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Why are Insurance Companies Focusing on Maintenance Drugs?

Why are Insurance Companies Focusing on Maintenance Drugs?

(This content is being used for illustrative purposes only; any person depicted in the content is a model)

Author: Justin Mckibben

Addiction is not an easy problem to address. It is a complex issue with many variables, so of course there is no simple answer to fix it. There is no one-size-fits-all solution; no monopoly on the right kind of treatment. It is understandable that there is a degree of effectiveness with utilizing any medical means available to try and address addiction, but are maintenance drugs really the answer?

Surely medication assisted treatment is useful, and it helps a lot of people. Most inpatient treatment programs utilize some form of medication to ease withdrawal symptoms and other side-effects of long-term drug use. The detox period of treatment usually focuses on medically assisting someone struggling with drugs in this transition.

However, is getting people off of one drug by making them dependent on another really the best case scenario? It seems now insurance companies are putting more effort into using maintenance drugs to treat addiction. Is this really a better strategy?

Maintenance Drugs

Firstly, let us make a clear definition of what maintenance drugs are. Typically, the definition of maintenance drugs is along the lines of prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines.

Examples of common maintenance drugs are medications such as:

  • Fluticasone and salmeterol (Advair Diskus) which is used to treat asthma
  • Insulin glargine (Lantus) used to treat diabetes

If you consider these examples the point is that people use these medications to “manage” their illness, not to overcome or remedy it. So looking at the issue of addiction, there are some well-known maintenance drugs, specifically concerning opioid addiction.

These medications can be effective, but they also present a level of danger themselves. Even though doctors prescribe them to combat withdrawals, they actually can create their own devastating withdrawals, especially with long term use.

Aetna Aims for Maintenance Drugs

Aetna is one of the nation’s largest insurance companies. In a recent Aetna report, the company is prepared to remove a major restriction for patients seeking maintenance drugs for opioid addiction. The change is set to begin this coming March. Aetna is the third major health insurer to announce such a shift in policy in recent months, now in league with Anthem and Cigna insurers.

To be more specific, this insurance company will stop requiring doctors to seek approval before they prescribe particular medications that are used to combat withdrawal symptoms. One of these medications is suboxone, a well-known medication that many people use to fight opiate addiction.

The common insurance practice is known as “prior authorization”. The reason they are seeking to eliminate this policy is because it sometimes results in delays of hours to days before a patient can get the medications.

This new approach to regulation of maintenance drugs impacts all its private insurance plans, an Aetna spokeswoman confirmed.

Advocates of Maintenance Drugs

Addiction treatment advocates to support having expanded access to maintenance drugs. Dr. Corey Waller, an emergency physician who chairs the American Society of Addiction Medicine’s legislative advocacy committee, states:

“It’s a first-line, Food and Drug Administration-approved therapy for a disease with a known mortality. [For] every other disease with a known mortality, the first-line drugs are available right away.”

Essentially, the idea that parity laws require insurers to cover addiction treatments at the same level as other kinds of healthcare means these kinds of medication should be available for immediate access. This should be the same for all forms of addiction treatment.

Opinion: Treatment over Maintenance

While many would argue that maintenance drugs are a form of treatment, it is still a relevant argument that maintenance drugs are also imperfect and could actually be harmful if they become the cookie-cutter answer implemented by most insurers.

While harm reduction is understandable, and maintenance drugs can help people struggling with heroin or other dangerous opioids avoid other serious risks, the fact is many maintenance drugs include their own side-effects. Some often become subject to abuse themselves.

For instance, suboxone can be useful as a harm reduction tactic, but it can also be abused. Many people who have used suboxone as a long-term solution have found themselves battling suboxone withdrawal symptoms. The dangers of suboxone are very relevant.

The same, if not worse, has often been said about methadone maintenance drugs. While they may keep someone alive to get treatment, there should still be a strong emphasis on treatment itself. Maintenance drugs are most effective when part of a program. They are not a substitute for a treatment program.

Treatment should focus on finding solutions, not prolonging the suffering. Drug and alcohol addiction treatment should come from a holistic approach that addresses more than just physical ailments. Holistic treatment focuses on providing extensive and personalized therapy, combined with physical and emotional heal. If insurance companies want to focus on combining rational medical resources with comprehensive treatment, then this could be a great thing. However, if the focus becomes a quick-fix drug option opposing a full recovery through treatment, it only adds to the danger.

Maintenance drugs have support from the recovery community, but typically they must be accompanied by therapy and other means of treatment. Maintenance drugs are just that- drugs. They are often powerful narcotics, and are true to their title- “maintenance,” not a permanent solution.

