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Tag: prescription drug abuse

  • ADHD medication abuse in schools is a ‘wake-up call’ | CNN

    ADHD medication abuse in schools is a ‘wake-up call’ | CNN



    CNN
     — 

    At some middle and high schools in the United States, 1 in 4 teens report they’ve abused prescription stimulants for attention deficit hyperactivity disorder during the year prior, a new study found.

    “This is the first national study to look at the nonmedical use of prescription stimulants by students in middle and high school, and we found a tremendous, wide range of misuse,” said lead author Sean Esteban McCabe, director of the Center for the Study of Drugs, Alcohol, Smoking and Health at the University of Michigan in Ann Arbor.

    “In some schools there was little to no misuse of stimulants, while in other schools more than 25% of students had used stimulants in nonmedical ways,” said McCabe, who is also a professor of nursing at the University of Michigan School of Nursing. “This study is a major wake-up call.”

    Nonmedical uses of stimulants can include taking more than a normal dose to get high, or taking the medication with alcohol or other drugs to boost a high, prior studies have found.

    Students also overuse medications or “use a pill that someone gave them due to a sense of stress around academics — they are trying to stay up late and study or finish papers,” said pediatrician Dr. Deepa Camenga, associate director of pediatric programs at the Yale Program in Addiction Medicine in New Haven, Connecticut.

    “We know this is happening in colleges. A major takeaway of the new study is that misuse and sharing of stimulant prescription medications is happening in middle and high schools, not just college,” said Camenga, who was not involved with the study.

    Published Tuesday in the journal JAMA Network Open, the study analyzed data collected between 2005 and 2020 by Monitoring the Future, a federal survey that has measured drug and alcohol use among secondary school students nationwide each year since 1975.

    In the data set used for this study, questionnaires were given to more than 230,000 teens in eighth, 10th and 12th grades in a nationally representative sample of 3,284 secondary schools.

    Schools with the highest rates of teens using prescribed ADHD medications were about 36% more likely to have students misusing prescription stimulants during the past year, the study found. Schools with few to no students currently using such treatments had much less of an issue, but it didn’t disappear, McCabe said.

    “We know that the two biggest sources are leftover medications, perhaps from family members such as siblings, and asking peers, who may attend other schools,” he said.

    Schools in the suburbs in all regions of the United States except the Northeast had higher rates of teen misuse of ADHD medications, as did schools where typically one or more parent had a college degree, according to the study.

    Schools with more White students and those who had medium levels of student binge drinking were also more likely to see teen abuse of stimulants.

    On an individual level, students who said they had used marijuana in the past 30 days were four times as likely to abuse ADHD medications than teens who did not use weed, according to the analysis.

    In addition, adolescents who said they used ADHD medications currently or in the past were about 2.5% more likely to have misused the stimulants when compared with peers who had never used stimulants, the study found.

    “But these findings were not being driven solely by teens with ADHD misusing their medications,” McCabe said. “We still found a significant association, even when we excluded students who were never prescribed ADHD therapy.”

    Data collection for the study was through 2020. Since then, new statistics show prescriptions for stimulants surged 10% during 2021 across most age groups. At the same time, there has been a nationwide shortage of Adderall, one of the most popular ADHD drugs, leaving many patients unable to fill or refill their prescriptions.

    The stakes are high: Taking stimulant medications improperly over time can result in stimulant use disorder, which can lead to anxiety, depression, psychosis and seizures, experts say.

    If overused or combined with alcohol or other drugs, there can be sudden health consequences. Side effects can include “paranoia, dangerously high body temperatures, and an irregular heartbeat, especially if stimulants are taken in large doses or in ways other than swallowing a pill,” according to the Substance Abuse and Mental Health Services Administration.

    Research has also shown people who misuse ADHD medications are highly likely to have multiple substance use disorders.

    Abuse of stimulant drugs has grown over the past two decades, experts say, as more adolescents are diagnosed and prescribed those medications — studies have shown 1 in every 9 high school seniors report taking stimulant therapy for ADHD, McCabe said.

    For children with ADHD who use their medications appropriately, stimulants can be effective treatment. They are “protective for the health of a child,” Camenga said. “Those adolescents diagnosed and treated correctly and monitored do very well — they have a lower risk of new mental health problems or new substance use disorders.”

    The solution to the problem of stimulant misuse among middle and high school teens isn’t to limit use of the medications for the children who really need them, McCabe stressed.

    “Instead, we need to look very long and hard at school strategies that are more or less effective in curbing stimulant medication misuse,” he said. “Parents can make sure the schools their kids attend have safe storage for medication and strict dispensing policies. And ask about prevalence of misuse — that data is available for every school.”

    Families can also help by talking to their children about how to handle peers who approach them wanting a pill or two to party or pull an all-night study session, he added.

    “You’d be surprised how many kids do not know what to say,” McCabe said. “Parents can role-play with their kids to give them options on what to say so they are ready when it happens.”

    Parents and guardians should always store controlled medications in a lockbox, and should not be afraid to count pills and stay on top of early refills, he added.

    “Finally, if parents suspect any type of misuse, they should contact their child’s prescriber right away,” McCabe said. “That child should be screened and assessed immediately.”

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  • Biden administration declares fentanyl laced with xylazine ‘an emerging threat’ in the US | CNN

    Biden administration declares fentanyl laced with xylazine ‘an emerging threat’ in the US | CNN



    CNN
     — 

    The White House has declared that the powerful synthetic opioid fentanyl combined with xylazine – an animal tranquilizer that’s increasingly being used in illicit drugs – is an “emerging threat” facing the United States due to its role in the ongoing opioid crisis.

    Administration officials call the threat FAAX, for fentanyl-adulterated or -associated xylazine.

    The move, announced Wednesday, marks the first time in history that any administration has declared a substance to be an emerging threat to the country, said Dr. Rahul Gupta, director of the Office of National Drug Control Policy. The SUPPORT Act of 2018 established that the office has authority to declare such “emerging threats,” and no administration has used it until now. Last year, Congress declared methamphetamine an emerging drug threat but none have been declared by an administration previously. Under other agencies or in separate circumstances, concerns such as bioterrorism, infectious diseases or climate change may be identified as “emerging threats.”

    “This drug, which is an animal sedative, is being mixed with fentanyl and is being found in almost all 50 states now,” Gupta said Tuesday. “It’s become an important part for us to make sure that we’re declaring it an emerging threat.”

    Now that the administration has declared fentanyl combined with xylazine an emerging threat, it has 90 days to coordinate a national response. “We are working quickly to develop and implement a whole of government nationwide plan, with real deliverable action, that will save lives and will be published within 90 days of this designation,” Gupta said.

    Xylazine, also known as tranq or tranq dope, has been linked to an increasing number of overdose deaths in the United States due to its rising illicit use. Between 2020 and 2021, overdose deaths involving xylazine increased more than 1,000% in the South, 750% in the West and about 500% in the Midwest, according to an intelligence report released last year by the US Drug Enforcement Administration.

    And in some cases, people might not even know that xylazine was in the drug they used.

    Just last month, authorities at the DEA issued a public safety alert about the “widespread threat” of fentanyl mixed with xylazine, reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.

    Fentanyl, which has been driving the opioid crisis, is a fast-acting opioid, and people who use it illicitly say that adding xylazine can extend the duration of the high the drug provides.

    Xylazine is not an opioid. It is approved by the US Food and Drug Administration for use as a tranquilizer in veterinary medicine, typically in horses, but it is not approved for use in humans. And xylazine can do major damage to the human body, including leaving drug users with severe skin ulcers, soft-tissue wounds and necrosis – sometimes described as rotting skin – that can lead to amputation.

    “Xylazine is one of the contaminants in fentanyl, but there could be others,” Gupta said. “So, I think with the declaration of an emerging threat, we’re sending a clear message to producers and traffickers of illicit xylazine and illicit fentanyl that we’re going to respond quicker, we’re going to match the challenge of evolution of these drugs supply, and that we’re going to protect lives first and foremost.”

    Now that xylazine has been declared an emerging threat, some of President Biden’s $46 billion drug budget request to Congress can be used to respond.

    This year, the Biden administration announced that the President has called on Congress to invest $46.1 billion for agencies overseen by the Office of National Drug Control Policy to tackle the nation’s illicit drug crisis.

    If the budget request is not approved, there could be the option to reallocate money within the Office of National Drug Control Policy, but “we don’t want to be in a position where moneys that are being utilized for some other important aspect of saving lives has to be moved away for this purpose,” Gupta said Tuesday. “That is the reason we are asking Congress to act.”

    Such funds could be used to test drugs on the street for xylazine, collect data on FAAX, invest in care for people exposed to FAAX and develop potential treatments for a xylazine-related overdose.

    The medication naloxone, also known as Narcan, is an antidote for an opioid overdose, but people who have overdosed on a combination of opioids and xylazine may not immediately wake up after taking naloxone, as it may not reverse the effects of xylazine in the same way it does opioids.

    “We need to recognize, first of all, that there is a shift that is occurring from organic compounds and substances like heroin and cocaine to more synthetics,” Gupta said of the state of the nation’s illicit drug crisis.

    “Both the types of drugs have changed – from predominantly organic to predominantly synthetics – but the way drugs are bought and sold have also changed,” he said. “Now, all you need is a phone in the palm of your hand and a social media app to order and buy some of the most dangerous substances on planet Earth.”

    Xylazine is just one of the many adulterants – or substances that are typically added to others – found in the nation’s illicit drug supply.

    “All of a sudden, you can synthesize hundreds of compounds and kind of mix them together and see what does the best in the market,” Joseph Friedman, a researcher at the University of California, Los Angeles, told CNN in March. “People are synthesizing new benzodiazepines, new stimulants, new cannabinoids constantly and adding them into the drug supply. So people have no idea what they’re buying and what they’re consuming.”

