Ohio Addiction Policy Inventory and Scorecard

This report is the first in a series of inventories and scorecards analyzing Ohio’s policy response to the addiction crisis and outlining areas where the state could be more effective.

The report provides policymakers and other stakeholders with the information needed to take stock of Ohio’s policy response to the addiction crisis over the past five years by reviewing state-level policy changes enacted in Ohio from 2013-2017. It includes:

  • An inventory of policy changes (legislation, rules, regulations and new or expanded state agency initiatives, programs, systems changes or guidelines) 
  • A scorecard that indicates the extent to which Ohio is implementing strategies that are proven effective by research evidence
  • Opportunities for improvement in both the public and private sectors

The report focuses on the first three elements of a comprehensive policy response to addiction: prevention, treatment and recovery. HPIO plans to develop similar inventories and scorecards for other key elements in 2018 and 2019 (see graphic below).

3 key findings for policymakers

In 2016, 4,050 Ohioans died because of  unintentional drug overdoses, and preliminary 2017 data indicates that the number of deaths has continued to rise.

The consequences of addiction are widespread. For example, the number of babies born with neonatal abstinence syndrome (NAS) increased 500 percent in the past 10 years and thousands of children experience trauma because they live in families struggling with addiction. Employers report difficulty hiring drug-free workers, and researchers estimate that the opioid crisis cost Ohio $3,385 per capita in healthcare and criminal justice spending and reduced worker productivity in 2015. 

Public and private stakeholders have worked hard to understand and address the crisis. Policy changes advanced by the executive and legislative branches have led to implementation of many evidence-based programs in Ohio, reduced the amount of opioid prescriptions dispensed and increased health insurance coverage and treatment access for thousands of Ohioans through expanded Medicaid eligibility.

AEP_Scorecard1_Fig1

Although this report has a strong focus on prescription opioids and other opiates, the detailed inventory and scorecard (available below) also review policy changes related to several other substances (alcohol, tobacco, methamphetamine, cocaine, etc.).

HPIO logo

The report is part HPIO’s Addiction Evidence Project, which provides policymakers and other stakeholders with information needed to address substance use disorders in a comprehensive, effective and efficient way. This inventory and scorecard addresses three topics: prevention, treatment and recovery. Future reports will address the other topics listed below, including overdose reversal (naloxone).

Additional resources on addiction prevention, treatment and recovery

Link to original site here.

Opioid Crisis Takes Personal Toll on Washington

The opioid crisis is hitting families across the nation regardless of income, race or gender. Lawmakers are no exception. In the past few months, The Hill has talked to a number of House and Senate members who have a personal connection to addiction and the opioid epidemic. This is the first in a five-part series presented by Partnership for Safe Medicine.

The epidemic has put enormous strain on health care responders, treatment providers and communities across the country, creating a health emergency that shows no signs of abating.

Yet despite the gravity of the problem, there’s a sense from some that the nation isn’t doing enough to stem the crisis.

Congress has approved $6 billion in new spending over the next two years to combat opioid abuse and bolster mental health services, but some say that is a drop in the bucket compared to what’s needed.

“If it were some other illness, we would be throwing exponentially more dollars at this than we are,” said Patrick Kennedy, a former Rhode Island Democratic congressman who’s now a vocal advocate for fighting drug addiction.

TextGrabOpioids

“We would be mobilizing significantly more federal resources toward tackling this. We would be marshaling every agency within the federal government to attack this,” said Kennedy, who served on the president’s commission to combat the opioid epidemic last year and has since been critical of the White House’s response to the crisis.

Deaths involving opioids have been rising since 1999. They increased nearly 28 percent from 2015 to 2016, an increase largely driven by a synthetic opioid packing up to 50 times more power than heroin.

An estimated 115 people are dying of an opioid-related overdose every day. When members of Congress return to their districts, they say they hear first-hand how painkillers, heroin and fentanyl are wrecking lives — and that’s resulted in a sea change in attitudes about drug abuse.

The notion that addiction is a disease, rather than a moral failing, is increasingly the consensus.

“My old boss, Michael Botticelli [former President Obama’s drug czar], would say all the time, ‘you can’t hate up close,’ ” said Regina LaBelle, the White House Office of National Drug Control Policy’s chief of staff under Obama.

