Amount of Opioids Prescribed Declined from 2010-2015, But Remains High

There was an overall decline in the amount of opioids prescribed in the United States between 2010 and 2015, but the quantity of prescriptions is still extremely high, according to a new government report.

The Centers for Disease Control and Prevention (CDC) reported that the amount of opioids prescribed was three times higher in 2015 than in 1999, The New York Times reports.

The amount of opioids prescribed varies county by county, the CDC found. Half of U.S. counties have seen a decrease in the amount of opioids prescribed from 2010 to 2015. The highest prescribing counties still dispense six times more opioids than the lowest prescribing counties. Far more opioids are prescribed per capita in parts of Maine, Nevada and Tennessee than in most of Iowa, Minnesota and Texas.

To read more click here.

Public Health Officials are Overwhelmed! 

Those of us who work on alcohol policy are wondering what has happened  to the public health perspective.  Many states are considering legislation to change alcohol regulation– often characterized as “modernization.”  These debates are often couched as “economic development”, but very rarely is there any opposition, perspective, or comment from the public health community. And, there is almost no discussion of the harm alcohol causes and the likely consequences of loosening our regulations.  Legislators are very focused on creating jobs and tax revenue.  Good government policies really need a balanced debate and to have public health officials to weigh in.

But, they are overwhelmed with the current opioid overdose epidemic.  Indeed, it is shocking. In 2015 there were 52,404 overdose deaths and 2016 is likely overshoot that amount.

Many started with a legal prescription for pain killers, but became addicted. As pain killers became harder to get, some switched to heroin or other street drugs.   The main overdose culprits are illegally obtained prescription drugs, synthetic opioids (fentanyl) and heroin.  Deaths due to synthetic opioids increased 72% from 2014 to 2015 and heroin deaths went up 21%.  There have been recent incidents where fentanyl is sold as heroin and is mixed with cocaine. After all, you never are sure what you are getting from an illegal drug dealer! Even more horrifying is the recent appearance in street drugs of carfentanil, an elephant tranquilizer, 5,000 times stronger than heroin.

But, there are good reasons to pay attention to alcohol.  According to the Centers for Disease Control, alcohol is still responsible for an estimated 88,000 deaths each year.  Treatment issues, whether prescription drugs or alcohol, require a comprehensive approach.  When I worked in prevention, I had an intern who said her mother was a meth addict.  I asked what she meant by “was a meth addict.”  She replied her mother had kicked meth, but now was “just an alcoholic.”  In fact, people with addictions frequently mix substances– legal and illegal. If alcohol becomes cheaper, less regulated and more available, addicts may be encouraged to use alcohol more frequently.

Many of the solutions proposed for the drug epidemic are not unlike those for alcohol: reduce access, expand treatment, and support law enforcement. Unfortunately, these tend to be long-term changes which may not have the immediate impact we seek. A nurse my daughter knows said she sees people every day seeking prescription pain killers. Few believe they are dependent on such drugs. Denial is one of the major obstacles to getting people the help they need.

Maybe we should broaden our approach. While we must continue to reduce access, expand treatment and support law enforcement, it may be time to consider ways to change our permissive culture around substance use and the practice of “getting wasted.”  I recently saw a movie about a bachelorette party where the women got completely “wasted” on large amounts of cocaine! Why would such a dangerous practice be considered okay or funny?

We now have some successful models that involved culture change to consider. Our efforts to reduce underage drinking and drunk driving both involved culture change and both have resulted in major reductions. Remember when underage drinking was considered inevitable and a “rite of passage.” That has changed. Reducing this problem took a long time and a lot of work from community partners, but it was an exceptionally successful effort as youth are now drinking at historically low levels. This should serve as a model of what is possible. Here are some ideas about cultural issues that could be addressed:

  1. Educate our citizenry about the danger of self-medication to mask both physical and mental pain. We need a better understanding of the role pain plays in life. I remember attending a conference in Africa and learning that African children are taught how to bear pain. I was struck by that because I don’t believe we teach our children this same thing.  Too often pain is to be curtailed with a pill or some other substance.  Yet, pain has important messages.  When you break a bone, it is painful.  The message is:  go immediately to a doctor to fix it. In reality, pain is part of healing.  Relationships that cause you pain may suggest a course correction. We all will lose loved ones at some point and must be able to go on with life. As a society we need a better understanding of when medication is appropriate for dealing with pain. After all, no one should expect a pain-free existence.
  2. Support efforts to promote a “better drinking culture.” Groups are springing up that advocate for “mindful drinking.” The focus is on drinking less but higher quality products. Such a group is According to their website, they are “a grassroots movement of people who love craft beer, spirits, and wine.” Their desire is “to shift our culture’s relationship with alcohol in a healthier and more positive direction- a lifestyle free from hangovers, pain, harm, and regret”.
  3. Be like the Irish! Seriously! Irish youth are drinking at historically low rates. According to the European School Survey report (ESPAD), 15-16 year olds in Ireland use alcohol 48% less and binge 40% less than previous generations. One commentator noted that “Ireland is being hit by a wave of sobriety.”   In 2005, Ireland consumed 14.41 liters per capita; in 2016, that dropped to 10.9 behind the British, French and Germans. Suggested reasons for the change include: the recession which ushered in a certain amount of austerity; the health and exercise craze; and, the fact that there are now alternatives to alcohol in pubs such as good tasting non-alcoholic beer.