    Some of these adulterants may be as simple as sugar or artificial sweeteners added for taste or additives or fillers that bulk up the drug. Sometimes, they may be contaminants left over from the manufacturing process.

    But all of these things can carry real-life health harms, says Naburan Dasgupta, an epidemiologist and senior scientist at the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill.

    Like an opioid, xylazine can depress the respiratory system, so the risk of overdose multiplies when it’s combined with heroin or fentanyl.

    Also, “in the veterinary literature, we know that it causes a really bad severe form of anemia. And so when people are injecting heroin that’s contaminated with xylazine, they can end up with a near-fatal form of blood iron deficiency,” Dasgupta said in March. “We had one person here who ended up going to the hospital needing multiple blood transfusions. And it was all because of the xylazine.”

    US lawmakers are moving to classify xylazine as a controlled substance.

    In March, bipartisan legislation – the Combating Illicit Xylazine Act – was introduced in the House and Senate. It describes illicit xylazine as an “urgent threat to public health and safety” and calls for it to be a Schedule III drug under the Controlled Substances Act, a category on the five-level system for substances with moderate to low potential for physical or psychological dependence. Xylazine would be one level below opioids like fentanyl.

    “Our bipartisan bill would take important steps to combat the abuse of xylazine by giving law enforcement more authority to crack down on the illicit distribution of this drug, including by putting stiffer penalties on criminals who are spreading this drug to our communities,” Sen. Maggie Hassan, D-N.H., said in a statement in March.

    The bill would also require manufacturers to send reports on production and distribution to the DEA so the agency can ensure that the product is not being diverted to the black market.

    “This bill recognizes the dangers posed by the increasing abuse of animal tranquilizers by drug traffickers, and provides new tools to combat this deadly trend,” Sen. Chuck Grassley, R-Iowa, said in the statement.

    “It also ensures that folks like veterinarians, ranchers and cattlemen can continue to access these drugs for bona fide animal treatment.”

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  • The US sanctioned Chinese companies to fight illicit fentanyl. But the drug’s ingredients keep coming | CNN

    The US sanctioned Chinese companies to fight illicit fentanyl. But the drug’s ingredients keep coming | CNN



    CNN
     — 

    The seller, who went by the name Linda Wang, was curt when asked if she sold a chemical often used to create fentanyl.

    “That’s banned,” Wang replied, before quickly providing an alternative: “CAS79099 powder is best. U can have a try.” 

    After more than a week of back and forth, she seemed impatient. “Ok. 79099 powder in USA warehouse now…if you need. Pls order asap,” she wrote in a text message exchange.

    The interaction is part of a CNN investigation that explored whether US-sanctioned chemical companies in China are evading Washington DC’s crackdown on illicitly made fentanyl – finding at least one China-based company that had links to a sanctioned entity, and a seller eager to ship potential ingredients for the lethal drug.

    More than 100,000 Americans died from drug overdoses in 2021, and two-thirds of the fatalities involved synthetic opioids – much of it believed from illicitly made fentanyl, according to the Centers for Disease Control.

    The drug can be 50 times stronger than heroin and 100 times stronger than morphine – and pharmaceutical grade versions of it can be prescribed by doctors for severe pain. But illegally manufactured fentanyl has turbocharged the US’s opioid overdose crisis in the last decade, according to data from the CDC.

    Controlling the illegal trade of the drug has turned into a geopolitical headache for the Biden administration, as China’s vast chemicals market – which supplies the world with raw materials for everything from perfume to explosives– is also a major pipeline of the building blocks of fentanyl, known as fentanyl precursors, according to US officials. 

    Further complicating the fight against fentanyl is the sheer variety of precursors that can be used to make fentanyl and other illicit drugs. Most such precursors also have legitimate uses – including for medical research – and are perfectly legal to sell, making up part of the booming transnational trade.

    China has strict anti-drug policies domestically, but critics in the US say it is not doing enough to help monitor or regulate purchases from buyers aiming to use Chinese-made ingredients to manufacture illegal drugs overseas.

    In 2019, Beijing stepped up its crack down on the production and sale of finished fentanyl and its variants, but US-China anti-drug cooperation has since stalled amid disagreements on trade, human rights, the Covid-19 outbreak and Taiwan. Hopes that US Secretary of State Antony Blinken would bring up fentanyl during a planned visit to Beijing died in early February, when Blinken postponed his trip after a surveillance balloon from China floated over the continental US. 

    As the opioid crisis topped the domestic agenda in 2021, the US sanctioned four companies in China accused of exporting fentanyl or fentanyl precursor chemicals. Online commercial records suggest ties between one of those sanctioned companies, Hebei Atun Trading Co., Ltd., and another China-based company called Shanxi Naipu Import and Export Co., Ltd., that continues to sell fentanyl precursors legally.

    According to official public records in China, Hebei Atun Trading Co., Ltd., began liquidating in June 2021 and was formally dissolved in August that year. Shanxi Naipu Import and Export Co., Ltd. was registered in the same period, according to official records, and it shares a number of key things in common with Hebei Atun.

    For example, Hebei Atun’s still-active Facebook page once linked to a now-defunct website of Shanxi Naipu – which is where CNN found Wang’s phone number.

    The two companies’ websites are registered to the same email address, and at one time appeared to share an IP address. Today, Shanxi Naipu’s websites appear to be carbon copies of Hebei Atun’s since-deleted page – with the same navigation tabs, email address and stock photo of a pipette dropping amber-colored liquid into a cell tray. The Russian and Portuguese versions of the site list “Hebei Atun Trading Co. Ltd.” as their copyright holder.

    One post on a Shanxi Naipu website was titled, “Hebei ATUN Trading Co., Ltd. Wishes you a Happy New Year!” (sic). It has since been deleted. 

    When presented with CNN’s findings, Shanxi Naipu denied ties to Hebei Atun, saying, “we are not related at all.” In statements emailed to CNN, Shanxi Naipu said it had purchased the sanctioned company’s Facebook account, email and cell phone number in order to “attract internet traffic.”

    Shanxi Naipu also denied selling the fentanyl precursor that Wang offered by text, and stressed that everything they sell is legal, and said that they were taking steps to stop the repercussions from the apparent links to Hebei Atun.

    “To prevent further impact from Hebei Atun, we have immediately removed relevant promotional websites and platforms,” the company said in an emailed statement.”

    Logan Pauley, a China analyst who tracks criminal and drug networks, told CNN, “It’s easy on the Chinese side to start a new company to copy and paste the same text that you’re posting on social media or you’re posting on a trade website, and then just to recreate the same operation over and over again.”

    And Gary Hufbauer, trade expert at the Peterson Institute for International Economics and former US treasury official, likens it to a game of cat-and-mouse. While the US government can add an entity to its sanctions list “overnight,” said Hufbauer, there may not be the resources in the US Treasury’s Office of Foreign Assets Control, which enforces sanctions, to keep tabs on new companies that may leverage sanctioned companies’ branding or operations. 

    In a statement to CNN, a spokesperson for the US Treasury said it “had not hesitated” to go after “bad actors” – citing the four sanctioned Chinese companies – and would continue to sanction companies and individuals involved in the drug trade.

    “Treasury continues to monitor the effects of our designations,” they said. “If additional information becomes available that can assist sanctions compliance efforts, when appropriate, we provide that information to industry and/or the public.”

    Asked if Beijing was knowingly lax in its efforts to stem the flow of precursor chemicals from its country, the Chinese Foreign Ministry pointed out that most were not controlled substances, in a lengthy statement that also questioned US efforts to treat addiction and demand for opioids.

    “China has always strictly controlled precursor chemicals in accordance with international conventions and domestic laws. The US side’s so-called ‘fentanyl precursors,’ a small number of them are listed substances by the United Nations, and China has always been resolute in implementing the listed measures. But most of the rest are common chemicals that are not listed by the United Nations, China or even the United States itself,” it said in a written statement to CNN.

    “Government departments do not have the right or the possibility to regulate non-listed chemicals and common commodities,” it added.

    The ministry statement went on to highlight China’s harsh domestic penalties on drug trade and consumption. “The Chinese people deeply resent drugs. the Opium War was the beginning of China’s modern history of humiliation. The Chinese government has always cracked down on drug crime, and China is a no-go area for international drug dealers.”

     Such unregulated precursors, like the one offered by Wang, are not illegal to sell but can be used in the manufacture of illicit substances like fentanyl, methamphetamine, and cocaine.

    Several precursors used to create fentanyl have been put under international control since 2017, but a savvy chemical engineer can combine legal precursors further up the synthesis chain to make similar compounds.

    “What we have seen illicit chemists doing now is that certain components of the synthesis are now … harder for them to purchase, so what they’re doing now is they’re buying compounds that are structurally very, very similar,” Alexandra Evans, a forensic chemist with the D.C. Department of Forensic Sciences, told CNN from her lab in the US capital.

    Or they can create fentanyl analogues, substitutes that are chemically similar to fentanyl and which has made the crisis more deadly in recent years. One fentanyl analogue was found to be 10,000 times stronger than morphine, according to a 2021 US government report.

    Controlling the stream of chemicals has turned into a deadly game of whack-a-mole – where manufacturers are able to use a variety of precursors to synthesize fentanyl and its analogues faster than either can be identified, banned, or regulated. 

    Many of the building blocks to fentanyl have benign purposes and are legal to buy, but a menu Wang sent of Shanxi Naipu’s chemical products for sale appeared designed to support illegal drug manufacture, according to a synthetic chemist who analyzed the list for CNN. 

    It was “obviously a list curated to help people create illicit drugs,” Lyle Isaacs, a professor in the Department of Chemistry and Biochemistry at the University of Maryland, told CNN of the more than 25 chemical compounds on the menu. 

    At least three compounds on the list could be made into fentanyl, he said. One of the compounds, CAS 79099-07-3, also known as 1-Boc-4-piperidone, was what Wang offered to sell CNN; the other two compounds also have legitimate uses and can be found, for example, in academic laboratories researching future medicines, Isaacs said. 

