Effective treatments for opioid use disorder are underutilized

NIH research confirms effective treatments for opioid use disorder are underutilized

June 19, 2018

Released by the National Institute on Drug Abuse (NIDA)

A National Institutes of Health-funded study found that treatment of opioid use disorder with either methadone or buprenorphine following a nonfatal opioid overdose is associated with significant reductions in opioid related mortality. The research, published today in the Annals of Internal Medicine, was co-funded by the National Institute on Drug Abuse (NIDA) and the National Center for Advancing Translational Sciences, both parts of NIH.

Study authors analyzed data from 17,568 adults in Massachusetts who survived an opioid overdose between 2012 and 2014. Compared to those not receiving medication assisted treatment, opioid overdose deaths decreased by 59 percent for those receiving methadone and 38 percent for those receiving buprenorphine over the 12 month follow-up period. The authors were unable to draw conclusions about the impact of naltrexone due to small sample size, noting that further work is needed with larger samples. Buprenorphine, methadone, and naltrexone are three FDA-approved medications used to treat opioid use disorder (OUD).

The study, the first to look at the association between using medication to treat OUD and mortality among patients experiencing a nonfatal opioid overdose, confirms previous research on the role methadone and buprenorphine can play to effectively treat OUD and prevent future deaths from overdose.

Despite compelling evidence that medication assisted treatment can help many people recover from opioid addiction, these proven medications remain greatly underutilized. The study also found that in the first year following an overdose, less than one third of patients were provided any medication for OUD, including methadone (11 percent); buprenorphine (17 percent); and naltrexone (6 percent), with 5 percent receiving more than one medication.

In an editorial commenting on the study, Dr. Nora Volkow, director of NIDA, said, “A great part of the tragedy of this opioid crisis is that, unlike in previous such crises America has seen, we now possess effective treatment strategies that could address it and save many lives, yet tens of thousands of people die each year because they have not received these treatments. Ending the crisis will require changing policies to make these medications more accessible and educating primary care and emergency providers, among others, that opioid addiction is a medical illness that must be treated aggressively with the effective tools that are available.” The editorial was co-authored by NIDA scientist Dr. Eric Wargo.

Another alarming study finding was that despite having had an opioid overdose, 34 percent of people who experienced an overdose were subsequently prescribed one or more prescriptions for opioid painkillers over the next 12 months, and 26 percent were prescribed benzodiazepines.

“Nonfatal opioid overdose is a missed opportunity to engage individuals at high risk of death,” said Marc Larochelle, M.D., the study’s lead investigator at Boston Medical Center’s Grayken Center for Addiction and Boston University School of Medicine. “We need to better understand barriers to treatment access and implement policy and practice reforms to improve both engagement and retention in effective treatment.”

The authors conclude that a nonfatal opioid overdose treated in the emergency department is a critical time to identify people with OUD, and an opportunity to offer patients access to treatment inventions, providing linkage to care following their discharge, and making improvements in treatment retention.

Read the whole article here.

The Public’s Health: Six-tier strategy targets substance abuse

KAREN SULLIVAN for The Montana Standard

Substance abuse is the No. 1 health issue in Butte-Silver Bow, and collaborators in the community are working to develop a plan to address the problem.

Substance abuse in the state as a whole is a reigning health issue, ranking among the top concerns in most Montana communities.

Locally, a substance abuse task force, created last year by Butte-Silver Bow Chief Executive Dave Palmer, is at work to develop local strategies to address substance abuse and substance use disorders. The task force is ably facilitated by local therapist Laura Cross, president of Butte Cares, an organization that focuses on substance abuse prevention.

Statewide, a strategic plan has been developed to address substance use disorders. The plan will define statewide strategies through 2019.

“More than 100 people die every year from drug overdose in Montana, and almost 22,000 hospital or ER visits annually are attributable to alcohol and drug use,” says the introduction to the document, titled “Addressing Substance Use Disorder in Montana.” “The impacts of substance use span every generation and cut across socioeconomic lines, from children in our foster care system to seniors prescribed opioids for chronic pain.”

At the local task force’s first meeting a few months back, Mike Thatcher, chief executive officer of Butte’s Community, Counseling, and Correctional Services, Inc., underscored how substance abuse crosses every spectrum. Thatcher said CCCS officials are contacted weekly by Butte people worried about themselves or a family member and looking for assistance.

The state plan says rural states such as Montana are limited in ability to provide access to “robust, evidence-based systems to prevent, treat and manage” substance use disorders. However, with that reality in mind, the Montana plan — developed after five meetings were held statewide, with 114 people participating and 82 agencies represented — forwarded six areas for targeted strategy. They are partnerships; prevention and education; enforcement; monitoring; treatment; and family and community resources.

At the beginning of the state plan, Montana Gov. Steve Bullock wrote a letter saying that “we are in the midst of a significant public health crisis.” Bullock added, “drug overdose deaths have been on the rise nationally, and although alcohol abuse is more prevalent in Montana, opioid and methamphetamine use are a significant cause for concern as well. Drug overdoses are the third leading cause of injury-related death in Montana, accounting for 1,334 deaths between 2003 and 2014.”

Here’s what is going on in Montana — an estimated 64,000 residents have a substance use disorder; 90 percent of those with these disorders are not receiving treatment. Annually in the state, 390 deaths can be attributed to alcohol, with 34 percent of all traffic fatalities in the state being alcohol-related. Twenty percent of Montana adults report binge drinking in the last year, compared to 16 percent of adults in the United States, and seven percent of Montanans ages 12 and over are dependent on abusing alcohol.

In regard to methamphetamine, Montana has seen a 427 percent increase in meth violations from 2010 through 2015; 46 percent of all open Child and Family Services placements involve meth.

