Foster care system struggles to keep pace with opioid epidemic – Dayton OH

As the opioid crisis spread across the Miami Valley, it took a tragic toll on many of the region’s youngest residents — forcing more children into foster care and exposing many to severe trauma.

County agencies have struggled to recruit and train enough foster parents, at times sending children from Montgomery County to homes as far away as Arkansas and Missouri. Taxpayer costs have risen as the children required longer stays in foster or group homes, and needed more intensive care.

The Dayton Daily News’ Path Forward project is seeking solutions to the region’s biggest challenges, including how we recover from the opioid crisis. This story digs into how children have been hurt and examines potential solutions to make sure we don’t lose a generation of kids to addiction.

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By Katie Wedell, Staff Writer

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Addiction professionals urge employers to work with people in recovery

With the workforce small and the number of people in recovery on the rise, people who treat and coach substance abusers say the time has come for hiring managers to see people in recovery as an opportunity and not a threat.

There is fear on both sides, says Marc Burrows, program manager for Challenges Inc., an addiction outreach service. Employers are worried about liability and employees “are terrified” of being found out, he said.

“In most cases, people in recovery are too scared to inform their employer of their addiction. Rightfully so, due to the stigma and discrimination that often exists,” Burrows said. “People in recovery might think that their employer would see them as a liability.”

But according Rich Jones of FAVOR Greenville, it may be at least as risky to hire someone with no apparent history of drug abuse and recovery.

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Two crises in one: As drug use rises, so does syphilis

Public health officials grappling with record-high syphilis rates around the nation have pinpointed what appears to be a major risk factor: drug use.

“Two major public health issues are colliding,” said Dr. Sarah Kidd, a medical officer at the Centers for Disease Control and Prevention and lead author of a report issued Thursday on the link between drugs and syphilis.

The CDC study shows a large intersection between drug use and syphilis among women and heterosexual men. In those groups, reported use of methamphetamine, heroin and other injection drugs more than doubled from 2013 to 2017.

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Many Addiction Centers Lack Anti-Opioid Meds: Study

Although the U.S. opioid epidemic dates back more than a decade, only 6 percent of treatment centers in 2016 offered the three medications approved to treat opioid addiction, new research reveals.

And only about a third offered even one of the three recommended drugs, the study found.

“The country is dealing with an opioid overdose death epidemic,” said study lead author Dr. Ramin Mojtabai, a professor of mental health at the Johns Hopkins School of Public Health in Baltimore.

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By Alan Mozes
HealthDay Reporter

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Health plans don’t want patients on opioids. So what are they doing for pain?

The national effort to curb the opioid crisis faces another big potential obstacle — insurers who won’t pay for less-addictive ways to control patients’ pain.

Patients seeking other pain treatment options often find that their insurers won’t foot the bill or are forcing them to jump through maddening hoops to get coverage. Experts in and out of government worry that this will make it more difficult to reverse the deadly opioid crisis that killed more than 47,000 people nationwide in 2017, even as doctors cut back on opioid prescribing and state and federal governments step up efforts to prevent and treat addiction.

“The epidemic isn’t just about how easy opioids have been to come by. It’s also about how hard it is to access alternatives,” said Caleb Alexander, co-director of Johns Hopkins University’s Center for Drug Safety and Effectiveness. “No one ever died of an overdose of physical therapy.”

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Opioid Prescribing Trends and the Physician’s Role in Responding to the Public Health Crisis

The opioid overdose epidemic affects millions of Americans and their families. Nationwide polls reveal that 49% of respondents personally know someone who is or has been addicted to prescription opioid medication. In 2017, more than 49 000 people died in the United States of opioid overdoses, according to preliminary data from the Centers for Disease Control and Prevention (CDC). This crisis has spanned different phases, beginning with increased overdose deaths from prescription opioids, which then evolved to increased heroin overdose deaths, and most recently manifesting as a dramatic spike in overdose deaths from illicitly manufactured fentanyl and fentanyl analogs.

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The Public Is Angry About the Opioid Crisis. We Need to Listen.

Chris McGreal, a veteran reporter for the Guardian, explores in his recent book American Overdose: The Opioid Tragedy in Three Acts how many Americans have been left feeling enraged by the people who caused the ongoing opioid crisis.

“They’re very angry at what they consider betrayal,” McGreal tells TIME. “Betrayal by the medical profession for having given them these drugs without the warnings of what might follow. Anger at the companies that marketed them. Anger at the government for ignoring them for a very long time whilst their communities were devastated.” The list continues of institutions that either didn’t appreciate the impact that opioids were having on American society, or didn’t act soon enough as the problem emerged.

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Women’s hormones play role in drug addiction, higher relapse rates

Women’s hormonal cycles may not only make them more prone to drug addiction but also more affected by triggers that lead to relapse, a new Vanderbilt University study revealed. The findings are especially significant since there are virtually no addiction studies in women that account for these cycles.