    Still more compounds on the list appeared to be building blocks for meth, ecstasy, ketamine, and the cutting of cocaine, as well as over-the-counter drugs like paracetamol, a common pain medication that can also be used to cut heroin and other narcotics, he added. 

    Asked about the list, Shanxi Naipu reiterated in its statement to CNN that all products on it are legal in China, stating: “We are not professional chemists but just a trading company. Even though we don’t have an intimate knowledge of the composition and use of thousands of chemicals, we have always strictly ensured the legality of our products!”

    Attempts to contact Wang through the company for comment were not successful, and the company said in its statement that she no longer works for them.

    There are measures that responsible chemical sellers can take to avoid their products being used for illegal drugs.

    Identity checks are a hallmark of reputable sellers, said a former Drug Enforcement Administration (DEA) official. The source spoke to CNN on the condition of anonymity because they were not authorized to speak to the media. To sell non-listed chemicals, a good-faith seller would normally ask a buyer about the intended use of the compound, and whether the buyer had the backing of a company or institution, such as a research organization or university.  

    American buyers of regulated chemicals require licenses from the DEA, depending on how hazardous they are. Reputable sellers may also ask for tax identifications even for chemicals that are not controlled, like precursor materials, the source said.

    At no point in the conversation was Wang aware, nor did she ask for the identities of the CNN reporters speaking to her or what CNN planned on using it for. She even offered a “door to door” precursor delivery service via warehouses in the US or Mexico – locations that CNN has been unable to verify.

    In its statement to CNN, Shanxi Naipu denied that it had warehouses in either country.

    The small quantity of precursor needed to manufacture fentanyl ultimately makes shipments destined for illicit ends hard to catch at the border, points out Martin Raithelhuber, an illicit synthetic drugs expert at the United Nations Office on Drugs and Crime.

    “You have hundreds of thousands of tonnes (of chemicals in a shipment), and you are looking for a few kilograms, which are sufficient to produce a supply of millions of doses (of fentanyl),” he said. 

    Since China banned the production of fentanyl and related substances in 2019, Mexican criminal organizations have largely taken control of the drug’s production and sale, smuggling finished fentanyl to consumers in the US, according to a 2022 report from the Congressional Research Service.

    Mexico is now the source of “the vast majority” of meth, heroin and illicit fentanyl seized in the US, according to the US International Narcotics Control Strategy Report (INCSR) released in March 2023. “In 2022, the United States identified Mexico as the sole significant source of illicit fentanyl and fentanyl analogues significantly affecting the United States,” it reads.

    “Criminal elements, mostly in the People’s Republic of China, ship precursor chemicals to Mexico, where they are used to produce illicit fentanyl,” Dr. Rahul Gupta, director of the White House’s Office of National Drug Control Policy, told the Senate Foreign Relations Committee earlier this year. 

    “The only limit on how much fentanyl they can make is the amount of precursor chemicals they can get,” DEA Administrator Anne Milgram told CNN in early March.

    The Biden administration has taken aim at these groups and in February sanctioned a network of Sinaloa Cartel members and associated entities for their involvement in the fentanyl and methamphetamine trade. 

    Mexico’s law enforcement has also fought the trade, seizing and impounding hundreds of kilos of fentanyl precursors and pills – including a cache of over a million potential fentanyl pills in the Mexican border city of Tijuana on March 13.

    Ultimately, tackling fentanyl requires close coordination between the US, Mexico, and China. Even if countries like Mexico had the best national control measures, international cooperation is needed to understand “which flows are the ones we need to watch or [be] worried about,” Raithelhuber said.

    Former DEA official Matthew Donahue told CNN he would like to see Mexico do more, including cracking down on properties and other assets of those involved in the drug trade.

    But as the US pressures other governments to help slow the flow of illicit fentanyl, relations between the three countries have turned into a three-way blame game.

    Following the kidnapping of four Americans in a Mexican border town by cartel members in early March, US Republicans called for the US military to be allowed to fight cartels and destroy drug labs in Mexico – something Mexican President Andrés Manuel López Obrador called “an offense to the people of Mexico.” 

    “We are not a protectorate of the United States or a colony of the United States. Mexico is a free, independent, sovereign country. We don’t take orders from anyone,” López Obrador said at a news conference on March 9. 

    Washington has also called on Beijing to do more, with the latest US INCSR report describing China’s oversight functions as “poorly staffed and under-resourced to oversee its massive chemical industry.” Though it acknowledges Beijing’s harsh penalties for drug trafficking, the report laments ineffective controls on shipment labeling, customer vetting and pill-making equipment.

    The Ministry of Foreign Affairs’ statement to CNN emphasizes its “stringent” control of listed chemicals that could be used for drug-making and argues that Beijing has “improved” several “regulatory mechanisms such as end-user verification, leakage monitoring, and source backtracking, and has strengthened management of more than 200,000 chemical companies.”

    Both China and Mexico have called on the US to do some soul-searching about demand for illicit fentanyl.

    “US legislators and the authorities there are not doing their job because they are not addressing the causes (of addiction); there are no care programs for young people in the US,” López-Obrador said last week.

    “Using China as a scapegoat will not solve the drug crisis in the United States … ,” the Chinese Foreign Ministry’s statement to CNN read. “We advise the US side to reflect on itself, stop shifting blame, strengthen domestic prescription drug control, enhance publicity on the dangers of drugs, and take practical measures to reduce domestic drug demand.”

    Prescription opioids like oxycodone and hydrocodone – which have a similar chemical structure to heroin and fentanyl – were major contributors to the early opioid crisis in the US. Pharmaceutical giants, notably Purdue Pharma, downplayed the potentially addictive properties of the drugs and incentivized US doctors to prescribe the painkillers. But prescribing was curtailed as overdoses from prescription opioids climbed and now waves of heroin and illicit fentanyl took over, making the crisis far more deadly. 

    Amid the recriminations, fentanyl products continue to pour through US borders and Americans continue to die. 

    To raise awareness of the human toll, the US Drug Enforcement Administration last year created “The Faces of Fentanyl” exhibit at its headquarters in Arlington, Virginia where families can submit a photo of a loved one lost to the fentanyl crisis. So far more than 5,000 photos have been submitted.

    “We can’t be desensitized” to the number of lives lost to drug overdoses,” Donahue, the former DEA official, said. “The pain and suffering that these families are going through. That has got to mean something.” 

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  • Fact check: Republicans at CPAC make false claims about Biden, Zelensky, the FBI and children | CNN Politics

    Fact check: Republicans at CPAC make false claims about Biden, Zelensky, the FBI and children | CNN Politics


    Washington
    CNN
     — 

    The Conservative Political Action Conference is underway in Maryland. And the members of Congress, former government officials and conservative personalities who spoke at the conference on Thursday and Friday made false claims about a variety of topics.

    Rep. Jim Jordan of Ohio uttered two false claims about President Joe Biden. Rep. Marjorie Taylor Greene of Georgia repeated a debunked claim about Ukrainian President Volodymyr Zelensky. Sen. Tommy Tuberville of Alabama used two inaccurate statistics as he lamented the state of the country. Former Trump White House official Steve Bannon repeated his regular lie about the 2020 election having been stolen from Trump, this time baselesly blaming Fox for Trump’s defeat.

    Rep. Kat Cammack of Florida incorrectly said a former Obama administration official had encouraged people to harass Supreme Court Justice Brett Kavanaugh. Rep. Ralph Norman of South Carolina inaccurately claimed Biden had laughed at a grieving mother and inaccurately insinuated that the FBI tipped off the media to its search of former President Donald Trump’s Florida residence. Two other speakers, Rep. Scott Perry of Pennsylvania and former Trump administration official Sebastian Gorka, inflated the number of deaths from fentanyl.

    And that’s not all. Here is a fact check of 13 false claims from the conference, which continues on Saturday.

    Marjorie Taylor Greene said the Republican Party has a duty to protect children. Listing supposed threats to children, she said, “Now whether it’s like Zelensky saying he wants our sons and daughters to go die in Ukraine…” Later in her speech, she said, “I will look at a camera and directly tell Zelensky: you’d better leave your hands off of our sons and daughters, because they’re not dying over there.”

    Facts First: Greene’s claim is false. Ukrainian President Volodymyr Zelensky didn’t say he wants American sons and daughters to fight or die for Ukraine. The false claim, which was debunked by CNN and others earlier in the week, is based on a viral video that clipped Zelensky’s comments out of context.

    19-second video of Zelensky goes viral. See what was edited out

    In reality, Zelensky predicted at a press conference in late February that if Ukraine loses the war against Russia because it does not receive sufficient support from elsewhere, Russia will proceed to enter North Atlantic Treaty Organization member countries in the Baltics (a region made up of Latvia, Lithuania and Estonia) that the US will be obligated to send troops to defend. Under the treaty that governs NATO, an attack on one member is considered an attack on all. Ukraine is not a NATO member, and Zelensky didn’t say Americans should fight there.

    Greene is one of the people who shared the out-of-context video on Twitter this week. You can read a full fact-check, with Zelensky’s complete quote, here.

    Right-wing commentator and former Trump White House chief strategist Steve Bannon criticized right-wing cable channel Fox at length for, he argued, being insufficiently supportive of Trump’s 2024 presidential campaign. Among other things, Bannon claimed that, on the night of the election in November 2020, “Fox News illegitimately called it for the opposition and not Donald J. Trump, of which our nation has never recovered.” Later, he said Trump is running again after “having it stolen, in broad daylight, of which they [Fox] participate in.”

    Facts First: This is nonsense. On election night in 2020, Fox accurately projected that Biden had won the state of Arizona. This projection did not change the outcome of the election; all of the votes are counted regardless of what media outlets have projected, and the counting showed that Biden won Arizona, and the election, fair and square. The 2020 election was not “stolen” from Trump.

