The U.S. Drug Enforcement Administration today launched CampusDrugPrevention.gov, a new website focused on preventing and addressing college drug use.
“We must talk to folks about the dangers and consequences of drug abuse, and base those conversations on facts and science,” said DEA Acting Administrator Chuck Rosenberg. “With this website, we put valuable information in the hands of higher education leaders who can use it to enlighten, teach, and change the culture.”
This new website is DEA’s latest effort to support drug abuse prevention programs on college campuses and in surrounding communities. The website was created as a one-stop resource for professionals working to prevent drug abuse among college students, including educators, student health centers, and student affairs personnel. In addition, it serves as a useful tool for college students, parents, and others involved in campus communities.
CampusDrugPrevention.gov offers valuable information, including data, news updates, drug scheduling and penalties, publications, research, national and statewide conferences and events, state and local prevention contacts, and resources available from DEA’s federal partners. The website also includes a “Help a Friend” resource to educate and prepare those who plan to talk to their friends or loved ones about drug use concerns.
For more information and to receive updates on campus drug prevention efforts and resources, visit www.CampusDrugPrevention.gov.
*New data compiled from hundreds of health agencies reveals the extent of the drug overdose epidemic last year.
Drug overdose deaths in 2016 most likely exceeded 59,000, the largest annual jump ever recorded in the United States, according to preliminary data compiled by The New York Times.
The death count is the latest consequence of an escalating public health crisis: opioid addiction, now made more deadly by an influx of illicitly manufactured fentanyl and similar drugs. Drug overdoses are now the leading cause of death among Americans under 50.
Although the data is preliminary, the Times’s best estimate is that deaths rose 19 percent over the 52,404 recorded in 2015. And all evidence suggests the problem has continued to worsen in 2017.
Because drug deaths take a long time to certify, the Centers for Disease Control and Prevention will not be able to calculate final numbers until December. The Times compiled estimates for 2016 from hundreds of state health departments and county coroners and medical examiners. Together they represent data from states and counties that accounted for 76 percent of overdose deaths in 2015. They are a first look at the extent of the drug overdose epidemic last year, a detailed accounting of a modern plague.
The initial data points to large increases in drug overdose deaths in states along the East Coast, particularly Maryland, Florida, Pennsylvania and Maine. In Ohio, which filed a lawsuit last week accusing five drug companies of abetting the opioid epidemic, we estimate overdose deaths increased by more than 25 percent in 2016.
“Heroin is the devil’s drug, man. It is,” Cliff Parker said, sitting on a bench in Grace Park in Akron. Mr. Parker, 24, graduated from high school not too far from here, in nearby Copley, where he was a multisport athlete. In his senior year, he was a varsity wrestler and earned a scholarship to the University of Akron. Like his friends and teammates, he started using prescription painkillers at parties. It was fun, he said. By the time it stopped being fun, it was too late. Pills soon turned to heroin, and his life began slipping away from him.
Mr. Parker’s story is familiar in the Akron area. From a distance, it would be easy to paint Akron — “Rubber Capital of the World” — as a stereotypical example of Rust Belt decay. But that’s far from a complete picture. While manufacturing jobs have declined and the recovery from the 2008 recession has been slow, unemployment in Summit County, where Akron sits, is roughly in line with the United States as a whole. The Goodyear factories have been retooled into technology centers for research and polymer science. The city has begun to rebuild. But deaths from drug overdose here have skyrocketed.
In 2016, Summit County had 312 drug deaths, according to Gary Guenther, the county medical examiner’s chief investigator — a 46 percent increase from 2015 and more than triple the 99 cases that went through the medical examiner’s office just two years before. There were so many last year, Mr. Guenther said, that on three separate occasions the county had to request refrigerated trailers to store the bodies because they’d run out of space in the morgue.
It’s not unique to Akron. Coroners’ offices throughout the state are being overwhelmed.
In some Ohio counties, deaths from heroin have virtually disappeared. Instead, the culprit is fentanyl or one of its many analogs. In Montgomery County, home to Dayton, of the 100 drug overdose deaths recorded in January and February, only three people tested positive for heroin; 99 tested positive for fentanyl or an analog. Fentanyl isn’t new. But over the past three years, it has been popping up in drug seizures across the country.
Most of the time, it’s sold on the street as heroin, or drug traffickers use it to make cheap counterfeit prescription opioids. Fentanyls are showing up in cocaine as well, contributing to an increase in cocaine-related overdoses.
The most deadly of the fentanyl analogs is carfentanil, an elephant tranquilizer 5,000 times stronger than heroin. An amount smaller than a few grains of salt can be a lethal dose.
“July 5th, 2016 — that’s the day carfentanil hit the streets of Akron,” said Capt. Michael Shearer, the commander of the Narcotics Unit for the Akron Police Department. On that day, 17 people overdosed and one person died in a span of nine hours. Over the next six months, the county medical examiner recorded 140 overdose deaths of people testing positive for carfentanil. Just three years earlier, there were fewer than a hundred drug overdose deaths of any kind for the entire year.
This exponential growth in overdose deaths in 2016 didn’t extend to all parts of the country. In some states in the western half of the U.S., our data suggests deaths may have leveled off or even declined. According to Dr. Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco, and an expert in heroin use in the United States, this geographic variation may reflect a historical divide in the nation’s heroin market between the powdered heroin generally found east of the Mississippi River and the Mexican black tar heroin found to the west.
This divide may have kept deaths down in the West for now, but according to Dr. Ciccarone, there is little evidence of differences in the severity of opioid addiction or heroin use. If drug traffickers begin to shift production and distribution in the West from black tar to powdered heroin in large quantities, fentanyl will most likely come along with it, and deaths will rise.
First responders are finding that, with fentanyl and carfentanil, the overdoses can be so severe that multiple doses of naloxone — the anti-overdose medication that often goes by the brand name Narcan — are needed to pull people out. In Warren County in Ohio, Doyle Burke, the chief investigator at the county coroner’s office, has been watching the number of drug deaths rise as the effectiveness of Narcan falls. “E.M.S. crews are hitting them with 12, 13, 14 hits of Narcan with no effect,” said Mr. Burke, likening a shot of Narcan to “a squirt gun in a house fire.”
