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Feds Launch Largest Ever Health Care Fraud Enforcement Action

Department of Justice (DOJ) officials are calling it the “largest ever health care fraud enforcement action.”

More than 400 people in 30 states were arrested almost overnight for their roles in defrauding Medicare, Medicaid and other insurers of roughly $1.3 billion – mostly involving bogus claims involving sober living homes and some addiction treatment centers.

The massive series of arrests also involved breaking up “patient brokering” schemes, in which real people addicted to opiates, desperate for help, are recruited off the streets by former or current people afflicted with addiction who earn commissions for sending them to shady treatment centers. These centers then file fake insurance claims, pocket millions, and seldom provide any real treatment and are traumatizing the vulnerable people who thought they were going to get help.

Bryn Wesch, CFO of Novus Medical Detox Center, lauded the DOJ action and said the crackdown on fraud was badly needed.

“Health care fraud drives up health care costs everywhere,” Wesch said. “Sober homes and other facilities that pay bounties for ‘recruited patients’ are often unlicensed and unaccredited. And they tend to be more focused on insurance payments than patients’ wellbeing.

“They also tarnish the reputation of legitimate drug detox and treatment centers and make it more difficult for us to provide patients with proper care, because so many insurers have been burned by fraudulent or excessive claims,” Wesch added.

$1.3 billion in false billings

The DOJ says the record number of arrests by the Medicare Fraud Strike Force totaled 412 defendants across 41 federal districts, and included 115 doctors, nurses and other licensed medical professionals for their “alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings.”

The sweep involved more than 1,000 law enforcement agents, including 30 state Medicaid Fraud Control Units. In addition, the Department of Health and Human Services (HHS) initiated suspension actions against 295 providers, including doctors, nurses and pharmacists.

Attorney General Jeff Sessions and Department of Health and Human Services Secretary Tom Price, M.D., revealed that the fraud involved fake billings for Medicare, Medicaid, and TRICARE, a health insurance program for members and veterans of the armed forces and their families, for medically unnecessary prescription drugs that often were never even purchased or distributed to patients.

Contributed to the opioid epidemic

The sweep also involved medical professionals who have contributed to the opioid epidemic by illegally selling opioids and other prescription narcotics. Among the defendants are 120 people charged with opioid-related crimes, making this “the largest opioid-related fraud takedown in American history,” the DOJ said.

Just a few highlights:

  • A group of Michigan defendants – including six doctors – billed Medicare for $164 million in false and fraudulent claims prescribing unnecessary opioids which ended up for sale on the street.
  • A fake rehab facility in Palm Beach, FL, is alleged to have “recruited addicts with gift cards, visits to strip clubs, and even drugs” – enabling the company to bill over $58 million in false treatments and tests.
  • An illegal clinic in Houston allegedly sold prescription drugs to anyone for cash. One doctor allegedly sold 12,000 opioid prescriptions for over 2 million illegal painkiller doses.

Violated their oaths

“Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” Sessions said. “Amazingly, some have made their practices into multimillion dollar criminal enterprises.

“They seem oblivious to the disastrous consequences of their greed. Their actions not only enrich themselves often at the expense of taxpayers but also feed addictions and cause addictions to start. The consequences are real: emergency rooms, jail cells, futures lost, and graveyards.”

The problem is compounded by the fact that America “is in the midst of the deadliest drug crisis in our history,” Sessions added. Drug abuse is bankrupting and breaking up families, ending friendships, causing more crime and violence and cutting short promising lives across the country, he said.

Drug industry involvement

Numerous lawsuits, from states, counties, cities – and even an Indian tribe – have been launched recently against some of the larger opioid drug makers, alleging they must know that colossal amounts of their products are being overprescribed and reaching the streets.

These suits allege that the drug industry is involved in causing the opioid epidemic and should be held accountable. As expected, the companies deny such responsibility. The suits are ongoing.

Meanwhile, legitimate addiction treatment centers everywhere are fully aware that they’re dealing with the results of countless millions of prescription opioids that have somehow reached the wrong hands.

According to the DOJ, one American dies of a drug overdose every 11 minutes and more than 2 million Americans are ensnared in addiction to prescription painkillers.

The DOJ’s Sessions is talking tough: “While today is a historic day, the Department’s work is not finished. In fact, it is just beginning. We will continue to find, arrest, prosecute, convict, and incarcerate fraudsters and drug dealers wherever they are.”

Here in Florida, where it’s as bad as anywhere and often worse, Novus Medical Detox Center is at the center of the fray and working to help fight opiate addiction with several important advances in medical detoxification helping personalize treatment to make a difference one person at a time.

