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Friday, February 17, 2017

Suboxone and Prior Authorizations from Insurance

Opioid narcotics are highly effective substances used to treat varying degrees of pain in patients around the world. There is, arguably, no other form of drugs that can mitigate symptoms of pain as well as opioids, such as oxycodone (OxyContin ®) and hydrocodone (Vicodin ®). The efficacy of such drugs, and mandates on pain management in the United States, resulted in the most severe drug epidemic in the history of mankind. And America is ground-zero.

You are probably aware that in recent years there has been a major push from both health experts and lawmakers to rein in the American opioid addiction epidemic. Efforts which came in the form of legislation and prescribing guidelines, as well as the creation of prescription drug monitoring programs (PDMPs). The efforts had, in many ways, the intended effect—leading to a serious reduction in prescriptions written, the closing of pharmacies and clinics and prosecuting certain doctors. However, given that the crux of ending the epidemic is helping the millions of opioid-dependent Americans get the treatment they need—it is fair to say that much more work is needed.

Most of the people charged with tackling the opioid epidemic agree that we can no longer hold on to the misguided belief that we can arrest addiction away. Even if doctors stop prescribing opioids outright, patients will find their drugs on the street. If they cannot afford prescription opioid street prices, they will typically opt to use heroin. A cheaper and stronger alternative. Law enforcement could arrest every dealer in the country, but others will fill the void in their absence.

The point, which you have probably gathered by now, is that addiction treatment is the best weapon. Unfortunately, it has been a real struggle for some people to get the help that they need. The result being this crisis is now in uncharted water, at least in some cases. The National Institute on Drug Abuse (NIDA) has been urging more doctors to prescribe Suboxone (Buprenorphine), a drug that can greatly alleviate the pain typical of opioid withdrawal. The drug, when used within a maintenance model has been shown to reduce the risk of relapse.

The call to make Suboxone more accessible has been somewhat difficult to heed, for a number of reasons: 1) Few doctors are licensed to prescribe the drug. 2) Doctors can only prescribe the drug to a set number of patients. 3) Insurance companies have been slow to offer coverage for Suboxone or have policies that make it difficult for patients to get the drug.

Fortunately, the third issue appears to be coming to an end. Starting in March one of the top insurance providers will make it easier for patients to get Suboxone, making them one of three to change their coverage in recent months, NPR reports. Aetna will no longer require doctors to seek prior authorization from the insurance company before they prescribe Suboxone. This is a big move that should help thousands of Americans.

With addiction treatment, and the decision by a patient to seek it, time is of the utmost importance. The decision to seek help is often times fleeting. If doctors can't provide help immediately, reneging on one’s decision typically follows. The Aetna policy change should mitigate the risk of an addict changing their mind.

"If someone shows up in your office and says, 'I'm ready,' and you can make it happen right then and there ― that's great," said Dr. Josiah Rich, a professor of medicine and epidemiology at Brown University. "If you say, 'Come back tomorrow, or Thursday, or next week,' there's a good chance they're not coming back.”

Wednesday, February 1, 2017

AUD, PTSD and American Indians

If you study U.S. history in high school, you are aware of the gruesome picture painted in textbooks of how our ancestors treated American Indians. From before the “Trail of Tears,” to the present day. Now in the 21st Century, it could easily be argued that not a whole lot has changed regarding the treatment of native peoples. Attempts to exploit their land and disenfranchise a people who desire to find a place in America, continues to this day.

While it is easy to look at history and say that several efforts have been made to make reparations for the awful treatment American Indians endured and continue to be subject to, sadly, it would seem that they are hardly enough to undo the centuries of psychological trauma inflicted upon this land's first men and women. Statistically speaking, American Indians (AIs) / Alaskan Natives (ANs) peoples living in this country experience higher rates of mental illness. And that’s not all, according to an American Psychiatric Association Fact Sheet:
  • Native Americans have twice the rate of victimization than that of African Americans, and more than 2.5 times that of whites.
  • Native Americans experience serious psychological distress 1.5 times more than the general population.
  • Compared to all other ethnic groups, Native Americans use and abuse alcohol and other drugs at younger ages and at higher rates.
Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) often go hand in among any group of people. Untreated PTSD commonly results in self-medicating with drugs and alcohol, which in turn leads to AUDs, and the like. A new study sought to compare rate of PTSD and AUD among the Native peoples, to that of non-Hispanic Whites (NHWs), Newswise reports. The findings were published in the journal Alcoholism: Clinical and Experimental Research.

The researchers found that PTSD was significantly associated with AUD in both populations, according to the article. However, the link was much greater among AI/ANs. AI and AN males experienced both PTSD and AUD at three times the rate of NHW men (9.5% vs. 3.1%). The research team would like to see more studies that look at the trauma that arises from cultural loss.

Tuesday, January 17, 2017

People With Mental Illness Want to Quit Smoking

mental health disorders
Only 15 percent of American adults smoke cigarettes, quite a drop from not that long ago. Cigarettes are both addictive and a leading cause of preventable death. While adult smoking rates are at relatively low rates among the general public, the same cannot be said for people with mental health disorders. As many as 57 percent of people living with serious mental illness smoke cigarettes, according to PsychCentral. Highlighting the need for psychiatrists and caseworkers to help people with mental health disorders quit smoking.

A new study found that a large number of psychiatric patients would like to be free from cigarettes, the article reports. However, researchers found that mental health caseworkers don’t prescribe smoking cessation drugs or refer patients to outside resources that could help with quitting.

