Addiction Treatment
Experts Await Details of Parity Rules
Addiction and mental health treatment experts say they are
hopeful new rules issued by the federal government that require parity between
treatment for mental and physical illness will greatly expand access to care.
They say a critical component of the rules’ success will be the criteria
insurers use to include patients for addiction and mental health coverage.
“This has been anxiously and long awaited,” Dr. Jeffrey Lieberman, President of
the American Psychiatric Association, told NBC News. “Everything we’ve heard
gives us a lot of encouragement. We just hope the rule goes far enough.” He
said his organization will carefully review the new regulations, to see how
much information insurers will be required to reveal about their coverage
criteria, and how the rule will be enforced. The regulations will apply to
almost all forms of insurance. Administration officials say the rules will
ensure that health plans’ co-payments, deductibles and limits for visits to
health care providers are the same for addiction and mental health services as
they are for medical and surgical benefits—referred to as “parity.” The rules
will put into effect the 2008 Mental Health Parity and Addiction Equity Act.
Under the regulations, a health plan will not be able to restrict patients to
in-state substance abuse treatment, while allowing them to go anywhere for
medical or surgical treatment. “What it means for us is that we should see more
people coming into the treatment world,” said Cynthia Moreno Tuohy, Executive
Director of the National Association of Alcoholism and Drug Abuse Counselors.
“One of the reasons people don’t come into treatment is that they don’t have
health care. This takes those barriers away.”
Changes by Makers of Cold
and Cough Medicines Reduced Children’s ER Visits
Changes made by makers of cold and cough medicines in 2007
have resulted in a significant decrease in visits by infants and toddlers to
hospital emergency rooms due to these medicines, according to a new study. Drug
makers voluntarily withdrew infant cold and cough medicines intended for
children under age 2 from the market in 2007, and made changes in labeling on
other products warning parents they should not be given to children under 4,
The New York Times reports. The study, conducted by researchers at the Centers
for Disease Control and Prevention, included data from 63 hospitals. The study
estimated the number of visits to emergency rooms from 2004 to 2011 by young
children who had taken cold and cough medicine. Before the 2007 changes,
children under 2 accounted for 4.1 percent of emergency room visits for
suspected drug-related effects. After the change, they accounted for 2.4
percent of the visits. Among children ages 2 to 3, ER visits related to cold
and cough medicines dropped from 9.5 percent before the changes took effect, to
6.5 percent afterwards. There was no significant reduction in ER visits among
children 4 to 11. Among children ages 4 and 5, visits related to cold and cough
medicines increased from 5.6 percent to 6.5 percent. “We’re making great
progress in under-2s, and we’re making relatively good progress in 2 to 3s,”
said Dr. Don Shifrin, a spokesman for the American Academy of Pediatrics. “But
we’d like better news for kids over 4.” Most infants and toddlers who end up in
the ER for problems related to cold and cough medicines got hold of the
medicines when a parent’s back was turned, the article notes. “Of adverse
events still occurring, 90 percent in 2- to 3-year-olds were unsupervised
ingestions,” said study senior author Dr. Daniel S. Budnitz. The findings are
published in Pediatrics.
Advice for Small Employers
Testing New Hires for Drugs
Question: How can a small company do drug testing for job
applicants? How much does it cost? Do you send the employees to a local lab, or
hire a contractor to handle the whole process?
Answer: Illicit drug users are significantly more likely to
take time off for illness or injury, skip work, and change jobs frequently than
employees who don’t use drugs, according to a 2007 report by the U.S.
Department of Health and Human Services. Screening for substance abusers in the
hiring process can boost companies’ productivity and retention rates.
Government contractors and companies in safety-sensitive industries, such as
public transportation, are legally mandated to test their employees. Most
private companies are not, but many find it makes sense financially. The HHS
report shows that nearly 43 percent of full-time American employees work for
companies that do drug testing before hiring. Testing can be carried out
randomly or after accidents, as well. Continue
this article here.
