5 months 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)

25 mins ago

7 Things: Two articles of impeachment, polling has Sessions still up, Trump gets trade win and more …

7. Biden is still first, but Warren is falling

  • New polling data from the Quinnipiac University has been released that shows former Vice President Joe Biden is still in first place with 29%, but U.S. Senator Bernie Sanders (I-VT) has moved up into second with 17%.
  • U.S. Senator Elizabeth Warren (D-MA) has fallen to third place with 15%, South Bend Mayor Pete Buttigieg is down to 9%, New York Mayor Michael Bloomberg follows with 5% and entrepreneur Andrew Yang has 4%.

6. Stopping the spread of misinformation

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  • Alabama Secretary of State John Merrill has met with Twitter and Facebook representatives in an effort to stop misinformation from spreading online throughout the state in preparation for the upcoming 2020 election cycle.
  • Merrill said that it’s important that everyone in Alabama is “informed with up-to-date, complete, and accurate information.” Merrill added, “[E]lection security and protocol is higher than ever in Alabama. We continue to introduce new ways to improve security every single day.”

5. Ainsworth has endorsed Ward

  • Lieutenant Governor Will Ainsworth took to Twitter to endorse State Senator Cam Ward (R-Alabaster) for the Alabama Supreme Court. Ainsworth confirmed the endorsement, saying, “I am supporting his candidacy and encourage my friends to do the same.”
  • Ward responded to Ainsworth’s endorsement by saying he’s “honored” to have the support and that Ainsworth “knows my legislative record and the conservative values I will bring to our Supreme Court.”

4. Tuberville doubles down on his reasonable drag queen take

  • When former Auburn football coach Tommy Tuberville expressed that a Christmas parade may not be the appropriate place for a drag show, you knew the media would take the bait and attack him for it.
  • In response, Tuberville further explained that a parade designed for children isn’t really the place for this stuff. He stated, “Christmas is about celebrating with family,” adding, “Our public celebrations ought to be family-friendly for young and old.”

3. Democrats are supporting trade agreement

  • The United States-Mexico-Canada Agreement (USMCA) is now supported by House Speaker Nancy Pelosi’s (D-CA) caucus, which is the trade agreement that would replace NAFTA.
  • Pelosi’s announcement of her support comes only one day after Alabama Senate President Pro Tem Del Marsh (R-Anniston), House Speaker Mac McCutcheon (R-Monrovia), State Senator Gerald Allen (R-Tuscaloosa) and State Representative Wes Allen (R-Troy) sent a letter to Pelosi pushing for her to support the trade agreement.

2. New polls in Alabama Senate race

  • The Alabama Farmers Federation has released new polling data that shows former Attorney General Jeff Sessions and former Auburn Football Coach are polling closely, with Sessions at 35% and Tuberville at 31%, whereas data released by the Sessions campaign showed that Sessions was at 44% and Tuberville was at 21%.
  • The Farmers Federation data also showed that U.S. Representative Bradley Byrne (R-Fairhope) is at 12%, former Alabama Supreme Court Chief Justice Roy Moore is at 8% and State Representative Arnold Mooney (R-Indian Springs) and Stanley Adair are only at 1% each.

1. Abuse of power and obstruction

  • The House Democrats have announced formal articles of impeachment they’re bringing against President Donald Trump, which are abuse of power and obstruction of Congress. In doing so, U.S. Representative Jerry Nadler (D-NY) said that Trump “endangers our democracy; he endangers our national security.”
  • U.S. Representative Bradley Byrne (R-Fairhope) responded to the articles of impeachment, saying it’s “nothing more than a pathetic witch hunt.” U.S. Representative Robert Aderholt (R-Haleyville) said that the “charges are so political, not even all their members will be able to stomach voting for them.”

54 mins ago

Mo Brooks: Obama’s attack on law enforcement tied to spike in police killed in the line of duty

On Friday, another Alabama police officer was shot and killed in the line of the duty, which was the sixth such death in 2019.

