Tag Archives: overdose

What’s Fentanyl? The facts about the synthetic opioid

Prince died of an overdose of the powerful opioid fentanyl, according to autopsy results released in June.

Among the questions investigators were reviewing was whether Prince had a prescription for painkillers before his death.

A person close to the investigation of Prince’s death told The Associated Press that pills found in Prince’s home marked as acetaminophen-hydrocodone actually contained fentanyl, suggesting they were counterfeit pills obtained illegally.

Prescription opioid overdoses reached nearly 19,000 in 2014, the highest number on record.

Total opioid overdoses surpassed 29,000 that year when combined with heroin, which some abusers switch to after becoming hooked on painkillers.

Some information on fentanyl:

 

WHAT IS FENTANYL?

Fentanyl is a synthetic opioid, 50 times more potent than heroin, that’s responsible for a recent surge in overdose deaths in some parts of the country. It also has legitimate medical uses.

Doctors prescribe fentanyl for cancer patients with tolerance to other narcotics. It comes in skin patches, lozenges, nasal spray and tablets.

Because of the risk of abuse, overdose and addiction, the Food and Drug Administration imposes tight restrictions on fentanyl; it is classified as a Schedule II controlled substance.

Some pharmaceutical fentanyl is illegally diverted to the black market. But most fentanyl used illicitly is manufactured in clandestine labs.

The U.S. Drug Enforcement Administration has tied fentanyl seizures to Mexican drug-trafficking groups.

On the street, fentanyl is sold alone as powder, added to heroin or made into counterfeit OxyContin pills. Users don’t always know when they’re taking fentanyl, increasing the risk of fatal overdose.

The DEA issued a nationwide alert about fentanyl overdose in March 2015. More than 700 fentanyl-related overdose deaths were reported to the DEA in late 2013 and 2014.

Since many coroners and state crime labs don’t routinely test for fentanyl, the actual number of overdoses is probably much higher.

WHAT IS A LETHAL DOSE?

It’s tricky with opioids like fentanyl.

Anyone who takes prescription opioid painkillers for a long time builds up a tolerance to the drugs. A dose that could kill one person might provide medicinal pain relief to another.

Experts in medical toxicology say it’s important to know how much opioid medication a person has been using before a death to know how to interpret post-mortem blood levels. Pill bottles and medical history may become crucial evidence.

DOES PAIN TREATMENT LEAD TO ADDICTION?

Prince had a reputation for clean living, and some friends said they never saw any sign of drug use. But longtime friend and collaborator Sheila E. has told the AP that Prince had physical issues from performing, citing hip and knee problems that she said came from years of jumping off risers and stage speakers in heels.

Becoming tolerant to opioid painkillers may lead some patients to seek stronger drugs from their doctors.

Some users — whether they start as recreational users or legitimate pain patients — become addicted, experiencing an inability to control how much they take, so they use much more than is prescribed or seek out drugs on the black market.

With good management, however, opioids can offer relief to people with only a small risk of addiction, according to a 2010 review of the available studies.

FDA: People overdosing on anti-diarrhea drugs

Federal health officials are investigating sometimes-deadly overdoses with common anti-diarrhea drugs, a bizarre manifestation of the nation’s drug abuse problem.

The primary ingredient in prescription Imodium and similar over-the-counter drugs is intended to control diarrhea. But abusers sometimes try to achieve heroin-like highs by taking massive doses, up to 300 milligrams at once, according to cases in the medical literature. Recommended doses range between 8 milligrams and 16 milligrams per day.

The Food and Drug Administration warned doctors and patients Tuesday that the drugs can cause potentially deadly heart problems when taken at higher-than-recommended levels. The agency has received 31 reports of people hospitalized due to the heart problems, including 10 deaths over the last 39 years. The agency’s database is not comprehensive and many drug overdoses are not reported to the government.

But national poison centers reported a 71 percent increase in calls involving loperamide-containing drugs between 2011 and 2014, according to a journal article published last month in the Annals of Emergency Medicine.

The paper’s authors recommended restricting over-the-counter sales of the anti-diarrhea drugs, similar to other easily abused medications like pseudoephedrine, the decongestant that can be processed into methamphetamine.

