Alcohol & Substance Abuse

The Obama administration is making it easier for people addicted to opioids to get treatment.

Health and Human Services Secretary Sylvia Burwell announced new rules Wednesday to loosen restrictions on doctors who treat people addicted to heroin and opioid painkillers with the medication buprenorphine.

Doctors who are licensed to prescribe the drug, which is sold mostly under the brand name Suboxone, will be allowed to treat as many as 275 patients a year. That’s almost triple the current limit of 100, and HHS estimated that as many as 70,000 more people may have access to the drug as a result.

“There are a number of ways we are trying to increase access to medication-assisted treatment,” said Michael Botticelli, the director of national drug control policy, on a conference call with reporters. “This rule itself expands access and gets more physicians to reach more patients.”

Suboxone is itself an opioid. It eases withdrawal symptoms and cravings, but doesn’t make people high.

In 2000, Congress passed legislation that allows doctors who are trained and pass a test to offer office-based buprenorphine treatment. However, the same law capped how many patients a doctor can treat. These are the only medications that are under such restrictions.

In a related move, HHS said it is changing how it uses patient satisfaction surveys to determine Medicare payments. Burwell said some doctors and hospitals said they felt pressure to prescribe opioid painkillers because the surveys could affect their income.

“This rule eliminates the connection between pain management questions in the survey and payments to doctors and to hospitals,” she said on the conference call.

Even as they announced the new rules, administration officials urged Congress to allocate more money to help pay for more addiction treatment programs.
House and Senate negotiators are considering a series of opioid treatment bills, but those proposals don’t include all the funding President Obama requested.

Botticelli said many Democrats in the House have said they won’t sign off on a compromise bill unless it includes the $1.1 billion that the president requested.

Botticelli said an average 129 people a day die from opioid overdoses.

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Among Gov. Bill Walker’s list of vetoes last week was what looks like $6.5 million in cuts to the Department of Health & Social Services. One is slated for substance abuse treatment pilot programs. Another for children’s services. But here’s the catch — even with those cuts, the department will still be getting extra money for those services next year.

When setting the FY17 budget, the legislature included some additional funds over FY16. Including $11 million to create new substance abuse treatment programs around the state, like detox centers and residential treatment programs. Division of Behavioral Health Director Randall Burns said he was still happy even when the governor cut that down to $6 million.

“I think any additional funding that the legislature and the governor are willing to provide for new substance abuse services in Alaskan communities is very positive news,” Burns said in a phone interview.

The Office of Children’s Services will see a positive boost as well. The legislature had given OCS an additional $2.3 million on top of their regular budget for two purposes: preventative programs that help families work through problems and stay together, and reunification programs to help restore families if kids are put into foster care. Of that, $1.7 million will stay in the budget.

“They’re really all funds to help supplement and enhance what the OCS caseworker is doing and oftentimes, with the high workload, isn’t able to do as much as we’d like to do,” explained OCS Director Christy Lawton. “So these services really help to accelerate services we can offer.” She said she was grateful that most of the money remained in the budget.

The funding will be used to expand current programs and try innovative strategies.

The $1 million cut to child care benefits is a reduction from the current budget, but the department does not see it impacting services. There is not a wait list for child care assistance.

A Dillingham woman has been missing in Juneau for nearly three months. The family of 30-year-old LoriDee Wilson has no information on her whereabouts, but hopes she’ll be found alive.

Wilson came to Juneau in mid-March to get drug addiction treatment program at the Rainforest Recovery Center.

Wilson’s older sister Gwen Larson said she last spoke to her younger sister on the phone on March 24th. At that point, Wilson had been at the hospital less than two weeks, but Larson said she seemed to be in a good state of mind during the phone call.

“And apparently that evening, she walked away,” Larson said. “We got notified that she was no longer at her treatment center on 28th or 29th of March, and so my father went down that weekend, and stayed down there for a while looking for her.”

