Category Archives: Addiction

The changing face of heroin

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By Teresa Wiltz
Stateline

On Super Bowl Sunday, most football fans watched ads for Victoria’s Secret, the lost Budweiser dog and a deadpan Kim Kardashian extolling the virtues of T-Mobile. But in St. Louis, those national ads were supplemented with a different kind of Super Bowl commercial.

On screen, the camera focused on the face of a white middle class teenager as he died of a heroin overdose. Off screen, a singer crooned along to perky guitar music: First you stole prescription pills from your mom/You threw back a few and then they were gone/So you’re jonesing real bad and you need some more… And that’s how, how you got addicted to heroin. 

Beginning in the 1920s, when heroin became illegal, people tended to think of heroin abuse as a problem plaguing people of color in the big cities.

But in the past decade, heroin abuse has exploded—and it is hitting white people in suburbs and rural areas particularly hard. As the demographics of heroin use have changed, so have states’ efforts to combat the problem.

“People have recognized that (heroin addiction) is a problem facing folks they know as well as groups that are distant from them. That certainly affects the way you view the problem,” said Kurt Schmoke, who as Baltimore mayor from 1987 to 1999 was harshly criticized for his efforts to decriminalize drug use.

Twenty-seven states and the District of Columbia now have laws designed to make naloxone, a heroin antidote that is 99 percent effective, more easily accessible to overdose victims, according to the Network for Public Health Law.

Since 2007, 21 states and the District adopted so-called “Good Samaritan laws” that provide some type of immunity for people calling 911 to report or seek help for an overdose.  Continue reading

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States gear up to help Medicaid enrollees beat addictions

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CocaineBy Chrisine Vestal
Stateline

Under the Affordable Care Act, millions of low-income adults last year became eligible for Medicaid and subsidized health insurance for the first time.

Now states face a huge challenge: how to deal with an onslaught of able-bodied, 18- to 64-year olds who haven’t seen a doctor in years.

“It took a lot of time and effort to enroll everyone, particularly those who were new to the system,” said Matt Salo, director of the National Association of Medicaid Directors. “The next big step, and the biggest unknown, is finding out exactly how this newly insured population will use the health care system.”

In addition to increasing the number of people with health insurance, the Affordable Care Act for the first time made coverage of addiction services mandatory for all insurers, including Medicaid.

Until now, the vast majority of Medicaid beneficiaries were pregnant women, young children, and disabled and elderly adults. Relatively few able-bodied adults without children qualified, so states did not set up their Medicaid programs to treat them.

The newly insured, most of them young adults, have different needs. Though not as sick as existing Medicaid beneficiaries, the newcomers are more likely than the general population to have undiagnosed and untreated chronic illnesses such as diabetes and heart disease.

The starkest difference between the new population and the old one, however, is that the new enrollees have much higher rates of drug and alcohol addiction and mental illness.

The number of Medicaid enrollees receiving addiction services is expected to skyrocket over the next two years.

Of the estimated 18 million adults potentially eligible for Medicaid in all 50 states, at least 2.5 million have substance use disorders. Of the 19 million uninsured adults with slightly higher incomes who are eligible for subsidized exchange insurance, an estimated 2.8 million struggle with substance abuse, according to the most recent national survey by the U.S. Substance Abuse and Mental Health Services Administration.

In addition to increasing the number of people with health insurance, the ACA for the first time made coverage of addiction services and other behavioral health disorders mandatory for all insurers, including Medicaid. As a result, the number of Medicaid enrollees receiving addiction services is expected to skyrocket over the next two years.

Although Medicaid and other state and federal programs historically have provided care for people with serious mental illness, coverage of addiction treatments has been spotty. Optional under Medicaid until now, coverage in most states was limited, typically just for pregnant women and adolescents.

“It’s the biggest change in a generation for addiction services,” said Robert Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors. “Comprehensive addiction programs didn’t exist in Medicaid until now.” Continue reading

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Alcohol poisoning kills six Americans a day – CDC

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From the US Centers for Disease Control and Prevention

whiskey-glassAlcohol poisoning deaths are caused by drinking a large amount of alcohol in a short period of time.

This can result in very high levels of alcohol in the body, which can shutdown critical areas of the brain that control breathing, heart rate, and body temperature – resulting in death.

