Tracy was aiming for a vein, but she missed. Instead of entering her bloodstream, the heroin went directly into the fatty tissue around the vein. It hurt, but she figured it was no big deal.

She was wrong…

4 Dangers of Missing the Vein With IV Drug Use

Injecting a drug (often called “shooting up”) means using a needle to deliver drugs like heroin, cocaine, and methamphetamine directly into a vein. When the needle fails to reach its target, this is called a “missed shot.”

A “missed shot” happens when a needle either: 1) doesn’t enter the vein properly, 2) enters the vein then slips out again, or 3) enters the vein and goes all the way through to the opposite side of the vein.

During IV drug use, when the needle slips or punctures the vein, it causes fluid to enter the tissue around the injection site. This often leads to infection, and from there, things can quickly go downhill. People can experience abscesses, cellulitis, vein collapse, and other complications.

Let’s take a look at four serious problems that can develop if IV drug users miss the vein.

#1 Abscesses

When a missed shot gets infected, you may get an abscess at the injection site. Your body is trying to fight the infection, so it sends cells to the damaged tissue to repair it. This causes the area to become swollen and fill with pus. (Pus is a mix of white blood cells that are sent to fight the infection, plus germs and dead tissue.)

Side effects of an abscess include:

• Redness of the skin
• Smooth swelling under the skin
• Pain in the infected area
• Warmth of the skin in that area
• A build-up of pus in the area

Because of the infection, you may also experience a fever and chills. Here’s how some people have described the abscess experience:

#2 Cellulitis

A missed shot can also lead to cellulitis. This is a deep, bacterial skin infection. It can occur when a break in the skin allows bacteria to invade (which happens when drugs are injected outside a vein). And it can be very serious.

Common symptoms of cellulitis include:

• Pain
• Tenderness
• Swollen skin
• Redness of the skin
• Bruising
• Blisters
• Fever
• Headache
• Weakness
• Chills

The pain and other symptoms start at the injection site, but the infection can spread quickly throughout the body. It can cause damage to tissue and tissue death. If you get cellulitis repeatedly, this can cause damage to your lymphatic drainage system and cause ongoing swelling of the affected arm or leg.

And the infection can enter your bloodstream, lymph nodes, bones, heart, or nervous system. At that point, it can become life-threatening. Complications from cellulitis can lead to amputation or even death. When you factor in the complications from addiction, it’s easy to see how things can spiral.

#3 Vein Collapse

Repeated missed shots can also cause your veins to collapse.

Here’s how it happens:

1. The injection causes damage to the lining of the vein.
2. Clots form around the damaged site.
3. The clots harden into scar tissue.
4. These clots narrow the vein, which restricts blood flow and causes future clots to form more quickly.
5. Eventually, the sides of the vein heal together (the vein “collapses.). There’s so much scar tissue that it draws the sides together and shuts off the vein.

Once a vein collapses, blood can no longer flow through it. Sometimes a collapsed vein can heal, but the damage can be severe enough that the collapse is permanent. In some cases, this can cause circulation problems.

#4 Substance Complications

In addition to the damage caused by the needle, the drugs themselves can irritate the vein or cause other issues. For example, research has shown that the acidity in heroin can damage veins. Researchers found that some batches of heroin have a pH level as low as 2.6 – which means the heroin is very acidic. (In comparison, lemon juice and vinegar both have a pH of 2.) Imagine the irritation your veins would experience with something that acidic flowing through them. With repeated exposure to such high pH levels, veins can develop life-threatening infections.

It’s also worth mentioning that, when people inject heroin that is mixed with cocaine, the cocaine actually numbs the injection area. That means you aren’t able to feel the typical pain associated with missing the vein. And when you can’t feel it, you don’t know there’s a problem.

IV Drug Users Can Expect Complications

Are complications from missed shots a common problem? Are you likely to experience one of these issues? Well, over half (56%) of people who inject drugs admit they’ve missed a vein. And one in six intravenous drug users reports experiencing a missed shot more than four times every month.

So, yes, IV drug use problems are common, and the risks are high.

You may know him as a young John Conner in Terminator 3: Rise of the Machines. Or you may recognize him as the child actor who co-starred with Mel Gibson in Man Without a Face in 1993.

Nick Stahl began performing at age 4 and was recruited by Hollywood at age 10. He was just 11 when Gibson discovered Nick’s talent, and his career took off from there.

And it was just two years later, at age 13, that Stahl discovered alcohol.

But let’s back up a bit.

Looking back at his childhood, Stahl gains some insight into why the stage was so appealing – and why alcohol was so appealing at a young age, too.

A Blanket of Fear

Stahl was raised by a single mom who worked two jobs to make ends meet.

Stahl recalls, “From a very young age, I was always under this blanket of fear, financial fear. There was this idea that if we didn’t come up with enough money for that month, we would end up on the street. That colored my outlook growing up. My default mode was untrusting, with this mentality of waiting for the other shoe to drop.”

“I don’t look back on my childhood with real fond memories,” he says. “But for some reason, when I did plays, that stuff shut off and I had this ability to just be very comfortable.”

