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“In this report, the Blue Cross Blue Shield Association (BCBSA), in collaboration with Blue Health Intelligence (BHI), examines opioid prescription rates, opioid use patterns and opioid use disorder among commercially insured Blue Cross Blue Shield (BCBS) members (excluding members diagnosed with cancer or who were undergoing palliative or hospice care). In 2017, BCBSA released a report illustrating the impact of opioid use and opioid use disorder on the health of Americans. This analysis examines progress towards preventing inappropriate prescription opioid use.

Specific Findings

  • Nationally, the total number of opioid medications filled by commercially insured BCBS members has declined by 29 percent since 2013, with significant variation among states. Thirty-four states had higher reductions, with Massachusetts leading at 51 percent.
  • In 2017, 67 percent of BCBS members filled their first opioid prescription within the CDC-recommended guidelines for both dose and duration. Some states did significantly better than the average, led by Rhode Island at 80 percent, Mississippi at 74 percent and Vermont and Massachusetts at 73 percent.
  • When examining total opioid prescriptions for BCBS members in 2017, not just the first prescription, 45 percent of members filled prescriptions within the CDC-recommended dose and duration guidelines, up from 39 percent in 2013.
  • In 2016, opioid use disorder claims stabilized, with 6.2 in 1,000 BCBS members diagnosed. The rate dipped slightly to 5.9 in 1,000 members in 2017.

Read more at: https://www.bcbs.com/the-health-of-america/reports/the-opioid-epidemic-america-update

Source: Blue Cross Blue Shield – July 12, 2018

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“In areas of the country disproportionately affected by the opioid crisis, treatment programs are less likely to accept patients paying through insurance of any type or accept pregnant women, a new Vanderbilt study found.

Vanderbilt researchers focused on four Appalachian states — Tennessee, Kentucky, North Carolina and West Virginia — that have among the highest rates of opioid use in the country and are more affected by opioid overdose deaths. In their study published in the journal Substance Abuse, researchers found that only about 50 percent of opioid treatment providers took any insurance, and there was also a huge variance among the states in programs that accepted Medicaid.

While 83 percent of treatment programs in West Virginia accepted Medicaid insurance, only about 13 percent of programs in Tennessee accepted Medicaid. Additionally, the study found that while 91 percent of programs were accepting new patients, only 53 percent of outpatient buprenorphine programs would treat pregnant women.”

Read more at: http://news.vumc.org/2018/07/12/opioid-patients-barriers-treatment/

Source: Vanderbilt University Medical Center – July 12, 2018

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 “Once you’re into heroin, it’s almost like a relationship with a person you love. And letting go of that – the thought of never seeing someone I love again – I couldn’t imagine giving it up forever.” – A homeless user in San Francisco (Time Special Report: “The Opioid Diaries”).

Attempting to make sense of the worst crises and catastrophes to plague mankind, analysts often describe how “a perfect storm” of events and conditions have worked together to bring about some great evil.

The ship was traveling too fast. The steersman made a wrong turn. An uncontained coal-bunker fire raged below deck. The hull’s iron rivets were too weak. The weather was conducive to drawing icebergs into the ship’s path. Though specific iceberg warnings were received over the wireless, the Titanic’s captain wasn’t told because the message didn’t carry the required prefix. And binoculars that would have enabled lookouts to see the iceberg for themselves were locked up on-board ship – the key held by an officer cut from the crew just before departure. A perfect storm.

Today, like the Titanic disaster, America’s ever-growing opioid epidemic is the result of another perfect storm of cascading events and conditions. But instead of 1,500 dead, the opioid crisis has taken the lives of more than 500,000 Americans since 2000 – and some experts believe another 500,000 may die in the next decade if current trends persist. In 2016 and 2017, more Americans lost their lives each year to drug overdoses than died during the entire Vietnam War, driving Americans’ life expectancy as a whole downward.”

Read more at: http://www.wnd.com/2018/07/projected-500000-american-deaths-in-decade-from/

Source: WND.com – July 8, 2018

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“The Pennsylvania Supreme Court is considering whether a pregnant woman’s use of illegal drugs qualifies as child abuse under state law. In May, the Drug Policy Alliance filed a friend of the court brief in the case — on behalf of itself, Families for Sensible Drug Policies, and eight nationally recognized experts in health, psychology, medicine and law — urging the Court to decide that the use of illicit drugs during pregnancy is not child abuse and women who used drugs while pregnant should not be punished by being named in a statewide child abuse registry.

There is a popular, but scientifically disproven, belief that a pregnant woman’s use of drugs harms her fetus in certain and predictable ways. In fact, the harms associated with prenatal exposure to controlled substances are indistinguishable from other factors, such as social determinants (the conditions in which people are born, grow and live) and environmental factors (poverty, lack of access to medical care, malnutrition, or chronic stress), which may affect newborn health.

In the context of the opioid crisis, there is a popular-culture view that all babies born dependent on opioids experience harms and that the harms are distinct from those caused by other factors. This perception is simply false. In fact, physicians routinely and effectively treat babies born with opioid withdrawal symptoms, just as they treat babies born with myriad other manageable medical conditions.”

Read more at: https://www.salon.com/2018/07/08/drug-use-during-pregnancy-is-not-child-abuse-experts-weigh-in-on-pennsylvania-court-decision/

Source: Salon.com – July 8, 2018

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“More than half of Americans who have a prescription opioid use disorder or use heroin have had contact with the criminal justice system, a retrospective cross-sectional analysis suggests.

