What’s a “save shot” and why did Prince reportedly get it?

Prince_at_Coachella_001
Maybe you believe TMZ’s tabloid reports that Prince overdosed on opioids -twice – and had to be given a “save shot” – twice- or maybe you don’t.

Or maybe you want to know what a save shot is.

Short answer: It’s Naloxone, also known by one brand name, Narcan. Naloxone is an antidote to an opioid overdose. That can be from opioids such as Percocet, which Prince’s sister said the singer used, or from heroin.

It can be agonizing. But it’s a re-entry to life, and everyone from the Surgeon General to the President of the United States is urging broader access to the drug.

Delray Beach, Sarasota, Stuart: They needed no convincing. Police officers in all three cities are carrying Narcan.  And with good reason. Less than a day after Delray police started carrying it, they had to use it, saving the life of a 20-year-old who relapsed and overdosed on heroin.

Narcan kit used by Delray Beach police.
Narcan kit used by Delray Beach police.

In dozens of other states, you can buy Narcan over the counter, no prescription needed. In one northeast city, a doctor wrote an “open prescription” so that anyone could go into any drugstore and buy the life-saving drug.

But not in Florida, home to unprecedented numbers of heroin overdoses.

Those overdoses reflect the large  numbers of people coming to Palm Beach County to recover from heroin- and the numbers of unscrupulous businesses exploiting them. That includes dumping them into cheap hotels after they relapse- with deadly consequences.

Read more about addiction in our series Addiction Treatment: Inside the Gold Rush.

A clock is counting the dead from overdoses

6968
6,968

6,986. 

Moments before a cluster of congressmen began their 9:30 a.m. presentation at the 2016 National RX Drug Abuse and Heroin Summit in Atlanta Wednesday, the grim clock above them stood at 6,970: the number of people dead from an opioid or heroin overdose in the roughly 72 hours since the summit began Monday evening.

When the speakers arrived at the dais, it was 6,970.

6971
Minutes later: 6,971

When they sat down, it was 6,971.

The speakers, including long-time prevention and treatment advocate U.S. Rep. Hal Rogers of Kentucky, had some other numbers.

They cited the 23 percent drop in crime in Gloucester, Massachusetts, since the police chief there told addicts who turned themselves in they would not be arrested but would instead get treatment.

There’s the street value of a single bottle of oxycodone: $2,000. And there’s the sevenfold increase in the amount of Mexican heroin coming into the U.S. in just seven years.

When the congressmen began winding up their speeches two hours later, though, the number left behind was this one.

6975

At drug summit, Obama arrives bearing gifts

Moderator Sanjay Gupta listens as President Barack Obama speaks during a panel discussion at the National Rx Drug Abuse & Heroin Summit at AmericasMart in Atlanta, Tuesday, March 29, 2016. (AP Photo/Jacquelyn Martin)
Moderator Sanjay Gupta listens as President Barack Obama speaks during a panel discussion at the National Rx Drug Abuse & Heroin Summit in Atlanta. (AP Photo/Jacquelyn Martin)

What’s the use of being the commander in chief unless you can do a little commanding from time to time?

Which is why President Barack Obama didn’t show up empty-handed Tuesday afternoon at the 2016 Summit on RX Drug Abuse and Heroin in Atlanta. He had executive branch agencies arrive bearing gifts. Among them:

  • Health and Human Services (HHS) is issuing a proposed rule to increase the current patient limit for qualified physicians who prescribe buprenorphine to treat opioid use disorders from 100 to 200 patients. HHS had already released $94 million in new funding to 271 community health centers, with a specific focus on expanding medication-assisted treatment of opioid addiction and abuse- it could assist 124,000 new patients.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) is releasing a $11 million for up to 11 states to expand medication-assisted treatment for addiction.
  • Back to HHS: Information on HHS-funded programs regarding the use of federal dollars to start or expand needle exchanges.  Obama last year reversed the longstanding ban on federal money for such programs.
  • Also from the White House, an announcement that more than 60 medical schools, beginning in fall 2016, will require their students to take some form of prescriber education, the better to curb the kind of prescribing that has resulted in 215 million U.S. prescriptions for narcotics every year. The only Florida school named: University of Central Florida College of Medicine.

“Very rarely is money the answer alone,” said Obama to a crowd of about 2,000. “But it helps.”

Doctor, you’ve got mail. The Surgeon General would like you to read it.

Surgeon General Vivek H. Murthy
Surgeon General Vivek H. Murthy

Doctor, you’ve got mail.

Not stamped yet, not even in the envelope, but it’s as good as done, said Surgeon General Vivek H. Murthy Tuesday afternoon at the 2016 Summit on RX Drug Abuse and Heroin in Atlanta.

