Op-Ed: The Wrong Way to Treat Opioid Addiction

Before Joe Thompson switched treatments for his opioid addiction, he was a devoted stay-at-home father, caring for his infant son after his wife returned to work. His recovery was aided by the anticraving medication buprenorphine. But after over two years free of heroin, Mr. Thompson, a former United Parcel Service worker from Iowa, relapsed and decided to try another kind of treatment program.

Unfortunately, his new counselors insisted that continuing his buprenorphine, though it was approved by the Food and Drug Administration, was just as bad as using heroin, according to his wife, Deborah. He wasn’t even allowed to start therapy until he’d been abstinent for several weeks. Stressed by withdrawal, he went to a third center. It, too, banned medication. Within a week of entering the program, he was dead from a heroin overdose. He was 35.

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Buprenorphine is one of only two treatments proven to cut the death rate from opioid addiction by half or more. But the programs Mr. Thompson tried viewed abstinence as the only true recovery — even though abstinence treatment has not been shown to reduce mortality and is less effective than medication at preventing relapse.

Unfortunately, Mr. Thompson’s experience is more the rule than the exception. Only about one-third of American addiction programs offer what many experts worldwide see as the standard of care — long-term use of either methadone or buprenorphine. Most programs view medication as a crutch for short-term use and provide only talk therapies.

This widespread rejection of proven addiction medications is the single biggest obstacle to ending the overdose epidemic. Funding isn’t the barrier: Outpatient medication treatment is both more effective and significantly cheaper than adding inpatient beds at rehabilitation centers. The problem is an outdated ideology that views needing a medication to function as a form of addiction.

Rather than defining addiction as destructive, compulsive behavior, this ideology focuses on physical dependence. If you need a drug to avoid being physically ill, you are considered addicted. So Prozac would be considered addictive, but not cocaine, because quitting Prozac abruptly can cause flulike symptoms while stopping cocaine doesn’t, even though it elicits extreme craving.

In the 1980s, crack cocaine made clear just how addictive cocaine could be, even without physical withdrawal symptoms. Today, both the National Institute on Drug Abuse and the Diagnostic and Statistical Manual of Mental Disorders reject the idea that addiction is synonymous with dependence. Unfortunately, many clinicians, including doctors, haven’t caught up.

What is addiction, then? The root problem is craving, which drives a compulsion to use drugs despite the harm they cause. That’s what makes crack addictive, while Prozac can be therapeutic.

Because methadone and buprenorphine are opioids themselves, it’s easy to assume that using them is “substituting one addiction for another.” However, the pattern of taking the same dose every day at the same time means that there is no high or intoxication. Patients on maintenance doses are able to nurture a baby, drive, work and be a loving spouse.

In these patients, addiction is replaced by physical dependence. And that’s not a problem for those who have health care coverage: It’s no different from needing antidepressants or insulin. When a drug’s benefits outweigh its risks, continued use is healthy, not addictive.

Sadly, though, there’s another reason for widespread skepticism about addiction medication. It comes from the fact that many patients will continue to misuse opioids. Medication reduces relapse more than abstinence does — but relapse is still common, as in Mr. Thompson’s case. In abstinence treatment, however, relapsers drop out and are invisible; with medication, they often remain in treatment.

And remaining in treatment is important because it cuts overdose risk, even during relapse. Many highly traumatized people also need the continued health care support before they are able to quit street drugs.

When we fail to understand that these medications can be used both to reduce harm and stabilize people in recovery, we risk letting the perfect be the enemy of the good. For some, medication is a way to reduce risk while drug use continues. For others, it’s a path to rapid recovery. Often, people will need to take the first route to survive long enough to reach the second.

Pill Split In Half Leaking Liquid

For harm reduction to work, maintenance drugs need to be almost as accessible as street drugs. Whenever people take buprenorphine rather than heroin, their risk of dying is lowered, especially since so much heroin these days is tainted with deadly strong fentanyl. For stabilization, people need empathetic counseling that doesn’t view dependence as continuing addiction.

Change will require innovative measures. The governmennt should stop funding and insurers should stop covering any program that does not use all the F.D.A.-approved anticraving medications and does not provide informed consent about their effectiveness. While abstinence can work for some, we need many options. We also need to rethink our regulations for methadone and buprenorphine prescribing.

Then we need to publicly recognize that recovery on medication is every bit as valid as any other treatment. What matters is whether, as Freud put it, you can love and work, not the chemical content of your brain or urine.

Original article here: The Wrong Way to Treat Opioid Addiction posted January 17, 2018

New York Times

Walmart offers free opioid disposal product in effort to fight painkiller abuse epidemic

  • Walmart is now offering pharmacy customers a free drug disposal product, DisposeRX.
  • The retail giant is offering the product as a means to combat the ongoing opioid epidemic in the United States.
  • More than 64,000 Americans died from drug overdoses, mainly from prescription painkillers and heroin, in 2016.

Walmart will offer a drug disposal product — for free — to pharmacy customers as part of an effort to combat the nation’s opioid abuse epidemic, the retail giant said Wednesday.

The product, a powder known as DisposeRX, when mixed with warm water and prescription medication in a pill bottle creates a solid that can then be thrown out safely in the trash, without the risk of contaminating groundwater.

