Blog 7 – Programs to Make a Difference
POSTED 11-28-21
In collaboration with Weed For Warriors (WFW), 100 Million Ways (100MW) has expanded its mission:
"To support scientific data collection to determine the impact cannabinoids have on opioid use and PTSD, and the associated anxiety, depression, and decreased quality of life, and to provide an online community to support people with these life challenges who are interested in cannabinoids as a wellness treatment option."
In addition to website upgrades, there are three programs in the works:
1. Online, moderated, and anonymous psycho-social sessions on various topics including managing day-to-day anxiety and relationship management programs are being built with Shimmer.Care, spun out of UCSF. This is supported by a gift from Columbia Care.
○ Participation is free for 100MW members.
○ Each session is one hour and includes ten participants at $12 per session per person. and $1,200 for a complete ten-week curriculum for ten participants.
○ Most curriculums run for ten weeks.
2. 100MW is collaborating with The National Association of Mental Illness (NAMI) in San Diego to build a peer support curriculum that will give individuals a certification as a peer support specialist. 100MW is fundraising for this.
○ 100MW can engage them (pay them) as moderators for 100MW Buddy Bot online chat sessions.
○ The certificate could bring additional similar opportunities.
○ It could become a career pathway for certified individuals.
○ Each certification costs $250.
3. Finally, 100MW has built a research data collection registry, a secure web-based observational study, using validated questionnaires to measure the impact cannabinoids’ have on PTSD symptoms and opioid use. 100MW is fundraising for this.
○ This will roll out on the web and to multiple dispensaries in early 2022.
○ The cost is $50/year per participant.
○ Enrollment will be at least 2,500 and the duration will be at least three years.
○ The quality-of-life toolkit enables participants to measure their ups & downs over time.
○ It's expensive, but the model is built on best practices for regulatory-grade data collection. Data output (publications) will inform 100MW members, people using cannabinoids and support WFWs’ efforts to drive change in federal policy.
Blog #78: The Overdose Crisis
POSTED 11-16-21
Doctors are under pressure to reduce the amount of opioid drugs they prescribe to their patients. As a result, thousands of physicians, hospitals, and pharmacies across the country use the software program NarxCare to distill information from states’ drug databases to guide their prescribing practices. The NarxCare algorithm creates profiles of patients and is designed to identify individuals who may be at risk for drug addiction and overdoses. But is NarxCare locking patients out of pain medication that they need?
In a recent presentation by a major clinical information provider, there was a sense of success regarding a significant decline in the number of opioid prescriptions being written in America. Unfortunately, I think this is not so. In 2020, the pandemic year, a record 93,000 Americans died from overdoses — 254 people a day - more than 10 every hour. Three-quarters of them died from opioids, often by unknowingly using drugs laced with fentanyl. Fact is that the “success” of less prescriptions being written is part of the problem — not part of the solution.
A paper by UC San Francisco indicates, “there are more overdose deaths when drugs are not available,” as unavailability sends users into the streets where the drugs are laced with cheaper, dangerously potent opioids, including fentanyl. Thus the opioid crisis has become the overdose crisis.
A new blueprint for confronting this epidemic has emerged that is better than algorithms that merely restrict access, it is a public health approach. A public health approach includes increasing access to medications and treatments for people suffering from substance use disorder (SUD). It also implies increasing the availability of harm reduction services including life-saving emergency medications like naloxone, which can prevent an overdose from becoming a death and raising awareness and reducing stigma through public communication campaigns. Finally, it also means lending creativity and alternatives to a failed system.
The Drug Addiction Treatment and Recovery Act, Measure 110, goes into effect in Oregon on Feb. 1, 2022. Oregon will be the first state in the nation to decriminalize the personal possession of hard drugs such as cocaine, heroin, methamphetamine, and oxycodone. In addition, the measure reclassifies possession of small amounts of drugs as a civil violation. Offenders will face a $100 fine, which can be avoided by agreeing to participate in a health assessment. The Oregon Criminal Justice Commission estimated that yearly convictions for possession of a controlled substance would decrease by 3,679, or 90.7%.
Measure 110 also funds addiction treatment and harm-reduction efforts by relocating dollars from the Oregon Marijuana Account, the state's cannabis tax. Funds also are expected to come from state savings from reductions in arrests, incarceration, and official supervision. It’s a radical approach and just may work. Canada is trying a similar program called “Safe Supply.” Safe Supply goes further than Oregon’s plans. It makes pharmaceutical-grade drugs available to users to eliminate/minimize the need to buy street drugs.
Can these new approaches find the success Portugal has had after all drugs were decriminalized in 2001?
All eyes are on Oregon and Health Canada.
Blog #77: Mental Health Is Health
POSTED 10-26-21
"Mental health is health" has become a common phrase as the COVID-19 pandemic's toll on mental wellness becomes clear. Mental health is a continuum that can stretch from feeling good to where we are struggling (and back again). From the glass-half-full perspective, the pandemic experience has increased the reach and accessibility of mental health services. That’s a good thing since half of Americans will meet criteria for a mental disorder at some time in their lifetimes. The connection between mental and physical health with the disease that is addiction and the disorder that is PTSD, has become a first order of business for 100 Million Ways (100MW). With Shimmer Care, 100MW is building a program that will provide free, web-based, moderated, and anonymous support sessions, one hour each week for ten weeks. These sessions will cover a number of mental health topics like dealing with day-to-day stress and managing relationships.
In a nicely controlled study of the medicinal effects of cannabinoids, published in the journal Frontiers in Psychiatry, found cannabinoids relieve depression and improve quality of life. The study included a control group, although no placebo group and used a self-reported model. These outcomes have become “no surprise.” So many well-designed, but not placebo controlled, clinical studies provide a lot of real-world evidence – but they are not scientific clinical trials. Clinical trials are limited by federal governments classification of cannabis as a schedule 1 drug, like heroin. Considering the large number of people using cannabinoids, clinical trials are increasingly important to inform policy makers, clinicians, and the population at large. Ask someone with PTSD anxiety and depression. Ask someone trying to manage chronic pain with less opioids. Ask them about their quality of life with cannabinoids versus without cannabinoids. In the partnership between 100MW and Weed For Warriors (WFW), WFW will continue to drive political action and 100MW will continue to collect high quality real-world data. Together, we will provide services that will help all our members get by.
Clinical trials of “illegal” substances can be done. It’s not easy but thanks, in part, to the ground-breaking work by the Multidisciplinary Association for Psychedelic Studies (MAPS), with MDMA in PTSD, Johns Hopkins has received the first National Institutes of Health (NIH) grant to fund a multi-site study on psilocybin and smoking addiction. Cannabinoids are not far behind.
Blog 76 – Good Things Are Happening
POSTED 10-26-21
100MillionWays (100MW) has received a generous donation from Columbia Care, Inc., one of the largest and most experienced cultivators, manufacturers, and providers of medical and adult-use cannabis products. As we prepare to launch free, web-based, psycho-social sessions for our members, this donation will fund fifty, 10-week sessions (one hour, each week). That is huge. Thank you.
And in another piece of good news: Sean Kiernan, Co-Founder of Weed for Warriors Project (WFWP) announced that his organization is "excited to be partnering with 100MillionWays to bring more services and good science to bare on the problems facing veterans needing safe access to medical cannabis and supportive care. With 100MW, W4WP will be able to expand the services offered to its members and access to clinical health services that will serve to further validate our community-centered approach to caring for veterans living with PTSD and chronic pain who use cannabis to reduce their dependency on narcotic drugs like opioids."
This is a natural fit. There is a significant amount of cross over in the populations we both serve. The 100MW and WFWP partnership will bring services to members to improve day-to-day quality of life. And cannabinoids have so much real-world evidence to support safety and effectiveness in helping to treat pain, anxiety. Together, we will continue to drive for policy change to de-schedule cannabis at the federal level so clinical trials can inform the best uses of cannabinoids to treat diseases and disorders and social inequities related to incarceration can be rectified.
Blog 75 – PTSD - a Similar Mission
POSTED 9-26-21
100 Million Ways (100MW) is adding Post-Traumatic Stress Disorder (PTSD) to its mission. The same questions being asked about cannabinoids and opioid use need to be asked about cannabinoids and PTSD. Over two million Americans have opioid use disorder (OUD), and 62% of them also have a mental illness. US veterans of Iraq and Afghanistan with a mental health diagnosis, especially PTSD, have an increased risk of receiving opioids for pain, a high risk of opioid use, and increased adverse clinical outcomes. As 100MW examines the impact cannabinoids have on opioid use, it makes sense to extend the research question to determine if cannabinoids help people with PTSD deal better with anxiety and depression. Can cannabinoids be an adjunct to psychological counseling to better treat PTSD? Does participation in a web community bring value to veterans with PTSD?
Post-traumatic stress disorder (PTSD) is a mental health condition that can be triggered by a terrifying or traumatic event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares, and severe anxiety, as well as uncontrollable thoughts about the event. DSM-5 proposes four distinct diagnostic clusters instead of three. They are described as re-experiencing, avoidance, negative cognitions and mood, and arousal.
In some cases, particularly where it is not treated, PTSD can last a very long time, perhaps the remainder of one’s life. Most people with longstanding PTSD find that the symptoms are not steady in their severity. For some people, PTSD symptoms gradually fade over time.
While PTSD is most often associated with veterans of foreign wars, and it is unconscionable how many of America’s veterans are living with PTSD, it can happen to anyone. It’s a significant life challenge. Take a quick self-assessment at https://landing.google.com/screener/ptsd?source=google
Blog #74 International Overdose Awareness Day
POSTED 9-12-21
#InternationalOverdoseAwarenessDay is August 31 each year. It is sad that we have this day. The seeds were planted in 1995 when the American Pain Society introduced pain as the #FifthVitalSign. That same year, oxycodone (#OxyContin) came to market.
Half million deaths and way too much pain and suffering later there is good stuff being done.
The National Institutes of Health established the Helping to End Addiction Long-Term Initiative (#HEAL), funding scientific solutions to address the opioid (overdose) crisis, clearly made even more urgent since the #COVID19Pandemic fueled a 30% increase in #OverdoseDeaths to 93,000 in 2020 — the highest ever.
#Naloxone became readily available, and 46 states enacted laws that provide protection for laypeople or first responders who administer naloxone.
The number of clinicians able to prescribe #Buprenorphine and the number of treatment facilities continue to increase.
To date, the HEAL initiative has funded $1.5 billion to more than 500 research projects on #OpioidMisuse and #PainManagement including:
—#Community-based #communication campaigns targeting #stigma, naloxone delivery, and data dashboards to guide community decision-making.
—#Research has led to a new, non-opioid approach to treat neuropathic pain and 16 INDs have been approved for existing medications to be tested to treat opioid use disorder.
—Novel treatments are being explored, such as an #OxycodoneVaccine - currently being tested in phase 1 #ClinicalTrials.
—FDA-granted “breakthrough device” status on devices to treat infants with #NeonatalOpioidWithdrawalSyndrome and patients with #ChronicBackPain.
—Three large clinical studies are underway to define a standard of care for babies born dependent on opioids.
This is good stuff; but there is so much to be done. In addition there is not nearly enough attention being paid to #MentalHealth. The public effort is slow. The private community needs to lend creativity by funding the development of alternative approaches, #MentalWellness initiatives and driving #PublicPolicy to help people with the disease that is #OpioidUseDisorder.
Blog #73 – Patience, Persistence, and Optimism
POSTED 8-9-21
FDA advisory committees has had little love for investigational painkillers. Thumbs-down went to Nektar's oxycodegol, Intellipharmaceutics' oxycodone extended-release tablets known as Aximris XR, Durect's bupivacaine depot, and Esteve Pharmaceuticals' combination of the mild opiate tramadol and the anti-inflammatory drug celecoxib (Celebrex). “Much concern is understandably centered on the potential harms of putting new painkillers on the market, especially new opioids, without fully understanding their abuse potential. We can't approve a drug in the midst of a public health crisis based on speculation."
Post-surgical pain management is better. Orthopedic surgery was a substantial consumer of opioids. Today, post-operative total knee replacement is managed effectively with low dose, short-term opioids, and meloxicam. This approach should help decrease some percentage of future opioid abuse potential. Of course, all the above does nothing to help deal with an “out of control” overdose crisis worsened substantially by the COVID-19 pandemic.
What do we do? Mental health has to be front and center. Mental health support through web communities is proving effective. Online anonymous moderated peer engagement works. Check out https://shimmer.care. In Single Session Therapy (SST), a therapist and a client approach the web-meeting as though it will be the only one. This is also proving effective. Diversions are good such as a single shift at a food kitchen, even if it’s in-between getting high. Opportunities to get basic mentor training and manage online peer discussion groups or contribute a blog to an online community. Joining the 100 Million Ways online community provides an opportunity to share your story, engage with others, and be a part of a community.
Little things are better than nothing. There is better access to medication-assisted treatment, and America seems on the precipice of clinical trials to measure the impact of cannabis on opioid use.
Patience, persistence, and optimism!
Blog #72 – Opioid Use and C-19 Vaccinations
POSTED 8-26-21
A study published in January, 2021 from Yale, evaluating the association between county level cannabis dispensary counts and opioid related mortality rates in the United States, concluded, “Counties with higher cannabis dispensary counts saw reduced opioid related deaths.” While this data cannot be assumed to be causal, it “highlights the importance of considering how the complex supply side of related drug markets shape opioid use.”
University of Georgia, Athens analyzed Medicare drug prescription data from 2010 to 2013, and reported in the July issue of Health Affairs, “In medical marijuana states, each physician prescribed an average of 1826 fewer doses of conventional pain medication each year. That translates into many millions of doses per year in those states.”
Sir John Russell Reynolds, physician to Queen Victoria and president of the Royal College of Physicians in London, wrote in The Lancet in 1890, “In almost all painful maladies I have found Indian hemp by far the most useful of drugs.” He thought cannabis might help reduce the need for opium-based painkillers. “The bane of opiates is the relief of the moment, the hour, or the day, is at the expense of tomorrow’s misery. In no one case to which I have administered Indian hemp, have I witnessed any such results.”
Cannabis needs to be de-scheduled and clinical trials need to inform decision makers, clinicians and the increasing number of people using cannabis substances for a variety of disorders, diseases and wellness, and recreational reasons.
Blog #71 The Complex Supply Side
POSTED 8-7-21
A study published in January, 2021 from Yale, evaluating the association between county level cannabis dispensary counts and opioid related mortality rates in the United States, concluded, “Counties with higher cannabis dispensary counts saw reduced opioid related deaths.” While this data cannot be assumed to be causal, it “highlights the importance of considering how the complex supply side of related drug markets shape opioid use.”
University of Georgia, Athens analyzed Medicare drug prescription data from 2010 to 2013, and reported in the July issue of Health Affairs, “In medical marijuana states, each physician prescribed an average of 1826 fewer doses of conventional pain medication each year. That translates into many millions of doses per year in those states.”
Sir John Russell Reynolds, physician to Queen Victoria and president of the Royal College of Physicians in London, wrote in The Lancet in 1890, “In almost all painful maladies I have found Indian hemp by far the most useful of drugs.” He thought cannabis might help reduce the need for opium-based painkillers. “The bane of opiates is the relief of the moment, the hour, or the day, is at the expense of tomorrow’s misery. In no one case to which I have administered Indian hemp, have I witnessed any such results.”
Cannabis needs to be de-scheduled and clinical trials need to inform decision makers, clinicians and the increasing number of people using cannabis substances for a variety of disorders, diseases and wellness, and recreational reasons.
Blog # 70 – Big – But Not Likely Big Enough – Yet
POSTED 7-22-21
Senate Majority Leader Chuck Schumer (D-NY), along with Senator Cory Booker (D-NJ), have introduced legislation to legalize marijuana at the federal level – easing restrictive drug policies that have disproportionally impacted communities of color and the poor.
The Cannabis Administration and Opportunity Act removes marijuana from the Controlled Substances Act (CSA) and introduces regulations to tax cannabis products. This bill directs tax revenues to be invested in the opioid/overdose crisis. It also expunges federal records for nonviolent cannabis offenders.
The bill will require 60 votes to pass the Senate. This is a big step towards being able to do clinical trials on cannabis and its derivatives – but not likely big enough – yet. Another look at the MORE Act, with similar language, originally sponsored by Vice President Harris, then Senator from California, may also be on tap for review this year.
So far, 37 states and the District of Columbia have legalized the medical use of cannabis, and 18 states and the District of Colombia have legalized adult use of cannabis.
Depending on the poll you choose, nearly 70% of Americans support legalizing cannabis.
We will be watching this legislation closely.
Blog #69 : When Patients Ask...
POSTED 7-2-21
When patients ask if cannabis-based substances work for chronic pain, nausea, opioid withdrawal, migraines, or a dozen other diseases and disorders – the answer is, “probably.” While there is a growing body of real-world evidence, there are limited evidence-based answers because cannabis, in America at the Federal level, is a Schedule 1 substance like heroin. DEA defines a Schedule I substance as, “having no currently accepted medical use.” Therefore, conducting clinical trials to gather evidence to determine if there are acceptable medical uses, cannot be performed without jumping through Federal hoops, some of which can be insurmountable. In addition, there needs to be clinical trials to inform public health policies directed towards a population already using cannabis, both the medicinal and adult use consumer.
Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), said, “It’s been difficult to do research because of the Schedule 1 process,” referring to the restricted drug classification. She said NIDA is working with DEA and FDA for solutions “that will make research on marijuana less cumbersome.”
Sponsoring a cannabis clinical trial has layers of Federal bureaucracy. First, applicants must discuss their research with DEA and apply for a Schedule I license, which requires a federal site-inspection. Though registration is issued by DEA, it is NIDA which is then responsible for overseeing the distribution of cannabis for research. And since NIDA is tasked with the study of drugs of abuse, their focus is principally on the potential for harm and its prevention, rather than the potential for therapeutic use. The lack of more direct involvement by FDA creates additional challenges when it comes to proving there are accepted medical uses for cannabis.
Some of these questions about cannabis may soon be answered, at least with respect to migraines. In addition to the FDA approved study of the impact of cannabis on migraines, the University of California, San Diego now has 5 controlled FDA clinical trials underway involving cannabis. Other academic medical centers (AMCs) have also jumped through those hoops. Evidence-based answers for a number of medical uses for cannabis, when patients ask, may be on the horizon. These efforts will further add to the growing body of evidence making the inclusion of cannabis on Schedule 1 of the Controlled Substances Act (CSA) increasingly untenable and inconsistent with the facts and evidence, and more importantly better guide consumers using cannabis to manage a variety of symptoms and for recreational purposes. Bravo and thank you to all those who are participating in these trials.
Blog #68 – Three Waves
POSTED 6-22-21
The number of deaths from fentanyl have jumped more than 2100% in five years.
Fentanyl is attractive to drug dealers - cheaply manufactured in foreign labs and substituted for more expensive drugs like heroin or pressed into pills sold as OxyContin or Percocet, according to the DEA.
But chasing the supply side is a small part of the solution and to expect sobriety is not realistic. We must curtail demand by treating addiction and the root causes behind overdose risk, including mental health, incarceration, unstable housing, economic stagnation, and class-based despair.
The overdose crisis is seen as three waves. First, some drug companies convinced some doctors to prescribe vast amounts of opioids. This led to hundreds of thousands of new addictions in the 1990s and 2000s. And overdose deaths began to rise.
The second wave began in 2011, when states cracked down on “pain clinics” that were really “pill mills”, offering “doses for dollars.” Prescriptions decreased, prices rose and people who use opioids turned to street alternatives. Again, overdose deaths increased.
