Answer Addiction

Tag: medication-assisted treatment

  • Study Questions Treatment For Pregnant Women With Opioid Addiction

    Study Questions Treatment For Pregnant Women With Opioid Addiction

    The study’s findings might cause medical providers to reconsider what is the best standard of care for pregnant women with opioid addiction, according to the lead study author. 

    A study released this week found that infants who are exposed to opioids in the womb have significantly smaller head sizes at birth than babies who were not exposed to opioids, suggesting that they are at increased risk of mental health and developmental problems and potentially calling into question the standard treatment for women with opioid use disorder who discover they are pregnant.  

    The study, published in the journal Pediatrics, found that infants who were exposed to opioids were three times more likely to have a head circumference that measured in the bottom 10%. A small head circumference has previously been linked to mental health problems and developmental delays. 

    “Babies chronically exposed to opiates [during pregnancy] had a head size about a centimeter smaller’ than babies born to moms not using drugs,” said Dr. Craig Towers, lead study author and professor of obstetrics and gynecology with the University of Tennessee Medical Center in Knoxville. This included babies whose mothers were on medication-assisted treatment with methadone or buprenorphine, the current standard of care for women who discover they’re pregnant while abusing opioids. 

    Towers said that the findings might cause medical providers to reconsider what is the best standard of care for pregnant women who are addicted to opioids. 

    “What we’re recommending these moms do, which is get on methadone and buprenorphine, may result in a smaller head size of the baby,” Towers said. “This is going to have to make us re-look at what we’re doing.”

    During the study, mothers were routinely screened for drugs so that researchers could control for the influence of alcohol or illicit drugs other than opioids. With this information, they were able to definitively link opioid exposure and lower head circumference. 

    Although the results may call into question the use of prescribed opioids during pregnancy, Towers said that putting women on maintenance therapy remains the best option for now. Women who are abusing opioids and stop suddenly can experience withdrawal that may cause them to miscarry or can increase their risk of relapse, which can have fatal results for both mom and baby. 

    “I don’t want anyone to think putting them on methadone or buprenorphine is not the way to go. If they continue to use street drugs, that’s exponentially worse,” Towers said. With prescribed drugs, a woman and her doctor at least know exactly what she is taking, he said. 

    He said the study could encourage more conversations between women and their care providers. 

    “There are risks to the mom if she tapers and detoxes, but there are risks to the baby if she stays on maintenance therapy,” Towers said. “There needs to be informed consent so the mother can choose how she wants to go.”

    Dr. Mark Hudak, a professor of pediatrics at the University of Florida College of Medicine who wrote an editorial accompanying the study, said that the research is likely to be “very controversially received.”

    “I think there’s going to be pushback on it, but one has to follow the evidence,” he said. ”The whole pillar of opioid maintenance therapy is based upon the fact this is better for the mother and the baby in the sense that the mother is in therapy, she is more closely monitored, she’s more likely to access good prenatal care, she’s less likely to engage in behaviors that would be harmful to her or the fetus… You now have to ask, is that the only or the best way for all women.”

    View the original article at thefix.com

  • Opioid Court Aims To Prevent Overdose By Offering Treatment

    Opioid Court Aims To Prevent Overdose By Offering Treatment

    The Rochester-based opioid court offers treatment instead of jail time for minor drug-related offenses.

    A new court program in Rochester, New York aims to save lives by connecting people with opioid use disorder with treatment immediately, lessening their risk of overdose after spending a brief amount of time detoxing in jail. 

    “Their tolerance goes down from their short stay in the jail, and that’s when they use again and fatalities occur,” Monroe County Court Judge John DeMarco, who will oversee the new program, told WHAM.

    Rochester helped lead the national push for drug courts, which offer treatment instead of jail time for minor drug-related offenses. However, the drug court program in Monroe County has a months-long waiting list. Officials noticed that people with opioid use disorder weren’t getting the chance to participate in the program because they often relapsed after being released from jail following their arraignment. 

    To help prevent overdoses, the new program, called Opioid Stabilization Part (OSP), will evaluate people at the time of their arrest and help connect them with immediate treatment. opioid court — as it’s already being called — is meant to serve the people who are most at-risk for overdoses.

    “We have their attention. Having their attention creates maybe the only opportunity that those folks have to commit to get this thing turned around,” DeMarco said. 

    As part of the program, people showing signs of opioid use will be screened at Monroe County Jail the day of their arrest. Those who screen into the program will have their criminal cases put on hold. Instead of waiting for arraignment and being released on bail — oftentimes to return to the community to get high — participants will quickly be seen by a special judge and enrolled into treatment. From there, participants need to check in with the judge daily in person, if they are in an intensive out-patient program. 