Opioid Overdose Deaths Graph 1

Opioid Overdose Deaths Graph 2

The shift in perspective has resulted in a less punitive response than in the past. In the 1980s, for example, policymakers responded to the crack cocaine epidemic by launching the “war on drugs” and creating mandatory minimum prison sentences for drug offenders.

“If your brother or your sister or your neighbor is dying of a drug overdose, you are less likely to want to have a punitive response, and the difference in what happened today than what happened in the ’80s reflects that,” LaBelle said.

Advocates working on addiction policy say it has also gotten easier to publicize the problem.

More than 15 years ago, when Andrew Kessler first began working in the field, he said advocates “had to fight for every bit of attention we got.”

Kessler, the founder of the behavioral health consulting firm Slingshot Solutions, recalled a presentation he gave in 2013 on addiction advocacy.

“The reason we can’t get a lot of traction is because no member of Congress is going to go home to their districts and say, ‘I’m running on a platform of treating substance abuse and addiction,’ ” Kessler recalled telling the crowd.

“Three years later, in the 2016 election — boom — I was already wrong,” Kessler said.

Kessler attributes the turnaround to the increasing number of opioid overdose deaths, which rose nearly 70 percent between 2013 and 2016.

Drug Overdose Deaths Map

The response from policymakers is improving, though much more is needed, said Patty McCarthy Metcalf, the executive director of Faces and Voices of Recovery.

“Getting Congress to take this issue up took a lot of work and a lot of advocacy from the grass roots to put pressure on Congress to understand that this didn’t happen overnight, it’s been coming for a while,” she said. “The rate [of opioid-related overdose deaths] has been increasing — we haven’t seen it decreasing, so something is not working.”

Efforts are underway in both chambers to produce opioid legislation, which could be one of the only larger legislative packages to pass before the midterm elections in November.

The House Energy and Commerce Committee has held three legislative hearings on more than 65 separate bills with the goal of getting an opioid package to the House floor before Memorial Day weekend.

On the other side of the Capitol, a bipartisan group of eight senators introduced a follow up to the Comprehensive Addiction and Recovery Act, passed in 2016, dubbing the bill “CARA 2.0.” One of the bill’s most controversial provisions is a three-day limit on first-time opioid prescriptions for patients with acute pain.

Earlier this month, the leaders of the Senate Health Committee released a bipartisan discussion draft of an opioid bill, which the panel reviewed at a hearing last week and will mark up April 24.

The Trump administration is also pushing for action.

Declaring “we can be the generation that ends the opioid epidemic,” President Trump made opioids a national public health emergency in late October. But some advocates have expressed frustration with that move, saying it has led to little concrete action.

Last month, Trump released a three-pronged approach to tackle the opioid epidemic, which included some measures popular with public health advocates.

But a portion of Trump’s rhetoric, and a bulk of the subsequent media attention, focused on the inclusion of a controversial provision — mandating that the Department of Justice seek the death penalty for some drug traffickers, when appropriate under current law.

Advocates have said the concept is reminiscent of the war-on-drugs approach that failed in the past.

Instead, they say a focus on prevention, treatment and recovery is what’s needed, as advocates work to stomp out the stigma of addiction. Some progress is being made on that front, advocates say, with more people coming forward to say they have an addiction or lost a loved one to a drug overdose.

“You can see it in the obituaries,” Kennedy said, “literally for the first time ever, you’re seeing on a regular basis people actually acknowledge the true cause of death for people dying of overdoses.”

Kaitlin Milliken contributed to this report. Graphics and illustration by Nicole Vas. Video by Tom Pray.

Original article here on thehill.com.

Naltrexone: What Should Patients Expect With First Dose?

This two-part video gives both providers and patients detailed information about naltrexone, including benefits and possible side effects following the injection.

Dr. Mariani, Associate Professor of Clinical Psychiatry at the College of Physicians and Surgeons of Columbia University, is a PCSS clinical expert.  He discusses naltrexone with a patient who has chosen that medication to treat her opioid use disorder.

Part 1

Part 2

 

View more videos at pccsNOW.org

ASAM and the AMA Announce Innovative Payment Model to Improve Treatment of Opioid Use Disorder

Washington, D.C. – The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) jointly announced today the release of a concept paper detailing a groundbreaking alternative payment model (APM) that could revolutionize how patients with opioid use disorder are treated.

