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noraboston904-blog · 6 years ago

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Loan & Careers Articles.

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. For doctors in Northern Kentucky, handling narcotics addicts creates a lonely profession road. First-run flicks, fine meals options, on-site made produced beer, red or dodaci-za-zdravlje.info white wine, as well as pleasant seating along with a hold-up team - it's cinema bliss. Eleven state Medicaid programs put lifetime therapy restrictions on how long addicts may be prescribed Suboxone, ranging between one and also three years. There were opportunities when I even failed to remember to consume my nachos, as I was actually thus soaked up in the account on the display. We could view everything on the monitor coming from basically every slant that you will ever before discover on your own at, as well as we possessed no problems from a tiny group that our company assembled to view a 1080p film trailer. They additionally hold aristocracy free of charge music and acquistion popular music which is actually ideal for use as background music for video clip, quick docudrama, television and also film development. While the very early silent age films were actually assembling a raw anecdotal foreign language inspired through movie theater and literature, Buñuel rather developed a film that went ahead on the unique reasoning of a dream. In 1995, the channel of Walt Disney's computer animated cinema Pocahontas" revived a lengthy neglected story of courage and excitement that redesigned the way of life of Indian historical amount - the Indian princess Pocahontas. Each these channels return with films, popular music, regular cleansing soaps that rate of number of customers. Along with every little thing in position, I kicked back on my couch, a mere 6 shoes out of the display screen, and also enjoyed my very first residence projector adventure: the teaser advertisement for Star Wars: The Force Awakens. Share you really love and also Contentment with your buddy, household and also liked ones with the beloved scent of Vegetation and create the day cheerful. Getting here right into Nice flight terminal and then taking a taxi flight right into Cannes is actually always the most ideal intro into this movie festival for me. I mesmerize on the current French politics and also phrase on the streets of France with my cab driver, who generally has some Italian blood stream, coming from the days Nice was actually linked with northerly Italy.

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pharmaphorumuk · 4 years ago

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Indivior pays $300m to settle Suboxone marketing allegations

Indivior has paid out $300 million to resolve civil claims from US states after it was last year found guilty against criminal charges of improper marketing of the opioid addiction drug Suboxone.

Last year, Indivior reached a $600 million settlement plea deal to settle criminal fraud charges, after US authorities found the company’s conduct had results in improper use of state Medicaid funds.

In a statement California attorney general Rob Bonta announced that Indivior will pay the settlement to resolve various civil fraud allegations raised by 50 states, the District of Columbia and Puerto Rico.

Indivior will pay just under $204 million to Medicaid while the remainder will go to the states for their Medicaid recovery.

California’s share of the settlement is just over $1.64 million, according to the statement.

The settlement resolves allegations that from 2010 to 2015, Indivior promoted sale of Suboxone to doctors who were writing unnecessary and unsafe precriptions.

Indivior also promoted Suboxone sublingual film based on false and misleading claims that it was less subject to diversion and abuse than other buprenorphine products.

It also wrongly claimed that Subxonone sublingual film was less likely to be accidentally swallowed by children and blocked generic competition that would have reduced pressure on Medicaid budgets.

Reckitt Benckiser Group, the UK firm that previously owned Indivior before spinning it out as a separate entity, has already paid $700 million against similar charges.

In a statement Indivior said that the settlements announced this week are “administrative in nature” and formalise agreements as part of the criminal and civil settlements reached in July 2020.

The company said that “no new financial or legal obligation has arisen” as a result of the announcements.

Attorney General Bonta said: “Today’s settlement should send a message that false marketing and improper use of California’s Medicaid dollars will have costly consequences.”

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jasonlawson0 · 5 years ago

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Lawsuit against B.C., pharmacists' college, drug company over medication switch

VANCOUVER — A drug user "forced" to switch to a reformulated methadone treatment introduced in British Columbia six years ago has filed a proposed class-action lawsuit against the provincial government, the college of pharmacists and a pharmaceutical company.

Laura Shaver was among an estimated 18,000 people given Methadose instead of methadone, a change she said Friday was done without consultation and puts patients who relapse at risk of death from illicit street drugs that could contain fentanyl.

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Shaver and others taking compounded methadone as part of a daily treatment program to try and quit opioids such as heroin have maintained that Methadose is a weaker medication and causes painful withdrawal symptoms for a high proportion of people who end up seeking street drugs to cope.

"I hadn't used heroin in four years or something," she said. "Within six days I was a raging injection junkie again. The things I went through, the sweats, the shakes. I don't even know where to start."

Shaver, who heads the B.C. Association of People on Methadone, said the withdrawal symptoms were so severe she took illicit drugs and overdosed eight times.

"They did not give me or anybody else a choice," she said of the province's decision, adding despite awareness that Methadose caused an increase in relapses, overdoses and deaths, it refused to allow access to methadone as part of a change she believed saved money.

The Health Ministry, which is named as a defendant in civil claim filed in B.C. Supreme Court, made the switch to Methadose in 2014 but the Ministry of Mental Health and Addictions was created two years later as overdose deaths related to fentanyl were increasing and the province declared a public health emergency.

A spokeswoman for the Ministry of Mental Health and Addictions said the province had not yet been served with the court document.

The ministry did not immediately provide comment on the allegations.

Drug company Mallinckrodt Canada ULC, and its parent company Mallinckrodt Plc, are also named in the court document but neither returned a request for comment. The College of Pharmacists of British Columbia said it did not wish to make any comments about the change to Methadose, which is dispensed by pharmacists.

"The defendants knew or ought to have known that restricting patient access to compounded methadone and granting Mallinckrodt the right to distribute Methadose as the exclusive (therapy) medication in British Columbia could result in relapse and harms associated with relapse," the court document says.