Finally, the third wave was initiated by drug dealers in 2015 - they cut already dangerous street drugs with fentanyl and other synthetic opioids. Again, addiction worsened – and worsened more by the pandemic - with nearly 100,000 deaths from overdose in 2020 - the deadliest toll from overdose in history.
Alternatives or adjunctive options are increasingly available. America can do this.
Blog #67 Peer Mentorship – The First Commitment: Don't Die!
6-8-21
100MillionWays.Org is gearing up to offer online training as a peer mentor to become an integral part of this supportive community on the journey to a better life balance. 100 Million Ways does not require a commitment to sobriety - just a commitment to use less opioids and not die. Peer mentors will receive compensation.
100MW believes the pendulum has swung too far in the other direction. Opioids are the best pain management solution for chronic severe pain. And people with Opioid Use Disorder will benefit significantly by using fewer opioids. Before NOT prescribing an opioid, Clinicians need to assess what’s going on with the whole person, including their disease process, social issues, and mental health. We can’t do it in a five-minute “biopsychosocial” online visit.
Opioid’s work (for some!). The 100MW mentorship program is for any community member: opioid user, family member, or friend. While 100MW is collecting data on the impact cannabis-based substances have on decreasing the number of opioids a person uses, using cannabis or not, peer mentorship is a crucial component of support for anyone challenged by opioid use. In the coming weeks, Visit https://100MillionWays.Org to learn more about membership and our fellow’s program with online training to become a peer-mentor.
Blog #66: Opioids Work
Posted 6-2-21
#Opioids are the mainstay for #painmanagement in #ICUs. Guidelines recognize the negative effects opioids pose and encourage #multimodaltherapies to decrease opioid use.
“Opioids produce analgesia by activating G protein–coupled receptors (GPCR), particularly μ-opioid receptors, in the brain and spinal cord - transmission and modulation of pain. Activation of GPCRs alters pain perception, increases pain threshold, and inhibits ascending pain pathways.”
Opioids used in ICU settings include #fentanyl, #hydromorphone, and #morphine, because #titratability of other opioids including Vicodin, Percocet, OxyContin, Oxycodone, Methadone, Opana, Dilaudud, are equally challenging.
All opioids are potentially lethal. However, the most common adverse events are constipation, drowsiness, nausea, sedation, and vomiting.
This is the same and different in the street, but the goal to use something to decrease the amount of opioids to manage #chronicpain and #opioidusedisorder (#OUD) makes sense.
#CannabisBasedSubstances help reduce pain and are readily available. There needs to be clinical trials to inform a population already using cannabis for many diseases, disorders and recreationally. For #clinicaltrials to proceed, without current restrictions, the Federal government must #DescheduleMarijuana. It is NOT a Class1 #narcotic.
Blog #65 I Feel So Disorganized
Posted 5-29-21
Whoa, so many choices we could make
There's one hundred million ways
And I tried and failed again
But I won't rest another day
Until I break the combination,
The question will I ever see the day
that paints a picture
And frees me of #addiction?
I plead #insanity
Oh, I feel so #disorganized
I couldn't even tell you where I left my #mind
And I know you'll supply the prize, you'll supply the prize…
100 Million Ways by Nash - from The Chancer
Submission from an anonymous blogger
The Death of I I sold my kids bike For a spike in my vein, My wife threw me out, In spite of my pain. I stole food from my mom, I have a right to eat, And nobody cares that I live in the street. It’s not my fault, It isn’t fair. I’m alone, I stare into the dark sky. I think it’s time for I to die.
Blog #64 Overdose Deaths in 2020, Mental Health, and What is Being Done
Posted 5-20-21
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The final 2020 total in the United States could exceed 90,000 overdose deaths, compared to 70,630 in 2019, the highest annual number on record. Adults between 25 and 44 years have been twice as likely to die from opioid overdose than Covid-19.
There has been a substantial increase in fatigue-related Google searches, and the question “why do I feel bad?” reached a record high. Americans have a collective feeling of exhaustion and are looking for ways to cope. There has also been an increase in searches related to meditation, virtual therapy, walking, and digital detoxes.
Our body’s threat detection system is working in overdrive – trying to make sense of what’s causing stress and how to react to it.
As a global society, there’s a long way to go - a reconstruction phase – and transitioning out of this will take time. The federal government has initiated a public health approach to address the opioid crisis, which includes expanding funding and resources, reforming the criminal justice system, increasing insurance coverage, increasing access to Medication-Assisted Treatment (MAT) and Mental Healthcare, and making it easier for providers to prescribe buprenorphine — a key component of MAT. A December 2020 funding package included $4.25 billion in mental health and substance use emergency funding; the recently passed American Rescue Plan (ARP) provides an additional $3.5 billion for block grants with an additional $2.5 billion to support states in their efforts to address the opioid epidemic.
A policy tool that can address multiple objectives is Medicaid Expansion. Data continue to show the positive impact of expansion on coverage, MAT access, and mortality outcomes for substance-use patients.
What is needed is an Operation Warp Speed for the Opioid Epidemic
Blog #63 - A Conversation with a Junkie
Posted 5-10-21
"I hate the word 'junkie' – but that's how I feel, like a piece of junk. Two nights ago I was high. I would have gotten higher, but I ran out of stash too early. I told myself, that’s a good thing. I told myself, no more. I’m pretty. I had a good job – maybe I can get it back. I went to bed.
"I woke up sweaty but with a chill. My stomach felt weird, and my body hurt – not a lot – but enough. I thought, maybe I’m getting the flu. I wasn’t getting the flu. Every time I quit; I wake up feeling like this. I hate waking up feeling like this, I told myself, this time I’m serious. This time I’m gonna quit.
"By 2 o’clock in the afternoon I realized that I had no plan and no one to help me. I thought, maybe I can wean myself slowly, just take a small hit. It will be easier that way, less painful. It's a good plan.
"So I scored and took a couple of hits. I felt better.
"That’s the trick; a few hits each day, until I don’t need to do it anymore. It's a good plan.
"Later that night I was high, as usual. As I ran out of stash, I told myself, no more…."
Blog #62 There's No Maybe About It
Posted 5-1-21
Americans are getting vaccinated. The economy is coming back – but the implications of COVID-19 linger for vulnerable populations. A new record – not one to feel good about – CDC reports more than 87,000 Americans died of drug overdoses over the 12-month period that ended in September – heading towards 100,000 overdose deaths in 2020. More people died of overdoses than COVID in San Francisco. This number has me feeling blue – but the glass is half full. Clinics are open. And due to the pandemic, medication assisted treatments (MATs) are more available. More physicians are able to prescribe MATs. Hopefully, PAs and NPs will get MAT approval for same.
But we are going after the supply side of this crisis and that just isn’t going to get it done. People using drugs started using in ways that were higher risk —alone and from street sources due to a confluence of despair. Fentanyl has fully permeated the illicit drug market and was/is a major factor in most overdoses. Curtailing supply is an almost impossible task. One can get fentanyl through every social networking site if you know the process. Proof is positive. I did it.
And sending people who have committed non-violent drug related crimes to jail is an anti-solution. Besides getting raped and learning all kinds of new ways to break the law, it’s just as easy to get drugs in prison as it was for me to order it online.
It’s time for America to wake up and turn to tactics that will help solve this problem. With what we’ve learned from this pandemic experience and the sense of resilience America is starting to feel, there are more creative paths to pursue. Maybe absolute sobriety for people dependent on opioids or with substance use disorder is not the only way to stop overdose deaths. Maybe adjunct treatments with less opioids will work. Maybe proposition 110 in Oregon will work. Maybe we will focus more on the mental health side of this horrible equation. Let’s get creative.
There is no “maybe” that America can do better.
Blog #61 "Caring for Caregivers:"
Technology Innovations for Caregivers
Posted 4-20-21
Family responsibility, personal satisfaction and even being acknowledged for the efforts made by caregivers are good things – but soft and don’t address the hard facts of caregiving. Deep-breathing, yoga, exercise, self-care, and time alone all make sense but can be impractical, maybe not achievable and don’t address a caregiver’s issues at hand. Frustration, stress, and unsureness of what to do loom much larger and regardless of the underlying love and concern the caregiver has for the person receiving care, family caregiving is hard. “I can’t afford a professional caregiver. It’s on me. I don’t need advice. I need real, practical help.”
Newer technologies, such as artificial intelligence, sensors and naturalistic user interfaces, can be leveraged to support family caregivers. These innovations may make it possible to provide comprehensive care to loved ones while reducing caregiver burden and burn-out. The majority (57%) of caregivers currently use technology, here and there, for one-off solutions such as medication reminders and emergency response systems.
In a recent survey, 71.5% of caregivers responded that they are interested in using technology for Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) caregiving tasks but caregivers looking to use more effective and efficient caregiving technologies are frustrated by the lack of more comprehensive technology solutions. This suggests that currently available technology does not adequately meet caregiver needs which include:
• Making and supervising medical appointments
• Assessing health needs and conditions
• Ensuring home safety
• Monitoring medication adherence
• Checking in on the care recipient
• Managing stress and emotional challenges (of caregiver)
• Grocery and other shopping
• Transportation
• Housework
• Making medical or care decisions
• Providing meals
• Budgeting for and arranging supervising paid services
• Giving medicines, pills or injections
• Making legal and financial decisions
In a 2015 Georgetown University reported that while 83% of caregivers believe “technology is going to make getting older a better or easier experience,” and while those caregivers are “actively using technology in their own lives,” they do not currently use technology “to any meaningful degree in their caregiving responsibilities because available technologies do not adequately match caregivers’ needs.” Because of this, the mélange of technology solutions present caregivers with usability challenges that prevent meaningful use.
Software developers too often provide technology the developer thinks should work. This shoehorning of a solution, that kinda, sorta covers a user’s needs, is a recipe for failure. Since this type of technology development seems unlikely for a for-profit opportunity to undertake, the responsibility falls to the government and/or the not-for-profit sector to get this done. And, since family caregivers provide billions of dollars each year of value (savings) to social costs, this seems easily turned around be grants and/or donations to cover the costs of building specific caregiver technology solutions with functions and features to support a broader range of a caregivers’ needs. It’s not that hard to do. And while talk is cheap, this needs to happen.
Caregiving will never be easy. But it can be easier. A foundation, or collaboration of Foundations is a good place from which to drive this innovation.
Blog #60 "I am abusing opioids; I have a mental illness, oh yeah, and I’m fat."
Posted 4-8-21
Explanations for the opioid crisis have focused on the supply-side factors. Probably not the right approach. Chronic pain and mental health are inextricably associated. About half of people with chronic pain also have depression and anxiety. Obesity in people with mental illness is often called the double epidemic – with a double stigma as well. Obese individuals have almost a 200% increased likelihood of chronic opioid use. Does that make this a triple epidemic/triple stigma?
Anxiety and depression can worsen chronic pain and pain can exacerbate mental health issues. Like addiction and dependence, chronic pain is complicated. The X-rays of 2 people might look the same, but their pain can be totally different. The mental impact of pain is equally individual. Obesity is associated with several pain conditions – especially low-back pain. Back pain affects nearly one-third of people classified as obese. One study found an association between obesity, low back pain, and mood disorders. In a population-based sample of men, high-intensity low back pain and disability is associated with increased levels of obesity, particularly in those with an emotional disorder.
A complicated series of reactions explains the connection between physical and emotional pain as well as obesity. The cycle of pain and mental health issues changes stress hormones and brain chemicals, including cortisol, serotonin, and norepinephrine. And as pain moves from acute to chronic, the number of areas affected in the brain expands.
Treatment for opioid abuse must start with an assessment of mental health.
Blog #59 The ODC "Odyssey" Registry
Poster 3-26-21
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Within the next few months, 100MillionWays is launching a prospective data collection #registry to measure the impact #CannabisBasedSubstances have on opioid use. The ODC (Opioid Dependence and Cannabis) Registry, pronounced "Odyssey", uses a secure online survey instrument to collect pseudonymous data about #OpioidDependence and #OpioidUseDisorder (OUD) experiences of #OpioidUsers, their families, and their friends.
The protocol and informed consent form will be submitted to an #EthicsCommittee for review in June. (An ethics committee is an independent group of people with credentials that represent healthcare as well as the community. Ethics Committees were established by federal law to protect the rights of research subjects.) The ODC Registry database will include only de-identified data. Data will not be sold. Only de-identified data will be used to inform the public about the potential for cannabis-based substances, used in a #PainManagement treatment regimen as an adjunct with or alternative to opioids, to decrease the amount of opioids patients need to manage #ChronicPain, #Dependence or #Addiction.
Illinois passed The #CompassionateUse of Medical Cannabis Pilot Program Act in 2013 allowing access to medical cannabis for individuals who have or could receive a prescription for opioids.
#MontefioreEinstein Health system in New York is collecting data for a research study called, The Medical Marijuana and Opioids (MEMO) Study: A study to examine if medical cannabis reduces opioid use among adults with chronic pain. The New York State Department of Health announced that opioid replacement is now a qualifying condition for medical marijuana (a cannabis-based substance).
The ODC Registry will add information to this growing body of research to determine the impact cannabis-based substances have on opioid use.
The DRAFT Registry database is available for review and comment at https://hundredmillionways.surveysparrow.com/s/ODC-ODYSSEY-REGISTRY/tt-64458b
Blog #58: Jail-Hell
Posted 3-18-21
More than 2 million people are in American #JailsandPrisons: 1 of 5 for drug related crimes. Department of Justice estimates 65% of the US #PrisonPopulation has #SubstanceUseDisorder (SUD). Another 20% does not meet criteria for #SUD but were #UnderTheInfluence at the time of their crime. Twenty percent more have serious #MentalIllness (SMI).
#Overdose is the leading cause of death for people recently released from prison, and the third leading cause of death for people in prison.
There are limited options for #prisoners with SUD - only a few prisons in America have implemented #MedicationAssistedTreatment (MATs) programs – <5% of people in #prison with SUD receive medication assisted treatment. Otherwise, it is limited to #BehavioralCounseling and #detoxification.
It costs about $45,000/yr. to incarcerate someone. Once incarcerated, #recidivism is high. It’s hard to have empathy for addicts – harder still for #addicts in prison. The Supreme Court has interpreted the 8th Amendment (cruel and unusual punishment) as guaranteeing the right of adequate medical care to #PrisonInmates.
It is clear that people who commit non-violent #DrugRelatedCrimes are better served by #DiversionPrograms – and so is society.
Blog #57: Mental Illness and Opioids
Posted 3-18-21
Sixteen percent (16%) of Americans have #mentalhealthdisorders. Interestingly, they receive over half of all opioids prescribed in America each year. #Opioiduse in people with serious #mentaldisorders is nearly double the general population.
Other way around – 20% of people with #opioidusedisorder, not diagnosed with #mentalillness, receive prescription medication for mental illness. The relationship between #opioidabuse and #depression is bi-directional - suffering from one increases the risk of the other. Establishing causality or directionality is difficult.
When a sample of veterans with no recent (24-month) history of depression or opioid use, received opioids for a #paincondition the risk of developing depression increased as the duration of opioid analgesic exposure increased due to the potential for a depressogenic effect from opioids.
People with #mooddisorders receive treatment 37% of the time. People with #anxietydisorder receive treatment 24% of the time. But less than 1 in 5 people with #substanceusedisorder receive treatment (18.8%). All of these number need to improve if we are to regain ground lost during the pandemic.
#Stigma is a major reason why people with either/both mental illness and OUD do not get treatment – OUD made worse by legal and social sanctioning of that stigma. But the most prevalent barrier to treatment was affordability due to a lack of #insurancecoverage.
The insurance coverage problem can be fixed – the #NOPAIN Act would have been a start – maybe it comes around again – being able to treat opioid use disorder with simultaneous attention to #mentalhealth – and vise-versa –will improve #outcomes for these #vulnerablepopulations.
Blog #56 Rats
Posted 3-4-21
#Community is defined as “a group living in the same place or having a particular characteristic in common, as well as a feeling of #fellowship with others, a sharing of common attitudes, interests, or goals.”
In the 70s, #Bruce Alexander, MD placed a rat alone in a cage. The rat was given two water bottles. One bottle contained just water. The other bottle had water with #heroin. The rat repetitively drank from the heroin-laced bottle until he overdosed and died. The #experiment was repeatable. Dr. Alexander wondered: “Is this all about the #drug or could it be related to the setting?” To test this idea, he put rats in “rat parks,” a community where they were free to roam, play, socialize and have sex. Given the same 2 types of water bottles, when in their community, the rats preferred the plain water (over the water with heroin). And if they did drink the heroin-laced water, they did so intermittently, not obsessively, with NO overdoses.
Humans, also need also to be part of a community, sharing experiences and support. This is a basic psychological truth. In medicine, the focus is symptoms, diagnoses, and evidence-based therapies. Effective, but with the unintended effect of less attention to the benefits of human interaction and community.
While participating in community is just one piece of the complex #harmreduction puzzle to decrease the amount of opioids people use, community drives #mentalwellness and it is a vital part of the path to #recovery.
Blog #55 - Who’s Caring for the Caregiver?
Posted 2-24-21
Living with someone with the disease that is addiction presents enormous challenges which affect all members of a household. “Addiction is a family disease.” The below suggested planning items scream stress, tension, sadness, anger…
• Keep you and your family safe.
• Have a response plan if matters escalate.
• Restrict access to money.
• Set boundaries for your household.
• Encourage treatment.
• Prioritize self-care.
• Join a support group.
In fact, being a family caregiver is a common family dynamic. According to CDC, 25% of Americans report being or having been a caregiver for a family member. The most common care given is for the elderly, and for people with mental illness. The typical caregiver is a 49-year-old woman. Sixty-One percent (61%) of caregivers are women. The economic value is estimated at $450M/year.
While it can be fulfilling to provide care for a family member, facts are, “Fifty-three percent of caregivers report that their physical health suffered as a caregiver.” A study in the American Journal of Nursing indicates, “caregiving creates physical and psychological strain over extended periods of time.” Caregiving can be “accompanied by unpredictability and lack of control, and can adversely affect work and family relationships, even the relationship with the person getting the care exacerbating the caregiver’s state of stress.” Caregiving has been called “exhaustlessness.”
Advise about coping with the challenges of caregiving, while well-intended, can be met with, “Do you think I want to live one day at a time? No, I want to look forward to doing fun and interesting things again, like I did before” or, “I don’t want advice, I want help.”
There’s nothing easy about being a caregiver, but there is help out there:
• SAMHSA’s National Helpline, 1-800-662-HELP (4357)
• The National Institute of Health's MedlinePlus site has an overview of caregiver services. It also offers resources to help you protect your own health.
• Many government programs allow family members of veterans and people with disabilities to get paid for caring for them. Contact Medicaid Self-Directed Care program.
• Online supports group, Caregiver Space has 3,600 members around the world.
• The Family and Medical Leave Act (FMLA) provides up to 12 weeks of unpaid job-protected leave for the care of a family member. (Note: approximately half the workforce in America is eligible for this coverage.)
• The National Alliance on Mental Illness (NAMI) HELPLINE 800.950.6264 – CRISIS text NAMI to 741741 - 24/7
• The local Area Agency on Aging Family Caregiver Support Program.
• Launched in 1991, the Eldercare Locator is the only national information and referral resource to provide support for older Americans. The National Call Center (800.677.1116) and website (www.eldercare.acl.gov).
• Two apps are CareZone and Caring Village.
We have to care for our caregivers.