More Colorado Students
Bringing Marijuana to School, Anecdotal Reports Suggest
School officials, counselors and nurses in Colorado say they
are seeing an increase in the number of students bringing marijuana to school,
according to The Denver Post. The rise has taken place since the state
regulated medical marijuana in 2010 and legalized recreational marijuana last
year. Colorado’s marijuana laws forbid anyone under age 21 from using
marijuana. Mike Dillon, a school resource officer with the Mesa County
Sheriff’s Department, said he is seeing a growing number of younger students
bringing marijuana to school. “When we have middle school kids show up with a
half an ounce, that is shocking to me,” he told the newspaper. While school
disciplinary statistics in the state do not isolate marijuana from general drug
violations, anecdotal reports suggest an increase in marijuana-related
incidents in middle schools and high schools around the state. “We have seen a
sharp rise in drug-related disciplinary actions which, anecdotally, from
credible sources, is being attributed to the changing social norms surrounding
marijuana,” said Janelle Krueger, the program manager for Expelled and At-Risk
Student Services for the Colorado Department of Education. She said school
officials think the increase is linked to the message that legalization sends
to children that marijuana is a medicine, and is a safe and accepted
recreational activity. It is also believed to be more available, she adds.
Parents or other adults may be less likely to hide marijuana now that it is
legal, making it easier for students to obtain. Last year, a report about 720
student expulsions from public schools in Colorado found marijuana accounted
for 32 percent of cases—more than any other drug. Christine Harms, Director of
the Colorado School Safety Resource Center, said federal grants for drug abuse
prevention have been cut, making it more difficult to counteract the message
that legalization is sending to young people.
Homeless veterans discuss
challenges of shaking addiction
On the job as a member of the Coast Guard, Ryan Kazmarek
said he learned responsibility and discipline. But when he was off duty, the
Dundalk man struggled with a "work hard, party hard lifestyle" that
led him to alcoholism and — after he left the service — homelessness. To get
back on his feet, Kazmarek joined Helping Up Mission, a Baltimore homeless
shelter that provides housing, food and services to help its 500 members
through long-term addiction recovery. Of that group, about 10 percent are
military veterans, and Helping Up served a Veterans Day steak dinner Monday
night to thank them for their service. After leading the group in prayer before
dinner, Michael Sheppard talked about the similarities between his time in the
Army National Guard and the homeless shelter. He said both have enriched his
life and helped him grow as a person. Rest
of this story is here.
No Easy Answer to Opioid
Addiction Epidemic: Experts
There are no easy answers to solving the opioid addiction
epidemic, according to experts at the American Association for the Treatment of
Opioid Dependence annual meeting this week. Thomas McLellan, CEO of the
Treatment Research Institute, told NBC Philadelphia a multi-faceted approach is
needed. “You don’t have any alternatives [to opioids]. The only alternative is
a non-steroidal anti-inflammatory; well it’s got liver toxicity and it’s not
all that potent. There’s nothing between that and a very powerful opioid,” said
Dr. McLellan, who served as the Deputy Director of the White House Office of
National Drug Control Policy. “This is one of those problems that society has
to manage. You can’t do away with it. Not with 70 million older Americans who
vote and are aging and need them. You can’t ban them.” Doctors don’t have
proper training to understand opioid addiction, Dr. McLellan noted. “They
prescribe too much. They don’t manage them. About 70 percent of all the
overdose deaths occur within 48 hours after the first prescription or after the
first refill,” he said. He and Dr. Jeannemarie Perrone, Director of Toxicology
in the Hospital of the University of Pennsylvania’s Emergency Medicine
Department, recommend that doctors follow national guidelines from the American
Academy of Pain Management. These guidelines recommend that patients sign a
usage contract, and submit to an annual toxicology screening test to confirm
they are taking the medicine and not taking other drugs before the doctor
issues a prescription. Patients also need to be part of the solution to opioid abuse,
Dr. McLellan says. “It has to be the joint responsibility of the patients to
take medication as prescribed. Don’t give them to your sister, don’t leave them
in your medicine cabinet, don’t take more than you need,” he added.