Erin Calipari, an assistant professor of pharmacology in the Vanderbilt Center for Addiction Research, points out that women represent a particularly vulnerable population, with higher rates of addiction following exposure to drugs, but addiction studies have primarily focused on the mechanisms underlying these effects in men. Her study found that, when fertility-related hormone levels are high, females learn faster, make stronger associations to cues in their environment and are more prone to seek rewards.

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The Importance Of Patient-Centric Opioid Prescribing Guidelines

In light of an opioid crisis that has claimed tens of thousands of lives, health authorities and regulators have attempted to reduce the number of opioids prescribed to patients by forced tapering or the institution of quotas. While the U.S. Centers for Disease Control and Prevention (CDC) advocates tapering and, in some cases, discontinuing opioids in patients who have used using them as long-term therapy for non-malignant chronic pain, it purposely designed its guideline as non-mandatory. However, a number of legislators, pharmacies, and payers have perhaps misinterpreted the recommendations and turned them into compulsory limits and quotas. In certain instances, mandatory opioid tapers may do more harm than good, medical experts warn in a letter published in the journal Pain Medicine. The letter states that “rapid forced tapering can destabilize patients, lead to a worsening of pain, precipitate severe opioid withdrawal symptoms and cause a profound loss of function.”

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In Ohio’s fight against the opioid epidemic, coverage for all aspects of addiction treatment is key: Author: Shawn A. Ryan (Opinion)

CINCINNATI — Ohio’s fight against the opioid overdose epidemic has been more of a marathon than a sprint. In our state’s race to save lives, there have been many signs of progress — from the influx of federal dollars going to state and local treatment programs to serious efforts to further incorporate evidence-based substance-use treatment into the state Medicaid program. Preliminary opioid death numbers for 2018 track reductions in Cleveland, Dayton and many other big cities as well as other parts of the state, marking a trend from last year when the number of prescription opioid overdose deaths reached an eight-year low. Unfortunately, in 2017, the overall deaths attributed to opioids hit an all-time high as well.

But for all the critical ground it’s made, Ohio – like the rest of the nation – still has significant room for improvement in a key area that can make all the difference for patients and families: comprehensive insurance coverage for evidence-based addiction treatment.

According to the Substance Abuse and Mental Health Services Administration, only about one in ten individuals with a substance use disorder receives treatment. Even fewer receive medication-assisted treatment (MAT), which has emerged as one of the most effective ways to treat individuals with opioid use disorder and has been proven to reduce relapse and overdose deaths. MAT works by combining counseling support and behavioral therapies with the appropriate administration of FDA-approved medications meant to help patients cope with withdrawal symptoms and cravings.

Policymakers in Ohio and across the country have begun to recognize MAT as an important tool in treating addiction – and recent efforts to integrate these elements into our state Medicaid program are an important step toward widespread adoption.

There are still many barriers to overcome. One of the most significant is the fact that the current financing structure for outpatient treatment is insufficient in many ways – especially in regard to office-based opioid treatment. The fee-for-service model, which is most commonly used by insurers to pay for addiction services, does not necessarily incentivize coordinated care and in many cases is insufficient to support the resources required to identify, diagnose, and develop a treatment plan for opioid use disorder. As a result, treatment is often segregated and coordination among providers is sometimes nonexistent.

In April, the American Society of Addiction Medicine and the American Medical Association announced an innovative alternative payment model that could revolutionize how opioid use disorder treatment is delivered and covered by insurers. The Patient-Centered Opioid Addiction Treatment (P-COAT) model is explicitly designed to integrate and provide comprehensive insurance coverage for the medical, psychological, and social support aspects of addiction treatment in a way that encourages quality care while also reducing expensive emergency department visits and hospitalizations.

P-COAT would provide physicians and health professionals with the structure they need to effectively treat patients with opioid use disorder and require that the treatment delivered is consistent with national standards and known best practices.

Patients treated by a provider who uses the P-COAT model can expect to receive three types of outpatient services: office-based MAT, outpatient psychological counseling/therapy, and appropriate care coordination and social support. The model allows for collaboration between providers to deliver the full range of care.

Most importantly, P-COAT’s development was guided by a wealth of research showing that evidence-based MAT, when combined with appropriate medical and psychosocial support, is the most effective means of treating individuals with opioid use disorder. According to the latest research, health care costs were cut by more than half (to $13,500 from $31,000) for patients who received a combination of MAT and psychosocial support services compared to those who received no treatment – in part by reducing expensive emergency room visits. The model and its cost-savings potential should be welcome news for state officials tasked with ensuring federal dollars go as far as possible to save lives.

With the proper tools and resources, it is possible to achieve a future where all Americans have access to evidence-based addiction treatment. P-COAT brings us one step closer to that goal.

Dr. Shawn A. Ryan, a member of Gov. Mike DeWine’s RecoveryOhio Advisory Council, is the immediate past president of the Ohio Society of Addiction Medicine and chaired the American Medical Association-American Society of Addiction Medicine alternative payment model working group. He is also the president and chief medical officer of BrightView Health, an outpatient addiction treatment organization with sites throughout Ohio.

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