Drug Monitoring Programs Are Driving More People Toward Heroin, Says Study

Opioid prescription drug monitoring programs (PDMPs) are driving more people toward heroin use, a recent research at Columbia University (CU) has indicated. The researchers at CU’s School of Public Health reviewed 17 studies and discovered that as prescriptions run dry, people move to more potent street drugs.

Although 10 studies found that post implementation of drug monitoring programs, there were reduction in opioid overdose deaths, three found that with restricted opioid prescribing heroin use and overdose deaths have increased. The study was published in the Annals of Internal Medicine in May 2018.

PDMPs are used by physicians and pharmacists to identify doctor shopping behavior, over-prescription rates and risk of misuse to help curb the opioid epidemic. These programs are either in place or passed by legislation to start afresh in all 50 states and the District of Columbia. According to lead author David Fink, it is important to understand if these programs are instrumental in alleviating the number of opioid overdose cases.

At places where the programs were effective, the researchers found that the databases was updated at least once a week and there were well-monitored systems for authorization. Additionally, the system was also updated with those drugs that do not feature on the Drug Enforcement Administration’s (DEA) list of scheduled controlled substances.

Co-author Silvia Martins was of the opinion that the “programs aimed at reducing prescription opioids should also address the supply and demand of illicit opioids.” Consequences like people substituting opioids with heroin shouldn’t go unnoticed.

Heroin use often begins with prescription opioids

Many people addicted to opioids progress to heroin use as it’s cheaper and easily available. Moreover, it doesn’t require a prescription. A recent paper even suggested that after the introduction of OxyContin in 2010, “each prevented opioid death was replaced with a heroin death.” Fentanyl use has also increased in recent years and PDMPs are not yet equipped to track or control its rapid rise.

Patients are generally prescribed opioids after a surgery or when they are in deep pain from some chronic illness. But they are often not educated about the potential harm of misuse and abuse by them and their families. Some patients might be prescribed unnecessary refills when they do not need them.

A recent survey by Mayo Clinic established that a majority of patients (63 percent) who were prescribed opioids after surgery did not use them and only 8 percent disposed their leftover medications. The leftover pills could be misused or ingested by children and pets at home.

The monitoring of database necessitates that the doctors check the number of prescriptions being written, the duration for which they are being prescribed, and types of opioids being given to the patients. Additionally, patients should be educated about safe storage and disposal practices.

Recovering from opioid addiction

Opioids are potent drugs which not only numb pain, but also produce a euphoric effect. Their long-term use can cause tolerance and dependence. Addiction to opioids can ruin a person’s life affecting his/her psychological and physical health in various ways.

The risk of discord in relationships, loss of productivity at work and school due to daytime sleepiness and absenteeism, as well as incidents of driving under the influence, unsafe sexual practices and violence also increase. It is important that an individual addicted to opioids seeks support from a certified drug abuse clinic and avails the best drug abuse facilities at the earliest.

Beyond Needle Marks – How Substance Abuse Affects Skin

The damage caused by substance abuse becomes increasingly challenging to camouflage. You may see the signs in yourself; you may see the signs in someone you care for. The mirror rarely lies. Your reflection will eventually reveal the burden you work so hard to conceal.

Substance Abuse Damages the Skin

For those who are relatively healthy, skin changes are often the first recognizable indicator of substance use and abuse. This may explain why dermatologists are often the first of the medical professionals to recognize the early signs of substance abuse disorder.

For better or worse, your skin is a reflection of what’s happening inside your body. The chemicals fueling your addiction will impair your skin’s ability to repair and heal. The effects are cumulative. While chemical abuse will cause your skin to take on a dull, unhealthy tone, certain types of substances are known to cause specific skin concerns. Some of the common skin concerns include:

• Infections

• Ulcers

• Vascular damage

• Mouth sores

• Skin flushing

• Hyperpigmentation

• Breakouts

Accelerating the Aging process with Stimulants

If you are indulging in any type of stimulant, you potentially expedite the aging process. Your heart beats faster, and your body needs to work harder to keep up with the increased demands. Under the strain of stimulants, your body produces the stress hormone, cortisol. Cortisol breaks down the collagen and elastin in your skin.