Head Shops See Business
Increasing as Marijuana Legalization Spreads
Owners of stores that sell drug paraphernalia, known as head
shops, say their business is growing as more states legalize the medical and
recreational use of marijuana. These stores stay out of trouble with the law by
saying their products are for tobacco use only, USA Today reports. The stores
sell products including water pipes, rolling papers and vaporizers. Special
Agent Erin Mulvey, spokeswoman for the Drug Enforcement Administration, said
that under the federal Controlled Substances Act, head shop owners cannot be
arrested for selling drug paraphernalia because they can claim their products
are for tobacco use. “Our laws don’t just focus on paraphernalia, but the drugs
themselves,” she said. According to a Pew Research Center survey released
earlier this year, 12 percent of Americans say they have used marijuana in the
past year. Among people younger than 30, the survey found 27 percent say they
have used marijuana in the past year, at least three times the percentage in
any other age group.
Who Is Responsible for the
Pain-Pill Epidemic?
When I started working as a medical resident, in 2004, I
heard from a patient I had inherited from a graduating resident. The patient
had an appointment scheduled in a couple weeks. “But I need your help now,” he
said. He was a former construction worker who had hurt himself on the job a
couple of years earlier. He told me, “I also need some more OxyContin to tide
me over until I can see you.” The hospital computer system told me that he had
been taking twenty milligrams of OxyContin, three times a day, for at least the
last couple of years. I had rarely seen such high doses of narcotics prescribed
for such long periods of time. I’d seen narcotics prescribed in the hospital to
patients who had been injured, or to those with pain from an operation or from
cancer. But I didn’t have much experience with narcotics for outpatients. I
figured that if the previous resident—now a fully licensed doctor—was doing
this, then it must be O.K. What I didn’t know was that my time in medical
school had coincided with a boom in the prescribing of narcotics by outpatient
doctors, driven partly by the pharmaceutical companies that sold those drugs.
Between 1999 and 2010, sales of these “opioid analgesics”—medications like
Vicodin, Percocet, and OxyContin—quadrupled. Continue
reading here.
Women have been
particularly affected by the War on Drugs
Orange is the New Black and the disproportionate impact of
drug policy on women
The wildly popular Netflix television series Orange Is the
New Black has garnered an enthusiastic following for its frank portrayal of
female inmates in a federal prison: their raunchy wit, their ingenuity, their
desires and intimacies, their checkered pasts, and their suffering. The show
features Piper Chapman, a fashionable yuppie blonde serving a 15-month sentence
for a 12 year-old drug charge. OItNB follows, through Piper’s often naïve
perspective, relationships among inmates and their experiences with bureaucracy,
injustice, and abuse in the criminal justice (CJ) system. The series is based
on the memoir by Piper Kerman, former inmate at the Federal Correctional
Institution at Danbury, today a formidable figure speaking out for prison
reform. Her personal experience in a federal prison lends urgency to her
calls for reform in women’s prisons, especially when it comes to prosecution
and sentencing of drug offenses.
Rest of the article is here.
Alcohol without the
hangover? Scientist claims to invent alcohol substitute
A leading British neuroscientist says he has developed an
alcohol substitute that mimics the drug's pleasurable sensations, yet when
chased by a pill makes the user instantly sober without a hangover. David Nutt,
a professor at Imperial College London and columnist at The Guardian, claims it
is an initial discovery that could do for alcohol what e-cigarettes have done
for smoking -- but he needs investors to fund his research. "I find it
weird that we haven't been speaking about this before, as it's such a target
for health improvement," he tells BBC. Please
click here to continue.
