Editorials

Good federal, Florida steps to help curb heroin epidemic

pvidela@bradenton.com

The nation's alarming epidemic of heroin and prescription drug abuse and overdose deaths merits an intense counter attack, but in unveiling his administration's new policies last week President Obama only took modest steps. Likewise, Florida Gov. Rick Scott laid out a modest proposal in September to address mental health and substance abuse in the state.

But both are welcome developments as federal and state officials become increasingly aware of this spreading and deadly disease, with the number of heroin overdose deaths nationwide quadrupling over the past decade. That fatality figure now exceeds vehicle accident deaths.

The challenge is particularly acute here. Manatee County ranks as the worst in the Florida with the highest per capita overdose deaths from the opioids heroin and fentanyl, according to 2014 figures from the state Medical Examiners Commission.

Both Obama and Scott aim to increase drug addiction services by treating abuse as a sickness and not a crime. But the president's proposal for $133 million in new spending and the governor's plan for more than $19 million in beefing up programs are small in comparison to the out-of-control epidemic.

But major barriers that block addicts from treatment remain as the Herald's Kate Irby reported last week. Local addiction health experts including Centerstone CEO Mary Ruiz embrace Obama's policy changes but cite the need for greater resources.

The president's plan intends to curb overprescribing by increasing the training for doctors, dentists and other medical practitioners on the safe prescription of opiate medications; boost the amount of overdose data that is collected to more accurately track the problem; and expand access to naloxone, the generic version of Narcan, which can reverse the effects of opioid overdose.

Florida is ahead of the curve on that latter issue. The Legislature passed a bill during the 2015 session allowing doctors to prescribe naloxone to third parties such as family members and friends of addicts. Scott signed it into law in June. Paramedics are also equipped with Narcan.

But the addiction still exists for overdose victims. Many addicts cannot access treatment because of insurance, either the lack thereof or rejections from insurers. The Affordable Care Act requires insurers to cover addiction like other medical conditions, but that edict only became implemented in January for many insurance plans.

Plus, overburdened treatment centers cannot accept new patients.

One of the issues cited by Ruiz and Dr. Mark Sylvester, a Lakewood Ranch-based addictions specialist, as another barrier to treatment is the absurd federal limit on the patient load for doctors who prescribe medication for addiction.

Upon becoming certified, physicians can only treat 30 patients the first year and then 100 in subsequent years. In Irby's report, Sylvester noted that a doctor typically treats anywhere from 400 to 1,500 patients at a time, 90 percent of his 1,000 patients are addicts but he can treat only one out of nine. But the federal Department of Health and Human Services plans to change those rules.

The Obama policy changes also expand a pilot program that offers medication-assisted treatment in federal prisons, an idea that should be embraced by state prisons and county jails. In her ongoing coverage of Manatee County's heroin crisis, Irby interviewed one woman who bravely escaped her hellish existence but not before sitting in jail on more than one occasion detoxifying alone only to return to her addiction once released.

Ruiz described medication-assisted care the "gold standard" in addiction treatment. The Obama initiatives would double the number of doctors certified to prescribe buprenorphine to treat opioid abuse, from 30,000 to 60,000. At least one congressman disputed the validity of expanding this treatment, and that points to the uphill political battle the administration faces.

In announcing his proposals, the president hit a home run in saying the country needs to overcome the shame of addiction: "We can't fight this epidemic without eliminating stigma. With no other disease do we wait until people are a danger to themselves and others. ... This is an illness, and we've got to treat it as such."

Recalcitrant politicians should be first in line to embrace that notion. Otherwise, the resources vital to curbing this epidemic will be lacking.

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