The Big News

In last night’s episode of The Weekly on FX, an investigative journalism series by the New York Times, Pulitzer Prize-winning reporter Barry Meier shined light on a confidential government memo that had the potential to change the course of the opioid crisis but was kept in the dark for more than a decade. According to the report, Purdue Pharma executives were implicated in the memo but the Department of Justice chose not to pursue felony charges against them and buried the memo, paving the way for a settlement that ended a four-year investigation but failed to change industry behavior. Producers found the people who testified at the Purdue settlement hearing in 2007 and recorded the words they spoke 12 years ago about losing their loved ones to overdose. On Twitter, Meier wrote, “It is devastating. … Today Purdue Pharma, the Sacklers, and other makers and distributors of opioids are facing a massive wave of lawsuits. Perhaps this time, the truth will come out.” Meier also published a new report checking back in with a nun, doctor and lawyer who were among the first in the country to sound an alarm to him two decades ago about the growing misuse of prescription opioids. He says their activism was crushed by Purdue Pharma but helped kindle the national awareness that has led to the legal actions now awaiting resolution. Meier adds that their continued work with people who have addiction “illustrates the national failure to contain an epidemic that not only continues but also has grown more complex.”

In related news, another new analysis of the DEA database recently obtained by the Washington Post reveals that a relatively small number of pharmacies—15 percent—distributed roughly half of the prescription opioids nationwide from 2006 to 2012. Apparently, the DEA wasn’t paying attention to its own data, instead relying on drug companies and pharmacies to police themselves. In one particularly engaging multimedia story, the Post took a close look at a southwestern Virginia area that was flooded with 74 million opioid pills over seven years—enough for 106 pills per resident every year. Journalists from over 30 states have now published more than 90 articles based on the previously undisclosed DEA data. For example, our Joseph Lee, M.D., joined one of the Post’s data analysts on an hour-long public radio program that aired last week in Minnesota.

Congress has been on recess this month and will remain out of session until after Labor Day, which also will mark the beginning of National Recovery Month.  Hope everyone is planning Recovery Month activities!

Even with lawmakers back in their home districts, important news continues to come out of Washington. One big development is a new recommendation from the U.S. Preventive Services Task Force, an influential group of experts convened and supported by the Department of Health and Human Services. After declining to do so a decade ago, the task force is now recommending that doctors screen all adults for use of illegal drugs, saying the evidence for doing so has grown ample. Screenings for tobacco and alcohol use are relatively common (though sometimes superficially executed). This recommendation is to also screen for illegal substance use, including nonmedical prescription drug use and marijuana use. It’s true that education for primary care providers is woefully light on substance use disorders, how to elicit honest answers from patients about their substance use, and how to respond, but expanding provider-patient conversations to cover all substances is an important step in the decades-long effort to get mainstream medicine more engaged in addressing addiction. Asking about illicit drug use (if done with compassion and without judgment) can help reduce stigma and facilitate the initiation of appropriate care. This is also the kind of change—though non-binding—that can shine light within the grassroots medical community on its own educational needs and the importance of proactively coordinating and integrating care with specialty treatment providers. Currently in draft form, the new recommendation from the USPSTF is posted for public comment through Sept. 9. After the task force reviews comments, it will issue a final recommendation. As a heads up, we will be publishing a new Emerging Drug Trends report soon that will also make the case for the routine screening of adolescents, which is the typical age of onset for substance use disorders. So, please stay tuned for that.

In other agency news, we’re expecting a SAMHSA proposal soon regarding changes to 42 CFR Part 2, the law that governs addiction treatment records. For more on that topic, see the Health Care and Parity section below.

And, tomorrow, watch for the latest 2018 data findings from SAMHSA’s National Survey on Drug Use and Health, which is used widely to support prevention and treatment programs, monitor substance use trends, estimate the need for treatment and inform public policy. SAMHSA, by the way, has proposed changes for next year’s NSDUH, including new survey questions related to vaping, synthetic marijuana, synthetic stimulants, marijuana withdrawal symptoms, and more.

This week’s featured media is a recent episode of the MomEnough podcast, with mother-daughter co-hosts Marti & Erin Erickson talking to our colleague Helene Photias about helping young children whose family is affected by addiction. Helene is director of operations for Hazelden Betty Ford’s Children’s Program, which recently expanded to Minnesota. If you’re in the state on Wednesday, join us for an open house at our Plymouth site!

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Treatment Industry Issues and Reforms

At the National Conference on Addiction Disorders East in Baltimore this past weekend, experts discussed how better outcomes data will drive a transition to value-based reimbursement models. Interestingly, according to the report above, the chief psychiatric officer for Aetna said addiction treatment and mental health providers are not far behind the rest of medical care in terms of value-based contracting. Another panel at the conference focused specifically on trends toward more effective and standardized measurement and evaluation of outcomes. Learn more →

In this Q&A, a telehealth policy expert discusses the promise and obstacles of using technology in everyday healthcare to expand services to underserved populations.

Cannabis

The third annual “Lessons Learned Report” from our friends at Smart Approaches to Marijuana is a comprehensive study of the data outcomes in ‘legalized’ marijuana states and should serve as an eye-opener for lawmakers and help slow the rush to legalize. The report looks at impacts on youth and schools, mental health, social justice, hospital and ED visits, the “black market,” crime (including drugged driving), and the workforce. Learn more →

We, along with the American Medical Association, received a recent plea from a member of Marijuana Anonymous, who is frustrated that doctors don’t seem to understand the risks of marijuana use for people who have substance use disorders or are vulnerable to them. She writes:

“A member shared today on a phone meeting that, as a terminally ill patient, he has been encouraged by three physicians to consume marijuana. … He has disclosed his problem with drugs and alcohol. It is really sad. He is seriously distressed by this, and was crying, as he really wants to be sober. This is actually quite common in the recovery rooms—physicians, therapists, marriage counselors again and again are suggesting marijuana to people with addiction problems. … More than anything, I think the medical community needs education as legalization expands. … The ignorance is astounding. … Weed is not harmless, and right now, the misinformation is at a peak. It is akin to when physicians prescribed tobacco for weight loss, with the way they give the worst advice possible to people struggling with addiction. Please, I am really asking sincerely for your help.”

We appreciate the letter and will continue to do our part to educate the public and professionals about addiction, recovery and the risks and costs of expanded marijuana use. We hope the AMA does, too. Our Chief Medical Officer Marvin D. Seppala, M.D., also wrote a noteworthy doctor’s opinion for Marijuana Anonymous addressing this topic.

A New England restaurant chain named Legal Sea Foods is hitching its wagon to the perceived popularity of marijuana legalization with a cheeky TV ad campaign that begins today at 4:20 p.m., incorporating virtually every pot cliché possible.

A new JAMA article says insufficient evidence exists for the use of medical cannabis for most conditions for which its use is advocated.

Just like cigarettes, e-cigarettes increase your risk of using marijuana, new research suggests.

In Philadelphia, racial disparities that existed prior to the decriminalization of marijuana remain, even if cops are now reaching for a ticketbook instead of handcuffs.

Former U.S. Rep. Patrick J. Kennedy urges New Mexico policymakers to stick to their guns and continue to reject the commercialization of marijuana.

How disappointing to see a Portland City Commissioner lecture a parent who doesn’t want a cannabis dispensary next to his daughter’s kindergarten. That is today’s reefer madness.

A new study finds that adults who mix cannabis with opioids for pain report higher anxiety and depression.

Marijuana legalization isn’t reducing alcohol sales.

A Canadian columnist calls marijuana legalization a “public-health disaster.”

More on the concerning rise in pot smoking among pregnant women.

CBD marketing looks more like snake-oil scams.

A new study found a 27% increase in children and teenagers getting emergency treatment for marijuana toxicity, and 70% of the cases occurred in states with legalized marijuana.

Massachusetts Gov. Charlie Baker is kicking off a campaign to make people aware of the danger of impaired driving, particularly driving under the influence of marijuana. He’s also working to add more “drug recognition experts” to the public safety force, a plan some say risks punishing innocent people.

Here’s the latest attempt at a marijuana breathalyzer.

Opioids

Some pharmacies appear to be a barrier to buprenorphine access. Learn more →

Federal prosecutors served Indivior with another indictment last week, accusing the company of assuring doctors and health programs that the packaging of its Suboxone Film would prevent diversion of the drug or exposure to kids, despite being told by the FDA that it would not.

