Eden Laikin and Patrick McIntyre


Dental Painkillers: From Extraction To Addiction

More than half the patients getting wisdom teeth removed will leave the dental office clutching a prescription for a powerful opioid pain medication. 

The surgery often comes with pain, so more than two-thirds of patients are prescribed opioids such as oxycodone or Vicodin. The likelihood for chronic opioid use, misuse or dependence meanwhile increases after the third day of use and rises rapidly thereafter, according to the U.S. Centers for Disease Control (CDC). Although sometimes necessary, these pain relievers come with a high risk of addiction.

Experts say dental surgery has statistically been a contributor to the opioid epidemic plaguing our nation, yet its role is often overlooked. Dental clinicians are a potential source of initial opioid exposure and abuse for adolescents and young adults.

“Dentists and patients are well served to consider alternative pain management strategies in connection to wisdom teeth removal, including rest and ice after the procedure and the use of over-the-counter pain medications,” says Dr. Ted Wong, Chief Dental Officer of UnitedHealthcare (UHC). “Recent studies have shown a combination of over-the-counter pain relievers, such as Tylenol® and Motrin®, can be just as effective as opioids, without the risk of addiction.”

According to Wong, UHC recently launched several new strategies to combat the opioid epidemic, which include: All first-time opioid prescriptions written by health professionals for UHC members age 19 and under are capped at three days and fewer than 50 morphine milligram equivalents per day, as recommended by the CDC; informational campaigns have been launched for dental health professionals, the public, and specifically dental plan participants on the risk of opioid misuse among adolescents; and parents are advised to raise questions about opioids prescribed for their children after wisdom teeth removal, including the use of alternative medications for managing pain.

Analysis by UHC officials found that oral health professionals write 12 percent of opioid prescriptions and 45 percent for adolescents — an age group especially vulnerable to addiction, according to Wong. 

A study published in December by the Journal of the American Medical Association found that adolescents who get their first opioid prescription from a dentist or oral surgeon are at greater risk of falling victim to addiction. 

More than 130 Americans die each day from opioid overdoses. Teens are especially at risk. This year, roughly 5 million people in America will have their wisdom teeth removed, including scores of young people in New York State.

Under the new campaign, all UnitedHealthcare dental plan participants with dependents ages 16 to 22 will be mailed information about the risks associated with opioids to help parents and young people identify pain management alternatives and strategies to manage the frequency of use, dosage and proper disposal of unused opioids. 

Public Service Announcements airing on TV and radio help parents and health professionals understand the connection between oral health and the opioid epidemic.      

UnitedHealthcare is also collaborating with health care providers to tailor ways to treat people who are addicted and to support long-term recovery. 

“In addition, parents should be directly involved with dispensing the medication and keep close track of how much has been used and how many pills are left,” Wong says. “Following the procedure, parents can also help keep opioids in a safe place and help with proper disposal of unused medications. We know approximately 70 percent of misused opioid prescriptions were obtained, stolen or purchased from a friend or relative, according to the U.S. Department of Health and Human Services. That’s why it is important to keep opioids in a safe place, like a locked cabinet.” 

So far, the UHC initiatives have met with some success.

Dental health professionals identified as among the top 10 percent of highest opioid prescribers in UnitedHealthcare’s network last year received information about their status. Prescribing patterns improved by 17 percent.

UHC is now expanding this campaign to the top 15 percent of the highest prescribers in its network.  

Wong says that for acute pain following wisdom teeth removal, a three days’ supply or less is often all that is needed. 

“If people are experiencing significant pain after that, it is likely a sign of a complication, such as an infection or dry socket, and a follow-up visit to a dental professional is the recommended next step rather than the use of additional opioids,” he says.

For help ending addiction to opioid pain relievers, call the Long Island Council on Alcoholism & Drug Dependence, Inc. at 631-979-1700.

New Partnership Closes Treatment Gap

A groundbreaking partnership in Nassau County will close a long-held treatment gap by providing overdose patients with immediate transportation and admission into residential treatment from the emergency room.

The pilot program, years in the making and announced last month, involves Nassau County District Attorney Madeline Singas, Northwell Health, Nassau University Medical Center (NUMC) and Maryhaven’s New Hope Crisis Center in Freeport. New Hope staff will now be on call to respond directly to hospital emergency rooms to counsel the patient and immediately transport the patient to New Hope to begin treatment.