Says Novus CFO Wesch: “I take the position that drug makers should be subject to a tax type of system that specifically funds treatment. All opioid sales, from manufacturer on down the distribution channels, should be required to funnel some of their profits into cleaning up the mess they have helped to create.”

DEA Warns First Responders of Fentanyl Overdose Risk

Just how dangerous is fentanyl?

The synthetic opioid painkiller that’s usually mixed into heroin is turning up almost everywhere.

Fentanyl is so dangerous that the Drug Enforcement Agency has issued a formal warning to law enforcement and paramedic first responders to be super-careful when responding to any situation or emergency that involves drugs.

Fentanyl and its equally dangerous synthetic derivatives are threatening the lives of anyone that comes in contact with it.

Fentanyl can be ingested orally, inhaled through the nose or mouth, or even absorbed through the skin or eyes. And a tiny amount, 2-to-3 milligrams (like 5-to-7 grains of salt) can cause respiratory depression and even death.

As a recent report said, brushing a speck of fentanyl smaller than a snowflake off your shirt with a bare hand can kill you.

The DEA warning guide

The DEA Warning Guide is a comprehensive and highly-technical 19-page report that also includes the history and development of fentanyl and its derivatives such as carfentanil – often called “elephant tranquilizer” in the media and its role in today’s opioid epidemic.

The guide cautions first responders to get educated about fentanyl and its many derivatives, and trained to recognize the drug when they see it. The DEA says that to be properly protected from any contact with the drug, first responders should at least use the basics – gloves, dust masks, safety glasses and disposable paper suits and shoe covers.

Entering a lab or “pill-milling” location is another story altogether, and requires full HAZMAT protective gear – and immediate notifications to the building’s owners and occupants.

The agency also says that first responders should always have a supply of the opioid overdose antidote naloxone with them. Fentanyl can bring on an overdose so quickly and unexpectedly that naloxone – and several doses of it – should be close at hand.

The DEA has also released Fentanyl Roll Call, a video for all law enforcement and first responders nationwide, about the deadly consequences of improperly handling fentanyl.

Not news to the feds

The fentanyl problem is not so new to the DEA. Following a surge in its use in 2013, the DEA formed a Heroin-Fentanyl Task Force (HFTF) in 2014 to address what was becoming a serious national health problem.

The HFTF involves at least six government agencies, all working together to facilitate what is called “a whole of government approach” to the fentanyl and synthetic opioid epidemic in the United States.

The HFTF currently includes people from the DEA, Homeland Security (HIS), Customs and Border Protection (CBP), the FBI, the IRS and even the Post Office Inspection Service – this last agency because most synthetic opioids have been arriving in North America from China by mail.

China agrees to crack down on fentanyl

During the 1st quarter of 2017, the DEA ID’d 230 fentanyl and fentanyl-related substances in seized drugs. Fentanyl was found in combination with heroin in 61 percent of the samples, as well as with U-47700, alprazolam, ketamine and cocaine in other samples.

Most of this fentanyl comes from China or Mexico – highly refined from China, not so refined from Mexico. As we reported in April, China has agreed to crack down on fentanyl and other synthetic drugs.

Brand-name look-alikes

Although it’s usually a chunky or powdered substance, Fentanyl and other synthetic opioids are turning up as pills or capsules that look like OxyContin (oxycodone), Xanax (alprazolam) and other diverted pharmaceuticals. The dangers are the same as when mixed into heroin.

The DEA says criminals love fentanyl-type drugs because they’re so cheap and they boost the effect of other drugs when mixed into them.

“Due to the elevated potency of fentanyl over traditional opioid drugs (i.e., heroin), criminal organizations can use one kilogram of fentanyl to produce approximately 1 million 1-milligram counterfeit pills, resulting in potentially 10-to-20 million dollars in revenue,” the DEA says. “There are also reports that consumers in some areas are seeking fentanyl over heroin, as the ‘rush’ is greater.”

DEA Guidelines will save lives

The rush may be greater, but overdose deaths involving fentanyl are soaring and the drug is definitely threatening our first responders.

We recently read about a policemen who returned to the station after a drug bust, noticed a speck of white on his shirt, brushed it off and fell immediately into an overdose. The speck turned out to be fentanyl. Fortunately, fellow officers saved his life with naloxone. There have been numerous similar reports recently.

The new DEA fentanyl safety guidelines will help protect our first responders in the field. And we hope our report will help protect you. If you or anyone you care about needs help with opioid use or misuse, call Novus Detox today.

