In the Land of Legal Weed, Drug Education Moves From ‘Don’t’ to ‘Delay’
A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’
In Rural California, This New Addiction Treatment Is Being Ignored -- by the Doctors
How Drugmakers Used Money and Influence to Shape the National Response to Opioid Abuse
Half of Americans Take Prescription Drugs That Could Lead to Addiction
Insurance Rules Put Up Roadblocks to Opioid Addiction Treatment
More Addiction Training at Stanford Med School as Opioid Epidemic Surges
Addiction Reframed as Health Problem, Not a Crime, in U.S. Senate Bill
San Diego's Methamphetamine Problem Strains Criminal Justice System
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","imgSizes":{"thumbnail":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM-400x226.png","width":400,"height":226,"mimeType":"image/png"},"post-thumbnail":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM-672x372.png","width":672,"height":372,"mimeType":"image/png"},"guest-author-32":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM-32x32.png","width":32,"height":32,"mimeType":"image/png"},"guest-author-50":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM-50x50.png","width":50,"height":50,"mimeType":"image/png"},"guest-author-64":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM-64x64.png","width":64,"height":64,"mimeType":"image/png"},"guest-author-96":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM-96x96.png","width":96,"height":96,"mimeType":"image/png"},"guest-author-128":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM-128x128.png","width":128,"height":128,"mimeType":"image/png"},"detail":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM-150x150.png","width":150,"height":150,"mimeType":"image/png"},"jmtc-small-thumb":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM-280x150.png","width":280,"height":150,"mimeType":"image/png"},"kqedFullSize":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM.png","width":691,"height":390}},"fetchFailed":false,"isLoading":false}},"audioPlayerReducer":{"postId":"stream_live"},"authorsReducer":{"byline_stateofhealth_360808":{"type":"authors","id":"byline_stateofhealth_360808","meta":{"override":true},"slug":"byline_stateofhealth_360808","name":"\u003ca href=\"http://khn.org/news/author/brian-rinker/\">\u003cstrong>Brian Rinker\u003c/strong>\u003c/a>","isLoading":false},"byline_stateofhealth_353704":{"type":"authors","id":"byline_stateofhealth_353704","meta":{"override":true},"slug":"byline_stateofhealth_353704","name":"\u003cstrong> \u003ca href=\"http://californiahealthline.org/news/author/pauline-bartolone/\" target=\"_blank\">Pauline Bartolone\u003c/a>\u003c/strong>\u003c/br>California Healthline","isLoading":false},"byline_stateofhealth_238941":{"type":"authors","id":"byline_stateofhealth_238941","meta":{"override":true},"slug":"byline_stateofhealth_238941","name":"Associated Press and Center for Public Integrity","isLoading":false},"byline_stateofhealth_234838":{"type":"authors","id":"byline_stateofhealth_234838","meta":{"override":true},"slug":"byline_stateofhealth_234838","name":"Richard Harris \u003cbr />\u003ca href=\"http://www.npr.org/sections/health-shots/\">NPR Shots\u003c/a>","isLoading":false},"byline_stateofhealth_223727":{"type":"authors","id":"byline_stateofhealth_223727","meta":{"override":true},"slug":"byline_stateofhealth_223727","name":"Jake Harper\u003cbr />\u003ca href=\"http://sideeffectspublicmedia.org/\">Side Effects Public Media\u003c/a>","isLoading":false},"byline_stateofhealth_217466":{"type":"authors","id":"byline_stateofhealth_217466","meta":{"override":true},"slug":"byline_stateofhealth_217466","name":"Natalie Jacewicz","isLoading":false},"byline_stateofhealth_212218":{"type":"authors","id":"byline_stateofhealth_212218","meta":{"override":true},"slug":"byline_stateofhealth_212218","name":"Alison Kodjak\u003cbr />\u003ca href=\"http://www.npr.org/sections/health-shots/\">NPR Shots\u003c/a>","isLoading":false},"byline_stateofhealth_211809":{"type":"authors","id":"byline_stateofhealth_211809","meta":{"override":true},"slug":"byline_stateofhealth_211809","name":"Kenny Goldberg\u003cbr />\u003ca href=\"http://www.kpbs.org/news/2016/jun/27/san-diego-addicted-meth/#\">KPBS\u003c/a>","isLoading":false},"cfeibel":{"type":"authors","id":"11314","meta":{"index":"authors_1591205172","id":"11314","found":true},"name":"Carrie Feibel","firstName":"Carrie","lastName":"Feibel","slug":"cfeibel","email":"cfeibel@KQED.org","display_author_email":false,"staff_mastheads":[],"title":"KQED Contributor","bio":"Carrie Feibel is a former health editor at KQED, where she has also reported for radio and online. Her stories have appeared on the national NPR shows \u003cem>Morning Edition\u003c/em>, \u003cem>All Things Considered\u003c/em>, and \u003cem>Here & Now\u003c/em>, and on the national website, Kaiser Health News. Her print career included stints at the \u003cem>Houston Chronicle\u003c/em>, \u003cem>The (Bergen) Record,\u003c/em> and the Associated Press in New York City. A native of St. Louis, Feibel attended Cornell University, and earned a master's in journalism from Columbia University.","avatar":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g","twitter":"KQEDHealth","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"stateofhealth","roles":["administrator"]}],"headData":{"title":"Carrie Feibel | KQED","description":"KQED Contributor","ogImgSrc":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/cfeibel"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_363545":{"type":"posts","id":"stateofhealth_363545","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"363545","score":null,"sort":[1526497955000]},"guestAuthors":[],"slug":"in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay","title":"In the Land of Legal Weed, Drug Education Moves From ‘Don’t’ to ‘Delay’","publishDate":1526497955,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Californians legalized marijuana in 2016, with 57 percent of the vote. But the momentousness of that decision was somewhat lost in the drama of Donald Trump’s victory. Voters also had to wait over a year for full implementation, while state agencies crafted new regulations for quality, safety and marketing.