Yes, it has been quite a while since I last blogged. Look for this to change starting tonight. Last year saw the beginning of insurance companies 'changing' what they will pay for, or more importantly, NOT pay for.
One of their goals is to make this year be the year that all opiate detoxifications will be done on an outpatient basis - no more medical addiction treatment units. If a person does have concurrent medical issues in addition to their opiate dependency, then yes they can have a medical bed. But that's it, no addiction program. One hospital in the Boston area has an addiction counselor visit them while they are being medically detoxed. They are limited essentially to providing the patient with aftercare information and possibilities.
I guess that is better than nothing though.
As for detoxification from alcohol and benzodiazepines they are thinking along the same line as the opioids. Unless there is an accompanying medical condition they want this to be on an outpatient basis. This may be more difficult to implement due to the seizure risk in these two types of detoxification.
At least with the opiates their rationalization is there are established methadone and suboxone clinics that can provide this service and there is not the seizure risk that the two aforementioned bring to the table. Although from an observational point of view these clinics tend to promote maintenance (form of harm reduction) as opposed to detoxification. I have yet to counsel someone that told me the day they went on suboxone or methadone the clinic discussed a proposed titration date & plan to get them off.
Hey, we're talking big business, right?
Last year saw 'designer' drugs in the news and they are carrying over to this year as well Drugs such as "Mollies" made their appearance on the Club Scene often with disastrous results: (http://blogs.cbn.com/healthyliving/archive/2013/09/05/new-recreational-drug-molly-popular-but-deadly.aspx). Bath Salts, also known as MDPV are still on the scene and can cause serious mental and physical health issues (http://www.abovetheinfluence.com/facts/drugsbathsalts).
Last summer and again recently overdose deaths have occurred due to street heroin being cut with acetyl fentanyl. Rather than decreasing the potency, acetyl fentanyl is five times the strength of heroin (http://www.forbes.com/sites/davidkroll/2013/08/29/cdc-issues-alert-on-deadly-new-designer-drug-acetyl-fentanyl/).
The latest threat is a drug called "Krokodil" which is a form Desomorphine which is a derivative of morphine. Originally started in Russia due to a heroin shortage, this drug 'rots' the body from the inside out. I have read the life expectency of a user of this drug is usually around one year. (http://www.huffingtonpost.com/2013/10/09/krokodil-drug_n_4073417.html?utm_hp_ref=krokodil).
This year should be the year that licensed alcohol drug counselors in the Commonwealth are finally granted their insurance billing rights (projection of December). About time. Those that are licensed as 'Addiction Specialists' (LADC-I) have had to sit on the sidelines while disciplines with minimal (if any) experience have been working with the population. Not a knock on them, at least someone has been working with them. It only makes sense to give the people with addiction issues the option of seeing an addiction specialist among the possible choices.
As far as "Recovery Coaches" I am not too keen on the whole concept for several reasons. I see this as deluding the addiction profession and downplaying the seriousness of addiction. Also, the minimal training required to obtain the designation.
Another issue has been the increase in detoxification beds while transitional programs (usually for thirty days after detox) lagged behind in numbers. Just recently new transitional program starts have been announced. This is a positive note for the longer a person is in treatment, the higher their probability of remaining sober. Prior to these announcements a person could complete detox and not have a transitional bed available to them.
That's it for the episode. Look for this blog to return to a weekly format.
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