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A Powerful Story from the Face of Addiction

A Powerful Story from the Face of Addiction

Author: Justin Mckibben

Wednesday evening, 9 Frederick County residents in Area 31 in downtown Frederick went in front of a camera. But this wasn’t any ordinary photo shoot. Not some promotion for a new shoe or the next big diet plan. These 9 brave individuals went under the spotlight to divulge some of their darkest memories of addiction, to spread home for recovery.

The filming is for a new video on recovery awareness. Stories like these of struggles and survival are incredibly powerful.

The Face of Addiction

The project has the title “I Am the Face of Addiction.” This in-depth film is intended to showcase progressive and empowering narratives from individuals in recovery. Ultimately, the hope is to inspire other residents of the area struggling with substance abuse.

The dream behind the film and a lot of the work put into it comes from Pam Knight, a Libertytown resident. When talking about how the project came to be, Knight stated:

“We just want to break the stigma of the term ‘drug addict,’…This is a major epidemic, but there are still so many people who are too ashamed or too embarrassed to admit ‘my life is out of control.’”

Knight, a former special education teaching assistant at Linganore High School, has her own history with addiction. That history puts her in a unique position to know the power of perspective.

Accidentally Addicted

In active addiction, at face-value Knight’s life seemed flawless. Her husband, Daniel, owns a successful hair salon in Frederick. The couple has three adult children and three grandchildren. To some this sounds like the American dream, but many wouldn’t know there could be nightmares behind the scenes.

Under it all, Knight was hid a pill addiction for years. She says it began in 2011 after falling off the bleachers at her son’s high school football game. After she was prescribed Vicodin for pain, she began taking more and more. While in the beginning she said the pills made her feel “like Superwoman,” she later describes the experience of addiction as “purgatory.” Knight stated,

“Towards the end, there was no high anymore. You have to have it to make your brain feel normal. The first thing I would do in the morning is pop my pills.”

It didn’t take long before Knight graduated from Vicodin to Percocet. After experimenting with opiates she began doctor-shopping to obtain prescriptions. She admits that her final years of addiction she found herself buying pills off the street.

Her drug of choice was Roxicodone — known as “Roxys” on the street — an opioid-based painkiller. She would purchase quantities of 30 milligram tablets and take multiple doses at a time. Knight said,

“If I didn’t have them, I would get horrible shakes.”

Seeing the Signs

Knight’s husband and her oldest daughter, Loren Maxwell, admit that Knight’s gradual descent into addiction was easy to brush off in the beginning. The signs were somewhat there, but not easy for her family to see for what they were.

Her husband Daniel said he would notice days when she seemed especially manic or sweaty, but Knight always had an explanation.

Maxwell said her mother’s ability to function made her addiction harder to spot. Many people don’t acknowledge the dangers of ‘functioning addiction’ because they don’t understand it.

During this time the family said the signs were simple to dismiss unknowingly or miss altogether. Now that Pam Knight has gone through recovery, Daniel Knight said,

“I see them everywhere.”

Family Fight Knight

Like many people have experienced, the fight with addiction can often be a family affair.

Knight’s youngest son, Connor, was also struggling with addiction at the same time as his mother. Like Pam Knight, Connor said his problems started with the opioid painkillers prescribed for his football injuries. His struggles with opiates graduated much quicker. At 17 years old, Connor first snorted heroin with a bandmate, and his progressive addiction took off.

After years, both Pam and Connor finally found a new chance through rehabilitation at treatment centers in Florida.

Pam has been sober for three years; Connor for 11 months.

Inspiring Others

Pam Knight’s motivation for sharing the gritty details of her experience for this film is to show that recovery is possible. Knight currently speaks in Frederick County Public Schools as an advocate for addiction recovery. She says she hopes to screen the finished video for these audiences to spread more of this story.

Other participants in the film also hope their contribution will inspire recovering addicts. A huge part of inspiring others is to help overcome addiction stigma. Statistically we know that far too many addicts prolong their suffering and lose their lives because they don’t know of a better option, or because they are afraid of the assumptions and stereotypes attached to addiction. Breaking those stereotypes is exactly why we need such powerful stories, such as Pam Knights. A mother, a wife and a miracle who has persevered through a great deal of difficulty. We celebrate her and the others involved in this project helping to reach out and change lives by showing people the true face of addiction is not always what you would expect.

Sharing your story isn’t always easy, but once you have a chance to rewrite your story it can be more powerful than you can imagine. It isn’t always easy to change that story, but it is always possible. If you or someone you love is struggling with substance abuse or addiction, please call now.

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New Hampshire Introduces Tougher Opioid Prescription Laws

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:

  1. Require patient risk screening before writing a new prescription
  2. Ensure all patients prescribed pain medication understand the risk of addiction
  3. Limit the dosage of pain prescription to the lowest effective dose
  4. Forbid doctors in ER and Urgent care from prescribing a prescription longer than seven days
  5. 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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New Florida Bills: One to Protect Addicts and One to Punish

New Florida Bills: One to Protect Addicts and One to Punish

Author: Justin Mckibben

Sometimes new policy can be good. Sometimes, not so much.

