House Speaker Paul Ryan and other House Republican leaders are expected to unveil a health plan this week that would repeal some or all of health reform and put a different plan in its place. Our recent blog series analyzed some of its possible elements. The plan as a whole would likely:
Zac Talbott sees the irony of running an opioid treatment program from a former doctor’s office.
“The funny thing is, a lot of patients are like, ‘This is where I first started getting prescribed pain pills,’ ” Talbott said.
Now, the Tennessee native says those same patients are coming to his clinic in Chatsworth, Georgia, a small city about a half hour south of the Tennessee border, to fight their addiction to those very pills.
Outpatient clinics like the one Talbott co-owns dispense drugs like methadone and buprenorphine, which are legal synthetic opioids that block cravings and withdrawal symptoms. Federal health officials say this medication-assisted treatment, coupled with counseling, is the best way to treat an addiction to prescription painkillers or heroin. Patients are required to show up a set number of times a week — the number of visits determined by how long they’ve been receiving treatment — to take their medicine in front of a nurse.This story is part of a partnership that includes WABE, NPR and Kaiser Health News. It can be republished for free. (details)
Talbott’s clinic, Counseling Solutions, started treating patients in February, but he says it is already treating 150 people in a space that’s fit for about 200. There’s such a need in this part of the state, Talbott says, he is already making expansion plans.
More than 1,200 people died of an overdose in Georgia in 2014, according to the Centers for Disease Control and Prevention, with opioid drugs frequently implicated in those deaths. That’s a 10 percent increase over the previous year. So Talbott is outraged that Georgia has put a one-year moratorium on issuing licenses to clinics that use medicine to treat people addicted to heroin or painkillers.
“We’re in the middle of an opioid addiction and overdose epidemic,” Talbott said. “You just think about that for a minute.”
Too Many Clinics?
The reason for the moratorium, according to state Sen. Jeff Mullis, a Republican, is the state needs to figure out why so many opioid treatment programs have opened in Georgia. Mullis sponsored the legislation — which has since been signed into law — that created the freeze on new clinics. The law also required that a committee be established to look into Mullis’ question.
“If you go to the parking lot of any of these clinics in northwest Georgia,” Mullis said, “you’ll see as many Tennessee, Alabama, North Carolina, Kentucky tags as you do Georgia tags.” People are driving in from all over the South, he says, to get treatment there.
Georgia has 67 opioid treatment programs, more than any other Southeastern state. Tennessee has only 12, in contrast; Alabama has 24, and Mississippi has one. Only Florida comes close numbers-wise, with 65 clinics. But its population is nearly double that of Georgia’s.
While individuals who want to open a clinic in Georgia still have to fulfill multiple licensing requirements and approvals from both the state and federal governments, Mullis says it’s too easy; unlike other surrounding states, Georgia doesn’t have a certificate of need program for narcotic treatment centers. Those programs limit entry or expansion of some health care facilities by requiring operators to show there’s a need for it. For opioid treatment programs in Georgia, open competition has been the only real constraint on the number of clinics.
“I don’t want to take these facilities away from people who need it, but we need to manage, and govern, and regulate the ones that are here, and the ones that are coming here,” Mullis said.
There’s also stigma around the addiction drugs used at opioid treatment centers because the drugs dispensed are opioids themselves. Critics say drugs like methadone are replacing one addiction with another.
Tapering off these treatment drugs is optional, and some patients can stay on them all their lives.
Jonathan Connell, who heads the Opioid Treatment Providers of Georgia, an advocacy group for state providers, says pushing people off medication-assisted treatment shouldn’t be the focus of lawmakers’ efforts.
“If someone stays on a medication, that’s not really the issue,” he said. “People can still be dependent on something, but not live an active addiction.”
Connell, who operates three opioid treatment programs in southwest Georgia, rejects Mullis’ claim that Georgia clinics lack regulations. However, he does support the moratorium.
He says the problem is that regulations are not enforced properly by the Georgia Department of Community Health, which oversees the clinics.
“We have had some clinics open up — some people with limited knowledge of the field,” Connell said. “They have not received surveys. How do we know they’re functioning correctly?”
The Department of Community Health has only a small staff to keep track of the 67 clinics — three workers, with another person now in training. An agency spokesman says its rules and regulations also do not specify how frequently treatment centers should be inspected but that re-licensure surveys are conducted every two years.
A Treatment Shortage
A shortage of clinics in other states means Georgia’s are filling a need other Southern states aren’t meeting, Talbott argues.
He has some personal experience to bring to bear on this issue — he is in long-term recovery for an opiate addiction.
While getting his master’s degree in social work eight years ago, Talbott was prescribed painkillers for some lower back pain. He says things spiraled from there.
“I still recall to this day, learning how to help people with behavioral conditions in class, and then going to the bathroom to shoot pills and/or heroin,” Talbott said.
