To the Editor: As a physician who specializes in pain management, I agree that we are overusing opioids and underusing other treatments. Certainly, the lack of insurance coverage for many of these other treatments is a significant problem. There is an even more important factor, however, that hinders patient access to them. Most physicians receive little education on pain management in medical school and in postgraduate training. It is unrealistic to expect physicians to recommend treatments about which they possess little knowledge. If the surgeon general really wants to have an impact on how we treat pain in this country, he needs to address this. Philadelphia [end]
About half of opioid overdose deaths involve prescription drugs. With that stark fact in mind, the surgeon general, Dr. Vivek Murthy, sent an unusually direct plea last week to 2.3 million doctors and other health care workers to help fight the opioid epidemic by treating pain "safely and effectively." A website for his "Turn the Tide" campaign highlights alternative, nonaddictive treatments for pain. Not only doctors but also policy makers, insurance companies and other players in the health care system should pay attention. [continues 334 words]
ALBANY - Moving to address complaints about New York's new medical marijuana program, the state's Health Department is making substantial changes to expand access to the drug, including allowing home delivery, quite likely by the end of September. The program, which saw its first dispensaries open in January, has struggled to gain broad traction in the medical community and with potential patients. Advocates for the medical use of marijuana have said the program, allowed by a 2014 law signed by Gov. Andrew M. Cuomo, was too restrictive, and its regulations too cumbersome to fulfill its mandate. [continues 972 words]
On a Sunday morning in late July, in a small town in southwest Alabama, Barbara Moore Knight gave her fellow church members news that brought spontaneous applause and murmurs of "Amen!" She told them that her son, James LaRon Knight, was among the drug felons whose sentences had been commuted by President Barack Obama the week before. In 2004, Knight was convicted of conspiracy to sell cocaine. Although the crime was nonviolent, he was sentenced to more than 24 years in a federal prison. The sentence was a travesty, an unduly harsh punishment for a family man never accused of running a substantial criminal enterprise. [continues 507 words]
Washington - As a college student in Virginia, Corey Jacobs started selling drugs with the help of a group of friends to make some extra money. A Bronx native, Mr. Jacobs was no kingpin, and no aspect of their drug conspiracy involved violence. Now age 46, Mr. Jacobs has served 16 years of a sentence of life without parole in the federal system. No question, Corey Jacobs should have gone to prison for his felony. But does he deserve to die there? [continues 1176 words]
Supporters of a saner marijuana policy scored a small victory this week when the Obama administration said it would authorize more institutions to grow marijuana for medical research. But the government passed up an opportunity to make a more significant change. The Drug Enforcement Administration on Thursday turned down two petitions - one from the governors of Rhode Island and Washington and the other from a resident of New Mexico - requesting that marijuana be removed from Schedule 1 of the Controlled Substances Act. Drugs on that list, which include heroin and LSD, are deemed to have no medical use; possession is illegal under federal law, and researchers have to jump through many hoops to obtain permission to study them and obtain samples to study. Having marijuana on that list is deeply misguided since many scientists and President Obama have said that it is no more dangerous than alcohol. [continues 485 words]
Naloxone saves lives after a heroin overdose, but does it also encourage addiction? To the Editor: In an effort to be balanced, the article notes that critics' opposition to naloxone is based on the premise that it gives drug users a safety net, allowing them to take more risks and seek higher highs, resulting in multiple overdoses. These claims are refuted by studies in New York, San Francisco and here in Connecticut of overdose risks, undertaken before widespread availability of naloxone, in which a strong predictor of an overdose was a previous nonfatal overdose. To date, no evidence has been presented that naloxone availability or use in response to overdoses increases risk-taking or overdose frequency. Instead, there is plenty of evidence that it saves lives and provides those individuals an opportunity to seek treatment. The critics' disparaging of the lifesaving benefits of naloxone is just another example of the stigmatization of those with the chronic disorder of opioid abuse that brands such individuals as unworthy of efforts to reduce their mortality. New Haven The writer is a professor at the Yale University School of Public Health. [end]
