Category Archives: Substance Abuse

Waiting lists grow for medicine to fight opioid addiction

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A self-serve supply of needles and containers for their disposal at a Burlington, Vermont, needle exchange center that distributes more than 2,500 needles every day. As the opioid epidemic mushrooms, the demand for treatment is outpacing capacity.

By Christine Vestal
Stateline

BURLINGTON, Vermont — After more than a decade of getting high on illicit opioid painkillers and heroin every day, Christopher Dezotelle decided to quit. He saw too many people overdose and die. “I couldn’t do that to my mom or my children,” he said.

He also got tired of having to commit crimes to pay for his habit — or at least the consequences of those crimes. At 33, he has spent more than 11 of his last 17 years incarcerated. The oldest of seven children, he started using marijuana and alcohol when he was 12.

It’s been five years since Dezotelle started treatment the first time, and he still hustles for drugs every day. Only now, instead of heroin or OxyContin, he’s trying to score buprenorphine, one of three federally approved opioid-addiction medications. He says heroin is much easier to find, and it’s less than half the price of buprenorphine on the streets and parking lots of this college town.

Vermont Gov. Peter Shumlin, a Democrat, was among the first in the nation to address the opioid epidemic. He devoted his entire State of the State address to the crisis in 2014. Since then, his administration and many of Vermont’s private practice doctors have made treatment more available than it is in most of the country.

But it’s not enough.

In this state of about 626,000, almost 500 addicts are on waiting lists to receive medication for opioid dependence. More than half will wait close to a year.

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Nationwide, a shortage of doctors willing to prescribe buprenorphine, which reduces drug cravings, and a federal limit on the number of patients they can treat, prevents many who could benefit from the addiction medication from getting it.

Less than half of the 2.2 million people who need treatment for opioid addiction are receiving it, U.S. Health and Human Services Secretary Sylvia Burwell said this month, previewing President Barack Obama’s new budget, which was released Tuesday and proposes $1.1 billion to expand the availability of buprenorphine and other opioid-addiction medications.

Where are the Doctors?

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CDC warns of the danger of drinking while pregnant

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From the US Centers for Disease Control and Prevention

Alcohol and Pregnancy

Why Take the Risk?

An estimated 3.3 million US women between the ages of 15 and 44 years are at risk for exposing their developing baby to alcohol because they are drinking, sexually active, and not using birth control to prevent pregnancy, according to a new CDC Vital Signs report.

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The report also found that 3 in 4 women who want to get pregnant as soon as possible do not stop drinking alcohol.

  • Alcohol use during pregnancy, even within the first few weeks and before a woman knows she is pregnant, can cause lasting physical, behavioral, and intellectual disabilities that can last for a child’s lifetime. These disabilities are known as fetal alcohol spectrum disorders (FASDs). There is no known safe amount of alcohol – even beer or wine – that is safe for a woman to drink at any stage of pregnancy.
  • About half of all pregnancies in the US are unplanned and, even if planned, most women will not know they are pregnant until they are 4-6 weeks into the pregnancy when they still might be drinking.

Every woman who is pregnant or trying to get pregnant – and her partner – want a healthy baby. But they may not be aware that drinking alcohol at any stage of pregnancy can cause a range of disabilities for their child.

It is critical for healthcare providers to assess a woman’s drinking habits during routine medical visits; advise her not to drink at all if she is pregnant, trying to get pregnant, sexually active, and not using birth control; and recommend services if she needs help to stop drinking.

For this Vital Signs report, scientists from CDC’s National Center on Birth Defects and Developmental Disabilities analyzed data from the 2011–2013 National Survey of Family Growth, which gathers information on family life, marriage, divorce, pregnancy, infertility, use of birth control, and men’s and women’s health.

National estimates of alcohol-exposed pregnancy were calculated among 4,303 non-pregnant, non-sterile women aged 15–44 years.

A woman was considered to be at risk for an alcohol-exposed pregnancy if she was not sterile, her partner was not known to be sterile, and she had vaginal sex with a male, drank any alcohol, and did not use birth control in the past month.

