Lessons From Maine’s Fight Against Limits on Addiction Treatment

By Celia Vimont | August 3, 2012 | 4 Comments | Filed in Addiction,Government, Insurance, Prescription Drugs & Treatment


Maine’s decision to retroactively limit Medicaid payments for buprenorphine to treat opiate addiction is likely to have disastrous consequences, warns the President of the Northern New England Society of Addiction Medicine.

As state budgets continue to tighten, more states are likely to take Maine’s lead, says Mark Publicker, MD. In some states, buprenorphine (Suboxone) and other opiate agonists may not be covered for addiction treatment, while other states are imposing prescribing and refill limits, says Publicker, who is also Medical Director of Mercy Recovery Center in Portland. He is calling on addiction treatment professionals to lead the battle to maintain the availability of medical treatment for addiction.

At the recent American Society of Addiction Medicine (ASAM) annual meeting, Dr. Publicker spoke about the new Medicaid limits on buprenorphine in Maine. He noted patients face a cutoff in medication after a maximum of two years of treatment. The limitations are retroactive, meaning patients on long-term therapy will be hit first and hardest, he said.

“The intent of the new limitations is to save money, but legislators had no concern about the fiscal consequences of such a move, such as increases in crime rates, illnesses, child neglect and an increased number of premature births, which are all anticipated to be far more costly than medications,” he says.

Targeting addiction treatment for budget cuts is an easy move for legislators, he adds. “Addiction is a highly stigmatized condition, and there is no grassroots organization that will rise up to oppose treatment limitations. There is a fundamental misunderstanding about addiction as a chronic disease, and the role of medication in maintenance management.”

Dr. Publicker and colleagues, with the help of ASAM and a number of other medical groups, lobbied against the limits in Maine, but were only able to get a one-year delay in the implementation of the retroactive limit.

“The impact will be disastrous,” he states. “Many of my patients have been on buprenorphine for more than two years, and are leading successful, healthy lives. Many, if not most, of my patients who have achieved sobriety on buprenorphine will go into withdrawal, and the relapse rate will be extremely high. My patients’ lives are at stake.”

In Maine, which is largely rural and poor, opiate addiction is endemic, according to Dr. Publicker. “In many areas, there are no alternatives to medication-assisted treatment. This is a treatment that primary care providers can offer in their offices.”

ASAM is developing a state-by-state survey about the status of buprenorphine limitations, Dr. Publicker notes. At the annual meeting, he urged his colleagues around the country to take action against legislative attempts to cut funding for medication-assisted treatment for addiction.

“The fight against limitations requires coalitions,” he says. “It requires a comprehensive approach involving organizational support and cooperation, effective lobbying, developing personal relationships with legislators and the executive branch, and public information involving the media. It is important to make the clinical case and the economic case against limitations. It is just as important to take this issue to the public, to enlist patients, patients’ families, and other advocacy organizations to join in the fight.”

The Truth About the Kennedy Curse

With Mary Kennedy's suicide in May followed by Kerry Kennedy's car crash this month, talk turned again to the eerie hex cast on this golden American dynasty. Could the mystery be hiding in plain sight?


By Susan Cheever
08/01/12
When Kerry Kennedy got into a potentially fatal accident with a tractor-trailer after nodding off at the wheel at around eight in the morning on the way to her gym two weeks ago, she became part of a long tradition of accidents has haunted one of America’s political dynasties for three generations: the crashes of four planes and at least six cars, a fatal ski accident and a lethal drug overdose, not to mention the assassination of President John F. Kennedy in 1963 and of Robert F. during his own presidential campaign in 1968.

Kerry, 52, the daughter of Robert and Ethel Kennedy and the former wife of New York governor Andrew Cuomo, was charged with misdemeanor “driving with ability impaired” by drugs; she pleaded not guilty. Kennedy’s first public response was that she may have nodded off because she took an Ambien sleeping pill instead of her thyroid medication that morning. Then she released a statement saying that the accident may have been caused by a partial seizure or some related neurological event.

