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  • Harm Reduction: How to Engage Parent Advocates Effectively

    Harm Reduction: How to Engage Parent Advocates Effectively

    I’ve had to correct parents whose first line to any policymaker is “my kid was from a good family, not just some homeless person.”

    “I never thought I would end up here, but here I am. I choose to create beauty in the space left in this world that my daughter used to occupy” – Lettie Micheletto, mother of Megan McPhail, 1987-2014.

    Lettie Micheletto never thought she’d find herself on the steps of the General Assembly advocating for better treatment of people who use drugs. Neither did Shantae Owens, Tanya Smith, or Kathy Williams, all parents united by the loss of a child to drug poisoning. Stunned and grieving, these parents nevertheless possess a raw passion that makes them a force to be reckoned with. Like so many others across the country, they are mobilizing to demand change to how society treats people who use drugs and to memorialize the children they have lost.

    Undeniably, there is power behind directly impacted parents. In my years as a lobbyist for drug policy reform, I’ve seen the hardest, most tough-on-drugs legislators dissolve under the gentle tears of a mother pleading for reform. There is a connection between legislators and parents that no lobbyist or well-executed advocacy campaign could dream of forging alone. But at the same time, there are challenges to working with new, often unpredictable allies. So I thought I’d lay out, from my own experience, the top benefits and challenges of involving parents in harm reduction advocacy.

    Benefit #1: Effectiveness

    Parents who have lost a child to the drug war are a potent force for change. They have drive, motivation, and a unique ability to elicit sympathy. Nothing changes hearts and minds quite like a compelling, emotional story of personal loss. In some states, efforts to change drug policy have been led almost entirely by parent groups. In Georgia, parents rallied to pass one of the country’s most progressive 911 Good Samaritan laws. In Florida, a coalition of moms has been the driving force behind expansion of naloxone access. In Iowa and Illinois, parents are leading efforts to legalize syringe exchange programs. Everywhere, parents are standing up to declare that their children are more than just statistics.

    “If no one speaks up for our children and sheds the truth on the fact that they were bright, wonderful kids who had an illness that they simply couldn’t battle, nothing will change,” says Tanya Smith, who helped advocate for a Georgia’s 911 Medical Amnesty Law in 2014 after her daughter, Taylor, died of a reaction to methamphetamine the year prior.

    Parents can unravel the false narrative of drug users as inherently deviant or immoral and paint a true, complex portrait of people who use drugs and people who love them. They can show the devastation of loss on families and communities. Most importantly, they can help battle the number one obstacle to meaningful reform – stigma.

    Benefit #2: New Allies

    Most movements start with a small group of people with similar ideas who are passionate about reform. But in order to evoke lasting change on a macro level, movements need to expand – and that means welcoming new allies into the fold. This isn’t always easy. New allies don’t have the institutional history and knowledge of the movement. Sometimes they have more social or political power than the original group of activists, which is good for expanding influence, but can threaten to hijack the founders’ original intent. The harm reduction movement has seen a lot of this dynamic as it has grown in recent years, accruing allies such as faith leaders, recovery communities, first responders, public health professionals and impacted parents. There have been some growing pains and continued debate over the allies’ role, but the expansion has led to wider conversations about harm reduction and more advocacy wins. Parent advocates have played a large role in bringing conversations about harm reduction into homes and communities that were previously silent on drugs.

    Benefit #3 Finding an Outlet for Grief

    For many parents who have lost a child, simply getting through each day can be an enormous challenge. But pain can also be a powerful agent of change. Lettie Micheletto lost her 27-year-old daughter, Megan, to heroin poisoning in 2014. Since then, she has been part of bringing awareness about drug laws to other parents.

    “About six months after Megan’s death I crawled out from under my rock and began to work with a local coalition in my hometown to help educate and bring awareness of the opioid epidemic,” says Micheletto. “I am obsessed with spreading the message and talking to everyone I can, everywhere I go. I have many friends who have lost children, other family members or friends to overdose. It is a nightmare that many people live and many others ignore.”

    Thanks to Micheletto’s efforts, a North Carolina lawmaker recently included $100,000 in the state budget to raise awareness about the state’s 911 Good Samaritan law. For many parents, advocacy creates a much-needed opportunity to channel grief into purpose.

