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Friday, October 28, 2016

Parity Task Force Final Report

addiction parity
Mental health parity is one of the most important problems of our time. Millions of Americans battle with mental illnesses every year, from depression to substance use disorder. While there are effective, evidence based treatments available that have proven to improve the quality of people’s lives, the vast majority of people with such disorders never receive the treatment they need. Of course, there are a number of reasons that people with mental health disorders don’t get treatment, such as:
  • Stigma
  • Lack of Insurance
  • Insurance Plans Lacking Parity
Sadly, many people who have access to care, do not seek it because of the fear that accompanies being diagnosed with mental illness. Stigma has long gone hand and hand with mental health disorders. Only in the last decade, with the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA), people who were previously uninsurable can get insurance because you can no longer be denied due to a pre-existing condition. What’s more, insurance companies have been mandated to cover mental illness the same way they would, let's say, diabetes.

Since the passing of the two important acts of legislation, millions of previously uninsured Americans now have coverage. However, there are still concerns about parity being properly enforced, which is why the President created the Mental Health and Substance Use Disorder Parity Task Force in March 2016. Federal Departments and Agencies were ordered to work together to ensure that Americans benefit from the mental health and substance use disorder parity protections. The Presidential memorandum stated:

“My Administration has made behavioral health a priority and taken a number of steps to improve the prevention, early intervention, and treatment of mental health and substance use disorders. These actions are especially important in light of the prescription drug abuse and heroin epidemic as well as the suicide and substance use-related fatalities that have reversed increases in longevity in certain populations.” 

The task force released its final report, after receiving feedback from more than 1,100 individuals with mental health and substance use disorders, families, their providers, advocates, and other stakeholders. The White House points out that:

“Parity aims to eliminate restrictions on mental health and substance use coverage – like annual visit limits, higher copayments, or different rules on how care is managed…”

Tuesday, October 25, 2016

OxyContin and The American Opioid Epidemic

Providing adequate pain management was one of the factors that led first to the prescription opioid epidemic and second to the heroin scourge. In the early 1990’s there was much concern raised about the significant number of patients who were in severe pain and were being overlooked by physicians. That being said, it used to be much harder for patients to acquire prescription opioids.

Clearly, some changes were made and it just so happened to coincide with the release of Purdue’s miracle opioid painkiller, OxyContin (oxycodone). The company went through a lot of trouble to convince America that their drug was both effective, safe and less addictive than other opioids. Along with some bad, or otherwise misread research, doctors began to change their position on prescription opioids.

On Sunday, the Emmy-winning comedian and political commentator of HBO’s Last Week Tonight, John Oliver to a close look at the practices of pharmaceutical companies in the 1990’s. During the course of his and his colleagues' investigation he found that Purdue created promotional videos, like “I Got My Life Back” (1998) featuring testimonials of people whose lives changed dramatically for the better after being prescribed OxyContin. Purdue paid doctors, such as Alan Spanos, to say that people who were treated for pain with OxyContin that exhibited signs of addiction, were actually experiencing what he referred to as “pseudo addiction.” Which is not the same as Addiction.

Doctors around the country must have found such promotions convincing, and over the course of a short period of time, OxyContin became the go-to drug among American doctors. And here we are today, facing the worst drug epidemic in history. Every doctor agrees that all opioid drugs carry the potential for addiction, yet it is next to impossible to stop prescribing them, because there is a real need. As is evident by the fact that doctors still prescribe to patients, even after an overdose.

The investigation revealed that many of the stars of “I Got My Life Back” actually became addicted, some losing everything and some losing their life. While John Oliver may be a comedian, he seems to understand that what is needed to rectify this problem is taking care of the over 2.5 million Americans who are suffering from opioid use disorder.  We need “more investments in treatment programs…”

You might like to watch John Oliver's video on the subject, please be forewarned there is some profanity:

If you are having trouble watching the video, please click here.

Friday, October 21, 2016

Mixing Heroin With Carfentanil

There are a number of drugs that can be acquired with relative ease, which were never intended for human consumption. Not only are people doing such drugs, they are dying from them. The drugs we are referring to are in the fentanyl family, a group of synthetic opioids that are so powerful that just coming in contact with them can result in loss of life.

