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Bipartisan Legislation Introduced to Require Warning Labels on Addictive Prescription Opioids & Mandate Education for Opioid Prescribers

In a rare bipartisan effort, Senators Edward J. Markey (D-Mass.) and Mike Braun (R-Ind.) introduced two bills last week aimed at combating the opioid epidemic. The first first piece of legislation is called Lessening Addiction By Enhancing Labeling (LABEL) Opioids Act. The bill calls for labeling prescription opioid bottles with a consistent, clear, and concise warnings that opioids may cause dependence, addiction, or overdose.

The second bill, entitled the Safe Prescribing of Controlled Substances Act, requires any prescriber of opioid medication to undergo mandatory education on safe prescribing practices. Specifically, it mandates that all prescribers, who are applying for a federal license to prescribe controlled substances, must complete mandatory education to help encourage responsible prescribing practices.

Nearly 50 percent of opioid dependence originates with prescribed opioid painkillers. The two pieces of legislation seek to make sure patients and prescribers understand the dangers and full impact those prescriptions may have on the life of a patient.

Specifically, the LABEL Opioids Act would require the Food and Drug Administration (FDA) to issue regulations providing for a warning label to be affixed directly to the opioid prescription bottle handed to the patient by the pharmacist. Utah, Arizona, and Hawaii have passed state laws requiring labeling of prescription opioids, and legislation has been introduced in several other states. Last year, Canada issued regulations to require opioid labeling nationally. Congressman Greg Stanton (D-AZ-09) has introduced companion legislation in the House of Representatives.

The Safe Prescribing of Controlled Substances Act mandates education for prescribers that focuses on best practices for pain management and alternative non-opioid therapies for pain. Such education includes methods for diagnosing and treating a substance use disorder, linking patients to evidence-based treatment for substance use disorders, and tools to manage adherence and diversion of controlled substances. The legislation also requires the Department of Health and Human Services to monitor and evaluate the impact this new education requirement has on prescribing patterns.

The Council on Recovery supports these bipartisan efforts by the U.S. Congress to address the opioid epidemic.

If you or a loved one is struggling with opioid addiction or any substance use disorder, call The Council on Recovery at 713-942-4100 or contact us online.

Discrimination, immigration, treatment expectations, and family stigma are among barriers to Latinos seeking treatment

The following article was recently published on the research page of the Recovery Research Institute website. It explores a new study that indicates Latinos have the lowest treatment seeking rates compared to people of other racial and ethnic backgrounds.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

National studies have shown that individuals who identify as Latino are less likely to seek treatment for substance use disorder or complete treatment at specialty treatment facilities. Barriers to treatment engagement by race and ethnicity have been examined in only a few national studies and results are inconclusive. Identifying barriers to treatment is a foundational step that will allow for public health planning aimed at addressing barriers. The purpose of this in–depth qualitative study was to gain a better understanding of barriers to specialty treatment for substance use disorder that are more prominent among Latinos than other racial and ethnic groups.

HOW WAS THIS STUDY CONDUCTED?

From 2017-2018 the authors conducted a qualitative study which consisted of telephone interviews with participants from Riverside, Los Angeles, San Diego, and Oakland, CA; Brooklyn, NY; Chicago, IL; Miami, FL; and San Antonio, TX, recruited via craigslist (i.e., a web-based advertising platform) to compare barriers to treatment utilization among racial and ethnic groups.

WHAT DID THIS STUDY FIND?

Figure 1. Source: Pinedo et al, 2018

Latinos reported attitudinal barriers to specialty treatment more than other racial and ethnic groups (i.e., cultural, perceived treatment efficacy, and non-abstinent recovery goals). Overall, Latinos commonly felt specialty treatment providers did not understand their unique needs and experience. Specifically, they perceived healthcare providers to be unfamiliar with cultural issues such as discrimination and immigration. Providers were, therefore, discussed in terms of not being able to relate to personal experiences associated with being Latino including alcohol or other drug use which was in turn associated with low treatment efficacy. Being able to have a recovery goal of moderated alcohol use, and not complete abstinence, emerged as a larger barrier for Latinos in seeking treatment at specialty facilities. Its is unclear if these barriers could vary according to generation, meaning, foreign versus native born Latinos.