\u003c/p>\n\u003cp>But the social significance of the vote finally burst into view this Jan. 1, when eager customers -- who had lined up in the darkness outside medical marijuana dispensaries across the state -- streamed through the doors at the stroke of midnight.\u003c/p>\n\u003cp>But the change hasn’t been confined to the cannabis cash register. Everyone has seen the advertising or heard the chatter -- and that includes minors, although marijuana remains illegal for those under 21.\u003c/p>\n\u003cp>“Coming out of SFO airport, there are billboards for \u003ca href=\"https://www.eaze.com/\" target=\"_blank\" rel=\"noopener\">Eaze\u003c/a> that say ‘Marijuana is here,’ ” said \u003ca href=\"http://profiles.ucsf.edu/danielle.ramo-larios\" target=\"_blank\" rel=\"noopener\">Danielle Ramo\u003c/a>, a psychologist who conducts research at UCSF on adolescent drug use.\u003c/p>\n\u003cp>“I'm not sure parents were expecting to see so many images of cannabis all over,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Public schools in California are required by law to provide anti-drug abuse education, although experts say the quality of the instruction varies widely from district to district, and there’s little enforcement.\u003c/p>\n\u003cp>I was curious to know how marijuana legalization was being discussed in schools, so I embedded with \u003ca href=\"http://livingadept.org/beingadept/\" target=\"_blank\" rel=\"noopener\">Being Adept\u003c/a>, an evidence-based curriculum that has been used in about 20 schools in the Bay Area.\u003c/p>\n\u003cp>To my surprise, I discovered that the rollout of legal recreational marijuana in California and other states hasn’t led to any big changes in substance abuse prevention. Drug educators have always covered both legal substances (alcohol, tobacco, prescription drugs) and illicit ones (pot, ecstasy, cocaine, LSD, heroin, meth … ). Students have accessed, and abused, both categories of drugs for decades.\u003c/p>\n\u003cp>But I was more struck by the evolution of drug education since the 1980s. Today, drug abuse education is an advanced pedagogy, drawing on decades of rigorous effectiveness research and the newest teaching techniques.\u003c/p>\n\u003cp>The “Just Say No” approach, popularized by Nancy Reagan, has been discredited. The PSAs that Gen-Xers may remember -- the egg in a frying pan (“\u003ca href=\"https://www.youtube.com/watch?v=GOnENVylxPI\" target=\"_blank\" rel=\"noopener\">this is your brain on drugs\u003c/a>”), or the boy calling out his dad’s drug use (“\u003ca href=\"https://www.youtube.com/watch?v=MkxCcXHwRkk\" target=\"_blank\" rel=\"noopener\">I learned it by watching you!\u003c/a>”) -- live on as memes, but they’re no longer used as messages.\u003c/p>\n\u003cp>“Those scare-tactic-based programs have tended to quite clearly not work, based on most of the research that evaluated its effectiveness,” Ramo said. “Today there is an entirely different mindset about school-based prevention.”\u003c/p>\n\u003cp>In a nutshell, the focus now is on facts, not fear. Also conspicuously absent are simplistic dictates like “just say no.” Instead, teachers spur students to examine data, speculate on motives, discuss risks, and deliberate on their own goals and values.\u003c/p>\n\u003cp>Ashley Brady, a Being Adept instructor, was completely open about her method when she stood in front of the eighth-graders at Marin Primary and Middle School, a private school in Larkspur.\u003c/p>\n\u003cp>“I'm not here to tell you what to do today. Not at all,” she began. “I'm here to give you the most up-to-date information possible so that you can make your own healthy, informed decisions.”\u003c/p>\n\u003cp>Brady then jump-started a fast-paced, fact-filled discussion on brain chemistry and physiology. There was an animated video about how marijuana affects dopamine pathways in the brain. Then a discussion about marijuana “edibles” and how they are metabolized by the liver.\u003c/p>\n\u003cp>“It can take up to 30 minutes to maybe even an hour or two before it really hits you,” she said. “When somebody eats an edible and they don't really feel the effects, what do you think happens?”\u003c/p>\n\u003cp>“They eat more!” a student called out.\u003c/p>\n\u003cp>“They eat more,” Brady nodded. “Yeah, an hour, an hour and a half later? Boom! Like a freight train, they've been hit, and, you know, can barely move or can barely talk. That kind of thing. So they may have to go to the hospital.”\u003c/p>\n\u003cp>True, that sounds a \u003cem>little\u003c/em> scary, but it’s presented neutrally, as a consequence at the end of a sequence of decisions.\u003c/p>\n\u003cfigure id=\"attachment_363549\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363549\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/05/IMG_8238-e1526427780998-800x1067.jpg\" alt=\"\" width=\"800\" height=\"1067\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-1020x1360.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-900x1200.jpg 900w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-960x1280.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-240x320.