Op-Ed: A Few Things You May Not Know About The Senate Opioid Bill

By State Sen. John Keenan, of Quincy 

In the midst of an opioid addiction crisis that has claimed over 1,200 deaths in 2014 and thousands more in the preceding decade, the state Senate has passed a bill intended to help prevent opioid addiction. There’s more to it than most have realized.

You’ve probably read about the proposed expansion of so-called Screening, Brief Intervention and Referral to Treatment (SBIRT) programs in public schools — a proposal initially deemed controversial, with people believing it involved blood samples and lab testing. Even my mother called to report her concerns, and conveyed that my 88-year-old aunt was also opposed. For the record, the Senate bill does not include any drug testing. It does include a verbal survey and assessment, of students, to gain a better understanding of trends and risks among youth.

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How I Was Seduced By Cigarettes, And What Set Me Free

By David C. Holzman
Guest Contributor

More than half a century has passed since Luther Terry released the landmark U.S. surgeon general’s report on smoking and health.

Since then, smoking in the U.S. has declined dramatically. Nonetheless, roughly 50 million Americans still smoke.

Tobacco’s ‘Fantastic Voyage’

If anyone should have been immune to taking up smoking, it was me.

As a prepubescent child, I absorbed the lessons about the importance of living healthily that my parents instilled. At age 10, I got them to quit smoking after the first surgeon general report came out — although I’m sure they would have done it on their own, if not quite as quickly. Early on in my writing career, I wrote a “fantastic voyage” article about all the carcinogens in tobacco, where they went in the body, and what nefarious things they did when they got there. Little did I ever suspect I would become briefly but definitely addicted.

The germ of the habit occurred when I was medical writer for Insight Magazine. Dennis, the head copy editor, smoked like a chimney.

The author, smoking at his sister's wedding in June 1991 (Photo illustration courtesy of the author)

The author, smoking at his sister’s wedding in June 1991 (Photo illustration courtesy of the author)

“How’s that cigarette?” I’d tease him every morning when I arrived at work. “Not long enough!” he’d say. Or, “Not as good as the first one.” It became our way of bonding.

One day he said, “You want to try it?”

Curious, I took a puff. It gave a powerful kick, like a turbocharger. But it was not something I felt I needed.

But one Sunday, a few years later, I needed it. I’d gone to the car races at Summit Point, West Virginia, with my friend, Don, a former racer, and his wife Eva, who smoked. I’d slept little the week before, and D.C., where I lived at the time, was being its usual oppressively hot, humid summer self. By mid-afternoon I’d gotten so sleepy that I was getting ready to curl up in the back of my car and snooze. Then I remembered Dennis’ cigarette. I asked Eva if I could finish one of hers. A couple of puffs, and I was wide awake, once again enjoying being with my friends.

My FDA Cigarette

Around this time, I was working for daily biotech news publication, regularly covering meetings of the Advisory Committee to the head of the Food and Drug Administration. These meetings were boring. They took place in a windowless room of the incredibly ugly, mid-’50s institutional style Parklawn building. As soon as they started, off went the lights, and on went the Powerpoints.

At that point, no matter how much coffee I’d had, my head would start to sag.

So the next time I had to cover one of these meetings, I bummed a cigarette. I took several puffs, and then tossed it. This time, I remained painlessly alert after the lights went out.

I took to bumming cigarettes while I waited for the FDA meetings to start, and ultimately I bought my own pack. Continue reading

The Face Of Opioid Addiction: Vinnie, A ‘Regular’ Guy From Revere

In this 2013 file photo, a recovering heroin addict holds a demonstration dose of the medication Suboxone. (M. Spencer Green/AP)

In this 2013 file photo, a recovering heroin addict holds a demonstration dose of the medication Suboxone. (M. Spencer Green/AP)

Correction: An earlier version of this story said that approximately 100 Americans died each day from opioid overdoses in 2013. In fact, this number refers to all drug overdoses in that year, and opioid related overdoses, including deaths involving prescription opioids and heroin, accounted for two-thirds of the total, or approximately 67 deaths each day. 

By Dr. Annie Brewster
Guest Contributor

Want a glimpse of what opioid addiction really looks like?

Meet Vinnie: a self-described “regular” guy from Revere, Mass., and a recovering drug addict.

Toothless, and 60, Vinnie was prescribed opioids — Oxycodone, Oxycontin, Dilaudid, among others — for a chronic pain condition. Though he says he never intended to abuse these medications, Vinnie became an addict, taking painkillers for 28 years as his doctors kept prescribing higher and higher doses to manage his pain. Listen to his story here:

Vinnie stopped caring about anything except opioids, and finding his next dose of medication.