Perhaps you have been tuning into the latest news regarding the American opioid epidemic, then you are probably aware of the fact that it is becoming more and more common to see heroin laced with fentanyl. Mexican cartels are acquiring the chemical ingredients to make fentanyl from China, producing fentanyl and mixing the product into batches of heroin. Not only is fentanyl considered to be 50 times more potent than pharmaceutical grade heroin (diacetylmorphine), it causes much more severe respiratory depression that makes deadly heroin—even more deadly.

If fentanyl weren't bad enough, wait until you meet the drug's cousin—carfentanil. In 2016 there have been a number of reports of a drug, normally used to sedate elephants and other large zoo animals, that has led to several overdose deaths. The U.S. Drug Enforcement Administration issued a statement last month:

“Carfentanil is surfacing in more and more communities. We see it on the streets, often disguised as heroin. It is crazy dangerous.” 

A few days ago, the alternative news outlet VICE News did a short exposé about carfentanil, pointing out that heroin dealers are mixing the drug into their product to increase potency and profit. Fentanyl is 100 time more potent than morphine and it is leading to scores of overdose deaths, carfentanil is 100 times stronger than fentanyl.

“Two milligrams of carfentanil would be enough to kill 100 people,” said Jill M. Head, supervisory chemist at the DEA Special Testing and Research Lab in Sterling, Virginia. 

Please watch the short segment on the subject, starting at 12 minutes and 15 seconds in:

If you are having trouble watching the video, please click here.

Heroin on its own is highly addictive and can easily cause a deadly overdose. Heroin addicts are fully aware of the risk they take. With the introduction of synthetic opioids like fentanyl and now, carfentanil, people with opioid use disorder have no way of knowing which “hit” might be their last. If you are struggling with heroin, or any other form of opioid narcotic, please contact Hope by The Sea.

Tuesday, October 18, 2016

Engineering Models Explain Drinking Patterns

drinking patterns
Within the sea of students that engage in regular alcohol consumption, it can be difficult to spot which college kids are drinking problematically. It is often said that drinking alcohol goes hand in hand with college. Between Thursday and Sunday, college students congregate to consume alcohol. While the majority of young adults attending college do not have drinking problems, there are some students whose drinking behavior has gotten out of control.

To be sure, a person who works in the field of addiction medicine could attend a college party and be able to spot the young adults who may have a problem with alcohol. However, that is not a luxury that college faculties have at their disposal. Which is why researchers continue to look for ways to best influence the decision making of young adults when it comes to drinking.

Humans are not machines that can easily be understood. We are complex beings, all of us with different backgrounds, upbringings and genetic coding. While we do not have an instruction manual for the human brain, we might be able to learn something about drinking behavior through the lens of engineering.

At Ohio State University, a team of social workers and engineers utilized mathematical models to assist in shining a light on the factors that drive alcohol consumption, Newswise reports. The research team’s findings allowed them to compare the decision making process of young people’s drinking behavior to that of a cruise control system that you find in your car. Your car will know when to speed up or slowdown in order to maintain the desired speed (equilibrium), just like a person will drink more or less to maintain a desired feeling. The findings were published in the journal IEEE Transactions on Cybernetics.

"The way the students made decisions about drinking actually resembled the single most common feedback controller that's used in engineering," said Ohio State engineer, Kevin Passino. "It's called a proportional-derivative controller, and it measures how far a system has moved from a particular set point and adjusts accordingly. It's the same as cruise control on a car." 

The use of engineering models, and the information they produce, can help experts determine when to intervene regarding drinking patterns. Such models could reveal hidden relationships about high-risk drinking among college students.

"We're looking for the best points to intervene strategically, so that we can aid a person in their decision-making and potentially derail problematic behaviors," said John Clapp, a professor of social work and director of the Higher Education Center for Alcohol and Drug Abuse Prevention and Recovery at Ohio State.

Friday, October 14, 2016

Parental Absence Can Lead to Drug and Alcohol Use

Early onset drug and alcohol use is never a good thing, as it can lead to a number of complications—especially later on in life. Naturally, there are a number of factors to consider when determining what leads to adolescent substance use. Age, sex and environment are on the list, as well as family history of substance abuse and mental illness.

Every parent hopes that if their child does happen to experiment with drugs and alcohol, that it merely be a passing phase—a part of growing up. Parents are instructed to talk with their kids about the dangers of mind altering substances, and while their words may be heeded from time to time, it is sometimes the case that adolescents will experiment with drugs and alcohol regardless.

Parental units are role models for children, if a parent exhibits unhealthy behaviors there is a good chance that their child will adopt them as well. Young people are extremely impressionable; it is vital that parents set an example that will not detract from the course of their children’s life. But what if there isn’t any example at all?

New research has sought to determine the link between risky behavior with children who have experienced parental absence, MNT reports. Children who grow up in broken families have long been considered to be at greater risk of using alcohol and/or cigarettes in their teenage years, but the new research found that substance initiation may begin sooner. The findings were published in Archives of Disease in Childhood.

The authors say:

"Associations between parental absence and early smoking and alcohol consumption may operate through a range of mechanisms, such as reduced parental supervision, self-medication, and adoption of less healthy coping mechanisms. For instance, nicotine, in particular, demonstrates psychoactive properties and may have benefits for mood regulation." 

Using data from the UK Millennium Cohort Study, researchers looked at several health factors for about 19,000 children born from 2000-2002, according to the article. The analysis showed that of those children who has experienced a loss of parent, a number of these children began using alcohol by the age of 11, of which they were mostly boys. Children, who lost a parent before the age of 7, were more likely to start smoking and drinking by the time they turned 11. Understanding this trend could lead to early interventions that prevent adolescents from developing a substance use disorder later in life.

Wednesday, October 12, 2016

Losing Control Over Cocaine Use

cocaine use
At Hope by The Sea, we feel that it is important to remember that while opioid abuse is the most serious addiction problem the United States has ever faced, there are other drugs that people abuse that can have a pernicious effect on one’s life. Today, most of the talk is about opioid use disorder, but in the 1980’s and ‘90’s cocaine was enemy number one. It was a time when cocaine was cascading into America by Colombian cartels. On top of cocaine addiction rates skyrocketing, many of the draconian drug sentencing laws that we are still dealing with amending today are the direct result of the government's response to the cocaine epidemic.

Every day in the United States, people abuse cocaine, but it fails to generate much press because cocaine overdose deaths are somewhat rare. Nevertheless, cocaine addiction can tear one’s life to pieces and often requires long-term substance use disorder treatment to find recovery.

Even if you have never struggled with addiction, there is a good chance that you have attended a party where cocaine was being consumed. Perhaps you even experimented with the drug yourself. And when the party ended, you continued living your life, going about your normal routine. However, for some people, occasional cocaine use will morph into a cocaine use disorder in a relatively short period of time. At which time, the gears of addiction take over and without some form of intervention, cocaine abuse can continue for extended periods of time.

So, why does cocaine use sometimes lead to cocaine addiction? Naturally, there are a number of variables and factors to consider when attempting to answer that question. The National Institute on Drug Abuse (NIDA), sought to shine some light on the aforementioned question by creating a short animation video.

The researchers point out that it comes down to two types of neurons and the balance between the two; the “urge” neurons, which promote feelings of reward and repeating behaviors that have produced rewards, and “control” neurons, which dampen those feelings and inhibit behavior. Having a clear picture of how cocaine use disorder develops could help lead to more effective treatments in the future.

Please take a moment to watch the animation, below:

If you are having trouble watching the video, please click here.

Friday, October 7, 2016

Addiction and Mental Illness Genetic Link

co-occurring disorder
Not only is addiction a form of mental illness that can be found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), more times than not it is also accompanied by other forms of mental illness. Which is what is known in the field of addiction medicine as having a co-occurring disorder. It is well known that having a co-occurring disorder can complicate the treatment of addiction, because it requires that both the other form of mental illness and addiction be treated at the same time. Failure to do so can result in an unsuccessful recovery.

While co-occurring disorders are extremely prevalent among addicts and alcoholics, there is not a whole lot of research that shines a light on why that is the case. To be sure, a large percentage of people with untreated mental illness will resort to using drugs and alcohol to self-medicate their disorder. It is a behavior that can quickly spiral out of control, and in turn lead to addiction. Yet, it is possible the common trend of co-occurring disorders among people with substance use disorder, could be the result of things happening at the molecular level, i.e. DNA.

