Addiction treatment is not enough

 The President’s Commission on Combating Drug Addiction and the Opioid Crisis heard a consistent message from families, advocates and experts at its first meeting on June 16: now is a terrible time to throw millions of people off of health coverage. That’s because coverage under the Affordable Care Act, including the Medicaid expansion, is essential for access to life saving addiction treatment. Republican Senators from hard hit states including Ohio and West Virginia are now trying to reconcile their party’s ideology with the health of millions of their constituents.

The obvious approach would be to protect the Medicaid expansion. An alternative approach is now emerging: Roll back Medicaid, but set aside $45 billion or more over 10 years in special funding for opioid addiction treatment. 

I am a doctor who specializes in the care of patients with opioid addiction. Even though this alternative approach would assure funding for clinics like mine, I think it is a terrible idea.

First, it won't work to expand access to all who need care. According to the Surgeon General’s 2016 report, Facing Addiction in America, only about 1 in 10 people who need treatment get it. And the number of people who need treatment for opioid addiction keeps climbing, without an end in sight. Our country needs much more access to treatment, but who would invest to build and staff treatment programs for temporary funding?

Second, the proposal misunderstands the problems facing people with addiction. It's more than opioids. It is HIV, hepatitis C, skin and heart valve infections, cancer, high blood pressure, diabetes, chronic obstructive lung disease, schizophrenia, and depression. And those were just the challenges facing my patients last week.

Medicaid provides access to a range of essential services, from medications for psychiatric disorders to laboratory testing for infectious disease to surgery for hernias. When patients come to me, I take care of their addiction and work to assure these other needs are met. It’s part of what is necessary to get them back on their feet, and help them stay there.

The Congressional recess is starting soon. If a Republican Senator wants to appreciate the impact of this latest proposal, he or she is welcome to visit my clinic in Baltimore. What will be apparent on such a visit is that my patients suffer from opioid addiction, but they are not defined by it. They are real people, with families who love them and with futures they are reaching for. They want not only to be free of addiction but also to be healthy.

Throwing money at addiction treatment is no substitute for real access to care. I implore Senators concerned about opioid addiction to see the whole picture.

Powerful words from Massachusetts on the Stigma of Opioid Addiction

Thank you, Massachusetts, for a powerful, and empowering, public health message! 

May all of us step up to the challenge of changing our language -- and actions. 

The Stigma of Opioid Addiction

                                   from Massachusetts department of Health and Human Services

It’s a huge public health threat – addiction to powerful opioid painkillers.  But you can help by changing the way you think about, talk about and treat people with addiction. Words like “junkie,” “addict” and “druggie” can hurt and stand in the way of recovery. There are perceptions that addiction is a personal choice (when in fact it’s a disease), that addiction is a sign of human weakness, or a lack of morals or willpower.  While the initial decision to take drugs may be voluntary, neurological changes to the brain restrict a person’s self-control. The disease hinders the ability to resist impulses to take drugs despite harmful consequences.

A stigma is a mark of disgrace that sets a person or a group apart.  Stigmas aimed at people with substance use disorders come from many sources including personal shame and disgust at one’s own appearance, behavior and feelings of being unworthy of help, negative labels from friends or family, negative attitudes from healthcare providers, the media, law enforcement, places of work and government agencies.

We are all affected by the current epidemic of opioid addiction. Many of us know someone who struggles with addiction, or who is in treatment.  What can we do?

• We can take a stand against stigma. 

• We can support treatment opportunities. 

• We can encourage people in recovery.

          We can talk about addiction with our friends and family.

          Each of us can commit to not using hurtful or damaging words about those who struggle with addiction.  

Great article from Chris Vestal on MAT in Washington Post

Christine Vestal of Stateline, a Pew Charitable Trust initiative, just wrote a great article on opioid addiction and treatment with medications published yesterday in the Washington Post. Check it out!

https://goo.gl/OQCdFp

Hillary Clinton's substance use initiative

On this Labor Day, I thought it fitting to highlight Hillary Clinton's newly unveiled proposal for how she would address alcohol and drug addiction as President.

We know that one of the best ways to help people achieve and maintain recovery is through treatment, often including a medication. When people are able to manage their chronic illness (or illnesses as if often the case), they are more likely to return to work or school, reconnect with their families, and improve their quality of life. All those things we celebrate today.

So please check out the attached story and the link to the complete proposal:

http://www.huffingtonpost.com/entry/hillary-clinton-addiction_55e6fca6e4b0c818f619ceca

Complete proposal:

https://www.hillaryclinton.com/p/briefing/factsheets/2015/09/02/combat-addiction/

Support the Comprehensive Addiction and Recovery (CARA) Act

I just received the following message from Sean Clarkin at Partnership for Drug-Free Kids -- and I signed the petition to support the Comprehensive Addiction and Recovery Act in Congress. Please check it out and see if you could support it too.