Naloxone saves lives after a heroin overdose, but does it also encourage addiction? To the Editor: The same arguments about encouraging more risk taking were made earlier about needle exchange programs to fight H.I.V., delaying their implementation by years. But when New York State stopped heeding the naysayers and did expand access to clean needles, H.I.V. infection rates in drug users, which had stood at 54 percent in 1990, fell to only 3 percent by 2012. Now state health officials call the formerly contentious practice "the one intervention which could be described as the gold standard of H.I.V. prevention." Let's not make the same mistake by spreading similarly baseless fears about naloxone. New York The writer is the author of "Unbroken Brain: A Revolutionary New Way of Understanding Addiction." [end]
President Obama last week commuted the prison terms of 214 federal inmates who were sent to prison under draconian, '80s-era laws that have since been revised. Among them were 67 people serving life sentences, nearly all of them for nonviolent drug offenses. Mercy was granted in these cases. But the federal clemency system - which moves far too slowly and is too often blocked by politics in both the Justice Department and the White House - was never intended to manage miscarriages of justice that happen on a vast scale, as was the case when so many Americans were sent to prison under the "tough on crime" policies of the 1980s. [continues 378 words]
Naloxone saves lives after a heroin overdose, but does it also encourage addiction? To the Editor: You say naloxone "carries no health risk; it cannot be abused and, if given mistakenly to someone who has not overdosed on opioids, does no harm." In fact, like most drugs, naloxone can have adverse effects, most of which are mild, but some, such as severe hypertension, decreased platelet function, coma and death, are very significant. Severe hypertension and tachycardia can likely be exacerbated in patients who have taken amphetamines or cocaine in addition to opioids, causing heart attack or stroke. Fortunately, most overdoses treated with naloxone occur in young patients who tolerate side effects. However, I am concerned about propagating the myth that this drug is completely safe and thereby inadvertently adding a new game to the highs of addiction - get high, push the experience to near death, make sure naloxone is handy for reversal, and repeat. We may indeed see more complications if patients are using multiple rounds of opioids and naloxone. Milford, Conn. The writer is an anesthesiologist. [end]
Naloxone saves lives after a heroin overdose, but does it also encourage addiction? To the Editor: Re "A Lifesaver for Heroin Users, but No Cure for an Epidemic" (news article, July 31): As an emergency physician, I have personally administered naloxone and seen patients who would otherwise die from an opioid overdose be revived within seconds. Those who say that saving someone's life with naloxone will only foster addiction are being unscientific, inhumane and ill informed. We would never refuse an EpiPen to someone experiencing a peanut allergy for fear that it would encourage him to eat peanut butter. In Baltimore, we believe that naloxone should be part of everyone's medicine cabinet and everyone's first aid kit. That is why I issued a standing order that has made this medication available to all of the 620,000 residents in our city. We must make policy decisions based on science, not stigma. Addiction is a disease. We must treat it with the same urgency, humanity and compassion as we treat all diseases. Baltimore The writer is the Baltimore city health commissioner. [end]
Naloxone saves lives after a heroin overdose, but does it also encourage addiction? To the Editor: Some of those you interview make the case that people use naloxone to continue their pattern of pleasure-seeking behaviors, even to their own detriment. However, abuse of opioids is not an act of free will; it is an agonizing compulsion. A person with a substance abuse disorder is compelled to use even when he or she no longer feels pleasure from the act. I volunteer with the Needle Exchange Emergency Distribution to distribute naloxone, clean syringes and other harm reduction supplies to clients in the East Bay area. Tellingly, the article quotes Gov. Paul LePage of Maine saying that "naloxone does not truly save lives; it merely extends them until the next overdose." Perhaps if Governor LePage met our clients he would see that people with substance abuse disorders are as worthy of compassionate care as anyone with a chronic disease. Berkeley, Calif. The writer is pursuing a master's of public health degree at the University of California Berkeley School of Public Health. [end]