Blog #54 An Imperfect Solution:
Not dying is also a good aspiration
Posted 2-18-21
Chronic pain drives opioid dependence. Opioid use disorder (OUD), better known as addiction, is more challenging, often “accidental” and often co-exists with mental illness. Does depression or anxiety drive a person to addiction? Does addiction cause psychological, maybe even psychotic symptoms? The answer to both questions could be yes. Which came first – that’s harder to answer, but perhaps it doesn’t matter. Outcomes for the person with OUD and opioid dependence improve when treatment equally addresses underlying mental health issues.
Most treatment programs for people with the disease that is OUD or those dealing with unwanted dependence are considered cured when they become sober. Sobriety is a good aspiration. But if sobriety is not an option for whatever reason, treatment approaches must offer more than “all or nothing” processes. Not dying is also a good aspiration. Treatment approaches that allow for opioid tapering or the use of pain management adjuncts, like cannabis-based medicine, do not equal sobriety – but can save lives. One less dose of opioids a day will increase a person’s quality of life and decrease the potential of death by overdose. While this is an imperfect solution, harm reduction must come first.
Addressing the role of lurking depression and menacing anxiety helps the person troubled by opioid use and misuse understand the bigger picture. OUD is not a moral shortcoming. Pain, mental health issues, probably a genetic predisposition, and a confluence of other events can manifest themselves the disease that is OUD.
While new treatment guidelines and practices have created a pain treatment paradigm shift to alter the pathway to future dependence and addiction, the opioid crisis is now. At least four things must change to take control of the opioid crisis:
1. Eliminate jail-hell for non-violent crimes committed because of a disease.
2. Acknowledge people with OUD as patients.
3. Support treatment approaches that do not require sobriety.
4. Address mental illness issues simultaneously and continuously for patients with OUD and families of patients with OUD - in every treatment approach
Blog #53 – Double Trouble
Posted 2-10-21
A NIDA Research Report indicates, “43 percent of people in treatment for nonmedical use of prescription painkillers have a diagnosis or symptoms of mental health disorders, particularly depression and anxiety. About half of people who experience a mental illness will also experience a substance use disorder and vice versa.”
Vice versa: Chicken and egg
The NIDA Report says, “Establishing causality or directionality is difficult. People may be undiagnosed due to subclinical symptoms, but subclinical mental health issues may prompt drug use. Also, people’s recollections of when drug use/abuse started may be imperfect, making it difficult to determine if substance use or mental health issues came first. Common risk factors can contribute to both mental illness and substance use disorder.”
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, or DSM-5, has 11 criteria, or symptoms, for substance use disorders.
Substance use and mental health disorders are complex co-conditions – and double trouble.
Blog #52 – Ravaged Families
Posted 2-7-21
Data from the Centers for Disease Control and Prevention shows more than 81,000 drug overdose deaths occurred in the United States in the 12 months ending in May 2020. This is the highest number ever recorded in a 12-month period. The number for 2020 overall will be even worse!
The opioid epidemic is a complex problem affecting not only those who live with opioid dependence, but also their families. An essential aspect of an individual's recovery is having input from stakeholders’ who are willing to be involved. They can include the individual with substance use disorder (SUD), their family and friends, healthcare providers, members of their community, the state, and the nation; however, “there is limited research that explains the lived experience of individuals with SUD with families and friends.”
This is an area with lots of chicken and egg questions. I like to say that since all chickens were once eggs but not all eggs are chickens then it's probably true that the egg came first. But the facts are families with a member(s) living with SUD are likely families who may be struggling. Pride, denial, embarrassment, fear, limited finances, concomitant family conditions like cancer and heart disease, are just some of the things that make the opioid epidemic a complex family problem. Family members displaying codependency can struggle to cope with the unpredictable behavior of those family members who are struggling to live with their SUD. It’s hard to realize the difference between support, enablement, and good intentions. Misunderstandings and arguments sabotage communication. This can lead to confusion, hopelessness, and despair.
Families can be ravaged.
Legal costs, jail, death - almost half the kids in foster care in America are there related to the opioid crisis. Family support for the family member with SUD is important – but support for family members without SUD is important too.
There is much to be done.
Blog #51 - Our "Provocative" Surveys
Posted 1-26-21
100MillionWays.Org has developed three, exclusive "provocative" surveys under the supervision of Professor Linda Strause, PhD. We have been deliberate in our approach in asking real-world questions to stimulate your thoughts about your own personal situation. Our goal is also to generate data and insights useful to our larger community. 100MillionWays.Org shares accumulated, anonymous information with our membership.
We were hesitant at first to be too provocative and direct. But we have learned that people in our community are provocative and straight talking in their own right. You have a lot to say! We urge you to take these surveys now at https://www.100mw.org/resources/surveys/ Survey Topics --What is the effect of opioid dependence on your sex life, your sexual satisfaction, your sexual behavior/decision making? --Are you opioid dependent or an opioid addict? --What is your opinion on cannabis as a non-lethal pain management option?
Who We Are An opioid-dependent person is not likely someone living on the street or committing crimes to support a habit. It is likely someone in the office down the hall, at the kid’s soccer game or on the school board. Just regular people – except the opioid thing. Just about everything an opioid dependent person does is challenged by the opioid medications they need to manage chronic pain.
And that person with the disease that is substance use disorder – the addict – the junkie – also has a life; also has opinions, also has a right to be healthy. 100 Million Ways’ focus is the impact cannabis has on opioid dependence and substance use disorder – but we provide every resource available, our insights, and the support of our community to anyone who wants to join.
Blog #50 "It Takes a Web Community"
Posted 1-22-21
Web or online communities are the new town square where people, driven by shared interests or concerns, can find one another and connect. People look for places where they feel they belong. The most successful web communities are co-produced by membership. Communities that are anonymous allow user to share thoughts and express feelings – “detached from the illusion of social media popularity” - in a secure and safe environment where it’s easier to be honest and vulnerable without the fear of suffering social consequences. People who engage with and become a part of an online community experience the commonality and satisfaction of advancing the collective group towards a common goal. A recent study published by the online community platform, Reddit, suggests five essential components for a successful community:
1. Belonging
2. Engagement
3. Trust
4. Discovery
5. Influence
Spaces affect how people interact with one another. We act differently in a football stadium than a library. The same is true in digital space, where we act differently on LinkedIn than WhatsApp. Branded web communities, like Facebook, are different than other public social media; while a user might spend casual time on a public or personal social network, members of private/branded online communities often feel intent on investing time and resources with a purposeful mindset to design and shape a community that both reflects their ideals and provides an authentic shared space.
Https://100MillionWays.Org offers a powerful, data- and feature-packed web community experience using powerful web-based technologies. While you are in the 100 Million Ways Community, we invite you to have a look and share your thoughts as there is always room to improve. The function and feature set includes:
"Blog of the Week:" Timely comments on the latest developments in topics related to substance use disorder and opioid dependence.
"Perspective of the Week:" Exclusive weekly insightful commentary by University of California San Diego Professor Linda Strause, PhD on topics related to substance use disorder and opioid dependence.
Powerful Internal Search Engine: To search the comprehensive 100 Million Ways website database.
"BuddyBot:" Automated, online system connects two or more "buddies" in ongoing but anonymous chats where neither party reveals their personal email to the other buddy. Designed for mutual support, monitored by a clinical professional and implemented with privacy-ensuring software.
Survey and Interactive Learning System: Challenging surveys on a variety of topics such as the differentiation of dependence from addiction, the impact of opioid use on sexuality, and the role of cannabis (THC) medicine in reduction of opioid dependence.
Thread of The Month: This supervised blog invites participants to join in discussion around a specific topic of the month related to opioid dependence. Example: "How has opioid dependence affected the most important relationships in your life?"
Share Your Saga: Invites participants, those personally dependent on or addicted to opioids, friends, and family, to share intimate stories of personal struggle as well as advice to others. Saga’s are moderated by a clinical professional.
Links Library: Hotlinks to a structured, comprehensive set of external web-based resources.
Observational Registry: (Under construction) Enlists, qualifies, and follows volunteers in an ongoing study to measure the potential benefits of THC medications in reducing reliance on opioid painkillers.
Blog #49 The Opioid Tax
Posted 1-12-21
Patients in New York who rely on opioids to manage chronic pain have been affected by the state's decision in July 2019 to enforce an excise tax on opioid prescriptions. “The goal of the tax is to penalize pharmaceutical companies for their role in the opioid epidemic and to generate funding for treatment programs.” Unfortunately, this tactic fails to address the root of the problem and worse, to avoid paying the tax, many manufacturers and wholesalers have stopped selling opioids in New York State all together. And instead of the anticipated $100 million of tax revenue, tax revenue is reportedly less than $30 million.
Taxes on opiate medications is intended as part of an effort to curb the misuse of prescription opioids. But, instead of affecting manufacturers, the bulk of the burden is falling on patients who depend on prescription opioids to manage pain. And as can be the case, good intentions don’t always lead to good decisions, and often have unintended consequences and collateral damage in the form of patients losing access to essential medication.
According to UCSF School of Medicine: “when there is decreased supply, users often substitute drugs with which they may be less familiar. They also can change habits, making dosing less reliable. Overdoses go up, paradoxically, as supply goes down.”
A study by the Academy of Orthopedic Surgeons shows, “states, where cannabis is legal are associated with significant reductions in opioid prescribing in the Medicare Part D population. This finding was particularly strong in states that permit dispensaries, and for reductions in hydrocodone and morphine prescriptions.”
While it is essential to reduce the misuse of opioid medications it is also important to ensure that patients have access to medicines that will manage their pain and support a good quality of life.
On Monday, during his State of the State address, New York Governor Andrew Cuomo re-emphasized marijuana legalization as a priority for this year’s legislative session. The National Academy of Sciences found cannabinoids an effective treatment for chronic pain in adults (NAS Report 2017). With attention paid to the impact cannabis-based medicines can have on pain management and opioid use, marijuana legalization is a much better plan than an opioid tax.
Blog #48 Peer-to-Peer Online Communities
January 3, 2021
Research provides validity to the supportive content generated on an online recovery-oriented community, while also revealing discussions of self-reported struggles with opioid use disorder (OUD) among group members. Future research should explore the feasibility of incorporating web-based peer support into traditional addiction treatments. https://www.sciencedirect.com/science/article/abs/pii/S037687161730491X
Apps like BuddyBot hosted exclusively here on the 100 Million Ways website, provide support from a community with similar experiences and common goals providing support for those using or recovering from opioid dependence. (BuddyBot is free online app that matches participants with others confronting the same opioid dependence issues to enable mutual support.)
The collision of pandemic with epidemic makes web-based solutions even more important.
Online peer communities can be a public space where thoughts are exchanged. Moderated web-communities provide that forum with rules of engagement to drive focus on issues at hand; especially important in substance used disorder online exchanges.
Advantages of Web-based peer support, in contrast to meetings in-person, include: easy access, self-paced, and limited restrictions regarding time and location. A web-based peer support environment allows participants to articulate thoughts and feelings they may not want to share with family, friends, healthcare professionals, or in-person. It also provides an opportunity to share knowledge from their experiences of living with substance use disorder. It should be an anonymous platform. This makes honesty easier and alleviates the stress of “identifiable” interactions.
Disadvantages of web-based peer support result from an information paradigm shift that elicits conflicting views about the value of sharing unverified data.
Disadvantages likely lose the day to a study published in Qualitative Health Research that states, “People with a disease, a disorder or a problem long for solidarity and emotional support. They are motivated to seek or share advice, ideas and hope with peers.”
Blog #47 A Junkie’s New Year Resolutions
Posted 12-30-20
1. I WILL NOT DIE
Especially on New Year’s Eve. I will use drugs with others around and keep Narcan available.
Just because New Year’s resolutions have a track record of failure doesn’t mean all resolutions fail. Use a SMART approach:
2 SPECIFICALLY - I will:
• Stop referring to myself as a junkie and I will not let others refer to me as a junkie. I am better than that word.
• Allow myself to succeed – celebrate and document every success no matter how small.
• Allow myself to fail – and commit to trying again. Addiction is complex and recovery involves setbacks and relapse rates about 50% - similar to rates of relapse with other chronic diseases like hypertension or diabetes.
• Take a positive view – a 50% failure rate to relapse leaves a 50% success rate not to relapse.
3 MEASURABLE - I will:
• Eliminate 1 dose of opioids per day – use cannabis-based medicine or another NON-LETHAL alternative. This will significantly decrease my chance of dying from an overdose.
• Measure my progress using a daily diary.
4 ACTION-ORIENTED - I will:
• Find purpose – a hobby or providing a service to others. This spends free time, is a positive distraction and I will feel good about myself.
• Find a friend or loved one upon who I can depend. Or join a Web Community and get into an anonymous peer-support relationship.
5 REALISTIC - I will:
• I will start small and keep it simple. Small changes will accumulate first focused on not dying (harm reduction) and potentially recovery can be accomplished over time.
6 TIMELY - I will:
• Take responsibility for my situation and my actions.
Life is already too short. I resolve not to make it shorter.
Blog #46: It Makes America a Better Place
Posted 12-22-20
There are so many #vulnerablepeople this holiday season. If you can, help someone. It makes us better people. It's one of the things that makes America a better place.
In 2021 the #pandemic will end. More focus can be placed on #poverty, #homelessness, #mentalillness, and the #opioidcrisis – all made so much worse by the pandemic.
Americans will emerge more resilient from 2020.
Have a safe and peaceful holiday season. If you find your joy, share it!
Blog #45 Opioids and the "Holidaze"
Posted 12-15-20
For those with the disease that is substance use disorder (SUD), isolation spurred by the pandemic has resulted in treatment facilities being closed and less expensive more dangerous street synthetics becoming more readily available. America is now experiencing what could be a 50% increase in opioids deaths in 2020. This holiday season is not only expected to see a spike in COVID-19, but because holidays are wrought with additional triggers, the CDC reports overdose deaths typically spike in December and January.
The holiday season brings an increase in stress levels, busy schedules, holiday parties, loneliness… those in recovery have an increased chance to relapse. The stress of facing families during holiday events while suffering from addiction or being excluded from family events because of addiction is a common trigger for people actively using drugs. This year the uptick in holiday overdoses is expected to be significant as a result of the additional stress and isolation due to COVID-19. Many are preparing for a December that could see 20% more deaths. In total, over 100,000 people may die in 2020. That is frightening. Drug overdoses are now the leading cause of death for Americans under the age of 50.
Phew – not a lot of joy to their world. It’s hard to be optimistic. The year before the pandemic there was the first decrease in opioid deaths in 15 years. It was a small decrease - but it was a decrease. The year after the pandemic we will pick up that ball. Medication assisted treatments (MAT) will be more available. Alternatives to opioids will be available and some will be covered by insurance. By 2022 we will be testing cannabis-based medications as an alternative for harm reduction. And, while it’s still a bit extreme, we need to monitor the Safe Supply experiment in Canada and Oregon’s Measure 110.
Something’s gotta give!
Blog #44: Kids – Innocent Bystanders
Posted 12-11-20
More than 400,000 children in America are in foster care. About one third due to opioids - a neglected sub-population of “innocent bystanders.” And that path to foster care often starts at birth. According to 2016 data from the Healthcare Cost and Utilization Project (HCUP), approximately 80 newborns are diagnosed with neonatal abstinence syndrome (NAS) every day.
A baby born to a mother addicted to opioids will start life with NAS; conditions caused when a baby withdraws from the opioids (or other drugs) to which he or she is exposed in the womb. When taken during pregnancy, these drugs can pass through the placenta and cause serious problems for the baby including:
A new initiative is turning NAS treatment sideways with a simple concept: treat the baby like a baby and the mom like a mom. Keep the baby and the mother together. Keep the baby out of the NICU. Do not give the baby opioids (for weaning) unless absolutely necessary. This approach is known as “Eat, Sleep, Console”. This approach allows the babies to eat and sleep when they want and lets mom console them when they cry. While the impact of mother and child nurturing each other cannot be measured, with this protocol, newborns experienced no adverse effects and it reduced the average hospitalization of babies with NAS from 18 days to 11 days.
For mothers who want to keep their babies, some child welfare programs are supporting those moms through withdrawal so they can keep their babies or get their babies back. The mom featured in this story said, "I want to. She's worth it. I'm worth it. I just want to be a good mom." And it well for this mom for 6 months. Life happened. She slipped. “I suck at both sides of this. I am bad at being sober and I am bad at being high. But I still keep trying. I will never stop trying to get clean." We hope.
- Poor growth in the uterus
- Premature birth
- Seizures
- Birth defects
- Developmental delays and problems with motor and learning skills and behavior
- Problems with nutrition and growth
- Problems with hearing and vision
A new initiative is turning NAS treatment sideways with a simple concept: treat the baby like a baby and the mom like a mom. Keep the baby and the mother together. Keep the baby out of the NICU. Do not give the baby opioids (for weaning) unless absolutely necessary. This approach is known as “Eat, Sleep, Console”. This approach allows the babies to eat and sleep when they want and lets mom console them when they cry. While the impact of mother and child nurturing each other cannot be measured, with this protocol, newborns experienced no adverse effects and it reduced the average hospitalization of babies with NAS from 18 days to 11 days.
For mothers who want to keep their babies, some child welfare programs are supporting those moms through withdrawal so they can keep their babies or get their babies back. The mom featured in this story said, "I want to. She's worth it. I'm worth it. I just want to be a good mom." And it well for this mom for 6 months. Life happened. She slipped. “I suck at both sides of this. I am bad at being sober and I am bad at being high. But I still keep trying. I will never stop trying to get clean." We hope.
Blog #43 – Finding Optimism
Posted 12-7-20
Let’s make the glass half full. Vaccinations will soon be available. Planning for post COVID-19 opioid treatment programs will recharge some of the early momentum of the public health emergency declared in 2017. The Opioid Crisis in the “new normal” is preparing for people in a worsened state due to pandemic complexities’, so many other vulnerable people are just getting by, and too many are dead. If you’re in Oregon or areas in Canada, the concept of safe-supply is an interesting option– it’s starting to make sense. Quality drugs in a controlled environment are safer. No question – less people die. And there are so many street synthetics available, some not even illegal yet, that are more deadly, less expensive, and they can be delivered to your door with a phone call. Being entirely drug free is a great aspiration but living healthfully while still using combination treatments including drugs for chronic pain, may be more realistic and is equally aspirational. People in our community often walk the opioid use/abuse line hoping to find a happier, healthier “normal” lifepath. Get a life-line. Try an anonymous buddy. Find purpose. You have so much to share. For the person that knows he or she has to stop, even if it’s the 4th time, you’re right, you have to stop. We want to help.
There will be more health clinics, less invasive questions, alternative drugs for consideration, and innovative therapeutic combinations. Co-produce your solution. It would be marvelous to just decrease the anxiety, danger, and legal exposure of having to acquire street drugs. We will be better after COVID than we were before COVID and we will likely be humbler, maybe a little more afraid and/or a little less trusting - but definitely we will be more resilient.
It’s time to get going again. In a couple of months, in the “new normal” while a lot will still be online, and that’s probably more efficient, but meeting in person is important to so many people dealing with unwanted dependence or substance use disorder. Visits to clinics should be easier – probably not as frequent, with online meetings in between. And let’s keep a close eye on Measure 110 in Oregon and SafeAccess in Canada. If there is success with these models as has been the experience in Portugal, America will need to consider this option. If you are tired of the extra challengers and health dangers of opioid dependence or shattered by substance use disorder – try to use the momentum of new opportunities being created as the pandemic winds down to get help and give help. You may find an easier pathway through the process of flexible drug programs. Methadone and Buprenorphine should be more available. And Cannabis-based medicines options could be added by mid-2021 with other pain management treatments in development. Find optimism.
Blog #42 – Measure 110 - Have we gone too far?