Early data from 2017 suggests that drug overdose deaths will continue to rise this year. It’s the only aspect of American health, said Dr. Tom Frieden, the former director of the C.D.C., that is getting significantly worse. Over two million Americans are estimated to be dependent on opioids, and an additional 95 million used prescription painkillers in the past year — more than used tobacco. “This epidemic, it’s got no face,” said Chris Eisele, the president of the Warren County Fire Chiefs’ Association and fire chief of Deerfield Township. The Narcotics Anonymous meetings here are populated by lawyers, accountants, young adults and teenagers who described comfortable middle-class upbringings.
Back in Akron, Mr. Parker has been clean for seven months, though he is still living on the streets. The ground of the park is littered with discarded needles, and many among the homeless here are current or former heroin users. Like most recovering from addiction, Mr. Parker needed several tries to get clean — six, by his count. The severity of opioid withdrawal means users rarely get clean unless they are determined and have treatment readily available. “No one wants their family to find them face down with a needle in their arm,” Mr. Parker said. “But no one stops until they’re ready.”
About the Data
Our count of drug overdoses for 2016 is an estimate. A precise number of drug overdose deaths will not be available until December.
As the chief of the Mortality Statistics Branch of the National Center for Health Statistics at the C.D.C., Robert Anderson oversees the collection and codification of the nation’s mortality data. He noted that toxicology results, which are necessary to assign a cause of death, can take three to six months or longer. “It’s frustrating, because we really do want to track this stuff,” he said, describing how timely data on cause of death would let public health workers allocate resources in the right places.
To come up with our count, we contacted state health departments in all 50 states, in addition to the District of Columbia, asking for their statistics on drug overdose deaths among residents. In states that didn’t have numbers available, we turned to county medical examiners and coroners’ offices. In some cases, partial results were extrapolated through the end of the year to get estimates for 2016.
While noting the difficulty of making predictions, Mr. Anderson reviewed The Times’s estimates and said they seemed reasonable. The overdose death rate reported by the N.C.H.S. provisional estimates for the first half of 2016 would imply a total of 59,779 overdose deaths, if the death rate remains flat through the second half of the year. Based on our reporting, we believe this rate increased.
While the process in each state varies slightly, death certificates are usually first filled out by a coroner, medical examiner or attending physician. These death certificates are then collected by state health departments and sent to the N.C.H.S., which assigns what’s called an ICD-10 code to each death. This code specifies the underlying cause of death, and it’s what determines whether a death is classified as a drug overdose.
Sometimes, the cases are straightforward; other times, it’s not so easy. The people in charge of coding each death — called nosologists — have to differentiate between deaths due to drug overdose and those due to the long-term effects of drug abuse, which get a different code. (There were 2,573 such deaths in 2015.) When alcohol and drugs are both present, they must specify which of the two was the underlying cause. If it’s alcohol, it’s not a “drug overdose” under the commonly used definition. Ideally, every medical examiner, coroner and attending physician would fill out death certificates with perfect consistency, but there are often variations from jurisdiction to jurisdiction that can introduce inconsistencies to the data.
These inconsistencies are part of the reason there is a delay in drug death reporting, and among the reasons we can still only estimate the number of drug overdoses in 2016. Since we compiled our data from state health departments and county coroners and medical examiners directly, the deaths have not yet been assigned ICD-10 codes by the N.C.H.S. — that is, the official underlying cause of death has not yet been categorized. In addition, the mortality data in official statistics focuses on deaths among residents. But county coroners typically count up whichever deaths come through their office, regardless of residency. When there were large discrepancies between the 2015 counts from the C.D.C. and the state or county, we used the percent change from 2015 to calculate our 2016 estimate.
We can say with confidence that drug deaths rose a great deal in 2016, but it is hard to say precisely how many died or in which places drug deaths rose most steeply. Because of the delay associated with toxicology reports and inconsistencies in the reported data, our exact estimate — 62,497 total drug overdose deaths — could vary from the true number by several thousand.
Overdose Free PA; coroners and medical examiners covering Allegheny, Bucks, Dauphin, Delaware, Erie, Lackawanna, Lancaster, Lehigh, Luzerne, Montgomery, Northampton, Philadelphia and York counties
West Virginia Department of Health and Human Resources
Wyoming
96
none
In all cases, “cause of death” refers to what the National Center for Health Statistics classifies as the underlying, rather than the immediate, cause of death. Example: For a person who dies from an infection because of H.I.V., while the infection might be the immediate cause of the person’s death, the underlying cause would be H.I.V.
Deaths from car crashes include all deaths caused by motor vehicle accidents according to the N.C.H.S. Deaths from guns include homicides, suicides and accidental deaths from firearms, in addition to firearm deaths of undetermined intent. It excludes firearm deaths caused by legal intervention. Deaths from drug overdoses excludes deaths caused by substance use disorder or withdrawal, which accounted for an additional 2,573 deaths in 2015.
Definitions for causes of death can change slightly with each revision of the International Classification of Diseases. Where applicable, deaths counted under earlier editions of the I.C.D. were adjusted to correct for this.
The call came in at dinnertime: an 11-year-old girl, not breathing.
Pittsburgh paramedics with Medic 8 supposed the girl was choking on her food as they raced to the address in Beechview. But paramedics with Medic 2 got to the home first and sent out an update over the air: The girl showed telltale signs of heroin use. This was an overdose.
What followed was unique only because of the girl’s young age.
The paramedics gave the girl an adult dose of naloxone and revived her. The drug, often known by the trade name Narcan, blocks the effects of opioids, and can save patients from otherwise fatal overdoses, but also plunges patients into immediate physical withdrawal. The girl, like many heroin users, became combative and nonsensical when she was revived. Paramedics sedated her on the way to the hospital, and left her there in stable but critical condition.
This happens, on average, eight times a day in Pittsburgh. The call for an unconscious person, the Narcan, the anger and withdrawal is routine — so routine that it’s easier for paramedics to count days without overdoses than days with them.
The city’s paramedics are on the front line of the opioid epidemic, a growing wave of people abusing opioid drugs. In 2012, paramedics responded to about 900 calls for overdoses in the city; in 2016, it was 2,300. Pittsburgh EMS Chief Robert Farrow expects calls for overdoses to hit 3,000 this year.
The sheer volume takes both a practical and psychological toll on first responders. Paramedics save the same patients so many times that they know their first names, watch fathers perform CPR on sons and listen to children call out for unconscious, overdosing parents.
