Months in prison didnt rid Daryl of his addiction to opioids. “Before I left the parking lot of the prison, I was shooting up, getting high,” he said.
Daryl had used heroin and prescription painkillers for more than a decade. Almost four years ago, he became one of more than 200 people who tested positive for HIV in a historic outbreak in Scott County, Ind. After that diagnosis, he said, he went on a bender.
But about a year ago, Daryl had an experience that made him realize he might be able to stay away from heroin and opioids. For several days, he said, he couldnt find drugs. He spent that time feeling terrible because of withdrawal sickness.
His friend offered him part of a strip of Suboxone Film, a brand-name version of the addiction medication buprenorphine that is combined with naloxone.
“At first it felt like I was high,” Daryl said. “But I think thats what normal feels like now. I have not been normal in a long time.”
Buprenorphine is a long-acting opioid that is generally used to treat opioid addiction. It reduces cravings for the stronger opioids he had been taking, prevents physical withdrawal from those drugs and comes with a significantly lower risk of fatal overdose.
Daryl injected the buprenorphine, and his opioid withdrawal symptoms disappeared. (Daryl is his middle name, which NPR and Kaiser Health News are using to protect his identity because it is illegal to use buprenorphine without a prescription.)
Weeks later, the grind of chasing heroin had worn on him. Buprenorphine controlled his withdrawal symptoms longer, and Daryl decided to use it to stay away from other drugs.
“I didnt crave nothing. I wasnt sick. My belly didnt hurt. I wasnt hurting in my joints,” he said.
Buprenorphine is one of just three federally approved medications to treat opioid addiction. Its an opioid itself, so some people misuse it — they snort or inject the medication. And patients who have prescriptions for buprenorphine sometimes sell or give it away, which is known as diversion. Some policymakers and officials point to diversion as a reason to further increase regulations. Providers already need to be certified to prescribe it, and theres a cap on the number of patients they can treat with the drug.
But addiction treatment professionals argue the problem of buprenorphine diversion is often misunderstood. A black market exists in part, they point out, because addiction treatment can be hard to find. President Donald Trump is expected to sign a bill that would increase access to the medication, but its unclear how quickly that access will grow.
In the meantime, many people dealing with addiction will turn to the black market for buprenorphine — sometimes using it to get high, sometimes using it to prevent withdrawal until they can get something stronger and sometimes using it exactly as it is intended to be used: to treat addiction.
Its a weaker opioid
Dr. Kelly Clark, president of the American Society of Addiction Medicine, which supports the measure that would increase access to buprenorphine, contends that making the drug more widely available outweighs the risk. For one thing, buprenorphine is not as dangerous as other opioids. “The risks of overdose with buprenorphine are minimal,” she said.
It is possible to fatally overdose on buprenorphine — especially if users dont have a tolerance to opioids or they mix it with other substances. But that is rare.
Buprenorphines effects are less potent than those of heroin and fentanyl, and the medication can block other opioids effects. Because of these attributes, few people use buprenorphine to get high. Instead, more people use it to prevent withdrawal and to stay away from other illegal drugs such as heroin and illicit fentanyl.
Some leading addiction experts argue that self-treatment with buprenorphine can save lives because it is used in place of more dangerous substances that are blamed for the continued rise in overdose deaths.
“It was not diverted buprenorphine thats responsible for our current situation,” said Dr. Zev Schuman-Olivier, an addiction specialist and instructor at Harvard Medical School. “The majority of people are using it in a way that reduces their risk of overdose.”
“Its definitely illegal,” Daryl said. “But would they rather me be driving to Louisville and picking up two 8-balls of heroin?”
“These people want help, and they tried and they didnt succeed. So now theyre going to go get it if its available,” she said.
Professional treatment with buprenorphine can be difficult for patients to get. Prescribers need a special waiver to prescribe the medication, and federal rules limit the number of people they can treat, a cap that is specific to buprenorphine.
Federal guidelines changed under the Obama administration to increase the number of prescribers and the number of patients they can treat. Nurse practitioners and physician assistants can now apply for a waiver to prescribe buprenorphine, and doctors who meet certain requirements can now treat up to 275 patients — thats up from the previous limit of 100.
The new bill on its way to Trumps desk would let more nurses prescribe buprenorphine and allow some doctors who recently got waivers to treat more patients.
Amid these efforts, some law enforcement officials and policymakers have said that more regulation and enforcement actions are needed to stop diversion.
But Basia Andraka-Christou, an assistant professor and addiction policy researcher at the University of Central Florida, said increasing regulations or shutting down prescribers would limit treatment options for people addicted to opioids.
“I guarantee you,” she said, “theyre either going to go and buy heroin and get high — which surely is not a great policy solution here — or theyre going to go buy Suboxone on the street.”
A Step Toward Safer Treatment
Getting Suboxone on the black market is obviously not ideal. Addiction is a complex, chronic disorder and patients need comprehensive care. That means a treatment professional to help them figure out the proper dose and counseling to address other mental health needs that are common among people with addiction. But Lofwall said people addicted to heroin or painkillers often realize they want professional help in quitting after trying buprenorphine illegally.
“Theyve had it and they know it works for them and they want to get it legally,” Lofwall said. “They want to get their life back.”
Daryl had that sort of experience. Several weeks after he began using buprenorphine regularly, Daryl tried to sign up for insurance so he could get help — medication and counseling — in staying away from other opioids.