DisposeRX, is meant to be used by customers who no longer need their prescription painkillers or are concerned that someone else might take their pills.
DisposeRX box

Repeated tests have been unable to extract opioids from the resultant solid after DisposeRX is mixed with the drugs, DisposeRX’s CEO John Holaday said.

Walmart said a small packet of DisposeRX will now be given free automatically to any pharmacy customers filling new Class II opioid prescriptions at all of the retailer’s 4,700 pharmacy locations.

Patients with chronic Class II opioid prescriptions will be offered a free DisposeRX packet every six months, and existing pharmacy customers can request a free packet at any time. DisposeRX packets also are being given away free at Sam’s Club pharmacies.

“The health and safety of our patients is a critical priority,” said Marybeth Hays, executive vice president of consumables and health at Walmart U.S.

“That’s why we’re taking an active role in fighting our nation’s opioid issue, an issue that has affected so many families and communities across America,” Hays said.

Hays declined to say during a conference call with reporters how many opioid prescriptions Walmart fills annually.

The move comes nine months after the Cherokee Nation sued Walmart and two major pharmacies, Walgreens and CVS Health, along with large drug distributors, for allegedly profiting by “flooding” Native American areas in Oklahoma with prescription painkillers.

Last week, a federal judge granted Walmart and the other defendants a preliminary injunction preventing the case from being brought in tribal court. The tribe, which says it is prepared to seek damages against the companies in state court, notes in its suit that from 2003 to 2014, more than 350 deaths related to opioids occurred in Cherokee Nation.

Although the offer of DisposeRX for free is coming as a result of the opioid epidemic, the product works on any type of prescription drug, according to Holaday.

More than 64,000 Americans died from drug overdoses in 2016, with most of those deaths related to prescription opioids or illegal opioids such as heroin. That level of carnage led President Donald Trump in October to declare the opioid epidemic a public health emergency.

Walmart’s offer of free DisposeRX is just the latest in a series of efforts by pharmacies to reduce the risk that opioids will be diverted from their appropriate use as painkillers and abused by either the original customer or another person.

Walmart already was among those pharmacies that sells a product, a pouch, that is used to neutralize drugs. However, the retailer does not accept the return for disposal of the drugs that it sells.

Some pharmacies, including CVS and Walgreens, accept returns of drugs for disposal at select locations.

Walmart’s Hays said DisposeRX “provides a [disposal] solution for customers to manage that at home, and much more conveniently.”

Walmart touted an endorsement of its move from Sen. John Boozman, a Republican who represents Arkansas, where the company’s headquarters is located.

“About one-third of medications sold go unused,” Boozman said.

“Too often, these dangerous narcotics remain unsecured where children, teens or visitors may have access. I commend Walmart for taking this innovative approach to help keep unused prescription drugs out of the wrong hands.”

Original article here: Walmart offers free opioid disposal product in effort to fight painkiller abuse epidemic

Posted by: Dan Mangan on CNBC.com 1/16/2018

JAMA Forum: A New Year’s Wish on Opioids

As overdose deaths mount, leading to a decline in US life expectancy 2 years in a row, my New Year’s wish is for more people to appreciate this statement: Not all well-intentioned approaches to addressing the opioid epidemic are good ideas. Some are based on evidence and experience, others on misunderstanding, blame, fear, or frustration. What’s needed in 2018 is the wisdom—and the courage—to tell the difference.

Addiction Treatment

The use of the opioid agonists methadone and buprenorphine reduces overdose, illicit drug use, crime, and transmission of infectious diseases. A common misconception, however, is that these medications are part of the problem. Even in the field of addiction treatment, many still believe that those who take methadone or buprenorphine are “trading one addiction for another,” “in bondage,” or taking a “cop-out.” The majority of privately funded treatment programs for opioid use disorder do not offer patients the chance to use medications. In addition, Narcotics Anonymous allows chapters to block people who take medications from telling their stories at support meetings. Some judges order patients off medications or allow social services agencies to remove children from parents doing well on medications in treatment.

The consequence of these attitudes and actions? More fatal overdoses. A must-read investigation by journalist Jason Cherkis, a finalist for the Pulitzer Prize, found that the ideology against medications can be so fierce that it leads some to shrug off a greater risk of death.

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For 2018, I ask for greater understanding that medications can help—not hinder—an individual in taking responsibility for his or her own recovery. Indeed, many patients who take medication explain that it clears their mind of intense cravings and allows them to focus on making amends and rebuilding their lives. Programs such as the Hazelden Betty Ford Foundation that historically promoted “abstinence only” are now incorporating effective medications into their programs. This is not new ground: Medication use and personal responsibility coexist for many other conditions, from diabetes to nicotine addiction.

An expanded appreciation of the role of medications would support the growing bipartisan interest in broadening access to all of the FDA-approved options. Consistent with the approach taken by the Obama Administration, President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis emphatically endorsed treatment that includes medications, and US Food and Drug Administration Commissioner Scott Gottlieb recently testified: “We should not consider people who hold jobs, reengage with their families, and regain control over their lives through treatment that uses medications to be addicted. Rather, we should consider them to be role models in the fight against the opioid epidemic.”

Criminal Justice

It is now recognized by many across the political spectrum—including the Koch brothers—that the arrest and jailing of millions of Americans for their addiction has complicated efforts to address the opioid epidemic. Charging nonviolent individuals for possessing small amounts of drugs strains the courts and jails and tags people with addiction with criminal records that hinder recovery. Yet as overdoses have spiked—in large part due to heroin laced with fentanyl—several states have again increased penalties for possessing small amounts of drugs, and some prosecutors have turned overdoses into crime scenes, charging friends and family with murder. The instinct to “get tough” is understandable, but users rarely know the content of their drugs, and the result is likely to be fewer people calling for help.

There is also the very real danger of overdose after incarceration. In most jails across the country, individuals with an opioid use disorder are forced to endure a painful (and occasionally fatal) withdrawal. While incarcerated, they lose their tolerance to opioids, raising the chance of overdose when opioids become available again. Studies document up to 10-fold elevations of risk of death upon release from detention.

In 2018, I hope for far wider adoption of alternative approaches: fewer arrests for drug use and much greater access to treatment within the corrections system. There are some inspiring examples. Innovative police departments and prosecutors in Massachusetts, New York, Washington, Vermont, and elsewhere are diverting nonviolent users of drugs to treatment instead of detention. Initial results of some of these efforts show substantial declines in recidivism.

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In addition, states including Rhode Island and Connecticut are beginning to offer access to effective treatment with medications to detainees, with transitions to community care upon release—a promising approach supported by evidence from other countries and consistent with the recommendations of the President’s Advisory Commission.

Health Care System

There is now broad understanding that the overprescribing of opioids has contributed to today’s opioid epidemic. There is much less appreciation, however, that some responses to this insight can make the overdose problem worse. At a time when most insurers still do not provide adequate reimbursement for nonpharmaceutical approaches to pain or treatment for opioid use disorder, overly restrictive prescribing policies risk pushing patients with pain or addiction to illicit drugs, a transition many have made. A few distraught patients have even committed suicide.

The good news is that tools and evidence-based guidelines and coverage policies are available to reduce excessive prescribing of opioids, while preserving the ability to provide individualized care. In 2018, I hope that medical community rapidly adopts a recently released set of quality metrics that was designed to support these thoughtful approaches.

I also hope that in the new year, more health care organizations embrace their responsibility not only to cause less of the opioid problem (by reducing excessive prescribing for pain) but also to contribute more to the solution (by expanding access to addiction treatment). A randomized trial found double the rate of short-term treatment success when emergency departments offered buprenorphine therapy and a warm handoff to ongoing treatment. Similarly, starting treatment with medications on the wards is far better than the oft-provided “detox,” which is associated with a risk of death from overdose.

An inspiring example for the new year? Massachusetts General Hospital, which recently began training emergency department physicians to start treatment on the spot.

Looking to Evidence

On opioids, it can sometimes seem that there are 3 bad ideas for every good one. Public officials have supported limiting the number of naloxone resuscitations and afterwards letting people die, requiring drug testing before enrolling in Medicaid, and launching stigmatizing public relations campaigns that can reduce the chance people will seek treatment. Can we leave such approaches behind in 2017?

Young-man-praying

Worth holding onto are approaches by states like Rhode Island, where the Governor asked a team of local experts to listen to the public, consult the evidence, and provide recommendations for priority strategies. As one Rhode Island expert told an assembled group, “Our goal here is not to make everybody in this room happy. Our goal is to cut down on overdose deaths.” Three years later, after developing a terrific dashboard, investing in access to effective treatment, developing programs to improve prescribing of opioids and benzodiazepines, and setting standards for hospital activities, the state is one of a few actually seeing a decline in overdoses.

The sheer scale of the opioid epidemic is staggering. There needs to be much more work on understanding and addressing the root causes of this problem, as well as greater willingness to try out promising approaches to the emerging threats of fentanyl and related compounds.

To get started on the right foot in 2018, the opioid epidemic demands much more of what works, and much less of what does not—as do our friends, family, and neighbors who are struggling for their very lives.

About the author (pictured below): Joshua M. Sharfstein, MD, is Associate Dean for Public Health Practice and Training at the Johns Hopkins Bloomberg School of Public Health. He previously served as Secretary of the Maryland Department of Health and Mental Hygiene, as the Principal Deputy Commissioner of the US Food and Drug Administration, and as Commissioner of Health for Baltimore. He is a consultant for Audacious Inquiry, a company that has provided technology services and other support to Maryland’s Health Information Exchange. A pediatrician, he lives with his family in Baltimore.

JoshuaMSharfsteinAuthor

About The JAMA Forum: JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.

Link to the original article here: JAMA Forum: A New Year’s Wish on Opioids

To understand why America’s opioid epidemic keeps getting worse, just look at this map

America’s opioid epidemic keeps getting worse, with the latest data showing that drug overdose deaths in the US climbed by roughly 21 percent between 2015 and 2016 — from a record high of more than 52,000 to a new record of nearly 64,000. About two-thirds of those overdoses were linked to opioids.

To understand how this crisis keeps growing, take a look at an insightful map by amfAR, an advocacy group dedicated to the fight against HIV/AIDS. The map shows three things: the availability of facilities that treat drug addiction, the facilities that provide at least one medication for opioid addiction (marked as MAT, or medication-assisted treatment, on the map), and the facilities that provide all three kinds of medications for opioid addiction.

