DANDRIDGE, Tenn. — Rachel Solomon and judges hadn’t been on the best of terms. Then Judge O. Duane Slone “dumbfounded” her.

Solomon was given her first Percocet at age 12 by a family member with a medicine cabinet full. It made her feel numb, she said. “Nothing hurt.” By 17, she was taking 80-milligram OxyContins. A decade later, she was introduced to heroin.

During those years, Solomon was in and out of trouble with the law.

Then, five years ago, at 32, she arrived in Slone’s courtroom, pregnant, fearing the worst. But the state circuit court judge saw promise. He ruled that Solomon would serve jail time for an outstanding warrant for aggravated burglary and then would be placed in a program for pregnant or parenting women recovering from addiction. She would retain custody of her son, Brantley, now 4.

Slone also offered an option that many judges, particularly in rural jurisdictions, at that time were averse to extending: medication for opioid use disorder, or MOUD.

A study conducted a decade ago found that barely half of drug treatment courts offered medication treatment. Those that didn’t cited uncertainty about its efficacy and noted political, judicial, and administrative opposition. But research in the years since has persuaded many of the most insistent abstinence-only advocates.

According to Monica Christofferson, director of treatment court programs at the Center for Justice Innovation, amid an accelerating opioid crisis there has been a “huge shift” among judges, prosecutors, and law enforcement agencies away from the stigma associated with medication treatment. Simply put, “MOUD works,” Christofferson asserted.

By 2022, more than 90% of drug courts located in communities with high opioid mortality rates that responded to a survey said they allow buprenorphine and/or methadone, the medications most commonly used to treat addiction. The study also found that 65% of drug court program staffers have received training in medication for treatment, and a similar share have arranged for clients to continue receiving medications while serving jail time for program violations. Still, almost 1 in 4 programs told researchers they overrule medication decisions.

Federal legislation has lowered the barriers to it. And Bureau of Justice Assistance funding for treatment-court programs now mandates that medication for substance use disorder be provided.

Solomon experienced that shift in real time in Slone’s courtroom as the judge allowed her access to medication to treat her addiction to opioids.

As a young prosecutor in the 1990s in mostly rural eastern Tennessee, Slone was embedded with a drug task force and was well versed in efforts to counteract the supply side of the opioid crisis. Then, as a circuit court judge, he’d put his share of people behind bars on drug-related convictions.

As the crisis deepened, he started to wonder if addressing the demand side would be more effective.

Like so many other prosecutors and judges, Slone believed abstinence was the only path to recovery. But in 2013, after consulting with substance use disorder experts, he relented, introducing medication as an alternative to incarceration for pregnant women. By 2016, he had fully embraced it throughout his recovery courts — even as most judges, he said, “still believed that it was substituting one drug for another.”

Building from evidence-based research, Slone has launched programs that show how a judge, and a region, can trade an abstinence-only, lock-’em-up approach for one that offers a full range of paths to recovery.

Before witnessing medication treatment’s efficacy, Slone said, he would tell a defendant charged with a drug offense, “‘This is your second chance. If you violate the conditions of your probation, I’m going to put you in jail.’”

Often, six months later they’d be back in his courtroom, charged with a low-level crime and having tested positive for drugs. “They’re 19, maybe 20 years old, and I’m executing a five-year sentence. It makes me sick to my stomach now.”

Slone was sure there must be a better way.

A drug recovery court, which he co-founded in his 4th Judicial District in 2009, was a first step. It allows defendants with nonviolent drug-related charges to avoid jail time by entering treatment and counseling. They’re closely monitored by a team that includes a judge, case manager, public defender, prosecutor, and probation officer. If the participant violates the terms of the agreement, the first step is a reassessment of treatment needs. Multiple violations may result in incarceration.

Because this form of drug court is resource-intensive, relatively few people can be enrolled. So in 2013, Slone introduced the Tennessee Recovery Oriented Compliance Strategy, or TN-ROCS, an alternative to jail for those who aren’t considered at high risk of recidivism but are deemed in urgent need of treatment. Many are pregnant women or mothers of young children.

Given the reduced need for supervision, the program can accommodate more participants. So far, more than 1,000 people have been on the district’s TN-ROCS docket.