“Patients with serious mental illness die an average of 25 years younger than people who don’t have these problems, and smoking is a big factor,” said study first-author, Li-Shiun Chen, M.D., an assistant professor of psychiatry at Washington University School of Medicine and BJC Behavioral Health in St. Louis. “Smoking is a common and serious problem for our patients, and although smoking rates have been decreasing in the general population, the rates remain very high in this vulnerable population.”

The researchers surveyed 213 psychiatric patients, of which 82 percent expressed interest in smoking cessation, according to the report. However, only 13 percent were receiving treatment at the time. The lack of encouragement from providers to quit may be the result of a long held belief that mental health patients have "bigger fish to fry" than cigarettes. Yet, new research indicates that quitting smoking can help mitigate the symptoms of mental illness. And for recovering addicts who smoke, quitting can reduce their risk of relapse.

A large population of people in recovery have co-occurring mental health disorders, such as depression or bipolar disorder. If quitting smoking can reduce the recurrence of symptoms and reduce the risk of relapse, mental health care providers could do a lot of good by encouraging smoking cessation, prescribing drugs like Chantix and refer patients to outside services.

“We want the psychiatrists and caseworkers to know whether their patients have expressed a wish to stop smoking so that they can refer them to counseling or provide them with prescriptions for nicotine lozenges, patches, or other medications that may help these patients quit smoking. We think those fairly simple changes really could pay off in a big way.”

The research was published in the Community Mental Health Journal.

Wednesday, January 4, 2017

Mysterious Cannabis-Related Illness

It is of the utmost importance to have marijuana research continue, considering the new additions to the list for states that now allow adults to use cannabis for recreation. California was one such state that legalized recreational marijuana last November, 20 years after becoming the first medical marijuana friendly state in the country. And it is likely that more Californians will begin using the drug, and in some cases people with a history of pot use may begin using the drug more frequently.

It is fair to say that the biggest marijuana health-related concerns are towards teenage and young adult use, considering that their brains are still developing. However, while adults may not be concerned about the drug negatively affecting their health (setting addiction aside for the moment), a bizarre illness related to cannabis use is being seen more often in states with a relaxed stance on the drug.

In recent years, an increasing number of people living in marijuana-friendly states have been seen in emergency departments complaining of severe abdominal pain and vomiting, The Huffington Post reports. At first, the condition was rather mysterious, with no clear explanation; but when some patients reported having found relief from the symptoms by taking hot showers, it gave doctors a clue. The condition is known as cannabinoid hyperemesis syndrome, or CHS for short.

ER cases involving CHS have nearly doubled at two hospitals in Colorado since 2009, according to a new study. CHS cases have continued to increase since Colorado legalized the drug for adult recreational use in 2012. As you can probably imagine, it is an alarming trend being witnessed in other parts of the country, as well. While the cause of cannabinoid hyperemesis syndrome is not fully understood, the researchers have some theories:

“The science behind it is not clear,” Heard told the Denver Channel. “The most likely cause is that people using marijuana frequently and in high doses have changes in the receptors in their body, and those receptors become dysregulated in some way, and it starts causing pain.”

Many adults living in California may think that, because the drug is now legal, it is completely safe. That may be the case for some people, but this new research shows that there is a population that may be acutely affected by the drug. What’s more, the drug has been found to be habit forming and can lead to abuse. If you are struggling with cannabis, please contact Whiteside Manor for help.

Wednesday, December 14, 2016

NAS Impacts Rural America

Opioid abuse is affecting the lives of millions of Americans, and in many cases those people reside in rural America. One of the reasons rural Americans have arguably been impacted the most is the fact that addiction treatment services are limited in these parts of the country. Without access to help, people will continue to toil in their addiction indefinitely—potentially overdosing before they ever find help.

The lack of treatment centers in rural America means that some people who need help the most will go without. Some of those people have more than just their own health to worry about, particularly pregnant women. If you know anything about opioid addiction, it is likely that you are aware that addicts who run out of drugs are susceptible to withdrawal symptoms. The same holds true for babies exposed to opioids in utero, who are severed from the drugs the moment the umbilical cord is cut.

Babies whose mothers used opioids throughout the pregnancy are often born with a condition known as neonatal abstinence syndrome (NAS). There is a long list of symptoms that accompany the syndrome, the most serious of which include:
  • Tremors
  • Irritability (excessive crying)
  • Sleep problems
  • Seizures
Without close supervision, NAS can be deadly. It is vital that everything is done to provide treatment and recovery services to pregnant women with opioid use disorder. The problem is staggering in rural America, new research shows that the rate of NAS increased from 1.2 cases per 1,000 hospital births in 2004 to 7.5 cases per 1,000 births by 2013, Reuters reports. The study, published in JAMA, showed that cases of NAS in rural counties increased from 13 percent to 21 percent over the course of the research period.

“Prior to our study, we had limited data from a few states like West Virginia and Tennessee that showed rising rates of neonatal abstinence syndrome in some rural counties,” Villapiano said by email. “What we didn’t know was how the opioid crisis has affected rural moms and their infants across the country.”

If you are expecting a child and are addicted to opioids, please contact Whiteside Manor. Our female women’s drug rehab program appreciates that females with substance abuse disorders have unique rehabilitation needs and circumstances, including safety, security and pregnancy.