Odds of Dying from Opioid Overdose Now Greater Than Auto Crash: Study

A study by the National Safety Council concludes the worsening opioid crisis now tops the list of the causes of “preventable deaths” for Americans.

An American is more likely to die from an accidental opioid overdose than from a motor vehicle crash, according to the National Safety Council (NSC).

The odds─one in 96─surpass the one-in-103 odds of dying in a car crash for the first time in history, the NSC said in its analysis  of “unintentional, preventable injuries” released Monday.

“The nation’s opioid crisis is fueling the Council’s grim probabilities, and that crisis is worsening with an influx of illicit fentanyl,” the NSC said in a statement accompanying the data.

Ken Kolosh, manager of statistics at the National Safety Council, added that the opioid figures underlined the rise in accidental deaths from all causes, averaging 466 lives lost every day.

Americans are dying from accidents “at rates we haven’t seen in half a century,” despite the general increase in U.S. longevity, he said. “This new analysis reinforces that we must consistently prioritize safety at work, at home and on the road to prevent these dire outcomes.”

NSC analysis of data compiled by the Centers for Disease Control and Prevention also shows that falls – the third leading cause of preventable death behind drug overdose and motor vehicle crashes – are more likely to kill someone than ever before.

The lifetime odds of dying from an accidental fall are one in 114 – a change from one in 119 just a year ago.

Preventable injuries are the third leading cause of death, claiming an unprecedented 169,936 lives in 2017 and trailing only heart disease and cancer, the NSC said.

The full report can be downloaded here.

from https://thecrimereport.org

The Presumption of Guilt

     Anastasio Prieto was driving his truck toward home along US Route 54, just north of El Paso, Texas on a late night in August 2007. While enjoying the beautiful countryside passing him by, he noticed a weigh station and pulled over t…

     Anastasio Prieto was driving his truck toward home along US Route 54, just north of El Paso, Texas on a late night in August 2007. While enjoying the beautiful countryside passing him by, he noticed a weigh station and pulled over to have his truck inspected. A state trooper approached him and asked whether he could search Anastasio's truck for contraband. Not protective of his own privacy, Anastasio said, "Of course," knowing  that no contraband would be found. During his conversation, Anastasio did mention that he happened to be carrying $23,700, his life savings, used to pay bills and maintain the truck, which he carried with him because he did not trust banks. What he did not realize was that his opinion of banks would be his undoing.

     The money was confiscated, and Anastasio was detained, photographed, and fingerprinted while canine dogs sniffed his truck. The state police, who believed that Anastasio must be guilty of something, turned the cash they seized from him over to the federal Drug Enforcement Administration. Though no evidence of illegal substances was found, the DEA explained to Anastasio that they would be keeping the money, and that in thirty days he would receive notice of federal proceedings to forfeit the money permanently to the government. Anastasio was told that if he wanted to get the money back, he would have to petition a court and prove that the money was legally obtained by him and not the product of criminal conduct.

     That's right; even though not a single shred of evidence of any illegal activity was found in his truck, Anastasio was considered guilty and would have to prove his innocence. Thankfully, the ACLU stepped in and sued the DEA on behalf of Anastasio. With the lawsuit looming, and fearing a more public revelation of its Gestapo tactics at a trial, the DEA returned the money months later.

Judge Andrew P. Napolitano, Lies the Government Tells You, 2010

from http://jimfishertruecrime.blogspot.com/

Laws Restricting Opioid Care Undermine Efforts to Curb Epidemic: Study

Allowing nurse-practitioners more “independence” in prescribing opioids to treat patients could play a key role in curbing the opioid epidemic, according to a University of Alabama study.

Allowing nurse-practitioners more “independence” in prescribing opioids to treat patients could play a key role in curbing the opioid epidemic, according to a University of Alabama study.

Scope of Practice (SOPs) laws in many states restrict nurse practitioners— often the primary providers of health care in rural and under-served communities—from prescribing  opioids for treatment of patients without the supervision of a physician.

But such laws are counter-productive and may even “undermine patient safety,” concluded the study by Benjamin J. McMichael, an assistant law professor at the University of Alabama’s Hugh F. Culverhouse Jr. School of Law.

McMichael analyzed over 1.3 billion individual opioid prescriptions, representing about 90 percent cent of all opioid prescriptions filled at outpatient pharmacies between 2011 and 2017, to examine the impact SOP laws have on the quantity of opioids prescribed by both physicians and NPs.

Although SOP laws are strongly backed by the American Medical Association, among other groups, as a way to ensure patient safety, McMichael said he found no evidence to suggest that opioid patients’ health was compromised by NPs in states where such laws were not in existence.

