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The Rosenthal Report - August 2016

Rosenthal Reports
What Congress Didn’t Do

Before it broke camp for its seven-week summer recess, Congress passed legislation to address the nation’s epidemic of opioid addiction. With more than 28,600 overdose deaths in 2014, an army of addicts uncovered or insufficiently covered by health care insurance, and a health system that lacks adequate capacity to meet today’s substance abuse treatment needs, President Obama had pressed Congress to provide $1.1 billion in new money, most of which would go to the states to support medically-assisted treatment (MAT) of opioid addiction.

After painful compromises had been worked out in both houses and the conference committee, the measure was passed and sent to the President. It authorizes the federal government to make grants to the states for addiction treatment and prevention programs, but fails to appropriate the funds for them. Although there was strong pressure—and clearly need—for an immediate appropriation, the summer recess began without it. House Republicans say they will appropriate $581 million (far less than the $1.1 billion requested by the administration) when they return to Washington, but there is no guarantee that this promise will survive the haggling over appropriations that comes as the government’s fiscal year winds down at the end of September.    

What Congress and HHS Did Do

As part of the addiction treatment measure, Congress has made it possible for physician assistants and nurse practitioners to prescribe buprenorphine for patients in opioid treatment programs (OTPs).  In a more significant move, the Department of Health and Human Services (HHS) increased the number of patients for whom authorized physicians (and now their surrogates) can prescribe buprenorphine step-down medications (such as Suboxone) from 100 patients to 275.

Threatened to be lost in the shuffle is the federal requirement that opioid treatment programs offering medically assisted treatment  (MAT) provide “a range of services to reduce, eliminate, or prevent the use of illicit drugs, potential criminal activity and/or the spread of infectious disease.”

Bear in mind that the key word in medically assisted treatment is “assisted.” Medication itself is not treatment.  SAMHSA (Substance Abuse and Mental Health Services Administration) defines medically assisted treatment as “the use of medications, in combination with counseling and behavioral therapies to provide a ‘whole patient approach’ to substance use disorders.” HHS requires physicians seeking to increase their patient limit to “attest” that they will “adhere to evidence-based treatment guidelines.”

It is not likely, however, that much in the way of behavioral healthcare services will be available at the “Suboxone clinics” now proliferating in states hit hard by the opioid abuse epidemic.  And the prescription of buprenorphine’s step-down (and addictive) medications to an expanding list of patients troubles a good many health officials there. As the medical director of Tennessee’s Department of Mental Health and Substance Abuse Services warns, “I think the focus has been so much on expanding treatment and getting treatment out to people, that they really haven’t focused on some of the unintended consequences.”

High Risk Munchies

Pot is all too often good for a giggle, but news about marijuana edibles from the National Poison Data System is anything but humorous. Reporting on “single substance exposure calls” for marijuana cookies, candies and the like between January 2013 and December 2015, the poison service found 430 calls nationally with more than half from the two states that have legalized recreational marijuana use. There were 166 calls from Colorado and 96 from Washington, with the number of calls increasing over the course of the study. The age group found most at risk were children under five, who were the subjects of 109 calls. Lethargy, rapid heartbeat, and agitation were the most common symptoms. Three exposed patients (including a four-year-old) had to be intubated, half were hospital treated and released, and three admitted to a critical care unit. Our friends at NFIA (National Families in Action) and SAM (Smart Approaches to Marijuana) alerted us to the Poison Center’s report and also to news about Défoncé Chocolatier’s high end marijuana chocolates (see below).

High Test Bonbons

The high style, high powered inaugural bar of Défoncé chocolate comes in 18 pyramid-shaped detachable segments and 180 milligrams of THC. With concentrated cannabis extract alleged to spread evenly throughout the bar, each pyramid section should deliver a ten-milligram hit of THC, believed to be roughly equivalent to several good pipe puffs. Défoncé (it’s French for “stoned”) is the creation of a former production manager at Apple set on delivering a fashionable product with predictable high-making capacity. Available now in California dispensaries, the Défoncé bar comes in such flavors as coffee, vanilla bean, dark, mint, and hazelnut. The obvious question is how hard is it for consumers to stop munching after a pot-laden pyramid or two.

1st August 2016
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