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Tag: substance abuse

  • University of Kentucky physicians push for standard-of-care opioid treatment for incarcerated patients

    University of Kentucky physicians push for standard-of-care opioid treatment for incarcerated patients

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    Newswise — In a recently published commentary, UK HealthCare physicians call for standard-of-care treatment for opioid use disorder (OUD) among patients who are incarcerated.

    The viewpoint article by Anna-Maria South, M.D., Laura Fanucchi, M.D., and Michelle Lofwall, M.D., published in JAMA April 24 highlights the barriers to initiating medication for opioid use disorder (MOUD) among people who are incarcerated.

    For patients with opioid use disorder, medications such as buprenorphine and methadone are considered by the medical community as standard of care treatments, as they alleviate withdrawal symptoms, reduce cravings and pain, decrease infections, and lower the risk of mortality. However, the use of these medications is often restricted in U.S. prisons and jails, with only a few states mandating their use in the carceral system. 

    The physicians’ article draws attention to the significant moral distress experienced by doctors when patients who are incarcerated need to be hospitalized due to serious medical complications resulting from untreated opioid use disorder, but they are unable to provide them with the best treatment.

    The article also highlights the fact that denying patients standard-of-care treatments because they are incarcerated violates medical ethics, constitutional amendments and the Americans with Disabilities Act (ADA) and emphasizes the need for physician advocacy.

    “Incarcerated people with opioid use disorder are among the most vulnerable patient populations that also have the least ability to advocate for themselves,” said South, an assistant professor in UK College of Medicine’s Division of Hospital Medicine and an attending physician on the Addiction Consult and Education Services. “We as physicians have a powerful voice for advocacy to make substantial change. We need to educate ourselves on the rights that our patients have and where we can go to advocate for them.”

    South is the paper’s first author and UK’s 2022 Bell Addiction Medicine Scholar. South’s work on this article was supported by the Bell Alcohol and Addictions Scholar Program.

    Read the full JAMA article here.

    UK HealthCare is the hospitals and clinics of the University of Kentucky. But it is so much more. It is more than 10,000 dedicated health care professionals committed to providing advanced subspecialty care for the most critically injured and ill patients from the Commonwealth and beyond. It also is the home of the state’s only National Cancer Institute (NCI)-designated cancer center, a Level IV Neonatal Intensive Care Unit that cares for the tiniest and sickest newborns, the region’s only Level 1 trauma center and Kentucky’s top hospital ranked by U.S. News & World Report.  

    As an academic research institution, we are continuously pursuing the next generation of cures, treatments, protocols and policies. Our discoveries have the potential to change what’s medically possible within our lifetimes. Our educators and thought leaders are transforming the health care landscape as our six health professions colleges teach the next generation of doctors, nurses, pharmacists and other health care professionals, spreading the highest standards of care. UK HealthCare is the power of advanced medicine committed to creating a healthier Kentucky, now and for generations to come. 

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    University of Kentucky

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  • Immigration experts on Title 42, analysis of immigration policies, and other migrant news in the Immigration Channel

    Immigration experts on Title 42, analysis of immigration policies, and other migrant news in the Immigration Channel

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    Title 42, the United States pandemic rule that had been used to immediately deport hundreds of thousands of migrants who crossed the border illegally over the last three years, has expired. Those migrants will have the opportunity to apply for asylum. President Biden’s new rules to replace Title 42 are facing legal challenges. The US Homeland Security Department announced a rule to make it extremely difficult for anyone who travels through another country, like Mexico, to qualify for asylum. Border crossings have already risen sharply, as many migrants attempted to cross before the measure expired on Thursday night. Some have said they worry about tighter controls and uncertainty ahead. Immigration is once again a major focus of the media as we examine the humanitarian, political, and public health issues migrants must face. 

    Below are some of the latest headlines in the Immigration channel on Newswise.

    Expert Commentary

    Experts Available on Ending of Title 42

    George Washington University Experts on End of Title 42

    ‘No one wins when immigrants cannot readily access healthcare’

    URI professor discusses worsening child labor in the United States

    Biden ‘between a rock and a hard place’ on immigration

    University of Notre Dame Expert Available to Comment on House Bill Regarding Immigration Legislation, Border Safety and Security Act

    American University Experts Available to Discuss President Biden’s Visit to U.S.-Mexico Border

    Title 42 termination ‘overdue’, not ‘effective’ to manage migration

    Research and Features

    Study: Survey Methodology Should Be Calibrated to Account for Negative Attitudes About Immigrants and Asylum-Seekers

    A study analyses racial discrimination in job recruitment in Europe

    DACA has not had a negative impact on the U.S. job market

    ASBMB cautions against drastic immigration fee increases

    Study compares NGO communication around migration

    Collaboration, support structures needed to address ‘polycrisis’ in the Americas

    TTUHSC El Paso Faculty Teach Students While Caring for Migrants

    Immigrants Report Declining Alcohol Use during First Two Years after Arriving in U.S.

    How asylum seeker credibility is assessed by authorities

    Speeding up and simplifying immigration claims urgently needed to help with dire situation for migrants experiencing homelessness

    Training Individuals to Work in their Communities to Reduce Health Disparities

    ‘Regulation by reputation’: Rating program can help combat migrant abuse in the Gulf

    Migration of academics: Economic development does not necessarily lead to brain drain

    How has the COVID-19 pandemic affected immigration?

    Immigrants with Darker Skin Tones Perceive More Discrimination

     

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    Newswise

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  • Substance use disorder expert available for comment

    Substance use disorder expert available for comment

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    According to the U.S. Department of Health and Human Services, 13.5% of young adults aged 18 to 25 had both a substance use disorder and some form of mental illness in 2021. 

