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Cornyn, Feinstein Substance Abuse Prevention Bill Passes in Opioids Package

US Senate 1 — U.S. Senate Passes of The Opioid Crisis Response Act of 2018

The Council on Recovery applauds the efforts of the United States Senate in passing the Opioid Crisis Response Act of 2018 by a vote of 99-1. The bill included the Substance Abuse Prevention Act, sponsored by Senators John Cornyn and Dianne Feinstein. The following press release was issued shortly after the bill passed:

U.S. Senators John Cornyn (R-TX) and Dianne Feinstein (D-CA) released the following statements after their Substance Abuse Prevention Act, a bipartisan bill to reauthorize drug abuse programs, passed as a part of The Opioid Crisis Response Act of 2018.

“Our nation continues to suffer from a drug crisis, and this critical legislation will combat the supply of opioids and help individuals and families suffering from substance abuse,” said Sen. Cornyn. “By including the Substance Abuse Prevention Act in this bill, we will be able to strengthen the ability of law enforcement and healthcare agencies to reduce addiction and support those in recovery.”

“Drug addiction and overdoses have reached crisis levels in our country,” Sen. Feinstein said. “In order to address this issue we must strengthen the agencies and programs that are focused on stopping drug use before it starts, dismantle drug trafficking organizations and expand access to treatment. This bill embraces that strategy by reauthorizing the Office of National Drug Control Policy and other successful initiatives like the Drug-Free Communities and High Intensity Drug Trafficking Areas programs. The bill also establishes new programs to provide law enforcement with tools, training and equipment to detect and prevent fentanyl-related overdoses and to ensure families and children have more access to substance abuse treatment.”

Background:

The Substance Abuse Prevention Act was originally introduced by Senators Cornyn and Feinstein to reauthorize drug abuse programs, and to provide assistance to various agencies so they can better combat opioid addiction and support those recovering from substance abuse.

Office of National Drug Control Policy: Reauthorizes the Office of National Drug Control Policy (ONDCP) at the White House, which oversees Executive Branch efforts on narcotics control and ensures efforts complement and strengthen state and local anti-drug activates.
Drug Abuse Prevention Programs: Reauthorizes several important programs under the ONDCP including the Drug-Free Communities Program and the High-Intensity Drug Trafficking Area Program and allows the ONDCP Director to participate in and expand opioid and heroin awareness campaigns which were authorized under the Comprehensive Addiction and Recovery Act (CARA).
Drug Courts: Reauthorizes Department of Justice funding for drug courts, which provide targeted interventions for individuals with drug addiction and substance abuse disorders and allows non-profit organizations to provide important training and technical assistance to drug courts.
Supporting Families with Substance Abuse Challenges: Provides resources to the Department of Health and Humans Services (HHS) for screening, treatment, supportive housing, and interventions in order to help support families as they battle substance abuse challenges.
Better Substance Abuse Treatment: Directs the Government Accountability Office (GAO) to conduct a study on reimbursements for substance use disorder services and make recommendations in order to bring parity to and improve reimbursements.
Educating Prescribers: Requires Attorney General and HHS Secretary to complete a plan for educating and training medical practitioners in best practices for prescribing controlled substances.
Supporting Education and Awareness: Allows the Attorney General to make grants available to entities that focus on substance use disorders and specialize in family and patient services.
Sobriety Treatment and Recovery Teams: Authorizes the Director of ONDCP in coordination with SAMHSA to provide grants to establish Sobriety Treatment and Recovery Teams (START) to determine the effectiveness of pairing social workers and mentors with families that are struggling with substance use disorder and child abuse or neglect.

The following groups supported the Substance Abuse Prevention Act: the Community Anti-Drug Coalitions of America (CADCA), the Addiction Policy Forum, the National Association for Children of Addiction (NACoA), the Moyer Foundation, the National Council for Behavioral Health, the National District Attorneys Association, the Fraternal Order of Police, the National HIDTA Directors Association, the Partnership for Drug-Free Kids, the National Criminal Justice Association, the National Association of Police Organizations, and the National Association of Drug Court Professionals.

CNN Reports Nearly 30% of All Opioid Prescriptions Lack Medical Explanation

CNN Report Opioid Rx Lack Medical — Nearly 30% of All Opioid Prescriptions Lack Medical Explanation [Click to watch CNN report]

This CNN story reported findings of a recent study by the Annals of Internal Medicine that indicated nearly 30% of all opioid prescriptions lack medical explanation:

(CNN) How large a role do doctors play in the opioid crisis? Nearly 30% of all opioids prescribed in US clinics or doctors’ offices lack a documented reason — such as severe back pain — to justify a script for these addictive drugs, new research finds.