The opiate epidemic in America has hit some states with staggering rates of overdose and death. The paralyzing truth gripping the nation today is that more people are dying from drug overdose than homicides and car crashes. Heroin, fentanyl and prescription painkillers collectively decimate entire communities. People from all over are starting to push officials and lawmakers for more progressive and effective solutions.

Addiction has led to an overdose outbreak that shakes the country to the core, everywhere. Now, Florida lawmakers are pushing for new legislation to try and protect and serve those who suffer from an overdose. One of the first bills on the 2017 agenda is one that hopes to change how law enforcement treats overdose victims.

Although, another bill is trying to turn things in a very different direction.

Florida HB 61 Bill

Florida Representative Larry Lee, a Democrat from Port St. Lucie, has filed a proposal titled HB 61. If approved, this piece of reform would require several new policies for healthcare providers, starting with hospitals.

  • It would require hospitals to screen overdose victims to determine the need for additional health care services
  • Prohibits hospitals from discharging overdose patients to a detox or treatment facility until stabilized
  • Requires attending physician to attempt contact with patients primary care physician, or other treatment providers, who prescribe controlled substances to notify them of overdose
  • Requires hospital to inform medical director of treatment center (if patient is currently in treatment) of the overdose
  • Hospital must inform overdose victim’s family or emergency contact of overdose
  • Must inform contacts what drugs they suspect to have caused overdose
  • Attending physician must provide list of drug treatment providers and information about Florida’s Marchman act and Backer act in case the family or contact wishes to seek legal action to protect the addict

The Big Change in HB 61

Lastly, what is probably the most progressive part of this legislation, is the HB 61 bill would prohibit criminal charges from police officers and prosecutors against the overdose victim for possession of any drugs found on them during the incident.

This final aspect of HB 61 this writer thinks is a big deal, because from personal experience I have seen and heard many stories of individuals not calling for help in the event of an overdose out of fear of prosecution. In some cases people actually die because of the fear of criminal punishment. Adding this kind of measure to the bill is an attempt at eliminating the loss of life due to fear of discrimination. Even if it is not a perfect system, this kind of reform takes first responders and law enforcement a step closer to dealing with addicts who are fighting a fatal illness like sick people instead of criminals.

Florida SB 150 Bill Attacks Fentanyl

From across the aisle we see another push from Republican Senator Greg Steube from Sarasota. The question is, will this push go in the right direction? On December 12, he introduced bill SB 150. This is set to be a direct attack on fentanyl.

For those who are not yet familiar, fentanyl is an incredibly powerful, and lethal, opioid painkiller. It’s medical use is to sedate surgical patients and relieve chronic pain. However, being several times more powerful than heroin, it has crept into the illicit drug trade in various parts of the country. And with its arrival also came a horrifying increase in overdose and death.

This proposal means to make 4 grams or more of fentanyl a first-degree felony through:

  • Manufacturing
  • Selling
  • Buying

November 20, the Palm Beach Post released an analysis of people who died in 2015 from heroin-related overdoses. Out of the 216 individuals profiled in this report, 42% of the cases were found to involve fentanyl. So of course, with Steube coming from a district hit particularly hard by the opiate epidemic, it is logical to want to do everything you can to cut the flow of fentanyl off.

Yet, some say that this kind of strategy is too close to the concept of mandatory minimums.

Is SB 150 Too Close to Mandatory Minimums?

For those who need more clarification, mandatory minimum sentencing laws were a “one-size-fits-all” strategy implemented originally back in 1951 against marijuana, then repealed in the 1970s, and refined in 1986. In 1973, New York State enacted mandatory minimums of 15 years to life for possession of more than 4 ounces of any hard drug.

The idea is that regardless of the individual or the circumstances that a certain crime will have an inflexible punishment across the board. Ever since their introduction, criminal justice advocates have fought these laws, and they have always been surrounded by debate and controversy.

Essentially, some are already saying that SB 150 will ruthlessly make addicts into victims of the already overpopulated prison system. To be clear and fair- the bill does not seem to directly require a specific prison sentence like mandatory minimums, but it’s similar in that it treats every issue related to fentanyl the same.

The issue has already been argued time and time again that non-violent low-level drug offenders have spent excessive amounts of time in prison for possession of a substance. In some cases, an individual will do more time behind bars for possessing a large quantity of drugs than someone who has actually killed someone. Some have come to the conclusion that this tactic just doesn’t work.

The fear with SB 150 is not about the manufacturers or the dealers as much as it is for the consumers. Sometimes individuals purchase drugs on the street believing it to be heroin or another substance without even knowing there is fentanyl in it. So this bill would make first-degree felons out of desperate addicts?

