Bills urge help for addicts in ERs and prompt RX drug reporting

Pharmacists and doctors who participate in the state’s prescription drug monitoring program would be required to report every prescription they fill for opiates and other controlled substances within 24 hours under a bill introduced on Friday.

HB 557 was filed by Rep. Nicholas Duran, D-Miami. There is no companion bill in the Senate. 

Currently, pharmacists and doctors who participate in the state’s Prescription Drug Monitoring Program have seven days to report controlled substances they dispense.

Although participation in the PDMP is not mandatory, the database improves clinical decision-making and can identify doctor shopping and pill mills.

» Read the Post’s coverage of the opioid epidemic »

Currently, 6,546 pharmacists and doctors input their prescribing data into the PDMP database. Sixty-six percent of participants already report data within 24-hours.

The database contains 37,048,030 prescriptions for 7.3 million Florida residents.

Also on Friday, Republican Sen. Kathleen Passidomo filed SB 558, which would require hospitals to provide additional services to overdose patients. Passidomo, vice-chair of the Senate Committee on Health Policy and Appropriations Subcommittee on Health and Human Services, represents Collier, Hendry and parts of Lee counties – all hard hit by the opioid epidemic.

The bill mirrors HB 61, filed by Rep. Larry Lee, D-Port St. Lucie, which requires hospitals to screen overdose patients to determine the need for additional services and prohibits hospitals from discharging overdose patients to a detox or drug treatment center until the patient is stable.

The bills also require attending physicians to contact the overdose patient’s primary care physician or any other treatment providers who prescribed a controlled substance to the patient.

If the patient is currently in a treatment program, the hospital’s attending physician must also inform the medical director at the treatment center about the overdose.

The bill would also require the hospital to inform an overdose patient’s family or emergency contact about the overdose

 

 

Kratom becomes illegal tomorrow…or not

Democratic Rep. U.S. Lois Frankel has joined efforts to delay the DEA’s attempt to outlaw kratom tomorrow, claiming the drug – abused for its opioid-like effects – shows promise in treating addiction and outlawing the drug would halt research.

kratom2aFrankel is one of 51 members of Congress who signed a letter to DEA Acting Administrator Charles Rosenberg on Sept. 26, asking the agency to “engage consumers, researchers, and other stakeholders, in keeping with well-established protocol for such matters.”

On Aug. 30 the Agency filed notice in the Federal Register that it intended to place kratom’s active ingredients ― the opioids mitragynine and 7-hydroxymitragynine ― on Schedule I, a list of drugs such as heroin that have no accepted medical and have a high potential for abuse.

Kratom is derived from a tree (Mitragyna speciosa korth) grown in Southeast Asia. It has become increasingly marketed and sold to recreational drug users as an alternative to controlled substances. Kratom is legal but is currently on the DEA’s “drugs of concern” list.

Law enforcement has seized kratom in various forms, including powder, plant, capsules, tablets, liquid, gum/resin and drug patch. Because the identity and purity levels are uncertain and inconsistent, “they pose significant health risk to users,” according to a DEA press release announcing the intention to ban kratom.

However, research funded by the National Institutes of Health at the University of Mississippi and University of Massachusetts found that a kratom extract, mitragynine, could be useful in treating opioid withdrawal.

In 2010 the schools applied for a patent. According to the patent application, “the present invention contemplates that kratom extract may also be useful for the treatment of other addictive drugs besides opiate derivatives.”

According to the letter sent to the DEA, outlawing kratom “will put a halt on federally funded research and innovation surrounding the treatment of individuals suffering from opioid and other addictions – a significant health threat,”

The ban proposed by DEA would go into effect on Sept. 30. The ban would sunset after two years and the agency could downgrade kratom to less restrictive Schedule 3 to 5 – drugs that are less addictive and have come medical use.

The response to the DEA’s announcement has been intense.

In a recent survey of 6,000 kratom users conducted by the Pain News Network and American Kratom Association,  98 percent of kratom users do not believe kratom is a harmful or dangerous substance; 75 percent said it is not possible to get “high” from kratom; and 95 percent said that making kratom illegal would be harmful or society.

The American Association of Poison Control Centers identified two exposures to kratom from 2000 and 2005. Between 2010 and 2015, U.S. poison centers received 660 calls related to kratom exposure.