FDA Takes Aim at Abuse-Deterrent Opioids

FDANew FDA Commissioner Scott Gottlieb, MD, says the agency wants to know whether abuse-deterrent prescription opioids “are having their intended impact on limiting abuse and helping to curb the epidemic.”

To help get a meaningful answer, Gottlieb has called a public meeting for July 10 and 11, 2017, to “engage external thought leaders in a discussion about how we can better leverage existing data sources and methods to evaluate the impact of these products in the real world.”

The meeting will seek to find or create “new data sources and study designs to ensure the best possible answers” about abuse-deterrent formulations which will influence regulatory decision-making.

Abuse- deterrent prescription opioids are designed to “deter” abuse by various methods, such as snorting or injecting. Some formulations make crushing a pill to dissolve it in a liquid for injection or into a powder for snorting more difficult. Others combine naloxone with the main active ingredient to block the “high” of the opioid.

“This has been an important area of innovation that the FDA continues to support,” Gottlieb said. “However, we recognize that there is a gap in our understanding of whether these products result in a real-world, meaningful decrease in the frequency and patterns of opioid misuse and abuse.”

For anyone interested in attending the public meeting or learning more about the issues involved, the agency has made available for download an issues paper outlining existing regulatory and public health challenges.

As we reported two weeks ago, the new Commissioner told his first staff meeting that “our greatest immediate challenge is the problem of opioid abuse.” This was followed by the news a week later that the FDA has asked for an abuse-deterrent prescription painkiller, Opana ER, to be taken off the market because it’s been so widely abused.

“Opioid formulations with properties designed to deter abuse are not abuse-proof or addiction-proof,” Gottlieb said in a lengthy statement about expanding the FDA’s role in combating the opioid epidemic. “These drugs can still be abused, particularly orally, and their use can still lead to new addiction.”

However, the Commissioner said, these new formulations “may hold promise” as part of a broad effort to reduce abuse.

“We recognize there is a gap in our understanding of whether these products result in a real world, meaningful decrease in the frequency and patterns of opioid misuse and abuse,” he said. “One thing is clear: We need better scientific information to understand how to optimize our assessment of abuse deterrent formulations.”

In his statement, Gottlieb said that “everyone at the FDA is committed to focusing on all aspects of the epidemic.” As part of this program, a steering committee is being formed to examine “additional regulatory and policy actions to combat this crisis” that can reduce the number of new cases of addiction.

The FDA has just published a paper, FDA Facts: Abuse-Deterrent Opioid Medications, that details the agency’s strong support for abuse deterrence formulations. It says that opioids with abuse-deterrent properties are, as Gottlieb says, “not abuse-proof.” But the agency points out that they are “a step toward products that will help reduce abuse.”

The agency “fully supports efforts to better understand the impact of these products in the real-world setting and develop innovative formulations that have the potential to make abuse of these products more difficult or less rewarding,” the paper says. “The FDA is working with many drug makers to support advancements in this area and help drug makers navigate the regulatory path to market as quickly as possible. In working with industry, the FDA is taking a flexible, adaptive approach to the evaluation and labeling of potentially AD products.”

Here’s a list of the currently approved brand-name abuse-deterrent prescription opioids on the market. No generic versions have yet been approved for abuse-deterrent labeling:

The FDA has approved the following opioids with labeling describing AD properties consistent with the FDA’s Guidance for Industry: Abuse-Deterrent Opioids – Evaluation and Labeling:

  • OxyContin – oxycodone, Purdue Pharma
  • Targiniq ER – oxycodone and naloxone, Purdue Pharma
  • Embeda – morphine and naltrexone, Pfizer Inc.
  • Hysingla ER – hydrocodone, Purdue Pharma
  • MorphaBond – morphine, Daiichi Sankyo, Inc.
  • Xtampza ER – oxycodone, Collegium Pharmaceutical Inc
  • Troxyca ER – oxycodone and naltrexone, Pfizer Inc.
  • Arymo ER – morphine, Egalet Corp.
  • Vantrela ER – hydrocodone, Teva Pharm.
  • RoxyBond  – oxycodone, Inspirion

We can certainly see the popularity of oxycodone – half of the 10 approved formulations are built around that drug. Three are morphine and two are hydrocodone. Three are designed with the antagonists naloxone or naltrexone, the rest with some sort of crush and dissolve resistance.

It does look like the FDA is working hard to be responsive to the opioid epidemic.  Meanwhile we are working hard to help those that want to end their dependency on opioids.

