Trump cre­ates panel to com­bat na­tional opi­oid epi­demic.

The Washington Times Daily - - FRONT PAGE - BY LAURA KELLY

Chris Barth had his first taste of Per­co­cet as a teenager, but his ad­dic­tion didn’t be­come full-blown un­til the early 2000s, when he was work­ing as an elec­tri­cian at a D.C. methadone clinic.

“It was an open-air drug mar­ket,” the 43-year-old Mary­lan­der said. “Some­one of­fered me some­thing, and all of a sud­den I had found a source. It turned into a habit.”

Now a re­cov­er­ing ad­dict, Mr. Barth could have been among the more than 500,000 peo­ple who have died from drug over­doses since 2000. Deaths from over­doses of pre­scrip­tion and il­licit drugs con­tinue to rise de­spite calls on all fronts to bat­tle the opi­oid epi­demic.

Pres­i­dent Trump last week took a first step in eval­u­at­ing his ad­min­is­tra­tion’s re­sponse to the epi­demic by cre­at­ing the Com­mis­sion on Com­bat­ting Drug Ad­dic­tion and the Opi­oid Cri­sis.

“I made a prom­ise to the Amer­i­can peo­ple to take ac­tion to keep drugs from pour­ing into our coun­try and to help those who have been so badly af­fected by them,” the pres­i­dent said in a state­ment.

The Amer­i­can So­ci­ety of Ad­dic­tion Med­i­ca­tion says that pre­scrip­tion med­i­ca­tion is driv­ing the opi­oid epi­demic.

A 2015 re­port by the Sub­stance Abuse and Men­tal Health Ser­vices Ad­min­is­tra­tion found that 3.8 mil­lion peo­ple age 12 or older re­ported mis­use of pre­scrip­tion pain re­liev­ers within 30 days of the sur­vey. Around 1.9 mil­lion re­ported use of co­caine in the same time frame, and 300,000 used heroin.

The Cen­ters for Dis­ease Con­trol and Pre­ven­tion says that while over­doses on heroin have quadru­pled since 1999, heroin users re­port us­ing pre­scrip­tion opi­oids first.

“The cri­sis was caused, in large part, by decades of pre­scrib­ing too many opi­oids for too many con­di­tions,” CDC chief Thomas Frieden wrote in an op-ed for Fox News last year.

The pres­i­dent’s com­mis­sion will be led by New Jersey Gov. Chris Christie and will work closely with the re­cently cre­ated Amer­i­can Of­fice of In­no­va­tion, led by pres­i­den­tial ad­viser Jared Kush­ner. It’s un­clear which other per­sons or or­ga­ni­za­tions also will serve on the com­mis­sion.

In De­cem­ber Congress ap­proved $1 bil­lion in fund­ing to be dis­trib­uted over the fol­low­ing two years for for­mer Pres­i­dent Barack Obama’s plan to com­bat the opi­oid epi­demic.

The money is ear­marked to pro­vide fed­eral grants to states for pro­grams work­ing to pre­vent pre­scrip­tion drug over­doses. The fund­ing aims to “in­crease the avail­abil­ity of med­i­ca­tion-as­sisted treat­ment pro­grams, im­prove ac­cess of the over­dose-re­ver­sal drug nalox­one and sup­port tar­geted en­force­ment ac­tiv­i­ties,” a state­ment on the for­mer pres­i­dent’s White House web­site reads.

Nalox­one, the “over­dose first-aid kit,” is also known as Nar­can. It blocks opi­oid re­cep­tors in the brain to re­verse the ef­fects of an over­dose. The most pop­u­lar ver­sion of nalox­one is as a nasal spray.

From New York to New Mex­ico, states and phar­ma­ceu­ti­cal com­pa­nies are fos­ter­ing part­ner­ships be­tween hos­pi­tals and law en­force­ment to in­crease the avail­abil­ity of nalox­one.

Schools in New York City are re­ceiv­ing the Nar­can nasal spray for free, The New York Times re­ported.

In De­cem­ber Wal­greens an­nounced that nalox­one can be pur­chased with­out a pre­scrip­tion in its stores in 33 states and the District of Columbia.

The plan also men­tions ex­pand­ing ac­cess to treat­ment with buprenor­phine by al­low­ing nurse prac­ti­tion­ers and physi­cian as­sis­tants to pre­scribe it.

This out­line is sim­i­lar to a rec­om­men­da­tion made by the Amer­i­can Col­lege of Physi­cians (ACP) last week.

“Sub­stance use dis­or­ders are treat­able chronic med­i­cal con­di­tions, like di­a­betes and hy­per­ten­sion, that should be ad­dressed through ex­pan­sion of ev­i­dence-based pub­lic and in­di­vid­ual health ini­tia­tives to pre­vent, treat and pro­mote re­cov­ery,” ACP Pres­i­dent Nitin Damle said.

The or­ga­ni­za­tion’s guide­lines in­clude work­ing to stan­dard­ize pre­scrip­tion prac­tices to reign in the over-pre­scrip­tion of opi­oids as pain med­i­ca­tion — an on­go­ing ef­fort of ed­u­ca­tion for physi­cians since the early 2000s, when stud­ies and schol­arly ar­ti­cles started to ques­tion the ef­fec­tive­ness of pre­scrip­tion pain man­age­ment and high­light­ing wor­ry­ing trends of abuse.

The ACP guide­lines stress that treat­ment for ad­dic­tion should be pri­or­i­tized over crim­i­nal­iza­tion and in­car­cer­a­tion. The as­so­ci­a­tion rec­om­mends pair­ing coun­sel­ing with med­i­ca­tion-as­sisted ad­dic­tion treat­ment.

This is what has kept Chris Barth sta­ble for the past 10 years. He is pre­scribed buprenor­phine, a nar­cotic ap­proved by the FDA in 2003 for ad­dic­tion treat­ment. It’s taken daily, ei­ther in the form of a pill or a dis­solv­able tablet.

A few months ago, Mr. Barth switched to a buprenor­phine im­plant. Placed un­der the skin, usu­ally in the arm, it pro­vides a con­stant re­lease of the drug for up to six months.

“My life is so much bet­ter, it’s ex­ceeded my ex­pec­ta­tions,” he said, adding that he lived with con­stant anx­i­ety about ei­ther los­ing or for­get­ting his pills. He also re­ports an im­prove­ment in his mood, say­ing the pre­vi­ous med­i­ca­tion had a “yo-yo” ef­fect on him.

“I’d like to even­tu­ally wean off the buprenor­phine. I’ve read the odds are against me for get­ting off opi­ates, but I’ve lost all that ad­dic­tive per­son­al­ity that I’ve had, and it’s given me a head start.”

Dr. An­ton Mi­nas­sian, a psy­chi­a­trist in Bethesda, Mary­land, who is treat­ing Mr. Barth, is en­thu­si­as­tic about the im­plant but is more crit­i­cal of the coun­sel­ing aspect of treat­ment.

“De­spite the fact that the Amer­i­can Med­i­cal As­so­ci­a­tion and other authorities on the sub­ject keep em­pha­siz­ing coun­sel­ing and re­ha­bil­i­ta­tion, the epi­demic keeps grow­ing, and very lit­tle [progress] has been made,” Dr. Mi­nas­sian said. “Med­i­cal treat­ment with buprenor­phine was quite a big de­vel­op­ment of treat­ment of opi­oid de­pen­dence, and prob­a­bly has saved many lives.”

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