    NATIONAL HARBOR, MARYLAND - MARCH 03: Former White House chief strategist for the Trump Administration Steve Bannon speaks during the annual Conservative Political Action Conference (CPAC) at the Gaylord National Resort Hotel And Convention Center on March 03, 2023 in National Harbor, Maryland. The annual conservative conference entered its second day of speakers including congressional members, media personalities and members of former President Donald Trump's administration. President Donald Trump will address the event on Saturday.  (Photo by Anna Moneymaker/Getty Images)

    Bannon has a harsh message for Fox News at CPAC

    Fox, like other major media outlets, did not project that Biden had won the presidency until four days later. Fox personalities went on to repeatedly promote lies that the election was stolen from Trump – even as they privately dismissed and mocked these false claims, according to court filings from a voting technology company that is suing Fox for defamation.

    Rep. Jim Jordan claimed that Biden, “on day one,” made “three key changes” to immigration policy. Jordan said one of those changes was this: “We’re not going to deport anyone who come.” He proceeded to argue that people knowing “we’re not going to get deported” was a reason they decided to migrate to the US under Biden.

    Facts First: Jordan inaccurately described the 100-day deportation pause that Biden attempted to impose immediately after he took office on January 20, 2021. The policy did not say the US wouldn’t deport “anyone who comes.” It explicitly did not apply to anyone who arrived in the country after the end of October 2020, meaning people who arrived under the Biden administration or in the last months of the Trump administration could still be deported.

    Biden did say during the 2020 Democratic primary that “no one, no one will be deported at all” in his first 100 days as president. But Jordan claimed that this was the policy Biden actually implemented on his first day in office; Biden’s actual first-day policy was considerably narrower.

    Biden’s attempted 100-day pause also did not apply to people who engaged in or were suspected of terrorism or espionage, were seen to pose a national security risk, had waived their right to remain in the US, or whom the acting director of Immigration and Customs Enforcement determined the law required to be removed.

    The pause was supposed to be in effect while the Department of Homeland Security conducted a review of immigration enforcement practices, but it was blocked by a federal judge shortly after it was announced.

    Rep. Ralph Norman strongly suggested the FBI had tipped off the media to its August search of Trump’s Mar-a-Lago home and resort in Florida for government documents in the former president’s possession – while concealing its subsequent document searches of properties connected to Biden.

    Norman said: “When I saw the raid at Mar-a-Lago – you know, the cameras, the FBI – and compare that to when they found Biden’s, all of the documents he had, where was the media, where was the FBI? They kept it quiet early on, didn’t let it out. The job of the next president is going to be getting rid of the insiders that are undermining this government, and you’ve gotta clean house.”

    Facts First: Norman’s narrative is false. The FBI did not tip off the media to its search of Mar-a-Lago; CNN reported the next day that the search “happened so quietly, so secretly, that it wasn’t caught on camera at all.” Rather, media outlets belatedly sent cameras to Mar-a-Lago because Peter Schorsch, publisher of the website Florida Politics, learned of the search from non-FBI sources and tweeted about it either after it was over or as it was just concluding, and because Trump himself made a public statement less than 20 minutes later confirming that a search had occurred. Schorsch told CNN on Thursday: “I can, unequivocally, state that the FBI was not one of my two sources which alerted me to the raid.”

    Brian Stelter, then CNN’s chief media correspondent, wrote in his article the day after the search: “By the time local TV news cameras showed up outside the club, there was almost nothing to see. Websites used file photos of the Florida resort since there were no dramatic shots of the search.”

    It’s true that the public didn’t find out until late January about the FBI’s November search of Biden’s former think tank office in Washington, which was conducted with the consent of Biden’s legal team. But the belated presence of journalists at Mar-a-Lago on the day of the Trump search in August is not evidence of a double standard.

    And it’s worth noting that media cameras were on the scene when Biden’s beach home in Delaware was searched by the FBI in February. News outlets had set up a media “pool” to make sure any search there was recorded.

    Sen. Tommy Tuberville, a former college and high school football coach, said, “Going into thousands of kids’ homes and talking to parents every year recruiting, half the kids in this country – I’m not talking about race, I’m just talking about – half the kids in this country have one or no parent. And it’s because of the attack on faith. People are losing faith because, for some reason, because the attack [on] God.”

    Facts First: Tuberville’s claim that half of American children don’t have two parents is incorrect. Official figures from the Census Bureau show that, in 2021, about 70% of US children under the age of 18 lived with two parents and about 65% lived with two married parents.

    About 22% of children lived with only a mother, about 5% with only a father, and about 3% with no parent. But the Census Bureau has explained that even children who are listed as living with only one parent may have a second parent; children are listed as living with only one parent if, for example, one parent is deployed overseas with the military or if their divorced parents share custody of them.

    It is true that the percentage of US children living in households with two parents has been declining for decades. Still, Tuberville’s statistic significantly exaggerated the current situation. His spokesperson told CNN on Thursday that the senator was speaking “anecdotally” from his personal experience meeting with families as a football coach.

    Tuberville claimed that today’s children are being “indoctrinated” in schools by “woke” ideology and critical race theory. He then said, “We don’t teach reading, writing and arithmetic anymore. You know, half the kids in this country, when they graduate – think about this: half the kids in this country, when they graduate, can’t read their diploma.”

    Facts First: This is false. While many Americans do struggle with reading, there is no basis for the claim that “half” of high school graduates can’t read a basic document like a diploma. “Mr. Tuberville does not know what he’s talking about at all,” said Patricia Edwards, a Michigan State University professor of language and literacy who is a past president of the International Literacy Association and the Literacy Research Association. Edwards said there is “no evidence” to support Tuberville’s claim. She also said that people who can’t read at all are highly unlikely to finish high school and that “sometimes politicians embellish information.”

    Tuberville could have accurately said that a significant number of American teenagers and adults have reading trouble, though there is no apparent basis for connecting these struggles with supposed “woke” indoctrination. The organization ProLiteracy pointed CNN to 2017 data that found 23% of Americans age 16 to 65 have “low” literacy skills in English. That’s not “half,” as ProLiteracy pointed out, and it includes people who didn’t graduate from high school and people who are able to read basic text but struggle with more complex literacy tasks.

    The Tuberville spokesperson said the senator was speaking informally after having been briefed on other statistics about Americans’ struggles with reading, like a report that half of adults can’t read a book written at an eighth-grade level.

    Rep. Jim Jordan claimed of Biden: “The president of the United States stood in front of Independence Hall, called half the country fascists.”

    Facts First: This is not true. Biden did not denounce even close to “half the country” in this 2022 speech at Independence Hall in Philadelphia. He made clear that he was speaking about a minority of Republicans.

    In the speech, in which he never used the word “fascists,” Biden warned that “MAGA Republicans” like Trump are “extreme,” “do not respect the Constitution” and “do not believe in the rule of law.” But he also emphasized that “not every Republican, not even the majority of Republicans, are MAGA Republicans.” In other words, he made clear that he was talking about far less than half of Americans.

    Trump earned fewer than 75 million votes in 2020 in a country of more than 258 million adults, so even a hypothetical criticism of every single Trump voter would not amount to criticism of “half the country.”

    Rep. Scott Perry claimed that “average citizens need to just at some point be willing to acknowledge and accept that every single facet of the federal government is weaponized against every single one of us.” Perry said moments later, “The government doesn’t have the right to tell you that you can’t buy a gas stove but that you must buy an electric vehicle.”

    Facts First: This is nonsense. The federal government has not told people that they can’t buy a gas stove or must buy an electric vehicle.

    The Biden administration has tried to encourage and incentivize the adoption of electric vehicles, but it has not tried to forbid the manufacture or purchase of traditional vehicles with internal combustion engines. Biden has set a goal of electric vehicles making up half of all new vehicles sold in the US by 2030.

    There was a January controversy about a Biden appointee to the United States Consumer Product Safety Commission, Richard Trumka Jr., saying that gas stoves pose a “hidden hazard,” as they emit air pollutants, and that “any option is on the table. Products that can’t be made safe can be banned.” But the commission as a whole has not shown support for a ban, and White House press secretary Karine Jean-Pierre said at a January press briefing: “The president does not support banning gas stoves. And the Consumer Product Safety Commission, which is independent, is not banning gas stoves.”

    Rep. Ralph Norman claimed that Biden had just laughed at a mother who lost two sons to fentanyl.

    “I don’t know whether y’all saw, I just saw it this morning: Biden laughing at the mother who had two sons – to die, and he’s basically laughing and saying the fentanyl came from the previous administration. Who cares where it came from? The fact is it’s here,” Norman said.

    Facts First: Norman’s claim is false. Biden did not laugh at the mother who lost her sons to fentanyl, the anti-abortion activist Rebecca Kiessling; in a somber tone, he called her “a poor mother who lost two kids to fentanyl.” Rather, he proceeded to laugh about how Republican Rep. Marjorie Taylor Greene had baselessly blamed the Biden administration for the young men’s deaths even though the tragedy happened in mid-2020, during the Trump administration. You can watch the video of Biden’s remarks here.

    Kiessling has demanded an apology from Biden. She is entitled to her criticism of Biden’s remarks and his chuckle – but the video clearly shows Norman was wrong when he claimed Biden was “laughing at the mother.”

    Rep. Kat Cammack told a story about the first hearing of the new Republican-led House select subcommittee on the supposed “weaponization” of the federal government. Cammack claimed she had asked a Democratic witness at this February hearing about his “incredibly vitriolic” Twitter feed in which, she claimed, he not only repeatedly criticized Supreme Court Justice Brett Kavanaugh but even went “so far as to encourage people to harass this Supreme Court justice.”

