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Fentanyl, The Opioid Crisis You’ve Never Heard Of

Fentanyl, The Opioid Crisis You’ve Never Heard Of

Users of a lethal drug 30 to 50 times more potent than heroin are dying in far greater numbers than those reported by some federal agencies, a study of medical examiner reports in those states hardest hit by the epidemic reveals.

The most widely quoted figure for deaths linked to the use of fentanyl is from a nationwide alert issued March 2015 by the Drug Enforcement Agency, which estimated the number, between the end of 2013 through 2014, at 700.

But a study of medical examiner and other reports from eight of ten states where the largest number of seizures of fentanyl were reported reveals much larger and more frightening numbers.

More than 2000 fentanyl-linked deaths were reported in 2014 by medical examiners in those states, which include Ohio, Florida and Massachusetts.

In Ohio, in 2014, 502 died from fentanyl-linked overdoses, up from 92 the previous year, while 397 perished in Florida that same year, up from 185.

And in the small state of New Hampshire, where ahead of the state’s primary the presidential candidates were moved to raise the issue of opioid abuse but failed to specifically mention fentanyl, the 2014 death toll stood at 261, up from 19 the previous year.

Massachusetts reported 336 in the year up to the end of September, 2015.

The U.S. Senate has passed a bill to tackle the opioid abuse crisis, but it does not include specific language addressing fentanyl. The House Judiciary Committee is this week considering its own version of the bill.

The Centers for Disease Control and Prevention (CDC) reports an 80 percent increase in the number of fentanyl-linked deaths between 2013 and 2014, meaning it is a key driver of what health professionals and addiction experts are describing as a health emergency linked to opioid and heroin use.

In total, some 28,000 people died from opioid or heroin overdoses in 2014, up from 22,000 the previous year, and compared to 7,000 in 2001, according to the CDC. The centers, in a warning issued February, said the number of fentanyl seizures increased from 618 to 4,585 between 2012 and 2014, the majority in ten states in the east and midwest.

But the full extent of the fentanyl crisis may not yet have fully emerged, as many medical examiners across the country did not test for the drug until recently, marking the death as a heroin overdose.

The overall death toll would be even greater but for the wider availability of a drug called naloxone, also known as Narcan, which reverses the effects of an overdose, Even then, multiple doses are need to counter the effects of fentanyl.

Originally designed as pain medication for stage four cancer patients and severe burn victims, fentanyl is often prescribed to those suffering from much lesser pain, which made it easier for some to leak on to the black market.

Now, Mexican drug cartels are in the game, with chemists hired to make illicit fentanyl, which is then either mixed in with heroin or packed by itself and marketed as heroin. It is also mixed with cocaine and is now appearing in tablet form.

The demographic of those dying from fentanyl is mixed, though a high proportion are young, white, and male, often from suburban or rural areas, according to the CDC. Many progressed from pain killers to heroin, then often unwittingly to taking fentanyl.

Erin Artigiana, deputy director for policy at the University of Maryland’s Drug Policy, said fentanyl, both legal and illicit, is marketed and distributed as heroin.

On the numbers of deaths, Artigiana said, “The short answer is it’s probably more than 700. States have got better at identifying fentanyl as they realize the situation they have to address.”

“It’s easy to have a bad reaction especially if you do not know what you are taking.”

Michelle Hillman, interim director of communications at the Massachusetts Department of Health and Human Services, described it as a “serious problem” in the state.

“In 2014 alone, 1099 people died from unintentional overdoses. Opioids, including powerful combinations such as heroin cut with fentanyl, are taking almost four lives a day in the Commonwealth,” Hillman said.

Gov. Charlie Baker and Attorney General Maura Healy have moved to tighten criminal sanctions against those caught with more a certain amount of fentanyl, making it a trafficking offense.

In a briefing, Healy’s office said fentanyl is a major contributing factor to the opioid and heroin epidemic, and to the sharp increase in overdoses.

Ohio Sen. Rob Portman, whose state has been badly hit by the crisis, introduced — along with Democratic colleague Sen. Sheldon Whitehouse — a bill to combat the health emergency.

The bipartisan bill was passed by the Senate 85-1 last month. It does not have any measures to specifically address the issue of fentanyl.

And Sen. Portman, a Republican, fears the bill now being considered by the House contains major changes to that passed by the Senate, specifically that it reduces the number of grants and allows states more control over what should be funded.

The House Judiciary Committee began considering its version of the bill Wednesday.

Photo: Fentanyl. Wikimedia Commons/ Alcibiades.

Sounding The Alarm As Prescription Drug Abusers Turn To Heroin

Sounding The Alarm As Prescription Drug Abusers Turn To Heroin

By Lisa Girion, Los Angeles Times (TNS)

LOS ANGELES — Standing in the pulpit above Austin Klimusko’s casket three years ago, his mother used his death to draw the connection between pills from a pharmacy and drugs from the street.