The new payment model, known as Patient-Centered Opioid Addiction Treatment (P-COAT), is expected to increase the number of patients with opioid use disorder who are able to lead satisfying, productive lives through successful management of their condition while also reducing health care spending on costs associated with addiction, such as emergency department visits and hospitalizations.

“We have seen significant increases in the rate of individuals dying from opioid poisonings across the United States once again this year,” said Kelly J. Clark, MD, MBA, DFAPA, DFASAM, president of ASAM. “At the same time, millions of individuals across the country continue to lack access to treatment due to insurance reimbursement and coverage barriers. I am proud of the AMA-ASAM APM Working Group for developing a framework that seeks to address these issues.”

The new payment model seeks to increase utilization of and access to medications for the treatment of opioid use disorder by providing the appropriate financial support to successfully treat patients and broaden the coordinated delivery of medical, psychological, and social support services. P-COAT is also designed to support office-based opioid treatment in order to facilitate coordination between multiple treatment providers. Previously, payment for these services has been segregated, which contributes to patient difficulties receiving comprehensive care.

“Arbitrary limitations on effective, comprehensive treatment are stymying physician efforts to treat patients with opioid use disorder,” said Patrice A. Harris, MD, MA, chair of the AMA Opioid Task Force. “This new tool will remove a brick in the wall that prevents patients from accessing needed treatment. Eventually, this wall will be torn down. Until then, we must continue fighting for our patients and remove arbitrary barriers to care.”

The P-COAT APM is based on a wealth of research showing that medications combined with psychosocial supports is effective in treating individuals with opioid use disorder. Unfortunately, the current physician payment system offers little support for the coordination of behavioral, social and other support services that patients being treated for opioid use disorder need in addition to their medication. Non-face-to-face services – such as phone calls and email consultations with patients – in addition to better coordination between specialists, outpatient treatment programs and other health providers such as emergency rooms, are essential to the delivery of effective, evidence-based treatment to the individuals who need it.

“The current physician reimbursement structure does not account for all the services that patients with an opioid use disorder need to progress to successful treatment and recovery,” said Shawn Ryan, MD, MBA, ABEM, ABAM, FASAM, chair of the AMA-ASAM APM Working Group and ASAM’s Payer Relations Committee. “While we know that a combination of medication and psychosocial support systems is the evidence-based standard for treatment, we continue to find that patients are not able to access treatment due to limited or non-existent insurance coverage. We hope that today’s announcement will begin a national conversation with insurers and policymakers about what it takes for successful treatment and recovery.”

AMA logo asam-logo.png

For more information about the P-COAT APM, please review ASAM’s issue brief here.
The complete P-COAT APM is available here..

Media Contacts:
Rebecca Reid (ASAM)
(410) 212-3843
rreid@schmidtpa.com

Jack Deutsch (AMA)
(202) 789-7442
jack.deutsch@ama-assn.org

Confronting the Opioid Crisis: Nursing Colleges Add Curricula

Nursing colleges add curricula to deal with a growing public health problem. Nurses are on the front lines of the opioid epidemic. As the first faces many patients see, nurses have the opportunity to identify individuals who are addicted, and they can also save lives by administering naloxone, an “opioid antagonist” that reverses the effects of an overdose.

But many nursing colleges are only relatively recently adding programs about preventing and treating opioid addiction.

Deborah Finnell, associate professor in the department of acute and chronic care at Johns Hopkins University’s School of Nursing, said that since she arrived at Hopkins about five years ago, she’s made a concerted effort to push for more instruction on substance use, which she said is lacking in nursing programs across the country.

Finnell co-authored a report published by Nurse Educator last year that said nursing programs lacked curricula on substance use disorders, and offered ways to remedy this problem. The emergence of the opioid crisis has emphasized the need to better inform nursing students about addiction, the report says.

“Nursing curricula have not kept pace with the growing public health crises related to alcohol and other drug use and the expanding evidence base for treatments,” the report states, adding that curricula on addiction haven’t changed much in four decades.  Nurses have an important role in combating the opioid epidemic because they can intervene before an addiction spirals, the report says.