And when he had his first drink at 13, he discovered a way to “shut stuff off” when he wasn’t on stage. The tense feelings disappeared.

“Suddenly, I had a freedom from thinking, from uncomfortability,” he explains. “I felt okay in my skin — and I hadn’t really felt that before.”

Full Steam Ahead

By age 16, Stahl’s career was in full gear, and he and his mother moved to Los Angeles. There, he discovered the party scene.

He recalls, “I was going to bars. I had a very easy time getting into these places. A lot of my friends were older, and I had a great time.”

“That became what I chased,” he says. For Stahl, the drugs alleviated anxiety. He wasn’t partying for fun, but for release. He explains, “Very early on, it was not ‘I want this,’ but ‘I need this.’”

Falling Apart

In 2001, Stahl starred in Bully, a true-crime drama. Brad Renfro, his co-star, also battled addiction at the time.

Stahl recalls, “He was more severe in his addiction than I was. He just progressed to a point where he had to have someone on set with him to keep him sober.”

Stahl knew he was headed in the same direction. He tried to stop the deadly addiction train he was on.

But none of that worked.

“Things started to get awful pretty quickly,” Stahl recalls. “I started to miss appointments. I put on a good front. The extent of my illness stayed hidden even from me. It’s common to justify, rationalize things. I looked around and said, ‘Everyone is partying the way I am.’ In retrospect, there were far less people going as hard as I did.”

In 2007, at age 27, Stahl entered rehab for the first time. In 2009, he tried again.

But Stahl couldn’t stay away from Hollywood for long. He went back – and was arrested multiple times. The charges included disorderly conduct and possession of meth.

Picking Up the Pieces in Recovering from Addiction

Despite his struggles, Stahl never lost an acting job. He was able to hold it together enough that he never got fired. But he knew he would soon, if something didn’t change. In 2012, he knew it was time to step away from acting for a while.

“I was physically there, but I was checked out,” he admits, “and I certainly wasn’t feeling any real enthusiasm for acting anymore. I knew that I had to step away, for self-preservation, but also for the preservation of my career, if I was going to have one again.”

Stahl spent the next five years in Dallas, “diving into his recovery” as he puts it.

Once he achieved sobriety, Stahl was able to give his life new direction. “It proved to be reconstructive for me,” he says. “That’s when I really started to piece together that I had neglected building a real life outside of the business. For many years, I had everything — but I didn’t have anything resembling a satisfying life. I didn’t have outside interests, I lost touch with friends and family. The film world made up too much of my identity.”

A New Life While Recovering from Addiction

When Stahl stepped away from Hollywood while recovering from addiction, he didn’t leave with millions in the bank. That meant he had to get a job like any other Joe. “So, I started working for a friend’s moving company,” he says.

“I tried other things. I worked at a coffee shop in New York for a little bit. Not only did I learn how to live as a sober person, which I didn’t know how to do, but I learned how to have a life outside the business.”

And this fresh perspective has allowed Stahl to re-enter show business with a healthy, sober outlook. “That passion inside me that burned for film and acting, it had dulled progressively over time,” he explains.

“But once I was separated from Hollywood, all of that started to come back. Over the past few years, whether I’m working on a film or auditioning, I don’t take it for granted, ever. I work much harder at it now. I just feel a renewed love for it.”

Clean for four years now, Stahl, age 41, is back in action with a full line-up of acting roles on his calendar.

But recovering from addiction comes first. “Recovery has to be the most important thing for me,” he says. “I put it first in my life. But I’m grateful for it, and it’s given me the opportunity to try to help people in the same situation I was [in]. It’s more important to me than making films. I search out people who have had similar struggles and show them how I got well. I speak from my experience and show them what worked for me.”

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-934-1582(Who Answers?) today.

You say tomato. I say tomahto.

You say oxycodone. I say Percocet. Same difference, right?

Actually, no. The two drugs do have some similarities, but when comparing opioids, the terms are not interchangeable.

Let’s talk about how they differ.

Chemical Makeup

Both of these drugs are opioid pain medications. Oxycodone is a synthetic drug made from opium. Percocet is made of oxycodone and acetaminophen. (Acetaminophen is another painkiller, which you probably know by its brand name: Tylenol.)

If you take either of these drugs, you’re taking oxycodone. But when you take Percocet, you’re also getting the second medication, acetaminophen. This is one of the primary reasons oxycodone and Percocet get confused when comparing opioids.

Oxycodone and Percocet Use

Oxycodone is available in three different forms, which are used for different types of treatment:

• Immediate-release tablets enter the bloodstream right away
• Extended-release tablets gradually release the drug into the bloodstream
• An oral solution, often given through a gastric tube, is available for patients who can’t swallow tablets

Oxycodone is used for treating moderate to severe pain. The extended-release form is often prescribed for patients who have ongoing pain, such as cancer-related issues. 

Percocet is also prescribed to treat moderate to severe pain. But it is used for treating conditions that also cause a fever because acetaminophen is a fever reducer. It may also be used to treat patients who experience pain while on another long-acting painkiller. 

