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Suboxone Being Sold On the Black Market and May be Stopping Drug Overdoses

When you think of “street drugs,” more than likely the first thing that comes to mind is illegal ones such as heroin. These aren’t the only types of drugs being sold by dealers. Prescription drugs are making their way from medicine cabinets to the street, where they are being sold to users who never had a prescription for them initially. This is not an uncommon practice; however, it has now expanded to include medications normally prescribed to treat drug addiction itself.

Buprenorphine on the Streets

Suboxone is a brand name for one of the addiction treatment medicines used to treat patients for opioid abuse. Another brand name is buprenorphine. Both of these medications contain opioids. They are normally given under a doctor’s orders as part of a medication-assisted treatment program (MAT) that includes counseling with a licensed alcohol and drug counselor or a therapist with experience in this area of practice.

Instead, they are being sold along with drugs designed to give users a “high.” Many people are looking for Suboxone through these channels to try to protect themselves from an opioid overdose. They may also be wanting to get off opioids and are looking for Suboxone to make the withdrawal process easier. Some users try to put together enough of the medication so that they can try to treat their substance abuse issue on their own, which is never a good idea.

One of the Worst Opioid Crisis Cities in US

In Philadelphia alone, more than 1,000 people are dying from drug overdoses annually. This figure pushed the City of Brotherly Love into the dubious category of being the large city with the worst opioid crisis in the US.

In response, city and state officials have taken measures to get more people into drug treatment programs. Along with eliminating the requirements for having insurance company pre-authorizations and having identification, they have set up mobile treatment centers where doctors are issuing prescriptions for Suboxone to patients on the street.

Treatment is still an expensive proposition for those who don’t have Medicaid or private health insurance coverage. People who have lost their health insurance due to a job loss may find themselves at a disadvantage. Some of them bought Suboxone on the street to get off heroin on their own. This is a less expensive option than paying to see a doctor and seeking professional help.


New Laws to Get Addicted and Mentally Ill Into Treatment Are Not Being Enforced

Last year, San Francisco decided to expand its ability to force people who are severely mentally ill and those who are addicted to drugs into treatment. The idea behind introducing court-ordered treatment was to stop the cycle of the most severe cases — “the sickest of the sick” — continually moving and out of the city’s Emergency rooms.

San Francisco’s Homeless Population Tops 8,000

There is no question that San Francisco already has a significant problem with homelessness. The city is finding it difficult to provide services for its current homeless population. Most of its homeless are already living with mental health issues and drug addiction.

Legislation Meant to Apply to Few SF Residents

The legislation was expected to apply only to a small segment of the Golden Gate City’s population. Along with the types of patients mentioned above, another 50-100 people representing a small number among the city’s most vulnerable population, were expected to meet the criteria for court-ordered treatment.

The law has been in effect for a year. To date, no one has been considered for the program. Several public agencies are pointing fingers at each other for the delay in implementing it. The coronavirus pandemic has not helped the situation, either.

Public health officials have said they have the names of approximately 10 people who may qualify for conservatorship (court-ordered treatment). They can’t take any further action because the City Attorney’s Office and the Superior Court must agree on the procedure to file a petition under the new legislation. The Department of Health has said it will support those people under other services in the meantime.

Court Says it is Prepared to Accept Petitions for Treatment

Ken Garcia, speaking on behalf of the court, has said it is ready to accept petitions. None have been filed. Mr. Garcia said that the court is ready to process petitions when they are brought to the court office. He explained that it is not the court’s function to start petitions and that it is unable to do anything until a case is brought before it.

The City Attorney’s Office, for its part, said that it is waiting for the court to approve the process. It stated that this effort has been delayed due to the pandemic.

John Coté, the City Attorney’s spokesperson, explained that his office is working with the court to finalize the procedure. He stated that the City Attorney’s office hopes to have it in place “soon.”

New Law Expands Conservatorship Definition

The new laws expand the definition of “conservatorship” to include people who are addicted to drugs. It also includes those who are severely mentally ill. People in the latter category must have been taken to a 5150 hold (emergency crisis hold) a minimum of eight times. Approximately 630 people are currently in this situation in San Francisco. This figure includes those being treated in residential and outpatient treatment programs.

The program’s critics say that the bar for someone to receive court-ordered treatment is still too high. They point out that there are still more people who are too sick to seek help on their own. The critics also point out that the program’s guarantee that participants will receive housing after completing their treatment is inappropriate in a city like San Francisco which already has an issue with limited housing resources.


gaming addiction

Video Game Addiction Likely to Climb During Coronavirus Pandemic

The coronavirus pandemic has many households across the United States and in Europe locked down. As residents look for ways to keep themselves occupied, video game use has skyrocketed. This popular pastime has become a way for millions of people who are spending time at home to try to stave off boredom as well as stay connected to others.

