Recovery Michigan

http://bit.ly/2NcmNXj

What I’m experiencing — sometimes weeks will go by without it, and sometimes it happens multiple times in a few days — is technically called an episodic cranial sensory shock, but it’s more popularly known as exploding head syndrome. It’s alarming but not actually dangerous in itself; it is a parasomniac condition, rooted in a dysfunction in one of the many complex mechanisms by which the brain transitions to and from sleep. It’s part of a disease I have, one that has shaped my life so completely that it is impossible to imagine who I would be without it.

That disease is insomnia. Something, somewhere in my brain, in the system that triggers sleep, is broken. My condition used to be called primary insomnia: lifelong, chronic rather than acute, not linked as other insomnia experiences often are to anxiety, depression, or a wide range of other factors and causes. I’ve had it all my life.

The longest I’ve ever gone without sleep was 11 days, which is roughly the same as the official world record. That was particularly brutal, but going three, four, five, or six days without sleep is a pretty common occurrence for me. Without reliable pharmaceutical assistance — and I didn’t find anything even mildly effective until I was well into my twenties — I will sleep, on average, three or four nights in any given week. The rest of the time, I will just be lying there, locked in my head, in the dark, for hours.

It’s unpredictable. Some weeks I might sleep okay, the next barely at all. Some nights I struggle from midnight until dawn, and then finally sleep, staying under for 18 hours or more. Other nights I drift off in a relatively brisk two or three hours, only to be woken minutes later, irreversibly and in exasperation, by a noise from outside.

http://bit.ly/2IGToRu

There is another opioid crisis happening in the U.S., and it has nothing to do with the overdose epidemic: Hospitals are frequently running out of widely used injected painkillers.

Manufacturing shortages are forcing many doctors and pharmacists to sometimes ration injected opioids, reserving them for the patients suffering most. Other patients get slower-acting or less effective pain pills, alternatives with more side effects or even sedation.

Medical groups are urging regulators to help, saying some people having surgery, fighting cancer or suffering with severe burns are getting inadequate pain control. They also say shortages frequently cause medication switches that could lead to deadly mistakes.

Earlier this month, the American Medical Association declared drug shortages a public health crisis, saying it will urge federal agencies to examine the problem as a national security threat and perhaps designate medicine factories as critical infrastructure.

Injected opioid shortages have happened before, in 2001 and 2010, but they weren’t as acute and long-lived, experts say. This one started almost a year ago and is expected to last into next year.

“It’s definitely the most severe I’ve seen in tracking drug shortages for 17 years,” says Erin Fox, a University of Utah Hospitals pharmacist. She tracks national medicine shortages and recalls two patients dying due to medication errors during the 2010 shortage.

Such shortages steal time from patient care, increase hospitals’ costs and affect just about every department, including operating rooms, emergency departments and cancer clinics. Doctors occasionally find opioids missing from emergency carts and surgery supply trays, “borrowed” by colleagues needing them for other patients.

The shortages started hitting hospitals last summer, after the Food and Drug Administration found sterility and other serious problems at a Pfizer factory in Kansas. The company, which makes 60 percent of the country’s injected opioids, had to slash production to fix the problems.

By January, shortages were so bad hospitals started creating teams to manage their supplies, said Michael Ganio, director of pharmacy practice at the 45,000-member American Society of Health-System Pharmacists.

The group’s April survey of 343 hospital pharmacists found 98 percent had dealt with moderate or severe shortages of the key opioids for treating serious pain: morphine, fentanyl and hydromorphone, better known as Dilaudid. Many hospitals were completely out of at least one.

http://bit.ly/2NfFrxB

The MetroHealth System is looking internally to strike the next blow in Ohio's battle against the opioid epidemic.

Through a concentrated focus on prescribing practices over the past year and a half, MetroHealth cut the number of opioid pills prescribed by 3 million, Dr. Akram Boutros, president and CEO of MetroHealth, announced Friday during MetroHealth's annual stakeholders meeting at the Huntington Convention Center of Cleveland.

The hospital system also looks to further drop prescription rates with the creation of a new Pain and Healing Center, which launched this week.