FDA regulators said in an online posting that they are monitoring the issue and considering next steps.

Reports of abuse are rising amid an epidemic of addiction and abuse involving opioids, a family of drugs that includes narcotics like heroin and legal prescriptions like morphine and oxycodone. In some cases, opioid abusers will attempt to wean themselves off those drugs by substituting the anti-diarrhea drugs.

In 2014, more than 47,000 drug overdoses were recorded in the U.S., with opioids accounting for 61 percent of that total, according to the Centers for Disease Control and Prevention. Federal and state authorities have been trying to reduce opioid abuse for years, though overdose deaths have continued to rise.

 

 

Senate probe finds ‘systemic failure’ in Tomah facility review

There were “systemic failures” by the federal agency charged with independently investigating complaints at a western Wisconsin Veterans Affairs medical facility known as “Candy Land” because of the free flow of prescription drugs, a U.S. Senate committee probe has determined.

The report singles out the VA’s inspector general’s office for “failure to identify and prevent the tragedies” at the Tomah Veterans Affairs Medical Center, including not publicly releasing findings from its probe that could have saved lives and improved operations.

“This is a leadership failure,” Sloan Gibson, deputy secretary of the VA, testified at a field hearing of the Senate Homeland Security and Governmental Affairs Committee. “There’s lots of finger pointing and everything else. At the end of the day, we own this. VA leadership owns this. We had ample opportunities over the years to fix this.”

The report by the Republican majority of the Senate committee found the VA inspector general’s office discounted evidence and testimony, needlessly narrowed its inquiry and has no standard for measuring wrongdoing. The report also says a culture of fear and whistleblower retaliation continues at the facility.

The inspector general office’s failure to publish results of an investigation into the Tomah facility, which found that two providers there had been prescribing alarming levels of narcotics, “compromised veteran care,” the report found.

The inspector general’s office needs to “clean house,” said Wisconsin Sen. Ron Johnson, chairman of the committee.

Johnson said that he “absolutely” believed there were problems at other VA facilities across the country not being found by the inspector general’s office, but the “vast majority” of veterans he speaks with are satisfied with the care they are getting. Johnson said the ultimate solution to problems with health care within the VA system is to give veterans access to the private health care system.

Inspectors for the VA in 2014 found that doctors were over-prescribing opioid painkillers, leading to the “Candy Land” nickname. Jason Simcakoski, a 35-year-old Marine veteran, died from “mixed drug toxicity” at Tomah five months after the inspector general closed the case. He died days after chief of staff Dr. David Houlihan approved adding another opiate to the 14 drugs he had already been prescribed. Houlihan was nicknamed “candy man” by some patients.

“What we heard here was good,” Simcacoski’s father, Marvin Simcakoski, said after the hearing. “I think the outlook is good for favorable changes.”

After Simcakoski’s death, the VA conducted its own investigation which led to the firing of Houlihan and the medical center’s director Mario Desanctis.

The Senate report found that inspector general investigators suspected Houlihan and nurse practitioner Deborah Frasher “appeared to be impaired” when they were interviewed in 2012, but no action was taken. Houlihan was fired in November 2015 after being on administrative leave for months. Frasher, who worked alongside Houlihan, resigned in February 2015.

Houlihan’s attorney, Frank Doherty, disputed the report’s findings. He said claims that Houlihan was impaired were “nonsense.”

Two listed telephone numbers for Frasher were disconnected. She could not immediately be reached for comment Tuesday.

Democratic Rep. Ron Kind, who represents western Wisconsin in Congress, and Rep. Tim Walz, a veteran and a Democrat from nearby southeastern Minnesota, attended the field hearing along with Johnson and Wisconsin Sen. Tammy Baldwin.

“For far too long, serious problems have existed at the Tomah VA and they were simply ignored or not taken as seriously as they should have been by VA and the VA inspector general,” Baldwin said.

Democrats on the committee issued a four-page response to the Republican majority’s findings, saying that while improvements have been made at Tomah, continued oversight is needed by the VA, the inspector general’s office and Congress “to ensure that the facility is held accountable and that our veterans receive the quality care and attention they deserve.”