“They’ll [have] a safe and supportive place to go through withdrawal and to be directed to the next phase of treatment,” Singas said. “Now there will be no delay between the hospital and help.”

In 2018, 123 Nassau residents died of an opioid-related overdose, according to the Nassau County Medical Examiner. There are still 72 cases pending, that may or may not be opioid over-dose-related. In 2017, 184 individuals died of an overdose in Nassau.

While running for District Attorney in 2015, Singas provided $585,000 in criminal asset forfeiture funding to expand New Hope’s services and admission hours to 24/7 coverage. It allowed New Hope to hire a nurse practitioner and psychiatrist to allow admission to patients with underlying mental health issues and to provide medically assisted treatment.

Typically, users who overdose and are revived are stabilized and released from the emergency department because withdrawal is not considered medically life-threatening, according to Singas.

“Typically, the person in crisis is released back into the community during the most violent, painful and difficult throes of withdrawal. This treatment gap leaves many patients on their own, often leading to repeat use that can continue uninterrupted until death,” Singas said. Under this program, “treatment and hope for the future will start immediately,” she added.

“Finally,” said Valerie Labiak of Bellmore. “I remember being in NUMC begging for help, telling them that I couldn’t take [my son, Michael Jr.] home. They gave me the number of a shelter!”

Less than a month later, Michael Labiak was found dead of a heroin overdose at the age of 26.

Now the patient will be assessed to determine the next phase of treatment.

The New Hope staff will assist the patient with any necessary insurance, Medicare or Medicaid paperwork. The patient will remain at New Hope until there is availability in the next program. The average length of stay is seven to 10 days. Nassau University Medical Center has further committed to the efforts to fight the continuing epidemic by making 20 more beds available for detoxing patients. NUMC will also work with Sheriff Vera Fludd to bring the Nassau County Correctional Facility a re-entry program using Vivitrol treatment to prevent relapse in opioid-dependent patients.

“Addiction is a very complex and painful condition that continues to overwhelm families in our local communities, as well as law enforcement and medical professionals who are tasked with providing answers,” says Northwell Health President and CEO Michael J. Dowling. “New Hope will serve as a bridge to treatment for patients in our emergency departments who are struggling with addiction. It’s an important step in our ongoing commitment to alter the course of this crisis.”

For more information on New Hope and other Long Island treatment programs go to heroinprevention.com.

Long Island Recovery Advocates Fight For Sobriety

Recovery advocates lead the charge on the state capitol last year for Advocacy Day 2018.

People who are struggling to get their child into drug treatment, fighting with insurance companies over fairness of coverage for rehab, or having a negative experience with a so called “sober home” are joining forces with other recovery advocates.

And the movement is exploding. The Long Island Recovery Association (LIRA) is a  Hauppauge-based, grassroots recovery community organization. It advocates on behalf of individuals in recovery seeking help for addiction-related illnesses, along with their family and friends. It’s also dedicated to eliminating negative public perception, ending discrimination, and removing barriers to recovery, including those that exist in treatment, housing and employment.

“I saw how difficult it was to find help and how expensive treatment is,” one member who’s the mother of a college student now in recovery said at a recent group meeting. “I’ve met people who had to mortgage their homes and still couldn’t afford treatment. They don’t know where to turn. No one should die because they don’t have enough money for treatment. A lot of our advocacy really does work.”

LIRA was created in January 2000 to give a voice and visible presence to the Long Island recovery community, which until then had primarily remained underground. Each year, the group has organized a trip to Albany to call on state lawmakers to address the addiction crisis in New York State.

While only about two dozen LIRA activists made the first trip to Albany 19 years ago, more than 1,000 advocates are expected to descend upon the state capitol on March 20 to urge passage of bills that would bolster efforts to fight the opioid crisis.

“Today and every day going forward the recovery community has cemented our presence as a constituency of consequence, not only in New York but in communities across the country,” says Richard Buckman, a founding LIRA member and its immediate past  president.

This year, LIRA is advocating for certification of recovery homes so that individuals in early recovery are afforded a safe, supportive living environment. The organization is asking the state to fund a recovery outreach center in each county statewide and to establish recovery high schools, which have been shown to dramatically improve recovery outcomes for teens. They want assurances that anyone in need has 24/7 access to detox, treatment, and recovery support services as well as proactive interventions to assist those in crisis after opioid overdose reversal.

