7 in 10 U.S. Workplaces Hit by Opioid Abuse

Source: | March 16th, 2017
70 percent of businesses say prescription drug abuse affects their workers, per a survey released by the National Safety Council. The report found:
  • While 71 percent of employers believe that abuse of prescription painkillers is a disease that requires treatment, 65 percent also consider it a justifiable reason to fire a worker.
  • Only 19 percent of employers said they felt “extremely prepared” to deal with prescription drug abuse in their workplace, only 13 percent were “very confident” that workers could spot signs of misuse, and 76 percent do not offer training on the topic.
  • 57 percent of employers said all employees underwent drug testing. Of those who conduct drug testing, 41 percent do not test for synthetic opioids such as oxycodone, hydrocodone, and fentanyl, the findings showed.
  • The survey also found that 81 percent of employers’ policies lack at least one major element of an effective drug-free workplace program.
  • 88 percent of employers said they would be interested in having their insurer cover alternative pain relief treatments so workers could avoid taking narcotic painkillers, but 30 percent of those employers said they would not act on that interest.
  • On a positive note, 70 percent of employers did say they would help workers struggling with prescription drug abuse return to their jobs after completing treatment.

    Source: WEB MD

Stopping Smoking Helps People Stay Sober

Source: | March 10th, 2017
Researchers at Columbia University’s Mailman School of Public Health and the City University of New York have discovered that smokers in recovery from substance use disorders are at greater risk of relapsing three years later compared with those who do not smoke cigarettes. The researchers assessed subjects at two time points, three years apart, daily smokers and non-daily smokers had approximately twice the odds of relapsing to drug use at the end of the three-year period compared with nonsmokers. “If research continues to show a relationship between smoking and relapse to substance use among those in recovery, making tobacco treatment a standard part of treatment for illicit substance use disorders may be a critical service to provide to adults toward improving substance treatment outcomes over the long term,” suggested Renee Goodwin, Ph.D., Mailman School of Public Health.
Source: Psych Central

New Approach Reduces Teen Risk for Drug Addiction

Source: | February 28th, 2017

Emerging research suggest programs that improve impulse control are the best method to prevent substance abuse. The findings emerged from a final assessment of 387 young people, ages 18-20, who were recruited as 10 to 12-year-olds in 2004 for a long-term study by the Annenberg Public Policy Center of the University of Pennsylvania in collaboration with the Children’s Hospital of Philadelphia. Drug use in adolescence is often linked to later substance-abuse problems. The new study finds that key risk factors include a combination of weak working memory and cognitive processing which can lead to poor impulse control. Working memory refers to the ability to concentrate on a task without being easily distracted. Youth with weak working memory tend to have problems controlling their impulses and thus appear to be at greater risk of continuing drug use. There is a lot of research that links early onset of use to later substance use disorders. “Drug prevention strategy in the schools typically focuses on middle school when early drug use tends to take place and assumes that any drug use at all is a problem,” said co-author Dan Romer, research director of the Annenberg Public Policy Center. “Our study advances the field by showing that just addressing early use is not going to solve the problem.” Interventions that strengthen working memory and cognitive processing related to inhibiting impulsive responses need to be developed to help adolescents better navigate drug-related temptations.

Source: PsychCentral

Future of SUD Policy Under Trump Administration

Source: | February 15th, 2017

During the last Administration, there was significant attention and policy action regarding addiction – much of it propelled by the Prescription Drug and Opioid epidemic. There is mounting concern among SUD advocates that these policy advances may be stalled or reversed by the Trump administration. Observers note the “Repeal and Replace” effort driven by Trump and THE GOP majority Congress may not include provisions which expanded access to mental health and addiction treatment by designating it as an “essential benefit” that must be covered through the A.C.A. marketplaces and expanded Medicaid.  And, there will likely be a return to a tough law and order approach to the drug crisis which could reverse recent trends in sentencing reductions and treatment in lieu of incarceration policies. But advocates are also concerned that there doesn’t seem to be a policy strategy formed and the White House’s website currently does not list addiction as one of the issues they intend to address. On the campaign trail, Trump highlighted construction of the border wall as his main response to the addiction crisis and the Executive Order he signed last week claims, “The trafficking by cartels of controlled substances has triggered resurgence in deadly drug abuse and a corresponding rise in violent crime related to drugs.” The other indicator this administration will likely double down on tough enforcement is the confirmation of Sen. Jeff Sessions as Attorney General.  Sessions has a history of supporting “drug war” policies.