“When his prescriptions dried up, he turned to heroin,” Susan Klimusko said in a frank eulogy meant as a warning to the young mourners at Simi Valley’s Cornerstone Church.

Last week, the nation’s top public health official used the bully pulpit to sound the same alarm. The prescription drug epidemic is stoking the nation’s appetite for heroin with disastrous results, Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, told reporters in a teleconference.

“We are priming people to addiction to heroin with overuse of prescription opiates, which are, after all, essentially the same chemical with the same impact on the brain,” he said.

Frieden made his comments as he announced that heroin use had increased 62 percent and related deaths had nearly quadrupled since 2002.

The biggest increases were among groups associated with a parallel rise in the use of prescription painkillers, such as OxyContin and Vicodin. Today’s heroin user is increasingly likely to be wealthy, privately insured and between the ages of 18 and 25, according to the study by researchers at the CDC and the U.S. Food and Drug Administration.

heroin use on the rise

Graphic showing the rise in heroin use and that overdose deaths have quadrupled from 2002-2013.

It is a phenomenon familiar to people on the front lines of the crisis from Simi Valley to San Diego.

“The face of the heroin addict has changed very much to that of an 18- to 25-year-old surfer kind of guy,” said Susan Bower, a San Diego County health official who noted the shift there a few years ago.

And the prescription painkiller has become the new gateway drug to heroin use, eclipsing marijuana, cocaine and alcohol, the study found. People addicted to narcotic painkillers are 40 times more likely to misuse heroin, it reported.

At the same time, Frieden said, the flow of cheap heroin from Mexico has surged, offering users a ready supply of an inexpensive substitute to prescription painkillers.

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“It’s really a one-two punch,” he said. “Those two factors are driving the increase and will drive the strategies we need to turn this around.”

Frieden called for a series of responses, including a crackdown on heroin, more treatment and more judicious prescribing. “For prescription opiates, the risks are very palpable,” he said. “A few doses and someone can have a life of addiction. A few pills too many and someone can die of an overdose.”

The findings offer a glimpse into the “real devastation the epidemic is causing to communities across the country,” Frieden said.

One affected area is Ventura County, where heroin-involved deaths more than doubled between 2009 and 2012 to 43. But in 2013, heroin deaths retreated, while deaths involving prescription painkillers jumped to 69. The shift coincided with a law enforcement push against heroin trafficking and may be further evidence of the interchangeability of legal and illegal drugs.

“You work one side of the problem, but then you see a ballooning on the other side,” said Patrick Zarate, who manages alcohol and drug programs for Ventura County. “We will probably continue to see a bit of back and forth over time.”

Simi Valley, on Ventura County’s eastern edge, is emblematic of the tandem crisis of pills and heroin. Austin Klimusko was one of several young overdose victims whose deaths brought the community to Cornerstone Church in 2012. Less than a week after his funeral, another family was planning a service for a daughter. And Austin, 23, was buried in the same cemetery as another victim who died at 21.

At his funeral, the Rev. Pat McCoy summed up the devastation.

“All of us, everyone sitting in this room has been affected by what happened,” McCoy said. “We don’t want that to keep happening. This is the fourth time I’ve done this in the last eight months. And I don’t want to do it anymore.”

Austin’s death illustrates heroin’s new reach. He grew up in a comfortable ranch home with a swimming pool and three dogs. He hung out with his older brother and the boys in the neighborhood. He liked to make them laugh. He loved Harry Potter books. He was enrolled in gifted classes. His mother is a hospital nurse; his father owned an electronics manufacturing plant. The family traveled to Mexico and Europe, and enjoyed skiing and fishing.

After high school, Austin moved to San Diego with friends. Susan Klimusko realized that her son had a serious drug problem when he accidentally “pocket dialed” her one night and she overheard him pressuring a friend to take drugs. She demanded he move back home in the belief that she could help him stop. Instead, he found a new supplier for his oxycodone habit, a medical clinic in Reseda.

“It just got worse and worse and worse,” she recalled. “He was a walking zombie.”

His parents convinced him to check into the Malibu Beach Recovery Center on his 21st birthday. He stayed sober, working in his father’s plant, for more than a year. But then, he slipped. Before long, Susan Klimusko said, he was spending his entire paycheck on prescriptions for oxycodone and other pills. At some point, he switched to heroin, pawning family valuables for cash. His parents locked their wallets in a safe when they went to bed.

His parents pleaded with Austin to give rehab another try. He agreed, driving himself to a facility in Bakersfield. “We were so hopeful,” Susan Klimusko said.

Sober for almost 90 days, Austin came home for Christmas, hung out and exchanged gifts. His parents gave him a purple and gold Lakers’ Snuggie. Austin headed back to Bakersfield, where he had a new job and a new girlfriend. It looked like a fresh start. But a few days later, he was dead of a heroin overdose.