Posted 11-25-20
The "Drug Addiction Treatment and Recovery Act" will transition Oregon's drug policy from a punitive, criminal approach to a humane and practical approach. "People suffering from the disease that is substance use disorder are more effectively treated with health care services than with criminal punishments.” This is both a significant and radical attempt at harm reduction.
Are we going too far? How can it work?
Canada is experimenting with a program called “Safe Supply.” ”Treatments for opioid use disorder, including methadone and buprenorphine, are potentially lethal and don’t work for everyone. Prescribing a safe supply of regulated opioids, can allow people to know real dosage and pharmaceutical grade quality. This should decrease reliance on deadly street options, and also decrease legal exposure if not procuring street drugs.” 100MillionWays suggests a study arm, maybe replacing one dose of opioids each day with a cannabis-based medicine, and/or IV meloxicam or SC ketamine. These options should be explored in these models. One less opioid dose every day = less deaths.
The Canadian Programs defines safe supply as “providing a legal and regulated supply of drugs otherwise available only in illicit drug markets. This is trying to use an imperfect tool in response to an overwhelming crisis of death. And it Is important to note that implementation of a safe supply program is no easy challenge for multiple, regulatory, legal, and operational reasons – so it’s got to be a realistic approach and prove positive to bring value.
Time will tell regarding safe supply and Measure 110. But components of these programs are derived from published accounts of successes in Portugal. A 2009 Cato Institute study of Portugal’s decriminalization of all drugs in 2001, reported a dramatic reduction of pathologies associated with drug use, such as sexually transmitted diseases and overdose deaths. A 2015 European Drug Report found that Portugal's drug overdose death rate is five times lower than the European Union average.
Availability of deadly street options - According to a recent NPR investigation, it has become apparent that even when the Chinese Government helps to slow the flow of synthetic fentanyl and components, new synthetic, more powerful and deadlier opioid derivatives boldly appear in public markets and through social networking sites. NPR suggested that Alibaba has the most open illicit drug sales, but illicit drug vendors also operate on Facebook, Twitter, Wickr, MeWe, Vimeo AND even LinkedIn. Understandably, it is a challenge to monitor such activity as it is a head-spinning array of chemicals tagged with an obscure international numerical naming systems and dynamic change management. So it’s even harder for America to stop the inflow of illicit synthetic opioids, as some are so new, they are not recognized and are not illegal.
The point is, no matter how hard we try to stop the flow, the flow continues anew.
The scope and collaboration required to implement these programs makes me concerned for the success of the “safe supply” model in America. Oregon has guts. Lots of loose ends. Hopefully, the federal government takes a look because over 80,000 Americans may die from a drug overdose in this pandemic year, street drugs are available everywhere and so much worse than pharmaceutical grade products, and people are in jail-hell for non-violent drug related crimes. Safe supply and 110 deserve a chance.
Are we going too far? How can it work?
Canada is experimenting with a program called “Safe Supply.” ”Treatments for opioid use disorder, including methadone and buprenorphine, are potentially lethal and don’t work for everyone. Prescribing a safe supply of regulated opioids, can allow people to know real dosage and pharmaceutical grade quality. This should decrease reliance on deadly street options, and also decrease legal exposure if not procuring street drugs.” 100MillionWays suggests a study arm, maybe replacing one dose of opioids each day with a cannabis-based medicine, and/or IV meloxicam or SC ketamine. These options should be explored in these models. One less opioid dose every day = less deaths.
The Canadian Programs defines safe supply as “providing a legal and regulated supply of drugs otherwise available only in illicit drug markets. This is trying to use an imperfect tool in response to an overwhelming crisis of death. And it Is important to note that implementation of a safe supply program is no easy challenge for multiple, regulatory, legal, and operational reasons – so it’s got to be a realistic approach and prove positive to bring value.
Time will tell regarding safe supply and Measure 110. But components of these programs are derived from published accounts of successes in Portugal. A 2009 Cato Institute study of Portugal’s decriminalization of all drugs in 2001, reported a dramatic reduction of pathologies associated with drug use, such as sexually transmitted diseases and overdose deaths. A 2015 European Drug Report found that Portugal's drug overdose death rate is five times lower than the European Union average.
Availability of deadly street options - According to a recent NPR investigation, it has become apparent that even when the Chinese Government helps to slow the flow of synthetic fentanyl and components, new synthetic, more powerful and deadlier opioid derivatives boldly appear in public markets and through social networking sites. NPR suggested that Alibaba has the most open illicit drug sales, but illicit drug vendors also operate on Facebook, Twitter, Wickr, MeWe, Vimeo AND even LinkedIn. Understandably, it is a challenge to monitor such activity as it is a head-spinning array of chemicals tagged with an obscure international numerical naming systems and dynamic change management. So it’s even harder for America to stop the inflow of illicit synthetic opioids, as some are so new, they are not recognized and are not illegal.
The point is, no matter how hard we try to stop the flow, the flow continues anew.
The scope and collaboration required to implement these programs makes me concerned for the success of the “safe supply” model in America. Oregon has guts. Lots of loose ends. Hopefully, the federal government takes a look because over 80,000 Americans may die from a drug overdose in this pandemic year, street drugs are available everywhere and so much worse than pharmaceutical grade products, and people are in jail-hell for non-violent drug related crimes. Safe supply and 110 deserve a chance.
#41 — I’m finally numb
Posted 11-17-20
TRIGGER WARNING: The content of this week's blog entry might upset some readers
This is why I am involved with 100 Million Ways. I’m finally numb, My pain is gone, I’m safe, I’m dead, I put a bullet in my head. He left a note and his house door ajar. He used a rifle to shoot himself in the head late one night. The police said the gun must have jerked his arms because the first bullet hit the far side of his head and didn't kill him. What is worse, though, and I still have nightmares thinking about how he next somehow managed to position that rifle into the middle of his forehead and take a second shot. I shudder when I think about how he must have been feeling during those dark moments. I first met him when he was in his twenties. When he was growing up, I am told, he was a wild-boy but nothing so unusual. After all, we were kids growing up in the big city. As a young man, he was successful in business and made money. When the two-martini lunch became a two-martini breakfast, he began attending AA meetings. He was sober for 15 years. However, he was constantly battling anxiety and depression. He would commute 2 hours each way to work every day and hated free-time. He started to self-medicate with valium. Valium progressed to opioids and eventually, he started drinking again. We finally got him to seek psychiatric help, but it was too late. RIP. We learned, perhaps too late, that access to a support network can provide help for people in changing their direction on the road to or through addiction. 100 Million Ways wants you to know that you are not alone, that there are ways to seek help, to connect you with others who have "been there" and getting help sooner, rather than later, so that it is not too late for you.
#40 — The 2020 Elections
Posted 11-12-20
“I am out of jail. My life is in shambles. Jail traumatized me and made it much harder to get clean.” You can't arrest your way out of a national drug problem; “the chance of dying of an overdose actually increases for a person in jail."
From www.100millionways.org Sagas and Perspectives. A recent CDC survey of "5,000 people indicated 40% were suffering from one of the common mental health conditions like depression, anxiety, or post-traumatic stress, along with substance use. 13% said that they had either started to use substances (drugs, alcohol…) or have increased the amount of substances they use as a result of stress related to the pandemic.” The 2020 elections delivered good news for cannabis stocks and several states legalized adult-use of recreational marijuana. Fifteen states have voted to enact adult-use legalization laws, while 36 states have voted to enact medical marijuana access laws. The Marijuana Opportunity Reinvestment and Expungement Act of 2019 (MORE Act) to decriminalize marijuana is more likely to pass (probably not this current vote) but as Kamala Harris was/is the sponsor, the MORE Act should succeed in 2021. Governor Cuomo of NY spoke to new economic opportunities for a challenged C-19 economy and seems ready to legalize marijuana in New York. Cannabis-based medicines and cannabinoids are not an option for everyone. And new pharmaceutical alternatives are in development for pain management. But the opioid crisis is about more than alternatives to pain management and needs treatment options now – and those treatment options need to be affordable, accessible, and nonlethal. The economic opportunity for a recreational marijuana industry, an opioid crisis getting worse by the day, and the newly elected administration may provide the chance to do clinical trials on cannabis-based medicines so the public can be informed to make knowledgeable choices.
#39 — Are drugs better than sex?
Posted 11-4-20
The 100 Million Ways Foundation went live on September 9th. The website is so well done. Thank you Don. Version 2 was just released with attention to useability feedback. And it’s already starting to feel like a community. People are contributing stories of their successes and failures, of their fears and hopes. Those stories drive a weekly post about common issues and items. Thank you Linda. There are discussions on posted topics and ad hoc commentary. Are you dependent or are you addicted? That is a complicated and sensitive topic. Are drugs better than sex? The Buddies’ program is about to be operational. A pub-med study (ePub 2017 Oct 5) indicated “recovery-oriented online communities have proven beneficial when offering online peer support for people working towards recovery.”
So, 100 Million Ways is just starting its journey. If cannabis-based medicine can cut the edge of pain or be a substitute for just a few pills a day, there will be fewer opioid related deaths. People often ask, “How does marijuana become a medicine?” Cannabis-based medicine is not about smoking a joint here and there. Cannabis-based medicine is taken as a pill, a patch or vaped in prescribed doses at prescribed times. The opioid epidemic is way worse because of COVID-19 (C-19). 100,000 Americans could die of overdoses in 2020. Even more disheartening, this year there could be 45,000 babies born with neonatal abstinence syndrome.
Every single opioid pill a person does not have to take is a good thing. Our approach to harm reduction.
Of course, we could not have picked a more challenging time to go on the fundraising trail. With C-19 there aren’t many philanthropists taking meetings with new foundations. 100 Million Ways is surviving on a small but generous grant. Thank you Nick. We hope to generate donations through the website. We are doing some web media advertising with Tap Native and Facebook. As mentioned above, 100MillionWays.Org is starting to get some traction. We are in survival, no, "birthing mode," but our content is dynamic and our services are running. We are giving it our best and we hope we can make a difference. And even though there are hot dogs for dinner again, we are excited to be “live” and optimistic about the future.
So, 100 Million Ways is just starting its journey. If cannabis-based medicine can cut the edge of pain or be a substitute for just a few pills a day, there will be fewer opioid related deaths. People often ask, “How does marijuana become a medicine?” Cannabis-based medicine is not about smoking a joint here and there. Cannabis-based medicine is taken as a pill, a patch or vaped in prescribed doses at prescribed times. The opioid epidemic is way worse because of COVID-19 (C-19). 100,000 Americans could die of overdoses in 2020. Even more disheartening, this year there could be 45,000 babies born with neonatal abstinence syndrome.
Every single opioid pill a person does not have to take is a good thing. Our approach to harm reduction.
Of course, we could not have picked a more challenging time to go on the fundraising trail. With C-19 there aren’t many philanthropists taking meetings with new foundations. 100 Million Ways is surviving on a small but generous grant. Thank you Nick. We hope to generate donations through the website. We are doing some web media advertising with Tap Native and Facebook. As mentioned above, 100MillionWays.Org is starting to get some traction. We are in survival, no, "birthing mode," but our content is dynamic and our services are running. We are giving it our best and we hope we can make a difference. And even though there are hot dogs for dinner again, we are excited to be “live” and optimistic about the future.
#38 — Marijuana as an Opioid Alternative: Substantial Evidence, and More Substantial Need
Posted 10-29-20
There is substantial research – still mostly limited to real-world data – but substantial, suggesting medical marijuana may be a viable alternative and is likely an effective adjunct for opioid users treating chronic pain. Less opioid use equals less deaths – no doubt about it. Opioid use disorder is a recent addition to approved conditions for medical marijuana (check your state). “States that have approved medical cannabis saw a dramatic reduction in opioid use,” according to a new study at University of Georgia. There are four alternatives available for acute pain management — and one (Ketamine) is exploring secure subcutaneous delivery systems (like insulin pumps) for automated delivery and controlled dosing. There are sub-cutaneous electro-stimulators that block or interrupt pain impulses. And yet, there is available a non-lethal pain medicine that needs a few clinical trials to prove (or not) that is safe and effective. The Federal Government could, at least, allow clinical trials to proceed to inform patients and clinicians. Rick Doblin at MAPS got this done and patients with PTSD now have an effective treatment option.
Some of the recent literature continuing to build this huge catalogue of real-world evidence for cannabis-based medicine include:
"Patients with chronic pain reported weekly average pain intensity (primary outcome) and related symptoms before and at 1, 3, 6, 9 and 12 mths. following MC treatment initiation. At 1-year, average pain intensity declined from baseline by 20 percent with a decrease of 42% in daily dosage of opioids.” Medical cannabis treatment for chronic pain: Outcomes and prediction of response, European Journal of Pain, 2020 “At-least-daily cannabis use was associated with a decreased rate of injection. There was no significant association between at-least-daily cannabis use and injection relapse. This is the first longitudinal study to identify a positive association between cannabis use and cessation of injection drug use.” Frequent cannabis use and cessation of injection of opioids, Vancouver, Canada, 2005-2018, American Journal of Public Health, 2020
“This review found a much higher reduction in opioid dosage, reduced emergency room visits, and hospital admissions for chronic non-cancer pain by MC [medical cannabis] users, compared to people with no additional use of MC. There was 64–75% reduction in opioid dosage for MC users and complete stoppage of opioid use for chronic non-cancer pain by 32–59.3% of MC users, when compared to patients without additional use of MC. … Given the current opioid epidemic in the USA and medical cannabis’s recognized analgesic properties, MC could serve as a viable option to achieve opioid dosage reduction in managing non-cancer chronic pain.” Medical cannabis for the reduction of opioid dosage in the treatment of non-cancer chronic pain: a systematic review, Systematic Reviews, 2020
“Among our subjects, over 90 percent of CU [cannabis users] and PU [past users] reported “a little” or “great” relief from symptoms with MC [medical cannabis] and 61.20 percent claimed that MC had allowed them to reduce or discontinue use of other medications.” Utilization of medicinal cannabis for pain by individuals with spinal cord injury, Spinal Cord Series and Cases, 2020
“Depression among patients in the OP (opioids), MM (medical marijuana) and OPMM groups was 57.1%, 22.3% and 51.4%, respectively. Rates of anxiety were 48.4%, 21.5% and 38.7%, respectively. … Levels of depression and anxiety are higher among chronic pain patients receiving prescription opioids compared to those receiving MM. Findings should be taken into consideration when deciding on the most appropriate treatment modality for chronic pain, particularly among those at risk for depression and anxiety.” Depression and anxiety among chronic pain patients receiving prescription opioids and medical marijuana, Journal of Affective Disorders, 2017
Some of the recent literature continuing to build this huge catalogue of real-world evidence for cannabis-based medicine include:
"Patients with chronic pain reported weekly average pain intensity (primary outcome) and related symptoms before and at 1, 3, 6, 9 and 12 mths. following MC treatment initiation. At 1-year, average pain intensity declined from baseline by 20 percent with a decrease of 42% in daily dosage of opioids.” Medical cannabis treatment for chronic pain: Outcomes and prediction of response, European Journal of Pain, 2020 “At-least-daily cannabis use was associated with a decreased rate of injection. There was no significant association between at-least-daily cannabis use and injection relapse. This is the first longitudinal study to identify a positive association between cannabis use and cessation of injection drug use.” Frequent cannabis use and cessation of injection of opioids, Vancouver, Canada, 2005-2018, American Journal of Public Health, 2020
“This review found a much higher reduction in opioid dosage, reduced emergency room visits, and hospital admissions for chronic non-cancer pain by MC [medical cannabis] users, compared to people with no additional use of MC. There was 64–75% reduction in opioid dosage for MC users and complete stoppage of opioid use for chronic non-cancer pain by 32–59.3% of MC users, when compared to patients without additional use of MC. … Given the current opioid epidemic in the USA and medical cannabis’s recognized analgesic properties, MC could serve as a viable option to achieve opioid dosage reduction in managing non-cancer chronic pain.” Medical cannabis for the reduction of opioid dosage in the treatment of non-cancer chronic pain: a systematic review, Systematic Reviews, 2020
“Among our subjects, over 90 percent of CU [cannabis users] and PU [past users] reported “a little” or “great” relief from symptoms with MC [medical cannabis] and 61.20 percent claimed that MC had allowed them to reduce or discontinue use of other medications.” Utilization of medicinal cannabis for pain by individuals with spinal cord injury, Spinal Cord Series and Cases, 2020
“Depression among patients in the OP (opioids), MM (medical marijuana) and OPMM groups was 57.1%, 22.3% and 51.4%, respectively. Rates of anxiety were 48.4%, 21.5% and 38.7%, respectively. … Levels of depression and anxiety are higher among chronic pain patients receiving prescription opioids compared to those receiving MM. Findings should be taken into consideration when deciding on the most appropriate treatment modality for chronic pain, particularly among those at risk for depression and anxiety.” Depression and anxiety among chronic pain patients receiving prescription opioids and medical marijuana, Journal of Affective Disorders, 2017
#37 – Building Better COVID-19 Controls will Decrease Opioid Deaths
Posted 10-19-20
“People with substance use disorders (SUDs) are more likely to become infected and die of COVID-19,” according to a recent study funded by the National Institutes of Health and published in Molecular Psychiatry.
Specifically, the study found that people with opioid use disorder and tobacco addiction were more likely to die of COVID-19. "It is very important for substance users to recognize that they are at a higher risk," said Dr. Nora Volkow, Director of NIDA.
The pandemic has hampered access to addiction treatment, with “a third of Americans noting disruptions in care and about 14% saying they’re unable to access treatment at all.” And the need for treatment services has gone up significantly while mental health and addiction treatment centers have struggled to stay open. Financial burdens caused by safety regulations, quarantine rules, limited capacity and fewer physician referrals are only some of the reasons these centers have been having a hard time staying afloat.
The Washington Post reported that suspected overdoses jumped 18% in March, 29% in April and 42% in May. The figures are based on data from ambulance teams, hospitals, and police.
Bold efforts are needed to reduce the adverse effect that COVID-19 will have on progress in addressing opioid-related morbidity and mortality. In the absence of such efforts, we risk more catastrophic effects from these colliding epidemics,” wrote William Becker and David Fiellin in a paper published in the Annal of Internal Medicine journal.
A “bold effort” that could have a significant impact on opioid overdoses and death is a relatively simple solution. Note an early study by NIDA suggests “In states with medical cannabis dispensaries, researchers observed a 14.4 percent reduction in use of prescription opioids and nearly a 7 percent reduction in opiate prescriptions.
In fact, there is a huge amount of real-world evidence across hundreds of cannabis-based medicine studies that medical cannabis improves quality of life, reduces pain and opioid use, and leads to cost savings.” Large randomized clinical trials are warranted to further evaluate the role of cannabis in the treatment of chronic pain, but clinical trials will only occur after the federal government eases restrictions on marijuana research.
There is so much going on in America, it’s hard to focus on anything but COVID-19; but the opioid epidemic is worse and not going away. And it’s especially frustrating when there is a potential treatment option readily available – a new tool in the opioid epidemic treatment tool kit that is being overlooked. If the potential for more than 80,000 deaths in 2020 doesn’t move us, the cost to society, at close to $100 billion/year, should make the powers that be stand up and notice. America has to do better. \
Specifically, the study found that people with opioid use disorder and tobacco addiction were more likely to die of COVID-19. "It is very important for substance users to recognize that they are at a higher risk," said Dr. Nora Volkow, Director of NIDA.
The pandemic has hampered access to addiction treatment, with “a third of Americans noting disruptions in care and about 14% saying they’re unable to access treatment at all.” And the need for treatment services has gone up significantly while mental health and addiction treatment centers have struggled to stay open. Financial burdens caused by safety regulations, quarantine rules, limited capacity and fewer physician referrals are only some of the reasons these centers have been having a hard time staying afloat.