And as the intensity of their opioid use increased, so did their involvement with the criminal justice system, reported Tyler Winkelman, MD, MSc, of Hennepin Healthcare in Minneapolis, and co-authors in JAMA Network Open.

The study included 78,976 respondents — 42,495 women and 36,481 men — representing 196,280,447 adults in the U.S. In the 12-month period:

  • 2% (124,026,842 adults) reported no opioid use
  • 3% (61,462,897 adults) reported prescription opioid use
  • 3% (8,439,889 adults) reported prescription opioid misuse
  • 8% (1,475,433 adults) reported prescription opioid use disorder
  • 4% (875,386 adults) reported heroin use

People who reported any level of opioid use were significantly more likely to be white; have low income; and report a chronic condition, disability, severe mental illness, or co-occurring drug use than were individuals who reported no opioid use.

As the level of opioid use rose, involvement in the criminal justice system (excluding minor traffic violations) climbed. History of criminal justice involvement was associated with:

  • 9% of those who reported no opioid use
  • 4% of those who reported prescription opioid use
  • 2% of those who reported prescription opioid misuse
  • 7% of those who reported prescription opioid use disorder
  • 8% of those who reported heroin use

Read more at: https://www.medpagetoday.com/neurology/opioids/73898

Source: MedPageToday.com – July 8, 2018

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“Among the most serious consequences of the opioid epidemic is the spread of hepatitis C among injecting drug users.

A major new study shows that if a hepatitis C vaccine were successfully developed, it would dramatically reduce transmission of hepatitis C among drug users—even though it’s unlikely such a vaccine would provide complete immunity.

The study, which employed mathematical modeling, is published in Science Translational Medicine.

Vaccines are currently available for hepatitis A and hepatitis B, but a vaccine for hepatitis C is still under investigation. A clinical trial is testing an experimental hepatitis C vaccine on injecting drug users. Unlike many other vaccines, the hepatitis C vaccine is not expected to provide complete immunity, known as sterilizing immunity. A vaccinated person exposed to HCV could still be infected with the virus, although the amount of virus in the bloodstream would be significantly reduced.”

Read more at: https://medicalxpress.com/news/2018-07-hepatitis-vaccine-transmission-people-drugs.html

Source: MedicalExpress.com – July 11, 2018

See related article on Hepatitis C: State prisons fail to offer cure to 144,000 inmates with deadly Hepatitis C available at: https://www.salon.com/2018/07/15/state-prisons-fail-to-offer-cure-to-144000-inmates-with-deadly-hepatitis-c_partner/

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“The top Massachusetts court unanimously ruled on Monday that a judge can require defendants with substance use disorders to remain drug-free as a condition of probation and send them to jail if they relapse.

The case, which challenged a requirement routinely imposed by judges across the country, had been closely watched by prosecutors, drug courts and addiction medicine specialists. For many, it represented a debate over the nature of addiction itself.

The defense argued that addiction is a chronic, relapsing brain disease that compromises an individual’s ability to abstain. The prosecution maintained that addiction varies in intensity and that many individuals have the ability to overcome it and can be influenced by institutional penalties and rewards, like incarceration or a cleared criminal record.

While acknowledging the numerous experts who weighed in on each side, the seven justices of the Massachusetts Supreme Judicial Court declined to take a stance in the debate. Instead, they said, the defendant in the case should have raised the issue when her probation condition was first imposed, when it could have been fully argued before a trial judge.”

Read more at: https://www.nytimes.com/2018/07/16/health/addict-relapse-probation-jail.html

Source: NYTimes.com – July 16, 2018

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“The opioid epidemic continues to take an emotional, physical and financial toll on Americans. The U.S. Food and Drug Administration is committed to taking every possible step to address the many facets of this complex public health crisis.

While we work to ensure appropriate and rational prescribing of opioids, we won’t lose sight of the needs of Americans living with serious chronic pain or coping with pain at the end of life. They too face significant challenges.

So, as we consider new policy steps to address the opioid addiction crisis, the FDA remains focused on striking the right balance between reducing the rate of new addiction by decreasing exposure to opioids and rationalizing prescribing, while still enabling appropriate access to those patients who have legitimate medical need for these medicines.”

Read more at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm612779.htm

Source: FDA.Gov – July 9, 2018

See related article: FDA: Limiting Opioids Won’t Curb Crisis, Responsible Prescribing Will available at: https://www.thefix.com/fda-limiting-opioids-wont-curb-crisis-responsible-prescribing-will

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“More than one in three Americans are prescribed opioids, National Survey on Drug Use and Health data shows. A new study indicates that the trend extended to children, who legally use the drug at as young as 2 years old, to treat pain following minor dental procedures or outpatient surgeries.

One in 10 children enrolled in Tennessee’s Medicaid program were prescribed opioids between 1999 and 2014, concurrent with the onset of the opioid crisis, a study published in the journal Pediatrics found. Researchers argued that the drugs, all prescribed to children without severe conditions, caused “unnecessary exposure” to potential harm, and suggested that health care providers consider therapeutic options before prescribing the potent painkillers.

Over 15 years, Tennessee physicians prescribed more than 1.3 million opioids as pain relievers to children and teens between the ages of 2 and 17. While the Food and Drug Administration recommends opioids for minors with “severe conditions” such as cancer and sickle cell anemia, more than 30 percent of the drugs were prescribed after dental procedures in lieu of nonaddictive medications like ibuprofen.”

Read more at: https://www.newsweek.com/study-one-10-children-prescribed-opioids-1026838

Source: Newsweek.com – July 16, 2018

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