    Lokesh Shahani, MD, PhD, associate professor of psychiatry and behavorial sciences at McGovern Medical School at UTHealth Houston, has done extensive research on substance use disorder. 

    Shahani’s research and clinical background includes substance use, HIV psychiatry, addiction, adult general psychiatry, and geriatric psychiatry. He is board certified by the American Board of Internal Medicine, the American Board of Psychiatry and Neurology, and the American Board of Internal Medicine. He has over 45 publications in peer-reviewed journals and presented his work nationally.

    To arrange an interview contact:

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    University of Texas Health Science Center at Houston

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  • Finnish study shows those at risk were less likely to get vaccinated.

    Finnish study shows those at risk were less likely to get vaccinated.

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    Newswise — A large-scale registry study in Finland has identified several factors associated with uptake of the first dose of COVID-19 vaccination. In particular, persons with low or no labor income and persons with mental health or substance abuse issues were less likely to vaccinate.

    The study, carried out in collaboration between the University of Helsinki and the Finnish Institute of Health and Welfare, tested the association of nearly 3000 health, demographic and socio-economic variables with the uptake of the first COVID-19 vaccination dose across the entire Finnish population. 

    This work, just published in the Nature Human Behavior, is the largest study to date on this topic. 

    The single most significant factors that associated with reduced likelihood of being vaccinated were lack of labor income in the year preceding the pandemic, mother tongue other than Finnish or Swedish and having unvaccinated close relatives, especially the mother. Among health-related variables, factors related to mental health and substance abuse problems associated with reduced vaccination.

    “Lack of labor income can be due to unemployment, sickness or retirement. Furthermore, among individuals with labor income, we saw that low-income earners where the least likely to vaccinate”, explains Tuomo Hartonen, Postdoctoral Researcher at the Institute for Molecular Medicine Finland FIMM, University of Helsinki.

    The study was based on the FinRegistry data. Researchers analysed population-wide national health and population register data from the pre-pandemic period and compared these with the vaccination status data. The analyses were limited to people aged 30-80 years.

    “A particular strength of our study is that it is based on registers covering the entire Finnish population. This way we can avoid all selection bias, which is a major challenge of survey studies”, Postdoctoral Researcher Bradley Jermy from FIMM says.

    The researchers stress that their results describe the association between the studied variables and vaccination uptake at the population level, but do not allow conclusions to be drawn about causal relationships. Furthermore, the generalizability of the findings outside Finland requires further studies. However, it is clear from the results that in Finland, vaccination uptake was lowest among those who are already in a vulnerable position.

    Researchers created a machine learning-based model to predict vaccination uptake

    In addition to studying single predictors, the research team constructed a machine learning-based model to predict vaccination uptake. This prediction model allowed the researchers to group individuals according to their likelihood of receiving the COVID-19 vaccine.

    Approximately 90% of the total study population received at least one dose of COVID-19 vaccination. In contrast, the group with the lowest probability of being vaccinated based on the model had a vaccination rate of less than 19%.

    “Our research has created a framework for using machine learning and statistical approaches to identify those groups that are at higher risk of not vaccinating”, says the corresponding author of the study, Associate Professor Andrea Ganna from FIMM.

     “These results and the predictive model could be used in the future, for example in designing vaccination campaigns”, says the Principal Investigator of the FinRegistry study, Research Professor Markus Perola from THL.

    “This study is a great example of the possibilities that the FinRegistry study creates for investigating highly topical issues in a short timeframe. The collaboration between THL’s genetic and registry researchers and FIMM scientists will help to understand the many pathways that lead to susceptibility to different diseases,” Perola continues.

    The study is part of the FinRegistry project, a joint research project between the Finnish Institute for Health and Welfare (THL) and the Institute for Molecular Medicine Finland (FIMM) at the University of Helsinki.

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    University of Helsinki

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

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

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    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

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    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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  • FDA Approves First Over-The-Counter Narcan To Reduce Overdoses

    FDA Approves First Over-The-Counter Narcan To Reduce Overdoses

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    The Food and Drug Administration has approved selling the overdose-reversal drug Narcan without a prescription, a move long sought by advocates to aid the national response to the opioid crisis. What do you think?

    “I’m not comfortable with just anyone being able to save someone’s life.”

    Joel Budnik, Ball Pit Monitor

    “I guess the opioid crisis has finally gotten as bad as America’s upset-tummy crisis.”

    Jared Hanlon, Unemployed

    “Then what’s the incentive to not overdose?”

    Cindy Ryerson, Sound Distortionist

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  • Fatal Drug ODs Among U.S. Seniors Have Quadrupled in 20 Years

    Fatal Drug ODs Among U.S. Seniors Have Quadrupled in 20 Years

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    By Cara Murez 

    HealthDay Reporter

    THURSDAY, March 30, 2023 (HealthDay News) — Drug overdose deaths — both accidental and intentional — have quadrupled over the past 20 years among older adults in the United States, a new study finds.

    This increase in people ages 65 and older suggests the need for greater mental health and substance use policies, the authors said.

    “The dramatic rise in overdose fatalities among adults over 65 years of age in the past two decades underscores how important it is for clinicians and policymakers to think of overdose as a problem across the life span,” said co-author Chelsea Shover, an assistant professor of medicine at the University of California, Los Angeles David Geffen School of Medicine.

    “Updating Medicare to cover evidence-based treatment for substance use disorders is crucial, as is providing harm reduction supplies such as naloxone to older adults,” Shover said in a school news release.

    About three-fourths of those who died accidentally were using illicit drugs, including synthetic opioids such as fentanyl, heroin, cocaine and methamphetamine. In 67% of intentional overdoses, seniors used prescription medication, including opioids, antidepressants, benzodiazepines, antiepileptics and sedatives.

