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Need help for your recovery from opiates? Please visit us at VictoryRetreatMontana.com where you can recover from the comfort of your home or office in a one to one dynamic program that is both affordable and will fit into your schedule.
Heroin and other opioids are ravaging communities across America. Deaths from heroin increased 328% between 2010 and 2015, and drug deaths from fentanyl and other synthetic opioids are now seeing a sharp rise as well. More Americans die from drug overdoses than in car crashes, and this increasing trend is driven by Rx painkillers.
A new study released earlier this week confirms that deaths in opioid-related hospital stays in the U.S. have quadrupled between 1993 and 2014, PBS NewsHour reports.
Zirui Song, an assistant professor of health care policy at Harvard Medical School and a physician at Massachusetts General Hospital, launched the study in 2016 in an effort to gain a better understanding of the patients he treated.
Dr. Song analyzed nearly 385,000 hospital stays involving patients who were admitted for opioid use with data from the National Inpatient Sample of the Healthcare Cost and Utilization Project, a national database compiled by the Agency for Healthcare Research Quality.
His research confirmed that by 2014, four times as many patients died from opioid-related causes while staying in the hospital, rising from 0.43 percent before 2000 to 2.02 percent.
Over the same time period, the study also found that patients admitted to the hospital for opioid use skewed younger — the average age was 39 years old — and were more likely to be Caucasian. The number of black and Hispanic patients admitted to hospitals for opioid or heroin use remained relatively stable.
Dr. Song said his study is intended to raise awareness for the need for better strategies for hospitals when patients are admitted for using opioids, in addition to continuing and improving public health.
Doctors need to STOP prescribing Opiates and, those who do, need to properly detox their patients so they don’t have to go to Heroin! Talk to your doctor about this today.
A new report released Friday by the Centers for Disease Control and Prevention reveals deaths from drug overdoses in America rose 21 percent last year. That jump is more than the last four years combined. For every 100,000 people, almost 20 died from a drug overdose in 2016, compared to 16.3 the previous year, Bloomberg reported.
The report shows deaths from liver disease, suicide, cancer and HIV have decreased. However, the overall death rate continued to increase. Farida Ahmad, the report’s author and mortality surveillance lead at the CDC says this is because people are dying in larger numbers from other causes, such as drug overdoses, or homicides and firearm-related injuries, both of which also rose last year.
The CDC measures 20 causes of death in its report, and although there are slight increases in other categories, Ahmad says drug overdoses show “the most stark increase,” WTKR News reported. Every quarter in 2016 saw an increase in the number of deaths related to drug overdoses.
These findings come shortly after President Donald Trump declared the opioid crisis in America a public health emergency. This allows the Trump administration and Department of Health and Human Services to allocate funding and resources to address the crisis under the Public Health Emergency Act. The order lasts for 90 days and can be renewed every 90 days until deemed unnecessary.
The president had been heavily criticized over his handling of the epidemic after he announced he would declare the crisis a national emergency but did not. A declaration of national emergency would have allowed for additional funding from the Federal Emergency Management Agency’s Disaster Relief Fund.
A new study finds 10 percent of people saved by the opioid overdose antidote naloxone die within a year of treatment.
“Patients who survive opioid overdoses are by no means ‘out of the woods,’” lead study author Scott Weiner, MD, Director of the Brigham Comprehensive Opioid Response and Education Program at Brigham and Women’s Hospital, said in a news release. “These patients continue to be at high-risk for overdose and should be connected with additional resources such as counseling, treatment and buprenorphine.”
The study, presented at the annual meeting of the American College of Emergency Physicians, found half of patients who died within a year of naloxone treatment died within one month of treatment, Health Day reports.
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President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis released its final report on Wednesday, calling for expanding drug courts into all 94 federal court jurisdictions. The commission also recommended easier access to alternatives to opioids to treat pain, The Washington Post reports.
Drug courts are specialized court programs that target criminal defendants and offenders, juvenile offenders, and parents with pending child welfare cases who have alcohol and other drug dependency problems.