Michael Missal, who took over as inspector general for the VA last month, testified that his office made many mistakes and he vowed to improve its operations, including keeping Congress better informed.

Release of the 350-page report comes as Johnson is in the midst of a tough re-election battle against Democrat Russ Feingold. Tomah has already been an issue in the race, with attack ads from both sides blaming Johnson and Feingold, who was in the Senate until 2010, for not doing enough to prevent abuses at the facility.

Johnson, telling reporters before the hearing he intends to be the “watchdog of the watchdog,” denied that he was trying to politicize the issue.

Ryan Honl, a whistleblower who spoke out against practices at the facility, said he felt vindicated by the report. But he said those who let the abuses continue “have a lot to answer for.”

Three deaths at the Tomah facility remain under investigation.

Ways people die by state, including drunken falls in Wisconsin

In Wisconsin and nearby Iowa and Minnesota, there are disproportionate instances of accidental falls that are fatal. It’s a phenomenon that has puzzled researchers for years, said Patrick Remington, an associate dean at the School of Medicine and Public Health at the University of Wisconsin.

“We’ve supposed that it’s due to cloudy weather, no sun and so no vitamin D (which promotes bone health), but there’s not been a good answer yet,” Remington said. Wisconsin’s Health Department has a fall prevention program, which points out that the elderly are particularly susceptible to falling.

Elizabeth Stein, a preventive medicine resident at the University of Wisconsin medical school, said low vitamin D levels can lead to both fatal falls and dementia in older people, though studies have yet to confirm a link between those causes of death and the area’s cloudy weather.

But Wisconsin has an unusually high number of people who fall to their deaths while inebriated. A study last year found that in 2012 more people in the state died from falling while drunk (349) than driving while drunk (223).

A study released just a week ago by 24/7 Wall Street found that 7 of the country’s top 10 “drunkest cities” are in Wisconsin, led by Appleton at No. 1. Twelve of the 20 drunkest cities in the nation are in Wisconsin, including Madison (fourth highest) and Milwaukee (17th highest).

“Drunkenness”per city was measured by the percent of the population that acknowledged either binge drinking (4 to 5 drinks at one time) or drinking heavily (15 or more drinks in one week.)

The findings used data from the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute.

Although Wisconsin is the drunkest state in America, alcohol is more likely to be the cause of death in much of the Southwest than in other parts of the country. New Mexico and Arizona, where American Indian reservations have struggled with alcohol for decades, have high rates of alcohol-related deaths.

Varied by region

Although the top causes of death are similar for most states, many states have their own peculiar hard cases —types of deaths whose rates are higher than the national norm, a Stateline analysis of 2014 data from the Centers for Disease Control and Prevention shows.

The analysis, which relies on a method similar to one used in a CDC journal, shows some understandable disparities in the causes of death in some regions. The South, the epicenter of the nation’s obesity epidemic, has high rates of heart-related deaths. Some are more puzzling.

State and local health officials increasingly plumb such disparities for clues that may help them develop preventive programs and save lives.

For instance, Kentucky and New Hampshire have high rates of death by accidental poisoning, which includes drug overdose. In response, Kentucky has begun a program to monitor the prescribing of addictive painkillers. It has also expanded the availability of treatment for substance abuse.

In parts of Appalachia and New England, drug overdoses account for a disproportionate number of deaths. New Hampshire Gov. Maggie Hassan, a Democrat, signed a bill in January calling for stiffer penalties for drug dealers and more tracking of prescription drugs, calling the epidemic of heroin and prescription painkillers “the most pressing public health and public safety issue facing our state.”

Suicide by gun stands out as disproportionately lethal in parts of the Upper Midwest and Alaska.

Sometimes states can only do so much about higher incidents of mortality. Take suicide, for example. Guns often are more available in some western states, said Catherine Barber, who directs the Means Matter Campaign at Harvard University. Their prevalence can drive up suicide rates, she said, not because gun owners are more likely to be suicidal — but because guns are more lethal if a person decides to commit suicide.

