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.

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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:

“They are trying to thread the needle here. They’re trying to balance, on the one hand, the importance of clear guidance to clinicians, and on the other, the danger it could turn into a rigid policy that undermines patient care. The general intent is to foster individualized patient care.”

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.

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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.

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Fentanyl on social media
The cartels have harnessed the perfect drug-delivery tool: social media applications that are available on every single smartphone in the United States.

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.

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47,300* People Addicted
23,100* Getting Help
8,209* Deaths
*Statistic from 2015

The Emerging Risk of Fentanyl on Social Media

Drug dealers are selling 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.

Just two milligrams of fentanyl can be lethal—an amount as small as a few grains of sand. Throughout 2021, the DEA seized enough fentanyl to kill every American. In the fall of 2021, the DEA seized more than eight million fake prescription pills. These fake pills have been found in every single state in the U.S.

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:

When you open Snapchat, when you open Facebook, when you open Instagram, when you open TikTok, when you open YouTube, the drug traffickers and the criminal networks are there waiting for you. The Mexican drug cartels don’t care that they’re killing a staggering number of Americans every day, they will just target and find new customers so they can profit.

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.”

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What Can Be Done About Fentanyl on Social Media

Social media companies are not preventing 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.

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“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.

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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.

Trumbull and Lake county attorneys argued that pharmacies “should be the last line of defense to prevent opioid pills from getting into the wrong hands.”

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.

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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.

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69,710.

That’s the number of people who died from opioid overdose in the U.S. in 2020. That’s up nearly 30 percent from the year before. And many expect those numbers to continue rising.

And why wouldn’t they? As we see more and more drugs laced with deadly doses of fentanyl, overdoses are becoming more and more likely. What’s the solution? Better interventions? More awareness? Fewer prescriptions? Policy makers, law enforcement, and health officials are looking into these options and many more.

Meanwhile, one group suggests going with a solution that’s less mainstream. In fact, it’s less…legal. (At least for now.) Enter the Safe Supply movement.

Introducing the Safe Supply Movement 

The Drug User Liberation Front (DULF) took to the dark web and introduced their own solution: Safe Supply. DULF hopes policies change in the future and they can garner support off the dark web. For now, they’ll take what they can get.

DULF founders Jeremy Kalicum and Eris Nyx seek to provide drug users with the drugs they want – but with less risk of overdose. How? By purchasing the drugs and testing them before they are passed on.

With fentanyl showing up in opioids, cocaine, and meth these days, DULF founders hope to intercept these deadly drugs before they hit the streets and ultimately provide a “safe supply” for users.

With overdose numbers climbing, the founders upped their game over the past two years. Last year, they staged their first protest, demanding a “safe supply” of drugs.

And in April of this year, they distributed pre-tested heroin in downtown Vancouver. And this past July, in what was likely their boldest move yet, DULF distributed drugs in front of Vancouver police HQ.

What’s in the Bag?

Nyx and Kalicum point out that no one really knows what they’re getting their hands on when they buy drugs in unmarked bags. Dealers could be giving them anything – and they often are. With just a few surprise milligrams of fentanyl in the mix, the user easily becomes another overdose statistic.

So, DULF founders hope to follow the same model as alcohol and cigarette distributors. They want to test the ingredients and label the substances clearly. They’d test street drugs and distribute them in packaging that clearly states what’s inside. Clients and groups could get their supply from DULF at protest events.

Kalicum admits that purchasing the drugs is a lot like buying anything else online – but you’re not using eBay or Amazon. He buys drugs on the dark web.

Kalicum admits that purchasing the drugs is a lot like buying anything else online – but you’re not using eBay or Amazon. He buys drugs on the dark web, a virtually unregulated sector of the Internet that offers sites where people can buy drugs and even leave reviews for the vendors. If Kalicum gets fentanyl when he is supposed to get heroin, he can dispute the purchase and ask for a refund (and has done so).

Of course, Kalicum admits, he might be purchasing from a criminal organization and further funding their illicit efforts. “But, we’re forced to leverage the resources that we have access to,” Kalicum argues.

