Showing posts with label drug abuse. Show all posts
Showing posts with label drug abuse. Show all posts

Sunday, February 18, 2018

Heroin and Opiate Update for Calhoun County, February 2018

This disturbing news is only softened with the knowledge that our county's Substance Abuse Council has 30 years of tracking with a thorough network of reliable information.  Other counties are just at the start of their programs, so their shocks will come as their connections increase.

These charts are for heroin/opiate overdoses that did not result in death.

The typical demographic is a white male, 20-30, for heroin/opiate overdose.  This year, the January numbers have this demographic nearly equally divided between male and female.  Also note that with the added controls placed on hydrocodone-based analgeics (the "Norco" or "Vicodin" prescriptions), the prescription opiate number is down, but the heroin use is up. 

Overall, the numbers continue to increase. 

The graphs come courtesy of the Calhoun County Substance Abuse Council, a group who generously offers me a seat at the table whenever my time at WMU permits.  It hardly seems like enough time. 

Note that the current reports are for an overdose per day.  In 2017, there were months where the death rate was one every three days.



I'll just let the numbers sink in.  There are many things to say, but if you live in Calhoun County, these are your neighbors, your co-workers, your children, your parents.  In 2018, there are several requirements being put in place to clamp down on physician prescribing patterns, which should slow the prescription opioids.  However, judging from these numbers, the users seem to make their downhill slide to heroin...and, as I say in my public presentations, there isn't a Walter White in any of those labs.

Monday, January 16, 2017

Breakout Discussions at the October 2016 Heroin Summit Conference, Battle Creek, Michigan

Questions, notes, and discussion from the Opiate Summit - October 2016, Firekeeper’s Casino, Battle Creek MI
Breakout session - Jim Middleton, moderator
(the session ran 90 minutes - here are some of the notes I took during the discussion, covering nine of the dozen questions posed by the moderator (me), the panelists, or the audience.)

1. Akron, Ohio had a sudden emergence of carfentanil - how do we prepare for such an emergency in this area? - increased monitoring of nalaoxone use in treating overdoses - if it takes more than a few milligrams to resurrect the patient, chances are strong that the product in question contains carfentanil.  At present, fentanyl and carfentanil are not part of routine screening; current law enforcement personnel is able to focus on marihuana possession with greater interest because the product itself is so very visible.  Carfentanil can be lethal at a dose of 1mg.

2. When can we see improvements to the current MAPS program?  - the new server is set to roll out in January 2017, with clinicians being able to review their own MAPS usage data (to check for unauthorized use of their DEA information) in April 2017.  The internal flags within the MAPS program are set pretty high - reportedly, it takes the use of many multiple unique clinicians in a 30 day period to flag a patient as being suspicious, placing a lot of the interpretive burden for abuse at the level of the pharmacist.  Clinicians are still underutilizing the MAPS program, not helped by its “voluntary” participation.  (The Lieutenant Governor, during his opening remarks, openly acknowledged the challenge of the narcotic problem in Michigan, but seemed reluctant to increase any regulatory burden by Michigan upon the clinicians.)

3. How do you perceive the 25% reduction in opioid production affecting the current heroin crisis?  - the lack of access to legally prescribed and manufactured opioids will result in an increase in illicit use.  While the DEA is taking steps to reduce the total amount of opioid products available for use, with the tools they have at their disposal, the overall impact of this restriction is being regarded as misguided: pharmacies with the wherewithal will begin stockpiling product in anticipation of the shortage by year’s end, which will only further contribute to the shortage.

4. What responsibility do drug companies have in this opioid abuse problem?  - the concensus in the group was that it laid a lot of blame on the drug manufacturers, both for creating the problem and for apparent price gouging for the treatment - naloxone prices have escalated 400% in just the past few years.  LARA (Michigan’s Licensing and Regulatory Affairs) was also taken to task for their perceived lack of oversight, giving Michigan the reputation of being the “new Florida” (one peninsula switched to another) for “bad prescribers.”

5. Family medical providers are the most common over-prescribers.  Any studies on the causes of this or the actions being taken to reign in this practice?  - It takes 30 seconds to say yes, 30 minutes to say no.  Independent physicians have been placed in group practices in order to maintain reimbursement through their insurance contracts.  Blue Cross began cutting reimbursement by 25% to independent clinicians while linking reimbursement to community health improvement.  In January 2017, Blue Cross, through its pharmacy benefits provider (PBM) Express Scripts,  is also restricting controlled substance analgesics to a 30 day supply, along with a maximum daily “morphine equivalent” for pain therapy before triggering a prior authorization process.   Caremark, the nation’s other primary PBM is implementing similar restrictions in 2017.  Both PBMs are implementing these new controls in a rapid manner, often with only a few weeks’ (or days) notice.

