Archive for March, 2017

Few teens receive effective treatment for opioid addiction

Posted on: March 13th, 2017 by sobrietyresources

Published March 13, 2017 Reuters


Just a small fraction of adolescents with opioid addiction will receive medications that can help them quit, new research shows.

These medications, usually methadone or suboxone, are prescribed to reduce craving for opiates and ease withdrawal symptoms, and studies show they help opiate users to abstain. In 2016, the American Academy of Pediatrics advised doctors to consider medication-assisted treatment, specifically suboxone, for adolescents with “severe opioid use disorders.”

To get a “baseline” sense of medication-assisted treatment in adolescents with opiate or heroin addiction, Kenneth Feder of Johns Hopkins School of Public Health in Baltimore and his colleagues looked at data on 139,092 patients receiving treatment at publicly funded programs in the United States in 2013.

While 26 percent of adult heroin addicts received medication-assisted treatment, that was true for just 2 percent of adolescents.

Among patients addicted to opiates, 12 percent of adults received medication, compared to less than 1 percent of adolescents, the researchers reported in the Journal of Adolescent Health.

“There’s more that needs to be done across the board to facilitate access to these treatments when they’re medically necessary,” Feder told Reuters Health by phone. “The best validated treatment for somebody struggling with an opiate addiction is treatment that includes some sort of medication assistance.”

Patients seeking medication-assisted treatment face a number of obstacles. Methadone is only offered at specific substance abuse treatment centers, and these centers need a waiver to treat anyone under 18. Also, Medicaid rules state that adolescents with opiate addiction must have failed treatment twice in order to be prescribed methadone. Doctors can prescribe suboxone, the other main drug for this purpose, to patients 16 and older, but only if they have a waiver.

“These treatments may not be covered by a state’s Medicaid program,” Feder added. “And if they are medically necessary, we think they should be covered by a state’s Medicaid program.”

The difference in medication-assisted treatment rates between adolescents and adults is “really striking and very concerning,” Dr. Lisa Marsch of Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire, told Reuters Health by phone. Marsch has studied medication-assisted treatment but did not participate in the new study.

Medication-assisted treatment is clearly more effective for adults and adolescents, Marsch said, and by not extending the treatment to more patients, “we are doing a real disservice based on the science and the data.”

About a half-million US adolescents use prescription opiates every year, and just under 10 percent will become addicted, Marsch added. “We want a chance to stop this problem early.”




GOP health-care bill would drop addiction treatment mandate covering 1.3 million Americans

Posted on: March 10th, 2017 by sobrietyresources

By Katie Zezima and Christopher Ingraham March 9 at 8:48 PM


The Republican proposal to replace the Affordable Care Act would strip away what advocates say is essential coverage for drug addiction treatment as the number of people dying from opiate overdoses is skyrocketing nationwide.

Beginning in 2020, the plan would eliminate an Affordable Care Act requirement that Medicaid cover basic mental-health and addiction services in states that expanded it, allowing them to decide whether to include those benefits in Medicaid plans.

The proposal would also roll back the Medicaid expansion under the act — commonly known as Obamacare — which would affect many states bearing the brunt of the opiate crisis, including Ohio, Kentucky and West Virginia. Thirty-one states and the District of Columbia expanded Medicaid under the ACA.

“Taken as a whole, it is a major retreat from the effort to save lives in the opiate epidemic,” said Joshua Sharfstein, associate dean at Johns Hopkins Bloomberg School of Public Health.
Advocates and others stress that mental-health disorders sometimes fuel drug addiction, making both benefits essential to combating the opioid crisis.

Nearly 1.3 million people receive treatment for mental-health and substance abuse disorders under the Medicaid expansion, according to an estimate by health care economists Richard G. Frank of the Harvard Medical School and Sherry Glied of New York University.

House Republicans confirmed the benefit cuts during a meeting of the House Energy and Commerce Committee on Wednesday. Republicans on the committee argue that the change would give states additional flexibility in coverage decisions, and believe they would continue to provide addiction and mental-health coverage to Medicaid recipients if needed.

