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Tennessee House Passes Governor’s Bill Limiting Some Opioid Prescriptions

The Tennessee House of Representatives has approved a new measure limiting opioid prescriptions for temporary and first-time uses. With this action, it has passed a critical part of Governor Bill Haslam’s plan to deal with the state’s opioid crisis.

Senate Majority Leader Mark Norris, R-Collierville, and Rep. David Hawk, R-Greeneville sponsored the measure, which limits prescriptions for new opioid patients. It doesn’t cut prescriptions for current prescription opioid users or patients living with chronic pain. The measure passed by a count of 94-1.

Legislation to Fight Opioid Epidemic

Rep. Sabi Kumar, R-Springfield, who is also a surgeon, referred to the measure as a “major piece of legislation in our fight against the epidemic.”

Earlier this year, the governor outlined a $30 million effort to take on the Tennessee opioid crisis.

Doctors Critical of Proposed Law

The Tennessee Medical Association and the state’s doctors were critical of the governor’s plan, called TN Together. They were concerned that it limited doctors’ ability to prescribe opioid medications to patients on an as-needed basis.

Compromise with Healthcare Providers Reached

Healthcare providers, the Haslam administration and lawmakers reached a compromise on the measure that gave doctors more leeway when prescribing opioids. Instead of the original five-day limit for prescriptions, doctors can prescribe up to 10 days’ of medication in some cases.

The goal of limiting prescriptions is to curb the number of new state residents becoming addicted to opioids. Studies have shown that patients who receive prescriptions for more than five days’ of opioids are at higher risk for addiction.

The new bill sets limits of three, five and 10 days for opioid prescriptions. Dosages can’t exceed a total of 500 milligrams of morphine equivalent.

The bill recognizes exceptions for patients with serious ailments, as well as those who are undergoing “more than a minimally invasive procedure” or one where “the risk of intense pain exceeds the risk of addiction.”

FDA Strengthens Warning About Kratom, Saying Herb is an Opioid

The Food and Drug Administration (FDA) boosted its warning about kratom. The agency said that the results of new research indicated the unregulated herb has “opioid properties.” It has also been associated with numerous deaths.

FDA “Confident” in Calling Kratom an Opioid

FDA Commissioner Scott Gottlieb stated recently that the Agency feels confident in “calling compounds found in kratom, opioids.” The FDA came to its conclusion based on recent computational modeling, scientific literature and reports of adverse effects on people. He added that the new data reinforced the Agency’s concerns about kratom’s “potential for abuse, addiction and serious health hazards, including death.”

Possible Addiction Treatment

Kratom is imported from Southeast Asia. The product, which is marketed as a supplement, is being bought by consumers looking for relief from anxiety, depression and pain. It is also being used to treat opioid-withdrawal symptoms. Some researchers are studying whether kratom can be used to treat addiction. Other experts warn that the supplement, which is available in capsule form or used as a tea, is simply too risky to use.

No FDA-approved Uses for Kratom

Commissioner Gottlieb stated in November 2017 that there are no FDA-approved uses for kratom. The Agency now knows of 44 deaths related to kratom which took place between April 2011 and December 2017. In one instance, the deceased had no history of opioid use, “except for kratom.”

In many of the cases, the deceased had used kratom in conjunction with other drugs. This fact makes it difficult for authorities to determine the actual cause of death. Kratom supporters say that the government has blamed it on deaths due to other substances. The new death, which occurred in the absence of other substances, reinforces the FDA’s concerns about kratom’s safety.

FDA scientists analyzed the 25 most-common compounds in kratom. They concluded that all of them share “most structural similarities” with opioid pain medications. The model also showed that 22 of the compounds bind to opioid receptors in the brain, as well as to stress reponses “that impact neurological and cardiovascular function.” The Agency had previously warned the public about kratom’s side effects, which include respiratory depression and seizures.

