Tag Archives: Prescription Drugs

Fentanyl Overdoses Are Rampant, But Where Is The Drug Coming From?

Fentanyl Overdoses Are Rampant, But Where Is The Drug Coming From?

By now, most of America is well aware of the ongoing opioid epidemic, or has at least heard about it on the news a time or two. However, while most of the country recognizes the names of the most common opioids – names like heroin and OxyContin – and may even have a little knowledge regarding their effects, the true danger of fentanyl remains a mystery to many. What is Fentanyl? Why is it so dangerous? Where does it come from?

What Is Fentanyl?

Fentanyl is an opioid, which means that it is a compound that resembles opium in the way it physically or psychologically affects the user. Originally developed in 1959, fentanyl is a synthetic opioid meant to provide anesthetic and pain relieving effects to those who had recently had major surgery. Like other opioids, such as morphine and codeine, fentanyl was first produced for medical purposes.

Fentanyl is over 100 times stronger than morphine, which made it extremely effective at addressing pain during and after surgery. In the 60’s, fentanyl was administered as an intravenous dose to provide anesthetics before surgery. Due to the drug’s usage primarily in the hospital setting, there were no cases of fentanyl abuse at that time.

However, in the 1990s, manufacturers developed a fentanyl patch that could be applied to the skin for long-term pain relief, as well as a lollipop that could be consumed to provide pain-relieving benefits. Cancer patients enjoyed the pain relieving benefits of fentanyl, as well as the reduction in the emotional responses to pain. Unfortunately, recreational users did, as well.

Why Is Fentanyl So Dangerous?

As mentioned, fentanyl is extremely potent – 100 times stronger than morphine and 50 times stronger than heroin. In fact, even two milligrams is strong enough to cause death in adults. So, why do users risk death with such a strong substance? Sometimes, those using fentanyl are unaware.

In the early 2000’s, drug cartels began cutting fentanyl with a number of other illicit drugs, including cocaine, methamphetamines, and especially heroin. Sometimes, the cut drugs are diluted and sold in bricks; other times, the product is pressed into pills and sold as Xanax, OxyContin, or other prescription medications. Either way, a poorly mixed batch can feature areas rich in fentanyl, which is much stronger than the drugs it imitates. An unsuspecting user can consume high amounts of fentanyl without even knowing they’re using the drug.

What’s the motivation behind cutting fentanyl into other drugs? First, fentanyl’s ready availability from foreign laboratories makes it hard for dealers to pass up the ease of mass production. Compared to heroin, which takes months of growing and cultivating – not to mention land – accessing synthetic fentanyl is simply easier. In addition, the high potency of fentanyl means manufacturers must only include a little in each pill on order to give the user the effects of using another prescription opioid.

Diluting and cutting fentanyl can result in a great deal of money to be made. In fact, street values of a kilogram of diluted fentanyl can reach upwards of $350,000, all for a product that cost only $3,000 in its purest form. In pill form, that same kilogram can result in a million pills worth as much as $20 apiece – up to $20 million in profits for the seller.

Where Does Fentanyl Come From?

One source of fentanyl in the US is legal prescription medications. Some users improperly obtain and consume fentanyl lollipops for recreational purposes. Others remove fentanyl gel from the fentanyl patches and concentrate and inject or smoke it. Still, legal prescriptions are only one source of fentanyl.

Primarily, fentanyl in the United States comes from China, through multiple channels. One way Chinese manufacturers send fentanyl to the US is via direct mail. Consumers purchase fentanyl and other drugs over the dark web; the drugs are then packaged and arrive directly at the consumer’s mailbox, ready for consumption. Since fentanyl is so potent, the product arrives in tiny envelopes, packed in small packages that are easy to overlook with the large volume of international mail that passes through the US Postal System every day.

In many cases, fentanyl via mail is intentionally mislabeled so that it passes through other countries that proved less conspicuous than China. Often, packages travel through countries like Tonga and Canada before finding their way to the United States. Hundreds of shipments are seized each year, but hundreds more arrive at their destinations. When you consider just how potent a small envelope of fentanyl is, hundreds of shipments takes on a scary, new meaning.

However, in other cases the fentanyl pipeline is much more complicated than a direct route from China to US shores. First, much of the bulk fentanyl produced in China gets funneled through Mexico, where it is accessed and distributed by the same drug cartels that push other drugs across the US border. It is diluted, cut with other drugs, and distributed – usually through San Diego – to dealers across the county.

How does the fentanyl cross the border? The bulk of the US fentanyl trade comes from the Sinaloa and Cártel Jalisco Nueva Generación cartels. Like many other drugs, fentanyl reaches the US via the cartel’s smuggling routes on foot, via car, semi-truck, or boat. To that end, seizures of fentanyl have occurred in produce trucks, shoes, buses, and in airport passenger terminals.

