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April 4, 2018 NewsOpioid Addiction0

Understanding the Epidemic

Combatting the Opioid Overdose Epidemic

CDC is committed to fighting the opioid overdose epidemic and supporting states and communities as they continue work to identify outbreaks, collect data, and respond to overdoses, and provide care to those in their communities. CDC’s Prevention for States and Data-Driven Prevention Initiative programmatic aims center around the enhancement of PDMPs within clinical and public health settings, insurer and community interventions, evaluation of state-level policies, and other innovative strategies that states can employ. CDC’s Enhanced State Opioid Overdose Surveillance program aims to support and build the capacity of states to monitor the epidemic by improving the timeliness and quality of surveillance data focusing on both fatal and nonfatal opioid overdose.

Drug overdose deaths continue to increase in the United States.

  • From 1999 to 2016, more than 630,000 people have died from a drug overdose.
  • Around 66% of the more than 63,600 drug overdose deaths in 2016 involved an opioid.
  • In 2016, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 5 times higher than in 1999.
  • On average, 115 Americans die every day from an opioid overdose.

epidemic

From 1999-2016, more than 350,000 people died from an overdose involving any opioid, including prescription and illicit opioids.

This rise in opioid overdose deaths can be outlined in three distinct waves.

  1. The first wave began with increased prescribing of opioids in the 1990s 2, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999.
  2. The second wave began in 2010, with rapid increases in overdose deaths involving heroin.
  3. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids – particularly those involving illicitly-manufactured fentanyl (IMF). The IMF market continues to change, and IMF can be found in combination with heroin, counterfeit pills, and cocaine.

Combatting the Opioid Overdose Epidemic

CDC is committed to fighting the opioid overdose epidemic and supporting states and communities as they continue work to identify outbreaks, collect data, and respond to overdoses, and provide care to those in their communities. CDC’s Prevention for States and Data-Driven Prevention Initiative programmatic aims center around the enhancement of PDMPs within clinical and public health settings, insurer and community interventions, evaluation of state-level policies, and other innovative strategies that states can employ. CDC’s Enhanced State Opioid Overdose Surveillance program aims to support and build the capacity of states to monitor the epidemic by improving the timeliness and quality of surveillance data focusing on both fatal and nonfatal opioid overdose.

CDC’s work focuses on:

  • Building prevention efforts by equipping states with resources, improving data collection, and supporting the use of evidence-based prevention strategies.
  • Improving data quality and tracking trends to better understand and respond to the epidemic. Collecting and analyzing data on opioid-related overdoses to better identify areas that need assistance and to evaluate prevention efforts.
  • Supporting healthcare providers and health systems with data, tools, and guidance for evidence-based decision-making to improve opioid prescribing and patient safety.
  • Partnering with public safety officials, including law enforcement, to address the growing illicit opioid problem.
  • Encouraging consumers to make safe choices about opioids and raising awareness about prescription opioid misuse and overdose.

Collaboration is essential for success in prevention opioid overdose deaths. Medical personnel, emergency departments, first responders, public safety officials, mental health and substance abuse treatment providers, community-based organizations, public health, and members of the community all bring awareness, resources, and expertise to address this complex and fast-moving epidemic. Together, we can better coordinate efforts to prevent opioid overdoses and deaths.

Read more about CDC’s role in the opioid overdose epidemic.

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November 14, 2017 Drug AddictionNews0

Portugal: Why hardly anyone dies from a drug overdose

Portugal decriminalized the use of all drugs in 2001. Weed, cocaine, heroin, you name it — Portugal decided to treat possession and use of small quantities of these drugs as a public health issue, not a criminal one. The drugs were still illegal, of course. But now getting caught with them meant a small fine and maybe a referral to a treatment program — not jail time and a criminal record.

Whenever we debate similar measures in the U.S. — marijuana decriminalization, for instance — many drug-policy makers predict dire consequences. “If you make any attractive commodity available at lower cost, you will have more users,” former Office of National Drug Control Policy deputy director Thomas McLellan once said of Portugal’s policies. Joseph Califano, founder of the Center for Addiction and Substance Abuse at Columbia University, once warned that decriminalization would “increase illegal drug availability and use among our children.”

But in Portugal, the numbers paint a different story. The prevalence of past-year and past-month drug use among young adults has fallen since 2001, according to statistics compiled by the Transform Drug Policy Foundation, which advocates on behalf of ending the war on drugs. Overall adult use is down slightly too. And new HIV cases among drug users are way down.

Now, numbers just released from the European Monitoring Centre for Drugs and Drug Addiction paint an even more vivid picture of life under decriminalization: drug overdose deaths in Portugal are the second-lowest in the European Union.

Among Portuguese adults, there are 3 drug overdose deaths for every 1,000,000 citizens. Comparable numbers in other countries range from 10.2 per million in the Netherlands to 44.6 per million in the U.K., all the way up to 126.8 per million in Estonia. The E.U. average is 17.3 per million.

Perhaps more significantly, the report notes that the use of “legal highs” — like so-called “synthetic” marijuana, “bath salts” and the like — is lower in Portugal than in any of the other countries for which reliable data exists. This makes a lot of intuitive sense: why bother with fake weed or dangerous designer drugs when you can get the real stuff? This is arguably a positive development for public health in the sense that many of the designer drugs that people develop to skirt existing drug laws have terrible and often deadly side effects.

Drug use and drug deaths are complicated phenomena. They have many underlying causes. Portugal’s low death rate can’t be attributable solely to decriminalization. As Dr. Joao Goulao, the architect of the country’s decriminalization policy, has said, “it’s very difficult to identify a causal link between decriminalization by itself and the positive tendencies we have seen.”

Still, it’s very clear that decriminalization hasn’t had the severe consequences that its opponents predicted. As the Transform Drug Policy Institute says in its analysis of Portugal’s drug laws, “The reality is that Portugal’s drug situation has improved significantly in several key areas. Most notably, HIV infections and drug-related deaths have decreased, while the dramatic rise in use feared by some has failed to materialise.”

As state legislatures debate with issues like marijuana legalization and decriminalization in the coming years, Portugal’s 15-year experience may be informative.

Read more on the Washington Post

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November 14, 2017 Drug AddictionNews0

Meet 60 Minutes’ DEA whistleblower

Why has the country’s opioid problem become a national emergency? A high-ranking whistleblower from the DEA explains how the drug industry–and Congress–fueled an epidemic

“People are dying.” That’s what whistleblower Joe Rannazzisi told 60 Minutes over and over again. “People are dying.”

This week, the broadcast airs Bill Whitaker’s interview with Rannazzisi, a former high-ranking DEA agent who saw the opioid epidemic killing hundreds of thousands of Americans, tried to stop it, and ran into a brick wall — in the form of Congress.

Joe Rannazzisi is not gonna give this fight up…He’s going to pursue this until he gets some satisfaction.”

Whitaker talks about his report “The Whistleblower,” which was a joint investigation with The Washington Post, with 60 Minutes Overtime and explains why Rannazzisi decided to talk publicly.

“Joe Rannazzisi is not gonna give this fight up,” says Whitaker. “He’s like a dog with a bone. He’s going to pursue this until he gets some satisfaction.”

The Whistleblower

CREW: Speeding, We’re good, Let’s go…

BILL WHITAKER: Okay. Well, Joe, if you would first of all please state your name, so we have it at the top of your interview?

JOE RANNAZZISI: Okay. My name is Joseph Rannazzisi—

BILL WHITAKER: My story on 60 Minutes this week is about a former DEA agent who saw the opioid epidemic growing, and tried to stop it, and ran into a brick wall in the form of Congress.

JOE RANNAZZISI TO CONGRESS: 16,651 people in 2010 died of opiate overdose, ok? Opiate-associated overdose. This is not a game.

BILL WHITAKER: Are you the most high-level whistleblower to come out of the DEA?

JOE RANNAZZISI: As far as this? Yes. As far as pharmaceutical opioid abuse and the way we’ve handled it? Yeah, I’m pretty much the highest-level person that’s come out.

60 MINUTES OVERTIME: Joe Rannazzisi is in your story called one of the most important whistleblowers ever to be on 60 Minutes. What’s your sense of what drives him?

BILL WHITAKER: He is a no-nonsense principled man. He saw this crisis and wanted to stop it. What he zeroed in on was the distribution of the pills. So he started to put pressure on the distributors. And the distributors pushed back.

JOE RANNAZZISI: This is an industry that allowed millions and millions of drugs to go into bad pharmacies and doctors’ offices, that distributed them out to people who had no legitimate need for those drugs.

BILL WHITAKER: This story was like a continuation of the two previous stories we did on the opioid crisis. That one was personal.