New Courses Trickle In

 

Over the past year or so, a number of nursing schools have introduced programs to teach students to prevent and treat an opioid addiction or overdose.

At the University of Pennsylvania Nursing School, starting this fall, the nursing program will offer an undergraduate elective, Opioids: From Receptors to Epidemic, which includes a lecture on overdoses, according to Peggy Compton, an associate professor, who will co-teach the class with Heath Schmidt. The course covers acute and chronic pain, the composition of opioids, the pathophysiology of opioid addiction, treatment options, the historical foundations of the crisis, and current policies regulating opioid distribution. While the class is geared toward nursing students, it’s open to all majors “because the implications go beyond health care,” Compton said via email. Doctor talking to patient

Penn is also in the midst of developing two simulation programs — one in person, and one via virtual reality. In February, Penn piloted a two-hour in-person simulation for nursing students. In the session, actors mimicked the symptoms of an opioid overdose, as well as overdoses of heroin and fentanyl, which are more potent versions of prescription opioids (many times, opioid users will switch to heroin or fentanyl if their prescription is not renewed). Students were able to practice treating these patients, including dealing with their reactions, which run the gamut from anger to distress to fear, according to Ann Marie Hoyt-Brennen, Penn’s simulation education specialist. The pilot was deemed a success and starting this summer will be a requirement in two courses, one graduate and one undergraduate.

A February 2017 study by the National Bureau of Economic Research found that when states increased access to naloxone, opioid fatalities declined by 9 to 11 percent. Despite this, naloxone has received some negative press: critics say the opioid antagonist encourages addicts to use again. Because of this perception, said Clare Whitney, a Ph.D. candidate in Penn’s school of nursing, many nurses are not aware of the medication or do not know how to administer it.

“This is a really problematic narrative,” Whitney said. “The problem is not that we have a drug that can save a life. The problem is that we don’t have proper care.”

Marymount University will also pilot an opioid-related simulation this month for 90 students in the health department, including the nursing program. Catherine Hillberry, director of the college’s nursing lab, will show students a video of an opioid overdose and follow up with a discussion on treatment and prevention strategies. Nurses need to learn to work as a team with other medical professionals, Hillberry said.

“We don’t work in silos, we work with other people, so we have to know how to talk to other people, how to interact with them,” Hillberry said.

The University of Cincinnati Nursing School started reviewing its curricula on addiction a year ago after joining 190 other American Association of Colleges of Nursing members in an agreement to teach advanced-practice nurses about the Centers for Disease Control and Prevention’s “Guidelines for Prescribing Opioids for Chronic Pain,” released in 2016. In response, Sherry Donaworth, associate professor of clinical nursing at Cincinnati, wove the guidelines into the college curriculum. Donaworth now requires her advanced-practice nursing students to take three hours, in addition to the usual six, of instruction on prescribing opioids. “Providers have an obligation to prescribe in a way that doesn’t perpetuate the problem,” Donaworth wrote in a blog post.

Some community colleges are also focusing on the opioid epidemic, too.

At Washington State Community College, in Ohio, Alicia Warren, director and associate professor of practical nursing education, said the nursing department recently introduced more information on opioid use. In June, faculty members were urged to take a four-hour course called Understanding Substance Use Disorder in Nursing, offered by the National Council of State of Boards of Nursing. This semester, students were required to watch a short video released by the board called “Substance Use Disorder in Nursing” and take part in discussions on opioid addiction in introductory and ethics courses. Students are also taught to administer naloxone, which is becoming increasingly accessible, Warren said.

Overcoming Stigma

Many nursing instructors cite stigma as a key challenge. To Craig Sellers, director of the master’s program at the University of Rochester School of Nursing, subverting perceptions of addiction begins with language.

Nurses discussing pamphlet

“We know that addiction is a health-care problem. It’s not about a lack of character, if you will,” Sellers said. “We really try to avoid the term ‘addict.’”

Stephen Strobbe, clinical associate professor at the University of Michigan, echoed Sellers’s point, cautioning against using the word “abuse.”

“The term ‘abuse’ has fallen out of vogue in our field, and is now seen as negative, judgmental and pejorative,” Strobbe said.

