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A List of Common Opioids in Increasing Strength

These are some of the common opioids and their generic names. They are listed in order of increasing strength.

Codeine

Hydrocodone (Vicodin, Hycodan)

Morphine (MS Contin, Kadian)

Oxycodone (Oxycontin, Percoset)

Hydromorphone (Dilaudid)

Fentanyl (Duragesic)

What are Opioids?

Opioids are a group of drugs that are used for treating pain. They are derived from opium which comes from the poppy plant.

Opioid vs Opiate vs Narcotic

The term opiates refers to natural or slightly modified components of opium such as codeine, morphine and heroin. The term opioids was originally used for synthetic opiates such as Oxycontin and Fentanyl. But now is used for the entire class of drugs. Narcotics is an older name originally referring to any mind-altering compound with sleep-inducing properties.

Opioids Addiction

Opioids produce a sense of wellbeing or euphoria that can be addictive to some people. Opioids are legitimately used for treating pain. When used for pain relief, many people develop tolerance, meaning they need more and more to get the same effect. Some people go on to develop an addiction to opioids. They begin to obsessively think about getting more opiates and in some cases engage in illegal activities such as double doctoring.

A high dose of opioids can cause death from cardiac or respiratory arrest. Tolerance to the euphoric effect of opioids develops faster than tolerance to the dangerous effects. Therefore people often overdose by mistake because they are trying to get a higher high and take too much.

Opioid overdose can be reversed in hospital with intravenous naltrexone. Please contact emergency services if you feel you are in danger of an overdose.

Do You Have an Opioid Addiction?

Has your use of opioids increased over time?

Do you experience withdrawal symptoms when you stop using?

Do you use more than you would like, or more than is prescribed?

Have you experienced negative consequences to your using?

Have you put off doing things because of your drug use?

Do you find yourself thinking obsessively about getting or using your drug?

Have you made unsuccessful attempts at cutting down your drug use?

If you answered yes to at least three of those questions, then you are addicted to opioids. (Look here for a more detailed addiction self-assessment quiz.)

Opioid Withdrawal

Opioid withdrawal can be extremely uncomfortable. The important thing to remember is that opioid withdrawal is not life threatening if you are withdrawing only from opioids and not a combination of drugs. ( Drug and alcohol withdrawal is different for each drug. Alcohol withdrawal and benzodiazepine withdrawal are potentially dangerous)

Opioid Withdrawal Symptoms Include:

Low energy, Irritability, Anxiety, Agitation, Insomnia

Runny nose, Teary eyes

Hot and cold sweats, Goose bumps

Yawning

Muscle aches and pains

Abdominal cramping, Nausea, Vomiting, Diarrhea

Stages of Opioid Withdrawal

Opioid withdrawal symptoms can last anywhere from one week to one month. The first phase ( acute withdrawal) begins about 12 hours after your last opioid use. It peaks at around 3 - 5 days, and lasts for approximately 1 - 4 weeks. The second phase ( post-acute withdrawal) can last up to two years. The symptoms include mood swings, anxiety, variable energy, low enthusiasm, variable concentration, and disturbed sleep.

The acute stage has mostly physical symptoms, and the post-acute stage has mostly emotional symptoms. The symptoms of post-acute withdrawal are less severe but last longer.

The Opioid Crisis (Epidemic)

The opioid crisis (epidemic) began in the 1990s with over-prescription of powerful opioid pain relievers. They quickly became the most prescribed class of medications in the United States, exceeding antibiotics and heart medication.

In the late 1990s, pharmaceutical companies reassured the medical community that "patients would not become addicted to prescription opioid pain relievers." [1]

But the facts are that 20 to 30 percent of patients who are prescribed opioids for chronic pain will misuse them. [2]

About 80 percent of people who use heroin began by first misusing prescription opioids.[3]

Drug overdose is the leading cause of accidental death in the United States. There are more drug overdose deaths in America every year than deaths due to guns and car accidents combined. In 2016 there were more than 64,000 drug overdose deaths. Most of those deaths were due to opioid use. The opioid "fentanyl" was involved in more than 20,000 of those fatalities.

Fentanyl

Fentanyl is so strong that it can easily cause an accidental overdose. It is 50 to 100 times more potent than morphine. About two milligrams of fentanyl - equivalent to six or seven grains of salt - is a lethal dose.

There are many chilling statistics about fentanyl. Here is just one of them. In one-third of fentanyl overdoses, the individual died within seconds of taking fentanyl. They died so quickly that their body didn't have enough time to begin to metabolize the drug, and no metabolites of fentanyl were found in the autopsy. [4]

How did fentanyl become such a big part of the opioid epidemic? Around 2010, heroin became so abundant that it suddenly became cheaper than many other drugs, and addicts started to switch from other drugs to heroin. In one survey, 94% of people in treatment for opioid addiction said they used heroin because prescription opioids were more expensive and harder to obtain. [5]

Next, drug cartels discovered how to make fentanyl cheaply. Heroin cannot be created entirely in a lab. It must first start as morphine. Huge quantities of fentanyl from China started flooding the market. Because fentanyl is easier to make and more powerful than heroin, drug dealers began to lace their heroin with fentanyl.

People taking fentanyl-laced heroin are more likely to overdose because they do not know they are taking a more powerful drug. Which brings us to the opioid epidemic and the crisis of opioid overdoses.

Fentanyl is now starting to find its way into prescription pills. Fentanyl pills are pressed and dyed to look like oxycodone. If you are using oxycodone and take fentanyl not knowing it is fentanyl, you will almost certainly overdose.

A new variation of fentanyl is finding its way into the drug trade. Carfentanil is 100 times stronger than fenatanyl, which makes it 10,000 times more potent than morphine.

Naloxone

Naloxone is used to rescue individuals from opioid overdose. Naloxone is an opioid antagonist, meaning it binds to opioid receptors but does not produce the high or the dangerous side effects. What makes naloxone useful is that it binds to opioid receptors more strongly than heroin or any prescription opioids.

If someone is overdosing on heroin or any other opioid and naloxone is administered, it will replace the opioid drug in the person's receptors, and reverse the high and side effects of the opioid. The person can go from comatose one moment to awake and moving the next.

Naloxone is carried by many EMS services, and can be administered either in intravenous form or as a nasal spray.

Opioid Treatment Recovery Plan

Break the cycle of guilt and shame. Do your recovery with other people who are going through the same thing. This is the benefit of going to 12-step meetings such as Narcotics Anonymous NA or Alcoholics Anonymous AA. (Refer to the Links page for more resources.)

Ask for help. Have a strong support system.

Be honest, and practice sharing how you feel.

Avoid high risk situations.

Learn relapse prevention strategies.

Do your recovery one day at a time.

What is Suboxone - Buprenorphine?

IMPORTANT: This is general medical information, and is not tailored to the needs of a specific individual. This material is NOT complete. It does not cover all possible precautions, side effects, or interactions. You should always consult your physician when making decisions about your health.

Suboxone is a medication used for withdrawing and detoxing from opioids. It is a combination of buprenorphine a mild opiate, and naloxone a medication that reverses the effects of opiates if taken intravenously.

Buprenorphine is unlike other opioids in that it does not lead to a greater high the more you take. It is a partial opioid agonist, meaning that it produces a mild high at most. Therefore it is sometimes used to get people off more addictive drugs such as Oxycontin or heroin.

The reason for combining buprenorphine and naloxone is that it reduces the risk of intravenous use. Suboxone is supposed to be taken as a tablet and held under the tongue. But if Suboxone is dissolved and taken intravenously, the naloxone reverses the effects of the buprenorphine, which blocks the high. Therefore there is less danger of diversion.

Patients do not have to go to special clinics to get their Suboxone as they do with methadone. Physicians with proper training and certification can prescribe Suboxone in their offices, and patients can take it home.

The Effects, Side Effect and Dangers of Suboxone

Suboxone is potentially addictive.

You will probably experience withdrawal symptoms as you come off Suboxone.

If you take Suboxone too soon after another opioid, you may experience withdrawal symptoms.

Suboxone can increase the drowsiness due to other drugs or alcohol.

Suboxone overdose can cause slow breathing, seizures, confusion, loss of consciousness, coma, and death.

Suboxone Withdrawal

Suboxone causes withdrawal symptoms, similar to other opioids, if stopped too quickly: low energy, irritability, anxiety, hot and cold sweats, muscle aches and pains, abdominal cramping, nausea, diarrhea. Some people feel that the withdrawal from Suboxone is just as difficult as the withdrawal from methadone.

Medications to Treat Opioid Withdrawal

Suboxone, Subutex (buprenorphine) helps shorten reduce the withdrawal period and lessen symptoms.

Methadone helps relieve withdrawal symptoms and make detoxification easier.

Medications to Treat Opioid Addiction

Suboxone, Subutex (buprenorphine) a partial opioid agonist that can be an opioid replacement.

Methadone used for opioid replacement therapy.

Revia (naltrexone) Used to reduce opioid cravings and prevent an opioid high.

References

1. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-crisis
2. Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015;156(4):569-576.
3. Muhuri PK, Gfroerer JC, Davies MC. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. CBHSQ Data Rev. August 2013.
4. Overdose Deaths Related to Fentanyl and Its Analogs - Ohio, January-February 2017. Morbidity and Mortality Weekly Report (MMWR)/ September 1, 2017 / 66(34);904-908
5. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821-826.]

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Dr. Steven Melemis, I Want to Change My Life

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Opioids - Opiates: Addiction, Withdrawal, Crisis, Recovery Facts

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These are some of the common opioids and their generic names. They are listed in order of increasing strength. Codeine Hydrocodone (Vicodin, Hycodan) Morphine (MS Contin, Kadian) Oxycodone (Oxycontin, Percoset) Hydromorphone (Dilaudid) Fentanyl (Duragesic) Opioids are a group of drugs that are used for treating pain.

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If you are like many Americans, you drink alcohol at least occasionally. For many people, moderate drinking is probably safe. But drinking less is better for your health than drinking more. And there are some people who should not drink at all.

Because drinking too much can be harmful, it's important to know how alcohol affects you and how much is too much.

How does alcohol affect the body?

Alcohol is a central nervous system depressant. This means that it is a drug that slows down brain activity. It can change your mood, behavior, and self-control. It can cause problems with memory and thinking clearly. Alcohol can also affect your coordination and physical control.

Alcohol also has effects on the other organs in your body. For example, it can raise your blood pressure and heart rate. If you drink too much at once, it could make you throw up.

Why are the effects of alcohol different from person to person?

Alcohol's effects vary from person to person, depending on a variety of factors, including:

How much you drank

How quickly you drank it

The amount of food you ate before drinking

Your age

Your sex

Your race or ethnicity

Your physical condition

Whether or not you have a family history of alcohol problems

What is moderate drinking?

For most women, moderate drinking is no more than one standard drink a day

For most men, moderate drinking is no more than two standard drinks a day

Even though moderate drinking may be safe for many people, there are still risks. Moderate drinking can raise the risk of death from certain cancers and heart diseases.

What is a standard drink?

In the United States, a standard drink is one that contains about 14 grams of pure alcohol, which is found in:

12 ounces of beer (5% alcohol content)

5 ounces of wine (12% alcohol content)

1.5 ounces or a "shot" of distilled spirits or liquor (40% alcohol content)

Who should not drink alcohol?

Some people should not drink alcohol at all, including those who:

Are recovering from an alcohol use disorder (AUD) or are unable to control the amount they drink

Are under age 21

Are pregnant or trying to become pregnant

Are taking medicines that can interact with alcohol

Have medical conditions that get can worse if you drink alcohol

Are planning on driving

Will be operating machinery

If you have questions about whether it is safe for you to drink, talk with your health care provider.

What is excessive drinking?

Excessive drinking includes binge drinking and heavy alcohol use:

Binge drinking is drinking so much at once that your blood alcohol concentration (BAC) level is 0.08% or more. For a man, this usually happens after having 5 or more drinks within a few hours. For a woman, it is after about 4 or more drinks within a few hours.

Heavy alcohol use is having having more than 4 drinks on any day for men or more than 3 drinks for women

Binge drinking raises your risk of injuries, car crashes, and alcohol poisoning. It also puts you of becoming violent or being the victim of violence.

Heavy alcohol use over a long period of time may cause health problems such as:

Heavy alcohol use can also cause problems at home, at work, and with friends. But treatment can help.

NIH: National Institute on Alcohol Abuse and Alcoholism

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Many people drink alcohol. Drinking too much can take a serious toll on your health. It's important to know how alcohol affects you and how much is too much.

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6 Cannabis Strains for People Who Love Earthy Terpene Profiles

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Find Marijuana Strains, Dispensaries, & News | Leafly

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Learn all about cannabis and find the best strains and products in medical & recreational marijuana dispensaries near you.

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WILMINGTON, Del. (WPVI) -- Delaware Governor John Carney has signed a bill raising the legal age to purchase tobacco products in the state from 18 to 21.

The governor signed the bill just before noon Wednesday in Wilmington.

It includes not only cigarettes, but e-cigarettes and vaping pens as well.

Retailers caught selling tobacco products to anyone under 21 would face fines ranging from $250 to $1,000.

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Delaware governor signs bill raising smoking age to 21

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WILMINGTON, Del. (WPVI) -- Delaware Governor John Carney has signed a bill raising the legal age to purchase tobacco products in the state from 18 to 21. The governor signed the bill just before noon Wednesday in Wilmington. It includes not only cigarettes, but e-cigarettes and vaping pens as well.

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WHITE COATED drug dealers
trading prescriptions for sex

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Some 60 doctors, pharmacists and other licensed medical professionals in five states are being charged in connection with illegally prescribing more than 32 million pain pills, in some cases for sexual favors, federal prosecutors said on Wednesday.

The people charged across 11 federal districts, include 31 doctors, seven pharmacists, eight nurse practitioners, and seven other licensed medical professionals, the Justice Department said. The cases involve more than 350,000 prescriptions for controlled substances across Ohio, Kentucky, Tennessee, Alabama, and West Virginia. The arrests were the latest effort to combat the nationwide opioid epidemic.

"The opioid epidemic is the deadliest drug crisis in American history, and Appalachia has suffered the consequences more than perhaps any other region," U.S. Attorney General William Barr said in a release. "But the Department of Justice is doing its part to help end this crisis."

The indictments come as some 1,600 cases against the biggest opioid manufacturers in the country are being consolidated and transferred before U.S. Judge Dan Aaron Polster of the Northern District of Ohio. The companies are being accused by numerous counties, cities, states, and Native American tribes across the U.S. of downplaying the risks of addiction to doctors and patients while exaggerating its benefits.

From 1999 to 2017, nearly 218,000 people have died in the United States from overdoses related to prescription opioids, according to the U.S. Centers for Disease Control and Prevention. About 130 Americans die every day of an opioid-related overdose, the agency says.

The Justice Department said six individuals, including two doctors and three registered pharmacists were charged with several counts, including unlawful distribution of controlled substances and conspiracy to obtain controlled substances by fraud.

One arrest made public Wednesday involved a doctor in Kentucky who allegedly prescribed opioids to friends on Facebook, who would then come to his home to pick up prescriptions.

Another case involved a doctor in Tennessee who branded himself the "Rock Doc." He allegedly prescribed combinations of dangerous combinations of opioids and benzodiazepines, a class of psychoactive drugs, sometimes in exchange for sexual favors.

The Appalachian Regional Prescription Strike Force was formed late last year to the help combat the nationwide opioid epidemic. The strike force is working with the CDC, the Department of Health and Human Services, and local public health official, and analyzed databases to identify suspicious prescribing activity.

For more on investing in health-care innovation, click here to join CNBC at our Healthy Returns Summit in New York City on May 21.

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Doctors in five states charged with illegally dispensing painkillers, sometimes for sex

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Some 60 doctors, pharmacists and other licensed medical professionals in five states are being charged in connection with illegally prescribing more than 32 million pain pills, in some cases for sexual favors, federal prosecutors said on Wednesday. The people charged across 11 federal districts, include 31 doctors, seven pharmacists, eight nurse practitioners, and seven other licensed medical professionals, the Justice Department said.

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NEW YORK (AP) - U.S. health officials say overdose deaths involving the herbal supplement kratom are more common than previously reported.

A government report released Thursday said kratom was a cause in 91 overdose deaths in 27 states. Officials previously said they knew of 44 nationally.

Most who died had also taken heroin, fentanyl or other drugs. But kratom was the only substance detected in seven of the deaths.

The Centers for Disease Control and Prevention reported the numbers after combing through death certificates and toxicology reports from an 18-month period.

Kratom comes from a plant native to Southeast Asia. It is sold in capsules and powders with claims that it helps ease pain, anxiety and drug dependence.

Officials say it causes euphoric effects like the opioid drugs behind the current nationwide overdose epidemic.

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NEW YORK (AP) - U.S. health officials say overdose deaths involving the herbal supplement kratom are more common than previously reported. A government report released Thursday said kratom was a cause in 91 overdose deaths in 27 states. Officials previously said they knew of 44 nationally.

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Carl's Jr. will become the first major fast-food chain to debut a cannabis-infused burger
Kate Taylor  32 mins ago
File PhotoEx-UFC fighter in coma after emergency surgery
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a sandwich sitting on top of a table
© Carl's Jr.
Carl's Jr. is debuting a cannabis-infused burger on 4/20.
The Rocky Mountain High: CheeseBurger Delight will be topped with CBD-infused Santa Fe Sauce, and will be sold at a lone location in Denver, Colorado for a single day.
It will cost $4.20.
If the burger sells well, Carl's Jr. may consider expanding the test and selling CBD-infused burgers at more locations, an executive told Business Insider.
Visit BusinessInsider.com for more stories.
Carl's Jr. is making history this 4/20.

On Saturday, Carl's Jr. will debut the CBD-infused Rocky Mountain High: CheeseBurger Delight at a single location in Denver, Colorado. The CBD Burger will be available for $4.20 during the one-day test, fittingly held on April 20, a weed-filled celebration for many Americans.

With the test, Carl's Jr. will become the first major fast-food chain to roll out a cannabis-infused menu item - even if just for a one location, one-day event.

The CheeseBurger Delight consists of two beef patties, topped with pickled jalapenos, pepper jack cheese, fries, and CBD-infused Santa Fe Sauce.

The rise of the CBD-infused burger
a tray of food on a table
© Hollis Johnson/Business Insider
Carl's Jr. has been working on the CBD Burger since its vegan Beyond Meat burger launch in early January, according to Patty Trevino, Carl's Jr.'s senior vice president of brand marketing.

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Unlike most menu tests, one of Trevino's first conversations when Carl's Jr. decided to try to make a CBD-infused burger was with the company's legal team. The Denver restaurant was picked as the 4/20 test spot in part because of Colorado's decision to legalize marijuana in 2014.

Trevino says the test is more than a one-day 4/20 stunt. Carl's Jr. will be monitoring sales, as well as customer and franchisee response. If all goes well, Trevino says that expanding the test remains an option - with the possibility of one day rolling out a CBD-infused burger across America.

"If anyone is going to do it, I would want Carl's Jr. to do it," Trevino said of the prospect of launching a CBD-infused menu item nationally.

While navigating state-by-state regulations could prove to be challenging, Trevino says that Carl's Jr. has an advantage as a West Coast chain, operating in more states that have fully legalized marijuana. In total, Carl's Jr. and sister brand Hardee's - which dominates the South and Midwest - have 3,800 locations in 44 states and internationally.

CBD has been celebrated for its potential health benefits and functions as the non-psychoactive component of marijuana - meaning that eating a CBD Burger will not get you high. With the passage of the Farm Bill, CBD is going mainstream, despite reports of dangerous ingredients and misleading labels.

a girl holding a piece of cake
© By Chloe/Leslie Kirchoff
Retailers and restaurants are increasingly intrigued by CBD, with CVS and Walgreens signing deals to sell CBD topicals and trendy chain By Chloe serving up CBD-infused sweets. A team of analysts at the investment bank Cowen recently estimated that the US market for CBD could skyrocket to $16 billion by 2025 from roughly $1 billion to $2 billion now.

Read more: The inventor of Jelly Belly has launched cannabis-infused jelly beans

Carl's Jr. is sourcing its hemp-derived CBD oil from BlueBird Botanicals, a Colorado-based company.

"If you were to ask me [about CBD and legal weed] when I was at Burger King back in the mid-2000s, I would have been like, no way," Trevino said. "But today, this is a huge trend with consumers."

The Rocky Mountain High: CheeseBurger Delight will be sold at a Carl's Jr. location located on 4050 Colorado Blvd. in Denver, Colorado starting at 6 a.m. on Saturday morning, while supplies last.

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Substance abuse and problematic patterns of substance use among youth can lead to problems at school, cause or aggravate physical and mental health-related issues, promote poor peer relationships, cause motor-vehicle accidents, and place stress on the family. They can also develop into lifelong issues such as substance dependence, chronic health problems, and social and financial consequences.

Substance abuse is the harmful pattern of using substances-such as tobacco, alcohol, illicit drugs, and prescription drugs-leading to impairment or distress with one or more of the following behaviors:

Recurrent substance use resulting in failure to fulfill major responsibilities at work, school, or home such as repeated absences, suspension, and expulsion

Recurrent substance use in situations where it is physically dangerous, such as driving while impaired

Recurrent substance-related legal problems, such as arrests for disorderly conduct that are substance-related

Continued substance use despite having persistent or recurring social or personal problems caused or worsened by substance use

One of the most highly abused substances among youth in the U.S. is alcohol. Youth engage in binge drinking, a pattern of drinking that elevates the blood alcohol concentration to 0.08 percent or above, more than adults do. This can lead to risky and potentially harmful behaviors, and many times substance abuse (60-75 percent of youth with substance abuse problems) co-occurs with mental health disorders.

Substance use, abuse, and dependence can negatively impact every aspect of an individual's life. Child-serving systems need to intervene early in the lives of youth to prevent or treat abuse, support young people, and provide them with the tools to choose the right path.

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Substance abuse and problematic patterns of substance use among youth can lead to problems at school, cause or aggravate physical and mental health-related issues, promote poor peer relationships, cause motor-vehicle accidents, and place stress on the family. They can also develop into lifelong issues such as substance dependence, chronic health problems, and social and financial consequences.

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The Nation is in the midst of an unprecedented opioid epidemic. More than 130 people a day die from opioid-related drug overdoses.Prevention and access to treatment for opioid addiction and overdose reversal drugs are critical to fighting this epidemic. Primary care settings have increasingly become a gateway to better care for individuals with both behavioral health (including substance use) and primary care needs.

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Where Families Find Answers on Substance Use | Partnership for Drug-Free Kids

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Know the facts, connect with resources, and get one-on-one support to help you address known or suspected heroin use with your child.
What is heroin?
Heroin is a highly addictive drug derived from morphine, which is obtained from opium poppy plants-otherwise known as an 'opioid.' It is a 'downer,' or depressant, that affects the brain's pleasure systems and interferes with the brain's ability to perceive pain.