They plan to urge Gov. Andrew Cuomo and the state Legislature to continue working to enforce parity laws in New York State and to hold insurance companies accountable so that people seeking help have access to at least 30 days of inpatient treatment. They support lawsuits that hold opioid manufacturers accountable and demand that revenue generated by such lawsuits be earmarked to support prevention, treatment, and recovery. Lastly, they want to educate the public about the power and promise of recovery.

“This is a day we can combine our voices best to be heard,” says a LIRA member in long term recovery. LIRA’s many advocacy victories date back to its first successful campaign in 2000, when members pushed for an act to amend the Insurance Law in relation to family member coverage for the treatment of alcoholism and substance abuse.

More recently, between 2014 and 2016, the group pushed strongly for increased funding to the state Office of Alcoholism and Substance Abuse Services (OASAS) budget, resulting in “millions of additional dollars to support recovery services that provided funding for the opening of the THRIVE recovery center here on Long Island and more than a dozen other centers statewide,” Buckman said.

“The legislature needs to hear us,” says an addiction professional who makes the trip each year. “There’s a huge recovery movement. We show up, we recover, and we vote. We have a voice.”

Deadly Fentanyl: Worse Than Heroin

Fentanyl is about 100 times more potent than morphine.

Experts say the nation is no longer facing a heroin crisis, it’s facing a fentanyl epidemic.

Fentanyl is now the drug most frequently involved in overdose deaths nationwide, according to a December report by the U.S. Centers for Disease Control and Prevention (CDC). The rate of drug overdoses involving the powerful synthetic opioid skyrocketed by about 113 percent each year from 2013 through 2016, replacing heroin as the deadliest drug. In 2016, more than 18,000 fatalities were attributed to fentanyl, according to the CDC.

On Long Island, by 2016, fentanyl deaths on LI outnumbered deaths from vehicle crashes.

Fentanyl is typically used to treat patients with severe pain or to manage pain after surgery but it has in recent years flooded the U.S. market, coming in from China often through Mexico, research shows. The painkiller, about 100 times more potent than morphine, is being mixed in with heroin, cocaine, and other drugs to boost profits and boost the high. Since it’s inexpensive, it’s being “pressed” into fake oxycodone pills — with deadly consequences.

“My findings continue to show that fentanyl is in approximately 90 to 95 percent of all heroin,” says Dr. Russell Surasky, the medical director of an outpatient addiction treatment program in Bethpage who analyzes thousands of urine samples monthly. “Even more frightening is the rise of fake pills which are made from fentanyl … I estimate that about 75 percent of oxycodone pills bought on the street contain fentanyl. In recent months there have been numerous cases of individuals who are dying from ingesting just one of these fake pills.”

In October, President Trump signed into law the Synthetics Trafficking and Overdose Prevention (STOP) Act. Effective Jan. 1, 2019, the law mandates that Customs and Border Protection use advance electronic data to screen all international packages — even those delivered by the U.S. Postal Service. A loophole in the global postal system had allowed criminals to ship deadly drugs like fentanyl into the U.S. without detection by law enforcement.

Long Island began to see sharp spikes in fatal fentanyl overdoses after 2012. But it was in 2016 that the number of Long Islanders to die from fentanyl jumped to a startling 289. Part of the rise is attributed to the medical examiners’ offices recognizing new fentanyl analogs, which are drugs that are developed to imitate a particular drug, but with different chemical compounds.

Overall, fatal opioid overdoses on Long Island are down from 614 in 2017 to 483 in 2018, according to preliminary statistics from the county medical examiners.

Garrett Kassler’s family is all too familiar with the popular synthetic opioid. The Plainview man had struggled with heroin addiction for several years but was clean for the months leading up to his February 4, 2017 overdose death. The medical examiner confirmed the 26-year old died from sniffing heroin cut with fentanyl. His parents started the Garrett L. Kassler Memorial Fund to help others suffering with substance use disorder.

“Had it been several years ago, and just heroin, maybe the results wouldn’t have been so catastrophic,” says his father, Lee Kassler. “All it takes is just once. Whoever’s choosing to use today, it’s a death sentence.”