    Challenge #1 Working with Newbies

    Though there are many advantages to working with parent advocates, these efforts are not without challenge. Of course many parents are or have been involved with drug use themselves, but it seems the majority of parent advocates today had little knowledge of drugs, drug policy or harm reduction until it impacted their children. In many cases, they didn’t even know their child was experimenting with drugs until after his or her death. Then suddenly they are thrust into a world of grief and new concepts that seems foreign and daunting. They want to act, but they lack institutional knowledge of harm reduction, drug policy and the criminal justice system. This can create some very uncomfortable situations.

    Some of my most memorable face-palm moments have come from bringing well-meaning, but very green parents to advocate at the legislature. I’ve spent many an afternoon with parents trying to explain the problems with involuntary commitment laws or to untangle the save-the-user but kill-the-dealer narrative. I’ve had to correct parents whose first line to any policymaker is “my kid was from a good family, not just some homeless person.” Sometimes step one is just to teach the parents to stop using stigmatizing language like “addict” to describe their own child.

    It takes patience to educate a parent who has been steeped in stigmatizing attitudes towards people who use drugs until the problem hit home and to help change the way they think about drugs and drug policy. There are so many wonderful parent advocates today who understand harm reduction and how all of us – users, sellers and people who have never touched illicit drugs – are caught up in the net that has killed so many people. They didn’t all start out with that knowledge, but by meeting them where they are at, we can get them there.

    Challenge #2 White Power

    It is frequently pointed out that the rhetoric around drug policy has softened since opioids started killing children from white, affluent communities. Certainly the majority of parent advocates who appear in the news are white and middle-class. And while there is nothing wrong with parents of any race or class becoming vocal advocates for reform, the stark homogeneity of media coverage doesn’t reflect the rapidly changing demographics of drug-related deaths, especially around opioids. According to the Centers for Disease Control, from 2015 to 2016 the age-adjusted rate of drug overdose deaths involving any opioid rose by 25.9% among whites in the United States, but 32.6% among Hispanics, 36.4% among Asian/Pacific Islanders, and a whopping 56.1% among black Americans.

    Diversity is an important, and often missing component to parent advocacy. Correcting this can mean making the extra effort to pro-actively reach out to under-represented groups and create space for their voices. Out in rural Brunswick County, North Carolina, Kathy Williams and Alex Murillo are teaming up to do just that. Kathy Williams lost her 32-year-old daughter, Kirby, to an overdose in 2016. The following year she helped found B.A.C.K. O.F.F., an organization of feisty families who are fed up with losing their kids and have started to organize for change. Kathy and Alex are working to welcome Hispanic families into the group.

    “We had two recent deaths in the Hispanic community due to drugs,” says Murillo, who lost his 19-year-old nephew last year to an overdose. “I want to help get the Hispanic community involved in education around drugs, but it’s hard because parents won’t admit there is a problem. Here, if a child dies of an overdose, the parent will say they died in their sleep.”

    Overcoming cultural and even language differences to organize a diverse group of parent advocates can be difficult. Many of us, myself included, don’t do this as often as we should. But that extra effort can go a long way to showing policy-makers the true breadth and complexity of drug use.

    Shantae Owens, a parent advocate from New York, lost his 19-year-old son to heroin poisoning in 2017. “Whether it’s a white kid from Richmond or a black kid from New York, we need to put aside our differences and come together to solve a common problem,” says Owens. “The longer we keep looking at the one thing that separates us, the more people will die.”

    Shantae, Alex, Kathy, Lettie, and Tanya are among thousands of family members across the country united by tragedy, but also by strength. They may not have wanted or imagined ending up in this place, but they are here, creating beauty in the space where their loved ones used to be.

    View the original article at thefix.com

  • States Consider Foster Care Alternatives As They Grapple With Parental Addiction

    States Consider Foster Care Alternatives As They Grapple With Parental Addiction

    Some states are taking approaches that focus on reducing the trauma of separation from the child while encouraging parents to continue treatment.

    A new report from The Hill notes that the rise in the number of children who enter foster care has forced state governments to rethink the notion of separating families while parents undergo treatment for substance dependency.