The Washington Post reported that suspected overdoses jumped 18% in March, 29% in April and 42% in May. The figures are based on data from ambulance teams, hospitals, and police.
Bold efforts are needed to reduce the adverse effect that COVID-19 will have on progress in addressing opioid-related morbidity and mortality. In the absence of such efforts, we risk more catastrophic effects from these colliding epidemics,” wrote William Becker and David Fiellin in a paper published in the Annal of Internal Medicine journal.
A “bold effort” that could have a significant impact on opioid overdoses and death is a relatively simple solution. Note an early study by NIDA suggests “In states with medical cannabis dispensaries, researchers observed a 14.4 percent reduction in use of prescription opioids and nearly a 7 percent reduction in opiate prescriptions.
In fact, there is a huge amount of real-world evidence across hundreds of cannabis-based medicine studies that medical cannabis improves quality of life, reduces pain and opioid use, and leads to cost savings.” Large randomized clinical trials are warranted to further evaluate the role of cannabis in the treatment of chronic pain, but clinical trials will only occur after the federal government eases restrictions on marijuana research.
There is so much going on in America, it’s hard to focus on anything but COVID-19; but the opioid epidemic is worse and not going away. And it’s especially frustrating when there is a potential treatment option readily available – a new tool in the opioid epidemic treatment tool kit that is being overlooked. If the potential for more than 80,000 deaths in 2020 doesn’t move us, the cost to society, at close to $100 billion/year, should make the powers that be stand up and notice. America has to do better. \
#36 – Be Politically Aware
Posted 10-12-20
It is the political season in America. 100 Million Ways prefers to avoid the distraction of political folly, but it is important for people with the disease that is substance use disorder (SUD) to know how the candidate you prefer will impact the opioid epidemic.
The COVID-19 pandemic has exacerbated an already difficult situation by reducing access to life-saving treatment, harm reduction, and recovery support services, adding increased stress and isolation, and compounding the risk of overdoses and deaths. The pandemic has triggered an economic recession that threatens the survival of some addiction treatment centers and services. So far "in 2020 drug-related deaths in some states have climbed by over 30%" - and these numbers continue to climb. Clearly, solving the COVID-19 pandemic is at the top of the list in helping America build back a better approach to the opioid epidemic. So be sure your preferred candidate has a COVID-19 plan that best serves your interests (and the interests of America).
Before COVID-19, just one in five Americans with opioid use disorder/substance use disorder were able to access treatment. Currently, more than half of community health centers do not have the credentials to provide medication-assisted treatment (MAT). Since "treatments with buprenorphine and methadone are associated with 38% and 59% decreases in opioid-related mortality, respectively," your preferred candidate should have a plan to expand MAT services. Medicaid expansion through the Affordable Care Act (ACA) has been instrumental in increasing coverage of mental health and SUD services. Nationally, "Medicaid expansion is associated with a 6% reduction in total deaths from opioid overdoses" in states that underwent expansion compared to non-expansion states. So with the Affordable Care Act under political scrutiny, be sure the candidate you prefer has a health insurance plan for Americans that meets your needs.
And while there America is not a Portugal or Canada, treating SUDs as diseases, rather than moral failings or crimes, with decriminalization of non-violent drug-related crimes needs another look. These are certainly more radical approaches - that accept SUD as a treatable disease. So be sure your preferred candidate has a rationale for his current approach and an approach for the future that best supports your needs.
Finally, without getting too political about the vast differences these candidates offer, be sure your preferred candidate has a position to address the opioid epidemic that you believe will offer the best prospects for you, your family and America.
The COVID-19 pandemic has exacerbated an already difficult situation by reducing access to life-saving treatment, harm reduction, and recovery support services, adding increased stress and isolation, and compounding the risk of overdoses and deaths. The pandemic has triggered an economic recession that threatens the survival of some addiction treatment centers and services. So far "in 2020 drug-related deaths in some states have climbed by over 30%" - and these numbers continue to climb. Clearly, solving the COVID-19 pandemic is at the top of the list in helping America build back a better approach to the opioid epidemic. So be sure your preferred candidate has a COVID-19 plan that best serves your interests (and the interests of America).
Before COVID-19, just one in five Americans with opioid use disorder/substance use disorder were able to access treatment. Currently, more than half of community health centers do not have the credentials to provide medication-assisted treatment (MAT). Since "treatments with buprenorphine and methadone are associated with 38% and 59% decreases in opioid-related mortality, respectively," your preferred candidate should have a plan to expand MAT services. Medicaid expansion through the Affordable Care Act (ACA) has been instrumental in increasing coverage of mental health and SUD services. Nationally, "Medicaid expansion is associated with a 6% reduction in total deaths from opioid overdoses" in states that underwent expansion compared to non-expansion states. So with the Affordable Care Act under political scrutiny, be sure the candidate you prefer has a health insurance plan for Americans that meets your needs.
And while there America is not a Portugal or Canada, treating SUDs as diseases, rather than moral failings or crimes, with decriminalization of non-violent drug-related crimes needs another look. These are certainly more radical approaches - that accept SUD as a treatable disease. So be sure your preferred candidate has a rationale for his current approach and an approach for the future that best supports your needs.
Finally, without getting too political about the vast differences these candidates offer, be sure your preferred candidate has a position to address the opioid epidemic that you believe will offer the best prospects for you, your family and America.
#35 – Cannabis-based medicine is effective for the treatment of chronic pain in adults
Based on data from the Overdose Detection Mapping application program, “Opioid overdoses increased in March 2020 by 18% compared to the same month in 2019, 29% in April 2020, and 42% in May 2020.” According to the American Medical Association, “Over 40 states have reported increases in opioid related deaths during the pandemic,” even as the US experienced nearly 71,000 opioid related deaths in 2019. A 42% increase across one year would see over 100,000 overdose deaths!
While SUD/OUD is an international problem, the biggest crisis by far is in America. America has to do better. There's lots of blame to go around for the opioid epidemic but 100 Million Ways does not have time for the blame game. Our chosen path is to work with the community of people dealing with the disease that is substance use disorder, or with those tired of the side effects dependency for chronic pain brings. This community becomes huge when you total all people affected by this epidemic – more than 100,000,000 people. At 100MillionWays.org our goal is for our web-based community to be an aid to this community and ultimately to be managed by a co-production effort with community participants driving technology and content requirements. The driving force for the 100Million Ways Community is to measure the value cannabis-based medicine has in reducing the amount of opioids a person needs to manage chronic pain and substance use disorder. But our responsibility is to support any person seeking assistance related to the opioid crisis especially as the opioid epidemic clashes with the C-19 pandemic. The National Academies of Sciences 2017 Report concluded that, "There is evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults." Less opioid use means better quality of life and fewer deaths. In this time when access to support programs is still strained by COVID-19, cannabis-based medicine is available without the challenges of methadone and buprenorphine, with a large volume of real-world data that indicates cannabis helps with pain relief, and cannabis is not lethal. People ask how does marijuana become a medicine? This is not smoking joints and eating pizzas, this is pills or patches on a dosing scheduled – like a medicine. Dose-finding studies and placebo controlled clinical trials must be done, but with marijuana still a controlled substance at the federal level, answering scientific questions must wait, and a community of people without many alternatives to opioids also wait.
While SUD/OUD is an international problem, the biggest crisis by far is in America. America has to do better. There's lots of blame to go around for the opioid epidemic but 100 Million Ways does not have time for the blame game. Our chosen path is to work with the community of people dealing with the disease that is substance use disorder, or with those tired of the side effects dependency for chronic pain brings. This community becomes huge when you total all people affected by this epidemic – more than 100,000,000 people. At 100MillionWays.org our goal is for our web-based community to be an aid to this community and ultimately to be managed by a co-production effort with community participants driving technology and content requirements. The driving force for the 100Million Ways Community is to measure the value cannabis-based medicine has in reducing the amount of opioids a person needs to manage chronic pain and substance use disorder. But our responsibility is to support any person seeking assistance related to the opioid crisis especially as the opioid epidemic clashes with the C-19 pandemic. The National Academies of Sciences 2017 Report concluded that, "There is evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults." Less opioid use means better quality of life and fewer deaths. In this time when access to support programs is still strained by COVID-19, cannabis-based medicine is available without the challenges of methadone and buprenorphine, with a large volume of real-world data that indicates cannabis helps with pain relief, and cannabis is not lethal. People ask how does marijuana become a medicine? This is not smoking joints and eating pizzas, this is pills or patches on a dosing scheduled – like a medicine. Dose-finding studies and placebo controlled clinical trials must be done, but with marijuana still a controlled substance at the federal level, answering scientific questions must wait, and a community of people without many alternatives to opioids also wait.
Blog #34: Positivity Counts
A common dictionary definition of the word relapse is “to suffer deterioration after a period of improvement.” When opioids are the concern, there are too many definitions to care about. Below are comments by people identified as experts. It would be good to hear feedback from people who lived it or who are living it.
And the stigma sucks. “I’ve lost jobs. I’ve lost friends. I’ve lost roommates. You know, you lose everything.” Pennsylvania has stated a program called “Life Unites Us. To “take on the stigma” of SUD. The program is brand new so there are no outcomes to report – but positivity counts.
- The risk of returning to substance use disorder (SUD) is highest in the first year after detox.
- People who receive professional treatment for SUD are less likely to use again.
- Those who participate regularly in follow-up support programs also reduce their risk of relapse.
- Substance use disorder relapse rates are similar—roughly 50 percent—to recurrence-of-symptoms rates for chronic diseases such as asthma. Hence, SUD is a chronic disease.
And the stigma sucks. “I’ve lost jobs. I’ve lost friends. I’ve lost roommates. You know, you lose everything.” Pennsylvania has stated a program called “Life Unites Us. To “take on the stigma” of SUD. The program is brand new so there are no outcomes to report – but positivity counts.
Blog #33: Blog #33: Basic Approaches to Substance Use Disorder
Refusing opioid prescriptions and/or coverage has improved neither the dismal health trends from opioid use nor the rising cost of the opioid epidemic to health care systems. A recent UCSF study confirmed what seems obvious, “when supply goes down, overdoses go up.” People turn to unsafe street synthetics laced with fentanyl and other dandy stuff and they die.
Crime and illicit drug use are linked – “about 80 percent of people arrested and imprisoned abuse drugs and/or alcohol. Of those in prison, about half are clinically addicted to an illicit substance or alcohol.”
Safe supply is an experiment underway in Canada. Safe supply is a form of harm reduction and refers to “providing users with a legal and regulated supply of drugs - as most deaths are related to fentanyl and its analogues adulterating the illicit drug market.” Again, diversion may be an issue and again, only time will tell. But recent heroin maintenance trials in Vancouver “involving over 200 participants had retention rates over 80 per cent after a year on treatment, and those remaining on treatment had significant reductions in illicit opioid use.” In comparison, in British Columbia, “retention rates on methadone is under 35 per cent after one year, and suboxone and slow release oral morphine show similar lack of effectiveness.”
In 2001, Portugal was experiencing an opioid crisis similar to the one gripping the United States, with HIV rates among people who use drugs, the highest in Europe. Portugal tried criminalization and incarceration to manage drug use.
In response to this increasing problem, Portugal changed the approach to a decriminalization program that year. Since, overdose deaths have plummeted, and the percentage of drug users diagnosed with new HIV infections fell. Rates of drug-related incarceration have also fallen and people voluntarily entering treatment for substance use issues have increased. It's not all good, but it is way better than it was.
Portugal and Canada are quite different than America. But these are lessons to be learned from these approaches to treating substance use disorder as a medical issue rather than a criminal problem.
Cannabis-based medicine is available, helps manage pain and is non-lethal adjunct for opioid treatment.
Crime and illicit drug use are linked – “about 80 percent of people arrested and imprisoned abuse drugs and/or alcohol. Of those in prison, about half are clinically addicted to an illicit substance or alcohol.”
- The Anti-Drug Act of 1986 introduced mandatory minimum sentencing laws resulting in a huge influx of people into prisons for offenses due to drugs. A recent analysis suggests drug offenses account for more than half of all charges in the prison system. Jail for non-violent drug-related crimes is a failed solution.
- Diversion to treatment allows eligible defendants to have criminal charges dismissed if they successfully complete a court-recognized drug treatment program and participate in surrounding social services. This process has challenges but is better than jail.
- Substitution treatments such as methadone, buprenorphine/suboxone, and slow release oral morphine are effective, but medication assisted treatment (MATs) programs require(d) daily visits to clinics and physicians approved specifically to prescribe MATs. Less than 20% of people with SUD participate in MATs programs. With COVID-19, some of these restrictions have been eased. As MATs are potentially lethal treatments, and diversion may be a problem – these outcomes are critical as this approach could help change the game. Time will tell.
- ”Drugs such as ketamine and meloxicam may prove effective substitutes for opioids for post-operative and acute injury pain management. Meloxicam is available as IV or SC formulation and both will be able to be delivered subcutaneously over longer periods of time for chronic pain (CP) using insulin-like medical device delivery systems. This will take time and whether either provides sufficient pain relief remains to be seen but seems promising.
Safe supply is an experiment underway in Canada. Safe supply is a form of harm reduction and refers to “providing users with a legal and regulated supply of drugs - as most deaths are related to fentanyl and its analogues adulterating the illicit drug market.” Again, diversion may be an issue and again, only time will tell. But recent heroin maintenance trials in Vancouver “involving over 200 participants had retention rates over 80 per cent after a year on treatment, and those remaining on treatment had significant reductions in illicit opioid use.” In comparison, in British Columbia, “retention rates on methadone is under 35 per cent after one year, and suboxone and slow release oral morphine show similar lack of effectiveness.”
In 2001, Portugal was experiencing an opioid crisis similar to the one gripping the United States, with HIV rates among people who use drugs, the highest in Europe. Portugal tried criminalization and incarceration to manage drug use.
In response to this increasing problem, Portugal changed the approach to a decriminalization program that year. Since, overdose deaths have plummeted, and the percentage of drug users diagnosed with new HIV infections fell. Rates of drug-related incarceration have also fallen and people voluntarily entering treatment for substance use issues have increased. It's not all good, but it is way better than it was.
Portugal and Canada are quite different than America. But these are lessons to be learned from these approaches to treating substance use disorder as a medical issue rather than a criminal problem.
Cannabis-based medicine is available, helps manage pain and is non-lethal adjunct for opioid treatment.
Blog #32: "Don't Call Me an Addict!"
This past weekend I was chastised on the subreddit site for chronic pain for not knowing the difference between dependency and addiction. The reader of my post was a chronic pain person using opioids and did not at all like those words used interchangeably. I get it. Addiction is an ugly word with lots of ugly connotations.
When opioids are the topic, the differences get really blurry. And what makes the words addiction and dependence harder to differentiate is they are often used interchangeably.
The word dependence "usually refers to a physical dependence on a substance. Dependence is characterized by the symptoms of tolerance and withdrawal."
The word addiction is more complicated. "Addiction is marked by a change in behavior caused by the biochemical changes in the brain after continued substance abuse. Substance use becomes the main priority of the addict, regardless of the harm they may cause to themselves or others. An addiction causes people to act irrationally when they don’t have the substance they are addicted to in their system."
To my critic on Reddit, I yield. I stand corrected and I will stop using the word addiction. Substance use disorder (SUD) is a preferred term in the scientific community – so I will instead use SUD. And I will differentiate between the person with chronic pain dependent on opioids and the person with SUD – but with caution — as it is possible to have a physical dependence without being addicted, substance use disorder could be right around the corner.
When opioids are the topic, the differences get really blurry. And what makes the words addiction and dependence harder to differentiate is they are often used interchangeably.
The word dependence "usually refers to a physical dependence on a substance. Dependence is characterized by the symptoms of tolerance and withdrawal."
The word addiction is more complicated. "Addiction is marked by a change in behavior caused by the biochemical changes in the brain after continued substance abuse. Substance use becomes the main priority of the addict, regardless of the harm they may cause to themselves or others. An addiction causes people to act irrationally when they don’t have the substance they are addicted to in their system."
To my critic on Reddit, I yield. I stand corrected and I will stop using the word addiction. Substance use disorder (SUD) is a preferred term in the scientific community – so I will instead use SUD. And I will differentiate between the person with chronic pain dependent on opioids and the person with SUD – but with caution — as it is possible to have a physical dependence without being addicted, substance use disorder could be right around the corner.
Blog #31: "Opioids Are Not Evil"
The marketing done and the damage they can do is evil. If you have serious chronic pain, Tylenol and NSAIDS don't cut it and most people cannot afford to add therapeutic massage or acupuncture. These are excellent adjuncts to a pain management therapeutic approach, but not real-world. Opioids work but they are so easy to abuse. #Methadone and #buprenorphine also work, but they are hard to get and when you get them, they are also easy to abuse. And all three medications can kill you.
A #painmanagement regimen in 2022 could read:10AM - 20mg tablet of sativa THC2PM - 20mg oxycontin6PM - 20mg tablet of indica THC10PM – 20mg tablet oxycontin
#Lessopioids = better #qualityoflife and less #overdosedeaths.
[NOTE TO MY LINKED IN READERS: This is my last 100 Million Ways post on Linkedin. I will post Mondays at #www.100millionways.org. My friend and mentor Dick Coletti, co-founder of the best online community i know, signs off with Roy Rogers and Dale Evans' Happy Trails - "Its the way you ride the trails that count..." Thanks to those of you that have viewed our posts and provided support as we worked to get here. Please visit us at 100MW.org. #HappyTrails and #Imagine.]
A #painmanagement regimen in 2022 could read:10AM - 20mg tablet of sativa THC2PM - 20mg oxycontin6PM - 20mg tablet of indica THC10PM – 20mg tablet oxycontin
#Lessopioids = better #qualityoflife and less #overdosedeaths.
[NOTE TO MY LINKED IN READERS: This is my last 100 Million Ways post on Linkedin. I will post Mondays at #www.100millionways.org. My friend and mentor Dick Coletti, co-founder of the best online community i know, signs off with Roy Rogers and Dale Evans' Happy Trails - "Its the way you ride the trails that count..." Thanks to those of you that have viewed our posts and provided support as we worked to get here. Please visit us at 100MW.org. #HappyTrails and #Imagine.]
Blog #30: "The Wisdom of Rats"
9-01-20
It is #InternationalOverdoseAwareness Day.Rat Experiment In the 70s, #BruceAlexander proved rats alone in a cage, offered two water bottles - one just water - the other with heroin - repetitively drank from the drug-laced bottle until they all overdosed and died. Dr Alexander wondered: is this drug or could it be related to the setting? To test, he put rats in “rat parks,” among other rats, free to roam, play, socialize and have sex. Given the same 2 types of water bottles, when in rat park, they preferred the plain water. And if they did drink drug water, they did so intermittently, not obsessively, with NO overdoses. A #socialcommunity beat drugs.
The Safe Supply approach is #harmreduction - prescribing pharmaceutical #opioids to individuals at #riskofoverdose - a bit like #theapproachinPortugal. Safe Supply initiatives have begun in Canada. But like the decision to provide #methadone supply to people unable to go to daily clinic with #COVID19, it is a risk they had to take – but a potentially double-edged sword. Thursday next, we'll hear first data from these initiatives.#30 100MW.Org
The Safe Supply approach is #harmreduction - prescribing pharmaceutical #opioids to individuals at #riskofoverdose - a bit like #theapproachinPortugal. Safe Supply initiatives have begun in Canada. But like the decision to provide #methadone supply to people unable to go to daily clinic with #COVID19, it is a risk they had to take – but a potentially double-edged sword. Thursday next, we'll hear first data from these initiatives.#30 100MW.Org
#29 BLOG "Covid-19: No work, no gym, no recovery"
From 100 Million Ways My Saga: “I am a #recoveringaddict. I have a routine to keep me clean: Working. The gym. My outpatient program with a urine test 3X/wk. With #COVID19 - no work, no gym, and my recovery program is online, sans drug tests. #NA meeting on Zoom don’t feel real. What I know best is getting high. No drug screenings - no one knows. I got what I call the stinkin thinkin.”