    People who do not have insurance will be able to access treatment thanks to a $1.8 million federal grant for the program. 

    Law enforcement said that the people who will use opioid court are often more of a danger to themselves than to others. 

    “We recognize they’re at high risk,” said Monroe County Sheriff Todd Baxter. “That’s exactly what we’re trying to we[a]n out of the jail and put them where they belong, into a bed and treatment program.”

    District Attorney Sandra Doorley said the people in opioid court do not represent a danger to the community. In fact, she said that these people would normally be released from jail, just with less supervision than the opioid court program will provide. 

    “They’re usually given bail, so they’re released (into the community) anyway,” Doorley said. “At this point we’re not allowing violent felons to get into the program.”

    A similar program that launched in Buffalo, New York last year has not lost a single participant to overdose. 

    View the original article at thefix.com

  • West African Clinic Offers Free Methadone, Clean Needles & More

    West African Clinic Offers Free Methadone, Clean Needles & More

    The goal of Senegal’s free program is not only to rehabilitate, but also to reduce the spread of HIV and AIDS among drug users.

    A clinic in West Africa is doing its part to mitigate the region’s opioid crisis.

    People line up at the Center for the Integrated Management of Addictions (known locally as CEPIAD) in Senegal to receive a daily dose of methadone and counseling. Some travel hours for treatment.

    “You get here, you have your methadone and you are not thinking about taking drugs. You are thinking about moving your life forwards,” says Moustapha Mbodj, who is in recovery from more than 30 years of heroin use.

    A new CNN report highlights CEPIAD’s efforts. Established by the Senegalese government in 2014, the clinic is the first in West Africa to provide free opioid substitution treatment. CEPIAD offers methadone, clean syringes and condoms, as well as skills workshops and help with reintegrating into family networks, according to CNN. It has helped more than 700 people since it opened.

    The goal of the free program is not only to rehabilitate drug users, but to reduce the spread of HIV and AIDS among drug users. Over 10% of injecting drug users in Senegal live with HIV, according to United Nations estimates. Among the general population, this number is less than 1%.

    An estimated 1,300 injecting drug users were counted in Dakar (Senegal’s capital) in 2011, according to a voluntary survey by the French National Agency for Research on AIDS.

    In response to the survey, Senegal’s government turned to a harm reduction approach. In a two-year period, public health workers distributed 18,614 clean syringes and 17,564 condoms to the public at no cost.

    The need for such services is rising.

    Senegal is among a handful of African nations that offer this type of free service. According to a 2017 report, out of 37 African nations reporting drug use data to the UN, just eight offer harm reduction approaches, including Senegal, Tanzania, Kenya and Mauritius.

    Pierre Lapaque, a representative with the UN Office on Drugs and Crime (UNODC) for West and Central Africa, explained that the market for drugs is growing in a region that previously served only as a transit point for drug traffickers.

    Lapaque says traffickers used a “smart approach” to introduce drugs to a “region where there was absolutely no market ten years ago.”

    “Often what the traffickers are doing is they are paying their support staff not only in cash but in drugs,” said Lapaque.

    View the original article at thefix.com

  • Inside The Methadone Clinic Boom

    Inside The Methadone Clinic Boom

    “We haven’t seen such a dramatic increase in the industry since the 1970s,” says one expert.

    The methadone treatment industry has exploded from 2014 to 2018, growing more in those four years than in the past two decades, the Boston Globe reports. 

    In the past four years, according to Drug Enforcement Administration (DEA) data, the industry has added 254 new clinics. The clinics allow for the administration of methadone, which is a type of long-acting opioid that can help short-acting opioid users manage withdrawals and allow them more time to detox, WebMD states.

    “We haven’t seen such a dramatic increase in the industry since the 1970s,” Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, told the Globe. 

    Critics of methadone treatment say it is just replacing one substance for another. Yngvild Olsen, an addiction doctor in Baltimore and board member of the American Society of Addiction Medicine, tells the Globe that needs to change.

    “There has been an underlying stigma against methadone for so many years that the industry naturally maintains a low profile,” she said. “Even now, access to methadone is highly geographic. It depends on where you live.”

    Indiana, Maryland, and New York have been at the forefront of states with access to methadone treatment, implementing dozens of new clinics in the past two years alone. Ohio and Florida plan to follow suit with expansions in the works.

    There are some states where laws limit the availability of such clinics. These include Georgia, Indiana, Louisiana, Mississippi, West Virginia, and Wyoming. 

