RU Texas The Beat

Aetna Loosens Restrictions on Addiction Treatment Coverage

[fa icon="calendar'] Feb 28, 2017 10:23:15 AM / by RU Texas posted in Recovery, Opioid Addiction, Addiction Treatment, Insurance, Aetna, Healthcare

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And now a bit of good news for addicts and their families who are concerned about treatment access in this uncertain healthcare climate. Leading health insurance provider Aetna recently announced plans to remove what has been critical roadblock for those seeking coverage for medication-assisted treatment for opioid addiction. The change will be implemented starting in March and will apply to all Aetna’s private insurance plans. Aetna, who is one of the world’s largest health insurance companies, is the latest provider to announce such plants over the past few months. Anthem and Cigna also announced looser restrictions on MAT with more and more Americans succumbing to overdose.

Specifically, Aetna will remove the requirement that doctors seek approval before prescribing medications, such as the buprenorphine-based Suboxone, to eligible candidates. Opponents of this requirement, called “prior authorization”, argue that it creates unnecessary delays in access to a potentially life-saving recovery resource. Mounting pressure, including findings from an investigation from New York’s Attorney General regarding coverage rates for addicts, compelled Cigna and Anthem to take this significant step. Aetna is the latest company to follow suit. With Medicaid expansions that make addiction and mental treatment more accessible facing uncertain futures in all states, it’s unclear what lasting impact this move will have or how many other insurance providers will follow.

In 2015, the United States saw record opioid overdose rates, eclipsing the all-time high of the prior year. Doctors at the ground level of this issue have expressed considerable frustration with the barriers that patients face when they’re ready to enter treatment. Addiction is a time-sensitive issue, and it’s rare that patients take the initiative to seek treatment on their own; when they do, it’s important that they have a clear and expedited path to treatment. Doctors have relayed powerful anecdotal evidence that if a patient is forced to wait for treatment, even for a few hours, there’s a chance they’re not coming back. Being forced to wait can permanently discourage them from seeking help.

Medications like Suboxone and Vivitrol have become a game-changing resource for eligible patients struggling with opioid and alcohol addiction. Looser restrictions on their dispensation from insurance providers represent one step forward in striking a balance between responsible prescription practices and proactive solutions for long-term treatment. With the epidemic of prescription opioid and heroin addiction claiming more and more Americans each year, it’s critical that vulnerable patients have every resource possible when endeavoring to overcome their dependency.

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Dropkick Murphys’ New Album Tackles Addiction and Substance Abuse

[fa icon="calendar'] Jan 16, 2017 1:54:39 PM / by RU Texas posted in Overdose, Recovery, Opioid Addiction, Treatment, Dropkick Murphys

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It’s called 11 Short Stories of Pain and Glory and it’s the ninth album from Quincy, MA punk legends Dropkick Murphys. The record was made right here in Texas and was deeply inspired by the Massachusetts opioid epidemic that claimed an estimated 1,747 residents in 2015. Like many other areas of the country, the synthetic drug fentanyl has led to a significant increase or overdose deaths (nearly 13 percent) throughout the state. The band, who have a documented history of advocacy and community activism, has felt the effects of opioid addiction first-hand, with members losing loved ones to the disease.

The deeply poignant 11 Short Stories of Pain and Glory was released on January 6th and will be supported by a European tour followed by a trek across the US, which will start in Bethlehem, PA on February 11th and conclude in their hometown of Boston on March 19th. Along the way, the band will be making a stop at Revolution Live, just three miles from RU’s flagship location in Fort Lauderdale, FL.

One of the more personal cuts off the record is a cover of the classic Rogers and Hammerstein song “You’ll Never Walk Alone”, a song that heard spoke to singer Ken Casey after leaving one of many wakes he has attended since his friends and family started to falling to addiction. Casey’s commitment to drug prevention goes back years. In 2009, he and his DM cohorts established the Claddagh Fund to raise funds for and broaden impact on worthy, underfunded non-profits that support the most vulnerable individuals in our communities.

During 2015, a year that saw a collective redoubling of efforts from lawmakers, police officers, clinicians and prevention advocates alike, the United States saw record opioid overdoses. Since 2000, over 300,000 Americans have been taken by these drugs. Despite advocacy and prevention efforts from all over, there doesn’t seem to be an end in sight. 

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What Does 2017 Hold for Addiction Treatment?

