4 weeks ago

State of addiction: How UAB is making an impact on the opioid crisis

The numbers – and the heartbreaking stories contained within them – are staggering.

According to the Centers for Disease Control and Prevention, two out of three drug overdose deaths involve an opioid. Overdose deaths from opioids, including prescription opioids, heroin and synthetic opioids like fentanyl, have increased almost sixfold since 1999. Opioid-involved overdoses killed more than 47,000 people in 2017, and 36 percent of those deaths involved prescription opioids.

Alabama is not immune to the consequences of opioid use. In 2017, the state had the highest overall opioid prescribing rate.

Why is that, and what can be done to make sure people are cared for while not harming them at the same time?

The University of Alabama at Birmingham has made significant contributions in the battle against opioids in the research field and at the bedside, all in an attempt to answer those questions and, ultimately, save more lives.

How did we get here?

Dr. Stefan Kertesz, an addiction scholar and professor in UAB’s Division of Preventive Medicine, has been a vocal leader in the fight against addiction. He has been an influential national voice by demanding opioid prescribing policies be made clearer, on behalf of patients and the doctors prescribing them.

Kertesz said there is no single person or entity to blame for the meteoric rise in opioid-related deaths, but physicians have been part of the problem.

“Part of how we got here certainly reflects a change in medical practice,” Kertesz said. “And that change was that we prescribed a lot more, and we created a market for people in pain – both with a history and with no history of addiction – to have more access to opioids.”

According to the CDC, after a steady increase in the overall national opioid prescribing rate beginning in 2006, the total number of prescriptions dispensed peaked in 2012 at more than 255 million. The prescribing rate was 81.3 prescriptions per 100 people. Although the overall rate has decreased in the past few years, in a number of U.S. counties enough opioid prescriptions were dispensed for every person to have one.

Because of the high volume of patients with opioid-related addictions, UAB saw an opportunity to strengthen its care of these patients. One route it took to enhance care was to create the Addiction Scholars Program.

The nation’s ongoing opioid crisis created a situation in which medical staff in virtually every unit of the hospital can, at some point, expect to find themselves treating patients who are abusing opioids and other drugs.

Created in 2017, UAB’s Addiction Scholars Program gives health care providers training and insight on opioid addiction. The initiative recruits hospital staff – physicians, nurses, therapists, social workers and more – who undergo a 15-month curriculum taught by UAB experts in addiction medicine. The goals are to better prepare staff for the challenges patients face with opioid addiction and to find better ways to provide the appropriate care to this patient population.

“Most physicians don’t receive formal training in addiction management,” said Dr. Eddie Mathews, a hospitalist and one of the first scholars. “Yet there is a clear need for enhanced education for all medical professionals. We need to learn about the disease process in addiction and learn how we can better treat these patients, both for their opioid use and for any underlying or concurrent medical issues.”

At UAB’s School of Dentistry, professors are taking the lead in the dental field to combat the growing opioid epidemic in hope that their measures will be translated into other practices and fields across the state and country.

“The public health crisis we are dealing with stems from many roots, ranging from easy access to prescription medication and the quantity in which medication is prescribed, to the inability of physicians to set realistic expectations with patients about pain,” said Dr. Nico Geurs, chairman of UAB’s Department of Periodontology. “As dentists, we’re facing a watershed time when patients have a list of requests for pain medications that they think they need and expect to receive, none of which are in line with reality. Pain management with opioids has been normalized in American culture, and it’s rapidly spiraling out of control.”

UAB dental students study pain, anxiety and pharmacology, and they learn to care for people in active addiction and recovery. Their training emphasizes best practices in pain management – such as dispensing small medication doses – and the complex factors to consider when prescribing. Two examples: UAB dentists take thorough patient histories, noting requests for specific painkillers, a possible sign of abuse. They check the Alabama Prescription Drug Monitoring Programdatabase to see who already has received potentially addictive medications.

“Closing the loop isn’t easy, and this is new territory for all of us,” Geurs said. “For the School of Dentistry to be in a position where we can help alter the trajectory of this epidemic is one that we take with great responsibility, and we hope public and clinical education will help protect others moving forward.”

More students at UAB’s School of Nursing use its state-of-the-art Nursing Competency Suites to train students to treat infants born to mothers who used opioids during pregnancy. Students are trained to treat these infants through an NICU simulation lab, which includes an NICU infant manikin that is able to mimic symptoms of a baby suffering from opioid withdrawal.

Strengthening commitment to care

Opioids can affect many different people – chronic pain patients, pregnant mothers – and often lead to other forms of addiction.