Data drives action

After noticing a stubbornly high rate of liver disease, intoxicated-driving and other causes of alcohol-related deaths, New Mexico’s Health Department this year began an alcohol-awareness program that focuses on areas of the state where the problem is most acute.

“The rate was not improving over time,” said Rosa Isabel Lopez, health data dissemination coordinator for the state health agency. “The decision was made to create more data points for community audiences and get this information into the hands of our neighborhoods.”

The state also launched a public website last year that displays data on health issues in small areas of the state, which communities can use to understand problems and target them.

Local detail, plenty of data, and plain language for policymakers are important aspects of successful state efforts to prevent deaths, said Ross Brownson, an epidemiologist at Washington University in St. Louis who wrote a 2010 guide on the subject.

“We like to say, ‘What gets measured gets solved,’” Brownson said. Until recently, he said, communities often didn’t have enough details about health problems to make policy decisions.

In the last few years, he said, there’s been improvement nationally in collecting and distributing health data. The University of Wisconsin’s Population Health Institute, for instance, introduced county health rankings for Wisconsin in 2003, and then expanded them nationwide in 2010.

The rankings noted drug overdose deaths “reaching epidemic proportions” in some areas such as northern Appalachia, and rising 79 percent nationwide since 2002. The Stateline analysis also found high rates of accidental poisoning, which includes drug overdoses, in Massachusetts and New Hampshire.

Washington state prepared a plan to address Alzheimer’s disease last year after data indicated it was the state’s third leading cause of death, killing people at a rate two-thirds higher than the national average. Worse, Alzheimer’s was on the rise while other top killers like cancer and heart disease were in decline.

But the apparent rise could be attributed to better data. Washington has a more rigorous method of collecting and verifying death data than some other states. States’ totals for all deaths from dementia, which includes Alzheimer’s, suggests that many might not be reporting the disease as carefully as Washington.

Differences between the states in recognizing and coding the cause of death can muddy the picture, said Francis Boscoe, a research scientist at the New York State Cancer Registry who used differing death rates by state as a “conversation starter” about state-specific mortality issues.

“It seems entirely plausible that physicians or coroners in Washington could be coding as Alzheimer’s what other states might call pneumonia or something else,” Boscoe said. “There are explicit rules for all this, but that does not mean they are all being followed the same way.”

After Boscoe wrote last year about peculiar death patterns in states, he said he heard plenty of feedback about data-collection issues that can make for misleading numbers.

Flawed death certificates

As Stateline has reported, how the cause of death is recorded on death certificates, from which officials draw data, can vary widely even within a state.

In Kansas, for instance, what appeared to be the most distinctive cause of death — hardening of the arteries, or atherosclerosis, killing people there at seven times the national rate — was actually more of a data-recording problem than a medical one.

“This is a classification issue,” said Cassie Sparks, of the Kansas Department of Health and Environment. She said the state plans to emphasize better reporting and classification in training materials for medical examiners and others who sign death certificates.

But even if some data is flawed, cities and states can get life-saving or life-extending results by taking action on the evidence of health problems that do emerge. Brownson of Washington University in St. Louis points to New York City as an example.

The life expectancy in the city grew faster than the national average, paced by drops in heart disease, cancer and HIV from 2001 to 2010, a study published in the currentJournal of Public Health Management & Practice found.

New York has focused in recent years on using health trends to guide new, albeit sometimes controversial, public policy — from restrictions on trans fats and tobacco to unsuccessful bans on oversized portions of sweetened drinks.

“The city health department is really a prime example of evidence-based policy, of making the policy dependent on the data,” Brownson said.

Stateline is a news service of Pew Charitable Trusts. Louis Weisberg also contributed to this story.

 

 

Mayor wants nation’s first supervised heroin injection facility

The mayor of Ithaca, New York, wants his city in upstate New York to host the nation’s first supervised injection facility, enabling heroin users to shoot illegal drugs into their bodies under the care of a nurse without getting arrested by police.

The son of an addict who abandoned his family, Ithaca Mayor Svante Myrick is only 28 years old, but knows intimately how destructive drugs can be.