In fact, he argued, the tendency of NPs to prescribe smaller doses or fewer prescriptions when they were not bound by what doctors ordered may be a significant factor in the successful treatment of addiction.

According to the data, the overall amount of morphine “milligram equivalents” prescribed by all providers during that period actually decreased slightly—by 1.2 percent— during that period.

“The clear majority of evidence demonstrates that granting NPs independence reduces the use of prescription opioids across three different measures of opioid prescribing,” wrote McMichael, in a working paper, entitled “Scope-of-Practice Law and Patient Safety: Evidence from the Opioid Crisis.”

He added: “Allowing NPs to practice independently, if anything, reduces the use of opioids, consistent with an improvement in patient safety, given the demonstrated harms associated with recent levels of opioid prescriptions.”

NPs are registered nurses who have undergone additional training to provide healthcare services historically provided by physicians, the study noted. In general, NPs may evaluate patients, provide diagnoses, offer treatment, and prescribe medications.

State scope-of-practice (SOP) laws—a subset of the occupational licensing laws that govern NPs and many other professionals—determine what services NPs may provide and the conditions under which they may provide those services.

Another significant effect of granting NPs more independence is lowering healthcare costs, McMichael noted.

McMichael cited other studies that have demonstrated that granting NPs more autonomy “can result in lower healthcare prices, increased access to care, and improved quality of care.”

“While SOP laws are not generally mentioned in the debate over the opioid crisis, the results… suggest that changing how the healthcare workforce is regulated via SOP laws could play a role in mitigating the effects of this crisis,” he wrote.

According to the Centers for Disease Control and Prevention, an estimated 40 Americans died each day from a drug overdose involving a prescription opioid during 2017.

Additional Reading: Can We Help Opioid Abusers Without Jailing Them?

A full copy of the report can be downloaded here.

Megan Hadley is a senior staff writer for The Crime Report.

from https://thecrimereport.org

Can We Help Opioid Abusers Without Jailing Them?

As the nation continue to suffer from the opioid epidemic, programs that can divert substance abusers away from the criminal justice system are critical. One increasingly popular approach called “deflection” partners police and public health workers.

Out of the tremendous heartbreak and suffering of our nation’s opioid epidemic, something new and hopeful is happening in communities across the country.

Police officers and drug treatment providers, previously unaccustomed and sometimes even reluctant to partner with one another, now can be found working side by side to reverse overdoses and connect people to drug treatment.

And while these emerging public safety-public health partnerships are not limited to combatting opioids—they also can address drug use in general, housing, mental health, and social services—it is the overwhelming number of people overdosing and dying from opioids that has accelerated the growth of these collaborations, and catalyzed their value in both saving lives and fighting crime.

The new approach is called ‘deflection.”

In deflection, law enforcement plays the critical role of connecting people to community-based treatment partners. This interaction may occur right on the street at the point of encounter, in the police or fire station, at the person’s home, or wherever the initial encounter occurs, all without fear of arrest.

On the receiving end of this “warm hand-off” are treatment providers and/or peer recovery partners who follow through to ensure the individual’s access to services. The operational specifics of each deflection program depend on the design of the local initiative, but the core idea is consistent: Instead of being a doorway into the justice system, law enforcement instead deflects people with substance use disorders to treatment.

Taken together, these new relationships signify the growing importance of “deflection,” which operates squarely at the intersection of law enforcement and treatment.

Sometimes referred to by other terms such as pre-arrest diversion, deflection is growing rapidly from its infancy. A few such programs came about in the 1990s and then faded, but the opioid epidemic has prompted new urgency for these efforts, birthing, or rebirthing, a wide variety of deflection efforts.

The most visible entry to this new stage was Seattle’s Law Enforcement Assisted Diversion (LEAD) program in 2011. Others soon followed, from the 2014 Civil Citation Network in Alachua and Leon County (FL) and the 2014 Drug Abuse Resistance Team (DART) in Lucas County, Ohio; to the 2015 “Angel” and “Arlington Outreach” programs in Massachusetts and the 2015 Quick Response Teams (QRT) developing in communities in Ohio and elsewhere around the country.

Combined with its longer-serving counterparts on the mental health side—such as Crisis Intervention Teams, co-responders, and triage centers—deflection is changing the narrative about fighting crime from “We can’t arrest our way out of this” to “We have better options than arrest.”

Deflection as a term is differentiated from its cousin in the justice system: diversion. In deflection, it is the presence of a behavioral health issue that is driving the contact with police that in turn triggers the deflection (movement) away from the justice system and to community-based behavioral health.

