Small Towns Can Spell Big Trouble for Persons with Substance Use Disorders

Studies show that persons in rural areas are significantly less likely to receive care for substance use disorders (SUD) than city dwellers. The evidence suggests that treatment disparities between rural and urban residents are not limited to opioid use disorders. They also span a range of addiction diseases such as alcohol use disorder. Studies also show that not only are those who live in rural areas less likely to initiate treatment but they’re also less likely to complete the recommended course of care.

However experts suggest that getting to the roots of the problem will require a sustained and multi-pronged approach. This is because persons who live in rural areas of the US face not just one barrier to care but many.

Among the most significant of these is the dearth of care providers in these areas. These shortages of behavioral and mental healthcare centers and addiction recovery specialists. This means that rural residents will often need to travel far from home to receive the care they need.

The frequency of treatment during early recovery may include up to five days of outpatient care per week. That makes the process untenable for adults who also have work and family responsibilities. A lack of access to reliable transportation and high fuel costs also make traveling great distances to receive care unfeasible for many rural residents.

In addition to these geographical barriers to treatment are the financial ones. Studies show that the care provided to most rural residents is out of network. This means that they will incur far more significant out of pocket costs than their urban counterparts for the same level of care.

Rural residents’ treatment expenses on everything from counseling to pharmacotherapy to transportation and beyond often those of city dwellers. Urban areas typically enjoy a host of therapeutic options and a selection of care providers who are in network with clients’ insurance plans.

Given the multitude of obstacles to care for the vast majority of Americans not living in the cities and suburbs, experts have advanced a new Collective Care Model to increase rural residents’ physical and financial access to treatment. One of the most important features of this new standard of care is the integrative approach that enlists patients’ primary care providers in the prevention, diagnosis, and treatment of SUD.

Incarcerated Persons with SUD Leave Prison Undiagnosed and Untreated

Incarcerated persons released from prison are unlikely to receive treatment needed for substance use.

National estimates suggest that 85% of inmates leave prison suffering from a drug addiction. Only 17% of former inmates have been diagnosed with substance use disorders, with even fewer being provided medications that combat addiction.

Researchers acquired data from Virginia’s health and corrections department to track former inmates who are diagnosed and treated for addiction following their release from prison. In 2022, more than 4,600 adults were released from jails and prisons, with 85% enrolling in Medicaid within one month of their release.

Despite the high percentage of Medicaid enrollment, only 17% of those released had seen a doctor and been diagnosed with a substance use disorder within three months of their release. This includes 13% of that group having an opioid use disorder.

However, only 25% of opioid-addicted ex-convicts are prescribed medications, like methadone and suboxone, to combat drug cravings and withdrawals. This is far less than the 78% of all Medicaid enrollees who received medication after their opioid addiction diagnosis.

Lead researcher Peter Cunningham, who is the interim chair of the Virginia Commonwealth University Department of Health Policy, stated, “Based on national statistics, we expected more people to receive a diagnosis and treatment for opioid addiction,” Cunningham went on to say “This is concerning because having an undiagnosed, untreated opioid use disorder greatly increases the risk of overdose.”

Most inmates do qualify for Medicaid during their time in prison. Although only emergency coverage is provided during their sentence, addiction treatment and most other benefits are not covered.

Researchers are surveying former inmates to discover what hurdles they face after being released. Cunningham stated, “If providers are able to diagnose substance use disorders and initiate treatment plans before a person is released from prison, this might reduce the risk of overdoses and improve health outcomes when they return to their community.”

Ozempic-Like Drugs Could Help People Stop Using Drugs and Alcohol

In recent studies, interest has been growing in the possible use of Semaglutide (sold as Ozempic, Wegovy, and Rybelsus) to treat addiction. Semaglutide is part of the new class of drugs, called GLP-1 receptor agonist drugs. While it is approved for use in diabetes and weight loss, there’s a possibility it can curb addiction.

The active ingredient, Semaglutide, was initially developed to treat diabetes. It works by stimulating the production of insulin to keep blood sugar levels in check. Additionally, there are anecdotal reports from patients taking Semaglutide for weight loss, suggesting it reduces appetite and food cravings. It’s because of this active ingredient that researchers are studying how this can be used for addiction treatment.

