Category: commentary

Top 10 Primer Points for President-elect Trump on Addiction Treatment

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President-elect Trump takes office in the midst of a devastating opioid epidemic. As he begins to grapple with the causes and solutions of this growing national tragedy, Odyssey House President Dr. Peter Provet offers ten fundamental points to anchor his efforts.

1: Treatment works. But there isn’t enough of it. Approximately 14 percent of Americans with substance abuse problems are able to get the appropriate treatment they need to stop using drugs, maintain a drug-free lifestyle, and be functional – and contributing – members of society, at work, and in the family. This means of the 21.7 million adults and teenagers who are addicted to legal and illegal substances, only 3 million people get the help they need.

2: Addiction does not discriminate. Substance abuse is a health problem that destroys the lives of men and women, young and old, from all ethnic backgrounds and communities. Today’s opioid epidemic is devastating families across the country. Prescription pain reliever overdose deaths among women have increased more than 400 percent from 1999-2010, compared to a 237 percent among men, and the number of deaths from heroin among women tripled from 2010 to 2013. Adolescents are using prescription pain relievers for nonmedical needs in large numbers: in 2015, 276,000 teenagers were current nonmedical users of pain relievers, with 122,000 having an addiction to prescription pain relievers.

3: Drug overdose is the leading cause of accidental death in the US. Of the 47,055 lethal overdoses in 2014, opioids claimed the lives of 29,467 Americans, with prescription pain relievers related to 18,893 overdose deaths and heroin 10,574. In all, opioid overdose deaths claim the lives of 91 Americans a day.

4: The tragedy is that a great many of these lives can be saved and for as little as $75 or less. Treatment centers, hospitals, police forces, fire departments, and other community organizations are training their personnel in the use of naloxone – a life-saving, easy-to-administer drug, proven to reverse opioid overdose death. A 2013 survey of organizations who provide naloxone to laypersons who might witness an overdose, including persons who use drugs, their families and friends, and service providers, received reports of 26,463 overdose reversals. The role of naloxone in saving people from a potentially fatal opioid overdose is dramatic: a 160 percent increase in the number of reversals reported; a 243 percent increase in the number of local sites providing naloxone; a 187 percent increase the number of laypersons provided naloxone kits; and a 94 percent increase in states with at least one organization providing naloxone.

5: While the human cost of addiction can be devastating, the financial burden on all Americans is staggering. The US spends more than $700 billion annually in costs related to health care, lost work productivity, and crime. Abuse of illicit drugs alone costs $193 billion.

6: The cost of treatment for substance abuse disorders pales in comparison to the costs of abuse. Publicly-funded, residential treatment administered professionally using evidence-based programs costs $62 a day. In-hospital opioid detox starts at $1,000 a day. In 2012, New York City paid $460 a day to feed, house, and guard each inmate, the majority nonviolent drug offenders.

7: Funding for treatment has not kept up with demand. When the Comprehensive Addiction Recovery Act (CARA) was passed into law in July 2016, it was the most significant federal legislation on addiction treatment in 40 years. CARA received overwhelming bi-partisan support in Congress and the Senate. It was hailed as the most comprehensive effort undertaken to address the opioid epidemic, encompassing all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. But the funding request was drastically reduced from $1Billion to $181Million.

Now we have cause to be hopeful that funding will be restored. Just this month the US House of Representatives passed HR 34, The 21st Century Cures Act. The legislation provides $1Billion over several years to states through the existing grant program for prevention, treatment, prescription drug monitoring programs, opioid treatment programs, and workforce development. The bill creates federal drug courts and programs for alternatives to incarceration for individuals with SUD. It also encourages the integration of care for SUD with primary care.

This landmark legislation – a turning point for addiction treatment and prevention – has now been signed by President Obama.

8: As demand for treatment increases, we are faced with a growing workforce crisis in the addictions field. This crisis is due to a variety of factors, including stigma, an aging workforce, and inadequate compensation.  A report to Congress from the Substance Abuse and Mental Health Services Administration (SAMHSA) warned that the addiction services field will need to fill more than 330,000 jobs to keep pace with demand for care.