Social norms barriers towards specialty treatment (i.e., stigma and lack of social support) were more pronounced among Latinos than their White and Black counterparts. Stigma for seeking treatment was strong across all groups but most frequently mentioned by Latinos. Lack of social support from family emerged because it was viewed as “confirming” they had a problem and may tarnish the family.

Control over specialty treatment specifically logistical barriers, such as lack of health insurance, cost of treatment, transportation, and long wait times were highlighted by all racial and ethnic groups during interviews, however, showed no considerable differences in number of times mentioned between groups.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

This study identified specific barriers that discourage individuals who identify as Latino with alcohol or other drug use disorders from seeking treatment, and compared these to other racial and ethnic groups. Barrier identification is important because Latinos seek treatment at about half the rate as their White counterparts although higher estimates have been reported. Latino expectations that providers do not understand cultural issues like discrimination and immigration was an attitude barrier for seeking treatment. Researchers have suggested acknowledging important social contexts such as immigration and discrimination experiences in the delivery of specialty treatment for substance use disorders may increase service use. Latinos low expectations around treatment efficacy where rooted providers having no lived experience with alcohol or other drug problems and therefore are unable able to relate. Treatment facilities may need to promote their use of, or integration with, peer services as a means of showing that lived experience can be a part of the treatment process. Clinicians should be prepared to work with patients whose recovery goals include an initial goal of moderate alcohol use given about half of people in the US who have resolved a problem with alcohol or other drugs are not completely abstinent.

Stigma was heavily endorsed by Latinos including concerns over being seen by colleagues at a specialty treatment facility. To address this barrier, treatment centers might offer telemedicine which is when treatment is delivered using telecommunications technology like Skype but specially designed for secure health care communication.  In fact, a National Recovery Study found that individuals who identify as Hispanic were over one a half times as likely than White individuals to use recovery-related online technology. So, this may be a way to engage more Latinos with substance use disorder in treatment.

LIMITATIONS

  1. Qualitative studies like this use smaller samples to obtain richer ideas and explanations. This study was on only on a total of 54 individuals, of whom only 20 were Latino, recruited by advertisement, so it’s unclear to what extent findings may generalize to Latinos with substance use disorder as a whole. Particularly given the participants were assessed in terms of meeting diagnostic criteria over a 5 year window instead of 12 months, which is more standard.
  2. The barriers to treatment seeking identified in this qualitative study should be further tested in larger samples, and ideally, in a national study to determine the US prevalence of these barriers among racial and ethnic groups.
  3. Latino alone is a large group and there may be generational issues to consider in these outcomes related to foreign versus native born Latinos.