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-375x500.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-520x693.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ashley Brady explains the increase over time in marijuana potency to a class of eighth-graders at Marin Primary and Secondary School in Larkspur. \u003ccite>(KQED/Carrie Feibel)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Where the legalization of the marijuana industry \u003cem>has\u003c/em> affected the content of these lessons is on the subject of potency. Brady tells the students that legalization has spurred competition and innovation among suppliers, to the point where they’re now churning out extremely potent and precisely calibrated forms of pot called “concentrates,” which comes in various forms.\u003c/p>\n\u003cp>Brady runs through their names: oil, bubble, shatter, wax and dabs.\u003c/p>\n\u003cp>“They call it a ‘dab’ because one tiny little nail head [of it] -- I mean I'm talking like the end of my pinky -- one tiny little nail head is the same as three joints hitting the system all at once. So it’s a lot stronger than it used to be.”\u003c/p>\n\u003cp>Tests of THC levels in marijuana samples over the years back this up. Whereas a typical joint in the '70s probably had a THC level of 4-5 percent, at best, growers are now breeding strains of cannabis that produce buds with THC levels as high as 20-30 percent.\u003c/p>\n\u003cp>But the concentrates are in another category altogether. Processed concentrates sold at dispensaries now regularly test at 80, even 90 percent.\u003c/p>\n\u003cp>“It's not the same drug,” Brady tells them. People sometimes vomit from concentrates. Some people hallucinate and have even become psychotic.\u003c/p>\n\u003cp>And yes, she adds, it can be addictive. Not just psychologically, but physically. People do go into THC withdrawal and do go to rehab for pot addiction.\u003c/p>\n\u003cp>Still, as she describes the transformation of marijuana from a relatively mild intoxicant to a potentially debilitating one, Brady never once says “that’s why you shouldn’t” or even “so please be careful.”\u003c/p>\n\u003cp>Afterward, the students applauded this approach.\u003c/p>\n\u003cp>“It made you feel more mature, and that you're in control,\" said Devon Soofer, 13. “This [class] was actually telling you the long-term effects and what it can actually do to you. So it actually made you feel like ‘Wow, this is actually really bad,’ and not just being \u003cem>forced\u003c/em> not to do it.”\u003c/p>\n\u003cp>Later units in the Being Adept curriculum give students concrete tools: They rehearse what to do or say at parties, and talk about better ways to cope than using cannabis -- or any substance.\u003c/p>\n\u003cp>Ramo, who serves as a scientific advisor to Being Adept, decried “the overwhelming stress, anxiety, depression, suicidality that is so pervasive among teens in the United States today, especially in high-intensity educational areas, like a lot of schools in the Bay Area are.”\u003c/p>\n\u003cp>“Addressing that problem is key,” she added, as is “having teens come up with solutions to manage their stress, that they actually would use.”\u003c/p>\n\u003cp>\u003cstrong>“Delay, Delay, Delay” \u003c/strong>\u003c/p>\n\u003cp>So if drug educators aren’t telling students “Don’t!” anymore, what exactly are they telling them to \u003cem>do\u003c/em>? As I observed, they’re not overtly telling them to do anything, because teens are naturally resistant to the authoritarian approach -- and some of them may resist to the point of doing the opposite.\u003c/p>\n\u003cp>The underlying goal of drug education remains the same as before: keep children safe. The dangers of intoxicated driving, sexual assault, academic or athletic failure, social humiliation, social media embarrassment -- all of these do come up in the lessons.\u003c/p>\n\u003cp>But the instructors put a special emphasis on a less visible risk: the potential damage to their brains. And the science backs them up.\u003c/p>\n\u003cp>“More research is coming out looking at the ways in which all different kinds of substances can hijack normal brain functioning, and particularly so in adolescence,” Danielle Ramo explained.\u003c/p>\n\u003cp>“In heavily cannabis-using teens, there are some particularly important implications of using cannabis on the frontal lobe, and that interrupts a type of thinking called ‘executive functioning.’ ”\u003c/p>\n\u003cp>Also worrisome is a substantial body of research showing that using any potentially addictive substance while the brain is still developing -- whether alcohol, marijuana, nicotine, or other drug -- triggers neurological changes that can lead to addiction.\u003c/p>\n\u003cp>“The earlier teens start using, the more heavily they use in adolescence, the more likely it is that they'll go on to have problems throughout their adulthood,” said Ramo.\u003c/p>\n\u003cp>Being Adept instructors don’t say it outright, but the message is clear: If you’re not going to abstain, just push it off for a while. \u003cem>Your brain is too vulnerable right now.\u003c/em>\u003c/p>\n\u003cp>Jennifer Grellman, a \u003ca href=\"http://www.jennifergrellman.com/index.html\" target=\"_blank\" rel=\"noopener\">psychotherapist\u003c/a> in Kentfield and the founder of Being Adept, sums up the strategy in three words, just like the “Just Say No” campaign: “Delay, delay, delay.”\u003c/p>\n\u003cp>“The way to handle that with your kids is to say: ‘You know, you don't have to use this now. Maybe you want to use it someday, but not today, not now. It will always be there.’ Just tell them to \u003cem>wait\u003c/em>.”