It says the province, the drug company and the college exaggerated the relative efficacy of Methadose and asserted that patients who switched from methadone should expect no adverse effects and downplayed or denied the risks associated with the change.

All three defendants are liable for making negligent, inaccurate and misleading representations to Shaver and members of the proposed class action, as well as pharmacists and doctors, the statement of claim says.

None of the allegations have been proven in court.

The lawsuit also alleges the charter rights of Shaver and other proposed members of the class action were infringed as a result of the "forced switch" to Methadose.

Shaver is claiming damages, restored access to methadone and costs.

The BC Centre on Substance Use recommends Suboxone as the first-line treatment for opioid use disorder because it has fewer side effects, is safer and can be taken home instead of being taken in front of a pharmacist. Methadose is recommended next, followed by slow-release morphine.

Jason Gratl, a lawyer representing Shaver in the lawsuit, which a judge must certify as a class action, said people who relapsed on methadose deserve compensation to try and restore their "shattered lives."

"Numerous individuals and organizations have come forward to try to persuade the province and the college of pharmacists to restore access to compounded methadone," he said, adding the change would be without cost.

This report by The Canadian Press was first published June 5, 2020.

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addictionrecoveryassistance · 6 years ago

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suboxonedoctor12-blog · 7 years ago

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Opioid Addiction Treatment in District of Columbia

● Opioid Death Rate Per 100,000: 30

● Approximate # of Opioid Deaths per Year: 209

● Opioid Prescribing Rate Per 100: 70.0

Often, prescription opioids are the start into addiction, as doctors across the country tend to over prescribe this type of medication. Patients begin taking the medications to handle pain, and then if their health starts to decline or if they cannot get the full amount of medication that they need in order to prevent full blown withdrawal, they may try to find illicit drugs to help them keep the level that they're accustomed to in their bloodstream.

Once a user is addicted to opioid medications, their brain chemistry adjusts and they actually need to have the chemicals present in order to function correctly. If they don't have the full level of opioids that they are used to in their system, they can begin to feel extremely uncomfortable due to withdrawal symptoms. These symptoms can be one of the biggest obstacles to individuals who are trying to get into and maintain successful treatment for an opioid addiction. Opioid withdrawal is extremely physically uncomfortable, and an individual will need a great deal of psychological and medical support to get through the process. Without this support, it is possible for an individual to become quite ill as they begin to withdraw from the opioids in their system.

Suboxone doctors in District of Columbia can guide the patient through an entire course of addiction therapy, with suboxone as a part of this therapy. Suboxone is made up of two different medications that work together to block the euphoria that these opioids can induce. It also helps to lower the onset of cravings and withdrawal symptoms. This specific drug allows the individual who has experienced addiction issues to stay on the course towards recovery, and keeps them from needing to constantly look for higher doses to feel stable. In addition, working in therapy allows them to develop important skills so that they can begin to live a life that is not dependent on opioids.

This combined treatment method, using suboxone and talk therapy, is the modern method for opioid addiction. Individuals seeking opioid addiction treatment in the District of Columbia should be sure to find a treatment model that addresses both their psychological and physical symptoms. Older, less successful models for addiction treatment required that individuals work through a waiting period before undergoing medical treatment or therapy.

Methadone has been used for quite some time to treat opioid addiction, but it is quite addictive on its own. Suboxone, on the other hand, has become very popular in many states as it is much harder to abuse and is much less addictive than methadone. Suboxone doctors in District of Columbia, therefore, use it to help their patients to break their addiction to opioids.

Those who need opioid addiction treatment in District of Columbia, or who have a loved one who needs said treatment, may feel that a suboxone treatment center is the best option. If this seems like it could be a good course of action for you, it may be time to contact [treatment center] to find out more about the options that are available for fighting addiction.

#opioid addiction treatment in District of Columbia #Suboxone doctors in District of Columbia

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suboxonedoctorcolumbia-blog · 5 years ago

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Experienced Suboxone Doctor in Columbia

When you come to our office in Columbia, you realize that an important aspect of your past is how it can help you reclaim your future. We offer judgment-free treatment, and respond to your honesty with personalized, caring treatment. Our goal is to make sure every patient feels like a whole person, not just someone struggling with opioid addiction.

Columbia Suboxone Doctor 1415 Barnwell Street, Columbia, SC 29201 (803) 219-3422

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gordonwilliamsweb · 5 years ago

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Trusting Injection Drug Users With IV Antibiotics At Home: It Can Work

Two mornings a week, Arthur Jackson clears space on half of his cream-colored sofa. He sets out a few rolls of tape and some gauze, then waits for a knock on his front door.

“This is Brenda’s desk,” Jackson said with a chuckle.

Brenda Mastricola is his visiting nurse. After she arrives at Jackson’s home in Boston, she joins him on the couch and starts by taking his blood pressure. Then she changes the bandages on Jackson’s right foot. His big toe was amputated at Brigham and Women’s Hospital in November. A bacterial infection, osteomyelitis, had destroyed the bone.

Jackson is still taking intravenous penicillin to stop the infection. He came home from the hospital wearing a small medication pump that delivers a steady dose of penicillin via a PICC line. PICC stands for a “peripherally inserted” or “percutaneous indwelling” central catheter, and it resembles a flexible IV tube, inserted into Jackson’s chest.

“This all looks good,” Mastricola said, after making sure the line was clean and in place. “You don’t need me.”

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When patients need weeks or months of IV antibiotic treatment but otherwise don’t need to be hospitalized, the standard protocol is to discharge them with a PICC line and allow them to finish the medication at home. It saves money and is much more convenient for patients.