    States such as New Jersey, which has struggled with high rates of opioid overdose, and Colorado are implementing programs which allow children to remain with the parent in treatment, or combinations of care by relatives with enhanced mental health services for the parents.

    In both cases, the hope is twofold: to reduce the trauma of separation from the child and encourage the parents to continue with treatment.

    Statistics have shown that after a decade of decline in the number of children entering the national foster care system, caseloads in 36 states rose by 10% between 2012 and 2016. The opioid epidemic was credited with much of the increase in many states, which treated substance dependency in a home with children as a form of abuse and therefore worthy of removing the children.

    However, as the numbers for both opioid dependency and foster care admission continue to rise, state agencies have begun to regard the approach as “impounding trauma upon trauma,” as Jason Butkowski, a spokesperson for New Jersey’s Department of Children and Families, stated.

    “Children do better when they’re with family,” said Wendi Turner, executive director of the Ohio Family Care Association. And several states have launched a variety of programs designed to enable that arrangement. In Nebraska, the state Division of Children and Family Services initiated its Mom and Me program, which grants long-term residential treatment for mothers in recovery and allows them to remain with dependent children ages eight and under.

    In New Jersey, state services do not equate exposure to substances taken by mothers as a form of child abuse, which grants the state more options to provide assistance to adults and their dependent children.

    And in Washington, D.C., foster care numbers have declined due to their use of kinship care programs, in which a relative takes in a child deemed at risk instead of a state program, along with Medicaid-funded treatment programs.

    In all cases, states are taking the stance that by eliminating the potential for stigma or trauma on children, parents may be more willing to seek treatment and hopefully keep their families together. New Jersey spokesperson Butkowski noted that in some cases, “folks aren’t reaching out for services because addiction is such a charged term.”

    Colorado has embraced this notion through its Lift the Label campaign, which seeks to inform the public about opioid dependency and recovery, and “provide a message of hope from people who used to feel hopeless,” according to a Department of Human Services press release. 

    “We want people to know if they are ready to seek help, we’ve got their back,” said department head Reggie Bicha.

    In all cases, states hope that the sympathetic approach will generate greater interest in their various treatment programs and in turn, bring down foster care numbers.

    “Put the person first,” said Butkowski. “We’re asking the question, ‘What happened? Why are you in this place in your life?’ rather than ‘What did you do? How can you make it better?’”

    View the original article at thefix.com

  • Can Blue Lights Deter Public Drug Use?

    Can Blue Lights Deter Public Drug Use?

    Public health experts say the blue lights make people more prone to hurting themselves and further stigmatize those who struggle with addiction.

    As the nation struggles with an ever-worsening opioid epidemic, some retailers are experimenting with an innovative solution to curb the drug use that takes place in their facilities.

    According to USA Today, a number of convenience stores and supermarkets have installed blue-colored lightbulbs in their restrooms. The strategy is simple; the blue lighting makes it all but impossible for people to see their veins, which retailers hope will prevent them from shooting up.

    “The hardest-core opiate user still wants to be accurate. They want to make sure the needle goes in the right spot,” said Read Hayes, the director of the Loss Prevention Research Council.

    The Council develops methods to deter theft and violent crime at retail stores. When it comes to drug users shooting up in the semi-privacy of public bathroom stalls, Hayes hopes to “disrupt that process” with the blue lights.

    Turkey Hill Minit Markets, a Pennsylvania chain of convenience stores with over 260 locations, partnered with the Loss Prevention Research Council to test whether the blue bulbs will do the trick in driving down drug use. While the study is just six months old, early word from its 20 test stores has been positive.

    Turkey Hill reports that employees haven’t found any used needles or people slumped over from an overdose. Matt Dorgan, Turkey Hill’s asset protection manager, knew it was time to take action in neighborhoods that have been slammed by the opioid crisis.

    “We realized we need to do something to protect our associates and our customers,” Dorgan said. “We’re not finding hardly anything anymore. It’s a pretty dramatic reduction. We haven’t had a single overdose.”

    Not everyone is convinced that blue lights are the answer, however. In previous research studies, opioid users said they’d shoot up anywhere “if it meant avoiding withdrawal symptoms,” USA Today reported.