A relapse after a period of sobriety is always a dangerous time for an opioid abuser as their tolerance level is lowered. Fentanyl makes it even more deadly.

“If you know someone who is using opioids, it is an absolute medical emergency which requires urgent help to stay alive,” says Dr. Surasky.


For grief support: compassionatefriends.org

For info and referrals 631-979-1700
24/7 Hotline Long Island Council on Alcoholism And Drug Dependence (LICADD)

For personal recovery: nassauna.org
Nassau Narcotics Anonymous (NA)

If you’re struggling: Vivitrol Information & Support Group, Tuesdays 7- 9 p.m. at St. Bernard’s Parish School, 3100 Hempstead Tpke., Room 209, Levittown.

Pols Eye Opioid Crisis With Pending Legislation

The Drug Take Back Act, a new law taking effect January 6, aims to reduce opioid abuse, while at the same time prevent the contamination of our waterways.

The law requires large chain pharmacies to take back and properly dispose of unused and expired prescription medications for free. Studies show that up to 70 percent of teenagers who abuse prescription drugs get them from their parents’ medicine cabinets. The law would encourage proper disposal rather than flushing unwanted meds down the toilet into the water system.

“This initiative will improve both the environmental health and the physical health of all New York citizens,” said ex-state Sen. Kemp Hannon (R-Garden City), who proposed the legislation before losing his seat in November.

From 2010 to 2015, the number of deaths in New York State from drug overdose and chronic drug abuse increased by 71 percent. More Americans died from opioid addiction in 2016 than the total number of Americans who died during the entire Vietnam War. Nationally, there are roughly 2.5 million Americans addicted to opioids.

Several bills which contain tools to fight the opioid epidemic are expected to be reintroduced into the 2019 New York State legislative session.

One is the Senate’s version of the Medication-Assisted Treatment Bill, which would require the state’s 54 jails to provide substance abuse treatment to an overwhelming majority of inmates who are opiate-addicted. Jails would be mandated to offer addiction medications that curb opioid cravings such as injectable Vivitrol or daily doses of methadone, along with counseling and behavioral services. The bill was introduced in the state Assembly last November and in the Senate in June.

“Given that the state Legislature is likely to tackle issues relating to jail reform in 2019, I believe it will be an excellent opportunity to highlight the Medication-Assisted Treatment Bill,” says State Sen. Phil Boyle (R-Bay Shore).

Boyle said funding for the program has been included in the 2018-2019 state budget, with $200,000 each for Nassau and Suffolk jails. In all, the State Senate Task Force on Heroin and Opioid addiction secured $247 million in this year’s budget for related programs including hundreds more residential substance abuse treatment beds throughout the state.

Another package of bills was introduced by Assemb. Linda Rosenthal (D-Manhattan), who chairs the Assembly Committee on Alcoholism and Drug Abuse. One would establish a one-cent per milligram surcharge on opioid prescriptions to fund statewide drug addiction prevention, treatment, and recovery programs. Opioids for Medication Assisted Treatment, cancer and hospice care would be exempt.

Other Rosenthal bills, introduced between January and May, would require organizations to have Narcan (or Naloxone) — the antidote to a fatal opioid overdose — on site, and to have staff trained to administer the lifesaving medication. These include state offices with at least 10 employees, homeless shelters, and handlers of K9 detection dogs.

Another bill would require controlled substance prescribers to receive education regarding safe opioid prescribing. Most experts would agree that the current opioid epidemic was started from the over-prescription of addictive pain medication. This bill would amend the education law by requiring the state to create a curriculum to be offered in colleges or by providers approved by licensing boards by August 1, 2019 to include information on pain management, alternatives to opioid pain medications, identification of patients who are at risk for addiction, and training on managing substance use disorders as chronic diseases.

Senate Republicans also left some relevant bills pending. Those would limit the initial prescription of a controlled substance prescribed for acute pain from seven to three days, and require practitioners to obtain written parental consent before prescribing opioids to minors.

Finally, a bill sponsored by state Sen. Neil Breslin (D-Bethlehem) in January 2017, would increase the penalty for the sale of an opioid which leads to someone’s death to manslaughter in the first degree. The felony Class B carries a sentence of up to 25 years. Currently, the penalty for selling drugs varies from a Class A to a Class D felony sale, depending on the weight. There’s no additional penalty if the drug causes a death.

