Drug, Alcohol & Suicide Deaths Could Rise 60% in the Next Decade

Source: | January 15th, 2018
About 1.6 million Americans could die from drugs, alcohol and suicide in the next decade, according to a comprehensive new report by the Trust for America’s Health and the Well Being Trust. The figure is a 60 percent increase over the past decade and the authors say the projections could be conservative as the opioid epidemic continues to wreak havoc on American communities. The report includes an online interactive tool that maps trends and also includes an analysis of  the economic impact of drug, alcohol and suicide-related health costs which total $249 billion a year – 9.5 percent of total U.S. health expenditures. The report advocates for the creation of a “National Resilience Strategy” to reduce suicide:

 

  • ATTACK THE CRISES:  Expand and scale up evidence-based efforts to deploy a full-scale strategy against opioids, excessive alcohol use, and rising suicide rates.
  • BOLSTER SUPPORTS: Prioritize prevention, reduce risk factors and promote resilience in children, families and communities.
  • IDENTIFY EARLY: Enhance programs that identify early warning signs, and connect people to the services they need.
  • ENHANCE TREATMENT:  Improve pain management and treatment, and modernize mental health and substance abuse services, to focus on individuals’ whole health.

Statistics Don’t Capture the Opioid Epidemic’s Impact on Children

Source: | January 8th, 2018
About half of opioid overdose deaths occur among men and women ages 25 to 44.  It’s reasonable to assume that many are parents. Statistics can’t tally the trauma felt by a seven-year-old who calls 911 to get help for an unconscious parent, or the responsibility undertaken by a twelve-year-old to feed and diaper a toddler sibling, or the impact of school absences and poor grades on a formerly successful high school student. Parental overdoses have an immediate impact on children, but there is also a cumulative impact as these children become adults and are themselves at risk from the same influences that drove their parents to drugs, overdoses, and early deaths.  Who are these children and adolescents?
  • Newborns whose mothers are addicted to opioids. These babies may undergo withdrawal themselves and need special treatment.
  • Children of all ages at risk for accidental ingestion or inhalation of toxic substances.
  • Children living with an addicted parent, dealing with constant uncertainty and fear.
  • Children who have taken over the role of family caregiver for younger siblings or for their addicted parents.
  • Children who are removed from their homes and placed in foster or kinship care. Some of these children have unmet mental health care needs.
  • Very young children exposed to toxic levels of stress that impair brain development.
No one knows how many of these vulnerable children there are in the U.S. because no one is counting. They remain hidden in families with addiction until a crisis erupts and law enforcement or child welfare agencies get involved. When relatives are unable to take in these children, foster care is the next option. In 2016, about 274,000 children entered the foster care system, 22,000 more than in 2012. One-third of those youngsters were removed from their homes because at least one parent had a drug abuse issue. Integrating child-centered policies into prevention and treatment programs is essential. We need targeted research that draws from the fields of addiction treatment, child development, family therapy, mental health, child welfare, law enforcement, and others to determine the best evidence-based solutions.

 

Source:  STAT

More Women Are Going to Jail in Need of Drug and Alcohol Treatment

Source: | December 19th, 2017
As a record number of women go to jail in Texas, sheriffs are increasingly coping with a special class of inmates: women with minor criminal records but major mental-health and addiction problems. A recent federal survey found that almost a third of women in jails showed symptoms of serious psychological distress, even higher than the rate for men. And when inmates die in jail, drugs are more commonly the cause for women than for men, according to an analysis of state data by The Dallas Morning News. At least 10 of the 86 female jail fatalities since 2011 were attributed to overdoses. But at least another 10 women died from addiction-related problems that the state failed to track. A higher percentage of women than men are jailed for substance-abuse incidents and don’t get adequate treatment in custody for addiction, said Ranjana Natarajan, director of the University of Texas Law Civil Rights Clinic. “Unless local lockups improve drug treatment”, she said, “you’re going to see a lot of women suffer in jail as a result – and sometimes, they’re going to die.” Texas has no statewide standards for detox procedures in county jails.  Some inmates withdrawing from alcohol or other drugs died while toughing it out cold turkey, suffering cardiac arrest, seizures or committing suicide. Sandra Bland’s suicide while in Jail led the Texas Legislature to pass a law named in her honor this past legislative session. It requires counties to provide inmates with prescribed medications, increase screenings for depression and suicide risk and offer around-the-clock access to mental health professionals. It also requires that independent law enforcement agencies investigate jail deaths. But the new law doesn’t provide money to pay for all of its mandates. Without financial help, most jails won’t be able to meet the standards, said Dennis Wilson, the sheriff of Limestone County. Like many smaller county jails, he contracts out medical services and spends a lot of its budget on health-care expenses, including frequent trips to the emergency room.  Jails were never designed to be stand-ins for mental health facilities or detox centers, but that’s how they’re being used, Wilson said.

