A lot has changed when it comes to prescription opioids and how they’re prescribed.

It’s been six years. Six years since the CDC released its Guideline for Prescribing Opioids for Chronic Pain. So, why did the CDC decide to propose an update this year? What compelled the organization to take action now?

Let’s take a trip back to 2016 to find out.

Headed Toward Disaster

Over the course of two decades, use of prescription opioids in the U.S. drastically increased. The result? A full-blown opioid epidemic.

Thousands of people became addicted to painkillers. And when they grew desperate to feed their addiction, many of them progressed from prescription painkillers to illicit drugs like heroin.

Realizing the dangers, healthcare providers began to cut back on opioid prescriptions by 2012. But the damage was already done.

Opioid addiction and opioid overdose numbers skyrocketed. And what’s worse, the numbers kept climbing.

In 2016, the officials finally decided something had to change. The CDC stepped in with official prescribing guidelines, which later became known as the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. These guidelines were designed to reduce dependence on opioids and lower the risk of overdose.

After releasing the CDC guidelines, opioid laws began to change. Many states limited opioid prescriptions for acute pain to no more than seven days. Some states also limited prescriptions for Medicaid patients.

Insurance companies and pharmacies also set their own limits. Doctors began to taper long-term patients off opioids. Medical boards sanctioned doctors who didn’t adhere to the guidelines. Opioid prescriptions decreased.

Were all these actions helpful? That depends on who you ask.

Prescription Opioids: Too Strict or Too Misunderstood?

Some doctors, patients, and drug manufacturers were upset by the guidelines. They said chronic pain patients were being denied relief.

They were also concerned that doctors might be cutting patients off opioid pain relievers too quickly or failing to give prescription opioids to patients who could benefit from them.

Dr. Bobby Makkumala, head and neck surgeon in Michigan, said the guidelines

“…have been a barrier to patient care, with some pharmacists pointing to the CDC’s suggested limits and refusing to fill prescriptions as doctors wrote them.”

Keith Humphreys, Stanford University psychiatry and behavioral sciences professor, noted:

“It’s important to tailor policies to a patient’s individual circumstances rather than adopt a blanket approach for all.”

One survey found that 84 percent of patients reported having more pain and poorer quality of life after the opioid prescribing guidelines were released.

But others didn’t see a problem with the overall guidelines – just with how they were interpreted.

The CDC published a paper in 2019 stating that many physicians “were guilty of a misapplication of the 2016 guideline that clamped down on the use of opioids.”

Christopher Jones, acting director of the CDC’s National Center for Injury Prevention and Control noted that the 2016 guidelines “were essentially taken out of context beyond (their) intent and applied as rigid laws, regulations and policies.”

The guidelines were voluntary. They offered suggestions to help curb the opioid epidemic. They encouraged doctors to try other medications or nondrug options to treat pain rather than turning to opioids as the first treatment option.

Doctors were also urged to limit prescription opioids to three days when treating acute pain. And to prescribe the lowest dose possible.

But in many cases, these suggestions quickly became strict regulations. And the CDC felt the backlash. Many experts say the guidelines are too strict, and they’ve been calling for change ever since.

That change is happening now.

Threading the Needle

The CDC released an update and expansion of the 2016 guidelines. The 229-page document is open for public comment through April 11, 2022.

The update does not include “hard thresholds” from the previous version. Jones noted, “We’ve built in flexibility so that there’s not a one-size-fits-all approach.”

Dr. Joshua Sharfstein is the vice dean for public health practice and community engagement at Johns Hopkins Bloomberg School of Public Health. He explained:

The new recommendations are still voluntary. The document clarifies that these are not prescriptive standards. And that healthcare providers should consider unique circumstances and needs of each patient when prescribing treatments.

The update also avoids language that puts precise limits on dosages and lengths of prescriptions.

So, what do the new guidelines recommend?

New Guidelines for Prescription Opioids: Changes in Store

The updated guidelines provide recommendations for primary care physicians, outpatient clinicians, and other specialty clinicians who are treating three categories of patients:

• Adults with acute pain (lasting less than one month)
• Adults with subacute pain (lasting one to three months)
• Adults with chronic pain (lasting three months or longer)

The guidelines do not apply to patients being treated for cancer or sickle cell disease or receiving palliative or end-of-life care.

The main issues addressed in the guidelines are:

• When to initiate or continue opioids for pain treatment
• Opioid selection, dosage, duration, follow-up, and discontinuation
• Risk assessment/addressing harms of opioid use

Changes made to the previous guidelines include:

• Removal of the suggestion to limit opioid treatment for acute pain to three days.
• Removal of the recommendation that doctors avoid increasing dosage to the equivalent of 90 milligrams of morphine per day.
• Removal of the suggestion to have patients undergo urine testing annually. (But the guidelines still say doctors should consider having patients get tested to see if they are using other drugs.)
• The CDC urges doctors to avoid abruptly halting treatment unless the situation appears life threatening. The agency offers suggestions for tapering patients off the drugs instead.