\u003c/p>\n\u003cp>Grellman said that advice may be more palatable for some teens, and therefore easier for parents to deliver.\u003c/p>\n\u003cp>They’re not forbidding something (and possibly making it more enticing). They’re not saying “never.”\u003c/p>\n\u003cp>\u003cstrong>The Role of Parents\u003c/strong>\u003c/p>\n\u003cp>Grellman said parents should talk about drugs and alcohol with their kids often -- as early as fourth grade. Use the new billboards or marijuana ads as an excuse to bring up the topic. Broach the subject obliquely: \u003cem>What do people at your school think about those ads? Do any of your friends know what a dab actually is? Did you see this article on the seventh-grader getting expelled for pot in his locker? What do you think about that? \u003c/em>\u003c/p>\n\u003cp>Listen to what they say and discuss it. Don’t lecture, but be clear about your expectations, and your values around drugs and alcohol.\u003c/p>\n\u003cp>At every school where Being Adept is taught, Grellman offers a “Parents Night” where parents can learn how to navigate those conversations. Some are encouraged when Grellman tells them that seemingly taboo subjects should be aired:\u003c/p>\n\u003cp>“Don't hide Uncle Harry, who is the old drinker, you know? Don't be ashamed to talk. You talk about Uncle Harry all the time,” Grellman said.\u003c/p>\n\u003cp>“Because these kids need to know ‘If I have alcohol, it could be, like, I may have the alcoholic gene,’ ” she added. “It doesn't mean they're going to for sure, but they sure need a heads-up about that.”\u003c/p>\n\u003cp>The same approach can be used for mental illness: “You know, I have anxiety. Your father has this issue. So chances are you might be a little anxious at times, so how are you going to deal with this?”\u003c/p>\n\u003cp>But it’s not just what parents say, it’s what they do, according to Grellman. Children are always watching how their parents use substances.\u003c/p>\n\u003cp>“Don’t glamorize it,” she advised. “It doesn't mean you have to become a monk and never have a drop of alcohol, but please drink responsibly. Never use it for stress control.”\u003c/p>\n\u003cp>“This idea of coming home from the office and saying ‘I've got to have my glass of wine’ ... if you want to have your glass of wine, have your glass of wine, but don't announce it! That you're just at wit's end, and you have to have this drink. “\u003c/p>\n\u003cp>Grellman said the modeling part becomes tricky when kids ask parents about their past: Did \u003cem>you\u003c/em> party? What drugs did you use?\u003c/p>\n\u003cp>When she led the Parents Night in March at Marin Primary and Secondary, she advised the parents to get ready for that moment, and have answers prepared.\u003c/p>\n\u003cp>\u003cem>But what if we did party in high school?\u003c/em> Several parents ask. \u003cem>Should we lie?\u003c/em>\u003c/p>\n\u003cp>Absolutely not, Grellman said, because if a kid senses dishonesty or hypocrisy, they’ll shut down. The most important thing is to keep the conversations going. If your child knows they can talk to you, no matter what, they will create a \"safety plan” with you. They will reach out to you when trouble comes.\u003c/p>\n\u003cp>\u003cem>But what do we tell them then?\u003c/em> \u003cem>How can we be honest, without encouraging them?\u003c/em>\u003c/p>\n\u003cp>“You don't have to tell the full story,” Grellman said. “You could say: ‘You know, I did smoke and I did drink when I was 13.' And if you loved it, I don't know if I would advertise that.\u003c/p>\n\u003cp>“You could say, ‘I did smoke, or I did drink, when I was 13. And you know, frankly? It was too early for me, man. I made some stupid decisions and I got in trouble.’ You can give them the consequences of it.”\u003c/p>\n\u003cp>Afterward, parents said they felt relieved to have concrete suggestions about how to talk with their kids, and how much was OK to bring up.\u003c/p>\n\u003cp>“It's much more prevalent than it was when I was growing up in the '80s,” said Joseph Sullivan, a physician from Larkspur.\u003c/p>\n\u003cp>“This is a different time, and so it's nice to hear that we're almost given permission to be talking about these different aspects of drug experimentation at different ages,” he added.\u003c/p>\n\u003cp>His wife, Dr. Sara Sullivan, said she’s glad that the “Just Say No” paradigm is dead.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Just to give the kids more information, I think, is such a different way to approach it and I really appreciate that. And we've kind of started to have conversations in our family because of that,” she explained. “To really kind of take that approach and not be like ‘You're kind of out there on your own.’ ”\u003c/p>\n\n","blocks":[],"excerpt":"Fear-based messages didn't work. Today's students are learning why waiting as long as possible can protect their growing brains. ","status":"publish","parent":0,"modified":1526764081,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":69,"wordCount":2428},"headData":{"title":"In the Land of Legal Weed, Drug Education Moves From ‘Don’t’ to ‘Delay’ | KQED","description":"Fear-based messages didn't work. Today's students are learning why waiting as long as possible can protect their growing brains. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"In the Land of Legal Weed, Drug Education Moves From ‘Don’t’ to ‘Delay’","datePublished":"2018-05-16T19:12:35.000Z","dateModified":"2018-05-19T21:08:01.