Types of narcolepsy: Type 1 vs. type 2
Edgefield County Officials: Fentanyl Has Made The Drug Scene One Of 'Russian Roulette'
In the very section of Edgefield County that has suffered most from the opioid epidemic, the county sheriff's department, EMS and Merriwether Fire; in conjunction with the county's designated alcohol and drug abuse treatment provider and a faith-based nonprofit, hosted a townhall meeting about the "hidden crisis" that has not discriminated between the affluent and the struggling.
"I can tell you it's from one end of our community to the other. We've been to a $500 trailer that had it, and I've been to a $2 million home in Edgefield County that had it," Edgefield County Sheriff Jody Rowland said. "It's in every community, it's in every family. If you think you're immune, you're not."
Data collected from Edgefield County EMS show that in 2022, the county recorded 60 cases of suspected overdose. For the first four months of this year, the county has recorded 23 cases of overdose, including one fatality.
Allen Easler told Post and Courier North Augusta that the Sweetwater-Merriwether area is where most drug overdoses occur.
Easler is a prevention specialist at Cornerstone, Edgefield County's designated outpatient treatment provider for alcohol and drug abuse. For Easler, who's been with Cornerstone 22 years – long before the opioid epidemic really got started in the mid-2010s – opioids, and especially the synthetic opioid fentanyl, are "just another example" of a nationwide drug abuse problem.
For those at Sweetwater Community Center on Thursday, fentanyl is a completely different animal than the come-and-go waves of meth, heroin and cocaine.
For one, it's easily disguised.
"You can't tell a SweeTart from a fentanyl tablet now. You can't tell sidewalk chalk from fentanyl anymore," Rowland said.
The drug is being mixed into other drugs, including marijuana. And "street pharmacists" are inconsistent: "I can test 10 tablets and no two will be alike," Rowland said. "The user is just playing Russian roulette."
To get an idea of how little fentanyl is needed for a lethal dose, Rowland said that just 12 grains of salt is about what it looks like.
Fentanyl is 50 times stronger than heroin and 100 times stronger than morphine, according to the Drug Enforcement Agency.
"Without any intervention, it is fatal. Nine times out of 10, they don't just wake up," said Garrett Lynn, EMS director for Edgefield County. "These people are hanging on the verge of death. To see someone's face turn completely blue because they haven't been breathing – it's kind of an eerie feeling."
"These types of scenes can be very violent; they can be hostile," he added. "Usually, crime is associated with them. And what I've seen with EMS over the past couple of years – they're grateful for our help when we get there but once the problem has been resolved they want us out of there, they want us gone."
Rowland said the drug business in Edgefield County is "a vicious cycle."
"It's a property crime that works into narcotics," he said. "If you arrest property crimes aggressively, you will make narcotics arrests; if you make narcotics arrests aggressively – we recover stolen property all the time."
But there's also "shame and stigma" associated with overdose and addiction of any kind.
Mitch Prosser, president of the faith-based Palmetto Family Council, said that "Most of the people who get stuck in addiction, they want to be made whole. They're trying to fill a void." Those in addiction are not taking a drug to end their life, he said.
Staff photo by Elizabeth HustadMitch Prosser, president of the faith-based Palmetto Family Council, said "addiction thrives in isolation. The biggest issue that people face is, because of the shame and stigma of this, they begin to isolate, withdraw and back away […] what we find is, when they isolate themselves, it's a downward spiral of turmoil they find themselves in, and it's a bigger struggle to get out of the further they get into it."
Those on the support services end of things – people like Prosser and Cornerstone's Easler – say that patience and understanding of those going through addiction is needed to help move a person toward recovery.
"Most of the people who get stuck in addiction, they want to be made whole. They're trying to fill a void," said Prosser, noting those in addiction are not taking a drug to end their lives.
Total overdose deaths in the state of South Carolina for 2021 were 2,168 or a 25% increase over 2020, according to data published by South Carolina Department of Health and Environmental Control.
Of those deaths, just 71 were considered to be intentional, a number that has remained static over the past decade even as the total number of overdose deaths has risen dramatically.