What are some slang terms for heroin?
Big H, Black tar, Brown sugar, Dope, Horse, Junk, Skag, Smack, China white, H, White Horse

What does heroin look like?
White to dark brown powder or tar-like substance.

signs of heroin use:

Fatigue

Fading in and out of consciousness

Slowed breathing

Constricted pupils

Flushed skin

Dry mouth

Itching

Nausea

Vomiting

"Track marks" on arms from injection

related resources:

related drugs:

How is heroin used?
Heroin can be used in a variety of ways. Heroin can be injected into a vein (also known as "mainlining"), injected into a muscle, placed on tinfoil and inhaled as smoke through a straw or snorted as powder.

What do young people hear about heroin?
Teens and young adults hear that an injection of heroin causes a surge of euphoria ("rush") accompanied by a warm flushing of the skin and heavy limbs. Following this initial euphoria, a person goes "on the nod," an alternately wakeful and drowsy state.

What are the risks of heroin use?
Long-term effects of heroin appear after repeated use for some period of time. Chronic use may lead to collapsed veins, infection of the heart lining and valves, abscesses (swollen tissue with pus), constipation and gastrointestinal cramping, and liver or kidney disease. Pulmonary complications, including various types of pneumonia, may result from the poor health of the person using heroin as well as from the drug's effects on breathing. In addition to the effects of the drug itself, street heroin may have additives that do not really dissolve and clog the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs. With regular heroin use, tolerance develops. This means a person must use more heroin to achieve the same intensity or effect.

As higher doses are used over time, physical dependence and addiction develop. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped. Withdrawal, which in people who use heroin regularly may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps ("cold turkey"), kicking movements ("kicking the habit") and other symptoms. Major withdrawal symptoms peak between 24 and 48 hours after the last dose and subside after about a week.

Heroin use is associated with a number of serious health conditions, including fatal overdose, spontaneous abortion, and infectious diseases like hepatitis and HIV (because these diseases are transmitted through contact with blood or other bodily fluids, which can occur when sharing needles or other injection drug use equipment.)

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Heroin (Opioid): Risks, Warning Signs & What Parents Should Know

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Know the facts, connect with resources, and get one-on-one support to help you address known or suspected heroin use with your child. What is heroin? Heroin is a highly addictive drug derived from morphine, which is obtained from opium poppy plants-otherwise known as an 'opioid.'

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There are different types of treatment for drug abuse but the best is to prevent it. Understand more about substance abuse.

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CLOSE

A Wilmington drug trafficker believed to be the leader of the "BWILLS Crew" that moved heroin and cocaine in Delaware has been sentenced to 21 years in federal prison.

Brian Wilson, 39, was convicted in Federal Court for the District of Delaware last year for his role in a cocaine and heroin distribution ring in and around Wilmington, according to court documents. He was sentenced on Feb. 26.

Wilson, also known as "Fudayl Wakim" and "B-Wills," could be in prison even longer after being indicted in January along with Eric Ray in New Castle County Superior Court on charges including first-degree murder in the death of Allen Cannon.

Drug trafficker ordered Wilmington murder, indictment says

At sentencing, U.S. District Court Chief Judge Leonard P. Stark recognized that Wilson's criminal conspiracy included acts of violence and witness intimidation. According to a DOJ release, Wilson's sentence was enhanced because he intimidated witnesses through third parties.

Brian Wilson aka Fudayl Wakim (Photo: DELAWARE DEPARTMENT OF JUSTICE)

Evidence presented at Wilson's trial and at sentencing showed that he directed co-defendant Thomas Brooks and others to sell heroin and cocaine on a daily basis.

Evidence also demonstrated that Wilson conspired with others, such as Kenneth Flowers, to stash his drugs at secret locations.

The DOJ release stated that Flowers was sentenced last month to 32 months in prison for storing 4.6 kilograms of cocaine in his home for Wilson. Brooks was sentenced to 15 years in prison last year.

According to court documents, Wilson used a West 30th Street home as a "stash house," selling "substantial amounts of cocaine" in Wilmington.

He had been under investigation since October 2013. That investigation intensified in October 2016, months after Cannon's death, when police received approval to tap four of his phone lines as well as a phone used by one of his drug trafficking conspirators, court documents state.

According to the DOJ release, Wilson shared responsibility for a drug stash house robbery in November 2016 during which three people broke into a residence, gunfire was exchanged, and one person was shot.

Wilmington Police Department responded and found a handgun, approximately 123 grams of cocaine and approximately 14 grams of heroin in the home, the release stated.

Police made 10 purchases of heroin or cocaine from Wilson using information from two confidential sources. At least seven confidential sources were used by police investigating Wilson's organization, according to court records.

In November 2016, police searched the stash house and found 4.5 kilograms of cocaine in a Lululemon bag with a receipt in it, according to court documents.

Wilson was arrested in December 2016.

He was charged with his alleged supplier, the owner of his stash house and distributors under him. Those distributors each pleaded guilty in federal court.

A jury found Wilson guilty of conspiracy to possess and distribute cocaine and heroin in September. He will be sentenced on those charges in February.

He had previously been convicted of drug possession and distribution charges in Superior Court in 1999 and 2003.
Reach Jerry Smith at jsmith17@delawareonline.com. Follow him on Twitter at @JerrySmithTNJ.
Boston kidnapping case: Feds charge man after woman's body found in trunk of car

Husband, daughter killed Maryland woman whose death was blamed on panhandler, police say

Police: Man tried to coax women into his vehicle near the University of Delaware

Read or Share this story: https://www.delawareonline.com/story/news/crime/2019/03/04/wilmington-heroin-and-cocaine-drug-trafficker-sentenced-21-years/3053066002/

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Wilmington heroin and cocaine drug trafficker sentenced to 21 years

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CLOSE A Wilmington drug trafficker believed to be the leader of the "BWILLS Crew" that moved heroin and cocaine in Delaware has been sentenced to 21 years in federal prison. Brian Wilson, 39, was convicted in Federal Court for the District of Delaware last year for his role in a cocaine and heroin distribution ring in and around Wilmington, according to court documents.

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Long-Term effects of Marijuana on the Brain.

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There's a lot to be said about that Socratic statement "Everything in moderation. Nothing in excess," especially when it comes to tripping out on weed.

Marijuana or cannabis is psychoactive, meaning it'll screw your mind if you take too much in excess and don't exercise moderation. You've got to get the "high" right and this means self-discipline.

Long-term weed use is a lot more dangerous than it is fun. Ask doctors and they'll tell you the same thing. A lot of medical studies show the long-term effects on the brain and body make marijuana dangerous to a lot of people.

These long-term issues with weed have to do with THC or tetrahydrocannabinol. THC, which triggers the marijuana high, mimics substances called endocannabinoids the human body naturally produces.

Endocannabinoids control the production of neurotransmitters in the human brain. Neurotransmitters are chemical substances that facilitate communication between the brain and the central nervous system.

Endocannabinoids also relax our muscles, reduce inflammation, protect damaged tissue and regulate appetite and metabolism, among other beneficial functions.

Now here's where the problem lies. Because THC mimics endocannabinoids, the same physiological effects that arise from the normal application of endocannabinoids are triggered with the use of marijuana, especially in the brain.

This explains why marijuana smokers have memory-loss issues, feel higher levels of pain, have to cope with altered emotions and suffer movement control problems. In other words, THC screws the communication between the brain and the CNS.

One of the most deleterious effects of long-term weed use is loss of memory. This is because cannabis temporarily prevents the brain from creating new memories and learning new things. This type of memory loss takes place in the hippocampus, the region of the brain that regulates short-term memory.

Heavy cannabis users are also at risk of developing false memories, even if these users haven't smoked pot for over a month, said a study published in journal Molecular Psychiatry.

This finding is one among many suggesting that people who were regular marijuana smokers in their teenage years are more likely to have memory problems as adults. Along this line, another study found teenagers that smoked pot every day for three years had "abnormally shaped" hippocampal regions when they reached their early 20s.

These people "performed around 18 percent worse in long-term memory tests" compared to other test subjects who had never smoked marijuana.

Medical researchers are surprised that there was "such a consistent association with verbal memory for chronic exposure to marijuana," even when other factors (like cigarettes and alcohol) were accounted for.

The key lesson: moderation in smoking weed will keep you thinking straight.

There's also a ton of research suggesting that people who smoke marijuana daily for a number of years struggle with cognitive tasks more than those who either don't smoke cannabis, or who do so infrequently or for shorter periods of time.

Research shows that people who occasionally smoke marijuana and then give up the habit have a lower risk of developing problems with their thinking power and memory.

The body pays a hefty price for long-term weed use. Long-term exposure to smoking can damage the bronchial passages and the lungs, as well.

Studies show regular pot smokers are more likely to have persistent coughs (like tobacco smokers), have trouble breathing and produce excess phlegm and mucus. What marijuana smoking does to respiratory health "has some significant similarities to that of tobacco smoking," said a study in the Journal of General Internal Medicine.

THC can increase the heart rate by as many as 50 beats per minute, which can last as long as three hours. That's a lot of unwanted stress on the heart.

Video: Marijuana addiction is real even if it doesn't affect most users (Newsy)

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Long-Term Effects Of Marijuana On Brain And Body

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There's a lot to be said about that Socratic statement "Everything in moderation. Nothing in excess," especially when it comes to tripping out on weed. Marijuana or cannabis is psychoactive, meaning it'll screw your mind if you take too much in excess and don't exercise moderation.

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Jason Jackson

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Combining Drinking and Drugs

Alcoholism increases the likelihood of developing co-occurring conditions such as a substance use disorder. Mixing alcohol and other drugs together can lead to serious physical, behavioral and health complications. Not only can drinking and drugs increase the effects of each substance, it can also trigger dangerous interactions.

Individuals who abuse alcohol are also more likely to abuse other substances, like prescription or illicit drugs. Illicit drugs - cocaine, heroin, ecstasy and marijuana - can cause severe bodily injury and life-threatening side effects. Drinking and taking drugs can quickly spiral out of control, leaving you at risk for potentially permanent health complications.

Disorders surrounding alcohol or substance abuse should not be self-treated. A specialized drug and alcohol treatment center will be able to help you through every step of the recovery process, giving you the greatest chance for lasting recovery. Contact a treatment expert now to find top-rated rehab facilities nearby and get started on your journey to recovery today.

Substance Abuse

Substance abuse involves the chronic use of alcohol and drugs. A person who abuses alcohol has a greater risk of using at least one other substance, such as marijuana, cocaine and heroin. Prolonged consumption of drugs and alcohol increases your tolerance, therefore requiring more of the substance to achieve the same desirable effects.

Alcohol and substance abuse can start out as a mild problem and gradually turn into more severe problems. For example, a person may mix small amounts of alcohol with a drug. Over time, their body becomes dependent on the chemicals released by each substance and begins craving more. After you've built a tolerance to both substances, you may increase the amount consumed in order to avoid experiencing uncomfortable withdrawal symptoms. In these cases, some individuals may turn to more addictive substances - heroin, cocaine and ecstasy - to experience an intensified high.

Recognizing the warning signs of of alcohol and substance abuse is key to getting help early. If left untreated over a long period of time, problems with drinking and drugs can escalate and become life-threatening.

Recognizing a Drug and Alcohol Problem

While some symptoms of alcohol and drug abuse are noticeable and can be caught early on, others may not be as recognizable. Warning signs sometimes go unnoticed when an individual hides their drinking and drug problem. Due to the stigma and negative connotations associated with alcohol and drug abuse, many people may deny they have a problem at all. In these circumstances, it can be difficult for close friends and family members to prepare an intervention and get their loved one the help they deserve.

Here are several questions to identify whether you or a loved one may be suffering from alcohol and drug abuse:

Have you felt irritated by the concern or criticism of your alcohol or drug use by those around you, like family members, friends, a colleague or teacher?

Have you ever thought of reducing your drinking or drug intake?

Have you felt guilt over your drug and alcohol consumption?

Do you find yourself craving a drink and other substances periodically throughout the day?

In the last year, have you failed to meet an obligation because of drinking and drugs?

Have you or someone else been injured due to your alcohol and drug abuse?

If you answered "yes" to one or several of these questions, you should seek help from a medical professional. These answers should not be considered an official diagnosis; however, they can warn you of potential substance abuse factors and motivate you to get help.

The Dangers of Drug and Alcohol Abuse

Depending on the amount of alcohol and type of drug consumed, you can experience an array of harmful side effects. Since alcohol is a depressant, mixing it with another drug can be detrimental for your health.

Here are the most common drug and alcohol combinations, as well as their specific dangers:

Cocaine and Alcohol

Cocaine and alcohol use is one of the most common combinations among drug users because of the powerful high that both substances produce. Cocaine is a stimulant that increases your blood pressure, heart rate and alertness. This helps alcohol reach the brain quicker. Mixing cocaine and alcohol causes cocaethylene, which produces intense feelings of pleasure. Other risk factors of combining cocaine and alcohol include heart attack, overdose or death.

Heroin and Alcohol

Both heroin and alcohol are depressants which can cause similar side effects. One of the most dangerous risks of depressants is slowed breathing. When you consume heroin with alcohol, these breathing problems can be even more serious and life-threatening. Heroin is a highly addictive drug, so it can prove difficult to quit. The consumption of both heroin and alcohol can also lead to an extremely slow heart rate and overdosing.

Ecstasy and Alcohol

Ecstasy is a stimulant that can cause severe adverse reactions when consumed with other substances, including alcohol. The powerful high experienced while taking ecstasy influences you to drink large amounts of alcohol in a short period of time. This can trigger extreme dehydration, among other side effects such as diarrhea, excessive sweating, heat stroke, nausea and vomiting.

Marijuana and Alcohol

Because both drugs are depressants, combining marijuana and alcohol increases the likelihood of an overdose. Both substances can cause dizziness, nausea, vomiting, high anxiety and paranoia. However, since marijuana reduces symptoms of nausea, it may prevent your body from throwing up alcohol. This can cause alcohol to remain in your system and potentially lead to alcohol poisoning.

Painkillers and Alcohol

Painkillers like Vicodin, Xanax and OxyContin are heavily prescribed in the United States to treat moderate to severe pain. When used with alcohol, these drugs can produce dangerous health conditions. Taken separately, painkillers and alcohol may cause liver damage. However, when the substances are combined, you significantly increase your risk for developing liver problems and possibly liver disease.

Antidepressants and Alcohol

Individuals with a mental health condition are typically prescribed an antidepressant such as Zoloft or Prozac. Mixing an antidepressant with alcohol can worsen the side effects of each - a potentially deadly combination. One of the biggest risk factors of consuming alcohol and antidepressants is feeling more depressed or anxious. This can lead to irritability, an inability to sleep and impaired judgment.

Sleeping Pills and Alcohol

There are various risks to taking sleeping pills on their own. However, when combined with alcohol use, the effects of sleeping pills can be life-threatening. Drinking even a small amount of alcohol while taking sleeping pills can increase its sedative effects. When mixed with alcoholic beverages, a sleeping medication can produce dizziness, confusion and faintness.

No one should ever drink large amounts of alcohol when taking prescription medications especially opioids, anxiety pills, or sleeping pills. All of these drugs are sedatives and mixing them with alcohol can cause profound drowsiness, respiratory depression and even death.

Alcohol and Drug Use Side Effects

Consuming excessive amounts of alcohol and drugs over the course of days, weeks or years can take a toll on your body. Some effects may be minor and only last temporarily. Other effects may last much longer and can cause permanent damage. Generally, the amount of alcohol consumed and type of drug involved influence health consequences. For example, alcohol mixed with heroin has more severe consequences than a less dangerous drug like tobacco.

Several short-term alcohol and drug use side effects are:

Increased or decreased heart rate

Muscle control difficulties

Lowering inhibitions

Short-term memory loss

Heightened emotions of sadness, anxiety or fear

Lack of concentration

Respiratory problems

Along with the temporary side effects of alcohol and drug abuse, there are complications that can be long-lasting. Some of these conditions can put you at a greater risk of developing additional health issues later on in life.

The long-term effects of alcohol and drug abuse include:

Damage to internal organs

Muscle and bone breakdown

Long-term memory impairment

Lack of coordination skills

Problems coping on the job or in school

Poor nutrition

Nasal perforation (in cocaine abuse)

Learn more about treatment
Treating Drug and Alcohol Abuse

Drinking and drugs can destroy your relationships with family and friends, your career and your health. While you may feel as though there's no end in sight, help is available. Alcohol and substance abuse are treatable conditions that can be overcome with the help of treatment specialists. Unfortunately, these conditions are often under-treated due to a lack of knowledge about recovery programs available.

What Are You Waiting for?

It's time to turn the page and start a new chapter - your journey to lasting recovery. There are many treatment options available, including inpatient rehab, government facilities, counseling and support groups like Alcoholics Anonymous and AI-Anon. Find out more.

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Alcoholism and Drug Use - A Dangerous Combination

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Alcoholism increases the likelihood of developing co-occurring conditions such as a substance use disorder. Mixing alcohol and other drugs together can lead to physical, behavioral and health consequences. Not only can drinking and drugs increase the effects of each substance, it can also trigger dangerous interactions

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List of Prevention & Education Programs Concerning Drugs & Alcohol in Delaware

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Call now 1-800-304-2219. The following article is a list of Drug Prevention and Education in Delaware.

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There's a saying in the recovery movement: Alcohol and drug addiction can cause mental illness but mental illness does not cause addiction. However, some mental illnesses, especially those that are not quickly diagnosed and treated, can trigger the use of alcohol and drugs.

Depressive disorders often cause acutely uncomfortable feelings such as overwhelming sadness, hopelessness, numbness, isolation, sleep disorders, digestive and food-related disorders. It is tempting, if medications aren't being prescribed or used properly, for people suffering from depression to self-medicate.

This can compound the depression and make it far worse. A drink or two, a line of cocaine or two, might temporarily relieve some symptoms, but the backlash when the chemical leaves the body brings the depression to new lows. This "withdrawal depression" happens each time an abused chemical leaves the body, though many people don't experience severe symptoms at first. The withdrawal depression itself can trigger the use of more alcohol or drugs because they will help get rid of the bad feelings.

Another compounding problem is that if drugs and alcohol are being used while medication is being taken, the alcohol or drugs can actually potentiate-make stronger-or deactivate the medication. Either way, this can put the person in medical danger.

Because of their personal life-shattering experiences with substance abuse, some people in recovery are leery of using any drugs, even prescribed ones. They have faced traumatic experiences with addiction and have a difficult time coming to terms with the necessity for medication intervention. In fact, I have had patients who have quit drinking or drugging the hard way-through willpower or cold turkey-yet are willing to endure the horrible symptoms of depression rather than take medication. Very often their social sober support network advises them to refrain from taking meds. Usually, this is not within the realm of the advisor's authority. Dually-diagnosed patients (those with both mental illness and addiction) should speak with their psychiatrist about this issue, not a friend, no matter how well-intentioned.

One question I get asked frequently from addiction-treatment patients who are diagnosed with depression after they are diagnosed with an addiction is "did my drinking or drugging cause the depression?" The initial answer is always a resounding "maybe." A well-trained psychotherapist will often be able to tease out the source of the depression and find out if it existed before the patient came in for addiction treatment. Therapists use a psychosocial evaluation and reports from family, friends, employers, court and police records and the like to help determine which condition occurred first.

Why is it important to know when the depression first occurred? Because someone who had depression before they began to abuse substances will most likely need treatment, including medication intervention, for a longer period of time compared to someone whose depression was caused by the cycle of addiction. Someone whose depression was caused by substance abuse generally will not need the same treatment as someone whose depression preceded his or her substance abuse.

Sometimes when someone comes in for addiction treatment and has a depressive disorder that was caused by addiction, they aren't able to accurately report what is going on for them. They may be too numb or sad or unable to focus. Or perhaps a less-than-thorough psychosocial evaluation is done. Lack of reporting or inadequate evaluation may prevent the full understanding of whether the depressive disorder preceded or was caused by the substance abuse.

If a patient whose depression was caused by chemical abuse is referred to a treatment track for those who were depressed first and chemically dependent later, within a few weeks he or she usually is asking "what am I doing here? I don't have these kinds of problems!" In these cases this isn't necessarily a function of denial but a valid observation due to an original lack of understanding about whether the depression or the addiction came first.

Depression and Substance Abuse: The Chicken or the Egg?

Related Articles

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Richard Zwolinski, LMHC, CASAC, SAP, ADS and C.R. Zwolinski

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Depression and Substance Abuse: The Chicken or the Egg?

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There's a saying in the recovery movement: Alcohol and drug addiction can cause mental illness but mental illness does not cause addiction. However, some mental illnesses, especially those that are not quickly diagnosed and treated, can trigger the use of alcohol and drugs.

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The agreement, negotiated with the state of Oklahoma, will allow the maker of OxyContin to avoid a televised courtroom trial.

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Purdue Pharma's corporate headquarters in Stamford, Conn. Credit Credit Justin Lane/EPA, via Shutterstock

Purdue Pharma, the maker of OxyContin, and its owners, the Sackler family, agreed to pay $270 million to avoid going to a state court trial over the company's role in the opioid addiction epidemic that has killed more than 200,000 Americans over the past two decades.

The payment, negotiated to settle a case brought by the state of Oklahoma, was far larger than two previous settlements Purdue Pharma had reached with other states. It could jolt other settlement talks with the company, including those in a consolidated collection of 1600 cases overseen by a federal judge in Cleveland.

"Purdue appears to have concluded that it was less risky to settle the Oklahoma case than have the allegations publicly aired against it during a televised trial and face exposure to what could have been an astronomical jury verdict," said Abbe R. Gluck, a professor at Yale Law School who directs the Solomon Center for Health Policy and Law.

"That said," she continued, "the settlement does put a stake in the ground for the other cases. It telegraphs what these cases might be worth and makes the elephant in the room even larger - namely, do Purdue and the Sacklers have sufficient funds to give fair payouts in the 1600-plus cases that remain?"

In a statement released after the settlement announcement, Purdue Pharma's chief executive, Dr. Craig Landau, said: "Purdue is very pleased to have reached an agreement with Oklahoma that will help those who are battling addiction now and in the future."

While numerous other drug manufacturers, distributors and pharmacy chains have been targets of lawsuits, Purdue, in particular, has been painted as the arch-villain of the opioid disaster, and the company has been feeling exceptional heat in recent months.

Not only was the company staring down an impending trial date of May 28 in Oklahoma, with cameras in the courtroom, but documents made public recently in a case brought by the state of Massachusetts accused Sackler family members of directing efforts to mislead the public about OxyContin's potency and addictive properties. A number of museums and cultural institutions around the world have recently stopped taking donations from the Sacklers, who have a long record of philanthropy.

As headlines mounted, the company began exploring the possibility of filing for Chapter 11 bankruptcy restructuring, a step that could temporarily insulate it from big judgments. While it has yet to decide, the possibility of bankruptcy exerted powerful leverage at the bargaining table in Oklahoma, people familiar with the negotiations said.

Once a company files for Chapter 11 protection, only secured creditors, such as banks, can expect to be repaid in full. While an Oklahoma jury could potentially have hit Purdue with a stratospheric civil judgment, the likelihood of the state collecting even a significant portion from bankruptcy court - never mind how much appellate courts would reduce the award - would be remote and at some point far in the future. Legal experts said the settlement amounts to a bird-in-the-hand decision.

Legal experts said similar calculations could come into play in the 35 other state cases still pending against Purdue, as well as in the federal litigation, which combines 1600 suits brought by cities, counties, Native American tribes and others.

"There is blood in the water now, and with the threat of bankruptcy, the concern is that counties and states may settle on the cheap early to avoid getting little to nothing later on," said Elizabeth Chamblee Burch, a law professor at the University of Georgia.

At a news conference Tuesday in Tulsa, Mike Hunter, the Oklahoma state attorney general, said that as part of the settlement agreement, Purdue's payment to the state had been secured against any possible bankruptcy filing.

"The addiction crisis facing our state and nation is a clear and present danger," Mr. Hunter said. "Last year alone, out of the more than 3,000 Oklahomans admitted to the hospital for a nonfatal overdose, 80 percent involved a prescription opioid medication. Additionally, nearly 50 percent of Oklahomans who died from a drug overdose in 2018 were attributed to a pharmaceutical drug. Deploying the money from this settlement immediately allows us to decisively treat addiction illness and save lives."

Lawyers for the plaintiffs in the federal litigation, while quick to praise Oklahoma's settlement, underscored that a resolution with Purdue hardly represented a broad settlement with the numerous companies involved in making, distributing and selling opioid painkillers.

"There are nearly two dozen other defendants with pending allegations against them in federal court, " the executive committee of the plaintiffs' lawyers said in a statement. "We believe all of these defendants - opioid manufacturers, distributors, and pharmacies - must be held responsible for their role in the epidemic, and we will continue to pursue accountability for the thousands of communities we represent."

According to details of the agreement announced Tuesday by Mr. Hunter, more than than $100 million will go to fund a new addiction treatment and research center at Oklahoma State University in Tulsa. The Sacklers, who were not named in the lawsuit, will contribute an additional $75 million over five years to the center.

"While the agreement announced today is not a financial model for future settlement discussions, the establishment of the National Center is a unique and important step that we hope will save lives, by creating breakthrough innovations in the prevention and treatment of addiction, and point towards how we can achieve a national resolution," the Sackler family said in a statement.

The statement added: "We also want to make clear that the recent attacks on our family are not accurate and misdirect attention away from crucial issues such as the terrifying rise in illicit fentanyl overdoses."

The new center, to be named the National Center for Addiction Studies and Treatment, will be housed at the university's Center for Wellness and Recovery, which has a current annual budget of only about $2.4 million.

About $60 million of the settlement money will be set aside to reimburse the state for litigation costs, and $12.5 million will be given to municipalities and counties to address their costs for the epidemic. The package also includes $20 million in medicine for addiction treatment. (The Food and Drug Administration recently granted Purdue a fast track designation to develop an emergency opioid overdose treatment injection, which the company pledged not to profit from.)

Public health experts cautiously welcomed the agreement.

"It will certainly be addressing the harms caused by the company, " said Dr. Joshua M. Sharfstein, a professor of public health policy at the Johns Hopkins Bloomberg School of Public Health.

"It creates an opportunity not just to improve treatment right on the university's site, but to expand access to lifesaving medications across the region, " he said.

So far, the trial, which includes other pharmaceutical companies such as Johnson & Johnson, is on track to begin May 28. On Monday, the Oklahoma Supreme Court turned aside a bid by the defendants to delay the start by 100 days.

Whether other defendants will settle before then is unclear. Unlike many opioid lawsuits, which have pulled in an array of defendants, including distributors and pharmacy chains, Oklahoma's case, filed in June, 2017, focused only on manufacturers. There were essentially three major pharmaceutical groups, including Purdue Pharma and its subsidiaries, Teva Pharmaceuticals, the Israeli-based company that mostly makes generic forms of opioids, and Johnson & Johnson.

Johnson & Johnson, which makes Duragesic, a fentanyl skin patch, has long had a reputation for being willing to risk jury trials, notably in cases involving the antipsychotic drug Risperdal and, this week, Xarelto, the blood thinner medication. With its co-defendant, Bayer, Johnson & Johnson prevailed in six jury trials over Xarelto, before it agreed to settle.
[Like the Science Times page on Facebook.| Sign up for the Science Times newsletter.]

Earlier reporting on Purdue Pharma and opioids

Jan Hoffman is a health behaviors reporter for Science, covering law, opioids, doctor-patient communication and other topics. She previously wrote about young adolescence and family dynamics for Style and was the legal affairs correspondent for Metro. @JanHoffmanNYT

A version of this article appears in print on , on Page B1 of the New York edition with the headline: Opioid Lawsuit Yields A $270 Million Payout. Order Reprints | Today's Paper | Subscribe

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Purdue Pharma and Sacklers Reach $270 Million Settlement in Opioid Lawsuit

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The agreement, negotiated with the state of Oklahoma, will allow the maker of OxyContin to avoid a televised courtroom trial. Purdue Pharma, the maker of OxyContin, and its owners, the Sackler family, agreed to pay $270 million to avoid going to a state court trial over the company's role in the opioid addiction epidemic that has killed more than 200,000 Americans over the past two decades.

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The drug overdose epidemic continues to worsen in the United States.

Drug overdoses, both fatal and nonfatal, continue to impact our nation.

Overdose deaths remain a leading cause of injury-related death in the United States. The majority of overdose deaths involve opioids. Deaths involving synthetic opioids (largely illicitly made fentanyl) and stimulants (such as cocaine and methamphetamine) have increased in recent years. In addition, overdose deaths accelerated during the COVID-19 pandemic.

For every drug overdose that results in death, there are many more nonfatal overdoses, each one with its own emotional and economic toll. This fast-moving epidemic does not distinguish among age, sex, or state or county lines. People who have had at least one overdose are more likely to have another. If a person who has had an overdose is seen in the ED, there is an opportunity to help prevent a repeat overdose by linking an individual to care that can improve their health outcomes.

Timely data help improve coordination and promote readiness among health departments, community members, healthcare providers, public health, law enforcement, and government agencies, for regional or multiple state overdose increases.

Featured Topics on Drug Overdoses and Deaths

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Drug overdoses, both fatal and nonfatal, continue to impact our nation. Overdose deaths remain a leading cause of injury-related death in the United States. The majority of overdose deaths involve opioids. Deaths involving synthetic opioids (largely illicitly made fentanyl) and stimulants (such as cocaine and methamphetamine) have increased in recent years.

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She's been going to the same clinic for five years. Every day, she takes a bus, walks the last two blocks from the bus stop and gets in line for her dose of methadone.

Five years ago, Kathy decided she needed help to break her Vicodin addiction. Someone told her about a clinic that offered "methadone therapy," and even though Kathy didn't know a lot about methadone, she heard it prevented withdrawal. Terrified to feel those sickening waves of nausea, debilitating physical aches, round-the-clock sweating and never-ending bouts of diarrhea, Kathy was more than willing to give Methadone a chance, after all she wanted to get clean.

While Kathy didn't go through opiate withdrawal, she still gets sick if she doesn't make it to the clinic for her daily methadone dose. Knowing she's firmly shackled to yet another medication, Kathy's asking herself a really tough question: Am I really better off now than I was five years ago?

The Never-Ending Escalator

Peter's been in a methadone program for 11 years. After a car accident, he developed an addiction to OxyContin - one that nearly ruined his life. He was thankful that methadone provided a way to help keep his withdrawal symptoms at bay.

What Peter wasn't focused on was the fact that his methadone dosage had gone up 300 percent during his decade long treatment, with no plans to wean him off the drug. He's now dependent on methadone. But, no alternatives are offered at the clinic; so they just kept increasing his dosage - further perpetuating the cycle.

The Short Leash

Hillary wanted to go away for the weekend with her friends. They were going camping, which sounded like fun, but Hillary had to say no. She made up an excuse - she couldn't leave town because she had to get to the methadone clinic every day. If she didn't, she would get extremely sick. Her "treatment" had being going on for years and she knew a missed dose wouldn't be pretty. It was so frustrating to feel like a methadone prisoner, but at least she could function enough to hold down a job.

Is it All About the Money?

With over 250,000 Americans enrolled in methadone clinics, these stories are becoming more and more common. Methadone maintenance programs are designed to help people who are addicted to opiates - heroin and OxyContin for example. Patients need just one dose a day in order to avoid withdrawal.

But some methadone clinics don't have a solid taper-down protocol, which means your treatment could go on forever. One missed dose and you're sick from withdrawal symptoms like vomiting, cramps, muscle pain and in some cases life-threatening side effects.

Methadone clinics and manufacturers are part of a billion-dollar industry that has spread to every city, making it much more profitable for people to continue with decades of treatment. With little to no alternatives being offered, those struggling with a opiate dependency are slowly but surely turned into lifelong consumers. They become shackled to methadone and, much like Kathy, unknowingly trade one addiction for another.

Image Source: iStock

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She's been going to the same clinic for five years. Every day, she takes a bus, walks the last two blocks from the bus stop and gets in line for her dose of methadone. Five years ago, Kathy decided she needed help to break her Vicodin addiction.

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Several American cities are rallying around a new response to the opioid epidemic: safe spaces for using heroin.

The concept has gained traction in New York City, Philadelphia, San Francisco, and other cities across the US. The thinking is to allow supervised drug consumption sites where people can use drugs with sterile injection equipment and the supervision of trained staff, who are ready with the opioid overdose antidote naloxone if anything goes wrong. The sites may also link people to addiction treatment on request.

The idea: While in an ideal world, no one would use dangerous and potentially deadly drugs, many people do. So it's better to give these people a space where they can use drugs with some sort of supervision. It's a harm reduction approach.

Others aren't receptive to the idea. The US Department of Justice, under President Donald Trump and Deputy Attorney General Rod Rosenstein, has become a vocal opponent of supervised consumption sites (also known as safe injection sites, medically supervised consumption sites, and many other names) - threatening and even taking legal action.

In a statement in December 2017 about a proposal to open supervised consumption sites in Vermont, the Justice Department warned that the facilities "would violate federal law" - in particular, the federal crack house statute. The Justice Department claimed, "It is a crime, not only to use illicit narcotics, but to manage and maintain sites on which such drugs are used and distributed."

Rosenstein, who published an op-ed in the New York Times on the topic, also issued a warning in August 2018 to city officials on the NPR member station WHYY in Philadelphia. "It remains illegal under federal law," Rosenstein said. "And people engaged in that activity remain vulnerable to civil and criminal enforcement."

Then in February, the Justice Department filed a civil lawsuit against the nonprofit Safehouse, which is attempting to open the safe injection site in Philadelphia, with local officials' support.

But advocates argue they have the scientific evidence on their side, citing some studies from sites in Canada, Australia, and Europe that found the sites can lead to major public health benefits. They claim that the sites don't violate federal law because they are medical facilities meant to help people survive and overcome their addictions.

There's a cultural battle, too. After decades of the war on drugs, much of America's drug policy is colored by a criminalized, stigmatized approach to addiction - one that demands shunning and shutting down all drug use, and trying to make sure that nothing is perceived as even remotely enabling or allowing drug use. Under this view, the idea of giving people a safe space to use drugs seems downright counterintuitive.

Now advocates are challenging the criminalized framing, arguing that if the goal is to save lives from addiction and overdose, a more compassionate approach is necessary.

In the middle of an opioid crisis, some cities are coming around to the new perspective. Drug overdose deaths in 2017 reached a record 70,000, around two-thirds of which were linked to opioids, according to data from the Centers for Disease Control and Prevention. With the death toll mounting, policymakers are desperate for anything that may help.

Cities' embrace of safe injection sites is triggering a broader culture war

Several cities have released plans to open a supervised consumption site, including New York City, Philadelphia, San Francisco, and Seattle. Others, such as Denver and Ithaca, New York, are considering the sites. It's not clear when any of these will open.

It's worth noting, however, that none of these cities would be the first in the US to open a supervised drug consumption facility should they move forward with their plans, because unsanctioned facilities have been operating in the country for years. Some of the sites are makeshift, set up where people commonly use drugs. At least one, though, is secretly run by a harm reduction group that provides other kinds of services to people who use drugs - as has been documented by some studies.

One reason these older sites have never been officially sanctioned is public opposition. There's a widespread not-in-my-backyard (NIMBY) sentiment with these kinds of services; essentially, people are worried that if a supervised consumption site opened in their area, it would attract people who use drugs to their neighborhood, and that could cause a rise in general crime and social disorder.

Critics also worry that supervised consumption sites would lead to more drug use, because they would remove a barrier - and perhaps some of the stigma - to drug use.

The Justice Department made this exact argument about Vermont: "Such facilities would also threaten to undercut existing and future prevention initiatives by sending exactly the wrong message to children in Vermont: the government will help you use heroin. Indeed, by encouraging and normalizing heroin injection, [supervised consumption sites] may even encourage individuals to use opiates for the first time, or to switch their method of ingestion from snorting to injection, the latter carrying greatly increased risk of fatality and overdose."

It's no coincidence that the Justice Department is making this argument. Law enforcement officials are some of the biggest opponents of supervised consumption facilities - and these officials can be particularly persuasive for politicians at the local and state level, where police hold a lot of sway over any policy related to public safety. In Philadelphia, for one, a key turning point seemed to be Police Commissioner Richard Ross going from being, as the Associated Press put it, "dead-set" against supervised consumption sites to "keeping an open mind if they can truly save lives."

It's that reformed perspective - one focused on saving lives - that advocates of harm reduction and supervised consumption sites focus on. It's not that the public and society should embrace or enable drug use or addiction, but that strategies should instead take people who use drugs seriously, listen to why they're doing what they're doing, and try to minimize the harms of what they're doing as much as possible.

The argument: While ideally, people would not use drugs and those with addiction would get into treatment, the reality is that many people aren't ready to stop using. By meeting people where they are, governments and providers can mitigate some of the harms until someone is ready to stop using - and potentially save lives in the process.

So if people are at risk of transmitting HIV or hepatitis C through reused syringes, maybe a program can give them a supply of sterile needles so that they don't need to reuse syringes. If people are at risk of overdose, maybe a program can provide them with naloxone - or create a space where they can be supervised in case they overdose and need medical aid. In concert with these services, providers can also lay the groundwork for treatment in case people decide they're ready for it.

It's similar to the thinking around teen pregnancy: Perhaps parents would prefer that their teens don't have sex at a young age, but, acknowledging the reality that teens might, it's better to provide them condoms and other forms of birth control.

As Jonathan Giftos, an advocate and doctor focused on addiction, said on Twitter, "No one is arguing that [supervised consumption sites] are THE answer to our overdose crisis, but they would fill an enormous gap in current care model - engaging a highly marginalized group of patients - and ultimately save many lives."

Accepting this view, however, requires rethinking how America approaches drugs. As Sarah Wakeman, an addiction medicine doctor and medical director at the Massachusetts General Hospital Substance Use Disorder Initiative, has told me, "For 100-plus years as a society, we've punished and criminalized people who use drugs." The harm reduction view asks that America move away from that criminalized approach.

The evidence for safe injection sites is promising, but critics want more

Researchers have been looking into supervised consumption sites for decades (since the first one opened in Switzerland in 1986), with many positive findings so far. But critics aren't convinced that the evidence is very strong.

Drawing on more than a decade of studies, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in 2018 concluded that safe injection sites led to "safer use for clients" and "wider health and public order benefits." Among those benefits: reductions in risky behavior that can lead to HIV or hepatitis C transmission, drops in drug-related deaths and emergency service calls related to overdoses, and greater uptake in drug addiction treatment, including highly effective medications for opioid addiction.

Despite concerns that the facilities would draw more people who use drugs to an area and cause disorder, the research suggests, according to the EMCDDA, that these facilities lead to less public injecting and fewer syringes discarded in the area - both of which can benefit local communities. The facilities also weren't linked to higher crime in Sydney, Australia, or Vancouver, Canada - and, in fact, were linked to reduced street disorder and encounters with police.

"These services facilitate rather than delay treatment entry and do not result in higher rates of local drug-related crime," EMCDDA concluded.

A recent review of the evidence from the RAND Corporation was more cautious. RAND found that there aren't many well-conducted studies on safe injection sites, and the studies that do exist are too few and far between and have too many methodological constraints and weaknesses to reach hard conclusions about the sites' overall effectiveness. "It's not that you can't learn anything from those studies," Beau Kilmer, the lead author of RAND's report, told me. "But you have to be really careful."

Still, even the RAND review found no evidence that supervised consumption sites lead to more crime and drug use, despite critics' claims.

One problem with supervised consumption sites may come down to scale. The sites have limits in where and when they're open, how many people they can serve at once, and whom they serve. For a city dealing with potentially thousands of people using drugs - many of whom use drugs multiple times a day - the sites don't have enough reach to help a lot of the population. That's particularly true for rural areas, where many people simply won't be able to make an hours-long trip every time they want to use drugs.

So even though some studies have been done, critics and skeptics want more.

The US has a lot of room for improvement in its response to the opioid crisis

Beyond supervised consumption sites, there's a lot the US could do to combat the opioid crisis.

At the top of those other things is treatment - specifically, medications like methadone and buprenorphine. There are decades of evidence behind these medications, showing that they reduce the mortality rate among opioid addiction patients by half or more and keep people in treatment better than other approaches. When France relaxed restrictions on doctors prescribing buprenorphine in response to its own opioid crisis in 1995, the number of people in treatment rose and overdose deaths fell by 79 percent over the following four years.

But these medications, and addiction treatment in general, remain largely inaccessible in the US. A 2016 surgeon general report concluded that only 10 percent of people with a substance use disorder get specialty treatment, in large part due to a lack of affordable and accessible treatment options. And even when treatment is available, other federal data suggests that fewer than half of treatment facilities offer opioid addiction medications.

The US could also do a lot more on the harm reduction front. Consider needle exchanges, where people can pick up sterile syringes and trade in used needles. The decades of research show needle exchanges combat the spread of bloodborne diseases like hepatitis C and HIV, cut down on the number of needles thrown out in public spaces and link more people to treatment - all without enabling more drug use.

Yet needle exchanges remain scarce in the US, as Josh Katz reported for the New York Times: "According to the North American Syringe Exchange Network, 333 such programs operate across the country, up from 204 in 2013. In Australia, a country with less than a tenth as many people, there are more than 3,000."

Then there's a more controversial idea: prescription heroin sites.

The idea behind these: Some people struggling with addiction are going to use heroin no matter what. For whatever reason, traditional therapies just aren't going to work for them - just like some treatments for, say, heart disease or cancer don't work for some patients. So if that happens, it's better to give them a safe source of the drug they're seeking and a safe place to inject it, rather than letting them pick it up on the street - laced with who knows what - and possibly overdose without medical supervision.

Researchers credit the European prescription heroin programs with better health outcomes, reductions in drug-related crimes, and improvements in social functioning, such as stabilized housing and employment. Canadian studies also deemed prescription heroin effective for treating heavy heroin use. A review of the research - which included randomized controlled trials from Switzerland, the Netherlands, Spain, Germany, Canada, and the UK - reached similar conclusions, noting sharp drops in street heroin use among people in the treatment.

The RAND review of the evidence also found solid support for prescription heroin sites, which actually had a much stronger evidence base than supervised consumption sites.

There is no prescription heroin program in the US.

Advocates of supervised consumption sites, though, argue that safe injection facilities provide a unique opportunity that other policy interventions do not.

For example, someone who uses heroin may have had bad experiences with the criminal justice system or health care system in the past. That may make him skeptical of going to these institutions - or any other official institutions - for help. A supervised consumption site, though, can be different, since it's an environment in which people are less judgmental about drug use. If the people running supervised consumption sites take advantage of this, they could use their better stature with people who use drugs to guide them to treatment and recovery.

There's some research, as the EMCDDA found, that supervised consumption sites can do this. But more evidence is needed, skeptics and critics argue.

But as tens of thousands die of drug overdoses a year, some local policymakers are desperate to find solutions. So despite the federal opposition, they're moving ahead with supervised consumption sites.

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Why some US cities are opening safe spaces for injecting heroin

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Several American cities are rallying around a new response to the opioid epidemic: safe spaces for using heroin. The concept has gained traction in New York City, Philadelphia, San Francisco, and other cities across the US.

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Kevin Brodie

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Kevin Brodie

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Kevin Brodie

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Kevin Brodie

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Jason Jackson

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Here are some of the ways drugs can change your physical appearance and your body-for the worse.

Your skin

Steroids cause acne breakouts on your face and body. Meth causes acne, dull skin, and self-inflicted wounds from picking at your face and body because you think that bugs are crawling under your skin, leaving sores and scars. And don't forget those needle marks and collapsed veins if you shoot up any drugs!

Your hair

Steroids can cause baldness in men and facial hair and baldness in women.

Your chest

Steroids can cause development of breasts in males.

Your nose

Snorting cocaine can lead to nosebleeds and a decreased sense of smell. Eventually it can entirely destroy the cartilage in your nose.

Physique

Meth causes a decrease in appetite, causing you to look thin and skeletal. Steroids can cause you to stop growing - you may never reach your full adult height.

Lungs

Smoking marijuana can cause breathing diseases, including a chronic cough, bronchitis, and emphysema, and lung inflammation and lung infection.

Kidneys

Ecstasy and meth raise your body temperature, causing dehydration, which restricts blood flow to the kidneys and may result in kidney failure.

Mouth

Meth causes dry mouth, teeth clenching, and poor dental hygiene, resulting in meth mouth - rotten teeth, gum disease, and bad breath.

Heart

Stimulants, like cocaine and meth, cause irregular heartbeats, heart attack, stroke, blood clots, heart damage, or sudden death. Inhalants can cause a rapid or irregular heartbeat, leading to heart failure and death. Fatal cardiac slowdown can be caused by sedatives, prescription pain medication, or opioids. Mix alcohol with any of these drugs and you increase your risk of coma and death!

Drugs + Your Body: It Isn't Pretty

Check out this poster from NIDA (National Institute on Drug Abuse) to see up close how drastically drugs can affect your looks and body.
Source: National Institute on Drug Abuse

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How Drugs Affect Your Looks and Your Body

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Steroids cause acne breakouts on your face and body. Meth causes acne, dull skin, and self-inflicted wounds from picking at your face and body because you think that bugs are crawling under your skin, leaving sores and scars. And don't forget those needle marks and collapsed veins if you shoot up any drugs!

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Jason Jackson

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Preface | National Institute on Drug Abuse

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How Science Has Revolutionized the Understanding of Drug Addiction

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The psychedelic drug DMT produces an effect in the brain similar to that felt by people undergoing near-death experiences, according to a new study.

A powerful hallucinogen, the substance is widely used for ceremonial purposes in South America as part of the brew known as ayahuasca.

Though the drug is illegal in most countries, its connection with spirituality is widely acknowledged and has earned it the nickname "the spirit molecule".

Near-death experiences (NDEs) are psychological events often reported by those who think they are about to die, and can include out of body experiences, feelings of transitioning to another world and inner peace.

As similar feelings are often reported by DMT users, researchers at Imperial College London wanted to investigate how deep the connection between these experiences went.

In a trial of 13 healthy volunteers, doses of either the drug or a placebo were administered intravenously over the course of two sessions.