    The researchers calculated overdose deaths among seniors from 2002 to 2021, using a database from the U.S. Centers for Disease Control and Prevention. The investigators compared demographics, specific drugs, and whether the deaths were intentional, unintentional or undetermined.

    They found that fatal overdoses quadrupled from 1,060 in 2002, which was 3 per 100,000, to 6,702 in 2021, or 12 per 100,000. Black seniors had the highest rates, at 30.9 per 100,000.

    By 2021, 1 in 370 senior deaths was from an overdose, the report noted. About 57% of those involved opioids, 39% involved stimulants and 18% included a combination of the two types of drugs.

    About 13% of overdoses in 2021 were intentional and 83% were unintentional. Another 4% were undetermined, and 0.7% — five people — were murdered.

    Women comprised 57% of the intentional overdoses and 29% of the accidental overdoses, according to the study.

    The researchers also determined that 37%, of overdoses among Asian-Americans were intentional compared to 17% among white people and 1% among Black people.
     

    Deaths from alcohol poisoning rose from less than 0.03 per 100,000 to 0.5 per 100,000 during the study period.

    “Even though drug overdose remains an uncommon cause of death among older adults in the U.S., the quadrupling of fatal overdoses among older adults should be considered in evolving policies focused on the overdose epidemic,” the researchers wrote. “Current proposals to improved mental health and substance use disorder coverage within Medicare, for example, applying mental health parity rules within Medicare, acquire greater urgency in light of this study’s results.”

    Study findings were published March 29 in JAMA Psychiatry.

    More information

    The U.S. National Safety Council has more on drug overdoses.

     

    SOURCE: UCLA, news release, March 29, 2023

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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

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    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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  • Substance use disorders do not increase the likelihood of COVID-19 deaths

    Substance use disorders do not increase the likelihood of COVID-19 deaths

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    Newswise — BOSTON – New research from Boston Medical Center found that substance use disorders do not increase the likelihood of dying from COVID-19. Published in Substance Abuse: Research and Treatment, the study showed that the increased risk for severe COVID-19 in people with SUD that has been seen may be the result of co-occurring medical conditions.

    Multiple large cohort studies from early in the pandemic have shown higher rates of hospitalization, intubation, and death from COVID-19 in those with SUD, while other studies found no association between SUD and COVID-19-related mortality or mixed results depending on substance use pattern. Given these conflicting data, the Centers for Disease Control and Prevention has classified persons with SUD as suggestive of higher risk for severe COVID-19. The goal of this study was to assess the association between SUD and inpatient COVID-19-related mortality.

    “BMC is known for excellent clinical care and innovative research related to substance use disorder. Since the early days of the pandemic, BMC has also been a leader in the treatment of individuals with COVID-19, including persons with complex medical and social needs,” said first author Angela McLaughlin, MD, MPH, an infectious disease fellow at Boston Medical Center. “These findings showing a similar likelihood of COVID-19-related complications in hospitalized patients with and without SUD helps expand knowledge of the infectious complications of SUD.” 

    As BMC sees a high proportion of patients who use substances, it was an apt location for the study: almost 14% of the study population had SUD, exceeding the national average of 10.8% in people ages 18 or older. Researchers reviewed medical records of 353 adults without SUD and 56 adults with SUD admitted to Boston Medical Center early into COVID-19 pandemic and compared the likelihood of COVID-19 related complications between individuals with and without substance use disorders. They compared the relationship between COVID-19 and mortality, clinical complications, and resource utilization.

    “Early in the pandemic, BMC developed protocols to closely monitor and quickly manage COVID-19-related complications in all hospitalized patients,” said senior author Sabrina Assoumou, MD, MPH, an infectious disease doctor at Boston Medical Center and Assistant Professor of Medicine at Boston University Chobanian & Avedisian School of Medicine. “The current findings suggest that such an approach might have benefited many patients, including individuals with substance use disorders.” 

    In this retrospective cohort study of patients admitted to a safety net hospital during the early phase of the COVID-19 pandemic, SUD was not associated with the primary outcome of COVID-19-associated inpatient mortality. The secondary analysis showed that those with and without SUD had similar COVID-19-related clinical complications, including secondary infections, renal failure requiring dialysis, acute liver injury, venous thromboembolism, cardiac complications, and the composite “any complications.” Of note, some clinical outcomes such as stroke were very uncommon overall. Likewise, there was no difference in resource utilization secondary outcomes between the two groups. In contrast to other studies, this found similar likelihoods of mechanical ventilation and ICU admission in patients with and without SUD. Although patients with SUD presented to the hospital earlier in their disease course, their total hospital length of stay was ultimately similar to patients without SUD. Insights such as these into the clinical complications and resource utilization patterns of patients with SUD and COVID-19 can help clinicians anticipate the trajectory of infection and healthcare needs in this vulnerable group.

    There were some notable limitations to the study. The results are from a single site, which might limit generalizability of the findings despite the racial and ethnic diversity of the BMC patient population. Second, the data presented are from the earliest phase of COVID-19 in the United States, so trends may have differed with subsequent waves and as COVID-19 management strategies have evolved over time. Third, there were no specific controls for socioeconomic factors like medical insurance status or income level, as over 75% of the BMC patient population has public payer insurance (Medicare, Medicaid, or Children’s Health Insurance Program) or no insurance. Lastly, differences in COVID-19 outcomes between current versus past SUD could not be detected – this area would benefit from further research.