Health officials are in favor of people sheltering in place to attempt to slow down the spread of the coronavirus. For the majority of users, playing video games is an enjoyable hobby. This is not the case for a certain percentage of the population, though. For them, spending extra time online opens the door to internet and video game addiction.

Video Game Addiction Increase Linked to Stress, Pressures of Being at Home

Video game addicts have the same kinds of pressure as people who live with a gambling addiction. They have everyday life stress, along with isolation, and unemployment or underemployment. At the same time, they are being told to spend time taking part in the behavior that is a problem for them.

Keith Whyte, the executive director at the National Council on Problem Gambling, said that all the risk factors for gambling addiction are increasing at present. He also points out that the same applies to internet and gambling addiction. Mr. Whyte commented that the possibility of a large increase in the number of gaming addicts is real.

The council’s 27 centers provide telephone counseling services. Some of the hotlines are already reporting higher-than-normal call volumes. Support groups are reporting that members are relapsing worldwide. Daria Kuss, an associate professor of psychology at Nottingham Trent University, estimates that the number of gamers with addiction issues ranges between 0.8-25%.

COVID-19 Creates Public Health Issue

These figures have created an issue for public health officials, who want to keep people safe during the current COVID-19 crisis. They need to get people to stay at home to avoid spreading the virus but the forced isolation makes a certain percentage of the population more susceptible to developing a video game addiction.

The World Health Organization (WHO) and tech companies are suggesting that video games are a positive way to spend time while stuck at home. Several companies have released free versions and discounts to their paid games to encourage the public to engage in this activity using the “Do your part, play at home” message. They are also offering rewards encouraging gamers to wash their hands often to help prevent the virus from spreading.


Food Addictions are Real and More People are at Risk

Compulsive eating can become a dangerous problem in a similar way as abusing alcohol or addictive drugs, according to researchers. In all these instances, the compulsion to use or consume a substance has the potential to become a full-on addiction.

Some Types of Foods Stimulate Brain’s Pleasure Centers

Repeated exposure to sugars, fats, salts, etc., stimulates the brain’s pleasure centers. It creates a feedback loop of craving, indulging, consuming and regretting. This cycle repeats itself the next day, and the next, and so on. If the person continues this cycle in spite of the negative consequences, you have a recipe for addiction.

Research has revealed that approximately 30% of people who try heroin become addicted to the drug. About 16 percent of cocaine users have the same experience. According to a study, when a group of overweight or obese subjects had the definition of addiction explained to them, 29 percent of the subjects said they were addicted to food (Frontiers in Psychiatry).

Over 40% of Americans are obese and 71.5% are considered overweight. These figures suggest an unhealthy relationship with food is common in this country.

No Abstinence Solution for Food Addicts

Food is more subtle than drugs. There is no way that someone with a food addiction can embrace abstinence, since food is essential for life. It would have to be a constant juggling act: Eat a little, without going overboard. Be sure to eat the good stuff and avoid junk food. Sometimes a person will do all the right things, as we all do. There will be days when they binge and make a bad choice about what they eat, just like we all do.

How Dopamine Relates to Pleasure Sensations

Pleasure gets processed in the part of the brain called the striatum. It’s located deep in the midbrain and is rich in D2 receptors, which exist to bind with the feel-good transmitter dopamine. It’s the transmitter that drives the reward system. When a person does something that gives them a sense of satisfaction, dopamine is responsible for the good feeling that follows. It’s also linked to feelings of pleasure around food, intoxication and having sex.

As long as the dopamine levels remain in balance in the striatum, a person’s ability to control their appetite for pleasure will stay in check. They will be able to limit themselves to one piece of cake for dessert or a glass of wine with dinner, for example. If this system starts to blink, such as when too few D2 receptors are in place and too little dopamine is released to engage with them, behavior changes strikingly. It becomes easier to act impulsively, with little thought to the consequences.

Compulsive eaters don’t simply lack willpower or discipline. They have a similar battle on their hands as drug addicts and they need support if they are going to recover.

Opioid Crisis Took a $631B Toll Out of US Economy in Only Four Years: Study

The results of a study conducted by the Society of Actuaries found that the opioid crisis cost the US economy $631 billion from 2015-2018. The largest portion of this cost was attributed to the potential lifetime earnings of people who died due to drugs, with healthcare costs coming in second place.