Deaths From Drug Poisoning
Rose by More Than 300% in Last 30 Years
Deaths due to drug poisoning have tripled in the last three
decades, a new study concludes. The study included poisonings from both illegal
and prescription drugs, according to U.S. News & World Report. Prescription
drugs make up the majority of drug overdose deaths, the study concluded. The
largest increase occurred in the last decade examined in the study. The
researchers at the Centers for Disease Control and Prevention found the
percentage of counties with drug poisoning death rates of more than 10 in
100,000 rose from 3 percent in 1999, to 54 percent in 2009. This is the first
study to look at drug poisoning rates at the county level in the United States,
the article notes. Previous studies have examined rates at the state or
national level. “Mapping death rates associated with drug poisoning at the
county level may help elucidate geographic patterns, highlight areas where
drug-related poisoning deaths are higher than expected, and inform policies and
programs designed to address the increase in drug-poisoning mortality and
morbidity,” lead researcher Lauren Rossen said in a statement. Drug poisoning
death rates rose by almost 400 percent in rural areas, and by almost 300
percent in large central metropolitan counties, the study found. Higher rates
were found in the Pacific, Mountain, and East South Central regions of the
nation. Lower rates were concentrated in the West North Central region, the
article notes. The findings are published in the American Journal of Preventive
Medicine.
Pain Relief is Goal in
Most Cases of Teen Opioid Misuse: Study
Most teens who misuse prescription opioids are seeking pain
relief, a new study concludes. University of Michigan researchers found four
out of five teens who misused opioids said they did so to relieve pain. Thirty
percent of teens who did not take their medication as directed, and 47 percent
of those who used another person’s prescription, were also motivated by other
reasons, such as wanting to get high. The study of 3,000 teens found teenage
girls were almost twice as likely as boys to have misused prescription painkillers
in the past year, HealthDay reports. The researchers did not find a gender
difference in teens’ reasons for taking the drugs. The study, published in The
Journal of Pain, found black teens were more likely than white teens to misuse
their prescriptions. Three-fourths of black teens who misused their
prescriptions said they did so to relieve pain. “The authors noted that racial
differences observed in this study could be related to inadequate pain
management, poor communication, insufficient opioid availability, and under
prescribing among black patients,” a journal news release notes. Teens who
misused their medications for reasons other than pain relief were more likely
to divert their medications. The researchers said their findings indicate a need
for close monitoring of opioids among teens.
One Thing Obamacare Can’t
Fix: Bad Addiction Treatment
After weeks spent offering up increasingly desperate excuses
for the glitchy rollout of Obamacare’s insurance exchanges, Health and Human
Services Secretary Kathleen Sebelius seemed elated to change the subject, at
least for a moment, when last week she announced regulations that will mean
that almost all Americans with health insurance will be fully covered for the
treatment of mental illness, including addiction, at least as well as they’re
covered for physical diseases. The regulations were trumpeted as part of the
President’s plans for curbing gun violence, but they have enormous implications
for untreated addiction, which alone costs the nation $420 billion a year,
mostly in health care, criminal justice and lost productivity. Click
here for more.
