The Big News

A settlement resolving all of the pending lawsuits over the opioid crisis is “unlikely in the near term,” according to state attorneys general and attorneys involved in the litigation. That means that it could be a long time before communities receive substantial new funding to address the crisis. Apparently, a global settlement framework pitched by four state attorneys general—worth $48 billion—is supported by only three other states so far. Not too surprising, considering the ongoing opioid crisis cost a staggering $696 billion in 2018 alone and more than $2.5 trillion between 2015 and 2018. That’s according to a new estimate by the White House Council of Economic Advisers.

A wise man once said, “If only Congress could run like a big (recovery) meeting—where people say what they mean and mean what they say.”

That person was a Member of Congress, since retired. His main legislative achievement was one we are all grateful for—namely the “parity law” that expanded access to substance use disorder treatment for millions of Americans. A brief allusion to that bill is included in this timely piece by the Congressman’s former chief of staff (and former colleague of ours).

The number of cases of a vaping illness continues to rise with 37 confirmed deaths—most connected to THC vapes—and more than 1,800 sickened throughout the U.S. The outbreak is now playing into marijuana legalization debates, and law enforcement is cracking down on marijuana vaping products where it can.

A former executive at e-cigarette maker Juul is alleging in a lawsuit that the company sent to market at least “one million mint-flavored e-cigarette nicotine pods that it admits were contaminated.”

Juul recently announced a halt in its flavored vape products, signaling further cooperation with the FDA. One catch—it banned all flavors but its most popular one, mint. Meanwhile, a new study found that youths and young adults are likely to continue using various tobacco products after trying flavored products like menthol or mint.

Methamphetamine led to more drug overdose deaths in 19 western states in 2017 than fentanyl, according to a new CDC report. Nationwide, the meth overdose rate has risen from 0.6 fatalities per 100,000 people in 2011 to 2.9 in 2017 — a growth trajectory similar to what researchers saw earlier with heroin and fentanyl.

The American Society of Addiction Medicine published a new definition of addiction.

SAMHSA unveiled a new modernized version of its online addiction treatment directory—FindTreatment.gov.

This week’s featured media is the latest episode in our Let’s Talk podcast with host William C. Moyers talking to Drew Horowitz about the intervention process. Horowitz challenges dated stigmas and explains what happens in interventions, who is typically involved, and how they can be most effective. Watch, listen or read.

Also, congratulations to William, Let’s Talk producer Lisa Stangl, and all of the guests and others behind the scenes who helped our podcast earn a 2019 Gold Award from Modern Healthcare for its impact in reducing the stigma of addiction and educating families and professionals on advancements in treatment and research.

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Treatment Industry Issues and Reforms At a California Assembly hearing last week, Hazelden Betty Ford VP and General Counsel Jennifer Lohse told lawmakers that the state needs to establish and enforce mandatory addiction treatment program standards focused on quality.

Pictured here with our own Emily Piper (left) and Assemblywoman Cottie Petrie-Norris, Jenni (center) specifically highlighted the need for all treatment programs to be licensed and all professionals working with patients to be credentialed. Learn more →

The New York State Office of Alcoholism and Substance Abuse Services has changed its name to the Office of Addiction Services and Supports, which along with other notable changes addresses the replacement of stigmatizing language in the state’s system of addiction care. Kudos to New York leaders!

As noted here before, SAMHSA’s proposed rule changes to 42 CFR Part 2, the law that governs the privacy of some addiction treatment records, were split into two separate proposals. The deadline for public comments on the first proposal ended Sept. 25, and the deadline for the second was Oct. 25. Here again were our brief comments opposing the first proposal, and here are our recently submitted comments on the second proposal. The second proposal—though positive in some regards—doesn’t sufficiently address the discrimination inherent in having confidentiality requirements for patients and providers in nonprofit addiction treatment settings that are entirely separate from the HIPAA requirements applying to for-profit facilities and all other areas of health care addressing every other health condition. Our priority—and that of the Partnership to Amend 42 CFR Part 2, a coalition to which we belong—remains legislation that would enable better coordination of care and advance parity by aligning Part 2 with HIPAA for purposes of treatment, payment and operations, and that would strengthen anti-discrimination laws and make it harder for law enforcement to gain access to records. 