For the first time, the California attorney general has charged a physician with murder for overprescribing opioids.

“Death, drugs and money. That’s why we’re here,” the prosecutor said as a trial opened for a Utah man accused in a major opioid ring.

An Ohio legislator says he introduced a bill to legalize kratom so that he could spur discussion about it.

In Michigan, surgeons reduced by nearly one-third the number of pills they prescribed patients, with no reported drop in patient satisfaction or increase in reported pain, according to new research.

A 14-year-old Canadian boy died of overdose while others appallingly laughed instead of helping.

Alcohol

A new study found that drinkers who also use cannabis drink more than those who don’t use marijuana. Learn more →

An even goofier term than sober curious: healthy hedonism.

Here’s a sign of progress: a university in Scotland is shutting down its student-union bar because students prefer coffee.

Mothers who drink moderate to high levels of alcohol during pregnancy may be changing their babies' DNA, according to a new study.

United Airlines pilots now must take their final sip of alcohol 12 hours before their pre-departure duty period begins, rather than eight. That policy change follows recent drinking-related pilot arrests. Here’s what happens when a pilot is arrested for drinking on the job.

Health Care Reform and Parity Four addiction treatment facilities have filed a federal lawsuit against Blue Cross Blue Shield of Michigan, claiming the insurer unjustifiably began denying a high number of claims and slashing payment rates for out-of-network residential treatment. Learn more →

After narrowly falling short in last year’s Congressional session, the push to align 42 CFR Part 2, the law regulating addiction treatment records, with HIPAA, the law governing all other health records, is gaining momentum again. Last week, we noted that almost 40 attorneys general sent a letter urging lawmakers to align the two laws. Meanwhile, HHS is expected to propose some related changes within its purview soon. This story explains one of many reasons for reform—to help ensure that doctors don’t inadvertently prescribe inappropriate, contra-indicated medications. Keeping addiction treatment records separate from other health records—with different rules, processes and workflows for managing them—also poses barriers to e-prescribing and other modern advances in care, coordination of care between providers and with payers, and research. In addition, some providers who would like to promote themselves as a resource for addiction treatments, including medications like buprenorphine, avoid it because implementing a separate system to manage those patient records is prohibitive. As a result, people with substance use disorders have fewer options and get something less than the best possible care and service, which is why we see it as a parity issue.

(cont.) Some are leery of allowing HIPAA to govern addiction treatment records as it does all other records (including those for many other stigmatized conditions, i.e. HIV, psychosis, etc.). They are worried about database breaches, healthcare employees who are willing to unlawfully disclose patient data, and any illegal discrimination that could result. We are as concerned as anyone about discrimination against patients and former patients—having advocated for them for seven decades and counting—but have not found that 42 CFR Part 2 is a solution to discrimination. Everything illegal under Part 2 and existing discrimination laws would still be illegal if Part 2 is aligned with HIPAA as proposed. In fact, the bill before Congress would strengthen anti-discrimination laws and significantly enhance penalties for any breach of a patient’s substance use record. Furthermore, any sharing of addiction treatment records that is not necessary and appropriate would remain illegal under HIPAA.

(cont.) The Veterans Administration already decided a couple of years ago to align its standards with HIPAA, and—not surprisingly—we’ve seen no reports of increased discrimination among that population. In addition, records from most for-profit addiction treatment centers, unlike those from nonprofits, have never been subject to 42 CFR Part 2; HIPAA is already their standard and, again, we’ve seen no reports of more prevalent discrimination among their patients. Yes, discrimination happens; here, in fact, is an example reported this past week. That’s why HIPAA and our anti-discrimination laws need to be strenuously enforced. But Part 2 didn’t prevent the discrimination above. Nor would that situation be any different in the absence of Part 2. The 1970s-era law is not a solution in a health care world now governed by HIPAA, designed around it, and advancing rapidly under that framework. Part 2 has instead become a barrier. Meanwhile, the VA and for-profit sector provide strong evidence that aligning Part 2 with HIPAA will not result in the problems some fear.