    Public health experts also say the blue lights only make people more prone to hurting themselves, not to mention further stigmatizing those who struggle with addiction.

    Also, people who are accustomed to injecting themselves won’t be deterred by a room bathed in blue light. Someone suffering from withdrawal “is going to want to use as soon as possible, even if the location is not optimal,” said Brett Wolfson-Stofko, a researcher at the National Development & Research Institutes, who has studied injection drug use in public places.

    Other experts advocate for more practical solutions like needle disposal containers.

    Meanwhile, some areas have taken the blue-light concept to new levels, USA Today reported. The city of Philadelphia, wracked by a 30% increase in opioid overdoses last year, has started distributing “needle kits” to its residents. The kit includes “a blue bulb for the front porch, no-trespassing signs, a tool to pick up used syringes, a needle disposal box and contact information for social services.”

    The city has given out over 100 kits since January. If the kits prove successful, the program could be expanded and potentially become a solution for similarly hard-hit areas.

    View the original article at thefix.com

  • China Presses US To Reduce Opioid Demands

    China Presses US To Reduce Opioid Demands

    “When fewer and fewer Americans use fentanyl, there would be no market for it,” said one Chinese official.

    China’s drug control agency has challenged the U.S. to sharply reduce its demand for opioids, The Hill reported. The agency specifically called out the United States’ role in driving demand for drugs like fentanyl.

    “It’s common knowledge that most new psychoactive substances (NPS) have been designed in laboratories in the United States and Europe, and their deep-processing and consumption also mostly take place there,” said Liu Yuejin, deputy chair of China’s National Narcotics Control Commission. “The U.S. should adopt a comprehensive and balanced strategy to reduce and suppress the huge demand in the country for fentanyl and other similar drugs as soon as possible. When fewer and fewer Americans use fentanyl, there would be no market for it.”

    While the U.S. doesn’t deny the situation, a congressional report from 2017 singled out China as the “top source” of all fentanyl in the U.S. The year-long probe found that fentanyl could be easily purchased online from Chinese labs and mailed to buyers in the U.S.

    Last November, on a state visit to Beijing, President Trump said that China and the U.S. would work together to curb the “flood of cheap and deadly” Chinese-made fentanyl from making it stateside. China quickly disputed the claim that it was responsible for the “flood” of fentanyl into the U.S.

    A recent Bloomberg feature called fentanyl “an Internet-era plague,” though fentanyl has been around since 1960.

    At the time, it was the world’s “strongest opioid approved for human medical use,” and intended to treat extreme pain and to help put surgical patients to sleep. Fentanyl is said to be 50 times stronger than heroin and 100 times more potent than morphine.

    In 2014, Bloomberg noted, fentanyl killed 5,000 people in the U.S. By September 2017, the drug was responsible for more than 26,000 deaths, accounting for more than half of all opioid-related deaths that year.

    “China’s drug control agencies, now and in the years to come, will place greater emphasis on drug control cooperation between China and the United States,” Liu insisted. “But I believe that to resolve this the more important issue is for the United States to strive to reduce and compress the great demand and drug consumption markets of opioids.”

    China doesn’t deny that some of the NPS in America were manufactured on Chinese soil, but said that “the substances are not yet readily abused and trafficked in China itself,” The Hill noted.

    Liu contends that Beijing has already taken steps to curb the production and export of synthetic drugs like fentanyl. They have even gone so far as to place fentanyl and 22 other compounds on a controlled-substances list. Liu also said that current political tensions between China and the U.S. wouldn’t affect China’s resolve in putting an end to the manufacture and trafficking of those drugs.

    “The U.S. should strengthen its crackdown on distributors, traffickers and drug-related criminal rings,” Liu argued, adding that it should “investigate and arrest more lawbreakers.”

    Last year, Trump labeled the opioid crisis as a public health emergency (stopping short of calling it a full-scale national emergency), and promised a comprehensive awareness campaign to help deter people from abusing drugs. 

    View the original article at thefix.com

  • Massive Drug Spoon Sculpture Dropped At Purdue Pharma HQ

    Massive Drug Spoon Sculpture Dropped At Purdue Pharma HQ

    The message behind the guerrilla art exhibit is to call attention to the potential danger of prescription opioids.