On Friday, we submitted comments to the U.S. House Energy & Commerce Committee, which requested input on best practices and needed reforms in the addiction treatment industry. We noted that we have seen incremental improvements over the past year but identified four remaining issue priorities: 1) ongoing brokering of vulnerable people for financial gain; 2) a lack of comprehensive, quality-based state regulatory oversight of the addiction treatment industry and inadequate incentives to prioritize adoption of necessary reforms; 3) separate privacy laws and regulations (42 CFR Part 2 v. HIPAA) that inhibit the integration and care coordination necessary to achieve true parity for patients; and 4) a lack of industry-wide quality standards, which enables some insurance carriers to circumvent parity laws. If our full comments and recommendations are posted online, as expected, we’ll share the link here in a coming edition.

The Recovery Research Institute wrote a nicely contextualized review of recently published research on our Comprehensive Opioid Response with Twelve Steps (COR-12®), highlighting its relevance to patients and families, professionals and care systems, researchers, and policymakers. Though developed seven years ago as a program for treating opioid use disorder, COR-12 has informed and inspired Hazelden Betty Ford’s broader framework of modern, integrated care for all substance use disorders and co-occurring mental health conditions. That framework includes the integrated use of medications, evidence-based clinical therapies and peer recovery in a patient-centered manner over an extended period of engagement—a topic our Dr. Marvin Seppala recently discussed on the Appalachian Health Podcast. 

Vox continued its crowd-sourced look at the cost of addiction treatment, profiling a woman who lost her son to addiction and then lost her house to save her daughter.

Cannabis A major new research review found scarce evidence that cannabis improves mental health, challenging pop-culture beliefs.

In this TV interview, our own psychologist Tim Portinga helped separate fact from fiction. Learn more →

Last week included some reports of cannabis candies in children’s Halloween treats here, here and here.

Women of weed rise high in Philadelphia.

A new study found that when people use alcohol and drugs together, including marijuana, their risk for an alcohol overdose increases.

Opioids Episode 2 of “The Opioid Fix,” a three-part docuseries produced by Twin Cities Public Television and Mayo Clinic, aired Sunday and focused on the role of community engagement in tackling the addiction crisis.

A careful watch revealed a shot of our colleague Jon Hartman (pictured, at left). The final installment this Sunday, Nov. 10, will focus on treatment and recovery and feature our Drs. Marvin Seppala and Joseph Lee, among others. Watch Parts 1 and 2 online →

For years, officials have worried that the next step in the opioid epidemic would be a larger public health issue. Now, in a small West Virginia town that has seen some of the worst of the crisis, that next issue is thought to be underway in the form of HIV infections.

Elle magazine is spotlighting eight women—one a week—who have been affected by the opioid crisis. Week 1: a mom who lost her son. Week 2: a chronic pain patient who ended up homeless. Next: a care provider.

New York’s governor has yet to sign legislation that would lift the state’s pre-authorization requirements for buprenorphine and methadone prescriptions. Some local advocates are worried he won’t.

A Philadelphia-area doctor has agreed to pay $1.4 million to resolve claims he wrote bogus opioid prescriptions to patients.

Suboxone plays a leading role in the opioid settlements. Is it an outsized role?

Alcohol

Minnesota will now be the lone state restricting grocery stores to selling only 3.2% alcohol beer. Learn more →

Walmart Grocery now offers curbside alcohol pickup at 2,000 U.S. stores. Not what the world needs.

A columnist in England wonders whether consuming less alcohol will become a social badge of honor in the same way not smoking or not eating meat have become.

In Australia, the alcohol industry is pushing for new alcohol consumption guidelines to take into account the “positive health benefits” of drinking. A cartoonist responded by writing, “There’s no such thing as safe levels of alcohol industry lobbyists.”

Amid the sober trend, there is one generation that is actually drinking more.

Reduced brain size may suggest a genetic predisposition toward heavier drinking, according to new research.

Should the national focus on overdose prevention include alcohol, too?

A year after opening, the Sobering Center in Austin, Texas, has helped more than 2,000 people who were publicly under the influence of alcohol or drugs and would have otherwise ended up in hospitals and jails.