But this arrangement is almost never offered to patients with a history of addiction. The fear is that such patients might be tempted to use the PICC line as a fast and easy way to inject drugs like heroin, cocaine or methamphetamine.

Jackson, 69, was addicted to heroin for 40 years. Although he’s been sober for years, most U.S. hospitals would force patients like Jackson to stay in the hospital, sometimes for eight weeks or more. But Brigham and Women’s in Boston, along with a few others in the U.S., is challenging that protocol, allowing some patients with a history of addiction to go home.

Supporters of the change argue that doing so boosts the chances these patients will stay on their antibiotics and beat the infection.

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A Path To Safe At-Home Treatment

A small team of Brigham doctors and nurses started planning this unusual option shortly after opening the Bridge Clinic, a walk-in health center in Boston for patients seeking treatment for a substance use disorder. Dr. Christin Price, one of the clinic’s directors, said virtually every patient who injects drugs develops some kind of infection. It’s difficult to avoid injecting bacteria into the bloodstream when using drugs in an alley or a public bathroom. The national opioid epidemic has led, in many cases, to a parallel increase in diseases related to injection drug use, such as HIV, hepatitis C and bacterial infections of the heart and bones. A study of North Carolina hospitals found a twelvefold increase in cases of bacterial endocarditis, a heart infection, from 2010 to 2015.

“Every time someone uses injection drugs, they’re putting themselves at risk for a very complicated infection,” Price said.

Treatment options for endocarditis patients with a history of drug use are limited. Some skilled nursing facilities, home care agencies and antibiotic infusion companies decline to work with these patients once they’re released from a hospital. And, Price said, some of her patients aren’t willing to remain in a hospital for weeks on end just to finish a round of IV antibiotics.

“They kind of get stir crazy,” she said. “You can imagine it’s almost like being held captive for six weeks, especially when you’re feeling fine now because the infection is clearing. A huge problem is that some of them can’t last — and so they leave before the six weeks are over.”

Patients who don’t complete their course of antibiotics can end up with a recurring infection and a repeat trip to the hospital.

Doctors and nurses affiliated with the Bridge Clinic wondered if there was a way to send patients with a history of drug use home — safely. They mapped out three requirements: First, patients would have to be taking an addiction treatment medication such as buprenorphine, or be willing to start one. Second, patients would have to check in weekly at the Bridge Clinic. Third, patients would need to have stable housing, and live with a sober friend or loved one. Price and colleagues began months of discussions with specialists in heart, bone and joint conditions, seeking buy-in from surgeons and nurses, so their patients could participate.

“A lot of people did sort of look aghast,” Price said. “It was just their policy that people with a history of injection drug use would not go home.”

When Dr. Daniel Solomon, who is also with Brigham and Women’s, encountered those looks, he said, he’d remind colleagues that “the alternatives aren’t that good either.”

Holding patients for weeks in a hospital room is hard on both the patients and medical providers, he said. And if patients want to use drugs, they’ll find a way to do it, even in a hospital bed.

In spring 2018, Price, Solomon and others enrolled a few of the first qualified patients, then a few more — intentionally cherry-picking those who wanted to be in treatment and had a sober, stable home.

Brenda Mastricola checks on the PICC line through which Arthur Jackson, a former drug user, is receiving penicillin to treat a bone infection.(Jesse Costa/WBUR)

‘I’m Not Going Back’

Arthur Jackson met the requirement that at-home PICC line candidates take addiction treatment medication. He had been on methadone for 10 years, used heroin again, then switched to Suboxone, a combination medication containing buprenorphine and naloxone, which he has been taking for two years. And, in fact, Jackson said he was insulted when one of the doctors presented the home treatment option to him but said she was worried the PICC line might entice him to inject heroin.

“Stop right there,” Jackson recalled telling the nurse. “When it comes to my recovery, I’m serious because I’ve done so much to lick this — this thing.”

Although the possibility did cross Jackson’s mind.

“First thing I thought was, ‘Oh, I could inject heroin in here easily,'” Jackson said. “But I dismissed that thought because I’m not going back” — back to winters on the streets and living from one heroin fix to the next.

Other Bridge patients scoff at the concerns about PICC lines.

“Everyone makes such a big deal about this PICC line,” said Stephen Connolly, 36, who went home with the open port last year, while being treated for endocarditis. “If I want to get high, I know how to do it. I’m not going to mess around with a PICC.”

Connolly said that when he first came to Brigham and Women’s Hospital he was focused on his heart, ignoring his other disease: addiction. He said he was surprised when every doctor he saw, even his cardiologist, wanted to talk about addiction.

“I’m like, ‘Listen, dude. My heart’s falling apart here, so let’s hold up with the drug talk,'” Connolly recalled. He assured the cardiologist he had his addiction under control, even though he wasn’t so sure. “Obviously, I didn’t, but my mind tells me that. It’s just crazy.”

Connolly said he realizes now that the conversation around drug use was relevant and related to his heart infection.

Connolly finished his antibiotic treatment while staying with family members in Abington, Massachusetts. Brigham doctors say the housing requirement excludes otherwise eligible patients. Recent research shows homeless patients who have HIV or hep C do take their antiviral medicines; there are no equivalent robust studies on treating homeless patients who have bacterial infections.

Nevertheless, a few other hospitals are testing ways to continue outpatient treatment for patients who don’t have a stable home. In Portland, Oregon, a medical center tried providing IV antibiotics inside addiction treatment programs. A hospital in Kentucky combines addiction treatment, counseling and outpatient IV antibiotics. In Vancouver, British Columbia, the Canadian national health program pays for small apartments, staffed with a nurse 24 hours a day, where patients can stay while they complete antibiotic treatment.