Narcan is more widely available now than it was even just a decade ago, when only doctors, nurses and paramedics had access to it. Edgefield EMS director Garrett Lynn said this greater availability of Narcan is indicative of where things are going in the opioid epidemic.
Staff photo by Elizabeth HustadThe idea of having patience for those in addiction has, in one way, taken hold: the availability of the often-saving Narcan is now widespread.
It used to be that only doctors, nurses and paramedics had access to Narcan, an antagonist drug that temporarily blocks the effects of another drug, buying time for paramedics to get to the scene of an overdose.
Now, authorized providers like Cornerstone (and its counterparts in other South Carolina counties), are able to give it away, no questions asked.
Lynn, with Edgefield County EMS, said the availability of Narcan is a sign of where things are headed in the opioid epidemic. "This used to be kind of an isolated thing. Now, if you get an opioid prescription, (doctors) have to write you a Narcan prescription to go with it. That used to be unheard of."
Lynn said it also used to be enough for an EMS van to stock just 2 milligrams of Narcan and that this once-standard dose would be enough for any overdose EMS responded to. "Now, it takes 4, 8, 10, 12mg – and sometimes still these people are not waking up. That just tells you how potent that stuff is."
Across the board, from law enforcement and EMS to support services and the faith community, those in Sweetwater on Thursday said the opioid epidemic requires a constant spread of information about the dangers of fentanyl and other substances.
"What I know about fentanyl is, if it doesn't get you the first time, if it doesn't get you the second or third time, it will catch up to you," said Lynn.
It also requires a joint response from the community – its citizens, its churches, its counselors. Said Rowland, "I can do the enforcement part, but I can't fix the soul."
Sign up to receive weekly roundups of the latest Post and Courier North Augusta stories. Handpicked by our editor, as well as breaking news, business profiles, and government recaps from North Augusta.Insomnia Drug Belsomra May Help Treat Opioid Addiction
Summary: A preclinical study found that suvorexant (Belsomra), an insomnia drug, could be a potential treatment for opioid use disorder (OUD) in rats.
If the results are replicated in humans, the drug could offer a promising treatment for the millions of people with OUD and reduce drug intake and block relapse.
Key Facts:
Source: Scripps Research Institute
The insomnia drug suvorexant (Belsomra) might be an effective treatment for opioid use disorder, according to a preclinical study from Scripps Research.
In the study, published April 27, 2023, in Frontiers in Pharmacology, the Scripps Research scientists found that suvorexant reduced prescription opioid intake and helped protect against relapse in rats modeling opioid use disorder (OUD). If the results translate to humans in clinical trials, the insomnia drug could offer a promising approach for the millions of people who have OUD.
"Our results suggest that repurposing suvorexant could be a good strategy for reducing drug intake and blocking relapse in cases of prescription opioid abuse," says study senior author Rémi Martin-Fardon, Ph.D., associate professor in the Department of Molecular Medicine at Scripps Research.
The study's first author was Jessica Illenberger, Ph.D., a postdoctoral research associate in the Martin-Fardon lab.
In the U.S. Alone, OUD is estimated to affect more than two million people, about 80,000 of whom die each year from opioid-related overdoses in an ongoing epidemic that has contributed to a striking decrease in Americans' average life expectancy. Available treatments for OUD include methadone, buprenorphine and naltrexone, but most patients relapse, making the need for better treatments urgent.
How suvorexant has a beneficial effect on OUD is not entirely clear, but it was designed to inhibit the activity of both the orexin-1 and orexin-2 brain-cell receptors. These receptors and their binding partners, known as orexin proteins, have been studied mainly for their roles in maintaining wakefulness, appetite, and overall arousal and alertness.
Over the past two decades, however, evidence has accumulated that orexin signaling also helps sustain the process of drug dependency, hinting that it could be a good target for treatments.
Suvorexant, approved by the U.S. Food & Drug Administration (FDA) for treating insomnia in 2014, was the first drug to inhibit the activity of both orexin receptors. In a study published earlier this year, Martin-Fardon and colleagues found that suvorexant reduced alcohol intake and blocked relapse in a rat model of alcohol use disorder.