The family reported Wilson as missing to the Juneau Police Department, and in early April, Larson also went down to Juneau to look.

She posted photos of her sister: 5-foot-4 and 130 pounds, with curly, dark brown, shoulder-length hair. Larson said there were several reported sightings of Wilson during that time, but she couldn’t confirm any.

“So I was constantly watching the bus routes, and I’d go to the store and just sit in the parking lot in hopes that I’d accidentally run into her. Because we don’t know what kind of state she’s in, if she’s OK, or … we just don’t know,” said Larson.

To Larson’s knowledge, Wilson doesn’t know anyone in Juneau outside the hospital, and she has not made contact with her friends, parents or three young sons back in Dillingham.

And, to add to her family’s concerns, Wilson is now overdue for a throat surgery that she gets each year due to a childhood accident that left her airway constricted.

“She hasn’t scheduled that yet, we talked to her doctor. And this is a thing she has to get every year, she has to have her throat dilated, for the last 20 years she’s had it done,” Larson explained. “We’re worried for her that she could choke, because usually when it’s close to surgery time, she has to have soft foods.”

Larson said the past few months have been difficult on the family, but they are holding out hope that Wilson is still alive.

“If she hears this, we love and care for her and we want her to call us,” said Larson, “and her kids miss her.”

If you have any information regarding LoriDee Wilson of Dillingham, call the Juneau Police Department at (907) 586-0600 or contact Gwen Larson at (907) 843-1412.

Alaska could receive up to $4 million in federal funding to increase access to opioid addiction treatment options. It’s part of the Obama administration’s $1.1 billion dollar nationwide plan to fight the epidemic.

According to a White House news release, the amount is determined by the severity of the local problem and the strategies each community has to respond to it. Alaska ranks 20th nationwide for drug poisoning death rates. Congress has not yet approved the spending.

The overdose death toll from opioids, both prescription drugs and heroin, has almost quadrupled since 1999. In 2014 alone, 28,000 people died of opioid overdoses, more than half from prescription drugs.

Just last month, public awareness of the opioid epidemic reached a new level when Prince was found dead with prescription narcotics on him and authorities began to investigate their role in his demise. In recent weeks, lawmakers and regulators have moved to augment treatment options for addiction and to require more education for doctors who prescribe opioids. The U.S. House of Representatives is voting on a package of bills this week; the Senate passed its own bill in March.

Also in that span, the Los Angeles Times has published an investigation of Purdue Pharma, the maker of the blockbuster pain pill OxyContin, and CNN held a town hall meeting on the consequences of addiction to narcotics. Dr. David A. Kessler, former commissioner of the Food and Drug Administration, wrote an op-ed in the New York Times, calling the embrace of opioids “one of the biggest mistakes in modern medicine.”

Today, ProPublica added warnings labels to the pages of narcotic drugs in our Prescriber Checkup news app, prompted by indications that some readers are using the tool to find doctors who will prescribe these drugs with few or no questions asked (See our editor’s note).

The effectiveness of any of these steps remains to be seen. There is broad consensus on the need for more treatment options, more education, more careful prescribing by doctors. But there’s still much debate about the details—and funding–for each of those steps.

What’s clear is that in recent months there has been an increasing emphasis on the role of health providers and the agencies that oversee them to stem access to widely abused prescription drugs:

• In March, the Centers for Disease Control and Prevention released guidelines on prescribing of opioids for chronic pain, defined as pain that lasts for more than three months (excluding pain related to cancer, end-of-life and palliative care.) The guidelines call on doctors to choose therapies other than opioids as their preferred option; to use the lowest possible doses; and to monitor all patients closely.
• That same month, the FDA announced tougher warning labels on immediate-release opioids, such as fentanyl, hydrocodone, and oxycodone, to note the “serious risks of misuse, abuse, addiction, overdose and death.”
• Nonprofit groups and medical experts in April asked the federal Centers for Medicare and Medicaid Services to remove questions about pain control from a survey of hospital patients’ satisfaction to remove any incentive to overtreat pain. And they asked The Joint Commission, which accredits health facilities, to revise its standards to deemphasize “unnecessary, unhelpful and unsafe pain treatments.” The commission pushed back, saying its standards do no such thing.