The Center for Disease Control (CDC) found that kratom abuse leads to agitation, irritability, tachycardia, nausea, drowsiness, and hypertension. Health risks found in kratom abusers include hepatotoxicity, psychosis, seizure, weight loss, insomnia, tachycardia, vomiting, poor concentration, hallucinations, and death.

DEA is aware of 15 kratom-related deaths between 2014 and 2016.

 

What’s a “save shot” and why did Prince reportedly get it?

Prince_at_Coachella_001
Maybe you believe TMZ’s tabloid reports that Prince overdosed on opioids -twice – and had to be given a “save shot” – twice- or maybe you don’t.

Or maybe you want to know what a save shot is.

Short answer: It’s Naloxone, also known by one brand name, Narcan. Naloxone is an antidote to an opioid overdose. That can be from opioids such as Percocet, which Prince’s sister said the singer used, or from heroin.

It can be agonizing. But it’s a re-entry to life, and everyone from the Surgeon General to the President of the United States is urging broader access to the drug.

Delray Beach, Sarasota, Stuart: They needed no convincing. Police officers in all three cities are carrying Narcan.  And with good reason. Less than a day after Delray police started carrying it, they had to use it, saving the life of a 20-year-old who relapsed and overdosed on heroin.

Narcan kit used by Delray Beach police.
Narcan kit used by Delray Beach police.

In dozens of other states, you can buy Narcan over the counter, no prescription needed. In one northeast city, a doctor wrote an “open prescription” so that anyone could go into any drugstore and buy the life-saving drug.

But not in Florida, home to unprecedented numbers of heroin overdoses.

Those overdoses reflect the large  numbers of people coming to Palm Beach County to recover from heroin- and the numbers of unscrupulous businesses exploiting them. That includes dumping them into cheap hotels after they relapse- with deadly consequences.

Read more about addiction in our series Addiction Treatment: Inside the Gold Rush.

A clock is counting the dead from overdoses

6968
6,968

6,986. 

Moments before a cluster of congressmen began their 9:30 a.m. presentation at the 2016 National RX Drug Abuse and Heroin Summit in Atlanta Wednesday, the grim clock above them stood at 6,970: the number of people dead from an opioid or heroin overdose in the roughly 72 hours since the summit began Monday evening.

When the speakers arrived at the dais, it was 6,970.

6971
Minutes later: 6,971

When they sat down, it was 6,971.

The speakers, including long-time prevention and treatment advocate U.S. Rep. Hal Rogers of Kentucky, had some other numbers.

They cited the 23 percent drop in crime in Gloucester, Massachusetts, since the police chief there told addicts who turned themselves in they would not be arrested but would instead get treatment.

There’s the street value of a single bottle of oxycodone: $2,000. And there’s the sevenfold increase in the amount of Mexican heroin coming into the U.S. in just seven years.

When the congressmen began winding up their speeches two hours later, though, the number left behind was this one.

6975

Fed report: More Medicaid equals fewer addiction troubles in Florida

Hypodermic needles found in the trash at a cottage apartment by Jean Thomas, 83, in West Palm Beach's Prospect Park neighborhood. (Thomas Cordy / The Palm Beach Post)
Hypodermic needles found in the trash at a cottage apartment by Jean Thomas, 83, in West Palm Beach’s Prospect Park neighborhood. (Thomas Cordy / The Palm Beach Post)

Elevator scene from the National RX Drug Abuse and Heroin Summit in Atlanta:

Reporter to woman: Are you here for the conference?

Woman: Yes, I’m from Detroit.

Reporter: We’re from South Florida.

Woman: Oh, South Florida. That’s where you go when you’ve got money for treatment.

Or not.

On Monday, Health and Human Services released a report on just how many Floridians with addiction or mental health issues can’t get adequate help – in some cases, any help – because the state won’t expand Medicaid, a key feature of Obamacare.

(Comes a day before President Obama is slated to speak at the Summit. Coincidence? You decide.)

Anyway: Florida has fought tooth and nail against any such expansion, even though the rolls of Floridians on the health plan for the poor continues to rise.

About three in every ten people living below 138 percent of the poverty level need treatment for drug abuse or mental illness or both, HHS estimates.