In total, opioids were prescribed in almost 809 million outpatient visits over a 10-year period, with 66.4% of these prescriptions intended to treat non-cancer pain and 5.1% for cancer-related pain, according to a study published Monday in the journal Annals of Internal Medicine.

However, for the remaining 28.5% of prescriptions — about three out of every 10 patients — there was no record of either pain symptoms or a pain-related condition, the Harvard Medical School and RAND Corp. researchers say.

‘Inappropriate prescribing’

“For these visits, it is unclear why a physician chose to prescribe an opioid or whether opioid therapy is justified,” said Dr. Tisamarie B. Sherry, lead author of the study and an associate physician policy researcher at RAND. “The reasons for this could be truly inappropriate prescribing of opioids or merely lax documentation.”

Sherry and her colleagues, who analyzed data from the National Ambulatory Medical Care Survey for 2006 through 2015, say the most common diagnoses at doctor visits that lacked medical justification were high blood pressure, high cholesterol, opioid dependence and “other follow-up examination.”

Opioid dependence, which accounted for only 2.2% of these diagnoses, cannot explain why a doctor failed to give an adequate reason for prescribing addictive painkillers.

“If a doctor does not document a medical reason for prescribing an opioid, it could mean that the prescription is not clinically appropriate,” Sherry said. “But it could also mean that the doctor simply missed recording the medical justification for an opioid, perhaps due to time constraints, clinic workflows or complicated documentation systems.”

We cannot assume that poor record-keeping “indicates a nefarious purpose on the part of the doctor,” she added.

Social media’s contribution

Tim K. Mackey, an associate professor at the University of California, San Diego School of Medicine and director of the Global Health Policy Institute, described the new study as “an important analysis,” with the findings highlighting “gaps in our understanding of why clinicians prescribed opioids.”

Mackey, who did not participate in the research, believes that the study could lead to stricter prescribing guidelines, which in turn could give rise to “unforeseen consequences.” For example, if new guidelines and initiatives make it harder for people to access opioids from hospitals and clinics, “this could shift demand to more accessible platforms, including the internet,” he wrote in an email.

“The public health danger of sales of opioids online has been well recognized by the US government, with a US General Accounting Office report from as early as 2004 warning about pain medications available online without a prescription,” he said.

Mackey’s own research highlights how online pharmacies use social media to sell controlled substances while drug dealers use Twitter to sell opioids by including their phone or email information.
Someone may start by getting medication for a legitimate “pain” diagnosis, but once they become addicted, their health provider may no longer be willing to write scripts, Mackey said.

“After exhausting friends, relatives and other personal contacts, many may go to illicit channels, including street buys no longer confined to the ‘street’ but digitized on social media,” he said. Some turn to internet pharmacies despite concerns about fraud and identify theft.

“Either way, this dangerous progression of different access points that continues to enable the opioid epidemic is not well understood,” Mackey said.

With more data needed to make sense of this public health crisis, technology companies, regulators, law enforcement and researchers need to come together to share ideas, innovations and research, he said.
“Unfortunately, some of this needed collaboration may be elusive,” he said. He explained that researchers who use machine-learning and Twitter’s public application programming interface to detect illicit online activity are prevented from sharing their findings with law enforcement due to Twitter’s terms of use.

“This leaves regulators like the US Food and Drug Administration and the US Department of Justice in the dark about how they can cut off this dangerous channel of access that may continue to fuel the opioid crisis even after we make strides in other areas, such as physician prescribing,” Mackey said.

Sherry said another key finding of her study was that “physicians were especially lax at documenting their medical reasons for continuing chronic opioid prescriptions” despite government guidelines from 2016 recommending “periodic formal re-evaluation” in cases of long-term opioid treatment.

“It is now more important than ever for physicians to transparently and accurately document their justification for using an opioid so that we can identify and rectify problematic prescribing behavior,” Sherry said. “Our findings indicate that we still have a long way to go to reach this goal.”

