Maryland's Prescription Opioid Storage Habits

The following update was provided by the Behavioral Health Research Team, University of Maryland School of Pharmacy: Kimberly Stinchcomb, MPH Marianne Gibson, MS Nicole Sealfon, MPH, Fadia Shaya, PhD

Non-medical use of prescription opioids is a public health epidemic that has touched all corners of Maryland. Results from the 2014 National Survey on Drug Use and Health (NSDUH) showed that over 206,000 Marylanders reported past-year non-medical use of prescription opioids. While there are many risks associated with prescription opioid misuse, including death, there is cause for more concern as many new heroin users are transitioning from prescription opioids.

Prescription opioids can be accessed in a variety of ways, including through sharing and stealing in homes. One way to prevent prescription drug diversion is through proper storage. In the fall of 2016, the Behavioral Health Research Team, housed within the University of Maryland School of Pharmacy, administered the second iteration of the Maryland Public Opinion Survey on Opioids (MPOS) to assess the opinions and behaviors regarding prescription opioids and heroin.

Participants of the 2016 MPOS included 5,496 Maryland residents aged 18 years and older. Storage habits of prescription opioids were identified through the following questions: 1) In your opinion, where should prescription opioids be stored? 2) Have you or anyone in your household been prescribed an opioid medication in the past 12 months? 3) The location where the prescription opioid is stored is a) always locked, b) sometimes locked, c) never locked, or d) I no longer have it. 4) How often do you count your prescription opioids for monitoring? Over 96% (n=4,301) of respondents stated that opioids should be stored in a locked place; however, among those who had a member in their household taking prescription opioids, about 58% (n=1,008) reported that the medication was stored in a location that was never locked. Only 16% (n=294) of the respondents reported that the medication was locked up sometimes or always. Furthermore, over 75% (n=1,398) reported that they never counted their prescription opioids, which would show proper monitoring.

MPOS findings showed that although people recognize that prescription opioids should be kept in a locked location, the majority are not doing so. Public health professionals need to continue to educate residents on how to safely store and monitor their prescription drugs. While safe storage of medications will not solve the opioid epidemic, it is a piece of the puzzle that can curtail drug diversion.

2017, Booklet 10: Education Sector Responses to the Use of Alcohol, Tobacco and Drugs

Click here for a pdf copy of the 2017 Good Policy and Practice in Health Education, Booklet 10, Education Sector Responses to the Use of Alcohol, Tobacco and Drugs.

This booklet has been developed through an international consultation process led by the United Nations Educational, Scientific and Cultural Organization (UNESCO) in partnership with the United Nations Office on Drugs and Crime (UNODC) and the World Health Organization (WHO).

Naloxone Available without A Prescription

Beginning June 1, 2017, anyone can get Naloxone at a Maryland pharmacy without a prescription. 

Naloxone is a life-saving medication that can quickly restore the breathing of a person experiencing an opioid overdose. Opioids are a group of drugs that include heroin and prescription medications like oxycodone, hydrocodone, morphine, fentanyl and methadone. Naloxone is available as a generic drug or under the brand names NARCAN® and EVZIO®.

Like other prescription drugs, what you pay depends on whether you have insurance with a prescription drug plan, and what that plan covers. Naloxone is covered by Maryland Medicaid. If you don’t have insurance, ask the pharmacist about any discounts or coupons from the pharmacy or drug maker.

For more information, click here.

Anne Arundel County Declares "Safe Stations"

County and Annapolis officials announced Thursday that area fire departments and police stations will function as resource centers for people addicted to drugs that want help and also will give free medical evaluations to those seeking treatment. These "safe stations" will be available 24 hours a day, seven days a week. Within two hours of the announcement, a person walked in to the Brooklyn Park Volunteer Fire Department and asked for help with his addiction.

 

Study Shows Marijuana Use Interrupts Adolescent Brain Development

This article states, "Regular marijuana use by teens can stop the brain from maturing, according to a new study by scientists at Rosalind Franklin University of Medicine and Science, North Chicago, IL. Published March 4 in the journal Molecular Psychiatry, the study is the first to establish a causal link between repeated cannabinoid exposure during adolescence and an interruption of the normal maturation processes in the prefrontal cortex, a region in the brain's frontal lobe, which regulates decision ­making and working memory and undergoes critical development during adolescence."