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"363545 https://ww2.kqed.org/stateofhealth/?p=363545","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/05/16/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay/","disqusTitle":"In the Land of Legal Weed, Drug Education Moves From ‘Don’t’ to ‘Delay’","path":"/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/2018/05/FeibelPotEducation.mp3","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Californians legalized marijuana in 2016, with 57 percent of the vote. But the momentousness of that decision was somewhat lost in the drama of Donald Trump’s victory. Voters also had to wait over a year for full implementation, while state agencies crafted new regulations for quality, safety and marketing.\u003c/p>\n\u003cp>But the social significance of the vote finally burst into view this Jan. 1, when eager customers -- who had lined up in the darkness outside medical marijuana dispensaries across the state -- streamed through the doors at the stroke of midnight.\u003c/p>\n\u003cp>But the change hasn’t been confined to the cannabis cash register. Everyone has seen the advertising or heard the chatter -- and that includes minors, although marijuana remains illegal for those under 21.\u003c/p>\n\u003cp>“Coming out of SFO airport, there are billboards for \u003ca href=\"https://www.eaze.com/\" target=\"_blank\" rel=\"noopener\">Eaze\u003c/a> that say ‘Marijuana is here,’ ” said \u003ca href=\"http://profiles.ucsf.edu/danielle.ramo-larios\" target=\"_blank\" rel=\"noopener\">Danielle Ramo\u003c/a>, a psychologist who conducts research at UCSF on adolescent drug use.\u003c/p>\n\u003cp>“I'm not sure parents were expecting to see so many images of cannabis all over,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Public schools in California are required by law to provide anti-drug abuse education, although experts say the quality of the instruction varies widely from district to district, and there’s little enforcement.\u003c/p>\n\u003cp>I was curious to know how marijuana legalization was being discussed in schools, so I embedded with \u003ca href=\"http://livingadept.org/beingadept/\" target=\"_blank\" rel=\"noopener\">Being Adept\u003c/a>, an evidence-based curriculum that has been used in about 20 schools in the Bay Area.\u003c/p>\n\u003cp>To my surprise, I discovered that the rollout of legal recreational marijuana in California and other states hasn’t led to any big changes in substance abuse prevention. Drug educators have always covered both legal substances (alcohol, tobacco, prescription drugs) and illicit ones (pot, ecstasy, cocaine, LSD, heroin, meth … ). Students have accessed, and abused, both categories of drugs for decades.\u003c/p>\n\u003cp>But I was more struck by the evolution of drug education since the 1980s. Today, drug abuse education is an advanced pedagogy, drawing on decades of rigorous effectiveness research and the newest teaching techniques.\u003c/p>\n\u003cp>The “Just Say No” approach, popularized by Nancy Reagan, has been discredited. The PSAs that Gen-Xers may remember -- the egg in a frying pan (“\u003ca href=\"https://www.youtube.com/watch?v=GOnENVylxPI\" target=\"_blank\" rel=\"noopener\">this is your brain on drugs\u003c/a>”), or the boy calling out his dad’s drug use (“\u003ca href=\"https://www.youtube.com/watch?v=MkxCcXHwRkk\" target=\"_blank\" rel=\"noopener\">I learned it by watching you!\u003c/a>”) -- live on as memes, but they’re no longer used as messages.\u003c/p>\n\u003cp>“Those scare-tactic-based programs have tended to quite clearly not work, based on most of the research that evaluated its effectiveness,” Ramo said. “Today there is an entirely different mindset about school-based prevention.”\u003c/p>\n\u003cp>In a nutshell, the focus now is on facts, not fear. Also conspicuously absent are simplistic dictates like “just say no.” Instead, teachers spur students to examine data, speculate on motives, discuss risks, and deliberate on their own goals and values.\u003c/p>\n\u003cp>Ashley Brady, a Being Adept instructor, was completely open about her method when she stood in front of the eighth-graders at Marin Primary and Middle School, a private school in Larkspur.\u003c/p>\n\u003cp>“I'm not here to tell you what to do today. Not at all,” she began. “I'm here to give you the most up-to-date information possible so that you can make your own healthy, informed decisions.”\u003c/p>\n\u003cp>Brady then jump-started a fast-paced, fact-filled discussion on brain chemistry and physiology. There was an animated video about how marijuana affects dopamine pathways in the brain. Then a discussion about marijuana “edibles” and how they are metabolized by the liver.\u003c/p>\n\u003cp>“It can take up to 30 minutes to maybe even an hour or two before it really hits you,” she said. “When somebody eats an edible and they don't really feel the effects, what do you think happens?”\u003c/p>\n\u003cp>“They eat more!” a student called out.\u003c/p>\n\u003cp>“They eat more,” Brady nodded. “Yeah, an hour, an hour and a half later? Boom! Like a freight train, they've been hit, and, you know, can barely move or can barely talk. That kind of thing. So they may have to go to the hospital.”\u003c/p>\n\u003cp>True, that sounds a \u003cem>little\u003c/em> scary, but it’s presented neutrally, as a consequence at the end of a sequence of decisions.\u003c/p>\n\u003cfigure id=\"attachment_363549\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363549\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/05/IMG_8238-e1526427780998-800x1067.jpg\" alt=\"\" width=\"800\" height=\"1067\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-1020x1360.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-900x1200.jpg 900w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-960x1280.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-240x320.