The rationale for studying GLP-1 agonists in addiction treatment stems from the overlap between the pathways that regulate hunger and those that mediate addiction. Both involve the brain’s reward systems which play a significant role in the pleasure and reinforcement of behaviors, including eating and drug use.

“”There’s really been a large number of clinical and anecdotal reports coming in suggesting that people’s drinking behaviors are changing and in some instances pretty substantially while taking [Ozempic or Wegovy],”” says Christian Hendershot, a psychologist and addiction researcher at the University of North Carolina.

Researchers have observed that by modifying the activity of these reward centers, GLP-1 agonists could potentially reduce the cravings that lead to the compulsive consumption of alcohol and other drugs. Preliminary animal studies have shown promising results, with drugs like Semaglutide reducing alcohol intake in rodents.

In addition, human trials are currently underway, with early anecdotal evidence supporting the theory that these medications could help manage addiction. Some individuals on GLP-1 agonists for diabetes or weight loss have reported a diminished urge to consume alcohol or engage in other addictive behaviors. These reports have fueled further clinical investigations into whether these drugs could serve as a tool in addiction therapy.

Gambling, Excessive Drinking–A Destructive Duo, Researchers Find

Problematic and potentially addictive behaviors strike on multiple fronts, according to a recent report from the American Psychological Association (APA). Current studies from the APA, persons who bet on sports are twice as likely as non-gamblers to also engage in binge drinking.

The study also found that the risk of alcohol misuse and/or alcohol use disorder (AUD) correlates with gambling behaviors. The higher the frequency of sports betting, the greater the likelihood of excessive alcohol consumption, researchers found.

More specifically, the data indicate that men who engaged in sports betting once or twice in the previous calendar year were 2.4 times more likely than the general population to binge drink. The risk of binge drinking among women who bet on sports was 1.9 times higher than the general population.

However, when gambling frequency increases, so, too, does the risk of alcohol misuse, according to the APA study. The data indicate that men who wager on sports at least once weekly are more than 4.7 times more likely than non-gamblers to binge drink. For women, in the same cohort, the binge drinking risk is nearly 6 times that of the general population.

And for those who gamble daily, the numbers are even more eye-popping. Daily sports betting is associated with a nearly nine-fold risk of binge drinking for men. Likewise, women who gamble on sports on a daily basis are more than 14 times more likely to binge drink than the general population.

The study reveals a significant correlation between addictive behaviors across multiple categories, providing researchers and clinicians alike with important insight into the etiology of addiction. The data also suggest that amendments in current standards of practice for healthcare providers may be required to include screenings for co-occurring addictions in persons engaging in problematic gambling or excessive drinking behaviors.

Doctors Urge FDA to Pull Genetic Opioid Marker Test Kit from Shelves

More than 30 prominent physicians across the country have signed a petition asking the FDA to reconsider its controversial decision to approve the opioid drug test AvertD. The drug, manufactured by SOLVD Health and approved by the FDA in 2022, claims to be able to check users for 15 genetic markers that make them susceptible to opioid use disorder. In theory, physicians who administer AvertD can be forewarned if patients have a greater susceptibility to becoming addicted to any pain medications that contain opioids.

However, as reported by NBC News, doctors have questioned AvertD’s promise. In their letter addressed to FDA Commissioner Robert M. Califf, AvertD’s ability to detect genetic markers predisposed to opioid addiction is not “any better than chance.” Studies have shown that the drug has a 20% chance of generating false positives–indicating that clients are likely to become addicted when they are actually not–or false negatives, in which a physician might assume that patients wouldn’t get addicted and over-prescribe medications.

In either case, one in five clients either had a false sense of security that they were immune from opioid addiction, or they were left stigmatized and deprived of needed medications.

In their letter, the doctors noted that, back in 2022, the FDA’s own review panel had highly recommended that the drug be rejected. Genetics, the panel had warned, was only one factor to consider. Opioid use disorder can be shaped by social and environmental factors, as well as the frequency of exposure.

The opioid crisis has called for innovation and, occasionally, taking chances on new medications that have yet to be fully proven to be effective. At times, the agency has had to reverse its decisions on drugs that can do more harm than good. In 2017, the FDA requested that Endo Pharmaceuticals recall its opioid medication Opana ER.