Vinnie, from Revere, is a recovering drug addict.

Vinnie, from Revere, is a recovering drug addict.

His marriage fell apart. He missed opportunities to spend time with his only daughter as she grew up. He became estranged from friends. He stopped taking care of his body and lost his teeth, gained 100 pounds, and developed diabetes, heart disease and arthritis. He fundamentally lost his will to live and contemplated suicide.

Ultimately, it was a pharmacist who put a stop to Vinnie’s opioid use by refusing to fill his prescription. After his initial panic, this abrupt end to the drugs led Vinnie to connect to a new doctor, an addiction specialist. His new regimen included a slow tapering of the narcotics and the initiation of Suboxone therapy.

The state and nation are in the midst of an escalating opioid crisis — it’s estimated that 67 Americans died each day from opioid overdoses in 2013, and the number of deaths from drug overdoses was three times that of the combined deaths from car accidents and homicides in that same year.

Just this week Massachusetts Gov. Charlie Baker enlisted medical schools to provide more addiction-related training to medical students. Against this backdrop, Vinnie’s story shows the harsh reality of addiction as well as a path to recovery.

How to fix it? It’s clear that a multifaceted approach is needed, as outlined in an extensive report put out by Gov. Baker’s Opioid Working Group in June.

One element, relevant to Vinnie, is consideration of one of several medications available to treat opioid addiction, including methadone, buprenorphine and naltrexone. Currently, these medications are underused, partly because they are controversial. Continue reading

Opinion: It’s Time To Screen Teenagers At School For Risky Substance Use

By Dr. Eugene Beresin
Guest Contributor

Hearings are being held in the Massachusetts State House on a bill that would enable public school nurses to screen teens for the risk of substance use. This practice is strongly supported by the Children’s Mental Health Campaign and the Addiction Free Future Project, and part of a mission in five states to promote screening for teenagers at risk of substance use problems.

We favor broad screening as a way to reduce death and disability due to substance use that typically starts in the teen years. We understand that this screening will be totally confidential — like all substance use screening and discussions between teens and health care providers. However, parents are free to oppose the screening of their children just as they may prevent their children from receiving vaccinations.

The downside to screening raised by some is that it will bring additional costs to the state, including extra time for training and to administer the tests. In addition, some kids may feel discomfort being asked sensitive questions. However, the overall reduced costs of treatment are great. And most kids really are open to talking about substance use in a confidential setting.

There are certainly some people who do not feel school is a place for screening of any kind. But after looking at research on substance use disorder prevention, professionals at The MGH Clay Center for Young Healthy Minds, The MGH Recovery Research Institute and the Massachusetts Children’s Mental Health Campaign feel that the benefits of early screening far outweigh the financial cost and time factors involved. The risks of excessive substance use in teenage years is very dangerous to brain development and social functioning.

A new blog post by screening advocates John F. Kelly, Ph.D., founder and director of the Recovery Research Institute and associate director of the Center for Addiction Medicine at Massachusetts General Hospital, and Courtney Chelo, behavioral health project manager at the Massachusetts Society for the Prevention of Cruelty to Children (MSPCC) lays out the details: Continue reading


What If Your Doctor Really Listened Instead Of Just Telling You What To Do?

(Alex Proimos/Flickr)

(Alex Proimos/Flickr)

On many a Friday, Dr. Joji Suzuki goes trawling through the medical wards of Brigham and Women’s Hospital with trainees in tow, looking for smokers.

One recent Friday, he finds Thrasher West, a patient who’d had trouble breathing but now is about to go home, where a tempting half-a-pack of cigarettes awaits her.

Dragging in the smoke, blowing it out — smoking feels good to her, West tells Suzuki. But then, she thinks, “Damn. Why’d I do that? Because it’s not good for me –” (Here, her deep cough adds emphasis.) “It’s bad for my health…Aw, I’ll give it up when I finish the pack.”

Suzuki, the hospital’s director of addiction psychiatry, does not lecture her about the risks of smoking. He does not suggest nicotine patches or pills or any other aids for quitting. He just mostly listens, and thoughtfully echoes what she says, and draws her out — when, for example, she mentions that she once quit for five years.

Dr. Joji Suzuki (Courtesy)

Dr. Joji Suzuki (Courtesy)

“Something happened, and you made a decision to stop,” he probes.

Her sons begged her, West recalls. One said, “Mommy, please stop smoking, please stop smoking.”

“Pleading with you…” Suzuki reflects.

“He had tears in his eyes. And he’s my baby, that’s my baby boy.” She reassured her son that she would be around for a long time, she remembers, and he answered, “You keep smoking, no, you won’t!”

