mental health – R&R – Reachout and Rebuild

Treating patients with opioid disorders is not just about treating addiction. Here’s why

David Posnett — Mon, 19 Jun 2017 21:35:56 +0000

Posted on STAT

JUNE 19, 2017

DOMINICK REUTER/AFP/GETTY IMAGES

Patients with opioid use disorder are much more likely than the general population to have a host of other health conditions, including hepatitis C, post-traumatic stress disorder, and anxiety.

That’s according to a new analysis from health care company Amino, which culled data from the claims of 3.1 million privately insured patients between 2014 and 2016. It calculated the frequency of a slew of health conditions — from back pain to binge drinking — in patients diagnosed with opioid use disorder. Then, it compared those rates to the general patient population.

Here’s what it found.

As the chart shows, patients with opioid use disorder are diagnosed with hepatitis C nine times as often as other patients, at least among the privately insured.

Cases of hepatitis C have skyrocketed as the opioid epidemic has spread: There were an estimated 30,500 new cases in the U.S. in 2014, nearly double the number of new cases in 2011. Most of those new cases are among people who inject drugs such as heroin.

Hepatitis C infections have increased particularly sharply among young people who live in rural areas of Appalachian states, according to the Centers for Disease Control and Prevention.

Painkiller prescriptions for back pain were an early target in the efforts to curb opioid misuse and abuse — and for good reason. The analysis by Amino shows that “failed back syndrome” — a broad category that covers back pain after surgery — is seven times more frequently diagnosed in patients with opioid use disorder.

Earlier this year, the American College of Physicians reviewed the evidence on treating back pain and released a new set of guidelines. Its recommendation: Opioids should be a last resort for treating lower back pain, after every other treatment has failed. It recommendeds patients first try non-drug therapies such as exercise, massage, and yoga.

If those don’t work, the ACP told doctors to have patients pop an over-the-counter pain reliever and wait it out, noting that most back pain improves over time regardless of treatment.

The new report also adds to the evidence of the connection between substance abuse disorders and other mental health conditions.

Alcoholism is diagnosed eight times more often in patients with opioid use disorder, according to the new analysis. And patients with opioid use disorder are also more frequently diagnosed as having suicidal thoughts, anxiety, depression, and insomnia. Many find it difficult to get the care they need. In part, that’s because people with mental health conditions and substance abuse problems are among the most likely to be uninsured.

Former President Barack Obama established a task force last year to tackle that problem. In October, the task force released a report urging mental health and substance abuse treatments to be covered like medical and surgical care.

Zeldin’s “War on drugs” ineffective

David Posnett — Thu, 02 Mar 2017 15:38:16 +0000

This letter appeared today March 1st in the East Hampton Press on page A7

Rep. Lee Zeldin writes about his health care goals in the Riverhead Local:

“… here in Suffolk County, our communities and families have been severely impacted by the rise of prescription drug abuse and the growing heroin crisis…”

He has been in office for over 2 years and the drug crisis has worsened dramatically. http://www.newsday.com/opinion/editorial/confronting-the-curse-of-opioids-and-heroin-1.11722083

As reported in April 2016, Suffolk County has the most heroin-related deaths in New York State. http://pix11.com/2016/04/10/suffolk-county-has-most-heroin-related-deaths-in-new-york-state-report-finds/

Rep. Zeldin’s says he will “continue working” on this problem and then proceeds with a list of uninspired old ideas. He says he wants to ”discuss and develop … solutions”.

This is a crisis best handled by drug-use professionals and requires national funding and action, immediately. Zeldin could declare this an emergency (like any medical emergency), he could attract top medical and drug abuse/addiction specialists and work with SUNY Stony Brook, other local hospitals and community centers.

Moreover, our new national government does not believe in institutions like the NIH and CDC and Mr. Zeldin does not seem to voice his concern about this. For example, there were directives freezing communications between NIH and congress: http://www.sciencemag.org/news/2017/01/memo-freezing-nih-communications-congress-triggers-jitters Note that the National Institutes on Drug Abuse (NIDA) is part of the NIH.

The CDC, notably, will lose 10% of its budget with repeal of the ACA. https://www.scientificamerican.com/article/trump-rsquo-s-cdc-may-face-serious-hurdles/

The drug abuse and heroin crisis is a healthcare emergency, as many families in the district know all to well. Rep. Zeldin’s promises to help, ring hollow. His lack of successful action over the last 2 years does not inspire confidence.

Mental Health and the ACA

David Posnett — Sat, 28 Dec 2013 18:27:19 +0000

Those of us with experience, either as patients or health care providers, in the field of mental health may wonder what the ACA provides towards better mental health. Truly, sometimes I wonder at the sorry state of this branch of medicine when it comes to keeping patients and the public safe. The NY Times had a sobering piece on how poorly we enforce our laws and regulations to keep weapons out of the hands of the mentally ill.

However, the ACA does help the mental health field (at least a bit)! Read more here and get answers to questions like these:

How is mental health care insurance provided to those in need?
With implementation of the health reform law, what options will be available to me for new, additional or expanded mental health care insurance?
I am a Veteran. What do I need to know about insurance for mental health care that will help me and my family?
I am a Hispanic American. What do I need to know about insurance for mental health care under the health reform law? Who will have access to insurance and who will not?
Does everyone need to have health insurance under the health reform law?
What is available now through the health reform law what do I need to know before 2014?
What health insurance benefits will be mandatory as part of the health reform law?
I have heard a lot about the issue of Medicaid expansion. What does this mean to me in my state?

Here, also, is an interesting view with a detailed discussion of state by state differences of the impact of ACA on mental health care! Some states have watered down the benefits considerably it seems.

Finally, this .gov site sums it up!

The ACA expands benefits and parity with other diseases
Covers preventative services
Cannot deny coverage for preexisting mental conditions