    Even so, the clinics are becoming more common, as in the past four years Medicaid has expanded its coverage and reimbursement for such services for low-income adults. And, in 2020, Medicare coverage of the treatment for those 65 and older will begin as part of the Opioid Crisis Response Act, meaning the need could become even greater. 

    If a state wishes to open such a clinic, they must apply for a license, Parrino tells the Globe.

    While there are other medications to assist in curbing opioid withdrawals, such as buprenorphine, methadone is the most highly regulated. 

    The Globe reports that often, patients are given methadone through a plexiglass shield. Patients are often screened to make sure they are not combining methadone with other drugs. At first, they are only given the medication in the clinic, under the watch of a professional. Eventually, some patients are allowed take-home doses. 

    In contrast, buprenorphine can be prescribed for 30 days at a time by doctors, nurse practitioners, and physician assistants and is viewed as the more obvious treatment by some. 

    “There’s no question that better access to methadone maintenance would save lives,” Andrew Kolodny, co-director of opioid treatment research at Brandeis University, told the Globe. “But for an addiction epidemic that is disproportionately rural and suburban, an intervention that relies on people visiting a clinic every day isn’t the best option. Buprenorphine would be better, but it’s not growing quickly enough.”

    View the original article at thefix.com

  • Inside Switzerland's Addiction Treatment Experiment

    Inside Switzerland's Addiction Treatment Experiment

    One Swiss organization is finding success with a treatment model centered around medical-grade heroin. 

    With some treatment models still offering fairly dismal success rates, specialists are broadening the parameters of what successful treatment looks like. In Switzerland, an injection center attached to the Geneva University Hospitals is conducting an experimental heroin-prescription program (PEPS). Patients addicted to heroin check in daily for their Swiss laboratory manufactured diacetylmorphine, or heroin.

    Switzerland’s 1,500 patients at 22 PEPS centers have all failed previous attempts to end their heroin addiction with drug-replacement therapy. Patient Marco, aged 44, was quoted in The Nation: “Methadone didn’t work for me. The side effects were terrible, and I didn’t get any tranquilizing effect. So I was taking other drugs on top of it. I’ve been registered here for the last six months. I’ve put on weight, and cut my heroin use by 80%. Eventually, I want to get clean.”

    Here is a new model for success: instead of complete and immediate sobriety, the goal is to slowly wean the patient off of heroin, while also providing treatment for the underlying issues of addiction during the course of the program.

    Meanwhile, the patient is receiving medical-grade heroin at highly controlled doses and is in much less risk of dying from an overdose, and at no risk of contracting a disease (such as HIV) or dying from tainted drugs or dirty needles. The patients are also much less likely to be involved in criminal activity around their drug addiction. The program offers “an easier, softer way” toward sobriety.

    Yves Saget, an addiction nurse, told The Nation, “Addiction happens when taking drugs becomes the only strategy for dealing with difficult situations. We don’t say ‘fix’ here, we say ‘treatment. The brain becomes dependent, and needs heroin to maintain its balance. At this center, we are treating 63 patients with diacetylmorphine. Medical heroin is pure, unlike the drug you buy in the street, which is cut with caffeine, paracetamol, and other substances. Street heroin isn’t satisfying, so addicts often take other narcotics with it, or alcohol, or psychotropic drugs such as benzodiazepine. Our dosage, which is individually tailored, allows patients to live as normal a life as possible.”

    Switzerland had a crisis in the 1980s when heroin use suddenly rose dramatically. The Swiss police tried to limit the criminal issues arising around this drug use by confining heroin uses to areas that soon became known as “needle parks.”

    The Swiss government decided they must act. Ruth Dreifuss is a Social Democratic former president of the Swiss Confederation. She told The Nation that at the time of the peak crisis, “We created a forum that brought together the federal state, the cantons, and the affected cities to allow the different actors to get to know each other’s viewpoints. Open drug scenes couldn’t be allowed to continue, but shutting them down would mean finding other solutions. Everything we’d tried had failed. The doctors prescribing methadone suggested allowing them to prescribe heroin. Methadone has been prescribed in Switzerland since the 1960s, so we were mentally prepared.”

    So began Switzerland’s program of prescribing heroin to people with addiction for whom replacement therapy had failed. A four-pillars policy was created, including prevention, therapy, risk reduction, and repression. The first injection centers for prescription heroin opened in 1994, most of them in Switzerland.

    Today, public hospitals as well as private, state-funded centers run the injection centers.