 

Portugal’s Radical Drugs Policy is Working

Source: | December 12th, 2017
On Dec 5, the Guardian published an article reviewing Portugal’s drug decriminalization policy.  Facing a crisis in the 1980’s where 1 in 10 people had fallen into heroin use, Portugal became the first country to decriminalize the possession and consumption of all illicit substances as strategy to address the crisis.  Portugal’s policy rests on three pillars: one, that there’s no such thing as a soft or hard drug, only healthy and unhealthy relationships with drugs; two, that an individual’s unhealthy relationship with drugs often conceals frayed relationships with loved ones, with the world around them, and with themselves; and three, that the eradication of all drugs is an impossible goal. Rather than being arrested, those caught with a personal supply might be given a warning, a small fine, or told to appear before a local commission (comprised of doctor, social worker) to talk about treatment and support services that were available to them.   With the new policy in effect, their opioid crisis soon stabilized, and the ensuing years saw dramatic drops in problematic drug use, HIV and hepatitis infection rates, overdose deaths, drug-related crime and incarceration rates. HIV infection plummeted from an all-time high in 2000 of 104.2 new cases per million to 4.2 cases per million in 2015. Portugal’s remarkable recovery, and the fact that it has held steady through several changes in government – including conservative leaders who would have preferred to return to the US-style war on drugs – could not have happened without an enormous cultural shift, and a change in how the country viewed drugs and addiction. In many ways, the law was merely a reflection of transformations that were already happening in clinics, pharmacies and around kitchen tables across the country. The official policy of decriminalization made it far easier for a broad range of services (health, psychiatry, employment, housing etc) to work together and serve their communities more effectively. Despite enthusiastic international reactions to Portugal’s success, it is important to note drug use didn’t disappear. While drug-related death, incarceration and infection rates plummeted, the country continues to deal with the health complications of long-term problematic drug use such as hepatitis C, cirrhosis and liver cancer which are burdening their health system. Harm-reduction advocates have also been frustrated by what they see as policy stagnation and criticize the state for dragging its feet on establishing supervised injection sites and drug consumption facilities; for failing to make the anti-overdose medication naloxone more readily available; for not implementing needle-exchange programs in prisons.  Portugal’s drug czar told the Guardian, “If the heroin epidemic had affected only Portugal’s lower classes or racialized minorities, and not the middle or upper classes, he doubts the conversation around drugs, addiction and harm reduction would have taken shape in the same way.
Source:  Guardian

Proposed Federal Policy Changes that Weaken Recent Gains in SUD Treatment Coverage

Source: | December 5th, 2017
The Affordable Care Act contained several provisions that significantly increased access to SUD services.  While earlier efforts by Congress to repeal Obamacare failed, there are several efforts underway to dismantle the program.  Below is a current summary of what is at stake:
  • Senate tax reform proposal proposes to double the standard deduction, likely shifting millions of taxpayers who currently itemize to taking the standard deduction. An analysis of this provision estimates that charities could see a staggering loss of up to $13.1 billion in contributions annually, directly impacting non-profit SUD service providers.
  • Proposed reductions in the Senate tax reform bill to the income threshold after which medical expenses can be deducted would impact the financial futures of millions of Americans living with costly and chronic conditions like mental illness or addiction.
  • The Senate tax reform bill proposes to eliminate the individual insurance mandate.  This provision is foundational to the Affordable Care Act because it spreads the risk thereby lowering health insurance premiums.  It also funds comprehensive coverage in insurance plans to include necessary services like mental health and addiction treatment.
  • President Trump has directed the Centers for Medicare and Medicaid Services (CMS) to change the rules on how the Essential Health Benefits (EHB) for marketplace insurance plans are administered.  The proposed changes would allow states to choose less comprehensive coverage for mental health and substance use service.

