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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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Drug Implant Could Save Australia’s Meth Addiction Crisis

Drug Implant Could Save Autrailia's Meth Addiction Crisis

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Author: Shernide Delva

Hundreds of addicts from Australia are turning to an unconventional and controversial treatment to try to cut their addiction to methamphetamines, or “ice”. The treatment has a 70 percent success rate but addictive medicine specialists are warning that it is not the answer.

The treatment involves surgery to have the drug naltrexone implanted in meth addicts to cut their craving. In Australia, meth is the most commonly used drugs next to marijuana. Each year, more than 300 people with drug problems consent to receive the naltrexone implant from the Fresh Start clinic in the city of Perth. The clinic is run by George O’Neil, one of the few doctors in the area who is willing to install the device. Naltrexone is an opioid antagonist that has been proven to reduce the reward associated with drug use.

“With amphetamine addicts, it just isn’t as enjoyable as it used to be,” on naltrexone. “And so the reward is reduced,” Dr. O’Neil said.

However, naltrexone treatments often run into problems. Drug users intentionally skip doses in order to get high or stop taking the treatment all together.  Essentially, the drug addict who desires to get high knows if they stop taking the drug, they can go back to using and feeling high again.

Now, with the implant, this will not be possible. The implant would be surgically placed into the patient’s abdomen which would remove the problem of compliance by slowly releasing naltrexone into the bloodstream maintaining an effective dose at all times.

Many believe the implant has not been proven effective. However Dr. O’Neil argues that is one of the more effective treatments. He argues that the implant has a bad reputation because other clinics provide inferior devices which dispense incorrect doses.

In 2012, three patients addicted to heroin passed away after getting naltrexone implants at a Sydney clinic. The danger of naltrexone is after it is used for a lengthy period of time, a user’s tolerance for opiates will be significantly reduced. When that happens, the chances of an overdose become much higher.

The Jury is Out

So far, The National Health and Medical Research Council’s position on the implants is that further research is needed before a statement on safety can be confidently made. A small study by West Australian addiction expert Gary Hulse is promising. Hulse studied 44 of Dr. O’Neill’s patients and found that 75 percent were not using methamphetamines after 12 to 14 weeks.  Hulse believes that the use of naltrexone for meth addicts is sound. However since there has not been any large scale studies, it is still uncertain how effective the implants could be.

Regardless, anything that could be effective in increasing the chance of recovery for addicts is worth examining further. According to a 2013 Nation Drug Strategy Survey, 7 % of the Australian population aged 14 years or older have reported using meth at least once in their lifetime.

Even in the states, meth has become a huge epidemic. People are creating meth in homemade labs. The meth crisis has resulted in many severe injuries, even death. The meth industry has become so huge all over the world that many are resorting to treatment facilities. A Thailand temple offers free treatment to addicts and its patients are most commonalty meth addicts.

Overall, the meth problem needs to be tackled. For many, it is a consuming addiction that takes over their life. If you or someone you love is struggling with substance abuse or alcoholism, please call toll-free 1-561-221-1125


Using Painkillers to Treat Depression?

Using Painkillers to Treat Depression?

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

Author: Justin Mckibben

Depression can be a prison of grief, disconnection and utter loss of interest that takes hold of someone in the most powerful and oppressive ways imaginable. While sorrow and feeling low are normal facets of the life we all share, the emptiness and hopelessness that can accompany depression is often a far deeper and more severe shade of sadness.

Depression can be difficult to understand, and difficult to treat. There are numerous methods of treatment out there, from anti-depressant medication or personal and behavioral therapy, designed to help diagnose, assess and treat depression, and as time marches on we see many respond, while others struggle and regress.

Now there is a new treatment plan being researched and developed that is actually pretty intriguing, because it includes painkillers, and a medication commonly used to combat addiction… for painkillers?!

Mice and Medicine

Currently a lot of antidepressants are considered selective serotonin reuptake inhibitors (SSRI) which are primarily utilized in treating depression by method of medication. In fact somewhere between 30% and 50% of people being treated for depression with medication use SSRI’s.

Still there is a real demand for newer depression therapies, as many people taking SSRIs do not respond adequately to them, and with severe cases of depression some worry there is too much of a risk of harmful results before treatment can be effective.

Recently scientists at the University of Bath in England conducted research on mice, and their findings suggest by combining a painkiller commonly used after surgery with a drug used to off-set the adverse effects of fighting addiction may be a new and efficient antidepressant treatment.