They see firsthand how addiction wears on family members, and witnessing that pain can be the hardest part of it all.
“It’s a living suicide,” Medic 2 crew chief Stacey Yaras said of addiction.
At 10:34 a.m. on Friday, EMS District Chief Jeff Meyer received a call for a man down, unconscious and not breathing, a suspected overdose.
He flipped on his truck’s red lights and sped to the home on Woodbourne Avenue in Brookline.
“This could be cardiac arrest, this could be dead or this could be a little Narcan goes a long way,” District Chief Meyer said on the way, laying on the horn as he escaped Downtown traffic.
When patients overdose on opioids, their breathing slows, they fall unconscious and then stop breathing altogether. The heart continues to beat for a few minutes, but the body soon runs out of oxygen, which leads to cardiac arrest.
The first step to saving an overdosing patient is to breathe for them.
But when District Chief Meyer reached the home on Woodbourne Avenue, there was no point.
Timothy Buehl, 25, was on the floor, curled up in the fetal position, surrounded by stamp bags. He’d been dead for hours.
District Chief Meyer made the official pronouncement.
A few minutes later on the front porch, the home’s owner, Thomas Alexander, watched a stream of investigators troop in and out: Pittsburgh police officers, detectives, a crime scene photographer. The Allegheny County Medical Examiner’s office was called to remove the body.
“I got up there and he was cold as ice,” Mr. Alexander said. “I reached down and felt his hand to do his pulse and it was freezing. I knew he was dead.”
He stared off, looked down at his hands. The 25-year-old man was just visiting the home, he said.
“He’s not a bad kid, he’s just a bad addict,” Mr. Alexander said. “He couldn’t stop.”
Many can’t.
“I’ve had the same guy overdose three times in three days,” said Jonathan Dalbey, a paramedic with Medic 2. “You go and take care of him one day, and then you take care of them the next. It’s sad because eventually they’re going to die.”
During 2016, 613 people died from overdoses in Allegheny County, compared with 424 in 2015, according to the medical examiner. In 2012, the county saw only 290 overdose deaths.
In Pittsburgh alone, at least 74 people have died from suspected overdoses so far this year, according to police, compared with 130 in all of 2016.
It’s relatively simple for a paramedic to save someone who is overdosing. Ten years ago, a heroin overdose call was a big deal, Mr. Dalbey and his crew chief, Jeff Reim, said.
“Now, it’s like a drill,” Mr. Reim said. “We could do it in our sleep.”
“I think my record is four back to back [overdose calls],” Mr. Dalbey said. “We know when a dealer hits an area because all the sudden you’ll have like eight overdoses within an hour.”
Overdoses are most often dispatched as top priority calls because they usually involve someone who is not breathing, paramedics said. That means a medic unit with an ambulance responds to the scene, as well as an EMS supervisor and rescue truck, a fire truck and multiple police units.
And when those first responders are at a heroin overdose, they can’t be at a car accident, for instance, or at a home where a woman is experiencing chest pain.
That’s true for any call, paramedics said, but overdoses strain the system because they happen simultaneously and frequently across the city.
“You might have four or five overdoses going on at one time, and you have med units out at each of those,” Mr. Dalbey said. “It’s rare that you would have multiple people having heart attacks at the same time. We have a limited number of ambulances, and as call volume goes up, response time goes up.”
Right now, EMS can keep up with overdoses and other medical calls, Chief Farrow said, although that could change if overdoses continue to skyrocket in coming years.
Other first response agencies have already made changes at their departments to adjust to the flood of opioid use. Allegheny County Police added eight detectives to their narcotics unit about a year ago, nearly doubling the unit’s size, Lt. Jeffrey Korczyk said.
Pittsburgh narcotics detectives now investigate overdose deaths, and most of their work these days is spurred by a death, rather than by citizen complaints, as it was in the past, Detective Calvin Kennedy said.
Police officers and firefighters carry naxolone in their vehicles.
For the time being, first responders are coping with the practical demands of the opioid crisis, officials said.
The psychological toll overdoses take on first responders themselves is perhaps more pressing, District Chief Mike Rogers said.
“Trucks we can replace,” he said. “It’s the wear and tear on the people.”
Nine times out of 10, patients saved from an overdose with naloxone aren’t happy to be saved, Mr. Dalbey said. Torn from their high and dumped into withdrawal — which feels like the flu on steroids, every cell hurts — overdose patients often lash out at paramedics, and it’s hard to constantly save patients who berate you afterward, paramedics said.
“You can only get screamed at for so long before you think, ‘Is this really worth it?’” Mr. Dalbey said.
And yet it always is, he and other paramedics said.
“It’s not our job to judge people,” Mr. Reim said. “Everybody deserves to be saved.”
Shelly Bradbury: 412-263-1999, [email protected] or follow on Twitter @ShellyBradbury.
Residents of Saline County dropped off more than 1,500 pounds of medications during the Saturday, April 29 Arkansas Drug Take Back Day, which was called Operation Medicine Cabinet in Benton. Since 2009, the start of Operation Medicine Cabinet, more than 5 tons of prescription medications have been donated to the Benton Police Department for environmentally safe disposal.
“This shows that residents here are passionate in reversing the opioid epidemic in our own communities and across the nation,” Benton Police Chief Kirk Lane said. “Statistics show that prescription drug abusers largely get them from home medicine cabinets. We are also very proud to see many parents bringing their children with them to show the importance of Operation Medicine Cabinet and the Arkansas Drug Take Back Day.”
There were 349 drug overdose deaths in Arkansas in 2014 and that number decreased to 287 drug overdose deaths in 2015, a reduction of 18 percent. In 2016 however, the number increased by 17 percent at 335 drug overdose deaths in Arkansas. Saline County had 13 drug overdose deaths in 2016. *(These charts were developed from autopsied individuals only. The data was generated from autopsy reports containing one of the following words: intox, overdose, toxicity)
More than 143 people in America die each day due to a drug overdose. The rate of overdose deaths involving opioids (heroin and prescription opioids – oxycodone, hydrocodone, codeine, morphine, fentanyl, and other pain relievers) has increased by 200 percent since 2000.
On an average day in the U.S: more than 650,000 opioid prescriptions are dispensed; 3,900 people initiate nonmedical use of prescription opioids; 580 people initiate heroin use; and 78 people died from opioid-related overdose. A large portion of people who abuse prescription opioids report that they obtained them in the homes of loved ones, including 42 percent of teenagers obtaining prescription medicines from their parent’s medicine cabinet. Also, 64 percent of teenagers (age 12-17) that have abused prescription pain relievers say they got them from friends or relatives. About two-thirds of all prescription drugs (which also include stimulants such as Adderall and depressants like Ativan) illegally obtained are taken from people’s homes and not pharmacies or off the street.
The April 29 Arkansas Drug Take Back Day and Operation Medicine Cabinet were both dedicated to the late William Christian Doerhoff and The William Christian Doerhoff Memorial Foundation. We encourage you to read more about Will Doerhoff and his parents dedication to a program called Speak Up-Speak Out at www.willswork.org.
On April 29 Saline County had drug-take-back collection sites at Walmart in Benton and Bryant, Harvest Foods in Salem and East End, and in Haskell. Together the agencies collected 1,504 pounds of prescription medications.
Benton Police Department – 1,067 pounds
Bryant Police Department – 300 pounds
Haskell Police Department – 51 pounds
Saline County Sheriff’s Office – 85.2 pounds
Saline County residents have continued to take part in the Operation Medicine Cabinet events, collecting a total of 15,130 pounds since 2009.
Benton Police Department Collection
OMC I: 146 pounds
OMC II: 540 pounds
OMC III: 790 pounds
OMC IV: 483 pounds
OMC V: 630 pounds
OMC VI: 718 pounds
OMC VII: 807 pounds
OMC VIII: 742 pounds
OMC IX: 250 pounds
OMC X: 1,600 pounds
OMC XI: 890 pounds
OMC XII: 1,246 pounds
OMC XIII: 1031 pounds
OMC XIV: 1,504 pounds
The Operation Medicine Cabinet event started in Benton after Russell Goodwin, owner of a local monument company and youth baseball coach, told Benton Police Chief Kirk Lane that he was “tired of making headstones for children” he knew due to the abuse of prescription drugs. Benton officers gathered data that showed there was a problem with abuse and misuse of prescription drugs by youth, including information from the Saline County Coroner’s Office which showed that 30 people died in 2009 as a result of prescription drug abuse.
There was just 146 pounds of prescription medications collected at the first Operation Medicine Cabinet in Benton back in the spring of 2009, but the program and education to the public continued growth. State officials took notice and the program expanded. In 2010, a coalition led by State Drug Director Fran Flener, then Arkansas Attorney General Dustin McDaniel and both Arkansas districts of the U.S. Attorney’s Office launched an ongoing educational program to encourage everyone to “Monitor, Secure and Dispose” of their prescription medications. The also launched the website ardrugtakeback.org.
On the heels of the success in Arkansas, the U.S. Drug Enforcement Administration announced a nationwide prescription drug take back campaign. In May 2016, the DEA announced that 893,498 pounds of prescription medications were collected in all 50 states, with 25,289 pounds collected from Arkansas.
Returning your unwanted medicines to Operation Medicine Cabinet is the safest and most environmentally protective way to dispose of unused medication. Medicines that are flushed or poured down the drain can end up polluting our waters, impacting aquatic species, and contaminating our food and water supplies. Most medicines are not removed by wastewater treatment plants or septic systems. Scientists have found medicines in surface, ground and marine waters as well as soils and sediments in the Pacific Northwest. Even at very low levels, medicines in the environment hurt aquatic life.
Medicines are a special type of hazardous chemical which are not safe in solid w
aste systems and landfills. Drugs can be very toxic for people and wildlife, even in low doses. Just as we do not put used motor oil or leftover paint thinner in the trash, we should not put these extremely potent pharmaceutical chemicals into unsecure curbside trash cans.
If you have prescription medications needing to be disposed of, drop them off in the Benton Police Department’s 24-7 drop box, located at 114 S. East St. For more information about Operation Medicine Cabinet and for a list of locations across the state where medicines can be dropped off, visit ardrugtakeback.orgor call (501) 618-8693.
Arkansas law enforcement agencies collected more than 24,000 pounds of prescription drug medications in a single day. Arkansas Attorney General Leslie Rutledge said that “Arkansans are helping save countless lives” by getting these prescription medications “out of our homes.”
“Studies show that drug overdose is the leading cause of accidental death in the U.S. with opioid addictions driving this epidemic,” Rutledge said. “I appreciate all the partnering agencies who helped make this prescription drug take back day a success as we continue to fight this growing threat.”
The 24,483 pounds of prescription medications were collected at 200 locations throughout the entire state as part of the semi-annual Prescription Drug Take Back held on Saturday, April 29. This exceeded the previous collection date (October 2016) by 1,000 pounds. Of the 200 locations in the state, 184 of those locations are from facilities with a permanent 24-hour drop-box. All locations can be easily found at ardrugtakeback.org by left-clicking on the Collection Sites/Events & Dropboxes tab, which includes a Google map and search by Zipcode or Collection Site Name.
“Prescription drug abuse has become the nation’s fastest growing drug epidemic, with almost 4 million Americans addicted prescription painkillers,” said U.S. Drug Enforcement Administration Assistant Special Agent in Charge Matt Barden. “Unfortunately, these prescription drugs are most often obtained from friends and family, who leave them in home medicine cabinets. The DEA’s and State of Arkansas’s Take Back initiative provides citizens an easy and safe wa
y to dispose of unwanted prescription drugs.”
“I encourage the citizens of Arkansas to please do your part to keep prescription drugs off the streets and help end this national epidemic,” Barden continued.
Benton Police Chief Kirk Lane said that the Arkansas Drug Take Back Day brings education and awareness to communities to utilize the method of “Secure, Monitor, Dispose,” with prescription drugs.
“It is a major tool in reducing deaths from prescription drug abuse and misuse, as we know that 70 percent of prescriptions that are abused come from our homes,” Lane said. “Great partnerships in this effort are a key part of its success, but there is much more work to do. It will take all of us working together to make the difference, and the difference will save lives.”
Rutledge also announced that the early bird registration is now available for the annual Prescription Drug Abuse Prevention Summit at ArkansasAG.gov. The summit, which was attended last year by more than 700 law enforcement officers, medical professionals, pharmacists and educators, gives an opportunity to hear from experts regarding prescription drug abuse prevention and treatment. This year the summit will be held in Hot Springs on Nov. 9. A full agenda will be announced at a later date.