"The study shows how chronic cannabis use by teens can cause persistent behavioral deficits in adulthood, including problems with attention span and impulse control. The findings also add to prior research that draws a correlation between adolescent marijuana abuse and the development of schizophrenia."

As an increasing number of states consider legalization of marijuana for both medicinal and recreational use, this discovery calls for prescribing physicians to take notice and for policy makers "to establish regulations to take advantage of the beneficial effects of marijuana while minimizing its detrimental potential."

To read the full article, click here.

 

 

Intriguing Washington Post Article About Senior (Beach) Week

Apprehensions, acceptance and alternatives are found in an April 17 article, "Senior (Beach) Week and teens can be a disastrous combination." If you will be faced with the decision to allow your teen to participate, if you have been down this road already, or if you are in any position to influence, you will likely find value in and enjoy this article's offerings. Aside from truly sound ideas which include a four-step approach to Beach Week by a group of parents, it ends in a surprising bit of humor. (Definitely worth the read to the bottom!) To view the article, click here.

 

Regional Heroin Ring Dismantled, 11 Indicted in Alexandria

According to a March 20, 2017 article on wtop.com entitled, Regional heroin ring dismantled, 11 indicted in Alexandria, “A rash of heroin overdoses in Alexandria launched a yearlong investigation that crossed into six communities on both side of the Potomac River and disrupted a trafficking network that has pushed nearly $1 million worth of heroin onto the region’s streets, Virginia authorities said Monday.”

“Eleven men and women from Northern Virginia and Prince George’s County, Maryland, have been indicted on charges of racketeering, illegal drug possession and distribution, the Alexandria City Police Department announced Monday.”

“This didn’t come from a few drug deals on a street corner,” said Gary Settle, director of the Virginia State Police criminal investigative bureau. “These men and women were organized. They were part of a complex network responsible for trafficking thousands of dollars worth of heroin and cocaine throughout the region – heroin that came very close to costing people their lives.”

The overdoses were reported by local emergency rooms and community members. Investigators found a common distributor that linked those non-fatal cases, Settle said.” To read the full article, click here.

KNOW About the "911 Good Samaritan Fatal Overdose Prevention Law"?

According to the Drug Policy Alliance, "Accidental overdose deaths are now the leading cause of accidental death in the United States, exceeding even motor vehicle accidents among people ages 25 to 64. Many of these deaths are preventable if emergency medical assistance is summoned, but people using drugs or alcohol illegally often fear arrest if they call 911, even in cases where they need emergency medical assistance for a friend or family member at the scene of a suspected overdose."

"The best way to encourage overdose witnesses to seek medical help is to exempt them from arrest and prosecution for minor drug and alcohol law violations, an approach often referred to as Good Samaritan 911...Good Samaritan laws do not protect people from arrest for other offenses, such as selling or trafficking drugs, or driving while drugged. These policies protect only the caller and overdose victim from arrest and/or prosecution for simple drug possession, possession of paraphernalia, and/or being under the influence."

Twenty states including Maryland and the District of Columbia have enacted such policies. To read the complete article, click here.  For a vivid illustration of the law in action, view this Public Service Announcement (PSA). 

 

Mutliple Opioid Overdoses Close to Home

WBAL News Radio 1090 reported the following story today entitled, “Opioid Overdose Hits Anne Arundel County Hard This Week”: 

“In less than 24 hours, more than a dozen people in Anne Arundel County this week overdosed. Three of them died. The Anne Arundel County Health Department sent out an alert to citizens reminding them to watch for signs of overdose in loved ones or strangers and to call 9-1-1 if they see any of the signs.

Health officials say there were 14 opiate overdoses from Tuesday to Wednesday. Those people were using drugs like heroin, fentanyl (a synthetic form of heroin), Percocet and OxyContin. Anne Arundel County Police told the Capital Gazette that many of the overdoses happened in the northern and western sections of the county. The county also offers training in giving someone Narcan, a heroin overdose reversal drug.” 

Note: The Capital Gazette reported there were 16 overdoses.

For concerns, questions or to find Naloxone (brand name Narcan) training in Howard County, contact HC DrugFree at 443-325-0040 or Admin@hcdrugfree.org.

