Many jails are slow to help inmates with substance abuse issues. They are just starting to offer medications to help control cravings. Most jails only dispense one of the drugs approved for this purpose. Medication-assisted treatment (MAT) is considered the standard treatment approach for opioid addiction. Buprenorphine and methadone are prescribed to treat withdrawal symptoms and reduce cravings. Naltrexone blocks the effects of opioids, and can also reduce cravings. This medication can also be used to treat alcoholism. Approximately 220 of more than 3,000 jails across the US make naltrexone available to inmates. In most instances, the medication is offered to those who are about to be released. Only about 20 jails offer buprenorphine or methadone.
Delegates attending the recent American Medical Association (AMA) annual meeting approved a number of policies, including doing away with barriers to medication assisted therapy (MAT). The delegates approved policies that will allow the AMA to do the following: • Push for the end to administrative barriers to MAT. These include prior authorization that is responsible for delays and denials of care to patients. • Push for the enforcement of substance abuse and mental health parity laws. • Support laws to ensure that patients have access to all FDA-approved medications and therapies in all drug treatment clinics and facilities. • Call for a public awareness campaign to share the information MAT is a first-line treatment for opioid use disorder. • Coordinate efforts with interested organizations to decide best practices to treat opioid abuse disorder in the manner of a chronic disease. • Support states in evaluating programs that have received funding from government sources to assist hospitals, medical practitioners and communities in order to coordinate care for patients living with opioid use disorder. • Work for expansion and increased access to treatment for substance abuse during pregnancy. • Make sure that practicing physicians, residents and medical students receive education on prescribing opioids.
Doctors Can Help Fight Addiction StigmaDr. Patrice A. Harris, the AMA’s president-elect and chair of the AMA Opioid Task Force, stated that doctors have a role in fighting to end the stigma around drug abuse and MAT. She went on to say that this type of treatment “has been shown to decrease overdose mortality, reduce transmission of infectious disease, and reduce general health care expenditures.”
Universal Access to MAT Not AvailableAccess to buprenorphine is not universally available to patients, in spite of scientific evidence showing that it prevents deaths from opioid use disorder. The Substance Abuse and Mental Health Services Administration (SAMHSA) also lists it as one of the medications that is commonly used to treat opioid addiction. A study found that that fewer than one in three eligible doctors have been avoiding prescribing buprenorphine. Another study revealed that buprenorphine is underprescribed by family doctors. For every 40 family doctors who prescribed opioid pain medications, only one family physician prescribed buprenorphine-naloxone.
Polk County, Iowa’s addiction treatment program has decreased by more than three-quarters and is now struggling to survive. Leaders of the Bridges of Iowa program, which has been called an “innovative way to respond to drug-related crime,” is blaming a lack of Medicaid funding for its current woes. Medicaid Covers Addiction Counseling for Offenders Medicaid is the public health-care plan that covers low-income state residents. Inmates who are sentenced to jail for crimes linked to addiction, such as theft, are also covered under Medicaid. Organizers at the Bridges of Iowa program have said they been unable to collect more than a fraction of the amount they have billed the public health-care plan for counseling and other services for clients involved with the justice system. Clinical Director Angie Rodberg stated that the Bridges of Iowa (Bridges) program, which at one point served up to 150 people, was reduced to only 23 clients by early February. Funding Rehab Programs Can Present a Challenge The Bridges program has been helping clients in a separate part of the jail from the one housing inmates since 2012. Most of the program’s participants enter the program once they are released from jail on probation; one of the conditions they are required to meet is that they comply with the Bridges treatment program. Program organizers said their main financial difficulty is that the private companies in charge of running the state’s Medicaid program have not provided reliable payments for therapy sessions. The leaders, who have become frustrated by the situation, have basically given up trying to bill Medicaid for services. Dozens of employees have been laid off, and the program is now relying on private donations to provide a reduced level of support to help clients get their life back on track following an arrest for addiction-related crime. System Has Become a Tragedy Ms. Connolly mentioned the opioid epidemic has been discussed at length in the press, and that it’s an issue that politicians have been saying needs to be solved. She said, “We know there’s a crisis — the state recognizes that — but they’re not fulfilling their obligations.” She went on to say that the whole system has become a tragedy.
Prescription opioid pain medications aren’t the only drugs being abused by Americans. Over the counter (OTC) preparations are also falling into that category. The results of a new study conducted by researchers at Boston University School of Health has revealed that close to one in five users of headache remedies like Advil and Aleve doesn’t use the medicine as recommended. They admitted to exceeding the maximum recommended dose during a one-week period.