Both the recovery court and TN-ROCS offer three medication options: buprenorphine, methadone, and naltrexone.

Since TN-ROCS’ launch, Slone said, his community has seen a decrease in property crimes and its jail population. Over its first five years, all 34 pregnant women in the program gave birth to healthy babies and 30 kept custody of their children. TN-ROCS is now being replicated across the state.

One barrier to broader acceptance of medication treatment in both rural and urban communities, Christofferson said, is a lack of education.

Corey Williams agrees. He advocates for educating criminal justice system officials. Williams is an officer with the Lubbock, Texas, Police Department and is a consultant with the Law Enforcement Action Partnership, which promotes drug policy and criminal justice reform. He believes that if more criminal justice officials had personal experience with medication to treat substance use disorder, they’d view it differently.

Williams’ wife, Brianne Williams, became addicted to opioids in medical school. She participated in a series of abstinence-only programs and was free of the drugs for seven years, then relapsed. She was arrested for writing herself a prescription for opioids and placed on probation.

She had entered a Suboxone treatment program, but her probation officer incorrectly informed her she couldn’t remain on Suboxone on probation. Williams relapsed, failed a drug test, and served 30 months in federal prison. After her release, she went back on Suboxone — a brand-name combination of buprenorphine and naloxone — and has maintained her sobriety. “It improved my life drastically,” she said. She now hopes to regain her medical license and specialize in addiction treatment.

The relative unavailability in rural areas of medication treatment is certainly a problem. A shortage, Christofferson noted, is not only an issue in itself, but also a barrier to overcoming stigma. More openings available, more success stories. More success stories, less stigma. Fewer provider options also means one bad actor — a provider who overprescribes or is otherwise negligent — perpetuates the stigma. Strict oversight is essential.

Physician Stephen Loyd influenced Slone’s decision to embrace medication treatment and is now a member of Slone’s recovery court team. Loyd was practicing internal medicine in eastern Tennessee when he developed a 100-pill-a-day addiction to prescription opioids. He was the inspiration for the character Michael Keaton portrayed in the Hulu series “Dopesick.” Loyd overcame his addiction and served as the state’s “opioid czar” under Gov. Bill Haslam from 2016 to 2018.

While in state government, Loyd helped plant the seed for TN-ROCS. He told Slone the first judge to take such an initiative would “be on the cover of Time magazine, because your success rates are gonna go up dramatically; you’re gonna save a bunch of lives.”

“He didn’t get on the cover of Time,” Loyd allowed, “but he did win the William H. Rehnquist Award.” The William H. Rehnquist Award for Judicial Excellence is among the country’s highest judicial honors.

Rachel Solomon contends one of those lives saved was hers.

Today she and her son are together; she’s employed. She remains on Suboxone. She feels good. And she feels fortunate she arrived in Slone’s courtroom when she did.

“He’s the reason I am where I am today,” she said. “He really is.”

The post Once-Resistant Rural Court Officials Begin to Embrace Medications to Treat Addiction appeared first on Medika Life.

The interim sheriff of Macon County, Illinois, posed the question in 2018 as he and Andricks discussed the community’s needs. When she responded that she’d have to do some research, she was told not to take too long because the offer wouldn’t be there forever.

“I thought: ‘Oh, my God, he’s serious,’” Andricks said.

That sheriff was Howard Buffett, the philanthropist son of billionaire investor Warren Buffett. The younger Buffett ended up giving Crossing about $30 million from his charitable foundation to build an addiction treatment center in Decatur, a city with a population of just over 69,000 in the heart of Macon County.

There was a caveat, though. The donation to Crossing was a one-time gift to pay only for the buildings. It was up to Andricks and her team to find money to run the programs. And that has proven difficult.

The covid-19 pandemic upended everything mere months after the facilities opened in October 2019. An audited financial statement said the inpatient recovery center had lost $2.5 million by June 2021, and management worried about its ability to continue operating. Even so, the center remained open while other addiction treatment facilities around the country shuttered.