The commission made more than 50 recommendations, including requiring doctors and others who prescribe opioids to demonstrate they have received training in safely providing the drugs before they can renew their licenses to handle controlled substances with the Drug Enforcement Administration.
Providers should be required to check prescription drug monitoring databases to ensure patients aren’t “doctor shopping” for prescription drugs, the commission said. In some states, use of the databases is voluntary, the article notes.
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I almost never thought I’d see the day when a Big Pharma founder and owner was finally arrested for running a criminal drug cartel, but that day has arrived.
“Federal authorities arrested the billionaire founder and owner of Insys Therapeutics Thursday on charges of bribing doctors and pain clinics into prescribing the company’s fentanyl product to their patients,” reports the Daily Caller News Foundation, one of the best sources of real journalism in America today.
Addictive drugs that include opioids, we now know, are claiming over 64,000 lives a year in the United States alone.
From the DCNF:
The Department of Justice (DOJ) charged John Kapoor, 74, and seven other current and former executives at the pharmaceutical company with racketeering for a leading a national conspiracy through bribery and fraud to coerce the illegal distribution of the company’s fentanyl spray, which is intended for use as a pain killer by cancer patients. The company’s stock prices fell more than 20 percent following the arrests, according to the New York Post.
Kapoor stepped down as the company’s CEO in January amid ongoing federal probes into their Subsys product, a pain-relieving spray that contains fentanyl, a highly-addictive synthetic opioid. Fentanyl is more than 50 times stronger than morphine, and ingesting just two milligrams is enough to cause an adult to fatally overdose.
The series of arrests came just hours after President Donald Trump officially declared the country’s opioid epidemic a national emergency. Drug overdoses led to 64,070 deaths in 2016, which is more than the amount of American lives lost in the entire Vietnam War.
As the opioid crisis has developed, more and more states have begun holding doctors and opioid manufacturers accountable for over-prescribing and over-producing the highly-addictive painkillers.
“We will be bringing some major lawsuits against people and companies that are hurting our people,” Trump said Thursday. He also spoke about a program similar to Nancy Reagan’s “Just Say No” initiative.
“More than 20,000 Americans died of synthetic opioid overdoses last year, and millions are addicted to opioids. And yet some medical professionals would rather take advantage of the addicts than try to help them,” Attorney General Jeff Sessions said in a statement. “This Justice Department will not tolerate this. We will hold accountable anyone – from street dealers to corporate executives — who illegally contributes to this nationwide epidemic. And under the leadership of President Trump, we are fully committed to defeating this threat to the American people.
Under President Trump, who continues to fight to end the drug cartels and health care monopolies that are destroying this nation, we may see more and more drug companies finally facing the legal scrutiny they deserve for engaging in the mass medical murder of Americans with dangerous, deadly drugs.
And then there’s the question of vaccines, the autism cover-up and the criminal racket run by the CDC, Big Pharma and the lying mainstream media. When that medical fraud and corruption scandal blows sky-high, we may see dozens of pharmaceutical officials going to prison.
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Over a 40-year career, Philadelphia attorney Daniel Berger has obtained millions in settlements for investors and consumers hurt by a rogues’ gallery of corporate wrongdoers from Exxon to R.J. Reynolds Tobacco. But when it comes to what America’s prescription drug makers have done to drive one of the ghastliest addiction crises in the country’s history, he confesses amazement.
“I used to think that there was nothing more reprehensible than what the tobacco industry did in suppressing what it knew about the adverse effects of an addictive and dangerous product,” says Berger. “But I was wrong. The drug makers are worse than Big Tobacco.”
The U.S. prescription drug industry has opened a new frontier in public havoc, manipulating markets and deceptively marketing opioid drugs that are known to addict and even kill. It’s a national emergency that claims 90 lives per day. Berger lays much of the blame at the feet of companies that have played every dirty trick imaginable to convince doctors to overprescribe medication that can transform both teens and adults into zombified junkies.
So how have they gotten away with it?
A Market for Lies
The prescription drug industry is a strange beast, born of perverse thinking about markets and economics, explains Berger. In a normal market, you shop around to find the best price and quality on something you want or need—a toaster, a new car. Businesses then compete to supply what you’re looking for. You’ve got choices: If the price is too high, you refuse to buy, or you wait until the market offers something better. It’s the supposed beauty of supply and demand.
But the prescription drug “market” operates nothing like that. Drug makers game the patent and regulatory systems to create monopolies over every single one of their products. Berger explains that when drug makers get patent approval for brand-name drugs, the patents create market exclusivity for those drugs, which protects them from competition from other brand drugs that treat the same condition as well as from generics. The manufacturers can now exploit their monopoly positions created by the patents by marketing their drugs for conditions for which they never got regulatory approval —and this dramatically increases sales. They can also charge very high prices because when you’re in pain or dying, you’ll pay virtually anything.
Using all these tricks, opioid manufacturers have been able to exploit the public and have created a whole new generation of desperate addicts. They monopolize their products and then, as Berger puts it, “market the hell out of them for unapproved and dangerous uses.”
Opioids are a drug class that includes opium derivatives like heroin (introduced by German drug maker Bayer in 1898), synthetics like fentanyl, and prescription painkillers like oxycodone (brand name: OxyContin). A number of factors are aggravating the addiction crisis: There has been a movement in medicine to treat pain more aggressively, while at the same time wide-ranging economic distress has generated a desire to escape a dismal reality. But a key driving force is doctors who have been wooed by Pharma marketing reps overprescribing for chronic pain.
“For the first time since the years after heroin was invented,” writes investigative journalist Sam Quinones in Dreamland: The True Tale of America’s Opiate Epidemic, “the root of the scourge was not some street gang or drug mafia but doctors and drug companies.”
Doctors were once reluctant to write prescriptions for opioids. The U.S. drug regulator, the Food and Drug Administration, would only approve such drugs for severe cases like cancer patients in chronic agony or certain people in short-term pain after, say, an operation. But representatives of Connecticut-based drug maker Purdue, which released OxyContin in 1996, along with other companies, began to flood doctors’ offices with reports asserting that using the drug for off-label purposes was harmless. Often the targets were primary care physicians with little training in addiction. Have a chronic arthritis case? Give your patient OxyContin. Tell folks to take it every day, for weeks, even years, to treat just about any kind of chronic pain. The upshot was dependence, typically not because people were getting high for fun, but because they were using a legal drug in precisely the way the doctor ordered.
Purdue and others whisked doctors to stylish retreats to push them to prescribe drugs for uses not approved by U.S. regulators—a marketing strategy banned by federal law. They even created fake grassroots organizations to make it seem as though patients were demanding more prescriptions. Pharmaceutical companies like to dodge responsibility for the opioid crisis by blaming dishonest distributors and pointing out that they’re not the ones prescribing or handing out drugs to patients. True enough: They don’t need to, because they’ve done their work hooking you long before the drug is in your hands.
“The marketing is not only fraudulent; it’s incredibly elaborate,” says Berger. “Fake scientific studies promote the lie that opioids are better than other medications for pain. They’ve gone to just about any length. Bribery, you name it. It’s outrageous.”
OxyContin is so addictive it can create physical dependency in a matter of weeks. As drug makers and doctors who began to dole out pills by the handful in pain clinics learned, addicts do not behave like ordinary consumers: They don’t “choose” to buy or to wait until next week. They need their drug right away and will do anything to get it because if they don’t they will suffer excruciating symptoms.
A Los Angeles Times report shows that among the lies Purdue spread about OxyContin was that one pill subdued pain for 12 hours. Except that for many patients it wears off much sooner, exposing them to unbearable pain and withdrawal. Purdue knew this, but feared lower sales if it admitted the truth. So sales reps advised doctors to just give stronger doses, which increased the addiction risk. As the money from hooked patients piled up, so did the bodies.
In 2007, Purdue pleaded guilty in federal court in Virginia to misleading doctors and patients about OxyContin’s safety and paid a $600 million fine. But that sum was hardly an annoyance. From 1995 to 2015, Purdue made $35 billion from OxyContin sales alone. The Sacklers, who own the company, is now one of the richest families in America, as revealed by this triumphant Forbes spread. They know that lax regulation keeps the heat off, and that even litigation and criminal prosecutions can do little to stop them. Berger says that until such legal programs are massive in scale and scope, companies will go on with business as usual.