"There are a lot of people to blame for the opioid crisis, a crisis that kills five people in the United States every hour. There are not a lot of people taking responsibility for fixing it. We are. We want to be an example. We want to fix this problem, and we want to be a model for others," Boutros told the crowd.

During the annual meeting, Boutros also told the crowd of 700 about a new initiative to address community trauma and shared updated plans for a new 11-story, 270-bed "hospital in a park" on its main campus off West 25th Street.

"We're going to own our part of the problem," Boutros said during an interview earlier this week. "Healthcare has been so focused on alleviation of pain that we did that without a clear focus on prevention of addiction."

http://bit.ly/2KEHLMz

Inflammation and ions

For some time now, researchers have understood that inflammation is reliant on the activation of the inflammasome within immune cells. This cellular structure is "switched on" by an influx of potassium ions.

The flow of ions is known to be pivotal, but exactly how they enter the cell was not understood — until now.

Prof. Malik and team identified a potassium receptor known as TWIK2. In particular, the scientists investigated the receptor's role within macrophages, which are multipurpose immune cells that clear up cellular debris during inflammation and attack pathogens.

New drugs from old molecules

Drugs that operate at potassium channels have already been designed, but none specifically target TWIK2. However, a potential starting point for research into new ways to influence this channel might be found in an old remedy: quinine.

Quinine — which is responsible for the bitter taste in tonic water — is a chemical found in cinchona bark. It has been used as an antimalarial and anti-inflammatory drug since the 18th century.

According to study co-author Dr. Jalees Rehman, "Some of the fever-suppressing effects of quinine may be due to its effects on the TWIK2 channel. We found that quinine reduced the levels of the inflammatory molecule interleukin 1-beta, which is known to cause fever."

Current anti-inflammatory medications tend to bring with them some unpleasant side effects, such as stomach ulcers, cardiovascular problems, and bowel perforations. So, finding something that acts in such a specific manner might help to design drugs with less harmful consequences.

Dr. Rehman hopes that their work will "pave the way for new personalized anti-inflammatory drugs, which minimize the side effects for patients."

http://bit.ly/2IFaH5f

After months of work on the topic, the House of Representatives last Friday passed a wide-ranging package of legislation aimed at addressing various facets of the opioid crisis. The bipartisan Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act (H.R. 6) combines 58 individual previously-passed bills that focus on topics ranging from expanding access to opioid addiction treatment to encouraging the adoption of alternative forms of pain management and more. Attention now turns to the Senate as legislators are building their own version of an opioid package, which will need to be reconciled with the House version before being signed into law by the president.

NATIONAL COUNCIL PRIORITY BILLS

Throughout Congress’ attention and efforts to address the opioid crisis, the National Council has been advocating for a number of important measures, some of which were included in the final SUPPORT Act. Among National Council priorities that were included are:

• The Special Registration for Telemedicine Clarification Act (H.R. 5483): Requires the Drug Enforcement Agency (DEA) to establish a special registration process for certain providers that wish to prescribe controlled substances via telemedicine. This would remove barriers to accessing medication-assisted treatment for opioid use disorders in rural and frontier areas, and is a direct result of National Council advocacy efforts.
• The Substance Use Disorder Workforce Loan Repayment Act (H.R. 5102): This bill would create a program to help addiction treatment professionals repay student loans, adding incentives for students to pursue these professions and ultimately increasing timely access to treatment for individuals living with addiction. This legislation was introduced as a result of education and advocacy by the National Council and the Association for Behavioral Health in Massachusetts.
• Improving Access to Behavioral Health Information Technology Act (H.R. 3331): Incentivizes behavioral health providers to adopt electronic health records (EHRs). Behavioral health providers have adopted EHRs more slowly than physical health providers as they have traditionally not had the resources needed to implement the technology. A companion bill passed the Senate in May. Read Linda Rosenberg, President & CEO of the National Council’s endorsement of the bill here.
• Ensuring Access to Quality Sober Living Act (H.R.4684): Requires the Substance Abuse and Mental Health Services Administration (SAMHSA) to identify and disseminate recovery housing best practices, such as the National Alliance for Recovery Residence’s (NARR) quality standards, to the states and provide them with technical assistance to adopt the standards. The bill aligns closely with the recommendations of the National Council’s State Policy Guide for Supporting Recovery Housing.
• The CHIP Mental Health Parity Act (H.R. 3192): Requires states to cover mental health and addiction treatment for pregnant women and children under the Children’s Health Insurance Program (CHIP). The measure ensures that the program covers behavioral health services at parity with physical health services and in a culturally and linguistically sensitive manner.