Despite the risks, more than 38 million U.S. adults report binge drinking an average of four times per month and consume an average of eight drinks per binge.

Binge drinking is defined as consuming four or more drinks for women and five or more drinks for men on an occasion.

The more you drink, the greater your risk of death.

Key findings of this Vital Signs report include:

  • There are more than 2,200 alcohol poisoning deaths in the U.S. each year – an average of 6 alcohol poisoning deaths every day.
  • Three in four alcohol poisoning deaths involve adults ages 35-64, and most deaths occur among men.
  • While the majority of deaths are among non-Hispanic whites, American Indians/Alaska Natives have the most alcohol poisoning deaths per million people.
  • Deaths rates from alcohol poisoning vary widely across states, from 5.3 alcohol poisoning deaths per million residents in Alabama to 46.5 deaths per million residents in Alaska.

Alcohol poisoning CDC Continue reading

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Naloxone kits for overdoses now available in Snohomish County

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Snohomish CountyNaloxone kits for treating opioid overdoses are now available at a number of pharmacies in Snohomish County.

These kits are available just by asking the pharmacists, there is no need to see a doctor to obtain a prescription.The cost of the kits is around $125.

Pharmacists will provide education to those being given a Naloxone kit on how to use it and when to use it.

In 2013 there were 86 opioid drug overdoses in Snohomish County, and 580 within Washington State.

The availability of naloxone (sold under the brand name Narcan) could potentially cut down on deaths due to heroin and prescription opioid drugs (morphine, oxycodone/OxyContin, methadone, hydrocodone/Vicodin, and codeine).  Continue reading

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Vicodin, some other pain meds will be harder to get – DEA

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Patients who use drugs containing hydrocodone as a pain reliever or cough suppressant are going to have to jump through more hoops to get them starting next month.

The Drug Enforcement Administration is reclassifying so-called “hydrocodone combination products” (HCP) from Schedule III to Schedule II under the Controlled Substances Act, which will more tightly restrict access. Vicodin, for example, is an HCP because it has hydrocodone and acetaminophen.

The final regulation, which takes effect Oct. 6, will mean that patients generally must present a written prescription to receive the drug, and doctors will no longer be able to call in a prescription to the pharmacy in most instances.

Many patients with painful chronic diseases, including cancer, take hydrocodone combination products

.The regulation is a response to the widespread misuse of prescription pain killers.

In an emergency, doctors will still be able to call in a prescription, according to the new rule. And although prescription refills are prohibited, a doctor can, at his discretion, issue multiple prescriptions that would provide up to a 90-day supply.

These measures don’t satisfy consumer advocates or pharmacists who are opposed to the new rule. Continue reading

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Women’s health week – 48: Drugs

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tacuin womenFrom the Office of Research on Women’s Health

As with many other diseases, the likelihood of becoming addicted differs from person to person, and between males and females.

For substance abuse overall, men are about twice as likely as women to be dependent on most illicit drugs and/or alcohol.

When someone first begins using drugs, addiction does not seem like a dangerous disease, and a person may perceive what seem to be positive effects of drug use. Continue reading

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Women’s health – Week 47: Alcohol

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tacuin womenFrom the Office of Research on Women’s Health

Even in small amounts, alcohol can have negative effects on a woman’s health. In some ways, heavy drinking is a lot more risky for women than it is for men.

Women who drink more than one drink per day increase their risk for motor vehicle crashes, other injuries, high blood pressure, stroke, violence, suicide, and certain types of cancer. Continue reading

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Deaths involving heroin and prescription painkillers continue to rise in King County

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drug thumbDeaths involving heroin and prescription painkillers continued to rise in King County in 2013, according to a new annual report prepared by the King County Drug Trends Workgroup.

The lead author of the report is Caleb Banta-Green, a scientist and epidemiologist at the University of Washington’s  Alcohol & Drug Abuse Institute.

The report found that deaths involving heroin in King County continue to steadily increase reaching 99 in 2013 up from 49 in 2009 though below the peak of 144 in 1998. Continue reading

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Medicaid tailored to those with mental health problems

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Jigsaw puzzle with one piece to add

This KHN story also ran in .

Studies show that enrollees with mental illness, who also have chronic physical conditions, account for a large share of Medicaid spending.