    In conclusion, in this study of hospitalized individuals at an urban safety net hospital with a diverse patient population in the early days of the COVID-19 pandemic, inpatient mortality and morbidity between patients with and without SUD were similar. The findings provide a detailed evaluation of outcomes in a unique patient population that has been disproportionately impacted by COVID-19 and may provide beneficial insights for similar settings across the country. These results point away from SUD as an independent risk factor for severe COVID-19 and further suggest a focus on medical comorbidities to mitigate the effects of COVID-19. Additional studies are needed to further evaluate for differential outcomes in this high-risk population, particularly in an era of newer COVID-19-directed therapies.

    ###

    About Boston Medical Center

    Boston Medical Center is a leading academic medical center with a deep commitment to health equity and a proud history of serving all who come to us for care. BMC provides high-quality healthcare and wrap around support that treats the whole person, extending beyond our physical campus into our vibrant and diverse communities. BMC is advancing medicine, while training the next generation of healthcare providers and researchers as the primary teaching affiliate of Boston University Chobanian & Avedisian School of Medicine. BMC is a founding member of Boston Medical Center Health System, which supports patients and health plan members through a value based, coordinated continuum of care.

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    Boston Medical Center

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  • How one state beat national surgery opioid trends

    How one state beat national surgery opioid trends

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    Newswise — A statewide effort to treat the pain of surgery patients without increasing their risk of long-term dependence on opioids has paid off in Michigan, a study shows.

    In less than two years, the effort led to a 56% reduction in the amount of opioids patients received after having six different common operations, and a 26% drop in the chance that they would still be filling opioid prescriptions months after their surgical pain should have eased.

    Both of those drops beat national trends for similar patients, according to the new study published in Annals of Surgery by a team from Michigan Medicine, the University of Michigan’s academic medical center.

    Michigan patients having certain operations – for instance, to remove part of their colon – saw the biggest drops over the study period in how many opioids they received after their operations. They also had the biggest drop in risk of developing persistent opioid use, which the researchers define as filling opioid prescriptions for months or years after surgery, when their initial surgery-related prescription was intended for short-term use.

    The Michigan effort used prescribing guidelines based on real-world evidence about how many opioid doses surgery patients actually need to ease their pain, compared with what they were prescribed.

    Importantly, the guidelines don’t leave patients in pain. In fact, past research showed that surgery patients receiving smaller opioid prescriptions had similar pain outcomes and were just as satisfied with their pain care.

    “Tens of millions of people have operations in the U.S. every year, and most of them go home with a prescription for an opioid painkiller. Although they are meant for short-term use during recovery from surgery, unfortunately, some patients keep filling opioid prescriptions for months or years after surgery, which raises their risk of opioid use disorder, overdose, and death,” said Ryan Howard, M.D., M.S., the resident in the U-M Department of Surgery who led the new analysis. “Reducing those trends is a key part of addressing our national opioid problems.”

    A statewide team effort

    The achievement was driven by the Opioid Prescribing Engagement Network and the Michigan Surgical Quality Collaborative – both based at U-M – and by surgical team leaders at 70 hospitals across the state that take part in MSQC and have implemented OPEN guidelines.

    “Our study shows how voluntary prescribing guidelines, and involvement of surgical teams in choosing evidence-based pain care options, can really make a difference,” said senior author Chad Brummett, M.D., co-director of OPEN and director of pain research at Michigan Medicine’s Department of Anesthesiology. “Fewer opioids prescribed and dispensed means lower risk not only of persistent use, but also of risks to others in the household from unused opioid medication.”

    Helping patients get leftover opioids out of their homes and disposed of safely is another key goal of the opioid prescribing engagement network. They offer several free programs to Michigan organizations including free medication disposal pouches, permanent disposal boxes and medication take back event planning materials.

    Making Michigan the safest place for surgery

    The team showed that declines in Michigan – where these guidelines were implemented – outpaced the nation, and other Midwest states, by comparing records from tens of thousands of patients who had the six types of operations in Michigan and those who had them in other states.

    Their analysis spans almost four years before the prescribing guidelines were deployed statewide, and nearly two years afterward, from 2013 to mid-2019.

    They focused on patients covered by traditional Medicare, who had not filled an opioid prescription for a year before their operation, and who had not had a second operation in the six months after their index operation.

    The study focuses on nearly 25,000 Michigan patients and more than 118,600 non-Michigan patients who had minimally invasive gallbladder removal or appendix removal, minor or major hernia repairs, removal of part of the colon (colectomy), or hysterectomy.

    Those six types of operations were the first ones that focused on when developing and implementing prescribing guidelines based on opioid prescription fills and surveys of patients undergoing surgery. They were first published in October 2017, and have been added to ever since with guidelines for other types of surgical and dental procedures. The opioid prescribing engagement network recently published its first pediatric surgery prescribing guidelines.

    The 70 hospitals across Michigan where the guidelines were deployed account for the majority of surgical care in the state. The non-Michigan patients were a 20% sample of all traditional Medicare patients who had the same operations in the same timeframe.

    The researchers looked for signs of new persistent use of opioids, which means a patient filled an opioid prescription immediately after surgery, and then also filled at least one more opioid prescription in the three months after surgery, and another up to six months after surgery. They also looked at the total amount of opioids that patients received in the six months after their operation.

    Because opioid prescribing in general was trending downward in the mid-2010s, the researchers looked at differences between Michigan and national trends to see if there was any difference.

    Michigan outperforms the nation

    Michigan patients had a larger decrease in the rate of new persistent opioid use than their non-Michigan counterparts, with the two drops differing by about half a percentage point.

    This was driven especially by a 2.76 percentage-point reduction among those having colon surgery, and smaller but significant reductions among those having gallbladder and minor hernia operations. Patients having other operations had either no difference between Michigan and the rest of the nation, or a slight increase in Michigan for appendectomy.

    On the whole, Michigan surgical patients saw a faster drop in the size of the opioid prescriptions they filled, compared with those in other states having the same operations in the same time period.

    The difference was nearly 56 mg of opioids by the end of the study period, with significant drops in all types of surgery except laparoscopic appendectomy. Michigan patients started at about 200 mg morphine equivalents, and dropped to 89 mg morphine on average, while non-Michigan patients started at 218 mg morphine and dropped to 154 mg morphine.

    The size of dispensed opioid prescriptions to Michigan surgical patients was actually already lower than national surgical opioid prescribing before the guidelines, though persistent opioid use after surgery was higher in Michigan at 3.4% compared with 2.7%.

    When the researchers excluded cancer patients, or patients with substance issues, Michigan still outperformed the rest of the country in decreasing persistent use and reducing the size of prescriptions dispensed to patients.

    Michigan’s colon surgery patients had the biggest drop in both the amount of opioids they received and their chance of developing persistent use.

    The researchers also did additional comparisons of Michigan with a group of Midwestern states, and with Indiana and Wisconsin, as well as doing analyses that excluded cancer patients and patients who had previously been diagnosed with a substance use disorder. In all these cases, Michigan performed better than the nation.

    Both MSQC and OPEN receive funding from Blue Cross Blue Shield of Michigan. The opioid prescribing engagement network also has received funding from the Michigan Department of Health and Human Services and National Institutes of Health, as well as support from the U-M Institute for Healthcare Policy and Innovation.

    In addition to Howard and Brummett, the study’s authors are Andrew Ryan, Ph.D., formerly of the U-M School of Public Health, Hsou Mei Hu, Ph.D., M.B.A., of OPEN; Craig S. Brown, M.D., M.S., of Surgery; and OPEN co-directors Jennifer Waljee, M.D., M.P.H., M.S., Mark Bicket, M.D., Ph.D. and Michael Englesbe, M.D. Many of the authors are members of IHPI and the Center for Healthcare Outcomes and Policy.

    Paper cited: “Evidence-Based Opioid Prescribing Guidelines and New Persistent Opioid Use After Surgery,” Annals of SurgeryDOI: 10.1097/SLA.0000000000005792

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    Michigan Medicine – University of Michigan

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  • Inmates With Opioid Addiction Report Peer Navigators Are Crucial for Successful Community Reentry

    Inmates With Opioid Addiction Report Peer Navigators Are Crucial for Successful Community Reentry

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    Newswise — Recently incarcerated people with opioid use disorder have trust in working with peer support specialists who recovered from addiction and faced similar life experiences, according to a Rutgers study.

    The study, published in the journal Psychiatric Services, found that peer support specialists were most valued for providing emotional and community-based addiction recovery support as well as housing and employment information — crucial when going back into the community.

    More than half of people incarcerated in state prisons have been diagnosed with a substance use disorder, according to the U.S. Department of Justice. They are most vulnerable in the months following their release, when they are at high risk of unemployment, homelessness, recidivism and overdose.

    “The risk of a fatal drug overdose in the two weeks after release is 129 times that of the general population, in part because of the high risk of relapse and the loss of drug tolerance while incarcerated,” said Margaret Swarbrick, associate director of the Center of Alcohol & Substance Use Studies at Rutgers, research professor at the Graduate School of Applied and Professional Psychology and an author of the study.

    The researchers interviewed 39 adult inmates diagnosed with an opioid use disorder who worked with peer support specialists upon their release from a New Jersey state prison between July 2020 and April 2021. Thirty completed a follow-up interview about four months later.

    They found that participants appreciated working with someone with a shared life experience with whom they could establish a trusting relationship. However, they reported that policy barriers to recovery and community reintegration presented challenges to meeting certain needs, such as housing, food, employment and access to timely medical and recovery services, even with the peer navigator’s assistance.

    Participants reported the peer support specialists were most valued for providing emotional support and housing and employment information and for navigating barriers to medical and community-based treatment. This was especially true for people with a conviction for drug distribution charges, which precludes access to resources for housing and employment, according to Michael Enich, an M.D.-Ph.D candidate at Rutgers Robert Wood Johnson Medical School, who reported on the findings.

    “Studies have shown that trained peer support specialists who have experienced addiction, incarceration or both, who assist newly released offenders significantly improve the success rates of their reentry into society, especially when it comes to mental health treatment and sobriety,” said Enich. “However, few studies have examined the role of peer services for substance use disorders during the early months after prison release.”

    Many participants viewed their peer navigators as role models who have overcome similar challenges, which was valued especially when they felt at risk of relapse, said Stephen Crystal, director of the Center for Health Services Research at Rutgers Institute for Health, Health Care Policy and Aging Research and an author of the study. “Having someone who was there for them ‘no matter what’ and whom they could call at any time was the most important aspect of the program as it gave them a sense of security,” said Crystal, who is also Board of Governors Professor at Rutgers School of Social Work.

    The participants reported the most effective peer health navigators were empathetic, open-minded and good listeners.

    The authors said more research is needed to rigorously examine the long-term impact of peer services on factors such as overdose reduction, treatment engagement and sustained recovery.

    Other Rutgers researchers involved in the study are Peter Treitler, Leigh Belsky and Micah Hillis.

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    Rutgers University-New Brunswick

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  • Upward trend in ‘deaths of despair’ linked to drop in religious participation, economist finds

    Upward trend in ‘deaths of despair’ linked to drop in religious participation, economist finds

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    Newswise — Over the past 20 years, the death rate from drug poisonings in the U.S. has tripled and suicide and alcoholic liver disease death rates have increased by 30 percent — particularly among middle-aged white Americans, according to studies by the National Center for Health Statistics. 

    Further evidence shows that these dramatic changes in mortality rates within American communities actually began in the late 20th century, but researchers have been unable to pinpoint a cause for these “deaths of despair.” 

    To fill that gap in understanding, Daniel Hungerman, professor of economics at the University of Notre Dame, and his co-authors studied the connection between a sharp downturn of religious participation in the late 1980s and the swift rise in deaths of white Americans ages 45 to 54 in the early 1990s. Their findings were recently issued in a working paper by the National Bureau of Economic Research.

    While the post-1999 mortality increase has justifiably attracted a large amount of attention with the introduction of OxyContin, “this change in the early 1990s is perhaps as striking but has received little attention in prior work,” the researchers explained.  

    “It’s pretty unusual for an advanced country like America to see people start dying sooner, at a younger age,” Hungerman said. “And what we found is that there is a direct correlation between the effects of religious practice and these mortality rates from alcoholism, suicide and overdose.”

    Their study highlighted how changes in religious participation can have large consequences for the health and well-being of middle-aged, white individuals, wrote Hungerman and his co-authors. 

    “Our work provides evidence that religious participation matters,” they said.
     

    Bringing the data together, comparing

    Comparing mortality data from the Centers for Disease Control and Prevention’s Multiple Cause of Death files and religiosity survey data from the General Social Survey, the researchers identified a definite correlation between the decline in religious affiliation and church attendance and the increase in deaths of despair among middle-aged white Americans that began in the late 1980s and continued through the 1990s.

    Researchers also found that states that had experienced larger declines in religious participation in the last 15 years of the century saw larger increases in deaths of despair. Notably, the decline in religious participation was not specifically driven by males or females, nor was it initially observed for non-white Americans. 

    Hungerman and his co-authors presented evidence that this decline in religious participation was driven more by a collective resistance to formal or organized religion than by changes in personal religious beliefs or spiritual habits. 

    “What happened is that they quit going to church — they stopped affiliating with religious places,” Hungerman said. “But if you ask them, ‘Do you believe in God,’ then that is still a constant. It has more to do with the social aspect of the formal participation.”

    One explanation for the decline in religious activity is the shifting relationship between religion and politics, Hungerman theorized. “There are some indications that more progressively oriented individuals stopped affiliating with religion,” he said. “Another is an increase in education — those educational gains may have led to lower participation.” 

    The causes of the decline in religiosity and religious participation are less important than the consequences, however, Hungerman said. “We’ve accepted this decline has occurred, and now we want to show what it has caused in people’s lives.” 
     

    Historical ‘shocks’ contribute to decline

    The researchers considered two additional “shocks” occurring at different times in our history that seem to have also contributed to the decrease in faith activities and increase in mortality. One was the repeal of the blue laws in the 1960s and 1970s. These laws restricted commerce during a certain time of week, typically Sunday mornings. Unlike some blue laws of today, which limit alcohol sales on Sundays, the earlier iterations prohibited all labor on that day — which allowed more people to attend church versus working or going shopping. According to the researchers, repealing the blue laws led to a 5-10 percent negative impact on weekly attendance of religious services for middle-aged Americans and increased the rate of deaths of despair by two deaths per 100,000 people.

    The second shock occurred much later with the increase of opioid use in the 1990s, particularly following the introduction of the prescription drug OxyContin in 1996 and its subsequent abuse. 

    “With these sorts of shocks occurring, we see — for the groups affected — a coinciding change in suicides, heavy drinking and drug use,” Hungerman said. “We’re seeing these relatively smaller, earlier shocks as setting the stage for the later, larger effects (sharp mortality rate increases). We use that as another piece of evidence to help us better understand this relationship between what you’re doing on Sunday morning and your health outcomes.”
     

    Cultural influence or true despair?

    Scientists have had difficulty studying the cultural or social influences in this arena, Hungerman said. “Despite the title ‘deaths of despair,’ they have struggled to see whether or not despair actually plays any role here, or if it’s just a cultural anomaly, more generally. We think our research provides novel evidence that it does.”

    Hungerman and his co-authors noted that prior studies have indicated nonreligious organizations are unable to provide the same sense of community, closeness and social service that religious traditions have typically supplied. And while they acknowledged that their study confirmed the importance of religion alone in promoting well-being, future research can be done to see if other cultural institutions — including voluntary and community activities — could have similar large-scale effects on health and mortality.

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    University of Notre Dame

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  • Anesthesiologists, including one who lost both sons to opioid overdose, crusade for over-the-counter naloxone access

    Anesthesiologists, including one who lost both sons to opioid overdose, crusade for over-the-counter naloxone access

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    Newswise — Physician anesthesiologist Bonnie Milas, M.D., experienced firsthand the power of naloxone – a drug that reverses opioid overdose – having used it to save her son when she found him unresponsive on the kitchen floor.

    With drug overdose deaths hitting a tragic record high in 2021, she knows that anyone could find themselves in her shoes, often without access to naloxone. Although she ultimately lost both of her sons to drug overdoses, she was grateful naloxone gave them additional chances to heal from their addiction.

    Dr. Milas, a clinical professor of anesthesiology and critical care medicine at the University of Pennsylvania in Philadelphia and a member of the American Society of Anesthesiologists’ (ASA) Committee on Trauma and Emergency Preparedness, is committed to reducing the stigma associated with opioid use disorder, saving lives from opioid overdoses with easy access to naloxone, and working to ensure others don’t experience her devastating loss.

    Both Dr. Milas and ASA support the U.S. Food and Drug Administration (FDA) advisory panel’s recommendation to make naloxone available over the counter and are crusading to ensure that it receives full FDA approval. She and Michael W. Champeau, MD, FAAP, FASA, president of ASA, are available to talk about the importance of easy naloxone access, how to identify and respond to an opioid overdose, ASA’s REVIVEme initiative, and how physician anesthesiologists have a critical role in the fight against opioid overdoses.

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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

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    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

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    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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  • New study reveals ketamine could be effective treatment for cocaine-use disorders

    New study reveals ketamine could be effective treatment for cocaine-use disorders

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    Newswise — CLEVELAND—As cocaine use continues to climb across the United States, scientists have struggled to develop an effective pharmacological approach to treat the devastating disorder.

    But by seamlessly combining artificial intelligence (AI), human intelligence, clinical testing and computer analysis, researchers at Case Western Reserve University have unearthed an existing option that appears to hold promise.

    “Ketamine, a small synthetic organic molecule used clinically as an anesthetic and a depression treatment, was found to be associated with significant improvement in remission among people with cocaine-use disorders,” said the study’s corresponding author Rong Xu, professor of biomedical informatics and founding director of the Center for AI in Drug Discovery at the Case Western Reserve School of Medicine.

    “This study is a great example of addressing an intractable problem by the creative use of AI using different sources of data,” said study coauthor Pamela Davis, the Arline and Curtis Garvin Research Professor at the School of Medicine. “It is our hope that this approach will suggest therapeutic approaches for other difficult problems.”

    The study, funded by the National Institute on Drug Abuse Clinical Trial Network, was published online today in the journal Addiction.

    More than 2 million people in the U.S. regularly use cocaine, more than three times the number who take methamphetamine. Roughly one of every five drug overdose deaths in this country involves cocaine, and its consistent use contributes to an array of serious health issues—including heart attack and stroke. However, there is no U.S. Food and Drug Administration (FDA)-approved treatment for cocaine-use disorders.

    Decades of research have found that existing medications such as antidepressants or stumulants have no meaningful effect, while others involve such small patient samples as to be years away from certain conclusions. Therapeutic interventions have yielded positive outcomes, but barriers such as cost, staffing and stigma significantly limit widespread adoption.

    By developing novel AI-based drug discovery algorithms to identify promising candidates from all FDA-approved drugs, reviewing top drug candidates by expert panels of  addiction experts such as the University of Cincinnati’s T. John Winhusen, Xu and her colleagues deterimined ketamine held the greatest potential to yield useful insights.

    They evaluated the potential clinical effectiveness of ketamine on improving remission rates among patients with cocaine-use disorders by analyzing tens of millions of electronical health records. They found that cocaine-use disorder patients administered ketamine for pain or depression experienced two to four times higher remission rates.

    While a few previous studies have found increased efficacy of ketamine in treating cocaine use disorder, the groups involved were largely homogenous. The Case Western Reserve study not only included greater diversity of participants by race and gender, but also those suffering from additional medical and psychiatric conditions.

    While this study substantially strengthens the argument for the use of ketamine in treating cocaine-use disorder, the researchers emphasized that additonal clinical trials are required to assess ketamine’s potential impact more thoroughly.

    The work was conducted at the Center for AI in Drug Discovery by research associate ZhenXiang Gao and medical school student Maria Goreflo, in collaboration with Davis, Winhusen, David Kaelber from MetroHealth and Case Western Reserve and Udi Ghitza from the National Institute on Drug Abuse Clinical Trial Network

    The Center for AI in Drug Discovery’s goal is to develop an integrated drug-discovery pipeline driven by advanced AI technologies, preclinical testing in collaboration with biomedical researchers and clinical studies using patient electronic health records.

                                                                ###

                                                               

    Case Western Reserve University is one of the country’s leading private research institutions. Located in Cleveland, we offer a unique combination of forward-thinking educational opportunities in an inspiring cultural setting. Our leading-edge faculty engage in teaching and research in a collaborative, hands-on environment. Our nationally recognized programs include arts and sciences, dental medicine, engineering, law, management, medicine, nursing and social work. About 5,800 undergraduate and 6,300 graduate students comprise our student body. Visit case.edu to see how Case Western Reserve thinks beyond the possible.

     

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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

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    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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  • The dark side of the sports betting boom | CNN Business

    The dark side of the sports betting boom | CNN Business

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    New York
    CNN
     — 

    The sports gambling gold rush is coming at a high cost.

    In 2018, the Supreme Court struck down a federal ban on commercial sports betting in most of the country. Thirty-three states have made sports gambling legal in the wake of the decision. Now, on Super Bowl Sunday, a record 50.4 million US adults are expected to bet on the game.

    The booming sports betting industry, lawmakers and even the professional sports leagues themselves are making it easier, faster and more tempting for people to bet on games — and develop gambling problems, say gambling researchers and addiction specialists.

    A flood of advertising, technology that allows for one-click betting at home, and nearly unlimited betting options during games have collided. There’s been a spike in inquiries to state gambling-addiction hotlines, states say.

    In the past five years, there has been an explosion of online sports betting apps from companies like DraftKings, FanDuel and Caesars. These apps are often replacing illegal betting venues. At the same time, they also attract an influx of new gamblers who had never set foot in a casino or would have known how to place a bet with a bookie.

    During the Super Bowl, there will be an onslaught of advertisements — most starring celebrity sponsors and athletes — meant to encourage new sign-ups and grab market share. DraftKings will air a commercial featuring Kevin Hart and David Ortiz, while Rob Gronkowski will attempt a field goal kick live in a FanDuel ad. (Any customer who places a Super Bowl bet of five dollars or more on FanDuel will win a share of $10 million in “free bets” if Gronkowski makes it.)

    Hear why FanDuel CEO thinks this Super Bowl will be biggest day in company’s history

    Sports teams and leagues were once fiercely opposed to gambling on the games. Now, they’ve partnered with sportsbooks.

    These days, gamblers can also do much more than wager on the outcome of a game. There are options to bet in-game on every quarter, player, and event.

    Resources for gambling addiction programs have long been thin in the United States and have been stretched further by the current wave of sports betting. In 2020, there were 5.7 million Americans with a gambling disorder, according to a nationwide survey by the National Association of Administrators for Disordered Gambling Services.

    Focus on gambling disorders has historically been minimal in the United States, said Timothy Fong, a psychiatrist and the co-director of the UCLA Gambling Studies Program.

    This is in part because people with gambling disorders have been viewed as foolish or lacking willpower, he said. “We equate the ability to hold onto money and win money with success and equate losing with greed.”

    There is also sparse federal oversight of the gambling industry, and there are currently no federal funds designated for problem gambling treatment or research, unlike federal funding for alcohol, tobacco and drug addiction programs.

    DraftKings is one of the most popular sports betting apps.

    A patchwork of state legislation, lack of robust consumer protections in many states, and limited advertising restrictions are adding to the problems.

    “Many states naively or some other way went about legalizing sports betting without adequately estimating the costs on problem gambling resources,” said John Holden, an associate professor of management at Oklahoma State University who studies sports gambling regulation.

    “There is more that state lawmakers can do within the confines of commercial speech restrictions,” including authorizing extra funding to go after false and misleading advertising, Holden said.

    Betting on sports can be a way for some people to develop, maintain or accelerate gambling disorders.

    There are several features of sports betting that make it different from other forms of gambling and can lead to addictive behavior.

    Many sports bettors tend to perceive their wages on games are safer and more informed by their own expertise and skills than luck, researchers say. This may give them a false illusion of control.

    Additionally, live betting within games reduces the delay between risk and reward, and it’s increasing the speed and frequency of wagers, experts say.

    “I got caught up in a lot of the live betting,” said one 24-year-old man with a gambling disorder who spoke to CNN on the condition of anonymity. He started betting on sports seven years ago through a bookie, but upped his wagers once he started using apps.

    During football games, he would bet on the outcome of drives and which team would score the next touchdown. As he lost more during a game, he would try again to to win it back on the next play.

    “You see the way the game is going and you think you know,” he said. “It’s not like back in the day with a bookie betting on who wins.”

    He said he lost $100,000 on sports gambling, including money from student loans. He’s currently in recovery at Beit T’Shuvah, in Los Angeles, which provides inpatient and outpatient services for people struggling with gambling disorders.

    Casey Clark, the senior vice president at the American Gaming Association, a trade group for the gambling industry, said that the legalization of sports betting has moved the black market of sports gambling into regulated marketplaces, benefiting states.

    The gambling industry and sports betting operators work with regulators, professional sports leagues, media companies and advocates to set standards, provide gambling education for consumers and fund recovery efforts for people seeking treatment, Clark said.

    “We’ve had a really fast escalation and movement towards giving American consumers access to the legal market that they clearly want. And so we have to continue to evolve that marketplace,” he said.

    Advocates for people with gambling disorders say demand for help and treatment services has grown alongside the rapid expansion of legalized sports betting.

    Inquires to the Council on Compulsive Gambling of New Jersey’s help hotline about sports gambling have increased 60% since it became legal in the state in 2018, said Felicia Grondin, the organization’s executive director.

    Grondin feels helpless against the constant barrage of advertising encouraging betting on games.

    An advertisement for DraftKings is shown on the scoreboard during the game between the Boston Red Sox and the Detroit Tigers at Comerica Park on July 7, 2019 in Detroit, Michigan.

    “We consider it to be predatory advertising because it’s incessant and it glamorizes gambling,” she said.

    Clark from the American Gaming Association said the group has created a responsible marketing code to set industry-wide advertising standards.

    But self-enforcement by the industry cannot make up for robust oversight from regulators, said Keith Whyte, the executive director of the National Council on Problem Gambling.

    “Self-regulation tends to dumb itself down to the lowest common denominator, not the highest,” he said. “Some operators are definitely taking advantage of weak regulatory environments in some states.”

    Every state where gambling is legal has a regulatory body that oversees it.

    But few have “really done more than the minimal amount to increase funding of problem gambling treatment,” said Holden. The sports gambling industry is most similar to financial markets, he said, but financial markets are much more regulated than banks.

    Most states require that sports betting ads disclose the minimum legal age to gamble and responsible gambling messages, such as problem gambling hotlines. Those messages are brief and usually run at the very end.

    DraftKings' Super Bowl ad with Kevin Hart, David Ortiz and Emmitt Smith.

    Regulators are wary of how tightly they can curtail messages in gambling advertising without running afoul of First Amendment protections on commercial speech.

    “A lot of state regulators have big First Amendment fears,” Holden said. “No one wants to fund litigation or lose a Supreme Court case over gambling.”

    In most states, the legal age for sports betting is 21 years old. But ads during games, in stadiums, and with star athlete sponsors normalizes sports betting for kids and teenagers, critics say. The United Kingdom last year banned top athletes and celebrities from appearing in ads endorsing or promoting gambling to try to curb underage gambling. That’s unlikely to happen in the United States.

    Additionally, researchers are troubled by the incentives and promotions some sports betting apps often provide to users, such as sign-up and referral bonuses, promo codes and bonus bets. One 2017 study of people with gambling addictions found that messages with an offer of risk-free kind of bonuses had a high impact.

    The Ohio Casino Control Commission in January fined DraftKings, Caesars and BetMGM $150,000 each for advertising promotions or bonuses as “free” or “risk-free” when, in fact, users were required to lose money or risk their own money to obtain the promotion.

    “I got more incentive to gamble with these apps that give you free play and match your deposit,” said the former sports bettor in Los Angeles currently in recovery. He enlisted friends to sign up to get referral fees, and looked at these enticements as free money. “I’d have to be an idiot to pass this up.”

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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

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    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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