As he worked his way from a homeless shelter into the Ivy League at Cornell University and then became Ithaca’s youngest mayor four years ago, Myrick encountered countless people who never got the help they needed.

“I have watched for 20 years this system that just doesn’t work,” Myrick explained in an Associated Press interview. “We can’t wait anymore for the federal government. We have people shooting up in alleys. In bathroom stalls. And too many of them are dying.”

Describing his proposals to the AP ahead of a formal announcement planned for this week, the mayor said creating a place where addicts can inject heroin safely is a key part of a holistic approach to drug abuse that Ithaca will be rolling out, one that treats addiction more like a public health issue than a problem for the criminal justice system to solve. Nurses or physicians could quickly administer an antidote if a user overdoses, while addicts also could get clean syringes and be directed to treatment and recovery programs, he said.

Myrick expects supervised injection sites to be a hard sell in Albany, let alone in Washington, D.C., but his political sensibilities reflect what polls show is a growing belief among younger Americans that the war on drugs announced in 1971 by President Richard Nixon has failed.

“I think for a lot of people this is going to sound like a weird concept — ‘Aren’t you just encouraging them to use drugs?’” he said. “But I think it’s more possible now than at any time in our history. The opioid epidemic is affecting more people and we know we can’t wait any longer for the federal government to do something.”

Canada, Europe and Australia are already working to reduce overdose deaths with these facilities. In the United States, even the idea of creating a supervised injection site faces significant legal and political challenges. But Myrick sees an opening now in response to huge increases in overdose deaths nationwide. In New York state, overdose deaths involving heroin and other opiates shot from 186 in 2003 to 914 in 2012.

Myrick said he will ask New York’s Health Department to declare the heroin epidemic a state health crisis, which he said would enable his city to proceed without involving the state legislature.

Ithaca officials began looking seriously at alternatives to simply jailing addicts after the city had three fatal overdoses and 13 non-fatal overdoses in a three-week span in 2014. The city of 30,000, which hosts Ithaca College as well as Cornell, is one of New York’s most liberal communities and is a prime candidate for new approaches, Myrick said.

Myrick crafted his plan in collaboration with police and prosecutors, overcoming initially strong opposition from the elected district attorney, Gwen Wilkinson.

“What brought me around was the realization that this wouldn’t make it more likely that people will use drugs,” Wilkinson said. “What it would do is make it less likely that people will die in restaurant bathrooms.”

Police Chief John Barber is not totally convinced. He “firmly” supports other parts of the plan, but said “I am wary of supervised injection sites.”

Spokesmen for the Department of Health and Gov. Andrew Cuomo didn’t respond Monday to the AP’s request for comment. Cuomo has supported needle exchange programs and boosted funding for addiction prevention and treatment, but has yet to take a position on supervised injection.

Some pieces of Ithaca’s plan don’t need state approval, such as the creation of a new city office of drug policy and a youth apprenticeship program to give young people alternatives to drugs. Myrick also wants police to send low-level drug offenders to treatment instead of jail, adopting a strategy used in Seattle.

Canada’s first injection facility, known as “Insite,” opened in Vancouver in 2003. Every day, 800 users visit, and between 10 and 20 of them overdose each week, but no one has ever died there, according to Dr. Patricia Daly, chief medical health officer at Vancouver Coastal Health, which operates it.

“These overdoses are completely reversible,” Daly said. “People die because they inject alone.”

Insite receives most of its funding from government now, but faced significant initial opposition from officials in Ottawa. A 2011 Canadian Supreme Court decision ordered federal officials to stop fighting the facility, noting that it has saved lives “with no discernable negative impact.”

In fact, overdose deaths dropped 35 percent in the surrounding neighborhood after Insite opened its doors at ground zero for Vancouver’s heroin problem, according to research by Brown University epidemiologist Brandon D.L. Marshall.

In the U.S., state and federal laws would put both users and operators of such a facility at risk of arrest.

Even some former addicts say it should stay that way.