Which is More Effective? Vivitrol or Suboxone

Source: | November 21st, 2017

The growing market for opioid treatment drugs has created fierce competition between drug manufacturers and the results from a long-awaited study are in. The study, funded by the federal government, compared Vivitrol and Suboxone and found that both are similarly effective. Fifty-two (52%) percent of those who started on Vivitrol relapsed during the 24-week study, compared with fifty-six (56%) percent of those who started on Suboxone.  But the study also found a substantial hurdle for Vivitrol because the medication can be started only after a person is completely detoxed from opioids. More than a quarter of the study participants assigned to Vivitrol dropped out before being able to take their first dose. Suboxone can be started shortly after withdrawal symptoms begin, and only six percent of those assigned to take that drug dropped out before taking an initial dose. Vivitrol is the most expensive addiction medication; $500-$1,000 per shot, Suboxone is about third to half as much with Methadone being the least expensive of the available drugs for opioid addiction. Alkermes has pushed for the use of Vivitrol in drug courts and jails, where Suboxone is often not allowed and has won fans among many law enforcement officials who see Suboxone as simply replacing one addiction for another. Suboxone is also more likely to be diverted into a black market. But Alkermes’ strategy has drawn attention from lawmakers and Senator Kamala Harris of California, announced a Senate committee investigation into the company’s “sales, marketing and educational” tactics, which she said had attempted to artificially boost sales by stigmatizing treatments like Suboxone. But Suboxone, which has more market share than any other addiction medication, has also come under scrutiny. Its maker has been sued by 43 state attorneys general who say the company schemed to block generic competition by conspiring with another company to create a slightly different delivery system for the drug. The new study was published in The Lancet and is only the second to compare the drugs. A study conducted in Norway and released last month had similar results, but it was shorter and included fewer patients.

Source:  New York Times

Insurers Declare Addiction Deserves the Same Urgency and Respect as Cancer

Source: | November 13th, 2017
The nation’s largest insurers issued a statement last week that addiction deserves the same urgency and respect as cancer or diabetes, and should be treated as a chronic disease requiring long-term treatment and monitoring.  16 health insurers covering 248 million people adopted 8 principles of care and said they would use their purchasing power to reward proven, evidence-based treatments, a step that could improve the quality of care available.   UnitedHealth Group, Aetna, Cigna and WellCare, all national companies were among the endorsing companies.  The eight core principles the insurers supported were derived from the U.S. Surgeon General’s 2016 report on alcohol, drugs and health.  These core principles are also providing the foundation for the work being done by Shatterproof’s Substance Use Disorder Treatment Task Force to create a universal standard of care for addiction.
 Source:  USA Today
  1. Routine screenings in every medical setting: During check-ups and in the ER, from pediatric to geriatric care-screenings for an SUD should be as common as measuring blood pressure.
  2. A personal plan for every patient: One size doesn’t fit all. Treatment must consider unique social, mental, biological, and environmental needs-with frequent check-ins and adjustments.
  3. Fast access to treatment: Addiction alters brain chemistry. So when an individual is able to seek treatment, that moment must be seized.
  4. Disease management, rather than 28 days: While inpatient treatment may be appropriate for some based on disease severity, this isn’t the best option for all. And it’s not enough for sustained success. Long-term outpatient care is key to recovery.
  5. Coordinated care for every illness: Many people with addiction also suffer from other mental or physical disorders. Treatment for all illnesses should be coordinated and integrated into the SUD treatment plan.
  6. Behavioral health care from legitimate providers: Behavioral interventions help individuals manage their disease and sustain recovery – and should be offered by properly trained, accredited, and well-supervised providers.
  7. Medication-assisted treatment: Just like with any other chronic disease, medication is appropriate for treating some addictions. It should be destigmatized and easily accessible.
  8. Support for recovery outside the doctor’s office: Recovery requires emotional and practical support from family members, the community, and peer groups.