From Sean:

Hello friends,

The Partnership is one of many organizations – and I’ll be among many thousands of people – who will be present at an October 4 rally in Washington called “United to Face Addiction,” aimed at mobilizing resources to prevent and treat substance use disorders and addiction.  Over 85 million Americans say they have been affected “a great deal” by addiction, and yet addiction remains ignored by mainstream healthcare while the majority of those suffering from addiction go untreated.

A major call to action of the rally is support for the Comprehensive Addiction and Recovery Act (CARA),which has bi-partisan sponsorship in both the Senate and House.  The Comprehensive Addiction and Recovery Act of 2015 will:

• Provide up to $80 million in funding for prevention, treatment, and recovery
• Launch an evidence-based opioid and heroin treatment and interventions program.
• Strengthen prescription drug monitoring programs to help states monitor and track prescription drug diversion and to help at-risk individuals access services
• Expand prevention and educational efforts—particularly aimed at teens, parents and other caretakers, and aging populations
• Expand the availability of naloxone to law enforcement agencies and other first responders to help in the reversal of overdoses to save lives
• Expand resources to identify and treat incarcerated individuals suffering from addiction disorders promptly by collaborating with criminal justice stakeholders and by providing evidence-based treatment
• Expand disposal sites for unwanted prescription medications to keep them out of the hands of children and adolescents

The Partnership has created a petition, urging members of both houses of Congress to vote for CARA.  This petition will be delivered to senators and congressmen on Monday, October 5, the day after the rally.

On behalf of myself and the Partnership, I ask you to please sign the petition, share it with friends and family, and post it on Facebook and Twitter using #howmanyfamilies: http://www.drugfree.org/unite_to_face_addiction

Congrats, David Z, on great media interview

Great interview and comments on addiction, recovery, and overdose prevention and response from David Z on Aljazeera America, starting at 23 minutes of this program: http://america.aljazeera.com/watch/shows/america-tonight/2015/7/inside-baltimores-radical-plan-to-battle-heroin-overdoses.html

buprenorphine portrayal and response from Stop Stigma Now

Dr. Phil Paris from Stop Stigma Now comments on buprenorphine portrayal in the media. Education on and promotion of safe medication use for all medications is necessary; not just for opioids. 

What was the drug Dylann Roof was holding when arrested in February?

                                                       By BIANCA SEIDMAN  CBS NEWS  June 19, 2015

When Dylann Roof, the suspect in the deadly shooting at the Emanuel AME Church in Charleston, was arrested last February on trespassing charges at a mall in Columbia, South Carolina, police said he was carrying the drug Suboxone, the brand name of a narcotic that's considered milder than others drugs in its class, such as oxycontin, heroin and vicodin. It is prescribed as a drug for the treatment of opiate and painkiller addictions. 

Suboxone has been a helpful tool in fighting opiate addictions without the need to send patients to methadone clinics."While its safer than heroin or methadone if you take it as directed, if you don't it's as dangerous as any of these other drugs," says Dr. Eric Wish, the Director of the Center for Substance Abuse Research at the University of Maryland.

Many people who use Suboxone are already opiate dependent and for them it's a milder drug.  But side effects of the drug may be greater for those who use it recreationally and not for its intended purpose of opiate recovery. Law enforcement seizures of buprenorphine drugs, which include Suboxone and generics, has increased from 90 to 10,537 packages between 2003 and 2010.

——————————————————————————————————————------------------------------------------------------------------------------------------------------------------

Response from Dr. Philip Paris, Stop Stigma Now

The introduction of Suboxone has been life saving for thousands of those suffering from opioid addiction.  But, like every other medication prescribed by doctors, when misused it can have serious side effects, including a fatal overdose.  This is true for each and every medication in our medicine cabinet from aspirin to Tylenol.  Unfortunately, the possible use of Suboxone by the accused killer of those praying in a Charleston church will surely be used by those who stand against the use of any medication in treating opioid addiction.  

ASAM's National Practice Guideline just released!

The American Society of Addiction Medicine just released its National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use (Practice Guideline). According to ASAM's press release from June 2, 2015: "The Practice Guideline will assist clinicians prescribing pharmacotherapies to patients with addiction related to opioid use. It addresses knowledge gaps about the benefits of treatment medications and their role in recovery, while guiding evidence-based coverage standards by payers."

This is a much-needed resource that helps explain what is meant by treatment of opioid addiction with a medication.

Click here for a copy of the Practice Guideline: http://goo.gl/Oe75JR

Visit with Director Botticelli

We had an amazing visit from the White House Office of National Drug Control Policy Director Michael Botticelli yesterday -- he spent almost an hour speaking with a small group of patients at REACH about their experiences and recovery. They, and he, are unbelievably inspiring!