 

 

"Drunk Suit" Experiment

On March 2, NBC Today demonstrated the use of a scientifically engineered "drunk suit" which simulates alcohol's effects on the body. To view the video, go to: http://www.today.com/health/drunk-suit-dramatically-shows-dangers-drunk-driving-t108748

The following article entitled, "Drunk suit dramatically shows the dangers of drunk driving" accompanied the video: 

"Just days ago, a driver plowed into pedestrians at a Mardi Gras parade, injuring 28 people. Some are still in the hospital. Police say the 25-year-old behind the wheel had a blood alcohol level nearly three times the legal limit.

According to the Centers for Disease Control, every day 28 people die in crashes involving alcohol. Now experts at Ford are trying to stop it by developing a scientifically engineered "drunk suit." They're trying it on teenagers in an effort to get them "scared straight," part of a program called Ford Driving Skills for Life.

TODAY national investigative correspondent Jeff Rossen tried on the drunk suit, which included weights on his knees and arms and literal "beer goggles" to limit his view. When he went through a sobriety test during a simulated traffic stop as well as driving an obstacle course, all while wearing the suit, the results were dramatic."

   

Article Addresses Inconsistencies in the Law

HC DrugFree's legal advisor David Zwanetz, an attorney and partner with Shapiro Zwanetz and Associates, recently wrote an article entitled “Wacky Weed” about the inconsistencies in the law.

To read the article,  click here

Maryland's Governor Declares a State of Emergency

At the Maryland Emergency Management Agency (MEMA) on Wednesday, March 1, Governor Larry Hogan declared a state of emergency in response to the rapid escalation of the heroin and opioid crisis in Maryland. With deaths doubling since last year involving these drugs, Governor Hogan considered the heroin and opioid epidemic to be a natural disaster.

"With this continuing threat increasing at such an alarming rate, we must allow for rapid coordination with our state and local emergency teams," Hogan said. The Governor issued the state of emergency mainly to cut through red tape to give local emergency agencies more flexibility for prevention, treatment and enforcement efforts.

The State of Emergency will assist the efforts of Maryland’s Lt. Governor, Boyd Rutherford, as he heads the governor’s Heroin and Opioid Emergency Task Force. Governor Hogan pledged an additional $50 million in State funding and continues to seek federal funds. Clay Stamp, Former MEMA Director who will lead the emergency coordination around the state said, "We have people dying every day in this state right now. (There's) probably no more important endeavor that I've been involved in my career in emergency management than what we're facing."

To view Governor Hogan's announcement on WBAL, click here.

 

Follow Up to "A Local Sister Lost to Heroin"

Today, The Baltimore Sun ran the article, "Maryland scrambling to deal with surging rate of heroin overdose deaths." An accompanying video follows up our posting from January 2 about Taylor Sprague who died of a heroin overdose at age 21 on December 31, 2015. Her mother and sister share their feelings when they got the news and how it has affected them since that day.

They describe how Taylor’s death changed the way look they at things, that it affected their health and relationships, and that the police announcement that she died of a heroin overdose had to be wrong – they never dreamed that their college honor student and former General Assembly Page could have been using drugs.

Kylie & Kerri Sprague express that they wish they had known the signs, known that nodding off and breaking out were not just symptoms of an overworked student. They also warn that death from a drug overdose can affect anyone and that it does not pick and choose.

To read the article and view their video, go to: http://www.baltimoresun.com/health/maryland-health/bs-md-heroin-death-response-20170228-story.html

Deprescribing Drugs - When More Is Less

Wikipedia defines deprescribing as “the process of intentionally stopping a medication or reducing its dose to improve the person's health or reduce the risk of adverse side effects”. In a January 30, 2017 Washington Post article entitled, “Prescribing drugs is good. So is deprescribing”, local physician Ranit Mishori discusses what doctors are taught about prescribing drugs and that they are not taught a lot about deprescribing.

Mishori writes, “Starting in the second year of medical school (course name: pharmacology) and continuing through residency training and beyond, doctors are taught how to prescribe drugs. Here’s some of what we learn: which drugs are best for different conditions (for high blood pressure, diabetes, depression, pain and so on); which antibiotic is best for which type of infection; what are the most beneficial dosages and how frequently should certain drugs be taken; what is the best route for certain drugs (oral, rectal, IV); what the common side effects of most drugs are; which drugs are better for children, which for adults. There is much to know, and doctors have to stay up-to-date constantly, on old and new medications, recalls, generics, brand names, warning labels.”