Collagen is the support structure within your skin. Elastin keeps your skin supple. When a body is under the stress of chemical dependency, the loss of collagen and elastin will result in saggy jowls, drooping eyelids, loose skin, wrinkles and deepened folds around your nose and mouth. In fact, stimulant abuse can cause you to look decades older. When you combine the effects of collagen loss with the potential weight loss and malnutrition associated with stimulant abuse, the acceleration of skin aging is even more pronounced

The Scars and Scabs of Methamphetamine Use

The chemical imbalances and dehydration caused by drug use, particularly methamphetamines, can result in uncomfortable and troubling sensations on your skin. You may feel like you have bugs crawling on your skin and below the surface. The sensations can be maddening. You may respond by scratching or picking at your skin. Irritation leads to more scratching and picking. Repeated skin irritation and skin injury will result in sores that heal slowly, or not at all. This cycle will scar your skin.

Sores that are slow to heal, blisters, scabs, and scars are some of the more recognizable skin problems associated with methamphetamine use. Commonly called meth sores or meth mites, these sores most commonly occur on your face and arms.

Since methamphetamines also interfere with blood flow, meth sores can appear anywhere on your body. Methamphetamines destroy blood vessels, interfere with your body’s ability to repair cellular damage and can also cause leathery looking skin.

The Enlarged, Protruding or Damaged Veins of Intravenous Drug Use

Many IV drugs are vasodilators that can also induce vasospasms. That means that IV drugs will cause your blood vessels to expand, but then quickly contract. Vasospasms disrupt your circulation, which results in pain, swelling, skin ulcerations, skin infections and blood clots.

Approximately 88 percent of intravenous drug users will also develop chronic venous insufficiency. Venous insufficiency means the valves inside your veins that keep your blood flow moving towards your heart don’t close properly. Leaky valves allow the blood to flow backward into the veins. This results in enlarged veins that can bulge and twist, varicose veins.

Severe venous insufficiency can also result in skin ulcers that are difficult to heal because of the decrease in circulation. This skin on your lower legs can discolor and take on a rough, scaly appearance. This is more than a cosmetic issue. Vein damage increases your risk of deep vein thrombosis (blood clots) and raises your risk of developing a life-threatening pulmonary embolism (a blood clot that travels to the lungs).

Cellulitis as a Consequence of Skin Popping

While most microorganisms living on your skin are harmless, they can cause devastating consequences when entering your body through an injection site. When veins become damaged by drug use, some IV drug users resort to skin popping, injecting drugs under the surface of the skin. Skin popping is linked to an increased risk of cellulitis, a rash-like skin infection caused by staph or strep bacteria. While this form of bacterial infection is not contagious, it forms a tender, hot, red swollen rash that spreads rapidly.

Cellulitis requires prompt medical attention. Left untreated this infection can enter your bloodstream and lymphatic system. Cellulitis can cause chronic swelling of the infected limb, or worse. Although it’s rare, cellulitis can destroy soft tissues, requiring surgery to remove the damage.

Staph and Fungal Infections Due to Immune System Impairment

Substance abuse disorders disrupt your immune system. They make it difficult for your body to fight infections, this can result in an increase in infections that your once healthy immune system could have eliminated before it could cause any problems. You may find yourself prone to staph infections and fungal infections, particularly on your feet, where fungus thrives in the moist environment. If you are prone to psoriasis or eczema, you may find your flares more frequent and increasingly difficult to manage.

Surface Indications of Alcohol Abuse

Skin flushing can be an indication of alcohol abuse. Alcohol is a blood vessel dilator. Alcohol breaks down to acetaldehyde, which can cause a histamine release, which is the same thing that can happen during an allergic event.

With long-term alcohol abuse, you may also notice an increase in spider veins, small, broken capillaries close to the surface of your skin. Spider veins are often the most noticeable on your face, neck, chest, arms, hands, and abdomen. Particularly in those with liver damage.

The damage to your liver caused by alcohol dependency can also cause jaundice, the yellowing of your skin and eyes. This discoloration is an indication that you have an excessive amount of bilirubin in your system. Your liver normally breaks down bilirubin, but the function has been impaired by alcohol. When treated in its early stages, jaundice caused by the alcohol-related liver disease can be improved.