He says there were long wait-lists at the three Tennessee clinics closest to him that were authorized to treat his opioid dependency. Rather than wait, he drove four hours back and forth between Knoxville and a clinic in Rossville, Georgia, nearly every day for six months to get treatment.
He says he’s grateful for that Georgia clinic.
“The old Zac — that Zac that was in that graduate program for clinical social work — quickly came back,” he said, once he was able to stop the opioid use.
Georgia’s moratorium went into effect June 1. It will last a year, to give the state Legislature time to look at new ways to regulate the clinics.
This week at CBPP we focused on health care, housing, the federal budget, food assistance, state budgets and taxes, and Social Security.
Tens of thousands of American lives could be saved each year with a concerted national effort to emulate what top military and civilian trauma centers are doing, a prestigious panel of top medical experts reported Friday.
“It is time for a national goal owned by the nation’s leaders: zero preventable deaths after injury,” said a committee from the National Academies of Sciences, Engineering and Medicine in an ambitious report released six days after the nation’s worst mass shooting took place in Orlando, Florida, ending 49 lives and injuring 53.
Citing the U.S. Army’s 75th Ranger Regiment’s performance in Afghanistan and Iraq, the report praised the special operations force for its successes in treating combat casualties under difficult conditions while virtually eliminating preventable deaths.
Over that 2001-2011 period, “in the civilian sector, as many as 200,000 American lives — the population of the size of the city of San Bernardino, California — could have been saved if all trauma centers in the United States had achieved outcomes similar to those at the highest-performing centers,” the report said.
San Bernardino was the site of a mass shooting last December that killed 14 people.Use Our Content This KHN story can be republished for free (details).
The National Academies committee called for a national trauma care system to promote learning across the health care spectrum — from an injury scene to hospitalization, rehabilitation and afterward.
“We do not have a cogent or well-designed research strategy on trauma care,” said Donald Berwick, the committee’s chair, in a public briefing on the report Friday.
The committee also urged more research funding. Trauma injuries — which include severe injuries from events such as car accidents, and falls as well as gun violence — are the leading cause of death for civilian Americans younger than 46, the committee said, but injury research drew less than 1 percent of the National Institutes of Health’s biomedical research budget in 2015.
As important, the report — more than 400 pages long — stressed that the U.S. must do more to encourage coordination, collaboration and standardization in trauma care across and within both the military and civilian sectors. Other groups have made similar recommendations, but the committee pointed out there is no central authority for trauma care — in either sector or overall — to promote those goals.
“We want to level the playing field across the country,” said John Holcomb, professor and vice chair of surgery at University of Texas Health Science Center and a member of the committee, in the briefing. “Where you’re injured shouldn’t determine if you live or die.”
Declaring that only the White House has the leverage to achieve the collaboration needed, the committee recommended that the nation’s chief executive set a national aim of zero preventable deaths and lead the integration of civilian and military trauma care.
The committee also offered other direction, suggesting for example that the secretary of Health and Human Services designate a “locus of responsibility” within the department to marshal a sustained effort to achieve these goals at all levels of government, in academia and in the private sector.
One step HHS could take each year, the National Academies report said, is to promote the widespread use of one proven treatment to improve trauma care, such as commercially-made tourniquets instead improvised ones to stop severe bleeding faster.
At the Boston Marathon bombing in 2013 and again in Orlando last week, bystanders aided some badly-wounded victims by applying tourniquets made from clothing such as T-shirts and belts. That is a testament to how the civilian-sector can apply a life-saving lesson from the military, the committee observed.
But according to the report, the military has found improvised tourniquets are not always effective and now favors tourniquets expressly made to stop bleeding. In the civilian sector, the tourniquet lesson has been “lost in translation,” the committee said.
What is the cloud, and is a move to the cloud right for your nonprofit or library? To help you decide, this article discusses what organizations should know before taking the plunge.
Your old computer might have some life left in it. But dropping it off at your favorite nonprofit, charity, or library might not be the best way to pass it on. Learn about the environmentally smartest options in this article.
Schools with lots of poor children are often poorly funded compared to other schools, undermining the country’s basic promise of equal opportunity. A rule that the U.S. Department of Education is considering could help change that by leading states and localities to raise funding for high-poverty schools.
Children in high-poverty schools often get the short end of the stick in two ways:
By virtue of its health threat and rapid spread, the Zika outbreak meets the criteria for appropriating emergency funds as allowed by the Budget Control Act (BCA). The President and Senate favor the emergency approach — which would not require offsetting cuts — while a smaller House-passed measure includes offsets. Both law and practice support the emergency approach.
As a conference committee reconciles the House- and Senate-passed Zika funding bills, here are some basic points about the BCA’s emergency exception: