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.


“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.

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/.

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