Increased Severity of Breakouts and Acne

Because of the increased amount of cortisol produced under stress; you may also find that your skin reflects the internal struggle by breaking out. Cortisol increases inflammation; acne is your skin’s response to the inflammation cortisol causes. Acne can also be aggravated by the skin picking habits associated with meth use and the simple fact that addiction may cause you to overlook your basic skin care needs.

Drug and alcohol abuse can cause inflammation, malnutrition, and dehydration. It weakens your immune system and damages blood vessels. Addiction adversely affects your body’s ability to heal. Your skin reflects the damage, while your brain, bones and internal organs continue to pay the price.

Restoring your appearance may be enough motivation to get you, or keep you, on the right path to a drug-free lifestyle. It may not. But as you conquer your addiction, you will see the signs of your progress. You can be assured that the improved health of your skin is a visible indication of the healing within.

Drug Detox Centers is physiological rehabilitation after drug addiction. An accredited and licensed facility that prevent unpleasant outcomes from suddenly quitting a drug. The focus of detox program is on monitoring and supporting the patient as the body cleanses itself of the drug’s toxins and goes through withdrawal symptoms.

Prescription Drug Monitoring Programs Are Unable to Combat Overdose, Finds Study

Prescription drug monitoring programs are now being used extensively in several American states, but there is a dearth of data on their effectiveness in curbing the number of opioid overdoses, as found out by a recent study. The rationale behind using these programs is to prevent the replication or overlapping of prescriptions for opioids – the practice commonly known as doctor shopping.

Chris Delcher, from the department of health outcomes in the University of Florida College of Medicine, said that it is important to understand if these programs are helping in any way by curbing the fatal and non-fatal overdoses. According to him, in an era where the changes are being made and implemented at the federal level to combat the opioid epidemic, it is natural to assess the utility of such programs.

Delcher and his team published their findings in the journal Annals of Internal Medicine in May 2018. The study was sponsored jointly by the Bureau of Justice Assistance and the National Institute on Drug Abuse (NIDA) and it was led by the scientists from the University of California, Davis and the Columbia University.

The team of researchers investigated as many as 2,600 scientific publications and found that only 10 linked prescription drug monitoring programs to overdoses. Even in these 10 studies, the team found an exceedingly low evidence of the effectiveness of the programs in reducing fatal overdoses, leading to inconclusive outcomes.

Inadvertent outcomes

The study authors came across some surprising findings. Three studies showed that after the implementation of the prescription drug monitoring programs, there was a rise in overdose-related deaths due to heroin. A 2013 study showed that in Philadelphia and San Francisco, there was a transition from prescription drugs to heroin because of the latter’s easy accessibility and cheap cost.

Moreover, in 2011 in Florida, after the implementation of the program, the number of overdoses dropped due to oxycodone, but there was a concomitant rise in overdoses related to fentanyl, heroin and morphine. Delcher explained this by stating that crackdown on prescription opioids facilitates transition to other drugs.

The researchers found three parameters from the prescription drug monitoring programs that impacted the number of fatal overdoses. These were:

Reviw of patient’s medical history by the doctors before writing a prescription.
Increase in frequent updation of patient’s prescription data.
Increased accessibility of patient data to the providers.

Delcher shared that investigating the efficay of the prescription drug monitoring tool is one of the ways to improve its efficiency and usability. He said that the tool could be made more refined and spontaneous so that it comes handy to the busy physicians, and they are better able to classify patients’ risk of misuse, abuse or overdose. Delcher is presently striving to improve the patient-risk algorithms, overlying medication dashboards, and other data-influenced methods to enhance the database.

Opioid overdose deaths on the rise

Nearly 350,000 people succumbed to opioid overdose – both prescription and illicit – between 1999 and 2016. The overdose-related deaths manifested through three phases:

The first phase began in 1999 when the prescriptions for opioids increased (methadone, natural and semi-synthetic opioids).
The second phase commenced in 2010 when overdose deaths increased due to heroin.
The third phase began in 2013 when overdose related fatalities increased due to fentanyl. Many times, fentanyl is laced with heroin and cocaine, and sold in counterfeit pills.

Road to recovery

Addiction usually begins from a prescription and when the prescription runs dry, people fuel their addiction through illicit drugs. These drugs can have a catastrophic effect on every area of one’s life. Thus, one should take drug abuse help from a good drug abuse clinic before it is too late.