Tag Archives: epidemic

Addiction Treatment Commitment Laws

addiction

Opioid use disorder is a deadly manifestation of the disease of addiction. The condition leads to the premature deaths of over a hundred Americans, every day. In 2016, some 64,000 people died from overdose across the country — more are expected to succumb in 2017. An "epidemic" is perhaps the only word to be used in describing the severity of the opioid crisis in America.

As with most serious health conditions, finding solutions is particularly tricky. However, if experts and lawmakers agree on one thing it’s that addiction treatment is our best recourse. Substance use disorder treatment works, having helped a significant number of people break the cycle of addiction. Those who keep on the path of recovery can live meaningful and productive lives into old age. Without that type of assistance, there isn't a guarantee that an individual will survive to the end of a given year.

Encouraging people with opioid use disorder to seek treatment is more critical than ever. The rise of synthetic opioids like fentanyl and carfentanil has dramatically increased the risk of overdose. More times than not, individuals are unaware that the heroin they just bought contains an iteration of synthetic opioid. They administer their heroin as usual, which under normal circumstances carries the risk of overdose, only to find that they bit off more than can be chewed. Synthetic opioids are exponentially more potent than what’s seen in the typical bag of heroin. So toxic that the overdose reversal drug naloxone often proves an ineffective antidote.

A heightened prevalence of synthetic opioids begs the question: Is it possible to protect opioid addicts from this invisible foe? That may seem like a simple question, but answering the poser is philosophical.

Are Opioid Addicts a Danger, to Their Self?

We could rephrase the above question to say: How can an addict be protected from their self? Hopefully, we can all agree that addiction treatment services are the most effective tool at our disposal. Individuals with opioid use disorder are no longer at risk of overdose when they are in recovery. Treatment is the surest way to develop the skills necessary for a program of lasting recovery.

Under ideal conditions, a person with alcohol or substance use disorder seeks help on their own accord. They see that the path they are on is only leading to one inevitable end, prompting them to make moves to correct course. Unfortunately, the disease of addiction is both cunning and baffling; even when someone knows they need assistance, they often resist. When that occurs, some suggest mandating individuals to treatment.

Persons exhibiting signs of being a danger to their self and others are often committed to psychiatric evaluation. The standard for commitment is 72 hours, giving clinicians time to assess the level of threat. After that period patients are usually released, but there are times where longer lengths of commitment are in order. Some people view opioid use, or overdose more specifically, as a form of suicide. With that in mind, there is an argument to be made for mandating addiction treatment. Court ordered addiction rehab is a practice that occurs more often than you would think.

Addiction-Related Civil Commitments

The practice of asking the courts to protect individuals from him or herself is happening across the country. Parents, at their wit's end, will turn to the judge and plead for help in saving their child’s life. In fact, over 30 states have laws allowing for addiction-related civil commitment, The Washington Post reports. There were more than 6,000 civil commitments in Massachusetts last year, alone. While it can be easy for some people to see the benefits of mandating treatment, the policy may not have the desired outcome.

Michael Stein at the Boston University and Paul Christopher at Brown University examined this subject. They wrote an opinion piece warning that the efficacy of civil commitment is unknown, potentially doing more harm than good. They bring up three valid points worth consideration:

  • Research is lacking and there isn’t any evidence that civil commitment saves lives. Those forced into treatment may just bide their time until release. With diminished tolerance, the risk of overdose death is particularly high.
  • Given that civil commitment is a response to the level of imminent risk, shorter stays may be warranted. How can a judge be tasked to decide what length of stay is most effective for a given individual?
  • As the number of civil commitment instances grows, greater funding will be needed to pay for beds and facilities.

Stein is chair of health law, policy, and management at the BU School of Public Health. He is the author of “The Addict: One Patient, One Doctor, One Year.” Christopher is an assistant professor of psychiatry and human behavior at Brown University.

