The Opioid Crisis!….What is the Real Answer????

opoid023Yes, more professional golf to help you get through the weekend. But more was happening in all our communities in the form of drug addiction and its effects on all of us. President Trump declares opioid crisis a national emergency. Wagner of The Washington Post reported that President Donald Trump on Thursday declared the country’s opioid epidemic is “a national emergency.” Trump delivered the announcement “to reporters outside a national security briefing” in Bedminster, New Jersey, adding his Administration is “going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis.” The Post says the declaration of emergency will permit the Administration “to remove some barriers and waive some federal rules enabling states and localities to have more flexibility to respond.”

Recently our Town Council and Health Department was “gifted” with funds from the Governor to combat the Opioid catastrophe. Is throwing money at the problem the answer????                                                                                                                                  Health Officer Outlines Plan Of Attack! Our local reporter, Denae Spiering reported that in our small neighborhood Dr. Frieda Wadley, Talbot County health officer, has outlined how the Talbot County Health Department plans to spend the $79,000-plus it has received from the state to fight the growing epidemic within the county.

On July 7, the Maryland’s Opioid Operational Command Center, Department of Health and the Governor’s Office of Crime Control & Prevention announced more than $22 million to fight the heroin and opioid epidemic in the state.

A previous article announced that the first quarter report for fatal overdose data showed that for our small county the fatal overdose numbers had increased significantly since last year’s first quarter report. Worse than that is that fentanyl-related deaths have more than doubled compared to last year’s first quarter’s report.

So what are they decided is the right way to combat this crisis? Their solution-the health officer outlined their plan. She said that $50,000 would be used for recovery houses in the county with $45,000 going to beds for clients and initial assistance for independent living arrangements. And another $10,000 will help recovery houses with appropriate urine screening for residents, especially for individuals who are not able to pay and have no direct source of funding.

She then said that $12,000 will be used to pay for initial visits for treatment of uninsured clients, while the health department care coordination team simultaneously helps those clients in getting health care coverage.

Additionally, the local public schools will receive $5,000, which will be broken down to two areas-$3.000 to add age appropriate curriculum to all grade levels, focusing specifically on the harms related to addition, and $2,000 to assist with teaching materials for the new curriculum.

First, what are the real numbers?

By the Numbers: The Real Opioid Death Rate is what? A Study finds many states underestimate the size of the opioid epidemic. Matt Wynn, a staff writer for the MedPage reported that there’s been more and more pressure for the government to tackle the opioid epidemic head-on. But in a piece published in the American Journal of Preventive Medicine, Christopher Ruhm, Ph.D., of the University of Virginia, argues that there could be a big hang up: even with all the hand-wringing, we’re still underestimating the size of the opioid epidemic.

That’s because a big chunk of death certificates that list overdose as a cause of death — 25% in 2008, and 20% in 2014 — don’t report what drug was to blame. The rate of the discrepancies varied dramatically from state to state, further exacerbating the problem at the local level.

To get a better sense of the scope, Ruhm corrected the data using information from death certificate reports where at least one drug category was identified to impute drug involvement for cases where drug involvement categories were left unspecified. He applied models to each case based on several variables to predict probabilities of opioid involvement.

His corrected results ended up increasing the number of opioid deaths by 24% nationally. The effect was especially pronounced in certain states. Rhode Island had the information filled out in 99% of cases and didn’t see much of a change. But in some cases the correction was extreme. Pennsylvania, for example, had more than double the number of deaths under the corrected model. That change shot the state up the rankings as well. While the official number pegs the state as having the 32nd highest opioid mortality rate, the corrected figures skyrocket it up to seventh highest in the nation.

The maps below show the original, uncorrected overdose figures as well as the corrected results Ruhm calculated. Use the map toggle to switch between the two.

“Corrected rates … yielded a more coherent geographic pattern than reported,” Ruhm wrote in the study.

The corrected rates show a concentration in the Mountain States and Rust Belt.

So, why am I so concerned regarding the “new” strategy for managing the opioid crisis. First, you can’t solve the crisis by throwing money at the problem unless the strategy was a true solution and it isn’t.

Consider the following: Beach Town Tries To Reverse Runaway Growth Of ‘Sober Homes’!                                                                                                                                           Greg Allen reported that Delray Beach’s charming downtown, palm trees, and waves attract locals, vacationers and, increasingly, drug users who come here to try to get off opioids. In some parts of the small Florida community, there’s a residential program for people recovering from addiction — a sober living house or “sober home” — on nearly every block. Sometimes two or three or more.

On a block where resident Michelle Siegel was walking a dog recently, there are at least six sober homes. She says “you can usually tell” by the white vans and “no trespassing” signs out front.