BOTTOM LINE

  • For individuals & families seeking recovery: This study of barriers to treatment for substance use disorder found that expectations of low efficacy were common. This low perceived efficacy of treatment was related to  experiences with treatment providers who had no lived experience with substance use disorder, or providers who were perceived to not understand stressful cultural issues like immigration and discrimination and its association with the onset, clinical course, and remission of substance use disorder. Talk to a treatment provider about setting expectations around the likelihood of remission, their use or integration with peer services, and provider cultural competency.
  • For scientists: This qualitative study found that social norms around low family support and acceptability of seeking treatment may be a barrier among individuals who identify as Latino. Preventative interventions aimed at adolescents and emerging adults that seek to improve the acceptability of using professional services for substance use disorders may have lasting impacts on creating a future culture of support and reduced stigma, that extends to families and communities across generations. In addition, it is important to develop and test strategies that can help engage Latino individuals with services. For example, 12-step facilitation for Spanish speaking Latinos since they value lived experience.
  • For policy makers: This was a qualitative study that examined barriers to specialty treatment for substance use disorder by race and ethnicity. Latino treatment seeking may be improved (and treatment seeking in general) by promoting the use of peer services (i.e., persons with lived experience in recovery), training providers in “cultural humility” in order to increase education around immigration and discrimination and its effect on recovery, and increasing privacy options during treatment. Telemedicine is an emerging option to increase privacy during treatment and provide access to hard to reach populations but research on effectiveness needs to be studied.
  • For treatment professionals and treatment systems: This was a qualitative study that examined barriers to specialty treatment for substance use disorder among individuals who identify as White, Latino, and Black. Latino treatment seeking may be improved by (and treatment seeking in general) by accommodating non-abstinent recovery goals around alcohol use, promoting organizational integration with evidence-based peer services (i.e., persons with lived experience in recovery), training providers in cultural humility to increase education around immigration and discrimination and its effect on recovery, and increase privacy options during treatment seeking. Telemedicine is an emerging option to increase privacy during treatment and provide access to hard to reach populations but research on effectiveness needs to be studied. It may be important for clinicians to process and problem solve around Latinos’ mistrust in professional treatment and address the family and cultural barriers they may face if attending treatment (i.e., stigma or lack of social support).

CITATIONS

Pinedo, M., Zemore, S. & Rogers, S. (2018). Understanding barriers to specialty substance abuse treatment among Latinos. Journal of Substance Abuse Treatment, 94, 1-8.

How Does Spirituality Change the Brain?

The following article by Dr. Mark Gold, recently published on the Addiction Policy Forum Blog, explores the growing body of research about what regions of the brain are changed during a person’s spiritual practice. It presents compelling ideas for how fellowship and treatment programs can empower individuals in recovery to use spirituality as a proven tool to improve their mental health.

Spirituality can be an important component of recovery from addiction, as it can be a key way for a person seeking recovery to connect to something outside themselves – spiritual practices have long been cornerstones of mutual aid groups, such as Alcoholics Anonymous. Recently, researchers and those looking at trends have concluded that Americans are becoming less religious but at the same time identify as more spiritual. Spiritual engagement can be a way to find, as the authors in the study write, a “sense of union with something larger than oneself.” In a recent study of the brain done at Yale directed by Dr. Mark Potenza, Neural Correlates of Spiritual Experiences, scientists used functional Magnetic Resonance Imaging (fMRI) to examine exactly how spirituality activated or deactivated, certain regions of the brain, changing how people perceive and interact with the world around them.

Dr. Christina Puchalski, Director of the George Washington Institute for Spirituality and Health, defines spirituality as “the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.” Importantly, the authors of the study encouraged diverse, personally-motivated definitions of spiritual experience, examples of which included participation in a religious service at a house of worship, connection with nature, mindfulness meditation, and contemplative prayer.

How do we Measure the Effect of Spirituality?

Spirituality and religious practices are a key part of many people’s lives – 81% of U.S. adults describe themselves as spiritual, religious, or both. Despite the majority of American adults engaging in some form of spiritual practice, little is known about what happens in certain parts of the brain during these spiritual experiences. Although studies have linked specific brain measures to aspects of spirituality, none have sought to directly examine spiritual experiences, particularly when using a broader, modern definition of spirituality that may be independent of religiousness. This study used a special kind of brain imaging, functional magnetic resonance imaging (fMRI), to examine neural structures and systems that are activated when we engage in spiritual practice. By detecting changes in blood flow to certain regions of the brain, the fMRI is able to detect activity in the brain when participants were asked to recall spiritual experiences.

Methodology

A potential challenge in this study is the wide variety of spiritual experiences that individuals can find personally meaningful. The authors of the study sought to address this by using a personalized guided-imagery fMRI procedure in which participants were asked to describe a situation in which they felt “a strong connection with a higher power or a spiritual presence.” Their accounts were turned into a script, which was recorded and played back to the participant during fMRI. The brain activation measured during the participant’s recall of a spiritual moment was compared to measurements taken while participants listened to narrations of their neutral and stressful experiences.