As for AvertD, the FDA has yet to respond to the petition.

Fentanyl to Play a Pivotal Role in Presidential Election, Pundits Predict

Voters unite on wanting to end the rampage that fentanyl has taken on US soil. Despite different ideas being tossed around, from tightening borders to increasing treatment options, partisans across the political spectrum charge that leaders have forgotten about the issue.

Between 2019 and 2023, an estimated 270,000 people died of drug-related causes. The synthetic opioid, fentanyl, is believed responsible for a majority of the overdoses, which have risen to 80,000 each year. Approximately 80% of voters in seven swing states consider the fentanyl crisis to be a key factor when deciding on who to vote for in the 2024 presidential election.

According to Bloomberg News, about one-third of voters trust neither Biden nor Trump to handle the crisis. Critics claim that the Trump administration failed to allocate the necessary resources to contain the crisis early on. Meanwhile, critics of the current Biden administration blame “lax” immigration laws under the current regime, pointing to the more than 100 million pounds of fentanyl and 150 million fentanyl-laced pills seized at the US southern border since Biden took office in January 2021.

While former President Trump has criticized Biden’s immigration policies for the increase in overdoses, Biden condemns Trump for encouraging conservative lawmakers to hold up a bipartisan border security bill that, proponents claim, would strengthen the US’s authority to sanction foreigners involved in fentanyl trafficking.

As political leaders continue to point fingers, progressive cities such as Portland, Oregon, and San Francisco, California, are implementing bills to tighten drug possession laws. In San Francisco, voters backed Mayor London Breed’s bill requiring suspected drug users on welfare to submit to drug screenings and attend a drug treatment program.

The swing states of Nevada and Arizona have reported a surge in lethal synthetic opioid exposures in the 12 months through October 2023. Such trends suggest that fentanyl will remain a pivotal issue for voters until election day.

Voters across parties believe that the US should work with Mexico and Canada to combat the cross-border trafficking of illicit drugs.

Youth 911 Calls Surge Following Magic Mushroom Decriminalization

Calls to US poison control centers and first responders among youth have surged in the wake of a recent push to decriminalize “magic mushrooms” by states and municipalities across the nation.

Statistics from the National Poison Data System show that emergency calls following exposure to psilocybin, the active ingredient in hallucinogenic mushrooms, more than tripled in the 13-19 age group between 2018 and 2022. Calls for emergency assistance more than doubled among young adults between the ages of 20 and 25 in the same time period.

The surge follows years-long efforts to decriminalize recreational psilocybin consumption among persons 21 and over. Decriminalization has already occurred across a number of states, including Colorado and Oregon, and cities, including Seattle, Detroit, and Washington D.C.

Despite efforts to restrict unlawful use by minors, however, the alarming increase in adverse medical and mental health events related to magic mushroom use among teenagers reflects the limitations of such regulations.

The implications are concerning, researchers note, because the long-term impacts of psilocybin on teens’ developing brains are unknown. However, the prevalence of severe adverse reactions, with more than 75% requiring medical intervention, does not bode well for youth who consume these hallucinogens.

Among the most prevalent effects of psilocybin exposure in teens and young adults include hallucinations and delusions, agitation, tachycardia, and confusion. Outbursts of violent behavior have also been reported.

The sometimes extreme neurophysiological impacts of magic mushrooms on young people are thought to be caused by disruptions to neurotransmitter activity. Given that any lingering effects on adolescent brain development and neurochemistry remain a mystery, the increasing accessibility and appeal of magic mushrooms to young people is especially worrisome, researchers suggest. They note that these hallucinogens are becoming widely available in edible forms that are likely to attract teens, including chocolates and gummies.

Combating Homelessness May Slash Drug and Alcohol Death Rates

Cutting the homeless rate by just 25% could prevent more than 2000 lethal opioid overdoses annually, according to recent estimates. Such a reduction in homelessness may also save the lives of more than 850 people from alcohol poisoning and avoid over 500 cocaine-related fatalities. The data is based on a study from the University of Georgia analyzing the federal data on the rates and causes of death among the unhoused population between 2007 and 2017.