“I have walked down the street sometimes and seen kids just passed out, face down on the ground,” she says. “And you ask them if they’re OK and they’re like, ‘Yeah, yeah, I was just tired. I was sleeping.’ And you don’t know whether you should get them help; whether you should leave them alone.” What a wonderful addition to your neighborhood!

In South Florida, there’s been runaway growth of these residential programs. As group homes for people recovering from addictions, the Americans with Disabilities Act and also the Fair Housing Act protect sober homes. Those federal laws have made it difficult for local communities to limit or otherwise regulate the facilities.

And the nation’s epidemic of opioid abuse has created new opportunities for insurance fraud. Under federal law, health care insurance pays for the costs of recovery. That’s led to a boom in residential programs to treat addiction, and also growth in deceptive marketing by some programs, fraudulent claims and what’s known as patient brokering.

The state attorney for Palm Beach County, Dave Aronberg, convened a special task force to study opioid abuse and the drug recovery industry, with a report released early this year.

Aronberg says while there are many legitimate sober homes, there are also many others operated by unscrupulous providers. They tap into insurance money by offering free rent and getting kickbacks from outpatient drug treatment centers. Aronberg calls the practice of “patient brokering” a scheme.

“The outpatient treatment center van picks your residents up three times a week to go drug test them,” he says, “which is then billed to insurance at very high rates.”

Treatment centers bill insurance companies not just for drug tests but also for other services, like group counseling, massage, and acupuncture. They share the money with the people supplying the patients, Aronberg says.

“In return,” he says, “you as a sober home owner, you get a nice check for patient brokering — which is what you’ve done.”

Although they’re in Delray Beach for recovery, residents of sober homes can find easy access to heroin and other drugs. The city’s fire rescue crews responded to more than 1,300 overdose calls last year — many of sober homes.

“We respond there sometimes repeatedly in the same shift,” says Matt Pearce, an EMS captain. On one recent night, he says, “they responded to the same sober home two times within 10 minutes, both for overdoses.”

With a cost of $2,500 for each EMS call, these overdoses have put a strain on the city’s budget. Much worse is the human toll. Countywide, nearly 600 people died of overdoses last year.

It’s a problem for Delray Beach and for people with addictions who are often lured by marketers to South Florida on false pretenses.

“They make the individual on the other line think that they’re a doctor and they’re diagnosing them,” Aronberg says, “when, in reality, they’re only reading from a script given to them by the treatment center which is paying them.”

Rather than operating on a recovery model, Aronberg says, unscrupulous sober homes and treatment centers operate on a “relapse cycle,” which bring clients back time and again for treatment that is covered by health insurance.

Neill Timmons has seen how reputable facilities can work — from both sides. “I’m in recovery myself,” he says, “six years next month.” Timmons runs four houses for sober living in another Palm Beach County community, Boynton Beach.

Like other reputable operators, he doesn’t receive payments through arrangements with drug treatment centers. He says for someone going through recovery, landing in a good sober home can make all the difference. Of his residents, he says, “They’re not certain … if they want to stay sober the rest of their lives or return back to use. And they’re struggling with what they need to do … if they do want to stay sober.”

A good facility, he says, “should really guide and give them some guidance toward recovery.”

Timmons and others who run good facilities want more regulation. They’re pleased by a law, recently signed by Florida’s governor, that increases the penalties for patient brokering and deceptive marketing.

A study commissioned by Delray Beach, and released in May, found at least 250 sober homes in a town of just 60,000 — about a quarter of them operating under the city’s radar.

The town’s mayor, Cary Glickstein is no fan of the drug recovery industry and sober homes — or of the problems he says they’ve brought to his city. He runs down the list — “patient brokering, drug trafficking, human trafficking, prostitution. It’s a Pandora’s Box of problems that the unscrupulous operators bring to a community.”

Glickstein is confident a new ordinance just adopted by Delray Beach will enable the city to crack down on sober homes. It requires them to be certified by an independent trade association and limits their presence to no more than one per block.

After adopting a similar ordinance, officials in Prescott, Ariz., say the number of sober homes in their community is now a third of what it once was.

We are also forgetting the non-addicted people who live around the “sober-homes”, which become havens for recidivist addicts, whose property values have plummeted. They can’t sell their homes even if they want to and have to put up with addicts vomiting on their front lawns and attracting all sorts of felons. Did we also forget the other facets to the opium addiction epidemic in our communities…Human trafficking????? This where those involved in human trafficking inject teens with heroin and forcing them into prostitution.

Additionally, the gangs in each and every city depend on the drug trade to make their money and support the gang community. These are not the physicians giving them prescription drugs, as we are fast to blame.