Suzuki interprets: “They love their mama so much, they don’t want to lose her.”

The conversation, lasting just a few minutes, may sound like a simple chat. But Suzuki is expertly following principles that have been hammered out over decades and studied in copious research. He listens — actively, empathetically — more than he talks. His comments and questions remind West of her reasons to quit, and bolster her confidence that she can do it. They tap into her values and goals — her love for her family, her desire to live.

By the end, West says she wants badly to stop smoking, and she urgently asks Suzuki to write her a prescription for nicotine patches.

She has just experienced the subtle power of a method that’s increasingly popular in medicine: It’s called motivational interviewing, often referred to just by its initials, MI.

“The big shift in the practice of MI for most practitioners is that you go from telling patients why they should change or how they could change to drawing out from the patient their own ideas about why change would be beneficial to them and about how they might be able to do it,” says Dr. Allan Zuckoff of The University of Pittsburgh, a national leader in the field and author of a new self-guided book, “Finding Your Way to Change: How the Power of Motivational Interviewing Can Reveal What You Want and Help You Get There.”

Click to enlarge. (Courtesy Chang Jun Kim, of the Motivational Interviewing Network of Trainers)

Click to enlarge. (Courtesy Chang Jun Kim, of the Motivational Interviewing Network of Trainers)

Motivational interviewing goes back decades in the field of addiction counseling, Zuckoff says, but in medicine, it’s been really taking off in the last few years.

Hundreds of studies have been published on using it in health care, from diabetes control to reducing the risk of heart disease. It’s being tried for patients with incontinence, psoriasis, hepatitis C, Parkinson’s — virtually any disease in which the patient’s behavior — taking medication, choosing food — affects the outcome. And of course, it can be used for the lifestyle issues that are the biggest driver of American chronic illness: overeating, smoking and drinking and drugs, lack of exercise.

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Report Finds Stark Gaps In Mass. Addiction Care

The math is simple and starkly clear.

There are 868 detox beds in Massachusetts, where patients go to break the cycle of addiction. They stay on average one week. Coming out, they hit one of the many hurdles explained in a report out this week from the Center for Health Information and Analysis on access to substance abuse treatment in the state.

There are only 297 beds in facilities where patients can have two weeks to become stable. There are 331 beds in four-week programs.

As the table below shows, there are almost four times as many men and women coming out of detox, with its one-week average, as there are from a two- or four-week program.

From the CHIA report on Access to Substance Use Disorder Treatment in Massachusetts

From the CHIA report on Access to Substance Use Disorder Treatment in Massachusetts

Patients who can’t get into a residential program right away describe a spin cycle, where they detox and relapse, detox and relapse. Some seek programs in other states with shorter wait times.

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2014: CommonHealth Year Of The Brain, From Depression To Dyslexia


A map of nerve fibers in the human brain (. (Courtesy of Zeynep Saygin/Massachusetts Institute of Technology.)

A map of nerve fibers in the human brain (. (Courtesy of Zeynep Saygin/Massachusetts Institute of Technology.)

Happy almost 2015. Instead of doing our usual “Top 10 CommonHealth stories of the year” post, we’ve decided instead to look back at our tip-top, far-and-away #1 organ of the year for 2014.

Hint: It’s well above the waist. The brain is, to quote Pink Floyd: “All that you touch/All that you see/All that you taste/All you feel./All that you love/All that you hate/All you distrust/All you save.”

Etcetera. The brain is also the focus of some of the most fascinating research in modern-day science.

Our 2014 series, “Brain Matters: Reporting from the Front Lines of Neuroscience,” tried to capture a partial snapshot of this pivotal moment in brain science, a time of new tools and insights so promising that scientists themselves are saying this is the most exciting time ever to work on the brain.

The series included the set of gorgeous images below, compiled by former intern Suzanne E. Jacobs, and a collection of short video interviews with young neuroscientists, produced by WBUR’s Jesse Costa: 11 Young Neuroscientists Share Their Cutting Edge Research.

The individual “Brain Matters” pieces, in reverse chronological order:

Wishing you a wonderful new year. Special thanks to WBUR’s Iris Adler, who supervised the “Brain Matters” series. And now, for your visual pleasure, the wondrous view inside your head: Continue reading

As Mass. Lawmakers Take Up Addiction Bill, What’s Most Effective Treatment?

Hydrocodone pills, also known as Vicodin. (Toby Talbot/AP)

Hydrocodone pills, also known as Vicodin. (Toby Talbot/AP)

As Massachusetts lawmakers work on differences in the $20 million bill designed to address the state’s opioid crisis, questions remain about which treatments are best.