What is Right?

The big question we all face at the end of the day is- what is the right thing to do? How is the best way to handle something that feels so utterly out of hand?

Well, it would seem like its time to finally let go of the archaic stigma. More states and law enforcement officials are turning to compassionate and supportive progress. Many places in America are starting to do everything they can to help people struggling with addiction to find help before it is too late. So why move backwards?

In my opinion, strictly based on what has been presented so far, SB 150 seems dangerous. There are countless advocates out there who say that intensifying the punishment is not how you deter the crime. Especially when it comes to addiction, because this kind of method still suggests it is a moral failing and not a psychological and physical illness.

HB 61 seems to be trying to call health care providers to action and add more accountability on the front lines in the fight against the overdose outbreak. At the same time it seems to move in the opposite direction of SB 150 by trying to limit the persecution of addicts. HB 61 makes more room to help preserve life and offer treatment and solutions. By now we should already know, the solution isn’t a War on Drugs, it is community and compassion.

These are some of the initial responses to recommendations recently made by the grand jury. Every day there are countless people suffering. And every day there are countless more recovering and fighting to help others recover. If you or someone you love is struggling, please call toll-free now. We want to help. You are not alone.

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Tramadol Abuse: How Some Overlook a Deadly Opiate

Tramadol Abuse: How Some Overlook a Deadly Opiate

Author: Justin Mckibben

When most people hear someone say ‘opiates’ they probably think of OxyContin, morphine or even heroin. These have become the usual suspects when discussing the dangers of opiate-based drugs. While the country has come to terms with the status of the opiate epidemic, some dangerous drugs remain overlooked. One such opiate is Tramadol.

Tramadol, like most opiates, is a medication used to treat moderate to severe pain. Approved in 1995, Tramadol is now taken by thousands of people every day. With other names such as:

  • Ultram
  • Conzip
  • Rybix ODT

Tramadol works by activating changes in the brain to relieve pain. At the same time, the drug increases levels of serotonin and norepinephrine. These chemicals regulate our mood. Such changes are what lead to the substance abuse, because they produce a euphoric effect.

While Tramadol has not had the spotlight during the opiate epidemic, there is plenty of cause for concern when it comes to Tramadol abuse.

Tramadol Takes a Toll on Ireland

While the drug hasn’t gained as much infamy in America as other opiates, in Ireland Tramadol is claiming more lives than any other drug – including heroin and cocaine – according to Northern Ireland’s top pathologist.

Like many prescription medications, this painkiller doesn’t typically cause harm if taken correctly. However, with excessive use of powerful medications comes an elevated risk of adverse effects. The greatest danger with Tramadol also arises when users mix it with other drugs or alcohol. Just last year, 33 deaths in Northern Ireland were linked to Tramadol.

Professor Jack Crane, the State Pathologist for Northern Ireland, has spoken out about his fear that more people will die unless urgent action is taken. Tramadol should only be available on prescription in Ireland after it was reclassified in 2014, making it an illegal Class C drug without prescription. However, the illegal drug trade took advantage of the situation and people continue to die.

Professor Jack Crane wants to upgrade the classification again to Class A. Crane will be meeting Northern Ireland’s Chief Medical Officer later this month to push for change.

 Cane stated:

“I don’t think that people realise how potentially risky taking tramadol is. I think it’s because it’s a prescription drug – people assume it’s safe.”

Continued Abuse Issues

The drugs original reputation of being a safe alternative is mostly to blame for why it is so commonly overlooked as a seriously dangers opiate. Many still hold a false view of this drug as not being a health threat if abused. Yet, it is extremely deadly when abused and mixed with other substances.

When used in amplified amounts the unhealthy levels of the medication throw off our complex chemical balances. This unbalance can negatively affect our well-being physically, emotionally and psychologically.

Physical dependence on the drug increases other risks such as overdose. Signs of an overdose can include:

  • Difficulty breathing
  • Irregular heartbeat
  • Seizure
  • Loss of consciousness
  • Coma

Physical dependence on Tramadol can also cause withdrawal symptoms when users try to stop taking the drug. These include:

  • Depression
  • Agitation
  • Hallucinations
  • Stomach Pain
  • Diarrhea
  • Paranoia
  • Confusion

Medically supervised detox is recommended when trying to safely stop using the drug. Medical detox is incredibly helpful to minimize the dangers of withdrawal. Tramadol abuse and dependence presents challenges similar to the health risks associated with other opiate drugs, so they should definitely not be overlooked.

The opioid epidemic is affecting Americans in every part of the country, and even prescription drugs like Tramadol are making an impact. So in the face of overdose deaths, more than ever people need safe and effective treatment to help them change for life. If you or someone you love is struggling with substance abuse or addiction, please call now.

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