6. What is “Pink”?  An Upjohn test drug with about 7 and ½ times the potency of morphine, it was not considered useful enough to go beyond initial studies, but was assigned an ID of U-47700.  The patent has apparently expired, and its manufacturing information has been circulating.  Pink, carfentanil, “bath salts” all seem to be originating from labs in China and are being distributed to the United States by way of Mexico.

7. What can hospital administrators do to help or support providers/clinicians?  Hospital emergency departments in Grand Rapids have created a network to identify and move opioid “frequent fliers” into rehabilitation programs, while strictly limiting outpatient prescriptions for controlled substance analgesics.  Cross-platform EMR databases also help to identify patients with similar health-risk behaviors.

8. Heroin addicts - criminals or victims?  - The original view that the overdosed heroin user was a victim was embraced by law enforcement in March of 2016.  However, by year’s end, the repeated revisits to overdosing are taking their toll on law enforcement attitudes.  One weekend, police rescued the same patient 6 times in a 48 hour period, and the patient refused further treatment.  Such rescues are becoming a challenge with pressures to work staffing more “efficiently” and with other police services still requiring attention.

8. What is the status of naloxone and pharmacy distribution in Michigan?  - still adrift in the Michigan legislature (October 2016), Kent and Kalamazoo counties have proactively partnered with Spartan-Nash stores and Dr. Sandra Dettman of Grand Rapids to provide naloxone kits with a prescription umbrella from Dr. Dettman.  The kits are 2-packs of naloxone in nasal spray format, with 4mg naloxone per dose.   The public is still completely misinformed about the effects of naloxone being a “cure” for the overdose - it is only effective for minutes before requiring re-administration, and carfentanil requires a substantial increase in dose for effectiveness (and is effective for an even-briefer period of time).

9. Has Adderall been a problem? - Adderall and other ADHD stimulants in the DEA C-II category are routinely abused or sold by students, prescribed with very brief physician interactions, and are coming under increased DEA scrutiny once it feels adequate processes are in place for opioid review.  “Helicopter” parents are pressing clinicians to prescribe stimulants, not for ADHD, but for performance enhancement in academics and athletics.  Stimulants used in such a manner may increase attentiveness and short-term memory retention, but may actually diminish long-term retention of information.

(cc) Jim Middleton, The Animating Apothecary

Wednesday, July 04, 2012

Flashback to 1981 - The Battle Creek International Balloon Festival

EDITOR’S NOTE:
For the first few days of the international ballooning festival, I played keeper to one Stan Donovan, an acquaintance from my college days who went on to become an itinerant events reporter for such pillars of literature as High Times, the Cosmic Experience, and, in his more lucid moments, the Rolling Stone. When he left, I found some of his notes stuffed into a half-empty case of Rebel Yell. I have pieced them together for what follows, with his approval, of course.