From those numbers, the feds put together these numbers in the report:

  • 390,000: Number of uninsured Floridians age with either mental illness or an addiction problem who would qualify for treatment under Medicaid expansion. (For bragging right purposes, that’s second only to Texas among states without Medicaid expansion.)
  • Nine: Percentage of uninsured Floridians getting help for the above, 2010-14.
  • $7 million-$190 million. Budget savings range reported by different states which expanded Medicaid.
  • 17, 18, 33: Percentage drop in arrests among three groups of people frequently in trouble with the law after Washington state began providing them with Medicaid-financed substance abuse treatment.

We already tackled one tricky addiction math question this morning, one raised by this festive magazine cover.

Harpers' controversial piece on legalizing drugs- all drugs.
Harpers’ controversial piece on legalizing drugs- all drugs.

Stay tuned as Post reporters Christine Stapleton and Pat Beall cover the Summit live from Atlanta.  Stapleton and Beall are members of a team of reporters that have been investigating scams in Palm Beach County’s $1 billion drug treatment industry

The 8-month long investigation by the Palm Beach Post uncovered patient brokering, insurance fraud and kickbacks.

 

UPDATED: 15 questions addicts should ask to find a safe halfway house

These 15 questions will help you avoid being the victim of insurance fraud and patient brokering in a halfway house.

Picking a sober home: What to ask

More than two dozen sober home operators have been arrested since October 2016 and charged with accepting and paying kickbacks to enroll insured addicts living in sober homes to specific treatment centers. Asking these 15 questions will help you determine if a sober home is doing business legally and offers the best accommodations for recovery. 

1. Are you certified by the Florida Association of Recovery Residences? FARR certifies sober homes that meet 38 standards for recovery, housing, administration, training, finance and good-neighbor practices. Certified homes can be found at farronline.org.

2. Is the residence coed? Experts agree that newly recovered addicts, especially women, are vulnerable. Dating and relationships in early sobriety can take the focus off recovery.

3.What will happen if I relapse? FARR recommends that sober homes devise individual relapse protocols that include contacts and alternative housing arrangements.

4. Have there been any overdoses or deaths? Is staff trained in CPR?

5. How often do you drug test? Are tests random? What kind of tests? How much do they cost?

Here’s how the fraud works

6. Do you bill insurance? Sober homes are not licensed to offer medical care and cannot bill insurance for services, including rent.

7. How much is rent? How is it paid? What is included in rent? What is the refund policy? Are there rules about pocket change and money transfers? Experts warn insured residents to be leery of free rent, gift cards, cellphones, gym memberships and other inducements if linked to attendance at an intensive outpatient program (IOP) or the provision of urine samples.

8. Do you have an ownership interest or receive referral fees from an intensive outpatient program (IOP) or lab? Such kickbacks, often disguised as “case management fees” are illegal under Florida’s patient brokering law. 

9. Have there been any complaints filed against the sober home or its employees, including code violations?

10. How much training, education and clean time do you require of employees, including house managers?

11. Are properties and vehicles that transport clients insured? Are clients allowed to drive vehicles?

12. Are there 12-step meetings on property? Do you provide transportation to meetings? The grocery store? Is there public transportation within walking distance?

13. What are your policies regarding guests and furloughs?

14. What is your cellphone policy?

15. What is the maximum occupancy? How many to a room? How many bathrooms?

Read more of the Post’s coverage of corruption in the drug treatment industry.

Palm Beach County addiction business a $1 billion gold rush, FBI investigating

Urine test stripsUnder the radar, local fortunes are being made here, and quickly, from getting addicts and alcoholics clean and sober.

With the big money has come big problems: Reports of kickbacks, patient brokering, inflated medical testing bills and insurance fraud are rampant. Take the out of state couple who opened a bill from a local drug testing lab with links to the sober home where their son was treated, to find a $300,000-plus bill. For urine testing.

In fact, South Florida drug testing labs affiliated with sober homes have mushroomed in the last few years, creating potential for conflicts of interest – and hefty revenue – as sober home clients are told urine testing is required, then steered to the lab owned by the sober home operator, or one the operator has a financial interest in.

It’s against this backdrop, and the state’s weak efforts to regulate sober homes, that the Florida Association of Recovery Residences, a Boca-based association of sober home owners and treatment businesses, gets its Orlando conference off the ground this morning.

Maybe the FBI will come, too – they’ve been investigating for months now….