FDA Moves to Get Opana ER Off the Market

FDAIn a surprise move that won’t please Endo Pharmaceuticals, newly-appointed FDA Commissioner Dr. Scott Gottlieb says the agency is asking drugmaker Endo Pharmaceuticals to remove its opioid painkiller Opana ER (oxymorphone hydrochloride) from the market.

“We are facing an opioid epidemic – a public health crisis, and we must take all necessary steps to reduce the scope of opioid misuse and abuse,” Commissioner Gottlieb said. “We will continue to take regulatory steps when we see situations where an opioid product’s risks outweigh its benefits, not only for its intended patient population but also in regard to its potential for misuse and abuse.”

The FDA approved a new abuse-deterrent version of Opana ER in December 2011, but that formulation has failed to significantly slow abuse in the field. This March, an FDA expert advisory committee voted 18 to 8 that the benefits of the reformulated Opana ER does not outweigh its risks.

The agency cited “a serious outbreak” of HIV and hepatitis C, as well as cases of a serious blood disorder called thrombotic microangiopathy, associated with widespread injection abuse of Opana ER in several states.

Oxymorphone is roughly 10 times as potent as morphine when it’s injected. A single Opana ER pill contains roughly a 12 hour dose for serious pain control when swallowed. So when it’s crushed and injected, it’s a clear invitation for overdose. And when the needles are shared by infected users, the public health threat becomes something of a disaster.

Not the first time for oxymorphone

“After careful consideration, the agency is seeking removal based on its concern that the benefits of the drug may no longer outweigh its risks,” said the FDA statement. “This is the first time the agency has taken steps to remove a currently marketed opioid pain medication from sale due to the public health consequences of abuse.”

The FDA’s claim that this is the first time it has ever sought to get an opioid painkiller off the market due to public health concerns is simply not true.

In fact, back in 1979 – 38 years ago – the very same painkiller, oxymorphone, made by the same company, Endo Pharmaceuticals, suddenly disappeared from the market. The only difference back then was that the drug was called Numorphan instead of Opana. And neither the FDA nor Endo publicly admitted that the suspension of sales had anything to do with the vicious, 20-year-long epidemic of deaths from 1959 to 1979.

Whether or not the FDA and Endo owned up to it, amongst those concerned with opioid addiction and treatment it was common knowledge that all those injuries and deaths were directly attributable to Numorphan. Although the pills were gone, the Numorphan name remained as an injectable and rectal medication.

The oxymorphone back-story

How the oxymorphone pill Opana came to make its reappearance in 2006 is anyone’s guess. In spite of the hideous history of pill-form Numorphan, for some reason that FDA approved Endo’s new forms of the dangerous old painkiller it was now calling Opana. Five years later, in 2011, the agency approved the abuse-deterrent formulation.

Back in May, 2015, Novus reported on the devastation Opana ER was causing. We described the checkered history of Numorphan, Opana and oxymorphone, and how it now was causing a new wave of overdose deaths and the spread of HIV and Hep-C – possibly the worst outbreaks in over a decade. We told how Opana ER had become the favorite among prescription opioid injection abusers in Indiana and the Appalachian states.

Since then, some federal and state agencies have been working on it, but until now we haven’t heard from the FDA.

So when Scott Gottlieb took over the reins at the FDA a couple of weeks ago and announced that his major priority would be to do whatever the FDA can to combat the opioid epidemic, we crossed our fingers and hoped for the best.

Well, it appears that Gottlieb is a man of his word. We’re happy to see that one of the major players in diverted prescription opioids soon may be off the market – a market already glutted with far more opioid painkillers than are needed.

Billie Joe Armstrong: I Had No More Choices

(Novus writes inspirational stories of people in the news who have overcome addiction.  This is not to infer that these people are connected to Novus Medical Detox Center but simply to provide hope and encouragement to those fighting addiction.)

On September 21, 2012, in front of thousands of fans, Billie Joe Armstrong, lead singer and guitarist of the band Green Day, suffered an onstage, mid-song “meltdown” by suddenly screaming obscenities into the mike, smashing his guitar to pieces and storming off the stage.

Armstrong’s two band-mates were almost as shocked as the crowd at the  iHeart Radio Music Festival in Las Vegas. But they knew more about what was happening than anyone else. It wasn’t the first meltdown, there’d been several recently.

Soul-searching after that event helped Armstrong decide to enter treatment for decades of alcoholism and prescription drug addiction. But it didn’t immediately repair the damage. His concert-ending rant also ended the band’s tour, crashing sales of their latest albums. And it almost ended his lifelong friendships with bassist Mike Dirnt and drummer Tre Cool.

Nevertheless, Armstrong entered outpatient rehab on September 24th, just three days after the appalling meltdown.