Percocet is not recommended for long-term use, since the acetaminophen in it can wreak havoc on the liver and cause serious damage over time.

Effectiveness

Both drugs are proven to effectively relieve pain. When you take Percocet or immediate-release oxycodone, you start to feel relief within half an hour, and the effects usually last for three to six hours. 

Extended-release oxycodone starts to work within two hours and continues to relieve pain for up to 12 hours. The brand name drug OxyContin is a type of extended-release oxycodone.

Over time, patients can develop tolerance to these drugs. This means they need higher doses to get the same pain relief. Tolerance can begin to develop within just one week of taking regular doses of either drug.

Side Effects

Since we’re comparing opioids with the same primary ingredient, both oxycodone and Percocet naturally have similar side effects.

Both commonly cause:

• Constipation
• Sleepiness
• Calmness
• Nausea
• Dizziness
• Loss of appetite
• Headache
• Impaired motor skills

There are two main differences in their side effects:

• Oxycodone is more likely to cause feelings of euphoria
• Percocet can cause abdominal pain, black stools, and yellowing of the skin (jaundice) because of its effect on the liver

One of the biggest potential side effects of either drug is addiction. Tolerance can happen quickly and lead to physical and psychological dependence, so “>both drugs are considered highly addictive. 

Drug Classification

Here’s an area where the two drugs don’t differ. The Drug Enforcement Administration (DEA) classifies drugs into five categories or “schedules.” A drug’s class is determined by its potential for dependency and its accepted medical use. 

Both oxycodone and Percocet are Schedule II drugs.

Schedule II substances have “a high potential for abuse, with use potentially leading to severe psychological or physical dependence.” They are considered dangerous.

Other examples of Schedule II drugs include methamphetamine, cocaine, fentanyl, and Ritalin.

Pop Quiz

Here’s a quick quiz comparing oxycodone and Percocet. Don’t worry – you won’t be graded!

Match the following descriptions with the correct drug. (Hint: Some are true for both substances.)

1. An opioid
2. Contains acetaminophen
3. Relieves pain
4. Is considered addictive
5. Comes in an extended-release form
6. Can cause drowsiness
7. Reduces fever
8. Is not recommended for long-term use
9. Tolerance can develop in 7 days
10. A Schedule II narcotic

How’d you do? You can check your answers below.

And remember, if you’re trying to decide which medication is best for your situation, always consult with a doctor and use the drug only as prescribed.

If you need help with drug abuse, call 800-934-1582(Who Answers?) .

Pop Quiz Answers:

1. Both
2. Percocet
3. Both
4. Both
5. Oxycodone
6. Both
7. Percocet
8. Percocet
9. Both
10. Both

Eight days ago, Angela was in rehab. Now she’s completely off heroin and has an impressive five weeks of sobriety under her belt. She has a new job and a new apartment. But things are starting to get a little more stressful than she thought they’d be — so many changes, so many new responsibilities.

One night after work, Angela’s stress became too much to handle. She could feel herself slipping. Her mind was overcome by cravings.

In an instant, that familiar voice in her head reappeared. “You just need a little something to take the edge off — something to help you relax. It’s just this one time. No big deal. You can go back to being sober tomorrow.”

Three hours later, Angela woke up in a hospital bed. She’d overdosed on heroin. Fortunately for Angela, she was saved when a neighbor found her unconscious and barely breathing in their apartment complex hallway. EMTs were able to revive her from the overdose.

Many others aren’t so lucky.

The Heightened Risk of an Overdose After Rehab

When Angela entered rehab, she stopped using opioids. Before rehab, she had been using drugs for two years. During those two years, her body built up a tolerance for opioids. Eventually, she needed a much bigger dose to keep getting the same effect from the drugs.

Fresh out of rehab, Angela had been drug-free for weeks. Her body had returned to a normal, healthy state. And that can be dangerous.

Angela’s systems weren’t constantly interacting with and reacting to the effects of opioids. That means she no longer had the same tolerance she’d built up before entering treatment.

But Angela wasn’t thinking about detox, tolerance levels, or the potential of an overdose. So, she took the same dose of heroin she was using right before rehab. And her body went into shock.

She hit her body with an amount of heroin it was no longer used to, and her system couldn’t handle it. So, it started shutting down.

The result: an overdose that nearly killed her.

The Common Story of Overdosing After Rehab

Angela’s situation isn’t unusual. After leaving rehab, many people return to their old habits. And while their habits haven’t changed, their bodies and tolerance levels have.

When people relapse after treatment, they often make the mistake of thinking they can take the same dose they used pre-rehab. They don’t realize that dose could now be fatal, and they end up overdosing.

Some people get lucky and survive the overdose. But many don’t.

Top Reasons for a Post-Rehab Overdose

Angela looked to opioids to help her cope with stress. This is a common reason for overdose after rehab. Whether at home or work, stress builds up, and the person who is addicted feels they can’t cope with everything without using substances.

Here are five other common mindsets that can lead to a post-rehab overdose:

• Just One More Time:

Jeff wanted to take his life in a new direction. He hadn’t taken any pills in weeks.