Final toxicology reports released July 25 showed that she was apparently right the first time—she had a generic version of the top-selling prescription sleep agent in her system when police found her dazed and disoriented behind the wheel of her damaged 2008 Lexus after she drove away from the scene. In fact, Ambien, a quick-acting, supposedly non-addictive anti-insomnia agent, has long been suspected of causing a wide range of unwanted “sleep” behaviors, from walking to eating to driving. The drug is on the top-10 list of drugs found in impaired drivers in many states. These so-called Ambien driverstend to display a type of road recklessness more bizarre than most DUIs, such as driving in the wrong direction or slamming into stationary objects like parked cars and light poles. Kennedy was reportedly driving erratically before colliding with the tractor-trailer and then continued driving up the road until pulling off at the first exit.


Being accident-prone is a well-documented symptom of addiction, even if the accident is as small as reaching for the wrong pill.

Yet toxicology reports aside, this latest scandal inevitably reinforces the suspicion that the Kennedy clan is, at the very least, conspicuously accident-prone. Kennedy watchers refer to this seeming propensity for accidents as the “Kennedy Curse”—a frequent trope in media coverage. But given that Kerry Kennedy’s close friend Mary Kennedy, the estranged wife of Kerry’s brother Robert, committed suicide in May, this most recent trouble seems like something more than generic bad luck. Still, like the husband of Diane Schuler who went the wrong way on the Taconic Parkway in Westchester causing multiple deaths, many people would rather believe that an enraged cosmic deity like H.P Lovecraft’s Cthulu has cursed this family than admit a much simpler diagnosis. Perhaps the Kennedy Curse is nothing more mysterious than garden-variety alcoholism and drug abuse.

Kerry Kennedy appears not to have been drunk that morning—no alcohol was reported to have been found in her blood—and the causes of the Kennedy accidents may ultimately be impossible to know. Still, having accidents is a well-documented symptom of alcoholism and drug abuse, even if the accident is as small as reaching for the wrong pill. The way the disease of addiction has emerged in the Kennedy family, skipping some generations and shapeshifting others, is an almost textbook profile of how the disease works.

Some members of the family, including Kerry’s brother Robert, have come to terms with their addictions and found help in recovery. Chris Kennedy Lawford, whose mother, Patricia, was one of nine children of Joseph P. Kennedy Sr. and his wife, Rose, has written brilliantly about recovery in and out of Alcoholics Anonymous. Lawford’s Aunt Joan took him to his first AA meeting, and when he knew that he had to finally stop using, he called his cousin Bobby. “I called the one guy on the planet I didn’t want to bow to, my cousin Bobby, and asked him to tell me what to do,” he writes in Symptoms of Withdrawal.

Lawford’s memoir is a heart-rending portrait of what it was like to be a golden boy in a beloved and legendary family undermined by addiction. Of his cousin Michael’s death in a 1996 skiing accident on Aspen Mountain—he was playing football—following a scandal over his inappropriate relations with an underage baby-sitter, Lawford writes, “To many it didn’t make sense—he was way too good at both sports to die like this—but to me it made perfect sense. If I hadn’t had drugs to alleviate my internal angst, the emotional pain would have sent me looking for a hot babysitter to fuck or a giant tree I could slam into going 70 miles an hour on skis."

The litany of Kennedy traumas and troubles is painful to contemplate, but to mistake their appalling series of human accidents and errors for Greek tragedy is to avoid the distinctly unromantic reality of addiction. Only the plane crashes are, as reported, free of the suspicion that alcohol or drugs may have played a role. Joseph P. Kennedy Jr.’s plane crashed over England during World War II in 1944; four years later, his sister Kathleen died when her plane went down over France. The most heart-breaking plane crash was probably the loss of John F. Kennedy Jr.’s Piper Saratoga off the coast of Martha’s Vineyard in 1999, in which he, his wife and her sister were killed.