“People who use drugs deserve the same standard of care,” said Dr. Christy Sutherland, medical director at the Portland Hotel Society in Vancouver. “We can’t change what we offer as clinicians — to give people subpar treatment with the excuse that they are IV drug users.”

Promising Early Signs

Arthur Jackson lives alone in his studio apartment (he does not live with a sober friend or loved one), but he convinced doctors he’d be better off there than in the hospital, so he could visit his 93-year-old mother daily, feed his tankful of tropical fish and his cat, and attend regular Narcotics Anonymous meetings.

“I guess the best way to put it is, I have a life and I need to get back to it,” he said.

Jackson is one of 40 patients with a history of drug use the Brigham team has discharged from the hospital to complete IV antibiotic treatment at home. The team is paying particular attention to 21 patients within that group who, unlike Jackson, are active drug users. So far, these men and women have finished their antibiotic treatment via a PICC line with no complications. One had to be readmitted because he had trouble administering the antibiotics. Price said three patients relapsed into drug use, but no one used the PICC line to inject illegal drugs.

“I think we’ve shown, through this pilot, that it is safe and feasible for certain patients,” Price said.

Brigham doctors have not yet published these initial results in a medical journal, though they plan to. But already, Price said, the pilot program is helping to cut health care costs.

Taken as a group, the 21 high-risk patients who needed IV antibiotics spent 571 days at home rather than in a hospital or rehab facility. Not including the cost of home care visits by a home nurse, the savings tally more than $850,000, based on estimates of $1,500 per hospital day.

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

Trusting Injection Drug Users With IV Antibiotics At Home: It Can Work published first on https://nootropicspowdersupplier.tumblr.com/

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dinafbrownil · 5 years ago

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Trusting Injection Drug Users With IV Antibiotics At Home: It Can Work

Two mornings a week, Arthur Jackson clears space on half of his cream-colored sofa. He sets out a few rolls of tape and some gauze, then waits for a knock on his front door.

“This is Brenda’s desk,” Jackson said with a chuckle.

“This all looks good,” Mastricola said, after making sure the line was clean and in place. “You don’t need me.”

Supporters of the change argue that doing so boosts the chances these patients will stay on their antibiotics and beat the infection.

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Please confirm your email address below:

A Path To Safe At-Home Treatment

“Every time someone uses injection drugs, they’re putting themselves at risk for a very complicated infection,” Price said.

Patients who don’t complete their course of antibiotics can end up with a recurring infection and a repeat trip to the hospital.

“A lot of people did sort of look aghast,” Price said. “It was just their policy that people with a history of injection drug use would not go home.”

When Dr. Daniel Solomon, who is also with Brigham and Women’s, encountered those looks, he said, he’d remind colleagues that “the alternatives aren’t that good either.”

Holding patients for weeks in a hospital room is hard on both the patients and medical providers, he said. And if patients want to use drugs, they’ll find a way to do it, even in a hospital bed.

Brenda Mastricola checks on the PICC line through which Arthur Jackson, a former drug user, is receiving penicillin to treat a bone infection.(Jesse Costa/WBUR)

‘I’m Not Going Back’

“Stop right there,” Jackson recalled telling the nurse. “When it comes to my recovery, I’m serious because I’ve done so much to lick this — this thing.”

Although the possibility did cross Jackson’s mind.

Other Bridge patients scoff at the concerns about PICC lines.

Connolly said he realizes now that the conversation around drug use was relevant and related to his heart infection.

Promising Early Signs

“I guess the best way to put it is, I have a life and I need to get back to it,” he said.

“I think we’ve shown, through this pilot, that it is safe and feasible for certain patients,” Price said.

Brigham doctors have not yet published these initial results in a medical journal, though they plan to. But already, Price said, the pilot program is helping to cut health care costs.

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

from Updates By Dina https://khn.org/news/trusting-injection-drug-users-with-iv-antibiotics-at-home-it-can-work/

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stephenmccull · 5 years ago

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Trusting Injection Drug Users With IV Antibiotics At Home: It Can Work

Two mornings a week, Arthur Jackson clears space on half of his cream-colored sofa. He sets out a few rolls of tape and some gauze, then waits for a knock on his front door.

“This is Brenda’s desk,” Jackson said with a chuckle.

“This all looks good,” Mastricola said, after making sure the line was clean and in place. “You don’t need me.”

Supporters of the change argue that doing so boosts the chances these patients will stay on their antibiotics and beat the infection.

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A Path To Safe At-Home Treatment

“Every time someone uses injection drugs, they’re putting themselves at risk for a very complicated infection,” Price said.

Patients who don’t complete their course of antibiotics can end up with a recurring infection and a repeat trip to the hospital.

“A lot of people did sort of look aghast,” Price said. “It was just their policy that people with a history of injection drug use would not go home.”

When Dr. Daniel Solomon, who is also with Brigham and Women’s, encountered those looks, he said, he’d remind colleagues that “the alternatives aren’t that good either.”

Holding patients for weeks in a hospital room is hard on both the patients and medical providers, he said. And if patients want to use drugs, they’ll find a way to do it, even in a hospital bed.

Brenda Mastricola checks on the PICC line through which Arthur Jackson, a former drug user, is receiving penicillin to treat a bone infection.(Jesse Costa/WBUR)

‘I’m Not Going Back’

“Stop right there,” Jackson recalled telling the nurse. “When it comes to my recovery, I’m serious because I’ve done so much to lick this — this thing.”

Although the possibility did cross Jackson’s mind.

Other Bridge patients scoff at the concerns about PICC lines.

