Medication-Assisted Treatment Needs Community Support

Communities like Portsmouth, Ohio, regularly make national news for waves of overdoses. On any given day, nearly 100 people across the country die due to opioid overdose. The problem always feels like an uphill battle, and often a losing one for social workers and drug counselors who hope to get clients on the path to sobriety.

Evidence shows that one method, medication assisted treatment (MAT), works; however, for MAT to be truly effective, it takes an entire community.

What Is Medication Assisted Treatment?

Medication assisted treatment is an evidence-based recovery process that combines traditional therapies and detox programs with the use of medication. Medication helps patients manage cravings and provides relief from detoxification symptoms. MAT is useful for people who are addicted to opioids or alcohol.

Addiction Spelled Out in Scrabble Pieces

These are some of the most common medications used to treat in MAT.

  • Buprenorphine: A partial opioid agonist, buprenorphine is used for the treatment of patients who are addicted to prescription painkillers. This medication is the first opioid treatment not required to be administered in a clinic.
  • Probuphine: Approved by the FDA in 2016, the probuphine implant requires four rods to be inserted into the upper arm. The rods provide a continuous dose of buprenorphine for six months to alleviate cravings and withdrawal symptoms.
  • Methadone: Methadone is known as a full opioid agonist, which means that it provides many of the same effects of other opioids. The effects are usually milder and do not impact the patient’s ability to function as much, though.
  • Naloxone: An opioid antagonist, naloxone can reverse or prevent life-threatening overdoses by blocking opioid activity at receptor sites. Police officers and medical workers typically carry these injections and administer as necessary. Sometimes, users also carry them in case of an emergency.
  • Naltrexone: Available as an injectable or in pill form, naltrexone is available as a monthly or daily dose and lacks the potential for abuse.
  • Acamprosate: Sometimes referred to as Campral, acamprosate is used to prevent relapse in alcoholics by lessening the post-acute withdrawal symptoms that often lead to relapse.

Along with medication, patients in an MAT program are required to participate in therapy or counseling.

Healthcare Providers and Community Members Can Erase Stigma

Even though MAT has proven to be an effective form of treatment, there’s still a stigma associated with it, as many believe that it’s about replacing one drug with another. What can be done so that members of behavioral healthcare can recommend this treatment?

Change in Mindset

Addiction is complex. It is a brain disease. Simply viewing addiction as a disease rather than a moral or criminal problem can help make addiction treatment programs, including MAT, more accessible. Despite inclusion in the Diagnostic and Statistical Manual (DSM) and research that states addiction is a disease, many community members and medical professionals do not view addiction in this way. If behavioral healthcare professionals don’t understand addiction as a disease, MAT will continue to be underutilized.

Education

Addiction professionals have a responsibility to educate others on MAT and its effectiveness. There are still misconceptions about what the treatment actually entails.

Social workers, counselors, and others must understand MAT and the evidence that supports this type of program. This also means that healthcare organizations need to mandate ongoing education for staff. Education enables counselors to make appropriate recommendations as to when individuals need abstinence-based treatment or MAT. Both types of treatment can be effective, but which is appropriate for the patients they are treating?

Law enforcement officials should also receive education and training on MAT. This includes promoting MAT as a treatment method for incarcerated addicts. A lack of MAT in prisons means many addicts end up relapsing, and even dying of an overdose because they didn’t receive proper treatment.

Access to Naloxone

Reducing stigma associated with MAT means that access to medication should go beyond the treatment setting. First responders should be trained to carry and administer naloxone. As mentioned earlier in this article, it can be a life-saving step in reducing overdose fatalities. Many states already passed legislation to allow access to naloxone. Healthcare professionals can share research and evidence with community officials to allow access to naloxone or increase supply in cities that already have it.

A holistic solution that involves the whole community is necessary to combat the opioid epidemic, reduce fatalities, and direct people to the appropriate treatment option, whether it’s MAT or not. Community officials and healthcare providers should also look to treatment centers as resources. What can they learn from the individuals who are working with these patients? In order to make MAT effective, it takes community involvement before, during, and after treatment.

Original article here posted on psychcentral.com

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.

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.

Police-Assisting-Man-With-Overdose
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.

Man-Overdosed-On-Bed-EMTs-Assisting
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.

Narcan-Nasal-Spray.jpg
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

Naloxone reverses 93% of overdoses, but many recipients don’t survive a year

(CNN) As the opioid overdose epidemic continues to surge, public health officials and first responders have turned to naloxone, the drug that reverses overdose, to help combat the rising tide. New research from Brigham and Women’s hospital in Boston shows its effectiveness.

A review of emergency medical services data from Massachusetts found that when given naloxone, 93.5% of people survived their overdose. The research looked at more than 12,000 dosages administered between July 1, 2013 and December 31, 2015. A year after their overdose, 84.3% of those who had been given the reversal drug were still alive.