The main prescribing guideline change is the removal of specific limits on treatment with opioid painkillers. The CDC hopes to avoid any misinterpretation that could prevent patients from receiving needed care.

The new guidelines still emphasize that opioids should not be the first-line option to treat chronic pain. And they advise physicians to start with a low dose of immediate-release pills.

Millions of Lives on the Line

Between spring 2020 and spring 2021, the U.S. saw an astounding 100,306 drug overdose deaths.

An additional study published in February 2020 projected “1.2 million people will die from overdose deaths in the U.S. and Canada through 2029 unless leaders enact evidence-based public health policies.”

Will the changes to the CDC opioid prescribing guidelines improve or worsen these numbers? Are we headed for better pain treatment or an increase in prescriptions that lead to addiction?

Time will tell.

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

It was a day she would never forget. Tammy came home from work and found her husband slouched in the recliner. She thought he was dozing, but then he didn’t respond when she tried to wake him.

She tried again. Then she noticed his lips had a blue tint to them, and his breathing was extremely slow. She put her hand to his cheek, and his face felt clammy.

He was taking painkillers for a back injury, and Tammy knew he had been taking extra pills here and there – more than the doc had recommended. Recognizing the signs of an opioid overdose, Tammy quickly grabbed the naloxone from her purse and sprayed it into her husband’s nose. She then called 911.

The paramedics told her later that her husband wouldn’t have made it if Tammy hadn’t given him the naloxone.

What is Naloxone and Who Can Administer It?

Nearly 80 percent of opioid overdose deaths happen in a non-medical setting. Settings where there are no doctors, emergency techs, or medical supplies. But one thing is available – naloxone.

Also known by the brand name Narcan, naloxone is a medication that can reverse an opioid overdose. An overdose occurs when opioids fully block the brain’s receptors. This blockage causes breathing to slow down and then stop.

Naloxone clears the brain’s receptors of the opioids so breathing can return to normal. It can literally save the person’s life.

A prescription is not required to purchase naloxone. It is available at most pharmacies, and anyone can carry it. It’s easy to use, so anyone can administer it when someone is experiencing an opioid overdose.

Who Should Carry Naloxone?

You may want to consider keeping naloxone on hand if any of these situations apply to you:

• You or a loved one is taking an opioid pain medication such as Vicodin, OxyContin, Codeine, or Percocet.
• You suspect your loved one may be struggling with opioid addiction or is misusing a prescription or other opioids.
• A loved one has recently received treatment for an opioid addiction.
• You want to be prepared to help save a life in your community if the situation arises.

When Should You Use Naloxone?

If you suspect someone is overdosing from opioid use, give them naloxone. The medication is not known to cause any harm if it turns out the person was not overdosing, so it’s best to go ahead and administer it.

Look for the following symptoms of overdose:

• Slow or erratic breathing, or breathing has stopped
• Non-responsive to their name or firm knuckle-rub to the chest
• Blue lips and fingertips
• Clammy face
• Paleness
• Deep snoring or gurgling sound
• Slow heartbeat or no heartbeat

How to Save a Life With Naloxone

If you suspect an overdose, take the following steps immediately:

1. Call 911: If the person is unresponsive, call 911. Try to get their attention by calling their name and telling them you’re going to call 911. Rub their chest firmly with your knuckles to try to wake them. If they are unresponsive to these attempts, call 911.

Put the person on their side with their legs bent and their head resting on the arm that is on the floor. This position will prevent them from choking if they vomit.

2. Administer Naloxone: Depending on the delivery method used, you will administer naloxone in one of the following two ways.

• Spray bottle: Insert the spray nozzle into either nostril and spray the medication into the person’s nose.
• Auto-injector: Remove the injector from its outer case. Remove the safety guard. Place the injector against their outer thigh, through clothing if needed. Press firmly and hold for 5 seconds.

3. Apply Rescue Breathing

If the person is not breathing or is struggling to breathe, conduct rescue breathing. Place them on their back. Tilt their head back, pinch their nose, and breathe one slow breath into their mouth every 5 seconds. Their chest should rise and fall with each breath.

4. Provide Support

When the person starts breathing on their own, roll them back onto their side and wait for paramedics to arrive. Keep in mind the person may feel sick, confused, and upset. Offer comfort and reassurance while you wait with them for emergency responders. And do not let them use any drugs.

5. Follow Up

After they have recovered from the overdose, have an honest but loving conversation with them about the situation. This may be a good opportunity to suggest getting treatment for opioid abuse or addiction.

Get help today at 800-934-1582(Who Answers?) to learn about treatment programs for drug and alcohol addiction.

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.

Medication-assisted treatment (MAT) has been a life-saving tool for so many people with opioid use disorder. In fact, the most popular medication used in MAT—Suboxone (buprenorphine/naloxone)—is approved and endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA), the Federal Drug Administration (FDA), and the National Institute on Drug Abuse (NIDA).

