Recovery Army Solutions

Awareness is Paramount!

The most important solution is Awareness. We must ALL be INVOLVED in the solution.

We need to develop and monitor a “Strategic Public Health Awareness Campaign.” We must make people face the reality that prejudice and injustice is killing people.

Following is data collected over recent years:

  • Opiate and heroin overdose are the #1 cause of injury death in US. 1
  • In 2014, nearly 65% of all deaths from opioid analgesics involved natural and semisynthetic opioid analgesics, such as hydrocodone, morphine, and oxycodone. 2
  • Opiate and heroin fatalities have quadrupled in 3 years
  • Only 1 in 5 who need treatment, get treatment
  • 47, 055 people died from “legal” opioid drug poisoning in 2015, the highest mortality rates on record.
  • Morbidity and mortality of legally prescribed FDA approved pharmaceuticals is far greater than the prejudicial media campaign of “abuse”. Nothing can be abused until after it is prescribed.
  • Giving legally prescribed FDA approved pharmaceuticals to our Medicare and SSI population is another “silent” subset of people being harmed.
  • According to the American Medical Association (AMA) addiction is a disease, neuro-biological, and MUST be treated that way.
  • Currently, society “excludes” individuals with substance use disorders”, we must move to “inclusion”.

Pharmaceutical Industry

Financial Incentives Removed for Prescribing and Direct Marketing of Pharmaceuticals

  • Remove pharmaceutical advertisements from TV/Cable/Media.
  • AMA Calls for Ban on Direct to Consumer Advertising of Prescription Drugs and Medical Devices29
  • Re-evaluate the Medicare physician/ER visit billing guidelines and remove the medical decision/risk making incentive to write a script during a patient visit.
  • Truth and Trust: Virtually everything we know about drugs is what the companies have chosen to tell us and our doctors…the reason patients trust their medicine is that they extrapolate the trust they have in their doctors into the medicines they prescribe. 

Institute Transparent Commission to Study Schedule III & IV Drugs
Renewed outlook with new evidence based data of dependence, addiction, misuse and/or abuse.
Examples: Benzodiazepines, Valium, Darvon, Ativan, Xanax, Soma.

Electronic Script Pads
Eliminating prescription pads is critical in removing the ability for fraud. We need to move completely to an Electronic Prescription Orders Program which has proven to be a safer and more secure method from the prescriber to the dispenser.

  • The regulations provide pharmacies, hospitals, and practitioners with the ability to use modern technology for controlled substance prescriptions while maintaining the closed system of controls on controlled substances.14, 15, 16

Best Practices Prescribing Guidelines for All Controlled Substances, Not just Opioids
We must establish standards and best practices for managing pain, and support the CDC’s efforts to improve “Opioid Prescribing Guidelines.” We need transparency and efficacy at the FDA. No longer can we accept high volumes of addictive opiates to be prescribed to our citizens, particularly, our youth. We must look at all providers across all specialties. This is about “controlling” controlled substances in EVERY instance, regardless of the patient diagnosis.

Medical Standards of practice currently vary state to state because “medicine” is regulated by each state individually and not by the federal government. Therefore, we must immediately demand and require that all controlled substance prescribers participate in mandated “transparency” education.

  • Broader Strategies Urged to Counter Painkiller Over-Prescribing
  • Transparency only policy
  • ALL 3rdparty payers must come to the table as the controlled substance overprescribing epidemic crosses all patients and payers.
  • America’s painkiller epidemic grips the workplace while opioid prescribing plan lacks guidance on workers comp issues
  • Wide Disparity in Opioid Doses in Veteran Overdoses17
  • Benzodiazepines: Sedative-Related Overdoses on the Rise – Starrels and colleagues used data that tracks drug prescriptions and drug overdoses. They found the number of adults who used benzodiazepines rose from 8.1 million prescriptions in 1996, to 13.5 million in 2013- a67 percent increase. The quantity of filled prescriptions more than doubled during that period.
  • Adderall: Nonmedical Use of Adderall on the Rise Among Young Adults – with a 67 percent increaseamong young adults between 2006 and 2011.
  • Kids on Anti-depressants: The number of children prescribed antidepressants to combat suicidal thoughts has soared in the past decade despite guidelines saying that their use should be limited.

Educators and School Districts

STUDENT EDUCATION – Age appropriate awareness and prevention
Updating and mandating school curriculum that includes effective LEGAL and ILLEGAL drug education for all students will increase student’s awareness on prescribed pharmaceuticals.

  • Mandate curriculum change for Health/PE to include addiction education with community service hours
  • Mandate student assemblies on a regular basis, preferably built into curriculum. It is very hard to take students away from the current mandated instructional time but this must be done to curb this epidemic
  • Self-worth education throughout a student’s entire education, elementary, middle and high school
  • Social Service (Guidance Counselors) must be trained in childhood trauma and a multitude of other ailments linked to addiction. Early intervention must be a priority.