    Facts First: This story is false. The witness Cammack questioned in this February exchange at the subcommittee, former Obama administration deputy assistant attorney general Elliot Williams, did not encourage people to harass Kavanaugh. In fact, it’s not even true that Cammack accused him at the February hearing of having encouraged people to harass Kavanaugh. Rather, at the hearing, she merely claimed that Williams had tweeted numerous critical tweets about Kavanaugh but had been “unusually quiet” on Twitter after an alleged assassination attempt against the justice. Clearly, not tweeting about the incident is not the same thing as encouraging harassment.

    Williams, now a CNN legal analyst (he appeared at the subcommittee hearing in his personal capacity), said in a Thursday email that he had “no idea” what Cammack was looking at on his innocuous Twitter feed. He said: “I used to prosecute violent crimes, and clerked for two federal judges. Any suggestion that I’ve ever encouraged harassment of anyone – and particularly any official of the United States – is insulting and not based in reality.”

    Cammack’s spokesperson responded helpfully on Thursday to CNN’s initial queries about the story Cammack told at CPAC, explaining that she was referring to her February exchange with Williams. But the spokesperson stopped responding after CNN asked if Cammack was accurately describing this exchange with Williams and if they had any evidence of Williams actually having encouraged the harassment of Kavanaugh.

    Sen. John Kennedy of Louisiana boasted about the state of the country “when Republicans were in charge.” Among other claims about Trump’s tenure, he said that “in four years,” Republicans “delivered 3.5% unemployment” and “created 8 million new jobs.”

    Facts First: This is inaccurate in two ways. First, the economic numbers for the full “four years” of Trump’s tenure are much worse than these numbers Kennedy cited; Kennedy was actually referring to Trump’s first three years while ignoring the fourth, which was marred by the Covid-19 pandemic. Second, there weren’t “8 million new jobs” created even in Trump’s first three years.

    Kennedy could have correctly said there was a 3.5% unemployment rate after three years of the Trump administration, but not after four. The unemployment rate skyrocketed early in Trump’s fourth year, on account of the pandemic, before coming down again, and it was 6.3% when Trump left office in early 2021. (It fell to 3.4% this January under Biden, better than in any month under Trump.)

    And while the economy added about 6.7 million jobs under Trump before the pandemic-related crash of March and April 2020, that’s not the “8 million jobs” Kennedy claimed – and the economy ended up shedding millions of jobs in Trump’s fourth year. Over the full four years of Trump’s tenure, the economy netted a loss of about 2.7 million jobs.

    Lara Trump, Donald Trump’s daughter-in-law and an adviser to his 2020 campaign, claimed that the last time a CPAC crowd was gathered at this venue in Maryland, in February 2020, “We had the lowest unemployment in American history.” After making other boasts about Donald Trump’s presidency, she said, “But how quickly it all changed.” She added, “Under Joe Biden, America is crumbling.”

    Facts First: Lara Trump’s claim about February 2020 having “the lowest unemployment in American history” is false. The unemployment rate was 3.5% at the time – tied for the lowest since 1969, but not the all-time lowest on record, which was 2.5% in 1953. And while Lara Trump didn’t make an explicit claim about unemployment under Biden, it’s not true that things are worse today on this measure; again, the most recent unemployment rate, 3.4% for January 2023, is better than the rate at the time of CPAC’s 2020 conference or at any other time during Donald Trump’s presidency.

    Multiple speakers at CPAC decried the high number of fentanyl overdose deaths. But some of the speakers inflated that number while attacking Biden’s immigration policy.

    Sebastian Gorka, a former Trump administration official, claimed that “in the last 12 months in America, deaths by fentanyl poisoning totaled 110,000 Americans.” He blamed “Biden’s open border” for these deaths.

    Rep. Scott Perry claimed: “Meanwhile over on this side of the border, where there isn’t anybody, they’re running this fentanyl in; it’s killing 100,000 Americans – over 100,000 Americans – a year.”

    Facts First: It’s not true that there are more than 100,000 fentanyl deaths per year. That is the total number of deaths from all drug overdoses in the US; there were 106,699 such deaths in 2021. But the number of overdose deaths involving synthetic opioids other than methadone, primarily fentanyl, is smaller – 70,601 in 2021.

    Fentanyl-related overdoses are clearly a major problem for the country and by far the biggest single contributor to the broader overdose problem. Nonetheless, claims of “110,000” and “over 100,000” fentanyl deaths per year are significant exaggerations. And while the number of overdose deaths and fentanyl-related deaths increased under Biden in 2021, it was also troubling under Trump in 2020 – 91,799 total overdose deaths and 56,516 for synthetic opioids other than methadone.

    It’s also worth noting that fentanyl is largely smuggled in by US citizens through legal ports of entry rather than by migrants sneaking past other parts of the border. Contrary to frequent Republican claims, the border is not “open”; border officers have seized thousands of pounds of fentanyl under Biden.

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  • More than 4.5 million fentanyl pills, 3,000 pounds of methamphetamine seized in Arizona investigation, DEA says | CNN

    More than 4.5 million fentanyl pills, 3,000 pounds of methamphetamine seized in Arizona investigation, DEA says | CNN



    CNN
     — 

    Arizona authorities targeting the Sinaloa drug cartel have seized narcotics estimated to be worth more than $13 million, including more than 4.5 million fentanyl pills, 3,100 pounds of methamphetamine and large quantities of heroin, cocaine and fentanyl powder, according to the Drug Enforcement Administration.

    In a news release, the agency said the seizure was the culmination of a three-year-long investigation during which 150 people had so far been charged.

    “The fentanyl seized represents more than 30 million potentially lethal doses,” the DEA said, announcing the seizure in partnership with the Tempe Police Department and Arizona Attorney General Kris Mayes.

    Authorities displayed some of the recovered narcotics at a joint news conference Thursday, attended by CNN affiliate KNXV.

    “The sample you see here today is staggering. There are over 4.5 million fentanyl pills, over 140 pounds of fentanyl powder, over 135 kilos of cocaine, over 3,000 pounds of methamphetamine, 35 kilos of heroin, 49 firearms and over $2 million in cash,” Interim Tempe Police Chief Josie Montenegro told reporters.

    Montenegro said the substances recovered “would be poisoning members of our community, including our youth and vulnerable population,” had the seizures not been made.

    “In addition, the dangers and crimes associated with illegal drugs would be plaguing our community,” Montenegro added.

    According to authorities, “numerous” people were taken into custody in the bust. At this time, authorities do not plan on releasing the names of those involved because it is a continuing investigation, according to Montenegro.

    Phoenix DEA Special Agent in Charge Cheri Oz said investigators are “laser-focused” on the Sinaloa cartel.

    “I want to be crystal clear, the drugs in this room and the drugs that are flooding Arizona every single day are sourced primarily by one evil as the Sinaloa drug cartel,” she said at the news conference. “We are laser-focused on the Sinaloa drug cartel and we will defeat them. We will not stop.”

    Oz also praised the efforts of DEA agents and other officers over the last three years. “Their hard work and tenacity is responsible for removing these deadly drugs before they poisoned our family, our friends and our neighborhoods,” she said.

    The country is struggling with a decades-long opioid epidemic in which fentanyl has become the most commonly used drug involved in overdoses.

    Pharmaceutical fentanyl is a synthetic opioid intended to help patients manage severe pain. It is 50 to 100 times more potent than morphine, and typically prescribed in the form of skin patches or lozenges. But most recent cases of fentanyl-related harm, overdose, and death in the United States are linked to illegally made fentanyl, according to the US Centers for Disease Control and Prevention.

    Deaths involving synthetic opioids increased by 22% in 2021, according to CDC data, and in 2022, there were about 181,806 nonfatal opioid overdoses recorded in the United States.

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  • After recent student fentanyl overdoses in Texas community, court documents reveal drug supplier lived blocks away from schools | CNN

    After recent student fentanyl overdoses in Texas community, court documents reveal drug supplier lived blocks away from schools | CNN



    CNN
     — 

    Parents across the Carrollton-Farmers Branch Independent School District (CFBISD), located in a Dallas, Texas, suburb, are reeling following a string fentanyl overdoses by nine students who attend schools in the district.

    The students, who range in age from 13 to 17 and are not identified by name in court documents, overdosed between September 18, 2022 and February 1, 2023. Three of the students died, and one of the students, a 14-year-old girl, overdosed twice, according to a statement by the US Attorney’s Office, Northern District of Texas.

    Law enforcement officers traced the drugs the students overdosed on to a house within walking distance from a middle school and a high school, court documents say.

    “First with all the school shootings, now this with drugs,” Lupe Rebadan, who has two children, as well as nieces and nephews, attending schools in the district told CNN. “Our kids are not safe at school… When is this all going to stop?”

    Luis Eduardo Navarette and Magaly Mejia Cano have been charged with conspiracy to distribute fentanyl, according to the US Attorney’s Office.

    “To deal fentanyl is to knowingly imperil lives. To deal fentanyl to minors – naive middle and high school students – is to shatter futures. These defendants’ alleged actions are simply despicable,” US Attorney Leigha Simonton said in the statement.

    The complaint illuminates a network of drug dealers and users, most of them teenagers who attend R.L. Turner High School, Dan Long Middle School and Dewitt Perry Middle School, and traced the proliferation of fentanyl tainted “M30” pills to Navarette and Cano’s residence.

    International drug trafficking organizations often produce M30 pills by mixing highly addictive fentanyl with acetaminophen “and other binder type substances and pressed into various tablets/pills,” says an affidavit by a Drug Enforcement Administration task force officer included in the criminal complaint.

    Many fake pills are made to look like prescription opioids such as oxycodone (Oxycontin, Percocet), hydrocodone (Vicodin), and alprazolam (Xanax); or stimulants like amphetamines (Adderall),” according to the DEA’s “One Pill Can Kill” website.

    Criminal organizations, according to the DEA officer’s affidavit, sell M30 pills for $1 to $2 dollars per pill when the purchasers buy in bulk amounts. Those are later sold to “street level dealers” for $3 to $5 per pill, and later sold to consumers for $10 per pill.