Center for Recovering Families IOP Program Completion Rate Twice the National Average

The Council on Recovery’s Center for Recovering Families posted a 74% completion rate per episode of care for its Healing Choices intensive outpatient treatment program (IOP) during the 2018 fiscal year. This rate of completion is 14% higher than 2017 and more than twice the national average reported in the most recent survey by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The rate of completion is based on discharge data routinely tracked by treatment facilities and reported to SAMHSA, and may be one of the best indicators of program success. In the case of Healing Choices, nearly three-quarters of the clients who entered this intensive eight-week outpatient treatment program completed it and many continued in the Center’s aftercare program. The latest national data provided by SAMHSA indicates the average completion rate for IOP programs is only 32%.

Lori Fiester, Clinical Director of the Center for Recovering Families, gives credit for the success of the Healing Choices program to her dedicated staff. “They have been the ones facilitating these treatment groups,” Fiester says, “and behind every great group facilitator is a whole team that touch on the clients and their families with their assessment and individual and family sessions.”

The Center for Recovering Families provides a wide range of clinical services and counseling for individuals and families across the entire spectrum of mental health and substance use disorders. Since becoming part of The Council on Recovery in 2002, the Center has helped thousands with programs aimed at prevention, education, treatment, recovery for children, adolescents, and adults. Healing Choices is the flagship of the Center for Recovering families, and is unique among IOP programs in its ability to help individuals and their families recover.

“While the data confirms the success of Healing Choices,” Fiester says, “it’s our people who make that happen. The connections they make with their clients, paired with their therapeutic skills, are unparalleled.”

For more information about Healing Choices or any other programs at the Center for Recovering Families, call 713-914-0556 or contact us online.

Time to cut back on drinking? Here’s how…

Written by Felice J. Freyer & published by The Boston Globe, the following article provides excellent tips to those who drink. Timely information for those who use, misuse, or abuse alcohol.

Alcohol is deeply ingrained in American life, central to our habits of socializing, celebrating, and relaxing. But the pleasure of these routines can keep you from noticing when drinking has become a problem.

You can drink too much without necessarily being addicted to alcohol. Although some people who drink excessively find they must abstain, many others can just cut back — and moderation often makes their lives better.

How do you know when it’s time to reassess your drinking? And if you want to drink less, how do you do it?

The Globe asked for tips from experts in alcohol use at Harvard Medical School, the Boston University School of Medicine, the VA Boston Healthcare System, and the National Institute on Alcohol Abuse and Alcoholism. Here’s what they said.

Signs that you might be drinking too much

It’s starting to worry you or other people. Friends or relatives comment on your drinking.
You’re drinking more frequently and alcohol is starting to take a bigger role in your life.
You suffer from poor judgment while drinking, doing or saying things you regret when sober.
You find that you’re drinking more than you planned.
You can’t control how much you drink once you start.

Other reasons to cut back

Even if you’re not experiencing any of the problems listed above, it might be worth reducing your drinking if any of these apply to you:

You’re not getting any younger. At some point after age 55, your body’s ability to process alcohol slows down, and you may get drunk or sick with amounts of alcohol that didn’t faze you in your youth.
You have diabetes. Most alcoholic drinks pack a lot of carbohydrates.
You have high blood pressure. Alcohol makes it worse.
You’re overweight. Alcohol contains a lot of empty calories.
You suffer from a mental illness, such as depression and anxiety. Alcohol can bring temporary relief but can make symptoms worse over time.
You’re concerned about the health risks. John F. Kelly, Harvard Medical School professor of addiction medicine, lists the hazards: addiction can occur at any time; intoxication leads to accidents and injuries; and alcohol raises the risk of cancer, particularly breast cancer, and damages the liver.

Time to cut back? Here are some ways to do that.

Track your drinking and set a goal

Learn what is a standard drink size. Twelve ounces of beer, five ounces of wine, and 1.5 ounces of 80-proof distilled spirits all have the same amount of alcohol. One martini is equal to 2½ standard drinks.
Make a note every time you take a drink, advises Amy Rubin, a research psychologist with VA Boston Healthcare. Writing it down will reduce your drinking because you’ll be paying attention, and it’s also the best way to get an accurate tally.
Then, decide how much you want to be drinking. One possible goal: the federal guidelines. These define low-risk drinking as having up to seven drinks per week with no more than three on any one day for women, or up to 14 drinks per week with no more than four on any one day for men.

Slow down

Make sure to eat before and during drinking to slow absorption into the bloodstream.
Start drinking later in the evening, to reduce the amount of time you have for drinking (but don’t drink close to bedtime or you’ll disrupt your sleep).
Intersperse every alcoholic drink with a nonalcoholic one. Take small sips. Put the drink down between each sip.
Choose drinks with lower alcohol content. Or dilute your drinks with ice cubes or seltzer.