But, when he ran into an old friend who invited him over, he knew what they would end up doing. “Why not?” he thought. “I might never see him again. One last time can’t hurt.”

But, yes, it can. Jeff no longer has the tolerance for the level of drugs he and his friend used to use. If he takes that amount tonight, there’s a very good chance he’ll overdose.

• Feeling the pain 

Devan’s old shoulder injury was flaring up again. After battling with a painkiller addiction, he had been drug-free for six months. But the pain was back.

And he didn’t think he could manage it without those pills.

The problem: If Devan took the same dose of painkillers today that he was taking when he quit six months ago, the amount would kill him.

• Too Strong for Triggers

Sam used to get high every time he went to his cousin’s house. Now, he’s been out of rehab for three weeks and has stayed clean.

But just walking by his cousin’s place makes him want to use. He doesn’t try to avoid the neighborhood — or his cousin.

And the cravings are getting more intense.

If Sam doesn’t find a way to address his triggers and cravings, and gives in to them, he’ll be in danger of an overdose.

• Something Completely Different

Kelly went to rehab to deal with her alcohol addiction. Three months sober, Kelly starts using heroin instead of drinking. But her body isn’t used to this drug.

Because she substitutes one drug for another, Kelly is at high risk for an overdose.

• Feeling Despair

Sobriety has just become too much. Brian is in a deep well of depression and sees no hope.

He decides to take every pill he can find to escape it all with an intentional overdose to end his life.

And the Leading Cause for an Overdose After Rehab…

Of all the reasons for post-rehab overdose, one of the most common is self-deception. Here’s what that looks like:

“Sure, I had a drug addiction before, but I have control now. This time, I won’t let things get out of hand.”

But this line of thinking shows that things are already out of hand. And a relapse could be (and often is) fatal — especially after rehab.

For information about treatment options for you or a loved one, call 800-934-1582(Who Answers?) today.

– DEA Administrator Anne Milgram

The chemicals come from China to Mexico. The cartels in Mexico run drug production facilities. They sell deadly, unregulated substances, like fentanyl, on social media in the United States. Thousands of Americans die of drug overdose.

The Emerging Risk of Fentanyl on Social Media

Between April of 2020 and April of 2021, 100,000 Americans died from drug overdose. Around 75,000 of those deaths were due to opioids, mostly fentanyl.

According to data from Families Against Fentanyl, “the number of deaths from fentanyl between 2020 and 2021 surpassed the number of deaths from suicide, COVID-19, and car accidents.”

Fentanyl is a synthetic opioid originally developed to treat severe pain, specifically breakthrough pain in cancer patients. It is 50 -100 times more powerful than morphine.

Like other opioids, fentanyl overdose causes breathing to stop, which can lead to a coma, brain damage, and death.

The U.S. Drug Enforcement Agency (DEA) has confiscated so many pills containing deadly amounts fentanyl that they’ve issued a public safety alert. The pills are made to look like common drugs such as OxyContin, Xanax, and Adderall.

At least 76 recent fentanyl cases involved the use of social media to traffic the drugs. Dealers use Facebook, TikTok, Snapchat, Instagram, and YouTube to reach customers.

DEA Administrator Anne Milgram says:

Why Fentanyl on Social Media is Overtaking the Market

Fake prescription pills laced with fentanyl look nearly identical to legitimate pills. They closely resemble medications like Vicodin, Xanax, and Percocet.

The DEA reports that people use social media to purchase pills that they think are legit, but the pills can turn out to be deadly. Rather than the medication they were expecting, social media buyers receive fakes containing lethal amounts of fentanyl.

And it’s not just teens, either.

Milgram notes that the drug dealers’ social media strategy is “reaching all age groups—a curious teenager ordering a pill online, a college student trying a pill from a friend, an elderly neighbor searching online for a painkiller.”

She says, “They are using these platforms to flood our country with fentanyl. The ease with which drug dealers can operate on social media and other popular smartphone apps is fueling our nation’s unprecedented overdose epidemic.”

What Can Be Done About Fentanyl on Social Media

The DEA reports that dealers are use emojis as codes to advertise substances like fentanyl on social media. And Milgram says “social media companies are not doing nearly enough to block the ads for fake pills.”

Social Media Moderation

Social media companies claim they have tried. They say they have altered algorithms and hired more moderators to look for illegal items for sale.

But law enforcement and families of overdose victims say it’s inadequate. They suggest more parental controls and data-sharing to catch dealers who sell drugs like fentanyl on multiple social media platforms. In many cases, the dealer connects with a buyer on one site but goes to another to complete the deal, and then moves to a third to receive payment.

Decreased Social Media Use

Some suggest a radical idea: Don’t use social media. Block it on kids’ phones. Take their devices away. Many generations have survived without social media. Maybe a step back is what it will take to ensure the next one survives, too.

Safe Prescription Use

Meanwhile, the DEA and other law enforcement officials continue their efforts to get fentanyl off the streets and off social media. The DEA offers the following reminder:

“The only safe prescription medications are prescribed by trusted medical professionals, given by a licensed pharmacist. ‘Prescription drugs’ acquired from other sources should be assumed unsafe.”