Opioid Use Disorder Treatment

We need studies to guide the crafting of new commitment laws and the revision of existing ones. How long should commitment last? What services should be required during commitment that increase the chances of a safe release back to the community? Without data, judges will face desperate parents and their children and continue to direct commitments one by one, restricting civil liberties without knowing whether they are reducing overdose deaths or if the clinical and public health resources are justified.”

Even without science to back up the effectiveness of civil commitment, it’s relatively easy to see problems. It’s well established that mental illness doesn’t respond well to force. Compassion is considered to be the most effective method of encouraging people to seek treatment. Mandates imply that an individual has done something wrong. Mental illness is not a crime, over 2 million Americans have an opioid use disorder.

Despite the fact that commitment is not a criminal charge, it’s likely that individuals subject to it will feel punished. It may not be a criminal charge, but it’s a decree backed by the force of law. If one violates the terms of the commitment, it’s probably safe to assume there will be repercussions. There are many different roads one can take to find addiction recovery, force and ultimatums have rarely led to beneficial outcomes.

Consider an Intervention

At PACE Recovery Center, we offer a multi-pronged approach to our men's addiction treatment program and philosophy because we understand that our clients are complex beings. Having a place where men can delve into their underlying issues, which have caused them to resort to substance use and self-defeating behaviors, is the core philosophy of PACE.

Often accepting treatment is prompted by an intervention. Should you need guidance in arranging an intervention for your loved one, call our team.

Total Cost of The American Opioid Epidemic

opioid epidemicIs it possible to quantify the true impact of the American opioid epidemic? The unprecedented health crisis has left people in the public and private sector scrambling to find desperately needed solutions. With each day that passes—more Americans become dependent on opioids—more people lose their lives to overdose. And while efforts to curb the scourge of opioid addiction in the U.S. have had some effect, without a paradigm shift in thinking regarding prescription opioids—the problem will only continue to disrupt the country. While it is easy for us to look at the staggering death toll to stress the seriousness of the issue, it is important that we all take stock of the societal costs of opioid addiction. With over 2 million Americans living with an opioid use disorder and over 70 people paying the ultimate price for their addiction every day, there is an exponentially greater number of family members who have been affected by the epidemic. It may be impossible to compute the amount of heartache and pain that family members will endure for years, especially if they lost someone to an overdose.

The Cost Of An Epidemic

As you might imagine, there is a heavy price tag attached to the opioid epidemic. The bulk of the cost, naturally, is tied to the burden put on the health care system—whether it be to cover insurance claims for hospitalizations or treatments, or keeping babies born with neonatal abstinence syndrome (NAS) stable—the overall cost of the opioid scourge is daunting to think about. In fact, new research estimates that the epidemic cost is $78.5 billion annually, Newswise reports. Of that estimate, health care accounts for about one-third (over $28 billion) of the total cost. The findings will be published in next month's issue of Medical Journal. Even when opioid use disorder does not result in hospitalization or loss of life from overdose ($21.5 billion), there are other costs to consider as well. Those who are addicted to opioids are often too sick to get to work or hold down a job. The researchers found that loss of productivity accounts for about $20 billion, according to the article. Almost two-thirds of the total economic cost could be attributed to:
  • Health Care
  • Addiction Treatment
  • Lost Productivity
"The costs that we can identify, however, do help increase our understanding of the impact of the epidemic," the researchers conclude. "These estimates can assist decision makers in understanding the magnitude of adverse health outcomes associated with prescription opioid use such as overdose, abuse, and dependence."

Worth The Cost Of Treatment

It is worth pointing out that of the more than $28 billion spent on health care, $26 billion was covered by insurance companies, the article reports. It was not that long ago that it was extremely difficult to get insurance companies to cover mental health disorder treatment, i.e. extended stays at addiction treatment facilities. While there is still a lot more that insurance companies can do to help people with addiction issues, it is good to see that insurance companies are finally insuring people with a history of addiction and paying for some of the bill to help them find recovery. Research overwhelmingly supports addiction recovery services as being the best weapon against the opioid epidemic. Prescription opioids and heroin are extremely difficult to withdraw from and the chance of relapse is especially high among opioid addicts; while those who go to a substance use disorder treatment center have the best chance of achieving sustained recovery in the long run. If you or a loved one is battling opioid addiction, please contact PACE Recovery Center to begin the journey of recovery.