The birth of Green Day

Billie Joe Armstrong was born on February 17, 1972, in Oakland, CA and raised in Rodeo, CA, a small coastal town on San Pablo Bay roughly 15 miles north of Oakland. His dad was a part-time jazz musician, which may have influenced Armstrong’s interest in music from an early age.

By age 14, Armstrong was a proficient guitarist and song writer. With his best friend Mike Dirnt, also a guitarist, he formed a band that eventually became Green Day – named so because of their “fondness for marijuana” – with drummer Tre Cool.

The rest is history. By 1994 the band was world famous and by 2004 they were “huge,” as the promoters say. The album American Idiot blew the lid off, reaching No. 1 in 19 countries, selling 15 million copies. They’ve had their ups and downs, but have sold 60 million records worldwide.

But the pressure of touring and coming up with new material, coupled with the availability and acceptance of substance abuse in the business, wasn’t good for Armstrong. He told The Fix that he was pushing himself to keep up the pace, that “songwriting became this relentless thing, [I was] trying too hard,” and that he was fueling himself with alcohol and pills “to a point where I was surprised I would wake up in the morning.”

Drinking and drugs became routine.

The Rolling Stone interview

A few months after getting out of rehab, Armstrong agreed to an interview with Rolling Stone magazine. For the first time he really opened up about his near-20 year battle with alcohol and drugs. He was combining anxiety and sleep meds “to a point where I didn’t know what I was taking during the day and what I was taking at night…My backpack sounded like a giant baby rattle” from all of the pills inside.

Some people can have a couple of drinks and walk away. Not Armstrong.

“I couldn’t predict where I was going to end up at the end of the night. I’d wake up in a strange house on a couch. I wouldn’t remember how. It was a complete blackout,” he said. “I’ve been trying to get sober since 1997…but I didn’t want to be in any programs. Sometimes, being a drunk, you think you can take on the whole world by yourself. This [the iHeart / Las Vegas meltdown] was the last straw. I had no choices anymore.”

A sober future

Since that rehab a few years ago, Armstrong has partnered with longtime Green Day associate Bill Schneider, of the punk band Pinhead Gunpowder, to establish a guitar shop in Oakland called Broken Guitars. Also in 2015, Armstrong and Mike Dirnt launched Oakland Coffee Works, a company that sells organic coffee beans using organic, compostable bags and pods.

His latest album, Revolution Radio, was released last September – the band’s first studio album since 2009. It debuted at number one on the Billboard 200, and number one in the UK, Ireland, Italy, Canada and New Zealand. Pointing to the longevity of some other bands like The Rolling Stones, Armstrong said he expects to be playing with Green Day into his 50s and on.

Billie Joe Armstrong says he loves talking music with his two sons, Joseph and Jakob, now both musicians in their 20s.

Was the rehab – some of it at home with a hired nurse –  tough on his wife, Adrienne? Rolling Stone asked if she might have “kicked him to the curb” if he’d skipped treatment.

“I’m sure the thought crossed her mind – that if I didn’t get sober, I could potentially lose all of that stuff. I could have lost the band too. I didn’t realize how destructive I was. I thought everybody was in on the joke. But I was the joke.”

At Novus, we hope that anyone who needs help with substance abuse will not wait until they have no more choices. There is lots of help available.  All you have to do is ask.

Opioid dependent babies benefit from buprenorphine when suffering from neonatal abstinence syndrome

Newborns suffering from neonatal abstinence syndrome do better when treated with sublingual buprenorphine than the usual oral morphine, says new study

There’s been a lot of attention on the so-called “opioid epidemic” in America recently, and media coverage regularly echoes the call for wider application of medication assisted treatment (MAT), especially buprenorphine, which helps reduce opioid withdrawal symptoms while coming off heroin or opioid painkillers, for example.

Stepping down the daily dose of buprenorphine, which is used routinely at Novus for this purpose, results in a faster and more comfortable withdrawal from opioid dependence.

Buprenorphine is also helpful when used as a “holding” drug for opioid-dependent patients waiting to get into a treatment facility when a bed isn’t immediately available.

Buprenorphine is effective for adults, but…

Almost daily, we read the appalling statistics: 2 million Americans addicted, and over 33,000 overdose deaths a year – nearly 100 people a day.

But these horrible statistics, and the call for more buprenorphine, are consistently about adult Americans suffering from substance use disorder. As well as buprenorphine, some interests are still pushing for more methadone availability. Methadone is another replacement drug used to “treat” opioid dependence, but the problem is the treatment can go on for months, years or a lifetime.

Meanwhile, we’ve forgotten one colossally important situation.