Community Education of Recovery Residences
We must educate our communities on the disease of addiction, its chronicity, and its required treatment. We need communities that embrace and support the initiative of inclusion to improve treatment outcomes.

Student Peer-To-Peer Programs
School-based peer-to-peer programs are effective. We must focus on our youth and their fragile developing brains by depicting in a relatable way how drugs, both legal pharmaceuticals and illegal drugs, are harmful to their physical bodies and their mental health. “Don’t do Drugs” to mentor other youth, highlighting what works not only what doesn’t.

Educate the Educators
We must improve the illicit drug and legal prescription addiction recognition and reporting protocols for educators by eliminating any hindrance for school staff to refer students that might be under the parental radar. We cannot rely on teachers to recognize something we have failed to educate them with.

  • 75% of High School Heroin Users Started with Prescription Drugs8

Recovery High Schools
We must immediately change the structure of student enrollment such that it recognizes the needs of young people suffering from the neuro-biological disease of addiction.

  • The ADA Act 1990: The Americans with Disabilities Act (ADA) became law in 1990. The ADA is a civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs,schools, transportation, and all public and private places that are open to the general public.9
  • Recovery Schools10, 11
    In order to provide the best possible education and recovery support services to every student, the Recovery Schools assist in the following easily-accessible services.

Collegiate Recovery Programs on Every College Campus
Recovery programs and services for college students are critical. One out of three college students drop out of college in their freshman year, overwhelming due to alcohol and drugs. We must assist young adults with recovery in the most important educational time of their lives.

  • Life Of Purpose: No One Should Have to Choose Between Recovery and Education12

Mandatory Drug Testing in Schools

  • Begin in Middle School
  • Non-punitive responses to positive screens
  • The Effectiveness of Mandatory-Random Student Drug Testing –
    Students involved in extracurricular activities and subject to in-school drug testing reported less substance use than comparable students in high schools without drug testing, according to a new evaluation released today by the Institute of Education Sciences.31

Insurance Companies

Mental Health Substance Use Disorder Insurance Reform
We need to review insurance practices that impede access to addiction treatments, including long-term care. This is one of the most fundamental parts of how we will overcome this epidemic.

  • Mental Health Parity Act 2008 enforcement3
  • Anthony’s Act, which calls for 90-day minimum inpatient treatment must be approved and implemented immediately. Today’s 28-day “standard” is a massive failure with death and relapse being the outcome.4
  • Outpatient “fail first” insurance standard in fact causes harm to the patient, we must insist on immediate change to this policy.
  • Requirement for a “positive” drug screen to meet insurance industry criteria in fact encourages morbidity and mortality of those seeking help.

Change HIPAA Laws to Protect Addicts and Families
The HIPPA law protects the medical records of “emancipated minors,” and prevents parents, family members or friends from gaining access to medical information. This exists unless explicit permission is given by the patient to their loved ones. However, many addicts make deliberate efforts to hide their medical records from their parents to cover up their drug abuse.

In some ways, HIPPA hurts patients by preventing families from understanding the realities of the addict’s disease. With young adults now allowed to remain on a parent’s insurance until age 26, this law must be changed to protect the lives of youth and young adults who are suffering from the disease of addiction. It must be changed to protect the lives of ALL who suffer from this disease.

Does HIPAA help or hinder a patient’s medical/mental healthcare? – Rep Tim Murphy (PA) resolutions/solutions5

Judicial Systems

Treatment in County Jails
Study the need for treatment in county jails from the point of incarceration through discharge and aftercare. The SBIRT assessment must be utilized and included in the pre-sentence report. This is paramount to success, and encompasses medical care into an offender’s right to physical and mental health care. 6

We CANNOT arrest our way out of this problem without treating the AMA defined disease of addiction. In counties where drug overdoses have skyrocketed, so have the county jail populations and recidivism rates. This is not effective, and without a minimum of 12-Step meetings in county jails, it is perpetuates the stigma while exacerbating the problem.

  • McGreevey: Addicts need treatment more than jail7

Expand Effective Drug Courts
We must use a common sense approach to open up drug courts to more offenders. All jurisdictions MUST have operating drug courts offering crime analysis combined with judicial and prosecutorial discretion.

Ban the Box
Remove barriers that hinder those in recovery with addiction records from entering into and maintain recovery.

  • Ban the Box: U.S. Cities, Counties, and States Adopt Fair Hiring Policies30

Prison (State and Federal) Treatment
Mandatory addiction and mental health treatment in both state and federal prisons included as an incentive and part of sentence reduction. We must also look at probation issues and crossing state lines for treatment.