To mistake their appalling series of human accidents and errors for Greek tragedy is to avoid the distinctly unromantic reality of addiction.

Edward Kennedy, the late Massachusetts "lion of the Senate" and a longtime alcoholic, was severely injured in a crash in 1964; the pilot and one of his aides were killed. Five years later came the most infamous Kennedy automobile accident, in which the senator drove his car off a bridge in Chappaquiddick on Martha’s Vineyard, trapping Mary Jo Kopechne inside where she drowned. Later, Kennedy himself, who had been drinking at a party before the accident, wondered if “some awful curse” hung over the family.

Many third-generation Kennedys came of age in the '70s and early '80s, when recreational drug use among teens was rampant. The Kennedy kids did not come through unscathed. Hardest hit was David Kennedy, a son of Robert and Ethel who died of an overdose of cocaine and the opioid analgesic Demerol at age 28 in 1984. In 1973, David and his then girlfriend had been riding in a Jeep driven by his older brother Joseph when it overturned, paralyzing the girlfriend and seriously injuring David, who reportedly became addicted to painkillers and was in and out of rehabs for IV drug use over the next decade. But reports of hard partying by many of David's brothers, sisters and cousins surfaced over the years.

To be a Kennedy means to live in the glare of the public spotlight. American’s fascination with the family and its dozens of cousins has hardly abated since the legendary days of the Camelot White House. The Kennedys are unusually good-looking, glamorous and wealthy with a deep and noble commitment to public service. The activism that many of them embrace—from progressive politics to environmentalism and AIDS—are worthy causes. America is a country in need, now more than ever, of intelligent, altruistic politicians. Still, to have many members of a family that is so widely revered consistently try to downplay their own struggles with addiction when so many families nationwide are mystified and destroyed by it, seems less like a public service than a damn shame.

Susan Cheever, a regular columnist for The Fix, is the author of many books, including the memoirs Home Before Dark and Note Found in a Bottle, and the biography My Name Is Bill: Bill Wilson—His Life and the Creation of Alcoholics Anonymous.

Drug Screening Now Required for People Seeking Welfare Benefits in Utah

By Join Together Staff | August 1, 2012 | Leave a comment | Filed inCommunity Related, Drugs, Legislation & Prevention

People seeking welfare benefits in Utah must now take an online drug-screening survey, which is designed to determine if they are likely to have a substance use disorder, according to The Salt Lake Tribune.

Those who receive a high score will be required to take a drug test. A person with a positive drug test will have to enroll in a drugtreatment program and stay off drugs, or else their benefits will be cut off, the article notes.

The company that makes the drug screening survey, the SASSI Institute, has one version for adults and another for teenagers. It says its surveys are 94 percent accurate.

According to Utah State Representative Brad Wilson, who sponsored the bill, an estimated 5 to 10 percent of welfare recipients are drug-dependent. He said most welfare recipients qualify for Medicaid, which will help cover treatment costs.

The newspaper notes Michigan and Florida faced legal challenges when they mandated drug testing for welfare recipients. In both cases those laws were struck down as unconstitutional, according to the article.

Many states have been considering measures that would require welfare recipients to undergo drug testing.

Party Buses Draw Criticism for Turning Blind Eye to Teen Drinking

By Join Together Staff | July 31, 2012 | 1 Comment | Filed in Alcohol,Community Related, Prevention, Young Adults & Youth

Party buses, promoted as a safe way to transport teens and adults to nightclubs and other hot spots, turn a blind eye to teen drinking, according to critics. The vehicles also dump hard-drinking partygoers in neighborhoods that don’t want them, the San Jose Mercury Newsreports.

In one recent incident near Santa Cruz, California, a fight broke out on a party bus between two young adults, who fell out of the moving bus. One died. Everyone onboard, except the driver, was drunk.

California Assemblyman Jerry Hill is sponsoring a bill that would make party bus companies responsible for their passengers, including minors who drink onboard. According to a news release issued by Hill’s office, party buses have become an increasingly popular place for minors to drink. “Due to the lack of penalties and enforcement, minors often drink onboard resulting in tragedies covered in the news in recent years,” the release states.

