Author: Shernide Delva
Drug overdoses have skyrocketed across the United States, and as a result, the popularity and accessibility of naloxone have risen as well. Most pharmacies now carry naloxone and even schools are carrying it in the event of an overdose emergency. Nationwide, naloxone is available to emergency departments and paramedics who find they are using the overdose antidote more than ever before.
While the use of naloxone is saving countless lives, one of the major battles first responders are facing is that they often administer naloxone to the same people over and over again. The repeated overdoses have many pondering; Where do we go from here? What is the next step after naloxone?
After the Overdose Reversal
First responders have acknowledged the pattern of repeated overdoses throughout the country. While an overdose often is a turning point for many, for others it is not enough to stop the active addiction. Therefore, in many areas of the country, first responders and community members have launched programs to reach out to those who recently overdosed. These programs aim to offer resources on overdose prevention, mental health counseling and substance use disorder treatment.
In July 2015, the Township of Colerain, Ohio, started a post-naloxone outreach program led by their Director of Public Safety, Daniel Meloy. Ohio has some of the highest rates of drug overdoses in the country. Under the program, representatives from the Colerain Police Department, the Colerain Fire Department, and Addiction Services Council all meet to review overdose reports from the previous week. Then, the representatives, known collectively as the Rapid Response Team, go into their community to visit the homes where the overdoses occurred.
“We knock on doors and ask to speak with either the person who overdosed or any friends or family,” says Shana Merrick, a social worker with Addiction Services Council. “We explain that we are not there to make an arrest, but to offer resources to keep the person healthy, safe and well. Most people open their doors and we talk about their situation and needs.”
In cases where a person lacks medical insurance, these programs help them find insurance. For those who are not eligible for insurance or Medicaid or simply can’t afford insurance, there are dedicated funds to help pay for treatment costs.
“About 80% of the people we see eventually seek some form of treatment,” says Shana. “It’s not always right away, but if we build a relationship over time then they may contact us later on asking for help.”
One of the biggest challenges is treatment capacity. When all beds are full, Shana enrolls people in intensive outpatient programs until a slot opens up at a traditional inpatient program. Some will enroll in medication-assistant treatment programs. Another challenge is staying in touch with people who are transient and may have changed address or phone numbers.
Shana and The Rapid Response Team are fortunate to have a variety of resources available to them to help guide people. Other places are not so fortunate. The Santa Fe Prevention Alliance in New Mexico have similar post-overdose outreach program but have fewer resources to utilize.
“There aren’t a lot of substance use or mental health treatment services in our area where we can refer people,” says Bernie, who visits people who have recently overdosed each week, along with a paramedic from the Santa Fe Fire Department.
“We do offer to help people find treatment facilities if they want, but during most of our visits we work with families to come up with an overdose response plan, offer naloxone and training on how to use it, and brainstorm about how to reduce the risk of another overdose. People are excited and respond well to us. No one has ever refused to let us visit.”
Do These Programs Work?
The purpose of these programs is helping those who have recently overdosed from overdosing again. The vast majority of people are receptive to receiving help. In some cases, they may not want help right away but often reach out in the future.
There is a critical overdose epidemic nationwide, and communities are exploring ways to help past the initial overdose reversal. Post-naloxone programs do offer hope, however they are just one solution to a very complex issue. There is not a quick-fix one-step solution–—not naloxone, not post-overdose outreach programs, not more inpatient treatment, not injected medications that block cravings for opioids—is a magic cure.
A combination of efforts that explore a diverse range of treatment options is key. While saving lives using naloxone is extremely important, the post-naloxone addict needs just as much assistance. What are your thoughts? If you or someone you know is struggling with addiction, please call now. Do not wait.
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Author: Shernide Delva
New stricter legislation on opioid prescriptions aims to reduce the amount of prescription pills roaming the streets of New Hampshire. New Hampshire has one of the highest opioid death rates in the country. In an attempt to reduce the devastation, the legislation will require medical professionals to conduct a patient risk assessment before writing a new prescription. There are a variety of other changes implemented as part of the new legislation.
With the new legislation, patients must sign an informed consent form showing they understand the risk of addiction from the drugs they are receiving. The request is then checked against a database compiled by the prescription drug monitoring program.
