’s Theory says ‘survival of the fittest.’ Let these lost souls pay the price of their criminal choices and criminal actions. Society does not owe them multiple medical resuscitations from their own bad judgment, criminal activity, and self-inflicted wounds.”

It is inconceivable that anyone would view, say, heart disease or cancer in a similar way. If the health care system let someone die of a heart attack because he ate a hamburger, or of cancer because that person once smoked a cigarette, it would be widely decried.

After decades of treating addiction as mainly a criminal justice, not public health, problem, the same does not seem to apply to drug use disorders. The result is studies like this one — showing that rather than the lack of evidence for a policy intervention, it’s stigma that plays a prominent role.

By German Lopez on June 7, 2018

Original article here on vox.com.

On the Frontlines of the Opioid Crisis: A Doctor’s Experience

In an episode of Pew’s “After the Fact” podcast entitled “Treating the Opioid Epidemic,” Dr. Shawn Ryan, chief medical officer at BrightView, an outpatient addiction medicine practice based in Cincinnati, spoke about his work and issues surrounding treatment of opioid use disorder. This Q&A is drawn from his full interview. Dr. Ryan reflects on the challenges—and the promise—of treating patients suffering from opioid use disorder.

Dr Shawn RyanQ: Once you get someone past the critical phase of an overdose, how hard is it to get them into treatment?

A: Right now, we don’t have a lot of answers. There is not a good linkage to treatment at this time in many emergency departments across the United States. … There are wait times throughout the entire country for any appropriate treatment for opioid use disorder.You might be able to get into a treatment program, see a board-certified addiction specialist, a competent licensed therapist, and a social or case management support person and get the whole biopsychosocial intervention. Or you might end up camping in Utah. We need to work very hard in the medical system to get standardized treatment so people know what they’re getting when they go to get it.

Q: When you get a patient into your office, what do you tell them about the road they have ahead?

A: When we’re talking to them, we have got to give them the real story, which is: This is going to be some work, this is a fairly long journey. It’s the same discussion you have with anybody with another complex chronic illness, [such as] cancer or diabetes. You can’t—or shouldn’t—sit them down for a minute and a half and say, “As long as you take these medications, you’ll be perfectly fine,” because that’s not accurate.

We spend some time laying out the timeline because it’s important for them to be engaged. You want to make sure that they stay vigilant because relapse is a very challenging part of this chronic, relapsing disease.

Q: How does medication-assisted treatment work?

A: Currently, there are three FDA-approved medications: methadone, buprenorphine, and long-acting naltrexone. They are all very good medications and substantially increase the success of a patient being sober and getting to recovery. Medication-assisted treatment is the best [approach] for patients with opioid use disorder.

As physicians, we sit down with the patient, do a history, physical, and then we present them with options and talk about the risks and benefits. We also deal with friends, family, and law enforcement professionals who may not understand the medications. There’s a lot of stigma around methadone, for example. I always go back to the science and look at the results of studies. Thousands and thousands and thousands of patients across many decades have done very well on medication-assisted treatment, and it is our first and foremost recommendation.

Q: It’s not just a matter of giving folks these medications. Is there behavioral therapy as well?

A: That is correct. Patients come to us with all manner of disease severity. They may have just started to slip down the slope of substance use disorder and are using too many Percocet [pills] that they’re buying off a friend, or they may come in distraught and homeless. By and large, almost every one of our patients has some need for psychosocial intervention and some need for further support. If you’re in the area of the country where those sorts of other interventions are not available, then we should still advocate for medication use alone. It does by itself reduce mortality.

Q: Opioid use disorder brings with it a social stigma. What do patients tell you about that?

A: This is probably one of the most challenging topics, not only for our patients but also for the public. More problematically, this stigma pervades professional treatment. It’s throughout the entire society and obstructs people getting into treatment because they’re afraid of the stigma.

By and large, when [patients] go to primary care physicians, especially years ago when we started our program, they would be dismissed, the staff would be rude to them, and the physicians themselves would be rude to them. You can imagine if you’re a patient trying to get treatment and you haven’t used drugs in weeks or months and your life is starting to turn around, and you go see a medical professional who you think is supposed to be the one individual who will be accepting, and then they abuse you in that way. It’s very distressing.

Q: In addition to the stigma, what are some of the other challenges these patients face?

A: I think one is that people believe an individual can just stop using opioids, that they can just bite on a rag, go into a dark room, and just bear it and get through it. We know through the scientific studies of animals, as well as our experience with humans for decades in attempts to get people to stop using opioids, that that does not work. People need to understand that this drug really has what I would describe as the most profound grip on people that I can ever imagine.

Q: Do you sense that your colleagues in the medical community are starting to change?

A: I do. I’ve said the same message for about four years straight, and after much repetition, I’ve gotten through to many professionals. …. People have opened their eyes, and they’ve realized that it is their relative, it is their child, and they’ll say, “Please help me; I’ve got to fix this for my kid.”

Q: If you could wave a magic wand and ask for two or three changes, what do you think would make a real dent in this problem?

A: First and foremost would be harm reduction. We need to focus on that. I’d ship millions of doses of [opioid overdose reversal drug] naloxone all over the country. Second would be to make treatment—and I mean evidence-based, certified treatment—available to people right when they want it. When you look at the statistics, 1 out of 10 people [in need of care] get treatment for a substance use disorder, but that doesn’t mean you get medication-assisted treatment; that means they get some treatment.

But we know that as many as 3 out of 10 [of these] people are actively seeking treatment, so we already have 200 percent more people actively seeking it and would probably have many more if it wasn’t so stigmatized. And so immediate access to evidence-based, certified treatment would be my second magic wand.

We have a medical system that basically forces most primary care physicians to see their patients in about six to eight minutes. I am here to tell you that is not enough time to deal with the complex psychosocial and management of pain issues with anything other than a prescription for opioids. We have got to reorient our medical system and the primary care networks and support those physicians who are doing yeoman’s work and give them the time to talk to their patients about these complex issues.

Original article here posted on pewtrusts.org.

Listen to the full podcast by clicking on the image below. 

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BrightView Recognized as One of the Top Workplaces in Cincinnati

BrightView is proud to be a part of the Top Workplaces Cincinnati for Small Businesses 2018!  BrightView shares this honor with other companies whose employees feel that they are valued and respected. The Enquirer invited all 65 Top Workplaces in the small company division (149 employees or less) to tell us what makes each of them special. Below is the excerpt about our company featured in the full length article here.

BrightView Health

Division: Small  Year founded: 2014 Ownership: Private Sector: Substance abuse treatment Location: Cincinnati Rank in division: 26th

TWP Cincinnati Portrait 2018 AW

What the company does: Addresses the significant need for medical care created by the substance abuse epidemic plaguing Greater Cincinnati and our nation as a whole.

Why one employee loves working there: “BrightView makes me feel important. The best part is that there is no micro-managing. Everyone works together with ease.”

If you or someone you know is interested in joining our growing team of professionals, please visit our careers page here.

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