Now communities nationwide are preparing for an unprecedented windfall of their own for addiction treatment from a nearly $26 billion national opioid settlement and a more than $300 million expansion of a federal pilot program for mental health. The experience at Crossing offers them a model but also a warning: It will take more than a single shot of money to build a treatment program that can last.

https://www.marketplace.org/2023/01/19/a-30-million-gift-to-build-an-addiction-treatment-center-then-staffers-had-to-run-it//popout

Drug addiction wasn’t on Howard Buffett’s radar, he told KHN, until he joined the Macon County sheriff’s office as an auxiliary deputy in 2012. While the county has had some treatment resources, like a behavioral health center, it has one of the state’s higher death rates from opioid overdoses.

Buffett moved to the area in 1992 to work for food-processing giant Archer Daniels Midland. He runs a farm nearby and his Decatur-based foundation donates hundreds of millions of dollars for initiatives ranging from helping people kidnapped by Joseph Kony’s Lord’s Resistance Army in central Africa to revitalizing the cacao industry in El Salvador.

Soon after Buffett was appointed interim sheriff in 2017, he toured Crossing to learn more about local social services. The health center offers primary care, including mental health, for all ages and sees roughly 17,500 patients a year. Most Crossing patients are on Medicaid, the public health insurance for people with low incomes.

“He was impressed with what we were able to provide patients,” Andricks recalled. “I don’t think he expected the scope and size of what we do.”

Addiction treatment, though, is notoriously difficult. Evidence supports treating addiction like a chronic illness, meaning even after difficult short-term behavior changes, it requires a lifetime of management. Research suggests relapse rates can be more than 85% in the first year of recovery. So any new treatment program is likely to face headwinds.

Buffett didn’t set Crossing up for failure. In fact, he has helped fund other aspects of the organization’s work. Part of the idea behind paying for the addiction treatment buildings but not the operations, Buffett said, is to keep his foundation “creative.” If it spends all its money on the same programming every year, that means less is available to fund other work around the globe. Buffett said it’s also about sustainability.

“If Tanya can show ‘with this investment I made this work,’” Buffett said, “then other people should be making that investment.”

Crossing’s inpatient recovery center holds eight beds for medication-assisted detox, 48 beds for rehabilitation, and a cafeteria where meals are cooked with input from dietitians working with patients. An outpatient treatment center also has classrooms for continuing education, a gym with a small bowling alley, and a movie theater. Buffett insisted on the last two amenities. (“People have to feel good about getting better,” he said.)

A separate building holds 64 beds of transitional housing, and just across the street are 20 rent-controlled apartments. Buffett spent an additional $25 million on buildings at that campus for other organizations focused on housing, workforce development, and education, among other things.

“There’s a lot to like in this program,” said Dr. Bradley Stein, director of Rand Corp.’s Opioid Policy and Tools Information Center.

As positives, Stein pointed specifically to the spectrum of care offered to patients as they progress in their recovery, the use of medication-assisted treatment to help stave off physical cravings for opioids, the connection to the health center, and even the involvement of law enforcement.

Laura Cogan, a 36-year-old mother who has struggled with addiction since she was 14, is one of the patients working their way through the system.

Cogan said she was the first patient in the doors when the recovery center opened. Less than 24 hours later, she was also the first patient to walk out.

The biggest challenge with Cogan’s previous attempts at recovery, she said, was never being sure about her next steps: What was she supposed to do after getting out of detox and residential treatment?

Crossing’s approach was designed to address that by providing transitional housing, easy access to outpatient services, and educational programming.

On her third attempt, Cogan got a round of applause after completing the first three days in detox. After six days, she joined residential treatment. After a month, she moved over to transitional housing, began outpatient treatment, and started offering peer support at Crossing. She tutored other patients, taught a writing class, and helped them get on computers and fill out job applications.

Then the pandemic hit.

Like other health centers around the nation, Crossing turned its attention to providing covid testing and vaccines. Meanwhile, just about every aspect of addiction treatment became more expensive. Crossing halved the number of residential treatment beds so each room would have only one patient and converted the rooms into negative pressure chambers to reduce the risk of covid transmission.

Staffing grew harder amid a nationwide nursing shortage. The number of patients in residential treatment dropped, Andricks said, because few people wanted to live inside a facility and wear masks. It was common to have as few as 10 beds occupied on a given day. The women’s unit was temporarily closed due to lack of demand and staffing constraints.

