Let’s Get Serious About Treating Addiction
 

By Dr. David Rosenbloom | April 9, 2014 | 3 Comments | Filed in Addiction, Drugs, Insurance, Mental Health & Treatment


Every few years the media report an epidemic of heroin overdose deaths; often after a celebrity like Phillip Seymour Hoffman dies to set off the spark. This time the spike in deaths—which is real– is being attributed to heroin mixed with fentanyl. Attention will fade but the deaths will continue. We wring our hands about overdoses, but do little to make effective treatment widely available. Our continuing refusal to prevent and treat addiction is a medical and social scandal.

Here are the policy changes I believe we must make to end this scandal:

1) Complete the transition to individual health insurance with complete coverage for addiction treatment. The bulk of addiction treatment today is provided by small free standing programs that depend on contracts with public entities for treatment “slots” or individual out of pocket payment. The programs with contracts are responsive to their funders, not to the patients who may be filling a slot at the moment. The organization and funding of our treatment system works against developing a long term relationship between patient and provider that is key to successful long-term recovery. When a patient leaves, the treatment entity has no continuing contact with that person. Obamacare can cover almost all the people with addiction in the country if states, employers and insurers implement it properly. Sadly, some existing treatment programs are dragging their heels or opposed to getting their patients covered because they find it easier to bill the state or because they cannot meet the administrative and clinical requirements for accepting insurance payments.

2) Integrate addiction, mental illness and medical treatment around individuals with severe addiction. Telling a patient who is unemployed, homeless, addicted and mentally ill to go someplace different for each service or to wait weeks for an appointment is malpractice because the providers know it will not happen. We should force consolidation of addiction treatment, mental illness and medical care providers to coordinate and take care of the most severely ill patients in one place. The few places where this kind of care is provided now get much better results for their patients.

3) Increase insurance payment rates for addiction treatment to a level that meets providers’ costs, draws in new responsible providers, and pays for the required coordination. Very low Medicaid and private insurance payment rates create and perpetuate the shortage of quality treatment. Appropriate payment rates will attract higher quality providers.

4) Reward longer stays in treatment and stop using providers that are unable to successfully retain patients in treatment long enough for it to be effective. Longer time in treatment, inpatient or outpatient, improves outcomes. Research shows that drug treatment for less than 90 days is generally not effective, but very few public or private insurance programs authorize that much treatment now. It is shocking that some treatment programs still throw a patient out if he relapses during treatment. Relapse is part of the disease and a signal for more treatment, not a reason to end it.

5) Require hospitals, health centers, HMO’s and other primary providers, as a condition of their participation in Medicaid, Medicare, and public employee health programs, to demonstrate that they diagnose all patients with alcohol and drug disease and that they have a clinically sound program that gets individuals the care they need. Today, most hospitals refuse to provide addiction treatment at any appropriate scale even though many of their patients would have better clinical outcomes if they got brief interventions or treatment.

6) Stop the revolving door at detoxification programs. Current policy and reimbursement get the patient out the door as soon as he or she is “medically stable,” whether or not the person is connected or ready to enter real addiction treatment. The vast majority of people who leave detox without directly entering and staying in treatment quickly relapse. Many think they “failed” treatment but the truth is they never had any treatment, just detoxification.

7) Stop arresting people for non-violent drug offenses. And stop putting people back in jail or prison for non-violent addiction related probation violations. Our current policies ruin thousands of young lives. Addiction is a disease, not a crime. Drug court programs are fine, but they touch only a tiny proportion of the people in the criminal justice system who need treatment.

David L. Rosenbloom, PhD, is Professor, Boston University School of Public Health and former Director of Join Together.

This feature was originally published on the BU Today website.

Largest Health Insurer in Massachusetts Has Cut Narcotic Prescriptions
 

By Join Together Staff | April 9, 2014 | 1 Comment | Filed in Community Related, Insurance, Prescription Drugs & Prevention


Blue Cross Blue Shield of Massachusetts, the state’s largest health insurer, announced it has reduced prescriptions of narcotic painkillers by about 6.6 million pills in the past 18 months. The insurer limited the amount of opioids that members could obtain without prior approval of the company, WBUR reports.

Since the changes were implemented in July 2012, prescriptions for opioids including Percocet have declined by 20 percent, and those for long-lasting drugs such as OxyContin have declined by 50 percent, Blue Cross Blue Shield of Massachusetts President Andrew Dreyfus told The Boston Globe.

An initial review of prescription information, launched in 2011, revealed more than 30,000 of the company’s members received opioid prescriptions that lasted for more than 30 days. “What we found out is in looking at patients who deserved to get pain medications or needed pain medications, many of them were getting significantly more than they would need,” Dr. John Fallon, Senior Vice President and Chief Physician Executive, told WBUR.

Under the program, patients are initially given shorter-term prescriptions for opioids. Patients seeking long-term prescriptions must go through a review process. Before patients are given more medication beyond the new limits, they must be assessed for the risk of addiction, and must agree on a treatment plan with their doctor.

Patients with cancer or other terminal illnesses are exempt from the rules.

“In the past, physicians said that no one should be in pain, and people gave more prescription medication than they probably needed, and that led to supply sitting around, which was then used for inappropriate reasons,” Fallon said. “Now I think there’s an awareness in the physician community how hazardous these medications are.”

