Category: public policy

The Narcan Experiment

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Odyssey House President Dr. Peter Provet comments in The New York Times on a recent report (“If This Were an Overdose, Would You Help?” news article, May 10) on a controversial proposal to install lockboxes containing the opioid overdose antidote naloxone on the streets of Cambridge, MA. Dr. Provet argues that the public administration of naloxone could become a turning point in the opioid epidemic.

To the Editor:

The public administration of naloxone has the potential to be a turning point in the opioid epidemic. While overdose deaths continue to multiply throughout the country, a tipping point has yet to be reached regarding political resolve to fund treatment and a groundswell of public concern and compassion.

This experiment in Massachusetts to address the deadly consequences of addiction by empowering the public to administer a lifesaving dose of naloxone may be just what we need to get citizens involved in addressing our morass of addiction.

Ultimately, a vast number of lives will be saved only if the public comes to view addiction as a chronic relapsing disease that requires treatment that is coordinated, comprehensive and compassionate.

PETER PROVET, NEW YORK
The writer is president and chief executive of Odyssey House.

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.

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.

Chasing Heroin

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On Tuesday night, PBS aired a new Frontline documentary, “Chasing Heroin,” chronicling the impact of the opioid epidemic as well as the efforts of law enforcement, social workers, and public defenders and prosecutors to save the lives of addicted people without locking them up. The entire documentary is streaming online and will air on WLIW/Channel 21 (PBS’s sister station) on Friday, February 26that 7pm.
The documentary was accompanied by four feature articles, which you can access below.
Drug Czar: Treating Substance Abuse as a Crime is “Inhumane” –  As the first former addict to run the White House Office of National Drug Control Policy, Michael Botticelli has a different perspective from any of his six predecessors. In this interview, Botticelli talks about his own struggles with addiction, the nation’s heroin and opioid epidemic, and why he says “we can’t arrest our way out of our problem.”
How the Heroin Epidemic Differs in Communities of Color – People develop addictions for a variety of reasons, which makes it difficult to gather concrete data on what’s happening in each community. Frontline spoke to experts and community outreach workers around the country to try to understand the differences. While some have followed a similar trajectory as the white community, a closer look at the epidemic in some communities of color reveals a different story.
The Options and Obstacles to Treating Heroin Addiction – For decades, treatment has centered on an abstinence-only approach, consisting of detox and rehab, accompanied by counseling or group therapy, many inspired by the 12-step model. But as deaths have surged, many experts have begun rethinking that approach, arguing that opiate addiction should be treated the same as a chronic disease — like diabetes or depression. Abstinence and counseling is not enough; medication must also be an option.
How Bad is the Opioid Epidemic? – The epidemic didn’t happen overnight. Over the course of more than a decade, it has grown into a problem destroying lives across the nation, regardless of age, race, wealth or location. Here’s a look at how it happened and who is most affected.

Preventing heroin overdoses

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New York State Attorney General Eric Schneiderman is spearheading an effort to equip more law enforcement officers with the heroin antidote Narcan. It takes just three minutes to revive a person overdosing on heroin or prescription pain medication by pushing the drug out of their system.

Mary Callahan, senior manager, director of Odyssey House Outpatient Services, was featured in a News 12 segment about the initiative. “By doing this, they’re saving an immeasurable amount of people from overdose,” she said.

More police officers to be trained to administrate heroin antidote Narcan

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News 12 Bronx

More law enforcement agencies statewide will soon be trained on how to administrate the heroin antidote Narcan.

Narcan takes just three minutes to revive a person overdosing on heroin or prescription pain medication by pushing the drug out of their system.News12Narcan.jpg

Mary Callahan, the senior management director of outpatient services at Odyssey House, says Narcan is a gift. “By doing this, they’re saving an immeasurable amount of people from overdose,” says Callahan, who has 15 recovering opioid addicts at the recovery center.

Attorney General Eric Schneiderman has allocated millions of dollars to put Narcan in police cars and train officers how to use it.

Click here to watch the segment.

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.

Preparing for managed care

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The spring 2014 issue of Behavioral Health News included an article about how managed care regulations are transforming the behavioral health landscape, written by Peter Provet, Ph.D., president and CEO, and Gary Harmon, Ph.D., vice president and director of research and grants. Clik here to download the article and learn how Odyssey House is preparing for the challenges ahead.

Housing Line for Centers Brings Grants and Patient Health

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Alcoholism & Drug Abuse Weekly

In a development that so far is seen mainly as benefiting treatment centers that traditionally work with the neediest clients, a growing number of addiction treatment facilities are gaining direct expertise as providers of permanent housing for individuals and families with substance use issues.

These facilities are finding that helping to meet clients’ housing needs can assist in building a stronger, more long-term relationship with these individuals, while also being potentially attractive to funders that are increasingly seeing unmet housing needs as a critical barrier to long-term recovery for persons with substance use disorders.

“Branching out into areas such as housing has completely transformed our agency from a specialty health provider to a multiservice provider capable of meeting the multiple needs of our clients,” Mark Hurwitz, CEO of Palladia, Inc. in New York City, told ADAW. “Housing is a major determinant of public health.”