“Drugs have an important place. But rarely do we teach young doctors – that is one of the things I do now – how and when to deprescribe a drug. Doing so is not as simple as saying “stop”. Deprescribing is its own process, requiring extreme caution and a certain skill on the part of the physician. It is a skill, however, that is not being taught, and it is barely studied to develop best practices.” 

Mishori is a professor of family medicine and the director of the Health and Media Fellowship in the Department of Family Medicine at Georgetown University School of Medicine. To read the entire article, click here: http://www.independent.co.uk/life-style/health-and-families/healthy-living/prescribing-drugs-is-good-so-is-deprescribing-a7552971.html.

Breaking Heroin's Grip: Road to Recovery

On February 11, Maryland Public Television premiered "Breaking Heroin's Grip: Road to Recovery", a program that examined the stories of three Maryland residents in rural and urban settings with an opioid use disorder; this program concentrated on their individual struggles and recovery from addiction. Produced by MPT in association with the Maryland Department of Health and Mental Hygiene's Behavioral Health Administration, this is a poignant and personal program shedding light on our region's pressing heroin problem. To watch the program and to view related videos such as "Breaking Heroin's Grip: Peer-to-peer recovery" and "Breaking Heroin's Grip: Long-term recovery", click here: http://www.mpt.org/breakingheroin/.

 

Chasing the Dragon - The Life of An Opiate Addict (Edited Version)

In this powerful video produced by the FBI and the DEA, witness first-hand the journeys into addiction and continuing struggles of opioid addictions. With this epidemic on the rise in Howard County, we need to arm ourselves and our families with the truth and understand the realities of opioid misuse.

Public Warning: 7 Overdose Deaths in 2 Hours in Westminster, MD

On January 27, 2017, a public warning was issued by Carroll County health officials after 7 heroin overdoses occurred between 10:00 a.m. and noon that day in Westminster. Ed Singer, an officer at the Carroll County Health Department stated, "That made us very concerned that there was a potentially more deadly mix out on the streets than what people are commonly dealing with."

Increases in Drug and Opioid-Involved Overdose Deaths in USA, 2010-2015

According to the Center for Disease Control and Prevention (CDC), as presented in their Morbidity and Mortality Weekly Report from December 30, 2016, the U.S. opioid epidemic is continuing, and drug overdose deaths nearly tripled during 1999–2014. The CDC summarized the article as follows:

What is already known about this topic?

The U.S. opioid epidemic is continuing. Drug overdose deaths nearly tripled during 1999–2014. In 2014, among 47,055 drug overdose deaths, 61% involved an opioid. During 2013–2014, deaths associated with the most commonly prescribed opioids (natural/semisynthetic opioids) continued to increase slightly; however, the rapid increase in deaths appears to be driven by heroin and synthetic opioids other than methadone.

What is added by this report?

From 2014 to 2015, the death rate from synthetic opioids other than methadone, which includes fentanyl, increased by 72.2%, and heroin death rates increased by 20.6%. Rates of death involving heroin and synthetic opioids other than methadone increased across all demographic groups, regions, and in numerous states. Natural/semisynthetic opioid death rates increased by 2.6%, whereas, methadone death rates decreased by 9.1%.

What are the implications for public health practice?

There is an urgent need for a multifaceted, collaborative public health and law enforcement approach to the opioid epidemic, including implementing the CDC Guideline for Prescribing Opioids for Chronic Pain; improving access to and use of prescription drug monitoring programs; expanding naloxone distribution; enhancing opioid use disorder treatment capacity and linkage into treatment, including medication-assisted treatment; implementing harm reduction approaches, such as syringe services program; and supporting law enforcement strategies to reduce the illicit opioid supply.

Click here to read the full article.

A Local Sister Lost to Heroin

Taylor was a smart, beautiful girl with a lot to live for. At 21, she overdosed on Heroin leaving her younger sister, Kylie, to live without her. As a country, state and county, we are losing far too many young people to heroin overdoses. 

County Executive Allan Kittleman, the Howard County Health Department and HC DrugFree invite you to view this new public service announcement.