    The program has been a success. Drug-related crime has seen an “exceptional reduction,” according to a study by the University of Lausanne’s Institute of Forensic Science and Criminology. The number of people with addiction involved with police interaction has fallen by two-thirds.

    “Crime linked to heroin has almost disappeared because the drug is now available for free,” Regula Müller, social-affairs counselor for the city of Bern, told The Nation.

    In addition, heroin dealers have lost their customer base, and prices of the drug are low, making selling heroin a less attractive gamble. The personal gain for those addicted to heroin and those who love them have been enormous, with HIV positive rates at less than 10%, from 50% in the ’90s. And numbers impossible to argue with: drug-related deaths of those under 35 years old fell from 305 in 1995 to 25 in 2015.

    View the original article at thefix.com

  • France Approves New Drug To Treat Alcoholism

    France Approves New Drug To Treat Alcoholism

    Some are concerned about the efficacy of the drug as well as its possible side effects.

    French health authorities have approved the use of a muscle relaxant in the treatment of people addicted to alcohol, despite side effects.

    ANSM, the national drug agency, cleared Baclofen for alcoholism treatment after a trial period that began in 2014, reported Medical Xpress. The drug had been used off-label for years before this in several countries.

    Fierce interest in this muscle relaxant as a treatment for alcohol addiction began in 2008 when Olivier Ameisen, a French cardiologist who practiced in the United States, published his book, Le Dernier Verre (the last drink).

    Ameisen outlines cases of his patients with alcohol use disorder who had failed to remain sober through Alcoholics Anonymous or other common treatments. Using a treatment of high doses of Baclofen, Ameisen was able to assist many of his patients in achieving sobriety.

    There are concerns about side effects with this muscle relaxant, and the dosage is limited to 80 milligrams per day, a reduction from the previous from 300 milligrams.

    Other critiques of using Baclofen for alcoholism says that it’s efficacy has not been proven, and others believe that treating addiction to a substance with another substance is a bad idea. The idea that using a substance to assist recovery is harmful has lost traction in America, with many states pushing for wider access to medication-assisted recovery for addiction.

    A French drug oversight agency said last year that Baclofen had shown “clinical benefits in some patients” and despite lack of harder evidence, the country appears more concerned about providing options for those addicted than ensuring solid evidence before opening access for treatment.

    Oftentimes getting through studies and red tape can take years but the frequent use of Baclofen as an off-market treatment for alcoholism may have swayed the government toward acceptance.

    The trial that was done included 132 heavy drinkers. After being treated with Baclofen, 80% either became abstinent or drank moderately. Two other drugs commonly used to treat alcoholics, Naltrexone and Acamprosate, has a success rate of 20 to 25%.

    Medical Press reported that ANSM director Dominique Martin said that the authorization of Baclofen (sold under brand names including Kemstro, Lioresal and Gablofen) was important to meet “a public health need.”

    He went on to say that holding back approval of the drug “did not seem reasonable to us given the needs and the seriousness of alcoholism, and the fact that tens of thousands of people are taking the medicine for this treatment,” he said.

    View the original article at thefix.com

  • Lawmakers, Healthcare Facility Clash Over Treating Inmates With Addiction

    Lawmakers, Healthcare Facility Clash Over Treating Inmates With Addiction

    Is the risk of overdose higher in prison or upon release?

    A fight is underway in the state of Vermont over the execution of legislation designed to provide treatment for prison inmates with addiction.

    S.166, which was signed into law in May 2018, provides treatment with buprenorphine to inmates with the approval of a doctor—but legislators were dismayed to find that the medication was only being provided to inmates who were within weeks of their release dates.

    At the heart of the argument is the determination of medical necessity for treatment. 

    State Senator Tim Ashe, who was the bill’s main sponsor, told the Burlington Press that holding back treatment until a release date is counterintuitive. “For people who are serving relatively brief sentences, those who suffer from addiction should be getting the treatment and not having arbitrary deadlines,” he said.

    Centurion Managed Care, the state-contracted company assigned to provide health care for Vermont inmates, said the deadlines are in place to avoid increased risk of overdose after release.

    Risk of overdose is low in prison, according to Annie Ramniceanu, director of mental health and addiction services for the state Department of Corrections (DOC)—and therefore buprenorphine is not medically necessary until the risk is higher upon the inmate’s release. “Just because you want it doesn’t necessarily mean you meet that medical necessity,” she said.

    Ramniceanu’s position has health care advocates and criminal justice reform groups up in arms.