Do something else

“Ask yourself, why are you drinking? Try to find other things that meet those needs,” said Aaron White, senior scientific adviser to the NIAAA director. If you drink to relax, for example, try a yoga class or a swim instead.
Change your routines. Perhaps go for a walk, or see a movie during the time you would normally be drinking.
Avoid places where you expect to see a lot of drinking. Even if you go to a bar, get up and play a game of pool or do something other than sitting there drinking.

Take a break

Try abstaining for 30 days. You’ll find other ways to spend your time and money and get a sense of what it feels like to be alcohol-free. For many that means better sleep, more energy, and better memory. And your tolerance for alcohol will go down, so when you resume drinking you can get the same effect with less.
If you don’t want to take a month off, try taking a day off here and there. Make sure there are some alcohol-free days each week.

Be kind to yourself

Don’t beat yourself up if you don’t succeed at first. It’s hard to break habits, and few succeed on the first try. Try different methods or set different goals.

“It’s a trial-and-error process,” said Justin L. Enggasser, an assistant professor of psychiatry at the Boston University School of Medicine. “The people that are most successful are the ones who keep trying and keep it as learning process.”

Face facts

If you still can’t reach your goals, no matter what you do, your drinking problem might be more serious than you realized. The NIAAA ( https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders ) offers a helpful description of alcohol use disorder and a “navigator”to help you find treatment.

The Council on Recovery provides prevention, education, and treatment programs for individuals and their families dealing with alcoholism, drug abuse, other addictions, and co-occurring mental health disorders. Start at The Council. We can help. Call 713-942-4100 for more information or contact us online.

As School Starts, Know the Facts About College Drinking

As students start the Fall Semester at college, The Council on Recovery urges parents and students to consider the facts about college drinking from the National Institute on Alcohol Abuse and Alcoholism.

Harmful and underage college drinking are significant public health problems, and they exact an enormous toll on the intellectual and social lives of students on campuses across the United States.

Drinking at college has become a ritual that students often see as an integral part of their higher education experience. Many students come to college with established drinking habits, and the college environment can exacerbate the problem. According to a national survey, almost 60 percent of college students ages 18–22 drank alcohol in the past month, and almost 2 out of 3 of them engaged in binge drinking during that same time-frame.

Consequences of Harmful and Underage College Drinking

Many college alcohol problems are related to “binge drinking”. Binge drinking is a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours. Drinking this way can pose serious health and safety risks, including car crashes, drunk-driving arrests, sexual assaults, and injuries. Over the long term, frequent binge drinking can damage the liver and other organs.

Drinking affects college students, their families, and college communities at large. Researchers estimate that each year:

Death: About 1,825 college students between the ages of 18 and 24 die from alcohol-related unintentional injuries, including motor-vehicle crashes.
Assault: About 696,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking.
Sexual Assault: About 97,000 students between the ages of 18 and 24 report experiencing alcohol-related sexual assault or date rape.
Academic Problems: About 1 in 4 college students report academic consequences from drinking, including missing class, falling behind in class, doing poorly on exams or papers, and receiving lower grades overall. In a national survey of college students, binge drinkers who consumed alcohol at least 3 times per week were roughly 6 times more likely than those who drank but never binged to perform poorly on a test or project as a result of drinking (40 percent vs. 7 percent) and 5 times more likely to have missed a class (64 percent vs. 12 percent). Alcohol Use Disorder (AUD) About 20 percent of college students meet the criteria for an AUD.
Other Consequences: These include suicide attempts, health problems, injuries, unsafe sex, and driving under the influence of alcohol, as well as vandalism, property damage, and involvement with the police.

Factors Affecting Student Drinking

Although the majority of students come to college already having some experience with alcohol, certain aspects of college life, such as unstructured time, the widespread availability of alcohol, inconsistent enforcement of underage drinking laws, and limited interactions with parents and other adults, can intensify the problem. In fact, college students have higher binge-drinking rates and a higher incidence of driving under the influence of alcohol than their non-college peers.

The first 6 weeks of freshman year are a vulnerable time for heavy drinking and alcohol-related consequences because of student expectations and social pressures at the start of the academic year.

Factors related to specific college environments also are significant. Students attending schools with strong Greek systems and with prominent athletic programs tend to drink more than students at other types of schools. In terms of living arrangements, alcohol consumption is highest among students living in fraternities and sororities and lowest among commuting students who live with their families.

