Substance Misuse

Addiction: It may not be us; it may be our cages

Our country’s “War on Drugs” began in 1971 with President Nixon’s declaration that drug use was “public enemy number one in the United States.”

In addition to drugs as a symbol of youthful rebellion and radicalization, America’s new home-turf war was fueled by a growing literature base supporting the biological theory of addiction. However, one of the most interesting experiments to emerge from that era challenged this biological view. It became known as “Rat Park.”

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Beginners Guide: Neuroscience of Opioid Addiction

In February, President Obama proposed a FY17 budget that allocates $1.1B in new funding to address the opioid use disorder crisis in the United States.

Whatever one’s politics (or general anxieties about the 2016 election season), we all agree that something must change. Despite the best efforts of policymakers, health care professionals, and communities to combat this problem, opioid deaths continue to rise, prompting the question: Why is the epidemic so pervasive?

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Ketamine: Magic Bullet?

In the news: Recent publication of the almost immediate resolution of treatment-resistant depression (TRD) following Ketamine infusion has sparked tremendous interest within the fields of clinical psychiatry and psychotropic drug development. It has also sparked the entrepreneurial development of specialized ketamine clinics, despite the lack of Federal Drug Administration (FDA) approval of ketamine for this purpose. And, of course, third-party payers are being asked to cover these services. Should they? After all, there is replicated evidence for ketamine’s rapid antidepressant effects.[i] Background: Ketamine was FDA-approved as an anesthetic agent in 1964 and was widely used for soldiers injured in the Vietnam War.[ii] Its legitimate role has expanded over the years to include pain management and veterinary surgery. Ketamine was also…

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Medical Marijuana: An Oxymoron?

Has public opinion trumped the rigors of the scientific method – clinically sound research that supports or negates the efficacy of marijuana for medical use? A recent issue of the Journal of the American Medical Association (JAMA) devoted two extensive clinical reviews, a research letter, an editorial and a patient page to topics related to medical marijuana. The reviews lay bare what is at the heart of the medical marijuana debate for the health care industry: Has public opinion trumped the rigors of the scientific method – clinically sound research that supports or negates the efficacy of marijuana for medical use? There are downstream effects of the legalization of medical marijuana that are not specifically related to efficacy or safety….

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Overkill: Unnecessary Care Is Low-Value Care

Solution lies in adhering to evidence that shows what works. Last month, Dr. Atul Gawande published a thought-provoking essay in The New Yorker about the millions of tests, drugs and surgeries that American people undergo every year, which won’t make them better, may cause harm, and costs billions. Sadly, this avalanche of unnecessary care is not confined solely to physical health care. Behavioral health and substance use disorder systems are also guilty of deploying what researchers call “low-value” care. This message is jarring, and the data indicating system failure is even more so. For example, only 25 percent of the 30 million Americans prescribed an antidepressant in a primary care setting every year show substantial clinical improvement. Given that common…

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Opioid Addiction Calls for a Chronic Disease Model of Care

Read Beacon Health Options’ white paper, “Confronting the Crisis of Opioid Addiction“ You’re unlikely to read or hear the news these days without learning more about the devastation of opioid addiction in our communities – large and small, rich and poor, urban and suburban – it’s everywhere, much the way the flu snakes its way through schools and workplaces. Indeed, there are a staggering 2 million Americans addicted to opioids; this fact should have the public standing at attention in a way it never has before. We have to do something – and quickly. While we’re hearing of it more than ever, addiction is not new. Where and when has the system failed? Deep-rooted challenges include addressing stigma and the “character…

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Don’t Bring Back the Asylum: Recovery, Not Re-institutionalization

asylum

Amid the current opioid crisis, high-profile events of mass violence and suicide, mental health parity implementation, and continued efforts to expand Medicaid for childless adults, never has behavioral health featured so prominently on policy agendas. Industry experts are scrambling for solutions, including a serious proposal to reintroduce the “asylum” as described in the Journal of the American Medical Association (JAMA) in January of this year. The JAMA article argued for the expansion of institutionalized settings for people with mental illness who cannot live alone, cannot care for themselves, or are a danger to themselves and others. Surely the solution to tackling the incredibly complex problem of mental illness and substance misuse has to involve a broader dialogue than whether or…

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