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Prisoner death from drug withdrawal:

In my blog entry on October 20, 2015, I discussed the horrible death from drug withdrawal suffered by David Stojcevski in the Macomb County, Michigan, jail. I’ve been scouring the internet looking for updates on the lawsuit the family has filed against the county, but haven’t found anything. However, I’m pleased to find many news stories about this awful incident, which helps to keep the issue of medical treatment of prisoners in the news. This is something we must change. Incarcerated people should not be allowed to die from drug withdrawal!


Bad legislation:

On April 12, 2015, I blogged about NC bill S297, which is legislature intended to make drug use by a pregnant woman a criminal act. Regrettably, this sorry and misguided piece of legislation was passed on its first reading in the NC senate. It’s now been referred to the Committee on Rules and Operations of the Senate. If you live in NC, when you vote, remember that Republican Brent Jackson presented this bill, which I believe will keep pregnant women from seeking medical care during pregnancy if they have the disease of addiction. This bill is not good for society, pregnant women, and especially not good for fetuses.


I’ve written a few blog entries (September 2, 2011; March 30, 2013; May 21, 2013; and November 7, 2015), about Probuphine, implantable small rods that deliver buprenorphine into a patient’s bloodstream over six months.

In January of 2016, an advisory committee to the FDA voted to recommend Probuphine for approval by the FDA for the treatment of opioid addiction. The FDA is expected to hold its vote at the end of this month. You will recall that despite a similar recommendation last year, the FDA did not approve this implant, stating more study was needed, especially on patients who were stable at lower dose of buprenorphine.

This time, Titan Pharmaceuticals is seeking approval in patients who are stable on 8mg of the sublingual buprenorphine or less per day.

Of the minority of people on the advisory panel who voted no to the recommendation, concerns were expressed about identifying appropriate patients for this medication, and risks of both implantation and removal of the rods.

I’m still not clear if there will be changes to the rules for implantation and removal of the Probuphine rods. For a buprenorphine prescriber to be able to offer Probuphine, she would have to take a training class for the procedures for implantation and removal. This requires time away from work, to meet an uncertain demand for this product. Not all doctors who prescribe buprenorphine will want do this procedure anyway.

If I want to do this procedure in my office, how to I get the implants? Do I have to buy them, and wait for the patient to pay me back? Do I write a prescription and have the patient pick them up at the pharmacy? Will insurance cover the medication and the procedure? If yes, how long would I have to wait for payment from these companies? I’ve been able to stay in business at my private office by keeping overhead pared to a minimum, so if Probuphine requires an investment by me, I may decide it’s not worth my time and effort.

Hepatitis C treatment

As described in my July 3, 2015 blog entry, the CDC recently reported a surge in the numbers of U.S. citizens who have contracted Hepatitis C. Now another drug has entered the market to treat Hep C, but remains extremely expensive. Earlier this year, Merck pharmaceutical company launched a new Hep C drug called Zepatier. It’s an oral drug that costs an estimated $54,000 for a twelve week course, compared to $80,000 for a similar course of Harvoni. However, early reports say Zepatier cure rates may not be as high as Harvoni’s, so we await more information.

Many health insurance systems can’t afford to pay this much money for treatment of their insured, and so many people infected with Hep C have found their insurer refuses to pay for this new treatment that cures Hep C in most patients. Without insurance, few people could shoulder that expense themselves.

So we have another treatment option, and a little bit less expensive. Let’s hope this trend continues.

ALKS 5461

In my blog post from January 17.2015, I reported a new drug on the horizon that was hoped to be a novel treatment for resistant depression. This medication, known as ALKS 5461, contains buprenorphine (just like Suboxone, Subutex) and samidorphan, a new opioid receptor blocker. The medication was theorized to treat depression by the buprenorphine’s antagonistic action on the kappa receptors, and the samidorphan would serve to block the effect of buprenorphine on opioid receptors, so that the patient would not develop an opioid dependency.

Unfortunately, ALKS 5461 failed to show benefit in two phase III clinical trials, leading Alkermes stock to fall when this data was announced in January of 2016. Despite these results, Alkermes is reported to be continuing research into this potential new medication for depression.