Key to this study was that the accounts were completely self-directed by the participants — which enabled the researchers to identify commonalities in brain activity among diverse spiritual experiences.

How Does Spirituality Change the Brain?

04302019_inferiorparietallobe-2

The area highlighted in blue is the Inferior Parietal Lobe, which is associated with perceptual processing

Spiritual experiences were associated with lower levels of activity in certain parts of the brain:

  • The inferior parietal lobe (IPL), the part of the brain associated with perceptual processing, relating to the concept of self in time and space
  • The thalamus and striatum, the parts of the brain associated with emotional and sensory processing

This study furthers a growing body of research about spirituality and its connection to brain processing. These findings tell us that spiritual experiences shift perception, and can moderate the effects of stress on mental health. This study saw decreased activation in the parts of the brain responsible for stress and increased activity in the parts of the brain responsible for connection with others. A sense of union with someone or something outside of oneself and community engagement have been found to support a robust recovery from substance use disorders as well as other behavioral health issues. 

Looking to the Future

Marc Potenza, MD, PhD is an expert in Psychiatry, Behavioral Addictions, and his work at Yale in this important area is a welcome addition to the investigators working in this field. Neural Correlates of Spiritual Experiences has positive implications for instituting spiritual engagement in prevention, treatment, and recovery for substance use disorders. Importantly, participants were scanned while they recalled their own, individualized spiritual experience, but the results were consistent between participants. This means that a person does not have to participate in a certain type of spiritual practice to see the benefits, but can engage in whatever version of engagement is most compatible with their personal beliefs. This encourages treatment and recovery programs to encourage patients to pursue diverse means of spiritual engagement.

This study found a way to measure and visualize what many recovery and treatment communities have understood for years—that spirituality can reduce stress and create feelings of connectedness. By understanding what regions of the brain are changed during a person’s spiritual practice, fellowship and treatment programs can empower individuals in recovery to use spirituality as a proven tool to improve their mental health.

References:

  1. Smith, G., Van Capellen, P., (2018, March 7) Rising Spirituality in America [Audio Podcast]. Retrieved from https://www.pewtrusts.org/en/research-and-analysis/articles/2018/rising-spirituality-in-america.
  2. Lipka, M., Gecewicz, C., (2017, September 6). More Americans now say they’re spiritual but not religious. Retrieved from https://www.pewresearch.org/fact-tank/2017/09/06/more-americans-now-say-theyre-spiritual-but-not-religious/

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 55

Avalon mythical island

Guest Blogger and long-time Council friend, Bob W. presents Part 55 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

Santa Catalina is an island offshore southern California, “26 miles across the sea…” from Long Beach.  The “26 miles…” line is from a 1958 song by the Four Preps, a male quartet of Hollywood teenagers whose name conveyed their image…preppy, well groomed suburban kids in white shirts, identical suits and skinny ties. They had a number of hits in the late 50’s and 60’s as the popular music world was moving from traditional rock ‘n roll to folk ballads.

But the island of Santa Catalina eschewed their image.  It was a quiet, very rocky, almost magical island whose main harbor and city then and now is Avalon, a quaint village of shops, restaurants and B&B’s.  Avalon also was a very reverent name in ancient Celtic legends. 

Avalon was an island in the marshlands of Wales where spiritual beings with great healing powers were said to reside. It was also the place where the magical sword, Excalibur, was reportedly to have been forged, the instrument that empowered King Arthur with a mantle of invincibility.

When Arthur was wounded in his battles with Modred, he was transported to Avalon where he was attended to and healed by the Enchantress Morgana le Fay. While Avalon on Santa Catalina today is just a nice quaint city on a distant isle, those of us blessed with the miracles of the Process of Recovery can easily see it in its mythological constructions. Travelling there across the water, entering the beautiful harbor, walking among the rocky hills of the island, we can imagine ourselves as Arthurian Knights, reveling in the bliss of a magical existence, immortalized in so much literature…for our lives in the “sunlight of the spirit,” afforded by our diligent working of the program, is precisely that…is it not?

