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Treating Opioid Addiction in Primary Care Benefits Both Patients and Cash-Strapped Medical Practices
Press release content from PR Newswire. The AP news staff was not involved in its creation.
ANN ARBOR, Mich., Nov. 11, 2020 /PRNewswire/ — Buprenorphine-based treatment for opioid addiction is in short supply in many areas of the United States. And while many physicians want to offer it, clinics are unsure how to offer buprenorphine therapy in a financially sustainable way. Cost and revenue analysis from a team of Harvard Medical School researchers finds that even cash-strapped primary practices in high-poverty rural and urban communities can offer financially sustainable buprenorphine-based opioid addiction treatment.
The team, led by Sanjay Basu, MD, PhD, a Harvard primary care physician and epidemiologist and Jonathan E. Fried, MD, MPH, an internal medicine resident at Brigham and Women’s Hospital, interviewed practice managers and identified four common approaches to delivering buprenorphine-based treatment in primary care practices. The approaches differed based on who in the clinic delivered the majority of face-to-face care, the presence of nurse care managers, and whether care was delivered in traditional one-on-one or group settings.
The research team then used microsimulation modeling to identify the cost and financial benefit of delivering buprenorphine-based treatment in a variety of primary care settings, including Federally Qualified Health Centers (FQHC), non-FQHCs in both rural and urban high poverty areas,, and practices outside of high poverty areas. They found that all four approaches to care produced positive net revenue after the first year in a variety of practice settings, and net revenues were consistently highest for rural practices.
Physician-led treatment and shared medical visits, both of which relied on nurse care managers, consistently produced the greatest net revenue gains, generating from $29,000 to $70,000 per full-time physician per year across the practice types.
Additionally, net revenues were positive for all primary care practices that had at least nine patients in buprenorphine treatment per provider at any given time and no-show rates less than 34 percent. The findings suggest that in the current fee-for-service–dominated environment, offering office-based therapy for opioid addiction with buprenorphine can be a financially sustainable choice for cash-strapped primary care practices, despite hurdles.
Financing Buprenorphine Treatment in Primary Care: A Microsimulation Model
Jonathan E. Fried, et al
Center for Primary Care, Harvard Medical School, Boston, Massachusetts
View original content to download multimedia: http://www.prnewswire.com/news-releases/annals-of-family-medicine-treating-opioid-addiction-in-primary-care-benefits-both-patients-and-cash-strapped-medical-practices-301170615.html
SOURCE Annals of Family Medicine
Juice WRLD’s life ended way too soon due to his addiction and need to self-medicate. Although his artistry left—and continues to leave—a lasting impact on the world, the rapper’s mother wants to be open about her son’s struggle.
Juice WRLD’s mother, Carmela Wallace, sat down with Chicago’s ABC affiliate to talk about her son for the first time since his death. During the conversation, Wallace explains that her son’s passing can serve as an example for others as long as she is open about its cause.
“It was devastating,” Wallace said. “But, one thing I decided early on was that I was not going to hide the fact that he died from a drug overdose. I did not want to keep that a secret because there are a lot of people who deal with that every day.”
Wallace went on to say that she and Juice WRLD talked about everything—including his addiction. This led to a conversation about self-medication and putting his mental health in perspective.
“I said, ‘if you have anxiety, then you need to get medicated properly for it instead of medicating yourself,'” she recalled. “I talked to him about it. I told him my biggest fear was him overdosing on the stuff. That’s why I made the decision I have to talk about it with other people. I can’t keep that as a secret.”
To address this issue, Wallace is furthering Juice WRLD’s brand by starting the Live Free 999 Foundation. This organization will help young people dealing with mental health issues and drug addiction. Wallace explains that a lot of Juice WRLD’s fans and friends have reached out to her following his death to disclose their own mental health issue, moving her to start the foundation.
