SAFETY NETS

On August 7, 2018, Rolling Stone reported that Demi Lovato was given Narcan (naloxone) by paramedics in response to a drug overdose after 6 years of sobriety.“I want to thank God for keeping me alive and well,” she said. Yes, God – He works through people and available medications. After 2 weeks in the hospital, she entered rehab. I imagine she has health insurance for hospital expenses and the rehab costs should be no question considering her career.

But how many other Americans battling addiction are not insured – or under-insured – or insured without mental health or rehab coverage, as our son was? And how many can afford the costs of detox, rehab, medications, and long-term recovery programs? Here are some average costs:
Outpatient detox: $1500
Inpatient rehab: 30 days, up to $30,000 / 60-90 days, up to $90,000 or more
Medication: Methadone $5,000 yr / Suboxone $200-600 mo
Sober Living Homes: $500-$2000 mo

Opioid addiction needs detox, rehab, medication, and then – as has been proven time and time again – at least a year of sober living and perhaps a lifetime of medication – along with a 12-step community. Where is a student or an unemployed or under-insured addict supposed to go when there are no safety nets in our society?

The New York Times August 8, 2018 article “Too Little Too Late: Bankruptcy Booms Among Older Americans” – another group for whom safety nets have disappeared. In a study from the Consumer Bankruptcy Project, “A three-decade shift of financial risk has occurred from government and employers to individuals – who are bearing an ever-greater responsibility for their own financial well-being as the social safety net shrinks…older Americans turn to what little is left – bankruptcy court.”

We, as a society, should be ashamed of this. Are we so independently minded and lacking in empathy that we cannot accept the need to collectively care for the weak among us – those in need – with social safety nets? In previous generations, families took care of their own – from birth until death. But as modern society has shifted from rural and communal to urban and individualistic, there is a need for we as a society to have safety nets in place.

Our daughter and family live in Australia. They are the beneficiaries of one of the best single-pay health systems in the world. When we tell friends about it, the response is, “They have socialized medicine, right? They can’t get medical care when they need it and people die on the streets.” As the conversation continues, we hear they are a socialist country and lack freedoms we enjoy. None of this is true. They enjoy a very good standard of living and pay higher taxes – taxes that provide a safety net for each and every citizen.

As the opioid epidemic continues to take the lives of so many, leaving families destroyed, we need to not only acknowledge that addiction is a disease that can be treated with medication, rehab, and community, but also fight for a health insurance system – a social safety net – that cares for Americans from birth through death.

 

Medication Assisted Treatment – Part 1

Medication Assisted Treatment, or MAT, is finally gaining acceptance as a response to drug addiction in the US––it is a cultural shift from the view that addiction is a “moral failure.” The Hazelden Betty Ford Foundation, one of the top drug treatment providers in the country, used to subscribe almost exclusively to the abstinence-only model, based on an interpretation of the 12 steps of Alcoholics Anonymous and Narcotics Anonymous popularized in American addiction treatment in the past several decades. But in 2012, they announced they would begin providing MAT. There are four opioid substitutes that are used for MAT in opioid addiction: methadone, buprenorphine, naloxone, and naltrexone. More on these in the next blog.

November 6, 2013, the New York Times did an extensive article discussing the development, use, and risks of opioid substitutes, in particular bupreorphine and the combination drug, Suboxone. The author explaining that “While addiction is considered a chronic, relapsing disease, experts believe that replacing illegal drugs with legal ones, needles with pills, or more dangerous opioids with safer ones reduces the harm to addicts and to society. Addicts develop a tolerance to its euphoric effects and describe themselves as normalized by it, their cravings satisfied. It also diminishes the effects of other opioids but, studies have shown, does not entirely block them, even at the highest recommended doses.”

In a Frontline report in 2016, one of the doctors who specializes in addiction medicine related that doctors are limited by the DEA to treat only 100 patients per year with Suboxone. The thought behind this law is that they don’t want it to be abused––and it can be abused, as a commodity sold on the street to ward of withdrawals or for those who cannot afford the cost of a doctor and the medication. Our family faced the dilemma of the high costs for the doctors visits and the Suboxone because they were not covered by our son’s health insurance. We made the decision for him to not use this option, all hoping that a sober living house and meetings would help him succeed in his desire for sobriety. He was dead from a heroin overdose 7 months later.

The physician on Frontline pointed out the contradiction––the contradiction that has frustrated me and my husband for years––that there is still no limit on how many oxycodone or other opioid prescriptions physicians can write—the very abuse of which is documented to be fueling the opiate epidemic and creating the need for Suboxone. I personally experienced this absurd mentality towards opiates when my oral surgeon sent me home with 60 Vicodin after a root canal––60. I used two. He is the same oral surgeon who did JL’s wisdom teeth extraction and gave him multiple prescriptions for Percocet two weeks before and two weeks after the surgery––which fueled his relapse on heroin and ultimately, his death. He should have his license revoked.

As of a 2017 report by SAMHSA (Substance Abuse and Mental Health Services Administration), physicians who have prescribed buprenorphine/Suboxone to 100 patients for at least one year can now apply to increase their patient limits to 275 under new federal regulations. It is good to see movement in the right direction and I hope there will be more progress soon, especially in terms of making medication options a covered public health care benefit available to addicts who want to get their lives back.