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-375x500.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-520x693.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ashley Brady explains the increase over time in marijuana potency to a class of eighth-graders at Marin Primary and Secondary School in Larkspur. \u003ccite>(KQED/Carrie Feibel)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Where the legalization of the marijuana industry \u003cem>has\u003c/em> affected the content of these lessons is on the subject of potency. Brady tells the students that legalization has spurred competition and innovation among suppliers, to the point where they’re now churning out extremely potent and precisely calibrated forms of pot called “concentrates,” which comes in various forms.\u003c/p>\n\u003cp>Brady runs through their names: oil, bubble, shatter, wax and dabs.\u003c/p>\n\u003cp>“They call it a ‘dab’ because one tiny little nail head [of it] -- I mean I'm talking like the end of my pinky -- one tiny little nail head is the same as three joints hitting the system all at once. So it’s a lot stronger than it used to be.”\u003c/p>\n\u003cp>Tests of THC levels in marijuana samples over the years back this up. Whereas a typical joint in the '70s probably had a THC level of 4-5 percent, at best, growers are now breeding strains of cannabis that produce buds with THC levels as high as 20-30 percent.\u003c/p>\n\u003cp>But the concentrates are in another category altogether. Processed concentrates sold at dispensaries now regularly test at 80, even 90 percent.\u003c/p>\n\u003cp>“It's not the same drug,” Brady tells them. People sometimes vomit from concentrates. Some people hallucinate and have even become psychotic.\u003c/p>\n\u003cp>And yes, she adds, it can be addictive. Not just psychologically, but physically. People do go into THC withdrawal and do go to rehab for pot addiction.\u003c/p>\n\u003cp>Still, as she describes the transformation of marijuana from a relatively mild intoxicant to a potentially debilitating one, Brady never once says “that’s why you shouldn’t” or even “so please be careful.”\u003c/p>\n\u003cp>Afterward, the students applauded this approach.\u003c/p>\n\u003cp>“It made you feel more mature, and that you're in control,\" said Devon Soofer, 13. “This [class] was actually telling you the long-term effects and what it can actually do to you. So it actually made you feel like ‘Wow, this is actually really bad,’ and not just being \u003cem>forced\u003c/em> not to do it.”\u003c/p>\n\u003cp>Later units in the Being Adept curriculum give students concrete tools: They rehearse what to do or say at parties, and talk about better ways to cope than using cannabis -- or any substance.\u003c/p>\n\u003cp>Ramo, who serves as a scientific advisor to Being Adept, decried “the overwhelming stress, anxiety, depression, suicidality that is so pervasive among teens in the United States today, especially in high-intensity educational areas, like a lot of schools in the Bay Area are.”\u003c/p>\n\u003cp>“Addressing that problem is key,” she added, as is “having teens come up with solutions to manage their stress, that they actually would use.”\u003c/p>\n\u003cp>\u003cstrong>“Delay, Delay, Delay” \u003c/strong>\u003c/p>\n\u003cp>So if drug educators aren’t telling students “Don’t!” anymore, what exactly are they telling them to \u003cem>do\u003c/em>? As I observed, they’re not overtly telling them to do anything, because teens are naturally resistant to the authoritarian approach -- and some of them may resist to the point of doing the opposite.\u003c/p>\n\u003cp>The underlying goal of drug education remains the same as before: keep children safe. The dangers of intoxicated driving, sexual assault, academic or athletic failure, social humiliation, social media embarrassment -- all of these do come up in the lessons.\u003c/p>\n\u003cp>But the instructors put a special emphasis on a less visible risk: the potential damage to their brains. And the science backs them up.\u003c/p>\n\u003cp>“More research is coming out looking at the ways in which all different kinds of substances can hijack normal brain functioning, and particularly so in adolescence,” Danielle Ramo explained.\u003c/p>\n\u003cp>“In heavily cannabis-using teens, there are some particularly important implications of using cannabis on the frontal lobe, and that interrupts a type of thinking called ‘executive functioning.’ ”\u003c/p>\n\u003cp>Also worrisome is a substantial body of research showing that using any potentially addictive substance while the brain is still developing -- whether alcohol, marijuana, nicotine, or other drug -- triggers neurological changes that can lead to addiction.\u003c/p>\n\u003cp>“The earlier teens start using, the more heavily they use in adolescence, the more likely it is that they'll go on to have problems throughout their adulthood,” said Ramo.\u003c/p>\n\u003cp>Being Adept instructors don’t say it outright, but the message is clear: If you’re not going to abstain, just push it off for a while. \u003cem>Your brain is too vulnerable right now.\u003c/em>\u003c/p>\n\u003cp>Jennifer Grellman, a \u003ca href=\"http://www.jennifergrellman.com/index.html\" target=\"_blank\" rel=\"noopener\">psychotherapist\u003c/a> in Kentfield and the founder of Being Adept, sums up the strategy in three words, just like the “Just Say No” campaign: “Delay, delay, delay.”\u003c/p>\n\u003cp>“The way to handle that with your kids is to say: ‘You know, you don't have to use this now. Maybe you want to use it someday, but not today, not now. It will always be there.’ Just tell them to \u003cem>wait\u003c/em>.”