“With this reversal agent, we’re saving the vast majority of people,” said Dr. Scott Weiner, lead author of the study and an emergency physician at Brigham and Women’s Hospital. “These are people who got naloxone by ambulance. So we saved them. The lesson learned is not that naloxone is failing; it’s working.”
Pill-Bottle-Syringe-WhitePowder
But it also means that once saved from an overdose by EMS, a patient had about a 1 in 10 chance of not surviving a year. About 35% of those who were dead a year later died of an opioid overdose. And that should be a concern, Weiner said: “It doesn’t treat the underlying problem.”
The findings are being presented Monday at the American College of Emergency Physicians’ annual conference in Washington.
In 2014, only 12 states allowed basic EMS staff to administer naloxone for overdose. Today, laws in every state allow the drug to be administered by anyone, from a physician to a family member.
Dr. Sharon Stancliff, an expert on opioid overdose prevention, said that although it has long been known that naloxone is effective at keeping people alive, it was the first time she recalled seeing such specific numbers regarding its effectiveness.
“It’s really important data, and there’s a lot we can do with it,” said Stancliff, medical director of the nonprofit Harm Reduction Coalition, who was not involved with the research.
According to the US Centers for Disease Control and Prevention, last year alone, there were an estimated 64,000 fatal drug overdoses, most of them from opioids. And for each fatal overdose, there are approximately 30 nonfatal overdoses — many of the cases appearing in emergency rooms across the country. In fact, between 2005 and 2014, the rate of opioid-related emergency visits increased by 99.4%.
Stancliff believes that these hard numbers could be used to help persuade emergency rooms to change how they handle overdoses.
Weiner agreed and said the next steps on what to do with a patient are key in helping stop the drug overdose crisis. In emergency rooms, once people recover from an overdose, they may be given a list of phone numbers for treatment centers but not much else.
It is important to get people “engaged in treatment as soon as possible,” he said. A number of innovative emergency departments are working toward this, whether by bringing recovery specialists into the emergency room or even by having treatment facilities nearby.
“Some of the ERs in New York are really jumping on it, starting people on buprenorphine,” a medication used to help wean people off opioids, Stancliff said.
Weiner hopes that these data can be used to help persuade clinicians to figure out the next steps — and persuade patients to take those steps.
“If I’m taking care of a patient in the ED, I want to be able to tell them what the real chances of dying are if they continue using. I can look them in the eye and say, ‘you have a 1 in 10 chance of dying in a year if we don’t get you treated,’ and I think that’s really powerful,” Weiner said.
Written by: Nadia Kounang, CNN

How My Overdose Saved My Life

I’m a mom and a wife. I’m a Chemical Dependency Counselor Assistant and Peer Recovery Support Specialist for BrightView Health in Cincinnati, Ohio, supporting those struggling with substance use disorder.

And I’ve been in recovery from heroin addiction for five years.

That’s today.

Five years ago, I was sprawled on the pavement getting a dose of naloxone. I had overdosed on heroin. It was a near-death end to a reckless existence that had started without warning.

Naloxone didn’t just bring me back to life, it gave me a second chance at life. But more than that – naloxone was the bridge that got me from the brink of death to treatment and recovery.

When I was young, I had several knee surgeries. I was prescribed pain medication on a regular basis, whether or not I needed it. And at no point was naloxone part of any medical conversation.

If it were, maybe I would have been more aware of the high risks and addictive properties of prescription opioids.

Suddenly, I was hooked. By 15, I was diagnosed as an addict and the cycle of addiction consumed the next decade of my life. I doctor shopped for pills, took opioids, used cocaine, methamphetamine and ecstasy to get my fix. I dropped out of high school, gave up the rights to my first child, and married an abusive man whose drug use was like my own.

What started as a prescription from my doctor spiraled into a deadly mission of finding the next, stronger high – eventually leading me to heroin.

I committed felonies for drug money and couldn’t hold a steady job. My young life was decaying. I became associated with members of a Mexican drug cartel and eventually became a drug mule, buying and selling black tar heroin.

I was so far gone, until thankfully, I overdosed. I say thankfully because had it not happened then, I may not be here to share my story.

Addiction is no joke. It’s not a choice. Yes, I chose heroin, but I didn’t choose to be an addict. Naloxone gave me the chance to correct my wrong choice. It didn’t enable me to keep using, like some may think.

The only thing naloxone enables is breathing.

When I overdosed, my body was pushed out of a car and onto the pavement of a parking lot. I was revived by naloxone, I woke up to strangers around me. I refused treatment and within minutes, I stood up and walked away from where my body laid, moments from death. Six weeks later, I entered into treatment, March 9, 2012.

For ten days, I slowly purged my body of the deadly drugs that brought me to that place. I left clean and with a conviction to stay that way.

Quitting heroin was the easy part, rebuilding my life was hard. But it is possible.

I cleared my criminal record, I mended relationships with my family – my daughter that I had walked away from so long ago. I remarried and gave birth to another beautiful baby girl.

As I rebuilt my life, I decided to focus my energy on helping those that were in the same nightmare I had just escaped. I went through a certification course to become a Chemical Dependency Counselor Assistant. I have worked incredibly hard to build my credibility as someone working in the field to show other addicts that recovery is possible.

So today, on International Overdose Awareness Day, what I want everyone to know is that if it weren’t for naloxone, I’d be one of the mourned, not one of the recovered.

The second chance I got is only possible with the ability to enter treatment. If an addict is still alive, there is still hope.

When a person is revived with naloxone, that is the crucial time when we as a society must offer love and compassion to them. That is the moment to look at the patient and say, “You’ve been through a lot, I want to help you find treatment and change your life.” Because no matter how far a person has gone in their life to support their addiction, as long as they are alive, hope is never gone.

I carry naloxone with me everywhere I go. It is the world we are living in today, that I need to be prepared to reverse an overdose at any time. The only way we are going to change this epidemic is if we as members of society and fellow human beings call upon each other to show compassion and love. Not one person is immune to addiction. Addiction has no prejudice and does not care who you are or how much money you have or what you look like. I am living and breathing proof why naloxone needs to be in everyone’s possession. My life is beautiful today, because of naloxone.

Amy Parker is a Chemical Dependency Counselor Assistant and Peer Recovery Support Specialist for BrightView Health in Cincinnati, Ohio. She is a member of the WCPO 9 News Heroin Advisory Board and a Motivational Speaker. Amy has been in recovery from heroin addiction for more than five years.

Link to article on Huffingtonpost.com here: How My Overdose Saved My Life