    A gallery owner was arrested Friday morning (June 22) after placing a sculpture of a massive steel spoon at the headquarters of Purdue Pharma, the maker of OxyContin.

    Fernando Louis Alvarez was arrested and charged with obstruction of free passage, a criminal misdemeanor. The sculpture was displayed in front of the Stamford, Connecticut office for about two hours until it was hauled away by city workers.

    The 800-pound, 10.5-foot-long work of “guerrilla art” appears burnt and bent at the handle, a sight familiar to people who heat up and inject heroin. The artist, Domenic Esposito, of Westwood, Massachusetts, described how his family was affected by his brother Danny’s nearly 14-year addiction to heroin, which began with OxyContin and Percocet.

    “My mom would call me in a panic… screaming she found another burnt spoon. This is a story thousands of families go through. He’s lucky to be alive,” he said, according to the Hartford Courant.

    “The spoon has always been an albatross for my family. It’s kind of an emotional symbol, a dark symbol for me,” he added.

    The message behind the art exhibit is to call attention to the potential danger of prescription opioids, and to call on the federal government to “step in and do something,” Esposito said. Danny has been sober for the last four months.

    Purdue Pharma is among several pharmaceutical companies being targeted by lawsuits across cities, counties, and states that believe these entities had a hand in worsening the opioid crisis. Purdue, specifically, is accused of using deceptive marketing and downplaying the risk of addiction to promote OxyContin.

    The company has since announced that it will no longer market OxyContin to doctors, and just last week, laid off its entire sales team.

    Purdue released a statement on Friday regarding Esposito’s sculpture: “We share the protestors’ concern about the opioid crisis, and respect their right to peacefully express themselves. Purdue is committed to working collaboratively with those affected by this public health crisis on meaningful solutions to help stem the tide of opioid-related overdose deaths.”

    The night of the guerrilla art display, Alvarez hosted the opening of a full exhibit on the opioid crisis at his art gallery in Stamford.

    The spoon has reportedly been submitted as evidence.

    View the original article at thefix.com

  • Buprenorphine Exposure Affects Kids At Alarming Rates

    Buprenorphine Exposure Affects Kids At Alarming Rates

    The number of children exposed to the addiction drug rose 215% over three years. 

    As the opioid crisis continues to grow, some children are being put at risk as they are exposed to buprenorphine, an opioid medication used to treat opioid use disorder. 

    A new study published in the journal Pediatrics found that from 2007 to 2016, more than 11,200 calls were made to poison control centers in the U.S. with concerns about children being exposed to buprenorphine. Of those, 86% were about children under age 6 and 89% were unintentional exposures. 

    “This is never prescribed for children under 6. It is a significant risk to them,” Henry Spiller, director of the Central Ohio Poison Center and an author of the study, told CNN. “We’re not quite sure why it stands out so much. Perhaps the parents who have this may not think it’s as risky as their other opiates because it doesn’t have the big effect that the other opiates do for them.”

    Of the 11,275 children exposed to the medication, the overall exposure rate per 1 million grew by more than 215% from 2007 to 2010. It then decreased 42.6% from 2010 to 2013, before increasing again in 2016 by 8.6%.

    Dr. Jason Kane, an associate professor of pediatrics and critical care at University of Chicago Medicine Comer Children’s Hospital, tells CNN that the increase in exposure has to do with the increase in adults using buprenorphine as a treatment option.

    “This is not the first study to show these data, but it is the latest study to show a medication whose design it is to help adults with narcotic or opioid addiction is ending up poisoning, mostly unintentionally, children and in particular those who are most vulnerable,” Kane said. 

    Buprenorphine is an opioid receptor stimulant as well as a blocker. It is considered an opioid but does not have the same effect as other opioids for adults, thought it can still be habit-forming. For children, however, it can have a stronger effect on the respiratory system.

    “In adults, the respiratory depression, the part that slows the breathing and you stop breathing, is limited, and so there’s a lot less respiratory depression in adults,” Spiller told CNN. “That’s why it was felt to be safer. Unfortunately, in very young children under 5, preschoolers, toddlers, infants… that protection isn’t there, and they do get this respiratory depression. It does affect their breathing.”