Connolly said he realizes now that the conversation around drug use was relevant and related to his heart infection.

Promising Early Signs

“I guess the best way to put it is, I have a life and I need to get back to it,” he said.

“I think we’ve shown, through this pilot, that it is safe and feasible for certain patients,” Price said.

Brigham doctors have not yet published these initial results in a medical journal, though they plan to. But already, Price said, the pilot program is helping to cut health care costs.

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

Trusting Injection Drug Users With IV Antibiotics At Home: It Can Work published first on https://smartdrinkingweb.weebly.com/

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nancygduarteus · 6 years ago

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America’s Health-Care System Is Making the Opioid Crisis Worse

Outside a liquor store in a rough part of Trenton, New Jersey, a one-eyed woman with sores on her face walked by, seemingly in a hurry.

I asked if she used heroin, and when she said she did, I asked her if she had ever considered treatment. She said doctors have dismissed her. They tell her she’s living her “lifestyle” by choice. The woman—who, like others, wouldn’t give me her name because of the stigma associated with addiction—said that at one point she tried to get on Suboxone, a medication that reduces cravings for heroin. It didn’t work, she complained. She says she was on a 12 mg dose, one that is far lower than the maximum dose of 32 mg.

She turned to a few other drug users standing nearby and plotted where to get food. Meanwhile, the woman’s companion, a man with a green-dyed beard, told me about his own struggles with addiction. His voice tinged with bitterness, the man said that when he’s asked doctors for help quitting heroin, they gave him referrals to rehab programs that turned out to have long waits or otherwise rejected him from admittance.

One of the pair’s friends—a stringy-haired woman who told me she has a crack addiction—chimed in to say that in the past, she’s gotten high just to boost her chances of being admitted into a rehab.

Given addiction’s tendency to ravage a person’s life, it’s not clear how many of these are simply one-off misunderstandings between a busy doctor and desperate patient. But something clearly isn’t working. Though opioid deaths have declined in some parts of New Jersey, in several counties—including Mercer, which surrounds Trenton—the death toll continues to climb. Meanwhile, more than three-quarters of people with drug addictions in New Jersey go untreated. Overdose deaths in New Jersey rose by 21 percent between January 2017 and January 2018, compared to just 7 percent nationally.

The stories of the people I met in Trenton who are dealing with addiction reflect the many ways heroin users not only in New Jersey, but in every state, can tumble through the cracks of the American medical system. Had a doctor placed the one-eyed woman on a higher dose of Suboxone than the one she claimed she was given, the medication might have worked. And the referrals to rehab programs her companion said he received from his doctors were not necessary, since any doctor can get licensed to prescribe Suboxone. Unlike the better-known methadone, Suboxone does not have to be prescribed at a special, carefully monitored facility.

For the past two years, the number of Americans dying of drug overdoses each year have outnumbered those who died in the entire Vietnam War. But there’s an overwhelming consensus among experts on how to bring deaths down: Opioid addicts should be treated as soon as possible, and with medication. When France opened up the prescribing of buprenorphine, which is a form of Suboxone, to all of its primary-care doctors, heroin overdose deaths plummeted by 79 percent in four years.

In almost every U.S. state, meanwhile, doctors, patients, and experts describe a situation in which too few doctors offer Suboxone for free or cheap. Instead, many addicted patients are funneled into rehab programs, which are often pricey, unavailable, or ineffective. “Most of the general public thinks you should go to rehab if you have opioid addiction,” said Adam Bisaga, a professor of psychiatry at the Columbia University Medical Center. “But 70 percent of the success is giving [patients] the medication.” Adding things like housing and psychotherapy can bring the success rate up higher, but, Basiga added, “the core of it is really medication.”

He puts it this way: “If you have diabetes, you need insulin. Without insulin, you will perish.” Without easy access to Suboxone and other medications, people addicted to heroin continue to perish at a terrifying rate.

The grim overdose statistics in New Jersey are in part a matter of geography: The state is wedged between the drug-trafficking hubs of New York and Philadelphia, attached to a port, and webbed with well-developed organized crime networks. “I’ve had patients tell me, ‘I had to go out of state, because no matter where I go in New Jersey it’s so easy [to get drugs],’” said Rachael Evans, a doctor at the Henry J. Austin primary-care clinic in Trenton.

But the state’s medical system could also be doing more. Only one-quarter of all addiction-treatment providers in New Jersey offer medication-assisted treatment, or MAT, a category that includes Suboxone. Perhaps because Suboxone is so scarce, many heroin users seem to have gotten the idea that their only option is a residential program, which many experts now believe aren’t as essential as just getting started on Suboxone. In Atlantic City, I met a 54-year-old heroin user who was smoking a clove cigarette outside a drop-in center for the homeless. She said if there was a way to get Suboxone, she would “definitely” get on it. But she says treatment programs are hard to get into, especially since she does not have a photo ID.

An older man who said he was a veteran was also looking forward to “getting into treatment” for his heroin addiction. But he worried that a residential treatment program won’t help him in the long run, since it wouldn’t allow him to keep a job. He’s homeless, and he needs to earn money so he has somewhere to go once he’s clean. “Right now I have nothing in my pockets,” he said. “If we go in six months, we come out, we’re still broke.”

There are, however, examples around the state of addiction treatment performed in a way that aligns with the scientific evidence.

New Jersey actually has a higher-than-average number of doctors who have become licensed to prescribe Suboxone. In every state, doctors are required to take an eight-hour class before they can do so, despite the fact that no such class was required to prescribe the prescription painkillers that ignited the opioid epidemic. Nationally, only about 5 percent of all doctors have this Suboxone waiver, and in 2011, 43 percent of all U.S. counties had no doctors who could prescribe Suboxone. There are about 1,660 physicians and nurses who have the waiver in New Jersey, which has about 9,500 total primary-care doctors and psychiatrists who could get it.