In the new study, Martin-Fardon and his team examined suvorexant's potential in reducing intake and blocking relapse in OUD—specifically involving the powerful and frequently abused prescription painkiller oxycodone.
Suvorexant is cleared from the bloodstream much more quickly in rats than in humans, but the researchers found that when oxycodone-dependent rats were given the maximum dose (20 mg/kg) of suvorexant a half hour before their oxycodone binge sessions, they self-administered significantly less of the opioid in the first hour of each eight-hour session.
In the new study, Martin-Fardon and his team examined suvorexant's potential in reducing intake and blocking relapse in OUD—specifically involving the powerful and frequently abused prescription painkiller oxycodone. Credit: Neuroscience News Next, the researchers used a relapse model in which an auditory cue reminds long-abstinent rats of their past oxycodone binges. This normally triggers a reinstatement of strong oxycodone-seeking behavior, but the maximum suvorexant dose completely blocked this reinstatement in male rats, and significantly reduced its severity in females.
Martin-Fardon says the weaker effect in females was unsurprising, since—consistently with findings in many other addiction studies—they were clearly more deeply affected by opioid dependency: In their binges, they took more than twice the amount of oxycodone that males did, and their relapses were much stronger, too.
"If you were to treat people, you would have to consider whether the same dose of suvorexant would work equally well for men and women," Martin-Fardon adds.
On the whole, he says, the findings show that suvorexant does have an effect against both oxycodone intake during addiction and relapse behavior after abstinence, and thus would be worth studying in clinical trials in oxycodone-dependent patients.
He is now planning a follow-on preclinical study of whether suvorexant can restore normal sleep-wake cycles and thereby prevent relapse in animal models of oxycodone dependency.
Elsewhere, researchers have initiated small clinical trials of suvorexant as an add-on therapy in drug-use disorder patients.
Author: Press OfficeSource: Scripps Research InstituteContact: Press Office – Scripps Research InstituteImage: The image is credited to Neuroscience News
Original Research: Open access."Suvorexant, an FDA-approved dual orexin receptor antagonist, reduces oxycodone self-administration and conditioned reinstatement in male and female rats" by Jessica M. Illenberger et al. Frontiers in Pharmacology
Abstract
Suvorexant, an FDA-approved dual orexin receptor antagonist, reduces oxycodone self-administration and conditioned reinstatement in male and female rats
Background: The Department of Health and Human Services reports that prescription pain reliever (e.G., oxycodone) misuse was initiated by 4,400 Americans each day in 2019. Amid the opioid crisis, effective strategies to prevent and treat prescription opioid use disorder (OUD) are pressing. In preclinical models, the orexin system is recruited by drugs of abuse, and blockade of orexin receptors (OX receptors) prevents drug-seeking behavior. The present study sought to determine whether repurposing suvorexant (SUV), a dual OX receptor antagonist marketed for the treatment of insomnia, can treat two features of prescription OUD: exaggerated consumption and relapse.
Methods: Male and female Wistar rats were trained to self-administer oxycodone (0.15 mg/kg, i. V., 8 h/day) in the presence of a contextual/discriminative stimulus (SD) and the ability of SUV (0–20 mg/kg, p. O.) to decrease oxycodone self-administration was tested. After self-administration testing, the rats underwent extinction training, after which we tested the ability of SUV (0 and 20 mg/kg, p. O.) to prevent reinstatement of oxycodone seeking elicited by the SD.
Results: The rats acquired oxycodone self-administration and intake was correlated with the signs of physical opioid withdrawal. Additionally, females self-administered approximately twice as much oxycodone as males. Although SUV had no overall effect on oxycodone self-administration, scrutiny of the 8-h time-course revealed that 20 mg/kg SUV decreased oxycodone self-administration during the first hour in males and females. The oxycodone SD elicited strong reinstatement of oxycodone-seeking behavior that was significantly more robust in females. Suvorexant blocked oxycodone seeking in males and reduced it in females.
Conclusions: These results support the targeting of OX receptors for the treatment for prescription OUD and repurposing SUV as pharmacotherapy for OUD.