More than 700 primary care practices will take part in a $16 million HHS initiative, which will implement screening for unhealthy alcohol usage, medication-assisted therapy for those with an alcohol use disorder and interventions for those who drink too much.

One of the world’s largest brewers is set to bring cannabis-infused drinks to the Canadian market soon.

Health Care Reform and Parity Walmart Health launched its first clinic earlier this fall in Dallas, Georgia, and the facility—which is attached to a retail store but offers its own entrance—provides patients with primary care, dental care, vision care and psychiatric counseling alongside health education and wellness programs. Take a look inside →

Google bought Fitbit, generating fresh discussion about the future of wearables in health care.  

UnitedHealth Group’s Optum division has acquired remote patient monitoring company Vivify Health, another sign of a trend toward tools to help clinicians and health plans provide more efficient, effective care for patients who remain at risk after their initial episode(s) of care. Though not specified in this article, people treated for addiction ought to fall into that category.

Livongo is teaming up with MDLIve and Doctor on Demand to also expand options for people living with chronic conditions like addiction.

Some shifting in the pharmacy-based walk-in clinic business as both Walgreens and CVS move away from treating minor or acute issues and focus instead on people with chronic conditions.

Haven Healthcare, the joint venture between Amazon, JPMorgan Chase and Berkshire Hathaway, has created its first offering in the form of health insurance plans for tens of thousands of employees.

Lots of talk this weekend about U.S. Sen. Elizabeth Warren’s plan to pay for Medicare for All.

Georgia Gov. Brian Kemp released a set of waiver proposals that would effectively remake the individual market in that state.

Advocate Spotlight Our friend David Marion talks to Twin Cities Public Television about his experiences with opioids, addiction, recovery and holding on to hope. Learn more →

With overdoses at epidemic heights and recovery no longer a taboo secret, a new wave of theatrical plays dealing with the realities of addiction, treatment and recovery have started to emerge, often created by playwrights who have dealt with such problems themselves. But is the theater field itself becoming more hospitable to artists in recovery? The answer, according to the artists interviewed for this piece, is mixed.

Our friend Tommy Rosen, founder of Recovery 2.0, wrote a blog about a significant surgery and fresh encounter with opioids he had last week—28 years into recovery.

Elton John has been “carrying the message” in Hollywood for years.

Advocates are starting a Seattle chapter of Ben's Friends, a recovery support group for people in the hospitality and restaurant industry.

Great NPR interview with Chef Sean Brock about the restaurant industry, Southern food and overcoming addiction and workaholism.

Ronnie Wood of the Rolling Stones has a new documentary film coming out that will delve into his recovery from addiction.

Reality TV star Lala Kent celebrated a year of recovery.

Miscellaneous Musings

A sober Twin Cities hip hop artist says he hopes events like Hazelfest and the 2018 SoberBowl will “encourage more people to tell their story or maybe try something different.” Learn more →

• A new study looks at discrimination faced by people in recovery.

• Can you really be addicted to video games?

• The 7^th annual New York REEL Recovery Film Festival is under way, and we are among the sponsors.

• A Seattle woman writes about what it’s like to teach at a recovery high school.

• A meth sobering center is planned in San Francisco as an alternative to emergency rooms, psychiatric hospitals and jail.

• The President announced his nominee to be the next FDA chief.

• CBS This Morning held a live mental health town hall that included several personal stories, and subsequently published numerous videos and resources on its new Stop the Stigma web page.

• Nearly 6,000 people contacted the Wisconsin Addiction Recovery Helpline during its first year.

• In his latest blog post, William White reflects on the use of medications in addiction treatment and introduces an extensive new paper he published on the subject. He writes: “There is limited long-term value in replacing a mindless ant-medication bias with an equally mindless pro-medication bias.” So true.

• In another blog post, White provides a glowing review of William H. Schaberg’s new book Writing the Big Book: The Creation of A.A. White calls the book, which comes out Tuesday, a skillful, eloquent and scholarly extension of the history documented earlier in Ernie Kurtz’s classic—Not-God: A History of Alcoholics Anonymous.

• Thank you for reading. What do you think? Send us a note anytime, and have a great week!