The ingredients, which have spurred quite an interesting conversation, are:

  1. Buprenorphine

This is a painkiller that works by reducing a person’s response to stress by inhibiting the kappa opioid receptor in the brain.

However, buprenorphine also stimulates another receptor called the mu opioid receptor. This reaction could actually cause a person to develop a physical addiction to buprenorphine, especially after an extended period of use.

Buprenorphine is also one of the key ingredients in suboxone, which surprisingly is a medication containing naloxone and used to fight opiate addiction.

Weird, right?

  1. Naltrexone

This anti-addiction drug was added as a result of the dangers with buprenorphine. You may recognize it under the trade name Vivitrol, which is a version that comes as a once-monthly extended-release injectable formulation.

Naltrexone is a drug that blocks the mu opioid receptor in the brain, and is commonly marketed to help fight opiate addiction and alcohol dependence. This medication is also frequently sold under the trade names Revia and Depade.

Details of Study

According to the report on the research published in the Journal of Psychopharmacology when the combination was used on the mice the concoction produced an antidepressant effect, but results showed it came without any addiction issues.

Of course this new combo is not a fool-proof system as of yet. There is still a very long way to go before a buprenorphine-naltrexone mixed medication could be available to every day consumers. Mice is one thing, but humans are very different, so of course there needs to be human trials to determine whether there are any risks.

The study’s co-author Stephen Husbands, PhD, made a statement where he said:

“It may be hard to deliver this combination in the clinic because of the properties of these drugs. We have also been working on changing the chemistry of buprenorphine so that it has the properties of this combination treatment in one molecule which should simplify drug delivery.”

So while we can see a glimmer of hope, there is still some room for curiosity and concern when it comes to taking drugs so closely associated with addiction and combining them as a medicine, especially as a treatment for mental health.

It is understandable how this kind of formula would put people on edge. Combining a powerful opiate with another medication that is used to combat opiate addiction (but also doesn’t have the best reputation for recovery results) probably seems a bit sketchy to people who are trying to find a way to escape depression. I guess only time will tell if this is a surprise innovation or a nightmare disguised as a miracle.

Then you have to ask, what are the odds that humans will develop addictions to these drugs? What kind of new substance abuse could this kind of collision of chemicals create?

Depression and drug addiction often come hand in hand, and treatment can come in many forms. Dual diagnosis treatment is best for co-existing disorders such as these, and beyond medication there is a lot more that can be done holistically to ensure lasting and fulfilled recovery. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135


Maryland Program Treating Heroin Addicted Prisoners

Maryland Program Treating Heroin Addicted Prisoners

Author: Justin Mckibben

Last September I wrote about how the city of Baltimore, Maryland was being labeled the “Heroin Capital of the United States” and was suffering from a community crushing crisis as Government agencies estimate that as many as one in 10 of the residents of the city of Baltimore are addicted to heroin. So it is a true inspiration to see a program being established to help heroin addicts already pulled into the prison system by drugs being treated before released.

Demand for Intervention

Last year alone in Maryland there were 578 deaths due to heroin overdose. That is an astounding 25% increase from 2013, and more than double the number of deaths from heroin in 2010. Maryland suffered many losses due to overdose:

  • Baltimore City ranked first for heroin deaths last year- 303 deaths
  • Baltimore County-170 deaths
  • Anne Arundel- 101 deaths
  • Montgomery- 65 deaths

The Hogan Attack on Heroin

Some time ago Republican Governor Larry had declared a “state of emergency” concerning the increasing rate of heroin related deaths, acknowledging the opiate epidemic as a nationwide crisis.

At a news conference in February he even revealed his cousin had died of a heroin overdose, and said he was committed to an approach emphasizing compassion and treatment.

It appears now more than ever with this new initiative that he is holding true to that ideal.

He later formed a “coordinating council” of state officials, and he established an emergency task force of elected officials and substance-abuse experts to hold summits throughout Maryland and provide recommendations on how to tackle the epidemic.

This Tuesday the Hogan administration announced the plans to initiate the treatment of heroin addicts in 8 county jails and detention centers throughout Maryland in hopes of keeping inmates out of jail once they make it back to their neighborhoods.

This is the first program of its kind to be initiated by  Hogan, and the treatment for the prisoners is designed to be paid for by a $500,000 federal grant.