“That’s our objective with our foundation. Normalize the conversation, so it has to start with me,” she continued. “I hope it’s what he wanted, was a legacy of healing. To let people know that you don’t have to suffer alone.”
Although the focus is mental health relief, the Live Free 999 Foundation will also do its part to uplift the community in various ways. It has recently donated new musical instruments to Juice WRLD’s former high school in Chicago Heights.
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“In the drawings, I did pretty good,” said Eric Alick, 63, of Philadelphia, who completed a contingency management program for cocaine addition at the Corporal Michael J. Crescenz V.A. Medical Center in Pennsylvania. “I might get three ‘good jobs’ in a row, but then, bingo.”
Among the things he bought with his rewards were a new drill set for his job as a handyman, perfume for his wife and coffee and meals for homeless veterans whom he had met in the hospital cafeteria.
One problem with contingency management, evidence suggests, is that people have less success staying abstinent after the treatment ends. For that reason, Richard Rawson, a researcher at the University of Vermont who has studied meth addiction for decades, believes it should be used indefinitely, just as medications for opioid addiction often are.
“Unfortunately, addiction is a chronic brain disease and treatments need to be designed to accommodate this reality,” he said.
For Ms. Waxler-Malloy, losing the debit card when her four months of contingency management ended in early January was hard, although her therapy sessions and 12-step meetings helped. Then, in May, she lost her waitressing job because of the pandemic and she relapsed, using meth and heroin “full force,” she said, for three weeks before stopping with help from Brightview.
Still, the eight months she went without using drugs was her longest stretch of abstinence in more than two decades. She believes she may not have relapsed if contingency management, with its promise of rewards, had still been part of her treatment regimen.
“That kept me real accountable,” she said recently. “Even just to stop at McDonald’s when you have that little bit of extra money, to get a hamburger and a fries when you’re hungry. That was really big to me.”
McLean has sought professional help on his road to sobriety.
AJ McLean is opening up about his 20-year battle with addiction.
The 42-year-old Backstreet Boys star and “Dancing with the Stars” contestant revealed to “Good Morning America” what happened when he first did drugs.
“The first time I tried drugs was literally an hour before my call time to ‘The Call’ video shoot,” McLean recently told “GMA’s” Will Reeve. “I was off the walls.”
The singer also said he kept his addiction a secret until his behavior began affecting his band.
“When the boys kind of caught on, I missed out on rehearsal,” McLean said. “They basically broke into my house, and they dumped ice water on me while I was passed out in my bed.”
“Everybody started to catch on,” he added. “I wasn’t me anymore, you know, I was just living a lie.”
Eleven months ago, it appeared McLean’s addiction was in the forefront of his life after a trip to Las Vegas.
“I was never sober. Not for a second,” McLean said. “And the turning point for me was when I came back home, my wife could smell it on my breath and my youngest of my two daughters would not sit with me.”
McLean said he’s been sober since that day and he’s working with a program and a sponsor.
“There’s too much to live for today — my beautiful children, my amazing wife, my career, my brothers,” McLean said. “I’ve never felt more grounded than I do today.”
ABC News’ chief medical contributor Dr. Jennifer Ashton said a person can become addicted to drugs after trying them for the first time.
“In speaking with addiction experts, it absolutely does happen,” she said, adding that addiction can be associated with a genetic predisposition or could be situational.
“We’ve heard those stories as well — people who have surgery or are in an accident and that’s what starts their addiction,” Ashton noted.
Addiction warning signs according to Ashton, can include the following:
If you’re of thinking of holding an intervention for a loved one, Ashton’s advice is to “plan, plan, plan,” and seek professional help.
Ashton said when a person agrees to go for treatment, they often will need a transporter to accompany them to the facility.
“This requires daily work,” Ashton added. “This is a lifelong battle like any other chronic illness. If you can’t see it, sometimes people take it less seriously. I encourage people to look at this no differently than heart disease, cancer, high blood pressure. It’s a disease, period.”