Just yesterday, Dr. Steven J. Stack, president of the American Medical Association, called on doctors to do more. He encouraged doctors to use their state’s Prescription Drug Monitoring Program to ensure their patients aren’t shopping for multiple doctors to prescribe them drugs. He called on them to co-prescribe a rescue drug, naloxone, to patients at risk of overdose. And he told them to generally avoid starting opioids for new patients with chronic, non-cancer pain.

“As physicians, we are on the front lines of an opioid epidemic that is crippling communities across the country,” Stack wrote in a statement, published on the Huffington Post. “We must accept and embrace our professional responsibility to treat our patients’ pain without worsening the current crisis. These are actions we must take as physicians individually and collectively to do our part to end this epidemic.”

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As Opioid Epidemic Continues, Steps to Curb It Multiply

A Goose Creek Correctional Center prison guard has been arrested in connection with an alleged conspiracy to distribute drugs in the correctional facility. The corrections officer faces federal charges.

The criminal complaint charges corrections officer Adam Jason Spindler with conspiracy to distribute and possession with intent to distribute heroin and marijuana. The case has been brought against Spindler with the help of the FBI, based on an affidavit provided to the Department of Justice by FBI special agent Richard Fuller.

Alaska’s U.S. Attorney Karen Loeffler said it is not unusual for the FBI to be involved in a state case, and stressed the level of cooperation that it took to bring the case to light.

“It’s very important to federal law enforcement and working with our state partner, that we won’t countenance public servants violating their duties by trafficking in narcotics,” Loeffler said.

Charging documents provided by the Justice Department indicate that this month, the Alaska Department of Corrections contacted the FBI on suspicions that Spindler was smuggling drugs into Goose Creek for distribution to inmates. This week, FBI surveillance observed Spindler’s meeting with a suspected female drug courier in Wasilla, then followed him to Goose Creek, where he has worked the night shift for the past three years.

According to the documents, on arrival at the prison Spindler gave what he said was his bag of personal use marijuana to a fellow corrections officer who was leaving the prison to take away from prison grounds. Spindler was detained at the prison, but a search of his person did not turn up any drugs.

Prosecutors say a corrections K-9 unit detected drugs in Spindler’s truck, although agents did not find any in the vehicle at the time. However, the other corrections officer, who was literally holding the bag, called Goose Creek personnel, saying he suspected the presence of heroin in the bag. Tests showed the presence of 1.6 grams of heroin and half a gram of marijuana. Spindler then admitted to FBI agents that he intended to distribute the drugs to an inmate, according to the documents.

Spindler now faces federal drug charges. He was scheduled for an initial appearance in federal court Wednesday afternoon.

Corrections Commissioner Dean Williams said the incident has mixed significance for his department.

“This is a difficult day for us on one hand, and it is a fantastic day for us on the other hand,” Williams said. “And here’s why it is so difficult. One of our corrections officers went to the dark side.”

Williams also credited the cooperation of the FBI in making the case. Williams used the occasion to announce the formation of a new professional conduct unit within the corrections department.

“This really, I think, represents a new era of public trust, I hope, as well as staff trust, that when problems are brought to us, we’re going to do something about it, at least we are going to try our best to do something about it,” Williams said. “That’s the reason, quite frankly, that I set up the Professional Conduct Unit, the first unit of it’s kind in this department, to really make sure that we are objectively, professionally, doing internal investigations. And that unit, by the way, in conjunction with the FBI, is why this case played out.”

Brad Wilson with the Alaska Correctional Officers Association said he’s withholding comment until he learns more about the case.