If you or a loved one misuses prescription drugs, receiving treatment can be crucial. Many people begin using legitimate pills, but develop a high tolerance that requires more pills than are in their prescription to achieve the same effects. This progression can lead into the purchase of potentially dangerous counterfeit prescription pills online, such as fentanyl on social media.

Call 800-934-1582(Who Answers?) to learn more about opioids misuse and addiction treatment.

We know addiction can develop from a number of factors. And we also know the experiences we have during childhood can play a role in who we become as adults.

One of the childhood experiences that can have a huge impact on us as we grow older is emotional neglect. In fact, research shows it can even put us at higher risk for developing an addiction.

What is Emotional Neglect?

Childhood emotional neglect can occur when parents neglect their children’s emotions and emotional needs.

This means they do not ask about their children’s feelings, connect with them on an emotional level, or validate their feelings enough.

These parents may be physically present but emotionally unavailable, or they could be so damaged by their own childhood experiences of emotional neglect that they have no idea how to nurture their own children.

Who are Emotionally Neglectful Parents?

Jonice Webb describes childhood emotional neglect in more detail in a recent Psychology Today article.

Webb states:

The one failure of the emotionally neglected family is emotional.  There may be enough hugs.  There may be enough money.  There may be enough food and clothing.  But this family does not manage to provide enough emotional awareness, validation, compassion, or emotional care to the children.

Emotionally neglectful parents usually do not notice what their kids are feeling and, therefore, may have no idea that they’re neglecting their children’s emotions at all.

Connecting the Dots Between Emotional Neglect and Addiction

It is not uncommon for a person in addiction treatment to have an ah-ha moment where they realize their emotional or physical needs were neglected as children. They see for the first time how this neglect influenced their choices, feelings, and behavior as adults.

Researchers acknowledge that it’s impossible to identify the exact role of emotional neglect and other forms of abuse play in addiction. Dr. Cora Lee Wetherington, the National Institute on Drug Abuse’s Women’s Health Coordinator says:

Emotional neglect and abuse causes:

• Persistent feelings of fear and a high risk of developing post-traumatic stress disorder (PTSD)
• Hypervigilance
• High risk of developing anxiety or depression
• Learning deficits
• Delayed developmental milestones
• Difficulty processing positive feedback
• Difficulty with social cues and situations

These effects also have a high correlation with addiction. For example, research indicates that 30-59 percent of women in treatment for addiction have PTSD and 55-99 percent of these women have a history of childhood trauma, such as physical or emotional neglect.

What Are the Signs of Emotional Neglect?

Webb identifies eight signs of emotional neglect in a family:

• Family conversations tend to focus on surface-level topics, meaning they are seldom about emotional, meaningful, painful, or negative things.
• You sometimes feel unexplained resentment or anger towards your parents.
• You go to family events with hopes of having a good time, but oftentimes, you come away feeling empty or disappointed.
• Interpersonal problems in the family are generally ignored instead of acknowledged and discussed.
• It feels like your siblings are competing with each other, but you’re not sure for what.
• Affection in your family is expressed through acts of service (i.e., doing things for people) and not through emotional expression.
• Emotion, in general, seems to be off-limits in your family.
• When you’re with your family, you feel lonely or left out.

If you identify with any of the above signs, here’s the good news: The way you were raised does not have to dictate the rest of your life.

Can You Repair the Effects of Emotional Neglect?

While you cannot change the family you were born into, you can start by working on yourself, according to Webb.  She recommends selecting an item from the list that applies to your family, and then to start behaving the opposite way.

Webb also recommends making an effort to:

• Talking to others about meaningful things instead of only talking about superficial things
• Fighting against feeling guilty for your emotions
• Focusing on self-care when with your family
• Expressing your affection and warmth toward others through words, rather than actions

By taking these first steps, you will be better able to offset the impact the emotional neglect you experienced will have on your life moving forward.

Call 800-934-1582(Who Answers?) today to learn more about treatment options.

Let’s take a quick trip back to the 1990s. That’s when it all started.

Opioid prescription numbers were beginning to climb. And they didn’t slow down. Over the next two decades more and more doctors filled their prescription pads with painkillers.

By 2012, opioids were being dispensed at a rate of 81.3 prescriptions per 100 people. That year, doctors wrote more than 225 million opioid prescriptions.

By then, we were seeing alarming numbers of overdose deaths. We were in the middle of an opioid epidemic. We realized something needed to change.

And something did.

Doctors and officials saw the numbers climbing. They increased awareness and put new policies in  place. The rate started to decline. From 2012 to 2020, it continued to drop. By 2020, the opioid dispensing rate was the lowest it had been during that time period, at 43.3 prescriptions per 100 persons. This made a total of 142 million prescriptions that year.

As opioid prescribing falls, where does that leave us?

So…Where Are We Now?

The latest numbers show the rate is still dropping – but not evenly. A recent study by RAND Corp. found that opioid prescriptions dispensed by pharmacies declined by 21 percent from 2008 to 2018.