    Law enforcement tracked multiple teenagers engaging in “hand-to-hand transactions” with Navarette and Cano outside of their house, which is approximately five blocks from R.L. Turner High School and two blocks from DeWitt Perry Middle School, the court documents reveal.

    On January 12, a Carrollton Street Crimes Unit detective observed a 16-year-old obtain M30 pills from Navarette and Cano’s residence.

    The teenager appeared to crush and snort a pill on their front porch, “possibly package” the drugs, then walk toward the high school, where he was enrolled, according to the complaint.

    The school was notified by law enforcement, and later that day a school resource officer located the teenager in a bathroom making a “snorting sound” and appearing intoxicated.

    Navarette and Cano made their initial appearances in court on Monday, Erin Dooley of the US Attorney’s Office in Northern Texas told CNN. Naverette waived his right to a detention hearing and was ordered detained pending trial, and Cano had her detention hearing on Friday, she added. Attorneys for Navarette and Cano haven’t responded to CNN’s requests for comment.

    Days after the complaint outlining the 10 overdoses became available to the public, CFBISD released a statement expressing sorrow and concern over “the loss of young lives.”

    The district explained how it has educated the community about the threat from fentanyl over the past several months.

    “We will continue to work cooperatively with local law enforcement agencies to address this issue and to maximize safety on our campuses in every way possible. We believe if we work together as a community, we can avoid these tragedies,” the district said.

    The district said Narcan, or naloxone, an emergency drug used to treat fentanyl overdoses, had been obtained for all district facilities in October and random canine searches were being conducted on secondary campuses.

    Drug awareness presentations for parents will also resume this year, according to the district.

    “The fentanyl crisis is claiming far too many young Texans,” Texas Governor Greg Abbott tweeted Wednesday. Abbott launched the #OnePillKills campaign in October 2022 to “combat the growing national fentanyl crisis plaguing Texas.”

    In the first week of school in 2022, four students died from “fentanyl poisoning, or suspected poisoning” in Hays County Independent School District (HCISD), located in a suburb of Austin. This prompted the district to create “Fighting Fentanyl,” an informational campaign warning students and faculty about the deadly drug.

    Tim Savoy, the chief communication officer at HCISD, noted that the district has spent tens of millions of dollars for preventative measures against school shootings and Covid-19, two issues that have affected schools nationwide. The fentanyl crisis on school campuses deserves the same level of concern and response, he said.

    “This is a threat. We’re losing students, too. And so we made the decision that we have to get this equal attention and resources and do what we can,” Savoy told CNN.

    Despite the district’s awareness-raising campaign, an email from the superintendent on January 9 informed parents of “three more suspected accidental fentanyl poisonings” and one death in which fentanyl may have been to blame.

    “Our students are dying from this, and we have to do what we can,” Savoy said. “This is not just something that you’re seeing elsewhere. This is really happening in our community.”

    According to the Centers for Disease Control and Prevention, median monthly overdose deaths among 10- to 19-year-olds across the United States involving illicitly manufactured fentanyl surged 182% from December 2019 to December 2021.

    Adolescents are particularly vulnerable to fentanyl exposure due to the “proliferation of counterfeit pills resembling prescription drugs containing IMFs (illicitly manufactured fentanyls), and the ease of purchasing pills through social media,” according to the CDC.

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  • Tracking the opioid crisis: Inside the DEA’s secret lab | CNN

    Tracking the opioid crisis: Inside the DEA’s secret lab | CNN

    Watch CNN Films’ “American Pain” at 9 p.m. ET Sunday, February 5.



    CNN
     — 

    Sitting among the warehouses of Dulles, Virginia, is one of the US Drug Enforcement Administration’s forensic labs. It’s one of eight across the country where scientists analyze illegal drugs and try to stay ahead of what’s driving deadly overdoses.

    Starting in the late 1990s with overprescribing of prescription narcotics, the opioid epidemic has continued to plague the United States for decades. What has changed is the type of drugs that have killed more than half a million people during the past 20 years.

    CNN was granted rare access to the secret lab where the DEA tests seized illicit drugs to understand what’s coming next.

    “The market is constantly changing, so we are trying to do everything we can from a science base to keep up with that,” Scott Oulton, deputy assistant administrator of the DEA’s Office of Forensic Sciences, told CNN Chief Medical Correspondent Dr. Sanjay Gupta.

    Holding a white bag of fentanyl precursor powder – one of the chemicals used to make the opioid – Oulton explained that the illicitly made painkiller continues to be a dominant presence in the drugs officials are finding.

    “This kilogram can be converted into fentanyl to make approximately 800 grams,” he said. “So it doesn’t take that much material, it’s fairly cheap, it’s inexpensive to obtain.”

    Fentanyl is the deadliest drug in the United States, and it’s often found in combination with other illicit drugs, including cocaine and heroin. But increasingly, fentanyl is showing up in illicit pills disguised as common prescription drugs like oxycodone, hydrocodone, even Adderall.

    Users buying drugs on the street that look like prescription pills may end up with a highly potent, potentially deadly drug they never intended to take.

    “Over 99% of what we see are fake. They contain fentanyl,” Oulton says of the pills that the agency is seizing.

    The 800 grams of fentanyl that Oulton held could be turned into 400,000 to 500,000 potentially lethal pills.

    As more and more of these lethal pills circulate, the opioid epidemic is reaching more of the population.

    Deena Loudon of Olney, Maryland, is among those living with its effects.

    “I truly love sharing Matthew with the world,” Loudon says as she flips through pictures of her son.

    One of her favorite memories is Matthew playing hockey – what Loudon calls his happy place.

    Matthew Loudon's mom says he turned to drugs after struggling with anxiety.

    But she also recalls his struggles with anxiety, which led him to turn to drugs. He started dabbling in them in the 10th grade. By the following year, his grades began to fall, and he couldn’t keep them high enough to stay in hockey.

    “He was using Xanax to help self-medicate himself and I think to help get rid of some of that angst so he could live somewhat of a normal life,” Loudon said.

    Matthew was always honest, almost to a fault, Loudon says. “He told me he tried everything. Like everything. Heroin, meth, crack, you name it, cocaine, whatever – until I guess he found what made him feel the best, and it was Xanax.”

    And as much as a mother can worry, Loudon says, Matthew always tried to reassure her. “I know what I’m doing,” he would tell her.

    She had heard about fentanyl showing up in pills in their area.

    “But you don’t ever think it’s going to happen to you,” Loudon said.

    She said they even had a conversation about fentanyl the day before he died. “I was sort of naive, wanting to stick my head in the sand and thinking ‘I bet he does know what he’s doing.’ ”

    On November 3, 2020, she found 21-year-old Matthew on the floor of their basement.

    Matthew’s autopsy report lists his cause of death as fentanyl and despropionyl fentanyl intoxication.

    “I don’t say he overdosed. I say he died from fentanyl poisoning. … Truthfully, like, at the end of the day, to me, he was murdered, right? Because he asked for one thing. They gave him something different. And it took his life.”

    For a parent, she said, the hardest thing is burying their child. It’s a pain she speaks out about in hopes of keeping other families safe.

    “It’s Russian roulette,” she warns them. “You never know what you’re gonna get.”

    The number of pills the DEA has seized skyrocketed in just three years, from 2.2 million in 2019 to 50.6 million in 2022.

    The sheer volume of pills has been one of the biggest challenges for the DEA’s lab, Oulton says. As the fentanyl threat continues to grow, the Virginia facility is expanding to accommodate the analysis needed.

    The lab can test for something as simple as the presence of fentanyl, but something called the purity of the pill also offers important insight. This means how much fentanyl is actually in one of these illicit pills.

    “Lately, we’ve been seeing a purity increase over the last year, where we used to say roughly four out of the 10 seizures that we were receiving would contain a lethal dose of greater than 2 milligrams. As of October last year, we started reporting that we’ve seen an uptick. Now we’re saying that six out of 10 of the seizures that we’re receiving contain over 2 milligrams,” Oulton said.

    He says they’re finding an average of 2.3 milligrams of fentanyl in each pill.

    Two milligrams may be the cutoff for what is considered lethal, but Oulton says that doesn’t necessarily mean a pill with 1.99 milligrams of fentanyl can’t be deadly.

    “One pill can kill” is his warning.

    “The message I would like to send out is, don’t take it,” he said. “Don’t take the chance. It’s not worth your life.”

    Oulton says he and his team are constantly finding new and different drugs and substances in pills – things they’ve never seen before.

    One machine in the lab is almost the equivalent of an MRI in a medical office, showing the structure and detail of a pill.

    “We will do what we call structural elucidation to determine that this is a different version of a fentanyl that’s got a new compound and molecule that’s been added to it,” Oulton said.

    They’ve seen “hundreds and hundreds of unique combinations,” he said.

    “We’ll see one that contains fentanyl, one with fentanyl and xylazine, one with fentanyl and caffeine, one with fentanyl and acetaminophen, and you don’t know what you’re getting.”

    Xylazine, a veterinary tranquilizer, poses a unique problem. It’s not an opioid, so even when it’s mixed with fentanyl, drugs designed to reverse an opioid overdose may not work.

    Narcan or naloxone, one of the more common overdose-reversing drugs, has become increasingly necessary as the prevalence and potency of illicit drugs increases. About 1.2 million doses of naloxone were dispensed by retail pharmacies in 2021, according to data published by the American Medical Association – nearly nine times more than were dispensed five years earlier.

    Oulton wants to be clear: The problem Isn’t with pills prescribed by your doctor and dispensed by a pharmacy – it’s the pills on the illicit market.

    Those, Matthew’s mother warns, are easy to get.

    “The first pills [Matthew] got was in high school. And it was just flipping out, floating around, and it was easy for him to get his hands on,” she said.

    Loudon’s message for parents now: Keep your eyes open.

