Wednesday, January 22, 2014

This is a great resource for clinicians. They should become familiar with the Treatment Improvement Protocols. That are largely based on research and Best Practice.  Let seem if it pastes as a bottom on html The phone call is Free, the publication is Free, all you have to do is implemented.

Saturday, December 21, 2013

Florida is not alone, apparently Tennessee see my post on the bottom of this one.

Government Behaving Badly: Tennessee does it Again
janaburson at Janaburson's Blog - 6 days ago

I just read Tennessee’s new law regulating the treatment of opioid addiction with buprenorphine in office-based practices, due to take effect July 1, 2014. I repeatedly criticize Tennessee’s policies on addiction treatment, but they keep doing weird and counterproductive things, so I must blog about them. I don’t even blog about every little stupid thing […]

Saturday, December 14, 2013

Florida Medicaid not paying for Suboxone Bupernorphine?


 




Am being told by patients in Miami and South Florida that Medicaid is no longer paying for Suboxone  Treatment. I was told by Dr. Jeffery Kamlet told me that this was so, but I do not have the details if this for all patients or is this just an issue that one needs prior authority.

It it so that Florida Medicaid is refusing to pay for doctor and medication. Please leave me a post and/or write me to my email.  WorsetreatmentIhad@gmail.com

The only information I have found so far is this application for prior approval
http://ahca.myflorida.com/medicaid/Prescribed_Drug/pharm_thera/paforms/suboxone_subutex.pdf

I think there maybe a violation and perhaps the ACLU maybe interested in looking at it. or some
other attonies.

All I am getting from the internet is the usual list of doctors in Florida,

I have a strong impression of the healthcare management program that you most obtains approval for Suboxone and other similar medication maybe strong bias toward patients seeking maintains with Suboxone. People in Mental Health are not well known for reading research.

There is too much outright prejudice, and discrimination toward these types of patients.  Just because they are license does not mean they are protecting patients.

Please contact me at worsetreatmentihad@gmail.com

Thursday, December 12, 2013

Methadone Patients get bad stigma again.

This comes from Substance Matter by Dr. Mark Willinbring. M
http://mattsub.blogspot.com/2013/12/mmt-and-12-step-groups-stigma-persists.html

Sunday, December 8, 2013

MMT and 12-Step Groups: Stigma Persists

In his latest contribution to the academic literature, William L. White and colleagues turn their focus on 12-Step participation among patients in methadone maintenance treatment (MMT). Rates of self-reported Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) attendance were very high; however, participants frequently reported that their MMT status prevented them from taking part in many of the "key ingredients" of the groups that most members take for granted. When asked about the experience, nearly half of all respondents who had attended NA or AA reported that they had "received negative comments about methadone use" and nearly "a quarter (24.4%) reported having had a serious problem within NA or AA related to their status as a methadone patient."

The following table from the report details the "frequency with which respondents faced particular challenges":

Table 4: NA and AA Responses to MMT Patient Status                                NA            AA

Response to MM Patient Status:                                                                         (n=228)     (n=142)

Received negative comments about methadone use                                                43.0%     45.1%

Were pressured to reduce the dose of methadone                                                  21.9%     23.2%

Were pressured to stop taking methadone                                                             32.9%     34.5%

Were denied the right to speak at a meeting because of being
in methadone treatment                                                                                         14.5%      14.1%

Were denied the right to become a sponsor because of being                                  8.8%        9.9%
in methadone treatment


White and colleagues implemented this small study at not-for-profit opioid treatment program (OTP) in the Northeastern US. A total of 322 respondents answered a 53-question survey about their participation in recovery support groups. Of the 322, 259 (80.4%) reported a primary affiliation with a recovery support group. Of these, 88.8% reported it to be in some way a 12-Step group. Importantly, 66% of respondents reported past-year NA/AA participation, with 88-89% reporting the group was "helpful".

Despite these figures, the authors found MMT patients had low rates of participation in the "key ingredients" that seem to be critical influencers of long-term recovery outcomes: having a home group (50%), having a sponsor (26%), sponsoring others (13%), attending 12-Step social events (23%), and active step work (21%).

Anecdotally, we see a lot of patients at Alltyr who have a hard time finding a place in the local 12-Step scene. We even began compiling a list of medication-friendly meetings in the Twin Cities as we learned about them, but the stigma associated with maintenance is still prevalent. Could it be that we are on the verge of another breakthrough in medication acceptance? After all, there was a time when you weren't considered "sober" if you were on antidepressant or antipsychotic medications (but now, as Dr W likes to say, you're more likely to be referred to the psychiatrist by your sponsor than by anyone else). We would be interested to hear reader stories about this experience - or opinions on the topic. Are things changing - or not?