[fa icon="calendar'] Jan 2, 2017 5:09:23 PM / by RU Texas posted in Recovery, Opioid Addiction, Treatment, Heroin Addiction, Fentanyl, New Year

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Fotolia_123519808_Subscription_Monthly_M.jpgAs we begin to settle into another year, it can be overwhelming to contemplate how quickly time passes, and to think about what we failed to accomplish the year prior. The passage of time can be even more overwhelming when we’re working against the ticking clock of addiction. Whether it is ourselves or a loved one that has come to need help for drugs or alcohol, we are quickly reminded of the urgent and decidedly terminal nature of addiction, and the damage it can cause when left unaddressed. To that end, it is worth turning the arrival of a new year to our advantage by examining what is (or should be) on the horizon for clinical treatment in 2017.

This past year, the United States made great strides and sweeping demonstrations of commitment toward the monetization of addiction treatment, from the passage of the Comprehensive Addiction and Recovery Act to various states like New York and Ohio pledging additional resources to fighting addiction within their state. We also, however, saw multiple and highly publicized examples of overdose via social media which put a more-human-than-ever face on the American addiction epidemic. Some of these issues resulted in the direct and undeniable endangerment of children. It is also worth noting that Massachusetts is facing a battle to continue opioid treatment funding.

The reality is that, despite all of the new attention and money going toward addiction in the United States, there continues to be new and emerging threats that make us feel as though we’re taking one step forward and two steps back. It is, therefore, worth examining what types of substance abuse pose a particularly dangerous threat in the coming year in order to develop comprehensive strategies to dealing with them. For example, 2016 saw the seemingly rapid proliferation of a drug called fentanyl, a powerful opioid that is approximately 100 times more powerful than morphine. Its increase in accessibility is leading to an increase in overdose deaths all over the country, including New York, New Jersey, Illinois and more. The fentanyl problem is particularly urgent because the drug has proven to be resistant to Narcan, unlike other opioids.

Also big in 2016 was the continued infiltration of synthetic drugs like U-47700 or Pink. This drug, in particular, has sustained a temporary ban from the US Drug Enforcement Agency because of its involvement with at least 46 confirmed deaths—31 in New York and 10 in North Carolina. Law enforcement agencies have seized the drug in powder form and as counterfeit tablets that mimic pharmaceutical opioids. Earlier this year, law enforcement in Ohio seized 500 pills resembling a manufacturer's oxycodone immediate-release tablets. However, laboratory analysis confirmed that they contained Pink. Pink is usually shipped in from China and is typically combined with other drugs like heroin and aforementioned fentanyl.

Synthetic drugs represent a larger problem of overseas labs changing the chemistry of similar drugs that have already been banned here in the United States in an effort escape legal accountability. Lawmakers have been only marginally effective in keeping up with the regulation and prohibition of these drugs; and by the time they are made illegal, a new and unregulated version is waiting just around the corner. In the meantime dozens of people often suffer fatal overdoses because these drugs were allowed to fly under the radar for so long. This is a problem that has been going on for years, but emerges in different forms on a regular basis. All it takes is a slight change in a seemingly inconsequential chemical compound.

In addition to these latent addiction threats, the United States continues to struggle with a rampant and devastating heroin and prescription painkiller epidemic, as well as the enduring threat of cocaine and methamphetamine. Drugs like oxycodone and hydrocodone, though more difficult and expensive to obtain, continue to be a forceful driver of American overdoses. While 2017 may represent new and old challenges for the addiction care community, it also represents new opportunities to treat those who truly need help, and to, patient by patient, start reversing this tragic and alarming trend. With the right resources, attitude and level of commitment, we can do this.

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How Vivitrol Helps Families after Treatment

[fa icon="calendar'] Nov 29, 2016 11:51:49 AM / by RU Texas posted in Vivitrol, Opioid Addiction, Addiction, Family, Prison

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Those of us who have helped our loved ones manage addiction know how difficult it can be. Even after the best treatment and the most positive and encouraging signs of progress, the path can still be difficult. For every single person that suffers from addiction, there is usually a group of people suffering right alongside them. Sometimes this suffering consists of active conflict, including shouting fights and even physical confrontation; other times it can be as passive as watching a loved one struggle through the pain and sickness withdrawal symptoms. Many prefer actually fighting with their loved ones to watching them go through withdrawal because at least they have sense of control over a confrontation.

To watch a loved one struggle through their residual withdrawal period, even when they’re remaining faithful to their post-treatment recovery program, can be truly painful. Add to this, the constantly looming danger of relapse and subsequent overdose, and it’s easy to see how families can disintegrate in the wake of drug addiction. Loved ones of addicts are getting help from a newer and increasingly effective resource: Vivitrol. Vivitrol is an established and reputable medication for combatting alcohol and opioid abuse. It reduces cravings and blocks the euphoria associated with opioid highs. It is administer via a monthly injection by a licensed and credentialed physician.

Families of addicts are experiencing the benefits of Vivitrol through a growing variety of institutional avenues. In Duval County, Florida, an area which lies just under five hours from the Recovery Unplugged flagship facility in Fort Lauderdale, the prison system is using the medication to help inmates with their cravings so they’re able to better transition into their everyday lives once they’re released. The county is one of dozens across the country that is utilizing Vivitrol injections to help rehabilitate inmates. Vivitrol maintenance is not meant to replace any element of rehab like group therapy or individual counseling; but rather it’s meant to help patients reduce ongoing cravings.

For families who have an addict either in treatment or in prison, the reduction of cravings and the stabilization of physical health can be a game-changer in the way they’re able to transition into their lives in recovery. This mitigates family dysfunction, helps recovering addicts to focus and allows them to feel better every day. For a disease that is so complex, so powerful and so destructive, every single resource helps.

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An Important Message from Recovery Unplugged Medical Director Dr. David Kramer

[fa icon="calendar'] Nov 15, 2016 8:24:58 PM / by RU Texas posted in Overdose, Recovery, Opioid Addiction, Naloxone

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I’ve treated thousands of patients over my 20-year career as a doctor on the front lines of substance abuse and psychiatric illness. Recently, however, I had a heartrending experience that I feel must be shared; one that brings home the true nature of compassionate and genuine treatment in this fearful and uncertain time when millions of Americans suffer from life-threatening opioid addiction and struggle to access treatment.

It is all too easy to become detached in my world as I encounter hundreds of people suffering from the scourge of opiate addiction. In fact, so many insurance companies see the growth of the industry of addiction treatment in South Florida as a manifestation of fraud and “unnecessary” care, and are working to limit or deny treatment. That boundary, for me, was broken some months ago when an earnest 26-year-old woman who had worked very hard to achieve several months of recovery at the treatment center for which I serve as Medical Director succumbed to despair and compulsion and perished in a lethal overdose of opiates. This happened just two weeks after staff tried so desperately to reach out and re-engage her.

We have served more than 300 clients since opening our doors and this woman was one of over a dozen to meet this tragic end. The staff and clinicians had witnessed this tragedy too many times and, within days, met to try to address it. We decided that regardless of costs and time (thus far approximately $8000 out of pocket) we had a responsibility and a mission to educate and provide every discharged client with a potentially life-saving double dose of nasally-inhaled naloxone medication to use in the event of an overdose. This is not a measure that’s required in any treatment plan or by any particular insurance provider, nor am I aware of other treatment programs that take it. Several dozen discharged clients have now left the program with the life-saving naloxone nasal inhaler ($136 for the two-dose inhaler) in their pockets.

I happened to be a medical director at another intensive outpatient program where one of our clients eventually transitioned. Literally a month after starting the naloxone inhaler program, I learned that our former patient had utilized his inhaler, and another client’s, to administer four doses of naloxone within two minutes of a very lucky young female patient becoming non-responsive due to respiratory arrest caused by opiate overdose at her halfway house. The education on how to administer naloxone, and having it available immediately, literally saved this young woman’s life according to the later-arriving emergency medical services.

This epidemic is real and it’s killing tens of thousands of young Americans every year. Treatment can be complex, difficult and lengthy. It also can be cost-effective, sensible and life-saving. These are very real people: daughters and sons, sisters and brothers, friends and neighbors. Compassion, will and common sense can save so many of them and guide them toward the help they need.

David R. Kramer, M.D.