“I appreciate the partnership with the Attorney General’s Office, the DEA and other supporters involved in this year’s successful Take Back Initiative,” said FBI Little Rock Field Office Special Agent in Charge Diane Upchurch. “Improper disposal can have a devastating effect on our families and communities, as well as our environment. By taking back 24,000 pounds of prescription drugs, we’ve taken a step to save the lives of innocent children who accidentally use prescription drugs and the lives of those who abuse prescription drugs.”
Semi-annually a Prescription Drug Take Back Day is held with the Arkansas Attorney General’s office, Arkansas Department of Health, Arkansas Department of Human Services, Arkansas National Guard, Arkansas Rotary Clubs, Arkansas State Board of Pharmacy, DEA, FBI, Office of the State Drug Director and over 130 additional law enforcement and government agencies, community organizations and public health providers.
Event sites are held at various locations across the State but year-round locations are also available and can be found at ARTakeBack.org. The Attorney General’s office also hosts take back events at mobile offices around the State. Since the program began, more than 72 tons of medication have been collected in Arkansas, which is an estimated 201 million individual pills.
The opioid epidemic in the US can sometimes seem like a giant game of whack-a-mole for health officials — look away and the epidemic shifts. More people still overdose on prescription painkillers than any other opioid, but heroin and other illicit opioids like fentanyl are now fueling a separate, and perhaps even deadlier, drug epidemic.
And it turns out there are now big differences between age groups when it comes to opioid overdoses. Jay Unick, a professor at the University of Maryland and specialist in the health consequences of heroin use, found a stark divide in his analysis of drug overdose and emergency room data from 2013 and 2014: Americans in their 50s and 60s overwhelmingly overdosed on prescription opioids, while Americans in their 20s and 30s overdosed disproportionately on heroin.
Researchers first observed a shift in how people between the ages of 20 and 35 overdosed on drugs in 2007. The dramatic uptick in the use of heroin has continued since then, claiming more than 12,000 lives in 2015.
Unick, who presented his findings last week at the National RX Drug Abuse and Heroin Summit, thinks the age divide is an unintended consequence of states moving to crack down on opioid prescriptions. In other words, restrictions on prescription painkillers are driving younger Americans to use heroin and other opioids on the black market.
“Older people have greater access to pills,” said Unick — and many still have a pathway to obtain opioids legally because of either chronic pain or disability. “But younger people are just starting with heroin and aren’t even making that shift from pills to heroin.” (Heroin-related deaths are increasing for older Americans too — just not nearly as fast.)
Unick is currently working on a paper to publish his findings from the Agency for Healthcare Research and Quality (AHRQ) hospitalization data and Centers for Disease Control and Prevention data he analyzed. But at this stage they are preliminary and haven’t been peer-reviewed. You can access the presentation slides he shared with Vox here.
Heroin use varies dramatically in the US. But the problem is most serious in the Northeast and Midwest.
When we talk about the opioid epidemic in the US, much of the conversation centers on West Virginia, Kentucky, and rural Appalachia, where communities have been especially hard hit. In West Virginia, for instance, the drug overdose death rate is nearly three times the national average at 41.5 deaths for every 100,000 people.
But in his analysis of hospitalizations and emergency room visits, Unick found something unexpected — hot spots for heroin abuse were largely concentrated in the Northeast and Midwest. (He used hospitalization and emergency room data to better capture the magnitude of the problem, as drug overdose data only includes people who died.)
As you can see in the chart below, though, that is changing, as regions (excluding the West) have experienced a steady increase in emergency room visits from heroin overdoses since 2011.
To be clear, more people have died from prescription opioids than from heroin. But — and this is key — there isn’t as much regional variation in prescription overdose deaths as there is with heroin deaths. What’s more, as the chart below shows, hospitalizations from prescription painkillers started to decline in all regions of the US as of 2012.
It’s just another piece of evidence that the opioid epidemic is changing. And other data shows that increasingly, heroin and fentanyl are emerging as deadly drivers of the epidemic.
For the first time in 2015, heroin killed more people than prescription painkillers (even though a significant number of people still died from prescription opioids).
One thing that is apparent is the recent increase of fentanyl and heroin use has already devastated parts of the US, and states like Ohio are in the grips of a full-blown heroin crisis. As you can see in the chart below, Ohio has double the heroin overdose rate of its neighboring states.
And Unick fears states’ response of clamping down on pills won’t be enough to stem the crisis. “We’re going to get stuck if we don’t increase access to treatment,” he said. “A doctor can prescribe you hydrocodone but can’t prescribe [treatment] drugs like naloxone because of stigma. We can prescribe the drugs that kill you but not the drugs that save you.”
Studies have found naloxone to be effective in reducing the risk of opioid overdose. But as Vox’s German Lopez reported, only 45 states (plus Washington, DC) have laws that increase access to naloxone — and even then, the level of protection and access under the law can vary dramatically from state to state.
(CNN): Experts say the United States is in the throes of an opioid abuse epidemic, causing 91 overdose deaths each day. Yet the total number of opioid-related deaths may still be underestimated, suggests new research from the US Centers for Disease Control and Prevention.
“In early spring, the Minnesota Department of Health was notified of an unexplained death: a middle-aged man who died suddenly at home,” said Dr. Victoria Hall, a CDC field officer based in Minnesota. He’d been on long-term opioid therapy for back pain, and his family had worried he might be abusing his medication. The medical examiner assigned to the autopsy tested for and diagnosed both pneumonia and a toxic level of opioids.
“However, on the death certificate, it only listed the pneumonia and made no mention of opioids,” Hall said.
The researchers say it may be difficult to track causes of death, such as this one, within surveillance systems that are based solely on autopsy report codes known as International Classification of Diseases, Tenth Edition, or ICD-10.
Over half of the deaths involving opioids in Minnesota between 2006 and 2015 had not been captured in the state’s total, said Hall.
“While my research cannot speak to what percent we are underestimating, we know we are missing cases,” Hall said. “It does seem like it is almost an iceberg of an epidemic.”
Hall presented her findings Monday at the annual Epidemic Intelligence Service Conference, which showcased recent CDC investigations. CDC’s “disease detectives’ support over 10
0 field investigations each year in the US and worldwide.
Rural and urban, men and women
Researchers led by Hall examined death records within the Minnesota Department of Health’s Unexplained Death surveillance system, called UNEX, for 2006 through 2015.