Several business and insurance leaders have written to Gov. Deval Patrick saying that some parts of the bill may not encourage the most effective addiction treatment. Essentially, they say, more beds may not be the answer, but more medication and longer outpatient care might be better.

The House bill requires insurers to pay for at least 10 inpatient days of addiction treatment if that’s determined to be medically necessary; the Senate bill requires up to 21 days of inpatient coverage.

“We just believe patients should have a choice.”

– Leominster Sen. Jennifer Flanagan

But the American Society of Addiction Medicine estimates that 95 percent of opioid-dependent patients do not need inpatient care, and might be better off with medication maintenance and several months of outpatient therapy. Lawmakers maintain that they do not want to mandate any form of treatment.

“If we have this epidemic that continues to grow, we’re essentially in uncharted territory, and current treatment options aren’t working,” said Leominster Sen. Jennifer Flanagan, one of the bill’s co-sponsors. “If people want inpatient treatment or medication maintenance, they should be able to decide that with their doctors.”

At the same time, a new report contains some surprising findings about medication maintenance addiction treatment. It says that methadone, long used to treat heroin addiction, may be the most effective and cheapest treatment.

The report, from The New England Comparative Effectiveness Public Advisory Council, found that when comparing methadone with suboxone (Buprenorphine) or naltrexone (Vivitrol), more patients stayed in treatment longer if they were taking methadone. Continue reading

Study: Young Adults’ Casual Marijuana Use Causes Brain Changes



A new study by Boston researchers is believed to be the first that shows that young adults who even occasionally smoke marijuana could be damaging their brains.

The study, just published in The Journal of Neuroscience, found abnormalities in areas of the brain related to emotion, motivation and decision-making.

The researchers say the degree of brain changes appeared to be directly related to how frequently the study’s participants smoked pot.

The authors write in their paper:

The results of this study indicate that in young, recreational marijuana users, structural abnormalities in gray matter density, volume, and shape of the nucleus accumbens and amygdala can be observed. Pending confirmation in other cohorts of marijuana users, the present findings suggest that further study of marijuana effects are needed to help inform discussion about the legalization of marijuana.

The study comes with a plurality of Massachusetts residents supporting the legalization of marijuana for recreational use, and as the state is in the process of opening medical marijuana dispensaries.

Here & Now has more on the study this afternoon.

And hat-tip to The Boston Globe, which has more on the findings.

Second Opinion: Doc Says Blue Cross Opioid Policy Is Flawed

Amidst concerns over a massive national increase in the use and abuse of prescription painkillers, health insurer Blue Cross Blue Shield of Massachusetts instituted a new policy to reduce pain medication addiction and misuse.

This week The Boston Globe reports that as a result of the new policy, Blue Cross has cut prescriptions of narcotic painkillers by an estimated 6.6 million pills in 18 months.

But Daniel P. Alford, MD, an associate professor of Medicine and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) Program at Boston University School of Medicine and Boston Medical Center, calls the policy “flawed and irresponsible.” Here’s Alford’s response:

By Dr. Daniel P. Alford
Guest Contributor

The Blue Cross Blue Shield of Massachusetts opioid management program was implemented to provide members with “appropriate pain care” and reduce the risk of opioid addiction and diversion.

In a recent Boston Globe report they claim “very significant success” with this program after 18 months because they have cut opioid prescriptions by 6.6 million pills.

Dr. Dan Alford

Dr. Dan Alford

Is this really a measure of success and if so, for whom? It likely saves Blue Cross money but has it successfully achieved their program’s stated goals? Does decreased opioid prescribing mean more appropriate pain care? Does decreased opioid prescribing reduce the risk of addiction or diversion, or does it decrease access to a specific pain medication (opioids) for treating legitimate chronic pain? Is the observed decrease in opioid prescribing evidence that opioids have been overprescribed, as Blue Cross claims, or is it proof that instituting a barrier to opioid prescribing (prior authorization) will decrease prescribing even for legitimate need? Are patients with chronic pain really benefiting from this program? I doubt it.

Adding yet more paperwork for physicians will not improve pain care, decrease addiction or the numbers of accidental overdoses from prescription opioids. Those physicians who are unwilling (or ambivalent) to prescribe opioids even when indicated will use the prior authorization requirement as an excuse to continue not prescribing. Those who are overly liberal in prescribing will figure out the most efficient way to satisfy the insurance requirements for approvals. Physicians who responsibly prescribe opioids – that is, prescribing them only when the benefits outweigh any risks — will be saddled with more administrative burdens to justify their well thought-out treatment decisions.

Some physicians may ultimately decide that prescribing opioids isn’t worth the trouble despite known benefits for some patients. Continue reading