According to a new study, more than 40% of clinics said that they would not take a new patient who was using opioids to manage pain.
Patients who use prescription opioids to manage their pain may have a harder time accessing primary care, according to a new study.
The research, published in the journal JAMA Network Open, found that primary care clinics who were accepting new patients were less likely to take a patient who said that they were using opioids. In fact, more than 40% of clinics said that they would not take a new patient who was using opioids to manage pain.
Finding Care
“These findings are concerning because it demonstrates just how difficult it may be for a patient with chronic pain searching for a primary care physician,” lead study author Pooja Lagisetty told the blog of the University of Michigan.
For the study, researchers cold-called clinics that were accepting new patients. The callers said they were looking for a new provider for their parent, who took a Percocet (oxycodone) each day to manage pain.
The findings confirmed the researchers’ hypothesis that people on opioids have a harder time accessing primary care. Forty percent of the clinics said they would not take the patient, while two-thirds said they would require a preliminary visit before deciding. Seventeen percent said they would need additional information to make a decision.
Pain Refugees
“Anecdotally, we were hearing about patients with chronic pain becoming ‘pain refugees,’ being abruptly tapered from their opioids or having their current physician stop refilling their prescription, leaving them to search for pain relief elsewhere,” Lagisetty said. “However, there have been no studies to quantify the extent of the problem.”
Surprisingly, the researchers found that whether a patient had private insurance or Medicare did not make a difference in whether or not they were accepted as a new patient.
“Our results did not differ by insurance status, which was surprising because previous studies on primary care access have showed that patients on Medicaid tend to have lower access to primary care than those with private insurance,” Lagisetty said. “This may indicate that providers and clinics are not making these decisions to restrict access based upon reimbursement. Larger clinics and community health centers were more likely to accept new patients suggesting that there may be some system level factors that affect access to care.”
The lack of access to primary care is especially concerning in this case because the researchers who called clinics said that the patient was also on medication for high blood pressure and high cholesterol, both of which require regular treatment from a provider.
In addition, having a primary care provider can help people manage their use of opioids and taper off them, if possible.
“We hope to use this information to identify a way for us to fix the policies to have more of a patient-centered approach to pain management,” Lagisetty said. “Everyone deserves equitable access to health care, irrespective of their medical conditions or what medications they may be taking.”
While the decline is a positive step, many remain concerned about drug research and the lack of leadership in the DEA.
President Trump is celebrating—and claiming credit for—the first drop in the overdose death rate in decades, but political insiders say that his White House remains unorganized, especially when it comes to drug policy.
During an event last month that highlighted the overdose death decline, Trump said, “This is a meeting on opioid[s] and the tremendous effect that’s taken place over the last little period of time.”
“They’re going to make the political argument that they’re winning,” Regina LaBelle, Obama-era chief of staff for the Office of National Drug Control Policy (ONDCP), told STAT News. “Which they can say, since deaths are down. But I get concerned that we’re going to take our eye off the ball on the broader issue of addiction.”
One major concern that some people have is that the Drug Enforcement Administration (DEA) remains without a leader. It’s been that way for more than two years, which Clinton-era “drug czar” General Barry McCaffrey finds absurd.
“The White House is so disorganized and dysfunctional that they can’t pluck an apple sitting at eye level in front of them,” he said. “Why wouldn’t you have a DEA administrator, for God’s sake? In 14 workdays, you could come up with a dozen superlative people with political chops who would take that job.”
The Fight For Drug Research
While the DEA does not have a leader, the agency finds itself at odds with other government agencies. On June 20, one DEA official asked Congress to classify all fentanyl analogues as Schedule I substances. The DEA has argued that this is necessary for law enforcement, but others, including a researcher from the National Institute on Drug Abuse (NIDA), say that this would inhibit research on opioids and treatment for opioid use disorder.
As part of the process, the DEA expressed its desire to control drug classifications without input from the Food and Drug Administration (FDA) and the NIDA.
Senator Dick Durbin (D-Ill.) was so concerned by this power grab that he led a group of eight Senators (including one Republican) who authored a letter expressing their worries.
“We are concerned that the failure to engage necessary health experts vests far too much authority to a law-enforcement agency and may result in action that will deter valid, critical medical research aimed at responses to the opioid crisis,” the senators wrote.