It’s too soon for definitive data on #pandemic’s effects on people with the disease that is #addiction, but early data is concerning. “Millennium Health Signals Report on 500,000 urine tests showed substantial increases in #syntheticopioids, #methamphetamine, and cocaine. Nationally, #overdoses climbed 18% March – May (Univ. of Baltimore).” And since C-19 has also hobbled the bad guys – less supply, new dealers, unfamiliar drugs – bad outcomes – #overdosingalone – no one to help – no #Narcan – cases going to the morgue rather than the ED (See Post #9).If #Cannabisbasedmedicine, not lethal and deemed essential, can cut the edge just enough to need #lessopioids to manage pain and addiction; there will be #lessoverdoses, #lessdeaths, better #qualityoflife and #lesscost to society. Time to #deschedule medical cannabis and #decriminalize non-violent crimes associated with this disease.#29 100MW.Org
It’s too soon for definitive data on #pandemic’s effects on people with the disease that is #addiction, but early data is concerning. “Millennium Health Signals Report on 500,000 urine tests showed substantial increases in #syntheticopioids, #methamphetamine, and cocaine. Nationally, #overdoses climbed 18% March – May (Univ. of Baltimore).” And since C-19 has also hobbled the bad guys – less supply, new dealers, unfamiliar drugs – bad outcomes – #overdosingalone – no one to help – no #Narcan – cases going to the morgue rather than the ED (See Post #9).If #Cannabisbasedmedicine, not lethal and deemed essential, can cut the edge just enough to need #lessopioids to manage pain and addiction; there will be #lessoverdoses, #lessdeaths, better #qualityoflife and #lesscost to society. Time to #deschedule medical cannabis and #decriminalize non-violent crimes associated with this disease.#29 100MW.Org
#28 BLOG "Prosecute the Addict:" A Failed Addiction Model
Social recovery. Rat water experiment. Rediscovering purpose. Drug addiction down 50% in Portugal.See TED TALK on "Everything You Knew About Addiction is Wrong"
From "Share Your Saga" Click here to see whole story
“I am out of jail. My life is in shambles. Jail traumatized me and made it much harder to get clean. I know I made these choices, but not once was I offered treatment or compassion. Instead I was thrown in jail twice – both times for possession of a syringe – not a felony in most states. I have gaps in my employment and with felonies it is way harder to get a job. I have never stolen to support my addiction. I never hurt anyone. I have never driven under the influence. I'm lost."
There are patients whose disease is their addiction. Many are “accidental addicts.” And opioid addiction treatment in America is a failed system. America spends more than $70B/year on the opioid epidemic. The concept of social recovery needs some of those dollars to improve the relationship between these patients and their environment. Support harm reduction. Decriminalize schedule 1 drugs with treatment, not jail, for non-violent crimes. Build a real-world addiction recovery model. Help people with the disease that is addiction reintegrate into society and rediscover purpose. And learn from the approach in Portugal.
TED talk on this topic: https://youtu.be/PY9DcIMGxMs
“I am out of jail. My life is in shambles. Jail traumatized me and made it much harder to get clean. I know I made these choices, but not once was I offered treatment or compassion. Instead I was thrown in jail twice – both times for possession of a syringe – not a felony in most states. I have gaps in my employment and with felonies it is way harder to get a job. I have never stolen to support my addiction. I never hurt anyone. I have never driven under the influence. I'm lost."
There are patients whose disease is their addiction. Many are “accidental addicts.” And opioid addiction treatment in America is a failed system. America spends more than $70B/year on the opioid epidemic. The concept of social recovery needs some of those dollars to improve the relationship between these patients and their environment. Support harm reduction. Decriminalize schedule 1 drugs with treatment, not jail, for non-violent crimes. Build a real-world addiction recovery model. Help people with the disease that is addiction reintegrate into society and rediscover purpose. And learn from the approach in Portugal.
TED talk on this topic: https://youtu.be/PY9DcIMGxMs
#27 BLOG An abstract by experts in the field of #cannabinoidresearch: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135562/ Evidence for Cannabis' Role in Opioid Use Disorder Introduction: Despite decades of research on effective ways to treat #opioidusedisorder (OUD), #overdosedeaths are at an all-time high, and relapse remains pervasive.
Discussion: Although there are FDA-approved #opioidreplacementtherapies (ORT) to ease the severity of opioid withdrawal symptoms and aid in relapse prevention, these medications can be lethal. There are legal and logistical bottlenecks to obtaining ORTs such as methadone or buprenorphine, and the demand for these services far outweighs the supply and access. To fill the gap between OUD treatments and the prevalence of misuse, relapse, and overdose, the development of novel, alternative, or adjunct OUD treatments is highly warranted. There is emerging evidence that cannabis may play a role in ameliorating the impact of OUD by its potential to decrease opioid misuse (as an analgesic alternative), alleviate opioid withdrawal symptoms, and decrease the likelihood of relapse.
Conclusion: The compelling nature of these data and the safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.
At 100 Million Ways we agree. COVID-19 Places first-line opioid-dependence treatments further out of reach BLOG #26 With #COVID raging in the US, #overdosedeaths are trending toward a 20% increase. In 2020 that will be more than 80,000 overdose deaths and almost 40,000 babies born with #neonatalabstinencesyndrome (NAS). And studies of the impact C-19 is having on #mentalhealth in general, show lower psychological well-being and higher scores of anxiety and depression.
First-line #OpioidUseDisorder (OUD) treatment includes #buprenorphine and #methadone to decrease withdrawal symptoms while blocking effects of short-acting opioids like heroin. But, #accessbarriers to these meds include waiting lists for treatment, limited geographic and insurance coverage, and the requirement that patients receive methadone daily at #OpioidTreatmentPrograms. While some of these rules have been relaxed during the #pandemic, only about 20% of people with #OUD are in treatment.Researchers continue to call for #clinicaltrials after a new study conducted at #JohnsHopkins reported 72% saying it eased their withdrawal symptoms. And, #withdrawal severity scores nearly doubled on days #cannabis was not used. In the wake of the pandemic, it is a #publichealthemergency to evaluate this plant as a real-world solution for #opioidaddiction. PAST BLOG ENTRIES IN ORDER OF THEIR APPEARANCE
1. A Pandemic on Top of a Pandemic I know we must focus on COVID-19 - but there is another epidemic that has been raging for years. People addicted to opioids are having a terrible time. There are so many unplanned and unsupported opioid withdrawals as a result of the shutdown. I know people find it hard to feel empathy for addicts - but opioid addiction is a disease unto itself. So many opioid addicts are “accidental addicts.” It’s not an excuse - just an observation. America needs to officially acknowledge opioid addicts as “patients.” It would be a good start as we anticipate the new normal and deal with setbacks in the fight against opioid addiction in America.
2. Buprenorphine and Methadone There are 2 primary medication options to support opioid withdrawal: Buprenorphine and Methadone. This is called medication assisted treatment (MAT). Both are hard to get as they require a physician to be certified to write a prescription. Both work - but there is a 70% failure rate. And both are potentially lethal.
There is mounting real world evidence and numerous anecdotes about using CBD or cannabis-based medicine to support opioid withdrawal. A National Academy of Sciences report in 2017 concluded that there is evidence that cannabis is effective for the treatment of chronic pain in adults.
With no non-opioids to treat severe and chronic pain available, and likely not available for years, it seems an easy decision to give cannabis-based medicine a go. It is available. It is not lethal. And even if cannabis-based medicine works as an adjunct to opioids to manage severe and chronic pain, patients will need less opioids, there will be less overdoses and deaths and, there will be a decrease in cost to society. Finally, if we spend $100million to answer this research question, that is 0.13% of the cost for one year of the opioid epidemic in America (CDC says it cost $76.5B/year). 3. The Cannabis Option The challenges of sheltering have been overwhelming for our vulnerable population. People trying to break the chains of opioid addiction are in this group. Medication Assisted Treatments (MAT) are hard enough to get without a pandemic dropping by. With clinics shuddered and medical practitioners running on after-burners, being addicted to opioids and trying to get straight is causing a setback to progress made. Turning to the street may be easier. That’s a really bad thing.
The real-world data, peppered with a few prospective, but still observational studies, suggest cannabis-based medicine may offer an option.
One example comes from The Alcohol and Drug Abuse Institute at The University of Washington. They studied the use of cannabis as a substitute for opioid medication in an online survey of 2897 opioid patients also using cannabis-based medicine. The vast majority of patients (97%) reported using less opioids when using cannabis-based medicine and experienced more tolerable side effects with the combination than with opioids alone (92%).
This option needs further evaluation. 4. The Need for Cannabis Clinical Trials We need clinical trials to determine the impact cannabis-based medicine can have on opioid addiction. Of course, cannabis is a class 1 controlled substance – so people addicted to opioids will have to wait for clinical trials to answer research questions that could change their lives.
Does cannabis-based medicine, when added to an opioid pain management regimen, significantly:1. Reduce opioid use.2. Reduce opioid overdoses and deaths.3. Improve Quality of Life (QoL).4. Decrease cost to society.
The Multidisciplinary Association for Psychedelic Studies Foundation (MAPS) have paved the way for studying an "illicit drug" with properties proving effective in treating PTSD. MAPS is now doing FDA approved clinical trials and will soon be able to answer the research question: does MDMA improve symptoms of PTSD.
Cannabis and MDMA (aka Ecstasy) were both on the radar screen of researchers - but took a detour in the 60's. So there is an understandable social concern when considering illicit drugs as medications. But medications are simply defined as “substances used for medical treatment.” Rick, Ismail, Leslie and Team are proving that MAPS persistence and patience pays off. They are inspirational.
5. Cannabis Almost Impossible to Study Cannabis is a schedule 1 drug. This is not about recreational use. That’s a different discussion for another day. This is cannabis-based medicine; sig. one pill or one patch qhs.
DEA defines a schedule I substance as, “having no currently accepted medical use.”
The National Academy of Sciences found conclusive evidence that cannabis is effective in the treatment of chemotherapy induced nausea and for chronic pain in adults. (NAS Report 2017)
Just one of those indications is enough to repudiate Federal policy.
Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), who is not bullish on the potential of cannabis-based medicine said, “It’s been difficult to do research because of the Schedule 1 process,” referring to the restricted drug classification. She said NIDA is working with DEA and FDA for solutions “that will make research on marijuana less cumbersome.”
Change must be upon us. Controlled clinical trials must be done. 6. A Few Stark Reminders About the Opioid Epidemic-From 1999 – 2017 in the United States, 400,000 people have died from the opioid epidemic.1-On average, 130 Americans die every day from an opioid overdose.2-In 2018 there were 68,557 deaths from overdose with 50,000 of those deaths resulting from prescription opioids.3-This is more deaths than by guns, car crashes, or HIV/AIDS in one year in the US.4-People age 25 – 44 have the highest death rates.5-Children and adolescents are not spared as 8986 died between 1999 and 2016 from opioid poisoning – a 268.2% increase in mortality rate.6-There was a five-fold increase in babies born with a drug withdrawal syndrome called Neonatal Abstinence Syndrome (NAS) from 2004 to 2014 (last year reported). 7-Nearly one in every three people know someone addicted to opioids. 8-In 2016, CDC estimated 20.4% of US adults had chronic pain and 8.0% had high-impact chronic pain.9-Cost to society is $78.5B/year.10
Something Needs to be Done. 7. The Who Pain Ladder The World Health Organization (WHO) recommends that analgesics be prescribed following a pain ladder starting at:
Step 1: nonopioid analgesics, (Acetaminophen, NSAIDs…).Step 2: “weak opioids,” with or without a nonopioid alternative or adjunct.Step 3: a “strong opioid,” with or without a nonopioid alternative or adjunct.
The WHO pain ladder kind of says it all: weak opioids and strong opioids. Acetaminophen, NSAIDS, select anti-convulsive and anti-depressant medications, topical agents and interventional approaches don’t seem to cut it when treating serious and/or chronic pain.
The complete elimination of pain is rarely obtainable. Realistic treatment goals include reducing pain, maximizing function, improving quality of life and should incorporate suitable non-pharmacologic and complementary therapies for symptom management. While the psychology of pain and the expectations of pain management need to be re-invented; the epidemic is now.
And the bottom-line is that these patients have a disease. That disease is addiction. Opioids are addictive and lethal. Quality of life for the opioid addict is dismal. The opioid epidemic is out of control. And the process to recover from opioid addiction is wanting. 8. Non-opioid Clinical Pain Trials There are clinical trials underway for non-opioid alternatives. Most are IV and IM formulations, but at least there are alternatives to opioids in the development process. Meloxicam IV was recently approved and may be a viable option - although intravenous medications have challenges outside the in-patient setting. And there are trials on marketed drugs being re-purposed for non-opioid pain management.
There are four FDA-approved cannabinoid medicines available in America: Marinol, Syndros, Cesamet and Epidiolex. Sativex, a mixture of THC and cannabidiol, is a mucosal spray approved in Canada for pain in multiple sclerosis.
Why was Marinol approved? It was only slightly better than placebo for pain. But it was approved. So it makes sense to further explore the possibilities of other cannabinoids.
Cannabis-based medicine is uniquely positioned as a non-lethal, pharmacologic intervention that could impact the opioid epidemic. Cannabis-based medicine is reported to have anti-inflammatory and analgesic effects and can reduce anxiety and stress, contributors to the perception of pain.
Considering the alternatives for severe and chronic pain management as well as opioid withdrawal and recovery, knowing more about cannabis-based medicine is a matter of public health safety. 9. Covid-19 on Top of Opioid Pandemic People with the disease that is opioid addiction are facing unique challenges in this pandemic. They are more likely to be alienated from news, less likely to hear about risks and best practices that could prevent infection. They could be dealing with financial insecurity and may be living in shelters or jail. They are more likely to be immuno-compromised with reduced access to healthcare. And if in recovery, access to medication assisted treatment (MAT) is difficult. In short, vulnerable populations have been made more vulnerable in this pandemic.
There is a dark twist in a LA Times headline, “Coronavirus chokes the drug trade — from Wuhan, through Mexico and onto U.S. streets.” “Wuhan is known for production of chemicals to cook powerful synthetic opioids.” And “the narcotics trade relies on movement of goods, which has been stymied by travel bans. Mexican production of fentanyl and methamphetamine are hard hit.” While one might celebrate such a story, according to UCSF School of Medicine: “when there is decreased supply, addicts often substitute drugs with which they may be less familiar. They also can change habits, making dosing less reliable. Overdoses go up, paradoxically, as supply goes down.”
“The COVID-19 pandemic could usher in a fifth wave of the opioid crisis.”
10. Potential of Canabis Medicine for Reducing Harm For people with the disease that is addiction, the steps to recovery have many challenges. Once in recovery, medication assisted treatment is a daily commitment -- hard enough as an activity of daily living -- harder still in a pandemic.
Harm reduction organizations have long advocated for easier access to medications such as methadone and buprenorphine. This month, SAMHSA and DEA eased restrictions. This had to happen - but it is a double-edged sword for people with the disease that is addiction – especially under pressure. Methadone and buprenorphine are the best medications today to support opioid withdrawal - but they too can be lethal.
Cannabis-based medicine is a real-world solution. There is a volume of real-world data and the safety profile is sufficient. The best cannabis companies are prepared for regulatory oversight and are following GMP. There are formulations that can provide controlled dosing. Cannabis-based medicine needs dose-ranging studies and controlled clinical trials for the indications that appear to show benefit. For pain management, if cannabis-based medicine, as adjunct to opioid treatment, decreases the amount of opioids a patient needs to manage pain, there will be less overdoses, less deaths, better quality of life and less cost to society.
11. " A tale of two epidemics" There is a recent Harvard Health Blog – “A tale of two epidemics… Peter Grinspoon, MD is the author and a primary care doctor who has recovered from — and who treats — opiate addiction. Below are the headers to the paragraphs in his article. They say it all.· Social determinants of health create greater vulnerability· Treatments and support systems may be disrupted· Social isolation increases the risk for addiction· Isolation may increase the risk of overdose deaths· Multiple health crises mean comprehensive solutions
The entire article can be viewed at:https://lnkd.in/drCYchn
People with the disease that is addiction will not have a new normal because they did not have an old normal. Everything for them will be harder. If cannabis-based medicine is a real-world option for pain management and people can take less opioids to manage their pain, they will have a better quality of life, with less chance of overdose or death.---------------------------------------------------------------------------------------------------------------12. This is a real-world article by David Poses May 1, 2020https://lnkd.in/d_5CaUh
“Fear, economic distress and isolation could trigger anxiety and depression in anyone. For people who have opioid use disorder, the coronavirus pandemic is a tinderbox of potential triggers and double binds.
Depression was my gateway and relapse trigger. For me, healing required buprenorphine and intensive therapy. Both treatments are complicated by closures intended to inhibit the spread of coronavirus.
Restrictions on medically assisted treatment (MAT) were eased in mid-March — after the first wave of deaths was reported. Having a prescription, however, doesn’t eliminate all problems. Many clinics refuse to dispense more than one dose at a time. Crowded conditions and long lines across the country make social-distancing measures a challenge.
Without medication, people in recovery are forced to choose between the agony of withdrawal, or relapse.”
The immediate future for people with the disease that is addiction has gotten worse than the immediate past – and it is scary to think what worse will mean as the C-19 dust settles (if the dust settles). A real-world therapeutic option makes sense now more than ever.---------------------------------------------------------------------------------------------------------------13. The Multidisciplinary Association for Psychedelic Studies (MAPS), founded 30 years ago by Rick Doblin, PhD, is moving MDMA through Phase 3 clinical trials to treat PTSD. An interim analysis shows "a 90% chance of statistically significant difference in PTSD symptoms after MDMA-assisted psychotherapy.” This is inspiring at many levels.
During this pandemic, vulnerable populations are in trouble - and will likely stay in trouble until there is a vaccine. A Well Being Trust study calls mental health, “collateral damage” as a side-effect to C-19 imposed isolation. Yes, it would be lovely if people with the disease that is addiction could pursue alternative therapies like psychotherapy, yoga, massage… real-world, they cannot.
Cannabis-based medicine is a real-world option, available without the complexity required to access methadone or buprenorphine. It can be delivered in controlled doses. It does not need to be smoked. And it is not lethal.
“Don’t just talk about it, be about it.” MAPS is an example to emulate. Does cannabis-based medicine added to an opioid pain management regimen significantly: reduce opioid use - therefore reducing overdoses and deaths, improve Quality of Life and decrease costs.
We are starting a Foundation to answer these questions. More to come.---------------------------------------------------------------------------------------------------------------14. Starting a Foundation requires a lot of the same stuff starting a business requires. A business plan with a few budget scenarios is especially important. A 501 (c)(3) determination from IRS as a not-for-profit is a requirement. And everything has to be transparent.
Once nonprofit status is achieved (I will describe that process in future posts), it becomes a lot about funding. Small and self-funding can only get you so far. But you have to get going. We hope philanthropists friendly to the potential of cannabis and to this cause will help. But sustainability must come from the more than 100 million people affected by the opioid epidemic. 100 million small donations will do nicely.