President Trump’s Opioid Commission Issues Report

Source: | November 3rd, 2017
The final draft of the report includes over 50 recommendations on a variety of federal, state, and local agencies, but it stops short of calling for new federal dollars. Below are some of the biggest recommendations in the report. For all 56 proposals, read the full report.
  • Streamline federal funding for drug addiction using “one application and one set of reporting requirements.” The commission argues this would let states focus less on paperwork and more on actually implementing policies.
  • Remove barriers to treatment including better enforcement of parity laws that in theory require insurers to pay for such care.
  • Develop “a national curriculum and standard of care for opioid prescribers.” It also proposes that the Drug Enforcement Administration (DEA) require doctors renewing their opioid prescribing licenses to attend an education program for such prescriptions.
  • Stop evaluating doctors based on pain scores. The commission asks that patient satisfaction surveys used to evaluate doctors no longer include any questions about pain.
  • Allow more emergency responders to deploy naloxone and include all medical staff in the National Highway Traffic Safety Administration best-practices guide for emergency responders.
  • Tougher prison sentences for the trafficking of fentanyl and fentanyl analogues.
  • A media campaign on addiction stigma and the dangers of opioids.

House Select Committee on Opioids and Substance Use

Source: | October 27th, 2017

Speaker Straus created a Select Committee on Opioids and Substance Abuse which was included in his Interim Committee Charges. This Select committee will study the prevalence and impact of substance abuse and substance use disorders in the state. “Two years ago, we formed the Committee on Mental Health to look at behavioral health and substance abuse issues, and this new committee will continue some of that work,” Speaker Straus said. Rep. Four Price (Amarillo) has been tapped by the Speaker to chair and Rep. Joe Moody (El Paso) will serve as Vice Chairman. “Addressing the growing problems of substance abuse and opioid addictions would have a positive impact across the state by reducing the burden on the health care and criminal justice systems, Price said. “It’s an issue that Texans everywhere are dealing with”. ASAP worked well with Chairman Price and his office over the past biennium on the Behavioral Health Select Committee and legislation that was introduced from the committee’s findings. For his outstanding leadership directing that committee and passing significant legislation, particularly HB 10 to enforce parity, ASAP was honored to select him as a 2017 Lone Star Award recipient. We are excited to work with him again and look forward to similar positive results from the committee’s work.  he committee members are:

 

Representatives
 
Carol Avarado  (Houston)
Garnet Coleman (Houston)
Jay Dean (Longview)
Ina Minjarez (San Antonio)
Andy Murr (Junction)
Poncho Nevarez (Eagle Pass)
Kevin Roberts (Houston)
Toni Rose (Dallas)
J.D. Sheffield (Gatesville)
Gary VanDeaver (New Boston)
James White (Hillister)

Former CDC Director Recommends 10 Actions to Reduce Opioid Epidemic

Source: | October 17th, 2017
Tom Frieden, MD, MPH and his colleague published an article in Journal of the American Medical Association about actions that could be taken at the federal and state level to accelerate progress in preventing addiction, overdose and death. Below are the 10 specific areas:

 

Source:  The Hill
  1. Improve tracking of new opioid addiction-
  2. Improve quality of medical examiner and coroner work.
  3. Promote more cautious prescribing for acute pain.
  4. Restrict or eliminate marketing of opioids for chronic pain
  5. Increase insurance coverage for non-opioid pain management-
  6. Interrupt the supply of illicit opioids-
  7. Identify possible opioid addiction early-
  8. Expand access to treatment
  9. Implement harm reduction for current users
  10. Consider removing ultra-high dosage opioids from the market