“We’re talking about a government-sponsored shooting gallery,” said Mike Gimbel, an addiction expert who served as drug czar in Baltimore County after beating heroin. “It’s misguided. The addict is going to say: this is cool, a place I don’t have to worry about the cops. Why should an addict stop if there are no consequences for their behavior?”

That said, more funding to provide wider access to effective treatment is the only solution, Gimbel said. “We all recognize we’re not going to be able to arrest our way out of this problem.”

Confronting the ‘heroin tsunami’ in Kootenai County, Idaho

Crushing news came shortly after Cindy Schaffner heard sirens just a few blocks from her Post Falls home.

The sirens, Schaffner learned, were for her 19-year-old daughter, Cathryn Mason.

Cathryn, who loved the outdoors and was majoring in recreation management at North Idaho College, was in critical condition. She’d overdosed on heroin and alcohol.

Cathryn died two days later after she was taken off of life support. That was in May 2014.

“She was a very driven and focused person,” Schaffner said, fighting back tears. “She loved to go on hikes and was full of life. She was celebrating getting good grades for the semester.”

Schaffner said it was the first time she was aware of that her daughter had used drugs.

“She had a strong sense of morals and values and she had faith, but, for whatever reason, she decided to compromise those values,” Schaffner said. “It was a surprise to all of us because she wasn’t a user.”

Cathryn was caught on the edge of what officials refer to as the “heroin tsunami,” a nationwide opioid abuse epidemic that Kootenai County has not been immune to in recent years.

“We have seen a significant increase in the usage of heroin in our community,” Post Falls Police Chief Scot Haug said.

Haug said the rise of heroin usage is due to two reasons. It is not only used as a recreational drug for the intense euphoria it induces, but it is an opioid painkiller that people turn to when they are taken off prescription medications or those medications aren’t offering as much relief as desired.

Heroin is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. It appears as a “China white” or brown powder or as a sticky black substance as “black tar” heroin.

Heroin can be injected, inhaled by snorting or sniffing, or smoked. All three methods deliver the drug to the brain rapidly, contributing to its health risks and high risk for addiction.

“Some experts believe that heroin is more addictive than meth and more difficult to detox off of,” Haug said.

The street value of heroin is about $300 per gram, according to police. It is usually sold by the “point” — or tenth of a gram — for $30.

While Cathryn, who graduated from Post Falls High in 2012, was not on painkillers, her sudden and unexpected death shows how lethal heroin can be, Schaffner said.

“Some do it for years and years, while others may try it once and it kills them,” she said. “It’s like playing Russian roulette.”

Rising numbers

News earlier this month that multiple law enforcement agencies had busted an alleged heroin ring that included a Coeur d’Alene physician put a local point on the severity of the problem nationally.

At least 28,648 people in the U.S. died of causes linked to opioid drugs in 2014, according to the U.S. Centers for Disease Control, almost as many as are killed annually in car crashes. The class of drugs includes heroin and prescription painkillers such as oxycodone.

A CDC report released last year revealed the number of U.S. heroin users has grown by nearly 300,000 over a decade.

Haug said heroin has surpassed methamphetamine as the most common drug behind marijuana in the community.

PFPD processed no heroin into its evidence storage in 2010, but it obtained 20 heroin items in 2013, 19 in 2014 and 21 in 2015 (the numbers do not reflect heroin-related medical calls).

Haug said he’s aware of several heroin-related deaths across Kootenai County around the time that Cathryn died. Investigations into some of those cases, including Cathryn’s death, continue.

Haug said his department receives heart-wrenching calls on almost a weekly basis from families of those using heroin who are desperate for help.

“But many times the users don’t want help,” he said. “The challenge for us is that we can’t knock down doors and force people to get help, but we point them and their families in the right direction when there’s opportunities.”

Kootenai County Sheriff Ben Wolfinger said the rise in heroin has a ripple effect in the community, from law enforcement to substance abuse councils to the mental health sector.

“It’s not just a law enforcement problem; it’s a community problem,” he said.

Dr. Joseph Abate, medical director at the nonprofit Heritage Health, said he believes one reason heroin has regained momentum is because it’s cheaper than some prescription painkillers.