“We have to have injunctive relief [a court order to stop a behavior] that bans the marketing to doctors of opioids completely for unapproved uses, as well as an expansion of the FDA and DEA to specifically target the drugs,” says Berger. His law firm, Berger & Montague, is involved in the effort to seek relief for the city of Philadelphia, which has seen above-average opioid prescribing and suffered the highest rates of fatal drug overdoses in the state last year.
Even though prescriptions have been slightly reduced across the country since 2012, Philadelphia is finding out what happens to many people hooked on opioids when they can’t get a prescription or find the price too high: They turn to heroin. Fatal overdoses of heroin, oxycodone’s close cousin, have been skyrocketing since 2007 across the country.
‘Landscapes of Despair’
The opium poppy has been part of human history since at least 3,400 BCE, when it was cultivated in Mesopotamia as the “joy plant.” Derivatives such as laudanum and morphine offered more convenient, and people wrongly believed, safer ways to get the plant’s benefits. Bayer originally touted heroin as a non-addictive substitute for morphine (even for children) until it was outlawed in the U.S. in 1925. Rendering it illegal did not stop it from destroying the lives of many of America’s most celebrated artists, from Billie Holiday to Philip Seymour Hoffman. Drug overdoses now kill more people than gun homicides and car crashes combined. In 2015, nearly two-thirds of all overdoses had one thing in common: opioids.
Syracuse University’s Shannon Monnat, a sociologist focused on rural issues and an INET grantee, has been studying the epidemic and how it impacts various populations. Her research reveals that the rise in drug-induced deaths has been especially sharp among middle-aged people (45-55), with prescription opioid overdoses increasingly impacting both middle-aged and older populations. Heroin, whose sedating and euphoric effects are very similar to prescription narcotics, looks to be the culprit in more young adult overdoses.
Monnat considers how the opioid crisis points to bigger societal problems impacting the economy, educational institutions, the health care system, political systems, and communities. Her work centers on investigating the characteristics of what she calls “landscapes of despair”—places where people are hurting economically and socially, like Appalachia, the industrial Midwest and parts of New England. She points out that persistent disadvantage and long-term poverty are clearly connected to the opioid crisis, noting that many of the areas most impacted were once robust centers of manufacturing before jobs moved to other countries.
Opioid addiction seems to thrive in downwardly mobile small cities in rural areas—but not all of them. “What’s fascinating is that some of these areas have very high mortality rates from drug overdose, like Appalachia,” say Monnat. “But others, like the Southern ‘Black Belt’ [a region that stretches across Alabama and Mississippi], have not seen such rises.”
Originally named for its rich, dark, soil, which attracted cotton planters in the 19th century, the Black Belt has a high population of African Americans. The area has a history of unremitting poverty, low incomes, high unemployment, and high mortality. Yet despite many hardships, which are linked to the legacy of slavery, Monnat says that the region is also distinct for its “very tight-knit communities, strong kinship networks, and other networks where people can find emotional support.” It seems that when people have somewhere to turn in hard times, they may build up immunity to an epidemic like the opioid scourge.
Ironically, another factor that may have protected these communities, discussed by Quinones in Dreamland, is prejudice: The low-profile heroin dealers originating from Mexico’s west coast who are associated with the current opioid scourge prefer to target white communities. They also avoid big cities where large cartels are already established. So small, predominately white towns are their sweet spot.
Appalachia is known for kinship networks, but it also has a legacy of isolation and an outlaw tradition associated with the history of moonshining and bootlegging which can feed into today’s underground selling and distribution of opioid drugs. In this region, much of the struggling white working-class has seen economic distress with little hope of relief from America’s political system. Democrats often openly disdain the people they call rednecks and hillbillies, while concentrating on identity politics rather than economic distress. Republicans promote policies of free trade and deregulation that cast the region further into destitution.