    Of adolescent exposures, 77% were intentional and more than one-quarter used the medication with another substance. 

    “It was surprising that adolescents were actually using it for abuse. It’s very specific,” Spiller told CNN. “You have to be in a program to get this. It’s carefully managed. It’s not widely available… It is available on the street, but essentially, the majority of this is from these management programs and someone’s in therapy, someone in the house, them or a family member.”

    According to CNN, study authors expect the number of exposures to continue to increase.

    To limit exposure, Kane recommends disposing unused medications, using child-proof caps and making sure medications are labeled correctly.

    “Seven children under the age of 6 died as a result of an accidental poisoning from this drug, which was present in someone’s home, prescribed with the goal of making someone else better,” Kane said to CNN, adding, “that’s a striking thing for me.”

    View the original article at thefix.com

  • Healthcare Pros Talk Unintended Consequences Of Addressing Opioid Crisis

    Healthcare Pros Talk Unintended Consequences Of Addressing Opioid Crisis

    “Doctors just say, ‘That’s it, I’m done. I’m not going to lose my license over you and good luck,’ and that’s unconscionable,” said one health expert.

    The opioid epidemic has drawn more political and media attention than any other public health crisis in recent memory, but healthcare professionals say that the focus on preventing opioid-related deaths is having unintended consequences for patients dealing with other conditions including cancer, chronic pain and other forms of substance use disorder. 

    One of the biggest concerns is that patients are being taken off their opioids too quickly, which can increase physical symptoms of withdrawal and leave patients feeling overwhelmed by the idea of quitting. 

    “Some people will be tapered too quickly or in a way that is intolerable to them,” Elinore McCance-Katz, the Health and Human Services assistant secretary for mental health and substance use, told Politico. 

    Sally Satel, a psychiatrist and Yale University School of Medicine lecturer, said that some doctors are less understanding of slowly tapering patients because they’re concerned about their own liability. 

    “I’ve seen patients where doctors just say ‘That’s it, I’m done. I’m not going to lose my license over you and good luck,’ and that’s unconscionable,” she said.

    Although policies have shifted to focus on non-opioid pain relief, these options are still less likely to be covered by insurance, leaving patients with chronic pain with few options.

    The Department of Veterans Affairs and the Defense Department have begun paying for alternative care, but “beyond that it’s pretty much just been lip service and it’s a little challenging how to craft legislation that affects what private payers are able to offer in this arena,” said Bob Twillman, executive director of the Academy of Integrative Pain Management. 

    “It’s one thing for an insurer to cover [an opioid alternative]. It’s another thing to cover it at a co-pay that the patient can afford,” said Cindy Reilly, who recently left the Pew Charitable Trust, where she focused on issues around opioid use and access to effective pain management. “We need to stop making opioids the easy decision—in terms of writing prescriptions and patient access. Higher co-pays will stand in the way.”

    Sean Morrison, chairman of the geriatrics and palliative medicine department at the Icahn School of Medicine at Mount Sinai, said that he is increasingly seeing hospice patients unable to get the opioid drugs needed to make their end of life more bearable. 

    “Almost every patient I have prescribed for recently has either a) run into pharmacies that no longer carry common opioids; b) cannot receive a full supply; and c) worst of all had their mail order pharmacy refuse to fill or have had arbitrary and non-science based dose or pill limits imposed,” he said. 

    Joe Rotella, the chief medical officer for the American Academy of Hospice and Palliative Medicine, agreed. 

    “Even with exemptions for hospice care, prescription limits are still having an impact,” he said. “Patients have a tougher time getting these medications and it’s a lot more hassle for providers.”

    Cancer patients are also being affected as hospitals experience a shortage of IV fentanyl and morphine. 

    Finally, the focus on funding interventions for people abusing opioids has deflected money from other drug-intervention programs. This is especially problematic in areas like the Southwest, where overdose deaths from methamphetamine are rising sharply. 

    “We treat drug epidemics like ‘whack a mole,’” said West Virginia Public Health Commissioner Rahul Gupta. “We get one under control, another pops up.”

