Waiting Lists Grow For Medicine To Fight Opioid Addiction

[Chip (OP)]

source: http://www.huffingtonpost.com/entry/opioid-addiction-treatment_us_56bcb1a5e4b08ffac1241b63?section=politics

an excerpt:

Waiting Lists Grow For Medicine To Fight Opioid Addiction

This piece comes to us courtesy of Stateline. Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.

BURLINGTON, Vermont — After more than a decade of getting high on illicit opioid painkillers and heroin every day, Christopher Dezotelle decided to quit. He saw too many people overdose and die. “I couldn’t do that to my mom or my children,” he said.

He also got tired of having to commit crimes to pay for his habit — or at least the consequences of those crimes. At 33, he has spent more than 11 of his last 17 years incarcerated. The oldest of seven children, he started using marijuana and alcohol when he was 12.

It’s been five years since Dezotelle started treatment the first time, and he still hustles for drugs every day. Only now, instead of heroin or OxyContin, he’s trying to score buprenorphine, one of three federally approved opioid-addiction medications. He says heroin is much easier to find, and it’s less than half the price of buprenorphine on the streets and parking lots of this college town.

Vermont Gov. Peter Shumlin, a Democrat, was among the first in the nation to address the opioid epidemic. He devoted his entire State of the State address to the crisis in 2014. Since then, his administration and many of Vermont’s private practice doctors have made treatment more available than it is in most of the country.

But it’s not enough.

In this state of about 626,000, almost 500 addicts are on waiting lists to receive medication for opioid dependence. More than half will wait close to a year.

Nationwide, a shortage of doctors willing to prescribe buprenorphine, which reduces drug cravings, and a federal limit on the number of patients they can treat, prevents many who could benefit from the addiction medication from getting it.

Less than half of the 2.2 million people who need treatment for opioid addiction are receiving it, U.S. Health and Human Services Secretary Sylvia Burwell said this month, previewing President Barack Obama’s new budget, which was released Tuesday and proposes $1.1 billion to expand the availability of buprenorphine and other opioid-addiction medications.

Where are the Doctors?

... for graphics and a continuation of this, please go to http://www.huffingtonpost.com/entry/opioid-addiction-treatment_us_56bcb1a5e4b08ffac1241b63?section=politics

[smalls]

Yup. This is where I live and the waiting lists are insane. If you look up sub doctors in the SAMHSA listing, there are fewer in the entire state of Vermont than there were in the city I moved here from. I didn't call all of them, but I called all that were within an hour's drive (so, seven offices) and the waiting list situation is bad. Those that I was able to get a real person on the phone took my info to "put me on the waiting list" while others don't even answer their phones - they just have a voicemail message saying to leave your info to get on the list. That was back in JUNE and not one has called me. I doubt they keep a real list, they probably just give the open slots to whoever is persistent enough to call nonstop.

Also, seems like whenever there is funding awarded to "fight the addiction epidemic" about half of it goes to law enforcement efforts when it should be going to incentives to get doctors to take on sub training and therefore patients.

[thetalkingasshole]

i have very mixed opinions of opiate maintenance
huffington post has a lot of political and financial connections in the U.S. and abroad

why dont they also mention methadone?
there are only 4 clinics in my metro area, of over 1.3 million people
i can tell you there are A LOT of addicts here that would benefit from short tern maintenance
but more than not a lot of people get put on successively higher doses until they max out
and are parked at 240mg a day until forever, with no plan of trying to rehabilitate the person

personally i am beginning to think more and more that it is possible for all people to stop opiates completely
yes even some dependent CPPs could too (NOT REFERENCING ANYONE HERE, I DONT KNOW YOUR LIFE LIKE THAT)
opiates are a product of nature, legal, and some illegal, opiates are a product of the pharmaceutical industry
for 150 years now theyve been pimpin it hard to the point of getting reckless enough for government restrictions
buprenorphine is fairly expensive, that is a good point
but i think it would do people a lot more good to taper off over 3-8 weeks with methadone, with preferably daily therapy
of course that would require more money for training more therapists, which seems to be something the gov't seems unwilling to do

sorry, i just feel like there needs to be posts like this to counter an article like that for people who dont need buprenorphine or even methadone
i definitely didnt, even after using opiates for 5 years, and only taking 2mg, then 1, then .25mg a day for just 6 months
i did massive damage in terms of tolerance because until you get on maintenance, unless you have a script
its very, very hard to ALWAYS have more drugs than you even want to use


i specifically mention methadone and bupe
but i think morphine would be the absolute best opiate to use to ween someone off
the chemical structures of both methadone and buprenorphine are very different in terms of structure, and much more potent
i think morphine, and even heroin would be far more suitable, if people feel like the best thing for them is long-term maintenance
much more managable medications in terms of dose and side effects, and maybe even oxycodone (now im dreaming haha)