And the American Medical Association (AMA) reports that opioid prescribing nationwide has dropped a total of 44.4 percent in the years 2011 to 2020. This includes a 6.9 percent drop from 2019 to 2020.

If we’re hoping to turn the tide on the opioid epidemic, this means we’re on the right track – right? Maybe so. But the RAND study also discovered that these decreases have some interesting trends.

The rates aren’t dropping evenly across the nation. They noticed variances based on:

• The types of prescribers
• The types of patients
• The geographic area

Bradley D. Stein, PhD, MD, MPH, a senior physician researcher, admitted:

“The findings do not provide concrete answers about how much of the unnecessary prescribing of opioids has been eliminated. But…there is a lot more nuance in the changes in opioid prescribing than we previously understood.”

Here are some of the nuances researchers discovered:

• The volume of MME (morphine milligram equivalents) prescribed per capita declined the most in metropolitan counties and in counties with higher rates of fatal opioid overdoses.
• In some states, MME volume increased in multiple counties.
• In other states, some counties saw increased prescribing while other counties had decreases – and sometimes these counties were right next to each other.
• The greatest reductions seen in clinical specialties were among adult primary care physicians (a 40 percent decline).
• The biggest drop in opioid prescriptions written was among emergency physicians (a whopping 71 percent).

The CDC also reports that the 2020 numbers show dispensing rates remain high in certain areas. They found that in 3.6 percent of US counties there were enough opioid prescriptions dispensed for every person to have one.

And, while the overall rate had dropped to 43.3 prescriptions per 100 people by 2020, some counties still had rates nine times higher than that.

The bottom line: Opioid dispensing rates haven’t dropped everywhere. The numbers vary widely across the country. And some hotspots don’t seem to be slowing down.

As Opioid Prescribing Falls, What Does All This Mean?

The overall decrease seems to suggest things are headed in a positive direction. But it’s clear that some areas and populations remain at higher risk. And the AMA makes an important point about this.

Even with the decreased prescription rate, the nation’s overdose and death epidemic continues to worsen. In the 12-month period ending April 2021, there were 75,673 overdose deaths from opioids – up roughly 35 percent from the year before.

AMA President Gerald E. Harmon, MD noted:

“The nation’s drug overdose and death epidemic has never just been about prescription opioids. Physicians have become more cautious about prescribing opioids, are trained to treat opioid use disorder and support evidence-based harm reduction strategies. We use Prescription Drug Monitoring Programs as a tool, but they are not a panacea. Patients need policymakers, health insurance plans, national pharmacy chains and other stakeholders to change their focus and help us remove barriers to evidence-based care.”

“The medical community will continue to play its part,” he added. “And overall, the focus of our national efforts must shift. Until further action is taken, we are doing a great injustice to our patients with pain, those with a mental illness, and those with a substance use disorder.”

As opioid prescribing falls, there’s still so much work to be done.

For information about treatment options for you or a loved one, call 800-934-1582(Who Answers?) today.

Images Courtesy of Canva.

Did you know?

• IV drug use puts people at a much higher risk of overdose.
• People who inject drugs are at a higher risk of HIV, tuberculosis, and viral hepatitis.
• IV drug use increases the risk of addiction and the need for individualized treatment.

Why the danger? What makes IV drug use so hazardous? And why is it that—despite the researched dangers—an estimated 11 million people worldwide inject drugs?

Why is IV Drug Use Different?

During IV drug use, a syringe is used to inject a substance directly into the bloodstream. This method bypasses the body’s protective systems. The kidneys, liver, and digestive tract are all designed to dilute and metabolize substances as they pass through. But they can’t do their job if substances go around them.

While this might sound appealing to someone looking for a “bigger” high, it comes with an even bigger risk: overdose.

Which Drugs Are Commonly Injected?

Heroin is the most commonly injected drug. Others include:

• Amphetamines
• Buprenorphine
• Barbiturates
• Benzodiazepines
• Cocaine
• Methamphetamine
• Opioid painkillers

7 Common Dangers of IV Drug Use

All of the drugs mentioned above pose extreme danger when injected and can lead to fatal overdose. But the risks don’t end there.

Let’s take a look at some of the dangers often associated with IV drug use.

Addiction

IV drug use increases the risk of developing physical and psychological addiction.

• Physical Dependence: Tolerance occurs when the body becomes dependent on a drug; you have to take more and more of that substance to achieve the same effects.
• Psychological Dependence: Feeling like you can’t normally function without the use of a drug is a common symptom of psychological dependency. You experience withdrawal symptoms when you stop using it or use less.
• Addiction: While dependence and tolerance are both unique, they often contribute to the development of addiction.

Wound Botulism

The illness wound botulism is caused by a germ that can get into the skin during IV drug use. This toxin attacks the body’s nerves. It causes breathing difficulties and muscle weakness. If wound botulism isn’t treated properly, it can cause death.

This germ can contaminate drugs when they’re produced, transported, or cut with other substances. Drugs contaminated with botulism don’t look any different than non-contaminated ones. And cooking the drug won’t kill the germ.