What’s the real solution?

A ‘Vaccine (as proposed) For Addiction’ Is No Simple Fix. Richard Harris recently wrote that it’s always appealing to think that there could be an easy technical fix for a complicated and serious problem.

For example, wouldn’t it be great to have a vaccine to prevent addiction?

“One of the things they’re actually working on is a vaccine for addiction, which is an incredibly exciting prospect,” said Dr. Tom Price, secretary of Health and Human Services.

He was talking to reporters earlier this week after the White House discussed the recommendations from a government commission tasked with suggesting ways to cope with the nation’s opioid epidemic.

But, as is so often the case, there’s no quick fix on the horizon for an epidemic that is now killing more Americans than traffic accidents.

Researchers have been working on vaccines against addictive drugs, including nicotine, cocaine, and heroin, for almost two decades.

“Like any other vaccine, you inject the vaccine and you use your immune system to produce antibodies,” says Dr. Ivan Montoya, acting director of the division of Therapeutics and Medical Consequences at the National Institute on Drug Abuse. “In this case, the antibodies are against the drugs of abuse.”

So antibodies generated by a heroin vaccine, for instance, would prevent the molecules that cause euphoria from getting into the brain. (The vaccine actually targets morphine and a related chemical, since heroin breaks down into those components before crossing into the brain, Montoya says. It doesn’t block endogenous opioids — the brain’s built-in painkillers.)

The trick would be getting your body to produce enough antibodies to soak up a surge of drug injected into the bloodstream. “That is the biggest challenge, to get enough antibodies,” Montoya tells NPR.

That’s apparently a major reason that previous attempts to make a nicotine vaccine for smokers failed, he says. “The second challenge is getting the person to be vaccinated on a regular basis.”

These vaccines aren’t like the measles vaccine that you receive once or twice for a lifetime of immunity. Multiple shots per year would likely be required. So the strategy would only work in people who were actively trying to recover from a drug addiction. And people addicted to heroin who decide to get high could switch to some other opioid — like fentanyl, carfentanil, or oxycodone.

Kim Janda, a professor of chemistry at the Scripps Research Institute, says he’s thinking about developing a vaccine that targets both heroin and fentanyl. But his first priority is to test a heroin vaccine in people. So far, he’s used funding from the National Institutes of Health to test his potential vaccine in rodents and monkeys.

Human trials will cost tens of millions of dollars. The NIH generally doesn’t fund that kind of study and hasn’t made an exception for the opioid crisis. So Janda is hoping to get the money he needs from a pharmaceutical company, as other opioid vaccine developers have done.

He’s optimistic that human tests could begin in 18 months once he has funding, though it would take much longer than that to find out whether the vaccine is actually safe and effective.

Janda knows that a vaccine would supplement, rather than replace, the current approaches to treating addiction.

“I think we need to look at other ways of treating opioid addiction,” he says, “and I think this can help.”

Researchers at the Walter Reed Army Institute of Research and at the University of Minnesota are also developing vaccines against opioids, but so far none has been tried in people.

What about time release capsules that release slowly chemicals that either cancel the effects of opioids or make the addict severe ill if they inject or take narcotics by mouth, etc. I was the trial dummy for a drug called Antabuse for severe alcoholics. No. I’m not nor was I ever an alcoholic, but when I was in the orient I became ill with a parasitic disease and the drug that I was given had the same effect as the drug Antabuse. When I was in Hong Kong to visit a friend he took me out to dinner. I asked that the chief make sure to cook all the alcohol off the Peking duck, but you can surmise what happened. I was sick for 3 days. It was horrible. Why not a drug like Antabuse for opioids, etc??

My concern is that throwing money and declaring a national emergency solves nothing unless there are a viable strategy and solution. What are the solutions? Having these homes only produces more problems if you can’t get the drugs off the market/street, especially when the cost of heroin and fentanyl is so cheap and accessible. By having Narcan/naloxone over the counter may decrease overdoses but more seriously may increase the level of overdoses that the medical community sees as the addicts try to get even higher with the knowledge that someone will save them.

Seeing the results of the methadone clinics is worrisome as I over and over watch the clients that appear daily, weekly and monthly with very few cures coming and going through our town’s 2 clinics. And the people that own these clinics are making a killing and we the taxpayers are footing the bills.

We need to fully understand all these issues before we throw money at the crisis.

Unfortunately, we are progressively taking the power of law enforcement from those who do it best…the police. The excuses from the liberal groups are the police are too aggressive. Think about that when your own son or daughter overdoses and is found dead with a needle stuck in their arm.

Wake up!!!!!

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