Their reactions to the drug were then compared with the experiences of 67 people who had previously reported NDEs and completed standardised questionnaires to document what had happened to them.

After their sessions, the DMT users were asked questions such as "Did scenes from your past come back to you?" and "Did you see, or feel surrounded by, a brilliant light?".

The similarities between the responses of those who had taken DMT and those who had come close to death confirmed the anecdotal evidence from users of the psychedelic drug - that it is indeed able to mimic the effect of an NDE.

"Our findings show a striking similarity between the types of experiences people are having when they take DMT and people who have reported a near-death experience," said PhD candidate Chris Timmermann, the first author of the study.

Ex-government drugs tsar Professor David Nutt, who also contributed to the research, said the data suggested "the well-recognised life-changing effects of both DMT and NDE might have the same neuroscientific basis."

Dr Robin Carhart-Harris, who leads the Imperial College psychedelic research group and supervised the study, which was conducted as part of the Beckley-Imperial Research Program, said: "DMT is a remarkable tool that can enable us to study and thus better understand the psychology and biology of dying."

However, the researchers noted there were some subtle differences between the two experiences, with DMT users more likely to describe "entering an unearthly realm" rather than the more ominous "coming to a point of no return" reported by people experiencing NDEs.

The scientists said these distinctions may have been the result of the rigorous screening and preparation that preceded DMT dosing in these experiments.

The results of their study were published in the journal Frontiers in Psychology.

Psychedelic drugs such as DMT and LSD have previously been linked with improvements in mental health, and scientists have suggested illegal drugs have the potential to become the next generation of antidepressants.

While the Imperial scientists said their results added an intriguing dimension to this story, they advised against any self-medication by the general public.

"We hope to conduct further studies to measure the changes in brain activity that occur when people have taken the compound," said Mr Timmermann.

"This, together with other work, will help us to explore not only the effects on the brain, but whether they might possibly be of medicinal benefit in future."
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Potent psychedelic drug DMT makes the brain think it is dying, study finds

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The psychedelic drug DMT produces an effect in the brain similar to that felt by people undergoing near-death experiences, according to a new study. A powerful hallucinogen, the substance is widely used for ceremonial purposes in South America as part of the brew known as ayahuasca.

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ALEXANDRIA, Va. (AP) - Federal prosecutors say a Virginia man was sentenced to 20 years in prison for distributing cocaine.

Court documents say that 36-year-old Aidriss Saydi was a prominent drug dealer in Northern Virginia for the past decade and paid hundreds of thousands of dollars to have narcotics shipped to him. Court documents from late 2018 say Saydi pleaded guilty to conspiracy to distribute drugs and to brandishing a firearm in connection with drug trafficking.

Prosecutors allege that he made a co-conspirator hide nearly a kilogram of cocaine in 2018 and later beat him after authorities found the drugs because he believed the co-conspirator had stolen from him.

Authorities say that Saydi has forfeited $1 million and multiple vehicles.

An attorney for Saydi didn't immediately respond to an email seeking comment Saturday.

Copyright © 2019 The Associated Press. All rights reserved. This material may not be published, broadcast, written or redistributed.

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Virginia man sentenced to 20 years on drug charges | WTOP

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ALEXANDRIA, Va. (AP) - Federal prosecutors say a Virginia man was sentenced to 20 years in prison for distributing cocaine. Court documents say that 36-year-old Aidriss Saydi was a prominent drug dealer in Northern Virginia for the past decade and paid hundreds of thousands of dollars to have narcotics shipped to him.

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Iowa officer exposed to suspected fentanyl during traffic stop: police

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The Food and Drug Administration on Tuesday approved a form of ketamine, which is a rapid acting anesthetic that has been used illegally as a party drug known as "Special K," as a treatment for depression. Esketamine, developed by Johnson & Johnson and produced as a nasal spray, can only be administered in a doctor's office.

J&J touted esketamine as the first new drug treatment approved for depression in decades.

The nasal spray is a chemical cousin of ketamine, which has been used for decades as a powerful anesthetic to prepare patients for surgery. In the 1990s, the medication was adopted as a party drug by the underground rave culture due to its ability to produce psychedelic, out-of-body experiences. More recently, some doctors have given ketamine to people with depression without formal FDA approval.

The FDA approved Spravato as a fast-acting treatment for patients who have failed to find relief with at least two antidepressants. Up to 7.4 million American adults suffer from so-called treatment-resistant depression, which heightens the risk of suicide, hospitalization and other serious harm, according to the FDA.

Ketamine nasal spray could be used to treat depression

There have been no major pharmaceutical innovations for depression since the launch of Prozac and related antidepressants in the late 1980s. Those drugs target the feel-good brain chemical serotonin, and can take weeks or months to kick in.

Ketamine and J&J's version work differently than those drugs, targeting a chemical called glutamate that is thought to restore brain connections that help relieve depression.

When the drug works, its effect is almost immediate. That speed "is a huge thing because depressed patients are very disabled and suffer enormously," said Dr. John Mann, a psychiatrist and researcher at Columbia University. If the drug doesn't work, physicians can quickly switch to other options, he noted.

The FDA approved Spravato, known chemically as esketamine, based on study results that showed patients taking the drug experienced a bigger improvement in their depression levels than patients taking a sham treatment, when measured with a psychiatric questionnaire.

The drug is designed to be lower-dose and easier to use than ketamine, which is normally given as an intravenous infusion.

Robin Prothro, 60, began taking antidepressants more than 20 years ago. But she says none of the five medications she tried relieved the depression that has stymied her personal and professional life.

Since enrolling in a Spravato trial two years ago, Prothro says her depression has lifted and she's returned to hobbies she abandoned years ago, like gardening.

She takes the drug every two weeks at her psychiatrist's office while reclining in a comfortable chair.

"You can feel it coming on, it's a strong drug," she said, describing colors and shapes that drift before her eyes. "I just let the drug work. I close my eyes and my mind is amazingly quiet."

Psychedelics reconsidered

The ketamine-like drug is the first of several psychoactive substances making their way through the U.S. regulatory process as physicians search further afield for new therapies. Researchers are conducting late-stage trials of psilocybin, the active ingredient in magic mushrooms, and MDMA, a euphoria-inducing club drug, as potential treatments for depression and post-traumatic stress disorder.

"Substantially different agents are only rarely appearing from pharmaceutical companies or other laboratories," said Dr. Paul Summergrad, a psychiatrist at Tufts University. "That's prompting people to investigate other compounds."

Unlike ketamine, psilocybin and MDMA have no legal medical use. Classified in the same category as heroin and LSD, they are tightly restricted by the federal government. But the FDA's approval of esketamine could smooth their path.

Burden of depression

Depression is among the leading causes of disability in the U.S. and is being closely monitored by health authorities amid rising suicides nationwide. In 2017, the U.S. suicide rate rose to 14 deaths per 100,000 people, the highest rate in at least 50 years, according to federal records.

Government officials haven't suggested an explanation for the trend, though academic researchers point to the nation's widening income gap, financial struggles and divisive politics.

J&J's drug will be subject to a number of restrictions due to its abuse potential, side effects and lingering safety questions.

The drug will only be given by accredited specialists who must monitor patients for at least two hours after administration, due to its trippy, disorienting effects. Additionally, all patients will be tracked in a registry to monitor long-term safety and effectiveness.

The immediate impact of ketamine is thought to last just four to seven days and there's no consensus yet on how long patients can benefit from ongoing treatment.

Still, there are few other options for patients who fail to respond to antidepressants. The most effective treatment in such cases, electroshock therapy, requires patients to be fully sedated and can cause persistent memory loss.

Wall Street has high expectations for J&J's medication, with analysts predicting more than $600 million in annual sales by 2022. But J&J will face competition in the marketplace.

A decades-old drug, ketamine is already used off-label to treat depression by some doctors. At least 150 clinics around the U.S. provide treatment with various forms of the drug, which is available as a low-cost generic. Patients often pay hundreds or thousands of dollars for intravenous infusions of the drug over several weeks or months. Such therapies are generally not covered by insurance because they haven't been approved as safe and effective by FDA regulators.

Some doctors plan to offer both ketamine and the new J&J drug.

Dr. Steve Levine says having FDA-approved standards for dosing and administering the new drug should raise standards in the field and drive out some of the bad actors who are not qualified to treat depression.

"This is going to bring in some standards, regulation and it's going to make it safer and more accessible to patients," said Levine, who serves as vice president of the American Society of Ketamine Physicians, a group representing doctors, nurses and others using ketamine for treating depression or other nonapproved uses.

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FDA approves form of ketamine for depression treatment

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The Food and Drug Administration on Tuesday approved a form of ketamine, which is a rapid acting anesthetic that has been used illegally as a party drug known as "Special K," as a treatment for depression. Esketamine, developed by Johnson & Johnson and produced as a nasal spray, can only be administered in a doctor's office.

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Jason Jackson

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With over 30 million Americans currently struggling with substance abuse or alcoholism, it is shocking to remember the byproduct and repercussions of such a deadly epidemic. Economically, at a state and federal level, the price of addiction manifests through lost productivity and other devastating ways. Fatalities, traffic accidents and injuries related to substance abuse take thousands of lives each year, not to mention the accidental overdoses that occur more frequently amongst prescription drug addicts.

Despite all these tragic losses that result from substance abuse, the most saddening byproduct of substance abuse is the neglect, abuse, and maltreatment of children whose parents are addicted to drugs.

Because addiction and alcoholism alter perception and reality very frequently, children of parents who are chemically dependent are not uncommonly found to be put in harm's way, neglected or otherwise abused.

Child Abuse Clearly Defined

The terms and circumstances, which define child abuse and neglect, are clearly defined at a federal level. According to the Child Abuse Prevention and Treatment Act, the mistreatment of children is defined as:

Any recent act or failure to act on the part of a parent or caregiver, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm.

What could this mean in the case of children put in danger by way of drug abuse in the home? While even just exposing children to dangerous and illegal drugs could easily be considered maltreatment, additional abuse or neglect may manifest in any of the following ways:

Violence or verbal abuse resulting from being drunk or high

Sexual abuse or behavior which makes a child feel uncomfortable

Forcing a child to hide an adult's drug abuse or alcoholism

Consistently leaving a child alone at home

Consistently ignoring a child or their needs; lack of attention

The Long-term Effects of Childhood Exposure to Drug Use

Studies exist and have been completed which focus on the long-term effects of substance abuse on the youth who are present. A shocking number of currently detained prison inmates and rehab attendees admit they had a tumultuous upbringing, having experienced some sort of neglect, or physical, sexual or verbal abuse. Further, these individuals were aware of criminality or substance abuse in their environment, setting a powerfully negative example for such youth.

It is wholly observable that children who grow up amongst drug abuse, alcoholism and criminality tend to join in these activities. This creates something of a cyclic trend, making those children who are born into underprivileged homes and neighborhoods more likely to remain 'in the system' than those children who are born of better circumstances with attentive, drug-free parents.

Breaking the Cycle, What Can I Do

As we look at analyzing how drug-addicted parents affect children, we conclude that the most important focus of this issue is breaking the cycle of substance abuse amongst youth. Many youths have entered into drug and/or alcohol abuse paths of their own, largely due to their exposure to such activities as a young child. However, this cycle can be taken apart and the course of youth lives can be changed.

Support local children and family centers; these groups offer a safe environment and supportive care to children when parents are unable to.

Demand drug education in all schools in your area; although drug prevention begins in the home, having preventative education at a young age continues to be an effective way to keep kids off drugs.

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How Children are Affected by Drug Addicted Parents

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With over 30 million Americans currently struggling with substance abuse or alcoholism, it is shocking to remember the byproduct and repercussions of such a deadly epidemic. Economically, at a state and federal level, the price of addiction manifests through lost productivity and other devastating ways.

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Jason Jackson

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Greta Ferkel, M.M.Ed., is Executive Dean of Adler University's Global Campus. A member of the University's Leadership Team, she holds more than 20 years of experience leading online education program development, management, assessment, and student support.
Each year, nearly 700,000 people are released from prison in the United States. Within three years, 40 percent of them will go right back. According to a 2014 study by RAND Corporation, educated offenders have much lower recidivism rates than those who are released but received no education while incarcerated. These findings suggest that a major factor in our criminal justice system's failure to rehabilitate is a basic lack of education.

A review of the website reveals that only 28 out of the 50 states have any kind of education program listed, meaning 44 percent offer nothing-a number that correlates closely to the overall recidivism rate. More generally, states consistently prioritize funding for incarceration far beyond what they offer for K-12 education. Annually, on average, states spend $15,000 to $60,000 maintaining a prisoner, but only $7,000 to $18,000 on educating a student.

The Pew Charitable Trusts reports that federal spending for prisons rose seven-fold over the last three decades, from less than $1 billion (adjusted for inflation) in 1980 to nearly $7 billion in 2013. It's hard not to look at this dramatic increase and not make a connection to the privatized industrial prison complex, which has also rapidly grown over the past 30 years.

Privately owned prisons make their money based on the number of occupied beds, meaning states pay a certain amount for each prisoner. Often, in their contracts with state governments, privately owned prisons stipulate the state guarantee a certain rate of occupancy, sometimes as high as 90 percent. Keeping this in mind, it's alarming that inmates assigned to private prisons on average serve 4 to 7 percent more time than those assigned to public prisons. A major driver of this increase is the heightened incidents of prison conduct violations. Inmates in private prisons incur twice as many infractions-and subsequent sentence increases-than those in public prisons.

And yet the value proposition of a private prison is cost savings to the state, meaning a lower amount spent per prisoner on an annual basis. Given that sentences are longer in private prisons, the only way to reduce costs is to spend less on prisoners. There's no magic, no smart innovations in the way private prisons accomplish this; they simply cut services. Education and training programs are often among the first to go.

Beyond cost savings, providing education to prisoners goes directly against the interests of private prisons. Studies have shown education programs reduce recidivism by 40 percent. No business designed to maximize profit would intentionally provide a service or product that ensures 40 percent of its customers never return.

This conflict of interest highlights a clear need for reform of the criminal justice system and a distinct opportunity for institutions of higher education. We are positioned to have a tremendously positive impact. This is an opportunity to leverage the maturation of online education and strong cybersecurity measures, as a cost-effective, efficient means to provide instruction and support services, including tutoring, writing labs, and career services virtually.

This is higher education's moment. With our capacity for focused research and innovation, we can develop increasingly effective means to educate and rehabilitate incarcerated people. It is, in fact, the moral responsibility of educational leaders and institutions to create opportunities for the most vulnerable among us and the advancement of social justice. We should seek to partner with policymakers, prison leaders, private providers and communities to create a system that will make education available to those incarcerated.

Our success as a society depends upon it.

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Private Prisons and the End of Rehabilitation - The Socially Responsible Practitioner

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Given that sentences are longer in private prisons, the only way to reduce costs is to spend less on prisoners. There's no magic, no smart innovations in the way private prisons accomplish this; they simply cut services. Education and training programs are often among the first to go.

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HOUSTON -- Many beers and wines sold in the U.S. contain the weed killer glyphosate, the main ingredient in Roundup, according to a new report by U.S. PIRG Education Fund. In Glyphosate pesticide in beer and wine, U.S. PIRG tested 20 beers, wines and hard cider, including several organic brands, for glyphosate/Roundup and found that all but one contained the harmful chemical.

This revelation comes on the same day a San Francisco court begins hearing arguments in the first federal civil case over whether Monsanto's Roundup weed killer causes cancer.

"When you're having a beer or a glass of wine, the last thing you want to think about is that it includes a potentially dangerous pesticide," said U.S. PIRG Education Fund's Kara Cook-Schultz, who authored the study. "No matter the efforts of brewers and vintners, we found that it is incredibly difficult to avoid the troubling reality that consumers will likely drink glyphosate at every happy hour and backyard barbeque around the country."

U.S. PIRG tested five wines, 14 beers and one hard cider for the study. The wine brands were Barefoot, Beringer, Frey (organic), Inkarri Estates (organic), and Sutter Home. The beers examined were from Budweiser, Coors, Corona, Guiness, Heineken, Miller, Peak (organic), Sam Adams, Samuel Smith (organic), Sierra Nevada, Stella Artois, Tsingtao and New Belgium. Ace Perry Hard Cider was also tested. The study results confirm past results of several other groups, including Moms Across America.

Of particular note, the study found that, despite weed killer products like Roundup being prohibited in the making of organic beers and wines, glyphosate was discovered in three of the four organic alcoholic beverages tested.

The Brewers Association, which represents more than 4,900 small and independent craft brewers, said in a statement: "Brewers do not want glyphosate used on barley or any raw brewing material, and the barley grower organizations have also come out strongly against glyphosate."

The amount of glyphosate discovered in the samples ranged as high as 51 parts per billion (ppb) in Sutter Home wine and more than 25 ppb in non-organic beers from Budweiser, Coors, Corona, Miller and Tsingtao. The organic drinks were found to have totals as high as 5.2 ppb. While these numbers are below the EPA's risk tolerances for beverages, at least one previous scientific study found that as little as one part per trillion of glyphosate can stimulate the growth of breast cancer cells and disrupt the endocrine system.

"Craft brewers pride ourselves on producing the highest quality products for our patrons, and that necessitates the use of the highest quality, safest ingredients," said Elan Walsky, who is co-owner of Coalition Brewing in Portland, Oregon. "Maintaining this high standard of excellence is not only important for our beer and our health, but also for the local community from the farmers who grow our hops and barley, all the way down to the people enjoying our beer."

With the findings indicating glyphosate contamination is common in over-the-counter beers and wine, the report recommends that, unless it can be proved otherwise, the pesticide should be banned in the U.S. due to its many potential health risks and ubiquitous presence in food, water and alcohol.

"With a federal court looking at the connection between Roundup and cancer today, we believe this is the perfect time to shine a spotlight on glyphosate," Cook-Schultz said. "This chemical could prove a true risk to so many Americans' health, and they should know that it is everywhere -- including in many of their favorite drinks."

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U.S. PIRG Education Fund is an independent, non-partisan group that works for consumers and the public interest. Through research, public education and outreach, we serve as counterweights to the influence of powerful special interests that threaten our health, safety or well-being.

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Popular weed killer found in top beer and wine brands | U.S. PIRG

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Many beers and wines sold in the U.S. contain the weed killer glyphosate, the main ingredient in Roundup, according to a new report by U.S. PIRG Education Fund. In Glyphosate pesticide in beer and wine, U.S. PIRG tested 20 beers, wines and hard cider, including several organic brands, for glyphosate/Roundup and found that all but one contained the harmful chemical.

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DOVER, Del. (CBS) - Delaware lawmakers are trying to make it illegal for teenagers to smoke.

They introduced a bill Wednesday that would raise the legal age to buy tobacco products from 18 to 21.

That also includes tobacco substitutes like E-cigarettes and vaping devices.
$1 Million Mega Millions Ticket Sold In Delaware County
The bill would fine businesses caught selling the products to anyone underage, but would not punish people under 21 who try to buy them.

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Delaware Proposes Raising Smoking Age, Including Vapes And E-Cigarettes, To 21

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DOVER, Del. (CBS) - Delaware lawmakers are trying to make it illegal for teenagers to smoke. They introduced a bill Wednesday that would raise the legal age to buy tobacco products from 18 to 21. That also includes tobacco substitutes like E-cigarettes and vaping devices.

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Where does N.J. stand on legal weed as we head into 2019

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Drugs in Wilmington DE

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Are Opiates Harmful?

Opiates are among the most abused drugs in the United States as they're easy to get hold of, readily prescribed, and very addictive--a dangerous combination.

Opiates include numerous substances such as heroin, morphine, and thebaine, but they all have the same method of action. These highly addictive substances are called opiates because they are derived from chemicals found in the sap of the opium poppy - one of the biggest moneymakers in the Afghan mountains. Prescription opioids, which have essentially the same mechanism of action as natural opiates, include drugs such as hydrocodone, oxycodone, and fentanyl.

Opiates are extremely useful in the management of pain and for cough suppression in the case of severe lung conditions, but they do have a dark side. They are among the most abused drugs in the United States as they're easy to get hold of, readily prescribed, and very addictive--a dangerous combination.
Opiate abuse takes its toll on almost every major body system.
View our infographic to see the true dangers of these drugs.
Opiate Effects question 1

Opiate Effects question 2

Who Answers?

Short-Term Effects of Opiates

The biggest advantage to opiates is that they're very effective at controlling pain, and they're relatively cheap. Morphine has been around for over a century, yet it still is used regularly to control pain.

Opiates usually produce a "high" of some type; the faster-acting they are, the more intense the high they produce. Heroin produces a very intense high thanks to its very short duration of action: its half-life is between 15 and 30 minutes. Morphine is much longer, lasting from 4 to 6 hours.

The short-term effects of opiate use can include:

Opiates and Dopamine

Opiates initiate the release of a cascade of dopamine in the brain, which creates feelings of pleasure and reinforces the behavior, i.e., ingestion of the substance. See below:

Opiate Effects question 3

Side Effects

Because of the intense high produced by the interaction of several opiates and the brain, the drugs remain extremely addictive, sometimes causing measurable symptoms of addiction in under three days.

The side effects of opiate abuse are fairly varied and may include:

Because of the intense high produced by the interaction of several opiates and the brain, the drugs remain extremely addictive, sometimes causing measurable symptoms of addiction in under three days.

Opiates also cause your irises to relax, creating pinprick or pinpoint pupils. This is one of the big giveaways of opiate abuse, and it's hard to disguise.

Because of the way opiates often reduce your reaction times, driving while under the influence of opiates is often dealt with harshly, and you could lose your freedom along with your license. In some states, the mere presence of an illegal drug is enough to determine that you were driving while intoxicated, although the federal government is pushing states toward defined limits, just like with .

Opiate Effects question 4

Long-Term Effects of Opiates

Long-term effects can include:

Nausea and vomiting.

Abdominal distention and bloating.

Constipation.

Liver damage (especially prevalent in abuse of drugs that combine opiates with acetaminophen).

Brain damage due to hypoxia, resulting from respiratory depression.

Development of tolerance.

Dependence.

Effects of Injection Drug Use

Naturally, taking the drug in nonstandard ways increases its side effects. The body is not, for example, designed to cope with a load of powder floating around in the bloodstream, but a number of addicts grind up tablets, mix them with water or alcohol, and inject them. This can lead to heart problems, including long-term heart infections, as well as pulmonary embolisms. If the injection site gets infected, it can cause gangrene in the local area - the flesh dies and then rots. If the wound gets infected, it can cause a massive blood infection, which can be life-threatening.

A number of chronic infections such as viral hepatitis and HIV can be contracted as a result of unsterile needle techniques in conjunction with intravenous use of several opiates. The classic example would be heroin. Compared to the general population, intravenous heroin abusers have a much higher rate of contraction of HIV and other blood borne illnesses. More recently, however, rates of contraction of HIV have been noted in association with IV use of prescription medications such as Opana, or oxymorphone. Indeed, in 2015, the rate of HIV transmission in a population of IV Opana abusers in the state of Indiana was so high, that the Indiana state governor reversed one of his drug policies to implement an emergency needle exchange program in an attempt to reverse the alarming trend of newly infected people.