Once it enters the body, botulism attacks multiple body systems, and the person must receive antitoxin medication to treat it. The antitoxin can stop further damage and prevent death, but it can’t reverse damage already caused by the toxin.

Injection Complications

IV drug use involves injecting a substance into the body through a syringe. If the injection is too deep, it can pierce a vein. If it is too shallow, the drug pools below the skin instead of entering the bloodstream. Either condition can cause serious infections and painful sores.

Collapsed Veins

Repeated IV drug use causes veins to malfunction and collapse. But by then, the user is addicted. So, to continue using the drug, the person often injects into other parts of the body. This is called injecting intramuscularly (in a muscle) or subcutaneously (under the skin). These types of injections can cause a host of other problems, including:

• Necrotizing fasciitis (flesh-eating disease): A severe skin infection that kills tissue. It can result in loss of limbs and death.
• Gas gangrene: An infection that can lead to tissue death and can be fatal.
• Tetanus: This infection can cause neck stiffness, rigidness in the abdomen, lockjaw, and difficulty swallowing.
• Track marks: Acidic drugs (like heroin) cause agitation when injected. The entry site often becomes inflamed, bruises develop, and veins collapse. These visible symptoms on the skin are called “track marks.”

Heart Damage

Any drug injection method can cause heart problems. Specifically, bacteria may find their way to the heart and cause endocarditis (a life-threatening inflammation of the heart). Endocarditis increases the risk of stroke.

Poor Circulation

Injecting drugs damages the veins, which makes blood flow more difficult. This can cause swelling of the legs and feet, painful cramping in the legs, leg weakness, and sores on the legs or feet.

Infectious Disease

IV drug users often use syringes that are not sterile. Examples include reusing needles, sharing needles, or using needles that aren’t intended for intravenous injection.

This can expose the user to infectious diseases, specifically those spread through contact with bodily fluids. This includes HIV, Hepatitis B and C, Tuberculosis, and other blood-borne infections.

In fact, people who inject drugs are “22 times more at risk of HIV compared with the general population.”

How Can You Protect Yourself?

While there is no safe IV drug use, many dangers associated with drug injection can be treated. Some can even be reversed. The best way to avoid these dangers or stop them from progressing is to address the underlying dependence or addiction that leads to chronic misuse of injectable drugs.

If you or someone you know is struggling with IV drug use, help is available. Call 800-934-1582(Who Answers?) to learn more about your addiction treatment options.

– Albert W. Henley, Confederate army physician, 1879

In the 1990s, opioid prescriptions soared. Overdose deaths started climbing in 1999. In 2010, the second wave of the epidemic started, with alarming increases in heroin-related overdose deaths. The third wave began in 2013, with a rise in overdose deaths related to synthetic opioids.

And in a recent 12-month period, over 100,000 people died of opioid-related overdose.

These waves of the opioid epidemic take us back over 30 years. But our history of opioid addiction is much older. If we want to trace the history of opioid epidemics in the U.S., we need to go way back. To the Civil War era.

Finding Out Where Your Enemy Is

The Civil War (1861-1865) took the lives of over 700,000 Americans. Ulysses S. Grant, Commanding General of the United States, aptly said:

Those left behind after the war officially ended faced a new enemy that was harder to spot: opium addiction. The war marked the beginning of the history of opioid addiction in America.

At the time, medical treatment was a far cry from what it is today. And as the war broke out, opium was central to treatment for soldiers. Soldiers suffered horrible injuries. The softer bullets of the time left jagged wounds and often lodged in bones. Many solders underwent amputation. Tens of thousands were hurt and maimed.

In the unsanitary conditions of battlefield hospitals, many soldiers developed fevers, diarrhea, and bacterial infection.

And what did doctors turn to for the treatment of all of these maladies? Opium. They dispensed it first in powder or pill form.

Historian Jonathan S. Jones reports that opium was viewed as a valuable pharmaceutical “that does so many different things. It was used to kill pain, stop deadly diarrhea, and suppress coughs. Opium was a godsend.”

But then morphine was introduced, which could be given with a syringe, so it was even easier and faster to administer. And once the soldiers were back home, they could easily get opioids from the local store. (Until the early 1900s, opioids weren’t regulated.)

How Freedom Is Lost

-Abraham Lincoln

It is estimated that by 1890, several hundred thousand Americans—a majority of them Civil War veterans—were addicted to opioids. They had made it through the war, but now they faced the battle of addiction.

Jones says “It was epidemic both in scale, just the sheer number of people who got addicted, and also the fact that after the Civil War it becomes … front page news. It becomes a really major public health, and also kind of a cultural, crisis in the post-Civil War decades.”

Jones adds that doctors were previously aware of the risks of opioid use – tolerance with prolonged use and the potential for overdose. “But it was never…front page news…until the Civil War caused the number of cases to just go through the roof.”

While Jones is describing a crisis that happened over 130 years ago, much of his statements about opioid addiction ring as true in the 2020s as they did in the 1890s.