Cogan said several other transitional housing residents left once the $1,200 pandemic stimulus checks arrived, with some resuming treatment when that money dried up. But Cogan continued. Eventually she moved into Crossing’s rent-controlled apartments, where she has been one of just a few tenants.

Without the federal Paycheck Protection Program’s $1,375,200 forgivable loan in 2020, Andricks said, the outpatient treatment program might have had to close altogether.

But momentum at the recovery center started to change last spring as covid cases tapered off, Andricks said. Hiring became easier. More patients arrived. In October, the center received a grant to use the apartments for women with a history of substance misuse who are pregnant or who have given birth within the prior year. They’ve placed six women, in addition to Cogan, there already. The inpatient recovery center now averages about 27 occupied beds a day, within striking distance of the 30 that Andricks said the inpatient center needs to survive.

Rand’s Stein suggested another measurement of a treatment program’s success: whether people in the community get into treatment when they need it. National “secret shopper” reports have found significant barriers to service, such as long wait times.

Crossing’s program quadrupled the number of residential treatment beds in Macon County, according to Andricks. In the three years since the inpatient recovery center opened, it has had over 1,300 admissions. While most patients haven’t stayed in recovery, staffers have seen a pattern of success with those like Cogan who stay on campus and become involved with recovery offerings — although Andricks estimated that’s fewer than 10% of the patients.

Cogan said she hopes Crossing doesn’t get discouraged. People are going to mess up, she said, but she’s living proof of the impact the recovery center can have.

“I’m one of the lucky ones and I don’t know why,” Cogan said, sitting on a couch in the apartment on Crossing’s campus that she shares with her 12-year-old son since regaining custody of him. “I just know that today I am. And I hope that more people get the opportunity.”

The post A $30 Million Gift to Build an Addiction Treatment Center. Then Staffers Had to Run It. appeared first on Medika Life.

One of the ways is to indicate that a patient required more pain medication than was administered or to collect any containers that have medication in them and that were to be carefully discarded.

As noted in a professional journal, “Too many of us have known of a colleague with substance use disorder (SUD) whose behaviour resulted in severe consequences to the person or to others. SUD is not specific to our specialty, but doctors are at the top of the occupational risk ranking and the anesthesiologist is at the top of these….”

In fact, “Anesthesiologists experience substance use disorders at a rate reported to be 2.7 times that of other physicians.”

How do we know that any health care personnel working on a unit is or isn’t addicted? Also, how do we know that all of the physicians caring for patients are not cognitively impaired? I knew of one physician who had to be guided by the nurses on the unit whenever he was prescribing a medication.

There was no question that he should have retired, but he had a position of authority and was seen as an expert in his field, and no one wanted to step on his toes. I don’t know what happened to him, but I hope there were no serious mistakes because of his impairment.

Another physician at a nursing home, where he was the medical director, was a known alcoholic, and again the nurses always covered for him. He only left the position when the nursing home was acquired by a large corporation that cut back staff and brought in new management.

A third physician, a surgeon, was known to abuse alcohol and come into the operating room with alcohol on his breath. He was never reported. Once again, neither the nurses nor anyone else ever told anyone.

The Addicted Physician

I once worked at a hospital where a new psychiatrist came to one of the units where a colleague was working. His appearance was somewhat odd. He wore suits that were rumpled and outdated and were too flashy. We chalked it up to his not having done very well in the profession and let it go at that.

Imagine our shock when we discovered that another psychiatrist in the hospital was supervising him because he had previously been an anesthesiologist and was forced to change his specialty to psychiatry. However, the addicted physician found a way to continue his addiction, and it was simple. All he had to do was remove prescription sheets from the back of the pad of his supervisor. The supervisor had left the prescription pad in an unlocked office desk drawer.

How was his deception discovered? Foolishly, the addicted physician took the scripts, using patient names, to a local pharmacy to have them filled. In addition, the scripts were all for quaaludes. The pharmacist found this quite curious and called the director of medicine at the hospital to ask why this psychiatrist was handing in so many prescriptions. It was then that they discovered his ruse, and he was, once again, sent to an addictions rehab hospital. He had already been a patient at two prior addiction rehab facilities.

The cleverness of this deception was thwarted once the state in which he worked required all prescription pads to be printed on special paper and copies sent to a state database by pharmacists. This was not a unique instance, and other states quickly determined they needed to revise prescription pad production and recording databases to prevent misuse. But addiction isn’t the only challenge for medicine.

Setting Standards for Continued Practice

In the past few years, professional literature began discussing when a physician should retire or what types of evaluations should be put in place to maintain a license after a certain age. It doesn’t crop up often, and it is a tough call to make.

The state’s medical licensing board is one place where all physicians can be subjected to a review of their work or where complaints can be lodged. They examine both professional and consumer reports sent to them. If someone wishes to check on a specific physician’s credentials, there’s also a place for that, and it is here on Docinfo.

Unfortunately, another database, the National Practitioner Data Bank (NPBD), is accessible only to specific groups. It was created by federal law to protect consumers, and its site states, “Although these reports are not available to the general public, various entities (e.g., hospitals and other health care entities) may query the NPDB to obtain information on a specific licensee or entity.” I doubt that patients know the database exists or if it contains material on cognitively impaired physicians.

A “graying” of the physician workforce was noted before the 21st century, but there is a reluctance to report or to require evaluation of older physicians. How should this question(s) be resolved? “…the authors issue a call for an expert consensus panel to convene to make recommendations concerning aging physicians with cognitive impairment who are at risk for medical errors.”

We are awaiting such a panel and, in the meantime, let the patient be vigilant and keep good notes on their care and from whom they received it.

The post Are Lives Lost by Cognitively Impaired/Drug-Abusing Physicians? Who Reports Them? appeared first on Medika Life.

In the early days of the pandemic, two things shocked and dismayed me above other dim-witted responses to the virus: the CDC failing to promote early masking, and public health officials and politicians tripping over themselves to make alcohol more available than ever.

Liquor stores wouldn’t be closed, restaurants could deliver booze, or serve “to-go” alcohol with your take-out order.

The constant refrain I heard about why alcohol needed to be so ubiquitous was, “we will see hospitalizations from alcohol withdrawals go up and we can’t have these people crowding our soon-to-be overwhelmed hospitals.”

Guess what? Hospitalizations for alcohol withdrawal went up anyway.

Meanwhile, public parks, soccer fields, and other outdoor spaces were seen as a danger to public health and would need to be closed.

I can only assume these decisions were made with tax revenue and profits in mind over people’s health. After all, no one is collecting a fee to get into the local skate park.

People with years of experience and advanced degrees honestly looked around and thought outdoor spaces were a bigger risk than closing liquor stores to the public? Politicians here in America were obviously going to screw this up and make the wrong call, but public health officials should know better you would think, but then again, here in America many of them are political appointees with one eye on keeping their jobs.

I’m sympathetic to the businesses which relied on alcohol sales to try and stay afloat during that time, but better government policy should have ameliorated their financial suffering. Instead, we got a policy that purported to keep people out of the hospital but instead contributed to the deaths of more people than the virus was capable of killing.

Hell, if the CDC and governments kicked everyone outside for three weeks and made indoor spaces verboten this pandemic would have been over already, considering there is evidence that transmission rates outdoors are less than 1%.Outdoor Transmission of SARS-CoV-2 and Other Respiratory Viruses: A Systematic ReviewRecommendations about methods to curb transmission of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)…academic.oup.com

Feel free to cram into your local beer & wine though, just don’t take your kids to the park.

Now studies are being published showing just how brain-dead these policies turned out to be.Alcohol-Related Deaths Spiked During the Pandemic, a Study ShowsThe deaths were up 25 percent in 2020 compared with 2019 as stressors accumulated and treatment was delayed, according…www.nytimes.com

Among adults younger than 65, alcohol-related deaths actually outnumbered deaths from Covid-19 in 2020; some 74,408 Americans ages 16 to 64 died of alcohol-related causes, while 74,075 individuals under 65 died of Covid. And the rate of increase for alcohol-related deaths in 2020–25 percent — outpaced the rate of increase of deaths from all causes, which was 16.6 percent.

Deadlier than COVID.

Then you factor in rises in obesity, suicide, narcotics deaths…and you get a fuller picture of just how utterly public health officials and governments failed to enact policies with an eye on harm reduction during the pandemic.

Drug overdose deaths also reached record levels during the first year of the pandemic, with more than 100,000 Americans dying of overdoses during the 12-month period that ended in April 2021, a nearly 30 percent increase over the previous year, according to reports issued in November. The number of deaths from opioids in which alcohol played a role also increased.

Young adults ages 25 to 44 experienced the greatest increases in alcohol-related deaths in 2020, rising nearly 40 percent over the previous year, according to the new report.

Of course, more papers will have to be published to replicate these findings, but I have a feeling these numbers are probably even higher than reported in this study.

My biggest concern is that when the next pandemic hits (COVID-23: Giraffe Flu? It’s never Tofu Flu, Toflu?) it’ll be like day one on the job and the same half-assed and wrongheaded approaches that didn’t work for COVID-19 will get an encore de failure.

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We know police officers have three things they may share with those who wish to end their misery; high rates of suicide, substance abuse disorders, and marital difficulties. Mental health disorders do not disappear once a uniform is donned. The nature of the job brings them into contact with trauma on a daily, weekly, and monthly basis. It is not a job for the faint of heart.

A review of research over the past 20 years on those who choose to commit suicide by cop indicates that the typical perpetrator is a younger white male experiencing romantic relationship conflicts. There is also a significant mental health and criminal history.

The individual is often intoxicated at the time of the incident and is mentally impaired in their ability to recognize what they are pursuing. The most effective interventions by police are expected to be limited to verbal interactions related to the individual’s presenting problems. It’s a process of understanding and going slow. But there’s something more than an attempt at suicide here.

An important aspect of suicide by cops which cannot be ignored is the long-term effects of these types of situations for the police involved, who may experience a level of PTSD not previously explored. And let’s not forget that the incident may happen in a shool where the individual has many students who can be victims which escalates the deadliness of the situation.

In fact, school shootings have become endemic in our 21 Century culture with the ease of obtaining deadly weapons and protective gear. The number of students exposed to school gun violence since the killings at Columbine is an astounding 278,000 at 298 schools. How many of those kids will go on to have lives seriously affected by these shootings?

We know that the police incidence of PTSD related to violence in their line of work is also of great concern. “Approximately 15% of the police officers in the U.S. and globally experience symptoms of PTSD. Numbers can be much higher based on exposure, such as after natural disasters or tragedies like 9/11.”

But one other factor here is the fact that not all police personnel will report their difficulties or seek counseling, fearing it will affect their careers or how they are seen by others. We see the same reluctance to seek help in the military and healthcare professions. The numbers may be quite conservative.

Whether the shooters intended to kill as many victims as possible and, in the process, go out in a blaze of police gunfire is immaterial. The fact remains that mental health issues are becoming a serious concern for police, school safety officers, school administrators, teachers and ancillary school personnel. Anyone is fair game in these shootings and some will be collateral damage of stray bullets in the foray.

How many kids are, realistically, expressing a reluctance or refusal to go to school fearing they may be killed? This is no longer the attachment problems or school concerns we used to see. These kids are terrified and yet we expect them to return to a school where perhaps nothing happened, but they know all about the schools where kids and teachers were killed.

The danger isn’t necessarily from someone who comes into the school; they’re fellow students. Not even the metal detectors (and not all schools have them) are reassurance. Guns aren’t always the weapons used, as we’ve seen in other countries where knives and hammers have been used to harm or kill children.

The kids in Oxford, Michigan had been hearing of concerns about danger and it wasn’t just a silly fantasy, students died. When a ten-year-old boy tells his mother he doesn’t want to go to school and he’s seen the school psychologist once (did the psychologist think that was enough?), what does a parent do? Kids are asking who’s next? One survey found 91% of teachers are stressed.

Will home schooling become more prevalent as little is done to control the killings in schools by controlling their access to guns or treatment for their mental health problems? How many schools have a full-time school nurse available, much less a psychologist or other counselor? The need increase while the access decreases.

The generation growing up now will be in a world very different from the one we knew. Walking to school has already become unacceptable, going to a school wearing a bulletproof backpack may be suggested and school shooting drills will replace the nuclear bomb ones of the 1950s. Now, however, the fear is real, not a world away, but only a classroom away.

Our kids and our police need our support and our help in more ways than we currently know. How can each of us help? The question is vital and we must include it in discussions at school and in our homes.

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