Opiate Effects question 5

Video: How to Overcome an Opiate Addiction

The following short video provides information about getting help for an opiate addiction.

Opiate Dependence

The best-known side effect of opiates is addiction, and it's surprisingly easy to become addicted without realizing it.

Even codeine, a commonly prescribed painkiller, is addictive. Opiate dependence tends to be diagnosed when you cannot get off the drug despite the negative consequences of being on the drug. You might be stealing drugs or money to fund your habit. Your relationships might be breaking down. You could also find that your work performance has suffered, resulting in financial problems.

If you cannot get off the drug, suffer withdrawal symptoms upon cessation of using, and compulsively use despite harm to your health and life, you are dependent on the drug and may need help to stop. To find a program and being your recovery, call Who Answers? today.

Opiate Effects question 6

Opiates Withdrawal Treatment

Opiate withdrawal can be quite uncomfortable and includes intense flu-like symptoms. Successful treatment often includes supervised detox to maximize comfort and safety during the withdrawal process and minimize the risk of relapse.

As opiate dependency can be quite tenacious, many recommend three months as the minimum amount of time it takes to get someone off the drug and into recovery - for some, it can require even longer periods of treatment.

Often a replacement opiate is prescribed, such as buprenorphine or methadone, to create better stability during detox. You'll either go to a clinic each day to get your dose, or it will be administered in a residential rehab clinic. Over time, the dose will be lowered, and you may experience a few withdrawal symptoms. These symptoms, however, are minor when compared to the massive onset of withdrawal that occurs when you go cold turkey. During this time, you'll need to attend counseling sessions and undergo therapy to discuss the reasons for your drug abuse.

It's advisable to join a peer support group, though, as the support of others can help you avoid triggers and prevent relapse. In time, you might find that you're the sponsor to someone who is in exactly the same situation as you once were. To help an Opiate addict, call our 24/7 helpline at Who Answers? for more information.

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Opiates are among the most abused drugs in the United States as they're easy to get hold of, readily prescribed, and very addictive--a dangerous combination. Opiates include numerous substances such as heroin, morphine, and thebaine, but they all have the same method of action.

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"Drug-related offenses make up as much as 75-85 percent of inmate populations" in Wisconsin

By Eric Litke on Friday, February 22nd, 2019 at 12:51 p.m.

Gov. Tony Evers' announcement that he would push to decriminalize marijuana in Wisconsin was one of the biggest splashes of his young tenure.

It drew media coverage from across the country and sparked a war of news releases on the homefront.

Evers said Feb. 18, 2019, that his first budget would include proposals to legalize medical marijuana; allow possession of small amounts of marijuana for personal use; and expand the ability to expunge certain drug possession convictions.

A news release announcing the move touted the medicinal benefits of marijuana, then pivoted to making a social justice case for change.

"Reforming Wisconsin's marijuana laws to align with the people's support for medical marijuana is an important part of the governor's plan," the release said. "But so, too, is addressing the social and racial justice aspect of marijuana use. Wisconsin has the highest incarceration rate in the country for Black men, and drug-related crimes account for as many as 75-85 percent of all inmates in our prisons."

Evers touted the same 75-85 percent statistic in a since-deleted tweet that day making the case for decriminalizing marijuana. It was repeated in the text of the NBC News story on Evers' announcement.
Several ways to track drug crimes - but none top 30 percent
That's a really high number.

Given all the possible actions that could land a person in prison, do drug crimes really account for three-quarters or more of all inmates?

The Wisconsin Department of Corrections uses a number of measures to track how inmates landed behind bars. But none of them are anywhere close to Evers' number.

A February 2017 analysis examining the point of prison admission showed 27 percent of inmates were sent to prison for a drug crime in 2016. That included opioids, cocaine, amphetamines and marijuana. Marijuana crimes accounted for 6.4 percent of prison admissions.

Meanwhile, a point-in-time analysis done by the department showed 22 percent of Wisconsin inmates had an active drug offense in 2017 - meaning that was among the offenses for which they were serving time.

The numbers are even lower when examining only the most serious offense for each inmate - in other words the one most likely responsible for the length of their prison stay. Only 11 percent of inmates in 2017 had a drug offense as their most serious charge.
Staff acknowledges stat is incorrect
By comparison, a violent crime was the most serious charge for 66 percent of offenders, and a property crime for 14 percent.

So where did Evers get his number?

When we asked Evers' office for the evidence behind the drug offenses claim, Deputy Chief of Staff Melissa Baldauff said they made a mistake. Evers' staff has since removed the statistic from the online version of the news release announcing Evers' marijuana proposal.

Related: U.S. Sen. Tammy Baldwin strikes out on marijuana research claim

Related: U.S. Sen. Tammy Baldwin's claim that VA doctors 'are censored' from talking about pot misses plot

A staff member pulled the number from a 2013 WUWM radio story that attributed the number to retired Lutheran pastor Joe Ellwanger, Baldauff said. WUWM is Milwaukee's National Public Radio affiliate.

Ellwanger used the stat in the context of a University of Wisconsin-Milwaukee study that found Wisconsin had the highest rates of incarceration in the nation for black residents. But he was wrong.

"Upon further investigation, the claim as reported in the WUWM article above did not appear to have sufficient substantiation, and it should have been removed from our document," Baldauff said in an email. "So, the honest answer is that staff made a mistake. We have since updated our press release online to remove that statistic and note the error."

Evers' tweet citing the statistic as proof of the need to decriminalize marijuana garnered more than 500 retweets before it was deleted several days later.

Evers claimed in a news release and a tweet that drug-related crimes account for as 75 to 85 percent of the Wisconsin inmate population.

That statistic was pulled from an incorrect article published six years ago.

Current DOC data shows the actual number of prison inmates sentenced for drug offenses is a fraction of that number - about one-quarter of the prison population.

Indeed the numbers are so far off, and the sourcing - a six-year-old article based on a radio interview that focused on a different topic - is so remote, it's ridiculous.

We rate the claim Pants on Fire.

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Evers not even close on claim about drug offenders in prison

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Gov. Tony Evers' announcement that he would push to decriminalize marijuana in Wisconsin was one of the biggest splashes of his young tenure. It drew media coverage from across the country and sparked a war of news releases on the homefront. Evers said Feb.

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A drug treatment center in Wilmington is trying out a controversial new program aimed at reducing the number of drug-related deaths.

Brandywine Counseling is now offering free strips to test for fentanyl in heroin which can be a deadly concoction.

People who come to their needle exchange van can use these free strips to test for the presence of the powerful opioid.

The counselors hope this will prevent overdoses.

They explain that many users are often unaware that fentanyl is present until it's too late.

The plan has been controversial since it was announced.

Some say it's giving power and resources to active heroin users. Others say this could save lives.

Last year was Delaware's deadliest for overdoses and it's believed that Fentanyl is the main cause.

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Drug treatment center to offer fentanyl test strips

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A drug treatment center in Wilmington is trying out a controversial new program aimed at reducing the number of drug-related deaths. Brandywine Counseling is now offering free strips to test for fentanyl in heroin which can be a deadly concoction.

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Jason Jackson

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Homeless statistics: How many homeless people abuse drugs and alcohol?

It is difficult to precisely target how many people living without a home have drug and alcohol abuse problems. But according to the U.S. Department on Housing and Urban Development (USHUD) and its most recent report on homelessness (see below), more than 4 in 10 individual homeless adults (42.9%) have disabilities, which include drug and alcohol problems. This statistic can compared to 14 percent of adults who have disabilities and are living without a home with families.

Furthermore, drug and alcohol use and homelessness are related according to whether or not a person is homeless for a short term or long term. Specifically, of the 5% of the nearly 2 million homeless people reported by the USHUD in 2009 categorized as chronically homeless, nearly all people living without a home for more than a month have family problems and some kind of disability, including drug or alcohol addiction or mental illness. Based on the 2009 HUD Homeless Assessment Report to Congress,

about one-third of sheltered homeless persons [in a point-in-time January study] reported chronic substance abuse problem... However, contrary to the perceptions that some people have of homelessness, a majority of homeless shelter users do not have chronic substance abuse problems or severe mental illness.

With such varying rates and numbers (chronic vs. short term homelessness, homeless individuals vs. homeless families, and the lack of precise data on "disability"), it is difficult to come up with a definition conclusion on the relationship between addiction and homelessness. But it seem logical to conclude that drugs and alcohol can play an important role in either getting a person on the streets, or KEEPING that person on the streets. And this seems to be in line with real experiences on the streets.

Can drug and alcohol abuse cause homeless-ness?

Yes. We talked with Larry Huff, the President of Samaritan Inns, a non-profit that specializes in helping homeless addicts get off the streets, about this very issue. Of the causes of homelessness Larry says, "Unemployment or under employment results in homelessness. Additionally, people who have some physical or mental disorder cannot get help otherwise so they find themselves on the streets. Substance abuse is also a cause for homelessness. And in some cases, a very small percentage of people choose to live an alternative lifestyle and remain homeless."

What generally comes first...addiction or homelessness?

About the relationship between addiction and homelessness, Larry also says, "I think it's safe to say that addiction comes first. If a person is a homeless addict, most likely they became homeless because of their addiction."

Homeless addicts and costs to society

Furthermore, it is important to address addiction within the homeless population at large. While people who abuse drugs and alcohol make up a relatively small share of the homeless population, they consume more emergency and transitional shelters and occupy hospitals and jails at high rates.

In the interest of social welfare, we need to address the root causes of homelessness, and disability caused by addiction is one that is treatable. Again, Larry Huff says," local governments are seeking to solve the problem by getting people off the street and into subsidized housing. We have some resistance to this idea, as we don't feel that it solves some of the deeper problems of mental disoders or substance abuse."

So if affordable housing doesn't treat addiction, what can? What do you think? How can homeless men and women addicted to drugs and alcohol start to live new lives? How can we address the social need to care for the most vulnerable of our population? And are we culpable at all for other people's addictions? We explore this issue further here on Addiction Blog in an ongoing series about drug abuse alcoholism and homelessness.

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It is difficult to precisely target how many people living without a home have drug and alcohol abuse problems. But according to the U.S.

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The World Health Organization's survey of legal and illegal drug use in 17 countries, including the Netherlands and other countries with less stringent drug laws, shows Americans report the highest level of cocaine and marijuana use.

For example, Americans were four times more likely to report using cocaine in their lifetime than the next closest country, New Zealand (16% vs. 4%),

Marijuana use was more widely reported worldwide, and the U.S. also had the highest rate of use at 42.4% compared with 41.9% of New Zealanders.

In contrast, in the Netherlands, which has more liberal drug policies than the U.S., only 1.9% of people reported cocaine use and 19.8% reported marijuana use.

"Globally, drug use is not distributed evenly and is not simply related to drug policy, since countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones," researcher Louisa Degenhardt of the University of New South Wales, Australia, and colleagues write in PLoS Medicine.

U.S. Leads Drug Use

In the study, researchers surveyed more than 54,000 adults in the Americas (Colombia, Mexico, and the United States), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), Middle East and Africa (Israel, Lebanon, Nigeria, South Africa), Asia, (Japan, China) and Oceania (New Zealand).

The survey included questions about legalized drug use, such as alcohol and tobacco, and illegal drug use, including cocaine and marijuana, during the participant's lifetime.

Overall, alcohol had been used by most of those surveyed in the Americas, Europe, Japan, and New Zealand compared with much smaller proportions in the Middle East, Africa, and China.

Tobacco use was also most common in the U.S. (74%), followed by Lebanon (67%) and Mexico (60%).

Researchers found gender and socioeconomic differences in both legal and illegal drug use. For example, men were more likely than women to have used legal and illegal drugs , and younger adults were more likely than older adults to have used drugs of all kinds.

Single adults were more likely than married adults to report tobacco, marijuana, and cocaine use but not alcohol use. People with higher incomes were also more likely to use both legal and illegal drugs.

"The use of drugs seems to be a feature of more affluent countries. The U.S., which has been driving much of the world's drug research and drug policy agenda, stands out with higher levels of use of alcohol, cocaine, and cannabis, despite punitive illegal drug policies, as well as (in many U.S. states), a higher minimum legal alcohol drinking age than many comparable developed countries," write the researchers.

By Jennifer Warner
Reviewed by Brunilda Nazario
©2005-2008 WebMD, LLC. All rights reserved

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U.S. Leads the World in Illegal Drug Use

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The World Health Organization's survey of legal and illegal drug use in 17 countries, including the Netherlands and other countries with less stringent drug laws, shows Americans report the highest level of cocaine and marijuana use. For example, Americans were four times more likely to report using cocaine in their lifetime than the next closest country, New Zealand (16% vs.

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Image via Shutterstock

Ayahuasca! Maybe you tried it once on your South American backpacking odyssey. The same trip where you had that really good coke and fell in love with a mysterious silent German girl who was, in hindsight, just not very good at speaking English. It's a sacred ceremonial medicine used by Indigenous Amazonian people that's high in DMT and therefore induces some pretty heavy hallucinations that have proved "spiritually transformative" for many bored white tourists. Who, according to new research, might actually be benefiting from the experience they're partaking in solely to brag about back home.

Researchers from the University of Exeter and University College London suggest ayahuasca use improves overall well-being, and can help tackle alcohol abuse and mental health issues such as depression. They formed these suggestions analysing Global Drug Survey data from more than 96,000 people worldwide, which indicated its potential as a psychiatric medicine. The study, published in Nature journal , is thought to be the largest survey of ayahuasca users completed to date.

Users of ayahuasca-which is brewed with the leaves of two Amazonian plants, the psychotria viridis bush and the caapi vine-reported less problematic drinking than classic psychedelic users of LSD and mushrooms. When responding to the online Global Drug Survey, which was advertised through social media, ayahuasca users also reported better overall feelings of well-being than comparable groups.

In an accompanying media release, senior author of the study Celia Morgan said the results were encouraging. "In this work, long-term ayahuasca use has not been found to impact on cognitive ability, produce addiction or worsen mental health problems," she commented."In fact, some of these observational studies suggest that ayahuasca use is associated with less problematic alcohol and drug use, and better mental health and cognitive functioning."

It's worth noting though that the whole ayahuasca spiritquest thing isn't always pleasant. With its acute effects lasting six hours or longer, it's much more intense than LSD or mushrooms, and many respondents indicated as such. The survey data also showed a higher incidence of lifetime mental illness diagnoses among ayahuasca users, especially in countries without a tradition of ayahuasca use-aka people who have no idea what they're doing.

"If ayahuasca is to represent an important treatment, it is critical that its short and long-term effects are investigated, and safety established," Morgan said.

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Ayahuasca Helps Fight Depression and Alcoholism, Study Shows

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Image via Shutterstock Ayahuasca! Maybe you tried it once on your South American backpacking odyssey. The same trip where you had that really good coke and fell in love with a mysterious silent German girl who was, in hindsight, just not very good at speaking English.

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MDMA's full chemical name is "3,4 methylene-dioxy-N-methylamphetamine" or "methylenedioxymethamphetamine." The 3,4 indicates the way in which the components of the molecule are joined together. It's possible to produce an isomer which has all the same components but is joined differently.

Although MDMA is derived from organic material, it does not occur in nature. It must be created in a complex laboratory process. Various popular street names for MDMA include Ecstasy, E, Adam, X, and Empathy.

MDMA is a mood and mind-altering drug. Like Prozac, it works by affecting the level of serotonin in the brain. Serotonin is a neurotransmitter which is naturally present and can alter emotions. Chemically, the drug is similar to amphetamine, but psychologically, it's what's known as an empathogen-entactogen. An empathogen improve's one's ability to communicate with and feel empathy towards others. An entactogen makes an individual feel good about himself and the world.

MDMA was patented in 1913 by the German chemical company Merck. It was intended to be sold as a diet pill, although the patent doesn't mention any specific use. The company decided against marketing the drug. The U.S. Army experimented with MDMA in 1953, possibly as a truth serum, but the government has not revealed its reasons.

Alexander Shulgin is the man behind modern research of MDMA. After graduating from the University of California at Berkeley with a Ph.D. in biochemistry, Shulgin landed a job as a research chemist with Dow Chemicals. Among his many achievements, there was the development of a profitable insecticide and several controversial patents for what would ultimately become popular street drugs. Dow was happy with the insecticide, but Shulgin's other projects forced a parting of the way between the biochemist and the chemical company. Alexander Shulgin is the first reported human to use MDMA.

Shulgin continued his legal research into new compounds after leaving Dow, specializing in the phenethylamines family of drugs. MDMA is but one of 179 psychoactive drugs which he has described in detail, but it is the one which he felt came closest to fulfilling his ambition of finding the perfect therapeutic drug.

Because MDMA was patented in 1913, it holds no profit potential for drug companies. A drug cannot be patented twice, and a company must show that a drug's potential side effects are justified by its benefits before marketing it. This involves long and expensive trials. The only way of recouping that expense is by obtaining exclusive rights to sell the drug by holding its patent. Only a few experimental therapists researched and tested MDMA for use during psychotherapy sessions between 1977 and 1985.

MDMA or Ecstasy received massive media attention in 1985 when a group of people sued the U.S. Drug Enforcement Agency to try to prevent the DEA from effectively outlawing the drug by placing it on Schedule 1. Congress had passed a new law allowing the DEA to put an emergency ban on any drug that might be dangerous to the public, and this right was used for the first time to ban MDMA on July 1, 1985.

A hearing was held to decide what permanent measures should be taken against the drug. One side argued that MDMA caused brain damage in rats. The other side claimed this might not be true for humans and that there was proof of the beneficial use of MDMA as a drug treatment in psychotherapy. After weighing the evidence, the presiding judge recommended that MDMA be placed on Schedule 3, which would have allowed it to be manufactured, used by prescription, and subject to further research. However, the DEA decided to place MDMA permanently on Schedule 1 regardless.

Trial research into the effects of MDMA on human volunteers resumed in 1993 with the approval of the Food and Drug Administration. It is the first psychoactive drug to be approved for human testing by the FDA.

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MDMA's full chemical name is "3,4 methylene-dioxy-N-methylamphetamine" or "methylenedioxymethamphetamine." The 3,4 indicates the way in which the components of the molecule are joined together. It's possible to produce an isomer which has all the same components but is joined differently. Although MDMA is derived from organic material, it does not occur in nature.

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CLOSE

Fentanyl, a synthetic opioid painkiller, has finally topped heroin as America's deadliest drug, according to an announcement by federal health officials Wednesday.

The drug was found in more than 18,000 overdose deaths nationwide in 2016, the most recent year for which statistics are available. In Delaware, the state reported the presence of fentanyl in 210 drug overdose deaths last year.

That came as a 76 percent increase from 2016's overdose deaths involving fentanyl - large increases that describe America's bigger struggle with opioid addiction.

Overall, more than 63,000 Americans died of drug overdoses in 2016, according to the new report, which was prepared by the U.S. Centers for Disease Control and Prevention. This is an average of 174 deaths per day.

Delaware fentanyl-related overdoses triple in 2016

The study also said that many people who die due to overdoses have multiple drugs in their system.

"We've had a tendency to think of these drugs in isolation," Dr. Holly Hedegaard, lead author of the report, told HuffPost. "It's not really what's happening."

Delaware is seeing a similar pattern. Oftentimes, fentanyl is used to cut heroin and cocaine - sometimes without the knowledge of the user.

opioids, fentanyl, overdose (Photo: Alejandro Gonzalez)

Fentanyl, in its white, powdery form, looks strikingly similar to heroin and can be mixed in with other drugs. State officials here have cited fentanyl as a main driver behind Delaware's continued rise in drug overdose deaths.

This concern only intensified after Delaware experienced its deadliest month from suspected drug overdoses yet in the history of tracking these deaths. The state said then that 39 people died in the course of August's 31 days.

Fentanyl: What it is and why it's claiming the lives of dozens of Delawareans

More recent data from the state Division of Forensic Science indicates that number may be even higher, with 46 deaths reported.

"We suspect that many of the overdoses involved fentanyl so we are warning people who are in active use to assume that the illicit drugs they are using contain this highly toxic and dangerous synthetic opioid," said Dr. Kara Odom Walker, secretary of the state Department of Health and Social Services, in a statement in early September.

The following month, federal prosecutors charged numerous men with supplying fentanyl-laced heroin to a 28-year-old Newark man who died as a result of using these drugs.

Buy Photo

U.S. Attorney David C. Weiss review the links to a fentanyl overdose that killed 28-year-old Joel Davis last year stemming from Robin Cintron-Pratts, who has been federally indicted on drug charges. (Photo: Jennifer Corbett, The News Journal)

Investigators were able to work up the drug-dealing chain and tie Robin Cintron-Pratts to 13,000 baggies of fentanyl-laced heroin prosecutors say he brought from Philadelphia to Chester, Pennsylvania, and then distributed to a man who brought it to Delaware, according to a federal indictment.

The accused drug dealer indicated that he had multiple buyers die from his drugs in the past.

Feds charge 'ultimate supplier' with distributing fentanyl-laced heroin linked to fatal OD

On average, in each year from 2013 to 2016, the rate of overdose deaths from fentanyl increased by about 113 percent per year. In fact, the report said that fentanyl was responsible for 29 percent of all overdose deaths in 2016, up from just 4 percent in 2011.

After fentanyl, heroin, cocaine and methamphetamine were the deadliest drugs in 2016.

The study said that illegal drugs such as fentanyl and heroin were the primary causes of unintentional overdoses, while prescription drugs tended to be used in suicidal overdoses.

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Through recovery, Limen House gives residents newfound gratitude for life

Opinion: Narcan alone won't end addiction crisis. We need need more long-term treatment.
Contact Brittany Horn at (302) 324-2771 or bhorn@delawareonline.com. Follow her on Twitter at @brittanyhorn.
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Fentanyl: Deadly in Delaware, tops heroin for America's deadliest drug

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CLOSE Fentanyl, a synthetic opioid painkiller, has finally topped heroin as America's deadliest drug, according to an announcement by federal health officials Wednesday. The drug was found in more than 18,000 overdose deaths nationwide in 2016, the most recent year for which statistics are available.

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From Men's Health
Twenty-nineteen could be the Year of the Magic Mushroom. In Colorado and Oregon, efforts are currently underway to get voters acquainted with and in support of psilocybin, the compound that makes magic shrooms, well, magical. Research has begun, and the Food and Drug Administration (FDA) has registered its interest.

You can draw comparisons between growing support for psychedelic mushrooms and the push for recreational marijuana. Both are considered highly dangerous by the federal government, although scientific research and anecdotal evidence indicate otherwise. Both could have fascinating and potentially life-changing medical uses, and the stigma around each is being challenged. However, advocates for psilocybin acknowledge that it is a more complex and less understood substance than cannabis. (And that's not to mention the risk of experiencing an excruciatingly bad trip.) With that in mind, their efforts hinge on decriminalization and regulated medical use, not full legalization.

Marijuana, which has been voted into legalization in 10 states plus D.C., might be light-years ahead, but psilocybin seems to be the next illicit drug in line to take on the legalization battle. As that conversation amps up, here's what you need to know about psychedelic shrooms in 2019.