[thetalkingasshole]

Yup. This is where I live and the waiting lists are insane. If you look up sub doctors in the SAMHSA listing, there are fewer in the entire state of Vermont than there were in the city I moved here from. I didn't call all of them, but I called all that were within an hour's drive (so, seven offices) and the waiting list situation is bad. Those that I was able to get a real person on the phone took my info to "put me on the waiting list" while others don't even answer their phones - they just have a voicemail message saying to leave your info to get on the list. That was back in JUNE and not one has called me. I doubt they keep a real list, they probably just give the open slots to whoever is persistent enough to call nonstop.

Also, seems like whenever there is funding awarded to "fight the addiction epidemic" about half of it goes to law enforcement efforts when it should be going to incentives to get doctors to take on sub training and therefore patients.

and also make sure the DEA doesnt harass existing sub doctors, at least the ones who werent running pill mills previosly
i think if they spent even half of that on incentives for people like me, with psychology degrees (SO MANY)
to take on training like you mentioned, and invest in studies at more effective treatment methods
they might actually put a dent in how many people are psychically dependent on opiates who dont have to be

[Griffin]

http://projects.huffingtonpost.com/dying-to-be-free-heroin-treatment/350-miles-for-medication

That reminded me of this story from a few months ago about a man and his mother driving 350 miles to colorado to get their subs because there are no doctors who have room for more patients. It is awful, and the story highlights how much of a headache that doctors have to go through to prescribe it even from colleagues. It is ridiculous that there aren't enough doctors that are willing to prescribe it as it only takes an 8 hour course or something like that to be able to.

I have heard a lot more people with similar stories of not being able to get on MAT, and it really can be a lifesaver. I wish there was a study that could show how many people die each year waiting for a bed at a treatment facility to open up, or waiting to get into MAT. After I got arrested last year, I decided to stay clean and lasted 4 months before getting back on MMT. After I decided to get back on it, they were no longer taking any patients at all.

They stopped taking patients in april, I decided to go back on in June. They had a list for pregnant women and people who were on probation where they would do one intake a week if any spots opened up for the people on that list. I was 12th in line so at the very minimum it would of taken an extra 3 months to get on they said it would more than likely be 4-6 and that they were hoping that in September they would start taking patients again starting with that list and be doing 1 or 2 people a week.

I had been at the clinic for a year and a half when I got arrested and my counselor is awesome and he is the sole reason I was able to get back on with in a month instead of at the end of the year. I was going to 2 sessions with my counselor each month after I got out of jail and was staying clean because they are free with medicaid, I needed the help, and it looked good in court. So I was still technically a patient the whole time which made things easier for me to get on the list and get back on.

When I decided to get back on and found out how long it was going to take my counselor asked the doctor for a personal favor to see if he would make an exception to get me in and do an intake for me after he told him my story. Luckily the guy who was supposed to get an intake that week didn't show up and the doctor knew and liked me and decided to do it for me. So I was able to get in within a month of deciding to get back on it. If I hadn't been a patient with a good reputation and relationship with my counselor, I would of probably been arrested again.

[bignasty]

i specifically mention methadone and bupe
but i think morphine would be the absolute best opiate to use to ween someone off
the chemical structures of both methadone and buprenorphine are very different in terms of structure, and much more potent
i think morphine, and even heroin would be far more suitable, if people feel like the best thing for them is long-term maintenance
much more managable medications in terms of dose and side effects, and maybe even oxycodone (now im dreaming haha)

I've always thought the same thing in regards to morphine being a perfect drug for maintenance and/or tapering. Well not always 'cause I used to think morphine was shit when I'd only take 30-90mg's when 30-50mg's of hydrocodone or oxy would get me high. But once I found some 200mg MScontins for $5-6 each, I realized how good of a pain med and possible maintenance med it was. I took 300mg's every 12 hrs and at 12 hrs, I'd honestly still be feeling fine and not craving at all.

If they have a 24 hr version of ER morphine (can't remember if Kadians are 12 or 24 hrs and I know MScontins are 12 hrs), I don't see why they refuse to use that in people that don't like or respond to or have too many side effects from 'done or bupe. Even if they had to use the 12 hr versions, it seems like they could put something in it that would only show up in UAs if you IV'd it (not naloxone but something inactive where they could tell if you were IV'ing the morph or taking it orally as RX'd) and you could take your morning dose at clinic and them give u a take-home for 12 hrs later.