Michael Collins, director of national affairs for the Drug Policy Alliance, said that the agency is “playing on people’s fear in order to make a power grab that predates the fentanyl crisis.”
“We are being asked to give DEA control of the scheduling process and give up due process and allow more prosecutorial power—and give up researching these substances and potentially saving lives as a result of that research,” he said.
“By far this has been not only the toughest year of my life but also the toughest year of my recovery,” Osbourne wrote on Instagram.
Reality television star Jack Osbourne celebrated 16 years of sobriety this week.
Osbourne, the son of Ozzy and Sharon Osbourne, wrote about his recovery milestone in an Instagram post. He said that although he has been in recovery for a long time, this year was one of the most difficult that he has had to navigate sober.
“By far this has been not only the toughest year of my life but also the toughest year of my recovery. I have learned so many things about myself. Some good, some not so good,” he wrote. “But I continued to do it sober even in the face of legit pain and sadness. From divorce, to learning how to be a single father of 3 little girls, to showing up for my family when they have needed support.”
“If at 17 someone told me where I’d be at 33 with 16 years of continual sobriety I would have laughed and told you to fuck off,” he wrote.
Staying Sober During Hard Times
This year, Osbourne and his wife, Lisa, filed for divorce in May after six years of being married. Osbourne said that he is glad to have been able to handle that without turning to drugs or alcohol.
“Even though this last year of sobriety was filled with so much pain it all led to some fantastic personal growth,” he wrote. “I would love to tell you I managed this by being some kind of spiritual giant who roams the halls of recovery meetings, but it’s not the case. I’m here writing this today sober because of the friends in my life who showed up for me when I needed support the most.”
He still needs that support, he wrote, even after all these years.
“I will forever be grateful for all you did,” he wrote. “You know who you are. I love you all.”
Osbourne ended his post with a quote from The Big Book: “Through my years of darkness, some spark of spirit remained in me, helped me survive until I found my way into AA. Then, nurtured by the program, that inner spirit grew, deepened, until it filled the emptiness I had so long felt inside. Step by step I moved to a spiritual awaking [sic]. Step by step I cleared up the past and got on with the present.”
Kid Cudi, Big Sean and Jay-Z are just a few of the hip-hop artists who are helping to break mental health stigma by being open about therapy, depression and anxiety.
Speaking about mental health, substance abuse and suicide may have been taboo in the past, especially in hip hop and communities of color. But growing discussion, acceptance and understanding of these important issues today are encouraging young people of color to seek help for problems they otherwise would have swept under the rug.
Generally, people of color are discouraged to speak up about such issues. As Van Jones said in a conversation with rapper and business mogul Jay-Z last year, the stigma around mental health is ingrained in the African American community.
“You know, mental health, trauma, PTSD is so rampant in our community. As scared as black folks are of the cops, we are more scared of therapists. We are not trying to go to therapy,” Jones said.
Jay-Z (born Shawn Carter), who does not hide the fact that he sees a therapist, shared, “As you grow, you realize the ridiculousness of the stigma attached to it. You just talk to someone about your problems, you know.”
He expanded that therapy could benefit children who would otherwise struggle to process certain experiences and emotions. “I think actually it should be in our schools,” said Carter. “Children have the most going on, their minds aren’t fully developed… You don’t have the language to navigate it.”
Starting The Conversation
A new feature in High Snobiety illustrates how hip hop’s relationship with mental health awareness has evolved over the years. While the genre has long favored more aggressively masculine personalities, modern artists like Diddy, Big Sean, Kanye West, Kid Cudi, Timbaland and Fat Joe have shared their personal battles with depression, anxiety, bipolar disorder, substance abuse, grief and trauma—pushing the conversation further.
“I have noticed a shift, in that a lot more people of color seek psychotherapy than in the past and their decisions are far less motivated by a current crisis. A great number of the cases I received were from people who became aware of the role of their own mental health in the struggle for racial equality,” said Eben Louw, a therapist from Berlin specializing in black/ethnic minority clients.
“Empowerment programs and anti-discrimination awareness events have also sensitized people of color to their basic human rights, which includes the right to health. This made some of my clients more aware that they are entitled to mental health and a better quality of life.”