“That’s an attraction to people who are using opioids without a doctor’s recommendation,” Abate said. “But people who have been on opioids with a doctor’s recommendation turn to heroin too because they have a problem with tolerance to pain, especially younger people. They may start on low doses of pain medication, then they take more and more to get the same amount of relief. It may not make sense to you or I, but to patients who are trying to get relief . 

“Part of the rise of heroin is that people start on painkillers for legitimate reasons and then it just gets out of control. In the past people received the message that pain could be controlled with the right dosage, but now we’ve learned the hard way that it does nothing more than make a person worse over the long term rather than better.”

Spirit Lake Police Chief Keith Hutcheson said as prescription drugs have become more regulated in response to the rise in addictions, people revert to illegal drugs such as heroin. It’s a vicious cycle, he said.

“Instead of buying pills on the street, they’re now buying heroin because it’s cheaper and they can get a higher high for a longer time,” Hutcheson said.

Combating the epidemic

One of the ways Heritage Health is trying to right the ship when no opioid is enough is to educate on “mindfulness-based solutions.”

“It’s thinking of pain differently, just something you learn to deal with,” Abate said. “It’s not us saying that pain is all in your head. What we’re saying is how you perceive your pain makes a difference in what you search for as the solution.”

Part of the program is sharing with others how pain affects your daily life and how you label it.

“A lot of people don’t have a chance to tell about how it affects your life,” Abate said.

Abate said if the only weapon in one’s toolbox to fight pain is opioids, it’s not likely you’ll find relief in a fashion that will allow you to live a reasonable life. Mindfulness solutions, exercise, physical therapy and acupuncture are other tools people can use to treat pain.

“There are better ways to treat pain rather than assuming the only thing that will make it go away is pain medicine,” he said. “If people are willing to look at why the pain is not very well-controlled, we can offer them other options so they are safely and reasonably treated without fear of an unintentional overdose.”

Abate said while there are good substance abuse treatment programs available, there aren’t a lot of affordable ones. He said providers also need to be educated on who the highest-risk populations are before prescribing medication.

Abate said there has been a push in recent years for providers to monitor patients more closely and lower the maximum doses of painkillers. He said emergency doctors will now often times refer frequent patients back to their primary care providers for pain medication.

At the national level, President Barack Obama will ask Congress for $1.1 billion in his next budget to combat the opioid abuse epidemic, which has emerged as a 2016 campaign issue. The amount Obama wants to spend over two years is slightly more than the $1 billion he’s requested to expedite cancer treatments.

“Prescription drug abuse and heroin use have taken a heartbreaking toll on too many Americans and their families while straining resources of law enforcement and treatment programs,” the White House said in a statement.

Abate said the number of people who seek urgent medical care after using heroin is limited.

“We usually don’t see them,” he said. “They don’t wander into the clinic looking for care. They’re more likely to be found by law enforcement.”

Lisa Aitken, Kootenai Health spokeswoman, said there also hasn’t been an increase in people coming to the hospital’s emergency room with heroin-related issues.

“That’s definitely not to say that the use of heroin is not on the rise; they are just not making it to the hospital at this point,” she said. “It’s sad to think that there are people not coming to the hospital if they are in need of medical care related to heroin use.”

Schaffner said that since her daughter died, young women who have struggled or have been tempted have gravitated toward her for support.

“You need to have open communication with your kids and you’ve got to know where they are at,” she said. “If they think you are overbearing, too bad. It’s for their own good.”

Schaffner said she still struggles with what caused Cathryn to make a “foolish choice.” She said her faith and two other daughters have helped her from “rolling into a ditch” after the tragedy.

“You’ve got to stay focused on the things you do have,” Schaffner said. “You can’t stop living when other people love you and need you. I have good memories of Cathryn, and I think about her every day. There’s a purpose and reason for things and some day I’ll understand.”

Published via the AP member exchange. 


Colorado police: Student who died in fall ate more pot than recommended

A Wyoming college student who jumped to his death at a Denver hotel had eaten more of a marijuana cookie than was recommended by a seller, police records show — a finding that comes amid increased concern about the strength of popular pot edibles after Colorado became the first state to legalize recreational marijuana.