Map Of States MAT

Clearly, there are a lot of gaps in coverage. In a post on Health Affairs, Austin Jones, Brian Honermann, Alana Sharp, and Gregorio Millett of amfAR looked at 2016 data from the Substance Abuse and Mental Health Services Administration and found that only 41.2 percent of the more than 12,000 drug addiction treatment facilities in the US offered at least one kind of medication for opioid addiction. Only 2.7 percent offered all three.

These medications are widely considered by experts to be the gold standard in opioid addiction care. Studies, including systematic reviews of the research, have found that opioid addiction medications in general cut all-cause mortality among opioid addiction patients by half or more. The Centers for Disease Control and Prevention, National Institute on Drug Abuse, and World Health Organization acknowledge their medical value. That doesn’t mean these medications are for everyone (they’re not), but there’s a lot of good evidence for their general efficacy.

So it is pretty bad that a majority of addiction treatment facilities don’t provide access to any of these medications. It is similarly bad that even more of these facilities don’t offer access to more than one kind of medication; the individual types of medications don’t work for everyone — nothing in addiction treatment does — so it’s important to provide multiple options.

We are, as a country, nowhere close to that goal.

If the US isn’t making good use of even the bare minimum of evidence-based treatment, it’s no wonder the opioid crisis keeps getting worse.

One caveat: The map likely understates the amount of addiction treatment that is available in some parts of the US. For one, physicians can gain the ability to prescribe buprenorphine through a special waiver, but those kinds of practices wouldn’t appear in a map solely dedicated to drug addiction treatment facilities. Still, other data collected by amfAR shows that there are big swathes of the country without doctors who can prescribe buprenorphine.

There’s also other data that exposes America’s big gaps in addiction treatment. According to a 2016 report by the surgeon general, just 10 percent of Americans with a drug use disorder obtain specialty treatment. The report attributed the low rate to severe shortages in the supply of care, with some areas of the country lacking affordable options for any treatment — which can lead to waiting periods of weeks or even months.

The map exposes America’s inaction in the opioid epidemic

More than showing the specific counties and states that don’t have access to some kinds of treatment and medications, amfAR’s map shows that America isn’t truly serious about dealing with its opioid epidemic.

Given that we know these medications are highly effective for opioid addiction, providing access to them should be the low-hanging fruit for dealing with a drug overdose epidemic fueled by opioids. Coverage remains sparse, and there’s been little attention to changing that.

A major reason for that is stigma. These medications are often characterized as “replacing one drug with another” — say, replacing heroin use with methadone use.

This fundamentally misunderstands how addiction works. The problem is not drug use per se; most Americans, after all, use caffeine, alcohol, and medications without major problems. The problem is when drug use becomes a personal or social burden — for example, putting someone at risk of overdose or leading someone to commit crimes to obtain drugs.

Medications for opioid addiction, by staving opioid withdrawal and cravings without leading to a significant risk of overdose, mitigate or outright eliminate those problems — treating the core concerns with addiction.

Another reason for the treatment gap is a lack of federal attention. In the past few years, for example, the only new federal effort to dedicate a serious amount of money to the opioid crisis was the Cures Act, which committed $1 billion over two years.

Even that sum fell woefully short of the tens of billions annually that experts argue is necessary to deal with the opioid epidemic. For reference, a 2016 study estimated the total economic burden of prescription opioid overdose, misuse, and addiction at $78.5 billion in 2013, about a third of which was due to higher health care and addiction treatment costs. So even an investment of tens of billions could save money in the long run by preventing even more in costs.

As Stanford drug policy expert Keith Humphreys previously told me, “Crises in a nation of 300 million people don’t go away for $1 billion. This is the biggest public health epidemic of a generation. Maybe it’s going to be worse than AIDS. So we need to go big.”

America has not gone big, at least yet. So the opioid epidemic continues, killing tens of thousands of people in the process every single year.

Original Article here: To understand why America’s opioid epidemic keeps getting worse, just look at this map

How a Small Shift in Your Vocabulary Can Instantly Change Your Attitude

3 Suggestions to Boost Your Mood and Improve Your Performance

This past year I have noticed how my vocabulary impacts my attitude. Words have power. They impact others, of course, but they can also have an impact on us.

I was once headed out of town for a speaking engagement. A friend called and asked me where I was going. I said, “Oh, I’m headed to San Jose. I have to speak at a convention.” I said it with a little resignation in my voice.

The moment I hung up, it hit me. I don’t have to speak. I get to speak. That instantly changed my attitude.

How many people would gladly do this for free—or even pay for the opportunity? Yet I was getting paid to do it.

Lonely sad girl on the dark beach
Girl Sitting By The Ocean At Dusk

 

Small Shift, Big Difference

The first expression (i.e., I have to do it) is the language of duty. Nothing wrong with that. I am all for responsibility.

But too often we say it with a sigh, like it’s a sentence—or we’re a victim. It can easily become pessimistic, and nothing will kill your creativity, job performance, or relationships like going negative.

The second expression (i.e., I get to do it) is the language of privilege. It’s as if we have been given a gift, and we are relishing the opportunity.

This subtle shift may seem small, but it has had a big impact on my attitude. I am choosing the language of privilege every chance I get.