    Tom Dalton, executive director of Vermonters for Criminal Justice Reform, filed a complaint with the Department of Health’s Board of Medical Practice against Centurion’s medical director, Dr. Steven Fisher, that claimed that inmates are suffering due to the company’s directives and have taken to using buprenorphine smuggled into prisons.

    “Many high-risk incarcerated patients who are self-identifying as struggling with addiction and asking for help are unable to access treatment,” wrote Dalton in the complaint. “Some are being released back into our communities untreated.”

    Dalton’s stance is echoed by other public figures, including Burlington Police Chief Brandon del Pozo, who in a Facebook post from October 17 wrote, “Treat every prisoner who needs it with buprenorphine, methadone or Vivitrol as best fits them (Vermont is at least trying)”—as part of a list of strategies to combat the regional opioid epidemic that has gained national attention.

    DOC Commissioner Lisa Menard told the Burlington Press that the department is working to fully implement S.166 in the prison system, including a recent expansion of treatment to inmates who have reached their minimum release date, and treating inmates with longer sentences with other forms of medication-assisted treatment (MAT). 

    For Dalton, however, it’s the core issue that needs changing. “Their ignorance is killing people,” he said.

    View the original article at thefix.com

  • National Prison Strikers Demand More Drug and Mental Health Treatment

    National Prison Strikers Demand More Drug and Mental Health Treatment

    Effective drug and mental health therapy requires sincerity and trust. But prison is not a trustworthy environment for inmates. For example, all “therapeutic” prison spaces are recorded.

    Improved drug and mental health services were demands of the 2018 National Prison Strike in the U.S. and Nova Scotia. Just ask Isa, age 50, who is held in the federal prison system in Georgia. Why was better rehabilitative programming among the prisoner demands? Because confinement mixed with authoritarian corrections culture and dollar-driven bureaucratic mandates present almost insurmountable conditions for people seeking recovery from substance use disorder or mental health conditions.

    Isa explains:

    “Rehabilitation is used as behavior modification program where they (prison authorities) want to mold the inmate into being a better inmate against the greater good,” Isa told The Fix. “It’s a control mechanism in every facility.”

    Prisoners’ rehabilitative programming looks good on paper, he said, but is less so in practice. Why? Effective drug and mental health treatment requires sincerity and trust, according to Isa. Prisoners can and do see the lack of both. “They are not stupid,” he said. 

    While the notion of rehab in prison appears noble, below the surface we find that there’s a fundamental structural “conflict of interest” between prison administration and prisoner rehabilitation. According to Isa, prison is not a trustworthy environment for inmates. The simple fact of inmates divulging information to staff about their lives can be as problematic as the fact that all “therapeutic” prison spaces are recorded. For example: you would probably not talk in a support group about the fact that your whole family does opioids because you don’t want to risk putting them on law enforcement’s radar.

    Another example of the structural silencing of prisoners is that Isa participated “morally” (meaning in a less proactive fashion) in the 19-day 2018 prisoner strike due in part to fear of retribution. It’s no exaggeration to note that authorities in the federal prison system have a history of retribution against organized resistance.

    Speaking of relevant U.S. prison history, September 9, 1971 was the day the Attica prison riots began in upstate New York to honor fallen prison activist George Jackson, who perished in San Quentin after a battle with prison officials. On that day, Attica prisoners took control, leading to a four-day stand-off with authorities that saw 42 staff taken hostage. In the end, 33 prisoners and 10 officers and prison employees died as a result of the Attica authorities’ armed assault.

    In 2018, 47 years later, this infamous prisoner rights anniversary is recognized as the official end of the National Prison Strike that involved at least 10 states in work and pay stoppages as well as hunger and medical strikes at facilities in U.S. detention centers and locations in Nova Scotia. The inclusion of Nova Scotia speaks to the far-reaching appeal of striking for North American prisoners: inmates shared similar demands across national boundaries.

    Prisoner strike demand numbers 7 and 8 on the list of ten are crucial: “No imprisoned human shall be denied access to rehabilitation programs at their place of detention because of their label as a violent offender” and “State prisons must be funded specifically to offer more rehabilitation services.”

    The demand to provide prisoners with mental health services, including drug rehabilitation, is pervasive throughout the prison system and prison reform movements globally. In fact, the word “rehabilitation” has become such a prison industry buzzword as to have all but lost its legitimacy; unfortunately, we lack a better way to describe the improved facilities that prisoners and their supporters are fighting for.

    Anyone familiar with current prison conditions will laugh at the notion that today’s prisons are aspiring progressive rehab centers. In Live from Death Row and other works, author and political prisoner Mumia Abu-Jamal describes these current penal conditions as variations on a theme of death sentences, including the physically and sexually abusive climate, austere conditions and filth of the facilities, the low quality of food, water, and medical services, and the lack of cultural and educational opportunities for the incarcerated.