In addition to the above precautions, the legislation requires pain patients to be prescribed the lowest effective dose of pain medications. It also forbids doctors in emergency rooms and urgent cares from writing a pain prescription for longer than seven days. Additionally, the law requires patients who are on opioid medication for more than 90+ days to undergo random urine analysis designed to ensure they are still benefiting from the drug.
Overall, the new legislation in New Hampshire will:
- Require patient risk screening before writing a new prescription
- Ensure all patients prescribed pain medication understand the risk of addiction
- Limit the dosage of pain prescription to the lowest effective dose
- Forbid doctors in ER and Urgent care from prescribing a prescription longer than seven days
- Requires patients on pain prescriptions 90+ days to take a urine analysis designed to ensure they are still benefiting from the drug
Will This Work?
The objective of the new legislation is simple: prevent misuse of prescription drugs.
“By putting fewer pills out on the street there’s less chance for diversion and misuse,” Dr. William Goodman, chief medical officer at Catholic Medical Center in Manchester, told WMUR.
The prevalence of prescription opioids has been a major issue in New Hampshire, as it has the rest of the country.
“We know that—[with] this crisis we’re in now with the opioid epidemic with people suffering addiction and overdoses and so on—we know that looking back, the number of prescriptions has quadrupled since about the year 2000,” Goodman said.
The New Hampshire program is similar to programs implemented in other states including New York, New Jersey and much more. While New Hampshire had a prescription drug monitoring program since 2012, the new regulations are aimed to have a bigger effect.
“What’s being done here has been shown to be effective elsewhere. And we hopefully will have the same success in seeing fewer pills on the street and fewer people suffering from the side effects of opioids,” Goodman said.
Along with the new legislation, Goodman encourages doctors to find alternatives to opioid pills for treating pain and other chronic conditions.
“Some of the safer and very effective alternatives are often difficult to afford, either because they’re too expensive or health insurance companies don’t support their use.”
There are a variety of treatment options deemed as alternatives to prescription opioids; however, they often are not utilized. Some of these alternative routes include medical marijuana, nerve blockers, or herbal remedies like capsaicin. There are a variety of reasons why alternatives are not common including, costs, the uncertainty of efficacy, and the lack of incentives compared to prescribing opioids.
The country is in the midst of an opioid epidemic. Any step to reduce the impact of this epidemic is a step in the right direction. Do you think the new legislation will help in reducing the amount of dependence seen in this country to opioids? If not, what other methods should be sought out? If you or someone you know is struggling with addiction, please call now.
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(This content is being used for illustrative purposes only; any person depicted in the content is a model)
Author: Shernide Delva
The narrative of the orphan child has never been a positive one. We’ve all seen movies about it. Abandoned children struggle with mental illness, emotional distress and sadly, many fall into addiction. The nation’s drug-addiction epidemic is excelling the number of children enter foster care. Many states must take urgent steps to care for neglected children. Unfortunately, there are too many and the numbers only continue to rise.
The problem is addicts often neglect, abandon or mistreat their children. Several states such as New Hampshire and Vermont made laws to make it possible to pull children out of homes with addicted parents, or states increased budgets to hire more social workers to deal with the emerging crisis.
Other states like Alaska, Kansas and Ohio have issued emergency pleas for more people to foster neglected children, many of them infants, into their homes.
“We’re definitely in a crisis, and we don’t see an end in sight any time soon,” said Angela Sausser, executive director of the Public Children Services Association of Ohio, a coalition of public child safety agencies in the state.
Life as a Child in Foster Care
Sadly, these children grow up and have a high risk of having a drug addiction. According to a 2016 study funded by the National Institute of Mental Health (NIMH), 35% of older youth in foster care have a substance use disorder.
While there is no universally accepted cause of drug addiction, one theory commonly accepted is a relief from physical, mental, and emotional pain. There are emotions foster youth feel on a regular basis. Foster youth are ripped from their families and put into state care due to neglect or abuse. Those two words—neglect, abuse—result in an array of emotional and physical realities. These realities must be addressed.
Lisa Marie Basile was a foster youth from age 14 to 19. She is a successful edited and writer in New York who wrote the poetry book Apocryphal. She discussed her thoughts in an interview in The Fix:
“The narrative of the foster youth has been hijacked by this idea that foster youth are just losers. Like it’s inherent, expected. The thing is, something has been done to them. I wish more people understood the loneliness,” she explained.
