To the Editor: Re "Heroin Yields Ground to Fentanyl, Its More Potent Killer Cousin" (front page, March 26): The influx of fentanyl as an additive to heroin and as a free-standing active killer is a scary reminder that the drug epidemic must be addressed from the demand side as well as the supply. Supply-side strategies that rely on law enforcement, opioid prescription restrictions and international cooperation are necessary but not sufficient to reduce and reverse our national scourge of substance use disorder. [continues 155 words]
To the Editor: Re "Town's Anti-Drug Plan: Safe Site to Use Heroin" (front page, March 23), about a proposal by the mayor of Ithaca, N.Y., to establish the first site in the United States where people could legally inject heroin: Supervised injection facilities, or SIFs, are a longstanding public health tool in several countries and are rapidly gaining support elsewhere, including in the United States. Advocates like me understand why people have questions about something that at first pass looks as if it enables destructive behavior. [continues 117 words]
Patients and Doctors Discuss the Management of Drugs That Can Be Helpful or Harmful. To the Editor: Re "A Strong Response to the Opioid Scourge" (editorial, March 17): There are longtime users of low-dose opioids, like me, who never require an increase in dose and who find that this medication provides quality of life. How? By addressing chronic pain, sleep disorders and associated depression. The alternatives proposed by the Centers for Disease Control and Prevention, like aspirin and ibuprofen, can cause long-term damage to body organs and short-term stomach pain. For many of us, spare use of a low-dose opioid is the very best alternative. [continues 79 words]
Patients and Doctors Discuss the Management of Drugs That Can Be Helpful or Harmful. To the Editor: Re "New Standards for Painkillers Aim to Stem Overdose Deaths" (front page, March 16): The Centers for Disease Control and Prevention has been doing a commendable job monitoring and controlling the prescription opioid drug overdose epidemic. But other federal government agencies can and should do more to address this public health crisis. Specifically, the Drug Enforcement Administration should increase its crackdown on physicians running pill mills, and Congress should open an investigation into the role of the Food and Drug Administration in this completely man-made epidemic and hold hearings on the marketing approaches and other business practices of pharmaceutical companies that may have contributed to the skyrocketing increase in opioid drug prescriptions. New York The writer is a professor of epidemiology and director of the Center for Injury Epidemiology and Prevention at Columbia University. [end]
Patients and Doctors Discuss the Management of Drugs That Can Be Helpful or Harmful. To the Editor: The proper treatment of pain disorders by physicians should not be directed by the fear of lawsuits or pressure by insurance payers but rather by sound guidelines developed by organizations like the American Academy of Pain Medicine. The news media has readily noted a "prescription drug epidemic," but overdoses mainly result from drug diversion and misuse rather than from taking an opioid as prescribed. Epidemiological data has reported up to 16,500 deaths a year from the aspirin-ibuprofen family of medicines, which can cause ulcers, kidney failure and liver inflammation, none of which occur with opioids. [continues 68 words]
Patients and Doctors Discuss the Management of Drugs That Can Be Helpful or Harmful. To the Editor: Re "States Push to Curb Painkiller Overuse" (Business Day, March 12): As an orthopedic surgeon in Massachusetts, I applaud the efforts of my state to limit patients' excessive opioid use. Every year in this country, more than 70 million post-surgical patients receive opioids, and research shows that one in 15 will go on to long-term use, indicating that the surgical setting has become an inadvertent gateway to the overall societal epidemic. [continues 129 words]
Patients and Doctors Discuss the Management of Drugs That Can Be Helpful or Harmful. To the Editor: The number of deaths directly attributable to opioids far exceeds the incidence of fatalities associated with several other epidemics that we have experienced in this country in past years. More than a half of 460 autopsies I performed last year for coroners in southwest Pennsylvania were drug related, and a substantial percentage were people who got started on powerful analgesics prescribed by their physicians. [continues 51 words]
Patients and Doctors Discuss the Management of Drugs That Can Be Helpful or Harmful. To the Editor: For many people with chronic pain, opioid painkillers are a lifeline. The new guidelines from the Centers for Disease Control and Prevention, while perhaps reasonable as a first approach, are unrealistic for patients who have done well (sometimes for years) on carefully monitored opioid doses under continuing medical care. As The Times has reported, these longtime patients must now be subjected to humiliating "pain contracts" and random drug tests. [continues 127 words]
The Supreme Court has handed the marijuana-legalization movement an important victory. Two states - Nebraska and Oklahoma - sought to invalidate the landmark Colorado measure known as Amendment 64, which legalized recreational marijuana in that state. But the challenge fell flat when the Court announced last week that it wouldn't hear their case. That means the Colorado law will remain in effect - and more states can opt to legalize also. No one can deny the gathering momentum behind the legalization movement. Since 2012, four states have approved referenda that essentially legalize marijuana for recreational purposes: [continues 571 words]
ITHACA, N.Y. - Even Svante L. Myrick, the mayor of this city, thought the proposal sounded a little crazy, though it was put forth by a committee he had appointed. The plan called for establishing a site where people could legally shoot heroin - something that does not exist anywhere in the United States. "Heroin is bad, and injecting heroin is bad, so how could supervised heroin injection be a good thing?" Mr. Myrick, a Democrat, said. But he also knew he had to do something drastic to confront the scourge of heroin in his city in central New York. So he was willing to take a chance and embrace the radical notion, knowing well that it would provoke a backlash. [continues 1204 words]