But many drug users are poor, and not every waivered doctor accepts insurance. Doctors at places like the Henry J. Austin clinic in Trenton and at Project H.O.P.E. in Camden do. Lynda Bascelli, the chief medical officer of Project H.O.P.E., said some patients ask to transfer their Suboxone treatment to Project H.O.P.E. after they realize it both accepts Medicaid and prescribes Suboxone. “Some of the patients might have been to a physician that had a cash-only practice, and they did the best they could to pay to be seen so they could get their prescription,” she said.

If people use heroin, and would like to quit, they can walk into an appointment with a primary-care doctor at these clinics, just like they would if they had strep throat. Unless they want to be, they aren’t referred to an inpatient program or detox center. Doctors at places like Project H.OP.E. and Henry J. Austin prescribe enough Suboxone so that the patient feels like it’s working. This system allows heroin users who have jobs to keep them while they recover from their addictions, just like anyone with any other chronic illness would.

Places like Henry J. Austin have a markedly gentle approach that would seem anathema to abstinence-only drug-rehab programs, which believe that Suboxone simply replaces one drug with another. Many rehab programs require their clients to avoid all drugs and alcohol or face being kicked out, but Henry J. Austin gives patients repeated second chances. To them, firing a patient for relapsing makes as much sense as discharging a diabetic patient for eating cake. “There’s this fantasy that [doctors] can create accountability by being mean,” said Evans, who is Henry J. Austin’s chief medical officer. She says it takes patients about seven attempts at treatment before it works, so relapsing is to be expected.

The doctors at Henry J. Austin follow a “harm-reduction” approach that is popular with many public-health advocates: They remain clear-eyed about the fact that some people will continue using heroin, and they try to minimize the dangers associated with its use. They give heroin users Narcan, the drug that reverses overdoses, and advise them to never use alone. Evans says she has gone so far as to tell gobsmacked parents to buy their 15-year-olds clean needles so they can safely use at home.

Outside of clinics like these, the addiction field is rife with outdated information. One of the most common reasons why doctors won’t get waivered to prescribe Suboxone is that they don’t believe the treatment works. Another common misconception, according to Evans, is the idea that people who relapse “weren’t ready to quit getting high.” Instead, she says, most people addicted to heroin are just trying to avoid the agonizing pain of opioid withdrawal, which feels like a severe flu and can last up to six months. “Most people who are actively using are not seeking euphoria,” Evans said. “They’re avoiding pain.”

Suboxone can help ease these withdrawal symptoms and cravings for heroin, though it can take about 18 months for it to work fully. It does make patients technically “dependent” on another drug—the Suboxone—but it is much safer to use than heroin or oxycontin.

Last month, President Trump signed an opioid bill that did ease some of these obstacles to treatment, and the president’s commission on opioids last year called for broader prescribing of Suboxone and other types of buprenorphine. But “the opioid crisis is so vast that this bill is not going to solve the whole problem,” said Anna Lembke, a psychiatrist and addiction expert at Stanford University.

Several experts have said that what’s required to fully tackle this epidemic is something more like the Ryan White CARE Act that was passed during the HIV epidemic, which put AIDS drugs in the hands of thousands of patients, regardless of their ability to pay. Imagine a heroin user who wakes up feeling dope sick, with diarrhea or nausea, and knows where to buy a bag of heroin to make the sickness go away. If the bag of heroin is easier to find and cheaper than Suboxone, the person will keep using. “If we want to see deaths come down, treatment has to be less expensive and easier to get,” said Andrew Kolodny, the co-director of Opioid Policy Research at Brandeis University. Kolodny estimates that an investment of around $60 billion over 10 years is roughly what’s needed to curb the opioid crisis.

Meanwhile, other actions taken by President Trump will make addiction treatment even harder to access. People with addiction are already more likely to be uninsured than those who aren’t addicted, and their insurance status can affect their access to Suboxone and other medications. But the changes to Obamacare by the Trump administration are predicted to swell the ranks of the uninsured.

Medicaid payment rules further complicate the process of treating people addicted to heroin. Bascelli’s clinic in Camden employs one full-time staff member just to obtain prior authorizations from insurance plans for Suboxone. Still, a patient might leave with their Suboxone prescription, arrive at the pharmacy, and still be asked to wait for 72 hours for the medication to be approved by their insurance. “People overdose and die in that window,” Bascelli said.

Some doctors might be more likely to treat addiction patients if they had support from a psychologist or other mental-health expert. At Henry J. Austin, Lee Ruszczyk, the clinic’s senior director of behavioral health, works with the medical doctors to deliver small bursts of mental-health help during medical appointments. This is because in New Jersey, doctors are allowed to bill Medicaid for a patient’s medical visit and a mental-health visit if they occur on the same day. But in some states, this isn’t allowed, forcing clinics to eat the cost of one visit or the other. In Sacramento, California, doctors at One Community Health told me they lose $200 to $300 per visit on addiction patients if they see a psychotherapist and medical doctor on the same day, because only one visit will be reimbursed by Medicaid. (A spokeswoman for the California Department of Health Care Services defended this practice by saying that the rates these clinics are paid “specifically accounts for all of the costs of all of the services in a day.”) Some other states’ Medicaid rules require patients to “fail” at other types of treatments before they’ll grant them access to Suboxone.