Our aim is true. Does cannabis-based medicine - as adjunct therapy to opioids – reduce the amount of opioids a person needs to manage pain and addiction. A real-world solution.
Mission Statement: Support regulatory grade data collection and science to determine the effectiveness of cannabis-based medicine in helping to break the chains of addiction. First up; the indiscriminate killer that is the opioid epidemic.
Extended Mission: Reach beyond our mission to address the increased challenges people with the disease that is addiction are facing in the C-19 pandemic.
Our name: 100 Million Ways---------------------------------------------------------------------------------------------------------------15. The Foundation Name: We started with a vision to eliminate 100,000,000 doses of opioids from the “street” by the impact cannabis-based medicine has on decreasing the amount of opioids it takes to manage chronic pain and addiction.
There is evidence that cannabis-based medicine is one of the innovative and alternative ways to manage pain and slow the cycle of lethal drug use.
Along the planning pathway, 100,000,000 doses became 100 Million Ways – to fund clinical research, collect real-word evidence and publish quality data to realize this vision.
Foundations are dependent of givers. In order to receive a gift/donation, nonprofit status must be established. The process for 501(c)(3) determination by IRS takes time. But there are nonprofit organizations that can legally provide fiscal sponsorship to groups like 100 Million Ways while pursuing nonprofit status. Their board of directors is our board of directors. A fiscal sponsor has fiduciary responsibility, provides grant-management services and handles IRS documentation. A fiscal sponsor can charge 6% - 12% of donations – but operations and fundraising can start right away. It works for 100 Million Ways - especially because we are "connected" to cannabis, as it is a schedule 1 narcotic. More to come on that topic.16. In America, the 1970 Controlled Substances Act classifies cannabis as a Schedule I substance, the highest level of drug restriction, as having:
- Potential for abuse – potential for abuse exists with cannabis, methadone and buprenorphine. The difference: cannabis is not lethal.- No currently accepted medical use – The National Academies of Sciences concluded that cannabinoids are effective to treat chronic pain.- No accepted safety - History of cannabis use suggests an acceptable safety profile.
Sponsoring a cannabis clinical trial has layers of bureaucracy: discuss research plans with DEA with a Schedule I license site-inspection.
We do not expect controlled clinical trials - with broader application than studies managed by NIDA - until cannabis is de-scheduled.
Also, for nonprofit consideration, 100 Million Ways can only fund observational research and not “possess, manufacture, distribute, or dispense controlled substances.”
100 Million Ways online community will support people with the disease that is addiction and offer participation in a registry for real-world evidence about the impact cannabis-based medicine has on pain and opioid addiction management. It will also set the groundwork for a rapid response when clinical trials can be performed legally.
17. Despite cannabis legalization in 33 states and Washington DC, and the increasing use of cannabinoids for a variety of diseases and conditions in addition to recreational use, the federal government yet to de-schedule cannabis, at least for medical/clinical research, and continues to enforce restrictive policies and regulations on research into the possible health harms or benefits of cannabis products that are now available to consumers in a majority of states.
As a result, research on the health effects of cannabis and cannabinoids has been limited in the United States, leaving patients, health care professionals, and policy makers without the evidence they need to make sound decisions regarding the use of cannabis and cannabinoids. This lack of evidence-based information on the health effects of cannabis and cannabinoids poses a public health risk.
Investigators seeking to conduct research on cannabis or cannabinoids must navigate a series of review processes that may involve the National Institute on Drug Abuse (NIDA), the U.S. Food and Drug Administration (FDA), the U.S. Drug Enforcement Administration (DEA), institutional review boards, offices or departments in state government, state boards of medical examiners, the researcher's home institution, and potential funders.
18. The Quick Response Team (QRT) is a partnership of law enforcement, emergency medical personnel, social work professionals and peer support persons working at “street” level. A QRT responds to 911 reported overdoses. Dan Meloy, Founder of QRT and a retired Police Chief said, “the sooner we engage a person who has overdosed the better the outcome.” In 300 engagements in < 2 years, 250 people were engaged in 3 – 5 days, 80% of survivors decided to go into recovery. Dan took a road less traveled. His response team model adds humanity, compassion, and empathy. Kelly Firesheets is Dan's colleague. Kelly is a clinical psychologist and a recognized expert in national addiction crisis community interventions.Teams spend as much time as it takes. Building trust takes time. QRT provides in-home triage to link families and survivors to treatment services.This is amazing and inspiring work. Can society afford such a comprehensive hands-on model? CDC says 68,000 overdose deaths in 2018 - likely to increase with the C-19 pandemic. CDC says opioid epidemic currently costs America about $78B/year. Also likely to increase. The alternative of life-again and the opportunity to be a productive person is way less expensive over the long run.
These are Americans making a difference.
QRT National is a non-profit educational organization that provides training and instruction to individuals, public and private entities for the purpose of developing and/or enhancing a community or regions response capabilities. as it relates to addressing crisis intervention, and specifically, the opioid/heroin epidemic. QRT National offers an efficient and effective pathway to communities and leaders to work together to save lives!
https://www.youtube.com/watch?v=CBSrZSTt26M&feature=youtu.be
19. A May, 2020 study in The Journal of the American Academy of Orthopedic Surgeons adds evidence to the impact medical cannabis has on opioid addiction.
“Introduction – Cannabinoids offer a nonopioid analgesic option. This study examines the association between state cannabis laws and opioid prescriptions between 2013 – 2017.
Methods – Using Medicare Part D prescription database, this study measures annual aggregate daily doses of opioid medications prescribed by orthopedic surgeons, among the highest prescribers of opioids, in states where medical cannabis is legal, in addition to total daily doses of all opioids using lineal regression models to examine associations between state cannabis laws and annual total daily doses of opioid medications.
Results – States where medical cannabis is legal show a statistically significant reduction in aggregate opioid prescribing of 144,000 DAILY doses (19.7%).”
Evidence continues to accumulate that cannabis is a legitimate treatment option for chronic pain, drug withdrawal, and other ailments. Medical marijuana as adjunct therapy can help people with chronic pain decrease the risks of opioid treatment.
20. Two weeks ago the Quick Response Team (QRT) post asked, "Can society afford such a comprehensive hands-on model?" The conclusion: The alternative of life-again and the opportunity to be a productive person is easily the cost-effective option.
CDC estimates the opioid epidemic costs $79.5B/year. The White House Council estimate is $504B/year - one reason these numbers are so different is the WH estimate includes the most expensive cost - death. But those numbers are vast and vague.
We drilled down to cost estimates for 1 person with the disease that is opioid addiction. The numbers are still dramatic but easier to relate to: • $15,000 more each year in health care costs than a similar patient not diagnosed with OUD.• $38,000 more each year in lost productivity and disability costs than a similar patient not diagnosed with OUD. • $2,000,000 in mortality costs, life-earnings lost for people who die prematurely from opioid overdoses (ages 15-34).• $20,000 to treat Neonatal Abstinence Syndrome (NAS).
People with OUD that choose a Harm Reduction pathway such as cannabis-based medicine as an adjunct to opioid treatment to decrease the amount of opioids needed by a person to manage chronic pain and addiction include:• Less overdoses• Less deaths• Better quality of life• Way Less Cost to Society. 21. The COVID-19 Pandemic has worsened the opioid crisis. More people are dying of overdoses and fewer are being admitted for treatment.“COVID-19 has showed us the vulnerabilities and deficiencies in our addiction services—in addition, it has increased the mental health needs of this population.”The arrival of the coronavirus disease 2019 (COVID-19) pandemic has provided an unanticipated haven for the already formidable opioid epidemic. COVID-19–related protective shelter-in-place orders have pushed individuals battling sobriety into isolation and have decreased access to treatment and opportunity for distraction from addictions.The addiction community is raising alarms that the current epidemiological climate alone is a risk factor for substance abuse relapse, prompting the New York Times to label the coronavirus pandemic “a national relapse trigger.”2 In 2010, the CDC began to note that the average American life span was declining in correlation with an astounding increase in opioid-related deaths, causing the CDC to call for an “urgent” response. America holds the dubious distinction of being the lowest-ranked nation in life expectancy among developed nations due to the opioid epidemic, a statistic usually depreciated by factors such as civil war or lack of access to safe water or basic vaccinations.22. The 100 Million Ways Foundation will support regulatory grade data collection and science to determine the effectiveness of cannabis-based medicine in helping to break the chains of addiction. With the COVID-19 pandemic, 100MW will reach past the immediate mission to address the unique stresses this clash of pandemics has put on people with the disease that is opioid addiction.
100 Million Ways will fund clinical research to determine if medical cannabis, a non-lethal alternative to or adjunct with opioid therapy for pain and addiction management, can reduce opioid usage and support opioid withdrawal. If so, there will be fewer overdoses, less deaths, improved quality of life with decreased cost to society. 100MW will drive Harm Reduction strategies to reduce negative consequences associated with drug use and respect for people who use drugs. 100MW is building a web presence, a web-based registry, and an online community. A pub-med study (Epub 2017 Oct 5) provides validity to recovery-oriented online communities suggesting the incorporation of online peer support with traditional addiction treatments brings benefit. And 100MW will collaborate with academic medical centers and other foundations to bring this Mission to life.
23. Building 100 Million Ways Web presence during the C-19 pandemic has changed typical process for the software development life cycle. A panel of potential users - people with the disease that is addition – has yet to be organized for a proper requirements solicitation process. This will happen but C-19 makes that a challenge and going live as soon as possible to provide a source of information and support for those users seems most important. With that there are two web-based systems in the works: a community Website with a second interactive blog Website. Websites will be pseudonymous. There will be resources and links of value. There will be threads for discussion. There will be experts – not to advise a specific person - but to inform the community about challenges users present in their online stories. It will be linked to the 100 Million Ways Research Registry. It will educate users about the science of cannabis-based medicine when used to reduce pain and to reduce the amount of opioids necessary to manage chronic pain and opioid addiction. The website will enable online donations. So, if the spirit moves you, have a look at the two website work environments: www.100MW.org and www.100MW.blog . Comments and suggestions are welcome.
24. The impact of the #pandemic on people with the disease that is #opioidaddiction is already significant. There are new barriers to recovery - isolation, unemployment, and the fear of contracting COVID. In NJ, “#overdosedeaths are already 20% higher this year than last year.” 35 states report increases in opioid deaths. And the costs of C-19 are causing cuts in funding for treatment programs. Francis Collins said, “the #opioidcrisis is difficult, add a pandemic and it becomes difficult squared.” Nora Volkow said, “support systems to help addicts are no longer in place.” People in recovery could not get their medication assisted treatment - clinics closed, transportation a challenge... Even with harm-reduction modifications, these processes remain difficult.A randomized, double‐blind, placebo‐controlled trial had 27 subjects with chronic neuropathic pain. “Both doses, but not placebo, showed a significant reduction in pain from baseline and for 150 minutes.” It is small. It was performed for device marketing purposes. But - it was an RCT. This vulnerable population faces so many daily challenges, it is a #harmreduction decision to #deschedulecannabis for medical purposes and get on with clinical trials to sort out what this multi-faceted compound can do.see www.100mw.blog #27BLOGAn abstract by experts in the field of #cannabinoidresearch: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135562/ Evidence for Cannabis' Role in Opioid Use Disorder Introduction: Despite decades of research on effective ways to treat #opioidusedisorder (OUD), #overdosedeaths are at an all-time high, and relapse remains pervasive.
Discussion: Although there are FDA-approved #opioidreplacementtherapies (ORT) to ease the severity of opioid withdrawal symptoms and aid in relapse prevention, these medications can be lethal. There are legal and logistical bottlenecks to obtaining ORTs such as methadone or buprenorphine, and the demand for these services far outweighs the supply and access. To fill the gap between OUD treatments and the prevalence of misuse, relapse, and overdose, the development of novel, alternative, or adjunct OUD treatments is highly warranted. There is emerging evidence that cannabis may play a role in ameliorating the impact of OUD by its potential to decrease opioid misuse (as an analgesic alternative), alleviate opioid withdrawal symptoms, and decrease the likelihood of relapse.
Conclusion: The compelling nature of these data and the safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.
At 100 Million Ways we agree. PLEASE USE FORM BELOW TO SEND US YOUR THOUGHTS ON ANY OF THESE TOPICS
Discussion: Although there are FDA-approved #opioidreplacementtherapies (ORT) to ease the severity of opioid withdrawal symptoms and aid in relapse prevention, these medications can be lethal. There are legal and logistical bottlenecks to obtaining ORTs such as methadone or buprenorphine, and the demand for these services far outweighs the supply and access. To fill the gap between OUD treatments and the prevalence of misuse, relapse, and overdose, the development of novel, alternative, or adjunct OUD treatments is highly warranted. There is emerging evidence that cannabis may play a role in ameliorating the impact of OUD by its potential to decrease opioid misuse (as an analgesic alternative), alleviate opioid withdrawal symptoms, and decrease the likelihood of relapse.
Conclusion: The compelling nature of these data and the safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.
At 100 Million Ways we agree. COVID-19 Places first-line opioid-dependence treatments further out of reach BLOG #26 With #COVID raging in the US, #overdosedeaths are trending toward a 20% increase. In 2020 that will be more than 80,000 overdose deaths and almost 40,000 babies born with #neonatalabstinencesyndrome (NAS). And studies of the impact C-19 is having on #mentalhealth in general, show lower psychological well-being and higher scores of anxiety and depression.
First-line #OpioidUseDisorder (OUD) treatment includes #buprenorphine and #methadone to decrease withdrawal symptoms while blocking effects of short-acting opioids like heroin. But, #accessbarriers to these meds include waiting lists for treatment, limited geographic and insurance coverage, and the requirement that patients receive methadone daily at #OpioidTreatmentPrograms. While some of these rules have been relaxed during the #pandemic, only about 20% of people with #OUD are in treatment.Researchers continue to call for #clinicaltrials after a new study conducted at #JohnsHopkins reported 72% saying it eased their withdrawal symptoms. And, #withdrawal severity scores nearly doubled on days #cannabis was not used. In the wake of the pandemic, it is a #publichealthemergency to evaluate this plant as a real-world solution for #opioidaddiction. PAST BLOG ENTRIES IN ORDER OF THEIR APPEARANCE
1. A Pandemic on Top of a Pandemic I know we must focus on COVID-19 - but there is another epidemic that has been raging for years. People addicted to opioids are having a terrible time. There are so many unplanned and unsupported opioid withdrawals as a result of the shutdown. I know people find it hard to feel empathy for addicts - but opioid addiction is a disease unto itself. So many opioid addicts are “accidental addicts.” It’s not an excuse - just an observation. America needs to officially acknowledge opioid addicts as “patients.” It would be a good start as we anticipate the new normal and deal with setbacks in the fight against opioid addiction in America.
2. Buprenorphine and Methadone There are 2 primary medication options to support opioid withdrawal: Buprenorphine and Methadone. This is called medication assisted treatment (MAT). Both are hard to get as they require a physician to be certified to write a prescription. Both work - but there is a 70% failure rate. And both are potentially lethal.
There is mounting real world evidence and numerous anecdotes about using CBD or cannabis-based medicine to support opioid withdrawal. A National Academy of Sciences report in 2017 concluded that there is evidence that cannabis is effective for the treatment of chronic pain in adults.
With no non-opioids to treat severe and chronic pain available, and likely not available for years, it seems an easy decision to give cannabis-based medicine a go. It is available. It is not lethal. And even if cannabis-based medicine works as an adjunct to opioids to manage severe and chronic pain, patients will need less opioids, there will be less overdoses and deaths and, there will be a decrease in cost to society. Finally, if we spend $100million to answer this research question, that is 0.13% of the cost for one year of the opioid epidemic in America (CDC says it cost $76.5B/year). 3. The Cannabis Option The challenges of sheltering have been overwhelming for our vulnerable population. People trying to break the chains of opioid addiction are in this group. Medication Assisted Treatments (MAT) are hard enough to get without a pandemic dropping by. With clinics shuddered and medical practitioners running on after-burners, being addicted to opioids and trying to get straight is causing a setback to progress made. Turning to the street may be easier. That’s a really bad thing.
The real-world data, peppered with a few prospective, but still observational studies, suggest cannabis-based medicine may offer an option.
One example comes from The Alcohol and Drug Abuse Institute at The University of Washington. They studied the use of cannabis as a substitute for opioid medication in an online survey of 2897 opioid patients also using cannabis-based medicine. The vast majority of patients (97%) reported using less opioids when using cannabis-based medicine and experienced more tolerable side effects with the combination than with opioids alone (92%).
This option needs further evaluation. 4. The Need for Cannabis Clinical Trials We need clinical trials to determine the impact cannabis-based medicine can have on opioid addiction. Of course, cannabis is a class 1 controlled substance – so people addicted to opioids will have to wait for clinical trials to answer research questions that could change their lives.
Does cannabis-based medicine, when added to an opioid pain management regimen, significantly:1. Reduce opioid use.2. Reduce opioid overdoses and deaths.3. Improve Quality of Life (QoL).4. Decrease cost to society.
The Multidisciplinary Association for Psychedelic Studies Foundation (MAPS) have paved the way for studying an "illicit drug" with properties proving effective in treating PTSD. MAPS is now doing FDA approved clinical trials and will soon be able to answer the research question: does MDMA improve symptoms of PTSD.
Cannabis and MDMA (aka Ecstasy) were both on the radar screen of researchers - but took a detour in the 60's. So there is an understandable social concern when considering illicit drugs as medications. But medications are simply defined as “substances used for medical treatment.” Rick, Ismail, Leslie and Team are proving that MAPS persistence and patience pays off. They are inspirational.
5. Cannabis Almost Impossible to Study Cannabis is a schedule 1 drug. This is not about recreational use. That’s a different discussion for another day. This is cannabis-based medicine; sig. one pill or one patch qhs.
DEA defines a schedule I substance as, “having no currently accepted medical use.”
The National Academy of Sciences found conclusive evidence that cannabis is effective in the treatment of chemotherapy induced nausea and for chronic pain in adults. (NAS Report 2017)
Just one of those indications is enough to repudiate Federal policy.
Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), who is not bullish on the potential of cannabis-based medicine said, “It’s been difficult to do research because of the Schedule 1 process,” referring to the restricted drug classification. She said NIDA is working with DEA and FDA for solutions “that will make research on marijuana less cumbersome.”
Change must be upon us. Controlled clinical trials must be done. 6. A Few Stark Reminders About the Opioid Epidemic-From 1999 – 2017 in the United States, 400,000 people have died from the opioid epidemic.1-On average, 130 Americans die every day from an opioid overdose.2-In 2018 there were 68,557 deaths from overdose with 50,000 of those deaths resulting from prescription opioids.3-This is more deaths than by guns, car crashes, or HIV/AIDS in one year in the US.4-People age 25 – 44 have the highest death rates.5-Children and adolescents are not spared as 8986 died between 1999 and 2016 from opioid poisoning – a 268.2% increase in mortality rate.6-There was a five-fold increase in babies born with a drug withdrawal syndrome called Neonatal Abstinence Syndrome (NAS) from 2004 to 2014 (last year reported). 7-Nearly one in every three people know someone addicted to opioids. 8-In 2016, CDC estimated 20.4% of US adults had chronic pain and 8.0% had high-impact chronic pain.9-Cost to society is $78.5B/year.10
Something Needs to be Done. 7. The Who Pain Ladder The World Health Organization (WHO) recommends that analgesics be prescribed following a pain ladder starting at:
Step 1: nonopioid analgesics, (Acetaminophen, NSAIDs…).Step 2: “weak opioids,” with or without a nonopioid alternative or adjunct.Step 3: a “strong opioid,” with or without a nonopioid alternative or adjunct.