Prescription Addiction: Made in the USA

addictionThere is a lot of information, and unfortunately, deadly misinformation about prescription opioids circulating the internet and other major media outlets. Simply put, there is a lot that the average American adult is unaware of, and what they think they know isn’t always rooted in science. In the United States, we use the vast majority of the world’s supply of prescription opioids—despite the fact that we make only 5 percent of the world’s population. While prescription opioids are abused across the globe, America has the market share of the problem. In an attempt to shed some light on both the opioid addiction crisis and potential solutions—Dr. Sanjay Gupta joins Anderson Cooper of CNN’s "Anderson Cooper 360" for a town hall special—to discuss the prescription drug abuse epidemic in the U.S. The presentation, "Prescription Addiction: Made in the USA" airs tonight, May 11, 2016, at 9 P.M. EDT. It is likely to be more than informative and eye opening for many Americans. Dr. Sanjay Gupta has a remarkable understanding about pain narcotics, addiction and how opioid addiction became a pervasive problem in the United States. The Chief Medical Correspondent wrote an op-ed published today by CNN, which covers many aspects of the epidemic. But, perhaps most intriguing is his belief that doctors were responsible for creating the scourge we face, and it will fall on doctors to spearhead efforts for ending the epidemic. Gupta writes:
The fact is, we have accepted the tall tales and Pollyannaish promises of what these medications could do for too long. As a community, we weren't skeptical enough. We didn't ask enough questions. We accepted flimsy scientific data as gospel and preached it to our patients in a chamber that echoed loudly for decades.”
He points out that while the epidemic is the result of the medical community acting on opioid prescribing recommendations they were not based on fact, doctors continue to recklessly prescribe these deadly narcotics despite knowing that the drugs should be doled out as sparsely as possible. He cites a recent study published in the Annals of Internal Medicine which showed that 91% of opioid overdose survivors managed to obtain another prescription—usually from the physician who prescribed the narcotics the patient overdosed on in the first place. Gupta calls on prescribing physicians to:
  • Engage with patients and discuss treatment with them.
  • Set realistic expectations for patients.
  • Conduct follow-up conversations with patients to gauge treatment efficacy.
“It is not too late. In order for this American-made epidemic to finally end, however, it is the American doctors who must lead the way,” writes Gupta. Remember to tune in tonight, or catch it on DEMAND, to see CNN’s "Prescription Addiction: Made in the USA" May 11, 2016, at 9 P.M. EDT. Join in the conversation and share this family and friends. If you’d like, you can view a short trailer about the town hall meeting by clicking here.

Ending The War On Drugs

war on drugsIn 1971, President Richard Nixon declared drug abuse "public enemy number one," and thus began the United States’ “war on drugs.” While there is little doubt about the insidious nature of both drug abuse and the drug trade, it has become clear that not only was the war on drugs an unwinnable campaign - it has resulted in the jailing and imprisonment of millions of Americans whose only crime was to suffer from the disease of addiction. We know that incarceration has little effect on addiction rates, mental illness requires treatment not handcuffs. The United States has been faced with an opioid epidemic for well over a decade, a public health crisis that has affected people and families from every demographic. As the nation’s lawmakers address the issue, politicians from both sides of the aisle agree that addiction treatment and education is the most effective weapon. Unfortunately, we cannot reverse the damage that the war on drugs has inflicted on countless Americans, but we can take more humanitarian approach for the future - doing away with many of the nation’s draconian drug laws. This week, Der Spiegel published an essay written by Nobel Peace Prize winner and former United Nations Secretary-General Kofi Annan. With the use of powerful words, Annan declared that the global war on drugs has done more harm than good, and has given more weight to punishment than health and human rights. It has created the perfect environment for illegal drug manufacturers and distributors to foster. He writes:
“In my experience, good public policy is best shaped by the dispassionate analysis of what in practice has worked, or not. Policy based on common assumptions and popular sentiments can become a recipe for mistaken prescriptions and misguided interventions. Nowhere is this divorce between rhetoric and reality more evident than in the formulation of global drug policies, where too often emotions and ideology rather than evidence have prevailed.”
In April the United Nations General Assembly will hold a special session on drugs, a chance Annan believes for changes to be made regarding global drug policies. He wrote four critical steps that he believes should be accepted and implemented. 1) Decriminalize personal drug use. 2)Accept that a drug-free world is an illusion. 3)Look at regulation and public education rather than the total suppression of drugs. 4)Recognize that drugs must be regulated precisely because they are risky.

