Possible Medicaid reduction worries those fighting crisis
By Ricardo Alonso-Zaldivar
The Associated Press
WASHINGTON — The Republican campaign to roll back Barack Obama’s health care law is colliding with America’s opioid epidemic. Medicaid cutbacks would hit hard in states deeply affected by the addiction crisis and struggling to turn the corner, according to state data and concerned lawmakers in both parties.
The central issue is that the House health care bill would phase out Obamacare’s expanded Medicaid, which allows states to provide federally backed insurance to low-income adults previously not eligible. Many people in that demographic are in their 20s and 30s and dealing with opioid addiction. Dollars from Washington have allowed states to boost their response to the crisis, paying for medication, counseling, therapy and other services.
According to data compiled by The Associated Press, Medicaid expansion accounted for 61 percent of total Medicaid spending on substance abuse treatment in Kentucky, 47 percent in West Virginia, 56 percent in Michigan, 59 percent in Maryland, and 31 percent in Rhode Island. In Ohio,the expansion accounted for 43 percent of Medicaid spending in 2016 on behavioral health, a category that includes mental health and substance abuse.
Those states accepted the Medicaid expansion and represent a cross-section of places hardest hit by the nation’s drug-overdose epidemic, which claimed more than 52,000 lives in 2015. Of the deaths, more than 6 in 10 were due to opioids, from prescription pain relievers like oxycodone to street drugs like heroin and an elephant tranquilizer.
Tracy Plouck, Ohio’sdirector of mental health and addiction services, said Medicaid expansion dollars from Washington have allowed her state to redirect its own resources to priorities like providing recovery housing after detox. Reversing that would have real consequences for people who are trying to straighten their out their lives, she said. “If you go back into an environment where people are using, that sets you up with a risk that’s nearly insurmountable.”
In Youngstown, factory mechanic Paul Wright credits sustained help from Medicaid with his survival after he nearly died from a heroin overdose. Wright said he had started using as a teenager but now has been drug-free for 18 months. Before Medicaid expanded, his father’s health insurance would pay for detox but not for longterm treatment. Wright would relapse. With Medicaid, he’s been able to get follow-up.
“It’s truly sad, but I’ve been to many funerals since I’ve been clean,” said Wright, who’s in his mid-20s. “I just think Medicaid — honestly — it saves people.”
2018 UFAM Rally
Thursday, May 17, 2018
Scott Masi announced the date for the 2018 UFAM Rally. Continue to Be the Voice of Change and mark your calendar today! #bethevoiceofchange #strengthinunity #2018UFAMRally
Over a two-year period more Americans died of opiate addiction than died in the entire Vietnam War.By David Brooks, Syndicated columnist
The health-care bill failed. The odds of successful tax reform are remote, and in any case an actual proposal is months away. If we lived in a normal country our president would use the current moment to try to get a win — to try to pass something that would help people, demonstrate that Washington can function and rebuild his brand.
If we lived in a normal country the Trump White House would launch a major initiative to combat opiate addiction. There are roughly 2.5 million Americans addicted to opioids. Between 1999 and 2015, the number of those who died rose from 8,200 annually to 33,000. That means that over two years more Americans died of opiate addiction than died in the entire Vietnam War.
As Christopher Caldwell pointed out in a powerful essay called “American Carnage” in First Things, the opioid crisis is killing at a higher rate than crack or any other recent plague. At the peak of the crack epidemic there were about two deaths per 100,000 Americans. Today, the opioid epidemic is killing 10.3 per 100,000. The national spotlight has been put on this crisis, but the situation is getting worse, not better. The Washington Post reported that in Stark County, Ohio, for example, the number of opioid-related deaths has increased by 20 percent in the past year. The county just asked the state to send over a cold storage trailer because the morgue is already full.
And the crisis is hitting exactly in those places where Trump voters live, especially struggling rural areas in Appalachia, the Upper Midwest, and the working-class areas of New England. That’s why Donald Trump was so vocal about it during the campaign. He promised he would give every sufferer “access to the care and the help that he or she needs.” He told one Ohio town hall, “We’re going to spend the money, we’re going to get that habit broken.”
It’s a challenging problem. In 12 states there are more opioid prescriptions than people. According to the Centers for Disease Control and Prevention, those who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.
As Caldwell writes: “If you take too much heroin, your breathing slows until you die. Unfortunately, the drug sets an addictive trap that is sinister and subtle. It provides a euphoria — a feeling of contentment, simplification and release — which users swear has no equal. Users quickly develop a tolerance. … The dosage required to attain the feeling the user originally experienced rises until it is higher than the dosage that will kill him.”
The most dangerous day for an addict is the day he’s released from some sort of custody. On this day the dosage that he handled comfortably two weeks before could cause his death.
To its credit, the Trump administration has launched a commission to see how the federal government can tackle this crisis. Trump already appears to support Obama administration spending levels on opioid addiction. But Trump could propose legislation fully funding the Comprehensive Addiction and Recovery Act. When that was passed, by overwhelming bipartisan majorities in 2016, the price tag was put at $1 billion. But only a portion of that has actually been appropriated.
Special focus could be put on adding treatment centers. According to a 2014 federal study, about 90 percent of those who met the criteria for a drug-abuse disorder don’t get treatment. Some live in counties where there are zero facilities.
Something like half of all sufferers drop out of treatment within a few months, so it might be worth thinking about involuntary commitment too. Sally Satel has been treating people addicted to heroin for a quarter century and writes for The Wall Street Journal: “I speak from long experience when I say that few heavy users can simply take a medication and embark on a path to recovery. It often requires a healthy dose of benign paternalism and, in some cases, involuntary care through civil commitment. Many families see such legal action as the only way to interrupt the self-destructive cycle in which their loved ones are caught.”