    “Just be mindful of what your children are doing. You just just have to keep your eyes open. And even sometimes, when you keep your eyes open, you can miss some of the warning signs, but I think a parent knows their child best, so just keep talking.”

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  • Blinken under pressure to push China on role in lethal fentanyl trade when he visits Beijing | CNN Politics

    Blinken under pressure to push China on role in lethal fentanyl trade when he visits Beijing | CNN Politics



    CNN
     — 

    Members of Congress are urging Secretary of State Antony Blinken to pressure China to do more to curb the flow of fentanyl and synthetic opioids into the United States on his visit to the country which is expected to take place in the next few days.

    On Wednesday, a group of 14 Republican senators led by Marco Rubio of Florida wrote to Blinken ahead of his trip highlighting China’s role in the “fentanyl crisis” as one of many issues they wanted him to address.

    More than 100,000 Americans died of drug overdoses from July of 2021 to July of 2022 and two thirds of those deaths were fueled by synthetic opioids, primarily fentanyl, according to the CDC.

    An extremely powerful synthetic drug, fentanyl is 50 to 100 times more potent than morphine and 30 to 50 times more potent than heroin.

    The Chinese government cracked down on the manufacture and distribution of fentanyl in 2019, in a move that was hailed by the Trump administration. As a result, China it is no longer the primary source of fentanyl getting into the US. But it’s still the key source of precursor chemicals which are often shipped to Mexico and used by cartels to produce fentanyl which is brought over the border.

    “China is the leading producer of these precursor chemicals and is shipping and selling them to the two major Mexican cartels (Sinaloa and New Generation) producing fentanyl,” explained David Luckey, a senior international and defense researcher at RAND Corporation.

    “Virtually 98% of the precursor chemicals that are made used to make fentanyl are coming from China,” Democratic Rep. David Trone of Maryland told CNN. Getting China to engage on this crisis “has got to be Secretary Blinken’s number one mission when he gets there.”

    Experts and lawmakers say the production of precursor chemicals in China is a primary factor fueling the ongoing opioid crisis.

    “Synthetic opioid trafficking is an area where even a few meaningful steps from the PRC (People’s Republic of China) can play a significant role in combating this worsening epidemic and saving American lives,” Trone wrote in a letter to Blinken last month. He urged Blinken not to negotiate with Chinese officials on other topics until he has secured a commitment from Beijing to do more to stem the fentanyl crisis.

    Trone, whose nephew died of a fentanyl overdose, believes China should commit to adopting rules requiring drug companies to know who their customers are, put into place and enforce export regulations on the chemical sector, and cooperate with US agencies including the Drug Enforcement Administration and Office of National Drug Control Policy to crack down on the fentanyl trade.

    Blinken has directed his team at the State Department to work with interagency partners to do “everything possible” to address this deadly crisis which is the leading killer of Americans between the ages of 18 to 49, State Department spokesperson Ned Price said earlier this year.

    But it’s unclear what direct asks he will make of the Chinese government during his visit.

    “Though its past action has helped to counter illicit synthetic drugs, we continue to urge the PRC to take additional meaningful concrete action to curb the diversion of precursor chemicals and equipment used by criminals to manufacture fentanyl and other synthetic drugs,” Price said.

    Some lawmakers believe that Blinken should offer trade talks with China if it engages on efforts related to stemming the fentanyl crisis. Yet other congressional aides say that China will only respond to pressure and believe that the administration should consider steps including additional sanctions related to the dangerous substances – to force their engagement.

    Todd Robinson, the top State Department official for international narcotics and law enforcement affairs, said that the effective way to approach the challenge will be through “collaboration and cooperation.”

    “China has its own problems with narcotics. Mexico has problems has its problems with narcotics. Colombia also has a problem. And what we’ve been saying is, this is no longer an issue where you can solely use one or the other. Everybody’s got a problem.”

    But the need for Chinese engagement is clear: reducing the supply of precursor chemicals from China would have a “huge” impact on the crisis and would “mean a dramatic decrease” in US deaths resulting from drug overdoses, Robinson said.

    China is the largest producer of chemicals that are in everyday products such as cleaning supplies. Many Chinese companies have begun producing and selling the precursor chemicals in addition to the chemicals they have already been producing.

    Challenges to tackling the root of the problem persist when China and other countries often turn the tables on the US and blame Americans for the addiction problem which drives the demand.

    “It’s not as simple as saying, ‘China, stop producing and exporting these chemicals’. There are several sides to this issue. In response, China, for example, could counter with, ‘Americans, stop buying and using drugs,’” said Luckey.

    Many Americans with a direct connection to the crisis are watching Blinken’s trip closely.

    West Virginia – which had more than 1,300 deaths due to synthetic opioids from March of 2021 to March of 2022, according to the CDC – is an epicenter of the domestic crisis.

    Jordan Dennison lives in the state, grew up with parents who were drug addicts, and developed his own opioid addiction in his teens. A few years ago – after more than 10 overdoses – he finally got clean. The 30-year-old now works at an outreach program to get addicts into treatment.

    “Drugs led me to lose everything. Every relationship I ever had. I came to learn that what I was using was not heroine it was fentanyl. I was getting it off the street, I would go anywhere to get it,” he told CNN. “I never knew where it came from, but I always assumed it was coming from China.”

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  • Justice Department sues pharmaceutical company for allegedly failing to report suspicious opioid sales | CNN Politics

    Justice Department sues pharmaceutical company for allegedly failing to report suspicious opioid sales | CNN Politics


    Washington
    CNN
     — 

    The Justice Department on Thursday alleged that the AmerisourceBergen Corporation, one of the country’s largest pharmaceutical distributors, and two of its subsidiaries failed to report hundreds of thousands of suspicious prescription opioid orders to pharmacies across the country.

    The lawsuit, which spans several states, alleges that AmerisourceBergen disregarded its legal obligation to report orders of controlled substances to the Drug Enforcement Agency for nearly a decade. The company ignored “red flags” that pharmacies in West Virginia, New Jersey, Colorado and Florida were diverting opioids into illegal drug markets, the suit says.

    “The Department of Justice is committed to holding accountable those who fueled the opioid crisis by flouting the law,” Associate Attorney General Vanita Gupta said in a statement Thursday.

    “Companies distributing opioids are required to report suspicious orders to federal law enforcement. Our complaint alleges that AmerisourceBergen – which sold billions of units of prescription opioids over the past decade – repeatedly failed to comply with that requirement,” she added.

    If AmerisourceBergen is found liable at trial, the company faces billions of dollars in financial penalties, the Justice Department said.

    Lauren Esposito, a spokesperson for AmerisourceBergen, countered on Thursday in a statement that said the Justice Department’s complaint rested on “five pharmacies that were cherry picked out of the tens of thousands of pharmacies that use AmerisourceBergen as their wholesale distributor, while ignoring the absence of action from former administrators at the Drug Enforcement Administration – the DOJ’s own agency.”

    She added: “With the vast quantity of information that AmerisourceBergen shared directly with the DEA with regards to these five pharmacies, the DEA still did not feel the need to take swift action itself – in fact, AmerisourceBergen terminated relationships with four of them before DEA ever took any enforcement action while two of the five pharmacies maintain their DEA controlled substance registration to this day.”

    Yet AmerisourceBergen was allegedly aware that in two of the pharmacies, drugs it distributed were likely being sold in parking lots for cash, the Justice Department said. In another pharmacy, the company was allegedly warned that patients likely suffering from addiction were receiving opioids, including some people who later died of a drug overdose.

    The Justice Department also noted in its lawsuit that AmerisourceBergen’s reporting systems for suspicious opioid orders were deeply inadequate, and that the company intentionally changed its reporting systems to reduce the number of orders flagged as suspicious amid the opioid epidemic.

    Even when orders were flagged as suspicious, AmerisourceBergen often didn’t report those orders to the DEA, according to the complaint.

    Opioids are involved in the vast majority of drug overdose deaths, though synthetic opioids – particularly fentanyl – have played an outsized role. Synthetic opioids – excluding methadone – were involved in more than 72,000 overdose deaths in 2021, about two-thirds of all overdose deaths that year and more than triple the number from five years earlier.

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  • There aren’t enough facilities to treat all kids hooked on opioids | CNN Politics

    There aren’t enough facilities to treat all kids hooked on opioids | CNN Politics

    A version of this story appears in CNN’s What Matters newsletter. To get it in your inbox, sign up for free here.



    CNN
     — 

    After writing several previous newsletters on the stunning rise in opioid overdoses in the US, including among adolescents, I thought it was worth taking a look at what happens after an overdose, particularly for adolescents.

    I talked to Dr. Sivabalaji Kaliamurthy about what he’s encountering. A child and adolescent addiction psychiatrist who is board certified in general psychiatry, child psychiatry and addiction psychiatry, Kaliamurthy is also the director of the addiction clinic at Children’s National Hospital in Washington, DC.

    He told me that his clinic, which he set up in early 2022, has gone from getting one or two opioid use referrals per month to eight or more per month now, a year later.

    He particularly wanted to discuss some major news: The opioid overdose antidote naloxone, sold as Narcan, got approval from the US Food and Drug Administration on March 29, the day we talked, to be sold over the counter.

    Excerpts from our conversation, edited for flow, are below.

    WOLF: What is your reaction to Narcan being available over the counter?

    KALIAMURTHY: When I do an evaluation (of a patient), regardless of the substance use, you’re always talking about naloxone, brand name Narcan. …

    The message that I present parents with is always that it’s kind of like having a fire extinguisher at home. You hope you never need to use it, but you’re glad that you have it if you need to use it.

    Access is important. There are some controversies around increasing access to naloxone and fears that this may encourage more substance use. We have scientific research looking into this very specific question.