Kalicum uses an allegedly untraceable cryptocurrency for the purchases, then he tests the drugs using FTIR spectroscopy. This technology reveals what is in the substance using infrared light. Then, Nyx makes labels for the Safe Supply drugs and tracks data on the substances they distribute.

What’s Next for the Safe Supply Movement?

Kalicum notes they would prefer to use drugs provided by the government rather than illicit markets. He hopes other drugs become regulated, much like methadone is now. He and other DULF supporters are making efforts to implement a “safe supply” model and bring Canadian health officials onboard.

In August, DULF founders submitted a request for exemption to current policies so they could practice their “safe supply” model – due to the “health emergency” of the opioid crisis.

And the duo is actually gaining some official support. Vancouver Coastal Health, a regional health authority, gave DULF a letter of support for its plan. Some Canadian policy experts have also agreed to support DULF’s safe supply efforts.

In October, the Vancouver City Council voted to support DULF’s efforts, but only if they purchase the drugs legally. This will require cooperation from other organizations, such as Fair Price Pharma, to provide the supply.

Nyx and Kalicum see a long road ahead, but they continue to push the “safe supply” movement. Nyx noted in an interview, “We have a colossal amount of work to do. People are constantly dying, and there is no end in sight.”

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The Attorney General in Alabama has designated a good chunk of its opioid crisis settlement money go towards an impressive cause. 

In a series of attempts to right the wrongs that opioids caused the state, Alabama will allocate $1.5 million of their McKinsey & Company settlement to the Department of Child Abuse and Neglect Prevention. Additional funding will be allotted to several more critical law enforcement departments.

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Opioid Settlement Money From McKinsey & Company

Earlier this year, The New York Times reported the consulting firm McKinsey & Company agreed to pay nearly $600 million to settle investigations into their role in increasing opioid sales. One of the drug companies it gave sales advice to was Purdue Pharma, the manufacturer of the highly addictive drug OxyContin

McKinsey reportedly wrote a report for Purdue executives highlighting how their new marketing tactics could increase sales of highly addictive OxyContin by $200 to $400 million annually. The report included a suggestion that opioids are useful in reducing stress, making patients feel optimistic, and helping them feel less isolated. One might argue that’s the complete opposite of how opioid addiction presents – constant cravings, discontent, isolation, and symptoms of physical dependence.

Purdue Pharma was also found to be at serious fault in the opioid crisis by knowingly putting the well-being of millions of Americans at risk by marketing and selling opioids that it knew were dangerous. It was also alleged that the company had reason to believe some of the providers were diverting the drugs to people who were abusing them. In November last year, Purdue pleaded guilty to fraud and kickback conspiracies. 

Purdue agreed to an $8.3 billion settlement and plead guilty to criminal charges for its role in fueling the opioid crisis. McKinsey & Company agreed to a nearly $600 million settlement in order to end investigations into their role in helping Purdue “turbocharge” its opioid sales

Alabama Isn’t Wasting Its Opioid Settlement Money

Alabama sued McKinsey for their role in increasing opioid sales and were awarded $9 million, $7.6 million of which is due to be paid in 2021. (Alabama also has several other pending lawsuits against opioid manufacturers.) 

In a series of statements, the Alabama Attorney General announced the state would be awarding millions of dollars to the Alabama Department of Child Abuse and Prevention (ADCANP), their forensic lab, and specialty courts.

Alabama’s settlement with McKinsey & Company was the first multistate opioid settlement to address the crisis, totaling $9 million.

Here’s a breakdown of all three monetary awards:

#1 Opioids and Child Abuse

Official data suggests that a large percentage of children enter foster care in Alabama due to substance use. Child neglect accounts for 60 percent of child removal from their homes. 

Speaking about this intervention, the Marshall stated:

“The Alabama Department of Child Abuse Neglect and Prevention is a small state agency with a critical mission – strengthening families. I firmly believe that strong families are the answer to nearly every societal ill that our state is wrestling with, not the least of which is the opioid crisis.”

Marshall went on to say that he believes “…children are the invisible victims of the opioid epidemic.”