During the committee meeting, Rep. Joe Kennedy (D-Mass.) asked a GOP staffer whether those benefits are “no longer essentially covered, or required to be covered, by this version of this text. Is that not correct?”

“The text before us does remove the application of the essential health benefits for the alternative benefit plans in Medicaid,” a lawyer for Republicans on the committee responded.

“Including mental health?”


Rep. Joe Kennedy (D-Mass.) said he and Rep. Peter Welch (D-Vt.) introduced an amendment during the committee meeting to include mandates for substance abuse and mental-health coverage, but it was voted down along party lines.

Several Republican senators expressed concern about removing the benefits. Sens. Rob Portman (Ohio), Shelley Moore Capito (W.Va.), Cory Gardner (Colo.) and Lisa Murkowski (Alaska) sent a letter to Senate Majority Leader Mitch McConnell (R-Ky.) stating that the plan does not “provide stability and certainty” for individuals and families enrolled in Medicaid expansion programs, or flexibility for states.

President Trump has made combating the nation’s drug-overdose problem a focal point of his campaign and his presidency.
“We will stop the drugs from pouring into our country and poisoning our youth,” he said in a speech before Congress last week, “and we will expand treatment for those who have become so badly addicted.”

Trump has endorsed the Republican plan to replace the ACA.

A record number of people — 33,000 — died of opiate overdoses in 2015, according to the Centers for Disease Control and Prevention. Opioids now kill more people than car accidents, and in 2015 the number of heroin deaths nationwide surpassed the number of deaths from gun-related homicides. Authorities are also grappling with an influx of powerful synthetic narcotics responsible for a sharp increase in overdoses and deaths over the past year.

The 15 counties with the highest death rates from opiate overdoses were in Kentucky and West Virginia, according to a group of public health researchers, writing in the New England Journal of Medicine. Both of those states expanded Medicaid. Taking away those benefits, they wrote, would affect tens of thousands of rural Americans “in the midst of an escalating epidemic.”

Medicaid pays for 49.5 percent of medication-assisted treatment in Ohio, 44.7 percent in West Virginia and 44 percent in Kentucky when the drug buprenorphine, which is used to manage chronic opiate use disorder, is administered, according to Rebecca Farley, vice president of policy at the National Council for Behavioral Health.

Public health officials and advocates say there is a nationwide shortage of treatment programs to serve the growing problem of addiction and its effects, including diseases associated with long-term IV drug use such as hepatitis C and HIV.

Shawn Ryan, a doctor with Brightview Health in Cincinnati, which provides addiction treatment mainly to patients on Medicaid, said states are starting to increase drug addiction services to respond to rising needs, but the process could take years.

“The outpatient addiction treatment services that are starting to ramp up . . . they could be crushed by this if not done in a way that specifically protects the most vulnerable populations,” he said.

Stripping away addiction treatment services from low-income people is especially harmful, Frank, of Harvard, said in an interview, because the prevalence of drug abuse is much higher for people living well below the poverty line. He said Medicaid recipients who are covered for addiction treatment and maintain their coverage through 2020 would not lose the benefit under the GOP proposal. But, he added, because addiction is a chronic-relapse disease, people may get clean, relapse, stop working and need to go back on Medicaid.

“It’s a disease that hits suddenly at various points in the life cycle,” Frank said.

Some GOP lawmakers advocate a full repeal of the ACA, a move that would result in loss of coverage for 2.8 million people, 222,000 of whom have an opioid disorder, Frank and Glied, of NYU, estimate.

Gary Mendell, founder of the anti-addiction organization Shatterproof, said the group plans to run campaigns against the rollback in eight states where Medicaid was expanded, urging people to contact their elected officials. Mendell, whose son battled addiction and died in 2011, said the drug-abuse battle has transcended party lines. Last year, Congress passed a landmark bill to fight opiate addiction.

“It’s been a bipartisan effort to attack the opiate epidemic,” he said, “and now Republicans are putting fighting the opiate epidemic in the back seat to politics.”


