Did you Know?

 Ketamine Clinics for Depression

The anesthetic ketamine is increasingly being used off-label for depression. The drug seems to work rapidly, frequently in a matter of hours and lasting up to two weeks, but its long-term side effects are unknown. It’s also not clear if there’s a significant risk of addiction. Because those seeking care are often so desperate for relief, they’re willing to accept the risks, cost – a single infusion can cost hundreds of dollars, – and the uncertainties. Two decades ago, ketamine was known as an anesthetic used in pet surgery and a party drug nicknamed “special K” that was popular at raves. Now, it’s the hottest new treatment for depression that hasn’t responded despite psychotherapy or antidepressants. Dozens of ketamine “clinics” offering infusions have popped up across the United States over the past few years, everywhere from big cities like New York, Houston and Los Angeles to Boise, Idaho, and Charleston, S.C. Ketamine is approved by the FDA only as an anesthetic, not for depression. If it is used for depression, it must be combined with complex regimens of other psychiatric medications that treat depression. Some patients have undergone ketamine infusions for years, while others have seen its effects fade over time. More information here.

The Drug Overdose Epidemic in Indiana: Behind the Numbers
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Drug overdose deaths, more specifically opioid-involved deaths, have continued
to rise in Indiana and impact people of all races, sexes, ages and locations.

Opioids continue to be the most frequently found substance in overdose deaths.
Public health officials, law enforcement and other stakeholders should also be
concerned about polysubstance use and the rise in deaths involving non-opioid
substances, such as cocaine, benzodiazepines and amphetamines.

In 2017, there were over 1,800 drug overdose deaths in Indiana averaging to
five Hoosiers a day. The primary driver of overdose deaths is opioids as three out
of the five Hoosiers who died from an overdose each day involved an opioid.

Differences exist between male and female overdose rates. Males made
up 64% of all overdose deaths in 2017 and are at a higher risk of overdose than
females. The risk for women has increased over the years, suggesting that both
sexes struggle with substance use disorders. This same trend is seen for opioid-
involved overdose deaths.

The rise in opioid-involved overdose deaths has been attributed to multiple
factors. The first wave of the epidemic began in the late 1990s with the
increased prescribing of opioids. The second wave began in the middle to late
2000s when individuals who could no longer receive legal medications chose to
opt for the cheaper alternative of heroin. The third wave, beginning in Indiana primarily in 2014, was likely driven by illicitly manufactured fentanyl (IMF) and
fentanyl analogs that are an even cheaper and more potent alternative to heroin.

An increase in drug case submissions of fentanyl and its analogs were seen by
the Indiana State Police prior to the third wave. The IMF market continues to
change, and IMF is now found in combination with heroin, cocaine and
counterfeit pills 2. The influx of IMF into non-opioid substances places all
substance users at risk of overdose death. (Indiana State Department of Health)
Traumatic Brain Injury and Opioid Use Disorder Traumatic brain injury (TBI) is common among people who have a substance use disorder. Over 20% of non-institutionalized adults in the United States have had at least one TBI with a loss of consciousness, and this estimate more than doubles among people with a substance use disorder. Individuals with occurring substance use disorders and mental health problems are even more likely to have a history of TBI. The
increased vulnerability for misuse and addiction to other substances (e.g., alcohol) among people with TBI suggests the same may be true with opioids.

People with a history of TBI have risk factors for opioid use disorder: 
• More frequent headaches
• More likely to experience chronic pain
• More likely to be prescribed opioids
• Increased impulsive behavior that makes it difficult to self-regulate substance
use, due to damage to the prefrontal cortex during the traumatic brain injury.

Opioid use disorder may increase risk for future brain injury:
• Opioid overdoses can cause “anoxic” brain damage due to lack of oxygen to
the brain, often leading to repeated brain injuries.
• Opioid overdose can also lead to falls due to loss of consciousness, causing
TBI. The defining feature of TBI is damage to the frontal lobes of the brain which can reduce concentration, memory, planning, problem-solving or communication, as well as self-regulation skills like impulse control, emotional inhibition and self-awareness. These skills are the building blocks for successful opioid use disorder treatment.

Pharmaceutical Company Faces Federal Crime Charges

For the first time in U.S. history, federal authorities are bringing drug-trafficking charges against a major pharmaceutical distributor, Rochester Drug Cooperative, and two of its former executives. Rochester Drug Cooperative is accused of selling oxycodone pills and fentanyl products to pharmacies that were distributing drugs illegally. The company was ultimately “charged with conspiring to distribute drugs, conspiracy to defraud the United States and failing to file suspicious order reports.” One executive has pleaded guilty and is working with prosecutors. The other pleaded not guilty and, if convicted, faces a mandatory 10-year minimum sentence and a maximum of life in prison.