In the vast majority of these cases there are no criminal charges present, responding to the reality that 81 percent of police encounters are, in the final analysis, social service calls. (There are a smaller number of deflection efforts that allow for criminal charges to be placed in abeyance by the police or a citation with mandatory treatment is issued but still in these cases, no traditional justice involvement is required.)

To be sure, some ongoing contact between law enforcement and treatment is helpful beyond that deflection handoff. In some cases, ongoing communication between partners can serve to de-conflict ongoing encounters, share status updates, and support the person who’s been deflected to treatment.

Still, the intent is not meant to add to the already unrealistic expectations placed upon law enforcement to solve chronic social problems, but instead to lighten the burden from where it does not belong – law enforcement – and instead place it with community treatment, housing, healthcare, and social services.

Deflection does increase the demand for treatment capacity and, as such, strategies and action are needed to assure quick and sufficient treatment availability wherever deflection initiatives exist.

In looking at the variety of existing deflection programs, five “pathways” broadly summarize different ways that law enforcement is connecting people to treatment:

  • Self-referral
  • Active Outreach
  • Naloxone Plus
  • Officer Prevention
  • Officer Intervention

Each of these pathways describes the linkage point between police and treatment. While jurisdictions will usually start by facilitating a single pathway, in time as they get experience in deflection and see first-hand the power of their collaborative work, they will begin to add in additional pathways.

Currently, out of 18,000 law enforcement agencies in the United States, it is estimated that slightly over 600 departments are doing some type of deflection.

In the face of a national opioid epidemic, the growth of the field has occurred almost entirely in the last three years. As such, programs continue to be developed and implemented across the county—responding not just to opioids, but to any drug crises that communities face—collectively they can actually reduce the flow of people into the criminal justice system, while also offering necessary referrals to community-based treatment, housing, and services.

Annually, our nation’s 800,000 law enforcement officers encounter 68 million people, some 12 million of whom will end up churning through our jails. Police also encounter millions of people each year for whom there are no criminal charges present, but who have health, housing, and social service needs.

Jac Charlier

Jac A. Charlier

And, given that the majority of people who currently enter the justice system have a substance use disorder, a mental health condition, or both, deflection provides the opportunity to redirect people to treatment before they reach the justice system, emergency rooms, or homeless shelters.

In a country where over 72,000 people died from overdose in 2017 alone, the expansion of these deflection efforts by law enforcement, and the parallel expansion of treatment capacity, cannot happen soon enough.

Jac A. Charlier is executive director of the TASC Center for Health and Justice, and co-founder of the Police, Treatment, and Community Collaborative (PTACC). He welcomes readers’comments. NOTE: Jac is among the speakers scheduled for this year’s John Jay/HF Guggenheim Symposium on Crime in America. Please watch our site for upcoming information on how to register.

from https://thecrimereport.org

Some S.F. Drug Users Seek Fentanyl Despite Dangers

For many addicts in San Francisco’s Tenderloin district, fentanyl is a high-value drug that, if used carefully, can prevent dope sickness and deliver a strong high for a small fraction of the price of heroin.

Ever since the powerful synthetic opioid fentanyl started showing up in the U.S. eight years ago, experts have surmised that drug traffickers were using the inexpensive white powder to boost the potency of heroin, sometimes adding too much and killing their customers. In San Francisco’s gritty Tenderloin district, where fentanyl was only rarely seen until last year, drug users tell a starkly different story, Stateline reports. For many of them, fentanyl is a high-value drug that, if used carefully, can prevent dope sickness and deliver a strong high for a small fraction of the price of heroin. More than half of drug users in the Tenderloin area purposely seek fentanyl, despite its dangers, according to harm reduction workers who talk to hundreds of drug users every day. Fentanyl has become the biggest killer in the nation’s raging drug overdose epidemic.

Many other drug-using San Franciscans say they try to avoid the deadly white powder, and some reported overdosing after unwittingly consuming a wide variety of fentanyl-laced drugs, including methamphetamines, cocaine and counterfeit Xanax and Vicodin pills. Still, an increasing number of drug users say they are opting for fentanyl when it’s available, a trend not reported elsewhere. Despite its powerful potency, fentanyl isn’t killing nearly as many people in San Francisco as it is on the East Coast and in Appalachia. The consumer preference for fentanyl and relatively low death rate likely stem in large part from the way the drug is marketed by dealers, said Phillip Coffin of San Francisco’s public health department. Fentanyl sold in San Francisco is clearly labeled. It’s rarely disguised as heroin, as it is on the East Coast and in Appalachia. As a result, users who buy fentanyl know what they’re getting and, in most cases, take the necessary precautions, he said.

from https://thecrimereport.org

The Scourge of Methamphetamine

     The number one drug that poses the greatest threat to our society is methamphetamine, also known as meth or crystal meth. Meth is a highly addictive and powerful stimulant that affects the central nervous system. It causes mood swings, anxiety, euphoria, depression, delusional thinking, paranoia, and even permanent psychological damage. Prolonged use of meth can cause damage to the heart, liver, kidneys, and lungs, which can ultimately lead to death.