9: Addiction is a brain disease to be treated, not a criminal justice issue to be punished. A decade or more of scientific research has conclusively shown addiction is a disease that affects both the brain and behavior. Science has identified many of the biological and environmental factors and is beginning to search for the genetic variations that contribute to the development and progression of the disease.

10: Voters in eight states approved passage of marijuana laws ranging from full legalization of recreational use of marijuana to approving or easing of restrictions for medical marijuana laws. These laws will have undoubtedly increase marijuana use – and misuse. Keeping marijuana out of the hands of youth is everyone’s concern.  Ensuring prevention and treatment programs are ready to help those, is everyone’s commitment.

‘The Drumbeat of Bad News’ on the Opioid Toll

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In today’s edition of The New York Times, Odyssey House President Dr. Peter Provet comments on “New Mothers Derailed by Drugs Find Support in New Hampshire Home” (News, Dec. 12), on the devastating toll the opioid epidemic is inflicting on families.

The drumbeat of bad news on the toll the opioid epidemic is taking on communities across America just keeps getting worse. But the statistic cited in your article that as of 2012 a baby is born suffering from opioid withdrawal every 25 minutes is most sobering.

We have not seen such a collapse of families since the crack epidemic of the 1980s and 1990s. What we learned then, and need to remember today, is that when we connect pregnant women with treatment services that keep the mother and child together, we save two lives.

What’s different now is that many of the families affected are from rural and suburban communities, where access to treatment is limited, if not nonexistent. In urban centers like New York City, treatment organizations have developed supportive networks that connect at-risk people with services that both save lives and protect communities.

As we look to a new president with so much unknown about the direction his administration will take on containing the opioid epidemic, we hope that he will be open to listening to lessons learned decades ago: that treatment, not punishment, is the surest and cheapest cure for addiction, and that what works in the cities will also work in the suburbs and rural America.

Dr. Provet on the Surgeon General’s Report on Alcohol, Drugs, and Health

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It couldn’t be clearer. The Surgeon General’s Report on Alcohol, Drugs, and Health (The New York Times, Nov 17) is a wake-up call that we are facing a public health challenge that is ‘taking an enormous toll on individuals, families, and society.’ The financial costs of alcohol and illicit drug use combined are $442 billion. But the personal costs are much, much greater. At least 85 people a day (some reports say over 100) are dying from opioid-related overdoses.

Addiction costs infographicIt can’t go on. The death rate from what is a preventable, and treatable disease, is unconscionable. The financial costs are unsustainable.

Surgeon General Dr. Vivek H. Murthy makes a strong case for at last treating addiction as a public health not criminal justice issue. This is critical. Stigma and punishment combined have stopped people from getting help; have tied up our law enforcement agencies in a vicious and dangerous cycle of recidivism; and have claimed the lives of thousands and thousands of young Americans.

Let’s bring addiction out of the shadows of shame and commit to treating it like any other medical or mental health issue.

Deaths and Broken Lives from Drug Overdoses

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In today’s edition of The New York Times, Odyssey House President Dr. Peter Provet comments on a recent article (“Drug Overdoses Propel Rise in Mortality Rates of Whites,” front page, Jan. 17) on the rising death rates for young white adults, driven by the opioid epidemic.

 

Deaths and Broken Lives from Drug Overdoses

To the Editor:

The dramatic increase in drug overdose deaths is not new to drug treatment. For several years treatment providers have been racing to save the lives of young Americans addicted to opioids as what started as a surge in prescription drug abuse morphed into a full-blown opioid epidemic.

It is also not news that intensive residential and outpatient treatment services are in short supply, and what resources are available in many parts of the country are often prohibitively expensive for the vulnerable populations who need them the most.

That today’s vulnerable addicts now include growing numbers of young white Americans highlights the tragedy of opioid addiction as a great equalizer.

Decades of experience treating young people from inner-city communities ravaged by drugs has shown us that recovery is a multistep, time-consuming process that, for the fortunate ones who are helped quickly enough, starts with overdose-prevention injections and detox, and continues with medically assisted treatment, behavior therapy and continuing community-based support.