UAB Medicine’s Addiction Recovery Program offers an individualized approach to the assessment and treatment of alcohol and substance abuse. Staff includes licensed and certified counselors and social workers who work with patients individually and in groups to provide thoughtful, caring treatment for addiction.

Recovery is possible, Dr. Cayce Paddock emphasizes.

“Some of the most psychologically and emotionally healthy people I know are in recovery from a substance abuse disorder,” said Paddock, who leads the program alongside Dr. Peter Lane. “When I see someone in active addiction, I see them at their lowest. But they can live and thrive. When I meet people in active addiction, I see them as they can be, not as they are in that moment.”

Unfortunately, opioid addiction can affect the most vulnerable as well.

The National Institutes of Health found that a baby is born suffering from opioid withdrawal every 15 minutes in the United States. Use of opioids during pregnancy can result in a drug withdrawal syndrome in newborns called neonatal abstinence syndrome, or neonatal opioid withdrawal syndrome (NAS/NOWS).

The Comprehensive Addiction Pregnancy Program, led by Dr. Lorie Harper and UAB’s Maternal-Fetal Medicine team, provides an environment in which women suffering substance-use disorders during pregnancy and postpartum can experience recovery through comprehensive, peer-supported, multidisciplinary care. CAPP’s group prenatal care area provides a full complement of obstetric addiction therapy, including opioid replacement therapy, sub-specialty pediatric follow-up, care coordination, social services, peer recovery support and in-home parenting education.

In April 2019, CAPP celebrated its first year of outpatient treatment, graduating more than 40 women through the program from pregnancy to postpartum support. The program is growing tremendously and serves a critical role in providing necessary care and support to addicted mothers.

Alabama hospital emergency departments have become all too familiar with patients suffering from opioid overdose. According to the Centers for Disease Control and Prevention, Jefferson County alone had 98 deaths from heroin and 104 from fentanyl use in 2017.

“Emergency departments are the tip of the spear where societal problems meet health care,” said Dr. Erik Hess, vice chairman for research for the UAB Department of Emergency Medicine. “The nation’s opioid epidemic plays out every day in our emergency departments.”

The department has launched a new initiative to help patients with opioid use disorders get appropriate therapy and referral for further assistance in an effort to put a dent in the epidemic.

The program, called the ED MAT, or Medication Assisted Treatment Protocol, is funded by a $1.5 million grant from the Substance Abuse and Mental Health Services Administration, part of the U.S. Department of Health and Human Services.

The program has several components. ED MAT protocols include the use of buprenorphine/naloxone in the ED to treat the symptoms of opioid withdrawal and to decrease cravings. It is followed by a short-term prescription of buprenorphine/naloxone, if appropriate, and a take-home naloxone kit. Buprenorphine/naloxone, also known as Suboxone, is used to treat opioid use disorder. It can reduce withdrawal symptoms for 24 hours. Patients are connected with a peer navigator while in the emergency department. The navigator assists patients with referrals to follow treatment through the Recovery Resource Center of Jefferson County at Cooper Green Mercy Services.

Prevention through technology

Monitoring the latest tactics in drug sales used online to mask the activity, such as new street names for drugs, is the focus of a partnership between the UAB Computer Forensics Research Lab and Facebook. UAB works closely with Facebook’s Community Operations team to flag content that may violate its Community Standards for illicit drug sales.

“Our partnership with Facebook has grown from identifying spam to anti-terrorism work and now combating drug sales online,” said Gary Warner, director of research in computer forensics in UAB’s College of Arts and Sciences. “Our students receive hands-on learning in monitoring online communities to identify and develop a database of terms attempted by bad actors to skirt detection. These key terms will be used within the coalition to fight drug sales across multiple platforms.”

With the expertise based at UAB, CFRL shares insights from its research with Facebook and from what is monitored elsewhere on the web.

The CFRL works closely with the UAB Forensics Science Program led by Elizabeth Gardner, Ph.D., in the Department of Criminal Justice to study emerging drugs of abuse, and counterfeit and illicit drugs purchased online. The interdisciplinary partnership combines the online criminal expertise of CFRL and Gardner’s ability to perform drug analysis, along with her and her students’ chemical expertise, to assist a variety of law enforcement and government agencies.

In working with Gardner and her chemists, the CFRL team now has more than 350 search terms for synonyms and analogues of fentanyl. A combination of pairing these keywords with phrases about the purchase and shipping of drugs, combined with a complex “white list” of academic, medical and journalistic mentions of drugs, helps the team quickly target drug sales sites while avoiding many unhelpful sites.