\u003c/p>\n\u003cp>Grellman said that advice may be more palatable for some teens, and therefore easier for parents to deliver.\u003c/p>\n\u003cp>They’re not forbidding something (and possibly making it more enticing). They’re not saying “never.”\u003c/p>\n\u003cp>\u003cstrong>The Role of Parents\u003c/strong>\u003c/p>\n\u003cp>Grellman said parents should talk about drugs and alcohol with their kids often -- as early as fourth grade. Use the new billboards or marijuana ads as an excuse to bring up the topic. Broach the subject obliquely: \u003cem>What do people at your school think about those ads? Do any of your friends know what a dab actually is? Did you see this article on the seventh-grader getting expelled for pot in his locker? What do you think about that? \u003c/em>\u003c/p>\n\u003cp>Listen to what they say and discuss it. Don’t lecture, but be clear about your expectations, and your values around drugs and alcohol.\u003c/p>\n\u003cp>At every school where Being Adept is taught, Grellman offers a “Parents Night” where parents can learn how to navigate those conversations. Some are encouraged when Grellman tells them that seemingly taboo subjects should be aired:\u003c/p>\n\u003cp>“Don't hide Uncle Harry, who is the old drinker, you know? Don't be ashamed to talk. You talk about Uncle Harry all the time,” Grellman said.\u003c/p>\n\u003cp>“Because these kids need to know ‘If I have alcohol, it could be, like, I may have the alcoholic gene,’ ” she added. “It doesn't mean they're going to for sure, but they sure need a heads-up about that.”\u003c/p>\n\u003cp>The same approach can be used for mental illness: “You know, I have anxiety. Your father has this issue. So chances are you might be a little anxious at times, so how are you going to deal with this?”\u003c/p>\n\u003cp>But it’s not just what parents say, it’s what they do, according to Grellman. Children are always watching how their parents use substances.\u003c/p>\n\u003cp>“Don’t glamorize it,” she advised. “It doesn't mean you have to become a monk and never have a drop of alcohol, but please drink responsibly. Never use it for stress control.”\u003c/p>\n\u003cp>“This idea of coming home from the office and saying ‘I've got to have my glass of wine’ ... if you want to have your glass of wine, have your glass of wine, but don't announce it! That you're just at wit's end, and you have to have this drink. “\u003c/p>\n\u003cp>Grellman said the modeling part becomes tricky when kids ask parents about their past: Did \u003cem>you\u003c/em> party? What drugs did you use?\u003c/p>\n\u003cp>When she led the Parents Night in March at Marin Primary and Secondary, she advised the parents to get ready for that moment, and have answers prepared.\u003c/p>\n\u003cp>\u003cem>But what if we did party in high school?\u003c/em> Several parents ask. \u003cem>Should we lie?\u003c/em>\u003c/p>\n\u003cp>Absolutely not, Grellman said, because if a kid senses dishonesty or hypocrisy, they’ll shut down. The most important thing is to keep the conversations going. If your child knows they can talk to you, no matter what, they will create a \"safety plan” with you. They will reach out to you when trouble comes.\u003c/p>\n\u003cp>\u003cem>But what do we tell them then?\u003c/em> \u003cem>How can we be honest, without encouraging them?\u003c/em>\u003c/p>\n\u003cp>“You don't have to tell the full story,” Grellman said. “You could say: ‘You know, I did smoke and I did drink when I was 13.' And if you loved it, I don't know if I would advertise that.\u003c/p>\n\u003cp>“You could say, ‘I did smoke, or I did drink, when I was 13. And you know, frankly? It was too early for me, man. I made some stupid decisions and I got in trouble.’ You can give them the consequences of it.”\u003c/p>\n\u003cp>Afterward, parents said they felt relieved to have concrete suggestions about how to talk with their kids, and how much was OK to bring up.\u003c/p>\n\u003cp>“It's much more prevalent than it was when I was growing up in the '80s,” said Joseph Sullivan, a physician from Larkspur.\u003c/p>\n\u003cp>“This is a different time, and so it's nice to hear that we're almost given permission to be talking about these different aspects of drug experimentation at different ages,” he added.\u003c/p>\n\u003cp>His wife, Dr. Sara Sullivan, said she’s glad that the “Just Say No” paradigm is dead.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Just to give the kids more information, I think, is such a different way to approach it and I really appreciate that. And we've kind of started to have conversations in our family because of that,” she explained. “To really kind of take that approach and not be like ‘You're kind of out there on your own.’ ”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay","authors":["11314"],"categories":["stateofhealth_12","stateofhealth_1"],"tags":["stateofhealth_643","stateofhealth_3247","stateofhealth_2808","stateofhealth_3248","stateofhealth_2519","stateofhealth_3222","stateofhealth_3246"],"featImg":"stateofhealth_363550","label":"stateofhealth"},"stateofhealth_360808":{"type":"posts","id":"stateofhealth_360808","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"360808","score":null,"sort":[1502827229000]},"guestAuthors":[],"slug":"a-long-and-winding-road-kicking-heroin-in-an-opioid-treatment-desert","title":"A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’","publishDate":1502827229,"format":"standard","headTitle":"Kaiser Health News | State of Health | KQED News","labelTerm":{"term":3007,"site":"stateofhealth"},"content":"\u003cp>Heather Menzel squirmed in her seat, unable to sleep on the Greyhound bus as it rolled through the early morning darkness toward Bakersfield, in California’s Central Valley. She’d been trapped in transit for three miserable days, stewing in a horrific sickness only a heroin addict can understand. Again, and again, she stumbled down the aisle to the bathroom to vomit.