#2 Opioid Forensic Testing

The settlement awarded to Alabama’s forensic lab, which serves all 450 enforcement agencies in the state, is intended to improve the quality and turnaround of forensic services for opioid-related cases. 

“Our state forensics lab, like so many across the country, has been battling backlogs caused by the opioid epidemic. This investment in new technology will give ADFS the tools they need to quickly identify trends in increasingly complex synthetic opioids and to aid law enforcement in identifying opioid traffickers,” Marshall said.

#3 Specialty Courts

The Attorney General awarded the Office of Prosecution Services and officers from the Alabama District Attorneys Association $1.5 million to invest in specialty courts, including drug courts, veterans’ courts, and mental health courts.

Specialty courts, as they suggest, have a specific criminal justice reform role: treating offenders whose crime is related to substance use disorder and reducing recidivism. Attorney General Marshall believes that investing in drug courts is a way of relieving the strain of the opioid epidemic placed on their District Attorney’s offices and court systems.

Speaking about this investment on behalf of the District Attorney’s Association, DA Michael Jackson spoke of its potential value:

“Drug courts and pretrial diversion programs are an extremely valuable tool – not only can this type of intervention save the lives of addicted offenders, but these programs also help decrease victimization within communities.”

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More Opioid Settlement Money on the Horizon?

And it isn’t over yet. Alabama is still set for trials with other pharmaceutical companies, including Endo Pharmaceuticals and McKesson Corporation. It also has pending litigation against opioid manufacturers Purdue Pharma, Mallinckrodt, and Insys.

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A recent Biden administration proposal to crack down on opioids is causing quite a stir among criminal and civil justice reform groups.

The administration’s new drug policy proposal aims to reduce the supply and availability of illicitly manufactured fentanyl and related substances. However, civil rights groups warn this could have a significant impact on people of color and widen racial disparities in the U.S. 

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What is Fentanyl and Why Does it Matter?

Fentanyl is a synthetic opioid similar to morphine, but it is 50-100 times more potent. It’s a prescription pain medication that’s typically used among patients who are unresponsive to other opioids. Those patients may be experiencing chronic pain from certain forms of cancer or pain from surgery. Medically prescribed fentanyl is available as a shot, lozenge, or skin patch. 

Fentanyl is also available on the black market. The illegal version of fentanyl is commonly sold in powder form and often “cut” (combined) with another substance, including methamphetamines, heroin, cocaine and other prescription pills. In fact, the United States Drug Enforcement Administration (DEA) recently reported an alarming increase in the amount of fake prescription pills containing fentanyl. 

According to the DEA, drug networks are now mass-producing fake pills and selling them as legitimate prescription pills. In 2021, the DEA seized 9.5 million counterfeit pills containing fentanyl, a number that jumped by 430 percent since 2019. As a result, unsuspecting Americans are overdosing in record numbers.

The DEA reports two out of every five fake pills sold on the black market now contain a potentially lethal dose of fentanyl.

Drug overdose deaths involving fentanyl are now the most common type of overdose in the United States, accounting for 59 percent of all fatal overdoses. This figure has risen drastically since 2010, when fentanyl was responsible for 14.3 percent of the drug overdose deaths.

CDC data shows that, over the last year, the number of drug overdose deaths in the United States is predicted to hit 93,000.

While the COVID-19 pandemic has contributed to record high overdose deaths, the government also sees the importance of expanding the nation’s public health approach to substance use disorders in hopes of reducing overdose deaths. The new drug policy seeks to do that.

Key Points From Biden’s New Drug Policy

In September 2021, various government departments (Office National Drug Control Policy, Department of Health and Human Services, Department of Justice) presented recommendations to Congress in an effort by the Biden-Harris Administration to reduce the supply of fentanyl-related substances. This proposal also sought to protect civil rights and reduce barriers to scientific research for all schedule I substances.

The Biden administration’s recommendations “can help address the increasing rates of drug overdose deaths, primarily those related to synthetic opioids like fentanyl.” ~ Dr. Rachel Levine

Dr. Rachel Levine, Assistant Secretary for Health at the Department of Health and Human Services explained that expanding the nation’s public health approach to substance use disorders is essential. According to Levine, the proposal prioritizes comprehensive public health approaches that include expanding access to evidence-based treatment. The Biden administration’s recommendations “can help address the increasing rates of drug overdose deaths, primarily those related to synthetic opioids like fentanyl.”

The 2022 budget would provide a $41 billion investment in advancing a public-health approach to the overdose epidemic. The money would be invested in national drug program agencies, expansion of prevention, addiction treatment, harm reduction, and recovery support services. 

The key points of the proposal are:

  • Permanently place all fentanyl and fentanyl-related substances (FRS) into schedule I of the Controlled Substances Act, giving law enforcement more tools to respond to illicit fentanyl manufacture and distribution
  • Exclude FRS from all quantity-related mandatory minimum penalties
  • Ensure courts can reduce the sentence of an individual involved in an offence related to FRS
  • Expand research of scheduled substances to advance public policy
  • Monitor the changes and their impact on research, civil rights, and illicit supply, and manufacturing of FRS

The Drug Policy and Racial Disparities

While this sounds like a noble undertaking on paper, the reality is that it is typically people of color who are treated unfairly when it comes to drugs.

Sakira Cook, who closely follows issues for the Leadership Conference on Civil and Human Rights, told NPR that this won’t bode well for people of color. “Since the inception of the war on drugs, African Americans and Latino people have borne the brunt of enforcement-first approaches,” said Cook. 

A staggering 70 percent of defendants charged with fentanyl-related crimes have been people of color, according to Cook. What’s even more troubling is that people of color have disproportionately been affected by overdose deaths, with non-Hispanic Blacks facing the highest increase in opioid-related deaths. Between 2014 and 2017 death rates among non-Hispanic Black people involving opioids increased  818 percent.

Leading this opposition is the Drug Policy Alliance (DPA), who stated in a letter to congress that they were deeply distressed by the Biden-Harris Administration proposal to combat the overdose crisis. They asked that Congress reject the proposal because it leans heavily on law enforcement and not on evidence-based public health solutions to solve the overdose epidemic.

They reminded Congress of the fact that FRS were classified back in 2018, yet overdoses continued to skyrocket. Despite the administration’s stated desire to use evidence-based public health interventions, the DPA pointed out that scheduling is not science-based and endorses criminalization of drug use instead of treatment.

According to the DPA, the administration’s proposal minimizes potential harms caused by scheduling. They say a public health approach grounded in expanding access to harm reduction instead of arrest and incarceration would be a more effective solution. The DPA’s letter urged the administration to let the scheduling expire and embrace public health solutions instead.

The DEA reports two out of every five fake pills sold on the black market now contain a potentially lethal dose of fentanyl.

The DPA suggests a number of public health solutions to effectively combat the opioid overdose crisis, including:

  • Provide individuals with access to life-saving tools (like naloxone) and related education
  • Provide evidence-based treatment 
  • Use medication assisted treatment
  • Utilize syringe service programs
  • Promote overdose prevention programs
  • Provide drug checking tools so substances can be tested for fentanyl before use

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Overall, opponents to Biden’s proposed opioid drug policy suggest the administration should turn to science instead of fear when combating this public health crisis.

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“I just need a way out of my head. I’ll do anything for a way out of my head.”

These are the lyrics from Mac Miller’s platinum track “Come Back To Earth.” The song’s album, Swimming, achieved platinum status in February of 2021 – two and a half years after the rapper’s death.

It was Miller’s first album to go platinum.

Why didn’t Miller live to see his own success? Because on September 4, 2018, he was given counterfeit oxycodone pills. The drugs contained fentanyl, which is deadly in even the smallest doses.

Apparently unaware of the fentanyl laced into of the pills, Miller overdosed three days later. He died on September 7 from what the coroner labeled “mixed drug toxicity” – a combination of fentanyl, alcohol, and cocaine.

He was just 26 years old.

Dealer Knowingly Provided Pills Laced With Fentanyl 

Fast forward to October 2021. Miller’s songs are going double platinum, and the dealer who supplied the fentanyl-laced drugs has pled guilty of the crime. The dealer, Stephen Andrew Walter, now faces up to 20 years in prison and a fine of up to $1 million.

What happened, exactly?

According to the plea, Walter told a drug runner to give counterfeit oxycodone pills containing fentanyl to Miller’s dealer, who then provided them to Miller.

Walter admits he knew the pills “contained fentanyl or some other federally controlled substance.”

The plea also notes that, if it weren’t for the fentanyl in the pills, Miller would not have died from an overdose. But, because Walter supplied the laced drugs, Miller suffered a fatal overdose three days after receiving them.

Walter’s plea is guilty to one count of distributing fentanyl. The dealer and runner have also been charged.

Mac Miller’s Struggle With Opioid Addiction

Mac Miller, born Malcolm James McCormick, released five rap albums before his death. He was open about his struggle with sobriety, and his lyrics frequently referenced substance abuse.

Just four months before his fatal overdose, Miller crashed into a light pole while driving under the influence. Miller reported that the experience changed his perspective on life. But it clearly didn’t push him to total sobriety.

“I would just tell myself to worry a little less and…don’t create all of this weight for things. Everything has so much weight, but it’s all just chapters. It’s all just pieces of the story. There’s gonna be a next part.”

Miller was preparing to take his newest album, Swimming, on tour when the fentanyl-laced drugs landed in his hands. In one of his last interviews before the overdose, the rapper noted, “There’s pressure. A lot of times in my life I’ve put this pressure to hold myself to the standard of being whatever I thought I was supposed to be, or how I was supposed to be perceived. And that creates pressure.”

When asked what he would tell his younger self, Miller replied, “I would just tell myself to worry a little less and…don’t create all of this weight for things. Everything has so much weight, but it’s all just chapters. It’s all just pieces of the story. There’s gonna be a next part.”

Too Many Americans Never Made It to the Next Chapter

Miller was just one of nearly 30,000 people who died of opioid-related overdoses in 2018. The next year, the total jumped to 50,000.

This year, drug enforcement agencies are reporting unprecedented amounts of fentanyl in the drugs they confiscate. And stress from the ongoing pandemic seems to be escalating the crisis.

Between May 2019 and May 2020, there were over 81,000 drug overdose deaths in the U.S. That’s a record-breaker for any 12-month period, according to the CDC.

What’s next? Will we see the numbers continue to rise? Will we find new solutions to reach people and prevent future deaths like Mac Miller’s?

We’ll let his words speak for themselves:

“Somehow we gotta find a way

No matter how many miles it takes

I know it feels so good right now

But it all come fallin’ down.”

~“Ladders” by Mac Miller

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Darknet fentanyl. A 10-month investigation across three continents. Dozens of law enforcement agencies. This was no small operation.

And it paid off.

After careful coordination among nine countries, operation “Dark HunTor” took 500 pounds of illicit drugs off the market – along with $32 million in cash and 45 firearms.

The far-reaching drug enforcement operation was designed to send a message to people peddling illegal drugs: “There is no dark internet.”

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No More Hiding in the Dark for Darknet Fentanyl

The dark web has become a playground for online peddling of pills laced with fentanyl.

Dealers have found new ways to push drugs, post their offerings, and package them like any other online purchase.

“Today, we face new and increasingly dangerous threats as drug traffickers expand into the digital world and use the Darknet to sell dangerous drugs like fentanyl,” noted Administrator Ann Milgram of the Drug Enforcement Administration (DEA).

When researchers interviewed dealers on the dark web, they discovered that it has (seemingly) offered a “safe” space for illegal sales, attracting new criminals and illegal “entrepreneurs.”

One respondent admitted, “I hadn’t ever thought about selling drugs in any capacity because I dislike violence… I was always too scared and slightly nerdy to do that and never really contemplated it seriously until the dark web.”

Another boasted, “Selling offline is borderline stupid. You can make so much more money online, the risks [in selling outside cryptomarkets] aren’t even remotely worth it.”

Finally Holding Internet Criminals Accountable

This recent operation led to a staggering 150 arrests – so far. Jean-Philippe Lecouffe, deputy director of operations for Europol, reports that the investigation is ongoing, and will likely lead to even more arrests. He noted, “Each time we arrest people, each time we search a house, we find new leads.”

Law enforcement officials want to make it clear that dealers can’t hide behind the dark net.

Lecouffe explained, “The point of operations such as the one today is to put criminals operating on the dark web on notice: the law enforcement community has the means and global partnerships to unmask them and hold them accountable for their illegal activities, even in areas of the dark web.”

Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division also noted, “The men and women of the department’s Criminal Division, in close collaboration with our team of interagency and international partners, stand ready to leverage all our resources to protect our communities through the pursuit of those who profit from opioid addiction, under the false belief that they are anonymous on the Darknet.”

IRS Criminal Investigation Chief Jim Lee added, “The Darknet no longer provides a concealing cloak for criminals to operate.”

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Darknet Fentanyl Dealers Busted Around the World

Operation Dark HunTor included coordinated efforts among agencies in the United States, the United Kingdom, Australia, Bulgaria, France, Germany, Switzerland, the Netherlands, and Italy. The investigation and resulting arrests exposed key players in the illicit online drug market. The 150 arrests included 65 in the U.S., 47 in Germany, and 24 in the United Kingdom.

What kinds of dealings did the operation discover? In Monaco, officials exposed home-bound drug makers who produced deadly-disguised pills. Using special presses, they could create pills that resemble legitimate medication. Another piece of the investigation uncovered operations based in Florida and Rhode Island that “advertised and sold pressed fentanyl pills throughout the United States.” Lecouffe reports that the long list of suspects arrested includes some “long-sought, high-value targets.”

Deputy Attorney General Monaco noted, “Operation Dark HunTor prevented countless lives from being lost to this dangerous trade in illicit and counterfeit drugs, because one pill can kill.” And that’s no exaggeration. Just two milligrams of fentanyl can be fatal. And dealers often lace their drugs with far more than the lethal amount.

“These drug traffickers are flooding the United States with deadly, fake pills, driving the U.S. overdose crisis, spurring violence, and threatening the safety and health of American communities,” said Milgram. “DEA’s message today is clear: criminal drug networks operating on the Darknet, trying to hide from law enforcement, can no longer hide. DEA, the U.S. interagency, and our valued international partners are committed to dismantling drug networks wherever they are, including the Darknet.”

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The opioid crisis is a complex issue in the United States. Opioids kill 50,000 Americans every year, yet they’re still considered to be an effective pain reliever for chronic pain. That’s something lawmakers hope to change by implementing more training programs for doctors and providers prescribing opioids.

The Scope of Opioid Prescribing in the US

The CDC indicates that opioid prescribing has decreased in the last few years — from 259 million prescriptions in 2012 to 153 million prescriptions in 2019. However, 153 million prescriptions still amounts to nearly two thirds of all adults in the United States getting a bottle of prescription opioids. That’s pretty staggering when you think about it.

Fueled by concern in his community in West Virginia, Senator Joe Manchin is pushing the Food and Drug Administration to provide additional safeguarding training for healthcare providers prescribing opioids — something that is long overdue according to treatment providers and recovery advocates. 

Karren Simonsen, a practice nurse from the Mid-Atlantic Recovery Center, told reporters that providers need to be held accountable, and that doesn’t just include doctors. “It’s important that not only are primary care providers educated and held accountable for the prescriptions that they’re writing, but also dental providers because that’s something that we see often,” she said. 

Other treatment providers at MARC said it is critical to know about people’s backgrounds and any co-occurring disorders before treating those at risk of misusing opioids.

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The Risks of Opioid Use

There are multiple factors at play with the use and prescribing of opioids: patients are struggling with chronic pain and, in an attempt to  alleviate that pain, doctors rely on information they’ve been provided about opioids as an effective painkiller. 

Chronic pain is defined as pain that lasts more than three months and can be the result of an underlying medical condition or injury. It is estimated that over 100 million Americans live with chronic pain, which can be really challenging to manage.

While doctors did not know this initially, it has come to light that there is a significant risk associated with opioid use in the development of opioid dependence and even addiction (opioid use disorder). The true risks were withheld by opioid manufacturers, when they lied and misled doctors, telling them that opioids were safe and effective for the treatment of pain. The New York Times reported that Purdue Pharma knew there was significant abuse of their drug “OxyContin” years after its introduction, and they concealed that information. 

By that time, however, America was already dealing with an opioid crisis. According to the National Institute on Drug Abuse, opioid use disorder affects three million  Americans each year

In 2020, 93,000 Americans died of a drug overdose which is a 30 percent rise since 2019. Dr Nora Volkow, the director of the National Institute on Drug Abuse told NPR, “This is the highest number of overdose deaths ever recorded in a 12-month period, and the largest increase since at least 1999.” Volkow described this rise as “chilling” and another sign that the opioid crisis and COVID-19 pandemic are having a deadly effect on the US. 

“This has been an incredibly uncertain and stressful time for many people, and we are seeing an increase in drug consumption, difficulty in accessing lifesaving treatments for substance use disorders and a tragic rise in overdose deaths,” she said.

Prescribing Opioids for Pain Relief

Opioids are still the most commonly prescribed medication for pain symptoms or a pain-related diagnosis, and prescriptions are most frequently written in general and family practices. A staggering 20 percent of patients reporting symptoms of pain will be given an opioid

In writing the facts about opioids, it’s also important to put this information into context. There are thousands of stories online about how individuals live every day with chronic pain, and, worse, those who can’t get adequate pain relief. 

For example, Beth has lived with chronic pain for over 18 years, beginning from sciatica. The pain now extends to her lower back, arms and various parts of her body. Medication, among other lifestyle factors she says, “is a necessary and core tool for me in the management of chronic pain.”

Conversely, there are thousands of stories about people who have struggled with pain medication, such as Britton, a veteran who struggled with prescription opioids following an injury, Stevi Rae who struggled with addiction after a car crash and the use of prescription opioid medication, and Ann Marie who tragically lost her son to a prescription opioid overdose. 

The CDC states that prevention, assessment, and treatment of chronic pain are challenges for healthcare providers and systems, with a lot of pain going unrecognized, particularly among racial minority groups, women, the elderly, those with cognitive impairment, and those at the end of life. 

Is training the answer, or should there be more restrictions on opioid prescribing? The Centers for Disease Control and Prevention (CDC) seem to think it’s a combination of both.

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CDC Opioid Prescribing Guidelines

CDC data shows that since 1999 deaths from prescription opioids have increased more than five times — a loss of over 200,000 Americans have died from prescription opioids.

The CDC states that they are committed to combating the opioid overdose epidemic by improving the way opioids are prescribed. They provide clinical practice guidelines that can ensure patients have access to effective pain management but they also reduce the risk of opioid use disorder and death. 

The CDC Guideline for Prescribing Opioids for Chronic Pain provides clear recommendations to the prescribing of opioid pain medication.

The CDC also collects data to monitor trends and advances research, about opioid use; builds state, local, and tribal capacity to increase prevention activities and use data to inform a public health response to opioid use; supports providers, healthcare systems and payers with the ability to make evidence-based decisions that promote patient safety and improve opioid prescribing; partnering with public safety officials and community organizations; and increasing public awareness about opioid misuse and overdose.

While the FDA is being challenged by lawmakers to provide training to opioid prescribers, there is little information about such a training program. However, the FDA clearly states on their website that their highest priority is to advance efforts to address the crisis of misuse of opioid drugs harming families. Their approach seeks to decrease exposure and prevent addiction, support addiction treatment for those with opioid use disorder, foster the development of new novel pain therapies, and improve enforcement and assess the risk/benefit of opioids. 

If you or someone you love is struggling with a substance use disorder, help is available. Call 800-407-7195(Who Answers?) today to speak with a treatment specialist.

 

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