Author: Josh Boegner

Deaths from Synthetic Opioids outnumbered those from Prescription Opioids for the First Time in 2016

In a research letter published by the Journal of the American Medical Association, researchers noted that overdose deaths from synthetic opioids, such as fentanyl, surpassed prescription opioids and heroin as the leading cause of overdose deaths in the United States. There has been an increasing trend of fentanyl and other synthetic opioids being found in illicit supplies of heroin, cocaine, methamphetamine, and other drugs. Utilizing data from the National Vital Statistics based on death certificates including information on all deaths in the US, Jones et al were able to examine overdose related deaths. While there has been an increasing trend in the number of opioid overdose deaths, previously these have been primarily related to prescription opioids. Of the 42,249 opioid related overdose deaths that occurred in 2016, Jones et al found that 19,413 involved synthetic opioids, while 17,087 involved prescription opioids, and another 15,469 involved heroin. Of the 19,413 deaths related to synthetic opioids, the majority (79.7%) involved another drug or alcohol, with the most common being another opioid. There are some limitations regarding the completeness of data, and the authors suggested that the increase may be due to an increase in testing for synthetic opioids. Still, this data paints a startling picture of the state of the opioid epidemic, showcasing a need to move beyond prescribing habits in order to reduce overdose deaths.

 

Sources –

Jones CM, Einstein EB, Compton WM. Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016. JAMA 2018;319(17):1819-1821. doi:10.1001/jama.2018.2844.

Local Governments take Legal Action against Opioid Manufacturers

In response to the Opioid Epidemic currently being faced in North Carolina and the US, several local jurisdictions have taken steps towards legal action against the manufacturers and distributors of prescription opioids. Over four hundred federal lawsuits have emerged from local governments across the country, and these have been consolidated into a lawsuit in Ohio.

Yesterday, the City Council of Greensboro voted to join a nationwide lawsuit that targets manufacturers and distributers of prescription opiate painkillers. Later this week, the Davidson County Board of Commissioners will have a hearing and presentation around joining national opioid litigation. In total, more than forty of the State’s 100 counties have joined the lawsuit. In Forsyth County, containing the city of Winston-Salem, a similar lawsuit was filed that included defendants of more than 20 drug manufacturers.

Many of these local jurisdictions cited that the risks for addiction and dependency to prescription opiates were never communicated by drug companies, while manufactures continued to make profits with increasing supply and demand. As more municipalities continue to join litigation of file new lawsuits, while trying to adopt laws and policies to limit overprescribing, further attention should be paid to find and utilize effective strategies to limit opioid overdose deaths.

 

Sources –

 

News & Record: Greensboro joins lawsuit against drug manufacturers over opioid epidemic – http://www.greensboro.com/news/government/greensboro-joins-lawsuit-against-drug-manufacturers-over-opioid-epidemic/article_22ff745e-2002-5c27-a41a-454ab80403b7.html

Winston-Salem Journal: Forsyth County sues opioid manufacturers, distributers, claiming deceptive marketing practices – http://www.journalnow.com/news/local/forsyth-county-sues-opioid-manufacturers-distributors-claiming-deceptive-marketing-practices/article_7f8a2bf3-958f-5462-b63b-4c1affeca27d.html

The Dispatch: County to hear opioid litigation presentation – http://www.the-dispatch.com/news/20180430/county-to-hear-opioid-litigation-presentation

 

STOP Act: Implementation and Effects Part II

Earlier today, The News & Observer reported that thousands of doctors in North Carolina were breaking the recently passed STOP Act, by over-prescribing prescription opioids. In a previous post I briefly explained provisions under the STOP Act, STOP Act: Implementation and Effects on the Opioid Epidemic in North Carolina.

Based on preliminary data from the North Carolina Department of Health and Human Services, and Blue Cross and Blue Shield, showed that many were over-prescribing. The STOP Act limits opioid prescriptions to five days to first time patients, or seven days if the patient had surgery. The state health department presented their findings to staff of the North Carolina Medical Board, who noted that they do not have the capacity to investigate every prescriber reported to determine if prescriptions were legitimate.

Blue Cross and Blue Shield had started to electronically block the filling of prescription opioids for more than seven days at the start of April, noting that this policy had blocked more than 1,100 prescriptions. While there were questions about the precision of the data and its accuracy, these preliminary reports showcase the difficulties of challenging the opioid epidemic by policies limiting prescribing.

 

Sources –

The News & Observer – Thousands of N.C. doctors are over-prescribing opioids, breaking a new state law – http://www.newsobserver.com/news/business/article209824434.html

What you need to know about SESTA and the recent seizure of Backpage

Late last week, classified ad website Backpage.com went offline after being seized and disabled due to an “enforcement action by the Federal Bureau of Investigation, the U.S. Postal Inspection Service, and the Internal Revenue Service Criminal Investigation Division”. Backpage.com is known for personal ads, and was considered by many to be the dominant online platform for sex workers to advertise their services.

Various websites have been shutting down their personal ads section in response to the Stop Enabling Sex Trafficking Act (SESTA), which has taken aim at online platforms as a playing a perceived role in sex trafficking and prostitution. While many advocates have been fighting SESTA for a large part of the year, awareness seems to be low of the laws implications among the general population.

Advocates against SESTA argue that the act will do more harm than good in regards to the safety of sex workers. Online platforms for sex work have been viewed as safer than street based sex work, allowing for screening of potential clients. Others have argued that SESTA would limit online free speech, arguing that it would require platforms to put strong restrictions on users’ speech, extending beyond the space of personal ads. If you’re interested in seeing what you can do stop SESTA, check out https://stopsesta.org for more information on how to contact your elected officials.

 

Sources – Buzzfeed News: Backpage Has Been Taken Down By The US Government And Sex Workers Aren’t Happy – https://www.buzzfeed.com/blakemontgomery/backpage-service-disruption?utm_term=.mceyodXp#.bkjAQmNK

App Grindr under scrutiny over privacy concerns

In an article published yesterday by BuzzFeed News, it was released that Gay Dating App Grindr has been sharing its users’ HIV status with two outside companies, a move which many consider dangerous to the queer community that the app claims to serve.

The sites, Apptimize and Localytics, work with Grindr to optimize the app and user experience. While it has been noted that these companies do not share information with third parties, there are still concerns with the sharing of sensitive information of a historically vulnerable population. This could raise flags for users sharing their HIV status on the app, which could negatively impact public health interventions that work to reduce HIV transmission and stigma.

Grindr recently announced that they would remind users to get tested for HIV every three to six months, offering a cue to action for users to be more aware of their HIV status. Knowing ones status is a crucial component for reducing the number of new HIV infections, such as by offering the opportunity to those who are living with HIV to be connected to care and achieve viral suppression.

 

Sources:

BuzzFeed News: Grindr Is Sharing The HIV Status Of Its Users With Other Companies –https://www.buzzfeed.com/azeenghorayshi/grindr-hiv-status-privacy?bfsplash&utm_term=.eu9v16ZaQ#.akvOQgNJj

Medicaid Expansion and the Opioid Epidemic in the U.S.

As the United States continues to be embattled in an ongoing opioid overdose epidemic, new research is showing the benefits that Medicaid expansion has had under the Patient Protection and Affordable Care Act (ACA). According to a recent study out of the Center on Budget and Policy Priorities, the rate in which patients who were hospitalized due to opioid-related health issues, who were uninsured dropped in states that expanded Medicaid, from 13.4% in 2013 to 2.9% the following year. The same study also showed that Medicaid expansion had not contributed to the ongoing opioid crisis, showing that opioid-related hospitalizations were higher in states that expanded Medicaid three years before expansion occurred, and that the rates had been steady in expansion and non-expansion states. As we can see, Medicaid expansion has had a profound impact in reducing the rate of uninsured, and in the case of the ongoing Opioid epidemic, Medicaid plays a key and vital role in working to help curb the epidemic. For more information on this study from the Center on Budget and Policy Priorities, please check out the link below.

Sources:

Center on Budget and Policy Priorities, Medicaid Expansion Dramatically Increased Covered for People with Opioid-Use Disorders, Latest Data Shows – https://www.cbpp.org/research/health/medicaid-expansion-dramatically-increased-coverage-for-people-with-opioid-use

Achieving Health Equity and Justice through the Reproductive Justice Framework: keynote by Monica Raye Simpson

This past Friday marked the 39th annual Minority Health Conference, which is the largest and longest run student-led health conference in the world. This year’s 20th annual William T. Small Jr. keynote speaker was Monica Raye Simpson, who is the executive director of SisterSong Women of Color Reproductive Justice Collective, gave a keynote address titled: “Achieving Health Equity and Justice through the Reproductive Justice Framework”. In the talk, Simpson gave an energetic and powerful where she gave a history of the Reproductive Justice framework, and how her own life experiences shaped how she approaches her work. One of her main points was how the Reproductive Justice Framework’s focus on centering those who are the most marginalized is critical for the field of Public Health, in order to overcome health inequities. In case you were not able to attend the event in person, the keynote speech is available for broadcast in the link below, moderated by yours truly.

Sources: https://sph.unc.edu/sph-webcast/2018-02-23_mhc/

Adam Rippon: America’s Olympic Sweetheart

During the 2018 Winter Olympics that have been happening in Pyeongchang, South Korea, American Figure Skater Adam Rippon has stolen the hearts and minds of many, including this writer. But beyond his charming persona and impressive skating abilities, Rippon has brought visibility to other queer athletes by being the first openly gay athlete to compete in the Games.

Rippon presents by what is defined as stereotypically gay: often using more “feminine” mannerisms and speaking with what can be called the “gay lisp”. At the same time, he is being praised not just for his personality and looks, but also his athleticism, a praise that is often withheld from gay men who do not present in ways that are more heteronormative.

I look forward to seeing what other heights Rippon can reach, and what he will continue to do with the platform that he has amassed. If you’re interested in more reading on this topic, I would highly recommend the article below.