Anything less just doesn’t work and is merely a Band-Aid that will inevitably lead to the loss of more young lives – tragically, lives we know how to save.

 

The year ahead

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Experts’ Contributions: “Hopes and Fears” 2016

Leaders in the field of drug treatment share their predictions for 2016 and the challenges ahead. See Dr. Provet’s below. Click here for the full report. 

The escalating opioid epidemic among middle-class Americans drew unusual attention last year to our field across a wide public sphere of elected officials, leaders of medical and scientific communities, members of criminal justice and law enforcement agencies, and the mainstream media.

While this attention is welcome, we need to make sure the urgent need for treatment is reflected in the stabilization and expansion of services for vulnerable populations. As states (including New York, with high-need, disadvantaged populations) look to contain costs under Medicaid managed care, we must work hard to ensure that the federal block grant is maintained, the IMD [Institutions for Mental Diseases] exclusion is eliminated and parity under the ACA [Affordable Care Act] is fully enforced. Without these essential provisions built into federal and state budgets and policies, nonprofit organizations that provide the bulk of safety net services will find it harder and harder to meet the increased demands for care.

At Odyssey House, we have been preparing for the impact of managed care for quite some time and have established new systems to both contain costs and streamline care. These include: electronic health record keeping and linkages with hospital and other community-based providers; evidence-based practices and medication-assisted treatment; and extended outpatient and housing support services.

My hope as we look to 2016 is that we will not only continue to provide quality care for disadvantaged substance abusers (who often require intensive residential services in order to have a chance at achieving and maintaining a functional life), but that their needs will be reflected in the ongoing national debate on how best to treat addiction and its accompanying social ills.

Peter Provet, Ph.D.
President & Chief Executive Officer

“Housing & recovery are joined at the hip”

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In today’s edition of The New York Times, Odyssey House President Dr. Peter Provet comments on a recent article examining New York City’s response to an earlier investigative report (A Choice for Recovering Addicts: Relapse or Homelessness, May 30, 2015) on the deplorable conditions of three-quarter homes. 

NYT masthead 
Housing for Addicts

To the Editor:
Your investigative report on “three-quarter” homes (front page, Aug. 3) exposes flaws in a system that places vulnerable people with substance abuse and/or mental disorders in living situations with providers who at best do nothing to support their recovery, and at worst propel them toward drug use and chaos through crowded, substandard living conditions.

It is troubling to all of us who provide treatment services that people who leave our programs with the tools to live sober and independent lives are just one bad placement away from falling back into addiction. But the fact is that housing and recovery are joined at the hip.

Within long-term recovery, however, stable housing is necessary but not sufficient. Quality outpatient and recovery services are essential to maintaining successes achieved in what can otherwise devolve into a chronic relapsing disorder. That some corrupt providers may exist should not obscure the fact that hundreds of others offer critical community-based services that allow thousands in recovery to flourish.
PETER PROVET
President and Chief Executive
New York, April 3, 2014

Dr. Provet on Robin Williams

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Robin Williams’ death tragically underscores how depression combined with substance abuse create a common ground for suicide. Fame, fortune – and in Mr. Williams’ case, comedy – cannot prevent such self-inflicted tragedy.
Stigma still pervades meaningful societal consideration of suicide. Akin to substance abuse, it is commonly seen as an individual’s choice and as such engenders less empathy and concern than other forms of mental illness.
Science is illuminating important truths – both pertaining to the frequency and demographics of suicide and its biological/genetic basis. For example, suicide is a leading cause of death among people with substance use disorders. It has been convincingly demonstrated that mood disorders, such as depression and manic-depressive illness, also greatly increase the risk of suicidal behaviors. Prevention strategies must continue to explore and identify the genetic, biological, hormonal, and social correlates of suicide.

Mr. Williams gave so much of his life to making others feel joy and laughter.  Hopefully, his death will encourage us to learn far more than we currently know about suicide and help us to reduce the increasing frequency of this voluntary, final act.