The evidence suggests that the risk of death due to opioid overdose is strongly linked to homelessness. This connection is all the more alarming given the surge in homelessness in the wake of the lifting of the moratorium on evictions post-COVID. According to statistics from the US Department of Housing and Urban Development (HUD), 200,000 more people were homeless in 2023 than in 2017, a surge coinciding with the expiration of the eviction ban.

Though the nature of the relationship between homelessness and substance-related mortality is not exactly clear, researchers propose that the newly unhoused may engage in riskier substance misuse behaviors, thus increasing their risk of accidental overdose and death.

The researchers also noted that a housing-first approach to addressing the combined crises of homelessness and opioid addiction is critical. They suggest that reducing eviction rates and helping persons experiencing addiction to remain in their homes is often the first step in combating the opioid epidemic. Treatment, they assert, is the second.

Illicit Drug Activity on the Rise Report Shows

An annual report from the Southwest Narcotics Drug Task Force (SNDTF), based in Dickinson, North Dakota, showed a surge in drug seizures, fentanyl-related overdoses and deaths, and methamphetamine production. The report also notes a significant increase in drug trafficking operations related to the US southern border.

Of particular concern for authorities, according to the report, is the surge in fentanyl overdoses, with 17 incidents requiring hospitalization and three fatalities. The increase in lethal fentanyl exposures can be attributed both to the rapid rise in availability region-wide and to the increased potency of the drug.

In addition to the alarming prevalence of fentanyl in the Southwest region, the report also describes a surge in non-fentanyl drug seizures, including nearly 300 grams of cocaine, more than 3,600 grams of methamphetamine, and over 36,000 grams of marijuana.

But drug seizures are not the only notable point of concern, according to the report. Illicit drug manufacturing and trafficking operations have also spiked, the study found, citing the discovery of two working methamphetamine labs, including one located in the Dickinson County area.

The Southwest Narcotics Task Force’s findings and the drug counter-operations aligned with them derive from partnerships between federal, state, and local law enforcement. Federal authorities, the report suggests, are playing a critical role in monitoring and curtailing illicit drug operations connected to the US southern border and Mexico.

In a presentation before the Dickinson City Commission, SNDTF representatives stressed the urgent need for cooperation between law enforcement, public health agencies, and the community to combat the worsening crisis in the region and across the United States.

San Francisco Libraries May Soon Offer Free Addiction Recovery Books

Public libraries in San Francisco may soon provide unlimited access to addiction recovery books amid the recent surge in fentanyl overdoses. Officials assert that access to recovery-related materials is often readers’ first step toward recovery, citing the 3200+ books and workbooks distributed since the launch of a pilot program in April.

The idea behind the program derived from librarians’ recognition that addiction recovery materials were rapidly disappearing from circulation. San Francisco’s main library, for example, now must replenish recovery-related content every six weeks. Located at the heart of the Tenderloin District, the library is a primary source of shelter for the neighborhood’s many unhoused and addicted persons.

Representatives for the San Francisco public library system note that materials related to 12 Step recovery, also known as the Big Book, are among the most common materials not to be returned to library shelves, along with materials related to narcotic, opioid, and crystal meth addiction. In the face of long waitlists for many clinical rehab programs, these titles may be the first and perhaps only recovery resource for those who need it most.

Those who have turned to addiction-related books and workbooks assert that engaging with the materials is a private and personal act, giving persons who are experiencing addiction the time and space to learn about recovery on their own terms. These materials are designed to help readers understand the disease of addiction, acknowledge the existence of the disorder in their own lives, and recognize the possibility of recovery.

This, program proponents argue, can be a powerful incentive for a person experiencing addiction to move beyond the fear of stigmatization, regain their sense of hope, and reach out for help. They point to the city’s more than 600 community-based addiction recovery programs, including Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) as a common next step on the reader’s path to sobriety.

Though initially piloted to just three libraries at an initial cost of $40,000, the program, if approved, will roll out system-wide, offering content in multiple languages. Those interested in the content do not need a library card and are not required to return the materials.

What is Harm Reduction?

You may have heard the term harm reduction in recent years but are unsure of its meaning. So, what is harm reduction, really? While it may appear to be a relatively recent addition to pathways of recovery strategies, the term has actually been around as far back as the 1960s.