“I think if I had never started [Suboxone] on the street, I wouldnt have no interest in doing nothing but getting high,” he said.
Daryl still hasnt made it into treatment. He had trouble starting his insurance, and the market for illicit buprenorphine can be fragile. Daryl struggled to stay away from heroin when the person from whom he bought buprenorphine lost the prescription. Addiction can take years to conquer, and many attempts, but Daryl said his time on buprenorphine allowed him to see a way back to a normal life.
“Im at a point of my life now where I know Ive got to change something, or Im going to go back to prison,” he said. “Im definitely ready to do something different.”
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
A collar might help prevent sports-related concussions: Study
Team sports build character, teach discipline and keep your kids healthy, but for some sports, like ..
Team sports build character, teach discipline and keep your kids healthy, but for some sports, like soccer and football, they could also increase their risk of brain injuries. Helping to prevent these injuries, a new neck collar has shown promising results in protecting the brain.
The specialized collar, developed by researchers at the Cincinnati Children's Hospital Medical Center, applies pressure to the back of the neck. This pressure allows the artery in the neck to safely backfill the brain with blood, turning the blood into a cushion that makes it less likely for the brain to move upon impact.
The idea for the collar was born out of “biological mimicry,” Dr. David Smith, a visiting research scientist at the Children's Hospital who led a study that tested the collar, told ABC News.
Essentially, Smith and his colleagues looked to nature to solve a medical issue. “If a woodpecker could repeatedly hit its head and not sustain any head injury, why couldnt this be applied to humans,” Smith said.
The study involved 75 teen girls ages 14 to 18 who played for two local high school soccer teams. Only one team received the collars, and then they played soccer. Both teams were asked to undergo brain scans at the beginning and end of the season, as well as during the off-season.
The scans showed that while the brains of the team that hadnt worn the collars showed signs of damage from head impacts, the brains of the team that had worn the collars remained the same.
The results are encouraging considering that even minor impacts over the course of an athletes career can have long-lasting effects on their cognitive functioning.
Concussions have emerged as a major health concern across the United States, according to the American Academy of Physicians. Emergency departments report more than a million visits annually for traumatic brain injuries, most of which are concussions.
Womens soccer is the third most common cause of concussion in the U.S., and its estimated that 1.6 to 3.8 million sports-related concussions occur each year.
There is a debate as to whether the changes shown in the brain scans can result in long-term cognitive decline. However, the areas of the brain that were affected in this study are involved in behavior, personality, expression, decision-making, and long-term memory. (more…)
Baby box safety doubts raised by experts
Baby boxes are being promoted as a safe alternative to standard cots, bassinets and Moses baskets de..
Baby boxes are being promoted as a safe alternative to standard cots, bassinets and Moses baskets despite a lack of evidence on their safety, experts warn.
The cardboard boxes, which come with items like clothes and blankets and can be used as a bed, are offered to new mums in Scotland and parts of England.
The Royal College of Midwives wants the scheme rolled out across the UK, saying it offers a "more equal start to life".
But experts have raised concerns about how safe the boxes are to sleep in.
Writing in a letter to the BMJ, Prof Peter Blair and colleagues say that, as the evidence stands, the boxes should only be used as a temporary bed if nothing else is available.
The boxes, which come with a mattress, have routinely been given to every expectant mother in Finland since the 1930s.
Scotland started offering the free boxes to new parents last year, while some NHS Trusts in England have had pilot and full schemes in place for up to two years. The boxes are not offered by health bodies in Wales or Northern Ireland.
The Royal College of Midwives says the boxes can reduce the likelihood of babies sleeping unsafely, either on a surface like a sofa or with parents who smoke, drink alcohol, or take drugs, and would particularly benefit those born into deprived environments.
However, Prof Blair and colleagues, including representatives of the cot death charity Lullaby Trust, said there was a lack of evidence into how safe the boxes are for sleeping in.
Compared with cots, bassinets and Moses baskets, it is harder for parents to easily see their babies when they are sleeping in them, they warned. (more…)
Contaminated blood victims ‘on the breadline’
People affected by the contaminated blood scandal “lost everything” and “had to live on the breadlin..
People affected by the contaminated blood scandal "lost everything" and "had to live on the breadline" as they struggled financially, the chairman of the public inquiry says.
In a letter to the Cabinet Office, Sir Brian Langstaff said "decisive action" was needed over the support available.
There is a variety of schemes running across the UK.
Sir Brian said he was concerned about what he heard during the preliminary hearings, which started last month.
The inquiry is expected to last more than two years and is looking into how thousands of people in the 1970s and 1980s were given blood products infected with hepatitis viruses and HIV, and the impact this had on their families.
It will also examine whether there has been any attempt to cover up the scandal.
In his letter to Cabinet Office Minister David Lidington, Sir Brian wrote: "You should be aware that there were considerable concerns during the preliminary hearings about access to and variations in financial support and psychological support, and also concern that not everyone who was infected has been identified.
"During the Commemoration people were heard asking 'where is the compassion?' and describing how they had 'lost everything', had to 'live on the breadline' and 'feel betrayed'.
"Throughout the preliminary hearings there were repeated calls for financial assistance which fully recompenses individuals and families for the losses they have suffered.
"One of the legal representatives said: 'Recently there have been changes to the way in which these funds are administered, but any suggestion that this represents proper compensation for the hurt they have, they are and will continue to suffer, is met with anger and indignation.' (more…)
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