A Better Way to Treat Addiction in Jail

Posted on: March 2nd, 2017 by sobrietyresources

Medications are effective, but jails are still slow to provide them.



As downward spirals go, Mark’s was early and precipitous. He first tried alcohol at 13, began binge drinking shortly afterward, and graduated to pot, Percocet, then heroin. When he was 22, snorting drugs alone in a cheap motel room, he passed out on the floor, where he lay for hours in a position that cut off circulation to his right leg. It had to be amputated above the knee. While recovering in the hospital Mark had unfettered access to opiates, in severe pain but almost enjoying the little button on the morphine pump, he said. He went home with fistfuls of pills — Percocet, klonopin, morphine — and continued using until his mother finally called the police to report he was stealing from her.


For years MARK1 has been in and out of rehab and jail, each time returning home to the sick, panicky self-loathing it seemed only drugs could calm. Now, for the first time, he says, he’s receiving effective treatment for his addiction — in jail. Serving 12 months for the theft, he’s participating in the Rhode Island Department of Corrections’ medication-assisted treatment program, the newest and most far-reaching of a handful of such programs around the country.


Each day a nurse watches as Mark dissolves a film of the addiction medication Suboxone on his tongue. “Within 48 hours I felt like my old self, before I was even taking drugs,” he says. “It makes me feel comfortable in my own skin.”


Because Rhode Island’s is a unified system — all the state’s prisons and county jails are located on a single campus — it is the only state where almost every opiate-addicted inmate, whether in prison or jail, has access to a range of medications to treat their drug addiction. “Rhode Island has really embraced the opiate epidemic as an opportunity to improve services and treatment,” says Dr. Jennifer Clarke, the medical director for the state corrections department. “Locking people up is not a treatment.”


In fact, prison or jail can lead to greater harm: Forced abstinence during incarceration makes users’ tolerance go down and cravings go up. As a result, in the two weeks after release, inmates are 12 times more likely to die — and 129 times more likely to die of an overdose — than the general population.

Studies show that providing them with methadone or Suboxone in the weeks before release, and connecting them with providers in the community who can continue to prescribe the medication when they leave, increases the odds they will stay in treatment and reduces drug use and risk of death when they get home. Experts say long-term drug use can alter the physiology of the brain, such that users have difficulty feeling “normal” without medication.


Half to two-thirds of inmates abuse, or are addicted to drugs, and prisons and jails have long provided a wide range of substance abuse treatment, from 12-step programs to cognitive behavioral therapy, self-help groups, religious ministries — even Scientology. But medications are typically a bright line.


Studies are unequivocal that treatment with medications like methadone or Suboxone reduces drug use, overdose, death, crime, and risky behavior like sharing needles. Yet of the 3,200 jails around the country, just 23 provide methadone or Suboxone maintenance therapy to inmates, according to data compiled for the federal Bureau of Justice Assistance. Of the 50 state prison systems, four do so.


Andrew Klein runs the Bureau of Justice Assistance’s support program for drug and alcohol treatment in prisons and jails. He says stigma and misunderstanding drive a lot of the decision making about medication in lockups. “Inmates are off drugs while in prison,” one correctional administrator wrote in response to a 2009 survey. “They don’t need detox because they’ve been rehabilitated while in prison. It is assumed that they are no longer [drug] users.”


Methadone and Suboxone both work by activating the opiate receptors in the brain, and can, in large enough doses, make the user high. That causes many in law enforcement to question whether these treatments are “substituting” one addiction for another. It also means there is potential for abuse and for people to sell their medication to others — known as “diversion” — a major security concern inside prisons and jails. “Sheriffs say, ‘Suboxone! I spend all my time trying to keep it out of the institution, why should I bring it in?’ ” says Klein.

The exception is Vivitrol, an extended-release injection that blocks the brain’s opiate receptors so the user can’t get high. Vivitrol appeals to correctional administrators because it can’t be abused, so there is no black market for it. Since 2010, when the FDA approved it to treat opiate addiction, upwards of 150 jails and prisons have begun offering Vivitrol to inmates on their way out the door. But physicians like Clarke say Vivitrol should be one of a range of choices available to those with addiction. “The medication that works best is the medication someone will take,” she says — and almost all of her patients, given the option, choose methadone or Suboxone.