OTHER PROVISIONS

To access the materials, you sign up for a free membership.....

http://bit.ly/2NbDzpp

In this Virtual Forum, experts Roger McIntyre, MD, FRCPC, Professor of Psychiatry & Pharmacology at the University of Toronto, Head of the Mood Disorders Psychopharmacology Unit University Health Network, and Executive Director of the Brain & Cognition Discovery Foundation; and David Scheiderer, MD, MBA, DFAPA, Director of Education at Integrative Psychiatry, Inc reviewed the association between dysfunction of gut microbiota-brain axis and mental health disorders. They also discussed when, how, and in whom gut strategies for the evaluation and treatment of psychiatric illness may be appropriate.

A long, but very interesting read.....

http://bit.ly/2IEMdJu 

Brain imaging is illuminating the neural patterns behind pain’s infinite variety.

Initially, I was concerned that I was letting the team down. The capsaicin patch hardly tingled, and I scored the first round of pinpricks as a 3, more out of hope than conviction. I needn’t have worried. The patch began to itch, then burn. By the time the hot-water bottle was placed on it, about an hour in, I was surely at an 8. The next set of pinpricks felt as if I were being run through with a hot metal skewer.

“You’re a good responder,” Tracey told me, rubbing her hands together, when I emerged, dazed. “And you’ve got a lovely plump brain—all my postdocs want to sign you up.” As my data were sent off for analysis, she pressed a large cappuccino into my hands and gently removed the capsaicin with an alcohol wipe.

Tracey didn’t need to ask me how it had gone. The imaging-analysis software, designed in her department and now used around the world, employs a color scale that shades from cool to hot, with three-dimensional pixels coded from blue through red to yellow, depending on the level of neural activity in a region. Tracey has analyzed thousands of these “blob maps,” as she calls them—scans produced using a technique called functional magnetic resonance imaging (fMRI). Watching a succession of fiery-orange jellyfish flaring up in my skull, she had seen my pain wax and wane, its outlines shifting as mild discomfort became nearly unbearable agony.

http://bit.ly/2tFdruU

Many low income and disabled Americans rely on federally subsidized housing to survive, just as many Americans rely on medical cannabis to treat their medical conditions. Right now, it is legal to possess medical cannabis in many states and the District of Columbia, but it’s illegal for residents of federally subsidized housing to possess it inside their home. For Cannabis Wire, Vittoria Elliott looks at how many Section 8 residents secretly use legal cannabis for their health while living in fear of losing the housing they rely on. Poverty and class play into this problem, as does the way state legalizations conflict with federal law’s classification of cannabis as a Schedule 1 substance.

“What we’ve created is a two-tiered legal system when it comes medical cannabis,” said Chris Alexander, a policy coordinator with the Drug Policy Alliance (DPA) New York office. “There’s one set of laws for the poor and another set of laws for everyone else. You can’t be both sick and poor. If you don’t have your own home, you can’t participate.”

Alexander directs the DPA’s efforts to change cannabis policy in New York state. He says that the public housing smoking ban, passed in 2016, added complications for medical cannabis users across the country. Under the ban, intended for tobacco, smoking in the home is a violation like a traffic ticket, but smoking outside the building is permitted. Tenants who don’t want to risk smoking cannabis in their apartments have nowhere else to go; smoking cannabis outside is illegal even in legal jurisdictions like D.C.

“The smoking ban meant a double criminalization,” Alexander said. “The solution is a designated space where people can go and consume.”

Ways to change your epigenome, not necessarily for the better....

http://bit.ly/2IAw0oP

As scientists have become able to study epigenetics with advancements in molecular biology and DNA sequencing, hundreds of research groups have looked at how the epigenome changes with environmental factors. This evergreen post is intended to look at current research that supports the idea that the epigenome is dynamic and can change with various lifestyle influences.