June 20, '81 OPENING DAY
Battle Creek. The Best to You Each Morning. The place reeks of cereal. I wake this afternoon to the smell of burning Froot Loops and have to scrape the sugar coating off my windshield before I can leave for the airport, praying to the goddess of gasoline that I have nothing besides a tiger in my tank. The car, a rusted black market rental I got in a trade for three hot Visa cards, dies anyway, lunging one final yard before spilling its transmission onto Territorial Road, just blocks from the launch site. It's just as well. Two hundred thousand beings are there already, pressed against snow fences, huddled in overheating cars, piled on mopeds, falling off bicycles, most of them stoned on hot dogs, crusty mustard, and Sno cones...
I spend a good thirty minutes studying the traffic patterns around the airport. A uniformed Cambodian refugee is conducting those same overheated cars and mopeds into bloated parking areas with the grace of a fine chef brandishing his Ginsu. Six jets roar overhead, dive bombing the city's north side. They are the Thunderbirds—six red, white, and blue T-38 Talon jets, flying billboards for the Air Force. They can singe the hair on the back of your neck and be over the horizon before the smell hits you. They pass by once more, trying to scare the lookout tower. Two fellow reporters, one from the Spokane Post-Examiner, the other retired from the Blue Network, get whiplash on the spot. They are ushered into the nearby aid station, a self-proclaimed M*A*S*H* unit equipped for handling hangnails to Caesarian deliveries, but rendered impotent against an epidemic of Elephant Ear Enteritis. This locally-coined medical term requires some explanation.  It seems, with the appearance of the balloons, came the arrival of a grease-stained delicacy called Elephant Ears, a tidbit resembling a pita bread dusted with a coat of cinnamon. They act on the body much like a Roto Rooter. I can see them being created, pioneer-style, in the back of the Official Elephant Ear Wagon. No flapless Dumbos there--just a combination of flour, lard of indeterminant age or origin, and occasional hair. The hair seems to be the active ingredient.
I drops fifty milligrams of Dramamine and head to the field.
While the guard at the press gate is telling me that Reagan has sent his wishes for fair winds, a hot mist comes up from the southwest, turning the airstrip into fifteen acres of hazy meadow. Politicians should stick to politics. someone mentions canceling the evening's mass ascension. He is lynched quickly, quietly. This crowd means business.
The pilots appear now, marching in file, freshly briefed on the weather, and appraised of new red zones, chunks of Calhoun county where farmers will meet them with open pitchforks if they land. The masses divide for them, applauding. Once again, Man Will Conquer The Skies. Kitty Hawk, Cape Canaveral, and now, Battle Creek. Do I detect the National Anthem.
I am jolted from my reverie by a telephoto lens to the left kidney. The Japanese film crew has arrived...
I count about seventy-five ballons getting into position now, the silken enveloped pulled into place, the crews making them quiver and pulsate with jets of cold air. Then the propane is fired, and the American Dream is airborne with vivid colors extolling me to drink Smirnoff, eat at McDonald's, and read Playboy. I ache to comply.
A press balloon springs a leak, deflating in a heap nearly on top of me, so I stay behind, watching these ethereal teardrops defy gravity. They head to the northeast, their ground crews hastening to keep pace.
I dissolve into the crowd when my car is announced as a traffic hazard over the P.A.
A recorder picks up the following conversation between two ladies wearing "Bomb California" buttons:
"I don't see how Kellogg's could let that Playboy balloon in on this," says one.
"I think I'll write a letter," says the other.
"And did you see that girl they had here? Practically falling out of that little outfit."
"Just indecent."
I am about to say something, but notice they are standing in line for Elephant Ears, so I just smile and walk on.
The Exodus pushes me on in time for me to watch as my rental is towed away. Requiescat in pace.. I still have a dozen Visa cards....


I come upon one of the chase crews held up in traffic, and, seeing a chance for escape, hitch a ride. Ground control is giving chase vehicles     priority on the roads, but this driver hops the curb and heads cross-country anyway. I scrutinize my travel companions. The pilot of the van calls herself Bubbles and is navigating with a revoked license. Her nine-year-old daughter is passing around a diminishing six pack of generic beer. The third crew member turns out to be a stringer for ESPN who needs a landing shot to complete his report and who, like me, saw the chase van as the only way of escaping the crowds before midnight. The last inhabitant, buried beneath the portable videotape equipment, happens by some coincidence to be my Battle Creek host, a disgruntled pharmacist who thinks that some questionable ability will get him into films. The stringer and nine-year-old are seeing who can get him drunk first.
Bubbles then announces that she has lost our balloon and stops the van.
Her daughter quickly produces a map of Calhoun county, complete with Red Zones, add the stringer points out routes guaranteed to have us lost within minutes. The pharmacist struggles from beneath the videotape equipment and tells us that we've just parked in someone's front lawn. The daughter pats him on the head and gives him another beer. I suggest we continue northeast, the general direction the balloons seemed heading. The vote is three for, and one against, with the one abstaining member quickly becoming comatose.
By now, the police scanner is posting updated ABPs on a renegade chase van, so we return to the charted roadways. The Norwegian and Danish balloons gently collide above us. The mist is getting thicker. Also sweeter. Kellogg's is near.