Governments Suing Drug Companies

More than 2,000 local and state governments have taken drug manufacturers to court over their role in the opioid crisis. They are seeking to recover damages for the cost of first responder services, public health services and more. The results from the report found that the private sector and individuals bear most of the financial cost (more than two-thirds) as opposed to the government (less than one-third).

Financial Costs of Opioid Crisis Difficult to Track

The federal government has been keeping statistics on the number of deaths attributed to opioid abuse. The number has reached 400,000 American lives lost since 2000. Getting a clear figure of the financial cost has been more difficult.

According to a report released by the Centers for Disease Control and Prevention, the cost was $79 billion (2013). This figure is less than half the cost published in the latest report for more recent years. The opioid crisis has also intensified since 2013; fentanyl and carfentanil have contributed to a higher death toll. Opioid-related deaths grew throughout 2017 and stabilized in 2018 at approximately 47,000 lost lives.

According to the actuaries’ report, the opioid crisis will cost approximately $171-$214 billion in 2019. Even the most optimistic prediction puts the cost higher than the 2017 numbers.

Child Welfare, Criminal Justice Costs Up due to Opioids

The new study found that child welfare system and criminal justice costs have increased due to the opioid epidemic. Most of the increased health care costs related to opioid addiction and overdoses were absorbed by Medicaid, Medicare and other types of government programs. The crisis was also responsible for $18 billion in commercial insurance costs in 2018 and lost productivity accounted for an additional $27 billion hit to the economy last year.

New Resource Launched for Recovery Coaches

As more evidence points to long-term engagement being a key factor in permanent recovery rates, people are turning toward outpatient treatment, private therapists, peer support specialists and recovery coaches for help.

For a certain percentage of people struggling with substance use, there will always be a need for residential treatment, and they also still need aftercare programs to help build on the foundation that a treatment program can establish.

Recovery Coaches as a Part of the Continuum of Care

The American Society of Addiction Medicine (ASAM) has various levels of treatment, ranging from high-level medical detoxification to periodic outpatient treatment. People receiving these various levels generally have to meet certain criteria to determine medical necessity, which unfortunately is largely driven by insurance companies. However, there is a greater recognition that continuing on in a setting such as intensive outpatient treatment (IOP) for a period of a few months, then stepping down to regular outpatient for a few more months is improving recovery rates. Other services that improve recovery rates include paraprofessional help through peer recovery support specialists, recovery coaches and sponsors, mentors and support groups. When combined, they add significant value to the overall treatment process.

Now there is a new resource forming just for recovery coaches and these peer support specialists, and its launch coincides with National Recovery Month. provides a way for recovery coaches to offer their services directly to people in need, as well as a way for individuals to browse or search for recovery coaches who may be a good fit for them.

It is free to add a listing, and the intent is to grow it into a large, hand-curated resource for recovery coaches nationally.

Ketamine May Help Treat Cocaine Addiction: Study

The results of new research have found that a single ketamine infusion, when combined with mindfulness-based relapse-prevention therapy (MBRP) can be effective in improving abstinence rates in cocaine-addicted adults. This treatment has also been found effective in reducing craving rates.

The results from a randomized control trial conducted by researchers at New York City’s Columbia University Medical Center indicate that abstinence rates were “significantly higher” in patients who received the ketamine infusion and MBRP compared to patients in the control group.

Elias Dakwar, a medical doctor and an associate professor of psychiatry at Columbia University, explained that patients receiving behavioral modification treatment may benefit from certain medications, even if they only receive it one time.

What is Ketamine?

Ketamine is an anesthetic that is used for human and veterinary purposes. It is a dissociative drug, which means its use can cause a distortion of sights, sounds and colors. While under its influence, a person may also misinterpret himself or his environment. Ketamine is used in surgery for general anesthesia and as a pain control drug. Research has shown it may be useful for treating severe depression.

The US Food and Drug Administration (FDA) currently doesn’t approve any medications for treating cocaine use disorder.

Ketamine and Mindfulness Part of Treatment Studied

The researchers pointed out that treating this type of addiction is challenging due to low motivation, high behavioral reactivity and cravings. Ketamine may improve on many of these issues. It may also serve as a stepping stone for mindfulness training for patients.

The researchers assigned 55 participants to two groups in a random manner. All of them were seeking help for cocaine addiction. One group was given a 40-minute ketamine infusion (0.5 mg/kg) or midazolam (an anesthetic used for pre-operative sedation and in surgery) in a five-week trial.

All participants were admitted to a psychiatric research unit for five days. They received an infusion on the second day and MBRP sessions on Days 2-5. After the trial was completed, the participants were referred to follow-up treatment. Six months later, they were interviewed by telephone.