    View the original article at thefix.com

  • Link Between Trump Support And Opioid Use Revealed In New Study

    Link Between Trump Support And Opioid Use Revealed In New Study

    “When we look at the two maps, there was a clear overlap between counties that had high opioid use … and the vote for Donald Trump,” said the study’s author.

    There may be a geographic connection between those who supported Trump in the 2016 election and prescriptions for opioids, according to a new study published in the medical journal JAMA Network Open. 

    James S. Goodwin, chair of geriatrics at the University of Texas Medical Branch and the study’s lead author, along with other researchers, examined data from numerous sources which included the Census Bureau and the 2016 election, as well as data from Medicare Part D, a program for prescription drugs that helps those with disabilities and the elderly.

    “When we look at the two maps, there was a clear overlap between counties that had high opioid use… and the vote for Donald Trump,” Goodwin told NPR. “There were blogs from various people saying there was this overlap. But we had national data.”

    In order to estimate the amount of opioid use by county, Goodwin and his team utilized the number of Medicare Part D enrollees who had three months or more worth of opioid prescriptions. According to Goodwin, it was harder to estimate the amount of illegal opioid use, though prescription opioid use is strongly correlated with it.

    “There are very inexact ways of measuring illegal opioid use,” Goodwin told NPR. “All we can really measure with precision is legal opioid use.”

    In the research process, the team looked at a number of factors to determine how a county’s rate of chronic opioid prescriptions was influenced. They found that in the 2016 election, Trump support was closely tied to opioid prescriptions. In counties with higher-than-average numbers of chronic opioid prescriptions, 60% of those who voted did so for Trump whereas in counties with lower-than-average prescriptions, only 39% voted for him. 

    NPR also states that some of the correlation could have to do with social and economic factors, as many rural counties with struggling economies voted for Trump, and those are the areas where opioid use is common. 

    “As a result, opioid use and support for Trump might not be directly related, but rather two symptoms of the same problem—a lack of economic opportunity,” NPR noted. 

    Goodwin and his team also analyzed factors such as unemployment rate, median income, how rural areas were, education level and religious service attendance. They found that these factors account for about 66% of the connection between Trump voters and opioid use, but not the remaining percentage.

    “It very well may be that if you’re in a county that is dissolving because of opioids, you’re looking around and you’re seeing ruin. That can lead to a sense of despair,” Goodwin told NPR. “You want something different. You want radical change.”

    For some areas hit hard by the opioid crisis, NPR states, the Trump presidency may have seemed like a solution. 

    While the study shows a likely link, it isn’t definitive and has shortcomings, Goodwin states. 

    “We were not implying causality, that the Trump vote caused opioids or that opioids caused the Trump vote,” he cautions. “We’re talking about associations.”

    View the original article at thefix.com

  • Are Health Insurers Driving The Opioid Crisis?

    Are Health Insurers Driving The Opioid Crisis?

    While the brunt of the negative attention has focused on drug suppliers and prescribers, experts are now examining the role that insurers have played in the epidemic.

    Health insurers could be stoking the opioid epidemic, according to a new study published Friday in the journal JAMA Network Open.

    “Our findings suggest that both public and private insurers, at least unwittingly, have contributed importantly to the epidemic,” said study senior author Dr. G. Caleb Alexander, an associate professor in the Bloomberg School’s Department of Epidemiology.

    That’s based on a 2017 analysis of 15 Medicaid plans, 15 Medicare plans and 20 private insurers, which revealed that many aren’t applying evidence-based “utilization management” rules that could cut down on opioid overuse.

    “Opioids are just one tool in the pain management tool box, and unfortunately, many of the plans that we examined didn’t have well-developed policies in place to limit their overuse,” Alexander said. 

    The study comes even as a long-term uptick in opioid-related deaths has pushed dozens of states, counties, and cities to launch lawsuits against drug companies and distributors that make and provide the addictive prescription painkillers fueling the overdose crisis. 

    For the most part, the brunt of the negative attention has focused on drug suppliers and prescribers rather than on insurers, but the new findings by the Johns Hopkins Bloomberg School of Public Health probes what roles insurance plans could play in the epidemic.

    The researchers identified specific utilization management tools that insurers may not be relying on enough, such as restricting the quantity of drugs doctors can prescribe, requiring prior authorization or mandating that providers begin with less risky drug alternatives. 