Huntsville STAC Agent Bill Clardy III was shot and killed. LaJeromeny Brown, the suspect behind the killing, was charged with capital murder. Clardy’s death is the latest in an alarming trend of law enforcement officers killed while on the job.

During an appearance on Huntsville radio’s WVNN on Tuesday, Rep. Mo Brooks (R-Huntsville) expressed his frustration over the circumstances surrounding Clardy’s murder. He argued there was more elected officials could do to reverse the trend.

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“It saddens me,” Brooks said on “The Jeff Poor Show.” “It angers me that we allow criminals to stay on our streets as long as we do with the kind of records that they have. If media reports of this man’s record are correct, he should never have been in a position where he could have been exposed to the public or where he could have murdered one of our police officers. I think it is good [U.S. Attorney for the Northern District of Alabama] Jay Town is looking into … why this man was at large when he should have been in a penitentiary somewhere serving a long, long sentence. So I am frustrated with our judicial system, and I just hate what happened. And I feel for the family.”

“A lot of this is what we’ve seen over the last decade or so where we’ve seen some political elements that seem to be anti-law enforcement,” he continued. “The more get public officials making anti-law enforcement statements, the more you’re encouraging people to resist law enforcement officers, even to the point of pulling out a gun and people getting killed. There is so much to it that frustrates me as an elected official, and so many things we as a society could be doing better to protect innocent Americans on the one hand and our brave law enforcement officers on the other.”

The Madison County Republican argued for one policy prescription, which was a review of how public officials support and publicly speak about law enforcement. Brooks pointed to former President Barack Obama’s rhetoric and how he handled some high-profile officer-involved incidents, which, according to Brooks, has created an environment more difficult for law enforcement.

“We need to have more public officials who support law enforcement,” Brooks explained. “Keep in mind that under the last administration — I hate to be so partisan, but this is the truth of the matter — under the last administration, any time a law enforcement officer did what he needed to do to protect the public, and an individual was killed in the following fray, the Obama administration would immediately attack law enforcement, and that kind of jumping to a conclusion that Barack Obama did so frequently and his attacks on law enforcement, and his support for African-Americans for no reason apparently other than they were African-American — it wasn’t about whether they were guilty or not. We saw what happened with Ferguson, Missouri, where the Obama administration immediately came to the defense of the African-American who was killed, attacked the law enforcement community, and then later on it turned out that this guy was a thug and just finished committing a forceful robbery.”

“Another follow-up on that is what happened in Texas where an African-American probably emboldened to some degree by these anti-law enforcement statements of elected officials decided to go on a killing rampage, and his targets were two types of people: law enforcement officers and whites,” he continued. “And that is what he said. Words are important. And our elected officials — if they don’t want anarchy, if they don’t want crime to rule, then they better be a whole lot more forceful in protecting our law enforcement officers and backing them up, or else you’re going to see more of this.”

@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.

1 hour ago

Aderholt bashes partisan impeachment charges, reaffirms support for USMCA

On Tuesday, U.S. House Democrats announced two impeachment charges will be filed against President Donald Trump and then later in the day declared that they have a reached a deal to support the Trump-negotiated United States Mexico Canada Agreement (USMCA).

Republican Congressman Robert Aderholt (AL-04) reacted to both developments, first tweeting his continued opposition to impeaching the president.

No Republicans are expected to vote for the impeachment charges, as the real question is how many Democrats will break ranks by either abstaining from voting on or opposing the charges.

Speaking about his Democratic colleagues, Aderholt concluded, “These impeachment charges are so political, not even all their members will be able to stomach voting for them.”

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Aderholt on Tuesday later issued a statement regarding the latest news about the USMCA, which is the trade deal negotiated by the Trump administration that would replace NAFTA.