The CDC started the system in 1995 in many states, but Minnesota is the only one to maintain it.
The system was developed to “constantly be on the lookout for emerging diseases,” especially infectious diseases, explained Hall. It identifies cases in which there’s no clear explanation for death so more testing can be performed.
Because research has showed that opioid users are at increased risk of pneumonia, Hall and her colleagues searched for pneumonia as well as other infectious disease deaths among Minnesota residents over the age of 12 to see whether opioids might be involved and found in postmortem toxicology screenings.
Among the 1,676 deaths that fit the researchers’ criteria, 59 (or 3.5%) showed evidence of opioid use. Those 59 deaths had not been picked up by the state’s opioid surveillance system because they lacked the proper ICD-10 code. And, among these 59 deaths, 22 had involved toxic levels of opioids.
The deceased ranged in age from 16 to 82, with a median age of 43, and 53% were female. Hall said the demographics of cases caught in the UNEX system were very similar to those captured in the state overdose system, with adults of all ages and ethnicities, both rural and urban.
“Opioids don’t discriminate,” Hall said.
Pneumonia was found in 32 of the 59 deaths. Deaths involving infectious disease like pneumonia can be complicated if you have opioids in your system, explained Hall.
“Opioids at therapeutic or higher than therapeutic levels can impact our immune system,” she said. “It actually impacts your macrophages — so that’s one of your main immune cells that’s going to help fight off infections — and it kind of dampens them down. It also dampens down your antibody response.”
The sedative action of opioids also affects mechanical aspects of breathing.
“When you take an opioid and it makes you breathe more shallow and breathe slower and less likely to cough, it’s a lot more likely things can settle in your lungs,” Hall said.
Among the 32 pneumonia cases, nine of the deceased had a history of drug abuse, six had chronic pain, and one was taking methadone.
“Over half the cases that we found that were toxic or lethal were not counted in the system,” Hall said.
Written by Shawn Radcliffe | Published on April 20, 2017
Each year, surgery puts millions of people in the United States at risk of long-term prescription opioid use. Sometimes, use lasts long after the normal recovery period, a new study concluded. This occurs after both major and minor surgeries, leading researchers to blame other factors for this trend.
“The reasons for people continuing to use opioids are complicated and not always as simple as just pain after surgery,” Dr. Chad Brummett, a study author, and director of the pain research division in the University of Michigan Medical School’s Department of Anesthesiology, told Healthline.
‘Persistent opioid use’
The study, which was published April 12 in JAMA Surgery, found that about 6 percent of 36,000 adults continued to receive prescription opioids three to six months after surgery. The rates of “new persistent opioid use” were similar for people who had major or minor surgery. This was about 12 times more than the rate of long-term opioid use in a comparison group of similar people who didn’t have surgery during the study period.
Researchers also found that people who had certain conditions before surgery had a higher risk of long-term prescription opioid use. This included smoking, alcohol or substance abuse disorders, depression, anxiety, and arthritis or other chronic pain conditions. Around 50 million surgical procedures are performed in the United States each year. If the study’s findings hold for all patients, it would mean that each year about 3 million people who hadn’t used opioids recently would still be receiving these drugs months after their surgeries.
“This is an area that we have not focused enough on and certainly merits attention, given these high rates of new persistent use,” said Brummett. Experts say this study also addresses some misconceptions about prescription opioids.
“It’s a really important study because it’s one more piece of evidence that puts to rest this myth that people who become addicted to prescription opioids are people who were already addicted to something else,” Dr. Anna Lembke, psychiatrist and pain specialist at the Stanford University Medical Center, told Healthline.
Fueling the epidemic
This is not the first time that prescription pain killers have been implicated in fueling the opioid epidemic in the United States. A 2015 analysis published in the Annual Review of Public Health found that since the late 1990s, sales of prescription opioids have risen in parallel with opioid overdose deaths and opioid treatment admissions.
Opioids caused more than 33,000 deaths in 2015, according to the Centers for Disease Control and Prevention (CDC). Half of these deaths were due to prescription opioids, such as methadone, OxyContin, and Vicodin. But even after the CDC declared an opioid epidemic in 2011, doctors continued for several years to prescribe a significant amount of opioids to patients.
“It’s really only in the last year or so that we see some plateauing and some decrease,” said Lembke, “but not a substantial decrease.”
Two years ago, doctors wrote about 300 million opioid prescriptions. People in the United States use about 80 percent of the world’s opioid supply — yet the country only has 5 percent of the global population.
“We have no more need for analgesia than other high-income developed countries,” said Lembke, “and yet we consume vast amounts of opioids.”
Balancing risks, benefits
The JAMA Surgery study shows that opioids prescribed after surgery are contributing to the opioid epidemic, but that doesn’t mean these drugs don’t have their place in medicine.
“There’s no question that opioids are essential for the practice of modern medicine and are vital in managing acute pain, especially moderate to severe acute pain,” Dr. Itai Danovitch, chairman and associate professor of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center, told Healthline.
“For most chronic pain conditions, opioids would not be a first or even a second-line medication,” said Brummett, “and really should be limited to very specific situations.”
And the downsides of opioids quickly accumulate when you are on them for months.
“There is a lot of evidence to show that taking opioids for 90 or more days leads to lots of risk factors and adverse medical consequences,” said Lembke. “One of which is addiction, but there are others — depression, constipation, hormonal imbalance, hypoxemia, accidental overdose death, and tolerance dependence withdrawal.”
Not everyone who uses opioids becomes addicted. But a 2015 study found that the risk of developing an opioid use disorder increased with both duration and dose — with duration having the biggest effect. Better pain relief. There are many points at which doctors can target the problem of long-term opioid use after surgery.
Additional “psychological support and education” before surgery can give patients clear expectations about the risks and benefits of opioids, said Lembke, and may reduce their need for opioids.
This is especially important for people with risk factors such as mental illness or a personal or family history of addiction. And it means educating doctors as well, a core mission of the Michigan Opioid Prescribing Engagement Network.
“We have to retrain physicians as to how they think about opioids but also to set fair expectations for patients about what’s to be expected,” said Brummett.
During surgery, non-opioid pain relief may also be available.
“Localized lidocaine infusions are just one example of innovative techniques that doctors are coming up with now to try to minimize the use of opioids,” said Lembke.