But we still need our public health partners on alcohol policy. An episode in Massachusetts is really encouraging. Recently, the State Treasurer announced the creation of a task force to change the “antiquated and confusing rules that frustrate businesses and consumers.” But, public health advocates rose up and argued that “loosening alcohol rules will inevitably lead to higher rates of alcoholism, drunken driving, youth drinking, disease, and birth defects- even if each tweak, on its own, seems innocuous and is well-intended.”

And, maybe we need to broaden our approach to include promoting a healthy socializing culture where pubs, restaurants and bars are not a place to get “wasted,” but to enjoy the company of friends, hear good music and eat good food.


“Increases in Drug and Opioid Involved Overdose Deaths-United States, 2010-2015. MMWR, December 30, 2016.

“A grim tally soars: More than 50,000 overdose deaths in the US,

” Associated Press, December 9, 2016.

“Ireland: Young people in Ireland are drinking less alcohol than their parents and this could be the reason why. New figures show alcohol consumption is declining, as young people swig coffee and take up running. By Kim Bielenberg,, June 18, 2017.

MA: Mass. wants to update its alcohol laws. Not all are happy. Health advocates oppose loosening sought by business. By Dan Adams, Boston Globe, May 30, 2017.

Pamela S. Erickson, CEO
Public Action Management, PLC
P.O. Box 531726
Henderson, NV 89053
(503) 936-0443

Legalize All Drugs?

Earlier this week, the Drug Policy Alliance issued a ground-breaking report that called for the legalization of all drugs.  The report titled, “It’s Time for the U.S. to Decriminalize Drug Use and Possession,” sounds like something that might be a good idea.  Indeed, we want a public health model for people with substance use disorders that focuses on prevention, treatment and recovery, however, we must look a bit further to really understand the purpose of this report.

First, we must understand that the group that produced this report is one of the prominent groups that have been behind marijuana legalization.  This group has spent tens of millions of dollars to push legalization through the ballot initiative process and has completely denied and/or hidden the dangers of marijuana use. This action has not only created a mindset that marijuana use is benign but has also created an industry that brings stronger marijuana and markets to those who have a substance use disorder and children.

Second, this is the same playbook that the Drug Policy Alliance used to pass marijuana legalization over the past few decades.  Initially, the group talks about decriminalization, perhaps even pushing drugs from a “medical” standpoint and then full legalization, setting up a market whose targets are the most vulnerable.

Finally, the idea of prevention is lost on those who have written this report.  The impetus is to promote safe use and harm reduction. Although there are some facets of harm reduction that are important, such as needle exchange to curb the spread of AIDS and other blood borne diseases, we need to make sure that prevention is also part of the model to keep young people from starting these self-destructive behaviors.

The idea of prevention is under attack by a well-funded organization whose sole intention is to legalize all drugs – cocaine, methamphetamine, heroin and synthetics.  Our advocacy efforts need to include how important prevention is and how these ideas based on “decriminalization” are really efforts to create a market and industry for each of these drugs.  We have to make sure that evidence-based prevention strategies and the public health model are the means of dealing with drugs and alcohol so that our next generations are not lost.

Tony Coder
July 14, 2017

A Better Alternative?

In a meeting with many behavioral health and public safety representatives, there was a discussion had about expanding the group to include those who do not usually take part in discussions about substance use. As the discussion was wrapping up, there was a suggestion that a group called the Drug Policy Alliance be included in the discussion.  Most had heard of this group but there were some who had never heard of them.  The Drug Policy Alliance is a group funded by George Soros and advocates for the legalization of all drugs. They have been instrumental in many campaigns across the country to legalize marijuana and have been introducing legislation to legalize LSD “medically” in Arizona.

Some might say that legalizing and regulating drugs would be a smart way to manage the current crisis that we are in.  Vice, the news program and online news magazine, recently came out and said that we should legalize heroin to stop the opioid epidemic.  Their arguments are that we could regulate heroin and make it less available than through street dealers.

However, as we look at two of the most regulated industries in this country – alcohol and prescription drugs – we can see that regulation does not exactly work as groups like the Drug Policy Alliance describes.  In the US, regular marijuana use is around 12% while alcohol use is over 50%.  Since legalizing and “regulating” marijuana, the use of the drug is also increasing.

Also, we must remember that with regulation, the idea of capitalism is not far behind. We have seen this with prescription drug manufacturers pushing opioids on doctors and patients through slick marketing campaigns and sales pitches.  We see this now with marijuana.