Cincinnati recently started offering nursing students a presentation about the neurobiology of addiction, aiming to subvert negative attitudes tied to substance use disorder. Jennifer Lanzillotta, a clinical nursing instructor, created the session, which includes firsthand accounts from clinicians who became addicted to opioids themselves — an issue that isn’t unusual in the medical profession. Lanzillotta is surveying students before and after the course to determine how their perception of addiction shifted after viewing the presentation.

“No one wakes up and says, ‘I want to be a drug addict,’” Lanzillotta wrote in a blog post. “This presentation has shown we can reduce the stigma associated with drug abuse by health-care providers.”

Read more by Grace Bird

Original article here originally posted on https://www.insidehighered.com/.

Changes to Morphine Milligram Equivalent

Recently, the Centers for Disease Control and Prevention (CDC) released guidance that excluded buprenorphine from the narcotic mg equivalent (MME)/day calculation. OARRS will now calculate and display a patient’s narcotic (opioids) and buprenorphine equivalences separately.

Buprenorphine is often used as a form of medication assisted treatment (MAT). For most of 2017, a typical dose of buprenorphine, when prescribed for MAT, was 16 mg. This would result in a Patient Report of 480 MME value.

To reflect this change, the OARRS system will be making upgrades to the MME column in the patient reports starting on April 11th. This will include:

  • Buprenorphine excluded from displayed MME calculations
  • Summary section of Patient Report will no longer only display Active Daily MMEs
  • Prescriptions section of Patient Report to be updated to reflect mg/day for buprenorphine

The Science of Addiction – “Get the Facts”

Get the facts about how addiction affects our bodies, our brains, and our behavior, while learning about the biological and psychological factors that often drive addiction.

What is addiction?

The National Institute of Drug Abuse (NIDA) defines addiction as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.1

In the United States, 8–10% of people over the age of 12 are addicted to alcohol or other drugs. That’s approximately 22 million people.(Cigarette smoking is also an addiction that kills people.)

Addiction is chronic—but it’s also preventable and treatable

When a disease is chronic, that means it’s long-lasting. It can’t be cured, but it can be managed with treatment. Other examples of chronic diseases include asthma, diabetes, and heart disease.

It is critical that treatment simultaneously addresses any co-occurring neurological or psychological disorders that are known to drive vulnerable individuals to experiment with drugs and become addicted in the first place. Otherwise, the best addiction treatment in the world alone is not effective for those with co-occurring illnesses.

If video does not work correctly, please visit: https://www.youtube.com/watch?v=DMcmrP-BWGk#action=share

Addiction is a disease

Respected institutions like the American Medical Association and the American Society of Addiction Medicine define addiction as a disease.3 Studies published in top-tier publications like The New England Journal of Medicine support the position that addiction is a brain disease.4

A disease is a condition that changes the way an organ functions. Addiction does this to the brain, changing the brain on a physiological level. It literally alters the way the brain works, rewiring its fundamental structure. That’s why scientists say addiction is a disease.

Although there is no cure for addiction, there are many evidence-based treatments that are effective at managing the illness. Like all chronic illnesses, addiction requires ongoing management that may include medication, therapy, and lifestyle change. Once in recovery from substance use disorder, a person can go on to live a healthy and successful life. Addiction is treatable, and recovery should be the expected outcome of treatment.

How does addiction change the brain?

The human brain is wired to reward us when we do something pleasurable. Exercising, eating, and other pleasurable behaviors directly linked to our health and survival trigger the release of a neurotransmitter called dopamine. This not only makes us feel good, but it encourages us to keep doing what we’re doing. It teaches our brains to repeat the behavior.5

Drugs trigger that same part of the brain—the reward system. But they do it to an extreme extent, rewiring the brain in harmful ways.

When someone takes a drug, their brain releases extreme amounts of dopamine—way more than gets released as a result of a natural pleasurable behavior. The brain overreacts, reducing dopamine production in an attempt to normalize these sudden, sky-high levels the drugs have created. And this is how the cycle of addiction begins.