(cont.) With privacy now an expectation for all health care records through HIPAA, anti-discrimination laws poised to grow stronger, and Part 2 requirements butting up against modern advances in care, our public policy should no longer suggest that an appropriate solution to discrimination is for patients to consider compromising their own care. In today’s context, that itself is discriminatory. We would not propose such a stigma-perpetuating policy for any other population facing injustice. It’s time to align Part 2 with HIPAA. People with addiction deserve no less than all of the benefits of modern medicine and integrated care.

In other news, the American Medical Association is no longer opposed to the concept of a single-payer healthcare system such as “Medicare for All” and instead wants to study all options.

CMS announced it will now require Affordable Care Act plans offered through a Health Insurance Exchange to display their quality star ratings on HealthCare.gov and the state-based exchange websites.

Advocate Spotlight Had a nice chat Friday with Henry Abraham, a recovery advocate and author in Chicago. I share to highlight how much we enjoy hearing from people around the country about advocacy efforts, and to invite others to reach out similarly.

Interestingly, I discovered Abraham (as he goes by) is among those who have been featured on a website we like and have shared here before: the Online Museum of African American Addictions, Treatment and Recovery. Check out his September 2017 story on the site’s Story of the Month page. Learn more →

On the 50th anniversary of Woodstock, an advocate reflects on his journey from there to being “struck sober” 25 years later to an ever-growing gratitude for the gifts of his recovery lifestyle today.

Our annual sober music festival, hazelfest, was highlighted in a nice public radio conversation about musicians navigating sobriety.

Kelly Osbourne celebrated two years of sobriety.

Sober living options are expanding in Rochester, Minn., thanks to the recovery community organization Recovery is Happening.

An inspiring 69-year-old powerlifter in Philadelphia has overcome addiction, blindness, cancer, homelessness and the loss of his daughter to be a champion.

Nancy Mitchell, poet laureate of Salisbury, Md., has loved ones in recovery and, in this interview with our friend Perry Gaidurgis, says she is writing to teach, explore and heal.

Miscellaneous Musings

Interesting column in the New York Times about the medical myths that may be at the root of racial disparities in health care. Learn more →

• The first two episodes of Addiction Unplugged, a new series on A&E, aired Saturday and can now be viewed online.

• The CDC is investigating lung illnesses related to vaping and e-cigarette use.

• Juul may have taken some kid-targeted vaping products off the market, but Juul-alikes have stepped in to fill the void.

• The FCC plans to move forward with establishing a three-digit number, likely 9-8-8, to reach the National Suicide Prevention Lifeline.

• King County, home to Seattle, is investing a lot in an effort to get addiction treatment to homeless people.

• A law professor says it’s not drug crime that drives mass incarceration, but violence.

• There is only one psychiatrist in eastern Montana — the state with the highest suicide rate in the country, a stark example of the dire state of mental health care throughout the country.

• The FDA wants to add some particularly graphic images to cigarette packages to discourage use.

• The addiction doctor who made history as the first blind person to graduate from medical school in 1976 was honored this past weekend with the National Conference on Addiction Disorders Champion Award.

• Our colleague Jim Cowser and Nebraska state Sen. Sara Howard will present on addiction, recovery and mental health in the workplace at the Panhandle Safety Wellness Conference in Gering, Neb.

• A couple of dates we noted this week … Aug. 15, the 6^th anniversary of The Anonymous People’s official release in limited theaters; the film helped inspire recovery advocacy around the country … and Aug. 17, the 66^th anniversary of the first organizational meeting in Sun Valley, Calif., of what would become Narcotics Anonymous.

• In his latest blog post, William White reflects on all that binds us as people in recovery, the importance of honoring and remembering recovery ancestors and the idea of passing the torch. Also, White posted an excellent excerpt from his book, Recovery Rising, entitled: What Cancer Taught Me about Addiction Treatment—capturing a vision of what treatment could look like if it were treated on par with cancer and other chronic primary health conditions.

• Trivia question: Where are the Hazelden Pittman Archives located? Send me the answer and win a fancy advocacy pen!

• What else do you think? Send me a note, thank you for reading, and have a great week!

• (NOTE: Photo in the Health Care Reform and Parity section created by rawpixel.com - www.freepik.com.)