Medical Approach to Detox/Treatment on Demand
Barriers to medical care must be eliminated, we must help people in need of treatment find and access necessary services.

  • It is imperative that both the medical and criminal justice communities have the most accurate and up to date information about treatment options and resources. This information needs to be immediately accessible without delay.
  • We must assist and educate substance use disorder patients and their families to navigate the human services system and managed care systems as well.

Treatment Providers

Medication Assisted Treatment (MAT)
Utilize medication assisted treatment, such as Buprenorphine and Vivitrol with a clear understanding of the benefits, limitations and the risks. This treatment should not be used as a standard without provider monitoring and treatment/recovery assistance. We must not allow profits to trump patient safety and dictate success. We MUST honestly assess and study further those that rely on this for long-term treatment with a transparent risk versus benefit analysis.

  • Immediately reduce barriers to buprenorphine with mandatory requirement of physician counseling and monitoring.
  • Provide immediate access to Naltrexone shots, pellets and / or implants

Alternative and Holistic Treatment
We must look at at ypical treatments such as Ibogaine which should NEVER be discounted simply because they’re unusual. We must allocate the resources for transparent scientific studies. 

Medical Approach to Detox/Treatment on Demand
Barriers to medical care must be eliminated, we must help people in need of treatment find and access necessary services.

  • It is imperative that both the medical and criminal justice communities have the most accurate and up to date information about treatment options and resources. This information needs to be immediately accessible without delay.
  • We must assist and educate substance use disorder patients and their families to navigate the human services system and managed care systems as well.

Parents

PARENT EDUCATION
Mandatory parent attendance at school or community sponsored education programs linked to the student’s report card standards

  • Parent education is a MUST. We need to work with school districts to make parent programs mandatory. Parent education could be tied in with student trips etc., but at the very least a dedicated assembly for parents is critical.

Federal, State, and Local Governments

“Smart” Approaches to Marijuana Legislation Nationwide

  • DO NOT Legalize Marijuana for Recreational Purposes
  • Reverse State laws that have countered this Federal statute
  • Remove Marijuana from Schedule 1 to Schedule 2 and push the FDA to proactively and aggressively study the medicinal effects of THC and CBD
  • Develop SMART Approaches to medicinal marijuana that does NOT allow widespread availability which increases adolescent use of this drug

Perform a Complete Treatment “Industry” Overhaul

  • Medical standards of care
  • Continuum of care
  • Global change of “client” to “patient”
  • Informed consent
  • Patient Bill of Rights
  • Mental Health Parity Act 2008

Federal Prescription Drug Monitoring Program (PDMP)
Prescriber controlled substance education and use of PDMP MUST be linked to the DEA registration with urgent ramifications for non-compliance. Taking full advantage of the inherent and data proven, morbidity and mortality reducing outcomes of the PDMP. Linking this to the DEA eliminates the need for medical regulations by individual states. This is a national crisis and must be treated as such by the prescribing community.

  • Resources to immediately implement state-of-the-art technology to detect and deter prescription drug addiction. This must be real-time reporting with intestate sharing of prescription drug data.
  • PDMP Access and Registration Information13

Medical / Dental Provider / Student Education Laws
We need to offer mandatory continuing education for all health care professionals to stay abreast of changing trends and/or medical advancements in substance use disorder treatment and controlled substance prescribing.

This must be done in partnership with the state’s medical schools to establish a continuing education program ensuring prescribers and other substance use disorder treatment professionals possess the most current and valid information on pain management, controlled substance prescribing, opioid misuse/abuse, and suicide prevention.

  • How to Prevent Opioid Abuse: Training and Education18
  • Stop the Stigma and Expand Access to Comprehensive Treatment19
  • Steps Physicians Can Take20
  • Medical/Nursing/Pharmacy Schools and all Allied Health Care Related professions
  • Transparent mandatory substance use disorder, addiction and controlled substance prescribing training
  • Transparent education of prescribers and community of ADF’s with emphasis on the fact that ADF’s DO NOT mitigate risks of addiction. We must send a very clear message that “abuse” is NOT required for becoming addicted. Taken as prescribed leads to narcotic dependency, addiction, and overdose.

Good Samaritan Laws
Expansion and increased community awareness thru better educational programs on the “Overdose Protection Act”. This law protects users from prosecution for calling 911 to save the life of another user. Instituting a Federal Good Samaritan Law, so that every state protects those that contact 911 to save the life of an overdose victim, is the most expedient way to this means.

  • Good Samaritan Law and Legal Definition21

Rescue Drug Laws
Naloxone MUST be readily available not only to law enforcement officers, but to every family that is dealing with a user in the grips of legal opioids or heroin addiction, in every school and in every jail. This will immediately save lives.