Once someone is addicted, they’re not using drugs to feel good — they’re using drugs to feel normal

Studies have shown that consistent drug use severely limits a person’s capacity to feel pleasureat all.6 Over time, drug use leads to much smaller releases of dopamine. That means the brain’s reward center is less receptive to pleasure and enjoyment, both from drugs, as well as from every day sources, like relationships or activities that a person once enjoyed. Once the brain has been altered by drug use, it requires more and more drugs just to function at a baseline level.7

Withdrawal is a painful, whole-body experience

Withdrawal happens when a person who’s physically dependent upon a substance stops taking it completely: either in an attempt to quit cold turkey, or because they don’t have access to the drug. For pain-management and opioid users in particular, even if a user is not addicted, they can still become dependent on the medication, and they would still experience withdrawal. Someone in withdrawal feels absolutely terrible: depressed, despondent, and physically ill.

An addicted brain causes behavior changes

Brain imaging studies from drug-addicted individuals show physical, measurable changes in areas of the brain that are critical to judgment, decision making, learning and memory, and behavior control. Scientists believe that these changes alter the way the brain works, and may help explain the compulsive and destructive behaviors of addiction.8

A promising student might see his grades slip. A bubbly social butterfly might suddenly have trouble getting out of bed. A trustworthy sibling might start stealing or lying. Behavioral changes are directly linked to the drug user’s changing brain.

Cravings take over. These cravings are painful, constant, and distracting.9 The user starts seeking out drugs, no matter the consequences, often resulting in compulsive and destructive behaviors. Especially given the intensity of withdrawal symptoms, the body wants to avoid being in withdrawal at all costs.

What fosters addiction? Science says there are three main factors.

The first time a person tries alcohol or another drug, it’s a voluntary choice. But at some point during use, a switch gets flipped within the brain and the decision to use is no longer voluntary. As the Director of the National Institute on Drug Abuse puts it, their brains have been hijacked.

Anyone who tries a substance can become addicted, and research shows that the majority of Americans are at risk of developing addiction. Over 40% of 13–14 year olds, and over 75% of 17–18 year olds, report that they’ve tried alcohol. What’s more, 42% of 17–18 year olds report that they’ve tried illicit drugs.10

After initial exposure, no one chooses how their brain will react to drugs or alcohol. So why do some people develop addiction, while others don’t?

The latest science points to three main factors.

Three Main Factors Addiction

All this scientific evidence points to one bottom line: addiction is not a moral failing.

Addiction is not a choice. It’s not a moral failing, or a character flaw, or something that “bad people” do. Most scientists and experts agree that it’s a disease that is caused by biology, environment, and other factors.

Harmful consequences, shame, and punishment are simply not effective ways to end addiction. A person can’t undo the damage drugs have done to their brain through sheer will power. Like other chronic illnesses, such as asthma or type 2 diabetes, ongoing management of addiction is required for long-term recovery. This can include medication, behavioral therapy, peer-support, and lifestyle modifications.

Learn more about evidence-based prevention, treatment, and recovery methods.

References:

1. National Institute on Drug Abuse. The Science of Drug Abuse and Addiction: The Basics.
2. Grant B, Saha TD, Ruan WJ. “Epidemiology of DSM-5 Drug Use DisorderResults From the National Epidemiologic Survey on Alcohol and Related Conditions–III.” The Journal of the American Medical Association, January 2016.
3. ASAM. Definition of Addiction. 
4. Volkow ND, Koob GF, McLellan AT. “Neurobiologic Advances from the Brain Disease Model of Addiction.” The New England Journal of Medicine, 28 January 2016.
5. “Drugs, Brains and Behavior: The Science of Addiction.” National Institute on Drug Abuse, July 2014.
6–7. Volkow ND, Koob GF, McLellan AT. “Neurobiologic Advances from the Brain Disease Model of Addiction.” The New England Journal of Medicine, 28 January 2016.
8. “Drugs, Brains and Behavior: The Science of Addiction.” National Institute on Drug Abuse, July 2014.
9. Volkow ND, Koob GF, McLellan AT. “Neurobiologic Advances from the Brain Disease Model of Addiction.” The New England Journal of Medicine, 28 January 2016.
10. Swendsen J, Burstein M, Case B. “Use and Abuse of Alcohol and Illicit Drugs in US Adolescents: Results of the National Comorbidity Survey–Adolescent Supplement. The Journal of the American Medical Association, April 2012.
11. The National Center on Addiction and Substance Abuse. Addiction Risk Factors.
12. “Drugs, Brains and Behavior: The Science of Addiction.” National Institute on Drug Abuse, July 2014.
13. “Drugs, Brains and Behavior: The Science of Addiction.” National Institute on Drug Abuse, July 2014.