Diet

Exercise

Sleep

Yoga & Meditation

Weight Loss

Marijuana Smoking

Tobacco Smoking

Alcohol

Stress & Trauma

http://bit.ly/2Kk28Tu 

The opioid's potency has transformed the global trafficking — and policing — of narcotics.

Among the 5,000 apartments, on a high-rise’s 20th floor, lives Yan Xiaobing, a chemicals distributor with short, spiky hair. His wife, Hu Qi, operates an English tutoring business. Their social-media feed shows the couple and their two young children under blue skies at the beach and posing at landmarks in Europe and Japan. One photo shows Yan reading to pupils in a classroom.

In half-frame glasses, blue plastic house slippers and button-down shirt, Yan could have passed as an ordinary office worker when Bloomberg News reporters found him late last year. Filling the apartment doorway with his 6-foot frame, he expressed soft-spoken bafflement at the portrait the U.S. Justice Department paints of him: not a modest businessman, but a new type of international drug dealer. “This is horrifying,” he said. “Their investigation must have gone wrong.”

Federal prosecutors in Mississippi charged Yan, 41, in September with leading an empire built on the manufacture and sale of drugs related to fentanyl, one of the world’s deadliest and most profitable narcotics. So strong that it’s been studied as a chemical weapon, the drug has saturated American streets with breathtaking speed: It kills more people than any other opioid, including prescription pills and heroin, because it’s so easy to overdose. Authorities say they have linked Yan and his 9W Technology Co. to more than 100 distributors across the U.S. and at least 20 other countries. Investigators expect scores of arrests as they dismantle his alleged network.

A month after the indictment, Deputy Attorney General Rod Rosenstein held a Washington news conference to shine a spotlight on Yan and another man, Zhang Jian, 39, who’s accused of a similar scheme. Their indictments, Rosenstein told reporters, marked “a major milestone in our battle to stop deadly fentanyl from reaching the United States.”

Yan is the first Chinese national the U.S. has ever added to its “consolidated priority organization target” list of individuals thought to command the world’s most prolific drug-trafficking and money-laundering networks. Investigators say his strategy was to offer fentanyl-like compounds called analogues — which differ slightly on a molecular level but produce similar effects — in order to exploit discrepancies between the laws in the U.S. and China. Rosenstein expressed optimism that his Chinese counterparts would hold Yan accountable.

But if Yan doesn’t resemble a stereotypical drug lord, neither is fentanyl your average drug. It has upended how traffickers conduct business and how such activity gets policed. Bloomberg News examined hundreds of pages of court documents and government reports and interviewed drug dealers and law officers, retracing a byzantine path that took investigators from a Mississippi parking lot all the way to Wuhan.

Fentanyl’s astronomical profit margins have driven its rapid spread. When Gibbons and Metcalf went undercover, they bought a kilogram from China for $3,800, which, when turned into tablet form, could fetch on the street up to $30 million. Compare that with a kilo of heroin, which wholesales for about $50,000 in Gulfport and generates a profit of just $200,000.

“Fentanyl is a smuggler’s dream,” said Scott Stewart, a former U.S. State Department special agent who’s a vice president at Stratfor, a global intelligence firm. “It’s compact. It’s valuable. It’s fantastic for the smugglers and it’s terrible for law enforcement.”

There’s no need to grow vast fields of opium poppies, which must be defended against weather, competitors and government eyes. Raw materials and equipment are cheap. Synthesis takes about a week and requires neither heat nor skills more sophisticated than following a recipe. And in recent years, rogue chemists have unearthed instructions for analogues that researchers discovered decades ago but never put into legitimate use. Sellers offer these variations before governments can outlaw them. Potency and purity vary: One dose may produce a euphoric high, while another kills immediately.

Most fentanyl on America’s streets isn’t made for pharmaceutical use and then diverted. According to the DEA, it’s illicitly manufactured in overseas laboratories. Mexican cartels play an increasingly prominent role, using networks established for heroin and methamphetamine. But U.S. officials say most originates in China, one of the world’s top manufacturers and exporters of raw pharmaceutical ingredients.