  • I don’t have to workout this morning; I get to workout. What a privilege to be healthy and be able to care for my body.
  • I don’t have to write a new blog post. I get to write one. What a privilege to have readers that actually care what I have to say.
  • I don’t have to meet with the guys in my mentoring group; I get to. What a privilege to meet with eight young men who want to learn and grow.
  • I don’t have to go to church today; I get to go to church. What a privilege to belong to a church where I can worship God and where I have such good friends.
  • I don’t have to stop by the grocery store on my way home; I get to stop by the grocery store. What a privilege to live in a place and at a time where we don’t have to forage for food.

You get the idea.

3 Suggestions to Make the Shift Yourself

You can make this shift, too. Here are three suggestions:

  1. Become aware of your vocabulary. This is a little like my post on the difference between try and do. The first step is to actually become aware of the words you’re using. Sometimes it feels like the mouth has a mind of its own. We just say things out of habit.
  2. Start using get to rather than have to. Habits can be hard to break. This might require some practice and a little persistence. You don’t need to become compulsive about it, but start intentionally using the language of privilege rather than duty.
  3. Notice the difference it makes in your attitude. For starters, it can suddenly make you grateful. Rather than dreading or resenting an activity, you can be thankful for it. And the more gratitude we express, the better we feel and perform. It will give you several distinct advantages, especially at work.

Original article here: How a Small Shift in Your Vocabulary Can Instantly Change Your Attitude

Written by: Michael Hyatt

Podcast – Addressing Patient Resistance to Medication Assisted Treatment

This PCSS Podcast discusses up-to-date pain medicine and substance use disorder topics with the goal of increasing the general education of healthcare providers.  Medication-assisted treatment is widely accepted treatment for patients with opioid use disorders. Still, patients have many reasons, spoken and unspoken, to be reluctant to start this potentially life-saving treatment.

On this episode, Ashley Braun-Gabelman, PhD, discusses the importance of addressing this resistance and why it’s important to explore this barrier to treatment head on. Dr. Braun Gabelman is a clinical psychologist in Addiction Recovery Services at University Hospitals Cleveland Medical Center and an Assistant Professor in the Department of Psychiatry at Case Western Reserve University School of Medicine. She specializes in the treatment of substance use and co-occurring disorders including major depression, anxiety disorders, and PTSD.

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Click PLAY below to listen to this clear and easy to follow podcast that touches on the very essence of what holds many people back from seeking help: STIGMA.

On the front lines of drug crisis, US police split on Narcan

BATAVIA, Ohio (AP) — The sheriff of Clermont County firmly believes it’s a call of duty for his deputies to carry a nasal spray that brings people back from the brink of death by drug overdose. Less than 50 miles away, his counterpart in Butler County is dead set against it, saying it subjects deputies to danger while making no lasting impact on the death toll.

The divide over naloxone, the popular overdose antidote, between nearby sheriffs in two hard-hit counties in one of the hardest-hit states for drug deaths shows just how elusive solutions are on the front lines of the U.S. opioid crisis.

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Cincinnati Police Officer assists a gentleman who is experiencing a suspected overdose.

Some police officials cite lack of resources for obtaining, maintaining and tracking supplies and for training in when and how to use it. They worry about taking on new duties they say are better suited for medical workers, divert them from fighting crime and can put them in danger. They get support from some citizens weary of people who overdose repeatedly.

Police who do carry it say that development of a nasal spray called Narcan makes naloxone simple to administer, that the $75 two-dose kits are usually given to them by health departments or community organizations, that it’s not a major burden to track and maintain supplies and that it’s a natural extension of their mission to serve and protect.

“I just say from my personal experience that it is right thing to do,” said Sheriff Steve Leahy, whose Clermont County begins in the eastern Cincinnati suburbs, then rolls across hilly fields into Appalachia. Leahy, part of the early wave of police advocates of naloxone, acknowledges he was more inclined to support it after seeing someone close to him struggle for years with heroin.

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Cincinnati police officers, firefighters, and medics respond to a possible overdose report at a hotel in downtown Cincinnati.

“Don’t get me wrong,” Leahy said. “It doesn’t mean that we’re going to get out of this by hugging everybody, but … you know, no matter what their plight is and how they got to where they are, it’s not for us as law enforcement to decide whether they live or die.”

Butler Sheriff Richard Jones, whose county includes growing northern Cincinnati suburbs, older industrial cities and rural areas, also voices compassion. He lost a brother at a young age to alcoholism and drugs, he said, and he recounts cradling infants twitching from the effects of their mothers’ drug use.

But people using drugs make choices, he said: “Knowing that they can die from it, but they still do it.” (Addiction specialists and federal drug authorities say it’s more complicated than that; repeated uses of a drug can result in brain changes and the disease of addiction.)

And, Jones said, people who overdose can be combative when they come to, he said; an officer bent over giving naloxone could get “a brick to the head.”

“It’s not what we’re supposed to do,” said Jones, known for blunt talk on such issues as illegal immigration and Donald Trump’s GOP presidential campaign. “We won’t do it. Period.”

A recent visit with Jones by Associated Press reporters came the morning after a man in Middletown revived by firefighters came back to consciousness in attack mode. He injured a firefighter and tried to bite and punch others.