Excerpt from “The Heroin Epidemic“:

ANGIE PELFREY: We call this the “death wall.”
BILL WHITAKER: The death wall?
ANGIE PELFREY: Yes.
BILL WHITAKER: Why is that?
ANGIE PELFREY: Majority of the people on this wall have died of drug overdose.
BILL WHITAKER: I thought of those people we met and the people who died– all the time.
MAN: There’s 23 in there on the wall from my hometown.
BILL WHITAKER: Is it a small town?
MAN: Yeah.

BILL WHITAKER: It seems that some investigators with the DEA were aware that these pills were getting out of the pharmacies and into the streets, and they tried to ring the alarm bells. But not only did no one pay attention to them, it seems that members of Congress took steps to try to limit the DEA’s abilities to stop this. And the result was a bill in Congress that actually ended up taking away the most potent tool that the DEA had to go after the distribution of so many drugs.

JOE RANNAZZISI: This bill is going to protect defendants that we have under investigation, that we are investigating. And it restricts or prevents us from filing immediate suspension orders to stop– to stop the hemorrhaging of drugs downstream.

CONGRESSMAN TOM MARINO: It is my understanding that Joe Rannazzisi, a senior DEA official, has publicly accused we sponsors of the bill of –quote supporting criminals –unquote. This offends me immensely.

BILL WHITAKER: You know you have a reputation. And even people who support you tell us that you can be a bit of a hothead. True?

JOE RANNAZZISI: Yeah, I do get angry. I get angry when people don’t do their jobs. I get angry when people don’t do their jobs well.

BILL WHITAKER: And this crisis that he saw happening in front of his eyes enraged him.

JOE RANNAZZISI: I– I– I’m guilty. I’m guilty of being passionate. I’m builty of b– guilty of being angry. But I think anybody else in that situation would’ve done the exact same thing.

BILL WHITAKER: “People are dying.” He would say that to us over and over and over again. “People are dying.” So he was trying to figure out what he could do about it. And every time he ran into a roadblock, he got angrier and more forceful. And it depends on who ya talk to what his reputation is. If you talk to his investigators, the people who worked in the field for him, they love him. You talk to some people in Washington– at the DEA– his higher-ups at the DEA or at the Justice Department, certainly in Congress, they think he was too aggressive, to the point of being boorish.

JOE RANNAZZISI: What I needed was support. And it infuriated me that I was over there, trying to explain what my motives were or why I was going after these corporations. And when I went back to the office, and I sat down with my staff, I basically said, “You know, I just got questioned on why we’re doing– why we’re doing what we’re doing. This is– now this is war. We’re going after these people, and we’re not gonna stop.

BILL WHITAKER: He’s not the most diplomatic person you’ve ever come across.

60 MINUTES OVERTIME: No, but he makes a good whistleblower.

BILL WHITAKER: He makes a great whistleblower, and he’s got a reason to be upset.

JOE RANNAZZISI: It just hurts when somebody says, “Well, DEA should be doing more.” DEA was doing everything it could. DEA ran into a wall.

60 MINUTES OVERTIME: Do you think this investigation by 60 Minutes and The Washington Post will make waves?

BILL WHITAKER: I sure hope so. This is a terrible crisis. What I would hope would happen from this story is that Americans get angry.

60 MINUTES OVERTIME: It doesn’t look like Joe Rannazzisi’s gonna let this go.

BILL WHITAKER: Joe Rannazzisi is not gonna give this fight up. He’s like a dog with a bone. He’s going to pursue this until he gets some satisfaction.

CONGRESSMAN TOM MARINO: You know before coming to Congress, I was a prosecutor and an United States Attorney.

BILL WHITAKER: Congressman Marino has been nominated to be the next drug czar. What was your reaction when you heard that?

JOE RANNAZZISI: Total disbelief. Total disbelief. He’s just not qualified to do that job. Besides the fact that he pushed through a bill that’s curtailing the ability of DEA to do their job, I don’t understand how you could look at a congressman who’s done all of this and then decide he would be a great drug czar– to basically set policy for the United States; drug policy for the United States.

BILL WHITAKER: We will soon have a hearing with Congressman Marino. I would think that this would be an issue that will be brought up in his hearings.

JOE RANNAZZISI: The bill was bad. Him being the drug czar is a lot worse.

Watch the videos on the CBS NEWS Website

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