Peter Provet, Ph.D.
Odyssey House President & CEO
Board Member, National Action Alliance for Suicide Prevention

Mentally Ill, in Prison and Outside

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In Saturday’s edition of The New York Times, Odyssey House President & CEO Dr. Peter Provet is one of several experts commenting on a recent article examining the growing number of people with severe mental illness who are coming into contact with the criminal justice system in the absence of adequate health care services.

To the Editor:
Police Confront Rising Number of Mentally Ill” (front page, April 2), there is no mention of the intersection of drug abuse and mental illness, and how such use exacerbates psychiatric symptoms and leaves the individual far more unstable, symptomatic and volatile (though not necessarily more violent.)
As services for the mentally ill retract, greater disturbance will be evidenced, and increased demands will be placed on emergency personnel, police officers and prison guards. Unfortunately, it often takes a tragedy to secure adequate treatment funding to confront one of our biggest social challenges: the degree to which self-harm and harm to society are compounded by untreated and undertreated substance abuse and mental health disorders.

Working in Recovery: How do we know what works? We ask questions

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By Gary Harmon, Ph.D.
Vice President, Director of Research & Grants

As the substance use disorder field continues to evolve and move closer to a medical model, Odyssey House is poised to remain a leader.  The ability of the agency to retain the essential elements of treatment from its roots over 45 years ago, combined with cutting-edge and new research-supported treatment, has led to a model that we know works. 

Personally, I take great satisfaction in the quality of the services we provide and the excellent treatment outcomes that are produced.  Since my role often involves viewing our clients, programs, and services as data on a computer screen, I always make sure to remember that every number represents a person; someone who came to Odyssey House in need of help; someone with a dream or hope of a better life.  Keeping that important principle in mind helps to ensure that I never stop asking that very important question:  “How do we know what we do works?” 

Entering into the substance use disorder field six years ago, I was eager to apply my background in public health to one of the greatest problems facing our society.  I have worked with disadvantaged and disenfranchised populations for my entire career but this field presented an entirely new set of challenges and barriers.  It was clear from the start that our clients and residents were not only battling with drugs and alcohol, but most were also beset with poverty, trauma, mental illness and homelessness.  One of the reasons that I was attracted to Odyssey House was the organization’s approach to research and data.  Employing a full-time director of research and grants signaled to me that the agency had a value for exploring what was most effective for our clients and residents.  At that time, the agency had begun to implement several Evidence-Based Practices (EBPs), and was participating in a National Institute on Drug AbuseClinical Trial Network research study. 

The acceptance of new, data-driven interventions shows that Odyssey House is staying ahead of the field in terms of best practices and the most effective treatment services, and the commitment to research and implementation of EBPs has only grown. We now employ more than 12 different data-driven interventions throughout the agency, and we have recently participated in several clinical trials with both New York University and Columbia University. As an evaluator on several grant projects supported by the Substance Abuse and Mental Health Services Administration, I have seen from the data that the programs we implement are effective.

The first questions I asked of my colleagues upon entering the field was, “What do we do?” and “How do we know what we do works?” Although simple questions, it was clear to me that the answers were much more complex and the results more rewarding.

Working in Recovery is an occasional series of guest blog posts by Odyssey House clinical, administrative, and research experts.

A Time When Marijuana is Legal

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In response to Bill Keller’s column, “How to Legalize Pot,” in The New York Times, Dr. Peter Provet comments on the implications of legalizing marijuana.




A Time When Marijuana is Legal

To the Editor:

Bill Keller suggests that legalization of marijuana is a foregone conclusion. The voters in Washington State and Colorado have proposed that one way out of an intransigent public health problem, costly law enforcement, spiraling prison costs and reduced tax revenues is to legalize a known addictive substance.

It is wishful thinking, however, to believe that a government-regulated marijuana marketplace will raise enough money to offset the harm that today’s highly potent drug inflicts on communities across America.

The only chance we have to get ahead of the coming epidemic is by adequately financing treatment programs so the infrastructure of marijuana production, distribution and retail is matched by broad-based community services.

PETER PROVET
President and Chief Executive
Odyssey House