“Since coming to Congress, my focus has been on growing our local economy and bringing the best jobs to this area. This USMCA agreement will allow our region to continue building on our already strong economy,” he advised. “This agreement is a win for Americans across the country and in the State of Alabama.”

The dean of Alabama’s House delegation commended the president for his leadership on the USMCA.

“I congratulate President Trump for negotiating this agreement, and I look forward to working with him to continue building on our historic economic expansion,” Aderholt said. “By persuading Canada and Mexico to revise the outdated NAFTA agreement, and then negotiating on labor issues with Democrat leadership, President Trump has secured a trade deal which will establish a level playing field that keeps America competitive.”

Aderholt pointed to specific sectors of Alabama’s and his district’s economies expected to benefit from the USMCA.

“The automobile and agriculture industries are two of the biggest drivers of economic development in the Fourth Congressional District of Alabama. In 2017 alone, Alabama had more than $7 billion in exports to Mexico and Canada,” he outlined. “The USMCA agreement expands access for U.S. exports of chickens and eggs. As the representative of one of the largest poultry producing districts in the nation, I can say there is no doubt USMCA is a win for Alabama’s farmers.”

“According to an April 2019 report by the U.S. International Trade Commission, USMCA is estimated to increase U.S. production of automotive parts and employment in the sector. I have repeatedly called on House leadership to bring this deal to the House floor and look forward to supporting it,” Aderholt concluded.

A vote on the USMCA has been scheduled in the House for next week, however the impeachment process driven by House Democrats might actually stall ratification in the Senate after that.

Assuming the two charges get enough Democratic votes to pass the House and Trump is impeached, Senate Majority Leader Mitch McConnell (R-KY) has already said he will not take up the USMCA until the impeachment trial has concluded in the upper chamber.

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

2 hours ago

Alabama NFIB state director comments on spike in small business optimism

The National Federation of Independent Business (NFIB) on Tuesday released its latest monthly Small Business Economic Trends Survey, with the results boding well for Alabama’s economy as well as the national economy.

In fact, the nationwide survey showed small business optimism posting the largest month-over-month gain since May 2018, rising 2.3 points to 104.7 last month.

NFIB’s optimism index is comprised of 10 total index components, and the spike in November’s total index was bolstered by seven of those components improving. A 10-point improvement in the earnings component led this charge. Additionally, business owners reporting it is a good time to expand increased by six points, and those expecting better business conditions increased by three points.

In more good news, the NFIB’s business uncertainty index fell six points last month to 72, the lowest reading since May 2018.

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While the survey is not broken down into state-specific data, NFIB Alabama state director Rosemary Elebash said in a statement, “Our members here are telling us it’s a good time to reinvest in their businesses and add jobs.”

Read more about the survey here.

This came after NFIB released its monthly jobs report last week. That report showed a net 30% of small business owners, seasonally adjusted, raised compensation and 26% planned to do so in the coming months, up four points and the highest level since December of 1989. Job creation jumped last month, with an average addition of 0.29 workers per firm, the highest level since May.

This being said, finding qualified workers remains the top issue for NFIB members. Last month, 26% reported that this is their foremost problem. That number is one point below August’s record high.

The totality of November’s economic news reflects a stark departure from previous months, as speculation about a possible recession was dampening small business owners’ economic outlook. Additionally, NFIB noted that the current focus and noise in Washington, D.C. around impeachment is proving to have little, if any, impact on small business owners.

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

14 hours ago

Two officers on leave amid investigation into inmate’s death

Two Alabama prison officers are on leave as the department probes the use of force in the death of a state inmate.

The Alabama Department of Corrections said it is investigating the alleged use of force that resulted in the death of an inmate at Ventress Correctional Facility inmate.

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Fifty-five-year-old Michael Smith of Fairfield, died Dec. 5 after being removed from life support following a November incident at the prison.

The prison system said it is also investigating the death of another inmate at Holman Correctional Facility.

 (Associated Press, copyright 2019)

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