Monnat has found that counties with large numbers of people employed in physical labor—especially physical occupations with higher disability rates—have higher drug fatalities. These are places where coal miners work in backbreaking positions and military veterans suffer the pain of injuries. Drug companies have besieged these areas with aggressive marketing of pain pills. “In Appalachia, you’d see mining companies with physicians on staff prescribing opioids to keep people in pain working,” she says. “That was happening before OxyContin, but companies like Purdue targeted these communities to push OxyContin as a safer alternative to other pain medications.”
The National Institutes of Health report that the opioid epidemic, which started as a regional crisis, is now a national crisis, decimating communities and even helping to reshape the American political landscape. Monnat finds a relationship between the landscapes of despair and the 2016 presidential election. Voting patterns show that areas in which President Trump did better than expected, like Pennsylvania and Ohio, were also places where opioid overdoses and deaths from alcohol and suicide occurred at high rates over the past decade.
During his campaign, Trump expressed concern for people in regions like Appalachia and flung stinging barbs at the politicians who had failed them. These voters supported him in high numbers, yet his policies will likely give more power to the pharmaceutical companies that have turned their suffering into stock windfalls.
Profit Trumps People
Trump the campaigner shook his fist at Big Pharma for “getting away with murder”—one of those statements that occasionally drops from his lips with atomic accuracy. But Trump the president has done an about-face. As journalist David Dayen pointed out, a draft of an executive order on drug prices (which never materialized) called for deregulation of the FDA and favors to industry. It was written by a pharmaceutical lobbyist.
In March, President Trump issued an executive order creating a commission to study drug addiction and the opioid epidemic. The commission, headed by New Jersey Governor Chris Christie, has so far released recommendations that locate the overprescribing problem “in doctor’s offices and hospitals in every state in our nation,” while making nary a mention of pharmaceutical marketing departments. The panel suggests insufficient remedies like new treatment facilities and educating schoolchildren on the dangers of opioids, along with ineffective ideas like more funds to Homeland Security. Regulation of Big Pharma? Nope.
The federal government did announce it would team up with drug makers to research and generate non-opioid pain medications and additional medication-assisted treatment options. Among the participants? Purdue.
Economist William Lazonick of the University of Massachusetts Lowell and an INET grantee, agrees with Berger that the way the pharmaceutical industry operates amounts to a catastrophe for the public. “It’s crazy that each and every drug is not treated like a regulated monopoly,” he says. “Taxpayers fund much of the research that goes into creating these drugs through the NIH and other public research facilities. Moreover, the companies are gifted with a monopoly through patents which last two decades.”
Lazonick notes that Big Pharma claims it needs high profits to keep inventing new drugs, but the industry spends more of its profits buying back its own stock than increasing investment in R&D on new drugs. Executives running drug companies are incentivized to make profits any way they can because they are rewarded by high stock prices. Lazonick explains that they stoke those stock prices by gouging patients or lying about the safety of products—whatever it takes.
He observes that for the past several decades America has undergone a devastating experiment based on the philosophy of economist Milton Friedman, who claimed that the only social responsibility of a company is to make a profit. Untimely deaths from tobacco-related illnesses, auto safety failures, and now, harmful opioid drugs, prove that the experiment is a tragic failure.
Lazonick sees the need for nothing less than a new structure of corporate governance that ensures the ethical responsibly of drug makers to do what they are supposed to do: create high-quality, low-cost products that are safe. The current structure, based on the misguided idea that companies should be run for the sole purpose of enriching shareholders, is particularly perverse when it comes to products that are potentially fatal. The problem with this model is that when shareholders are the only people who matter, the rest of us suffer.
Since taxpayers support pharmaceutical companies by funding public research and many other things they require to do business, Lazonick says it is only fair and logical that someone representing the public sits on their boards. Berger adds that companies should be required to make drugs widely available at affordable prices in return for their use of publicly funded basic research at no cost whatsoever.
America, for the time being, stands out among nations in letting pharmaceutical companies run amok to inflate drug prices, advertise and market drugs without proper regulation, and use taxpayer resources while exposing them to egregious harm. “The only thing America’s drug companies are competitive about,” says Lazonick, “is getting people addicted.”