“I think we’ve come a long way,” said Daphne C. Watkins, PhD, a professor at the School of Social Work at the University of Michigan and founder and director of The YBMen Project. “We’re finally at a place in society where not only are black men talking more about their deepest, darkest, emotional thoughts and feelings but we as a society are more open to hearing what they have to say.”
Teens today have access to the world in a way many of us never experienced in our formative years. The drugs, sex, relationships portrayed in the show are absolutely something we see on the regular.
It’s no wonder why HBO’s new drama Euphoria has already been renewed for a second season—the riveting series is a no-holds-barred look at overstimulated teens who use drugs, deal with childhood trauma, and have sex; it’s a perfect recipe for “must-see TV.”
As gut-wrenching as it can be—scenes and images are raw and uncensored, eliciting visceral reactions—the vibrant ensemble cast led by Disney Channel star Zendaya and transgender model-turned-actress Hunter Schafer lights up the screen, making for electrifying viewing.
Creator Sam Levinson Struggled with Addiction as a Teen
Executive produced by rapper Drake and based on an Israeli teen series, much of what is seen onscreen was inspired by creator Sam Levinson’s personal experiences struggling with addiction.
“I spent the majority of my teenage years in hospitals, rehabs, and halfway houses,” Levinson told the audience at the premiere screening in Hollywood. “Some time around the age of 16, I resigned myself to the idea that eventually drugs would kill me, and there was no reason to fight it. I would let it take me over, and I had made peace with that.”
But then Levinson discovered a quote in a book that would change his life: “’In the end, we are nothing more than an amalgamation of our actions, and that’s ultimately what defines us.’ …that really spooked me in a sense that, if I were to die today, who would I be? I’m a thief. I’m an addict. I’ve been shitty to almost every person in my life that I love,” Levinson acknowledged.
“There was this voice that was clear as day that said, ‘stop fucking doing drugs.’ I’ve been clean for 14 years.”
While there are numerous irate people on social media accusing HBO of being too extreme, what the show describes is not all hyperbole: Teens who are using drugs are often self-medicating stress or trauma with untested high-potency chemicals. It’s an environment ripe for addiction or overdose.
“What we are witnessing with the availability of drugs and the viciousness of marketing aiming at normalizing use in younger and younger populations is a tragedy of immeasurable proportions,” said Daniel Ahearn, a certified addiction specialist and meditation counselor, who has worked with adults and teens in trauma clinics and rehabs for the past 16 years and also runs PTHWRK, a Buddhist-based meditation program.
Teens Use Drugs to Deal with Stress and Trauma
“Children are dealing with enormous stress in environment and influence on a daily basis. They are suffering and the drugs are becoming their outlet,” Ahearn told The Fix. “The real problem is the drugs work. They work for a while. Then things tend to get bad. Real bad. We are seeing record numbers of overdoses in younger and younger people.”
Ahearn is happy to see that at the end of each episode, HBO provides information on where to get help. “It’s important that Euphoria is offering an outlet of health and wellness resources. It’s hopeful that people are having this discussion and the series is contributing to this in a real way.”
Beck Gee-Cohen, director of LGBTQI+ Programming at Visions Adolescent Treatment Center, believes what is being portrayed is a “mirror” to the real world.
“Many parents/adults do not want to believe this is actually happening in the life of teens. However, those of us who work in the field of addiction/mental health see it regularly, and many times it’s worse. A show cannot capture all the pain/trauma that a person goes through; when we watch it from a 2D standpoint we can separate ourselves from it, because it doesn’t feel real,” he said.
“The trans character in the show has given an amazing narrative to what life can be like for a trans teenager today. Her being trans is not the main conversation. We are actually just starting to hear the word trans in the third episode and how it is relevant to her navigating a possible sexual relationship. In the past, a TV shows’ main focus would be about her being trans. Instead, we get to see her character’s depth, strength, and struggles, just like any of her cisgender peers.”
Transgender Youth Have to Deal with an Added Layer of Oppression
In working with trans youth, Gee-Cohen noted that gender is only one piece of the puzzle. “These teens are navigating a world that is coming at them at light speed. They have access to the world in a way many of us never experienced in our formative years. The drugs, sex, relationships that are being addressed in the show are absolutely something we see on the regular in teens today, despite gender. When it comes to trans young people, there is an added layer of oppression and struggle that needs to be addressed in order to help them find their way. As professionals, it is our responsibility to get educated in best practices and creating affirming environments for these young trans people to thrive.”
