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ZERO LEFT Grieving parents advance opioid crisis conversation State tightens rules on prescriptions

Portsmouth Herald - 2/12/2017

Adam Moser disappeared the night of Sept. 19, 2015, a night in which he was described as looking like a “zombie.” His friends checked the house, heading into downtown Portsmouth when they couldn’t locate him. When they returned, they found Adam cold in a spare bedroom, a room they left unchecked earlier in the night.

Moser was 27 when he died that night in Portsmouth from an apparent fentanyl overdose. One year later, his parents, Jim and Jeanne Moser, set out to create a short documentary, in partnership with Narrow Street Films, to allow their son’s death to teach others about the dangers of opioids. In the days and months since, the Mosers, of East Kingston, have committed themselves to opioid advocacy, including the launch of a campaign called Zero Left, intended to raise awareness about the risks of prescription drugs. They learned after Adam’s death that he’d had a prescription drug “hobby.”

“We’re talking about a well-rounded kid, a smart kid who comes from a great family,” Adam’s friend says in the documentary, titled “Just The One Time.” “If something like this can happen to Adam, then it can happen to anyone. That’s what I’ve learned.”

Adam had a degree in actuarial science from Temple University, Jeanne said. He was proficient in high-level math, fluent in French and taught himself Russian and Arabic. He was known for his role as a fisherman on the National Geographic Channel’s reality show “Wicked Tuna.”

The Mosers’ Zero Left campaign, short for “zero left for the medicine cabinet,” piggybacks off the new state prescription drug regulations that went into effect Jan. 1. The New HampshireBoard of Medicine in November adopted final rules for opioid prescribing for the management or treatment of non-cancer and non-terminal pain, as well as requirements to use the state prescription drug monitoring program.

“It’s all driven by the fact, if your son dies from a product and you’d never had a conversation about that product with him, it hangs over your head forever,” Jim said. “We wanted to make sure other parents don’t make that mistake.” The Mosers just finished a round of mailings to legislators and health care leaders about their initiative.

“We didn’t find out till he was dead,” Jeanne followed. “We pieced it all together. It was a matter of having friends over and talking about things, looking at phone records.” Jim said they figured out Adam was driving to meet people in Laconia and Hanover, likely to buy drugs. They think he had been taking pills since college.

“A couple of us had surgeries, he probably got them like that initially,” Jeanne said. “I didn’t even know what an opioid was. I’d had hand surgery so the prescriptions were there and they were not secured. We didn’t have the conversation because we had no idea.”

The new state regulations now require medical professionals to conduct a patient risk assessment prior to writing an opioid prescription. A patient must sign their informed consent, which will then be checked against the prescription drug monitoring program’s database to ensure the patient is not seeking drugs from multiple providers. In particular, one of the new rules dictates that given a patient’s pain condition, licensed practitioners should prescribe opioids for the “lowest effective dose for the shortest duration.” While the quantity is not defined, pain that extends beyond 30 days is required to be revisited by the prescriber before issuing a new opioid prescription.

The Mosers say one of their biggest regrets will be not having a prescription drug conversation with Adam. Often, prescription drug addictions lead to the use of more potent opioids, such as heroin and fentanyl. The Zero Left campaign focuses on the risks and side effects, how to store drugs safely and what parents can do. “Going forward, let’s get this right,” Jim said.

Heather Blumenfeld, family recovery support advocate for Safe Harbor Recovery Center in Portsmouth, said prescription drugs are “absolutely” a gateway for a high percentage of people that come into their center.

“A lot of young people, for legitimate reasons, whether it’s a broken bone or surgery, are prescribed opioids and that’s just where it starts,” she said. “Sometimes it’s their own prescription, other times it’s getting them off the streets, from a friend or someone’s medicine cabinet. They can be hooked from that day on.”

According to the Centers for Disease Control and Prevention 2011 to 2013 National Survey on Drug Use and Health, people who are addicted to prescribed opioid painkillers are 40 times more likely to be addicted to heroin.

“Each one of the new regulations is trying to reduce the amount of opioids we’re prescribing,” said Portsmouth Regional Hospital Chief Medical Officer Thomas Wold. “The state also put several measures in for us to consider alternative agents and to consider someone’s potential for abuse. The requirements make the patient very aware of the dangers.”

Wold said providers must now document in a patient’s medical record a “very specific reason” for why they are prescribing narcotics and additionally, note in the record that they considered alternative agents before prescribing the opioid medication.

“Many physicians have been under the cultural assumptions of what we were taught 10 years ago,” Wold said. “There was a point where pain was a fifth vital sign and we were taught to treat it, and there was a minimal risk of addiction associated with it. We know now with the new information that the risk for addiction is really quite a bit higher than we were continually told. Three consecutive days of an opioid prescription could lead to the habit and then eventually to addiction in a susceptible patient.”

Wold said Percocet and Vicodin are the top two opioid prescriptions. In fact, the United States prescribes 99 percent of the world’s Vicodin supply and 80 percent of its narcotics, according to numerous studies.

The regulations also require patient awareness of diversion. About 55 percent of non-medical users got opioid prescriptions from a friend or relative for free, according to a 2008-2011 National Survey on Drug Use and Health.

While it hasn’t been long since the new state regulations went into effect, Wold said Portsmouth Regional Hospital is already seeing patients leave with less medication.

“It’s still early to see an impact but we’re really hoping to see an improvement,” Wold said. “Once physicians understand the steps that are in the state initiative, I think they’ll begin to buy in and understand it’s the right thing to do.”

Blumenfeld said the new prescribing regulations are a “great step in the right direction.”

“I do believe a lot of the substance use disorders start there,” she said. “I think the new regulations are huge. We also need to put a message out to our kids. Of course we don’t want them to do drugs, but if they do and they get into trouble, we want to help them.”

The Mosers plan to show their documentary for students at Exeter High School in March. It can be viewed at www.youtube.com/watch?v=ZuaLlalpl8g.