Palladia in 2012 became one of five New York City treatment organizations to receive an initial round of funding under an Office of Alcoholism and Substance Abuse Services (OASAS) initiative to establish permanent supportive housing for families in which the head of household has a substance use disorder (see ADAW, Feb. 27, 2012). Later in the year, Palladia received a second housing grant from OASAS, under a separate housing initiative targeting high utilizers of Medicaid services such as individuals with numerous detox visits.

In all, Palladia now oversees nearly 450 units of permanent housing (some at sites it owns and the rest under scattered-site leasing arrangements), having been involved with various housing initiatives since the 1990s, said Hurwitz. Supportive housing under its control has allowed Palladia to see improvement in a situation where many of its clients were often caught in a revolving door of shelter and city jail stays.

“Many of the doctors who work with chronically ill individuals will say, ‘If I could write just one prescription, it would be for a unit of housing,’” Hurwitz said.

Assuming more control

Odyssey House was another of the five initial grantees under the OASAS housing initiative targeting families where the head of household has a substance use disorder (see ADAW, February 27, 2012). It now has received funding in two rounds of that program to secure a total of 35 apartments for families, said president and CEO Peter Provet, Ph.D.

Provet told ADAW that he believes addiction treatment agencies’ work in the permanent housing area can be successfully structured in more than one way — in fact, Odyssey House has looked into the possibility of entering a partnership venture with a housing developer in which it would lease units directly from the developer. But he does see advantages to a treatment agency building its own in-house expertise in fulfilling clients’ housing needs.

“In general, when you’re dealing with drug addiction, the more control you have, the better,” Provet said. “The addict has a way of splitting [service] systems; it’s part of the disease of addiction. The more agencies that are in the mix, the more complicated it gets to prevent that type of behavior.”

Like Palladia, Odyssey House now has a lengthy history of involvement with housing programs, having cut its teeth in this area via capital development grants from the state Office of Mental Health (OMH). Among its current projects, it is building two new housing facilities in the Bronx that each will serve 60 individuals with serious mental illness.

The OASAS project for which Odyssey House has secured funding for 35 apartment units targets chronically homeless families — Provet says those who benefit from the program are required to have been homeless for at least one year in the past two years.

Odyssey House and the other grantees under the program provide case management and wraparound services to clients; it is not a requirement of the grant program that grantees be delivering direct treatment services to clients that are receiving the housing. Clients are required to contribute a portion of their earnings/benefits toward rent.

Provet said that while it is important to recognize the importance of housing to a stable recovery, he believes the addiction treatment field must guard against buying into the assumption that secure housing and wraparound services alone will suffice for every individual.

“We don’t want to replace treatment with housing,” Provet said. “Housing is not treatment. In the past, some thought long-term residential was for everyone, and now we need as a field to be mindful of this pendulum swinging in the other direction. Housing with wraparound services makes sense for many, but not for all.”

Palladia’s Hurwitz is finding that payers and providers are generally shifting their thinking from seeing the treatment experience as a separation of patients from the community toward a vision of seeing treatment integrated into the community with a variety of social supports. In its staff’s being able to address a wider variety of the interconnected issues that can contribute to poor outcomes, Palladia “helps [clients] have a long-term trusting relationship with us through our staff, who can connect them with services and people,” Hurwitz said.

Public vs. private

To this point, it appears that direct involvement in permanent housing initiatives has captured more attention among treatment facilities that largely serve a lower-income population. Michael Walsh, president and CEO of the National Association of Addiction Treatment Providers (NAATP), told ADAW that he hasn’t heard of any NAATP member organizations moving to develop permanent housing for clients they’re serving.

Yet he added that he believes this could become part of more treatment centers’ plans in the future, for two reasons: because it would allow facilities to keep in closer contact with clients and therefore do a better job of tracking long-term outcomes, and because it is possible that permanent housing might ultimately generate less opposition from local communities.

Provet brought up another interesting twist to the discussion of permanent housing on the public-sector side. With the OASAS initiative for families targeting the homeless, one question that has arisen involves whether time spent in residential treatment for addiction should be considered a period of homelessness. Provet said his organization would interpret that period as being part of the homelessness stage, but he added that state and city regulations in New York appear to argue otherwise. •

Using addiction treatment techniques to tackle obesity

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Odyssey House President Dr. Peter Provet comments on the Institute of Medicine’s recent report on America’s obesity epidemic and its similarity to addictive disorders.

The Institute of Medicine Report on the obesity epidemic in America is welcome news. It may be the wakeup call the country requires to seriously address this public health disaster. We need an education and prevention campaign that focuses on children and adults, supports parents, and funds treatment services to help those struggling to live healthier lives.

Sound familiar? To those of us who work with substance abusers it is analogous to the heroin epidemic of the 1960s and 70s, crack and cocaine in the 80s and 90s, and methamphetamine and prescription drug abuse today.

Then, as now, thousands of people were sick and in danger of dying, and Americans were scared of losing whole generations to an addictive disorder. No one would claim high fat foods and sugar saturated beverages are the same as heroin, cocaine and other illicit drugs of abuse, but overeating to the extent it damages one’s health, family, and work life matches the diagnosis of addiction and warrants a national treatment response.

At Odyssey House today, we are addressing some of these challenges with proven addiction treatment techniques of group support, role modeling, and fitness activities that promote health and protect against relapse. We now have the opportunity to use what we have learned from earlier addiction epidemics to confront obesity.

Peter Provet, Ph.D.
President & CEO
Odyssey House

Click here to read the Institute of Medicine report, “Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation,” in full.