Bubbles stops at the factory to get our bearings. her daughter again produces her maps and my Battle Creek host wanders over to the main entrance to begin an animated repartee with the ceramic Tony the Tiger standing sentry.
Abruptly, the Hong Hong entry, guided by an Austrailian, lands in the parking lot not fifteen feet away. Its chase crew springs from a nearby billabong and has the balloon wrapped, packed, and shunted away before we can even get in a good chorus of "Waltzing Matilda." Bubbles stands in awe, the nine year old says"Whoa, Man," and the pharmacist doesn't notice, his conversation with Tony having degenerated into a corruption of Canadian French and Pig Latin. ESPN loses its exclusive report when the stringer can't dislodge a beer tab jamming his controls on fast forward.
The haze becomes a fog and we answer the call of the open road.  When an hour passes and we haven't heard an update on our position over the scanner, we realize we are lost. Our road has gone from gravel to a two-track to a field where a pony cantered through perhaps a week before. Bubbles stops the van. As near as we can estimate, we are in a Red Zone. "I am not enjoying this," she says.
She slams the gears into reverse, and we retreat about five yards when there is a metallic Ching and the front of the van sinks. A tire is dead, victim of a bear trap.
Now, it has always been my conviction that the presence of a bear trap in a Michigan field is not a good amen. For one, I don't like traps. For another, I don't like bears. I don't like to watch them wrestle Dan'l Boone, I don't like to lie on their rugs. I'm sorry. I'm just that way.
The pharmacist grunts a chorus to "La Boheme" and enters REM.
Dusk is setting in, and we can barely see the last of the entries drift over the trees to the northeast. Nor are we alone. The mosquitoes have discovered their free lunch. Between slaps, the stringer tells me how he was trapped in a blizzard and proceeded to videotape his last will and testament. Bubble's daughter is sitting on a rock, chanting, “Lions and tigers and bears, oh my." Her mother is wishing that her flashlight worked.
I begin to go quietly out of my mind.
An owl and two bats lend themselves to the scenario as my body temperature drops eight degrees.
Lions and tigers and bears oh my.
We pry off the flattened tire and the stringer takes it to the back of the van. I hear a thud.
Then silence.
Lions and tigers and...
The grass crackles.
...bears oh my...
Bubbles and I run to the back but see nothing. No stringer with a flat tire. No pharmacist behind the rear wheels. She calls out for her daughter.
Nothing.
I run to the cab and find the faulty flashlight. It flickers when I give it a good whack against the van. Come on, light up. The bulb dies again.
Lions.
I run back where I left Bubbles. No more Bubbles.
...and tigers.
I hear something walking around me, stalking me.
...and bears.
The grass crackles again.
...oh my.
Silence.
Madness helps at times like this. I yell like a stung hyena and run for the cab. For a moment, it works. I think I can make it.
Then it is on me. I'm knocked into the grass and it has me by the legs, pulling itself over me. I can feel it drooling, panting, its dank breath taking mine...
The flashlight.
I swing at it with the flashlight, making contact with a dull crack. The light comes on and I can see it now, arching back slightly from the blow. It starts to laugh at me, a low rumbling laugh
that grows and pushes me back. It looks like it's wearing a mask...
An elephant mask.
It lunges at me, and just before everything goes out, I wonder where its ears are...
I wake up on my back, staring into a bright light, smelling of Witch Hazel and iodine. A  Mephistophelean character peers at me, says something to a girl near him, and she leaves. My host, the comatose pharmacist, appears with my camera and recorder. I grab his shirt.
"You sure he just hit his head?" says the doctor.
My host says I'm always like this. I'll get him later.
"Get me out of here," I say. "That guy looks ready to do some quick surgery."
Outside, I am told that when the press balloon collapsed on me, I wandered away and became entangled in one of the ascending balloons' ground ropes and was dropped on my head from ten feet. Another plot, I'm sure. I check my arms for needle marks, some sign of drug entry, then I remember...
The elephant ears.
I run into the crowd as my car is announced as a traffic hazard over the P.A. I cannot maintain....

Tuesday, December 06, 2011

And so Albion and Marshall Don't Feel Left Out

Albion – Population 14224 (2010)

                         Stimulants  Vicodin like    Oxy-like    Methadone
totals               127774          737092           73520          134644
Per Capita         8.98              51.82              5.17               9.47



Marshall - population 14646 (2010)

totals               97505           375008             37238         69785
Per Capita       6.66               25.60                2.54              4.76

Monday, December 05, 2011

Battle Creek - You've Got A Problem!

The Michigan Automatic Prescription Service (MAPS) offers up a lot of information on controlled substance usage as reported from the state's pharmacies.  Their website even provides the raw data for the entire year of 2010, broken down by zip code.
After some research, it was possible to track down the populations for those zip code regions, then break the general use down 'per capita.'
The categories chosen for this snapshot of 2010 were 'stimulants' (meaning, all varieties of Ritalin, Adderall, Concerta, and its chemical relatives), 'hydrocodone' (for all drugs similar to Vicodin), 'oxycodone' (for those like Oxycontin), and 'methadone.'
The 49014 area corresponds to an area near Battle Creek known as "Harper Creek."  The 49015 refers to the "Lakeview" region, with 49016 being those who use a PO box as their primary address, 49017 referring to the city's northern side, and 49037 to the general region known as "Urbandale."
I recommend checking out the MAPS program and looking up your particular region and crafting a similar spreadsheet.  Battle Creek may look to be problematic, but I'm almost thinking that other regions may have a bigger problem....
Now, contemplate the causes.....