In an echo of former Surgeon General C. Everett Koop’s historic letter to 107 million households regarding the AIDS epidemic, Murthy is drafting letters to more than one million doctors, dentists and other health care providers in a call for action on the opiod epidemic.

It’s particularly targeted move: It’s physicians who have driven the opiod epidemic with massive numbers of narcotics prescriptions, Murthy and others at the Summit have pointed out.

Every year, Murthy said, another 215 million new opiod prescriptions are written, “enough to put a bottle of pills in the hands of every adult American.”

Former Surgeon General C. Everett Koop used his position to influence public discussion of HIV/AIDS.
Former Surgeon General C. Everett Koop used his position to influence public discussion of HIV/AIDS.

But, he said, doctors have gotten bad information, both about the addictive potential of drugs such as oxycodone, and addiction overall. For instance, physicians beginning in about 1996 were being taught that fewer than one percent of all patients treated with narcotics were likely to become addicted. State medical boards warns of sanctions against doctors who failed to aggressively treat pain.

“Far too often, doctors have been in situations with patients who they believed were addicted to opiods,”  said Murthy, but, he said, physicians did not have the education or tools needed to know whether their prescriptions were alleviating pain or feeding an addiction.

Murthy isn’t stopping with a letter.  He’s compiling the first report of any surgeon general addressing substance abuse, addiction and health.

Like the letter, such reports carry clout: Think the tobacco report in 1964 on tobacco and the 1987 report on HIV/AIDS, both of which moved the needle on public discussions of major health issues.

And, like Koop, Murthy intends to use his position as a bully pulpit to educate.

“I want to help the country see that (addiction) is not a moral failing, but a chronic illness that we need to treat with compassion, urgency and skill.”

Will Florida’s prescription monitoring database broaden to share anonymous information?

Deaths linked to prescription oxycodone in Florida plummeted after drug monitoring database was adopted.
Deaths linked to prescription oxycodone in Florida plummeted after drug monitoring database was adopted.

Tallahassee could probably feel the love emanating all the way from the second floor of the Westin Peachtree in downtown Atlanta Tuesday morning: The object of affection at the 2016 Summit on RX Drug Abuse and Heroin is Florida’s Prescription Drug monitoring database, or EForcse.

Fought for since 2001, approved in 2009 and finally operational in October 2011, the database curbs doctor shopping for opioids by tracking prescriptions for the drugs.

It’s been wildly successful at curbing oxycodone-related overdose deaths in Florida, as its latest report shows. In fact, it’s considered a model for other states of just how effective such a database can be.

At a Summit seminar Tuesday morning, there was a discussion by program manager Rebecca Poston of possibly broadening its scope, by linking it to other databases, such as the database of drug-related deaths compiled annually by Florida medical examiners, or the state database on Hepatitis C infections.

The idea is to provide a sweeping look at Florida public health issues, particularly as it involves patterns of drug use.

Nothing on that scale is happening yet. Whether it occurs depends in part on the University of Florida securing a grant which would fund such a program. (EForcse gets no state money for its operations.)

But it raises a question of whether Florida’s lawmakers would resurrect the same privacy concerns they raised back in 2009 and later when arguing against establishing the prescription monitoring database at all.

Poston points out that, as envisioned, there would be no way an individual could be identified. You could not, for instance, be able to individually link Adam Smith to his oxycontin prescriptions, then his treatment for Hepatitis C, his medical treatment for addiction or his death from an overdose. The data would have no names attached.

Post reporters Christine Stapleton and Pat Beall are covering the Summit live from Atlanta. Look for continuing updates on The Insider blog.

 

In unexpected moment, Agriculture Secretary Tom Vilsack reveals a life torn by addiction

Secretary of Agriculture Tom Vilsack
Secretary of Agriculture Tom Vilsack

Taking the wraps off a pair of new federal efforts to address addiction in rural America, Tom Vilsack did the expected thing, the sorta-surprising thing and the totally knock them right out of their socks thing.

Left sockless was a group of more than 1,000 people attending the  2016 Summit on RX Drug Abuse and Heroin in Atlanta.  Vilsack, head of the U.S. Dept. of Agriculture, was among the opening speakers at the Summit Monday. Tuesday afternoon, his boss – that would be the President- will show up for what is described as a Town Hall meeting.

But Monday night, it was Vilsack’s turn.

After announcing that his agency would be giving out $1.4 million in grant money to assist in researching opiate addiction in rural America, and that he would take part in a series of town halls in states hard-hit by the drug crisis, Vilsack explained the origins of his concern.

“I started life in an orphanage in Pennsylvania” before being adopted, he said. It was a loving home, but there was a problem tearing it apart: “My mom had a prescription drug addiction and she was violent. She was mean. She tried to commit suicide a couple of times.

