NPR: How Drug Combos Are Making Tennessee’s Opioid Problem Even More Deadly

Original By: AMY ESKIND
Posted On: September 25, 2017

NPR: Combining Dangerous Drugs Pushes Tennessee Overdose Deaths To Record High
NPR: How Drug Combos Are Making Tennessee’s Opioid Problem Even More Deadly

The combining of powerful drugs — both purposeful and unintentional — is making Tennessee’s opioid epidemic even more deadly. The latest figures out this month show 2016 was another record year for overdoses in the state — more than 1,600 people died. And experts say risky drug cocktails are compounding the problem.

Emergency responders have answered hundreds of 9-1-1 calls from friends and family members of people who have overdosed. Last year Davidson County lost 261 people to overdose, almost all of them from opiates. On the street, heroin is a cheaper opiate than pills. Many users are looking for whatever will give them the highest high, says recovering addict Mary Barton Lea.

“When I was buying my heroin I said, ‘who’s got the heroin with the fentanyl?’” she says. “That’s the heroin I want.”

Fentanyl is a very strong opiate that magnifies the experience and lasts longer. Experts expect to see more of it coming into Middle Tennessee.

“It’s a sleep-like state, it’s a state that you feel secure,” Lea says. “I’ve read — and I tend to agree with this — it’s almost like kissing God, because it takes you to a place you’ve never been before.”

But that incredible high comes with a physical and mental addiction, Lea says.

“When you come down from that state, all your body says is I want to get back there…You get up there quick, but then there’s a crash and the crash is horrible. The crash is you will do anything within your power to get more.”

Serious addicts like Lea may be willing to flirt with death. Others are simply unaware, says Sam MacMaster. He’s the chief clinical officer at JourneyPure, an addiction treatment provider. He warns that no one can be sure what they’re buying in the illegal market.

How Drug Combos Are Making Tennessee's Opioid Problem Even More Deadly
Sadly, 2016 was another record year for overdoses in the state — more than 1,600 people died. And experts say risky drug cocktails are compounding the problem.

“You would not be able to tell [by] how it looks at all, and that’s the issue,” MacMaster says. “They believe that they’re purchasing typically heroin or sometimes even a pilled opiate but it’s been cut with fentanyl.”

Indeed, the U.S. Drug Enforcement Agency issued a warning about counterfeit Vicadin and Oxycotin pills. As with heroin, unscrupulous dealers add fentanyl to give themselves a marketing edge — they’ve got the strong stuff.

But some users are buying the laced drugs unknowingly. They may erroneously think it’s stronger because it’s more pure. The next thing they know, they can’t breathe. Then their heart stops.

“If I believe I’m shooting x-amount of heroin, I may in fact be shooting something that is much more potent. And while I may have a sense of what my body can handle, I’ll have no idea what my body can handle in terms of the fentanyl,” MacMaster says.

Some dealers are even lacing their supplies with carfentanil, a veterinary opiate that can knock out a rhino.

But lethal combinations go beyond various opioids. Users have also been adding prescription anxiety medications, such as Xanax, Valium or Klonopin. Not only is that a doubling up on medications that depress the central nervous system, experts worn there can be a multiplier effect. And it’s hitting teens and young adults hard, especially since many of them already have anti-anxiety prescriptions. Others have painkillers, maybe prescribed for an injury.

“There’s actually prescription parties where kids will have a party and everybody raids the medicine cabinets they can get to, brings them to the party, and then you have whatever you have at that party for people to experiment with,” says Cinde Stewart Freeman, chief clinical officer at Cumberland Heights, an addiction treatment center.

Cole Szabo, adolescent specialist at Cumberland Heights, says the days when kids stuck to beer and marijuana are gone.

“The benzos and opioids are the new gateway drug,” he says. And it’s in the schools. “You’re seeing Xanax, you’re seeing benzos, you’re seeing hydrocodones, oxycodones, Vicodin – you’re seeing that more. The problem with that is, you’re going to die quickly. It’s a quick death, you’re going down fast.”

If administered in time a nasal spray called Narcan that reverses the effects of opiates can save a life. Emergency responders in Nashville have used it on more than 500 people already this year.

But Narcan has no effect on other drugs like anti-anxiety pills, cocaine, or alcohol, so combination overdoses can still prove lethal. That was unfortunately the case for Max Barry, the son of Nashville’s mayor, who could not be revived with Narcan, and died over the summer in Colorado with much more than opiates in his system.