Seeking to improve care and lower costs, Florida this month became the first state to offer a Medicaid health plan designed exclusively for people with serious mental illnesses, such as schizophrenia, major depression or bipolar conditions. Continue reading

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One in 10 deaths among working-age adults due to excessive drinking – CDC

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WhiskyFrom the US Centers for Disease Control and Prevention

Excessive alcohol use accounts for one in 10 deaths among working-age adults ages 20-64 years in the United States, according to a report from the Centers for Disease Control and Prevention published today in Preventing Chronic Disease.

Excessive alcohol use led to approximately 88,000 deaths per year from 2006 to 2010, and shortened the lives of those who died by about 30 years.

These deaths were due to health effects from drinking too much over time, such as breast cancer, liver disease, and heart disease; and health effects from drinking too much in a short period of time, such as violence, alcohol poisoning, and motor vehicle crashes.

In total, there were 2.5 million years of potential life lost each year due to excessive alcohol use.

Nearly 70 percent of deaths due to excessive drinking involved working-age adults, and about 70 percent of the deaths involved males. About 5 percent of the deaths involved people under age 21.

The highest death rate due to excessive drinking was in New Mexico (51 deaths per 100,000 population), and the lowest was in New Jersey (19.1 per 100,000).

 

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Women’s Health – Week 41: Quitting Smoking

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tacuin womenFrom the Office of Research on Women’s Health

Quitting smoking If you stop using tobacco, you could greatly improve your health. Tobacco use is the leading preventable cause of disease, disability, and death in the United States.

Smoking causes most cancers of the larynx (voice box), oral cavity (mouth) and pharynxesophagusbladderkidney, stomach, and cervix.

Tobacco smoke contains chemicals that are harmful. Health care providers know that at least 250 of the 4,000 chemicals in tobacco smoke are harmful.

If you smoke, your risk of developing smoking-related diseases, such as lung and other cancers, heart disease, stroke, and respiratory illnesses, increase with each additional year you smoke. Continue reading

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Obamacare boosts hospital mental healthcare for young adults

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teen-in-shadow-lightBy Jay Hancock
JUNE 11TH, 2014, 5:00 AM

Expanded coverage for young adults under the Affordable Care Act substantially raised inpatient hospital visits related to mental health, finds a new study by researchers at Indiana and Purdue universities.

That looks like good news: Better access to care for a population with higher-than-average levels of mental illness that too often endangers them and people nearby.

But it might not be the best result, said Kosali Simon, an economist at Indiana University and one of the authors.

Greater hospital use by the newly insured might be caused by inadequate outpatient resources to treat mental-health patients earlier and less expensively, she said. Continue reading

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How to keep kids safe with the legalization of marijuana

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Cannabis_leaf_marijuana_potFrom Seattle Children’s On the Pulse blog
Feb 24, 2014

The legalization of marijuana in the state of Washington, along with the impending legalization of marijuana sales this spring, has sparked concern among many parents who have questions on what this means for their children.

Leslie Walker, MD, division chief of Adolescent Medicine at Seattle Children’s Hospital, recently co-authored a guide for parents about preventing underage marijuana use. Walker says that it’s important for parents to know the facts, learn how to talk about marijuana and be aware of the messages that their children may see.  Continue reading

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lesson one

Oregon schools use ‘behavioral vaccine’ to reduce smoking

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Blackboard with "Lesson one" written on it.

Photo: Krzysztof “Kriss” Szkurlatowski

By Kristian Foden-Vencil
Oregon Public Broadcasting

Behaving well in elementary school could reduce smoking in later life. At least, that’s what Trillium Community Health Plan hopes, and it’s putting money behind the idea.

Danebo Elementary in Eugene, Ore., is one of 50 schools receiving money to teach classes while integrating something called the “Good Behavior Game.”

Teacher Cami Railey sits at a small table, surrounded by four kids. She’s about to teach them the “s” sound and the “a” sound. But first, as she does every day, she goes over the rules.

“You’re going to earn your stars today by sitting in the learning position,” she says. “That means your bottom is on your seat, backs on the back of your seat. Excellent job, just like that.”

For good learning behavior, like sitting quietly, keeping their eyes on the teacher and working hard, kids get a star and some stickers.

Railey says the game keeps the kids plugged in and therefore learning more. That in turn makes them better educated teens and adults who’re less likely to pick up a dangerous habit, like smoking.