Sources:

them. How a Fabulous, Femme Gay Man Finally Became America’s Sweetheart – https://www.them.us/story/how-a-femme-gay-man-became-americas-new-sweetheart

STOP Act: Implementation and Effects on the Opioid Epidemic in North Carolina

The rise of the opioid epidemic nationwide has led to an increase of attention from both media and policy makers. Here in North Carolina, a recently passed policy is the Strengthen Opioid Misuse Prevention, or STOP Act, which aims to reduce the amount of Opioids prescribed a one approach to tackle the epidemic. The STOP Act was signed into law by Governor Roy Cooper on June 29, 2017, and since then its four stage implementation has been put into effect, which will continue until 2020.

The first step of implementation occurred almost immediately after the law’s passage, on July 1st 2017, requiring Physician Assistants (PAs) and Nurse Practitioners (NPs) to personally consult with a supervising physician. This applied to Pas and NPs at facilities that primarily engage in treating pain, and the prescription will, or is expected to, last longer than 30 days. Additionally, PAs and NPs have to consult with a supervising physician every 90 days for patients for are continuously prescribed opioids.  Providers are also required to provide information on the disposal of controlled substances, both written and orally, when a patient concludes a course of treatment. The second aspect, implemented on September 1st, 2017, requires that pharmacies report targeted prescriptions to the North Carolina Controlled Substance Reporting System within a day of the prescription is dispensed.

The most recent aspect of the STOP Act was implemented on January 1st, 2018, and limits the amount of opioids prescribed for acute pain. Practitioners are not able to prescribe more than five days’ worth of any Schedule II or III Opioid or Narcotic, with an exception to things like pain after surgery, where the prescription cannot for longer than seven days. The final part of the law will be implemented on January 1st, 2020, and will require practitioners to electronically prescribed targeted controlled substances, with a few exceptions.

While it is still unclear what impact the law will have on overdose deaths in the state, it appears that the State government is attempting to address this issue. While more resources could be devoted to mental health services, naloxone access and syringe exchanges, and more programs geared toward injecting drug users rather than only those who use prescription drugs, it’s commendable that a joint effort was reached to combat this ongoing epidemic.

 

Sources:

New! Summary of NC’s new opioids law, the STOP Act: North Carolina Medical Board – https://www.ncmedboard.org/resources-information/professional-resources/publications/forum-newsletter/notice/new-summary-of-ncs-new-opioids-law-the-stop-act

FAQs: The STOP Act of 2017: North Carolina Medical Board – https://www.ncmedboard.org/resources-information/professional-resources/publications/forum-newsletter/article/faqs-the-stop-act-of-2017

STOP Act Provision Takes Effect Jan. 1, Will Limit Opioid Prescriptions: NC Governor Roy Cooper – https://governor.nc.gov/news/stop-act-provision-takes-effect-jan-1-will-limit-opioid-prescriptions

STOP Act Bill Summary: North Carolina Medical Board – https://www.ncmedboard.org/images/uploads/article_images/The_STOP_Act_summary-OnLetterhead.pdf

 

In 2018, is “Time Up” for the Grammy Awards?

Last Sunday marked the 60th Annual Grammy Awards presented by the Recording Academy. After the show ended, a number of pieces were shared across the web regarding the breakdown of winners. While Award Shows such as this year’s Golden Globes offering a timely critique of the violation of power, with bold statements of (TimesUp), the Grammys seemed to stumble to acknowledge the inherent misogyny in the Music Industry.

Lorde, who was nominated for Album of the Year for (Melodrama), did not perform because she was not offered a space to perform a song from her album. All of the other nominees in the category were men, and were offered a space to perform (Important to note: Jay-Z reportedly declined an offer to perform).

At a mid-point of the evening, the President of the Recording Academy addressed viewers, and gave a speech where women were encouraged to [come forward and share their truth]. But these words did not seem to correlate with the evening’s award winners. Of the categories awarded on the live broadcast on CBS, only one went to a female artist, with Alessia Cara taking home the trophy for Best New Artist. Even this win has had its fair share of criticism, with break-out star SZA having lost to Cara, and failing to take home a single award, after being the female artist with the most nominations at five.

At the very least, this year’s Grammy Awards felt dated. Some may argue that those who are voting members of The Recording Academy are out of touch with modern music, instead basing artistic value in forms of music that are more “respectable” and “tolerable” to white male audiences. If you have yet to read about this controversy in the Music Industry, I have included some further reading below.

 

Sources:

The New York Times- Grammy 2018 Winners: Full List – https://www.nytimes.com/2018/01/28/arts/music/grammy-winners.html

Spin Magazine – Grammys Producer on Lorde-Less Show: “There’s No Way We Can Really Deal With Everybody – https://www.spin.com/2018/01/grammys-lorde-snub-theres-no-way-we-can-deal-with-everybody/

Vox – 3 Reasons Why The 2018 Grammys Fell So Flat – https://www.vox.com/culture/2018/1/29/16943952/2018-grammys-recap-awards-winners-losers-boring