PHARMACIST STEVE

http://www.cleveland.com/metro/index.ssf/2016/09/dea_head_heroin_crisis_wont_be.html

CLEVELAND, Ohio — The head of the U.S. Drug Enforcement Administration says that the answer to the explosion of deaths attributed to heroin, fentanyl and other powerful opioids isn’t as simple as locking the problem away in prison cells.

Chuck Rosenberg, the former federal prosecutor who now heads the DEA, made the remark Monday while meeting with a small group of reporters in Cleveland, a city within a county that saw a record number of drug overdose deaths in August.  

“I’ve been saying this ever since I was brand-new (Assistant U.S. Attorney) 25 years ago: we’re not going to prosecute or enforce our way out of this mess,” he said. “Prosecution is enforcement is a big part of it, but we’ve got to do a much better job of getting the word out about how dangerous this stuff is.”

Rosenberg was in Cleveland as his agency is working in tandem with the U.S. Justice Department in launching a multi-faceted effort in treating the overdose epidemic by partnering with local hospitals, rehabilitation clinics and educators to try and inform the public about cutting down on the use of prescription painkillers.

Rosenberg said the agency is also urging doctors across the country to cut down on prescribing unnecessary painkillers to patients, who sometimes end up addicted to the drugs or turn to more dangerous forms of opioids, such as heroin, once their prescriptions end. 

How does a law enforcement agency go about determining when a opiate prescription is UNNECESSARY for a patient?

Rosenberg, appointed in March 2015 by President Barack Obama to lead the DEA, said they’re urging less prescriptions and for less pills. He said they’re also trying to teach parents that teenagers prescribed painkillers for sports injuries or other ailments don’t necessarily have to fill the prescriptions.

“You don’t have to come home with with 60 pills of substance X or 30 pills of substance Y when five or 10 pills will do,” Rosenberg said. “We have to be much more thoughtful and restricted in how we prescribe medication.”

The local task force is also trying to find a way around the provision in Medicaid law called the Institutions for Mental Diseases exclusion which limits federal funding to short-term in-patient service providers with more than 16 beds for people fighting heroin and other drug addictions.

The in-patient services are proving more effective in treating heroin addiction than out-patient services, U.S. Attorney Carole Rendon said.  But wait times for beds can take weeks or months since providers tend to stay under the 16-bed limit to keep Medicaid funding. 

“Our treatment providers need the ability to treat more people at the same time,” Rendon said. “One of the things they want addressed is that exclusion, especially in the midst of this epidemic. As a community we need to figure out a way to do that; as a nation we need to be able to figure out how to do this.”  

Cuyahoga County recorded a record-high 52 opioid deaths in August and could surpass that total in September, Rendon said. The county is on pace for more than 500 overdose deaths in 2016 and has already surpassed the 2015 record high of 228 deaths.

New drugs being cut into the heroin have contributed to the deaths, beginning several years ago with fentanyl, which is about 50 times more potent than heroin.

Now, carfentanil, sedative for large animals, is being cut into heroin sold in northeast Ohio. The opioid is between 2,500 and 5,000 times more potent than heroin and has been linked to a dramatic increase in deaths in the Akron area. The drug is trickling into the Cleveland area, with the first two confirmed carfentanil deaths in Cuyahoga County coming in August.

Carfentanil is so powerful, Rosenberg said, that even a small amount accidentally inhaled or absorbed through the skin by first responders could be deadly.

Rosenberg said they’ve trained their agents on distributing the opioid overdose remedy Narcan, not so much for victims, but to treat first responders or fellow law enforcement officers who handle the drugs and are the first to arrive to the scene of an overdose death.

“We’ve sent out an alert to all cops, all sheriffs, all first responders about the lethality of handling this or handling something that might contain fentanyl or carfentanil,” Rosenberg said.

Rendon said the county is dealing with another new drug trend: fentanyl-laced cocaine which resulted in 70 overdose deaths in the county this year. There were 17 cocaine-fentanyl deaths in Cuyahoga County last year, Rendon said.

“So if you think you’re buying cocaine and it’s really a mixture of cocaine and fentanyl, the likelihood of overdose is going to increase exponentially,” Rendon said. “We’re seeing this crisis change and morph from painkillers, to heroin, to fentanyl to carfentanil and all of these various mixtures.”

Rosenberg, who went to Toledo later in the day and planned to visit Detroit on Tuesday, said the version of fentanyl sold on the streets first made its deadly mark on the country about 10 years ago.

The DEA tracked the source to a single lab in Mexico and shut it down. The drug largely disappeared until several years ago, when dealers in China began making the drug available to dealers across the world via the internet.

“Your return on your, I hate to call it an investment, but your investment for fentanyl is many, many times higher,” Rosenberg said. “It’s easier, cheaper and more plentiful.”

Tracking online sellers is more complicated and a decline in DEA agents is hindering investigators ability to quickly find the suppliers, Rosenberg said.

U.S. dealers are also finding they make more money from users by selling the more potent form of heroin to customers seeking a more powerful high, Rosenberg said. The traffickers also save on costs from not having to grow and cultivate poppy plants that are turned into heroin.

“That’s why we’re also focusing on the demand side,” Rosenberg said.

Filed under: General Problems