OTC Medication Use by Consumers UnsafePeople who use too many of these NSAIDs (non-steroidal anti-inflammatory pain relievers) likely won’t be starting on the slippery slope of moving toward heroin use. That doesn’t mean what they are doing is safe. Dr. David Kaufman, the lead researcher on the study, and a professor of epidemiology at Boston University’s School of Public Health, explained that these drugs can produce serious side effects when taken. Even though they are readily available, it doesn’t mean that consumers can make up their own dose, no matter what the dosing instructions say on the label. Consumers Don’t Read Medication Packages When Dosing Consumers’ attitude that they can choose their own dose, no matter what the label states, along with lack of knowledge about dosing limits, is contributing to exceeding the daily limit, according to Dr. Kaufman. The study was conducted in 2015-2016 by having 1,326 participants keep drug diaries for a week. Participants were, on average, 45 years of age. The majority of them (75 percent) were white, and 60 percent were women. Most of the study participants (87 percent) took ibuprofen, which is sold OTC under brands like Motrin or Advil. Thirty-seven percent of the participants reported they took other NSAIDs like Aspirin or naproxen, such as Aleve.
Chronic Pain Patients More Likely to Take Higher DosesThe study results showed more than 15 percent of the study participants took too many of the pills at least one day of the week. Participants who live with chronic pain were even more likely to take more than the recommended dose. When asked whether non-prescription pill abusers were trying to avoid taking opioids, Dr. Kaufman replied he didn’t think that scenario applied in this instance. He said that avoiding opioids may influence prescribing behavior for physicians, but it may not have a similar effect on consumers.
One of the most common knee injuries is an Anterior Cruciate Ligament (ACL) tear. These injuries are common because they can be caused by any sudden movement like; stopping quickly, landing from a jump or changing direction suddenly. And while this a common injury, it still generally needs to be repaired with surgery and the patient is oftentimes in a lot of pain before and after the procedure. In order to make the patient more comfortable, doctors are likely to prescribe painkillers before the surgery to handle the pain from the ACL tear. However, new research suggests that consuming painkillers before an ACL surgery could be very dangerous to the patient, as it greatly increases their chances of developing an addiction to painkillers. Researchers at the University of Iowa Hospitals and Clinics released a study stating that patients who receive painkillers before an ACL surgery are ten times more likely to be on painkillers longer than patients who were not given painkillers before their surgery. And when it comes to painkillers, the length of time a patient uses the medication is extremely important. The longer a patient uses painkiller the more likely they are to develop a physical and mental addiction to the dangerous drugs. The researchers gathered information from, 4,946 ACL repair cases in order to come up with their findings. While most of the patients healed nicely after their surgeries, not requiring painkillers three months after the procedure, seven percent of the patients were still filling painkiller prescriptions. These seven percent had a much higher rate of pre-operation painkiller use. And younger people are more likely to fall victim to this increased painkiller usage than older people, according to the study. The study could provide doctors insight as to how dependent the body can become on opioids and may prevent further addiction cases. “With the ever-increasing opioid epidemic our nation is facing, understanding the risk factors for postoperative narcotic use could aid surgeons and healthcare systems in identifying patients who could benefit from a different pain management and counselling regimen than previously identified,” explained Chris Anthony, co-author of the study.
Scientists are constantly looking at and investigating different areas of the brain that the medical community knows little about. And in a new study, released by researchers at the National Institute on Drug Abuse, shows an interesting area of the brain that may be responsible for cocaine addiction. They found that an area of the brain that is responsible for appetite and alertness, may also be the same mechanism that promotes the urge to use cocaine. Each part of the brain is responsible for certain functions necessary for life. The hypocretin/orexin (HCRT) system of the brain exists to ensure that a person is driven to eat enough and also stay alert. This same part of the brain may also be compelling cocaine addicts to continue to seek out the dangerous drug. This phenomenon was discovered after researchers observed rats that were given access to cocaine and how their brain, specifically the HCRT system, reacted. They found that rats who had allowed to self-administer cocaine for an hour (a relatively short amount of time) did not have this part of the brain taking over. However, rats that were allowed to self-administer cocaine for six hours (a relatively long period of time) did display an overreaction of the HCRT. They then administered blocking medication designed to target this part of the brain. The rats who were exposed to cocaine did not have any reaction to the medication, but the rats that been using cocaine for six hours had a positive reaction. These rats stopped compulsively seeking cocaine. Researchers are hopeful that this study will pave the way for some sort of medication that would target the HCRT system of the brain in long term cocaine addicts and allow them to get some relief from the compulsive drug-seeking behavior that is usually present. “The results of this study would suggest that the hypocretin system could be considered a pharmacological target, with the hopes that a medication designed to target hypocretin receptors could be used in combination with cognitive behavioral therapies as part of a cocaine abuse treatment strategy,” explained Dr. Schmeichel, lead author of the study.