Star Witness In Schenectady Drug Case Likened To 'Lord Voldemort'
ALBANY — Defense attorneys in a federal Schenectady drug trial slammed the prosecution's star witness Tuesday as a "sociopath" and likened him to a child molester and notorious villain from the Harry Potter series.
"He is Lord Voldemort," Bronx attorney Stacey Richman told jurors, referring to government witness Christopher Kelly, an admitted drug dealer and four-time felon from Brooklyn, where he manages a nail salon. The attorney's reference to Voldemort, the antagonist in the fictional Harry Potter world, came during closing arguments in the cocaine trafficking case against Jeffrey Civitello Sr., 51, his son, Jeffrey Civitello Jr., 23; both of Schenectady; and Richard Sinde, 58, of Fort Lee, N.J., a reputed associate of the Bonanno crime family.
The defendants face a four-count indictment alleging they conspired to operate a $40,000-a-kilo cocaine pipeline between New York City and Schenectady. Federal prosecutors allege the Civitellos and Sinde conspired with Kelly and drug mule Robert Ingrao of Lodi, N.J., to traffic $600,000 worth of cocaine in late March and early April 2021 in the hidden compartment of the younger Civitello's Jeep Grand Cherokee.
Jurors were set to begin deliberations at 9:15 a.M. Wednesday after receiving instructions Tuesday from U.S. District Judge Mae D'Agostino, who has presided over the trial since it began April 17.
Earlier Tuesday, Richman, representing Sinde, described Kelly, 56, as a soul-selling criminal who is "like a child molester" because he uses victims, ruins their lives and moves on.
Richman said Sinde was an innocent victim of Kelly machinations. She said Sinde was unaware Kelly was moving drugs to Schenectady. She said her client did not hide his identity or phone from scrutiny.
Eric Galarneau, attorney for the elder Civitello, questioned why federal prosecutors did not better vet their star witness for red flags. Galarneau claimed Kelly steered the prosecution's evidence against his client and the other defendants.
"This case is all about Christopher Kelly and if you can't trust Chris, you can't trust their case," Galarneau said
James Knox, who along with attorney Julie Nociolo is representing the younger Civitello, described Kelly as a "sociopath" who will say anything for his own gain.
"If you believe that guy, I'm sorry, but you'd believe anybody who'd tell you any story," he said.
Assistant U.S. Attorney Michael Barnett acknowledged to jurors that Kelly was a "terrible person" and "sleazy southern Brooklyn nail salon operator." But Barnett reminded jurors that Kelly testified for prosecutors only after being charged alongside the defendants.
"We did not choose Christopher Kelly — they did," Barnett said, adding that he believed it was over the top for Richman to liken Kelly to a child molester and fictional dark wizard.
Kelly testified last Thursday that he repeatedly supplied Civitello, the owner of Focus Construction in Schenectady, with the $40,000-a-kilo shipments.
Kelly said that on March 31, 2021, he and Sinde met with the Civitellos in their Albany Street property known as "the yard," as Ingrao waited at a nearby gas station. Kelly said the younger Civitello instructed him on how to use the trap compartment to avoid detection by police.
Federal drug investigators, however, had secretly placed a GPS device on the vehicle. Prosecutors said the device followed the Jeep after Kelly, Sinde and Ingrao left for downstate in three separate vehicles, Sinde allegedly in the Jeep.
They said the device recorded the Jeep staying in Fort Lee that night, traveling the next day over the George Washington Bridge into Manhattan and then to the Breezy Point section of Queens. Kelly testified that he loaded the hidden compartment with the 9 kilos of cocaine — an estimated 20 pounds.
Prosecutors said the vehicle was then tracked in Fort Lee. On April 2, 2021, a state trooper stopped the vehicle, driven by Ingrao, on the Thruway in Greene County. Investigators found the cocaine.
Kelly and Ingrao have previously pleaded guilty to drug charges to resolve their cases. Ingrao, now 76, known as "Bobby," is not cooperating.
A previous version of this story gave the incorrect weight in pounds of what is alleged to have been found in a hidden compartment
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