Let’s be real about “regulating” drugs – when there is regulation, there is commercialization.  We must be wary and continue to fight against the commercialization of drugs, as these marketers prey upon those with substance use disorders and children. We have to continue to fight for good public health policies that include prevention, treatment, drug courts, recovery and other systems that make our society and communities safer and healthier without creating an industry that will market these products and focus on profits.

Prevention Action Alliance
Tony Coder
June 23, 2017

Envision Partnerships: Position Openings

Prevention & Early Intervention Specialist for an innovative agency specializing in Behavioral Health Prevention & Wellness programming in southwest Ohio (primarily serving Butler County) for over 50 years.   Full or part-time positions are available.  Our staff wear multiple hats and are responsible for various projects (substance abuse, violence, gambling prevention education, awareness and early intervention). The ability to multi-task and take initiative are important to our success and your professional growth.   Our services cover the prevention strategies spectrum which requires skills in working a crowd (training) and small group/individuals (facilitation).  Your knowledge and skills must be relevant to our style of working (autonomous) but with a mind to detail.  Energetic and forward thinkers are encouraged to apply who have a passion for service for and with the community.  School and community based assignment with youth and adults.  Work schedule can include nights and weekends.  Ohio Certified Prevention Specialist and/or Tobacco Treatment Specialist certification would be a plus (or ability/willingness to obtain).  Bachelor’s degree is a requirement.  Social media experience is a plus.  Bilingual English/Spanish Speaker is a double-plus.  Reliable transportation is a must.  Salary low to mid 30’s.

Email your resume and references, seeking full or part-time (if PT, how many hours desired) to  EOE.

Social Marketing/Prevention Specialist for an innovative agency specializing in Behavioral Health (Prevention & Wellness programming in southwest Ohio serving Butler County).  Full-time position is responsible for various social marketing projects to include gambling, substance abuse, child abuse prevention and awareness). School and community based education assignments with youth and adults. The ability to multi-task and take initiative is important to our success and your professional growth.   Your knowledge and skills must be relevant to our style of working (autonomous) but with a mind to detail.  Energetic and forward thinkers are encouraged to apply who have a passion for service and working with the community.  Work schedule can include nights and weekends.  Ohio Certified Prevention Specialist or Certified Health Education Specialist is desired (or ability/willingness to obtain).  Bachelor’s degree is a requirement.  Traditional media, social media and web experience is essential.  Reliable transportation is a must.   Salary in the low to mid 30’s.

Email your resume and references to    EOE.

PNC Bank Closing Bank Accounts of Major Marijuana Lobby-Industry Group as Potential DOJ Enforcement Looms over Pot Businesses and Companies Who Service Them

PNC Bank is closing the bank accounts of the Marijuana Policy Project (MPP), the country’s biggest marijuana interest group. According to officials at MPP, the accounts will close July 7.

PNC Bank’s move comes amidst mounting speculation of a Department of Justice crackdown on marijuana businesses and those who provide financial and other services to them. It also calls into question the legal status of accounts of political action committees (PACs) and marijuana industry associations, which may also receive money directly from businesses engaging in federally-prohibited activity. Further, the announcement comes on the heels of a decision by the U.S. Court of Appeals for the Tenth Circuit ( Safe Streets Alliance v. Alternative Holistic Healing, LLC, No. 16-1048) allowing certain Racketeer Influenced and Corrupt Organizations (RICO) Act lawsuits to proceed against Colorado marijuana businesses and corporations that service them.

“If I had marijuana stocks right now, I’d sell them short,” commented Kevin A. Sabet, former senior drug policy advisor to three U.S. Administrations and President of Smart Approaches to Marijuana (SAM). “Financial services companies are reading the tea leaves from Washington and are realizing that aiding and abetting federal crimes by the marijuana industry is risky business. Federally-regulated companies like banks are probably the most concerned given their exposure to potential criminal and civil liability. And they should be.”

These concerns are exacerbated by allegations from Colorado that state marijuana license holders were also running a criminal organization that shipped marijuana out of state, and a report from Oregon stating that at least 70 percent of marijuana market transactions there are illegal.

About: Smart Approaches to Marijuana (SAM) is a nonpartisan, non-profit alliance of physicians, policy makers, prevention workers, treatment and recovery professionals, scientists, and other concerned citizens opposed to marijuana legalization who want health and scientific evidence to guide marijuana policies. SAM has affiliates in more than 30 states. For more information about marijuana use and its effects, visit

Anisha Gianchandani
703-828-8182 or 703-665-1410

Redesigned NREPP Learning Center Launched

SAMHSA announces the launch of the new Learning Center for the National Registry of Evidence-Based Programs and Practices (NREPP). The site was designed to provide resources for developing, implementing, and sustaining culture-centered and evidence-based programs and practices. Learning Center tools provide practical support for using evidence-based programs and practices to improve the behavioral health of clients, family members, and communities.

  • Learning Center resources are organized around five themes: • Emerging Evidence in Culture-Centered Practices
  • Developing an Evidence-Based Practice or Program
  • Implement a Program
  • Sustain a Program
  • Behavioral Health Topics

Access the Learning Center