What Can We Do About It?

Investigators in the United States and Mexico are working together to try and halt shipments of fentanyl from coming into the United States, which includes efforts to cease manufacturing, cutting, and transport operations in Mexico. Border security, mail inspections, and other efforts continue on both sides of the US borders with Canada and Mexico. China, as well, has begun efforts to curb fentanyl production with a series of regulations on the chemicals involved.

Still, officials are fighting a tough battle. Fentanyl has maintained its position as the most commonly overdosed drug in the United States since 2016, when it first surpassed other opioids in that respect. Similarly, between 2014 and 2015, officials saw a 2,400% increase in the seizure of fentanyl at the border. Cooperation among all countries and agencies is necessary to limit the amount of this truly dangerous drug that crosses our borders.

We Need Your Help in Fighting the Opioid Epidemic

We Need Your Help in Fighting the Opioid Epidemic

Countless people throughout the United States have experienced substance abuse in some way, either personally or through a relative or close friend. Although there are many destructive substances causing havoc in American communities, opioids are the deadliest. The numbers of opioid prescriptions, opioid overdoses, and opioid-related deaths have skyrocketed in recent years, and it’s up to everyone to fight this ongoing epidemic.

How Can I Help?

One of the best ways you can help fight the opioid epidemic is by talking to your friends and loved ones about substance abuse. Even if you believe that no one you know is struggling, many people hide their addictions or simply don’t pay enough attention to them because they do not realize the danger. Starting conversations is one of the best ways to drive awareness of this issue, so be sure to talk to the people you know and love.

It’s also important to know how to spot the warning signs of addiction. If a friend or relative starts displaying odd behavior, seems preoccupied when you spend time with him or her, or has sudden financial trouble, these could all be signs of a blossoming addiction. Let him or her know you are concerned, and if you discover that any type of substance abuse is happening, help him or her find resources for treatment and recovery.

Advocacy Programs

Starting conversations in your own circles is definitely helpful, but you can take this a step further if you have the time to join an advocacy group. There are addiction advocacy organizations all over the country, so you should be able to find one close to you relatively easily. When you take part in an advocacy program, you may work toward informing your community about the dangers of substance abuse in your area, but these organizations offer other opportunities as well. People who have completed recovery often participate in such programs to act as mentors, guides, and sponsors to people just starting their recovery journey. You can also plan and participate in community actions, charity drives, and many other events.

Donating To Help Substance Abuse Treatment

Echo Recovery is a not-for-profit organization that helps connect people struggling with addiction to specialists and treatment centers that can help them recover. You can help this endeavor by donating items that sober living and addiction treatment homes greatly need.

Living in a residential treatment program or transitioning from rehab to recovery are difficult times for people struggling with substance abuse, and the items you donate can make a tremendous difference in many peoples’ recovery experience.

Basic items like bedding (twin size), pillows, pillowcases, and comforters help people in recovery live comfortably as they work toward lifelong sobriety. You can also donate paper items and cleaning supplies like paper towels, toilet paper, trash bags, soaps, detergents, and disposable plates, cups, and cutlery. During a stay in a residential treatment program, patients start to relearn the basic requirements of daily life like cooking, cleaning, and doing laundry. Dish soap, laundry soap, dryer sheets, cooking utensils, and pots and pans are tremendously helpful in this regard.

You can also donate lawn care equipment like mowers, weed whackers, and gardening tools. We accept new and some gently used items. Donations can also take the form of gift cards to gas stations, grocery stores, and department stores like Target and Walmart. These donations will allow recovery patients to shop for basic living essentials in their areas. You can also donate nonperishable food.

Questions About Donating?

If you’re unsure what type of donation to make, want suggestions for a future donation, or simply don’t know where to send your donated items, contact Echo Foundation today and we’ll be happy to answer any questions you may have about donating. We can also let you know of items in high demand or whether a gently used item qualifies for donation.

Mailing a donation of supplies may not work for everyone, so if you’d prefer to make a cash donation, you can do so through the Network for Good. Your donation may be tax deductible as well, so be sure to speak with a tax advisor in your area about your donation to make sure you meet any applicable regulations or donation caps for your area.

Join The Echo Foundation Network

The Echo Foundation blog covers the latest news in substance abuse, treatment, and the latest statistics across the country. We are dedicated to providing the public with the latest and most accurate information regarding substance abuse and treatment in the United States. Continue following our blog for the latest news and to learn more ways you can help those in need during recovery.

