30% Of Patients Prescribed Opioids For More Than A Month Still On Them A Year Later

From a review of 1,294,247 patient records from a database of commercial health plan information from a large number of managed care plans and is representative of the U.S. commercially insured population.

The rate of long-term use was relatively low (6.0% on opioids 1 year later) for persons with at least 1 day of opioid therapy, but increased to 13.5% for persons whose first episode of use was for ≥8 days and to 29.9% when the first episode of use was for ≥31 days.

(The study excluded patients with a substance abuse disorder diagnosis.)

CORRECTION: The title of this post has been corrected. It originally read, “Almost Half Of Patients Prescribed Opioids For A Month Get Hooked For A Year”. This is a good reminder of the Joint Commission’s lesson to not trust other people’s characterization of research and always read the source material.

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Bill White’s message to congress

Bill White shares an open letter to congress:

Two of the most important responses to the opioid epidemic have been the ACA’s expansion of Medicaid in 31 states and the District of Columbia and the ACA requirement that states include mental health and addiction treatment as reimbursable services. Those critical responses will be turned back if the GOP health reform proposal is passed in its current form.

Read the rest here.

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“the opioid epidemic is the new AIDS”

actup_forlife_haring1For the last couple of years, when trying to explain the experience of the opioid crisis, I’ve often said, “I imagine it’s kinda like the AIDS epidemic in the late 1980s and early 1990s.” However, I always qualify the statement by emphasizing “kinda” and saying something like, “I’m not saying it’s that rough.”

Now, Andrew Sullivan, who survived the AIDS epidemic, says the following:

Those of us who lived through the AIDS epidemic retain one singular memory: The plague that ravaged our lives was largely invisible to others. The epidemic was so concentrated for a while in a gay male subculture — often itself veiled by various closet doors — that straight people without gay family members or friends couldn’t see it. There was blanket media coverage, of course. But in your everyday life, if you were straight, you could live quite easily in the 1990s without coming across someone with AIDS. While gay men were living in a medieval landscape of constant disease and death, many others carried on in safe, medical modernity, that elysian period in human history when most diseases can at least be treated, if not cured.

It occurred to me reading this reported essay by Christopher Caldwell that the opioid epidemic is the new AIDS in this respect. Its toll in one demographic — mostly white, working-class, and rural — vastly outweighs its impact among urbanites. For many of us in the elite, it’s quite possible to live our daily lives and have no connection to this devastation. And yet its ever-increasing scope, as you travel a few hours into rural America, is jaw-dropping: 52,000 people died of drug overdoses in 2015. That’s more deaths than the peak year for AIDS, which was 51,000 in 1995, before it fell in the next two years. The bulk of today’s human toll is related to opioid, heroin, and fentanyl abuse. And unlike AIDS in 1995, there’s no reason to think the worst is now over.

It’s a very powerful statement. However, I’d need more information about the emphasis on the single demographic of  “white, working-class, and rural.” Especially since Sullivan’s emphasis on this demographic ends up becoming a convenient vehicle for his pet arguments in support of Charles Murray.

Sullivan also notes an important contrast between the opioid crisis and the AIDS epidemic:

There are major differences between the two health crises, of course, but none of them are very encouraging. AIDS was eventually overcome by innovation by pharmaceutical companies. The heroin epidemic is, in many ways, the creation of those very same companies, thanks to their cynical marketing of opioid products in the 1990s.

He ends with these thoughts about policy and advocacy:

Worse: Funds for AIDS research kept rising and rising through the 1990s. Today, the Trump administration’s proposed cuts to Medicaid could drastically reduce treatment options in a spiraling crisis. Silence = Death, once again. But where, one wonders, is the ACT UP of the red states?

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Sentences to ponder

grief by elycefeliz

grief by elycefeliz

From Atul Gawande:

We are running out of ways to emphasize how dire the opioid overdose crisis has become. In 2015, United States drug overdose deaths exceeded 50,000; 30,000 involved opioids. There were more deaths from opioid overdose than not only from motor vehicle accidents, but also than from HIV/AIDS at the peak of the epidemic in 1995.

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Sentences to ponder

From the Brookings Institute:

Forty percent of the men who aren’t working and aren’t even looking for work report taking pain medication every day, compared to 20 percent for those in the workforce.