In the series, Algee Smith (The Hate U Give), plays a football star adjusting to college life: “Euphoria is a must-watch because it’s truth and reality that we live in today. It’s important for us to know the state of many people dealing with these same issues. If we don’t talk about it, we can’t help fix it.”
He continued: “We have so many different characters from different walks of life that a lot of people will relate to. From the life of teenage Rue (Zendaya) to the very adult life of Cal, every character has their own secrets that they live with.”
Eric Dane (Grey’s Anatomy, The Last Ship), who has had his own struggles with addiction in the past, plays Cal Jacobs, a married man with a secret: “I don’t think anyone will look at this and think drugs are cool. This is not a series that glamorizes drug abuse in any way, shape, or form. It’s done so truthfully that it shows a lot of this stuff for what it really is. There is an honesty and beauty to the eventual redemption.”
One of the standout performances in Euphoria is Barbie Ferreira, who plays Kat, a high school student dealing with body image issues and sexuality.
“Playing Kat really allowed me to [understand] how the exploration of sexuality can come in any and all forms. The role brought me back to how I navigated the world as a curious teenager, with internet access and a chaotic amount of free time to spend diving into the niche worlds of the web. I wasn’t really into many hobbies outside of the internet, as a true Gen Z baby.”
Sex, Drugs, and Social Media
In an early episode, Kat has an unimaginable breach of privacy that left the character feeling vulnerable and exposed.
“She immediately reacts by making extreme decisions that make her feel the power she had lost,” said Ferreira.
“The fact that one person with an iPhone can take away Kat’s precious and strongly guarded anonymity that so many of us cling to is a frighteningly real fear and anxiety that is growing in modern society and continues to be brushed under the rug with little conversation about it. I love Kat because although her decision to be a cam girl is far from healthy, it’s a step into owning her power and feeling her worth.”
Kat’s relief and excitement at finding something outside of her real life rings true for everyone who uses the internet as an escape or sanctuary, to feel a sense of importance and understanding, noted Ferreira.
“Her need for escapism in fics and fan culture hits home for me and millions of other self-professed outsiders, who felt community with strangers via text posts and gushing over people we will never meet.”
A new study examined whether drinking alcohol outside led to a faster sunburn.
According to new research, there could be a link between consuming alcohol and increasing the risk for skin cancer.
The research, published in the British Journal of Dermatology, notes that part of this is due to the fact that when drinking, people may forget to apply sunscreen or spend more time in the sun than they normally would.
Feeling The Burn
However, there’s more that comes into play.
“The research suggests that alcohol reduces the amount of time you can spend in the sun before you get a burn,” Aaron White, senior scientific adviser with the National Institute on Alcohol Abuse and Alcoholism (NIAAA), tells NPR.
Previous research done in Germany backs this up. There, researchers looked at a group of healthy men and measured the amount of UV light necessary to burn their skin after each man had consumed about three drinks.
According to White, after the alcohol, “the amount of UV light it took to burn the skin was significantly less.”
Ultraviolet Light
This, White adds, is surprising “because it tells us that alcohol increases the risk of getting a sunburn—not just because people don’t tend to put on sunscreen.”
Though the exact reason for this is unknown, researchers do have some ideas. One possibility has to do with carotenoids, which are “the yellow, orange, and red pigments that are produced by plants,” according to NPR. When a person consumes these, they may be more protected from UV.
In the German study, the carotenoid concentration in the men decreased after they had drank alcohol, leading researchers to conclude that this could lead the skin to be more sensitive to burning. NPR states that two other studies, one in Japan and one in France, have demonstrated similar results.
Still, there is no conclusive evidence as to exactly why those who consume alcohol seem to be more at risk when it comes to developing skin cancer. Eva Negri of the University of Milan says, “There are [likely] several explanations.”
Researchers think alcohol may affect the body and skin in numerous ways, which can lead to a “chain reaction” leading them to be more likely to be diagnosed with skin cancer.
Though White says more research in this area is needed, he also notes that the connection between alcohol consumption and skin cancer is not one to take lightly.
“The added risk of sunburn with alcohol is probably one of the contributing factors to the [higher] rates of skin cancer [among] people who drink [alcohol],” he said.
