Can long-acting opioid blockers help stem OD crisis?

Wednesday, September 20, 2023

By Courtney Wise

We also look at the battle that trans people are fighting to access gender-affirming care in some state health plans. Plus, good news for sufferers of depression and anxiety: A new study finds that 7 daily habits may cut symptoms almost in half. 

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In Chicago, using long-acting opioid blockers to try and stem the overdose crisis

Malachi Castner is only 23, but he’s spent much of his life trying to kick his addiction to opioids. The struggle began his junior year of high school, after a doctor prescribed OxyContin to manage pain from a back injury sustained during a school wrestling match. It cost him a cheerful farewell to adolescence, a relationship with his parents, a home under their roof, and an opportunity to earn a living through legal employment. Most days, Castner told the Chicago Tribune, his waking hours revolve around the pursuit of heroin for another high. But on a recent day, Castner decided to pursue a different path by going to a local community clinic to get injected with an opioid blocker – a long-acting form of buprenorphine that stays active and effective for 28 days. 

“There have been times where I’ve gotten sober, gotten clean, and then I’ve fallen off again,” he said. “This is the umpteenth time I’m trying this. Hopefully, I get it this time.” Castner and some 200 other Chicago-area residents get their injections from Project LIFE, a substance abuse program at PCC Community Wellness Center whose acronym stands for  Long-acting Injection For Ending Overdose. 

People getting the shot are “following up with us at twice the follow-up rate than they have in the past,” said Ruchi Fitzgerald, service chief of inpatient addiction medicine at PCC. Patients come from all backgrounds, she said, including older adults, parents, folks living with HIV, and people experiencing homelessness. The dose of buprenorphine offers them 28 days of relief from withdrawal symptoms and keeps them from missing a dose of the widely-used daily formulation.

Patients rave about its results, telling Project LIFE, “that shot was a miracle.” Now the question is whether this strategy can be implemented equitably. Harvard health policy and management researcher Michael Lawrence Barnett has published research showing that Black patients are less likely to get buprenorphine after an overdose. He calls the monthly injectable a “compelling idea” but is dubious it will reach the neighborhoods on Chicago’s south and west sides that need it most. “We need investments in addiction provider presence and options across Chicago, which is not something that happens by itself,” he said.

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Seattle area crisis facilities reject a quarter of mentally ill patients, report finds

A lack of beds isn’t the main reason. More often, the patients are deemed to be “too sick,” to have a history of aggression, to have had  restraints used against them in the past, or to have autism or other cognitive or developmental disabilities, says a report in The Seattle Times. 

“[Facilities are] just not staffed or oriented towards taking care of people with complex needs,” said Paul Getzel, director of the Seattle chapter of NAMI, the National Alliance on Mental Illness. For Getzel, getting help for the most vulnerable is vital to keeping them on the path to treatment and away from incarceration. “What we’re concerned about is getting folks into care and not jail,” he said. 

People who are deemed to meet the criteria for an involuntary hold often find themselves languishing in hospital emergency rooms while appropriate treatment is sought. They can be held in the ER for up to one month under a temporary license known as single-bed certification – a practice that critics say often leaves them without access to needed servies. A Seattle Times analysis found that an average of 443 people per month were held on single-bed certifications last year.

Lack of beds is also a problem, especially since the closure of a large facility that provided 13% of King County beds slotted for involuntary treatment. Change may be coming, however, although not immediately. In April, voters passed a measure to build five new walk-in crisis facilities that can take people in crisis, regardless of insurance. But construction isn’t scheduled to begin until 2026. 

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Trans people wait in limbo as North Carolina fights to block gender-affirming care in state health plans

Since early last year, Hann Henson has held what many would consider a good job. As a communications specialist for a North Carolina school district, he earns a living wage and receives state health benefits. But they may not provide what Henson says he most needs – gender-affirming surgery. For now, a law passed by North Carolina legislators denying state employees coverage for such care has been temporarily blocked by a federal appeals court. So Henson is scrambling to get the surgery before another court ruling might strip it away. He feels “like somebody has got their hands around my neck,” he told ProPublica. 

Had laws like that been in place when he first came out as transgender 10 years ago,  “I probably would be dead,” he said. North Carolina is one of nearly two dozen states attacking access to gender-affirming care for trans youth and one of more than a dozen with a health plan that denies such coverage. But a lawsuit by transgender advocates against the North Carolina policy is the first to make its way to a federal appeals court. Supporters of the state’s policy, like gubernatorial candidate Dale Folwell, argue that gender-affirming care would burden the state with exorbitant costs. Opponents say that argument is a red herring, and that the coverage would actually cost the state very little. 

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In other news…

The FDA may approve MDMA to treat PTSD as soon as next year – but will your insurer pay? The Los Angeles Times explored the question. Spoiler alert: Stay tuned, but temper your expectations. While the American Medical Association has developed billing codes to help providers request payment from insurers, that’s no guarantee of coverage, said Anton L.V. Avanceña, a health policy researcher at the University of Texas at Austin.

Podcasting is one of the most accessible forms of media and one group now treading its own podcasting path is a group of Hmong mental health providers in Woodbury, Minnesota, that produce The Hmong Mental Health Podcast.

Each week, four Hmong therapists gather for frank conversations about pathways and obstacles to mental wellbeing, using their training and lived experiences to drive discussions. “From a therapist to a podcaster, I still want to hold that clinical lens,” said panelist Houa Vang. “As a podcaster, I still want to be myself too, because I am my own person. I have my emotions and experiences.” The panelists encourage listeners to tune, but note it is not a replacement for therapy. 

Seeking non-pharmaceutical relief for depression or anxiety? NPR reports on a new study in Nature Mental Health which finds that doing these seven things every day can cut your symptoms by up to 50%. 

• Go to bed! Your body needs adequate sleep for your mind to function well. 
• Move! It’s not far-fetched to think of regular exercise as an antidepressant.
• Consider what you eat. A plant-forward diet can not only cut your risk of diabetes, heart disease and certain types of cancers, it can also keep your mind sharp and clear, especially compared to processed foods and excess sugar.
• Restrict alcohol intake and do not smoke. ‘Nuff said.
• Sit as little as possible and limit screen time.
• Build connections with other humans by sharing space and time with them doing things you enjoy. We simply need each other to be fully well. 

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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