She and administrators in other jails with successful programs say it can be done safely. The oldest and largest of these is at New York City’s Riker’s Island. The program began in 1987 and now treats upwards of 2,000 people a year with methadone. Ross MacDonald, the jail’s medical director, says that a nurse watches each patient swallow his dose, to reduce the chance that he can smuggle it back to the cellblocks — a labor-intensive but workable system. The risk of diversion, “when minimized, pales in comparison to the increased risk of overdose death” after release, he says. “These are decisions that should be made by experts in medical treatment, not by experts in security.”


One of the surprises in Rhode Island, Clarke says, is that the treatment program has itself improved security. As doctors enroll an increasing number of people, Clarke says she hears from patients that the black market for drugs behind the walls is waning. One such patient, whom the authorities asked The Marshall Project not to identify by name, has been in and out of the Rhode Island system for a decade before getting on methadone during his current stay. With money in your commissary, this patient says, it’s easy to get drugs like fentanyl in jail. But during his current stay, “it’s almost been absent. Almost every opiate addict I know, no one talks about it. It’s weird. Everybody’s so grateful they’re on the Suboxone and methadone, I don’t hear much about heroin or pills right now.

“I’ve come in here before and all I wanted to do was go out and use,” he said. “I didn’t think about getting my life back on track. My number one concern was, ‘how do I get to feel better when I’m out of here?’ This is the first time I’ve ever been here where I’ve been mentally and physically at peace.”





FDA-Approved Implant Helping Patients Battle Opioid Addiction

Posted on: March 2nd, 2017 by sobrietyresources

February 27, 2017 11:08 PM By Heather Abraham


PITTSBURGH (KDKA) – In 2015, there were more than 3,500 overdose deaths in Pennsylvania. The state also reports that at least 10 people die every day from overdoses.

There’s no question that the opioid epidemic impacts a lot of families and for those who want help, it’s not always easy.

“It was a roller coaster,” a recovering addict, who did not want to be identified, told KDKA.

Because he wants to remain anonymous, we’ll call him John.

John said over the course of eight years, he’s been trying to get clean.

“I’ve been in inpatient treatment facilities at least 20 times,” John said.

While there is no miracle cure, we’re starting to see more treatment options available to help addicts.

Recently, the FDA approved an implant that delivers a slow, but steady dose of buprenorphine over six months. It’s called a Probuphine implant.

“It stretches out those possible weak times and gets them past them,” Dr. Frank Kunkel, of Accessible Recovery Services, Inc., said.

The implant consists of four rods and is placed under the skin of the upper arm. The procedure takes less than a half-hour. A month ago, Dr. Kunkel implanted the first Probuphine rods on a patient here in Pittsburgh.

That patient was John.

“Just stabilizes me. I know that I’m not going to have any huge cravings or physical withdrawals,” John said.

Dr. Kunkel said they’re seeing success with other patients as well.

“Relapse rates while patients are on the Probuphine rods are low compared to other similar medications,” Dr. Kunkel said.

For John, he was previously taking Suboxone daily. Traveling to receive the medication every day became cumbersome, and if he was feeling like he may use, he would simply not go that day for treatment.

“I don’t think it was remembering to take it, it was not wanting to take it,” he said.

By having the implant, John says he eliminates the cravings and desire to use.

“If they don’t take their medicines on Wednesday or Thursday, they might use other opiates on Friday,” said Dr. Kunkel. “It eliminates a lot of diversion. Problems we’re having with this medication, Suboxone and buprenorphine on the street.”

Dr. Kunkel said the implant is not for everyone. Under their program, the patient must be on 8 mg or less of Suboxone or other buprenorphine product for at least six weeks. He also says the patient must be committed to therapy as well.

Dr. Kunkel said while they just recently started offering the implant, they get over 100 patient treatment requests a day.




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