8 responses to this post.

  1. Posted by Debby on February 25, 2016 at 12:21 am

    The decision to approve probuphone was delayed another three months.


  2. Posted by doug on February 25, 2016 at 6:02 am

    Speaking of the alks 5461, I also heard they were trying hydrocodone for dependency on tobacco and quitting. I thought that was crazy


  3. Posted by J Reddy on February 25, 2016 at 1:28 pm

    this is so helpful. I find all of your blog posts clearly written, informative, and ideologically sound. thank you so much.


  4. Posted by Matty V on March 1, 2016 at 7:50 pm

    Arent their any human rights arguments that can be made in denying prisoners addicted to opioids their medications. Whether it be methadone, buprenorphine or even naltrexone therapy??
    In the 21st century this seems draconic to me at best


    • I certainly think so! But I’m no lawyer, and this would be a great cause to be championed by an interested lawyer.


    • Posted by tylogirl27aax on March 19, 2016 at 3:49 pm

      You might think that it’s a human rights issue, but you should hear citizen comments when I’ve tried to protest the conditions at our local jail. It’s vastly and perpetually over-crowded for decades now, has been decertified multiple times (despite the state of TN only have 6 inspectors to cover the whole state). Worse, is one of the few remaining jails built underground, lacking sufficient light and ventilation.

      In the last 30 days, there have been 2 lawsuits stemming from serious injuries at the death, and a riot 2 days ago. There have also been several suspicious deaths there over the years. Somehow video is never available.

      Citizen reactions mirror the Sheriff”s: “This isn’t a Holiday Inn!”, as if we are advocating for that level of comfort! Also common is, “Stay out of jail and it won’t be an issue!”, of course ignoring the fact that local jails hold people pre-trial, with the presumption of innocence, and regardless, all citizens are entitled to the right against cruel and unusual punishment. We can’t let ignorant mobs define our policy. They are vocal, but fortunately rarely set policy.

      The state of TN has perpetually operated in emergency over-crowding mode since the 80s, which means state prisoners serving long sentences are held in local jails that weren’t meant for such.

      This issue has so infuriated me that I’ve set up a Facebook Community here to start organizing voters so that we can begin electing people who care about this issue, and educating the general public. Along with this effort will certainly be access to medication. Of course, you have to expect to any narcotic will be less than in the public, but these people should at least be weaned off in a safe manner over the course of no less than 30 days (I know, still not ideal, but trying to be pragmatic about what can be done!).

      I focus on ‘drug policy’ because that is what has our state prisons and local jails bursting at the seams. Law enforcement, often compensated by their arrest count, and given proceeds from asset seizures, target the low-hanging fruit of local drug addicts, tricking them into exchanging drugs (as most addicts will do!), then charging them as drug dealers. Sure, casual exchange might be a more accurate charge, but that’s not how the criminal justice system works.

      It has taken decades of escalating abuse and failed policies to get to the level where the public is finally starting to take notice. It ‘helps’ that the nation as a whole is so far ahead any other major nation in our rate of incarceration, way ahead of Russia and China, and even beating China in total count, despite China having many times our population.

      Join the cause – or another organization if you don’t find my small starutp appealing – https://www.facebook.com/tnreform . All we need to do is to get more people to participate in local and state elections, then we can change so much.


  5. Posted by Brian on March 20, 2016 at 6:15 am

    And this piece of legislation about pregnant women written by a group of old white men though it will affect women only! What about the man who “planted his seed in a sinful garden”? Shouldn’t he be sentenced to 9 months and a hard labor? Is that any more or less absurd than the proposed legislation which targets one specific gender.
    The most frustrating part of a bill like this is that it will not stop anything, deter anything, fix anything, or protect anyone. It is nothing more than one more “shame finger” for our government to shake at someone who is already suffering.
    These politicians talk about reducing “big government” when it comes to the EPA insuring clean water in our homes but they will gladly spend a whole congressional session coming up with policies and legislation to prosecute and persecute people who already suffer from diseases like addiction and poverty.


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