Intermittent explosive disorder (IED) is a condition where a person has frequent outbursts. These outbursts can be verbal and/or violent in nature. While no one understands what causes the disorder, it does seem to effect people under the age of forty and is most likely to surface in childhood. Little is known about the problem, therefore many people witness characteristics of the disorder in children and chalk it up to some sort of social problem, instead of acknowledging it as a disorder. And while there is not a lot of research on this problem, a new study has been released that shows people who suffer from IED are more likely to abuse drugs and/or alcohol than those that do not have IED. “People don’t see this as a medical problem. They think of it as simply bad behavior they have developed over the course of their lives, but it isn’t. It has significant biology and neuroscience behind it,” explained Emil Coccaro, professor of Psychiatry and Behavioral Neuroscience at University of Chicago and one of the authors of the study. In fact, according to recent data, approximately 16 million people in the United States suffer from this disorder. This is especially important as health officials; law enforcement and government leaders are scrambling to figure out an effective solution to the growing drug problem in this country. The study was performed by using data from the National Comorbidity Survey, a national survey centered around mental health issues in this country. From the information gathered there, researchers were able to note that as a patient’s behavior worsened the tended to use more and more drugs and alcohol. This is likely because patients are seeking a way to control their behavior and are self-medicating with drugs and alcohol. However, researchers also point out that if they are given treatment for their aggression disorder they are less likely to abuse substances. And while some patients use drugs despite their treatment for IED, the authors state that effective treatment of their disorder could prolong drug use, and make it easier to spot when drug use is occurring.
It has long been suspected, but now a new study has confirmed that changes to prescription painkiller prescribing practices inadvertently increased heroin use. In 2010 policy makers began to adjust how much OxyContin could be prescribed to patients and changed the form in which OxyContin was made, making it more difficult to crush or snort. These changes were in response to a 2007 guilty plea made by Purdue Pharma (the maker of OxyContin) that they purposely mislead consumers about how addictive the pills actually were. And while these changes did help to reduce the amount of OxyContin being abused by patients and addicts, there has been some unintended consequences. Because so many were already addicted to the powerful opiate, they turned to another, similar drug to take the place of the OxyContin they could no longer crush and snort. Heroin became the obvious choice to these people, especially since this drug was cheaper and usually easier to obtain. Since the policy changes in 2010, the amount of people that are currently abusing heroin has risen dramatically. In fact, according to researchers, the change in OxyContin led to an almost 80% increase in the amount of heroin-related deaths in this country. A closer examination of these statistics shows that states throughout the nation are seeing an almost identical correlation between current heroin use and former OxyContin use. “States with the highest initial rates of OxyContin misuse experienced the largest increases in heroin deaths. Results show that this differential increase in heroin deaths began precisely in the year following reformulation,” explained the researchers. So, while changing accessibility to OxyContin was of course necessary, now policy makers have to grapple with the increased heroin epidemic. In the past, the correlation between increased OxyContin laws and increased heroin use was suspected, but not verified. This study has proven that there is a direct correlation between the two issues. Of course, heroin is more difficult to control, lawmakers cannot monitor the manufacturing or dispersal of the drug, two of the most effective solutions in the OxyContin shift.
As part of a continuous effort to increase drug treatment and education and reduce the amount of people incarcerated due to drug offenses, a study was conducted to examine racial disparity among people with drug charges. Performed by the Oregon Criminal Justice Commission, the results show that African-Americans were twice as likely to be convicted of drug charges than white people. What makes this information interesting is that research shows that black and white people appear to use drugs equally. So, if the same amount of black people and the same amount of white people are using drugs, why are black people more likely to be jailed because of it? This is a question that Governor Kate Brown wants answered. Requesting the study was the first step in determining how to effectively help addicts, while eliminating the one-sided punishment. Brown has offered a proposal in order to close the race gap and help addicts attain long lasting sobriety. The proposal includes dropping some drug possession felonies to misdemeanors and focusing on treatment rather than incarceration. These policies and interventions are newer to the state of Oregon, but there has been a noticeable shift across the country. More and more people are realizing that treatment is much more effective than jail time. In agreement with Brown, other public officials are speaking out against the racial disparity uncovered by this recent study. “Everyone who uses or possesses (illicit drugs) has committed that crime. Whether or not they are caught is completely different,” explained State Criminal Justice Commission Director Mike Schmidt. Additionally, the Multnomah County District Attorney is also working to reduce the amount of jail time addicts receive and instead replace the sentence with court-mandated, effective treatment. As a growing number of public officials understand that prisons are not an effective substitute for quality treatment, it is likely that more substance abusers will get a chance to redeem themselves, and return to their families, jobs, friends and lives.