Unique school to offer
sanctuary, help to youths fighting drug addition
The nationwide epidemic of prescription-drug abuse has reached some of the most vulnerable populations, according to public health experts. Kids, some still in their preteens, are reaching into their parents’ medicine cabinets, the experts say, confounding teachers and counselors who often have little training in dealing with addiction. "There is an explosion of kids using prescription drugs, which leads to heroin use," said Pamela Capaci, executive director a Prevention Links, a private, nonprofit substance abuse treatment agency in Roselle. Beginning in September, Union County will offer students recovering from alcohol and drug addiction a sanctuary, as well as a place to learn. "Public education is a constitutional right, and children with substance abuse problems are being denied that opportunity," state Sen. Raymond Lesniak (D-Union) said today as plans were unveiled for the Raymond Lesniak Recovery High School. The school, which will be housed at Kean University in Union Township, is being developed by the Housing Authority of Elizabeth in conjunction with Prevention Links. Capaci said the school will open with between 20 and 40 students. Plans call for enrollment to eventually grow to more than 100 students in grades 9-12. The school will provide recovery services throughout the school day, officials said. Students would attend based on referrals from their high schools and the amount of time they’d spend at Recovery High School would vary, the organizers said. It hasn’t been determined whether students from outside Union County would be able to attend. "Substance abuse at the high school level is a big deal and many, many times it is being swept under the rug," said William Jones, executive director of the housing authority. In September, the state Department of Education rejected an application to open the facility as a charter school, stating the financial plan appeared to be weak, and there was insufficient focus on classroom work. "The program’s emphasis is more on successful recovery than on academic rigor," state officials said in denying the application. "While recovery is a worthy goal in and of itself, the lack of clear focus or planning on the latter is a significant concern." Capaci disagreed with the criticism, saying there is a solid fund-raising strategy. She also said the application "demonstrated that our curriculum met the core educational requirements." Organizers now say the school will be a public-private partnership. This is the latest effort to start a "recovery high school" and something that has long been needed, said Frank Greenagle, who oversees recovery student housing at Rutgers University’s campuses in New Brunswick and Newark. "I applaud the effort, but I think it’s going to meet the same hurdles as the other attempts," said Greenagle. Students often go through rehabilitation programs only to re-enter the same school and social settings that resulted in their addiction. "I think the relapse rate for a student going back to the same high school is like 95 percent," Greenagle said. A member of the Governor’s Council on Drug Abuse and Alcoholism, Greenagle said the former state Division of Youth and Family Services, now the Department of Children and Families, proposed a similar high school in 2002, but encountered legislative and roadblocks. Other attempts met opposition from local school districts, said Greenagle, adding that, "it was a not-in-my-back-yard syndrome." There are about 30 high schools nationwide serving youth suffering from substance abuse, including Daytop Preparatory School in Mendham, according to the website for the Association of Recovery Schools.
The nationwide epidemic of prescription-drug abuse has reached some of the most vulnerable populations, according to public health experts. Kids, some still in their preteens, are reaching into their parents’ medicine cabinets, the experts say, confounding teachers and counselors who often have little training in dealing with addiction. "There is an explosion of kids using prescription drugs, which leads to heroin use," said Pamela Capaci, executive director a Prevention Links, a private, nonprofit substance abuse treatment agency in Roselle. Beginning in September, Union County will offer students recovering from alcohol and drug addiction a sanctuary, as well as a place to learn. "Public education is a constitutional right, and children with substance abuse problems are being denied that opportunity," state Sen. Raymond Lesniak (D-Union) said today as plans were unveiled for the Raymond Lesniak Recovery High School. The school, which will be housed at Kean University in Union Township, is being developed by the Housing Authority of Elizabeth in conjunction with Prevention Links. Capaci said the school will open with between 20 and 40 students. Plans call for enrollment to eventually grow to more than 100 students in grades 9-12. The school will provide recovery services throughout the school day, officials said. Students would attend based on referrals from their high schools and the amount of time they’d spend at Recovery High School would vary, the organizers said. It hasn’t been determined whether students from outside Union County would be able to attend. "Substance abuse at the high school level is a big deal and many, many times it is being swept under the rug," said William Jones, executive director of the housing authority. In September, the state Department of Education rejected an application to open the facility as a charter school, stating the financial plan appeared to be weak, and there was insufficient focus on classroom work. "The program’s emphasis is more on successful recovery than on academic rigor," state officials said in denying the application. "While recovery is a worthy goal in and of itself, the lack of clear focus or planning on the latter is a significant concern." Capaci disagreed with the criticism, saying there is a solid fund-raising strategy. She also said the application "demonstrated that our curriculum met the core educational requirements." Organizers now say the school will be a public-private partnership. This is the latest effort to start a "recovery high school" and something that has long been needed, said Frank Greenagle, who oversees recovery student housing at Rutgers University’s campuses in New Brunswick and Newark. "I applaud the effort, but I think it’s going to meet the same hurdles as the other attempts," said Greenagle. Students often go through rehabilitation programs only to re-enter the same school and social settings that resulted in their addiction. "I think the relapse rate for a student going back to the same high school is like 95 percent," Greenagle said. A member of the Governor’s Council on Drug Abuse and Alcoholism, Greenagle said the former state Division of Youth and Family Services, now the Department of Children and Families, proposed a similar high school in 2002, but encountered legislative and roadblocks. Other attempts met opposition from local school districts, said Greenagle, adding that, "it was a not-in-my-back-yard syndrome." There are about 30 high schools nationwide serving youth suffering from substance abuse, including Daytop Preparatory School in Mendham, according to the website for the Association of Recovery Schools.