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Grant Hill, a former basketball star, told The Daily Mail how athletes would do anything to recover quickly after surgery to play again. According to Hill, athletes want to be back on court immediately right after an injury or surgery because of pressure and impatience. They want something that quickly fixes everything, and for most, the solution is opioids.
Other basketball stars like Shaquille O’Neal, Jay Williams, and Rex Chapman admitted they used the drugs and how these are easily acquired. The rampant distribution of these drugs in the sports industry contribute to the opioid epidemic happening today. Most injured athletes are often prescribed opioid pain killers to get them by. Consequently, opioid prescriptions lead to a completely avoidable addiction. (Related: Student athletes becoming drug addicts after doctors prescribe opioids for their injuries.)
“One of the major issues we have is that doctors don’t want to leave their patients in an empty spot on a Saturday night in pain with nothing to do,” Paul Sethi, an orthopedic surgeon specializing in sports medicine, tells The Daily Mail.
“We’re accustomed to follow the physician’s orders and decisions, but you need to know that it’s important to take ownership of your health, and ask the important questions,” Hill expresses.
Sethi also explains that doctors may be overprescribing opioids to give out way beyond what athletes need to “cover their backs.”
Opioids are highly addictive painkillers that have killed, and are still killing, millions of Americans because of overdose. It is the leading cause of death for Americans below 50 years old. They are a class of drugs — which include heroin, fentanyl, and pain relievers — that are legally available through a doctor’s prescription. Opioid pain killers are generally safe, but because they also produce euphoric effect, they can be abused.
According to QuintilesIMS Institute as cited by The Daily Mail, nine out of 10 patients are exposed to opioids to manage post-surgical pain. These patients take an average of 85 pills a day. The report says that reducing surgery-related opioid prescriptions would cut the number of unused pills in the United States by 332 million per year, lessen the number of addicts by 300,000, and save $830 million.
Signs of opioid addiction started as early as the 1980s, but drug manufacturers reassured the public that opioids were less addictive in the 1990s, which led to the misuse and addiction of the drugs. The Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) only began reporting the rise of opioid overdose and addiction in the beginning of the 2000s. Health authorities announced in 2013 the addiction was an epidemic. In 2015, over 33,000 Americans died because of opioid overdose and over 90 million Americans are dying daily because of it.
The FDA has tried to address the abuse and misuse of opioids by implementing the Risk Evaluation and Mitigation Strategy (REMS) to immediate-release (IR) opioids. Scott Gottlieb, commissioner of the FDA, wrote in a blog post in September that the IR opioids produced by 74 manufacturers will be subjected to a stricter set of requirements under a REMS. The REMS will require training to available health care providers who prescribe IR opioids, which includes discussing non-opioid alternatives.
“Our hope is that we can help prevent new patients from becoming addicted, and keep some individuals from experiencing the serious adverse effects associated with these medications,” writes Gottlieb.
This is a VERY critical article for those of you who are being lied to about Gabapentin (Neurontin). It IS addictive and you should NOT be taking it… especially if you have suffered a prior addiction. Please read.
Has gabapentin become a drug of abuse?
|Response from Sarah T. Melton, PharmD
Associate Professor of Pharmacy Practice, Bill Gatton College of Pharmacy at East Tennessee State University, Johnson City, Tennessee
Gabapentin is approved by the US Food and Drug Administration (FDA) for the treatment of epilepsy and postherpetic neuralgia. It is often prescribed off-label for other pain syndromes, anxiety and mood disorders, restless legs syndrome, alcohol withdrawal, and other conditions.
Gabapentin is an analog of gamma-aminobutyric acid (GABA), a neurotransmitter that slows down the activity of nerve cells in the brain, but does not bind to GABA receptors or affect the production or uptake of GABA.How gabapentin works and how it relieves pain and suppresses seizures are unknown.
Gabapentin does not exhibit affinity for benzodiazepine, opioid (mu, delta, or kappa), or cannabinoid 1 receptor sites, which are often activated in drugs of abuse. Gabapentin is not scheduled as a controlled substance, indicating little potential for abuse and addiction. However, gabapentin shares characteristics of medications associated with misuse and addiction, in that it produces a withdrawal syndrome and certain psychoactive effects.