Seattle’s mayor says that the city and state both need to step up and find a better solution for handling repeat offenders with mental illness.
Seattle’s mental health crisis—intertwined with homelessness and drug abuse—has become not only a matter of public health, but public safety as well. Recent attacks on innocent strangers have highlighted the growing problem.
Crime against people is up 43% from 2016, according to the Downtown Seattle Association (DSA), which echoes the city’s own figures.
According to NPR, part of the problem lies in not knowing how to deal with repeat offenders who are living with mental illness.
In March, a man named Jonathan James Wilson was charged with attempted assault for grabbing a woman he did not know and attempting to throw her off of a 40-foot-high overpass. Wilson, who was homeless, had been arrested three times since September 2018 for assaulting strangers.
According to KIRO, a Seattle Municipal Court judge decided to dismiss all of the assault charges “by reason of incompetency” after Wilson was given a mental health competency evaluation.
Mental Health Revolving Door
Just last Tuesday (July 9), 29-year-old Christopher Morisette was arrested for randomly stabbing three people in the downtown area, including a valet worker. It was later reported that Morisette, too, was a repeat offender. Since 2009 he has had 34 cases filed against him, according to the Seattle Times.
Morisette received a diagnosis of unspecified schizophrenia spectrum and unspecified substance use disorder, according to a forensic mental health report on his condition. Police say he reported using methamphetamine on the day of the recent attacks, and that he had no memory of the time between July 4 and his arrest.
His mother, Susan Morisette, told the Times that her son has been through a “mental-health revolving door” in the last decade—repeating the cycle of going to jail, receiving help, then becoming unstable again. “It’s hard to get my hopes up when he’s doing well because I know it’s not going to last,” said Morisette.
Examples like these illustrate what Seattle is facing in terms of homelessness, drug abuse and mental illness.
Underfunded Programs
Following the attacks by Morisette, Seattle Mayor Jenny Durkan said, “I think what this incident this morning shows is we know we have severely underfunded and are unable to deal with significant mental health needs, and we have to do better as a city, county and state,” she said according to KOMO News.
City Attorney Pete Holmes says Seattle is struggling to provide the necessary support to combat this problem. “We’re finding out that the system is really at its maximum,” he said, according to NPR. “I think the judge and I even agree on that—that those services really are at their limit.”
The Juul CEO apologized during an interview in the documentary Vaporized: America’s E-cigarette Addiction.
When asked what he’d tell a parent of a child who was addicted to the popular e-cigarette company Juul Labs’ products, the company’s CEO, Kevin Burns, said that he was “sorry.”
Burns, who was interviewed as part of a CNBC documentary, Vaporized: America’s E-cigarette Addiction, which airs Monday, July 15, said that Juul products are not intended for use by children, and that as a parent of a teenager himself, he had “empathy for them, in terms of what the challengers they’re going through [sic].”
Juul, which comprises an approximate 40% of the e-cigarette industry, has made efforts to make its products less appealing for young consumers, including the closure of its US-based social media accounts.
A Fifth Of High School Students Vape
But with studies showing that 21% of American high school students used a vaping product in 2019, health advocates, and in particular, former Food and Drug Administration (FDA) Commissioner Scott Gottlieb, are pointing to Juul as the source of the problem.
In the documentary, CNBC reporter Carl Quintanilla asked Burns about parents of young Juul users while touring one of the company’s manufacturing plants in Wisconsin.
“First of all, I’d tell them that I’m sorry that their child’s using the product,” he said. “It’s not intended for them. I hope there was nothing that we did that made it appealing to them. As a parent of a 16-year-old, I’m sorry for them, and I have empathy for them, in terms of what the challenges they’re going through.”
Too Little, Too Late
As CNBC noted, Juul has attempted to counter interest among young people through a variety of measures, from eliminating fruit-flavored products, closing its Stateside social media accounts and supporting initiatives that recommend raising the minimum smoking age to 21.
For some critics, these efforts are too little, too late. CNBC quoted Juul co-founder Adam Bowen, who concurred with critics about the company’s early advertising efforts, which appeared to concentrate on elements that could appeal to young consumers – youthful models, bright colors, use of memes and cartoon imagery. Bowen called these efforts “inappropriate,” but also suggested that they had “no impact on sales.”