“While I strongly support an increase in criminal penalties on drug dealers who cause deaths by peddling their poisons in our communities, I think passage of this bill (manslaughter charge) is highly unlikely in a Senate and Assembly controlled by New York City-based Democrats,” says Boyle.

Medical Marijuana: The New Anti-Drug?

Medical marijuana is now approved to treat opioid addition.

Can medical marijuana help with the current opioid epidemic? Gov. Andrew Cuomo thinks so.

The potential link between marijuana and opioid addiction treatment is well documented. Multiple studies have indicated that for those struggling with chronic pain, marijuana could be a viable, nonaddictive alternative to opioids such as OxyContin, Vicodin or heroin. Medical marijuana has also been shown to help with the temporarily debilitating symptoms of opioid withdrawal — nausea, vomiting, spasms, cramps, and insomnia.

So, when New York State Health Commissioner Howard Zucker told the governor that medical marijuana offers a less harmful opioid replacement for recovery from opioid use disorder, Cuomo listened.

“In this battle against the opioid epidemic, it is critical that we use every means at our disposal to prevent the unnecessary prescription of these dangerous and addictive painkillers,” Cuomo said in a statement.

In September, the governor signed a bill that allows substance-use disorder treatment providers to recommend medical marijuana to treat pain instead of prescribing opioids. It also adds opiate-use disorder to the list of qualifying conditions for medical marijuana.

“Adding these conditions to the list of those approved for management with medical marijuana will help reduce the risk of addiction and provide suffering New Yorkers the relief they need,” Cuomo said.

Opioid abuse is the leading cause of lethal drug overdose nationwide. In 2015 alone, there were 20,101 deaths attributed to prescription painkillers, as well as 12,990 fatal heroin overdoses.

Nearly 80 percent of heroin users nationwide reported using prescription opioids before initiating heroin use.

In some states with medical marijuana laws, there has been a 24.8 percent drop in opioid overdose deaths. And each year after the medical cannabis law was passed, the rate of opioid overdose deaths continued to decrease, according to a report in the Journal of the American Medical Association.

At least 33 states, Guam, Puerto Rico, and Washington, D.C., have adopted medical marijuana programs.

“Medical marijuana has been shown to be an effective treatment for pain that may also reduce the chance of opioid dependence,” Zucker said. “Adding opioid replacement as a qualifying condition for medical marijuana offers providers another treatment option, which is a critical step in combating the deadly opioid epidemic affecting people across the state.”

Opioid replacement and addiction joins the following 12 qualifying conditions under the state’s Medical Marijuana Program: cancer; HIV infection or AIDS; amyotrophic lateral sclerosis (ALS); Parkinson’s disease; multiple sclerosis; spinal cord injury with spasticity; epilepsy; inflammatory bowel disease; neuropathy; Huntington’s disease; post-traumatic stress disorder; and chronic pain.

This new measure allows patients with severe pain to use medical marijuana as a replacement for opioids. It also allows patients with opioid use disorder who are enrolled in a certified treatment program to use medical marijuana as an opioid replacement.

To “recommend” medical marijuana to patients, practitioners — including doctors, nurse practitioners and physician assistants — must complete a state Department of Health approved course. They must also consult the New York State Prescription Monitoring Program Registry (PMP) prior to issuing a certification.

Patients who are certified by their practitioners must apply to the DOH for a registry identification card. Then, they may visit one of the state’s registered medical marijuana dispensaries.

Plans to add opioid replacement as a qualifying condition for medical marijuana in the state were first announced in June. They went into effect on a temporary basis in July and a 60-day public comment period began in August. As of November 13, there were 80,618 certified patients and 2,020 registered practitioners participating in the program.

In New York, medical marijuana is dispensed in several forms: capsule, liquid, vape, tablets, lozenges and ointments. The products contain varying levels of tetrahydrocannabinol (THC) — the psychoactive component of marijuana.

Dr. Stuart Wasser of Rockville Centre, a certified addiction specialist, says he’s skeptical.

“I believe it may reduce total amounts of opioids used, but I don’t think it will reduce absolute number of people using opioids,” he says. “In my experience, cannabis use leads to enough eіndorphin dysfunction that I would be concerned it would lead to opioid use. All we know is that experienced opioid users use less opioids when on THC, which is probably due to the [THC] having opioid-like properties.”