To fully understand harm reduction, it’s necessary to understand its history, what problems it is trying to solve, and what it looks like in practice. 

What is Harm Reduction?

As the name suggests, harm reduction aims to reduce the harm associated with drug use. According to the Harm Reduction Coalition, harm reduction incorporates a set of practical strategies and foundational principles to minimize the negative consequences for people who use drugs. 

The roots of harm reduction date back to the 1960s, 70s, and 80s, in several human rights movements:

  • The Black Panther Party providing health clinics and free breakfast for children
  • The Young Lords’ providing acupuncture for people who used heroin in the South Bronx
  • The women’s health movement arising from the 1970s feminist activism fighting for reproductive rights
  • Activism surrounding the AIDS crisis in the 1980s and beyond

It is these movements that led to a model of harm reduction that promotes a philosophy that safer use, interventions, and policies must center the individual and be designed to meet them where they are at. 

What are the Main Principles of Harm Reduction?

The core principles central to the harm reduction philosophy include:

  1. Accepts that people use drugs, and we can work towards minimizing their effects rather than ignoring or condemning the people who use them
  2. Understands drug use is complex and involves a continuum of behaviors from abstinence to more severe use, and some ways of using drugs are safer than others
  3. Promotes quality of life for individuals and communities rather than cessation of all drug use as measures used in interventions and policies
  4. Advocates for non-judgmental and non-coercive provision of services and resources for the people who use drugs in the communities in which they live, with the goal of reducing harm
  5. Ensures that people who use drugs, or have used drugs regularly, are consulted on the policies designed to serve them
  6. Empowers and affirms individuals who use drugs as agents of their change, and promotes their sharing of resources and strategies that meet their specific needs
  7. Acknowledges the role of racism, poverty, social isolation, trauma, class, sex-based discrimination, and other inequalities impact a person’s vulnerability to drug use and their capacity to reduce harm
  8. Does not attempt to minimize or ignore the realities and dangers associated with illicit drug use. 

How Does Harm Reduction Work?

The main goal of harm reduction is to save lives. Specifically, the lives of people who use substances through a number of strategies to:

  • Reduce the transmission of HIV and hepatitis B & C and improve the quality of life for people with these chronic conditions
  • Decrease the stigma associated with substance use disorder
  • Provide education on safer substance use, and associated behaviors, like promoting protected sex
  • Improve access to vital resources, like wound care, housing, insurance, and other social services
  • Provide free and widely available harm reduction drug supplies, like sterile syringes, Narcan, fentanyl test stops, smoking equipment, first aid kits, safe injection sites

Harm reduction also includes providing access to vital addiction treatment and related social services, like medication-assisted treatment, or medication-assisted recovery (MAT/MAR). MAT involves the use of FDA-approved medications to treat various substance use disorders. 

Is Harm Reduction Enabling?

Public health officials and proponents of harm reduction are often working to educate people and correct the belief that harm reduction enables people to use drugs. In fact, harm reduction improves health, increases access to addiction treatment services, provides vital medical care, and reduces the burden on the healthcare system. 

Expert Travis Rieder, PhD, MA, and associate professor at John Hopkins Berman Institute states “Opponents sometimes argue that giving people sterile syringes, clean pipes, naloxone, a space to use drugs under supervision, etc., incentivizes drug use or leads to drug use. But people are going to use drugs whether they have these resources or not, and so withholding them doesn’t prevent that use; it just makes it more dangerous. Making an activity more dangerous doesn’t stop people who are committed to engaging in that activity; it just hurts and kills more of them.”

Harm reduction, on the other hand, makes drug use safer which may support access to recovery, says Rieder “One can take the first steps of recovery while still using drugs fairly chaotically, and continue their road to recovery through small, slow steps that reduce the harms of drug use.”

Does Harm Reduction Work?

According to the National Institute on Drug Abuse (NIDA) decades of research show harm reduction works and has contributed to significant individual and public health benefits, especially in preventing deaths from overdose, decreasing the burden on the healthcare system, and improving treatment access. 

