Oklahoma's treatment for addiction: Why is a little bit not enough?

BY DR. CHARLES SHAW Modified: January 15, 2013 at 11:29 am •  Published: January 15, 2013
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I read with interest William Moyer’s recent article on the “know it: Addiction.” 

Again, I quote a comment made by Gil Kerlikowske: “Drug addiction is not a moral failing on the part of the individual, but a chronic disease of the brain that can be treated.” 

Mr. Kerlikowske really should know as he is the America’s Czar, the head of the Office of National Drug Control Policy.

I am not sure who our “Drug Czar” in Oklahoma is, but I do know that the only treatment afforded Oklahoma’s less fortunate is the Sooner Care Insurance plan.  I am speaking about the “treatment” offered for addicts and alcoholics who qualify for State supported health insurance, also called Medicaid.

I do not know the parameters which qualify a person for Oklahoma’s Medicaid, but obviously it has to do with annual proven income, physical or mental disability for one who qualifies. 

I am very much aware of the financial burden this state-supported insurance plan placed on the people of Oklahoma.  But, I am also aware that the treatment guidelines for in-patient detox and treatment of Medicaid-insured Oklahomans is woefully insufficient and poorly managed from a standpoint of dollars spent. 

How do I know this?  I treat alcoholics and addicts every single day whose only coverage is Medicaid.  At present, each patient is allowed only five days total time in the hospital for detox and planning for any type of follow up care. 

Not too infrequently I see the Medicaid patient, whether alcohol vs. drugs is the problem, hospitalized two or three times in a 12-month period. 

If we compare this to purely the psychiatric mentally ill patient, they may have up to six times that amount, depending on whether they are a danger to self or others. 

I am not arguing the strictly mental health admission or length of stay, but in comparison to the addict or alcoholics length of stay, it does not make sense.  Because it is a “treatment now or treat me later” -- again and again -- type of situation.

 We do not have anymore state mental hospitals to house the mentally ill and that is probably a good thing.  But, again in comparison, we have not changed our approach to state supported addiction treatment since whenever. 

I am not asking for 30-day treatment as in the 1970s and 1980s before insurance companies in our nation decided they would not pay for such treatment.  In reality, I don’t blame them for it was a very expensive outlay, although some good insurance companies still afford such treatment. But their numbers decrease each year. 

 My point is the state of Oklahoma must change the way its supports addiction treatment and devise new ways to address addiction.  Why do you ask?  Why now?  Because the biggest problem in addiction in the state of Oklahoma is our young people -- 18 to 29.  This is the very age group which will be the future of our state.   

 Why is Oklahoma in need of addiction treatment reform, even more than other states?  Because for one reason, the state of Oklahoma was No. 1 in the entire United States in Lortab prescription doses in 2010, with a whopping 120,000,000 Lortab prescribed.

That's even more than California, which is 10 times our population of 3.7 million.

 Prescription drug abuse is now recognized as the nation’s fastest growing drug problem.  While there has been a marked decrease in the use of illegal drugs like cocaine, data from the National Survey on Drug Use and Health (NSDUH) shows:

  • Nearly one-third of people age 12 and over who used drugs for the first time in 2009 began

 by using a prescription drug non-medically (not by prescription)

  • The number of prescriptions for opioid pain relievers has increased dramatically in

recent years

  • From 1997 to 2007, the number of milligrams per person used increased from 74mg to

369mg -- a 402 percent increase!

  • Retail pharmacies dispensed 174 million opiate prescriptions in the year 2000 but in

2009 they dispensed 257 million prescriptions, a 48 percent increase

  • Further opiate overdose deaths most always due to heroin are now increasingly due

to abuse of prescription pain medications.

  • Finally, almost 5,500 people every day start to use prescription pain killers!

I am on the front line of this battle against prescription abuse/addiction and I can tell you that, for the past four years, 75 percent of the patients I see admitted on our Addiction Treatment Unit are prescription opiate addicts, with the overwhelming majority being below the age of 18 to 29.

We are losing the battle!  We must face the problem and try to handle it in a different manner.  I am not saying I have the answer, but obviously we must change our approach.

I would propose the following:

1. Shorten the expensive detox stay to 72 hours only for state Medicaid patient.

2. Put into effect a longer outpatient follow up care sponsored by the treating hospital of 14 days.

3. Monitor each patient that is attending daily 12-step meetings by bringing signed notices of attendance.

And this is the biggie.

Change the policy of the Sooner Care Pharmaceutical guidelines which:

a)       Allow only one month of Suboxone medication therapy

b)      No. prescriptions for Subutex (the opiate in Suboxone) therapy “unless client is

pregnant.

Try to hold every opiate addict accountable to the doctor writing prescriptions for Suboxone or Subutex by a very

 simple drug screen costing $6 which not only checks for Suboxone/Subutex but other opiates.

Don't extend Suboxone (or Subutex) therapy past 6 months when 12-step meetings should take over.

I am not saying this is the best way or only way to treat opiate addiction in our state, but I believe it would be a start in the right direction.  The present way of treatment is next to worthless (lot of money down the drain). 

Again, I did not say there was an easy solution to the dilemma but we the people of Oklahoma deserve better than what our young people are getting.   By the way, we are No. 1 for 2012 in opiate use again according to according to a local TV report the other night.

Drug Doc

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