     Meth–sold in powder, ice, and tablet forms–can contain dangerous ingredients, including battery acid, drain cleaner, lantern fuel, and antifreeze….

Phil Chalmers, Inside the Mind of a Teen Killer, 2009 

     The number one drug that poses the greatest threat to our society is methamphetamine, also known as meth or crystal meth. Meth is a highly addictive and powerful stimulant that affects the central nervous system. It causes mood swings, anxiety, euphoria, depression, delusional thinking, paranoia, and even permanent psychological damage. Prolonged use of meth can cause damage to the heart, liver, kidneys, and lungs, which can ultimately lead to death.

     Meth--sold in powder, ice, and tablet forms--can contain dangerous ingredients, including battery acid, drain cleaner, lantern fuel, and antifreeze….

Phil Chalmers, Inside the Mind of a Teen Killer, 2009 

from http://jimfishertruecrime.blogspot.com/

Ex-Cartel Logistics Manager Testifies Against El Chapo

The former logistics manager of the Sinaloa cartel testified against his former boss Joaquín “El Chapo” Guzmán, giving jurors a rare opportunity to hear details of alleged high-level discussions within the cartel’s inner circle.

The former logistics manager of the Sinaloa cartel testified against his former boss Joaquín “El Chapo” Guzmán, giving jurors a rare opportunity to hear details of alleged high-level discussions within the cartel’s inner circle, reports the Wall Street Journal. The testimony of Vicente Zambada Niebla, who was arrested in Mexico in 2009, was highly anticipated. Zambada served among the leadership of the Sinaloa cartel for nearly a decade and recently pleaded guilty to drug-conspiracy charges. Officials have called him one of the most significant drug traffickers to ever be extradited to the U.S. In a plea agreement, Zambada agreed to a U.S. forfeiture order of more than $1.3 billion and to assist federal prosecutors. In exchange, he said the government allowed his family to move to the U.S. for their safety.

Zambada’s father, Ismael “El Mayo” Zambada García, once ran the cartel with Guzmán. The elder Zambada is still the cartel’s leader and remains at large. Guzmán, on trial in Brooklyn federal court, faces a 17-count indictment that accuses him of building a multibillion-dollar international narcotics empire over nearly three decades. As the person in charge of coordinating drug shipments, Zambada offered jurors a detailed account of how massive amounts of cocaine and methamphetamines were ferried from Colombia through Mexico into U.S. cities. He said the cartel hired families with U.S. citizenship who lived in El Paso, Tx., to drive across the Mexican border several times a day and return to the U.S. carrying cocaine or drug proceeds in hidden compartments in their cars. To get cocaine from the Mexican border to Chicago, drugs were hidden on trains carrying meat and other products, Zambada said. The trial is expected to last several more weeks. The judge on Thursday urged prosecutors to speed up the case.

from https://thecrimereport.org

California Pot Surplus Means Fewer Legal Sales

About $2.5 billion of legal cannabis was sold in California in 2018, half a billion dollars less than in 2017 when only medical marijuana was legal. Analysts say the black market remains strong because the state produces far more pot than it consumes.

A billion dollars of tax revenue, reductions in the black market, and the convenience of retail cannabis stores were some of the promises made by proponents of marijuana legalization in California. A year after the start of recreational sales, they are still just promises, the New York Times reports. California’s legalization is mired by debates over regulation and hamstrung by cities and towns that do not want cannabis businesses. California was the sixth state to introduce the sale of recreational marijuana after Alaska, Colorado, Nevada, Oregon and Washington. The enormous size of the market led to predictions of soaring legal cannabis sales, but sales fell. Around $2.5 billion of legal cannabis was sold in California in 2018, half a billion dollars less than in 2017 when only medical marijuana was legal, says GreenEdge, a sales tracking company.