An often-overlooked preventive factor involves the continuing influence of parents. Research shows that students who choose not to drink often do so because their parents discussed alcohol use and its adverse consequences with them.

Addressing College Drinking

Ongoing research continues to improve our understanding of how to address the persistent and costly problem of harmful and underage student drinking. Successful efforts typically involve a mix of strategies that target individual students, the student body as a whole, and the broader college community.

Strategies Targeting Individual Students – Individual-level interventions target students, including those in higher-risk groups such as first-year students, student athletes, members of Greek organizations, and mandated students. They are designed to change students’ knowledge, attitudes and behaviors related to alcohol so that they drink less, take fewer risks, and experience fewer harmful consequences. Categories of individual-level interventions include:

Education and awareness programs
Cognitive–behavioral skills-based approaches
Motivation and feedback-related approaches
Behavioral interventions by health professionals

Strategies Targeting the Campus and Surrounding Community – Environmental-level strategies target the campus community and student body as a whole, and are designed to change the campus and community environments in which student drinking occurs. Often, a major goal is to reduce the availability of alcohol, because research shows that reducing alcohol availability cuts consumption and harmful consequences on campuses as well as in the general population.

For more information on individual- and environmental-level strategies, the NIAAA CollegeAIM guide (and interactive Web site) rates nearly 60 alcohol interventions in terms of effectiveness, costs, and other factors—and presents the information in a user-friendly and accessible way. For more information, visit www.collegedrinkingprevention.gov/CollegeAIM.

2018 Houston Opioid Summit Creates Vital Awareness and Cooperation in the Battle Against Opioid Addiction

For two full days last week, nearly 250 leaders from across Harris County gathered at The Council on Recovery’s first Opioid Summit.

In keynote addresses, topical breakout sessions, panel discussions, round-table discussions, and interpersonal networking, people on the front-line in battling the opioid crisis exchanged ideas, information, and experience to develop understanding and viable solutions for dealing with the problem.

Unlike other opioid conferences that focus on individual or narrow aspects of the problem, the 2018 Houston Opioid Summit brought together all of the major sectors dealing with the issue. These included experts from the medical, legal, prevention, treatment, legislative, law enforcement and media communities who shared their perspectives of the opioid epidemic and explored ways to work together to stem opioid overdoses, currently the leading cause of accidental death.

Among the unique perspectives discussed at the Opioid Summit were the role and responsibility of media in the local and national dialogue, and the role of the faith-based community addressing the opioid epidemic.

In-depth discourse on the use of medication-assisted treatment (MAT) and the role of specialty medical care in managing substance use disorder shed new light on treatment opportunities and challenges.

Exploration of innovative criminal justice approaches and therapeutic treatment courts, and a report on narcotics law enforcement efforts, instilled vital understanding of recent legal trends.

An examination of the Harris County Opioid Litigation against manufacturers and distributors of prescription opioids by lawyers from the County Attorney’s office provided a glimpse of how the opioid crisis may be impacted by future court decisions.

The individual and family effects of the opioid epidemic were also central to the Opioid Summit as breakout sessions covered addiction treatment modalities and prevention and education programs for children and families.

Advocacy, another front in the war on opioids was keynoted by John Cates. Frank discussions were held on using technology and other therapeutic tools to promote recovery, as well as community efforts to help addicted pregnant women and deal with Neonatal Abstinence Syndrome (NAS), an increasingly alarming problem in delivery rooms across the Houston area.

A poignant and powerful closing keynote session focused on the personal perspectives of three individuals whose lives were forever touched by the opioid crisis. Moderated by KPRC’s Khambrel Marshall, the intimate conversation with Maureen Wittels, Randy Grimes, and Jim Hood drove home the devastating impact of substance use disorder. Maureen lost her son, Harris, to an opioid overdose in 2015, cutting short his 30-year old life as a rising star in Hollywood. Randy, a retired NFL player, suffered for 20 years with opioid addiction, that grew out of treating the pain of his football injuries, before getting sober nine years ago. Jim’s son, Austin, died at the age of 21 from an opioid overdose six years ago and prompted Jim to co-found a national organization, Facing Addiction with NCADD, to fight the opioid addiction with the same fervor of campaigns that have battled cancer and other deadly diseases for years.

The Council on Recovery is leading our community in the effort to find solutions to the opioid epidemic. Your support of The Council is greatly appreciated! For more information, click here.

More Photos from the 2018 Houston Opioid Summit: