The Big News

As we head toward the holidays and a week off from the Advocacy Update, we begin by expressing gratitude to all of you. Thanks for reading, passing this along to others, and sending tips, ideas, thoughts, photos and notes of all kinds. Thanks especially for the advocacy you do in your communities.

Now, on to the Big News …

One might think parity compliance would just continue to get better over time, as: 1) insurance companies dialed in fair criteria for approving coverage for substance use and mental health disorder treatment; 2) regulators got more attuned to enforcing the Mental Health Parity and Addiction Equity Act of 2008, which requires fairness; and 3) consumers sued over violations. But a new study looking at claims data from 2016 and 2017 outlines just the opposite, finding widening disparities of coverage between physical health and substance use disorders and mental health. Our trade association is requesting Congressional hearings to examine this disappointing inequity, which is also reflected in a new investigative piece by Vox about “how health insurance companies helped make addiction treatment expensive and ineffective.”

In a difficult story to read, the New York Times looks at the challenge of deciding when parents should get their kids back after being separated because of substance use.

You likely heard about South Dakota’s new public health campaign: “Meth. We’re on it.” The provocative double-entendre raised eyebrows and drew ridicule, eliciting a biting editorial from the state’s largest newspaper. Others, including the governor, highlighted the campaign’s success in raising awareness and creating conversation. A smart column in the state’s second largest newspaper said, “We’re paying attention, and our attention span is brief. A quick script flip with actual, actionable, steps for engagement, is an important way to follow a provocative message and keep people not just talking, but doing.” No one flipped the script faster than SoDak Supply Co., which already has a line of products out, with the slogan, “Meth. Let’s Treat It.”

Our own Dr. Joseph Lee talked last week about the the mainstreaming of meth. As the drug continues to get more attention from policymakers, it will be important to remind them that the majority of people who struggle with addiction use multiple substances, and encourage solutions that address all addiction—not just one specific drug.

Big changes may be ahead for the Addiction Policy Forum, which is losing its multimillion-dollar financial backer, PhRMA.

Presidential candidates sparred over marijuana and health care, among other issues, at the fifth Democratic primary debate.

The American Medical Association is calling for “a ban on all vaping products not approved by the FDA,” and the American Academy of Addiction Psychiatry is now recommending that Americans “cease using all vaping devices until … investigations determine … which, if any, vaping devices may be considered safe.”

The CDC now has confirmed 2,290 cases of the vaping-related EVALI lung injury, with 49 deaths. And now there are reports of another type of injury—popcorn lung. But those are hardly the only concerns.

A New York Times report took a deep dive into how e-cig company Juul hooked a new generation on nicotine, just as more states filed lawsuits alleging the company targeted young people with deceptive marketing and Massachusetts lawmakers voted to ban all flavored tobacco products and tax vaping devices. Some worry public health advocates are overreacting to vaping concerns, pointing to it as a safer alternative than combustible cigarettes. That is far from confirmed, though. While combustible cigarettes contain more contaminants, the biggest harm comes from nicotine being so addictive, leading to years of exposure. E-cigarettes are even more addictive, packing a far bigger nicotine punch, and because they’re so new, we know little about the long-term health impacts. Given that—as well as early studies suggesting that vaping may actually lead young people to begin smoking cigarettes—it can’t be assumed that vaping is a healthy, or healthier, strategy for anyone. For those who wish to quit smoking, it’s safer to stick with evidence-based recommendations.

This week’s featured media are from a White House roundtable on the teen vaping epidemic. Various interest groups offered the President contradictory opinions in an interesting discussion that was robust and, at times, heated. The President’s conclusions remain to be seen. He had previously retreated from his September announcement to ban the sales of flavored e-cigarettes, instead calling it a “suggestion” and warning that a full flavor ban could lead to an increase in illegal sales. He did voice support for legislation to raise the legal age to purchase vaping and tobacco products from 18 to 21. In this NBC report, watch a clip from the meeting plus a clip from pro-vaping demonstrations outside. CSPAN captured the full roundtable.

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Treatment Industry Issues and Reforms

A new research brief explains why our industry needs to change the language we use to describe people with substance use issues. Learn more →

Our trade association, NAATP, delivered to all members of Congress its recently released Addiction Treatment Provider Quality Assurance Guidebook: A Guide to the Core Competencies for the Delivery of Addiction Treatment Services.

A reporter in Southern California asks: “If somebody dies, even in drug rehab, shouldn’t it be a potential crime?” Interesting read. Certainly, some facilities are negligent and everything possible must be done to prevent deaths at every facility. At the same time, is this a question that would get asked about hospitals? There’s a balance to be struck here, and it once again highlights the need for more robust and consistent quality standards in our industry.

Neighborhood health centers like this one in Detroit are a vital part of recovery-oriented systems of care.

Cannabis

The U.S. government is barring federal dollars meant for opioid addiction treatment from being used on medical marijuana, arguing there is scant evidence to support the use of marijuana in the treatment of opioid use disorder but robust evidence for other treatments. We have argued the same and recently published a review of research showing that marijuana use actually puts an individual at heightened risk for misuse of opioids and other substances. Learn more →

Canada's Canopy Growth Corp. is the world’s largest marijuana company. Founded in 2013 and now worth about $6.4 billion, it is at the forefront an industry that appears to be following a familiar playbook. As one doctor predicted: “deny addiction potential, downplay known adverse health effects, create as large a market as possible as quickly as possible, and protect that market through lobbying, campaign contributions, and other advocacy efforts.” Marijuana companies, like those in the alcohol and tobacco industries, get 75 percent of their revenue from daily and near-daily users and therefore have an incentive to create more potent and more addictive products. Says the doctor: “Honestly, at what point do we say, ‘We’re not going to allow people to get rich on the health of other people?’ ” How about now?

The U.S. House Judiciary Committee last week endorsed the Marijuana Opportunity Reinvestment and Expungement Act, a bill to federally legalize, commercialize, and tax the use of marijuana. It now heads to the full House, where its fate is uncertain. Either way, it appears to be a nonstarter in the Senate. The bill would remove marijuana from the list of federally controlled substances, require federal courts to expunge prior convictions for marijuana offenses, and authorize a 5% tax on marijuana sales to establish a fund to help minority communities enter the cannabis business. Our friend Kevin Sabet at Smart Approaches to Marijuana said, “Dealing with social justice concerns is possible without greenlighting the industry” and “encouraging marijuana use in disadvantaged communities is in fact a social injustice.”

New Jersey legislators have abandoned a push to legalize marijuana during their 'lame duck' session and instead will let voters decide at the ballot.

Massachusetts has its first unionized marijuana company.

Rhode Island’s governor says she’ll take another shot at legalizing marijuana in 2020.

The FDA’s Amy Abernethy answers for the growing anger among companies and consumer advocates over her agency’s slow pace for figuring out how to regulate CBD.

A specific gene associated with autism appears to undergo changes in the sperm of men who use marijuana and could potentially be passed along to offspring, according to new Duke research.

Chicago’s mayor wants people to understand how to use weed safely.

Opioids U.S. Surgeon General Jerome Adams says you’re now more likely to have to administer naloxone than CPR. Learn more →

A new investigative piece by ProPublica looks inside Purdue Pharma’s media playbook, describing how the OxyContin maker delayed the reckoning for its role in the opioid crisis by funding think tanks, placing friendly experts on leading outlets, and deterring or challenging negative coverage.

In Pennsylvania, folks are still fighting, sadly, about buprenorphine.

In an Oklahoma opioid lawsuit, a judge reduced the amount Johnson & Johnson owes by $107 million. The state attorney general is appealing the final $465 million order, saying it’s not enough to cover the actual costs of the opioid crisis.

A large retrospective study found cautionary data on rapid opioid tapering.

This may be intuitive to some, but the American Academy of Sleep Medicine says doctors need to be more aware of sleep-disordered breathing that may result from chronic opioid therapy.

A linguist reflects on the origin of the words opium and heroin, among others.