Original article here on http://Shatterproof.org.

Federal Moves to Help Opioid Crisis Not Enough, Experts Say

Anybody who knows someone at risk of an opioid overdose should always carry naloxone, the anti-overdose drug, Surgeon General Dr. Jerome Adams said Thursday. He said his office was working with manufacturers and insurance companies to help make it possible.

At the same time, the National Institutes of Health announced a near-doubling of its budget for opioid addiction research, and the Food and Drug Administration commissioner said his agency would do more to stop the import of illicit opioids.

A bill to give the FDA more powers to regulate how opioids are packaged, and to help states treat and rehabilitate people with opioid addiction, was also moving through the Senate.

USSurgeonGeneral
US Surgeon General, Dr. Adams

It may sound like a lot is suddenly happening to fight the opioid crisis. But while each announcement is welcome, experts said, it will still be difficult to create action right away.

“We are hearing rhetoric,” said Lindsey Vuolo, associate director of health law and policy at the National Center on Addiction and Substance Abuse. “They are all important steps but none of them are sufficient to fully address the problem.”

Adams said he wanted to make it possible for just about everyone in some communities to be carrying naloxone, a drug that can reverse an opioid overdose almost immediately.

“With over half of overdoses occurring at home and three quarters of overdoses occurring in a nonmedical setting, we know we can’t rely solely on first responders to save lives,” Adams told NBC News.

“In some scenarios everyone in a community should have naloxone if there’s a high proportion of individuals who are at elevated risk.”

Adams said his office had helped negotiate some discounts with companies that make naloxone, including Kaleo, which makes an auto-injector for naloxone and Adapt, which makes Narcan, a nasal spray version of the drug.

“Kaleo has agreed to discount their price 90 percent to federal and state governments and to entities that have funding through federal and state government programs. And they also have a program to provide that medication for free to individuals who fall in the in the gap,” Adams said.

In six states — Arizona, California, Colorado, Missouri, Nevada and Ohio — people with commercial health insurance can call a pharmacy and get naloxone delivered at no cost, Kaleo said.

Baltimore City Health Commissioner Dr. Leana Wen said the plan is a good first step.

“Our problem isn’t the policies. It’s access to the medications,” Wen said. “We are being priced out of our ability to save lives.”

Wen said Baltimore needs $10 million a year from the federal government to fight the opioid epidemic.

“It cannot be one-time funding. It must be sustained,” she said. The discounted price offered by Kaleo is still too expensive,” she said.

“We are having to ration naloxone,” Wen added. “Between now and July I only have about 160 kits of naloxone left to give out, which means that every day, I have to make a decision about who is going to get this naloxone and who will have to go without.”

 There is no question that naloxone works, Wen said.

“I’m an emergency physician and in the ER,” she said. “I’ve used naloxone hundreds of times and I’ve seen how someone who is about to die from an opioid overdose, if they’re given naloxone, they’ll be walking and talking again in seconds.”

And there’s no question that the U.S. is suffering through a terrible epidemic of opioid abuse.

The CDC says synthetic opioid overdoses killed 20,000 people in 2016. Opioid overdose deaths are so bad they have helped drive down U.S. life expectancy.

The Kaiser Family Foundation said in a new report that the cost of treating opioid addiction and overdose has gone up eight-fold for private health insurance companies since 2004, from $300 million dollars in 2004 to $2.6 billion in 2016.

The federal government is under pressure to act.

The NIH said it was doubling its research budget for opioid abuse from $600 million to $1.1 billion and would focus on finding safer ways to treat pain and better ways to treat addiction and abuse disorders.

A bill in discussion in the Senate would provide grants for communities to operate opioid recovery centers and would give the FDA power to force companies to package opioids in blister packs to deter abuse.

FDA commissioner Dr. Scott Gottlieb said he would work to help better educate and guide doctors about the best ways to treat pain, including prescribing far lower doses of opioids.