    Now for the fight. 

    Rehabilitation automatically leads to discussions of drug use and abuse. Some drug use is recreational, but some people use drugs in order to self-medicate, to treat mental or other conditions. Therefore, we end up with a lot of prisoners who directly or indirectly require drug rehabilitation. If charges are drug-related, generally, incarcerated individuals have a better chance of qualifying for in-house or court-ordered outpatient rehab programs.

    But unfortunately, budget cuts and a lack of commitment to prisoners’ well-being have led to understaffed or nonexistent programs. Sometimes, you’re lucky if you’re able to attend a weekly Narcotics Anonymous (NA) or Alcoholic Anonymous (AA) meeting.

    It seems like there are at least three levels of needs here.

    The first is the need for specific programs targeting immediate and more emergency-based drug abuse issues. These kinds of programs would mean that a person entering with a drug addiction or mental health issue would immediately receive relevant services. Columbia University’s National Center on Addiction and Substance Abuse estimates that 90 percent of addicted inmates do not receive substance abuse treatment.

    The second level would be something like general wraparound services to incorporate mental health into a larger healthcare paradigm. Inmates who do not use drugs would have an opportunity to get support at this level. These rehabilitation services, like counseling, educational events and support groups, may be voluntary, but they would be well-funded enough to attract inmates and encourage sustained involvement.

    The third level would restructure the entire prison facility so that it becomes a rehabilitative atmosphere instead of a simple list of programs tacked onto a bulletin board with a signup sheet. Much easier said than done. This is the most utopian category because it requires a fundamental restructuring of mental health and wellness concepts. Prison abolitionism argues for the eradication of modern prisons because they are inherently unhealthy. It is virtually impossible to rehabilitate an atmosphere that is predicated on the social engineering, racism, sexism and the maximization of profit in a punitive climate marked by what some equate to slave labor conditions. Where the profit motive begins, quality rehabilitative programming in the federal prison system tends to end, according to Isa.

    Demands 7 and 8 relate to the first two levels described above.

    According to the Center for Prisoner Health and Human Rights, “Approximately half of prison and jail inmates meet DSM-IV criteria for substance abuse or dependence, and significant percentages of state and federal prisoners committed the act they are incarcerated for while under the influence of drugs.”

    At arrest, almost three quarters of arrestees have drugs in their system — especially marijuana and cocaine. In 2000- 2013, we saw the increase of opioids and methamphetamines. Considering that currently only 11 percent of inmates receive any form of drug rehab, any improvements in this area are welcome. At present, many inmates don’t even get the prescribed medication needed to overcome addictions or treat mental illnesses; increasing the availability of prescribed drugs would be an automatic improvement in any facility.

    Let’s take a look at the recidivism rates for jailed inmates: “… in the two weeks after release, inmates are 12 times more likely to die — and 129 times more likely to die of an overdose — than the general population.” If drug use rates are that high, then crimes associated with drug use are also more likely to occur just after release.

    Providing methadone or Suboxone to opioid-addicted inmates before release, and then “connecting them with providers in the community who can continue to prescribe the medication when they leave” considerably increases the inmates’ survival chances and also decreases the likelihood of crimes related to drug use on the street.

    A good sense of the rehab climate can be found in our state and federal facilities. The Federal Bureau of Prisons offers Drug Abuse Education classes to inmates. It also offers nonresidential, residential, and community-based treatment programs. While this list seems comprehensive, as it allows for variation inside as well as community-based treatment, we must consider that overcrowding, staff shortages, and limited funding impair inmates’ access to existing services.

    It’s these obstacles and others that led prisoners to strike this month.

    In all, such obstacles function as contradictions that render “prison rehabilitation” an oxymoron. The prison structure provides such a specific type of authoritarian environment; these conditions of confinement cannot structurally provide necessary skills and training. Sure, inmates can be taught life or job skills, or learn about themselves and their own addictions so they can function better. However, confinement itself is viewed by prison abolitionists as inhumane and therefore a non-rehabilitative climate. We are expecting inmates to learn and retain information about their own health in a place where their main focus is frequently just on daily survival. Inmates are expected to “recover” in structures designed to maximize their status as incarcerated people who are subject to the whim of prison authorities.

