Heroin Overdose Epidemic - what is your perspective?

[Nephrology]

Before addicted persons can get this stuff, doctors must first write prescriptions for the drugs so why is not the doctor part of the pipeline the place to start for controlling the flow of dope from manufacturer to distributor to pharmacy to addicted persons?

This has already been discussed several times in this thread, but there has been significant effort (& success) to shut down pill mills in the last ~10 years. Opiate Rxs have tapered and are starting to go down, due to 1) increased awareness among the provider community and 2) controlled Rx surveillance programs at the state and national level.

However, the void filled by the decreased supply of prescription opiates has been more than filled by illicit heroin. Not to mention that even with increased provider accountability for narcotic Rxs, there is an equally increased effort to illicitly divert opiates from the healthcare system (i.e. robberies of pharmacies, skilled nursing facilities & elderly communities, organized diversion of opiates from hospital settings, etc).

While there are probably still some holdouts, the healthcare community is painfully aware of the dangers of opiate Rxs and they are dispensed accordingly. We are taught in school that narcotics are to be limited to acute pain (i.e. post surgical) or given chronically to those with terminal disease.

I think there are a lot of doctors who deserve to have their licenses pulled but I don't see it ever happening. The suits against the pharmaceutical companies is part of the daily news here but nothing is ever publicly said about the doctors who wrote the prescriptions. On a local and state level the doctors who hand out pills like Halloween candy run in the same circles as the politicians, lawyers, judges, etc so it's not really surprising.

do you have any evidence for this? Physicians are investigated by law enforcement and their respective state medical boards for writing inappropriate opiate prescriptions all the time. There was a case here in Colorado (won't say what specialty or institution) who was busted for writing himself or proxies opiate Rxs so he could take them to get high. Didn't even make it to other people, but the degree of oversight now is such that he had no chance of going undetected.

[scjbash]

do you have any evidence for this? Physicians are investigated by law enforcement and their respective state medical boards for writing inappropriate opiate prescriptions all the time. There was a case here in Colorado (won't say what specialty or institution) who was busted for writing himself or proxies opiate Rxs so he could take them to get high. Didn't even make it to other people, but the degree of oversight now is such that he had no chance of going undetected.

Evidence for what? That the community "leaders" who grandstand about investigating and naming those responsible for the rampant prescribing of pills never mention the doctors who actually wrote the prescriptions? Or that it's not surprising that they leave that part out because they are all part of the same societal circle? I can't really provide evidence other than I live in ground zero of the epidemic and have seen with my own eyes how things happen around here. I'm not talking about Colorado or anywhere else, but specifically this part of Appalachia because that's what LL's article was addressing. That's my fault for not being clear about that.

It's important to understand that in this area it wasn't just an issue of pill mills. It was an issue of virtually every doctor over-prescribing narcotics. If you look at the county breakdown in WV for example, counties in the northern half of the state prescribed opiods at rate of less than 20 doses per person per year. In the southern half of the state that jumps to over 200 doses per person. I'm sure if you looked at maps of other states you would see the same in their hard hit areas. It wasn't an issue of awareness or provider education, which is why one half of the state varies so much from the other half. It doesn't take a brilliant doctor to know that you don't need to hand out a bottle of Lortabs to every person who bumps their toe on something, but that's exactly what's gone on in these areas. The word that comes to mind is culture. It's like the culture among doctors in certain areas became one of laziness and throwing pills at people to get them out the door.

[Nephrology]

Evidence for what? That the community "leaders" who grandstand about investigating and naming those responsible for the rampant prescribing of pills never mention the doctors who actually wrote the prescriptions? Or that it's not surprising that they leave that part out because they are all part of the same societal circle? I can't really provide evidence other than I live in ground zero of the epidemic and have seen with my own eyes how things happen around here. I'm not talking about Colorado or anywhere else, but specifically this part of Appalachia because that's what LL's article was addressing. That's my fault for not being clear about that.

It's important to understand that in this area it wasn't just an issue of pill mills. It was an issue of virtually every doctor over-prescribing narcotics. If you look at the county breakdown in WV for example, counties in the northern half of the state prescribed opiods at rate of less than 20 doses per person per year. In the southern half of the state that jumps to over 200 doses per person. I'm sure if you looked at maps of other states you would see the same in their hard hit areas. It wasn't an issue of awareness or provider education, which is why one half of the state varies so much from the other half. It doesn't take a brilliant doctor to know that you don't need to hand out a bottle of Lortabs to every person who bumps their toe on something, but that's exactly what's gone on in these areas. The word that comes to mind is culture. It's like the culture among doctors in certain areas became one of laziness and throwing pills at people to get them out the door.