“It was  a tough situation. My parents split up for a period of time. I nearly flunked out of high school.”

He said he judged her harshly, something he now regrets.

“I thought all she had to do was stop taking medications. I did not realize that at that point in time, we were dealing with a disease.”

But, Vilsack said, “on December 25, 1963, she realized she hit bottom.”

His mother got sober, said Vilsack. “She could not have done that without a 30-day treatment program. She could not have done it without a supportive community.”

With an estimated 78 Americans a day dying from prescription opioids, Vilsack said, entire communities now need to  step up: Pastors and community leaders as well as doctors and government.

“Person by person, we can do this,” he said. “We must do this.”

 

 

 

 

Fed report: More Medicaid equals fewer addiction troubles in Florida

Hypodermic needles found in the trash at a cottage apartment by Jean Thomas, 83, in West Palm Beach's Prospect Park neighborhood. (Thomas Cordy / The Palm Beach Post)
Hypodermic needles found in the trash at a cottage apartment by Jean Thomas, 83, in West Palm Beach’s Prospect Park neighborhood. (Thomas Cordy / The Palm Beach Post)

Elevator scene from the National RX Drug Abuse and Heroin Summit in Atlanta:

Reporter to woman: Are you here for the conference?

Woman: Yes, I’m from Detroit.

Reporter: We’re from South Florida.

Woman: Oh, South Florida. That’s where you go when you’ve got money for treatment.

Or not.

On Monday, Health and Human Services released a report on just how many Floridians with addiction or mental health issues can’t get adequate help – in some cases, any help – because the state won’t expand Medicaid, a key feature of Obamacare.

(Comes a day before President Obama is slated to speak at the Summit. Coincidence? You decide.)

Anyway: Florida has fought tooth and nail against any such expansion, even though the rolls of Floridians on the health plan for the poor continues to rise.

About three in every ten people living below 138 percent of the poverty level need treatment for drug abuse or mental illness or both, HHS estimates.

From those numbers, the feds put together these numbers in the report:

  • 390,000: Number of uninsured Floridians age with either mental illness or an addiction problem who would qualify for treatment under Medicaid expansion. (For bragging right purposes, that’s second only to Texas among states without Medicaid expansion.)
  • Nine: Percentage of uninsured Floridians getting help for the above, 2010-14.
  • $7 million-$190 million. Budget savings range reported by different states which expanded Medicaid.
  • 17, 18, 33: Percentage drop in arrests among three groups of people frequently in trouble with the law after Washington state began providing them with Medicaid-financed substance abuse treatment.

We already tackled one tricky addiction math question this morning, one raised by this festive magazine cover.

Harpers' controversial piece on legalizing drugs- all drugs.
Harpers’ controversial piece on legalizing drugs- all drugs.

Stay tuned as Post reporters Christine Stapleton and Pat Beall cover the Summit live from Atlanta.  Stapleton and Beall are members of a team of reporters that have been investigating scams in Palm Beach County’s $1 billion drug treatment industry

The 8-month long investigation by the Palm Beach Post uncovered patient brokering, insurance fraud and kickbacks.

 

Four million vs. 24 million: How many addicts are there in the U.S.?

Credit writer Dan Baum points for timing. But math? Maybe not.

Baum authored a recent Harpers magazine article suggesting that legalizing drugs might be the answer to the current fix we are in.

Harpers' controversial piece on legalizing drugs- all drugs.
Harpers’ controversial piece on legalizing drugs- all drugs.

His Sunday  interview on NPR about the legalization idea out there just hours before an estimated 1800 gather in Atlanta for the National Rx Drug Abuse & Heroin Summit. Among the attendees: President Obama, as well as the head of the DEA, the Surgeon General, the head of the National Institute on Drug Abuse, and various and sundry congresspeople.

Monday morning, a Daily Beast columnist weighed in on ending the war on drugs, citing Baum’s article and pointing out that Obama’s talk will take place in a city ravaged by drugs.

Michael Botticelli, director of the White House Office on Drug Control Policy, is among high-level fed officials at Summit.
Michael Botticelli, director of the White House Office on Drug Control Policy, is among high-level fed officials at Summit.

But while the timing is good, a crucial piece of math used in Baum’s interview is probably not only off base but out of the ballpark entirely.

He suggested about 4 million Americans have a drug dependency problem, citing Peter Reuter of the University of Maryland, who Baum said puts the number of people addicted to hard drugs at fewer than 4 million.

What is being defined as a “hard” drug isn’t entirely clear.

But the feds, based on years of national surveys and emergency room data, estimate more than 24 million people are in need of treatment for addiction.