Thousands of people say Suboxone literally changed their lives for the better. Surely we’d never see patients facing barriers and stigma related to such a well-researched and highly-endorsed medication – not in this day and age, right?

Wrong.

Despite all the supporting literature and data, clinicians hear horror stories on a weekly basis – stories about pharmacies preventing access to recovery by turning away patients presenting Suboxone prescriptions.

So, what’s the deal?

What is Medication Assisted Treatment?

Medication-assisted treatment (MAT) is the use of medications, in combination with behavioral therapies, to treat opioid addiction and alcohol dependence. These medications are critical because over two million Americans live with opioid use disorder, which includes prescription opioids and illicit drugs, like heroin.

According to SAMHSA, these medications can relieve withdrawal symptoms and reduce the psychological cravings that cause chemical imbalances in the body. MAT also helps to normalize brain chemistry, block the euphoric effects of alcohol and opioids, and normalize body functions without opioid use.

There are three main types of MAT that can be prescribed by a medical provider:

1. Medications for alcohol use disorder: the medications used to treat alcohol dependence include acamprosate, disulfiram, and naltrexone.
2. Medications for opioid dependence (also called opioid use disorder): these medications include buprenorphine, methadone, and naltrexone
3. Opioid overdose prevention medication: naloxone (commonly called its brand name, Narcan) is an opioid overdose drug that can be used to reverse the effects of opioids and save someone’s life.

How Effective is MAT?

MAT is clinically proven to be an effective treatment, with a number of positive outcomes. These medications:

• Reduce the need for detox
• Provide a comprehensive, but tailored, program combining therapy and medication that addresses most patients’ needs
• Improve patient survival
• Decrease illicit opioid use
• Decrease criminal activity
• Improve retention in treatment programs
• Increase a person’s ability to gain and sustain employment
• Improve birth outcomes among pregnant mothers with opioid use disorder.

Why Do Pharmacies Prevent Access to Recovery?

Given how effective and well-endorsed medication-assisted treatment is, you’d think that pharmacies would be happy to stock their shelves with more of the medications (and increase their bottom line). Instead, recent studies have shown that some pharmacies are refusing to stock one medication: buprenorphine.

In a recent AMERSA podcast (The Multidisciplinary Education and Research in Substance Use and Addiction), Dr. Jeffrey Bratberg and his colleagues decided to test the availability of MAT by hosting a phone-based “secret shopper.”

Bratberg, with researchers Dr. Lucas Hill, and Dr. Lindsey Loera, surveyed 800 pharmacies licensed by the state of Texas for the distribution of MAT. During their “secret shopper” experiment, Bratberg and colleagues asked pharmacies for the availability of the most prescribed MAT product, buprenorphine 8/2mg films. When medications were unavailable, researchers asked when it would come back in stock and  also asked about the availability of naloxone.

The findings were pretty alarming.

Bratberg and colleagues discovered that:

• Only 34 percent of pharmacies were willing to fill one week of buprenorphine and a naloxone kit
• Chain stores were more likely than independent pharmacies to fill Suboxone prescriptions
• Prescribing just one medication (buprenorphine) didn’t make a big difference, with 42 percent agreeing to fill the prescription
• Even if the medication was out of stock, only 62 percent of pharmacies were willing to order it (and it took more than two days for Suboxone delivery)
• Some pharmacists simply refused to dispense Suboxone altogether

Digging Into Each Pharmacy’s Excuses in Preventing Access to Recovery

Researchers wanted to understand why the medication was out of stock and why pharmacists were so unwilling to prescribe an FDA-approved medication and therefore prevent access to recovery.

Bratberg and colleagues found the reasoning was simple: stigma and misconceptions.

Some pharmacists held misconceptions, believing MAT could cause euphoria or even lead to misuse. They essentially believed that, since it was an opioid, patients would use it to get high –  even though that has been scientifically refuted. Other pharmacists pointed to cost issues saying that they could lose money if they had an excess supply on hand.

Critics say that the pharmacists’ perspectives are grounded in misconception and flawed arguments. Here’s why: Bratberg and colleagues pointed out in the podcast that surely all of these pharmacists had a supply of a highly addictive opioid, oxycodone, meaning the pharmacists’ reasoning was ill-founded.

Unfortunately, the lack of supply issues for MAT isn’t limited to Texas. A similar study in Kentucky found that pharmacists were terrified of DEA involvement. That reasoning does have more of a basis as wholesalers have been criticized for their part in the opioid epidemic by not reporting large orders of opioid medication.

Clearly the reasons that pharmacists prevent access to recovery are nuanced and Bratberg and colleagues say that the reasoning is complex and there needs to be a multidisciplinary approach that finds solutions and enables pharmacists to collaborate with other pharmacists, policy makers, and other MAT providers.

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.