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Van Jones, Newt Gingrich and Patrick Kennedy opioid advocacy paid by drug maker

money-pillsYou may recall that Van Jones, Patrick Kennedy and Newt Gingrich have started engaging in advocacy around the opioid epidemic.

Here’s what I said at the time:

You may have heard that the unlikely crew of Newt Gingrich, Patrick Kennedy & Van Jones have taken interest in addressing the opioid crisis. More allies is a great thing.

I then observed that:

  • they strongly advocated medication assisted treatment (buprenorphine in particular) as the standard of care,
  • they conflated recovery with access to MAT,
  • it was great that they provided sources, so we could look at their evidence.

I examined the evidence and found it didn’t speak to the goals of most families and people with addiction.

Turns out, I was being pretty naive to think of them as altruistic allies.

I thought these influential men had a common concern about a national crisis and decided to come together to use their power and influence to advocate for solutions. I disagreed with the emphasis of there solutions, but chalked that up to reasonable people disagreeing.

I looks like I assumed too much.

A new article in STAT describes them as paid advisers to the group and adds the following:

But the nonprofit group refuses to answer a simple question: Who is funding the campaign?

Gingrich told STAT he had no idea who was supporting Advocates for Opioid Recovery, which was founded last year. Kennedy declined to be interviewed, as did Van Jones, the CNN commentator and former Obama aide who is another paid adviser. Jones has coauthored opinion pieces with the other two men and promoted the advocacy group on social media.

Gingrich described Kennedy as the driving force and the article reports the following:

Kennedy has close ties to treatment centers that could benefit from wider use of the medications in opioid treatment and broader payment for the treatment by insurers. Several treatment centers that make use of medication-assisted treatment are sponsors of the Kennedy Forum, a nonprofit he founded to increase access to treatment for people suffering from mental illness and addiction and promoting research in the area.

One of those organizations is CleanSlate Addiction Treatment Centers, where Kennedy has also been a board member since 2015. The organization paid $750,000 last year to settle government allegations that it was improperly prescribing Suboxone, one of the class of medications advocated by Kennedy and the other paid advisers to Advocates for Opioid Recovery.

This begs all sorts of questions, right?

A spokesman for Advocates for Opioid Recovery declined to say how much the men are paid. He said the organization would not disclose information on who is funding it other than it is “a variety of organizations and people” that want to be anonymous. The spokesman, Peter Collins, declined to answer whether or not any of the funding is coming from manufacturers or suppliers of the medications, or facilities that base their treatment model on use of the drugs.

And, no one is willing to talk about it.

However, they’ve been all over TV and print media:

The three men, in opinion pieces and interviews, have called for increasing the number of patients a doctor can treat with the medicines as well as boosting government funding and insurance coverage for medication-assisted treatment.

STAT reports that the directors all have ties to Kennedy and the executive director is a former Gingrich staffer. And, the group is operated from a public relations firm.

Will we ever know who funds their group?

disclosure by Raul P

disclosure by Raul P

The STAT story looked like it was going to leave us with unanswered questions, but they came through in another story.

The answer, according to a filing with the Securities and Exchange Commission, is Braeburn Pharmaceuticals Inc. The private company, based in Princeton, N.J., won approval last year to market an implant that continuously dispenses the opioid addiction medicine buprenorphine.

Braeburn is the maker of Probuphine.

As my previous post on Probuphine indicated, STAT reports:

. . . some addiction experts have expressed skepticism that the Braeburn implant will be an effective treatment option. There are alternative opioid-addiction treatments that do not rely on medication, including abstinence-based and behavioral therapy programs.

Judge for yourself

Earlier this week, I posted an article from the Joint Commission that reviewed their role in the opioid crisis and attempted to identify lessons to be learned.

One of the lessons was “carefully review the primary literature on issues of critical importance and do not simply repeat the claims of experts in previous articles“.

 Well, I reviewed the evidence for Gingrich’s, Jones’ and Kennedy’s claims. You can see that, with links to sources, here.

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In case you were wondering how Pharma’s faring

money-pillsYesterday, I posted about the Joint Commission’s review of the unintended consequences of their emphasis on pain without the proper input, review and feedback systems.

The opioid crisis that this has contributed to have been a disaster for families, communities and health care professionals who are trying to navigate the standards, untrustworthy standards of care, and their medical/social consequences.

One might wonder how Pharma is faring in this crisis. Has there been regulatory, criminal, funding or popular backlash that has hurt their viability?

It would appear not.

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