Rx Take Back Day at The Council Nets 400 Pounds of Unused & Expired Prescription Drugs

The Council’s drive-through Rx Take Back site made Rx med disposal quick & convenient
DEA agents collected over 400 lbs. of unused & expired Rx prescriptions for disposal

The Council on Recovery was a busy collection site for the DEA’s 16th National Rx Take Back Day this past Saturday. Nearly 100 people stopped by The Council’s drive-in location on Jackson Hill Street to dispose of their unused and expired prescription medications. By the end of the four-hour collection period, DEA agents had collected more than 400 pounds of Rx drugs.

This is the first time The Council has participated in the DEA’s National Take Back Day. The national initiative was launched after Congress enacted the Disposal Act in 2014, which amended the Controlled Substances Act, that gave the DEA authority to collect unused pharmaceutical controlled substances for disposal in a safe and effective manner.

The Council views unused or expired prescription medications as a public safety issue that contributes to potential accidental poisoning, misuse, and overdose. Proper disposal of unused drugs saves lives and protects the environment. As a Rx Take Back Day collection site, The Council provided a secure, convenient, and anonymous way for its constituency to clear their homes of old or unneeded Rx medications in a responsible manner.

As one of nearly 350 collection sites across the state, The Council provided an easily accessible and central location for residents in the Heights, Rice Military, Montrose, River Oaks, Midtown, and near-Downtown areas to dispose of their medications. During the last Rx Take Back Day in October, over 67,000 pounds of Rx prescriptions were collected in Texas, according to the Drug Enforcement Administration Diversion Control Division. The Council on Recovery is pleased to contribute 400 pounds to this Spring’s total haul and plans to participate in future Rx Take Back events.

If you missed Rx Take Back Day at The Council, you can still dispose of unused or expired prescriptions at DEA authorized collection sites, many of which are located within national and local pharmacies. To search the DEA’s website for a collection site near you, click here.

The Council Taking Back Unwanted Prescription Drugs Saturday, April 27

On Saturday, April 27, from 10 a.m. to 2 p.m., The Council on Recovery and the U.S. Drug Enforcement Administration will give the public its 17th opportunity in nine years to prevent pill abuse and theft by ridding their homes of potentially dangerous expired, unused, and unwanted prescription drugs.

Bring your pills for disposal to The Council at 303 Jackson Hill Street in Houston. (We cannot accept liquids or needles or sharps, only pills or patches). This drive up/drop-off service is free and anonymous, no questions asked. The Council’s drive-through covered portico will keep everyone dry in the event of rain. Additional security personnel will also assure the safety of everyone who participates in the event.

Last fall Americans turned in nearly 460 tons (more than 900,000 pounds) of prescription drugs at more than 5,800 sites operated by the DEA and almost 4,800 of its state and local law enforcement partners. Overall, in its 16 previous Take Back events, DEA and its partners have taken in almost 11 million pounds—nearly 5,500 tons—of pills.

This Take Back initiative addresses a vital public safety and public health issue. Medicines that languish in home cabinets are highly susceptible to diversion, misuse, and abuse. Rates of prescription drug abuse in the U.S. are alarmingly high, as are the number of accidental poisonings and overdoses due to these drugs. The Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health shows year after year that the majority of misused and abused prescription drugs are obtained from family and friends. These include someone else’s medication being stolen from the home medicine cabinet.

In addition, Americans are now advised that their usual methods for disposing of unused medicines—flushing them down the toilet or throwing them in the trash—both pose potential safety and health hazards.

For more information about the disposal of prescription drugs or about the April 27 Take Back Day event, go to www.DEATakeBack.com or call The Council at 713-942-4100 or contact us online.