That's totally fair. I am probably lucky, but the idea that someone would be written for narcotics over something trivial clashes heavily with everything I have seen among the various hospitals and providers I've worked with. I'm not in WV, either, and am lucky to be at very competitive academic medical centers. This sort of behavior would absolutely not be tolerated.

[txdpd]

CVS is going to start selling Narcan over the counter. I'm going to pick some up just for me in case of an incidental exposure.

Anyone have any idea how long will these things will last stored in a patrol car or how often they should be replaced?

[scjbash]

https://www.cbsnews.com/news/drug-co...opioid-scheme/

The company makes a spray version of fentanyl, a highly addictive opioid intended only for cancer patients. Authorities allege Insys marketed the drug as part of a scheme to get non-cancer doctors to prescribe it. Numerous physicians were allegedly paid bribes by the company to push the painkilling drug.

[gtae07]

Before addicted persons can get this stuff, doctors must first write prescriptions for the drugs so why is not the doctor part of the pipeline the place to start for controlling the flow of dope from manufacturer to distributor to pharmacy to addicted persons?

I worked in a pharmacy half a lifetime ago (high school job). Back in the early 2000s, at least where I was working we basically knew who the abusers were (the addicts and those who sold them). But the prevailing sentiment I picked up on at the time was basically "there's nothing we can do since we don't have hard evidence, another doctor will write them more prescriptions, and the police are too busy with other stuff". We had one person who had a prescription for nine methadone tabs a day, had (supposedly) chewed off a couple of their own fingers--they were indeed missing at least--and on at least one occasion had them "stolen" from their glovebox--and the doc just wrote another script. We also had a celebrity customer who would get impressively-sized bottles of painkillers on a regular basis. I would hope/expect that some progress has been made by this point.


In my fire department days a decade later we got occasional drug overdoses, though not as many as the larger city nearby. I did get to see narcan in use one day--it leaves an impression on you. "Kid" was my age, and his parents found him in their back yard in naught but his skivvies, turning blue. Got to prep the injection for the paramedic, who turned to me with a shit-eating grin and said "watch this".


A couple of the people I grew up with are now dead from overdoses, including one of the kids who lived next door and the brother of one of my best friends growing up.

[KPD]

CVS is going to start selling Narcan over the counter. I'm going to pick some up just for me in case of an incidental exposure.

Anyone have any idea how long will these things will last stored in a patrol car or how often they should be replaced?

Do not store it in your car. The temp inside your car will well exceed the safe storage limit.
Before you go buy it yourself check with your local DTF or HIDTA office. There are lots of grants out there where you might get some for free and at worst a deep discount. One of those offices should have grant information. If they don’t, PM me. Narcan is not cheap at all any longer. What was $10.00 less than a decade ago is now usually $175.00 at a minimum.

[txdpd]

I checked with Hidta and no luck. I don't mind spending the money. Seems to be all too common theme of friendly fire going on with this stuff.

No car storage. That sucks.

[Nephrology]

I checked with Hidta and no luck. I don't mind spending the money. Seems to be all too common theme of friendly fire going on with this stuff.

No car storage. That sucks.

Definitely keep it stored at room temp. When properly cared for, the shelf life should be approx 18-24 months (Evzio brand injectors say 24m).

Relevant:

10 percent revived by Narcan in Mass. died within year, study say

Not surprising...

[voodoo_man]

CVS is going to start selling Narcan over the counter. I'm going to pick some up just for me in case of an incidental exposure.

Anyone have any idea how long will these things will last stored in a patrol car or how often they should be replaced?

We ran out in the first 5 months of this year. We are allowed to ask medics to give us a pack and use it if needed but the PD won't issue anymore for a bit.

What the policy is looking like it's going to be, every officer will sign out a pack of narcan every shift in a kit. Which is someone's good idea fairy gone full derp.

Unofficially we used 3000+ in those first few months, can't post internal numbers however. The type we got had a shelf life of two years.

Every local pharmacy sells narcan, I'm gana grab a few as well, also advise getting one time face mask things with gloves in a kit, have a few with you just in case, for vehicle searches and whatnot.