Office of National Drug Control Policy Director Botticelli's "coming out" and recovery

I just went to the White House Office of National Drug Control Policy's website and found Director Michael Botticelli's post from Feb 9, 2015 upon his Senate confirmation as the country's Drug Czar. It gave me goosebumps as I read it -- I was a fan of the Director before, but this really sealed my fandom forever. I hope others will be equally inspired and respond to his Call to Action.

http://goo.gl/z3LRt4

WBAL Radio interview on heroin crisis and Gov Hogan's new initiative

Just finished an interview with Robert Lange of WBAL Radio on the heroin crisis in Maryland and Governor Hogan's recently announced initiative.

http://goo.gl/UnvwnI

For more information on the budget cuts and the campaign to restore funding, check out the Keep The Doors Open campaign.

http://goo.gl/Sni1Jz

Solutions for the chronically homeless

Here's a great story on Housing First, the approach for housing chronically homeless individuals around the country that is being adopted in Baltimore. Worth the read......

http://goo.gl/CsTn0n

New campaign to support funding for behavioral health services

Check out this website for the Keep the Door Open campaign led by the Behavioral Health Coalition in Maryland. They have done some great work to advocate for appropriate funding for behavioral health services in Maryland.

http://keepthedooropenmd.org/

Amazing article in Huffington Post

Jason Cherkis, reporter for the Huffington Post, has written one of the best pieces I've ever read on heroin addiction and the current, tragic state of its treatment in the US. Very motivating and heart wrenching at the same time! http://goo.gl/8WQ4yP

Selected References for Treatment of Opioid Use Disorder with Methadone

This is a list of selected references that I have compiled to help those interested in learning more about the evidence base for the treatment of opioid use disorder with methadone.

https://dl.dropboxusercontent.com/u/24514445/Selected%20References.pdf

Celebrate Medication-assisted Recovery

It has been a busy fall and hard to believe 2015 is almost upon us!

There has recently also been a lot of discussion in the media and elsewhere about the treatment of opioid use disorder with medications, or so-called medication-assisted treatment.

I have come to believe that the better term is medication-assisted recovery as recovery is what happens with so many when medications are part of their treatment and recovery regimen.

So this holiday season, I say happy holidays and best wishes for a bright and wonderful 2015 to all of those people around the world living their lives in recovery with medications -- go MAR!

Comment on CNN and addiction treatment

This is from an article by Dr. Sanjay Gupta, CNN's Chief Medical Correspondent, on the transition from prescription opioid misuse and addiction to heroin addiction. 

"We must work to make sure treatment for drug addiction is a pillar of drug policy in the United States. We already know that it can work at levels similar to the effects of treatment of other chronic diseases, such as diabetes, hypertension and asthma."

Interestingly, as a colleague of mine pointed out, by the time Dr. Gupta "got around to writing a 2-sentence paragraph on need for treatment at the end of the article, he already mentioned how some countries are prescribing heroin..... Also unfortunate is that he did not mention how there are three effective, approved medications for treatment, and how stigma reduces their availability."

Decades of collective data and experience demonstrate that medications including methadone, buprenorphine, and the newer naltrexone, can significantly help people achieve and sustain recovery from opioid use disorder and allow them to lead productive lives. But the stigma, misunderstanding, and associated politics that surrounds these medications, especially methadone and buprenorphine, keeps us collectively as a society from making the most out of them. 

We don't need prescription heroin -- we need informed and courageous politicians, healthcare providers, family members, and people in recovery to stand up and support what we already know works.  

For the full story by Dr. Gupta, go to:  http://goo.gl/Lfd8sb

conference announcement

The Maryland Society of Addiction Medicine will be having their annual meeting on Saturday, Sept 13, 2014
from 8:00am to 2:00pm.

The topic is Healthcare Integration in Maryland: How Will It Impact Your Practice?
Keynote speakers include Dr. Joshua Sharfstein, Secretary of Health and Dr. Gayle Jordan-Randolph, Deputy Secretary for Behavioral Health.

In addition, the conference will feature an update on Maryland's Prescription Drug Monitoring Program, an overview of key scientific journals in addiction medicine in the past year, and a distinguished panel discussing their on-the-ground experiences with integrating care from different perspectives, including an Opioid Treatment Program, an Emergency Department, a rural and urban primary care practice, a mental health setting, and an inpatient acute care hospital system.

The conference is free, and you do not have to be a MDSAM member to attend.

Online registration and more information can be found at:
http://goo.gl/4IWTE5

thank you, david z!

In a world where stigma against methadone is rampant, it takes courage to tell your story of recovery. David Z has that courage and hopefully others will feel inspired to do the same -- we need to hear the voices of people who effectively manage their opioid use disorder with methadone.Those stories of recovery are the key to shattering the myths of methadone!

http://goo.gl/WsYTnX

new media campaign in MD

There's a new media campaign in Maryland, focusing on raising public awareness of opioid overdose and what to do when it happens -- how you literally can save a life!

http://goo.gl/vhN55K

The campaign offers great colorful pamphlets and posters for view on the facebook page and links to a number of different relevant resources from across the state. So take a look!