Why is Psilocybin Illegal?

Psilocybin is a Schedule I drug. That means the federal government thinks it has a high risk of abuse with no known medical benefit. It is 100 percent illegal, and possessing it is a felony offense. (Marijuana is also Schedule 1, as are drugs including heroin, ecstasy, and quaaludes.)

Shrooms-along with essentially every other drug, psychedelic or otherwise-have had a bad rap ever since the hazy hippie days of the '60s. However, last year, researchers from Johns Hopkins University made headlines when they recommended that the FDA reclassify psilocybin as a Schedule IV drug, alongside drugs like Xanax and Tramadol that have a low risk for abuse. The researchers also said that psilocybin could have therapeutic benefits, which we'll only discover if more research is conducted.

What Does Current Research Suggest About Psilocybin?

In late 2018, the FDA reviewed the work of a medical company experimenting with psilocybin to treat depression and upgraded the psychedelic to " breakthrough therapy" status, meaning the FDA acknowledged its potential and vowed to expedite its review process. That's a big deal, because past and present research has shown that psilocybin could be the mother-lode when it comes to treating mental disorders. One study showed a single dose of psilocybin could assist cancer patients in combating anxiety and dark moods. Psilocybin could help users kick drug, alcohol, and nicotine addictions, according to another batch of studies. Research on the use of psychedelics (including psilocybin) to treat depression and anxiety has been very promising.

In other words, psilocybin has the FDA's initial stamp of approval, and researchers are eager to further unpack its medical benefits. Even the practice of micro-dosing shrooms, LSD, and other psychedelics is creeping into the mainstream.

What's Happening in Oregon and Colorado?

This brings us to current grassroots efforts to get psilocybin ballot initiatives in front of voters in Colorado and Oregon.

In Colorado, the movement is limited to the city of Denver, which decriminalized marijuana in 2005. Advocates for decriminalizing psilocybin say they have collected enough signatures to make the May 7, 2019 municipal ballot. To make the ballot, 4,726 verified signatures were required; the Decriminalize Denver campaign said it turned in that many and then some. On February 1, the Denver Elections Division confirmed Denver residents will vote this spring on an initiative to make the use of psilocybin for adults 21 and older the "city's lowest law-enforcement priority." It would allow adults 21 and older to possess and grow mushrooms, but retail sales would be prohibited.

In Oregon, advocates are calling for reduced criminal penalties for using and possessing illegal psilocybin, as well as the legalization of its use by adults 21 and over when supervised by a licensed facilitator. That would open the door for psilocybin medical treatments when approved by a physician. The Oregon PSI 2020 campaign said it needs to collect 140,000 valid signatures to get its initiative on the 2020 state-wide ballot; it started collecting signatures in December.

In California, a statewide initiative to decriminalize psilocybin failed to get enough signatures to make the 2018 ballot.

Weirdly enough, a 2005 court case ruled that growing hallucinogenic mushrooms is not illegal in the state of New Mexico. However, altering them-i.e. drying them out-and selling them is illegal.

What is it Like to Take Shrooms?

Everyone's personal journey with psilocybin is unique. But for a highly detailed account of one man's magic mushroom trip, check out Michael Pollan's 2018 book How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence. You can find an excerpt describing his experience at the Atlantic, which includes the phrase: "I felt as though I were communing directly with a plant for the first time." Stay safe out there.
('You Might Also Like',)

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Psilocybin-A.K.A. Shrooms-Could Become the Next Legalized Drug

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From Men's Health Twenty-nineteen could be the Year of the Magic Mushroom. In Colorado and Oregon, efforts are currently underway to get voters acquainted with and in support of psilocybin, the compound that makes magic shrooms, well, magical. Research has begun, and the Food and Drug Administration (FDA) has registered its interest.

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As legal access to marijuana continues expanding across the U.S., more scientists are studying the effects of its active ingredient, tetrahydrocannabinol (THC), in teens, adults and pregnant women.

New research from Duke Health suggests men in their child-bearing years should also consider how THC could impact their sperm and possibly the children they conceive during periods when they've been using the drug.

Much like previous research that has shown tobacco smoke, pesticides, flame retardants and even obesity can alter sperm, the Duke research shows THC also affects epigenetics, triggering structural and regulatory changes in the DNA of users' sperm.

Experiments in rats and a study with 24 men found that THC appears to target genes in two major cellular pathways and alters DNA methylation, a process essential to normal development.

The researchers do not yet know whether DNA changes triggered by THC are passed to users' children and what effects that could have. Their findings will be published online Dec. 19 in the journal Epigenetics.

"What we have found is that the effects of cannabis use on males and their reproductive health are not completely null, in that there's something about cannabis use that affects the genetic profile in sperm," said Scott Kollins, Ph.D., professor in psychiatry and behavioral sciences at Duke and senior author of the study.

"We don't yet know what that means, but the fact that more and more young males of child-bearing age have legal access to cannabis is something we should be thinking about," Kollins said.

National research has shown a steady decline in the perceived risk of regular marijuana use. This, combined with the demand and wide availability of marijuana bred specifically to yield higher THC content, make this research especially timely, Kollins said.

The study defined regular users as those who smoked marijuana at least weekly for the previous six months. Their sperm were compared to those who had not used marijuana in the past six months and not more than 10 times in their lifetimes.

The higher the concentration of THC in the men's urine, the more pronounced the genetic changes to their sperm were, the authors found.

THC appeared to impact hundreds of different genes in rats and humans, but many of the genes did have something in common -- they were associated with two of the same major cellular pathways, said lead author Susan K. Murphy, Ph.D., associate professor and chief of the Division of Reproductive Sciences in obstetrics and gynecology at Duke.

One of the pathways is involved in helping bodily organs reach their full size; the other involves a large number of genes that regulate growth during development. Both pathways can become dysregulated in some cancers.

"In terms of what it means for the developing child, we just don't know," Murphy said. It's unknown whether sperm affected by THC could be healthy enough to even fertilize an egg and continue its development into an embryo, she said.

The study was a starting point on the epigenetic effects of THC on sperm and is limited by the relatively small number of men involved in the trial, Murphy said. The findings in men also could be confounded by other factors affecting their health, such as their nutrition, sleep, alcohol use and other lifestyle habits.

The Duke team plans to continue its research with larger groups. They intend to study whether changes in sperm are reversed when men stop using marijuana. They also hope to test the umbilical cord blood of babies born to fathers with THC-altered sperm to determine what, if any epigenetic changes, are carried forward to the child.

"We know that there are effects of cannabis use on the regulatory mechanisms in sperm DNA, but we don't know whether they can be transmitted to the next generation," Murphy said.

"In the absence of a larger, definitive study, the best advice would be to assume these changes are going to be there," Murphy said. "We don't know whether they are going to be permanent. I would say, as a precaution, stop using cannabis for at least six months before trying to conceive."

In addition to Kollins and Murphy, study authors include Nilda Itchon-Ramos, Zachary Visco, Zhiqing Huang, Carole Grenier, Rose Schrott, Kelly Acharya, Marie-Helene Boudreau, Thomas M. Price, Douglas J. Raburn, David L. Corcoran, Joseph E. Lucas, John T. Mitchell, F. Joseph McClernon, Marty Cauley, Brandon J. Hall, and Edward D. Levin.

The research was supported by a grant from the John Templeton Foundation.

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controlled substances; pregnancy and childbirth; fertility; marijuana; illegal drugs; gender difference; developmental biology; epigenetics research; mating and breeding

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Exposure to cannabis alters the genetic profile of sperm: Whether genetic changes can be reversed or are passed on to children is still unknown

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New research suggests men in their child-bearing years should consider how THC could impact their sperm and possibly the children they conceive during periods when they've been using the drug. Much like previous research that has shown tobacco smoke, pesticides, flame retardants and even obesity can alter sperm, the new research shows THC also affects epigenetics, triggering structural and regulatory changes in the DNA of users' sperm.

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Drug abuse trends may change over time, but the unique pressures college students face make drug and alcohol abuse a constant on college campuses. Some students are at higher risk for drug abuse than others.

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Facts and Statistics of College Drug Abuse - Drug Trends and Findings

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Drug abuse trends may change over time, but the unique pressures college students face make drug and alcohol abuse a constant on college campuses. Some students are at higher risk for drug abuse than others. Find statistics, facts, trends, symptoms and warning signs of substance abuse on college campuses.

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MANAYUNK, PHILADELPHIA - The father of a 9-month-old girl who was stuck with a hypodermic needle Wednesday night in Manayunk has been charged in the incident, according to court documents and police.

Steven Richard Welsh, 35, of Philadelphia, has been charged with aggravated assault; endangering the welfare of a child with a parent or guardian committing the offense; simple assault with the victim under 12 years old and defendant 18 years or older; and recklessly endangering another person.

Welsh was held on 10 percent of $10,000 bail after being arraigned Thursday, court records show. Welsh is slated to appear for a preliminary hearing on July 18, according to court records.

The charges come after Welsh's infant daughter reportedly rolled over in bed and was stuck with a hypodermic needle.

Police said officers and medics were called to the 200 block of Green Lane Wednesday at about 6:30 p.m. for a report of a child being stuck with a needle.

On scene, police and medics found a 9-month-old girl unresponsive and administered a dose of Narcan, an opioid overdose-reversing medication, to revive the girl, police said.

Medics took the child to Chestnut Hill Hospital and treated her for an accidental overdose, police said.

Police said the child is in stable condition at the hospital.

Police could not say if this was the youngest Narcan administration they have seen.

The Special Victims unit are investigating the incident, police said.

More than 2,000 opioid overdoses in Pennsylvania have been reversed by naloxone since November of 2014, Gov. Tom Wolf said back in December.

Wolf said that there were more than 3,500 drug overdoses in Pennsylvania in 2015. Opioid overdoses have been on the increase everywhere in recent months and years.

The Drug Enforcement Administration recently announced overdose deaths were up 37 percent in Pennsylvania in 2016.

There were 4,642 drug-related overdose deaths - approximately 13 people a day - in Pennsylvania in 2016, said Gary Tuggle, special agent in charge of the DEA's Philadelphia Field Division. That's a 37 percent increase from 2015 and establishes a death rate for 36.5 per 100,000 people.

Back in May, an 11-year-old girl was treated for an overdose with Narcan in the Pittsburgh area.

A paramedic who spoke to the Pittsburgh Post Gazette told the outlet the 11 year old was the youngest overdose victim she had encountered in her 24-year career as a paramedic, save from toddlers who accidentally ingested a drug.

According to Pennsylvania Department of Health Statistics, 14 Pennsylvanians from birth to age 14 died from drug-induced deaths between 2011 and 2015.
Image via Philadelphia Police
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Dad Charged In Manayunk Baby Overdose Incident

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MANAYUNK, PHILADELPHIA - The father of a 9-month-old girl who was stuck with a hypodermic needle Wednesday night in Manayunk has been charged in the incident, according to court documents and police.

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Baby overdoses in PA

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MANAYUNK, PHILADELPHIA - The father of a 9-month-old girl who was stuck with a hypodermic needle Wednesday night in Manayunk has been charged in the incident, according to court documents and police.

Steven Richard Welsh, 35, of Philadelphia, has been charged with aggravated assault; endangering the welfare of a child with a parent or guardian committing the offense; simple assault with the victim under 12 years old and defendant 18 years or older; and recklessly endangering another person.

Welsh was held on 10 percent of $10,000 bail after being arraigned Thursday, court records show. Welsh is slated to appear for a preliminary hearing on July 18, according to court records.

The charges come after Welsh's infant daughter reportedly rolled over in bed and was stuck with a hypodermic needle.

Police said officers and medics were called to the 200 block of Green Lane Wednesday at about 6:30 p.m. for a report of a child being stuck with a needle.

On scene, police and medics found a 9-month-old girl unresponsive and administered a dose of Narcan, an opioid overdose-reversing medication, to revive the girl, police said.

Medics took the child to Chestnut Hill Hospital and treated her for an accidental overdose, police said.

Police said the child is in stable condition at the hospital.

Police could not say if this was the youngest Narcan administration they have seen.

The Special Victims unit are investigating the incident, police said.

More than 2,000 opioid overdoses in Pennsylvania have been reversed by naloxone since November of 2014, Gov. Tom Wolf said back in December.

Wolf said that there were more than 3,500 drug overdoses in Pennsylvania in 2015. Opioid overdoses have been on the increase everywhere in recent months and years.

The Drug Enforcement Administration recently announced overdose deaths were up 37 percent in Pennsylvania in 2016.

There were 4,642 drug-related overdose deaths - approximately 13 people a day - in Pennsylvania in 2016, said Gary Tuggle, special agent in charge of the DEA's Philadelphia Field Division. That's a 37 percent increase from 2015 and establishes a death rate for 36.5 per 100,000 people.

Back in May, an 11-year-old girl was treated for an overdose with Narcan in the Pittsburgh area.

A paramedic who spoke to the Pittsburgh Post Gazette told the outlet the 11 year old was the youngest overdose victim she had encountered in her 24-year career as a paramedic, save from toddlers who accidentally ingested a drug.

According to Pennsylvania Department of Health Statistics, 14 Pennsylvanians from birth to age 14 died from drug-induced deaths between 2011 and 2015.
Image via Philadelphia Police
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Dad Charged In Manayunk Baby Overdose Incident

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MANAYUNK, PHILADELPHIA - The father of a 9-month-old girl who was stuck with a hypodermic needle Wednesday night in Manayunk has been charged in the incident, according to court documents and police.

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What is kratom?

Kratom is a tropical tree (Mitragyna speciosa) native to Southeast Asia, with leaves that contain compounds that can have psychotropic (mind-altering) effects.

Kratom is not currently an illegal substance and has been easy to order on the internet. It is sometimes sold as a green powder in packets labeled "not for human consumption." It is also sometimes sold as an extract or gum.

Kratom sometimes goes by the following names:

How do people use kratom?

Most people take kratom as a pill, capsule, or extract. Some people chew kratom leaves or brew the dried or powdered leaves as a tea. Sometimes the leaves are smoked or eaten in food.

How does kratom affect the brain?

Kratom can cause effects similar to both opioids and stimulants. Two compounds in kratom leaves, mitragynine and 7-α-hydroxymitragynine, interact with opioid receptors in the brain, producing sedation, pleasure, and decreased pain, especially when users consume large amounts of the plant. Mitragynine also interacts with other receptor systems in the brain to produce stimulant effects. When kratom is taken in small amounts, users report increased energy, sociability, and alertness instead of sedation. However, kratom can also cause uncomfortable and sometimes dangerous side effects.

What are the health effects of kratom?

Reported health effects of kratom use include:

Symptoms of psychosis have been reported in some users.

Can a person overdose on kratom?

In 2017, the Food and Drug Administration (FDA) began issuing a series of warnings about kratom and now identifies at least 44 deaths related to its use, with at least one case being investigated as possible use of pure kratom. Most kratom associated deaths appear to have resulted from adulterated products (other drugs mixed in with the kratom) or taking kratom along with other potent substances, including illicit drugs, opioids, benzodiazepines, alcohol, gabapentin, and over-the-counter medications, such as cough syrup. Also, there have been some reports of kratom packaged as dietary supplements or dietary ingredients that were laced with other compounds that caused deaths.

Is kratom addictive?

Like other drugs with opioid-like effects, kratom might cause dependence, which means users will feel physical withdrawal symptoms when they stop taking the drug. Some users have reported becoming addicted to kratom. Withdrawal symptoms include:

How is kratom addiction treated?

There are no specific medical treatments for kratom addiction. Some people seeking treatment have found behavioral therapy to be helpful. Scientists need more research to determine how effective this treatment option is.

Does kratom have value as a medicine?

In recent years, some people have used kratom as an herbal alternative to medical treatment in attempts to control withdrawal symptoms and cravings caused by addiction to opioids or to other addictive substances such as alcohol. There is no scientific evidence that kratom is effective or safe for this purpose; further research is needed.

Points to Remember

Kratom is a tropical tree native to Southeast Asia, with leaves that can have psychotropic effects.

Kratom is not currently illegal and has been easy to order on the internet.

Most people take kratom as a pill or capsule. Some people chew kratom leaves or brew the dried or powdered leaves as a tea. Sometimes the leaves are smoked or eaten in food. Two compounds in kratom leaves, mitragynine and 7-α-hydroxymitragynine, interact with opioid receptors in the brain, producing sedation, pleasure, and decreased pain.

Mitragynine can also interact with other receptor systems in the brain to produce stimulant effects.

Reported health effects of kratom use include nausea, sweating, seizures, and psychotic symptoms.

Commercial forms of kratom are sometimes laced with other compounds that have caused deaths.

Some users have reported becoming addicted to kratom.

Behavioral therapies and medications have not specifically been tested for treatment of kratom addiction.

Learn More

For more information about kratom, visit:

This publication is available for your use and may be reproduced in its entirety without permission from the NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

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Kratom is a tropical tree (Mitragyna speciosa) native to Southeast Asia, with leaves that contain compounds that can have psychotropic (mind-altering) effects. Kratom is not currently an illegal substance and has been easy to order on the internet. It is sometimes sold as a green powder in packets labeled "not for human consumption."

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A visitor to the Harvard School of Public Health's mock safe injection site checks out items on the demonstration table set up underneath a tent in Boston on April 30, 2018.

Supporters say harm-reduction strategies are like air bags or seat belts: common-sense, low-cost ways to save the lives of drug abusers while also saving communities millions of dollars in medical costs per year.

With multiple studies confirming the effectiveness of such approaches and decades of success in Europe, they say, adopting them should be a no-brainer for cities and towns fighting the seemingly unbreakable grip of the U.S. opioid crisis.

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Yet local and national politics - coupled with stigmatization and outdated notions of addiction - have dampened acceptance of practical ways to protect opioid users: issuing sterile hypodermic needles to curb infectious diseases, providing safe spaces for users to get high and prescribing other drugs, like methadone, to help them transition into recovery.

Months later, California Gov. Jerry Brown, a Democrat and progressive hero, vetoed a bill that aimed to allow so-called safe consumption sites in the Golden State, rejecting the argument that it would curb drug addiction. Proponents point to data showing the medically supervised clinics can stem fatal overdoses, but opponents say they coddle drug users who don't want to get clean.

Meanwhile, as Philadelphia officials forge ahead with plans for a safe consumption site, the federal government has placed potential hosts on notice. In August, Deputy Attorney General Rod Rosenstein declared that such sites remain "illegal under federal law," and users "remain vulnerable to civil and criminal enforcement," whether or not there's a doctor present.

And although Congress moved to expand access to opioid treatment with safer, substitute drugs like methadone and buprenorphine - and the number of methadone clients has surged in recent years - only a fraction of hardcore drug users who want to quit are engaged in the treatment, and some states don't allow methadone to qualify for Medicaid reimbursement.

Regina LaBelle, an attorney and addiction specialist, says pushback against harm reduction is evidence of a persistent societal misconception, in which drug dependence is seen as a weakness and not an illness.

"We don't address addiction as if it's a chronic health condition," says LaBelle, program director of the Addiction and Public Policy Initiative at Georgetown University's O'Neill Institute for National and Global Health Law. "We don't have a health care system currently where we treat addiction as a disease" the way doctors treat diabetes or hypertension.

At the same time, she says, "I think there's denial in some communities: 'We can't possibly have a (drug) problem like this.'"

Once on the fringes of public health strategies, advocates say harm reduction became part of the public health toolbox during the fight against AIDS in the late 1980s, when advocates distributed condoms and preached about safe sex to at-risk populations. The drug addiction and recovery world came aboard after AIDS spread among intravenous drug users who shared contaminated hypodermic needles. Syringe exchange programs - where used needles are traded for fresh ones - helped keep blood-borne disease outbreaks in check.

According to advocacy group the Harm Reduction Coalition, the concept includes "a spectrum of strategies" that help medical professionals and addiction specialists meet drug users "where they're at." It also means accepting that "illegal and illicit drug use is part of our world" and will never be completely eliminated, and that mitigation of the dangers of drug use can save lives.

Methods vary, but the goal is to keep drug users as healthy as possible and, best-case scenario, guide them into treatment, according to the coalition. At worst, advocates say, the strategy helps users live to see another day, with another opportunity to leave drugs behind.

Since the 1990s, multiple medical reports and scientific studies have confirmed its effectiveness. A 2018 report from Harm Reduction International notes that dozens of countries, ranging from progressive Denmark to Estonia, a former Soviet republic, endorse harm reduction in plans to fight drug abuse.

In the U.S., the strategy has gained a firm foothold: A report by amfAR, the Foundation for AIDS Research, found that more than 203 clean-syringe programs were operating in 34 states in 2012, and a Pew Stateline report in October, citing Drug Enforcement Agency data, showed that the methadone industry added 254 new clinics nationwide during the last four years.

Moreover, community-based programs distributing naloxone, an overdose-reversal medication, have boomed in the U.S. over the last two decades, from one in 1996 to 644 by 2014, according to a 2015 Harm Reduction Coalition survey.

"There are some bright spots around the country," LaBelle says.

But with some 130 fatal opioid overdoses each day in the U.S., the bright spots may not be enough. The U.S. still doesn't have a single legal safe consumption site, and although the number of methadone clinics is on the rise, the same Pew Stateline report said only 1 in 10 addicted opioid users are actually engaged in what's known as medication-assisted treatment, which can involve methadone, buprenorphine or another drug, naltrexone.

Meanwhile, many politicians and the public in general still see needle-exchange programs as controversial, last-resort strategies, acceptable only amid a public health crisis, and then, only temporarily. Exhibit A: Charleston's ill-fated program.

In 2015, with the blessings of city leaders and police, Michael Brumage, then-director of the Kanawha-Charleston Health Department, set up a clean-needle program. As word got around, the Charleston program quickly grew, as The New York Times reports: At its apex, it drew nearly 500 people in a span of eight hours, in a city of 50,000.

Then, anxious community leaders began sounding the alarm.

The mayor said the clinic had created a "mini-mall" for drug dealers and users. Police griped about carelessly discarded needles. And a 5-year-old girl accidentally pricked herself with a contaminated needle someone left in a McDonald's bathroom.

After police imposed a series of strict rules, health officials shut down the program last March.

"Part of the issue with the participants was not only the (large) number, but that they represented a class of society that many people didn't want to have around," says Brumage, now an assistant dean at the West Virginia University School of Public Health and an assistant clinical professor of medicine at the university's School of Medicine. "And so they became the object of unwanted attention."

Brumage says it's "extremely unfortunate" that "stigma and misinformation" scuttled an evidence-based program he says was working, though an audit reportedly found issues tied to its record-keeping and littered syringes, among others.

Charleston, Brumage warns, may learn about harm reduction the hard way.

"Eventually, the problems with infectious diseases like hepatitis B, hepatitis C and HIV will force the city to look at it," he says.

Dr. Laura G. Kehoe, a physician, substance abuse clinician and professor at Harvard Medical School, says that when it comes to drug addiction, fear and stigma often overwhelm science and reason. She says even some doctors don't believe in harm reduction and look down on treating drug-addicted patients.