MBRP therapy focused on learning how to be mindful and assimilating this practice into everyday life. It also challenged clients to apply mindfulness when faced with high-risk situations that might trigger a relapse.

Follow-up visits were conducted on a weekly basis starting two weeks after the infusion and ran through the fifth week following the procedure. The participants completed surveys and tests to measure mindfulness, stress sensitivity and cravings.

The researchers found that 92.9 percent of the midazolam group either used cocaine or dropped out, while 57.7 percent of the ketamine group did. At the six-month follow-up interview, none of the participants in the midazolam group had stopped using cocaine. Forty-four percent of the ketamine group were not using cocaine.

The results of the study were published online in the June 24 edition of the American Journal of Psychiatry.


Jails Slow to Help Addicted Inmates with Craving-Reducing Medication

Many jails are slow to help inmates with substance abuse issues. They are just starting to offer medications to help control cravings. Most jails only dispense one of the drugs approved for this purpose.

Medication-assisted treatment (MAT) is considered the standard treatment approach for opioid addiction. Buprenorphine and methadone are prescribed to treat withdrawal symptoms and reduce cravings. Naltrexone blocks the effects of opioids, and can also reduce cravings. This medication can also be used to treat alcoholism.

Approximately 220 of more than 3,000 jails across the US make naltrexone available to inmates. In most instances, the medication is offered to those who are about to be released. Only about 20 jails offer buprenorphine or methadone.

Cost One of the Barriers to Medication Assisted Treatment (MAT)

Experts say barriers to using medications to treat addiction are cost and the long-held belief that total abstinence is the way to attain sobriety. They point out that addiction doesn’t resolve itself because the affected person isn’t using drugs regularly. Many inmates with addiction issues will start using on release if they don’t get appropriate treatment.

A doctor must obtain a special license to distribute buprenorphine and methadone, which may not be easy for a physician working in a jail to acquire. These medications should be continued on a long-term basis to be an effective long-term drug treatment solution.

For inmates transitioning to life outside of jail, the change can be challenging enough without keeping track of medications. Many offenders who have recently been released have little support from family or friends.

MAT Can Help Reduce Relapses, Return to Custody

According to experts, offering opioid addiction treatment to jail inmates could help to address the opioid epidemic, since offenders may be less likely to use drugs after their release. Some research studies have shown MAT is effective at reducing relapses and the likelihood of returning to jail. The results of a small study on MAT with inmates in Rhode Island found that opioid overdose deaths among newly released offenders dropped by 60 percent.

AMA Approves Policy to Remove Barriers to Opioid Treatment

Delegates attending the recent American Medical Association (AMA) annual meeting approved a number of policies, including doing away with barriers to medication assisted therapy (MAT).

The delegates approved policies that will allow the AMA to do the following:

• Push for the end to administrative barriers to MAT. These include prior authorization that is responsible for delays and denials of care to patients.

• Push for the enforcement of substance abuse and mental health parity laws.

• Support laws to ensure that patients have access to all FDA-approved medications and therapies in all drug treatment clinics and facilities.

• Call for a public awareness campaign to share the information MAT is a first-line treatment for opioid use disorder.

• Coordinate efforts with interested organizations to decide best practices to treat opioid abuse disorder in the manner of a chronic disease.

• Support states in evaluating programs that have received funding from government sources to assist hospitals, medical practitioners and communities in order to coordinate care for patients living with opioid use disorder.

• Work for expansion and increased access to treatment for substance abuse during pregnancy.

• Make sure that practicing physicians, residents and medical students receive education on prescribing opioids.

Doctors Can Help Fight Addiction Stigma

Dr. Patrice A. Harris, the AMA’s president-elect and chair of the AMA Opioid Task Force, stated that doctors have a role in fighting to end the stigma around drug abuse and MAT. She went on to say that this type of treatment “has been shown to decrease overdose mortality, reduce transmission of infectious disease, and reduce general health care expenditures.”

Universal Access to MAT Not Available

Access to buprenorphine is not universally available to patients, in spite of scientific evidence showing that it prevents deaths from opioid use disorder. The Substance Abuse and Mental Health Services Administration (SAMHSA) also lists it as one of the medications that is commonly used to treat opioid addiction.

A study found that that fewer than one in three eligible doctors have been avoiding prescribing buprenorphine. Another study revealed that buprenorphine is underprescribed by family doctors. For every 40 family doctors who prescribed opioid pain medications, only one family physician prescribed buprenorphine-naloxone.