Wherever there are millions of people dependent on opioids there are thousands of dependent babies being born who are hooked on the same opioids as their mothers.

Babies in withdrawal

The condition is called Neonatal Abstinence Syndrome, or NAS. What that means is that babies born to dependent mothers are immediately thrown into “cold turkey” withdrawal because the source of their drugs has suddenly vanished. And it isn’t pretty.

NAS babies suffer from terrible gastrointestinal dysfunction, unimaginable aches and pains, temperature instability, high-pitched crying, and numerous central nervous system problems such as shaking, tremors, even life-threatening seizures. In other words, they suffer all the hell and horror that adults go through during a cold-turkey withdrawal from heroin or another opioid.

Newborns with drug dependence are quite common these days. According to the National Institute on Drug Abuse (NIDA), NAS births quintupled from 2000 to 2012 — equivalent to one NAS baby being born every 25 minutes.

NAS is costing hospitals an estimated $1.5 billion a year. And hospitals everywhere are still learning how best to deal with the NAS epidemic.

Buprenorphine works better for babies too

Roughly 80 percent of babies with NAS are treated with morphine to help reduce the newborn’s opioid withdrawal symptoms during the withdrawal period. The morphine is slowly reduced, balancing it against the withdrawal symptoms.

The average hospital stay for newborns under treatment with morphine for NAS is three weeks to a month – compared to 2 days for a normal baby. The cost for the specialized care is enormous. Just keeping NAS babies as comfortable as possible, never mind struggling to keep some of them alive, is well beyond the reach of average Americans.

Anything that could reduce treatment time is a welcome advance. And it looks like what’s good for the adults – buprenorphine – may become the new standard for NAS babies.

A study at Thomas Jefferson University Hospital in Philadelphia that compared morphine to buprenorphine found that using buprenorphine instead of morphine cuts drug treatment time almost in half, and hospitalization time by a full third.

“The median duration of treatment was significantly shorter with buprenorphine than with morphine – 15 days vs 28 days, as was the median length of hospital stay – 21 days vs 33 days,” the researchers said. “Rates of adverse events were similar in the two groups.”

The study added that babies in the morphine group had a lower respiratory rate than those in the buprenorphine group. “This potential advantage, along with a longer interval between doses, may allow for investigation of buprenorphine in outpatient settings, a use that was not examined in this trial,” the study said.

On a side note, the study said that in-utero exposure to benzodiazepines is associated with worsened symptoms of neonatal abstinence. Other clinical trials are underway to study the use of buprenorphine among benzodiazepine-exposed infants.

The clinical trial was funded by NIDA and was published in the New England Journal of Medicine.

Good advice for women: If pregnancy is a possibility in your life, avoid any and all addictive substances. If you’re using and also pregnant, don’t stop using the substance until you see a qualified doctor.

Best advice for everyone: For any reason other than medical necessity, don’t use or abuse drugs. Period.

Prescribing more opioids than needed can be dangerous

A recent study at Johns Hopkins Hospital in Baltimore, MD, has found that most orthopedic surgery patients go home with far more opioid pain pills than they need – some times as many as 80 pills too many. And it’s not uncommon for other types of patients to be overprescribed.

So what’s wrong with having some unused opioids in the house? That is, besides the extra cost to the patient and/or the insurance company? Isn’t it more convenient than having to call the doctor to get a refill and go back to the pharmacy?

Well, no, it isn’t better. Prescribing more opioids than needed opens the door to some common and serious problems.

  1. Opioids make me feel good

Some patients are at risk of continuing to take opioids after the legitimate need for pain relief has passed. They do this because they “like” how it makes them feel. Having a dozen or several dozen extra pills in the house can be for some people an open invitation to experimentation and eventual addiction. There are thousands of former pain patients who first became addicted taking legitimate, doctor-prescribed opioids.

  1. Risk of overdose

Overdose can happen whether or not you have more opioids on hand than you need. People can always take more pills or take them more often than the doctor or the label says. Tragically, this sometimes happens.

But there’s another reason people might overdose just because they saved unused pills.

When pain from surgery or accident is too intense, some patients simply increase their dose a little. If it hurts even more, they increase it again. And again the week after that. And again. Eventually they heal, stop taking the opioids and put the leftovers away.

But something else also happened. By gradually increasing their dosage over several weeks they increased their tolerance for opioids. Bodies can adjust gradually to dosages that are higher than normal people can tolerate when just starting out.