    As an example, Isa explained that the prison warden had effectively dismantled the mental health services for prisoners. How? He moved prisoners receiving mental health services to new locations throughout the detention facility. As a result, their mental health issues worsened as their housing changed. They suffered more. “A lot of these prisoners cycled back in and out of segregation, including solitary confinement,” Isa said.

    When we compare prison reformers’ vision of rehabilitation with the prison abolitionist credo that if prisons reformed people they wouldn’t be prisons, we see that they meet in the middle when it comes to drug and mental health issues. Rehabilitation is a marketing concept that redirects fundamentally critical views on prison conditions towards new programs and therapeutic services. That these services are delivered in a hostile environment, where inmates cannot be expected to trust therapy and health staff, is one problem. Another problem is that outside staff unfamiliar with the overall facility operations do not have an obligation to their patient/prisoners once the prisoners complete a program.

    Working with what is available in conditions of aggression and scarcity, one would expect all available avenues to be on the table. Two that loom large are to ensure continuity of care and the safekeeping of inmates. However, given the fundamental conflicts of interests involved, prisoners’ health and safety get short shrift time and time again.

    So much for rehabilitation?

    View the original article at thefix.com

  • How Do You Define "Recovery"?

    How Do You Define "Recovery"?

    Our time would be better spent trying to help people recover in whatever way is most effective for them rather than pushing and shaming everyone into one particular recovery pathway.

    I’ve lost count of the number of times I’ve heard someone say that a person might be sober, but that they’re not in recovery, or describe them as a “dry drunk,” because the person doesn’t attend some defined program of recovery. I find that attitude divisive, dogmatic, and unhelpful, particularly because it shames others to believe in only one gold standard of recovery. This simply isn’t true. And it’s harmful; we have too many people dying of substance use disorder. Our time would be better spent trying to help people recover in whatever way is most effective for them rather than pushing and shaming everyone into one particular recovery pathway.

    This kind of mindset originates from 12-step fellowships — where members often believe that these programs, combined with abstinence, are the only effective way to recover — and from the outdated professional definition of recovery provided by organizations like the American Society of Addiction Medicine (ASAM). However, with the emergence of recovery science, this outlook is beginning to change. Leading researchers are painting a much broader, more inclusive picture of recovery. Instead of accepting dogmatic perspectives, we can now turn to science, which shows us how people recover, the impact of the language we use, the complexities we face as people in recovery such as trauma and co-occurring disorders, and offers more cohesive definition of recovery.

    In 2005, according to ASAM: “A patient is in ‘a state of recovery’ when he or she has reached a state of physical and psychological health such that his/her abstinence from dependence-producing drugs in complete and comfortable.” Over the years, this definition has evolved. Other thought and policy leaders in addiction recovery have also updated their definitions, including the Betty Ford Institute (2006), William L. White (2007), the UK Drug Policy Commission (2008), the Scottish government (2008), the Substance Abuse and Mental Health Services Administration (SAMHSA, 2011), researchers John Francis Kelly and Bettina Hoeppner (2014), and the Recovery Research Institute (2017).

    One of the most popular definitions, and one I’ve favored as a writer in this field, is SAMHSA’s: “Recovery from mental disorders and substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” What I like particularly is that SAMHSA doesn’t define how someone should recover and they have no opinion on abstinence or the use of medication in the process of recovery.

    Cognizant of the varying definitions and the lack of general consensus among experts in the field, recovery scientists and professionals from across the country came together to formulate a new concept. The Recovery Science Research Collaborative (RSRC) met in December 2017, evaluated various definitions of recovery, and reviewed essential components of recovery in order to more clearly define the process.

    I spoke with Robert Ashford, one of the recovery scientists in the collaborative, about the process of formulating a new definition.

    The Fix: What would you say were the main limitations of previous definitions that led to your aim to define a new concept of recovery?

    Robert: We were hoping to bring together our understanding of recovery with the real-world empirical and practical evidence. Our desire for inclusivity was due to the high prevalence of co-occurring disorders (mental health and substance use disorder (SUD)) and the lack of inclusion of non-prominent recovery pathways (e.g. medication alongside abstinence modalities). We wanted to give the individual autonomy in self-directing their recovery process, both with and without clinical and other professional or peer recovery supports.

    In reaching a consensus for a new definition, what were the main components that were critical to include?

    It was a direct reflection of previous work describing the contention in recovery definitions, both real and perceived, by those in different “recovery” camps and between mental health and substance use disorder. Personally, I don’t believe recovery is reserved for the most severe and symptomatic individuals. If we conceptualize recovery as a series of interpersonal growth stages over time and in different settings or contexts, then recovery is a broad phenomenon that can apply to a range of issues. Our definition allows this to exist as a self-directed and intentional process that frames recovery as different in approach, style, and intensity depending on the range of diagnosis. Perhaps a good way to frame this, within the context of a continuum of SUD, is that recovery is also possible along a continuum that is proportional to the severity and type of SUD (mild, moderate, or severe), with most not needing to ascend along that continuum completely.

    Our definition: “Recovery is an individualized, intentional, dynamic, and relational process involving sustained efforts to improve wellness.”

    One of the main disputes within the recovery community is the belief that “true” recovery means complete abstinence. How did this belief factor into your discussions? And what would you consider to be the challenges of such a point of view?

    I think the field at large stands to benefit, at least from an empirical perspective, because not having the focus solely on abstinence allows us to capture, estimate, and perhaps even predict, recovery in different pathologies, different severities, and at different life stages. This recovery typology is only possible with an inclusive definition in mind. The advocacy community also stands to benefit. Inclusive definitions allow the size of the population, or the prevalence of recovery, to increase — which is a good talking point and a strong policy lever for behavioral health. There is a potential for the “watering down” of recovery for the most severe of cases and for those traditionally following an abstinence modality, but this potential is moderated in my mind through the potential benefits.

    At the end of the day, abstinence shouldn’t be excluded from the idea of recovery, but it should be situated where it best fits — as a potential outcome for a person who needs it. The definition of recovery can expand without diminishing those who are in abstinence-based recovery, and the expansion doesn’t negate anyone. If anything, not doing it negates the reality of millions of people seeking wellness.

    View the original article at thefix.com

  • Exploring The New Opioids Package: What Does The Legislation Cover?

    Exploring The New Opioids Package: What Does The Legislation Cover?

    The wide-ranging bipartisan legislation addresses overprescribing, overdose prevention, medication-assisted treatment and more.

    New legislation intended to aid in the fight against the opioid epidemic was approved by both the House and Senate in early October, and is currently headed for signature by President Donald Trump.

    The bill, known as the Substance Use Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act (or SUPPORT), is a rare bipartisan effort, authored primarily by Senators Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), and offers $8 billion in wide-ranging programs that intend to boost access to substance treatment, as well as methods of intervention to reduce the influx and availability of opioids.

    Policymakers have expressed their support for the bill, though treatment advocates have voiced reservation about the scope and effectiveness of the legislation. Here’s what is proposed by the SUPPORT Act:

    – Expansion of provisions for Medicaid programs, including expanded access to opioid addiction treatment, including secured flexibility for alternative services not permitted under a state Medicaid plan, improved data sharing between state databases, and increased screening for opioid dependency during doctor’s visits;

    – Increased Medicaid coverage for opioid treatment programs that prescribe medication-assisted treatment (MAT), which is currently not recognized by Medicaid, and an increase in the number of health care specialists that are allowed to prescribe and dispense such treatment;

    – A provision to expand a grant program that allows first responders to administer naloxone for opioid overdoses;

    – Creation of a grant program from the Substance and Mental Health Services Administration to establish comprehensive opioid recovery centers, which will provide dependency and recovery programs for communities;

    – A provision to allow the National Institutes of Health (NIH) to establish “high impact, cutting-edge research” for combating the opioid epidemic and development of non-addictive pain management medication, which will be funded through reauthorization of the Common Fund from the 21st Century Cures Act;

    – Authorization for the Drug Enforcement Agency to reduce manufacturing quotas for controlled substances, including prescription opioids, when the agency suspects diversion; 

    – Authorization for the Department of Health and Human Services to allow doctors to remotely prescribe medication-assistant treatments to assist needy individuals in remote or rural areas;

    – The “STOP Act,” which will assist the U.S. Postal System in preventing the import of fentanyl through international mail by improved digital tracking; 

    – Improved coordination between the Food and Drug Administration and the U.S. Customs and Border Patrol to allow greater means of detecting and halting the import of drugs at borders;

    – Increased penalties for manufacturers and distributors in regard to overprescription of opioid medication.

    Response from health care and dependency officials to the bill was mixed. Some, like Kelly J. Clark, the president of the American Society of Addiction Medicine, called it “an important step in ensuring that individuals with substance use disorder are able to get the help they need.”

    But Keith Humphreys, a drug policy expert at Stanford University who worked with White House staff on the bill, viewed the scope of the bill as limited.

    “This reflects a fundamental disagreement between the parties over whether the government should appropriate the large sums a massive response would require. Lacking that, Congress did the next best thing – which is to find agreement on all the second-tier issues as they could.”

    View the original article at thefix.com