See the full paper by White, et al., here: http://www.williamwhitepapers.com/pr/2013%20Co-participation%20in%2012-Step%20Groups%20and%20Methadone%20Maintenance.pdf

Her is a few things I have been copying from other sites but is worthwhile information. Gaia Vasiliver-Shamis, Ph.D If your phone's so smart, why isn't it doing science for you? Great tips for turning your toy into a tool! Gaia Vasiliver-Shamis, Ph.D Scientific Program Manager at NIH/ NIAMS 5 Killer Ways to Use Your Smartphone for Science - Scizzle Blog myscizzle.com Go from procrastination to productivity with these great ways to use your smartphone for...




Gaia Vasiliver-Shamis, Ph.D
Go from procrastination to productivity with these great ways to use your smartphone for...

Saturday, November 16, 2013

Stuff we should have been told in treatment ''The Hidden and Forgotten Plague''

The Hidden and Forgotten Plague 

Thanks to my colleagues from 

National Alliance for Medication Assisted Recovery 

 http://methadone.org  

"Just that you people who are involved in advocacy, keep up the work. I have seen
changes come about because of people becoming involved. It is these who are the real heroes
in all this. Without advocacy, changes will not come about within the present system."
Dr. Vincent Dole 
 
''Listen to your patients'', Dr. Vincent Dole spoken at the  American Methadone Treatment Association in San Francisco in 2001. (The AMTA is now AATOD http://www.aatod.org 
 
Don't miss the important documentary: 'The Hidden and Forgotten Plague - A film about hepatitis C'. with English subtitles Produced by The Swedish Drug Users Union. In Sweden approximately 50 000 persons are infected with…
00:46:13
Added on 9/29/13
293 views

Thursday, November 14, 2013

Am an enabler for health


Getting Off Right Safety Manual - Harm Reduction Coalition

harmreduction.org/drugs-and-drug-users/drug-tools/getting-off-right/

Getting Off Right Safety Manual

Getting Off Right is a straightforward, easy-to-read how-to survival guide for injection drug users. It is a compilation of medical facts, injection techniques, junky wisdom and common sense strategies to keep users and their communities healthier and safer. The Safety Manual was written in collaboration by drug users and services providers.
Read below and download the PDF here.
Hard copies are also available for purchase in our store.
We would like to thank Kif Scheuer for contributing artwork on pages 16, 24, 35, 48, 57, 60, and 77.

[PDF]

Getting Off Right - Harm Reduction Coalition

harmreduction.org/wp-content/uploads/2011/12/getting-off-right.pdf







From
StopTheDrugWar.org


Many locations, specially all over Europe have clinics for active users to "get off right", this service may also include nurses to assist. If it wasn't for our bigotry, we may learn there are many benefits to treating people with dignity.



 Clean, Well-Lit Place to Shoot Dope -- In Your City, Soon? [FEATURE]

The only existing supervised injection site for hard drug users in North America is Vancouver's Insite, but panelists at a session of the International Drug Reform Conference in Denver last month said activists in a number of US cities are working to be next. (Plans are also afoot in a couple of Canadian cities.)