Women can:

  • Talk with their healthcare provider about their plans for pregnancy, their alcohol use, and ways to prevent pregnancy if they are not planning to get pregnant.
  • Stop drinking alcohol if they are trying to get pregnant or could get pregnant.
  • Ask their partner, family, and friends to support their choice not to drink during pregnancy or while trying to get pregnant.
  • Ask their healthcare provider or another trusted individual about resources for help if they cannot stop drinking on their own.

Healthcare providers can:

  • Screen all adult patients for alcohol use at least yearly.
  • Advise women not to drink at all if there is any chance they could be pregnant.
  • Counsel, refer, and follow up with patients who need more help.
  • Use the correct billing codes so that alcohol screening and counseling is reimbursable.

FASDs are completely preventable if a woman does not drink alcohol during pregnancy.

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Few doctors willing and able to prescribe anti-addiction drugs

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By Christine Vestal
Stateline

Photo: Jr de Barbosa CC license

Photo: Jr de Barbosa CC license

SAN FRANCISCO — Dr. Kelly Eagen witnesses the ravages of drug abuse every day. As a primary care physician at a public health clinic here in the Tenderloin, she sees many of the city’s most vulnerable residents.

Most are homeless. Many suffer from mental illness or are substance abusers. For those addicted to opioid painkillers or heroin, buprenorphine is a lifesaver, Eagen said.

By eliminating physical withdrawal symptoms and obsessive drug cravings, it allows her patients to pull their lives together and learn how to live without drugs.

Clinical studies show that U.S. Food and Drug Administration-approved opioid addiction medicines like buprenorphine offer a far greater chance of recovery than treatments that don’t involve medication, including 12-step programs and residential stays.

But as the country’s opioid epidemic kills more and more Americans, some of the hardest-hit communities across the country don’t have enough doctors who are able — or willing — to supply those medications to the growing number of addicts who need them.DopamineOpioidsv4

More than 900,000 U.S. physicians can write prescriptions for painkillers such as OxyContin, Percocet and Vicodin. But because of a federal law, fewer than 32,000 doctors are authorized to prescribe buprenorphine to people who become addicted to those and other opioids. Most doctors with a license to prescribe buprenorphine seldom — if ever — use it. Continue reading

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Helping drug-addicted inmates break the cycle

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DEADLY BIAS: Why Medication Isn’t Reaching the Addicts Who Need It, Part II

By Christine Vestal
Stateline

Barnstable_County_Massachusetts_incorporated_and_unincorporated_areas_Buzzards_Bay_highlighted - by Rcsprinter123 via WikipediaBUZZARDS BAY, Mass. — A week before 22-year-old Joe White was slated for release from the Barnstable County Correctional Facility, 26 law enforcement officials and social workers huddled around a table to discuss his prospects on the outside.

For substance abusers like White, they aren’t good.

In the first two weeks after a drug user is released from jail, the risk of a fatal overdose is much higher than at any other time in his addiction.

After months or years in confinement, theoretically without access to illicit drugs, an addict’s tolerance for drugs is low but his craving to get high can be as strong as ever.

Most inmates start using drugs again immediately upon release. If they don’t die of an overdose, they often end up getting arrested again for drug-related crimes.

Without help, very few are able to put their lives back together while battling obsessive drug cravings.

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Medicaid to fund more addiction treatment

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By Ben Allen
WITF/KHN/NPR

For decades, if someone on Medicaid wanted to get treatment for drug or alcohol addiction, they almost always had to rely solely on money from state and local sources.

Now, in a dramatic shift, the federal government is considering chipping in, too. The agency that governs Medicaid is proposing to cover 15 days of inpatient rehab per month for anyone enrolled in a Medicaid managed care plan.

But in Pennsylvania, those who work in the addiction field are not happy with that news. While it’s a good start, they say, 15 days of residential care isn’t nearly enough time for many people addicted to heroin, opioids, alcohol or other drugs to get clean and stay that way.

“Where they came up with the 15 days, I don’t know, but it’s not based on research,” said Mike Harle, head of the nonprofit treatment program Gaudenzia, which serves about 20,000 patients a year in Pennsylvania, Maryland and Delaware. In just 15 days, he said, you can’t expect to achieve a positive outcome. Continue reading

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E-cigarette ads reach nearly 7 in 10 middle and high-school students

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From the US Centers for Disease Control and Prevention

About 7 in 10 middle and high school students – more than 18 million young people – see e-cigarette advertising in stores, online, in newspapers and magazines, or on television and in movies, according to a new CDC Vital Signs report.

