opioid addiction

In late May, several senators went to the floor of the Senate to talk about people in their states who are affected by the opioid crisis. Sen. Shelley Moore Capito, R-W.Va., talked about Chelsea Carter.

"She told me her drug habit began when she was 12 years old," said Capito.

A one-paragraph letter, barely a hundred words long, unwittingly became a major contributor to today's opioid crisis, researchers say.

"This has recently been a matter of a lot of angst for me," Dr. Hershel Jick, co-author of that letter, told Morning Edition host David Greene recently. "We have published nearly 400 papers on drug safety, but never before have we had one that got into such a bizarre and unhealthy situation."

In the day room at St. Ann's Corner of Harm Reduction, which runs a needle exchange program in the Bronx, a group of guys are playing dominoes and listening to salsa music while they wait for lunch. And Van Asher, one of the staffers in charge of "transactions" — that means he gives out needles — is talking up his latest idea for how to keep the users here safe.

He wants to tell them what's really in their stash.

"If you're doing dope," he says to one client, "we'll give you a test strip so you can test and see if there's fentanyl."

Volunteers at an overdose prevention site in Vancouver, Canada, say they saved the life of a rat named Snuggles after the little rodent overdosed on heroin.

Sarah Blyth, who co-founded the organization behind the prevention site, wrote about the rescue on Twitter. While Snuggles was initially described as a mouse, Blyth tells NPR that the pet is actually a rat.

In March, President Trump called opioid abuse in the U.S. "a total epidemic," and issued an executive order creating a commission focused on combating the opioid crisis.

A man named Eddie threads through the mid-afternoon crowd in Cambridge, Mass. He's headed for a sandwich shop, the first stop on a tour of public bathrooms.

"I know all the bathrooms that I can and can't get high in," says Eddie, 39, pausing in front of the shop's plate glass windows, through which we can see a bathroom door.

Nearly 1.5 million Americans were treated for addiction to prescription opioids or heroin in 2015, according to federal estimates, and when those people get seriously hurt or need surgery, it's often not clear, even to many doctors, how to safely manage their pain. For some former addicts, what begins as pain relief ends in tragedy.

In the midst of an opioid epidemic that continues to devastate families, a sliver of hope has arrived. Two long-term studies published Monday show that opioid use among teens and opioid poisonings among younger children are on the decline.

As the toll of the opioid epidemic grows, scores of doctors have lost their licenses and some have gone to prison. Pharmacies are being sued and shuttered. Pharmaceutical manufacturers are under investigation and face new rules from regulators.

But penalties against companies that serve as middlemen between drug companies and pharmacies have been relatively scarce — until recently.

Charlie Oen's battle with addiction started when he was 16 and his family moved to Lima, Ohio. It was the last stop in a string of moves his military family made — from Panama to North Carolina, Kentucky, Texas and Germany.

"I went toward a bad group because those were the people that accepted me," he says. Drugs became a substitute for real friendships.

It took a lot of convincing to get John Evard into rehab. He was reluctant to give up the medications that he was certain were keeping his pain at bay. But ultimately he agreed — and seven days into his stay at the Las Vegas Recovery Center, the nausea and aching muscles of opioid withdrawal are finally beginning to fade.

"Any sweats?" a nurse asks him as she adjusts his blood pressure cuff.

"Last night it was really bad," he tells her, "but not since I got up." Evard, who is 70, says he woke up several times in the night, his sheets drenched with sweat.

PIERCE COUNTY

Pierce County lawmakers this week voted down a sales tax that would have raised an estimated $10 million for mental health and substance abuse programs.

The South Sound county will remain the only one of Washington's densely-populated counties without the 1/10 of 1 percent sales tax for mental health. Twenty-two of Washington's 39 counties have the tax, along with the city of Tacoma.

In 1964, the U.S. surgeon general released a report on the health impacts of smoking, and it shaped the public and government's attitudes toward tobacco for years to come. On Thursday, another surgeon general's report was issued, this time tackling a much broader issue: addiction and the misuse and abuse of chemical substances. The focus isn't just one drug, but all of them.

Courtesy of Pierce County

More than half of Washington's 39 counties have a special sales tax funding mental health and substance abuse programs. 

Among the state's urban counties, Pierce County is the exception. Leaders there have resisted enacting tax the one-tenth of 1 percent sales tax for years. 

But with homelessness and addiction on the rise, some county leaders are looking to change that.

On the final day of June 2015, Colin LePage rode waves of hope and despair. It started when LePage found his 30-year-old son, Chris, at home after an apparent overdose. Paramedics rushed Chris by helicopter to one of Boston's flagship medical centers.

Doctors revived Chris' heart, but struggled to stabilize his temperature and blood pressure. At some point, a doctor or nurse mentioned to LePage that his son had agreed to be an organ donor.

"There was no urgency or, 'Hey, you need to do this.' I could see genuine concern and sadness." LePage says, his voice quavering.

Once people realized that opioid drugs could cause addiction and deadly overdoses, they tried to use newer forms of opioids to treat the addiction to its parent. Morphine, about 10 times the strength of opium, was used to curb opium cravings in the early 19th century. Codeine, too, was touted as a nonaddictive drug for pain relief, as was heroin.

Those attempts were doomed to failure because all opioid drugs interact with the brain in the same way. They dock to a specific neural receptor, the mu-opioid receptor, which controls the effects of pleasure, pain relief and need.

Some arrive on their own, worried about what was really in that bag of heroin. Some are carried in, slumped between two friends. Others are lifted off the sidewalk or asphalt of a nearby alley and rolled in a wheelchair to what's known as SPOT, or the Supportive Place for Observation and Treatment, at the Boston Health Care for the Homeless Program.

Health care claims for people with opioid dependence diagnoses rose more than 3,000 percent between 2007 and 2014, according to an analysis of insurance records.

The findings illustrate that the opioid problem is "in the general mainstream," says Robin Gelburd, president of Fair Health, a nonprofit that analyzes health care costs and conducted the study.

In a big hotel conference room near New York's Times Square, six doctors huddle around a greasy piece of raw pork. They watch as addiction medicine specialist Michael Frost delicately marks the meat, incises it and implants four match-sized rods.

"If you can do it well on the pork, you can easily do it on the person," Frost tells his audience.

MOLLY MCGUIRE

A University of Washington report on drug addiction in King County confirms that heroin use is still on the rise. But for the first time, researchers say opioid-related deaths are leveling off.

The Obama administration is making it easier for people addicted to opioids to get treatment.

Health and Human Services Secretary Sylvia Burwell announced new rules Wednesday to loosen restrictions on doctors who treat people addicted to heroin and opioid painkillers with the medication buprenorphine.

Bridgton, Maine, is the kind of place people like to go to get away. It's got a small main street with shops and restaurants, a pair of scenic lakes, a ski resort and plenty of hiking trails.

But about 10 years ago, Bridgton, a town of just 5,000 residents, began showing signs of a serious drug problem.