Medical Director and Treating Psychiatrist – Recovery Unplugged Treatment Center

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US Prisons Using Vivitrol to Curb Post-Release Opioid Addiction among Inmates

[fa icon="calendar'] Nov 14, 2016 10:24:51 PM / by RU Texas posted in Recovery, Vivitrol, Opioid Addiction, Treatment, Alcoholism, Medication-Assisted Treatment

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Addiction and incarceration have been closely linked for decades. One of the primary critics of this country’s current drug laws is that they disproportionately punish non-violent offenders, needlessly crowding the prison system and tearing families apart. Looking at the current incarceration rates in US prisons, it’s hard to disagree with this assessment. It’s also true that prisons, themselves, can be incubators for addiction. Most recently there was a controversy regarding the smuggling and abuse of Suboxone in American prisons, proving once again that even anti-opioid drugs can be diverted and abused. A pilot program that provides Vivitrol injections to addicted inmates may offer medication-assisted treatment with diminished opportunity for diversion.

Vivitrol shots last for four week and are used to block the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse. Vivitrol is used as part of a treatment program for drug or alcohol dependence. There have been remarkably encouraging signs regarding the medication’s efficacy in relapse prevention, with some studies claiming that it cuts relapse by nearly half. Opponents of the pilot program have many concerns, including its price tag. Vivitrol shots are $1,000 per injection, however proponents say Vivitrol could save money compared with the cost of locking up a drug offender.

Vivitrol’s slow-acting formula and infrequent dosages make it a viable alternative to other, more easily abused drugs like buprenorphine and methadone. The drug won approval from the Food and Drug Administration (FDA) in 2006 for the treatment of alcoholism and in 2010 for relapse prevention in opioid addiction patients. Vivitrol is not meant to replace proven and established elements of treatment like detox or counseling; but rather occur as part of patients’ ongoing post-treatment recovery. Eligibility is determined by patients’ physicians and treatment professionals.

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Kratom Stays Off of Schedule 1 List Pending Further Inquiry

[fa icon="calendar'] Oct 19, 2016 1:40:53 PM / by RU Texas posted in Recovery, Opioid Addiction, Treatment, Kratom, DEA, Pain Management, Prescription Addiction

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Plans by the Drug Enforcement Administration (DEA) to classify kratom as a Schedule 1 drug have been temporarily halted amidst a lawsuit by a group of vendors. The resolution comes after impassioned advocates took to social media, and the scientific community voiced concerns over their ability to further research the plant. The DEA has reconsidered plan, which they made public on August 31, to place kratom into the super-restrictive category after it received more than 2,000 phone calls, most of which were opposed to it. The agency now plans to open up a public comment period where those who have used kratom for medical purposes can share their experiences and relay the plant’s clinical value.

A relative of the coffee plant, kratom has gained increased popularity among those suffering from chronic pain who are trying curtail their opioid or alcohol use. The substance works in a manner similar to opioids (binding to some of the same receptors), but is said to produce a more mild result with none of the side effects. Although the DEA attributes a dozen deaths to kratom over the last two years, those victims had other drugs in their systems at the time of their death. Advocates are describing kratom as a viable alternative to powerful prescription opioids like oxycodone and hydrocodone on which many pain patients have come to rely.

The decision to temporarily withdrawal the Schedule 1 designation may represent a more progressive attitude toward drug control and prevention. Once kratom winds up as Schedule 1 drug, access will significantly decrease, even for those who depend on it as part of their regular pain treatment. Many advocates fear that it will suffer a similar legacy to marijuana. In a time in which prescription drug overdose is ravaging the United States population, any and all alternative methods of chronic pain relief are worthy of exploration. That being said, time will tell as to whether or not this drug is as safe and benign as its advocates claim.

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Missed Opportunity: What Last Night’s Debate Says about the Current State of Addiction Awareness and Political Will

[fa icon="calendar'] Sep 27, 2016 12:27:00 PM / by RU Texas posted in Recovery, Opioid Addiction, Politics, Heroin Addiction, Debate

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Let’s start with some numbers:

If you’ve been paying attention during this year’s admittedly bizarre presidential election cycle, you will notice that each figure above corresponds to a state that has been tasked with hosting a presidential or vice presidential debate in 2016, the last painting an overall picture of the current state of heroin and opioid addiction in the United States. Despite the urgent and alarming heroin and opioid abuse climate in each state and the country as a whole, however, Americans are not likely to hear any conversation regarding this urgent and pervasive public health crisis.

The State of Things

Last night, the nation saw the 2016 presidential candidates assemble on Long Island, a region that has arguably become the northeast cradle of opioid abuse, for the first of three debates. What followed was nothing short of a spectacle that, at times, bordered on absurd, no matter where one falls on the political spectrum. While the event represented an opportunity to have a frank and substantive discussion on a leading preventable killer of Americans, both candidates remained silent on the issue. It was apparently more important to engage in the same divisive rhetoric that has been the hallmark of this election, going back 18 months.