Alcohol

Planning a vacation? So, apparently, are a new wave of sober tourists. Learn more →

It’s been nice to see more celebrities talking openly about recovery. Helps make up for these celebrity-branded spirits and wines.

A new study strengthens the evidence for a relationship between anxiety and later alcohol use.

Could ketamine help people overcome alcohol use disorder?

New experiments into binge drinking may shed light on what eventually leads to continued drinking despite negative consequences.

In the UK, twice as many Baby Boomer men as Millenian men are being admitted to hospitals for alcohol-related conditions.

Interesting paper on how binge drinking affects the developing brain, and another on the mechanisms through which chronic alcohol consumption contributes to the development of various types of liver damage.

Health Care Reform and Parity

Hazelden Betty Ford is supporting a new bipartisan bill introduced by U.S. Sens. Smith and Barrasso to recruit and retain more rural health care providers. Learn more →

Insurers have jumped back into the ACA market, or expanded their footprint, after cutting back on plan offerings for 2018. This year, there are more plan offerings for 2020 and premiums, or premium increases, are lower than in past years.

Great read on a 'Street Medicine' model Mercy Care has deployed in Atlanta. It's a mobile health clinic model that provides healthcare services like flu shots for homeless residents in Atlanta. Mercy Care spends roughly $900,000 on the model each year to treat around 300 people each year.

A nice, quick synopsis on four health care trends: aging, value-based care, consumerism, and provider shortages. And some predictions for 2020.

Google defends the partnership that has raised privacy concerns, explaining what they are trying to accomplish.

Advocate Spotlight (This item was inadvertently truncated last week so we’re including again …) If you’ve ever shared your recovery story or other intimate details of your personal life publicly, you probably remember the first time. It’s not easy, but it’s so worth it.

Lindsey Kromer recounts her first experience as a recovery advocate here and the role of the supportive “She Recovers” community. Ultimately, she says, telling her story was “exactly what I needed … and what I now consider the missing piece in my own recovery journey.” Learn More →

A former Notre Dame football player sidelined by addiction is back on campus and thriving in recovery as he completes his degree. His inspiring story also caught the attention of the Chicago Tribune.

A Wall Street Journal obituary highlights PR executive James Abernathy’s longtime recovery advocacy.

Miscellaneous Musings Dec. 4 will mark the 19th birthday of our online recovery community, The Daily Pledge. Originally known as Sober24, it was one of the first communities of its kind, and remains free and open to all. Learn more →

• The Atlantic examines the trend of repurposing jails and prisons to provide shelter and health-care to people even when they haven’t committed a crime. Another story concludes that when you try to treat mental health through the justice system, the results are often neither healthy nor just. Perhaps it’s a sign that better options are needed outside of jails.
• Did Louisiana illegally test an addiction treatment on people in prison? Public Citizen wants to know and it’s asking the FDA for help.
• Congress and the President have extended funding for Certified Community Behavioral Health Clinics operating in eight states through Dec. 20. CCBHCs provide mental health and substance use disorder treatment services, and in return, receive enhanced Medicaid reimbursement rates.
• Wellness advocacy may be progressing at the biggest law firms, but more work is needed to reach the rest of the profession, according to recovery advocate Brian Cuban.
• An Ohio high school plans to drug test all students at least once a year. Here are reactions from students around the country.
• Children ages 1–3 are increasingly watching TV or using screen time in “high amounts,” according to a new NIH analysis.
• Here’s a nice peek at The Recovery Gym in Portland.
• A 21^st Century Cures Act 2.0 is in the works.
• From the Recovery Almanac: this past week marked three years since the release of the historic Surgeon General’s report on Alcohol, Drugs and Health. Take a look back at the release event organized by Facing Addiction, and the special TV event that aired the next day on 11 Viacom cable networks.
• William White remains on a break from his blog … we invite you once again to dive into his three lectures on recovery-oriented systems of care (ROSC), delivered 10 years ago—well ahead of their time. We think lectures 1, 2 and 3 are must-sees for anyone working in addiction treatment and/or recovery.
• Thank you for reading. What do you think? Send us a note anytime, and have a great week!