Arthur Robin Williams, a professor of clinical psychiatry at Columbia University, says some insurance plans require doctors to mail or fax drug-testing results to prove the patient is free of other drugs before starting the patient on Suboxone, or demand to see the provider’s psychotherapy notes. Because Williams wasn’t officially listed as one 22-year-old patient’s primary-care physician, Williams once had trouble getting the patient his Vivitrol—another medication that can treat heroin addiction. The man relapsed and developed a bacterial heart infection. “He wound up in the hospital for three months and had to have part of his heart transplanted because his insurance wouldn’t pay for his Vivitrol,” Williams said. “They make it so onerous.”

I asked more than a dozen experts why more doctors don’t prescribe Suboxone, over and over, they said the biggest factors were stigma and fear. Addicted patients are perceived as being disruptive or devious. The average med student spends only a few hours learning about addiction, and some doctors might simply be befuddled by how to treat addicted patients. Bisaga pointed out that it took years before primary-care doctors, rather than specialists, began treating ailments like depression and diabetes.

When antidepressants became popular in the 1980s, drug companies conducted medical-education courses, complete with free meals and trips, for primary-care doctors interested in learning about depression and its treatment. Pharma-sponsored trips come with their own pitfalls, but in the case of Suboxone, says Mack Lipkin, an internal-medicine expert at NYU Langone Medical Center, “there still has been no concerted effort to get the word out to primary-care doctors.” Similarly, the Ryan White Act came with funding for special training centers so that doctors could learn how to treat AIDS. There’s nothing like that for Suboxone.

For doctors, there can be a benefit to overcoming the Suboxone apprehension, however. Several doctors told me that once they began prescribing Suboxone, treating heroin users became the most rewarding part of their jobs.

It’s one of the few remedies that can instantly stop a deadly disease in its tracks and transform the patient’s life. It is as close to a miracle drug as people addicted to heroin can hope for. “It’s not often that you see this individual looking like an entirely different person,” Bascelli said. “Treating opioid dependence with medication has brought the joy back to practice.”

from Health News And Updates https://www.theatlantic.com/health/archive/2018/11/why-heroin-and-fentanyl-addicts-cant-get-treatment/576118/?utm_source=feed

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ionecoffman · 6 years ago

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America’s Health-Care System Is Making the Opioid Crisis Worse

Outside a liquor store in a rough part of Trenton, New Jersey, a one-eyed woman with sores on her face walked by, seemingly in a hurry.

There are, however, examples around the state of addiction treatment performed in a way that aligns with the scientific evidence.

Article source here:The Atlantic

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addictionrecoveryassistance · 6 years ago

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addictionfreedom · 6 years ago

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pate11gustafson-blog · 6 years ago

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In several countries, including Australia, Germany, France, Britain and Switzerland, federal governments have actually stepped in to rate medicines according to value due to the fact that medicine companies have actually not been willing to moderate their costs. This is regular and does not mean that you are not obtaining sufficient of the medication. Some take it to deal with colds or boost their energy; students take it to work late. Researchers have actually shown that taking the cholesterol-lowering medicine simvastatin with a 200ml glass of grapefruit juice each day for 3 days boosted the medication's focus in the blood three-fold. The highest possible number of drug abuser obtaining ESA lived in Bristol (340), adhered to by Edinburgh (270), Glasgow (200), Bournemouth (150) and also Aberdeen (140). A Philippine foreign division statement claimed that Manila was concentrated on the obliteration of medicines in society. Many researches have recommended that raising consumption of plant foods like ginger decreases the risk of obesity, diabetic issues, heart disease and overall death while advertising a healthy and balanced complexion and hair, raised power and also in general reduced weight. A well-coordinated strategy to chemical abuse therapy for older ladies ought to consist of an interdisciplinary therapy team with family members or significant others involved in a plan of customized support solutions. Road medicines are rampant in DC, with heroin as well as cocaine/crack each independently making up 32 percent of all treatment admissions in 2011. Taking http://blog-justdreams.info of the medicine is necessary to reduce reappearance of the eye cold. The International Power Company now projects that installed global nuclear capability in 2025 will certainly fall 5 percent, to 24 percent below what will be had to stay on the risk-free side of climate modification And carbon capture technologies, which will be necessary if the world is to maintain consuming any kind of kind of nonrenewable fuel source, stay hindered by high costs, meager investment and also little political dedication. As insurance provider, Medicaid and also Medicare programs make it easy for doctors to write prescriptions as well as get paid, it appears like the whole system of medicine has come to be simply a medication pressing conveyor belt. However it got them believing, and also they triggered trying to find similar compounds with bigger rings; plus they had an inkling bigger rings would certainly make the drug extra reliable at blocking DNA transcription. Robert Atkins, M.D. has been well-known around the world as an authority on diet regimen and nourishment, as well as is the creator and supervisor of the Atkins Facility for Corresponding Medication. http://blog-justdreams.info/eroforce-gia-danh-gia-nhung-tac-dong-la-gi/ is done standing up with the medicine ball held in between your hands with your arms right before your upper legs. Dr Chand last evening cautioned that providing the medications to low-risk clients was a commercialisation tool" and not in their rate of interests. Also the paving of new roads and railways comes to be incredibly cheap when energy costs absolutely nothing. While the idea of nuclear power conjures images of three-eyed fish, it's difficult to refute that the modern technology creates tidy, sustainable energy in tremendous amount. Energizers are medications could boost heart price and open up breathing, triggering users to feel even more energised and also alert. You will certainly initially be analyzed if you are seen at your regional medicine treatment solution.

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America Is Neglecting Its Addiction Problem | Policy Dose …

A Blind Eye to Addiction

Drug and alcohol addicts in the U.S. aren't getting the comprehensive treatment they need.