Regarding marijuana, 122,000 Montanans ages 12 and over are estimated to have used in the last year. Of drug violations in the state, 57 percent involve marijuana. Thirteen percent of high school students report using marijuana in the past month, even though 62 percent of youths believe smoking marijuana regularly is harmful.

And illicit drugs — in 2015, 116 heroin arrests were made in the state, up from four 10 years prior. Three percent of Montanans ages 12 and up — 18,000 people — say they are dependent on or abusing illicit drugs. Five percent of adults ages 18 to 25 report using cocaine in the past year.

“This challenge strains our families, our hospitals and healthcare providers, our health and our public safety,” Bullock wrote in his letter, adding that the plan “focuses not only on preventing deaths, but finding treatment and support for those struggling with substance use disorders so that our communities may heal.”

Please watch for future columns that will illustrate the contents of the state plan, and strategies being developed by the local task force.

I’m with Bullock — this is a straining challenge. But I very much look forward to working with local task force members to develop partnerships and prevention and education strategies, to beef up enforcement measures, to build monitoring strategies, to facilitate best-in-class treatment options, and to further develop family and community resources. It will take a village.

Karen Sullivan is Butte-Silver Bow Health Officer and Director of the Health Department. Her column, The Public’s Health, appears weekly on The Montana Standard’s health page.

Read the story on the Montana Standard

Rally sparks support for tobacco tax on ballot

HELENA – A rally was held Thursday to spark support for a ballot initiative that would increase the cost of a pack of cigarettes by $2 and add fees to other tobacco products to be used for Medicaid expansion and other health programs.

Kristin Page-Nei, American Cancer Society Cancer Action Network Montana Government Relations director, said a “major ground game” was planned for the tobacco tax proposal that is expected to be on the Nov. 6 ballot.

Dozens of people gathered at the amphitheater in the Great Northern Town Center, in the shadow of the carousel.

Read the whole story

By Phil Drake, pdrake@greatfallstribune.com

Published 2:25 p.m. MT April 19, 2018 at GreatFallsTribune.com

Report: Medicaid expansion pays for itself

Report: Medicaid expansion pays for itself; future economic impact seen as bright

HOLLY K. MICHELS holly.michels@lee.net
Apr 10, 2018

In the first two years after Montana expanded Medicaid, the savings to the state have eclipsed the costs. Though that could flip by 2020, increased activity in Montana’s economy because of the expansion will more than make up the difference.

That’s according to a report commissioned by the Montana Healthcare Foundation and Headwaters Foundation.

The full report will be released broadly later this week. A preliminary version was discussed at a state legislative interim hearing earlier this year. It was produced by the University of Montana’s Bureau of Business and Economic Research.

The report also found that in the time Montana has expanded Medicaid, workforce participation has increased among low-income earners. When Montana choose to expand Medicaid, it also added a program called Help-Link that connects those covered under expansion with employment assistance.

Read More: http://helenair.com/news/government-and-politics/report-medicaid-expansion-pays-for-itself-future-economic-impact-seen/article_8506e739-ad5c-5c75-8679-964e620ac5c6.html

Montana’s income inequality is growing faster

By HOLLY K. MICHELS holly.michels@lee.net

Montana is the state with the fastest growth of income inequality, according to a recent report based on U.S. Census Bureau data.

The report, from a website called Zippia that covers career issues, summarizes data from the American Community Survey from 2010-2016.

Montana’s income inequality increased 4.97 percent over those six years. The state ranks 30th in overall income inequality; New York tops that list.

“What we are seeing is not unique to Montana, but we have seen income inequality grow at a faster rate in Montana over the past five years,” said Heather O’Loughlin, co-director of the Montana Budget and Policy Center.

O’Loughlin said part of the reason Montana ranks at the top of the list is likely that non-wage income is making up a bigger share of the state’s economy. A vast majority of that kind of income, such as capital gains and real estate investments, goes to higher-income households, O’Loughlin said.

Read More

Billings Gazette Reports on Yellowstone County’s Top Health Issues

The Billings Gazette reported on February 6, 2017 that the “overall health and mental health of Yellowstone County residents is worse than it was a dozen years ago, even though they have access to more treatment and are seeking it out, a recent report shows.”

View the entire Billings Gazette Article

Montana Health Information Exchange Launch Stakeholder Meeting

Montana Medical Association hie-2016-theme-image

 

You are invited to join other top decision makers December 6-7 in Helena to jumpstart a sustainable Health Information Exchange Organization in Montana!
On December 6, key decision makers committed to the successful launch of this foundational component
of health care reform will engage in a straightforward conversation about unique legal, technical, and
governance challenges. Collaborative work groups will be formed to determine the feasibility of a Health
Information Exchange Organization in Montana.


Discussion continues on December 7 with targeted work groups diving deeper into areas critical to a
Health Information Exchange Organization’s success.
Works groups that will be formed are:
  • Clinical Use Cases
  • Finance / Business Model
  • Governance
  • Privacy & Security
  • Quality
  • Technology

To register for this important planning event click here.

 

Uninsured now accessing care with Medicaid Expansion

Uninsured now accessing care with Medicaid Expansion.

http://www.greatfallstribune.com/story/news/local/2016/02/03/uninsured-now-accessing-care-medicaid-expansion/79790504/  

Doctor Shortage Leads to Questions of Health Care Access

http://flatheadbeacon.com/2016/01/28/doctor-shortage-leads-to-questions-of-health-care-access/

Flathead Community Health Center mentioned.

 

Sapphire Community Health Center Opens

Sapphire Community Health Center Opens: http://ravallirepublic.com/news/local/article_ba4eec1c-90ad-11e5-9e5b-47a8aae652ea.html CEO Janet Woodburn quoted.