Original Article By: MICHAEL CORKERY, NY Times
Date: SEPT. 15, 2017

As drug addiction soars in the United States, a booming business of rehab centers has sprung up to treat the problem. And when drug addicts and their families search for help, they often turn to Google.

Google Sets Limits on Addiction Treatment Ads, Citing Safety

But prosecutors and health advocates have warned that many online searches are leading addicts to click on ads for rehab centers that are unfit to help them or, in some cases, endangering their lives.

This week, Google acknowledged the problem — and started restricting ads that come up when someone searches for addiction treatment on its site. “We found a number of misleading experiences among rehabilitation treatment centers that led to our decision,” Google spokeswoman Elisa Greene said in a statement on Thursday.

Google has taken similar steps to restrict advertisements only a few times before. Last year it limited ads for payday lenders, and in the past it created a verification system for locksmiths to prevent fraud.

In this case, the restrictions will limit a popular marketing tool in the $35 billion addiction treatment business, affecting thousands of small-time operators.

Google Sets Limits on Addiction Treatment Ads, Citing Safety

“This is a bold move by one of the world’s biggest companies, saying people’s lives are more important than profit,” said Greg Williams, co-founder of Facing Addiction, a nonprofit group that is an advocate for people struggling with addiction.

Many rehab centers, a large number of which are clustered in warm climates like Florida, Arizona and California, rely on Google searches to attract patients from across the country. Their strategy often included buying an ad that would come up when someone searched for phrases like “drug rehab” or “alcohol treatment centers.”

Google Sets Limits on Addiction Treatment Ads

As of this week, Google has stopped selling ads related to those searches, although it may lift the restriction if it can find a way to weed out misleading advertisements.

Search ads for addiction treatment are lucrative. Treatment providers, in some cases, have been willing to pay $70 per ad click, according to an analysis that Mr. Williams’ group conducted and presented to Google executives.

But the payoff for those clicks can be significant. Addicts who sign up for 30 days of residential treatment can bring in tens of thousands of dollars from private insurance.

The crucial, if unwitting, role that Google has played in the treatment industry exposes the deep flaws in how drug addicts are cared for in America. Despite the rapid growth in the number of addiction cases — and the Trump Administration’s declaration that the opioid crisis is a national emergency — the treatment industry remains a hodgepodge of upstart businesses, with only a few well-known providers.

What constitutes treatment is also all over the map, from yoga and equine therapy to daily doses of medication. And unlike other serious illnesses, like cancer or heart disease, where a physician typically refers the patient for treatment, many addicts and their families look for help on the internet.

That has made Google one of the largest referral sources for treating a disease that affects millions of Americans. And the companies willing to the pay the most for ads are the one that addicts are most likely to see on their search.

But ad-driven searches, according to advocates and law enforcement officials, have not always led patients to the best care. In some cases, they have found that patients are being duped, a phenomenon Google on Thursday acknowledged.

Last December, a Florida grand jury released a report detailing abuses in the state’s addiction treatment industry, which is centered around Palm Beach County. Among the findings, the grand jury zeroed on the problems with how some of the shoddy programs were being marketed online.

One witness, according to the grand jury report, described how “online marketers use Google search terms to essentially hijack the good name and reputation of notable treatment providers only to route the caller to the highest bidder.”

Another common trap: Addicts search Google for a rehab program close to their home, but they will click on an ad for a referral service pitching treatment in another state. The referral service then collects a fee, if they signed up.

Google’s restrictions were cheered by health officials, who have called for more medically based treatment. “People don’t always know what good treatment is,” said Dr. Vivek Murthy, who was surgeon general in the Obama Administration and published a oft-cited report last year that warned of the nation’s addiction crisis. “I am glad Google took steps to prevent the spread of these false ads.”

In targeting the ads for addiction treatment, Google consulted with experts including Mr. Williams, who himself has been in recovery for many years. He said he began discussions with Google executives around the time that Dr. Murthy released his report.

Mr. Williams said that he had explained to Google that his own experience trying to buy ads from the company had illustrated how the process of finding information about addiction treatment online was providing people with unreliable information. Mr. Williams said he discovered this when his group received a grant from Google that would help him buy ads promoting a website providing information about community based treatment — and found he couldn’t compete.

Buying ads on Google involves bidding to place your ad at the top of the search results when a user types in words relevant to your product or service. But Mr. Williams found that the bid prices for words related to treatment had gotten so expensive that his group couldn’t pay as much as the for-profit treatment providers. Some of those treatment providers, Mr. Williams told Google, were not only misleading, they had been charged with crimes.