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help for veterans with PTSD

For Veterans Suffering Trauma, Prescription Drugs Push Abuse and Addiction

Thirteen years of war and the now ongoing Operation Freedom’s Sentinel and Operation Inherent Resolve in the Middle East have resulted in the highest number of veterans of foreign wars since the Vietnam era. These men and women who have made great sacrifices on behalf of our country come home and face a variety of problems, including:

  • Lack of job opportunities
  • Financial problems
  • Homelessness
  • Mental health disorders

Mental health issues – such as post-traumatic stress disorder (PTSD), anxiety disorders and other stress-related disorders, such as major depressive disorder (MDD) – are especially common due to traumatic wartime experiences. According to a 2015 VA report, around 24 percent of veterans returning from the Iraqi and Afghanistan wars suffer from PTSD. And about 30 percent of Vietnam War era veterans have had PTSD at some time in their lives.

ptsd military man

PTSD Symptoms

The cause of PTSD is the body’s inability to come down from the flight or fight response and “gets stuck” or the person’s inability to move forward after going through a traumatic event. It can also manifest days, weeks or months down the road when something that reminds the veteran of the traumatic event triggers it.

Although diagnosis can only be done by a medical professional, here are some basic PTSD symptoms. These are not the only symptoms, there are others any of which could manifest or not, because not all PTSD sufferers are the same:

  • Reliving the trauma, hallucinations or having intrusive thoughts about the traumatic event
  • Hypervigilance, feeling unable to relax, always “keyed up” or on edge, irritability with no specific or rational cause, feelings of aggression, etc.
  • Nightmares, sleep disturbances, insomnia, other sleep-related problems

 

Dept Veterans Affairs Sign

Because treatment of PTSD relies on a certain set of criteria to manifest and if not all those criteria are met, many a veteran is misdiagnosed and not given the proper treatment. In 2014, the VA system was woefully inadequate to properly serve the needs of our veterans. In 2017, after a $10 billion program was instituted to reduce wait times and get vets faster care, the wait times for first appointments and specialty care appointments has gotten better, however there is still a lot of room for improvement, especially in patient care.

Not only do vets still face fairly long wait times, but when they finally see a doctor they are often simply given prescription medications that have a host of potential side effects, including addiction.

Help for Vets with PTSD: Are We Too Reliant on Prescription Meds?

organizations that help vets with PTSD

Trauma-related mental disorders are complicated to treat because each individual has different circumstances and varied responses to medication. Doctors need to be able to carefully diagnose the needs of each individual and try different treatment regimens to see what each patient responds best to, while minimizing harmful side effects. Many veterans also have co-occurring psychiatric issues, such as MDD, which occurs in about 50% of veterans diagnosed with PTSD.

But if it takes weeks and weeks for a vet to get one doctor’s appointment, and even then, getting the right diagnosis within a cattle-call system that still requires a lot of overhaul, then it’s very difficult for vets to get the individualized care they need. Simply giving them a prescription and then hoping for the best opens up vets to the very real risks of drug abuse and addiction, which only adds to the problems our vets face when they return home after serving our country.

The list of medications that can be used to treat mental illness in vets is extremely long (see below). What are the odds that the doctor is going to get it just right the first time when the patient is finally able to get an appointment?

Drugs that vets can be prescribed to treat PTSD-related symptoms fall into the following five categories.

Antidepressant Medications

These can be selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors and are meant to balance the chemicals in your brain called neurotransmitters that affect mood and emotions. They should help improve mood, allow for better sleep and concentration.

  • Amitriptyline (sold under brand names Elavil, Endep, Levate, others)
  • Amoxapine (Asendis, Defanyl, Demolox, others)
  • Bupropion or bupropion hydrochloride (Wellbutrin)
  • Citalopram (Celexa, Cipramil)
  • Clomipramine (Anafranil, Clofranil)
  • Desvenlafaxine (Pristiq)
  • Desipramine (Norpramin, Pertofrane)
  • Doxepin (Deptran, Sinequan)
  • Duloxetine (Cymbalta)
  • Escitalopram (Lexapro, Cipralex)
  • Fluoxetine (Prozac, Sarafem, others)
  • Flurazepam (Dalmane, Dalmadorm)
  • Fluvoxamine (Faverin, Fevarin, others)
  • Imipramine (Tofranil)
  • Maprotiline (Deprilept, Ludiomil, Psymion)
  • Mirtazapine (Avanza, Mirtaz, Zispin, others)
  • Nortriptyline (Sensoval, Aventyl, Norpress, others)
  • Paroxetine (Paxil, Pexeva)
  • Phenelzine (Nardil, Nardelzine)
  • Protriptyline (Vivactil)
  • Sertraline (Zoloft, Lustral)
  • Trazodone (Oleptro, Trialodine)
  • Trimipramine (Surmontil, Rhotrimine, Stangyl)
  • Venlafaxine(Effexor)
  • Vilazodone (Viibryd)
  • Vortioxetine (Brintellix)

Anti-Anxiety Drugs

These work by increasing serotonin in the brain and decreasing dopamine levels,or by blocking the effects of norepinephrine, a stress hormone involved in the fight-or-flight response. thus relieving the symptoms of anxiety.