Personal Battles in the History of Opioid Addiction

Jones has studied the Civil War history of opioid addiction extensively and will be releasing a book on the topic, Opium Slavery: The Civil War Veterans and America’s First Opioid Crisis, in 2023. His research has uncovered many stories like that of Albert W. Henley, a physician in the Confederate army.

Henley was taken prisoner when Vicksburg surrendered to the Union in 1863. Previously, he had contracted typhoid fever, which left him with chronic diarrhea. Other physicians advised him to take opium. He did…and quickly became addicted to the drug.

He tried repeatedly to quit, with no success. “I at length gave up all hopes of emancipating myself [and] gloom and despair haunted my very soul,” he wrote. Henley’s addiction lasted for the next 15 years.

J.M. Richards was a Union doctor who started taking opium in 1867. He had been suffering from diarrhea since the war’s end. But he, too, became addicted to the drug and was unable to stop using it. “I grew wholly unfitted for business” he wrote. “Poverty stared me in the face. My life was a failure, and the gloom and despair I felt were constant and unrelieved.” Richards poured all his resources into morphine or cures for the addiction and eventually tried to take his own life twice.

Like today, the stories go on. So many addicted. So many fighting personal battles with opioids.

Jones noted “In a lot of ways this is the first example in U.S. history of the problem of opioid addiction becoming really epidemic in the true sense of the word.”

If you or a loved one has felt the effect of the current opioid epidemic, help is available today. Call 800-934-1582(Who Answers?) now.

“We, the jury, find the defendants…guilty.”

In the first trial of its kind, a jury has found three major pharmacies guilty for their roles in fueling the opioid epidemic.

Pharmacies Take Their Chances With a Jury

The case is just one among more than 3,000 opioid lawsuits that have been filed across the country against various pharmacies, distributors, and manufacturers.

In many cases, the defendants have chosen to settle outside of court, paying significant settlements to counties and states.

But in this case, CVS, Walmart, and Walgreen’s pharmacies decided to take their chances with a jury. They took the case to trial, despite the fact they were urged by the judge to settle.

And they lost.

The amount all three pharmacies must pay has not yet been determined. U.S. District Judge Dan Polster will get to decide what the companies owe for posing a “public nuisance” in Ohio’s Trumbull and Lake counties.

Meanwhile, the case’s outcome may provide leverage for other local and state governments who filed cases against pharmacies or plan to file in the future.

What Crimes Did The Pharmacies Commit?

Between 2012 and 2016, around 80 million prescription painkillers were dispensed in Trumbull county. Another 61 million were distributed in Lake County during that same time. That’s enough to give each resident 400 pills.

Trumbull and Lake county attorneys claimed the three pharmacies should have done more to stop this flood of pills, which led to hundreds of overdose deaths and cost each county around $1 billion.

The attorneys pointed out that the companies should have hired more pharmacists and technicians or provided better training. They said the pharmacies failed “to implement systems that could flag suspicious orders.”

As a result, the attorneys argued, the pharmacies failed to confirm that each prescription was valid – which allowed an abundance of addictive drugs to flood their counties.

The jury sided with these arguments. After six days of deliberations, they returned with a guilty verdict, determining that the pharmacy chains did indeed create a public nuisance, and their actions resulted in “an oversupply of addictive pain pills and the diversion of those opioids to the black market.”

Pharmacies Claim “Not Guilty”

On the other side of the courtroom, attorneys for the pharmacies denied these allegations.

Pharmacy operators claimed they did take steps to prevent the diversion of pills. They pointed to policies designed to stop pill disbursement when a pharmacist has a concern.

Pharmacists are to notify the authorities when they receive suspicious orders from doctors.

The pharmacies pointed fingers at doctors, drug traffickers, and regulators. They pointed out that it was doctors who controlled the number of pills that were prescribed and whether they were prescribed for legitimate reasons.

Walgreens spokesperson Fraser Engerman noted:

“As we have said throughout this process, we never manufactured or marketed opioids nor did we distribute them to the ‘pill mills’ and internet pharmacies that fueled this crisis. The plaintiffs’ attempt to resolve the opioid crisis with an unprecedented expansion of public nuisance law is misguided and unsustainable.”

Will the Guilty Verdict Stick?

The jury sided with the Ohio counties, but it remains to be seen if the verdict will stick. The three pharmacies said they plan to appeal the verdict. They argue that it’s a misapplication of the “public nuisance” law and doesn’t fit the facts.

California and Oklahoma recently decided in favor of pharmaceutical companies involved in similar cases. And, in November, Oklahoma overturned a $465 million judgment against Johnson & Johnson.

So it’s possible that CVS, Walgreens, and Walmart may succeed in appealing this ruling.

And Still the Opioid Epidemic Rages On

Meanwhile, the verdict doesn’t seem to be affecting business at the three pharmacies. Their stock prices fell briefly, but rebounded quickly after the jury’s decision.

CVS and Walgreens remain the top two pharmacies in the U.S. based on the number of stores (nearly 10,000 for CVS and nearly 9,000 for Walgreens).

And Walmart has the #1 slot on the list of top 100 retailers 2021 based on sales, which totaled over $543 billion in 2020.

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-934-1582(Who Answers?) today.