Naloxone saves lives after a heroin overdose, but does it also encourage addiction? To the Editor: Your article discusses two interpretations of the effect of Narcan, the brand name of naloxone. The moral hazard interpretation is that Narcan gives drug users a safety net, allowing some to overdose numerous times in safety. Advocates of Narcan, on the other hand, say it allows people to get into treatment, and there is no evidence that Narcan increases opiate use. Given this uncertainty, I find it difficult to understand how you can write: "There is no question that the nation's death toll from heroin and prescription opioids would be significantly higher without naloxone." It is at least logically possible that Narcan will eventually be seen to have been a wholesale mistake. WILLIAM VAUGHAN Jr. Chebeague Island, Me. [end]
Naloxone saves lives after a heroin overdose, but does it also encourage addiction? To the Editor: How could naloxone ever be considered a "cure for an epidemic"? Putting out a fire is not a cure for causes of fires. Sorry, there are no quick solutions to the addiction problem. But there are some steps we should take. Help addicts get services for the addiction and underlying mental health issues. Access to clinics is key. Yet clinics are fewer and fewer and access harder and harder. And, yes, give Narcan to first responders and addicts' families. Norwood, Mass. The writer is a psychiatrist. [end]
Naloxone saves lives after a heroin overdose, but does it also encourage addiction? To the Editor: Your article profiles a 44-year-old woman who has been revived seven times using the lifesaving drug Narcan. At what point does her own personal responsibility make her accountable for her own life? Our society and our health care system need to recognize that we can't solve everyone's problems all the time. Providence, R.I. [end]
The police raids around a gritty Brooklyn intersection were meant to show that city officials were taking charge after 33 people had been stricken by suspected overdoses of K2. But the spectacle, captured by a crush of news media, came up all but empty, without a single packet of the drug seized. The outcome of the attempted crackdown underscored the challenges the authorities face in combating K2, a potent substance that is easy to distribute and hard to regulate. Its low price and powerful high have made it popular among some homeless people, and its effects have periodically transformed patches of the city - like the one on the border of Bushwick and Bedford-Stuyvesant where the raids were carried out - into theaters of public drug use. [continues 873 words]
Almost as soon as the young man crouching on a trash-strewed street in Brooklyn pulled out a crumpled dollar bill from his pocket and emptied its contents of dried leaves into a wrapper, he had company. A half-dozen disheveled men and women walked swiftly to where the young man was rolling a cigarette of a synthetic drug known as K2 to wait for a chance to share. The drug has been the source of an alarming and sudden surge in overdoses - over three days this week, 130 people across New York City were treated in hospital emergency rooms after overdosing on K2, almost equaling the total for the entire month of June, according to the city's health department. About one-fourth of the overdoses, 33, took place on Tuesday along the border of Bedford-Stuyvesant and Bushwick, the same Brooklyn neighborhoods where, despite a heightened presence of police officers, people were again openly smoking the drug on Thursday. [continues 918 words]
The legalization of marijuana is inevitable. The most we can hope for is that people are educated about the potential downsides of the so-called weed. We can hope that pot smoking will not give rise to the kind of alcohol fueled traffic fatalities we see now. Of course, we all know that people have been known to smoke and drive and have been involved in accidents but once it is legalized, there will doubtless be more pot users who will drive "under the influence." [continues 571 words]
A federal judge in Manhattan ruled on Tuesday that drugs seized from a man charged in a narcotics case could not be used as evidence, because agents had not obtained a warrant for a covert cellphone tracking device that led them to his Washington Heights apartment, where the drugs were found. The portable device, known as a cell-site simulator and often referred to as a Stingray, has been used widely by federal and local law enforcement officials around the country, including in New York, to solve crimes and locate missing people. [continues 521 words]
There is a word that local residents and workers use to describe a group of drug users whose presence they say has grown around a busy Brooklyn transit hub: zombies. What was once a few familiar faces has turned into a tribe of strangers, walking around, staggering and looking lost, in the throes, it is believed, of the ill effects of K2, a synthetic drug that officials in New York have been working hard to eradicate. The problem in the neighborhood has gotten to be such that a manager of an urban farm nearby, tired of the smoke wafting onto the property, posted two hand-painted wooden signs with a simple message: "No Smoking K2." [continues 774 words]
Inside New York