    And overall, there’s one study that came out this month that found that across 44 states where they increased access to naloxone for adolescents, it did not increase the rates of substance use in this population. And in some states, it actually decreased opioid use among adolescents. …

    The FDA approved the over-the-counter sale of naloxone, specifically the brand Narcan, because of how easily it can be administered. Naloxone also comes in other formulations, like injections, but Narcan is a nasal spray. We’re hoping that it will be out later this summer.

    The challenge remains how much is it going to cost? On average, it can cost anywhere between $50 to $100 right now. If it becomes over-the-counter, we don’t want insurances to stop covering [it].

    It will be interesting to see how the manufacturer goes about introducing it over the counter.

    WOLF: You said it’s like a fire extinguisher. Should everybody have it, or just people whose kids have demonstrated addictive behavior?

    KALIAMURTHY: Everyone should have it. Naloxone is not a treatment; it is more of an antidote. It reverses opioid overdoses, and the person who has the opioid overdose is never the one who’s going to use it somewhere in the community.

    WOLF: I’ve reported on a surge in overdoses. What are you seeing at Children’s?

    KALIAMURTHY: We are seeing an increase in the number of kids presenting to the hospital after experiencing an opioid overdose, and in general, opioid overdose deaths in the DMV (Washington, DC, Maryland, Virginia) region have significantly increased in the last two years. That aligns with a national trend we are seeing with regards to opioid overdoses.

    WOLF: Is there a profile for who these kids are? Do they share any traits?

    KALIAMURTHY: Yes. Let me talk about the kids we do see for opioid-related concerns first.

    At Children’s National, children often present after experiencing an overdose or having a medical complication because of using these M30, or the fake Percocet pills. We’ve had kids come in following conditions such as preliminary hemorrhage, where they were bleeding into their lungs, and overdose is not the only concern.

    Apart from that, we also have had kids presenting actively using these pills. They haven’t overdosed yet but they’re asking for help to stop using these pills.

    Some things that we have noticed, and this is the trend across the DMV region … the kids who are presenting to treatment, these are kids who are motivated to stop – they predominantly identify as Hispanic in ethnicity. Most of them have Medicaid for insurance.

    A lot of them, you know, they come to us – the average age is about 16, 16½ and their first use of opioids, these pills, was about a year ago. So the average first use was about 15 to 15½ years of age. They are really struggling, and they want to get better.

    KALIAMURTHY: Another common trait: cannabis use is quite common in this population. Pretty much every patient that I’ve come across started off around age 12 using cannabis products. This includes the flower and bud, vapes or edibles. Soon they transition to using the M30 pills.

    There are various different reasons, one of which is just access. A lot of other kids are using it. They’re using it in schools. They try it, they like it, and then it escalates and they stop using other substances.

    Most of these kids start off with crushing and try it nasally by snorting it and then they transition to smoking. What they do is they put these pills on a piece of aluminum foil, heat it up and inhale the fumes that come up. We haven’t had anyone come in who reported using any of these pills intravenously.

    WOLF: How is treatment for adolescents different than treating adult users who are seeking help?

    KALIAMURTHY: We have to take into consideration their developmental age and the psychological development that’s happening in adolescence, which is very different from adults.

    Oftentimes, this is the first point of entry into opioid use for these kids. Fentanyl, which is one of the most powerful opioids of abuse out there, is the first point of entry into opioid use for these children.

    Where for adults, they might have been prescribed pain medications. Or they might have started on opioids through other routes and might have used less potent products before transitioning to fentanyl.

    KALIAMURTHY: Historically, adolescents were not always the most motivated to seek treatment for substance use. What we would see was they would start off with experimenting, there would be a problem, it would take a few years and they’re adults by the time they’ve entered treatment and they’re trying different things to treat themselves before they enter treatment.

    With adolescents, now we are seeing that they can tell that they need help, and they are motivated and they are entering treatment.

    We have to take into account the presence of parents or guardians, how the school system interacts with them, what else do they do in their communities. There’s an increased association of violence and legal trouble that some of these patients end up in that we need to address while treating them. And these are some differences when it comes to treating adolescents versus adults.

    WOLF: One local community’s opioid response coordinator stressed to me that lack of availability of treatment is a real problem. Is that something that you agree with?

    KALIAMURTHY: Absolutely. That is a real problem at this point, because there is a huge discrepancy between the number of kids who need treatment and the available resources.

    The challenge is we can limit access and prevent these kids from getting the pills. But then you have a huge population of kids who are dependent on these pills, who can’t tolerate withdrawal symptoms, who have what we call opioid use disorder. That is going to perpetuate the problem if we’re not treating them. We need to do more in terms of increasing access to care for these kids.

    WOLF: Can you illustrate that capacity issue for me, through numbers or data? Or is it more anecdotal?

    KALIAMURTHY: Treatment is across different realms.

    For example, when a child is using these pills, and they have a problem with substance use, they need to go and be evaluated by a professional who has expertise in both addressing and evaluating mental health and addiction problems. And we don’t have very many people being able to do that.

    KALIAMURTHY: The first-time response is usually a counselor or social worker, sometimes physicians.

    But generally, there’s very little expertise in the pediatric health space with regards to addressing substance use-related problems. Screening is the point of entry.

    KALIAMURTHY: Then, say they need detox beds. Once they’ve entered treatment, we want to help them get through those initial days when their body is kind of adjusting to not using these pills, and we refer to that as detox.

    At Children’s National Hospital, when the kids come to the emergency room, we are not able to admit them for detoxes all the time. Sometimes we do end up admitting them.

    This depends on the availability of beds. The number of pediatric beds is very small to begin with. And beds may not always be available when somebody presents to the emergency room detox.

    And then there’s who is on call? Who’s available to treat these kids? I spoke about the lack of expertise in general, across the pediatric health space, so all that will determine whether a child is able to get access to detox services.

    That’s the detox part of treatment, which can be anywhere between two to five days.

    Detox doesn’t always mean somebody needs to be admitted. I also do outpatient detox where we are helping kids stop by providing them with medications and guiding their parents or guardians and the child on how to go through detox.

    KALIAMURTHY: Once you go through detox, depending on the extent of the problem, a child may require admission to a rehabilitation facility for anywhere between a month to six months.

    When we look at the number of facilities in the DMV region that provide this kind of rehab, I don’t think Virginia has any, DC doesn’t have any, Maryland has two. One is Sandstone Treatment Center, which is a private institution. The other is a treatment center, which is closer to Baltimore. There’s a limitation on who they can take.

    WOLF: Let me interrupt you. In a region that has millions of people, there are only two facilities that will take adolescents for one to six months’ treatment for substance use?

    KALIAMURTHY: Yes. For substance use.

    WOLF: Is that just a function of there’s more demand for those kinds of facilities among older people who are more likely to face addiction problems? Is that something the system is pivoting to address right now?

    KALIAMURTHY: It’s unclear. The system wants to help, but the challenge is historically adolescents are not always the most eager and motivated to get help.

    When we look at treatment programs, that didn’t exist in the past. They often relied on the judicial system, where some of these kids might have been mandated to treatment.

    Now we know that substance use disorders are chronic disorders and mandates don’t always work. Courts have stopped mandating treatment, because it’s like you mandate it for a month and then they come out and then what happens? There’s a lot of issues with mandating treatment.

    Now, most of the programs that were present prior to the pandemic also shut down during the pandemic because the needs also declined.

    This is not financially lucrative. That’s one reason why they’re having a huge issue with finding systems and having the county or the state take over with regards to creating the system.

    WOLF: I cut you off there. You were moving from the one-to-six-month facility to the next step in the process.

    KALIAMURTHY: So the next step is really engaging these kids in treatment. Not all kids require one to six months. Some kids might be OK with just completing detox and engaging in regular outpatient level of care. This might involve what we call intensive outpatient combined with medication.

    Which is where I would come in. A lot of what I do is provide medications for addiction treatment. These medications, the first part is for the detox to help with the child’s symptoms, but once you go through withdrawals, you can still have significant cravings to go back to using.

    The challenge, again, is the number of facilities. There are more options for intensive outpatient, but again, they are packed. The wait times to get in are longer now, and some of them are just virtual-only options, which may be good for some kids, but some kids might need more inpatient help.

    KALIAMURTHY: After this step, we have regular outpatient therapy and recovery support services, which is also lacking.

    The recovery support services are services which help kids get back on track academically. Catch up with your credit, get up on your grades and form a healthy, functioning resume. Get help finding part-time jobs. Keep these kids engaged in activities outside of school so that they are less likely to go back to the path that they were on which led to the substance use.

    WOLF: What’s your message to parents who are trying to keep an eye on their kids?

    KALIAMURTHY: Let’s look at the national-level data that we have collected up to 2021. Substance use is actually on the decline.

    Which is interesting because what is happening is that even though substance use among kids is on the decline – that’s both in middle school and high school – the substances that kids are using have become so much more potent.

    Take cannabis, which if you measure the potency by the percentage of THC content, has gone up significantly. The average THC percentage in the ’60s and ‘70s was like 2-5%. And now it’s like 20-25%. And kids are more likely to use what they call the concentrates, which is like 80% or more THC.

    When I talk to parents, the first thing I’m telling them about is the landscape of different substances that are out there, and kids are more likely to start off with cannabis or alcohol before they transition to the M30 pills.

    KALIAMURTHY: If you think about modifiable and non-modifiable risks, some risks just cannot be changed. These are things like genetics, family history and also if a child has a history of any traumatic experiences. Those are not things you can necessarily change. There are modifiable risk factors, like if a child has ADHD, they’re more likely to be at risk for developing substance use problems.

    If there are untreated mental health conditions, such as depression, anxiety, they’re more likely to have problems. We know that. The kids who identify as LGBTQ+, they also tend to have more risk factors in terms of initiating substances that transition into a problem.

    But also, we need to rethink how families address substances in the household. Kids learn by modeling they see from adults in their life and also the direct conversations we have. What are their values as a family around use of substances? These are not just legal and illegal – all substance use can have some harm. And early initiation is going to lead to more likelihood of having a problem.

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