Now, a year or two later, they experience some new pain and remember those opioids in the cabinet. They also remember how much they were taking at the end of their treatment, after they’d built up that tolerance. But in the time since then, their body has gone back to normal. They are no longer protected by the tolerance. So they take that huge dose – not the original starting dose – and succumb to a life-threatening overdose.

  1. Risk of diversion

Countless thousands of patients every year leave millions of unused opioid pills in medicine cabinets or in plain view on counters. This adds to the risk of “Diversion” – the medical and legal term for “diverting” legally prescribed drugs to another person for illicit use.

A high number of prescription opioid and heroin addicts say they got their first pills from a family member or a friend. They were given to them to treat some painful condition. Then the worst happened: They liked a little too much how good those pills made them feel. Lending or gifting prescription meds is a proven bad idea. And it’s always easier to do when you have lots of extras in the house. They’re also easier to steal – another popular way to divert drugs.

  1. I need them because it still hurts

Many patients fall victim to “opioid induced hyperalgesia” – a fancy term for a fairly common condition when opioids begin to cause pain. Opioids can cause bodies to become more sensitive to painful stimuli. Now the patient is in even more pain than before – surgery plus hyperalgesia pain – or the patient doesn’t know that the pain from the surgery is actually gone and it’s the hyperalgesia that’s hurting. In either case, the patient takes more opioids – and often at a higher dose.

Opioid induced hyperalgesia leads countless people into physical dependence and addiction. And it happens more frequently when there are dozens of extra pills in the house. Patients just keep taking them instead of calling the doctor to report that their pain still hasn’t gone away or it’s hurting even more. Had they called, the doctor would have suspected hyperalgesia and treated the patient accordingly – avoiding dependence or addiction.

How to dispose of unwanted opioids (and other medicines)

Go to this FDA webpage to read everything you need to know about how to dispose of those leftover opioids and other medications in your medicine cabinet.

Surgeons don’t know how much to prescribe

The Hopkins’ study concluded that more research is needed into how much painkiller patients really need, and the results need to be conveyed to the prescribing surgeons. They have little to go on, the study said, so they overprescribe to minimize patient complaints about pain control.

If you or someone you care for has a problem with opioids and pain control, or dependence or addiction to opioids or any other substance, don’t hesitate to call Novus Medical Detox Center.

We are the experts, and we’re always here to help.

Patients report worse outcomes with higher opioid dosages – Study

If you’ve been taking opioids for pain and found things getting worse the more you took instead of better, you’re not alone.

A large study by researchers at the VA and Kaiser Permanente found that increases in frequency and dosage are associated with worse patient-reported outcomes – more pain and more dysfunction.

“One of the things that makes this current study unique is that it’s the first to identify more impairment, and higher pain based on opioid dose, when using question and answer survey instruments,” lead researcher Benjamin Morasco, PhD, told Pain Medicine News (PMN).

Most earlier opioid use studies used medical records, which don’t tell you much about what a patient is really experiencing.

The problem is that the study’s methodology couldn’t ascertain whether increased pain and dysfunction were caused by higher doses of opioids, or whether patients were just getting more opioids because their painful conditions were worsening. A new study to answer these questions is being planned.

For the current study, a large group of 500-plus patients answered batteries of questions about their mental, emotional and physical health conditions and uses of other substances as well as their experience with prescription opioid painkillers.

Long-term opioid therapy for chronic pain

All patients were suffering from chronic musculoskeletal pain, and being treated with opioids long-term – at least 90 consecutive days. They were divided into three groups based on dose level for study analysis – lower doses, medium dosage and higher doses.

Dr. Morasco and colleagues found that patients in the higher-dose group reported greater pain intensity, more impairments in functioning and quality of life, poorer self-efficacy for managing pain, greater fear avoidance, and more health care utilization, PMN reported.

Also, the low-dose group scored lowest for potential substance use disorder, while the higher-dose patients scored highest.

For decades, doctors have known about and warned patients about “opioid induced hyperalgesia” – becoming more sensitive to painful stimuli because of the opioid painkillers. The more opioids you consume, the more painkiller you might feel you need.

Hyperalgesia is a possible side-effect of opioid painkillers. It can set off a deadly cycle of increasing consumption that can lead rapidly to dependence and even addiction. Patients chase after what they feel is very real pain – and in fact it is real – with more and more opioids.

The question of whether high opioid doses are contributing to or reflecting the requirements of more pain and dysfunction is of prime concern to the researchers.

“Are people that are trying high doses finding those lead to more impairment, and more problems, and more adverse effects, or do people that have more pain and lower quality of life—are they more likely to get higher doses of opioids?” Dr. Morasco asked. “The answer is, unfortunately, that we don’t know, and the results of the study don’t inform that question.”