The Washington, D.C., nonprofit Coalition for Evidence Based Policy says it works. It did a study that found that by age 13, the game had reduced the number of kids who had started to smoke by 26 percent — and reduced the number of kids who had started to take hard drugs by more than half.

The fact that a teacher is playing the Good Behavior Game isn’t unusual. What is unusual is that Trillium is paying for it. Part of the Affordable Care Act involves the federal government giving money to states to figure out new ways to prevent people from getting sick in the first place.

So Trillium is setting aside nearly $900,000 a year for disease prevention strategies, like this one. Jennifer Webster is the disease prevention coordinator for Trillium Community Health, and she thinks it’s a good investment.

“The Good Behavior Game is more than just a game that you play in the classroom. It’s actually been called a behavioral vaccine,” she says. “This is really what needs to be done. What we really need to focus on is prevention.”

Trillium is paying the poorer schools of Eugene’s Bethel School District to adopt the strategy in 50 classrooms.

Trillium CEO Terry Coplin says changes to Oregon and federal law mean that instead of paying for each Medicaid recipient to get treatment, Trillium gets a fixed amount of money for each of its 56,000 Medicaid recipients. That way Trillium can pay for disease prevention efforts that benefit the whole Medicaid population, not just person by person as they need it.

“I think the return on investment for the Good Behavior Game is going to be somewhere in the neighborhood of 10 to one,” Coplin says.

So, for each dollar spent on playing the game, the health agency expects to save $10 by not having to pay to treat these kids later in life for lung cancer because they took up smoking.

Coplin concedes that some of Trillium’s Medicaid recipients will leave the system each year. But he says prevention still makes medical and financial sense.

“All the incentives are really aligned in the right direction. The healthier that we can make the population, the bigger the financial reward,” he says.

The Oregon Health Authority estimates that each pack of cigarettes smoked costs Oregonians about $13 in medical expenses and productivity losses.

Not all the money Trillium is spending goes for the Good Behavior Game. Some of it is earmarked to pay pregnant smokers cold, hard cash to give up the habit. There’s also a plan to have kids try to buy cigarettes at local stores, then give money to store owners who refuse to sell.

This story is part of a reporting partnership that includes NPROregon Public Broadcasting and Kaiser Health News

Photo courtesy of Krzysztof “Kriss” Szkurlatowski

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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As Washington delays, states move on e-cigarettes

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eBy Jake Grovum
Stateline Staff Writer

Money grab, health concerns, or both? Absent guidance from Washington, states are pressing ahead with their own agendas on electronic cigarettes.

Heading into legislative sessions next year, policymakers, industry representatives, health advocates and tax wonks expect electronic cigarettes — or e-cigarettes for short — to be among the top issues at state capitols.

Legislatures are expected to tackle how to classify, regulate and, perhaps most importantly, tax the relatively new products.

The debates in states come as the federal government considers its own answers to similar questions. The Food and Drug Administration is considering classifying e-cigarettes as “tobacco products,” which would extend its reach and potentially subject e-cigarettes to a host of rules and regulations that apply to tobacco cigarettes.

“States are scrambling to figure out how to deal with this,” Ohio Attorney General Mike DeWine said in an interview. “It’s going to be fought out in 50 states; it’s going to be fought out in one jurisdiction after another.”

DeWine was a lead author of an Oct. 23 letter sent by 40 attorneys general to the FDA pushing for federal rules and for e-cigarettes to be treated as “tobacco products” for regulatory purposes.

So far, Washington hasn’t decided how to proceed with e-cigarettes. A proposed rule, expected to be released for public comment in November, was delayed by the government shutdown and is still pending.

That has left a patchwork of rules, regulations and product definitions across the nation, often at the urging of anti-tobacco advocates. “We think it’s really important that states act,” said Danny McGoldrick, vice president of research at the Campaign for Tobacco-Free Kids.

More than half the states, for example, have banned the sale of e-cigarettes to minors, but others have no restrictions. Currently four states — Utah, North Dakota, Arkansas and New Jersey — have lumped the products in with tobacco under indoor smoking bans, even as research about possible ill-effects from second-hand vapor smoke, if there even are any, remains limited.

Some local governments have taken similar steps on their own, enacting rules for e-cigarettes that sometimes go beyond those in place at the state level.