client at Vancouver's Insite supervised injection site (vch.ca)
Supervised injection sites (SIS) are a proven public health and harm reduction intervention that can save lives by preventing overdoses, bring a measure of stability to the sometimes chaotic lives of addicts, reduce the spread of bloodborne infectious diseases such as HIV/AIDS and Hepatitis C, and reduce crime and disorder in the community.
SISs also exist in a number of European countries and Australia, but face both legal and political hurdles in the US. Still, advocates are ready to push the envelope here in a bid to bring the life-, health-, and money-saving innovation here.
Donald Macpherson, executive \director of the Canadian Drug Policy Coalition and former head of Vancouver's Four Pillars drug policy program explained the prehistory of Insite, offering hints of possible courses of action in the US.
"We had a public health disaster," he said, referring to the city's escalating heroin problem in the 1990s. "Drug users themselves opened an SIS in 1995, and the police watched it, but didn't shut it down. A second opened in 2002. A year later, another non-sanctioned injection site opened up. It was really messy and it took years."
But in the end, Vancouver ended up with Insite and has managed to keep it open despite the best efforts of the Conservative federal government in Ottawa.
"Insite survives because it has an exemption from Canadian drug laws," Macpherson explained. "We won in the British Columbia courts, we won in the Canadian Supreme Court, which instructed the health minister to issue a permit. But we still barely have Insite, and though other cities are working on it, there is a big chill in Canada right now and we're just trying to hang on to what we've got."
Plans for SISs in the US face similar obstacles, but that isn't stopping advocates in a number of cities -- notably Austin, New York City, San Francisco, and Seattle, as well as somewhere in New Mexico -- from pressing forward with plans to open them there.
"I don't know if we'll be first, but we'll be one of many," said Robert Cordero, president and chief program officer of Boom! Health in the Bronx.
Boom! Health, which resulted from the merger of Bronx AIDS Services and Citiwide Harm Reduction, is a multi-service organization with a three-story building that includes a pharmacy, pharmacists with a harm reduction orientation, and a seven-day-a-week drop in center.
"Safe injection would be embedded with all these other services," he said.
"I don't know if we want to be first, but we want to be one of many," said Olivia Sloan, outreach and education associate for the Drug Policy Alliance (DPA) in New Mexico, which has been working patiently to bring cutting edge programs like SISs to the state. "We passed harm reduction, including needle exchange, through the state legislature, but it's not working," Sloan said. "We have overdose deaths at four or five times the national average."
Advocates in New Mexico have been and continue to lay the groundwork for SISs, Sloan said.
"We took a political and academic approach, and our conversation about injection facilities started a few years ago," she explained. "We have mobile syringe exchanges. We drafted legislation last year and the Senate passed a memorial to require we study the feasibility of SISs in New Mexico. We have partnered with the University of New Mexico and are looking for a principal investigator."

In San Francisco, preliminary discussions with local officials about SISs have been going on for some time, but the San Francisco Drug Users Union may follow the path taken by organized Vancouver drug users, as well as many of the needle exchange pioneers in the US, and just do it.
"We have a committee very committed to an SIS that meets every Monday for two hours," said Holly Bradford, the union's coordinator. "We're really on the verge. We have a very active bathroom here; you just open the door," she smiled. We're bringing it to San Francisco," she said. "It might not be sanctioned or aboveground, but it's going to happen."
Whether underground or not, SISs face a hazard-strewn trek. State, local, or federal officials can throw up any number of obstacles, said Lindsay LaSalle, a Berkeley-based law fellow for DPA.
"Drug possession remains illegal and could impact any SIS user, although probably not the staff or operator because they're not handling the drugs," she explained.
"Then there are the crack house laws, which both the federal government and some states have. They make it illegal for anyone to maintain, own, lease, or rent a property where drugs are used, consumed, or manufactured. These laws could cover SISs, and this could impact both clients and staff and operators alike," she elaborated.
"Then there are civil forfeiture statutes. They've used them to go after medical marijuana dispensaries," she enumerated.
Winning local official support reduces some risks, but not all, LaSalle said.
"If SISs were sanctioned at the local level, many of the legal risks dissipate, but state actors could still choose to prosecute," she warned. "In most states, local officers are deputized to enforce state law, so they could still go after an SIS. If authorized at the state level, that would be an incredible victory, but we would still have to deal with the federal government."
While acknowledging that lawyers can be "a buzzkill," LaSalle also hastened to add that things can change faster than we think.
"These legal barriers are not so different from the challenges we've faced with other drug policy issues, like syringe exchanges," she noted. "They were seen as completely radical, but now we have an almost universally accepted public health intervention with the exchanges."
Part of the process of initiating a supervised injection site is selling it to other stakeholders. Panelists had a number of ideas about messages that worked.
"For business people, you tell them this is how we clean up the neighborhood," said a Seattle activist.
"It is a very incremental change from syringe exchange to supervised injection sites," said LaSalle. "Position it as a very small change in an organization that provides all these other services to drug users."
"There's always 'what we're doing is not working,'" said Sloan.
"We're not going to arrest our way out of this problem," suggested Cordero. "But don't go straight to the SIS conversation. Let people see what we're doing, and then they say 'you're doing God's work' and second, 'Holy shit! Where would all those people be if you weren't open?'"
The obstacles to implementing supervised injection sites in the US are formidable, but the need to do so is urgent and increasingly understood, as are the benefits. With activists and advocates in a number of American locales pursuing SISs through a variety of means, the question is not whether it will happen here, but when and where.