Plenty of Blame to Go Around

As much as we’d like to place the blame solely on Trump and Clinton for their relative silence, we must recognize that the moderator, and the media in general, bare some culpability in the lack of conversation. When Prince died, American opioid addiction saw a brief uptick in media coverage; however when landmark legislation was passed as part of the Comprehensive Addiction and Recovery Act, coverage was scarce at best. The debate was broken into several 15-minute blocks; and it is altogether tragic to think that one of these blocks couldn’t be allocated toward the most significant and urgent public health crisis facing the country. Unfortunately, it doesn’t look as though we can expect anything to change going forward.

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RU Texas Medical Director Featured in TMA Article on Narcan

[fa icon="calendar'] Sep 8, 2016 3:17:53 PM / by RU Texas posted in Recovery, Opioid Addiction, Narcan

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Earlier this month, Recovery Unplugged Texas’ very own Dr. Carlos Tirado weighed on the availability and accessibility of naloxone (Narcan) in an article published by the Texas Medical Association. The piece described the urgent need for increased Narcan availability in the lone star state, and described a law enacted last year that allows ordinary citizens to administer the drug in a non-medical setting. It also outlined the toll that opioid addiction and overdose has taken on communities all over Texas and described the state’s opioid abuse status in relation to the rest of the country. Naloxone prices have been soaring since 2014.

Dr. Tirado, who currently serves as Medical Director for Recovery Unplugged Texas, discussed why he issued a standing pharmaceutical order for naloxone through the Texas Pharmacy Association (TPA), saying he felt it was important due to the historic nature of the opioid crisis consuming Texas and the rest of the United States. He has seen firsthand the increasingly devastating impact of opioid overdose on the Texas population and has called for more proactive solutions to the problem. To read Dr. Tirado’s exact quote, or the article in its entirety, click here.

In addition to Dr. Tirado’s point regarding the historic nature of Texas opioid addiction, the article highlights the dramatically increasing price of naloxone for communities that need it on a regular basis. One pharmaceutical manufacturer increased the wholesale price of its naloxone auto-injector to $4500 from under $700 in 2014. The price hikes have caught national attention; however, it has yet to be seen whether or not there will be any significant regulation or crackdown. Dr. Tirado noted that a doctor can prescribe three formulations of naloxone, and that coverage depends entirely on the patient’s prescription benefit plan and options.

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Kentucky Hospital Uses Music Therapy to Wean Babies Off of Opiate Addiction

[fa icon="calendar'] Aug 30, 2016 5:16:48 PM / by RU Texas posted in Recovery, Opioid Addiction, Music Therapy

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The power of music to heal addiction is being taken a step further at a hospital in Louisville, Kentucky. Physicians at Cosair Children’s Hospital are using music therapy to treat newborns suffering from neonatal abstinence syndrome (NAS). Kentucky’s explosion of opioid addiction has even managed to affect expectant mothers, causing babies to be born suffering from withdrawal symptoms before they take their first breaths. Some of the more common symptoms include elevated heart rate, gastrointestinal distress and tremors. More serious symptoms include seizures and respiratory problems. While these babies are not technically considered addicts, many are born with serious symptoms. The problem has become tragically common in a state that saw 1,087 overdose fatalities in 2014.

In addition to traditional methods like morphine therapy, staff at Cosair Children’s hospital have been integrating music therapy into NAS sufferers’ care plans. The hospital began using the therapy two years ago after seeing a significant increase in NAS patients. Since 2011, the number of NAS cases the hospital sees has risen from about 30 to between 70 and 100 per year. The therapy consists of gentle singing with rhythmic rocking and patting to match the baby's behavioral state. It is a series of complex rocking motions, the intensity of which increases with the baby’s state of activity. Practitioners also utilize a pressurized pacifier that plays music which is hooked up to machine that controls pressure and volume.

The goal of the therapy is to get the child to sooth itself. Practitioners believe that a more relaxed state improves eating and sleeping while reducing crying and physical discomfort. It is not clear how many other hospitals in Kentucky or the rest of the country are using music therapy for NAS; however, its success in treating patients at Cosair is just one more example of music’s power universal power to heal.

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