And after surgery, doctors can prescribe opioids in the smallest dose and duration that works for a patient. Surgeons also need to be alert for problems.
“If we begin to see patients going to two or three months of daily use, that should be a red flag,” said Lembke. “Not for stigmatizing the patient or shaming them or kicking them out of your practice, but for getting them additional support.”
This extra support might come from a pain management or addiction specialist. Or from a support group or the patient’s family physician. Danovitch also sees a need to break down the barriers between the physical health and mental health systems.
“We know that most people that struggle with chronic pain also have mental health issues — anxiety or depression or other adversity,” he said. “To achieve optimal health outcomes, they need to get both sets of services.”
Maumelle, AR – Scott and Shannon Doerhoff describe their son Will as someone who never met a stranger.
Sitting inside of their home, in a picturesque suburban neighborhood just outside of Little Rock, the two exchanged fond memories of their first-born, highlighting his comforting way with people.
“He always smiled,” said Scott Doerhoff. “They instantly knew that he was someone that they could approach and be comfortable with without ever saying a word, because he always had that smile on his face.”
But in the nation’s battle with opioid addiction, Will Doerhoff is now a statistic – another life lost to a heroin overdose.
Will began his path to addiction as a freshman at the University of Arkansas after being introduced to the prescription stimulant Adderall, according to his parents.
During his second semester, casual Adderall abuse with fraternity brothers led to painkillers and harder methods of consumption. And, as Will’s father recalled, it is at that time when the family began noticing changes in their son, who, at the time, was a teenager.
“He was struggling,” said Scott Doerhoff. “We could tell from just the tone of conversations.”
Deepening his addiction, Will began purchasing his poison online. By the end of the year, he was hooked.
“They would crush the pills up and smoke them or they would crush the pills up and inject them,” said Scott Doerhoff. “He had all of the skills when he came home.”
Will’s problem came to a head in the summer of 2015.
Early one July morning, Will’s mother found him unconscious in his bedroom, barely clinging to life.
“He was agonal breathing,” said Shannon Doerhoff. “At that point, I didn’t know. I knew he was in respiratory distress, but I didn’t know what was happening.”
Shortly after paramedics arrived, the family realized the severity of Will’s addiction. Lying near him on his bed was a piece of tinfoil, a straw, and a substance that was later determined to be heroin.
The budding lawyer survived the overdose and spent the next year recovering. He began a new life in Monroe, Louisiana, got engaged, and was preparing to attend a local college.
But in the fall of 2016, Will relapsed. And after failing to show up for work one day in October, the Doerhoffs were met with the phone call that no parent ever wants to receive.
“You knew,” said Scott Doerhoff while fighting back tears. “It’s not really a pain that you feel. It’s like you don’t even know how to exist at that moment because everything that you’d ever done in your entire life, the entire meaning of your life, really, which is to protect your children, had just been taken from you.”
Will died on Oct. 14, 2016 at age 20.
The Dark Web
Shortly after his passing, Scott and Shannon learned of how their son obtained his fatal dose of heroin – through a purchase on the so-called dark web. Will’s parents said that he was able to simply sit down at his computer and order the substance, unbeknownst to law enforcement or to those who delivered it to him.
“Three days later it was mailed to a post office box,” said Scott Doerhoff.
In a startling trend that is sweeping the nation, drug users are turning to that hidden swath of cyberspace to feed their addictions, according to conversations that Fox News had with numerous local, state, and federal law enforcement officials in at least six different states.
Specific to the opioid epidemic, Fox News is told that the dark web phenomenon is like adding gasoline to a wildfire.
Not indexed by search engines like Google or Bing, the dark web’s contents cannot be traced back to any one person, allowing individuals to carry out illegal activities and trade illicit goods anonymously.
“Both the seller and the buyer can remain anonymous,” said Captain Charles Cohen, the head of the Indiana State Police’s Intelligence and Investigative Technologies division.
The renowned law enforcement technologist likens criminal investigations that reach into the dark web to playing a game of digital whack-a-mole.
“We’re seeing, not just heroin, but other opioids – ranging from fentanyl to Carfentanil, Opana, and others – that are being shipped with great regularity; with the purchase happening in the dark web, the money transactions happen with a crypto-currency, and the shipment is being concealed,” said Cohen. “It makes it increasingly difficult for us to do those investigations.”
If the dark web and crypto-currencies sound like they may be out of reach for the unsophisticated Internet user, think again. Simply visiting a website and downloading free software is more than half the battle.
Popular add-ons like Tor and I2P allow users to mask their identities by automatically tapping their machines into a maze of servers planted all over the world, scrambling their true IP addresses in the process.
Arguably the most popular crypto-currency in the world is Bitcoin, which trades freely over the Internet. Most any user can transfer cash for Bitcoin by simply setting up a digital wallet through any number of online exchanges.
Not all who flock to the dark web or use crypto-currencies do so for nefarious purposes, but a 2016 King’s College London study of over 5,000 dark web sites found that more than half of those forums hosted content that was criminal in nature.
‘Buy Now’
Alongside Cohen and the Indiana State Police, Fox News saw firsthand just how simple a dark web drug deal actually is.
The search for a reputable dark web marketplace took less than five minutes. Using anonymizing software, Cohen then located the marketplace on the dark web.
Among the illegal site’s offerings were a variety of prescription opiates, marijuana, syringes, and a heroin “starter kit” that was listed for .021 Bitcoins with a “buy now” tab located beside it.
Cohen, who is all too familiar with the illicit items of this dark marketplace and the thousands of others that are estimated to exist, reminded the Fox News crew standing beside him that he was doing this all completely anonymously. He clicked the “buy now” tab next to the heroin kit and directed the website to an empty Bitcoin wallet that he had set up minutes before.
“I give them that, they debit it, and, in theory, I’m going to get my heroin in the mail,” said Cohen.
The narcotics are often sent to the consumer in innocuous objects, under the nose of shipping companies, the U.S. Postal Service, and law enforcement. Cohen said that he’s seen cases in Indiana where narcotics were shipped in everyday objects, ranging from videogames to computers to children’s toys.
“I can continue to live this lifestyle, but nobody will know,” said Douglas Carter, Indiana State Police superintendent. “But the person from some global point around the world doesn’t care about ‘John Jones’ living in rural Indiana, do they? All they care about is the Bitcoin transaction and getting paid for what they do. And they leave the incredible carnage all over America.”