Concern Kratom Users May Return to Opioids

Jack Henningfield, an addiction specialist with the drug policy group Pinney Associates, said that surveys of kratom users had revealed that many of them had been taking the supplement as a tool to stop using opioids. Mr. Henningfield argued that kratom use presents a lower risk than opioids. He stated that restricting or banning kratom use could push some people toward the black market to buy kratom or even make them start using opioids again.

Cocaine Traffickers Targeted by Latin American Authorities

The United States has long received much of its drugs from Mexico and other South American countries. The drugs are smuggled through the South American countries and then brought into the United States to be dispersed among thousands of gangs and street dealers. In an effort to combat this, the United States patrols its borders, maintains intelligence on known drug cartels in Mexico and continues to share information with South American governments as it relates to the drug trade. But this is not the only thing being done to prevent the illegal sale and distribution of heroin, cocaine, methamphetamine and marijuana. Guatemala and other South American countries are fighting back in their own countries.

In fact, Guatemalan authorities have reported that in 2016, drug cartels were stripped of 27,397.3 pounds of cocaine, the largest combined seizure in the last ten years. The last seizure of the year, made on December 3, was over 3,600 pounds of cocaine, an estimated street value of $22.3 million.

In order to achieve these types of captures though, authorities have to utilize all of their intelligence information and maintain standard policies of searching incoming vehicles, boats and planes into their country.

“They transfer the drug from Ecuador or Colombia, they depart it from the port and they bring it to Guatemala via maritime routes. There it is received by a structure that transfers it to its destination, like Mexico, or distributes it among local structures, which in turn distribute it to other structures,” explained Aldo Chapas, an anti-drug prosecutor in Guatemala.

And while these seizures happened a different country, United States officials will also feel the benefits of the reduction of over 27,000 pounds of cocaine. Experts have agreed that reducing the addiction problem in this country is a two-part answer. First, the supply of drugs has to diminish. Second, citizens need to be educated, and treated for their addiction. With the help of officials in other countries where drug smuggling is a problem, the United States can focus more on treating and educating addicts throughout the country.

Although drugs like methamphetamine and heroin have largely overshadowed cocaine use in the United States, it is still very much a problem in our country. Regardless of how effective the efforts become to try and prevent drugs from getting into our country, as long as there is a demand then someone will always be looking to cash in as a supplier. For this reason alone, it is imperative for more resources to be allocated to treatment and prevention programs rather than trafficking.

Discovery of Addiction Gene May Help with Future Treatment and Prevention

pnas addiction study

Genetics may Define Risks of Addiction

A new study conducted by a group of researchers may shed light onto why people get addicted and how to locate individuals that may be susceptible to addiction before they ever use drugs. This groundbreaking discovery is unique because the researchers were able to study the brain before and after drug addiction set in in rats that were engineered to be prone to addiction. The hope is that future generations will be able to get screened for the presence of addiction genes prior to drug or alcohol use, therefore preventing a potentially deadly addiction. This is especially important of late, given the high rate of overdose deaths in our country currently.

In order to conduct the study, researchers genetically modified rats to either be high responders (more likely to become addicted) or low responders (less likely to become addicted). The genetically modified rats were then studied prior to the introduction of cocaine. This was a first for scientists. While it was understood prior to the study that humans who were addicted to drugs had different chemical reactions in their brains, it was difficult to study this phenomenon prior to addiction setting in. With the ability to study the rats before an addiction began scientists could locate key indicators of the makeup in the brain, thus allowing for future screenings to be developed for humans.

“There’s a number of essays that could be created to look at these different molecules to identify if somebody has a history of addiction in their family. If they have certain low versus high levels of one of these molecules, then they can be a candidate for treatment to prevent addiction in the first place. Or, if we know that they’re an addict, to prevent relapse,” explained Shelly B. Flagel, Ph.D., the study’s lead author.

Results of the rat study show that rats who were more likely to become addicted to cocaine had a higher level of fibroblast growth factor, which remained high after the rats were addicted to cocaine. These rats also had lower than normal dopamine D2 receptors. More studies will need to be conducted, but researchers are pleased that they are able to now study addiction-prone brains before an addiction sets in.