Future of care

Unfortunately, experts agree that opioid-related issues seem to be here to stay – at least for the time being. With that understanding, UAB has commissioned an Opioid Stewardship Committee. A kickoff meeting will take place this summer, when the committee of about 40 members will be present.

The committee’s mission and vision is to provide safe, effective and patient-centered pain management at UAB Medicine. It will create an organizational infrastructure that advocates for safe opioid prescribing while sustaining effective, patient-centered pain management throughout UAB Medicine through engagement and education of patients, clinicians and administrators.

“The opioid crisis has had a significant detrimental impact on our community,” said Dr. Juhan Paiste, an associate professor of anesthesiology who will chair the Opioid Stewardship Committee. “With the Opioid Stewardship Program, we hope to address the complex issues and pain management needs that our patients have, and ensure our providers have access to the most innovative, efficient, evidence-based and safe-practice guidelines. We know that, once we have our resources and best practices in place, we can make a positive difference for everyone.”

UAB’s commitment to lead in the delivery of the highest-quality patient-centered integrative care is clearly defined in the university’s strategic plan, Forging the Future. Its desire to engage with the community and expand access to resources is a key focus, as is improving the welfare of our society.

The knowledge and will to fight the opioid epidemic from all angles – from the medical care and services it provides to aiding law enforcement and social media giants as they work to identify, squeeze and dismantle online drug dealers —  is why UAB is best positioned to combat the far-reaching opioid crisis.

“UAB is a national leader in research, clinical care and medical education,” said Jordan Demoss, UAB Medicine vice president of Clinical Operations. “We have a responsibility to find solutions to this problem. Our goal is to truly implement a multidisciplinary, integrated approach to battling this epidemic.”

This story originally appeared on the University of Alabama at Birmingham’s UAB News website.

(Courtesy Alabama NewsCenter)

2 hours ago

Watch: ALDOT Director John Cooper, State Rep. Matt Simpson clash over I-10 Mobile Bay Bridge project

Wednesday at an informational meeting for members of the Mobile County legislative delegation, things got a little heated between Alabama Department of Transportation Director John Cooper and State Rep. Matt Simpson (R-Daphne).

According to Mobile’s FOX 10 WALA’s Tyler Fingert, Cooper had previously planned not to speak at the meeting. That would have been keeping in line with what appears to be Cooper’s low-profile as the I-10 Mobile Bay Bridge brouhaha has transpired.

However, he broke that silence and spoke for a little more than 20 minutes about the hurdles he and his agency had faced in getting the project in line with what he said were requirements of the Federal Highway Administration and the issues with the Mobile County and Eastern Shore Metropolitan Planning Organizations (MPO) potentially removing the project on their long-term Transportation Improvement Plans (TIP).

At the tail end of his remarks, Cooper and Simpson engaged in a back-and-forth about the Mobile delegation’s role in opposing the project and a potential vote on it by both the Mobile and Baldwin County delegation with Cooper warning Simpson about the responsibility he was taking.

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Cooper accused Simpson of opposing the project without asking questions first, referring to a letter the Mobile County delegation had sent to Gov. Kay Ivey. However, Simpson, who is a member of both the Mobile and Baldwin delegations, refuted Cooper’s claim by pointing to a meeting attended by Baldwin County legislators that was held in Spanish Fort earlier in the summer.

For that meeting, in particular, the Baldwin County delegation had prepared a list of questions for Cooper, which Cooper later acknowledged having addressed.

Exchange as follows:

COOPER: I want to run on. I’ve got a phone call I’ve got to leave for. But I didn’t intend to speak today. But I want you to leave, with these folks trying to be nice and deal with the professional things that they do without I having said to you – you need to understand if I don’t satisfy the Federal Highway Administration there will be nothing.

I need you to understand bluntly that I have not spent begging and cajoling to approve a document and paying these people to do the same just because I like doing it. It’s what was required to get to this point – to give you the option to object to funding the road. That option can only come to you if I can get to you the information you need to know what option you’re voting on.

And I can’t get it in the position you’ve put me in.

SIMPSON: I haven’t seen anything where we get a vote.

COOPER: I beg your pardon?

SIMPSON: The first time you’ve …

COOPER: Sir, you’ve never asked for a vote on anything, but —

SIMPSON: I’m asking for a vote –

(CROSSTALK)

COOPER: And I’m telling you, I’ll recommend to the governor she let you vote on it.

(CROSSTALK)

COOPER: I will. I’ll recommend to the governor that she let the two delegations vote on it and I’ll further recommend we don’t do it if there’s not a majority in each delegation.