Even if you’re skeptical of figures provided by the federal government’s drug-fighting agencies, consider this: There are an estimated 600,000 or so heroin addicts in the U.S.  Given its lethal dangers, heroin has all the headlines right now, but it is far from the most common drug of abuse.

Think oxycodone, benzodiazepines, Percocet; throw in methamphetamine, and cocaine. For starters.

If even those five drugs generated the same level of addiction as heroin, once you add in the heroin figures you start bumping up against four million number.

Palm Beach Post Reporters Christine Stapleton and Pat Beall  are covering the four-day Summit live from Atlanta.  The two are members of a Post team of reporters investigating scams in Palm Beach County’s $1 billion drug treatment industry.

The 8-month long investigation by the Palm Beach Post uncovered patient brokering, insurance fraud and kickbacks.

Amid soaring heroin use, Gov. Rick Scott greenlights Florida’s first needle exchange program

Hypodermic needles   found in the trash at a cottage apartment by Jean Thomas, 83, in West Palm Beach's Prospect Park neighborhood. (Thomas Cordy / The Palm Beach Post)
Hypodermic needles found in the trash at a cottage apartment by Jean Thomas, 83, in West Palm Beach’s Prospect Park neighborhood. (Thomas Cordy / The Palm Beach Post)

It’s taken a while- a few years, actually- but today Gov. Rick Scott signed off on a pilot program in Miami-Dade County, run by the University of Miami, which establishes a needle exchange for addicts.

Once politically unthinkable, the state’s soaring rates of IV drug use- and deaths- have slowly made the idea of providing clean needles to addicts acceptable.

Credit the track record of needle exchanges in reducing rates of HIV/AIDS and Hepatitis C. That helps explain why the Florida Medical Association threw its considerable weight behind the pilot program, and why a Republican-led Congress has lifted the ban on using federal money for such exchanges.

Florida’s program is, however, just a pilot. And the University of Miami won’t be able to use state or local tax dollars to get it up and running and keep it going.

But in a written statement, Bill Piper, Senior Director of National Affairs for the Drug Policy Alliance, expressed optimism: “Hopefully this pilot syringe program is just the beginning of major changes in Florida,” he wrote.

Some neighborhoods locally might welcome that: In Prospect Park, 83-year-old Jean Thomas discovered a cache of needles in her trash last year.

 

As Youth Services International exits Florida, critics ask: Why are for-profit businesses in charge of youthful offenders?

It’s almost impossible to talk about Youth Services International exiting the Florida juvenile system without also talking about privatization.

“We should recognize as a community that we cannot derive profit off the punishment and rehabilitation of kids,” said Gordon Weekes, the Broward County chief assistant public defender who for years has locked horns with YSI over the treatment of kids in its care.

“This should never have been a profit center.”

Florida’s Department of Juvenile Justice long ago began putting the care and treatment

Palm Beach County Juvenile Correctional Facility, which YSI ran for years.
Palm Beach County Juvenile Correctional Facility, which YSI ran for years.

of juveniles bound for residential, treatment or detention facilities into the hands of private companies.

YSI was among the first to ink contracts and among the first to start chalking up troubling reports dating to its mid-1990s management of a Pahokee lockup: not enough staffers, not enough food and too much violence.

Last week, DJJ announced it was severing the company’s seven contracts as part of a whistleblower suit settlement. The whistleblowers, all former YSI employees, had reported, among other things: not enough staffers, not enough food and too much violence. (YSI said that, even though the suit was without merit,  it settled because it wanted to put the long-running litigation behind it. )

Caroline Isaacs
Caroline Isaacs

But, said Caroline Isaacs, Arizona director for the American Friends Service Committee, “This is not about a single bad actor or a few bad apples. It is inherent in the effort to make money and is driven by the concerns and needs of shareholders.”

“Oh, I never fault the companies on this stuff,” said Paul Wright. That’s a bit out of left field coming from Wright, a former prison inmate, the founder and Executive Director of the Human Rights Defense Center and editor of the award-winning Prison Legal News, which has for years has taken on prison privatization in all its manifestations.

Paul Wright
Paul Wright

But, said Wright, nobody should be surprised when a for-profit company finds ways to make profits.

“Let’s take them at their word they are in the business of making money,” he said. Cutting costs is part of the deal, he pointed out.

“It’s not their fault that government continues to shovel money at them.”

 

Weekes said YSI’s exit give DJJ an opportunity: a small, state-run facility that incorporates the best practices of juvenile detention. “Take the the profits we are paying to companies and get down to core  element of what a child needs to get back on the right track,” he said. “Once we have best practices, we can replicate that.

“We can’t just keep throwing good money after bad at the YSIs of the world.”