Treatment for Heroin Addiction Can Be Difficult to Find, Experts Say
 

By Join Together Staff | April 9, 2014 | 2 Comments | Filed in Drugs, Healthcare, Insurance & Treatment

People seeking treatment for heroin addiction face a number of obstacles, including a lack of treatment beds, expensive care, and insurance companies that refuse to pay for inpatient rehab, according to ABC News.

Most insurance companies will not pay for inpatient heroin detoxification or rehab because withdrawal from the drug is generally not deadly, according to Anthony Rizzuto, a provider relations representative at Seafield Center, a rehabilitation clinic on Long Island, N.Y. He says insurance companies either claim the patient does not meet the “criteria for medical necessity” for inpatient care, or they require the patient to first try outpatient rehab and “fail” before being considered for inpatient treatment.

Most experts say inpatient care is often needed for a person addicted to heroin. Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps, kicking movements and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last dose, and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health can be fatal.

The symptoms of withdrawal are so bad that many people go back to using heroin, often with deadly consequences. Even people who are able to stop using heroin without treatment often relapse. They may overdose because they use as much heroin as they did before, but their system can’t handle the same level of drug as before they went through withdrawal.

Even patients who do get some insurance coverage for heroin treatment generally don’t get 30 days in a residential center. The average duration is 11 to 14 days, according to Tom McLellan, CEO of the nonprofit Treatment Research Institute in Philadelphia. After insurance companies stop paying, facilities discharge patients, even if they are not done with treatment.

The average cost of a 30-day inpatient stay is about $30,000.

States That Don’t Expand Medicaid Leave Millions of Mentally Ill Uninsured: Report
 

By Join Together Staff | April 9, 2014 | Leave a comment | Filed in Community Related, Healthcare, Insurance, Legislation, Mental Health & Treatment

About 3.7 million Americans, who live in states that have not expanded their Medicaid programs under the Affordable Care Act, suffer from mental illness, psychological distress or a substance use disorder and don’t have health insurance, according to a recent report.

Twenty-four states have not expanded their Medicaid programs, according to USA Today. In the states that did expand Medicaid, about 3 million people with a mental health or substance use disorder, who were formerly uninsured, now are eligible for coverage. The findings come from the American Mental Health Counselors Association (AMHCA).

The Affordable Care Act originally required states to expand Medicaid benefits, but in 2012, the U.S. Supreme Court allowed states to opt out of participating in the expansion.

“It is really a tragedy,” said Joel Miller, Executive Director of AMHCA. “When uninsured people with mental health conditions, such as depression, gain Medicaid coverage, they become healthier and life expectancy increases, but in states that refuse to expand Medicaid, citizens will see their hopes dashed for a better life and better health.”

The report findings come from the National Survey on Drug Use and Health, which counted people with serious mental illness, serious psychological distress, and substance use disorders. The group found almost 75 percent (2.7 million adults) of all uninsured persons with a mental health condition or substance use disorder who are eligible for coverage in the non-expansion states live in 11 southern states that have rejected the Medicaid expansion: Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Virginia.

More than 1.1 million uninsured people who have serious mental health and substance abuse conditions live in just two states — Texas (625,000) and Florida (535,000). These more than 1.1 million people are eligible for coverage under the new Medicaid expansion program, but won’t receive it, the report noted.

PRO-ACT Family Addiction Education Program helps families address drug and alcohol addiction



Next free sessions start May 1, 6 or 7 at various locations in five counties



When someone is addicted to drugs or alcohol, the disease affects the entire family. Each month PRO-ACT (Pennsylvania Recovery Organization–Achieving Community Together) hosts a free Family Addiction Education Program to help individuals and families recognize and address an addiction problem in a spouse, parent, child or other loved one. Led by trained volunteers who have been in the same situation, these information and support programs begin the first week of each month and run one evening a week for three consecutive weeks. Each session lasts two hours.



Programs are offered at several locations throughout the five-county southeast Pennsylvania region:

· Tuesdays—From 7 p.m. to 9 p.m. in Media and Northeast Philadelphia.

· Wednesdays—From 6 p.m. to 8 p.m. in Pottstown; from 6:30 p.m. to 8:30 p.m. in North Philadelphia; and from 7 p.m.to 9 p.m. in West Chester.

· Thursdays—From 6:30 p.m. to 8:30 p.m. in Northern Liberties; 7 p.m. to 9 p.m. in Bristol and Colmar.

Sessions are free and confidential—first names only. Pre-registration is required. To register, call 800-221-6333, weekdays 9 a.m. through 5 p.m., or visit http://councilsepa.org/programs/pro-act/family-education-program/.

APRIL 9 v 12 TWELVE STEPPING WITH POWER IN THE PROVERB

If you become wise, you will be the one to benefit.
If you scorn wisdom, you will be the one to suffer.



STEP 12 - Having had a spiritual awakening as the result of these steps, we tried to carry this message to others and to practice these principles in all our affairs.



WISDOM - knowledge that is gained by having many experiences in life. : the natural ability to understand things that most other people cannot understand.

 

Step twelve is more than a step for those of us who work it on the daily . It is a milestone a Chapter in our lives that was fought for. We are not born with the gift of wisdom ,it is earned and I would not trade one single day of my struggles and suffering . The sorrows , struggles , and pain of our past made us the hard core Recovery advocates we are today . The knowledge and wisdom we have fought for and earned must be honed into a gift used in saving those like we once were .



Matthew 5 41 And whoever makes you go one mile, go with him too .

By : Joseph Dickerson