Slowly we are coming to realize the foolishness of our national "war on drugs" policy and that there is a more effective way to deal with the issue. Erie County's recent efforts to deal with the heroin issue are significant. Putting people in jail and demonizing drug usage has only allowed criminals to make billions of dollars and increase violence in our country. In his book, "Chasing the Scream," Johann Hari laid out some alternatives to our current policies. Switzerland, Canada and Portugal are just a few of the countries trying to establish policies that have not only decreased gun violence but decreased drug addiction. [continues 67 words]
STATEN ISLAND, N.Y. - Sure, let's just hoist the white flag of surrender in the war against heroin addiction. That's what Assemblywoman Linda Rosenthal (D-Manhattan) would effectively do with her bill to legalize "supervised injection facilities" for people to self-administer illegal narcotics under the supervision of medical staff. If it's not the dumbest proposal we've heard to battle drug addiction, it has to rank pretty close to the top of the list. And yet we keep hearing it. [continues 505 words]
William F. Buckley said it first and he had it right. To paraphrase Buckley: "Legalize everything, legalize all drugs." As a nation, the United States has thrown billions of dollars down an unquenchable rat hole in an effort to end the flow of drugs streaming in from Mexico, Afghanistan, wherever. The efforts have failed. Corner drug shops, similar to OTBs, should be erected and staffed so that addicts are able to satisfy their needs easily and at moderate cost. This will keep them out of my face during the day and out of my house at night. It will also relieve users of criminal, furtive behavior, of worrying about making a contact, having enough money for a buy and being arrested. Let's release the thousands doing time for minor drug offenses. Will it ever happen? Of course not. There's too much money being made and changing hands. But Buckley had it right. George D. Poe Williamsville [end]
The Centers for Disease Control and Prevention this week released well-reasoned guidelines for how doctors should prescribe opioid painkillers. The voluntary standards could make a difference in curbing the alarming increase in prescription drug deaths. In 2014, overdoses of opioids, like oxycodone and hydrocodone, and related drugs like heroin were responsible for 28,647 deaths, up 14 percent from the year before. About one in 550 people who received opioids for chronic pain not linked to cancer died from an opioid-related overdose a median of 2.6 years after their first prescription. "We know of no other medication routinely used for a nonfatal condition that kills patients so frequently," Dr. Thomas Frieden and Dr. Debra Houry of the C.D.C. wrote in The New England Journal of Medicine on Tuesday. [continues 384 words]
I congratulate the mayor on the plan to provide safe refuge for heroin injections. There may need to be changes to provide safety for all involved. He will and has received many criticisms, but what has worked over the past 100 years? Nothing. His plan deserves a chance; after all, it can be discontinued if there is an insurmountable problem. ITHACA [end]
ITHACA, N.Y. - A bustling economy. Record-low unemployment. A ballooning heroin problem. That's how Mayor Svante Myrick describes Ithaca, where he hopes to open the nation's first safe injection facility - a place where heroin users can shoot their illegal drugs under medical supervision and without fear of arrest. His proposal, part of a plan to address drug abuse in the college town of 31,000 in central New York, is not a novel idea. Safe injection sites, which also connect clients to treatment programs and offer emergency care to reverse overdoses, exist in 27 cities in other parts of the world. Some have been around for decades. [continues 592 words]
To the Editor: The recent increase in heroin use in Boston and throughout the country should come as no surprise to anyone. Following an increase in the prescribing of opioid painkillers, a number of steps were taken to reduce such prescribing markedly, but with no attention whatever paid to the patients who had become dependent, not even offers of detoxification. Many, predictably, turned to the much cheaper and widely available alternative of heroin. The only tangential reference to treatment in your article is the statement that a particular stretch of Massachusetts Avenue is known as Methadone Mile. Would that it were so! Along with all other forms of treatment, methadone maintenance - the gold standard of care - should be readily available to all who want and need help for their dependence, and who with tragic frequency die without it. The writer is a health care consultant. [end]
To the Editor: It's not easy to understand heroin addicts. They eschew replacement drugs like methadone and Suboxone that reduce sickness and cravings so they can shoot up and experience that momentary rush and ephemeral bliss. Many of them know that they are chasing that "first high," that first time that opened the door to heaven and hell. Shooting up is an extraordinary experience, but as much as they try, addicts will not get that first high again. For these people, life holds little meaning or joy outside of getting high. Their addiction gives them a reason to exist, a focus and its rewards. [continues 84 words]
To the Editor: Re "Use of Heroin in Public View Across the U.S." (front page, March 7): Until they are ready for treatment and have access to it, people with an addiction to heroin will find a place to inject, whether it's in a fast-food restaurant bathroom, a church basement, a public bus or an abandoned building. Making restrooms inaccessible will only push the problem elsewhere. Nurse-supervised safe injection sites like Insite in Vancouver, Canada, have been demonstrated to save lives and provide a pathway toward recovery. We need to follow suit. Brookline, Mass. The writer is a doctor of internal medicine at Massachusetts General Hospital and on the faculty of Harvard Medical School. [end]
In the first 10 days of March, heroin and other opiates are believed to have claimed as many as 10 lives in Buffalo. But that's only a portion. Since the beginning of the year, city detectives have determined at least 25 individuals died from overdoses. "We are at epidemic levels and there is no end in sight," Buffalo Police Commissioner Daniel Derenda said Thursday. "Sadly, it is probably going to get much worse before it gets better." But the epidemic goes beyond Buffalo. [continues 321 words]
Inside New York