  • Alprazolam(Xanax)
  • Buspirone (Buspar)
  • Chlordiazepoxide (Librium)
  • Clonazepam (Klonopin)
  • Diazepam (Valium)
  • Estazolam (ProSom, Eurodin)
  • Hydroxyzine (many names)
  • Lorazepam (Ativan, Orfidal)
  • Midazolam (Dormicum, Hypnovel, Versed)
  • Oxazepam (Serax, many others)
  • Temazepam (Restoril)
  • Triazolam (Halcion, Trilam, others)

Antipsychotics

Usually used for bipolar disorder, these also work for anxiety, as they treat the hallucinations, aggression and flashbacks that may be a part of PTSD

  • Aripiprazole(Abilify)
  • Asenapine (Saphris)
  • Fluphenazine (Prolixin, Modecate)
  • Haloperidol (Haldol, others)
  • Iloperidone (Fanapt)
  • Loxapine (Loxapac, Loxitane)
  • Lurasidone (Latuda)
  • Olanzapine, sometimes in combination with fluoxetine (Zyprexa, Zypadhera or Symbyax)
  • Perphenazine (Trilafon)
  • Pimozide (Orap)
  • Prochlorperazine (Compazine, Phenotil, others)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Thiothixene (Navane)
  • Ziprasidone (Geodon, Zeldox, Zipwell)

Mood stabilizer

Also mostly used for bipolar disorder, these literally stabilize the mood swings caused by PTSD, by reducing overreaction to stressful situations.

  • Carbamazepine(Tegretol, Carbatrol, others)
  • Divalproex sodium(Depakote)
  • Lamotrigine(Lamictal)
  • Oxcarbazepine(Trileptal)
  • Valproic acid(Depakene, Valproate)

Sleep Aids

These drugs help the brain reduce production of adrenalin and allow a person to go to sleep. Some of these are adrenergic blockers or beta blockers. These all also allow for a restful sleep.

  • Butabarbital (Butisol)
  • Eszopiclone (Lunesta)
  • Prazosin hydrochloride (Minipress, Vasoflex, others)
  • Ramelteon (Rozerem)
  • Zaleplon (Sonata)
  • Zolpidem (Ambien)

Bottom line: Simply medicating our vets, especially without giving them adequate follow-up care with their physicians, puts them at greater risk for problems stemming from prescription medication.

PTSD and Substance Abuse

Vets with PTSD are at greater risk for substance abuse in three ways:

  1. Some prescription drugs used to treat PTSD symptoms can be addictive.
  2. Vets who don’t get proper treatment for their symptoms may turn to alcohol and/or drugs to ease their symptoms on their own.
  3. Not enough or no psychotherapy or family support to help with PTSD symptoms.

While improper treatment can lead to addiction, many vets simply don’t get any care for their trauma-related illness, which can lead to:

  • Withdrawal from or disinterest in previously enjoyed activities
  • Job loss
  • Financial difficulties
  • Relationship problems
  • Feelings of hopelessness, guilt or shame
  • Homelessness
  • Death

woman soldier ptsd

The suicide rate for veterans with PTSD is 50 percent higher than the national average. Overdoses are more likely to occur when substances are mixed (like prescription meds and alcohol), which is more likely to happen without proper doctor supervision.

Vets who have already developed a substance use disorder need treatment for both the addiction and their PTSD. This requires timely access to dual diagnosis professionals who can properly assess the individual’s needs and provide appropriate treatment.

Healthcare organizations that help vets with PTSD and addiction need to use a combination of therapy, medication and other proven treatment methods. The important thing is to ensure that each veteran gets the care he or she needs in a timely manner and with appropriate ongoing treatment.

How Can I Help Veterans with PTSD?

stressed soldierJust as our servicemen and women have fought for freedom abroad, it is up to us to help fight for their well-being here at home. While there’s not a single solution to the problems that plague the VA medical system, our country can find solutions when concerned citizens take an interest.

The first step is engaging in open conversation about the issues and ways to solve them. We invite you to join the discussion online and share your thoughts on how we can better care for our soldiers when they return home.

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This was originally posted on May 15, 2018 and updated on August 8, 2019.