Sunday, May 25, 2014

The Sober Truth: about the recovery industry for your Review a fairly new book

Preface

ALCOHOLICS ANONYMOUS WAS PROCLAIMED the correct treatment for alcoholism over seventy-five years ago despite the absence of any scientific evidence of the approach’s efficacy, and we have been on the wrong path ever since. Today, almost every treatment center, physician, and court system in the country uses this model. Yet it has one of the worst success rates in all of medicine: between 5 and 10 percent, hardly better than no treatment at all.
Most of the expensive, famous rehab centers that base their treatment on the Twelve Steps likewise have offered no evidence for their effectiveness. Most of them don’t even study their own outcomes.
One would hope we could turn to science for careful studies of AA and its effectiveness. But science has failed us: the AA question was considered settled almost before it was asked, and what studies exist that claim to substantiate AA have been riddled with problems in both methodology and analysis. Nobody has ever carefully and rigorously reviewed these studies and reported the results to the public. In this book, we do just that.
The failure of addiction treatment in our country is especially discouraging since there are better ways to both understand addiction and treat it, and it’s costing us thousands of lives and billions of dollars. With this book, we hope to begin a more productive conversation.
A Note About Format This book was written by both of us, but because Lance has devoted his career to understanding addiction, we have decided to write it in the first person. Zachary’s equal contributions are everywhere, however, from the quality of the writing to his sharp understanding of good and bad science. Neither of us could have written this book alone.

What Do Prosecutors and Distric Attorneys say about Good Samaritan 911???


http://www.huffingtonpost.com/tessie-castillo/what-do-prosecutors-and-d_b_5159938.html


What Do Prosecutors and District Attorneys Say About 911 Good Samaritan Laws?

 

With the drug overdose epidemic still raging, 911 Good Samaritan and Naloxone Access laws are sweeping the country as states struggle to seek solutions that can turn back the tide of deaths. Currently, 18 states have implemented naloxone laws, 14 have medical amnesty laws on the books, and many more have introduced bills to their general assemblies. But while law enforcement, public health advocates, and people directly affected by drug overdose are front and center in these debates, state prosecutors and district attorneys also play a critical role in advocacy efforts -- often for, but sometimes against, these laws.
Within the legislative system, associations of prosecutors and district attorneys carry a lot of clout and their support for a bill can be essential to its passage. Case in point, in 2009 overdose prevention advocates in Washington state helped introduce a 911 Good Samaritan bill, but it quickly encountered opposition from the Washington Association of Prosecuting Attorneys and the Washington Association of Sheriffs and Police Chiefs, two organizations with enormous political leverage. The associations argued that the bill, which granted limited immunity from some drug charges to people who sought help for an overdose, sent the "wrong message" on drug laws. As the 2009 legislative session came to a close, it seemed clear that the bill could not move forward with such powerful opposition, so advocates convened a working group of stakeholders, including lawyers, law enforcement, public health advocates and people who had lost loved ones to overdose, to make the case for the law.
"In the end we were able to change [the associations'] minds," explains Mark Cooke, Policy Counsel with the ACLU of Washington, one of the main advocacy organizations for the bill. "Law enforcement officers and prosecutors realized that most people don't get in trouble for low level possession in overdose situations anyways, and if we can save one life, it is worth passing the law. Also, law enforcement from college campuses were some of the most vocal proponents for the 911 Good Samaritan bill, which was inspired by similar amnesty laws on college campuses."
When the legislative session reconvened in 2010, the Washington Association of Sheriffs and Police Chiefs came out in support of the 911 Good Samaritan bill, and the Association of Prosecuting Attorney's agreed not to oppose it. That year Washington became the second state in the nation (behind New Mexico) to implement a 911 Good Samaritan law, paving the way for a dozen other states to follow suit in the coming years.
Most recently, Georgia passed a similar medical amnesty and naloxone access law through their general assembly. The bill is currently awaiting signature from Governor Nathan Deal, and will take effect immediately. District Attorney Danny Porter says that prosecutors in Georgia opposed the original version of the bill because it included immunity for people who provided the drugs that resulted in an overdose. One of the main arguments of opponents concerned a case in North Georgia where a mother had given methadone to her child because she wanted to sleep. The child overdosed and died.
"We had to work with the author of the bill to reduce the range of immunities to a scope that was acceptable to prosecutors," says D.A. Porter. "We were able to reach an agreement quickly and help move the bill with our political leverage. We had no problem with the underlying social aspect of the bill. Kids who overdose shouldn't be afraid to get help."
Mike Noone, First Assistant to the District Attorney in Chester County, has been part of advocacy efforts for a 911 Good Samaritan law in Pennsylvania. The bill is currently being debated, but Noone is optimistic that it will pass.
"Our office advocates for the law because it's important to encourage people to do the right thing if they are in an overdose situation and people are dying," he says.
Prosecutors' support for overdose prevention laws seems to indicate a paradigm shift away from the harshly punitive drug laws of the late 20th century towards a more health-centered approach to drug addiction. Attorney Corey Davis, Deputy Director for the Network for Public Health Law, Southeastern Region, has been studying and advising stakeholders on naloxone access laws since 2010 and has noticed the shift in attitudes.
"I think there's been a changing tide in perceptions of the war on drugs in general," he says. "We see a growing acceptance of marijuana, both for medical and recreational use, relaxation of the crack/cocaine disparity, and reductions in state prison populations after many years of steady increases."
There are some who argue that the shift has to do with the danger and prevalence of prescription drugs, which are often abused by people of power and affluence. With the crack cocaine epidemic focused mostly in inner cities, or methamphetamine use most popular in poor rural areas, it was easy for people who make and enforce laws to crack down hard on drug users. But now, with drugs and overdose creeping into their own medicine cabinets, their own homes, with the suburban and middle class children of powerful people at risk, the laws are starting to change.
Attorney Mark Sigmon, a lawyer with Graebe Hanna & Sullivan PLLC in Raleigh, N.C., lost a family member from a narcotic overdose and now supports laws that encourage people to seek help for an overdose and increase access to the opiate overdose antidote, naloxone.
"For many years it was widely accepted among lawyers and judges that the penalties for drug crimes were too harsh, but no politician wanted to run on reducing those penalties. However, that ice is beginning to thaw," he says. "I believe that when both common sense and data suggest that we can save lives at relatively little cost [with naloxone and 911 Good Samaritan laws], there's no reason not to do it. To sacrifice those lives because of irrational discomfort or stigma is not just bad policy, it's immoral."
Attorney Davis agrees. "We now have a fair amount of evidence as to what works to reduce the likelihood that a person will commit crime, from quality pre-school and lead abatement all the way through evidence-based drug treatment and structured social learning," he says. "We also have a lot of evidence as to what works to get people who are using drugs problematically, particularly opioids, to start using them more responsibly or stop using them altogether. It's time we started making laws based on evidence instead of centuries-old prejudices."
That prosecutors and district attorneys, who were once 911 Good Samaritan and naloxone law's stiffest opponents, are now often its main advocates, is testament to the winds of change in the United States. What's left now is for advocates to continue to capitalize on this momentum so that policy change translates into real results -- lives saved and families prevented from grieving.



http://www.huffingtonpost.com/tessie-castillo/what-do-prosecutors-and-d_b_5159938.html

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.

Some times SAMHSA and NIDA has soem political agendas, but for the most part the protocols TIPs 1 though 54 are excellent resources.

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...