The group says it’s planning a larger study soon that will examine more closely the circumstances affecting the decisions to increase opioid dosages.

Meanwhile, Novus recently reported on another recent study showing that opioid induced hyperalgesia doesn’t require long-term opioid use – it can start happening right away. Best advice is to always first look for alternative pain treatments before resorting to opioids.

And if you or someone you care for is already in the grip of opioids, call Novus right away.

‘Gray Death’ – The Latest Deadly Heroin Mixture

If someone you care about is abusing street-level opioids like heroin, this information could save their life. A new heroin-based mixture of opioids, nicknamed ‘the gray death’ by investigators, is causing record overdoses and deaths across several states, authorities say.

Gray death is so unexpectedly powerful that even experienced drug users are overdosing and dying in record numbers. Street dealers often can’t tell their customers what’s in the bag. They get it from the higher-ups, they peddle it, and after people start dying they find out what they’ve been selling that’s killing their customers.

Gray death is the latest, and the deadliest yet, in a recent trend of mixing heroin with other opioids, usually fentanyl and fentanyl-related drugs. These mixtures are blamed for killing thousands of people nationwide over the past two or three years.

Gray death is a mixture of heroin, fentanyl, carfentanil (an enormously potent elephant tranquilizer) and a synthetic opioid called U-47700. The mixture is responsible for so many overdose deaths in Alabama, Georgia and Ohio that drug investigators, stunned by how lethal it is, gave it the nickname, base on its color. Dozens of fatalities, mostly in New York and North Carolina, are related to variations of the formula, but it’s being seen across the country.

Looks like concrete mix

Gray death varies in both proportions of ingredients and the consistency of the materials. But it looks like gray concrete mix and ranges from a fine powder to a hard, chunky material. Fentanyl and its many variations can be anywhere from 50 to 100 or more times more powerful than morphine or heroin.

The designer opioid U-47700 is incredibly deadly in even tiny doses. Invented as a painkiller in the 1970s by a team at The Upjohn Company, it was never studied on humans and never produced commercially. But the formula became public after underworld drug researchers found complete instructions on how to make it in the inventor’s U.S. patent.

Subsequently, the drug reached the streets, and could be purchased online from “any number of research chemical warehouses that trade in drugs created in labs,” according to Rolling Stone magazine. In fact, the magazine says, U-47700 was one of the drugs, along with fentanyl, implicated in the tragic overdose death of the musician Prince.

The U.S. Drug Enforcement Administration listed U-47700 in the category of “the most dangerous drugs it regulates,” the Associated Press says. The DEA announced that as of November 14, 2016, U-47700 has been assigned to Schedule 1 and is no longer technically legal.

“Scariest combo I’ve ever seen”

Deneen Kilcrease, manager of the chemistry section at the Georgia Bureau of Investigation, told the Associated Press (AP) that “gray death is one of the scariest combinations that I have ever seen in nearly 20 years of forensic chemistry drug analysis.”

The mixtures are “particularly lethal” to users because they don’t know what’s in them or in what concentration. And because some of the drugs, like fentanyl, can be absorbed through the skin, “simply touching the powder puts users at risk,” she said.

The Gulf Coast High Intensity Drug Trafficking Area (HIDTA) says users inject, swallow, smoke or snort gray death, but that it has a much higher potency than heroin making it especially dangerous. The agency’s primary function is to “identify, disrupt and dismantle major drug trafficking organizations” in Arkansas, Tennessee, Louisiana, Mississippi, Alabama and Florida and beyond.

According to AP, over the past three months in Georgia there have been 50 overdose cases reported involving gray death, mostly from Atlanta. And in Ohio, the Cincinnati area coroner’s office reports that a similar compound has been “coming in for months.”

Deadly risk to users

The state’s attorney general’s office has analyzed eight samples matching the gray death mixture seen in other states. Ohio Attorney General Mike DeWine told AP the mix is a deadly risk to users but also challenges investigators trying to figure out what they’re dealing with.

“Normally, we would be able to walk by one of our scientists and say, ‘What are you testing?’ and they’ll tell you heroin or ‘We’re testing fentanyl,’” DeWine said. “Now, sometimes they’re looking at it, at least initially, and say, ‘Well, we don’t know.’”

The takeaway from a story like this is plain: you can no longer put your faith and trust in your dealer – if you ever really could or should anyway. Best case scenario: get yourself into recovery while you’re still alive. It’s too late to get your life back if you’re dead.

If someone you care for has a substance use disorder of any kind, don’t wait. Call Novus for help. We will get you pointed in the direction that works and is right for you.