SIMPSON: That sounds wonderful. That is a huge step today.

COOPER: I’m fine.

SIMPSON: Until this point, following the process of going through what we have done, we have no control. Under the law, currently you don’t have to ask us to ask for a vote. It goes to the toll authority.

COOPER: Sir, I’m trying to listen to you patiently.

SIMPSON: OK.

COOPER: All you’ve done that I’m aware of is condemn the project before you ever asked a single question about it.

SIMPSON: Where have you seen I’ve condemned the project?

COOPER: You signed a resolution opposing the project.

SIMPSON: We signed the resolution asking for a better answer.

COOPER: No, you signed the resolution opposing the project.

(CROSSTALK)

COOPER: You didn’t ask a single question. None of –

SIMPSON: When didn’t I ask questions?

COOPER: None of you asked a single question before you did that.

SIMPSON: Sir, have you talked … just because we didn’t have a question you, we didn’t ask questions?

COOPER: All I know is you didn’t ask me anything.

SIMPSON: OK, the Baldwin delegation sent up a letter with about 22 questions — we sent up to you. You came down to Spanish Fort and answered these questions because you wanted to have them in writing, correct?

COPPER: Correct.

SIMPSON: So please don’t say we didn’t ask questions.

COOPER: The Mobile delegation as a delegation asked no questions.

SIMPSON: I’m in both, so don’t say I didn’t ask questions.

COOPER: Sir, I’m proud you are and I don’t wish to argue with you. But I’ll make that recommendation to the governor. But you as a body need to understand you can have that control. With that control comes great responsibility.

SIMPSON: Absolutely.

COOPER: And we’ll present alternatives to you but you need to help us get in a position we can do that.

SIMPSON: There is nothing in the law, and I’m sorry – I go back to the law. We can take your word all day long that you’re going to give us the opportunity to vote on it. But there is nothing in the law that requires this.

COOPER: Sir, I told you that I would recommend to the governor that she put that in writing.

SIMPSON: That means nothing.

COOPER: Well, then I’m going to have real difficulty pleasing you if my word means nothing and if the governor puts it in writing that means nothing. I don’t know what else I can do.

SIMPSON: This is the first time you have approached us. This is the very first time that has been discussed. So please don’t put it back to I haven’t asked question, because I have asked questions —

COOPER: We don’t need to go over whether you did or didn’t. I apologize for saying that.

(CROSSTALK)

COOPER: Is that a path forward?

SIMPSON: We’re trying to find a middle ground.

COOPER: I’m saying, is that a path forward, if the governor would do that? And I don’t know if she will.

SIMPSON: If the governor would allow us to vote, absolutely.

COOPER: I’ll recommend that to her.

SIMPSON: You can put that recommendation on a piece of paper and she can say no.

COOPER: If she does that, will you ask the MPO to put it back in the TIP?

SIMPSON: If you get it in writing first.

COOPER: I said if she does that —

SIMPSON: If you put it in writing that says I will put it to the delegation and let them answer the question, then I will recommend that.

COOPER: — will you ask the MPO to put it back in the TIP?

SIMPSON: If you get it in writing that says —

COOPER: I’ll make that recommendation.

SIMPSON: I think that’s it.

COOPER: You’ve caught it. I hope you’re ready to skin it.

Following the event, Simpson explained to FOX 10 why he saw his questioning of Cooper necessary.

“The purpose of this meeting was to ask questions, and I’m not going to apologize for asking tough questions,” Simpson said. “The project went from $850 million to $2.1 billion, and I think it’s fair to just ask questions, ‘how?’”

@Jeff_Poor is a graduate of Auburn University, the editor of Breitbart TV and host of “The Jeff Poor Show” from 2-5 p.m. on WVNN in Huntsville.

Episode 1: SEC Network’s Cole Cubelic

Dale Jackson is joined by the SEC Network personality and WJOX-FM’s Three Man Front host Cole Cubelic.

Cole describes his path to multimedia stardom — from putting on the pads as a middle-schooler to pharmaceutical sales to calling SEC football games. Cole shares how his wife’s supported him throw the lows and how he got to his highs.
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15 hours ago

Episode 22: It’s Bo time

With Auburn announcing Bo Nix the starter at quarterback, DrunkAubie reconvenes to react and answer listeners’ questions about the freshman. DrunkAubie also discusses the top traditions and top mascots in college football and offers up some advice for the upcoming season.