Some final thoughts…

At PACE Recovery Center our men's only extended care drug and alcohol treatment program is built on the idea that by helping the client work on their underlying issues, they will be able to achieve long-term sobriety. PACE's addiction treatment team incorporates the most effective treatment modalities, which have been proven through empirical research. We will follow with interest the special session on drugs that will be conducted at the United Nations General Assembly.

The First National Public Opinion Research On Opioids

opioidsThe unprecedented spike in prescription opioid use in America has raised a number of questions with regard to how the country found itself in the grips of an epidemic. Certainly, most people who experience pain which requires an analgesic of some kind; the pain goes away and they stop taking the prescription. On the other hand, many people continue using prescription opioids long after the pain dissipates, resulting in dependence and/or addiction. Many Americans understand that the country is in the midst of a prescription drug crisis, with thousands of overdoses every year and even more people in need of addiction treatment. Some people will use prescription opioids that were prescribed for someone else, despite having the knowledge that opioids are dangerous and addictive. A new study, which may be the first national public opinion research on opioids, has found that in the past year more than one in four Americans took a prescription opioid, ScienceDaily reports. What’s more, fifty-eight percent of those surveyed say they understand that opioid abuse is major public health problem. The study was conducted by researchers at Johns Hopkins Bloomberg School of Public Health.
"This study shows that many Americans have had direct experience using prescription pain relievers and a sizable share have misused or abused these medications themselves or have close friends or family members who have done so," says study leader Colleen L. Barry, PhD, MPP, an associate professor in the Department of Health Policy and Management at the Bloomberg School. "The seriousness of the issue has become salient with the American public."
The findings indicate that the American public may be in a unique position to pass bills that could combat the opioid epidemic, according to the article. The public could support:
  • Better medical training for safely controlling pain and treating addiction.
  • Curbing “doctor shopping” (seeing multiple doctors for the same drugs).
  • Requiring pharmacists to check identification.
"We think this is the perfect time to work on passing policies that can truly impact the crisis of prescription pain reliever abuse," says study co-author Emma E. "Beth" McGinty, PhD, MS, an assistant professor in the Department of Health Policy and Management at the Bloomberg School. "The issue has not yet been highly politicized like some public health issues such as the Affordable Care Act, gun violence or needle exchanges, so we may have an opportunity to stem this epidemic."
The findings were published in the journal Addiction. ___________________________________________________________________________ If you are or a loved one is abusing opioids, please contact Pace Recovery Center.

