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Substance Abuse in Rural America

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I have always lived in rural America, even when working in a city. I prefer rural areas because of their friendly folks with core values and the landscape—open fields, woods, and livestock, mainly beef cattle!

Since April 2016, I’ve had a part-time job commanding the Brown County, Ohio, drug and major crimes taskforce, which needed to be reenergized and expanded. I live just 15 minutes away and was eager to assist. For the past 2 years, Brown County (population: 45,000) has led Ohio in unintentional overdose deaths per capita. With Ohio appearing to lead the country in the number of these deaths, Brown County is a top contending overall leader in this tragedy. At first, I found this almost unbelievable, but then I began to receive almost daily texts regarding overdoses and related deaths in the county. Life squads and emergency medical technicians seem to be constantly busy trying to save individuals with naloxone, whether it be 1 dose or multiple doses. [Read more…]

Why Not Legalize All Drugs?

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We are undoubtedly in the midst of one of the most devastating drug abuse eras the United States has ever seen. Heroin by itself or, more likely, laced with fentanyl or carfentanil, along with pharmaceutical opioids, is causing thousands of overdoses across our country each year. Nasal naloxone has saved an incredible number of these overdose victims.

When drug problems intensify, the cry goes out that we have lost the war on drugs and our best way out to stop all of the death and destruction is to legalize drugs and let the government reap the profits in the form of taxes. It sounds simple: legalize all drugs, the prices will drop, the associated killing and violence will go away, and we will all live happily ever after. We can use the increase in tax revenues to build highways and roads or to fund other important projects. [Read more…]

Hope for the Future of Opiate Addiction

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The news on opiate addiction is usually bleak at best. Hundreds of articles, including some of mine, discuss addiction and overdose death with no apparent “light at the end of the tunnel.” My current employer, Brown County Ohio, leads Ohio’s list of top counties per capita for unintentional overdose drug deaths! It’s hard to accept that this is the situation in a sparsely populated rural county in southern Ohio, but it’s a snapshot of the problem in Ohio and well beyond.

About 2 years ago, I was at a conference where I learned about a new drug called Vivitrol. It seemed promising that a once-monthly injection could render an addicted individual unable to achieve a high. Along with counseling and an addict’s willingness to receive a monthly injection for many months, Vivitrol could result in lasting sobriety. It sounded too good to be true. The only hurdles were that addicts must be willing to participate and must not use their drug for several days before administration of Vivitrol. In addition, the cost of the drug is $600 to $800 per injection. The Warren County Ohio jail has an ongoing project involving this drug, and the results have been sensational. [Read more…]

The Value of Prescription Monitoring Programs

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A recent study from Vanderbilt University in Nashville proclaimed that prescription drug monitoring programs (PDMPs) can reduce prescription drug–related overdose deaths. According to the study results published in the June issue of Health Affairs, “If Missouri adopted its own PDMP, and every state enhanced its existing program, some 600 overdose deaths would be avoided annually.”1

Missouri is referred to because, as of this writing, it is the only state without a PDMP. Establishment of a PDMP is being debated in the Missouri legislature, however, as other states have enjoyed incredibly successful PDMPs for years. Missouri is not only a haven for in-state seekers of illegitimate refills, but the state also attracts offenders from bordering states! The prescribers and dispensers with whom I have spoken over the past few years are fed up with the problem and the legislature’s lack of response to it. [Read more…]

The Prince Frenzy

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Much of the turmoil over the death of Prince has subsided, but the news about his death and the public’s response have been interesting, especially when it was revealed that fentanyl and other controlled substances were determined to be part of the cause of death. Individuals who villainize all opiate medications and call for greater prescribing controls came out of the woodwork again.

My view all along, as the prescribing pendulum of controlled substances swings from high to low, is to try to achieve balance. Remember that the vast majority of prescribers are incredibly honest and primarily prescribe these medications to patients with legitimate pain. Therefore, it’s amazing to me that, for the sake of the 10% to 15% of individuals to whom these medications are prescribed and who abuse them, we are willing to drastically reduce prescribing. In some cases, physicians promote the “suck it up” approach, encouraging no prescribing of opiates, no matter the pain level. [Read more…]

How BIG is the problem?

Year after year, state and local law enforcement statistics indicate that pharmaceuticals are almost 30% of the overall drug problem in the United States, running a close second only marijuana abuse. However, until recently, law enforcement, health care professionals, and the general public have placed little emphasis on this huge problem.

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Pharmaceutical Diversion Education (PDE) is designed to assist a wide range of the population in understanding the potential abuse and addiction that can be associated with prescription medication.

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