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16 hours ago

State Rep. John Rogers not running for U.S. Senate, says Jones showing ‘conservatism’ but not racist

State Rep. John Rogers (D-Birmingham) on Wednesday told Yellowhammer News that he will not run in the 2020 Democratic U.S. Senate primary against Senator Doug Jones (D-AL).

Rogers began considering a potential bid towards the tail-end of the Alabama legislature’s regular session this spring. At that time, he told Yellowhammer News, “I don’t want to run a campaign just to run. I want to run to win.”

He said he needed to raise $500,000 in order to be competitive.

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However, after testing the waters for months, Rogers has concluded that he cannot raise sufficient funds, saying Jones’ war chest was too much to overcome in a primary. Rogers previously challenged Jones to a public debate, which Alabama’s junior senator ignored.

The state representative from Jefferson County on Wednesday also commented on the ongoing battle that has pitted Jones and the Democratic National Committee (DNC) against the leadership of the Alabama Democratic Party and the Alabama Democratic Conference (ADC).

Rogers said that he disagreed with the charges of racism against Jones made by the state party’s secretary, Val Bright, who last week penned an open letter saying that Jones and the DNC were targeting “blacks” in their effort to overhaul the party’s structure and leadership.

“Although blacks have been faithful to the Democratic Party and are largely responsible for electing Doug Jones and any white seeking office in this state, once elected on the backs of blacks, the urgency to remove black leadership begins,” Bright stated.

“In other words, as long as we’re working in the fields all is well, but when we move to positions of authority, a challenge begins,” she added. “From slavery through Reconstruction, Jim Crow and the Civil Rights movement, we are constantly being shown how little respect blacks receive for being hard working and loyal.”

Rogers advised that he does not believe Jones to be a racist.

“Because Alabama is a conservative state, and you’ve got to have some conservatives in the legislature (Congress) — I hate to say that, but it is Alabama, and if you’re going to run for a statewide office, you’ve got to be in the middle of the road,” Rogers said. “And Doug knows that. I mean — I don’t like some of the things he does to show his ‘conservatism,’ but if you want to be expecting to win against a Republican, you’ve got to show some conservatism.”

Rogers continued to say Jones is still his friend and has been “for a long time.”

“I don’t think he’s racist, I wouldn’t dare call him a racist,” Rogers concluded.

RELATED: Rogers: Jones called me, admitted I was ‘right’ on abortion remarks

Sean Ross is the editor of Yellowhammer News. You can follow him on Twitter @sean_yhn

16 hours ago

University of Alabama in Huntsville honored for discovering one of physics’ ‘Holy Grails’

The University of Alabama in Huntsville (UAH) announced this week that it has been honored by The Institute of Electrical and Electronics Engineers with a Milestone Plaque for a 1987 physics discovery.

The discovery of superconductivity at 93 Kelvin occurred on January 29, 1987, and the dedication of the award recognizes “the impact of the world’s first material to superconduct above the technologically significant temperature of liquid nitrogen.”

UAH said in a release posted to its website, “The material that is the subject of the discovery was first conceived, synthesized, and tested in a UAH physics laboratory in Wilson Hall. It has been referred to by some science writers as one of physics’ ‘Holy Grails.’ The discovery prompted an American Physical Society meeting in March of 1987 to become known as ‘The Woodstock of Physics.'”

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The site added, “By crossing the 77 Kelvin barrier and making superconductivity possible at the temperature of the much more affordable and easily used coolant liquid nitrogen, the material discovered at UAH opened up a realm of more practical superconductivity applications.”

The site also noted that superconductors have been useful in powerful electromagnets, such as those used in MRI and NMR machines, maglev trains, and fusion reactor research; low-loss electrical power cables; fast fault current limiters; fast digital circuits; sensitive detection and measurement of magnetism, subatomic particles, and light, along with radio-frequency and microwave filters.

The UAH material has been used in high field magnets (holding the current record of 45.5 Tesla), electric power cables, fault current limiters, and radio-frequency filters.

A bronze plaque, which was presented on Monday, will be mounted outside the room that once served as the superconductivity laboratory at UAH.

The plaque reads as follows:

On this site, a material consisting of yttrium, barium, copper, and oxygen was first conceived, synthesized, tested, and — on 29 January 1987 — found to exhibit stable and reproducible superconductivity at 93 Kelvin. This marked the first time the phenomenon had been unambiguously achieved above 77 Kelvin, the boiling point of liquid nitrogen, thus enabling more practical and widespread use of superconductors.

Kyle Morris also contributes daily to Breitbart News. You can follow him on Twitter @RealKyleMorris.