House Unanimously Passed Bills Aimed at Opioid Abuse

opioidsLawmakers in Massachusetts continue to spearhead an operation against the opioid epidemic devastating major cities and small towns across the nation. Massachusetts is a state that has felt the overwhelming effects of this crisis, a scourge unprecedented in our times. Lead by U.S. Rep. Joseph P. Kennedy III and U.S. Rep. Katherine Clark, the U.S. House of Representatives unanimously passed two bills devised to combat the insidious effects of opioid abuse, the Boston Herald reports. Kennedy said the unanimous support “speaks to the breadth and depth of the opiate abuse epidemic.” The bill that Kennedy co-sponsored reinstates federal funding to states prescription drug monitoring programs (PDMPs). Monitoring programs deter “doctor shoppers,” people who go to multiple doctors every month for the same types of prescriptions. While PDMPs exist in 49 states, the need for a nationwide system is necessary. The funding will also be used for drug screening and substance use disorder treatment, according to the article.
There are few people in this country who have been spared the heartbreak of watching a loved one, neighbor or friend fall victim to opiate addiction,” said Kennedy. “It’s an epidemic striking red states and blue states, small towns and big cities, neighborhoods rich and poor.”
Clark’s bill, if passed by the Senate, creates uniform standards for diagnosing and treating neonatal abstinence syndrome (NAS). The syndrome occurs when fetuses are exposed to opioids, after birth they experience withdrawal symptoms which require extra medical care. The bill would become the first law to address newborns exposed to opioid use, the article reports.
Right now there is no standard for treatment with NAS,” Clark told the Herald. “This problem leads to long stays in the NICU and hundreds of millions in Medicaid dollars.”
___________________________________________________________________________ If you or a loved one suffers from opioid addiction, please contact Pace Recovery Center.

California Emergency Rooms Treating Heroin Poisonings

heroin-overdoseAs the federal government and the implementation of state prescription drug monitoring programs make it more difficult for opioid abusers to get their hands on OxyContin ® (oxycodone), many have turned to heroin as an easier, cheaper and stronger alternative. When compared to a decade ago, today it is much easier for opioid addicts to get their hands on heroin - resulting in a surge of heroin overdoses across the country. “Most people who use heroin in the U.S. today used prescription opioids first. Reducing inappropriate prescribing will prevent overdose from prescription opioids and heroin,” said CDC Director Tom Frieden, MD, MPH, in a news release. Heroin overdose deaths nearly tripled from 2010 to 2013 in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). In California, emergency departments have seen a six-fold increase in heroin poisonings in the last decade, Reuters reports. In 2014 alone, California emergency rooms treated 1,300 young adults between the ages of 20 and 29 for heroin poisoning. "It's consistent with what we're seeing in our narcotic treatment programs - just a lot more young people," said Tom Renfree, who heads substance abuse disorder services for the County Behavioral Health Directors Association in Sacramento. "There's been a real spike." Heroin poisoning is not exclusive to overdoses; it also represents those who used a product ‘cut’ with something potentially lethal, according to the article. Across the country, there has been a rise in heroin cut with the opioid analgesic Fentanyl ®, users are often unaware just how powerful Fentanyl ® (100 times the strength of morphine) is, making dosing extremely difficult. Young adults were not the only age group affected in recent years. During the same period, adults ages 30 to 39 who were seen in emergency rooms for heroin poisoning doubled - from about 300 to about 600. Among teenagers, in 2014 there were 367 teens treated for heroin poisoning - compared with about 250 in 2005.

OxyContin Overdoses Drop – Heroin Overdoses Rise

needle-exchangeIn the United States, prescription drug overdoses are responsible for taking thousands of lives each year. While efforts to promote abuse-deterrent drugs and the implementation of prescription drug monitoring programs has had some promising results, the drop in prescription drug overdoses and prescribing rates has led to a surge in heroin overdoses, HealthDay reports. In 2010, the makers of OxyContin released a new version of the drug which incorporated abuse-deterrent properties. New research indicates that in the two years following the drug’s new formulation OxyContin related overdoses dropped 19 percent and prescriptions of the drug decreased 19 percent, according to the article. "This is the first time in the last two decades that narcotic prescribing had dropped, rather than continued to increase," said lead researcher Dr. Marc Larochelle, an instructor at Boston University School of Medicine. "With the pill, you used to be able to crush it up and either snort it or dissolve it and inject it. Now if you try and crush it, it doesn't turn into a powder -- it just kind of balls up, and if you try and dissolve it, it turns into a goo," Larochelle explained. Unfortunately, the opioid epidemic exhibits the properties of a hydra, cut off one head only to be faced with another. In the same time period, the researchers found that the rate of heroin overdoses increased 23 percent. "Reducing supply may have led some people who are abusing these drugs to substitute an illicit narcotic like heroin, and it may partially explain why we have seen an explosion in heroin use across the country," Larochelle said. Larochelle points out that simply altering drug formulations will not, in and of itself solve the drug abuse problem. "But it shows supply could be one part of the issue. Abuse-resistant formulations will not cure people who are addicted to narcotics. It could, however, prevent or slow down the number of new people who become addicted, because many people who use heroin may have started with pills," he said. The findings were published in JAMA Internal Medicine.