"It's beyond stigma. It's discrimination," says Kehoe, who also is medical director of the Substance Use Disorder Bridge Clinic at Massachusetts General Hospital. Their thinking, she says, "all goes down to this deep lack of understanding: 'These are illegal drugs. People are doing it to themselves.'"

LaBelle, the Georgetown policy expert, points out out that rural Scott County, Indiana, set judgment aside in 2015 after the number of HIV cases there skyrocketed, evidence of a major IV drug-use problem. Health officials and politicians soon enacted a needle-distribution plan, and infections reportedly fell.

Yet only about a handful of Hoosier State counties grappling with the opioid epidemic have followed Scott County's lead, and at least one shuttered a clean-needle program amid legal and moral concerns. Even the Scott County program - which the state approved only after declaring a public health emergency - faced intense opposition from influential critics, and was renewed in a 2-1 vote.

Any program "should require addicts to exchange needles only a limited number of times before they must enter treatment," Indiana Attorney General Curtis Hill, a Republican, wrote after a hearing on the needle-exchange issue last year. "No one is helped when addicts are allowed to use this program in an open-ended fashion."

Kathie Kane-Willis, a researcher for the Chicago Urban League and an expert on that city's opioid crisis, says politicians like Hill misunderstand addiction and have expectations about the recovery process based on movies or reality-TV shows like "Intervention." In the real world, she says, a tough-love approach can have the opposite effect, shaming drug users away from treatment.

"Because (substance abuse disorder) is not just stigmatized - it's taboo in some ways - it's easier to make space for some narratives that are not true," says Kane-Willis, herself a former heroin user.

Harm reduction "is not just about (illegal) drug use. It's the way that we approach medicine, it's how we approach pretty much everything," she says, pointing to prescription medications that help people with hypertension and other chronic diseases.

Kane-Willis continues: "Air bags and seat belts don't prevent fatalities. But they reduce the rate," she says. "I think that what people think about harm reduction is anything goes - it's condoning drug use and it's saying, 'Sure, drugs are totally fine.'"

Instead, "what it really does is use a trauma-informed approach and meet people where they are," she says. "And it's providing real benefits to people who use drugs and society in general."
U.S. News' Gaby Galvin contributed to this report.

Joseph P. Williams, Staff Writer

Joseph P. Williams is a news editor with U.S. News & World Report. E-mail him at JWilliams@usne... Read more Joseph P. Williams is a news editor with U.S. News & World Report. E-mail him at JWilliams@usnews.com.

Tags: opioids, drugs, addiction, prescription drugs, drug abuse, public health, community, government, patients, patient safety, research

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A visitor to the Harvard School of Public Health's mock safe injection site checks out items on the demonstration table set up underneath a tent in Boston on April 30, 2018. Supporters say harm-reduction strategies are like air bags or seat belts: common-sense, low-cost ways to save the lives of drug abusers while also saving communities millions of dollars in medical costs per year.

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The drug overdose epidemic continues to worsen in the United States.

Drug overdoses, both fatal and nonfatal, continue to impact our nation.

Overdose deaths remain a leading cause of injury-related death in the United States. The majority of overdose deaths involve opioids. Deaths involving synthetic opioids (largely illicitly made fentanyl) and stimulants (such as cocaine and methamphetamine) have increased in recent years. In addition, overdose deaths accelerated during the COVID-19 pandemic.

For every drug overdose that results in death, there are many more nonfatal overdoses, each one with its own emotional and economic toll. This fast-moving epidemic does not distinguish among age, sex, or state or county lines. People who have had at least one overdose are more likely to have another. If a person who has had an overdose is seen in the ED, there is an opportunity to help prevent a repeat overdose by linking an individual to care that can improve their health outcomes.

Timely data help improve coordination and promote readiness among health departments, community members, healthcare providers, public health, law enforcement, and government agencies, for regional or multiple state overdose increases.

Featured Topics on Drug Overdoses and Deaths

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Drug overdoses, both fatal and nonfatal, continue to impact our nation. Overdose deaths remain a leading cause of injury-related death in the United States. The majority of overdose deaths involve opioids. Deaths involving synthetic opioids (largely illicitly made fentanyl) and stimulants (such as cocaine and methamphetamine) have increased in recent years.

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What Safe injection site lawsuit could mean for the country.
Kevin Brodie

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Jason Jackson

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Editor's note: This is the eleventh in a collaborative series with the R Street Institute exploring conservative approaches to criminal justice reform.

I'd always believed that prisons in the United States had programs whereby people who had drug and alcohol problems could get clean while they were incarcerated. The thought behind this was that it was better to get a prisoner clean, keep him clean through his sentence, teach him how to stay clean, and then send him home where he could become a productive member of society and not be caught up in a never-ending cycle of crime and incarceration.

I was completely wrong. No such program exists, at least not on a national level.

I saw this firsthand and I saw it every day. Beginning in 2013, I spent 23 months in the Federal Correctional Institution in Loretto, Pennsylvania, after I blew the whistle on the CIA's torture program . At least 50 percent of the prisoners there were in on drug charges, and many of them were also addicts or alcoholics. There were simply no resources for them. None. If they came in addicted, well, they just had to suffer.

One of my cellmates was a young man from Pittsburgh named Randy. He came from a hardworking family. His mother was a teacher and his father worked at a local grocery store. Randy's brother had finished high school and also had gone to work for the grocery store. Randy was different though. He was unusually bright, but he just loved heroin.

Randy was sent to Loretto near the end of my sentence. He was sentenced to four months for a probation violation. His urine had tested positive for heroin. He was cheerful and outgoing when he arrived, although he was clearly in physical distress. I asked him if he was alright. He responded that he was expecting to have a tough week. He had last done heroin that morning, just to get him through his first day back in prison, but he was already starting to withdraw, and, he said, it wasn't going to be pretty. This was Randy's second stint in federal prison. He'd already done two years for selling a small amount of heroin in a federal park.

Having had that federal experience, Randy knew not to go to the medical unit once he began to detox. This was counterintuitive to me. But he explained that he had tested positive at the U.S. Marshal's office. Testing positive inside the prison, even though he had taken the heroin while still on the outside, would be a different thing altogether. It would land him in solitary confinement, where he would likely spend his entire sentence. He said that he would stay as far away from the medical unit as he could.

As much as I hated the prison experience, and I hated it more than anything else in life, I did feel a certain camaraderie with my cellmates. We worked to keep each other out of solitary and to make sure that daily life in our cell went smoothly. Randy was going to need some help.

He began to shake uncontrollably that very night. Then came the cramps, body aches, fever, and vomiting. Randy said that withdrawal was like the worst case of the flu you've ever had. He would moan all night, clearly in agony. But prisons are loud, even at night, and the guards didn't pay any attention to him. It took Randy about five days to get through it.

I thought it likely that he would then transition into a diversion program, something like RDAP, what the Bureau of Prisons calls the "Residential Drug Abuse Program." That only happened a few months before the end of his sentence. But Randy said it didn't matter because RDAP was a joke anyway.

RDAP be incredible. It is a voluntary 500-hour program that, if successfully completed, can reduce a prisoner's sentence of 36 months or longer by as much as 12 months. Because so many prisoners want a sentence reduction, the residential programs at designated RDAP prisons fill up almost instantly. Consequently, a sort of RDAP-lite is offered at other prisons, even when that prison is not specifically designated as an RDAP facility.

So what is an RDAP-lite program like? It really comes down to 12 one-hour sessions where prisoners sit in a classroom and watch videos of the A&E Network show "Intervention." Seriously. That's it. Those prisoners won't get 12 months off, but they might get six months. The problem is that they learn literally nothing in the class. They go home at the ends of their sentences and go right back on drugs. It's inevitable.

That's what ended up happening to Randy. He went home after doing his four months and almost immediately started doing heroin again. Of course, he tested positive at his first meeting with his probation officer, he went before the same judge, and he was sentenced to another year in prison. He told a mutual friend that he couldn't help it. "I just love heroin" is what he said.

The solution here is pretty obvious. If the Justice Department and its Bureau of Prisons were serious about lowering crime and reducing recidivism, they would spend money on treatment, addiction counseling, and job training. But they don't. In the good old days, if they can be called that, you could learn a trade in prison-plumbing, electrical work, or engine repair. That ended in the 1980s. Now, when a prisoner finishes his sentence, he just goes back to the old neighborhood and slips into his old life again. That's usually a life of crime and drugs.

A real RDAP program, not the insult of being told to sit quietly and watch television, would be money well spent. Not everybody is like Randy. Not everybody loves heroin. Some prisoners really do want to clean up. They really do want to go straight. They just need some help doing it. A little money would go a long way toward doing that, while reducing crime at the same time.

There is only one way to go about getting this done. First, we have to push our elected officials. We have to demand that Congress enact prison reform measures that include an appropriation for RDAP. Second, we have to require that the attorney general take his responsibilities in this area seriously. It's up to him to set the policy. We should demand that at confirmation hearings. Otherwise nothing will ever change. Crime will rise, overdoses will rise, and more and more Americans will continue to become addicted to drugs and alcohol and to fund their addictions through crime.

John Kiriakou is a former C IA analyst and c ase officer and senior investigator for the Sena te Foreign Relations Committee. He is currently an activist for the whistleblower community, a radio host, and the author of the recent book The Convenient Terrorist: Two Whistleblowers' Stories of Torture, Terror, Secret Wars and CIA Lies with Joseph Hickman.

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Drug Rehab in Prison? You Must Be Joking

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Editor's note: This is the eleventh in a collaborative series with the R Street Institute exploring conservative approaches to criminal justice reform. I'd always believed that prisons in the United States had programs whereby people who had drug and alcohol problems could get clean while they were incarcerated.

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Many people don't understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to. Fortunately, researchers know more than ever about how drugs affect the brain and have found treatments that can help people recover from drug addiction and lead productive lives.

What Is drug addiction?

Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person's self-control and interfere with their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug addiction is considered a "relapsing" disease-people in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug.

It's common for a person to relapse, but relapse doesn't mean that treatment doesn't work. As with other chronic health conditions, treatment should be ongoing and should be adjusted based on how the patient responds. Treatment plans need to be reviewed often and modified to fit the patient's changing needs.

Video: Why are Drugs So Hard to Quit?

What happens to the brain when a person takes drugs?

Most drugs affect the brain's "reward circuit," causing euphoria as well as flooding it with the chemical messenger dopamine. A properly functioning reward system motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again.

As a person continues to use drugs, the brain adapts by reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug-an effect known as tolerance. They might take more of the drug to try and achieve the same high. These brain adaptations often lead to the person becoming less and less able to derive pleasure from other things they once enjoyed, like food, sex, or social activities.

Long-term use also causes changes in other brain chemical systems and circuits as well, affecting functions that include:

Despite being aware of these harmful outcomes, many people who use drugs continue to take them, which is the nature of addiction.

Why do some people become addicted to drugs while others don't?

No one factor can predict if a person will become addicted to drugs. A combination of factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction. For example:

Biology. The genes that people are born with account for about half of a person's risk for addiction. Gender, ethnicity, and the presence of other mental disorders may also influence risk for drug use and addiction.

Environment. A person's environment includes many different influences, from family and friends to economic status and general quality of life. Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person's likelihood of drug use and addiction.

Development. Genetic and environmental factors interact with critical developmental stages in a person's life to affect addiction risk. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to addiction. This is particularly problematic for teens. Because areas in their brains that control decision-making, judgment, and self-control are still developing, teens may be especially prone to risky behaviors, including trying drugs.

Can drug addiction be cured or prevented?

As with most other chronic diseases, such as diabetes, asthma, or heart disease, treatment for drug addiction generally isn't a cure. However, addiction is treatable and can be successfully managed. People who are recovering from an addiction will be at risk for relapse for years and possibly for their whole lives. Research shows that combining addiction treatment medicines with behavioral therapy ensures the best chance of success for most patients. Treatment approaches tailored to each patient's drug use patterns and any co-occurring medical, mental, and social problems can lead to continued recovery.

More good news is that drug use and addiction are preventable. Results from NIDA-funded research have shown that prevention programs involving families, schools, communities, and the media are effective for preventing or reducing drug use and addiction. Although personal events and cultural factors affect drug use trends, when young people view drug use as harmful, they tend to decrease their drug taking. Therefore, education and outreach are key in helping people understand the possible risks of drug use. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

Points to Remember

Drug addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.

Brain changes that occur over time with drug use challenge an addicted person's self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease.

Relapse is the return to drug use after an attempt to stop. Relapse indicates the need for more or different treatment.

Most drugs affect the brain's reward circuit by flooding it with the chemical messenger dopamine. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy activities, leading people to repeat the behavior again and again.

Over time, the brain adjusts to the excess dopamine, which reduces the high that the person feels compared to the high they felt when first taking the drug-an effect known as tolerance. They might take more of the drug, trying to achieve the same dopamine high.

No single factor can predict whether a person will become addicted to drugs. A combination of genetic, environmental, and developmental factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction.

Drug addiction is treatable and can be successfully managed.

More good news is that drug use and addiction are preventable. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

Learn more

For information about understanding drug use and addiction, visit:

For more information about the costs of drug abuse to the United States, visit:

For more information about prevention, visit:

For more information about treatment, visit:

To find a publicly funded treatment center in your state, call 1-800-662-HELP or visit:

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Understanding Drug Use and Addiction DrugFacts | National Institute on Drug Abuse

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Provides an overview of drug use and addiction, including what happens in the brain during drug use, why some people become addicted while others don't, and the importance of prevention.

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Learn how addiction affects your brain and behavior.

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InSight Crime is a foundation dedicated to the study of the principal threat to national and citizen security in Latin America and the Caribbean: Organized Crime. We seek to deepen and inform the debate about organized crime in the Americas by providing the general public with regular reporting, analysis and investigation on the subject and on state efforts to combat it.

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InSight Crime is a foundation dedicated to the study of the principal threat to national and citizen security in Latin America and the Caribbean: Organized Crime. We seek to deepen and inform the debate about organized crime in the Americas by providing the general public with regular reporting, analysis and investigation on the subject and on state efforts to combat it.

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Gov. Phil Murphy says his administration is adding opioid addiction to the list of eligible illnesses in New Jersey's medical marijuana program.

Murphy announced the change Wednesday at Cooper University Hospital along with other steps aimed at fighting the state's opioid epidemic.

Murphy said the state's Medicinal Marijuana Program will have expanded availability by allowing for the use of medical cannabis as an adjunct to treatments involving medication for all patients that suffer from opioid addiction, not only those with chronic pain.

Murphy also said the state would be removing a requirement that makes it harder for opioid addicts on Medicaid to get treatments involving medication, known as Medication Assisted Treatment or MAT. The Democratic governor says the state is doing away with the so-called Medicaid prior-authorization requirement.

He also said Medicaid would be building opioid treatment centers in Camden at Cooper and in Newark at Rutgers New Jersey Medical School.

"The opioid epidemic continues to devastate families and communities across our state," Murphy said. "As we combat this crisis, it is critical that we use data-driven, evidence-based strategies to support individuals suffering from addiction and help them get on the path to recovery."

Murphy says New Jersey had more than 3,000 overdose deaths in 2018. That's up from more than 2,700 in 2017.

"We cannot defeat the opioid epidemic and we cannot win the fight against addiction, if we do not work together - and that's exactly what we have been doing," Attorney General Gurbir S. Grewal said.

Additionally, Human Services Commissioner Carole Johnson said "we need all-hands-on-deck to fight the opioid epidemic."

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Opioid Addiction Now Eligible Illness for Medical Marijuana

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Gov. Phil Murphy says his administration is adding opioid addiction to the list of eligible illnesses in New Jersey's medical marijuana program. Murphy announced the change Wednesday at Cooper University Hospital along with other steps aimed at fighting the state's opioid epidemic.

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In Delaware and around the country, heroin is in vogue again.

It's a deadly fad. In the last eight months, fatal overdoses from all drugs, including alcohol, have jumped from 12 to 15 a month. Heroin's resurgence is to blame for the rising death count, state officials say.

The problem is everywhere, and in all sections of New Castle County, from the Hunter's Run Trailer Park in Bear to the upscale Country Creek community near Newark. Some users died in bedrooms, others on bathroom floors. One was found in a shed behind a home in Chelsea Estates. Another was lying on a driveway in Bear.
Resources: Where to get help
The victims in the 15 suspected heroin deaths that New Castle County Police responded to so far this year range in age from 22 to 51 years old. Nearly a third of them were female. All but one of them was white. Some already had been through drug rehab before heroin killed them. Four had been released from jail within days of their deaths.

Eight of the deaths statewide have been due to heroin laced with fentanyl, a synthetic painkiller added to the heroin to make it stronger and more attractive to the addict.

U.S. Attorney General Eric Holder calls heroin an "urgent public health crisis" in America. Delaware Health and Human Services Secretary Rita Landgraf says it's an epidemic.

New Castle County Police Chief Elmer Setting, who once forced his teen daughter to watch an OD victim in a body bag get rolled into a medical examiner's van, said the drug is his department's top priority.

By all accounts, the latest spike in heroin use is a result of a successful crackdown on the abuse of prescription painkillers such as Percocet and Oxycontin. Doctors began to prescribe the drugs less and manufacturers made the tablets harder for addicts to crush so they could snort or inject them.

The cost of the pills skyrocketed as the supply dried up. Today, a single 30-milligram Percocet can cost $30, according to David Dongilli, the special agent in charge of the DEA for Pennsylvania and Delaware.
Heroin takes over
The heroin market responded with a drug that is more plentiful, purer and cheaper than ever before, Dongilli said. Twenty years ago, heroin was 17 percent pure and cost $10 a bag. Today, it's around 67 percent pure and can be purchased in Wilmington for as little as $3 a bag. Even novice users from the suburbs know which parts of the city to visit to find a willing seller.

At least 1,990 people each year who have sought treatment from 1998 to 2009 cited heroin as their primary drug of choice, state treatment numbers show. The number dipped to 1,529 in 2010, when the treatment numbers for other opiates such as Oxycontin and Percocet soared, state statistics show.

The crackdown on prescription opiates took effect last year. In 2012, 1,793 people sought state-funded treatment for the prescription painkillers. That number dropped to 1,261 in 2013.

Heroin clearly took its place. In 2012, 1,845 people sought heroin treatment. In 2013, it was 2,750, the highest number since at least 1987.

Dongilli said the bulk of Delaware's heroin comes from South America and travels through Mexico. Most of it arrives in New York City in bulk and gets processed in mills, where it's cut and bagged into individual doses.

It makes its way to Delaware on I-95 to Wilmington.

Wilmington's Vice Squad Commander Steve Barnes characterized the city as partly a retail spot for northern New Castle County's heroin trade, and partly a wholesale hub that supplies places such as Dover and Millsboro in downstate Delaware, as well as Elkton, Maryland, and Kennett Square, Pennsylvania.

While heroin sales have clearly branched out into New Castle County in recent years, Barnes said there's still a steady stream of young, white heroin addicts who come to Wilmington for heroin. Often, they buy in bulk and sell to their friends.

"We get college kids from Newark who meet dealers in the Adams Four parking lot to buy heroin for weekend parties," Barnes said. "They mark up the price, because they had to risk getting arrested, robbed or shot when they came and got it."

Police say seizures are getting larger. The DEA's Dongilli said a decade ago, he'd call a press conference if his agent confiscated a single kilogram of heroin. Now, that doesn't even warrant a press release, as multi-kilo seizures are the norm. Similarly, Barnes said arresting someone with a log of heroin - 10 bundles, or 130 bags - used to be a big deal. Now, two logs is considered a small seizure.
Addicted in weeks
State police have been making big heroin arrests on the interstate recently as well. In separate arrests on May 7, troopers took 40,000 bags from a car on Del. 1 near Middletown and 13,000 bags from a car in Claymont.

The euphoric rush of heroin is all encompassing. Addicts talk about feeling warm all over, like a full-body orgasm. Ask them about their first shot, they get a forlorn look on their face as though they're thinking about their favorite childhood pet.

"It sells itself," recovering addict John Dynan from Wilmington said. "You don't have to market it."

Public health officials issue cautionary press releases when fentanyl is found in heroin, because three grains of it can kill an addict. But for some addicts, the news makes them want it even more, because a fatal overdose means the dope was good.

"When somebody falls out, it definitely made the block hot," recovering addict Chad Golt said.

New Castle County paramedics have been busy this year with the spike in heroin use. They administer the opiate-blocker Narcan on a daily basis. They're no longer surprised, however, when they aren't greeted with gratitude by the addict whose life they just saved.

"Quite often, they're angry because we ruined their high," Chief of Emergency Medical Services Lawrence Tan said.

While heroin feels good in the beginning, the romance is brief. Users can become addicted in weeks and are soon using it purely as maintenance, to avert the symptoms of withdrawal.

"That's why the potential for fatality and devastation from heroin is so extreme," said Mandell Much, clinical director at the ARGO Institute, an outpatient clinic for young adults in Price's Corner. "I've known plenty of binge coke users. There are no social heroin users."

The fun ends quickly. Addicts come from all walks of life, but their lives soon take nearly identical paths. They embark on a twisted road of arrests, car accidents, emergency room visits, job losses and failed relationships. Many steal, usually first from family, then their employers, then strangers.
Filling the void
"You pretty much have to spend every waking hour securing, figuring, finagling, stealing, conniving, cheating and manipulating to get the $200 to $300 a day for your addiction," Much said.

Drugs tend to go through cycles of popularity, treatment experts and law enforcement officials say.

Sometimes it's because of availability. Use of a particular drug will wane because addicts see their older siblings or their friends wind up in rehabs, jails or cemeteries. Eventually, when those morbid reminders fade, a drug returns on to the scene. The National Institute on Drug Abuse (NIDA) calls this phenomenon "generational forgetting."

A drug addict will always find a new drug to use to get high.

"It's always going to be something," Much said. "These people have been damaged, and there's a void in them. We can remove all the heroin from the world and they're still going to have to fill that void."

Setting, the police chief, understands that record-setting heroin seizures are a drop in the bucket of the product that's on the street. And that another substance would replace it anyway.

"We did a good job with prescription drugs and heroin filled that void," Setting said. "With enforcement, education and treatment, we have to do the same thing with heroin. Then we'll have to take a deep breath and do the same thing with the next thing that comes along."
Special Report: Heroin: Delaware's deadly crisis
Contact Adam Taylor at 324-2787 or ataylor@delawareonline.com.

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Heroin in Delaware: Cheap, pure, plentiful

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In Delaware and around the country, heroin is in vogue again. It's a deadly fad. In the last eight months, fatal overdoses from all drugs, including alcohol, have jumped from 12 to 15 a month. Heroin's resurgence is to blame for the rising death count, state officials say.

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Jason Jackson

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Booths line a safe injection site in Montreal on June 26, 2017. Two Massachusetts mayors were visiting safe injection sites in Canada this week.

Two Massachusetts mayors crossed the United States' northern border this week to check out establishments that allow people to use illegal drugs under supervision.

The mayors of Boston and Cambridge, Massachusetts, on separate trips, were visiting safe injection sites Thursday and Friday in Canada amid continued efforts to battle the U.S. opioid epidemic.