This isn’t just about painkillers run amok. Instant and slow-motion suicide by alcohol and a range of other drugs are rising at the same time. And these addictions and deaths are happening in the most socially and economically barren parts of the country.
An anti-opioid effort won’t be effective unless it’s part of a broader effort at social and economic reweaving, a set of efforts to either help people move out of rural, blighted communities or to find jobs and social networks while there.
Trump could talk about many other approaches — medical marijuana as a substitute for pain relief, holding pharmaceutical companies more accountable — but ultimately this is a disease that grows in despair.
Trump was elected out of that despair, and a big anti-opioid push would be a first and politically viable step toward attacking it.
© 2017, New York Times News Service David Brooks is a regular columnist for The New York Times.
Two segments discussing Narcan, the Opiate Overdose Reversal Medication, and current issues surrounding Marijuana.Promises to be a spirited discussion this morning on FOX 2 Let it Rip Weekend Edition at 9:30 AM Sunday, with 2017 UFAM Rally Speakers Judge Jodi Debbrecht Switalski & Scott Masi. Masi posted last night to his Facebook Page, “Always a spirited discussion. Looking forward to participating with my friend Jodi Debbrecht Switalski.”
The State of Michigan is throwing a haymaker in the fight against the opioid crisis. This latest move stems from legislation passed late last year to combat what has become an epidemic.
“This here is the overdose kit that we were distributing. The same stuff that we would be giving out at the pharmacy level.”
Now people with opioid addictions or their relatives will be able to by the overdose reversal drug, Naloxone or Narcan, over the counter.
Governor Rick Snyder approved a standing order from the Department of Health and Human Services allowing pharmacies to dispense the drug.
“I think it’s very important that it’s readily available so we can save lives,” said Dr. Shaun Jayakar of St. John Providence.
The move comes as the number of deaths caused by opioid overdoses continues to rise, and the drugs are getting stronger.
“One application of Nalaxone might not be the antidote like it used to be because of the continued potency, the continued synthetic component that is being put into and utilized in the heroin that is being distributed on the street,” said Scott Masi at the Brighton Center for Recovery.
Those buying Naloxone can get enough for one treatment – but there is no limit on refills.
Before the order, only law enforcement, first responders, and doctors would administer Nalaxone. That won’t be the case anymore.
“If you give this medication they become agitated, they can become restless, their heart can race so ideally it would be a medication prescribed by a doctor. However, with this epidemic of deaths due to overdoses, i think the benefits outweigh risks,” said Dr. Jayakar.
Those in need of the overdose reversal drug may experience sticker shock at their local pharmacy.
“The nasal spray is going to be around $150 without insurance. If your insurance covers it, it will just be your co-pay. It injectable, the really expensive one is going to be around $4,500 to $4,900,” said Ghada Abdullah at Park Pharmacy.
There’s another potential drawback – will a readily available fix to an opioid overdose encourage more abuse?
“I personally don’t believe that this is going to be something that someone’s going to take to a party and say, ‘Hey guys we can get high just because we have this Narcan’, I really doubt that’s going to happen,” said Abdullah. “It’s just going to help save someone’s life.”
Now pharmacies have to register with the Department of Health and Human Services to dispense Naloxone, and they have to keep track of who’s buying it and how much.
Thursday, May 25, 2017
LANSING, Mich. – Gov. Rick Snyder today authorized the Michigan Department of Health and Human Services to issue a standing order pre-authorizing the distribution of naloxone by pharmacists to eligible individuals.
“Naloxone is a tool in the fight against opioid addiction that can save lives immediately and we need to make sure all residents statewide have access, both in rural areas and urban centers,” Gov. Snyder said. “Our entire state has been affected by this horrible epidemic. I have said that state government will use all possible resources to reverse the course of the opioid crisis. This is one more action that demonstrates our full commitment to addressing the problem.”
Naloxone is a fast-acting medication that reverses opioid overdose. Pharmacies that obtain the standing order will be able to dispense naloxone to those at risk of an opioid-related overdose, as well as family members, friends, or other persons who may be able to assist a person at risk of an overdose. Currently, naloxone is only available to be administered by law enforcement or other first responders.
“As we continue our fight against opioid addiction, this order makes naloxone more accessible for those most likely to need it,” said Dr. Eden Wells, chief medical executive of MDHHS. “This is a vital step in reducing deaths related to opioid addiction in Michigan. By allowing for shorter response times in emergency situations, we can help save lives.”
States nationwide have experienced a dramatic increase in the number of opioid-related overdoses in recent years. In Michigan, the number of heroin-related overdose deaths increased from 1.1 per 100,000 residents in 2007 to 6.8 per 100,000 residents in 2015. Opioids, including heroin and prescription drugs, accounted for 473 deaths in 2007; in 2015, that number increased to 1,275.
As part of their final recommendations, Gov. Snyder’s Prescription Drug and Opioid Abuse Task Force found that naloxone is a safe and lifesaving drug that should be more accessible. In 2016, Public Act 383 was passed giving the chief medical executive authority to issue a standing order that does not identify a patient for the purpose of dispensing naloxone. To dispense naloxone under the standing order, pharmacies must register with MDHHS online at www.michigan.gov/naloxone.
When obtaining naloxone from a pharmacy, individuals will be provided with the steps for responding to an opioid overdose as well as important information about where to go for treatment services. Pharmacies will be required to keep track of the amount of naloxone dispensed and will report these numbers to MDHHS on a quarterly basis.
To learn more about drug treatment services available near you, visit www.michigan.gov/bhrecovery.Courtesy of: http://www.michigan.gov/snyder/0,4668,7-277–413050–,00.html