Hogan himself made a statement saying the program would be a long-term money-saver for Maryland, saying it will reduce the costs of drug-related crime and recidivism on Maryland’s state and local governments.

New Policies for Prisoners

The key ingredient to these new programs policies is naltrexone, which is a nonnarcotic and non-addictive substance designed to block the euphoric effects of heroin and other opiates. The program provides that inmate receive a monthly injection of this possibly life-saving drug.

The system being set in place is to create some level of support once the prisoners are reinserted into society. For inmates to be eligible to enter the treatment program they must be housed at a county detention center and be within 3 months of release. During this time they will receive the initial naltrexone shots before being released, and after that they have the option to receive follow-up injections from county health departments.

The state goes even further by providing continued support, including:

  • Enrolling them in Medicaid or other health-insurance plans to pay for the anti-addiction drug
  • Post-release support services such as housing
  • Mental-health counseling
  • Education
  • Employment

Each jurisdiction that receives grant money must develop a program to monitor ex-offenders’ progress, compliance, recidivism and lingering substance abuse.

Hogan insisted the state needs to provide ex-offenders with “the tools to live sober, healthy, and productive lives.”

He went on to say,

“Addiction is a disease, and we will not be able to just arrest our way out of this crisis.”

Treatment advocates applauded the governor’s efforts, and understandably so. His supporters have rallied behind him with a feel that he is delivering on a promise he made to meet this disease head-on with effective and proactive treatment plans.

Leaps and Bounds

The plan may not yet be perfect, but it is a definite leap in the right direction. So far the Hogan administration granted funding to 8 county agencies. At this time Baltimore City has not received any state treatment funding yet, but according to the governor’s office it is developing a program to qualify for assistance.

Addiction and death as products of heroin abuse has risen dramatically in recent years. With this matter becoming such a widespread and horrifying reality for Americans, the whole concept of drug policy is under constant debate as more and more seek hope in the advancement and application of reforms to our drug laws and the way we address nonviolent drug offenses.

Hopefully as this program grows, as long as it is effective other states are bound to take notice and follow suit, especially considering that the death rate is only rising at this juncture, and is presumed to be fixed to do so for some time. Let us hope that active pursuit of these revolutionary ideas for improving the quality of life for addicts can keep inspiring further change.

While Maryland fights the heroin epidemic on its streets and in its prisons, thousands upon thousands of Americans fight the same fight in their homes and in themselves. Prison is not the only alternative, there is a whole community of individuals dedicated to recovery and we are waiting for you to reach out for that helping hand. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135



Vivitrol: Miracle Heroin Vaccine… or Nah?

Vivitrol: Miracle Vaccine... or Nah?

Author: Justin Mckibben

Vivtrol has been called a miracle drug, a shot in the dark, and a waste of money. What more can we say about this presumed ‘heroin vaccine’ that some people resort to in desperation?

Vivitrol is another name given to the generic drug Naltrexone that is often used in the treatment of drug addiction as an opioid antagonist. Naltrexone was originally approved by the U.S. Food and Drug Administration (FDA) for the treatment of alcohol dependence in 1994, and later became approved for the treatment of opioid dependence. While some seem to stand by its usefulness, some still speculate that it is not in itself a solution, and still others claim it is nothing but a temporary fix to a bigger problem.

The medications primary use from treating addiction appears to be blocking the opiate receptors in the brain, so that someone using heroin or other opiate based drugs cannot get high. The idea is that if an addict stays on the Vivitrol regiment then they will be able to avoid the desire to use, and even if they do it won’t work, to further negate their cravings.

Naltrexone was developed to be able to help patients overcome opioid addiction by blocking the drugs’ euphoric effects, but while it was designed to further help by overcoming the cravings for opiates, Naltrexone and Vivitrol have been refuted by many for having little to no effect on opioid cravings at all.

Treatment Details

The Vivitrol shot is made by Boston-based biotech Alkermes, and the way it was estimated to best overcome the hurdles of previous methods of Naltexone medication was that instead of being a pill taken once a day like the original medication, which would be easy to ‘forget’ or ‘lose’,  Vivitrol is an injection given every 4 weeks with a monthly doctor visit, and time released for longer lasting relief.

Vivitrol is injected into a muscle and can be given only by a doctor or nurse in a clinic, so the medication isn’t openly available for abuse. Most people using this course of treatment are warned that it is important to receive injections regularly to get the most benefit.