New drug rules could harm
patients: Opposing view
Don't hinder doctors' ability to prescribe pain relief.
Prescription drug diversion and abuse is a serious public
health problem that has reached crisis levels across the U.S. At the same time,
patients suffering from pain too often must go without adequate access to
effective pain medications, resulting in needless suffering. According to the Institute
of Medicine, 100 million Americans suffer from chronic pain. We are dedicated
to patient care and combating prescription drug abuse. But solutions must not
discourage physicians from appropriately treating pain or reduce access to
prescription drug therapies that reduce suffering. Policymakers should avoid
untested strategies that inhibit legitimate access to pain treatments and
impose an unnecessary burden on patients who must forgo treatment and endure
symptoms of constant pain when every agonizing minute counts.
Continue reading here.
Only 16% of Adults See
Progress on Prescription Drug Abuse: Survey
A new Pew Research Center survey finds only 16 percent of
Americans think the nation is making progress on prescription drug abuse, and
19 percent see progress in dealing with mental illness. In contrast, 54 percent
of Americans say the nation is making progress on cancer. The survey found 35
percent of Americans say the nation is losing ground on mental illness, and 37
percent on prescription drug abuse. The public’s perception of progress against
alcohol abuse is similarly gloomy. The survey found 17 percent see improvement
in addressing alcohol abuse, while 23 percent say ground is being lost, and 58
percent say the problem is staying about the same. The public’s outlook on
smoking is more positive—45 percent of adults surveyed see progress in this
area, and 13 percent think the nation is losing ground. The findings are based
on telephone interviews conducted among a national sample of 2,003 adults in
all 50 states and the District of Columbia.
Most Medical Groups Agree
on Opioid Prescribing Guidelines, Study Finds
A review of medical groups’ guidelines on prescribing
opioids for chronic pain finds most of the organizations are in are agreement,
Reuters reports. “There is widespread agreement about some basic ways of
mitigating the risks associated with prescribing opioids for chronic pain,” said
lead researcher Dr. Teryl Nuckols at the David Geffen School of Medicine at the
University of California, Los Angeles. Nuckols reviewed recommendations for
doctors about prescribing opioids to patients with non-cancer pain lasting for
more than three months. Most of the guidelines recommend doctors not prescribe
doses greater than 90 to 200 milligrams of “morphine equivalents” daily, and
that they have additional knowledge to prescribe methadone. The guidelines
agreed doctors should increase dosages slowly, and monitor patients for side
effects when they first prescribe opioids. They advise reducing doses by at
least 25 to 50 percent when switching opioids. The guidelines also recommend
opioid risk assessment tools, written treatment agreements and urine drug
testing to help manage the risk of overdose and misuse. The findings are
published in the Annals of Internal Medicine. The study did not address how
closely doctors are following the guidelines, the article notes.
“Unfortunately, guidelines are not followed as often as they should be,”
Nuckols said.
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