The intensity of the debate illustrates both the lack of good research on e-cigarettes as well as the money at stake. Often, those considering limits don’t even agree on whether applying tobacco regulations is appropriate, given how different the products are. Like tobacco cigarettes, nicotine levels in the “cartridges” that are loaded into the e-cigarette device can vary widely, complicating efforts to agree on a standard approach to regulation and taxation.

E-cigarettes first appeared about a decade ago, and sales have grown exponentially in recent years. The number of American adults who said they have tried them doubled to one in five in just one year (from 2010 to 2011), according to a Centers for Disease Control survey.

Use among middle and high school students also doubled from 2011 to 2012, according to the CDC, with nearly 1.8 million students saying they’ve used them.

E-Cig Revenue

In an era of revenue-hungry state governments — some still dealing with declining revenue from traditional tobacco taxes and recovering from the Great Recession — taxing e-cigarettes seems likely to get the most attention from state lawmakers in 2014. Questions of advertising limits, health claims and ingredient disclosure will likely remain federal issues.

So far, only Minnesota has put in place a specific state tax policy for e-cigarettes, a decision reached in 2012. The products are subject to a 95 percent tax that functions like a sales tax, tacked onto the wholesale cost of the product.

That generally means they are taxed at a higher rate than traditional cigarettes, which are subject to a $1.29-per-pack levy. The state expects to collect $1.16 billion from all tobacco taxes in the 2014-2015 fiscal year.

For now, most other states apply only a sales tax – if they have one – to e-cigarettes. But at least 30 others are considering e-cigarette taxes of some kind next year.

“I will be watching to see if more proposals like Minnesota are replicated in the states,” said Scott Drenkard of the Tax Foundation, an anti-tax research group, “But I hope they are not.”

What this is is a money grab.

As tax experts see it, there’s little rationale aside from simply raising revenue for taxing e-cigarettes as traditional cigarettes. Tobacco, they say, is taxed because it produces negative health consequences that cost the public. For now, there’s little research that shows similar effects from e-cigarettes.

“There is zero, emphasis on zero, justification for taxing e-cigarettes right now,” said David Brunori of the group Tax Analysts, a nonprofit tax analysis group that provides insight to private firms and government agencies. “What this is is a money grab. It’s a way of trying to find revenue to replace lost tobacco taxes.”

According to the nonpartisan Tax Policy Center, state and local tax revenues have somewhat leveled off in recent years as smoking has declined. Collections grew from $7.7 billion in 1997 to $15.8 billion in 2007, but reached just $17.6 billion in 2011, the most recent year available.

Tobacco companies that don’t produce e-cigarettes have often pushed tax parity so their own products are not at a disadvantage. In Minnesota’s case, the state simply said that under its laws, the tax must apply.

But the most popular argument is deterrence—higher taxes might make the product less attractive and less affordable to young people looking for nicotine.

“It has nothing to do with revenue,” Ohio’s DeWine said. “It has everything to do with discouraging use.”

An Alternative to Tobacco

Discouraging use, however, is exactly the opposite goal lawmakers should have, said Ray Story of the Tobacco Vapor Electronic Cigarette Association. It’s an opinion shared by some outside of the industry as well, especially with regard to those already smoking.

“Cigarettes are sold everywhere in the world, and we want to make sure that the e-cigarette is sold as a less-harmful alternative right there next to it,” Story said.

“We should expand the use, not restrict it,” he added, saying that if e-cigarettes can greatly reduce cigarette use the industry “will have made the greatest impact on humanity ever.”

The contrasting approach reflects two key differences in thinking about e-cigarettes: as a new recreational product similar to tobacco cigarettes, or as a potentially less-unhealthy alternative that could even help smokers quit entirely.

E-cigarette producers themselves are divided. Some welcome traditional cigarette-style regulations to a degree, content to play by similar rules as tobacco producers, especially if it saves them from more onerous limits applied to drug manufacturers, for example. Others argue that even thinking about e-cigarettes through the same frame of reference as tobacco is a flawed approach.

Federal officials in Washington will likely be the ones to eventually settle the dispute, and that decision could still be months away. Meanwhile, debates in the states over two key issues within their control – taxes and sales to minors – are likely to rage in 2014.

But the eventual decision from the FDA is sure to affect those debates. “If the FDA says these are essentially tobacco products,” said Brunori of Tax Analysts, “that will give all kinds of cover to state politicians.”

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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