By Lloyd Sederer, Opinion Contributor

June 1, 2015, at 2:45 p.m.

Stop neglecting addicts.JULIE MCINNES/MOMENT/GETTY IMAGES

ADDICTION IS AMERICA'S most neglected disease. According to a Columbia University study, “40 million Americans age 12 and over meet the clinical criteria for addiction involving nicotine, alcohol or other drugs.” That's more Americans than those with heart disease, diabetes or cancer. An estimated additional 80 million people in this country are “risky substance users,” meaning that while not addicted, they “use tobacco, alcohol and other drugs in ways that threaten public health and safety.” The costs to government coffers alone (not including family, out of pocket and private insurance costs) exceed $468 billion annually.

Over 38,000 peopled died of drug overdoses in the U.S. in 2010, greater than the deaths attributed to motor vehicle accidents, homicides and suicides. Overdose deaths from opioids (narcotic pills like Oxycontin, Percodan and Methadone as well as heroin) have become the fastest growing drug problem throughout the U.S., and not just in large urban settings.

[ READ: The Republicans' King v. Burwell Problem ]

NATIONAL INSTITUTES OF HEALTH/NATIONAL CENTER FOR HEALTH STATISTICS/CDC WONDER

Family dysfunction adds to the list of tragic consequences of our neglect. Addiction brings financial and legal problems (property and violent crimes) and increases domestic violence, child abuse, unplanned pregnancies and motor vehicle accidents. Addiction is also highly prevalent among jail and prison inmates, and in many instances, played a role in their incarceration.

Yet, and perhaps this is the most important – if not troubling – finding of all, only one in 10 people with addiction to alcohol and/or drugs report receiving any treatment at all. Compare this to the fact that about 70 percent of people with hypertension or diabetes do receive treatment. Can you imagine accepting that degree of neglect if that were the case for heart or lung disease, cancer, asthma, diabetes, tuberculosis, stroke and other diseases of the brain?

And when a person with an addiction seeks treatment, odds are they will be directed to Alcoholics Anonymous, Narcotics Anonymous or another 12-step recovery program. AA is a spiritual approach to recovery, developed in the U.S. by Dr. Bob Smith and Bill Wilson in 1935. A 2006 Cochrane Review, internationally recognized for evidence-based treatment reviews, reported that between 1966 and 2005, studies examining AA and 12-step programs concluded that “no experimental studies unequivocally demonstrated the effectiveness of AA” in treating alcoholism.

[ READ: Focus on Prevention to Cut U.S. Health Care Costs ]

The April 2015 issue of The Atlantic featured a story by Gabrielle Glaser titled “The Irrationality of Alcoholics Anonymous.” Glaser wrote that AA works for 5 to 8 percent of those who use it, citing an estimate by retired psychiatry professor Lance Dodes. Yet AA or 12-step programs remain the sole or core element in most private and recommended programs in this country. A forthcoming documentary, “The Business of Recovery,” exposes the private addiction treatment industry for it's predomination of the 12-step approach – with fees in the tens of thousands of dollars per month.

What is missing from the vast predominance of private or 12-step-based services is a comprehensive approach to managing addiction. Treatments have been developed for addiction that go well beyond AA. These include motivational techniques and cognitive-behavioral therapies. For those who want a non-medicinal and group approach, there is SMART Recovery, which, unlike AA, does not accept that individuals are powerless and seeks to help participants find their strengths and use them.

Perhaps the most neglected interventions for addiction are medication-assisted treatments. Medications are available that reduce cravings, deter use and help prevent relapse. These include naltrexone, acamprosate, Antabuse and methadone. And among the most promising and underused medication-assisted treatment is buprenorphine (Suboxone), a medication taken sublingually that can be one answer to our national epidemic of pain pill and heroin addiction. Buprenorphine, for example, is prescribed at a doctor's office for up to 30 days, and thus does not require attending a daily programwhere medication is dispensed, as it generally is in methadone programs. A bill was introduced in the Senate that would enable greater access to this medication.

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Psychiatric News reported on a recent speech by National Institute of Drug Addiction Director Dr. Nora Volkow, in which she explained that we once thought “addicts sought out drugs or alcohol because they were especially sensitive to the pleasure-inducing effects of dopamine.” In fact, the opposite prevails. Volkow said that “addicts are actually less sensitive to the effects of dopamine,” they reported. “They seek out drugs because of the very potency with which they can increase dopamine in the brain, often at the expense of other pleasurable natural stimulants that do not increase dopamine so dramatically.”

This neurological discovery helps explain alcoholic or drug cravings as well, Volkow said, as addicts are vulnerable to environmental triggers, like the sight of alcohol or a bar, contact with friends who share a drug life and exposure to substances in media – even including reports of addict deaths. Cravings and the heightened response to triggers are part of why addiction pirates an addict's behavior and renders them unlikely to pursue everyday life's pleasures and responsibilities. Treatments that target cravings and reduce the power of triggers are among our best hopes for recovery – and they now exist.

America has turned a blind eye to addiction. No wonder so many people walk into walls when paths of recovery are possible. Criminal justice approaches and interdiction are ineffective; they have become prohibitively expensive because they don't work and can make matters worse. It's time to give treatment a chance. But treatment must incorporate modern medical and psychological approaches, not only adhering to a tradition of spiritual recovery. Until we do that, more Americans will die, societal costs will continue to escalate, families will be bankrupted and cast asunder and communities will remain at risk for the crime that untreated addiction spawns.

Lloyd Sederer, Opinion Contributor

Lloyd Sederer is an adjunct professor at Columbia University's Mailman School of Public Health … READ MORE »

via America Is Neglecting Its Addiction Problem | Policy Dose …

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