California tightened rules on “prom limousines” that became popular in the 1980s, where teens drank in the back seat, behind tinted windows. Party buses are not regulated in the same way. Under Hill’s bill, party bus companies and their drivers would have to ensure that minors do not drink onboard, or board the bus drunk. If minors are onboard, a chaperone 25 or older would have to accompany them, to ensure they don’t drink.

Some Trucking Companies Use Hair Tests to Detect Drugs in Drivers

By Join Together Staff | July 30, 2012 | Leave a comment | Filed in Drugs,Government & Prevention

Some trucking companies are using hair tests to test drivers for drug use, according to the Milwaukee Journal Sentinel.

At Schneider National Inc., 38,000 applicants have undergone hair drug testing over the past four years, the newspaper notes. Of those, 1,411 failed the test, for drugs including cocaine and marijuana. More than 90 percent of those applicants passed a urine test for the same drugs. Urine testing is the government-mandated industry standard, according to the article.

While molecules of some drugs, such as methamphetamine, remain in the urine for only a few days, they can stay in the hair for months. Because applicants know in advance they will be tested, they can abstain from drug use for a few days to obtain a clean urine sample. A 2007 investigation by the Government Accountability Office found it is easy to cheat on urine tests, either by sending in someone else to take the test, by adding drug-masking agents purchased online, or by diluting the sample with water.

“The urine-based drug test is simply not catching chronic drug users,” Don Osterberg, Senior Vice President of Safety and Security for Schneider, told the newspaper. He says the government allows hair testing, but it is not officially recognized.

Schneider wants the U.S. Department of Transportation to make hair testing official, and allow test results to be shared with other trucking companies.

“It’s a deterrent,” said John Spiros, Vice President of Safety and Claims Management at Roehl Transport, which began testing hair last year. “When people know that you’re doing hair-follicle testing, a lot of them won’t even apply.”

Hair testing has drawbacks. It does not detect recent drug use, and may show positive results for smoked drugs in someone who has been in the same room but did not smoke drugs themselves

Relative of addicts 'planning on going to their funerals'

By SAMANTHA ALLEN

sallen@fosters.com

DOVER — A local woman told Foster's many of her relatives who abuse prescription drugs have recently turned to "bath salts," a legal stimulant soon-to-be outlawed this year, because it's cheaper and readily available in stores.

She said the effects of the "legal high" have ruined the lives of her family and she is terrified for the future.

"I'm just planning on going to their funerals," she said. "Drugs have literally ripped apart my entire family."

One relative of hers, a Farmington resident, has nearly overdosed or committed suicide several times this year while on bath salts.

"It's killed one of my relatives and it's about to take another if he doesn't get help," she said.

Different forms of bath salts — the street name for a legal substance falsely-advertised as bath beads, plant food and incense — contains methylenedioxypyrovalerone (MDPV) and mephedrone, stimulants which doctors say act like Ecstasy when taken.

Users consume the manufactured drugs by smoking, injecting or ingesting them and experience effects similar to those of cocaine, LSD, MDMA and methamphetamine, according to the Drug Enforcement Administration.

A ban on bath salts and other "synthetic marijuana" compounds is set to go into effect Oct. 1 of this year, with President Barack Obama signing new legislation earlier this month. This past week, more than 90 individuals were arrested and more than 19 million packets of "designer" synthetic drugs were seized in the first-ever nationwide law enforcement action, called Operation Log Jam, by the DEA.

But local agencies say they are still grappling with the phenomena of this drug, which is recently available on shelves at local gas stations and convenience stores.

Frisbie Memorial Hospital Memorial Hospital's Assistant Director of Emergency Medical Services Gary Brock said his team has dealt with calls from bath salts users since last year, and the episodes are typically very violent. He said at the peak of incoming calls, Frisbie Memorial Hospital EMS received about a dozen reports every week, primarily out of the Rochester area, though their coverage extends to other Tri-City communities and beyond.