The WHO pain ladder kind of says it all: weak opioids and strong opioids. Acetaminophen, NSAIDS, select anti-convulsive and anti-depressant medications, topical agents and interventional approaches don’t seem to cut it when treating serious and/or chronic pain.
The complete elimination of pain is rarely obtainable. Realistic treatment goals include reducing pain, maximizing function, improving quality of life and should incorporate suitable non-pharmacologic and complementary therapies for symptom management. While the psychology of pain and the expectations of pain management need to be re-invented; the epidemic is now.
And the bottom-line is that these patients have a disease. That disease is addiction. Opioids are addictive and lethal. Quality of life for the opioid addict is dismal. The opioid epidemic is out of control. And the process to recover from opioid addiction is wanting. 8. Non-opioid Clinical Pain Trials There are clinical trials underway for non-opioid alternatives. Most are IV and IM formulations, but at least there are alternatives to opioids in the development process. Meloxicam IV was recently approved and may be a viable option - although intravenous medications have challenges outside the in-patient setting. And there are trials on marketed drugs being re-purposed for non-opioid pain management.
There are four FDA-approved cannabinoid medicines available in America: Marinol, Syndros, Cesamet and Epidiolex. Sativex, a mixture of THC and cannabidiol, is a mucosal spray approved in Canada for pain in multiple sclerosis.
Why was Marinol approved? It was only slightly better than placebo for pain. But it was approved. So it makes sense to further explore the possibilities of other cannabinoids.
Cannabis-based medicine is uniquely positioned as a non-lethal, pharmacologic intervention that could impact the opioid epidemic. Cannabis-based medicine is reported to have anti-inflammatory and analgesic effects and can reduce anxiety and stress, contributors to the perception of pain.
Considering the alternatives for severe and chronic pain management as well as opioid withdrawal and recovery, knowing more about cannabis-based medicine is a matter of public health safety. 9. Covid-19 on Top of Opioid Pandemic People with the disease that is opioid addiction are facing unique challenges in this pandemic. They are more likely to be alienated from news, less likely to hear about risks and best practices that could prevent infection. They could be dealing with financial insecurity and may be living in shelters or jail. They are more likely to be immuno-compromised with reduced access to healthcare. And if in recovery, access to medication assisted treatment (MAT) is difficult. In short, vulnerable populations have been made more vulnerable in this pandemic.
There is a dark twist in a LA Times headline, “Coronavirus chokes the drug trade — from Wuhan, through Mexico and onto U.S. streets.” “Wuhan is known for production of chemicals to cook powerful synthetic opioids.” And “the narcotics trade relies on movement of goods, which has been stymied by travel bans. Mexican production of fentanyl and methamphetamine are hard hit.” While one might celebrate such a story, according to UCSF School of Medicine: “when there is decreased supply, addicts often substitute drugs with which they may be less familiar. They also can change habits, making dosing less reliable. Overdoses go up, paradoxically, as supply goes down.”
“The COVID-19 pandemic could usher in a fifth wave of the opioid crisis.”
10. Potential of Canabis Medicine for Reducing Harm For people with the disease that is addiction, the steps to recovery have many challenges. Once in recovery, medication assisted treatment is a daily commitment -- hard enough as an activity of daily living -- harder still in a pandemic.
Harm reduction organizations have long advocated for easier access to medications such as methadone and buprenorphine. This month, SAMHSA and DEA eased restrictions. This had to happen - but it is a double-edged sword for people with the disease that is addiction – especially under pressure. Methadone and buprenorphine are the best medications today to support opioid withdrawal - but they too can be lethal.
Cannabis-based medicine is a real-world solution. There is a volume of real-world data and the safety profile is sufficient. The best cannabis companies are prepared for regulatory oversight and are following GMP. There are formulations that can provide controlled dosing. Cannabis-based medicine needs dose-ranging studies and controlled clinical trials for the indications that appear to show benefit. For pain management, if cannabis-based medicine, as adjunct to opioid treatment, decreases the amount of opioids a patient needs to manage pain, there will be less overdoses, less deaths, better quality of life and less cost to society.
11. " A tale of two epidemics" There is a recent Harvard Health Blog – “A tale of two epidemics… Peter Grinspoon, MD is the author and a primary care doctor who has recovered from — and who treats — opiate addiction. Below are the headers to the paragraphs in his article. They say it all.· Social determinants of health create greater vulnerability· Treatments and support systems may be disrupted· Social isolation increases the risk for addiction· Isolation may increase the risk of overdose deaths· Multiple health crises mean comprehensive solutions
The entire article can be viewed at:https://lnkd.in/drCYchn
People with the disease that is addiction will not have a new normal because they did not have an old normal. Everything for them will be harder. If cannabis-based medicine is a real-world option for pain management and people can take less opioids to manage their pain, they will have a better quality of life, with less chance of overdose or death.---------------------------------------------------------------------------------------------------------------12. This is a real-world article by David Poses May 1, 2020https://lnkd.in/d_5CaUh
“Fear, economic distress and isolation could trigger anxiety and depression in anyone. For people who have opioid use disorder, the coronavirus pandemic is a tinderbox of potential triggers and double binds.
Depression was my gateway and relapse trigger. For me, healing required buprenorphine and intensive therapy. Both treatments are complicated by closures intended to inhibit the spread of coronavirus.
Restrictions on medically assisted treatment (MAT) were eased in mid-March — after the first wave of deaths was reported. Having a prescription, however, doesn’t eliminate all problems. Many clinics refuse to dispense more than one dose at a time. Crowded conditions and long lines across the country make social-distancing measures a challenge.
Without medication, people in recovery are forced to choose between the agony of withdrawal, or relapse.”
The immediate future for people with the disease that is addiction has gotten worse than the immediate past – and it is scary to think what worse will mean as the C-19 dust settles (if the dust settles). A real-world therapeutic option makes sense now more than ever.---------------------------------------------------------------------------------------------------------------13. The Multidisciplinary Association for Psychedelic Studies (MAPS), founded 30 years ago by Rick Doblin, PhD, is moving MDMA through Phase 3 clinical trials to treat PTSD. An interim analysis shows "a 90% chance of statistically significant difference in PTSD symptoms after MDMA-assisted psychotherapy.” This is inspiring at many levels.
During this pandemic, vulnerable populations are in trouble - and will likely stay in trouble until there is a vaccine. A Well Being Trust study calls mental health, “collateral damage” as a side-effect to C-19 imposed isolation. Yes, it would be lovely if people with the disease that is addiction could pursue alternative therapies like psychotherapy, yoga, massage… real-world, they cannot.
Cannabis-based medicine is a real-world option, available without the complexity required to access methadone or buprenorphine. It can be delivered in controlled doses. It does not need to be smoked. And it is not lethal.
“Don’t just talk about it, be about it.” MAPS is an example to emulate. Does cannabis-based medicine added to an opioid pain management regimen significantly: reduce opioid use - therefore reducing overdoses and deaths, improve Quality of Life and decrease costs.
We are starting a Foundation to answer these questions. More to come.---------------------------------------------------------------------------------------------------------------14. Starting a Foundation requires a lot of the same stuff starting a business requires. A business plan with a few budget scenarios is especially important. A 501 (c)(3) determination from IRS as a not-for-profit is a requirement. And everything has to be transparent.
Once nonprofit status is achieved (I will describe that process in future posts), it becomes a lot about funding. Small and self-funding can only get you so far. But you have to get going. We hope philanthropists friendly to the potential of cannabis and to this cause will help. But sustainability must come from the more than 100 million people affected by the opioid epidemic. 100 million small donations will do nicely.
Our aim is true. Does cannabis-based medicine - as adjunct therapy to opioids – reduce the amount of opioids a person needs to manage pain and addiction. A real-world solution.
Mission Statement: Support regulatory grade data collection and science to determine the effectiveness of cannabis-based medicine in helping to break the chains of addiction. First up; the indiscriminate killer that is the opioid epidemic.
Extended Mission: Reach beyond our mission to address the increased challenges people with the disease that is addiction are facing in the C-19 pandemic.
Our name: 100 Million Ways---------------------------------------------------------------------------------------------------------------15. The Foundation Name: We started with a vision to eliminate 100,000,000 doses of opioids from the “street” by the impact cannabis-based medicine has on decreasing the amount of opioids it takes to manage chronic pain and addiction.
There is evidence that cannabis-based medicine is one of the innovative and alternative ways to manage pain and slow the cycle of lethal drug use.
Along the planning pathway, 100,000,000 doses became 100 Million Ways – to fund clinical research, collect real-word evidence and publish quality data to realize this vision.
Foundations are dependent of givers. In order to receive a gift/donation, nonprofit status must be established. The process for 501(c)(3) determination by IRS takes time. But there are nonprofit organizations that can legally provide fiscal sponsorship to groups like 100 Million Ways while pursuing nonprofit status. Their board of directors is our board of directors. A fiscal sponsor has fiduciary responsibility, provides grant-management services and handles IRS documentation. A fiscal sponsor can charge 6% - 12% of donations – but operations and fundraising can start right away. It works for 100 Million Ways - especially because we are "connected" to cannabis, as it is a schedule 1 narcotic. More to come on that topic.16. In America, the 1970 Controlled Substances Act classifies cannabis as a Schedule I substance, the highest level of drug restriction, as having:
- Potential for abuse – potential for abuse exists with cannabis, methadone and buprenorphine. The difference: cannabis is not lethal.- No currently accepted medical use – The National Academies of Sciences concluded that cannabinoids are effective to treat chronic pain.- No accepted safety - History of cannabis use suggests an acceptable safety profile.
Sponsoring a cannabis clinical trial has layers of bureaucracy: discuss research plans with DEA with a Schedule I license site-inspection.
We do not expect controlled clinical trials - with broader application than studies managed by NIDA - until cannabis is de-scheduled.
Also, for nonprofit consideration, 100 Million Ways can only fund observational research and not “possess, manufacture, distribute, or dispense controlled substances.”
100 Million Ways online community will support people with the disease that is addiction and offer participation in a registry for real-world evidence about the impact cannabis-based medicine has on pain and opioid addiction management. It will also set the groundwork for a rapid response when clinical trials can be performed legally.
17. Despite cannabis legalization in 33 states and Washington DC, and the increasing use of cannabinoids for a variety of diseases and conditions in addition to recreational use, the federal government yet to de-schedule cannabis, at least for medical/clinical research, and continues to enforce restrictive policies and regulations on research into the possible health harms or benefits of cannabis products that are now available to consumers in a majority of states.
As a result, research on the health effects of cannabis and cannabinoids has been limited in the United States, leaving patients, health care professionals, and policy makers without the evidence they need to make sound decisions regarding the use of cannabis and cannabinoids. This lack of evidence-based information on the health effects of cannabis and cannabinoids poses a public health risk.
Investigators seeking to conduct research on cannabis or cannabinoids must navigate a series of review processes that may involve the National Institute on Drug Abuse (NIDA), the U.S. Food and Drug Administration (FDA), the U.S. Drug Enforcement Administration (DEA), institutional review boards, offices or departments in state government, state boards of medical examiners, the researcher's home institution, and potential funders.
18. The Quick Response Team (QRT) is a partnership of law enforcement, emergency medical personnel, social work professionals and peer support persons working at “street” level. A QRT responds to 911 reported overdoses. Dan Meloy, Founder of QRT and a retired Police Chief said, “the sooner we engage a person who has overdosed the better the outcome.” In 300 engagements in < 2 years, 250 people were engaged in 3 – 5 days, 80% of survivors decided to go into recovery. Dan took a road less traveled. His response team model adds humanity, compassion, and empathy. Kelly Firesheets is Dan's colleague. Kelly is a clinical psychologist and a recognized expert in national addiction crisis community interventions.Teams spend as much time as it takes. Building trust takes time. QRT provides in-home triage to link families and survivors to treatment services.This is amazing and inspiring work. Can society afford such a comprehensive hands-on model? CDC says 68,000 overdose deaths in 2018 - likely to increase with the C-19 pandemic. CDC says opioid epidemic currently costs America about $78B/year. Also likely to increase. The alternative of life-again and the opportunity to be a productive person is way less expensive over the long run.
These are Americans making a difference.
QRT National is a non-profit educational organization that provides training and instruction to individuals, public and private entities for the purpose of developing and/or enhancing a community or regions response capabilities. as it relates to addressing crisis intervention, and specifically, the opioid/heroin epidemic. QRT National offers an efficient and effective pathway to communities and leaders to work together to save lives!
https://www.youtube.com/watch?v=CBSrZSTt26M&feature=youtu.be
19. A May, 2020 study in The Journal of the American Academy of Orthopedic Surgeons adds evidence to the impact medical cannabis has on opioid addiction.
“Introduction – Cannabinoids offer a nonopioid analgesic option. This study examines the association between state cannabis laws and opioid prescriptions between 2013 – 2017.
Methods – Using Medicare Part D prescription database, this study measures annual aggregate daily doses of opioid medications prescribed by orthopedic surgeons, among the highest prescribers of opioids, in states where medical cannabis is legal, in addition to total daily doses of all opioids using lineal regression models to examine associations between state cannabis laws and annual total daily doses of opioid medications.
Results – States where medical cannabis is legal show a statistically significant reduction in aggregate opioid prescribing of 144,000 DAILY doses (19.7%).”
Evidence continues to accumulate that cannabis is a legitimate treatment option for chronic pain, drug withdrawal, and other ailments. Medical marijuana as adjunct therapy can help people with chronic pain decrease the risks of opioid treatment.
20. Two weeks ago the Quick Response Team (QRT) post asked, "Can society afford such a comprehensive hands-on model?" The conclusion: The alternative of life-again and the opportunity to be a productive person is easily the cost-effective option.
CDC estimates the opioid epidemic costs $79.5B/year. The White House Council estimate is $504B/year - one reason these numbers are so different is the WH estimate includes the most expensive cost - death. But those numbers are vast and vague.
We drilled down to cost estimates for 1 person with the disease that is opioid addiction. The numbers are still dramatic but easier to relate to: • $15,000 more each year in health care costs than a similar patient not diagnosed with OUD.• $38,000 more each year in lost productivity and disability costs than a similar patient not diagnosed with OUD. • $2,000,000 in mortality costs, life-earnings lost for people who die prematurely from opioid overdoses (ages 15-34).• $20,000 to treat Neonatal Abstinence Syndrome (NAS).
People with OUD that choose a Harm Reduction pathway such as cannabis-based medicine as an adjunct to opioid treatment to decrease the amount of opioids needed by a person to manage chronic pain and addiction include:• Less overdoses• Less deaths• Better quality of life• Way Less Cost to Society. 21. The COVID-19 Pandemic has worsened the opioid crisis. More people are dying of overdoses and fewer are being admitted for treatment.“COVID-19 has showed us the vulnerabilities and deficiencies in our addiction services—in addition, it has increased the mental health needs of this population.”The arrival of the coronavirus disease 2019 (COVID-19) pandemic has provided an unanticipated haven for the already formidable opioid epidemic. COVID-19–related protective shelter-in-place orders have pushed individuals battling sobriety into isolation and have decreased access to treatment and opportunity for distraction from addictions.The addiction community is raising alarms that the current epidemiological climate alone is a risk factor for substance abuse relapse, prompting the New York Times to label the coronavirus pandemic “a national relapse trigger.”2 In 2010, the CDC began to note that the average American life span was declining in correlation with an astounding increase in opioid-related deaths, causing the CDC to call for an “urgent” response. America holds the dubious distinction of being the lowest-ranked nation in life expectancy among developed nations due to the opioid epidemic, a statistic usually depreciated by factors such as civil war or lack of access to safe water or basic vaccinations.22. The 100 Million Ways Foundation will support regulatory grade data collection and science to determine the effectiveness of cannabis-based medicine in helping to break the chains of addiction. With the COVID-19 pandemic, 100MW will reach past the immediate mission to address the unique stresses this clash of pandemics has put on people with the disease that is opioid addiction.
100 Million Ways will fund clinical research to determine if medical cannabis, a non-lethal alternative to or adjunct with opioid therapy for pain and addiction management, can reduce opioid usage and support opioid withdrawal. If so, there will be fewer overdoses, less deaths, improved quality of life with decreased cost to society. 100MW will drive Harm Reduction strategies to reduce negative consequences associated with drug use and respect for people who use drugs. 100MW is building a web presence, a web-based registry, and an online community. A pub-med study (Epub 2017 Oct 5) provides validity to recovery-oriented online communities suggesting the incorporation of online peer support with traditional addiction treatments brings benefit. And 100MW will collaborate with academic medical centers and other foundations to bring this Mission to life.
23. Building 100 Million Ways Web presence during the C-19 pandemic has changed typical process for the software development life cycle. A panel of potential users - people with the disease that is addition – has yet to be organized for a proper requirements solicitation process. This will happen but C-19 makes that a challenge and going live as soon as possible to provide a source of information and support for those users seems most important. With that there are two web-based systems in the works: a community Website with a second interactive blog Website. Websites will be pseudonymous. There will be resources and links of value. There will be threads for discussion. There will be experts – not to advise a specific person - but to inform the community about challenges users present in their online stories. It will be linked to the 100 Million Ways Research Registry. It will educate users about the science of cannabis-based medicine when used to reduce pain and to reduce the amount of opioids necessary to manage chronic pain and opioid addiction. The website will enable online donations. So, if the spirit moves you, have a look at the two website work environments: www.100MW.org and www.100MW.blog . Comments and suggestions are welcome.
24. The impact of the #pandemic on people with the disease that is #opioidaddiction is already significant. There are new barriers to recovery - isolation, unemployment, and the fear of contracting COVID. In NJ, “#overdosedeaths are already 20% higher this year than last year.” 35 states report increases in opioid deaths. And the costs of C-19 are causing cuts in funding for treatment programs. Francis Collins said, “the #opioidcrisis is difficult, add a pandemic and it becomes difficult squared.” Nora Volkow said, “support systems to help addicts are no longer in place.” People in recovery could not get their medication assisted treatment - clinics closed, transportation a challenge... Even with harm-reduction modifications, these processes remain difficult.A randomized, double‐blind, placebo‐controlled trial had 27 subjects with chronic neuropathic pain. “Both doses, but not placebo, showed a significant reduction in pain from baseline and for 150 minutes.” It is small. It was performed for device marketing purposes. But - it was an RCT. This vulnerable population faces so many daily challenges, it is a #harmreduction decision to #deschedulecannabis for medical purposes and get on with clinical trials to sort out what this multi-faceted compound can do.see www.100mw.blog #27BLOGAn abstract by experts in the field of #cannabinoidresearch: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135562/ Evidence for Cannabis' Role in Opioid Use Disorder Introduction: Despite decades of research on effective ways to treat #opioidusedisorder (OUD), #overdosedeaths are at an all-time high, and relapse remains pervasive.
Discussion: Although there are FDA-approved #opioidreplacementtherapies (ORT) to ease the severity of opioid withdrawal symptoms and aid in relapse prevention, these medications can be lethal. There are legal and logistical bottlenecks to obtaining ORTs such as methadone or buprenorphine, and the demand for these services far outweighs the supply and access. To fill the gap between OUD treatments and the prevalence of misuse, relapse, and overdose, the development of novel, alternative, or adjunct OUD treatments is highly warranted. There is emerging evidence that cannabis may play a role in ameliorating the impact of OUD by its potential to decrease opioid misuse (as an analgesic alternative), alleviate opioid withdrawal symptoms, and decrease the likelihood of relapse.
Conclusion: The compelling nature of these data and the safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.
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