In a series of phone calls and a meeting in Washington, D.C., Mr. Williams presented the company his research. He highlighted that some of the biggest buyers of ad words related to treatment had been accused of misdeeds related to insurance fraud and sexual assault.

“We stumbled upon this issue organically,” said Mr. Williams. “And they heard us out.”


A version of this article appears in print on September 15, 2017, on Page B5 of the New York edition with the headline: In Rare Move, Google Imposes New Limits on Addiction Treatment Ads, Citing Saftey.

NASHVILLE, Tenn. (WKRN) – A hard hit can do more than just knock the wind out of a player on the field. It can leave them with an injury requiring medical attention and possibly pain medication.
“Sports are probably the leading cause of injury in kids but I think it is important to understand that sports in general are protective,” Dr. Alex Diamond said. “We know kids who play sports compared to kids who don’t are typically less likely to be involved in risky behaviors.”

 
High school sports injuries can lead to addiction depending on treatmentDr. Diamond is an assistant professor of Orthopedics and Pediatrics at Vanderbilt University Medical Center. He is also the team physician for Vanderbilt University, Nashville Predators and the Nashville sounds. He along with the other physicians at in his department treated 26,000 adult and children athletes in 2016.
“As physicians we need to be mindful when treating children with injuries what situation require pain medication and what situations can be handled without pain medication,” he said. “Most of them can be handled without pain medications.”

 
Pain medications like hydrocodone, oxycodone and other opioids can be very effective in treating chronic pain. But, they can also be addictive and lead to more illicit drugs like heroin.

 
At Cumberland Heights, a non-profit addiction treatment facility, the number of teens entering the facility’s Adolescent and Young Men’s Services department has grown so much in the past couple of months it is expanding to keep up with the need.

 
“We take kids from all over the country,” Director of Adolescent and Young Men’s Services Dean Porterfield said. “The primary diagnosis is substance abuse, but It is not uncommon though that the underlying issues once you take those substances away are anxiety, depression or trauma.”

 
According to Porter for the 18 year old to 25 year old age group that makes up the Young Men’s program a growing number are addicted to heroin.

 
“A notable factor with the young adult population that we serve is that several of them are athletes who have experienced high school or college sports injuries that have required surgery and have become addicted to painkillers.”

 
He continued, “When the painkillers run out or they become more expensive the more accessible affordable drug is the heroin. That replaces what used to be that passion for sports and athletics and now their primary goal is to drug seek.”

 
Porterfield said with heroin it is not uncommon for the treatment center to get a call from family or the patient themselves saying they are in route for immediate admission to the facility.

 
“They are also some of the most vulnerable patients and need a great deal of attention throughout the painful detox and early days of treatment to prevent them from leaving against medical advice,” he said. “One of the things Cumberland Heights clinicians have made a priority is educating these young men on the risks of relapse and the lethal dangers associated with resuming the volume of heroin use they came in handling with the assumption their tolerance level is the same.”

 
He continued, “This scenario increases the likely hood of a lethal overdose.”

 
At Cumberland Heights the process is based on the 12-Steps.

 
After detox the work begins to help the young men understand the underlying reasons they abused drugs. In many cases its tied to the emotion effect their injury had on them and their identities.

 
“Just being an adolescent adult in general is full of ups and downs,” Porterfield said. “When they realize this substance can help alleviate that, they get hooked pretty quick.”
The same progression from painkillers to heroin and stronger opioids is much the same in adult users.

 
According to the CDC Tennessee is one of the most overprescribed states for painkillers.

 
At one point doctor’s wrote more prescriptions for painkillers than there were people in the state.

 
“As physicians we need to be mindful when treating children with injuries about which situations require pain medication and what situations can be handled without pain medication,” he said.

 
“We have a lot of other options that don’t have the same complications and risk involved with addiction.”

 
Dr. Diamond said things like physical therapy, proper braces or casts and anti-inflammatory medications can be very effective.

 
“As a parent you need to be diligent on what pain medication your kids are getting,” he said. “For the most part the narcotic pain medication is not needed for what we are seeing in our children. It is very rare.”

 
Porterfield said parents should be involved in their teens lives take note if you start to notice missing money, missing prescription medication, if your child is hanging out with friends or in places you do not know, and if your child attends unsupervised parties.

 


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