Common side-effects include:

  • Nausea for a few days after an injection
  • Vomiting
  • Diarrhea
  • Mild stomach pain
  • Muscle or joint aches
  • Cold symptoms
  • Stuffy nose
  • Sneezing
  • Sore throat
  • Anxiety
  • Depressed mood
  • Sleep problems (insomnia)
  • Dry mouth

This drug also has the potential to be very dangerous to those with liver problems. Vivitrol is warned to have the ability to cause hepatitis, and it can even cause rapid withdrawals if the individual hasn’t waited at least 7-10 after stopping the use of opiates to get the shot.

Vivitrol has shown some promise in the past. In a 6 month clinical trial study there were 401 individuals on Vivitrol who completed the trial, and 17% to 25% showed a greater decrease in drinking days than those on a placebo, but only 38 of the 401 were abstinent. So if fewer than 10% of those who got the benefit from the shot achieved abstinence the drug appears to be at best successful for trying to promote ‘controlled drinking’ but NOT abstinence.

The Drawbacks

Any medications have draw-backs, and first let’s talk about the price-tag. According to some reports the Vivitrol shot also costs about $800 to $1,200 dollars! A big upcharge from the original $11 a month the Naltexone pill was going for. The up-side to that is that the number of health care insurance providers helping pay that bill is increasing, so there is more support than ever. Still the medication’s cost can present an issue for a lot of addicts.

A 2011 review of studies suggested that Naltrexone was not significantly superior to placebo (medicine prescribed for the psychological benefit to the patient, deceiving patient into thinking they’re receiving medication) or to no pharmacological intervention. Naltrexone was also determined not to be superior to benzodiazepine or buprenorphine for treating an alcohol or opiate addiction.

Over-all the poor quality of the reviewed studies forced the authors of the review to determine that there was insufficient evidence to support Naltrexone therapy for opioid dependence.

Voicing Opinions of Vivitrol

I wrote this blog after hearing 2 conflicting opinions on this kind of opiate addiction treatment. One person actually reached out to me after reading a article I wrote about the heroin epidemic’s current death toll, and she went on saying,

“I’ve been on it [Vivitrol] for 8 months now and it seriously saved my life”

During a later conversation she expressed that she felt it was a better treatment experience for her than suboxone, and that she had no withdraws while taking it. It is great to see that kind of confidence from an old friend in early recovery, and I’m so glad to see someone doing something that has changed their quality of life.

Some people seem to benefit from this kind of medication maintenance, and in some reports it has shown that through study periods it has been effective, but what about when that study period is over? Do you have to take the shot forever?

A close friend of mine we shall call ‘Spade’ stated that he had a very unsuccessful experience with Vivitrol, and that while it may work for some people, a ‘real deal’ addict or alcoholic can’t rely on it. When I asked him what it was like, the first thing he said was one word,

“SUCKED” followed by, “Didn’t work.”

After talking about it he concluded that for him it was a complete waste of a lot of money, because he craved heroin and kept trying to get high anyway. Both people I interviewed actually said that some people who use Vivitrol will keep using heroin and other opiates, and because they don’t feel the effect they will actually use until they overdose. The website for the medication even warns you may be sensitive to lower amounts of opiates than you were using previous to the treatment!

Spade said,

“I ended up spending twice the money, because I was buying the shot and then buying heroin anyway. And I kept using more and more trying to get high. I knew people who overdosed because they kept trying to get high. It’s not a solution.”

Spade recounted incidences where he knew people who used the shot for months and it worked, but when they stopped taking the shot and there was no other solution in their life, they would relapse. He said while the shot may help some people get their start, it is not a reliable recovery plan.

My opinion- for a ‘real deal’ alcoholic/addict like me or Spade it’s a Band-Aid on a bullet-hole. Don’t get me wrong, my opinion isn’t a doctors opinion, and whatever works for people is awesome and I am grateful they have a resource. It helps people, and that is good enough for me. We all have to chose our own path. But in my mind addiction is not just a physical problem with a miracle medicine solution. As I understand it, it’s a mental obsession or even a spiritual disease, and in my experience it takes a program of action for a fulfilled life in recovery.

There are all kinds of strategies for recovery out there, and everyone has to walk their own path. Examples of any maintenance medications being a successful factor in lasting recovery are typically accompanied with some form of behavioral therapy and/or drug treatment program, and an aftercare program. There is no miracle cure for addiction yet, but there is real treatment with real solutions. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135

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