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Some users find help by opiate substitute on black market: ‘What normal feels like’

This is a Kaiser Health News story.

Months in prison didnt rid Daryl of his addiction to opioids…

This is a Kaiser Health News story.

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?”

Limited access

People often try to treat themselves when they struggle to obtain real treatment, said Dr. Michelle Lofwall, an addiction specialist and researcher at the University of Kentucky.

“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.”

This story was produced in partnership with NPR, Side Effects Public Media, and Kaiser Health News. A longer version of the story appears in Side Effects podcast The Workaround.

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.

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The organization helping to bring new drugs for rare diseases to market

A research team has reason to celebrate after the Food and Drug Administration granted it approval o..

A research team has reason to celebrate after the Food and Drug Administration granted it approval on Friday to begin a clinical trial for a new pediatric brain cancer drug, one that might have ended up overlooked by pharmaceutical companies.

The lead researcher on the team, Dr. Teresa Purzner has already beat impossible odds. The neurosurgeon and mom of three managed to get the approval in record time and with little money thanks to the help of a team of scientific altruists called SPARK.

The development of new medications in the United States is driven by pharmaceutical companies; researchers at universities rarely bring their discoveries to the bedside. For every 10,000 potential new medicines sitting on laboratory shelves around the country, only one will ever reach patients in need, according to the National Institutes of Health. Why? Because the process can take 10 to 15 years, costing upwards of a billion dollars per drug.

As a result, the number of new medications approved by the FDA has remained stagnant at about 31 per year over the past 10 years. The majority of these medications are similar to already existing ones, and many target diseases for which there are large markets — like hypertension and high cholesterol — and therefore, a return on investment.

Enter SPARK, a non-profit program created in partnership between Stanford University and volunteers from the biotechnology, pharmaceutical, and investment industries, which helps academic researchers bring their discoveries to patients. Since its founding, SPARK has given special consideration to projects typically neglected by pharmaceutical companies, including rare diseases and diseases affecting children.

Purzner put her neurosurgery practice on pause to study medulloblastoma, a type of childhood brain cancer. Compared to diseases like hypertension and high cholesterol, which affect millions of Americans, medulloblastoma is rare, affecting only 250 to 500 children every year.

“Theres something especially poignant about seeing children —beautiful, wonderful, innocent things — and seeing the impact of the therapies we are giving them. The medications, the radiation therapies impact their cognition, their quality of life and their ability to function as independent adults in the future,” Purzner said in an interview with ABC News.

Purzner had a clear goal: to find a targeted therapy that could shut down the basic biochemical pathway responsible for the development of this cancer, and she did. She tested the potential drug in mice with good results, and she just received FDA approval to test it in clinical trials, which she will do through the Pediatric Brain Tumor Consortium. She did it all in five years and for a price tag of $500,000.

“To get from my initial findings in the lab to the point where the Pediatric Brain Tumor Consortium picked it up for clinical trials would have never happened without the help of SPARK… they gave me a clear pathway and made me believe it was possible,” said Purzner.

Every year, SPARK provides 10 teams with funding and expert mentorship to promote efficient and cost-effective drug development. (more…)

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Widowed father works with congresswoman on legislation to prevent maternal deaths

Sitting in the hospital room, mother and newborn baby were sound asleep.

“I was overjoyed. I reme..

Sitting in the hospital room, mother and newborn baby were sound asleep.

"I was overjoyed. I remember thinking my family is complete," Charles Johnson told ABC News.

But then he looked down and saw his wife Kiras catheter turn pink and then red with blood.

April 12, 2016 was supposed to be a joyous day for the Johnson family, but it turned into a "nightmare."

Ten hours later, Kira Johnson died as a result of internal bleeding following a cesarean section.

Now, two years later, Johnson is raising two children on his own and advocating to rectify the country's maternal health policies and regulations to prevent anyone else from sharing the same tragedy. Johnson took to Capitol Hill to share his wife's story before members of Congress, working alongside a congresswoman who experienced her own personal difficulties during pregnancy.

Charles and Kira Johnson welcomed their first son Charles V. in 2014. He was delivered via C-section. Two years later, the Johnson family relocated from Atlanta to Los Angeles and learned they were expecting their second baby boy.

"Kira and I had always wanted two boys," Johnson said. "I was excited."

The Johnsons decided to have Langston delivered at Cedars Sinai medical center, a non-profit hospital that is currently ranked as the eighth best hospital in the country by U.S. News and World Report.

Charles Johnson said his wife was in exceptional health and that she took all the necessary prenatal measures to ensure their second child would be born healthy. Since their first son was born via C-section, the doctor suggested the same for their second. (more…)

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States look to breathalyze convicted drunk drivers to reduce fatalities

This story is from Kaiser Health News

On Jan. 1, California joined the majority of states that ha..

This story is from Kaiser Health News

On Jan. 1, California joined the majority of states that have laws requiring drivers with drunken-driving convictions to install breathalyzers in vehicles they own or operate.

Researchers, public health advocates and political leaders believe these laws are helping reduce alcohol-related road deaths.

The gadgets, known as ignition interlock devices, are mounted on the steering wheel of a vehicle and prevent it from starting if the drivers blood-alcohol reading is above a predetermined level.

In California, the breathalyzers are mandatory only for repeat offenders. Five other states — Georgia, Indiana, Massachusetts, Montana and Ohio — have similar laws. Thirty-two states and D.C. require the devices even for first-time offenders.

The advent of such laws across the United States in the past 15 years has been accompanied by some good news: Deaths involving drunken driving are only about half of what they were in the early 1980s, though they have ticked back up in recent years. The long-term decline is largely attributable to greater public awareness, stricter seat belt enforcement and the establishment in 2000 of a nationwide legal blood-alcohol threshold of 0.08 percent — far below the 0.15 percent standard commonly used before then.

State Sen. Jerry Hill (D-San Mateo), the author of the California law, said breathalyzers in cars will make roads safer than under the current law, which generally relies on license restrictions and suspensions.

“Weve seen people on a suspended license continue to drive and continue to cause destruction,” said Hill, who lost his best friend to drunken driving in the 1980s.

There is some evidence that the breathalyzers have an impact. Nationally, from 2006 to 2016, ignition-locking breathalyzers prevented 2.3 million attempts to drive by people with a blood-alcohol level at or above 0.08 percent — the legal threshold for driving under the influence — according to a 2017 report by the advocacy group Mothers Against Drunk Driving.

Emma McGinty, an associate professor at the Johns Hopkins Bloomberg School of Public Health, found that laws requiring interlocks for all DUI offenders were associated with a 7 percent drop in the rate of fatal crashes caused by drunken drivers. Another study found that laws covering all offenders were associated with 15 percent fewer alcohol-related fatalities compared with states that have less stringent laws. (more…)

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