Need for Naloxone Price Reductions

naloxoneIn the fight against the prescription drug epidemic and subsequent opioid overdose deaths affecting every state in America, no other weapon has saved as many lives as naloxone. The life saving drug, if used in a timely manner, can reverse the effects of an opioid overdose. In many states, law enforcement officials have begun carrying easy to use naloxone kits, giving first responders the tools to save lives. Sadly, seeing the market value of naloxone has caused the drug’s maker to rapidly increase prices, making it difficult to afford for city and state governments. In the epicenter of the problem New York, Amphastar Pharmaceuticals, the makers of naloxone, made a deal with New York attorney general that would provide $6 rebate per dose to New York state agencies, The Hill reports. This move came in the wake of a New York Times article, which reported that the drug’s price had increased by as much as 50 percent. Now, two state legislators are calling for a nationwide price reduction so that the drug can have a further reaching effect. The high price of naloxone has prevented its widespread use, according to the article. “Over the past several months, police departments, law enforcement agencies, and public health officials across the country have warned about the increasing price of naloxone, which they use to combat the scourge of heroin abuse,” Senator Bernie Sanders of Vermont and Representative Elijah Cummings of Maryland wrote in a letter to Amphastar. “Although we are encouraged by your stated willingness to work with other states, it remains unclear why your company has not already lowered its prices in states other than New York,” the lawmakers wrote. “The rapid increase in the cost of this life-saving medication in such a short time frame is a significant public health concern.” As more states pass laws which increase access to naloxone, the need for price reductions will only grow.

Educating Teenagers About Prescription Drugs

prescription-drugsEducating teenagers and young adults as to the dangers of drug use has long been of the utmost importance. While such programs have put up a good fight, the reality is that the young are still losing their lives to overdoses which we all would like to see avoided. The prescription drug epidemic has touched all corners of America, putting high school teenagers at risk and opening the doors to other opioids like heroin. Rather than focus on drug use in general, new programs in Illinois and Pennsylvania designed for middle school and high school students, have set their sights on prescription drug use, Reuters reports. The developers of Narcotics Overdose Prevention and Education (NOPE), say it is more effective to zero-in on prescription opioids, rather than emphasizing a more generalized anti-drug approach. Prescription drugs are fast becoming the drug of choice amongst teenagers. Another new program, Heroin Prevention Education program uses interactive software centered around the life of a recovering teen heroin addict who began abusing opioid painkillers after having his wisdom teeth pulled, according to the article. Like many before, the teen’s addiction to opioids brought him intravenous heroin use. The article points out that these new programs face challenges due to lack of funding. In 2011, funding was cut according to the former Office of the Safe and Drug Free Schools and Communities. "The whole field is sort of in withdrawal," said William Hansen, who runs All Stars, a school drug-prevention provider out of Greensboro, North Carolina. He says that schools have been pouring more money into academic testing and pulling away from drug prevention. What’s more, there has been increased criticism of anti-drug programs in schools, citing program like Drug Abuse Resistance Education (DARE) - a program which has proven ineffective in deterring drug use amongst teens. However, the new programs argue that they have come up with more effective strategies. "Our program really is looking at adolescent brain development, addiction on a brain level," said Christopher Adzia, the program manager at the Robert Crown Center for Health Education.