A small number of postmarketing cases report gabapentin misuse and abuse.Although the rationale for abuse is unknown, some individuals describe “euphoria, improved sociability, a marijuana-like ‘high’, relaxation and sense of calm.” Other patients report feeling “zombie-like.”
In 2004, a report described gabapentin misuse in correctional facilities in Florida. A recall of all gabapentin prescriptions at one of the larger correctional facilities revealed that only 19 of 96 prescriptions were in the possession of the intended patients. Subsequently, 5 inmates reported they were inhaling the powder from gabapentin (300 or 400 mg) capsules intranasally. All 5 inmates had psychiatric or pain diagnoses, as well as histories of cocaine abuse. Four of the 5 inmates reported obtaining an altered mental state or “high” similar to that from cocaine. Gabapentin was removed from the formulary, and prescribing was restricted to exceptional cases. There was no further evidence of abuse. Gabapentin has been removed from formulary in other correctional facilities as well.
A 2007 report described the case of a 67-year-old woman with mood disorders and a history of alcohol abuse who was prescribed gabapentin (as well as naproxen and amitriptyline) for pain from polyneuritis. Owing to tolerance, she was prescribed 4800 mg/day (over the maximum recommended dose), but further escalated her intake to 7200 mg daily. She requested gabapentin without a prescription from pharmacists and visited numerous physicians, exaggerating her symptoms, to obtain the desired quantities.
When the patient was finally no longer able to obtain gabapentin through these methods, she developed withdrawal symptoms, characterized by trembling, sweating, excitation, pallor, and exophthalmia. The withdrawal required hospitalization, where a change to alternative pain control medications was made. Within several months, the patient had resumed abuse of gabapentin.
Another report described 3 cases of gabapentin-associated withdrawal symptoms after abrupt discontinuation of total daily doses of 4800 mg, 3600 mg, and 2400 mg.
Similar symptoms were reported in 2 patients with histories of alcohol abuse.The first case involved a 33-year-old man taking 3600 mg of gabapentin daily, which was twice his prescribed dose. He had been obtaining gabapentin refills early to reduce his craving for alcohol and make him feel calmer. When further refills were denied, he abruptly stopped taking the gabapentin and suffered acute withdrawal symptoms.
The second case described a 63-year-old man with a history of alcohol abuse who was taking gabapentin at 4900 mg/day instead of the prescribed 1800 mg/day. After presentation to the hospital and discontinuation of gabapentin, he developed severe withdrawal symptoms. Withdrawal symptoms in these patients included disorientation, confusion, tachycardia, diaphoresis, tremulousness, and agitation. The withdrawal symptoms resolved upon resumption of gabapentin.
The use of nonprescribed gabapentin by patients attending substance abuse clinics has also been reported. A questionnaire-based survey completed by 129 respondents attending 6 substance abuse treatment clinics found that 22% of patients admitted to using nonprescribed gabapentin. As a comparison, nonprescribed use of pregabalin was 3%, benzodiazepines 47%, and cannabis 43%. Some patients taking nonprescribed gabapentin reported using the drug to become intoxicated or to potentiate the effect of methadone.
On the basis of case reports and postmarketing reports, there appears to be potential for abuse, dependency, and withdrawal symptoms associated with gabapentin use. Patients involved in this misuse and abuse were using gabapentin at doses greater than those recommended, to relieve symptoms of withdrawal from other substances, and for uses that are not FDA-approved.
Providers should assess patients for drug abuse history when prescribing gabapentin, as well as monitor patients for any signs of misuse or abuse. Prescribers and pharmacists should monitor patients for the development of tolerance, unauthorized escalation of dosing, and requests for early refills or other aberrant behavior. Prescribers should consider requesting testing for the presence of gabapentin in urine drug screens if abuse is suspected.
Acknowledgment: Dr. Melton acknowledges the research assistance of Paige Graham and Charity Sands, Doctor of Pharmacy Candidates at the Bill Gatton College of Pharmacy at East Tennessee State University.
Article Source: Medscape.com
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