  • McGreevey: Addicts need treatment more than jail (Opinion)22
  • Naloxone for Opioid Safety 23
  • Pennsylvania: Heroin overdose drug naloxone to be provided free to all PApublic schools24
  • New York: Naloxone being made available over the counter in NYC25
  • AMA: Increasing Access to Naloxone: Help Save Lives from Opioid Overdose26

Civil Protection of Addicts
We MUST institute laws that allow medical and law enforcement personnel to consider an opioid drug poisoning survival victim as a danger to themselves and others like we do those who have attempted suicide (Mental Health Parity). Without this, drug poisoning victims are released without intervention. ALL drug poisonings MUST be treated by one standard of care, regardless if legal or illegal, including involuntary commitment. 

  • Baker Act/Marchman Act/Section – to be “usable” and “applicable” by all with no
    financial barriers27
  • Can probation be transferred across state lines?28

Laws to Fight Distribution
Improve weight to dosage laws by lowering the weight where criminal justice consequences attach with adequate penalties that are appropriate for high volume drug dealers. The amount of heroin it takes to warrant serious criminal penalties is much greater per dosage than other drugs. There needs to be some sort of deterrence to dealing heroin in suburban and rural America as well as urban America.

Community – C.U.R.E

C.U.R.E has a three prong approach to help in the community

  • a. Help – Street TeamResource/Transportation Team – Family Crisis Team
  • b. Hope – 12-Step & Recovery Groups – Co-Dependent Group -Prayer Team
  • c. Healing – Life Skills, Studies Groups, Social Connections, Outreach Groups

REFERENCE – Data and Resources

  1. http://www.cdc.gov/drugoverdose/data/overdose.html
  2. https://www.cdc.gov/nchs/data/factsheets/factsheet_drug_poisoning.pdf
  3. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet.html
  4. https://www.thefix.com/content/anthony%E2%80%99s-act-pushes-90-day-minimum-patient-drug-treatment
  5. http://murphy.house.gov/uploads/Summary.pdf
  6. http://www.nj.com/opinion/index.ssf/2014/03/mcgreevey_addicts_need_treatment_more_than_jail_opinion.html
  7. http://www.nyu.edu/about/news-publications/news/2015/december/from-popping-pills-to-using-heroin-nyu-study-finds-three-quarters-of-high-school-heroin-users-started-with-prescription-opioids.html
  8. https://adata.org/factsheet/ADA-overview
  9. http://www.huffingtonpost.com/entry/recovery-high-schools-teen-addicts_us_561eb212e4b050c6c4a408ee
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/
  11. http://www.lifeofpurposetreatment.com/
  12. http://dsps.wi.gov/pdmp/access/prescriber
  13. http://www.namsdl.org/prescription-monitoring-programs.cfm
  14. http://www.deadiversion.usdoj.gov/ecomm/e_rx/faq/faq.htm
  15. http://southoldlocal.com/2016/03/22/no-paper-scripts-doctors-required-send-prescriptions-electronically-pharmacies-starting-next-week/
  16. http://www.painnewsnetwork.org/stories/2016/2/1/study-finds-wide-disparity-in-veteran-overdoses
  17. https://www.ama-assn.org/content/state-medical-society-opioid-education-resources
  18. http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/stigma-of-substance-use-disorder.page
  19. http://www.hhnmag.com/articles/7005-steps-providers-can-take-to-fight-the-opioid-epidemic
  20. https://definitions.uslegal.com/g/good-samaritans/
  21. http://www.nj.com/opinion/index.ssf/2014/03/mcgreevey_addicts_need_treatment_more_than_jail_opinion.html
  22. http://prescribetoprevent.org/wp2015/wp-content/uploads/CA.Detailing_Provider_final.pdf
  23. http://fox43.com/2016/02/01/heroin-overdose-drug-naloxone-to-be-provided-free-to-all-pa-public-schools/?utm_medium=social&utm_source=facebook_WPMT_FOX43
  24. http://www.newsday.com/news/new-york/naloxone-being-made-available-over-the-counter-in-nyc-1.11203265
  25. http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/increase-naloxone-access.page
  26. http://gracepointwellness.org/site/article/52614-baker-act-and-marchman-act-backgrounder
  27. http://www.thelawman.net/blog/2015/11/can-probation-be-transferred-across-state-lines—iii.shtml
  28. https://www.ama-assn.org/content/ama-calls-ban-direct-consumer-advertising-prescription-drugs-and-medical-devices
  29. http://www.nelp.org/publication/ban-the-box-fair-chance-hiring-state-and-local-guide/
  30. https://ies.ed.gov/ncee/pubs/20104025/