    Quantity limits are commonly used for opioids—but those limits might still be higher than they should be, the researchers found. Generally, insurers capped scripts at a 30-day supply instead of the shorter limit recommended by the CDC. 

    Across all the plans studied in Medicare, Medicaid and commercial insurers, doctors typically weren’t required to start with less addictive alternatives like over-the-counter NSAIDs before doling out more powerful opioids.

    A median of just 9% of the covered opioids in Medicaid plans required doctors to start with something less risky first, the researchers found. For commercial plans, the median number was around 4%. Medicare plans typically had almost no so-called “step therapy” requirement. 

    The majority of opioid prescriptions didn’t require prior authorization, which is when the prescriber has to call the insurer for approval before writing the prescription. Some insurers, however, have begun putting such policies in place for patients with chronic, non-cancer pain. 

    “Insurers can either be part of the problem, or part of the solution,” Alexander said. “The good news is that an increasing number of health plans are recognizing their contribution to the epidemic and developing new policies to address it. The bad news is that we have a very long way to go.”

    The analysis comes on the heels of a 2017 deep-dive by the New York Times and ProPublica, which found that many insurers limited access to less addictive —but more expensive—alternatives. 

    “This is not a hypothetical problem,” Rep. Elijah Cummings (D-Maryland), later wrote in a letter to insurance companies. “In my home state of Maryland, 550 people died of an overdose in the first three months of 2017 alone. Synthetic opioids like fentanyl are driving up the epidemic’s death toll, but prescription opioids contribute significantly to this crisis by fostering addiction and causing fatal overdoses.”

    View the original article at thefix.com

  • Overprescribing Doctor Linked To Hundreds Of Deaths, Report Says

    Overprescribing Doctor Linked To Hundreds Of Deaths, Report Says

    The doctor’s “brusque and indifferent” prescribing of diamorphine led to the deaths of at least 456 patients between 1989-2000.

    A British doctor is making headlines once again, after a report released Wednesday (June 20) concluded that her policy of over-prescribing a powerful pain medication led to hundreds of patient deaths.

    Jane Barton, who is now retired, was found guilty of serious professional misconduct in 2010 by the General Medical Council (GMC) for her “excessive, inappropriate and potentially hazardous” prescribing of medication at Gosport War Memorial Hospital on the south coast of England, but was allowed to continue practicing medicine with some limitations.

    Although Barton retired the same year, families of the victims, outraged by the decision, have since fought for Barton to be held accountable for her alleged actions.

    On Wednesday, the Gosport Independent Panel released findings of a four-year investigation. While the Guardian states that “there is no suggestion that Barton intentionally took lives,” her “brusque and indifferent” prescribing of diamorphine (synthetic heroin) led to the deaths of at least 456 patients between 1989-2000, and potentially shortening the lives of another 200 patients.

    The report determined that “there was a disregard for human life and a culture of shortening the lives of a large number of patients,” and that the opioid-prescribing policy under Barton’s direction was “without medical justification.”

    “It represents a major crisis when you begin to doubt that the treatment they are being given is in their best interests,” said Rev. James Jones, chair of the independent panel. “It further shatters your confidence when you summon up the courage to complain and then sense that you are being treated as some sort of ‘troublemaker.’”

    On the day of the report’s release, British Health Secretary Jeremy Hunt apologized for the deaths “on behalf of the government and the (National Health Service).”

    The panel’s report mentions Harold Shipman, Britain’s worst serial killer, “in order to understand the context of events” in Barton’s case.

    According to CNN, Shipman was found to have killed 215 of his patients over a 23-year period. According to a review led by High Court Judge Dame Janet Smith, Shipman also administered excessive doses of diamorphine to his patients from 1975 to 1998. He was ultimately sentenced to 15 terms of life imprisonment, according to the latest report. He ultimately died by suicide in his prison cell in 2004.

    Still, Janet Barton maintains that she never meant to kill, and that her harmful prescribing was the result of the “excessive and increasing burden” of trying to care for too many patients.

    “Throughout my career I have tried to do my very best for all my patients and have had only their interests and well-being at heart,” Barton said in 2010.

    View the original article at thefix.com