Such instances are rare, authorities say. Quincy, Massachusetts, police pioneered naloxone seven years ago and have reversed nearly 800 overdoses without a single officer being injured, said Lt. Patrick Glynn.

And advocates for those battling addiction say it seems like a natural situation for police, whose very jobs call for facing sudden threats.

In a Butler County mobile home park where the sheriff’s office has stepped up patrols after complaints of drug activity, Jones’ position has strong support from Brandon O’Hair, 21. Snuggling his newborn daughter, he said he and nearly all his neighbors have had cars or homes broken into by people stealing to fund their heroin habits.

“That’s not what they’re supposed to do; they’re supposed to enforce the law,” O’Hair said of the sheriff’s refusal to stock naloxone. “I think it’s tough love. … The rest of us shouldn’t have to pay for it.”

An AP survey of Ohio’s 88 sheriffs found that at least 68, or a little more than three-fourths, equip deputies with naloxone. Of those, a half-dozen have begun within the past six months, and most others have less than two years’ experience.

It’s hard to say what effect naloxone is having on overdose death rates.

Woman-Being-Administered-Narcan-By-EMT
Medics with the Cincinnati Fire Department nasally administer naloxone to a woman while responding to a possible overdose report at a gas station in downtown Cincinnati.

Accidental overdose deaths in at least 11 Ohio counties where sheriffs have used the antidote for more than two years went up last year. Butler’s did, too, and is on track for another record toll this year. In Clermont, where sheriff’s deputies carry naloxone, the death toll went down last year. Statewide, the overdose death toll soared 33 percent, to 4,050 people, in 2016.

Naloxone is also widely distributed to families and friends of people with addiction. Its availability to police and sheriffs dates back only a few years. And attempts to gauge its effectiveness are hindered by variables including geographical variation in drug potency.

Amy Parker, a native and resident of Butler County, was saved twice by naloxone. She doesn’t know whether it was police or paramedics who administered it when she overdosed on heroin in Indianapolis a few years ago. She eventually ended her drug use and now is a peer drug counselor, leading group meetings for those in rehabilitation.

The talk by the sheriff and residents of her county against police use of naloxone, she said, adds to the stigma of those battling drugs and to their reluctance to seek help. She bristled at the claim by Jones and others that naloxone enables; the saying among advocates, she says, is that the only thing naloxone “enables” is breathing.

“I don’t care how many times it takes,” Parker said. “As long as that person is alive, there is hope.”

For the original article, including a video, visit this link: On the front lines of drug crisis, US police split on Narcan

Contributing to this report were Associated Press reporters Kantele Franko and Andrew Welsh-Huggins in Columbus, Lisa Cornwell in Cincinnati, and AP news researcher Jennifer Farrar in New York.

Health Insurer Aetna Announced Tues That it Will Provide Narcan to Some Of its Customers at No Cost

Health insurer Aetna announced Tuesday that it will provide the lifesaving opioid overdose reversal drug Narcan to some of its customers at no cost.

The medicine will be available to customers who are insured under Aetna’s commercial plans, such as those through work, beginning on Jan. 1. The company said it is the first national insurer to make such a provision available to its customers.

Narcan is a nasal spray that works to awaken someone who has overdosed on an opioid such as a prescription painkiller or heroin and also works to combat more potent drugs like fentanyl. A package of Narcan, which includes two nasal sprays, typically costs as much as $150. Aetna customers will be able to obtain two packs at at time.

Some states allow naloxone, the active drug in Narcan, to be given to patients without a prescription. Prior to the announcement Aetna already paid for most of the cost of the drug, and patients paid between $30 and $40 in co-pays.

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A hand holds Narcan Nasal Spray, the life saving opioid overdose reversal drug.

According to data Aetna received from Narcan’s manufacturer, nearly 35 percent of enrollees didn’t pick up their prescriptions between January and June. They also found that people were less likely to fill a prescription when the co-pay increased. The data show that 76.7 percent of prescriptions weren’t picked up if they had a co-pay of between $100.01 and $150, compared to a 46.1 percent drop in prescription pickups if the copay was between $40.01 and $50.

“Cost is clearly a factor in whether individuals with substance abuse disorder obtain medication that could save them from a fatal overdose,” said Dr. Harold Paz, executive vice president and chief medical officer of Aetna. “By eliminating this barrier, we hope to keep our members safe until they are ready to address their addiction.”

Aetna also said it was limiting the number of opioids prescribed for acute pain and after surgery to a seven-day supply. Many people who become addicted to opioids do so after receiving a prescription from a doctor to treat pain. When they are unable to obtain more medication, they turn to heroin as a cheaper alternative which carries a similar high. Deaths from opioids reached 33,000 in 2015, according to the latest available federal data.

by Kimberly Leonard | 

Link to original article  here:  Aetna to cover opioid overdose antidote at no cost to customers

PRESS RELEASE: Addiction Policy Forum Announces New Initiatives

Washington (December 12, 2017) – Today, the Addiction Policy Forum announced several new initiatives to help millions of families in the United States struggling with opioid addiction and other substance use disorders. The programs put in motion key elements of the organization’s multi-year plan announced in October, Priorities to Address Addiction in America, which provides a comprehensive, action-oriented approach to addressing the growing opioid epidemic.