Sources:  The Fix – The Hill – The Fiscal Times

42 CFR Rule Changes Finalized

Source: | January 26th, 2017

The U.S. Department of Health and Human Services (HHS) finalized changes to Confidentiality of Alcohol and Drug Abuse Patient Records regulations, (42 CFR Part 2) to facilitate health integration and information exchange within new health care models while continuing to protect the privacy and confidentiality of patients seeking treatment for substance use disorders. The new rule is published in Federal Register. Major provisions finalized in Final Rule include:

  • SAMHSA will allow any lawful holder of patient identifying information to disclose Part 2 patient identifying information to qualified personnel for purposes of conducting scientific research if the researcher meets certain regulatory requirements. SAMHSA also permits data linkages to enable researchers to link to data sets from data repositories holding Part 2 data if certain regulatory requirements are met. These will enable more needed research on substance use disorders.
  • SAMHSA will continue to apply Part 2 rules when a program is federally assisted and holds itself out as providing substance use disorder diagnosis, treatment, or referral for treatment.
  • SAMHSA will allow a patient to consent to disclosing their information using a general designation to individual(s) and/or entity(-ies)(e.g., “my treating providers”) in certain circumstances. This change is intended to allow patients to benefit from integrated health care systems. This provision also ensures patient choice, confidentiality, and privacy as patients do not have to agree to such disclosures.
  • SAMHSA has added a requirement allowing patients who have agreed to the general disclosure designation, the option to receive a list of entities to whom their information has been disclosed to, if requested.
  • SAMHSA has made changes that outline the audit or evaluation procedures necessary to meet the requirements of a CMS-regulated accountable care organization or similar CMS-regulated organizations (including CMS-regulated Qualified Entities). This change will ensure CMS-regulated entities can perform necessary audit and evaluations activities, including financial and quality assurance functions critical to Accountable Care Organizations and other health care organizations.
  • SAMHSA has updated and modernized the rule to address both paper and electronic documentation.
  • SAMHSA will monitor implementation of the final rule and is working to develop additional sub-regulatory guidance and materials on many of the finalized provisions.

Obamacare’s Repeal Could Increase Opioid Treatment Gap by 50%

Source: | January 12th, 2017

While Congress considers repealing Obamacare, two new reports estimate how many people with drug use disorders could be left to suffer without care. Researchers at Harvard Medical School and New York University, found that Obamacare’s repeal could increase the opioid treatment gap by 50 percent. Under Obamacare, the federal government has estimated that about 420,000 people with opioid use disorders couldn’t or didn’t get treatment. The new analysis found that if Obamacare is repealed without a complete replacement the total would increase by 220,000 — to about 640,000. The other report, from the US Department of Health and Human Services (HHS), outlines what the potential risks of Obamacare’s repeal are for patients with drug use disorders. The report found that the states likely to see the biggest losses in insurance coverage are also some of the states hit hardest by the opioid epidemic — particularly Kentucky, Massachusetts, New Hampshire, Ohio, Rhode Island, and West Virginia.

Source: Vox

Feds Issue New Guidance on Sober Homes

Source: | November 23rd, 2016
In a joint statement, the U.S. Department of Justice and U.S. Department of Housing and Urban Development announced new guidelines to regulating group homes, which include sober homes. The guidelines are provided to help give cities “the legal clarity they need to maintain the safety and character of their communities while protecting the rights and needs of people with disabilities, including those recovering from drug addiction.” Below are several points covered in the guideline:
  • A city may create a standard for health and safety in sober homes, such as requiring licensing, as long as they are not “based on stereotypes” and are fairly distributed to all sober homes. Under the Fair Housing Act, requirements imposed on sober livings must be “neutral” and not discriminatory.
  • A city may deny a sober home if it is deemed to “impose an undue financial and administrative burden on local government or would fundamentally alter a city’s zoning scheme.” The guideline gives “specific advice on reviewing requests for reasonable accommodations” from sober living homes and more clearly defines when it is appropriate to deny such requests.
  • Specifies protection provided by the Fair Housing Act does not apply to cases of “criminal activity, insurance fraud, Medicaid fraud, neglect or abuse of residents, or other illegal conduct occurring at group homes.” This rule affirms a local government’s right to act in response to such offenses.