“There are definitely days that I think that legalization has been a failure,” said Lynda Hopkins of the Sonoma County Board of Supervisors, which took a lead in licensing marijuana businesses and became embroiled in disputes over regulations and taxes, plus angry residents who did not want cannabis grown in their neighborhoods. The easy part of legalization was persuading people to vote for it. The hard part is persuading people to stop buying from the black market. In Colorado and Washington, licensed sales soared after legalization. California produces far more pot than it can consume. “The bottom line is that there’s always been a robust illicit market in California — and it’s still there,” said Tom Adams of BDS Analytics. Regulators thought they could go straight into an incredibly strict and high-tax environment.” The most estimate of California’s cannabis production showed the state producing as much as 15.5 million pounds of cannabis and consuming 2.5 million pounds.

from https://thecrimereport.org

How Heroin Can Kill

….When someone takes heroin there is an immediate rush. Then the body feels an extreme form of relaxation and a decreased sense of pain. What’s happening inside the body is the heroin is turning into morphine. Morphine has a chemical structure similar to endorphins–the chemicals your brain makes when you feel stressed out or in pain. Endorphins inhibit your neurons from firing, so they halt pain and create a good feeling….

     Most people die from heroin overdoses when their bodies forget to breathe….A heroin overdose can also cause your blood pressure to dip significantly and cause your heart to fail….Intravenous heroin users are 300 times more likely to die from infectious endocarditis, an infection on the surface of the heart.

     Heroin use can also cause an arrhythmia–a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart may not be able to pump enough blood to the body, and lack of blood flow affects your brain, heart and other organs. Heroin use can also cause pulmonary edema. That’s when the heart can’t pump blood to the body well. The blood can back up into your veins, taking that blood through your lungs and to the left side of the heart….

     Heroin can also come with other toxic contaminants that can harm a user–although deaths from such instances, while not unheard of, are thought to be rare….

Jen Christensen, “How Heroin Kills You,” CNN February 4, 2014 

….When someone takes heroin there is an immediate rush. Then the body feels an extreme form of relaxation and a decreased sense of pain. What's happening inside the body is the heroin is turning into morphine. Morphine has a chemical structure similar to endorphins--the chemicals your brain makes when you feel stressed out or in pain. Endorphins inhibit your neurons from firing, so they halt pain and create a good feeling….

     Most people die from heroin overdoses when their bodies forget to breathe….A heroin overdose can also cause your blood pressure to dip significantly and cause your heart to fail….Intravenous heroin users are 300 times more likely to die from infectious endocarditis, an infection on the surface of the heart.

     Heroin use can also cause an arrhythmia--a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart may not be able to pump enough blood to the body, and lack of blood flow affects your brain, heart and other organs. Heroin use can also cause pulmonary edema. That's when the heart can't pump blood to the body well. The blood can back up into your veins, taking that blood through your lungs and to the left side of the heart….

     Heroin can also come with other toxic contaminants that can harm a user--although deaths from such instances, while not unheard of, are thought to be rare….

Jen Christensen, "How Heroin Kills You," CNN February 4, 2014 

from http://jimfishertruecrime.blogspot.com/

The McDonald’s “Happy Meal” Case

     A McDonald’s employee in Pittsburgh, Pennsylvania was arrested on January 29, 2014 after undercover police officers said they discovered her selling heroin in Happy Meal Boxes….Shantia Dennis, 26, was arrested after undercover law enforcement officials conducted a drug buy….

     Customers looking for heroin were instructed to go through the drive-through and say, “I’d like to order a toy.” The customer would then be told to proceed to the first window, where they would be handed a Happy Meal Box containing heroin. [I imagine the drug buyer would pay someone else for the heroin at another location.]

     During the drug buy, the undercover officers recovered 10 stamp bags of heroin, as well as a small amount of marijuana….

Allie Malloy, “McDonald’s Worker’s Happy Meals Had a Bit Extra: Heroin,” CNN, January 30, 2014 

     A McDonald's employee in Pittsburgh, Pennsylvania was arrested on January 29, 2014 after undercover police officers said they discovered her selling heroin in Happy Meal Boxes….Shantia Dennis, 26, was arrested after undercover law enforcement officials conducted a drug buy….

     Customers looking for heroin were instructed to go through the drive-through and say, "I'd like to order a toy." The customer would then be told to proceed to the first window, where they would be handed a Happy Meal Box containing heroin. [I imagine the drug buyer would pay someone else for the heroin at another location.]

     During the drug buy, the undercover officers recovered 10 stamp bags of heroin, as well as a small amount of marijuana….

Allie Malloy, "McDonald's Worker's Happy Meals Had a Bit Extra: Heroin," CNN, January 30, 2014 

from http://jimfishertruecrime.blogspot.com/