Addiction-Policy-Forum-Logo
Addiction Policy Forum Logo

Developed by experts at the Addiction Policy Forum, the programs announced today will address the areas of prevention, recovery support, medical innovation, and healthcare system integration. Support from key partners, including a significant commitment from the Pharmaceutical Research and Manufacturers of America (PhRMA), will enable the Forum to scale the initiatives nationwide.

“We hear all too often that families and community leaders don’t know where to turn for services that can help loved ones who are in crisis – or prevent the crisis from happening in the first place,” said Jessica Hulsey Nickel, president and chief executive officer of the Addiction Policy Forum. “By working closely to families and experts in the field, we’re creating localized resources and evidence-based tools that will make a real difference in addressing substance use disorders. We are grateful to all of our partner organizations for their ongoing commitment to this important issue.”

The programs introduced today by Addiction Policy Forum include:

  1. The Addiction Resource Center: This online portal will be a comprehensive resource to assist patients and their loved ones with substance use disorders. The new platform, with support from the Chris and Vicky Cornell Foundation, will guide patients through a validated self-assessment tool, help them develop a proposed treatment plan, and provide a guide to reliable, evidence-based information about resources in their local area. Initially, the Forum will host a database of local resources in Ohio, Maryland and Minnesota. Over the coming months, new states will be added so that more and more Americans suffering with substance use disorder will have a place to turn for help.

  2. Prevention Initiative: Community Anti-Drug Coalitions of America (CADCA) and the Addiction Policy Forum will create and distribute educational kits and essential resources on prevention as well as prescription drug disposal and misuse. With more than 5,000 community coalitions throughout the country and a track record of helping create drug-free communities globally, CADCA is uniquely positioned to disseminate evidence-based prevention resources to scope and scale nationally.

  3. Emergency Medicine Initiative: The Addiction Policy Forum will work with hospitals to develop tools to support effective post-overdose interventions. This project will ensure that health systems have the necessary protocols, assessment tools, and linkages between care and follow-up to turn an overdose into an opportunity for intervention and connection with treatment and recovery. Pilots underway with Mercy Health Systems and Berger Hospital in Ohio will produce open-source tools and protocols necessary to support emergency departments across the country in implementing interventions to help patients who overdose.

  4. Research to Find a Cure: Together with our partners such as Faces & Voices of Recovery, the Addiction Policy Forum will launch the Addiction Science Initiative: Advancing Treatment and Recovery. This initiative will raise funds to support research by the National Institute on Drug Abuse (NIDA)* on treatment and recovery from substance use disorders, including opioid use disorder.

  5. Recovery Initiative: The Forum will work with national partner Faces & Voices of Recovery to support the growth of statewide recovery community organizations across all 50 states and to enhance recovery support throughout the nation.

“Taken together, the programs and partnerships announced today by the Addiction Policy Forum represent the most comprehensive, direct approach to the opioid crisis in America to date,” said Gen. Barry McCaffrey, advisory board chair for the Addiction Policy Forum and former Director of the Office of National Drug Control Policy. “The 21 million Americans who are living with the disease of addiction need our help urgently – there is simply no more time to waste. By welcoming all stakeholders to the table and focusing on action over rhetoric, we can have a lasting impact on this crisis.”

In the coming months, the Addiction Policy Forum will roll out additional initiatives that build on its efforts to implement a comprehensive response to addiction, including a partnership with the National Association for Children of Addiction (NACoA) to assist children who are impacted by addiction. In addition, the National District Attorneys Association (NDAA) and Treatment Alternatives for Safe Communities (TASC) Illinois will work with the Forum to improve the criminal justice response to substance use disorders. A partnership with Young People in Recovery (YPR) will assist in linking individuals to age-appropriate recovery support services. Further, the Forum will engage the Legal Action Center to expand awareness and understanding of substance use treatment insurance coverage parity requirements, and to support advocacy efforts to improve compliance with the law.

Programs are also in development to significantly enhance crisis support services with Live4Lali and to provide medical professionals with ongoing education about the identification and treatment of substance use disorders.

A copy of the Addiction Policy Forum’s comprehensive 8-point plan can be found here.

Link to original press release here.

The Addiction Policy Forum

The Addiction Policy Forum is a 501(c)3 established in 2015 as a diverse partnership of organizations, policymakers, and stakeholders committed to working together to elevate awareness around addiction, and to improve programs and policy through a comprehensive response that includes prevention, treatment, recovery, and criminal justice reform. Jessica Hulsey Nickel, whose own family was devastated by addiction, is the founder of a coalition of 1,700 families impacted by substance use disorders and is available for further explanation and interviews by media.

For more information, visit www.addictionpolicy.org and follow us on www.twitter.com/AddictionPolicy.

Contact:

Jay Ruais

(603) 475-0332

jruais@addictionpolicy.org

*NIDA does not participate in the business affairs, lobbying, or fundraising activities of the Addiction Policy Forum, or any other organization.

America’s Workforce Is Paying A Huge Price For The Opioid Epidemic

America’s opioid and heroin crisis was declared a national public health emergency last month. The epidemic claimed 64,000 lives last year – more than car accidents or guns. Opiate-related overdoses are now the leading cause of death for Americans under the age of 50.  Not surprisingly, data points to a significant impact on the American workforce and the economy at large.