The Numbers Are Now Increasing
For a while, the number of children in foster care was decreasing. The enormous increase in parental drug abuse is driving the number of foster care youth up at an incredible pace. As of 2014, the number was at 3.5%. In San Diego, more and more babies are in need of foster care placement, and many infants are born addicted to drug. Not only are these babies born experiencing withdrawals, they also have a long-term risk for medical, developmental, emotional and behavioral hardship. Furthermore, they are an extremely high risk for addiction.
There are programs out there to help these children, but they have to reach out for it. The first step is admitting the addiction. This is the exact reason why many addicts are stuck. Lisa Basile says she made her way through foster care without using, however once she reached college, she began to overindulge in drinking.
“I drank a lot more than most college students. And that behavior—day drunk, wine for lunch—stayed with me for a while after college. It became less about partying and way more about numbing everything out so I could get through college without facing my tragedies.”
The Emotional Aftermath
The issue lies in the emotional toll the foster care process can have on these children. The National Institute of Mental Health states that that foster youth have a high risk conduct disorder and post-traumatic stress disorder (PTSD). Youth with PTSD or conduct disorder are found to have the “the “highest risk for substance use and disorder.”
What is PTSD? PTSD is defined by the National Alliance on Mental Illness (NAMI) as “requir[ing] that children have experienced, witnessed, or learned of a traumatic event, defined as one that is terrifying, shocking, and potentially threatening to life, safety, or physical integrity of self or others.”
It is clear by this definition why foster children are likely PTSD sufferers and why they are more at risk for addiction rather than just drug experimentation. Foster children are often born in situations where their basis needs are ignored and where their emotional wounds remained unhealed.
There is Hope
With the right resources, children in these situations can be granted the opportunity to change their future. Everyone involved plays a role. From teachers, therapists, volunteers and neighbor, the right person providing the right connection can turn things around.
Foster children and addiction may go hand in hand, but that does not mean anyone’s situation is hopeless. There is not an excuse for changing your future. If you were brought up in an unfortunate situation, there is still time to shift the direction of your life. If you or anyone you know is struggling with substance abuse or addiction, please call now.
CALL NOW 1-800-951-6135
Author: Shernide Delva
The opioid crisis is pinpointed to a variety of sources, yet those blamed the most are doctors. Doctors are criticized for their generous prescribing of prescription painkillers that led to patients developing an addiction to the drug. Drugs like oxycodone were for a long time easily prescribed until recently. Once the prescription drugs became more difficult to obtain, addicts turns to heroin thus resulting in the shocking epidemic we are in today.
However, there is more to the story. Turns out, patient satisfaction surveys may be another major part of the puzzle. These surveys continue to influence doctors today. To understand the problem, you have to understand the influence these surveys have. Doctors incomes are based on survey scores, and patients who are not given a desired prescription leave doctors a low score on their satisfaction surveys.
The Opioid Crisis: Behind the Scenes
An article published in The Fix explained the behind the scenes in hospital emergency rooms. ER doctor of osteopathic medicine Gerald O’Malley opened up about what he considers to be the biggest culprit in the opioid crisis. With over 25 year of experience, he understands the depth of the epidemic from a medical point of view.
The culprit is the hospital satisfaction surveys mandated by the Centers for Medicare and Medicaid Services (CMS). CMS is a government organization that dictates payment for medical surveys and sets the agenda for the entire insurance industry.
The problem with these surveys is that they contradict the doctor-patient relationship dynamic. Instead of the relationship being about trust and integrity, it becomes about the doctor pleasing the patient for improved survey scores. The physician no longer is an adviser, but a corporate spokesperson. Hospital administrations hand out scripts to memorize and recite.
“We were told to say, ‘Hi, my name is So and So, and I’ll be your doctor today,’ and ‘Please let me know if there’s anything we can do to make your experience here more pleasant.’ It was incredibly insulting to me, and what you’d expect from a waiter or electronics salesman,” said O’Malley. “I like to treat people as individuals, not somebody who came to the ER to spend money.”
At Albert Einstein Medical Center in Philadelphia, O’Malley described a common scenario where staff were routinely lectured by the department chairperson. They were told their survey scores would be judged and to be aware of the consequences of low performance.