Gottlieb said he was going to speak with internet companies to see if they could help stop illegal sales of opioids. “The easy availability and online purchase of these products from illegal drug peddlers is rampant and fuels the opioid crisis,” Gottlieb told the National Prescription Drug Abuse and Heroin Summit, being held in Atlanta.

“We find offers to purchase opioids all over social media and the Internet, including Twitter, Facebook, Instagram, Reddit, Google, Yahoo, and Bing.”

These are all positive steps, said Vuolo.

“There are some efforts that are being made, but we are not seeing the wholesale, comprehensive approach that is needed,” she said.

“We have effective treatments for opioid addiction, but people aren’t getting them. The reality is the vast majority of people are unable to find care, they are unable to pay for it, or they’re not receiving care that’s effective,” she added.

Original article here on NBCnews.com.

National Public Health Week: OHSAM President Part of Panel Discussion at UC

Dr. Shawn Ryan, president of the Ohio Society of Addiction Medicine will join several other panelists on Wednesday to discuss the opioid epidemic in the Cincinnati area. The Keynote speaker for Wednesday’s event will be Tom Synan, chief of police for Newtown, Ohio, and a leading regional and national advocate in the fight against the opioid crisis. Synan is a 24-year police veteran with the Newtown Police Department, serving the last 10 years as police chief and as a SWAT Team Leader. He was a founding member of the Hamilton County Heroin Coalition and has provided testimony to the U.S. Senate Homeland Security Committee about deadly synthetic opiates. Synan will provide insight into the complexity of this issue.

Presented by Delta Omega Honorary Society Gamma Rho Chapter
Master of Public Health Program in the Department of Environmental Health
University of Cincinnati College of Medicine

Location:

Kowalewski 301 in the James L. Winkle College of Pharmacy, University of Cincinnati

Following Synan’s keynote will be a panel discussion featuring researchers, clinicians and health professionals.  Schedule of events for the day are as follows:

Wednesday, April 4: Keynote and Panel discussion 

9:30 a.m. – 9:55 a.m. Doors open, sign in

10 a.m. -10:10 a.m. Welcome and Opening Remarks
• Shuk-Mei Ho, PhD, Chair of Dept. of Environmental Health
• Neil MacKinnon, PhD, Co-Chair of UC/UC Health Opioid
Task Force, Dean of UC’s Winkle College of Pharmacy

10:10 a.m. -10:55 a.m. Keynote by Tom Synan, Newtown Police Chief and a founding member of the Hamilton County Heroin Coalition.

11 a.m. – 12:00 p.m. Panel Discussion featuring:

  • Jennifer Brown, PhD, associate professor, UC Department of Psychiatry and Behavioral Neuroscience, Addiction Sciences Division.
  • Tim Ingram, Hamilton County Health Commissioner, and adjunct instructor, Public Health.
  • Michael Lyons, MD, MPH, associate professor of Emergency Medicine, and a UC Health physician.
  • Jennifer Mooney, PhD, Cincinnati Health Department and affiliate professor, UC Department of Sociology.
  • Shawn Ryan, MD, president and chief medical officer of BrightView.
Lunch at Kettering Lab Complex atrium will follow the panel discussion, around noon. Hosted by the MPH program.  For those who cannot attend, a live WebEx feed, (Event number: 649 137 008 Event password: MPH2018) is available, and will also be posted after the event at http://med.uc.edu/eh/divisions/publichealth
National Public Health Week has been an annual event organized by the American Public Health Association (APHA) since 1995. The purpose is to recognize the contributions of public health and highlight issues that are important to improving our nation.

For a full list of all events for the week of 4/2 – 4/6 please click here.

For questions about any of the events, contact  deltaomega.gammarho@gmail.com

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Video: Physician Discusses Importance of MAT

Dr. Hillary Kunins, a Providers Clinical Support System Clinical expert, discusses the importance of treating opioid use disorder using medications. If the video below does not open or play properly, please visit: https://www.youtube.com/watch?v=E17A2F-ZvQA

The content on this site is intended solely to inform and educate medical professionals. This site shall not be used for medical advice and is not a substitute for the advice or treatment of a qualified medical professional.

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Additional video from PCSSnow.org on BrightViewhealth.com titled “Respect and Dignity Key in Treating Substance Use Disorders” can be found here.

Original article/link to above video here.

More videos on PCSSnow.org.