An October PBS NewsHour report, “How Opioids Have Decimated the American Workforce,” looked at a region in Ohio where employers are hard-pressed to fill job openings for skilled workers. The CEO of Columbiana Boiler Company, Michael Sherwin, said his company has had job vacancies lasting up to two years. He estimated a business loss of $200,000 a year due to the lack of skilled workers. In many cases, candidates who have the necessary skills are unable to pass drug screenings. Sherwin said they have to turn down about 25 percent of qualified applicants for this reason. The report highlighted the story of one skilled welder who had been out of the workforce for three years due to an opioid addiction that began a decade ago when he was prescribed Vicodin for pain, as well as a machinist whose struggle with addiction had kept him out of the workforce for six years.

Even as employers across industries face skilled labor shortages, a growing number of working age men and women are disappearing from the workforce. The labor force participation rate has been declining since 2000, with a notable and consistent decline in labor force participation among men aged 25-54.

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Heroin and opioid drugs are having an impact on the American workforce and the economy at large. Image: Shutterstock

Princeton economist Paul Kruger has linked the rise in opioid prescription rates by county with a decline in labor force participation of men and women alike. His findings suggest that the opioid crisis could account for as much as twenty percent of the decline in LFP of working-age men.

Construction and manufacturing – two major industries dealing with skilled labor crunches – are being hit hard by the opioid crisis. Recent reports from insurer CNA Financial Corp showed that spending on opioid prescriptions is consistently five to ten percent higher in construction than any other industry. Spending tends to be higher in manufacturing than in most other industries, CNA also found.

Employers And Unions Tackling The Problem

A group of construction industry stakeholders in St. Louis is confronting the problem head-on. Last December, Construction Forum STL devoted their December panel to the topic, titling the forum “Opioids: A Building Epidemic.” The panel brought together union leaders, medical experts and addiction recovery specialists for a frank discussion about the opioid crisis and what can be done about it.

Don Willey spoke candidly at the forum about his 36-year-old son’s death in 2016 from an overdose, which followed a 15-year struggle with addiction.

“Over the last few years when people would ask about my kids, I would tell them Matt struggles with life. He is a heroin addict,” Willey said. “If I couldn’t admit his addiction, how could I expect him to? And it was only right to make people aware.”

Willey is the business manager for the Laborer’s International Union of North America Local #110 in St. Louis. Since his son’s death, he has led efforts within his union to raise awareness about addiction and the challenges faced by individuals and families who are struggling with it.

Robert Riley, a recovery specialist on the STL panel, emphasized that addiction is a medical issue. “An addict’s brain has been hijacked,” Riley said. “Their body is telling them that before they eat, sleep, reproduce, take a breath – they need to put opiates in their system.” Riley also said, “It starts with the prescription drugs and that’s what we need to educate people on.” Recent data suggests that four out of five heroin users started down this destructive path via prescription opioids.

The dramatic increase in opioid prescriptions over a 15-year period is at the root of the epidemic. Sales of prescription painkillers in the U.S. quadrupled between 1999 and 2010, according to the Centers for Disease control and Prevention. The CDC also reports that since 1999, deaths from prescription opioid overdoses have quadrupled.

At the end of the forum, the moderator asked for a show of hands from those whose lives had been touched by the opioid and heroin epidemic. Nearly everyone in the audience of roughly 150 people raised a hand. In fact, all but three.

De-Stigmatizing Addiction And Supporting Workers

What can employers and industry stakeholders do? “The first thing is having the conversation,” said John Gaal, director of training and workforce development for the St. Louis-Kansas City Carpenters Regional Council. “It’s a tough subject to discuss but it’s not a matter of poor moral character. It’s a form of mental illness and we need to treat it that way.”

The Carpenters Council is addressing the issue in a number of ways aimed at raising awareness and providing support for workers and their family members who are struggling with opioid addiction.

In May, the council adjusted their drug testing policy. Formerly, policy dictated that a worker who didn’t pass a drug test was not eligible to work for a minimum of thirty days. The new policy gives workers the chance to return to work sooner, as long as they are following a treatment plan.

“We now know that isolation is an addict’s worst enemy,” said Gaal. “Sending someone home for thirty days with nothing to do isn’t the answer.”

The new drug-screening policy is more realistic, Gaal explained. “As long as they’re following their plan of treatment, they can return to work as soon as they’re able to test clean,” he said.

The council is also focusing on individual case management and resources to help struggling workers.

Both the Carpenter’s Union and the Laborer’s Union manage their own health care plans. Gaal said this offers an opportunity to provide focused case management for workers who have been prescribed opioids.

“We’ve got the ability to appropriately mine our data and follow up with our workers who have been prescribed opioids,” Gaal said. “And we can use that to educate people about the potential for addiction and provide support for individuals and families struggling with this.”

The Carpenters Council includes mental health courses in their safety training. Mentors in the apprenticeship program are required to complete eight hours of mental health “first aid”.

The Carpenters also participate in the Second Chance program, offering apprenticeships and a pathway to ex-offenders re-entering the workforce who have served their time and want to learn a trade.

“We can’t keep our heads in the sand about this issue. If we’re not talking about it, we’re not going to collectively solve it,” Gaal said.

Author: Nicholas Wyman  Published: 12/12/2017

Link to original article here.