“Then, just to be dramatic, I guess, the chair quoted a line from The Godfather,” said O’Malley. “He said, ‘This is the business we’ve chosen.’ Which meant, if you don’t like it, get out.”
What the Surveys Require:
The expectations to earn a high score on these surveys have little to do with a doctor’s ability to take care of a patient.
“It had nothing to do with medical care,” said O’Malley.
Instead, the surveys instill behaviors such as having staff knock on doors and introduce themselves. Doctors also must accommodate the requests of their patients.
“We had to allow as many people into the room if they requested it. One time there were five family members; two in wheelchairs. There was literally no way for me to get to the bed. I had to play traffic cop and say, ‘I’m sorry, I understand you all want to be here but I need to perform an exam so some of you have to leave.’
Seems like an appropriate request from a doctor attempting to do their job, however administration does not see it that way.
“That kind of honest, blunt conversation was frowned upon by the administration. They don’t practice medicine so they don’t understand that it’s fucking impossible to try to talk to someone about anything sensitive. They may not want their family members to know what drugs they’ve taken. But asking everybody to leave is uncomfortable.”
In addition, these surveys request that medical personnel sit during consultations. Studies show that sitting down makes customers feel like their physician is with them longer. That sounds manipulative because it is, but O’Malley says the point is to give customers the perception of good care. Moods matter too. Medical personnel are to maintain their energetic demeanor despite physical exhaustion from working long hours.
Drug Abusers: Doctors Struggle to Do the Right Thing
When it comes to patients seeking narcotics, their opinion of their doctor will largely relate to whether they leave with a prescription. Unfortunately, doing the right thing in this situation can negatively affect a doctor’s survey results and stir up conflict.
“They’d walk in and say, ‘I need two milligrams of Dilaudid 4 with 25 milligrams of Phenergan,’ and, ‘Come on, chop, chop, let’s go. Snap to it.’ Or they’d say, ‘I’m going home now, so I need a prescription for 50 tablets of oxycodone.’ After looking up their records in the computer, I’d have to say, ‘Hang on, you just got a prescription for 50 tablets of oxycodone last week.’
“Then suddenly, you’re in a confrontation. The patient is yelling ‘I want to speak to your boss!’ If it’s 2:30 in the morning, I was the most senior person there. In those circumstances I knew this was somebody abusing oxycodone or selling it in a school playground somewhere. So then it’s ‘What do I do now?’ Did I really want to deal with this for the next two weeks, having to explain why this guy got so pissed off and gave me bad survey numbers?”
In situations like these, doing the right things becomes a difficult decision. It is easy to see why doctors sometimes choose the easier route of prescribing the requested meds. Emergency room visits are skyrocketing because of lack of healthcare. Many addicts go to ERS because they are open 24 hours.
“I had a guy show up at three in the morning with a herpes outbreak. He said, ‘I need Acyclovir and Zovirax cream.’ Okay, that made sense. But then he said, ‘I need something for the pain—Percocet or Vicodin or Dilaudid.’ I go, ‘Dude, you’ve got herpes. It’s not like a broken leg.’”
Making Difficult Decisions
When the patient is denied their prescription, they may soar into a roaring fit, demanding to speak to higher authority and provoking further conflict. Sadly, it is easier for some doctors to decide to not do what is right, but what is easier. After all, their survey scores are sent to the CMS who use those scores to distribute reimbursements.
“Look,” said O’Malley, “we have certain metrics we have to meet. If CMS doesn’t like our scores, then, guess what? They’re not going to reimburse us. We’re going to be out money.”
Even when doctors tighten up on prescribing painkillers, it leaves behind those who need them most: chronic pain sufferers. Dr. O’Malley admits when a chronic pain sufferer comes into the ER late at night requesting a prescription for an opioid, it puts him in a difficult position.
“I’ve never seen them before. I don’t know if the stuff they’re saying is true. I don’t want to see people in pain but I have a social responsibility not to contribute to this opioid epidemic. They say, ‘I don’t care about your social responsibility. I want my narcotics NOW! If I don’t get them I’m going to slam you on your evaluation.’”
When it comes to administering Narcan (naloxone), Dr. O’Malley sees the increase availability of Narcan as a positive force in the opioid epidemic. When doctors revive patients, they often become belligerent with medical personnel.