Outgoing FDA Commissioner Gottlieb made e-cigarettes’ appeal to young consumers, and in particular, Juul’s impact on that demographic, one of the focal points of his tenure.
He issued warnings and money penalties to retailers that illegally sold their product to minors and took steps to cut off online sales of their product to young consumers, but held up a key deadline that would have required e-cigarettes to submit to an FDA review that would have determined their public health benefits or threats. He later expressed reservations about the decision.
Last weekend marked the sizxth anniversary of Monteith’s 2013 overdose death.
The late actor Corey Monteith was remembered via social media posts by his Glee co-stars, including his former girlfriend, Lea Michele, who has paid tribute every year on social media since his death from an accidental overdose in 2013.
Michele posted an image of the sun behind clouds over a body of water with the message “The light always remains,” while fellow castmates Kevin McHale, Amber Riley and others also remembered their friend with their own posts.
Monteith died in a Vancouver hotel room from an overdose caused by a toxic combination of heroin and alcohol, among other substances, on July 13, 2013.
“He Was Not His Addiction”
Michele, who met Monteith while both were starring on the Fox series and dated him from 2012 to 2013, has posted images and/or messages about the actor on each anniversary of his death, and carries more permanent tributes to him on her person in the form of several tattoos, including his Glee character’s football jersey number.
In a 2014 interview with Seventeen, Michele said that she “only had happy memories of Cory. He was not his addiction – unfortunately, it won. But that wasn’t who he was. Cory made me feel like a queen every day.”
In addition to Michele, Monteith’s co-star Kevin McHale posted an image of the actor on his Instagram page, with a caption that read, “The sweetest boy. Forever.”
Amber Riley’s Instagram post featured a candid of her with Monteith and the caption “6 years without those bear hugs.” And Heather Morris commented on Jenna Ushkowitz’s post by writing, “Missing him a lot lately.”
Their co-star, Matthew Morrison, later added, “I love this pic!”
His Struggle
Monteith’s struggle with drugs and alcohol began in his early teens, which he described in a 2011 interview with Parade as a period in which he “burned a lot of bridges.” He entered rehab for the first time at the age of 19, and earned headlines in 2013 for an on-set intervention by cast and crewmembers that resulted in a stint in rehab that same year.
After completing a 30-day period of treatment in April, Monteith was found dead in a room at the Fairmont Pacific Rim hotel on July 13. He was 31 years old.
“The NBA has kept me out because the mental health conversation forced them to look in the mirror, and none of them want to,” White said.
In recent years, there has been more focus on the importance of mental health in professional sports. A lot of athletes have been more open than ever about living with anxiety and depression, but outspoken basketball player Royce White isn’t sure that the NBA is doing enough to help.
White was a first round draft pick in 2012. He wanted the NBA to have a mental health policy, and he wasn’t going to play until it happened. White says he was then cast out of the league, and as he told the New York Post, “It’s not hard to get blackballed from the NBA. For any number of things.” (White now plays for Big3, a league founded by rapper/actor Ice Cube.)
His Fight
As White explained, “The NBA has kept me out because the mental health conversation forced them to look in the mirror, and none of them want to. And they don’t want to because they built an entire industry on fallacies and smoke and mirrors and circle jerks.”
White has dealt with anxiety and fear of flying, and he’s always been open about it. When he was drafted by the Houston Rockets, he immediately called out the NBA for not having a mental health policy.
“You have a drug abuse policy for players,” White says. “You have a list of banned substances—one of which, by the way, is benzodiazepines, which is one of the most prescribed drugs in America for anxiety. So you’re actually creating a boogie-man narrative around mental health.”
White adds, “Here I am, at 21 years old, and I’m having trouble seeing how I will be able to navigate this industry if there is a true ignorance around the mental health topic. And there was a true ignorance around it that has been admitted now and confirmed by the NBA.”
It’s All in The Approach
Some felt that White’s actions didn’t help his cause, and that he could have gotten more done if he approached the NBA in a different way.
“They literally told me, ‘Listen, you’re right about mental health. But if you don’t play, if you don’t play well, and if you don’t listen to us, no one is going to listen to you. We can control that. We have the platform, and without it you’re a nobody.’”
When White first started making noise, he felt he wasn’t taken seriously.
“Now that the mental health conversation has started to take its true shape, and people have got more information, everyone is starting to change their tune.”