Carter, who oversees the statewide police force, said that the broad opioid epidemic has washed over Indiana, impacting all 92 counties.
‘There are 144 Will Doerhoffs a day’
While there is no simple solution to the overall problem or its nexus to the dark web, law enforcement leaders, from federal agencies all the way to local police departments, agree that curbing the epidemic begins with educating Americans about the dangers of prescription pill abuse.
Officials with the Drug Enforcement Administration note that four out of every five heroin users begin with prescription pills.
“There are 144 Will Doerhoffs a day,” said Matthew Barden, assistant special agent in charge of the DEA’s Little Rock field office. “Prescription medication abuse and the heroin abuse in this country knows no neighborhood, no sex, no creed, no color, no race, no wealth status; it knows nothing except for the fact that it wants to hook you.”
For their part, Scott and Shannon Doerhoff are raising awareness. To honor their son, they started the William Christian Doerhoff foundation and are sharing Will’s story in the hopes that it will save lives.
“Death is final. And our baby is no longer with us,” said Shannon Doerhoff. “But his message and his story is; and that’s what we want to do. We want to be able to speak up, and speak out, and share. And the more people know, the more lives that are saved.”
Matthew Dean is Fox News Channel’s Department of Justice & Federal Law Enforcement producer. Follow him on Twitter @MattFirewall.
Arkansas Governor Asa Hutchinson signed a bill into law on Tuesday, April 11 which strengthens the monitoring of prescription medications. After the signing, Senate Bill 339 became Arkansas Act 820, which means prescribers of prescription medications are no longer just encouraged to monitor those prescriptions, it is now their legal duty.
John Kirtley, executive director of the Arkansas State Board of Pharmacy, said that the “Incredible abundance of opioids like Hydrocodone and Oxycodone in Arkansas paired with the mistaken belief that prescription drugs are safe and are not addictive has created an unfortunate prescription drug abuse epidemic in this state.”
“States which have mandatory requirements for prescribers to check their Prescription Drug Monitoring Program have shown a 25 percent decrease in deaths and emergency room visits,” said Benton Police Chief Kirk Lane. “These proven numbers, will be of great benefit to those struggling with this type of addiction along with their families. The law is not aimed to deprive anyone of needed medications, but is directed at prescribers to make better prescribing decisions based on history.”
Scott Doerhoff of Willswork.org and the Speak Up-Speak Out Program added, “This law will better ensure that the opiate supply available in society at any given time will have been measured and directed toward the intended purpose – versus unknowingly prescribed in abundance to a degree of the risk the drugs will be abused or in the hands of unintended individuals.”
Act 820 specifically states that, “A prescriber shall check the information in the Prescription Drug Monitoring Program when prescribing: an opioid from Schedule II or S
chedule III for every time prescribing the medication to a patient; and a benzodiazepine medication for the first timeprescribing the medication to a patient.”
The state law further mandates that a practitioners licensing board will also require the practitioners to check the Prescription Drug Monitoring Program before prescribing opioids or benzodiazepine (to first time patients). There are a few exceptions written in Act 820, including before and during surgery, recovery from surgery while the patient is in a healthcare facility, hospice patients, nursing home patients, or in emergency situations.
The Prescription Drug Monitoring Program was established in 2011 which states, “Arkansas law requires that each dispenser shall submit, by electronic means, information regarding each prescription dispensed for a controlled substance. Each time a controlled substance is dispensed to an individual, the dispenser shall submit the information required by Arkansas law to the central repository weekly for the previous week, Sunday through Saturday.”
In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills, according to the CDC. Drug overdose deaths involving heroin continued to climb sharply, with heroin overdoses more than tripling in 4 years.
In Arkansas, 1,067 people have died from a drug overdose in a 3-year span (319 in 2013, 356 in 2014, and 392 in 2015). Arkansas is also in the top 20 percent of states that prescribe the most painkillers per capita.
“This epidemic can be turned around if we all accept our responsibilities in this tragic and growing deadly epidemic, and work together collectively to make the difference,” Lane said. “Using the Prescription Drug Monitoring Program to it’s potential, improving prescribing habits, Prescription Drug Takeback programs and the Naloxone programs are tools that will turn the tide, if we will just accept them and use them as they were designed.”
For more information about the national opioid epidemic (as stated by the Centers for Disease Control and Prevention) and how to properly secure and to find a location to dispose of prescription medications, please visit ardrugtakeback.org.
Residents of Saline County dropped off more than 1,500 pounds of medications during the Saturday, April 29 Arkansas Drug Take Back Day, which was called Operation Medicine Cabinet in Benton. Since 2009, the start of Operation Medicine Cabinet, more than 5 tons of prescription medications have been donated to the Benton Police Department for environmentally safe disposal.
The Operation Medicine Cabinet event started in Benton after Russell Goodwin, owner of a local monument company and youth baseball coach, told Benton Police Chief Kirk Lane that he was “tired of making headstones for children” he knew due to the abuse of prescription drugs. Benton officers gathered data that showed there was a problem with abuse and misuse of prescription drugs by youth, including information from the Saline County Coroner’s Office which showed that 30 people died in 2009 as a result of prescription drug abuse.
Arkansas law enforcement agencies collected more than 24,000 pounds of prescription drug medications in a single day. Arkansas Attorney General Leslie Rutledge said that “Arkansans are helping save countless lives” by getting these prescription medications “out of our homes.”
Rutledge also announced that the early bird registration is now available for the annual Prescription Drug Abuse Prevention Summit at ArkansasAG.gov. The summit, which was attended last year by more than 700 law enforcement officers, medical professionals, pharmacists and educators, gives an opportunity to hear from experts regarding prescription drug abuse prevention and treatment. This year the summit will be held in Hot Springs on Nov. 9. A full agenda will be announced at a later date.
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To be clear, more people have died from prescription opioids than from heroin. But — and this is key — there isn’t as much regional variation in prescription overdose deaths as there is with heroin deaths. What’s more, as the chart below shows, hospitalizations from prescription painkillers started to decline in all regions of the US as of 2012.
Arkansas Governor Asa Hutchinson signed a bill into law on Tuesday, April 11 which strengthens the monitoring of prescription medications. After the signing, Senate Bill 339 became Arkansas Act 820, which means prescribers of prescription medications are no longer just encouraged to monitor those prescriptions, it is now their legal duty.