“They jump off the bed, and run out of the ER. That is terrifying. Narcan is only going to last 20 to 30 minutes. If they overdosed on opioids like methadone or oxycodone they’re going to go back into respiratory arrest, or pass out at the top of a staircase, or get behind the wheel of a car.”
Sadly, the epidemic is only getting worse. The worse part, O’Malley says, is having to tell families their children have died because of an overdose. Therefore, despite the consequences of bad survey scores, it is important all doctors take a stand in preventing the amount of overdoses reported annually in the United States. They must do the right thing.
Every 19 minutes, someone dies from opioids alone. The opioid crisis is complex and it may take time to figure out the right solution; however that does not mean you should give up. Treatment is critical and if you or someone you know is currently struggling, the time is now to seek treatment. Do not wait. Seek treatment today.
CALL NOW 1-800-951-6135
Author: Justin Mckibben
Tis’ the season for a lot of holiday celebrations. This time of year is always full of family, fun and fellowship, with the year 2016 coming to a close only days away. Considering so many parts of the country a plagued with harsh weather during winter, and so many people are out celebrating, it only makes sense that extra attention be brought to the need for safe traveling. The importance of which is definitely emphasized in the movement against drunk and drugged driving. While most of us know December as a holiday season for many reasons, it is also National Impaired Driving Prevention Month!
From the White House
Back in 2012 President Barrack Obama made a statement announcing National Impaired Driving Prevention Month, stating:
“As Americans gather with friends and family to share in the holiday season, National Impaired Driving Prevention Month reminds us of the importance of celebrating safely. Every year, accidents involving drunk, drugged, or distracted driving claim thousands of lives, leaving families to face the heartbreak of losing a loved one. We stand with all those who have known the tragic consequences of drugged or drunk driving, and we rededicate ourselves to preventing it this December and throughout the year.”
In these efforts the President and his administration invite families, educators, health care providers, and community leaders to promote responsible decision-making, and also to inspire young people to live free of drugs and alcohol. In the description of impaired driving the movement is not limited to alcohol. It includes:
- Distracted driving, such as driving tired or while texting
- Drugged driving
- Drunk driving
Understanding the Impact
This observation in so important, and several agencies encourage people to recognize and understand the impact, including:
- The National Highway Traffic Safety Administration (NHTSA)
- U.S. Department of Transportation,
- The White House’s Office of National Drug Control Policy (ONDCP)
- The U.S. Department of Health and Human Service’s Substance Abuse and Mental Health Services Administration
To put the importance of National Impaired Driving Prevention Month into perspective, in an average year:
- 30 million Americans drive drunk
- 10 million Americans drive impaired by illicit drugs
The Substance Abuse and Mental Health Services Administration (SAMHSA) conducted a study in 2010, which showed:
- 2% of people aged 16 or older drove under the influence of alcohol
- 3% drove under the influence of illicit drugs
- 8% of drunk drivers were 26 and older
- 5% of drunk drivers were 16 to 25 years old
- 8% of the older group drove drugged
- 4% of younger drivers drove under the influence of drugs
Again, the month of December makes plenty of sense for the National Impaired Driving Prevention Month, considering traffic fatalities involving impaired drivers increase significantly during the Christmas and New Year’s holiday periods. In fact, in December of 2010:
- 25 people on average were killed in alcohol-impaired driving crashes per day!
- Drivers 21 to 34 years old were alcohol impaired and involved in fatal crashes at a higher percentage than any other age group
Do Your Part this December
This National Impaired Driving Prevention Month, we have to keep in mind we should be doing our best to take care of each other. Spread good will and compassion to others with December. People are encouraged to always drive responsibly, and to be observant of each other on the roads. While reporting an impaired driver might not be the holiday present they want, but it could save their life and the lives of others. If you have a friend or relative who is impaired, don’t let them get behind the wheel.
Many people who struggle with alcohol or drug use disorders don’t even realize the severity of their problem until it is too late. Frequently driving impaired is often a warning sign of a deeper issue. Anyone who finds themselves driving impaired too often may want to seek help.
Sadly, fatal accidents happen across the country every year, claiming thousands of innocent lives as a result of impaired driving. Driving drugged, drunk or distracted is critically dangerous, and always avoidable. If you or someone you love is struggling with substance abuse or addiction, please call toll-free now. We want to help.
CALL NOW 1-800-951-6135