A new study, published in the journal Frontiers in Genetics, showed that a person’s genetic risk for mental illness could be tied to a person’s risk of abusing drugs or alcohol, ScienceDaily reports. The research is novel because it is the first time researchers have compared genetic risk for mental illness with substance use involvement with a group of people with no family relation. Study lead author Caitlin E. Carey, a PhD student in the BRAINLab at Washington University in St. Louis, says:

"Previous research on the genetic overlap of mental illness and drug use has been limited to family studies. This has made it difficult to examine some of the less common disorders. For example, it's hard to find families where some members have schizophrenia and others abuse cocaine. With this method we were able to compare people with various levels of substance involvement to determine whether they were also at relatively higher genetic risk for psychiatric disorders." 

The breakthrough study could eventually have major implications in the field of addiction medicine. It can lead to new research that looks into the “predictive power of genetic risk.” In the future, researchers may be able to tie specific drug use risk with specific mental health disorders.

“Our research shows that if someone is genetically predisposed towards having mental illness, they are also prone to use licit and illicit substances and develop problematic usage patterns," says Carey. "This is important because if a mental illness, like depression, runs in your family, you are presumed at risk of that disorder. But we find that having a genetic predisposition to mental illness also places that person at risk for substance use and addiction." 

The new research was published at a fortuitous time, considering that it is currently Mental Health Awareness Week, which is especially important to us at Hope by The Sea. We hope that everyone in the field of addiction medicine and beyond will join the with the National Alliance on Mental Illness (NAMI), and pledge to be #StigmaFree. Let’s work together to replace stigma with hope for everyone out there suffering from any mental illness.

Tuesday, October 4, 2016

Fentanyl Overdose Deaths Could Carry Death Penalty

We have come a long way since the 1980-90’s with regard to doing away with some of America’s draconian drug laws, mandatory minimum sentences that only served to overpopulate jails and prisons with nonviolent drug offenders. Such laws primarily affected people of color and socioeconomic disadvantage, and while every now and then someone is arrested and imprisoned whose sentence matches the severity of the crime, more times than not that is not the case.

The current White House administration has worked hard to push for treatment over jail and to give people already serving lengthy prison sentences for nonviolent drug offenses a second chance by way of a pardon. We find ourselves in the midst of an unprecedented drug epidemic, and it is vital that we do not repeat the mistakes of our past with draconian laws that most experts agree do little, if any, good at all.

A number of lawmakers, who were historically in favor of harsh drug sentencing laws, have changed their stance over the last few years. It is a sign that the times are changing, that the American zeitgeist is recognizing the value of treatment over jail. It is widely accepted that if strides are to made regarding the opioid epidemic, then unorthodox measures need to be taken. Those working in the field of addiction medicine are hopeful that the trend will continue.

However, there are signs that some lawmakers are looking to enact new, harsh drug sentencing laws in light of the uptick of fentanyl being used in America. Fentanyl is a powerful opioid analgesic that is typically used for surgery or end of life care, found to be 50 times stronger than heroin and 100 times more potent than morphine. What’s more, the drug can be synthesized with relative ease in clandestine laboratories. It is becoming more and more common for heroin distributors to lace heroin with fentanyl in order to increase the potency of weak batches, or to make fentanyl pills that are labeled with OxyContin symbols. Opioid addicts are often unaware of the presence of fentanyl, which can easily lead to an overdose.

In an attempt to deter the sale of the deadly admixture, some lawmakers would like to attach capital punishment sentencing laws when someone sells fentanyl that leads to a fatal overdose, The Huffington Post reports. U.S. Representative Tom Reed (R-N.Y.) introduced the Help Ensure Lives Are Protected Act last week, a bill that is co-sponsored by Ted Yoho of Florida, Doug LaMalfa of California, Bill Flores of Texas and Steve Chabot of Ohio. The legislation, if passed, would make heroin dealers subject to the death penalty or life in prison for selling drugs containing fentanyl that lead to an overdose death.

As you can probably guess, and for good reason, that there are a number of people who feel that the Help Ensure Lives are Protected Act is just another tough on drug crime policy that will be both ineffective and counterproductive—reminiscent of the “war on drugs” laws. Hopefully, the bill will not make it out of the House of Representatives, as it is likely to affect people who do not sell heroin or fentanyl in the long run.

“This bill is a doubling down on the very ineffective, harsh and punitive policies that characterized the early war on drugs and which have widely been proven ineffective at reducing drug use,” said Lindsay LaSalle, senior staff attorney for Drug Policy Alliance.

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