Levy Thamba Pongi, 19, consumed more than one cookie purchased by a friend — even though a store clerk told the friend to cut each cookie into six pieces and to eat just one piece at a time, said the reports obtained late last week.

Pongi began shaking, screaming and throwing things around a hotel room before he jumped over a fourth-floor railing into the hotel lobby March 11. An autopsy report listed marijuana intoxication as a “significant contributing factor” in the death.

Marijuana cookies and other edibles have become increasingly popular since Colorado allowed people 21 and over to buy recreational marijuana this year at regulated stores. Federal authorities don’t regulate the edibles because marijuana remains illegal under federal law.

After voters approved recreational pot, Colorado lawmakers tasked regulators with setting potency-testing guidelines to ensure consumers know how much pot they’re eating. Those guidelines are expected to be released next month.

Lawmakers also required edible pot to be sold in serving sizes of 10 milligrams of THC, marijuana’s intoxicating chemical.

The cannabis industry tries to educate consumers about the potency of marijuana-infused foods. But despite the warnings — including waiting for up to an hour to feel any effects — complaints by visitors and first-time users have been rampant.

In a separate case, a Denver man accused of killing his wife while she was on the phone with a 911 dispatcher ate marijuana-infused candy and possibly took prescription pain medication before the attack, according to a search warrant affidavit released last week.

It wasn’t known if pot influenced the behavior of Richard Kirk, 47, who is accused of shooting Kristine Kirk, 44. The affidavit says the woman told a dispatcher her husband had ingested marijuana candy and was hallucinating.

Pongi, a native of the Republic of Congo, and three friends from Northwest College in Powell, Wyo., traveled to Colorado for spring break.

At their hotel, the group of four friends followed the seller’s instructions. But when Pongi felt nothing after about 30 minutes, he ate an entire cookie, police said.

Within an hour, he began speaking erratically in French, shaking, screaming and throwing things around the hotel room. At one point he appeared to talk to a lamp.

Pongi’s friends tried to restrain him before he left the room and jumped to his death, police said.

One of his friends told investigators it may have been his first time using marijuana — the only drug toxicology tests found in his system. All three friends said they did not purchase or take any other drugs during their stay.

“The thing to realize is the THC that is present in edibles is a drug, and as with any drug, there’s a spectrum of ways in which people respond,” said Michael Kosnett, a medical toxicologist on the clinical faculty at the University of Colorado School of Medicine.

He said a person’s genetic makeup, health issues and other factors can make a difference, and first-time users might consume too much, unaware of how their bodies will react.

“The possibility for misadventure is increased,” Kosnett said.

The marijuana concentration in Pongi’s blood was 7.2 nanograms of active THC per milliliter of blood. Colorado law says juries can assume someone is driving while impaired if their blood contains more than 5 nanograms per milliliter.

In the days that followed the death of Pongi, Denver police confiscated the remaining cookies from the pot shop to test their levels of THC. The wrapper of the cookies bought by the students said each contained 65 mg of THC for 6 1/2 servings. Tests showed the cookies were within the required THC limits, police said.

However, the wrappers also cautioned that “this marijuana product has not been tested for contaminants or potency.” One of Pongi’s friends became sick to his stomach after eating part of the cookie, but the others felt no negative effect.

Colorado law bans the sale of recreational marijuana products to people under 21, and adults can be charged with a felony for giving pot to someone under the legal age.

Authorities, however, said they would not press charges against Pongi’s 23-year-old friend who told police she bought the cookies while he waited outside the store. Denver district attorney’s spokeswoman Maro Casparian said investigators determined there was no crime. She declined to elaborate.

Another one bites the dust

New York City police said the Rev. Zachery Tims of Orlando was found dead on the floor of his room at the W Hotel in Times Square. Police found a glassine envelope with a white powdery substance inside the right pocket of his shorts. The substance is being tested to see “whether it played a role in Mr. Tims’ death,” officers told The Wall Street Journal.

Tims was the senior pastor of New Destiny Christian Center in Apopka, Fla., one of the largest congregations in the region. He also hosted and appeared on Christian television and radio programs.