"The majority of calls we get are for individuals who are out of control," he said. "They're either out of control hallucinating or they're violent."

The unidentified woman said her addict relative has on many occasions called her house, claiming cracks in the walls are video cameras looking in on him, and his home is surrounded by police looking to arrest him. She said when her family drives to Farmington to help, he is often extremely agitated and fights against those wanting to help him.

Brock said this type of paranoia is a common occurrence in the calls he has responded to.

"Many of the signs and symptoms are very rapid heart rate, high blood pressure, chest pain — but very, very often, we encounter them hallucinating, acting paranoid and delusional," he said. "We haven't had any serious injuries (to EMS responders), but they certainly present a physical risk to both police and EMS as these patients ultimately have to be restrained while dealing with their medical issues."

With more than 30 years in emergency response, and 14 years at Frisbie Memorial Hospital, Brock said he can only hope the bath salts phenomena does not reach the level of the methamphetamine "epidemic" witnessed across the country. He said locally, bath salt users have already tied up hospital resources and emergency room staff for hours at a time.

"Bath salts do not clear their body for hours and hours and hours," he explained. "A patient can be in crisis for a very long time. It creates a log jam in the hospitals. A bath salt abuser who's in crisis can take up to half of the emergency room staff to initially try to deal with the crisis, and those are staff members that are being pulled away from other folks."

In 2010, 57 poison centers reported receiving 303 calls concerning bath salts use. In 2011, from January to August, that number rose 4,720. At the national level, the DEA reported the number of calls multiplied nearly four times, with 3,200 calls in 2010 to 13,000 in 2011. 60 percent of the cases reportedly involved patients 25 and younger.

Recently however, Brock said he has seen a drop-off in the calls and, while he can't point to anything specifically, he said it may have to do with the ban slated for this fall. Also, effective Jan. 1, 2013, New Hampshire's "driving while intoxicated" (DWI) charge will include language to outlaw all chemical substances which are considered to impair a driver, including bath salts, prescription drugs and over-the-counter medications such as Benadryl.

"We've certainly been seeing the decline in the bath salts issues and we'll welcome that relief," he added.

For the local woman concerned for her relative, she said she is appalled by the social systems in place that encourage her family members to keep using. She said her Farmington relative has a network of friends who trade narcotic prescriptions or buy pills at $1 per milligram, and when they can't get a hold of those substances, they fall back on bath salts to get them through the lull.

As she learns local stores are pulling their supply in advance of the upcoming ban, she said her relatives will even turn to alcohol. She wishes more rehabilitative services were available, noting her homeless relative, who lives hopping from couch to couch, can't afford health insurance.

"He stays in. He doesn't go out," she said. "It's a beautiful summer and he's pale, pale, pale. He's a vampire. They (his friends) all are. They stay up all night doing Suboxone and Oxys and Percocets, Vicodin, and then bath salts when they can't get those. That's why bath salts isn't an exclusive story."

Brock said his department is aware of the prescription drug users turning to bath salts to aid their addiction, but he said a patient's reaction to bath salts is unlike any other he has observed.

"One of the problems with it is their chemical makeups are very similar to amphetamines. Use creates a high in the addiction centers of the brain that would cause an individual to want to seek that high again," he said. "(But) the methamphetamine abusers we see tend to not have these violent and paranoid behaviors with every instance of use, whereas anecdotally, our experience has been that we see a great deal more violence and hallucinations with use of the bath salts. It may be the combination of all the unknown (manufactured) chemicals with this that's causing this very dangerous behavior."

Lawmakers continue to warn manufacturers of these drugs, said to be based internationally, find new ways to tweak their chemical compounds so they can stay ahead of the law and design new drugs that have yet to be banned in forthcoming years.

Time will tell how manufacturers respond to the new laws in place while the community hopes these bans have some effect on halting drug use at the local level.