That’s likely why harm reduction is supported globally. The Harm Reduction International website shows:

  • 92 countries have needle and exchange programs
  • 88 countries offer opioid treatment therapy
  • 17 countries have drug consumption sites
  • 109 countries support harm reduction in national policies

The specific benefits have been well researched. According to the Recovery Research Institute, harm reduction shows benefits in the following areas:

What to do When Medicare Runs Out for Rehab

When seeking treatment for addiction the last thing you, or your loved one, needs to focus on is limitations on Medicare benefits. There are various options to consider when evaluating your options for treatment. Our blog provides an overview of Medicare benefits, what is covered, what isn’t covered, and what to do when Medicare runs out for rehab.

Who is Eligible for Medicare?

Medicare provides a range of health insurance benefits to qualifying Americans. As a federal health insurance program, those who are eligible for Medicare include:

  • Individuals over the age of 65
  • People with a disability
  • End stage kidney disease
  • ALS (or Lou Gehrig’s disease)

Medicare insurance is made up of four parts:

  1. Part A: Hospital Insurance. This part is free, and you qualify if you already get retirement or disability benefits from Social Security, are 65 and older, or have already qualified (or your spouse has qualified) for Medicare).
  2. Part B: Medicare Insurance – this requires a premium each month depending on your income, or it can be deducted from other benefits.
  3. Part C: Medicare Advantage Plans – these monthly premiums vary depending on the plan.
  4. Part D: Drug Coverage – these also vary depending on the plan you join. 

What Does/Doesn’t Medicare Cover for Rehab?

Part A (hospital insurance) covers medically necessary rehabilitation, such as an inpatient treatment center. However, your doctor must certify that “you have a medical condition that requires intensive rehabilitation, continued medical supervision, and coordinated care that comes from your doctors and therapists working together.” There are various costs that Medicare does and does not cover.

What Medicare Covers

Medicare covers inpatient rehabilitation costs that include:

  • Rehabilitation services
  • A semi-private room
  • Meals
  • Nursing services
  • Prescription drugs
  • Other hospital services and supplies
  • Inpatient doctor’s services are covered (Under Medicare Part B)

Medicare Does Not Cover

  • Private duty nursing
  • A phone or television in your room – if these are billed separately
  • Personal items such as toothpaste, socks, or razors
  • A private room, unless medically necessary

Doctors at a hospital

How Long Do Benefits Last?

Medicare covers a rehab facility for up to 90 days per benefit period. However, you must first meet a deductible before Medicare covers 100 percent of the first 60 days of treatment and limited costs after that. This looks like

  • Days 1 to 60: $1,632 – but you do not have to pay this if you have already paid for deductible care in a prior hospitalization within the same benefit period. For example, if you transferred from an acute care hospital
  • Days 61 to 90: a daily $408 co-payment 
  • Days 91 and beyond: $816 per each “lifetime reserve day” after day 90 (you are allowed 60 reserve days over your lifetime)
  • After lifetime reserve days: you must pay all costs

What to Do When Medicare Runs Out 

There are various options available to you if your Medicare benefits run out, including: 

  • Medicare supplemental insurance: also called Medigap, this additional insurance policy can help with the parts of treatment that weren’t covered and even your Part A deductible, as well as additional out-of-pocket expenses
  • Medicaid: a federal-state health insurance program that can cover costs Medicare won’t. Typically costs that Medicare has rejected will be transferred to Medicaid and these will be paid after you meet your deductible.
  • Grants: you may be eligible to apply for certain grants to fund your treatment if you are uninsured or underinsured. For example, SAMHSA provides Block Grants for community mental health treatment. You’ll want to check with your state health department to see where these have been awarded, what services are covered, and any other grants you may be eligible for.
  • Payment plans: the rehabilitation program may offer payment plans for any costs Medicare and/or Medicaid won’t cover. Speak to the treatment center payment specialist who should be able to walk you through those options.
  • Sliding scale payments: some treatment centers offer sliding scale payment options to low income individuals. You’ll want to speak to the rehab admissions advisor to see if this option is available.
  • Scholarships: some rehabs offer scholarship options, and you can check this with their admissions team when evaluating different payment choices.
  • Financing: often treatment centers will offer a financing option to individuals if their insurance leaves uncovered costs. Ask their finance department for more information about your options. 

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-914-7089 (Info iconWho Answers?) today to learn about your treatment options.

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