"Our fact-finding trip to Canada is part of our overall comprehensive strategy to learn about and explore every possible way to address the ongoing opioid crisis in Boston and across our nation," Boston Mayor Marty Walsh said in a statement, The Boston Globe reports.

"I believe service providers and available case studies make a strong argument for why Massachusetts and others should expand the tool box we use to improve outcomes for residents and families caught up in the opioid epidemic," Cambridge Mayor Marc McGovern said in a statement, according to the the Globe.

Dozens of safe injection facilities - also known as safe consumption sites - have been established in various countries to prevent people who use drugs from dying from an overdose. Such sites allow people to use previously obtained drugs like heroin in a sterile environment under the supervision of medical professionals or trained staff.

No sanctioned safe injection sites have been implemented in the U.S., although multiple jurisdictions, including Philadelphia and San Francisco, have considered opening a facility. The sites also can offer clean needles and connections to health and addiction treatment services, but are considered illegal under federal law.

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Walsh planned to visit sites and meet with officials in Toronto and Montreal, while McGovern - traveling with Police Commissioner Branville Bard Jr., according to the Cambridge Chronicle & Tab - also was visiting Montreal.

Both mayors were appointed by Massachusetts Gov. Charlie Baker to the state's Harm Reduction Commission in October. The commission is looking into the idea of opening safe consumption facilities in Massachusetts, the Globe reports.

"Making it available to more people, or to people on the street who are alone, would be safer. It's about supervision and harm reduction," McGovern told the Chronicle & Tab. "At the end of the day, this is about keeping people from dying."

Katelyn Newman , Staff Writer

Katelyn Newman is a staff writer for the Healthiest Communities division at U.S. News & World R...Katelyn Newman is a staff writer for the Healthiest Communities division at U.S. News & World Report. You can follow her on Read more Twitter or reach her at knewman[at]usnews.com.

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Mayors Visit Safe Injection Sites in Canada

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Booths line a safe injection site in Montreal on June 26, 2017. Two Massachusetts mayors were visiting safe injection sites in Canada this week. Two Massachusetts mayors crossed the United States' northern border this week to check out establishments that allow people to use illegal drugs under supervision.

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Jason Jackson

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For many, beer, wine, and spirits conjure up thoughts of social gatherings and tipsy fun. But alcohol is a nervous system depressant and is also associated with damaging behavior as well as the emotional pain and physical disintegration of addiction.

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Drug abuse in Wilmington DE

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List of Drug and Alcohol Rehab Treatments in Wilmington, Delaware

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Call now 1-800-304-2219. The following article is a list of Wilmington's treatments for drug and alcohol addiction in Wilmington, Delaware.

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On behalf of Delawareans, Attorney General Matt Denn filed suit Friday against some of the nation's largest manufacturers, distributors, and retailers of prescription opioid drugs, alleging that their failures to meet their legal obligations have fueled an opioid addiction epidemic that is devastating individuals, families, and communities across Delaware.

The lawsuit seeks to hold them financially responsible for the harm they have caused to the State and its citizens and to require them to change their conduct to help end the epidemic.

"Opioid manufacturers misrepresented the addictive nature of their products. They, along with national opioid distributors and national pharmacies, knew that they were shipping quantities of opioids around the country so enormous that they could not possibly all be for legitimate medical purposes, but they failed to take basic steps to ensure that those drugs were going only to legitimate patients," Attorney General Denn said. "These companies ignored red flags that opioids were being diverted from legitimate channels of distribution and use to illicit channels. The failure of these corporate defendants to meet their legal obligations has had a devastating impact on Delawareans."

Delaware's lawsuit cites statistics showing that, each year, more than 50 opioid pills are shipped into Delaware for every man, woman, and child in the state. When limited to persons - including those who received prescriptions for a week or less following minor medical procedures - who actually have used opioids, the estimated number is 440 pills per person per year.

The manufacturer defendants named in Delaware's lawsuit are Purdue Pharma and Endo Pharmaceuticals. The distributor defendants named in the lawsuit are McKesson, Cardinal Health, Amerisource Bergen, Anda Pharmaceuticals, and H.D. Smith. The retailer defendants named in the lawsuit are CVS and Walgreens. Other defendants may be named in the future.

"The filing of this suit is an important step in what will likely be complex and time-intensive litigation against sophisticated national corporations," Attorney General Denn said. "But these defendants must be held accountable for the damage that they have caused to our state and its citizens."

The lawsuit, filed in Delaware Superior Court's Complex Commercial Litigation Division, can be found here.

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Delaware Files Lawsuit Against Opioid Industry - State of Delaware News

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Suit Seeks To Hold Manufacturers, Distributors and Retailers Responsible for Cost, Impact of Prescription Opioid Epidemic On behalf of Delawareans, Attorney General Matt Denn filed suit Friday against some of the nation's largest manufacturers, distributors, and retailers of prescription opioid drugs, alleging that their failures to meet their legal obligations have fueled an opioid addiction ...

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4 Reasons Why The U.S. Needs to Decriminalize Drugs - And Why We're Closer Than You Think

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Half of all adults in the U.S. have used an illegal drug at some point. If this was your loved one, family member or friend, would they deserve to be arrested, jailed, and face a lifetime of punishment and discrimination?

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A person with an addiction uses a substance, or engages in a behavior, for which the rewarding effects provide a compelling incentive to repeat the activity, despite detrimental consequences. Addiction may involve the use of substances such as alcohol, inhalants, opioids, cocaine, and nicotine, or behaviors such as gambling.

There is evidence that addictive behaviors share key neurobiological features: They intensely involve brain pathways of reward and reinforcement, which involve the neurotransmitter dopamine. And, in keeping with other highly motivated states, they lead to the pruning of synapses in the prefrontal cortex, home of the brain's highest functions, so that attention is highly focused on cues related to the target substance or activity. It is important to know that such brain changes are reversible after the substance use or behavior is discontinued.

Both substance use disorders and gambling behaviors have an increased likelihood of being accompanied by mental health conditions such as depression and anxiety, or other pre-existing problems. Substance use and gambling disorders not only engage the same brain mechanisms, they respond to many of the same treatment approaches.

Substance use and gambling disorders are complex conditions that affect the reward, reinforcement, motivation, and memory systems of the brain. They are characterized by impaired control over usage; social impairment, involving the disruption of everyday activities and relationships; and craving. Continuing use is typically harmful to relationships as well as to obligations at work or school.

Another distinguishing feature of addictions is that individuals continue to pursue the activity despite the physical or psychological harm it incurs, even if it the harm is exacerbated by repeated use. Typically, one's tolerance to a substance increases as the body adapts to its presence.

Because addiction affects the brain's executive functions, centered in the prefrontal cortex, individuals who develop an addiction may not be aware that their behavior is causing problems for themselves and others. Over time, pursuit of the pleasurable effects of the substance or behavior may dominate an individual's activities.

All addictions have the capacity to induce a sense of hopelessness and feelings of failure, as well as shame and guilt, but research documents that recovery is the rule rather than the exception. There are many routes to recovery. Individuals can achieve improved physical, psychological, and social functioning on their own-so-called natural recovery. Others benefit from the support of community or peer-based networks. And still others opt for clinical-based recovery through the services of credentialed professionals.

The road to recovery is seldom straight: Relapse, or recurrence of substance use, is common-but definitely not the end of the road. For those who achieve remission of an addiction disorder for five years, researchers report, the likelihood of relapse is no greater than that among the general population. Neuroscientists report that synaptic density is gradually restored.

Myths About Addiction

The processes that give rise to addictive behavior resist a simplistic explanation. There is not just one cause: Although genetic or other biological factors can contribute to a person's vulnerability to the condition, many social, psychological, and environmental factors also have a powerful influence on substance use.

Some characteristics, such as a lack of ability to tolerate distress or other strong feelings, have been associated with addiction, but there is no one "addictive personality " type that clearly predicts whether a person will face problems with addiction.

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Symptoms of Addiction

Recurrent use of a substance, or engagement with an activity, that leads to impairment or distress, is the core of addictive disorders. The clinical diagnosis of an addiction is based on the presence of at least two of a number of features:

The substance or activity is used in larger amounts or for a longer period of time than was intended.

There is a desire to cut down on use or unsuccessful efforts to do so.

Pursuit of the substance or activity, or recovery from its use, consumes a significant amount of time.

There is a craving or strong desire to use the substance or engage in the activity.

Use of the substance or activity disrupts obligations at work, school, or home.

Use of the substance or activity continues despite the social or interpersonal problems it causes.

Participation in important social, work, or recreational activities drops or stops.

Use occurs in situations where it is physically risky.

Use continues despite knowing it is causing or exacerbating physical or psychological problems.

Tolerance occurs, indicated either by need for markedly increased amounts of the substance to achieve the desired effect or markedly diminished effect of the same amount of substance.

Withdrawal occurs, manifest either in the presence of physiological withdrawal symptoms or the taking of a related substance to block them.

The severity of the condition is gauged by the number of symptoms present. The presence of two to three symptoms generally indicates a mild condition; four to five symptoms indicate a moderate disorder. When six or more symptoms are present, the condition is considered severe.

Causes of Addiction

Research makes it clear: There is no way to predict who will develop compulsive substance use or gambling behavior.

Addiction is a multi-faceted condition, arising from the confluence of many elements-including, of course, exposure to an addictive agent. It is more accurate to think of risk factors for the development of substance abuse disorders, rather than direct causes. (There are also factors that protect individuals against addiction.)

Biological factors

Genes. Estimates vary but scientists find that genetic factors contribute about half the risk for developing a substance use disorder. For example, one factor linked to vulnerability is variation in a gene that determines the makeup of brain receptors for the neurotransmitter dopamine. Another factor appears to be the nature of the body's hormonal response to stress.

Physiological factors. Variations in liver enzymes that metabolize substances are known to influence one's risk of alcohol use disorder.

Gender. Males are more likely to develop substance use disorder than females, although the so-called gender gap may be narrowing for alcohol use disorder, and females are more subject to intoxication effects at lower doses of alcohol.

Psychological Factors

Personality factors. Both impulsivity and sensation seeking have been linked to substance use and gambling disorders. Impulsivity may be particularly related to the risk of relapse.

Trauma and abuse. Early exposure to significant adverse experience can contribute to the development of substance use disorders by overwhelming an individual's coping ability, perhaps by sensitizing brain pathways of alarm/distress, or by adding to the burden of stress.

Mental health factors. Conditions such as depression, anxiety, attention deficit disorder, and post-traumatic stress disorder (PTSD) increase the risk of addiction. Difficulties managing strong emotions are also linked to substance use.

Environmental Factors

Family factors. While strong family relationships have been shown to protect against substance use disorders, several aspects of family functioning or circumstances can contribute to addiction risk. Having a parent or sibling with an addictive disorder raises the risk, as does a lack of parental supervision or support. Poor-quality or troubled parent-child relations and family disruptions such as divorce also add to one's risk, as does sexual, physical, or emotional abuse. Research shows that marriage and taking on child-raising responsibilities mitigate the risk of addiction.

Accessibility factors. Easy availability of alcohol or other substances in one's home, at school or work, or in one's community increases the risk of repeated use.

Peer group. As profoundly social animals, people are strongly influenced by their peers and, in generally seeking to be liked by them, may adopt many of their behaviors, particularly during adolescence. Positive social relationships, on the other hand, are known to strongly protect against substance use.

Employment status. Having a job, and developing the skills for employment, exerts pressure for stability and provides financial and psychological rewards that mitigate addiction risk.

Treatment of Addiction

Substance use is a treatable condition and complete remission is entirely possible. Recovery, however, is often a long-term process that may involve multiple attempts. Relapse is now regarded as part of the process, and effective treatment regimens address prevention and management of recurrent use.

Since success tends not to occur all at once, any improvements are considered important signs of progress. Increasingly, programs are available to help those who recognize that they have a substance-use problem but are not ready for complete abstinence.

Because addiction affects so many facets of an individual's functioning-from the ability to tolerate frustration to establishing and maintaining a productive role in society-good treatment focuses on many dimensions of life, including family roles and work skills as well as mental health.

Treatment can include any of a number of components, which are often deployed in combination and are likely to change over the course of recovery:

Detoxification, conducted under medical supervision, may be needed but is only the first stage of treatment.

Medications that reduce or counter use of illicit substances are suitable for some individuals, or medications may be used to target co-occurring disorders such as anxiety and depression.

Motivational Interviewing, which is a short-term counseling process to help a person resolve ambivalence about treatment and find and hold onto incentives for change.

Cognitive Behavior Therapy (CBT) can help a person recognize and cope with situations that trigger the desire to use substances.

Group therapy and other peer-support programs leverage the direct experience of many to support individual recovery and prevent the recurrence of substance use.

Family therapy helps individuals repair any damage done to family relationships and to establish more supportive ones.

Life skills training, including employability skills, may be part of an individual's treatment plan.

Good treatment programs also feature the regular monitoring of individual progress.

Treatment is available in a variety of settings, from a doctor's office or outpatient clinic to long-term residential facility. No one way will be right for everyone, and there is evidence that one's commitment to change is more important than the type of treatment program he or she selects. Whatever the treatment under consideration, say independent researchers, there are number of features to look for to identify an effective program:

Patients undergo comprehensive medical and psychiatric screening.

Treatment addresses individual needs, including co-occurring conditions, whether chronic pain, anxiety, or hepatitis.

Families are involved in treatment.

There is continuity of care via active linkages to resources in subsequent phases of recovery.

The facility maintains a respectful environment.

Treatment services are evidence-based and reflect best practices.

Staff members are licensed and certified in the disciplines they practice.

The program is accredited by a nationally recognized monitoring agency.

Patient response to treatment is monitored and the program or facility offers outcome data reflecting treatment performance.

Substance Use Disorders

The medical world currently views substance use disorders according to the class of drug that is used. As a result, it defines 10 distinct disorders. All share the defining features of addiction: They directly and intensely involve reward and reinforcement systems of the brain, stimulating compulsive use that typically leads to the neglect of normal activities and negative consequences. With some variation, they also share common symptoms, although withdrawal symptoms differ significantly among them and do not occur for some classes of drug such as hallucinogens and inhalants.

Alcohol Use Disorder: Alcohol is a brain depressant and alcohol use disorder is common, although more so among adult men (12.4 percent) than women (4.9 percent), although rates are rising among women. It affects men and women differently; women seem to be more susceptible to some of the detrimental effects of alcohol, researchers find. Most commonly, the disorder develops well before age 40.

Caffeine Intoxication: The consequence of very high doses of caffeine consumption, caffeine intoxication is marked by symptoms including restlessness, nervousness, insomnia, flushed face, gastrointestinal disturbance, muscle twitching, rambling thoughts and speech, cardiac rhythm disturbances, periods of inexhaustibility, and psychomotor agitation.

Cannabis Use Disorder: Cannabis use disorder is highest among 18-to29-year-olds (4.8 percent) and prevalence of the disorder decreases with age.

Phencyclidine and Other Hallucinogen Use Disorder: These substances alter perception. Phencyclidine is commonly called "angel dust" or PCP and produces feelings of separation of mind from body.

Inhalant Use Disorder: Inhalant substances are volatile hydrocarbons-toxic gases that are released from glues, fuels, paints, and other volatile compounds and have psychoactive effects. The disorder occurs primarily among those ages 12 to 17.

Opioid Use Disorder: Opioid drugs include the illicit drug heroin and prescription pain-relievers such as oxycodone, codeine, morphine, and fentanyl, among others. According to the American Society of Addiction Medicine, in 2015, 2 million people had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin. Opioid-related overdoses are now the leading cause of death in Americans under 50 years of age. Prescribed opioids are the "overwhelming initial source" of addiction, according to ASAM.

Sedative, Hypnotic, or Anxiolytic Use Disorder: Addiction to sleeping pills and anti-anxiety medications falls into this category. Like alcohol, these agents are brain depressants. Rates of the disorder are highest among 18-to-29-year-olds.

Stimulant Use Disorder: Substances in this group include amphetamines; methylphenidate, best known as the prescription drug Ritalin; and cocaine. Stimulant drugs are commonly prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. In the U.S., cocaine use is highest among those aged 18 to 25.

Tobacco Use Disorder: The nicotine in tobacco acts as a central nervous system stimulant. Studies show that 68 percent of adult smokers want to quit, and 50 percent have made attempts to quit.

Other (or Unknown) Substance Use Disorder: Substances ranging from antihistamines, betel nut, and cortisol to steroids may also have effects on the central nervous system that lead to compulsive use causing serious problems.

Gambling and Other Compulsions or Addictions

Addiction is not limited to biochemical substances such as cocaine, alcohol, inhalants, or nicotine. It can involve behaviors that provide opportunities for immediate reward. Because of the fast feedback that occurs from such activities, they can quickly turn a pastime into a compulsive pursuit of reward that may lead to the neglect of other life goals and create harmful consequences, from the loss of large sums of money to the disruption of important relationships.

Behaviors indicative of gambling disorder include:

The need to gamble with increasing amounts of money to achieve the desired excitement.

Restlessness or irritability when attempting to cut down or stop gambling.

Repeated unsuccessful efforts to cut back or stop gambling.

Preoccupation with gambling.

Feelings of emotional distress leading to gambling.

Gambling losses followed by attempts to make up for them.

Lying to conceal the extent of one's gambling.

Gambling that jeopardizes important relationships or work, school, or other obligations.

Financial desperation leading to borrowing money from others.

In June 2018, the World Health Organization included Gaming Disorder, involving digital gaming or video gaming to such a degree that it takes priority over other interests and daily activities despite negative consequences, in its newest edition of the International Classification of Diseases. This inclusion reflects a consensus of experts from different disciplines and geographical regions around the world. They point out that only a tiny proportion of those who engage in digital or video gaming activities-notably those who have impaired control over the activity and spend excessive amounts of time at it-are at risk for the diagnosis.

In the United States, excessive behavior patterns-involving smartphone use, Internet gambling, gaming, pornography, even eating and shopping-are being studied as possible behavioral addiction. While such activities may provide the opportunity for ample immediate reward, it has not yet been determined that they meet all of the criteria for addictive behavior.

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A person with an addiction uses a substance, or engages in a behavior, for which the rewarding effects provide a compelling incentive to repeat the activity, despite detrimental consequences. Addiction may involve the use of substances such as alcohol, inhalants, opioids, cocaine, and nicotine, or behaviors such as gambling.

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In 2016, news reports warned the public of an opioid epidemic gripping the nation.

But Madeline Vaughn, then a lead clinical intake coordinator at the Houston-based addiction treatment organization Council on Recovery, sensed something different was going on with the patients she checked in from the street.

Their behavior, marked by twitchy suspicion, a poor memory and the feeling that someone was following them, signaled that the people coming through the center's doors were increasingly hooked on a different drug: methamphetamine.

"When you're in the boots on the ground," Vaughn said, "what you see may surprise you, because it's not in the headlines."

In the time since, it's become increasingly clear that, even as the opioid epidemic continues, the toll of methamphetamine use, also known as meth or crystal meth, is on the rise, too.

The rate of overdose deaths involving the stimulant more than tripled from 2011 to 2016, the Centers for Disease Control and Prevention reported.

But unlike the opioid epidemic for which medications exist to help combat addiction, medical providers have few such tools to help methamphetamine users survive and recover. A drug such as naloxone, which can reverse an opioid overdose, does not exist for meth. And there are no drugs approved by the Food and Drug Administration that can treat a meth addiction.

"We're realizing that we don't have everything we might wish we had to address these different kinds of drugs," said Dr. Margaret Jarvis, a psychiatrist and distinguished fellow for the American Society of Addiction Medicine.

Meth revs up the human body, causing euphoria, elevated blood pressure and energy that enables users to go for days without sleeping or eating. In some cases, long-term use alters the user's brain and causes psychotic symptoms that can take up to one year after the person has stopped using it to dissipate.

Overdosing can trigger heart attacks, strokes and seizures, which can make pinpointing the drug's involvement difficult.

Meth users also tend to abuse other substances, which complicates first responders' efforts to treat a patient in the event of an overdose, said Dr. David Persse, EMS physician director for Houston. With multiple drugs in a patient's system, overdose symptoms may not neatly fit under the description for one substance.

"If we had five or six miracle drugs," Persse said, to use immediately on the scene of the overdose, "it's still gonna be difficult to know which one that patient needs."

Research is underway to develop a medication that helps those with methamphetamine addiction overcome their condition. The National Institute on Drug Abuse Clinical Trials Network is testing a combination of naltrexone, a medication typically used to treat opioid and alcohol use disorders, and an antidepressant called bupropion.

And a team from the Universities of Kentucky and Arkansas created a molecule called lobeline that shows promise in blocking meth's effects in the brain.

For now, though, existing treatments, such as the Matrix Model, a drug counseling technique, and contingency management, which offers patients incentives to stay away from drugs, are key options for what appears to be a meth resurgence, said Jarvis.

Illegal drugs never disappear from the street, she said. Their popularity waxes and wanes with demand. And as the demand for methamphetamine use increases, the gaps in treatment become more apparent.

Persse said he hasn't seen a rise in the number of calls related to methamphetamine overdoses in his area. However, the death toll in Texas from meth now exceeds that of heroin.

Provisional death counts for 2017 showed methamphetamine claimed 813 lives in the Lone Star State. By comparison, 591 people died due to heroin.

The Drug Enforcement Administration reported that the price of meth is the lowest the agency has seen in years. It is increasingly available in the eastern region of the United States. Primary suppliers are Mexican drug cartels. And the meth on the streets is now more than 90 percent pure.

"The new methods (of making methamphetamine) have really altered the potency," said Jane Maxwell, research professor at the University of Texas at Austin's social work school. "So, the meth we're looking at today is much more potent than it was 10 years ago."

For Vaughn, who works as an outpatient therapist and treatment coordinator, these variables are a regular part of her daily challenge. So until the research arms her with something new, her go-to strategy is to use the available tools to tackle her patients' methamphetamine addiction in layers.

She starts with writing assignments, then coping skills until they are capable of unpacking their trauma. Addiction is rarely the sole demon patients wrestle with, Vaughn said.

"Substance use is often a symptom for what's really going on with someone," she said.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

Ever find yourself scrolling through home-rental websites, day dreaming of a staycation or weekend getaway? Maybe you've flagged them with a heart or bookmark, saving them for easy viewing later when you're ready to book. We asked Airbnb about the most commonly "wish-listed" homes throughout Chicago. The results range from a Lincoln Park loft to a transformed garden apartment in Little Village and range from $65 to $109 a night. Two of the listings are Airbnb Plus, meaning they've passed an inspection to ensure they meet certain standards.

Through triumphs and tears, here are 18 folks who inspired Balancing Act columnist Heidi Stevens the most in 2018.

Although different, each of these rentals has one thing in common: It seems everyone wants to stay for a night.

(Susan Moskop)

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Meth's resurgence spotlights lack of meds to combat the addiction

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In 2016, news reports warned the public of an opioid epidemic gripping the nation. But Madeline Vaughn, then a lead clinical intake coordinator at the Houston-based addiction treatment organization Council on Recovery, sensed something different was going on with the patients she checked in from the street.