E-cigarette ads use many of the same themes – independence, rebellion, and sex – used to sell cigarettes and other conventional tobacco products.

Advertising of tobacco products has been shown to cause youth to start using those products.

The unrestricted marketing of e-cigarettes and dramatic increases in their use by youth could reverse decades of progress in preventing tobacco use among youth.

“The same advertising tactics the tobacco industry used years ago to get kids addicted to nicotine are now being used to entice a new generation of young people to use e-cigarettes,” said CDC Director Tom Frieden, M.D., M.P.H. “I hope all can agree that kids should not use e-cigarettes.” Continue reading

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States where pot is legal struggle with ‘drugged driving’

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Cannabis_leaf_marijuana_potBy Sarah Breitenbach
Stateline

Washington State Patrol Sgt. Mark Crandall half-jokingly says he can tell a driver is under the influence of marijuana during a traffic stop when the motorist becomes overly familiar and is calling him “dude.”

The truth in the joke, Crandall says, is that attitude and speech patterns can be effective markers for drugged driving. Continue reading

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Doctors seek to prevent abuse in midst of opioid epidemic

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The U.S. is in the grips of a prescription drug epidemic, fueled in part by an explosion in opioid prescriptions over the past several decades. Roughly half of those prescriptions are written by primary care doctors. NPR’s Robert Siegel talks with Dr. Wanda Filer, president of the American Academy of Family Physicians, about her experience prescribing opioids and what doctors can do to prevent abuse.

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Drug overdose deaths hit all-time high – CDC

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Tablet Thumb BlueMore persons died from drug overdoses in the United States in 2014 than during any previous year on record, the US Centers for Disease Control and Prevention report in this week’s issue of the MMWR.

Some facts from the report

  • From 2000 to 2014 nearly half a million persons in the United States have died from drug overdoses.
  • In 2014, there were approximately one and a half times more drug overdose deaths in the United States than deaths from motor vehicle crashes.
  • Opioids, primarily prescription pain relievers and heroin, are the main drugs associated with overdose deaths.
  • In 2014, opioids were involved in 28,647 deaths, or 61% of all drug overdose deaths; the rate of opioid overdoses has tripled since 2000.

The 2014 data demonstrate that the United States’ opioid overdose epidemic includes two distinct but interrelated trends: a 15-year increase in overdose deaths involving prescription opioid pain relievers and a recent surge in illicit opioid overdose deaths, driven largely by heroin.

To read the report go here.

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Most Americans say they have a personal tie to prescription drug abuse

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By Lisa Gillespie
KHN

The growing abuse of prescription painkillers now touches home for a majority of Americans, according to a poll released Tuesday.

One in three say either they have been addicted to painkillers or they have known a family member or close friend who was.

More than 56 percent of the public say they have a personal connection to the issue, reports the latest monthly tracking poll of the Kaiser Family Foundation.

That share includes those who say they know someone who died from a painkiller overdose, have been addicted themselves or know someone who has and those who know someone who took painkillers not prescribed to them, the poll’s results show. (KHN is an editorially independent program of the Foundation.)

Details from the poll:

— 16 percent say they know someone who has died and 9 percent say that person was a close friend or family member.

— 27 percent say either they have been addicted to painkillers or they have known a family member or close friend who was.

— 63 percent of whites say they have a personal connection to the abuse of prescription painkillers compared with 44 percent of blacks and 37 percent of Hispanics.

Half of those surveyed rank prescription painkiller and heroin abuse as a top priority for their governor and legislature, behind improving public education and making health care more accessible and affordable, which drew 76 percent and 68 percent shares, respectively.

Sixty-two percent of those polled said the drug Naloxone, which can reverse an overdose and is handed out in some states without a prescription and for little or no cost, should only be available via prescription.

Efforts to reduce painkiller abuse would be at least somewhat effective, many Americans say. Providing treatment for addicts is cited by 85 percent, monitoring doctors’ prescribing habits by 82 percent and encouraging people to dispose of leftover medication by 69 percent.

Kaiser’s tracking poll was conducted Nov. 10 to 17 among 1,352 adults.The margin of error for the full sample is +/- 3 percentage points.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

khn_logo_lightKaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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