Charts showing number of overdose deaths from various drugs. Tribune News Service

Charts showing number of overdose deaths from various drugs. Tribune News Service

Susan Klimusko viewed her son’s addiction as a battle that she lost. But she hasn’t stopped fighting a bigger war. Beginning with her son’s eulogy, she has been working to help other families struggling with addiction. She consoles grieving mothers and she counsels addicts who end up in the hospital where she works.

“Healing from heroin is a very long process,” she tells them. “I say, ‘I’m a mom. I lost my kid. I understand.'”

Photo: Susan Klimusko spent hours pouring through her son Austin’s phone logs and texts following his final moves before dying of a heroin overdose. This self-portrait is one of the last he took before passing away. He was 23. His opiate addiction began with prescription narcotics, according to his mother. Originally sent to his girlfriend, his mother says this picture now serves as a symbolic goodbye kiss to all his friends, family and loved ones.  (Liz O. Baylen/Los Angeles Times/TNS)

This Week In Health: Beware Of Brain-Eating Amoebas

This Week In Health: Beware Of Brain-Eating Amoebas

“This Week In Health” offers some highlights from the world of health news and wellness tips that you may have missed this week:

  • Naegleria fowleri — more memorably known as the “brain-eating amoeba” — is a rare, lethal swimmer’s affliction that has been in the news lately. The amoeba affects people who swim in contaminated pools and freshwater lakes and ponds — it crawls up their nose and causes an infection that destroys brain tissue. A California woman died last week of the infection; a Minnesota boy this week may be the latest victim, indicating that the amoeba — typically found in warmer climates — is inching north. To avoid infection, Centers for Disease Control advises swimmers “to avoid lakes, rivers and hot springs during heat waves or periods of low water levels.”
  • Screening for diseases could get a lot easier and lot less invasive soon. Researchers claim to have developed a “laserlyzer” (laser breathalyzer) that can analyze the contents of a cloud of gas (or breath) for disease and infection — essentially a device for “sniffing” out illness. Fittingly, the researchers are describing it as an “optical dog’s nose.”
  • According to both the FDA and the CDC, heroin addiction is up in the United States. A new report says “that 2.6 out of every 1,000 U.S. residents 12 and older used heroin in the years 2011 to 2013. That’s a 63 percent increase in the rate of heroin use since the years 2002 to 2004.” CDC Director Tom Frieden, MD, MPH, says the surge in heroin use is “driven by both the prescription opioid epidemic and cheaper, more available heroin.”

Photo: Iqbal Osman via Flickr

Heroin Use And Addiction Are Surging In The U.S., CDC Report Says

Heroin Use And Addiction Are Surging In The U.S., CDC Report Says

By Lisa Girion, Los Angeles Times (TNS)

Heroin use surged over the past decade, and the wave of addiction and overdose is closely related to the nation’s ongoing prescription drug epidemic, federal health officials said Tuesday.

A new report says that 2.6 out of every 1,000 U.S. residents 12 and older used heroin in the years 2011 to 2013. That’s a 63 percent increase in the rate of heroin use since the years 2002 to 2004.

The rate of heroin abuse or dependence climbed 90 percent over the same period, according to the study by researchers from the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention.

Deaths caused by heroin overdoses nearly quadrupled between 2002 and 2013, claiming 8,257 lives in 2013.

In all, more than half a million people used heroin in 2013, up nearly 150 percent since 2007, the report said.

Heroin use remained highest for the historically hardest-hit group: poor young men living in cities. But increases were spread across all demographic groups, including women and people with private insurance and high incomes _ groups associated with the parallel rise in prescription drug use over the past decade.

The findings appear in a Vital Signs report published in the CDC’s Morbidity and Mortality Weekly Report.

“As a doctor who started my career taking care of patients with HIV and other complications from injection drugs, it’s heartbreaking to see injection drug use making a comeback in the U.S.,” said Dr. Tom Frieden, director of the CDC.

All but 4 percent of the people who used heroin in the past year also used another drug, such as cocaine, marijuana or alcohol, according to the report. Indeed, 61 percent of heroin users used at least three different drugs.

The authors of the new study highlighted a “particularly strong” relationship between the use of prescription painkillers and heroin. People who are addicted to narcotic painkillers are 40 times more likely to misuse heroin, according to the study.

Once reserved for cancer and end-of-life pain, these narcotics now are widely prescribed for conditions ranging from dental work to chronic back pain.

“We are priming people to addiction to heroin with overuse of prescription opiates,” Frieden said at a news conference Tuesday. “More people are primed for heroin addiction because they are addicted to prescription opiates, which are, after all, essentially the same chemical with the same impact on the brain.”

Frieden said the increase in heroin use was contributing to other health problems, including rising rates of new HIV infections, cases of newborns addicted to opiates and car accidents. He called for reforms in the way opioid painkillers are prescribed, a crackdown on the flow of cheap heroin and more treatment for those who are addicted.

(c)2015 Los Angeles Times. Distributed by Tribune Content Agency, LLC.

Photo: JoshNV via Flickr