Category Archives: Substance use

Wilkes-Barre Faces Heroin Scourge

WILKES-BARRE, Pa. — For William Lisman, the longtime Luzerne County coroner, the first sign of the coming plague appeared in the hills of northeastern Pennsylvania in November 2015.

A 27-year-old woman from one of the mountain towns surrounding Wilkes-Barre was found dead in her family home.

Lisman suspected a drug overdose. She was young. She had been healthy. There were no obvious signs of trauma. And heroin abuse had been on the rise in recent years.

“When a person dies of an overdose, the lungs fill with fluid,” he said. “The victims essentially drown in their own fluids.”

Because autopsies are expensive and time consuming, many coroners faced with cases like these do toxicological tests designed to pick up traces of known drugs to determine the cause of death. But the first test Lisman administered came back negative. So did the second.

So Lisman listed the cause of death as undetermined.

Several days later, a 34-year-old man was found dead in a sleeping bag in the nearby city of Hazleton.

Once again, Lisman suspected a fatal drug overdose. Once again, the tox tests came back negative. And once again, he listed the cause of death as undetermined.

“I remember when it started because it was budget time and they were about to cut my budget,” he said, with a wry chuckle. “At that point the doctor I had been consulting with (about these two cases) told me, ‘Bill, there is something going on here’.”

Like many coroners in smaller counties, Lisman is not a doctor. But he knows about death. A third-generation Wilkes-Barre resident, he and his family ran a funeral home that buried several generations of city residents. He reached out to fellow coroners in neighboring counties to see if they had similar cases.

MSU study finds surprises about drug use

Conducting an economic analysis of drug use is a particularly difficult endeavor, but for Michigan State University professor and economist Siddharth Chandra, it just meant taking a look at the history books.

“You can’t simply go to Wal-Mart and look at the sticker price, and people don’t want to talk to you because drugs are illegal and they think they’ll get in trouble, ” Chandra said. “Our study is the first time the subject of how populations of consumers switch between drugs is being studied with data considered reliable.”1pillst.jpg

To find reliable economic data on drug use, Chandra, also the director of the Asian Studies Center at MSU, had to look back to early 20th century India, when the region was still part of the British Empire.

“One hundred years ago these products were legal. In British India the government was actually selling these things to the public, and they kept meticulous records,” Chandra said.

In his study – the first of its kind – Chandra pored through stacks of 100-year-old ledgers, called Excise Administration Reports, kept by the governments of the various provinces of India. Interpreting these data, he found surprising results about the economics of drug use behaviors. Despite the stark differences in the effects of opium vs. cannabis on the human body, the study shows that users would switch between the two drugs when the price of one went up – in economics, a phenomenon called substitution.

“The time, place and context are different, but the phenomenon is there. You might think consumers would treat them differently,” Chandra said. “But just because the two drugs used are very different, doesn’t mean people won’t switch.”

Opium, used legally to make the pain medicine morphine and illegally to make the drug heroin, is a highly addictive and potent depressant with potentially lethal side effects. Cannabis, also known as marijuana, is a less potent drug that produces a sense of relaxation and euphoria when used, usually through smoking or ingestion. These differences only came into consideration when analyzing cannabis in its weakest form, a drug called bhang, which consumers would not substitute for the more potent opium.

“There are many policy implications for these results,” Chandra said. “Targeting a particular drug with policies and enforcement might backfire.”

Chandra pointed to the epidemic of heroin, a product of opium that is relatively inexpensive and is devastating some communities in the United States.

“Many people know someone who has been affected by heroin – it is a very dangerous drug,” Chandra said. “But prohibiting harmful drugs selectively can be ineffective. Consumers may switch.”

Narrow Indication for Abuse-Deterrent Morphine

The latest opioid approved by FDA will be “expected” to reduce abuse by only one route — injection — in its official labeling.

In a carefully-worded press release, drugmaker Egalet said its extended-release morphine drug Arymo ER “increased resistance to cutting, crushing, grinding or breaking using a variety of tools. Due to its physical and chemical properties, Arymo ER is expected to make abuse by injection difficult.” 1pillst

In an FDA advisory committee meeting last year, participants voted that the drug could deter abuse via the oral, nasal, and intravenous routes of abuse. But there were several reasons only the intravenous route won labeling.

An FDA spokesperson told MedPage Today that MorphaBond, another morphine product, has “marketing exclusivity for labeling describing the expected reduction of abuse of single-entity, extended-release morphine by the intranasal route due to physicochemical properties.” MORE HERE