Source: The Fix

Texas and the Opioid Crisis

Source: | November 10th, 2016
Last month, the DEA announced plans to reduce the quantity of narcotics manufactured in 2017 by 25 percent, which would include almost all opiate and opioid prescriptions. Certain medications would be reduced further, including hydrocodone, which will be reduced by 33 percent. The National Safety Council recently released results of a survey indicating that 99 percent of providers exceed the recommended three-day dosage limit. According to the Centers for Disease Control (CDC), Texas providers prescribe 74 painkiller prescriptions per 100 people, which is below the national average.  Also, Texas monitors pain medication through the Prescription Monitoring Program, which is overseen by the Texas State Board of Pharmacy. With the increasing number of overdoses, Texas and many other states have passed laws making Naloxone available without prescription. Mark Kinzly, co-founder of the Texas Overdose Naloxone Initiative (TONI) said the Texas law, which came into effect last September, has improved accessibility and that there “has been a lot of uptake” within the opioid-using community. Kinzy’s organization, TONI, has handed out three-quarter million dollars worth of free medication. “In Texas, our heroin is the black tar Mexican [heroin]”; said Jane Maxwell, a research professor at the University of Texas at Austin, “This is different than what is available in the Northeast. In the Northeast, you’ve got white South American heroin that comes in through Newark and NYC and Miami. It’s more potent than the Mexican heroin.”  While lower potency causes fewer heroin overdoses in Texas than nationwide, methamphetamine is a rising threat. It is “by far our largest, and unrecognized, problem in terms of the poison center, treatment, law enforcement seizures, and deaths,” said Maxwell.
Source: Texas Tribune

ONDCP Issues Changing the Language of Addiction

Source: | November 4th, 2016
The office of National Drug Control Policy has issued a draft document addressing ways non-stigmatizing terminology can be used when discussing substance use and substance use disorders. It is intended to guide federal agencies on terminology to use when discussing substance use and substance use disorders. When certain terms are used, such as “abuser” instead of “individual with a substance use disorder,” health care providers are more likely to assign blame and believe that an individual should be subjected to more punitive (e.g., jail sentence) rather than therapeutic measures. Negative attitudes have been found to adversely affect the quality of health care and treatment outcomes.  Because stigma and shame may deter help-seeking behavior among individuals with substance use disorders and their families, the guidance draws attention to terminology that may cause confusion or perpetuate stigma. Suggested Language includes:
  • Substance Use Disorder – Alternatives include “misuse” or “unhealthy/harmful use” of a substance.
  • Person with a Substance Use Disorder – Use of Person-first language. Research shows that use of the terms “abuse” and “abuser” negatively affects perceptions and judgments about people with substance use disorders and terms like “addict” and “alcoholic” can have similar effects
  • Person in Recovery –  Instead of “clean,” the terms “negative” (for a toxicology screen) or “person in recovery” or “not currently using substances” are preferred when describing a person. Instead of “dirty,” the term “positive” (for a toxicology screen) or “a person who is currently using substances” may be used.
  • Medication Assisted Treatment – The terms “replacement” and “substitution” have been used to imply that medications merely “substitute” one drug or “one addiction” for another.  This runs counter to the evidence that medication-assisted treatment improves outcomes for patients. Preferred terms include “medication-assisted treatment” or “medicine/medication,” or simply “treatment.”

White House Parity Task Force Report Released

Source: | October 28th, 2016

President Obama created the Mental Health and Substance Use Disorder Parity Task Force in March 2016. Led by the Domestic Policy Council, the Report details parity implementation activities undertaken throughout the last eight years, outlines new resources available, and offers a number of recommendations for future action.
Source: HHS

Updated resources and guidance released:

  • A one-stop parity web portal to help consumers navigate parity. The portal, launched today in beta mode.
  • Updated FAQs Accompanying the report, the Department of Health and Human Services has issued a new set of FAQs. The guidance includes specific examples of how common utilization restrictions such as prior authorizations and fail-first policies fall afoul of the parity law.
  • Consumer Guide to Disclosure Rights” offering clear information about the types of information plans are obligated to disclose to consumers as they are selecting plans or evaluating whether their plan has unfairly denied a mental health or addiction service.


Recommendations for future action:

  • Increasing federal support for state efforts to enforce parity. Among planned activities are $9.3 million in grant awards to states to support parity implementation; and two State Parity Policy Academies designed to help state officials advance strategies for parity compliance.
  • Developing additional examples of how non-quantitative treatment limitations are regulated by the parity law. The Task Force notes that it will release an updated version of its “Warning Signs” document identifying potentially problematic cases of NQTLs.
  • Increasing federal agencies’ capacity to audit health plans for parity violations. Parity enforcement efforts to date have focused principally on addressing complaints filed after service denials occurred. The example of the state essential health benefits benchmark plans-which often failed to include services at parity as required by the law-shows that additional front-end compliance tools are needed.
  • Review of how parity principles apply in Medicare.