\u003c/p>\n\u003cp>She hadn’t used since Chicago. She told herself that if she could just get through this self-prescribed detox, if she could get to her mother’s house in her hometown of Lake Isabella, Calif., all her problems would be solved.\u003c/p>\n\u003cp>“I’ve been through a lot of horrible, crazy stuff,” said Menzel, now 34. “I’ve been raped. I’ve been beaten up. I’ve been in prison. But trying to kick heroin on the Greyhound on the way home was the worst experience of my entire life.”\u003c/p>\n\u003cp>When Menzel finally arrived at the Bakersfield bus station at 6 a.m. that day in February 2014, her mother and stepfather were there waiting. The two women hadn’t seen each other in years, not since Menzel stole her mom’s jewelry and fled the area. They didn’t talk much as they drove east though the twisty canyon on State Route 178 toward Lake Isabella, a two-stoplight town with a population of 3,500, nestled in the golden Sierra Nevada foothills.\u003c/p>\n\u003cp>Menzel hoped that the worst of the withdrawal was over — that a new life without heroin awaited. What she didn’t know was that heroin was now cheap and plentiful in Lake Isabella, as in so many small towns in the U.S., and that her best hope for treatment was far away.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>32 Churches, No Methadone Clinic\u003c/strong>\u003c/p>\n\u003cp>Experts recommend medication-assisted treatment for drug users like Menzel, one of nearly 2 million Americans struggling with opioid addiction, whether to prescription pills or heroin. MAT, as the therapy is known, has been proven far more effective — and less dangerous and miserable — than cold-turkey quitting. Drugs like methadone and buprenorphine can help suppress opioid cravings and stave off the physical and psychological symptoms of withdrawal.\u003c/p>\n\u003cp>When carefully managed, MAT can cut the risk of overdose death by half, research shows. But not all medical providers \u003ca href=\"http://californiahealthline.org/news/one-major-force-lacking-in-fight-against-opioid-addiction-in-rural-california-doctors/\" target=\"_blank\" rel=\"noopener noreferrer\">are properly trained\u003c/a> and approved to provide the treatments, which themselves are opioids (albeit less likely to be abused). Only state-licensed and federally approved clinics can provide methadone, and doctors need to apply for a federal Drug Enforcement Administration waiver to prescribe buprenorphine.\u003c/p>\n\u003cp>Lake Isabella sits in the Kern River Valley, home to 32 churches but not a single methadone clinic or doctor able or willing to prescribe buprenorphine. Like half the counties in California, the valley is an opioid “treatment desert.”\u003c/p>\n\u003cfigure id=\"attachment_360811\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360811\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg\" alt=\"After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In rural areas, historically, there has been a lot of stigma around addiction treatment,” said Kelly Pfeifer, a primary care doctor and opioid project director at the California Health Care Foundation. “Although the state is trying to remedy this, there are still wide treatment deserts across California.” (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>In July, the California Department of Health Care Services awarded 19 applicants part of a $90 million federal grant to improve MAT access. In addition, $6 million was dedicated to support treatment in tribal communities. The agency hopes to create a network of “oases” in the state’s vast treatment deserts, many of which are in far Northern California, as well as eastern Kern County, which encompasses Lake Isabella.\u003c/p>\n\u003cp>The grants aim to pay for clinical and educational support to rural physicians, many of whom have never been trained in addiction medicine. Local doctors will handle most buprenorphine prescriptions, and in some towns, a mini-methadone program may set up shop.\u003c/p>\n\u003cp>But eastern Kern didn’t make the cut. For now, expanding opioid treatment in this area, and eastward, will have to wait.\u003c/p>\n\u003cp>Without such help, many experts say people like Heather Menzel — whose story a reporter followed over the course of a year — barely stand a chance.\u003c/p>\n\u003cp>\u003cstrong>Hooked Again\u003c/strong>\u003c/p>\n\u003cp>From the beginning, Menzel struggled to stay clean at her mother’s. She soon fell back in with her old drug-abusing friends. Within two months of arriving home, her grand plan for getting clean slid into her veins and disappeared with the push of a plunger. She was hooked on heroin again, smoking methamphetamine and, once her mom kicked her out, homeless.\u003c/p>\n\u003cfigure id=\"attachment_360813\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"wp-image-360813 size-full\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_7_1170.jpg\" alt=\"After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cp>She was risking death, and she knew it. On average, 91 people a day in the United States died of an opioid overdose in 2015, the latest figures available \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">from the Centers for Disease Control and Prevention\u003c/a>, and \u003ca href=\"https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?_r=0\" target=\"_blank\" rel=\"noopener noreferrer\">projections show\u003c/a> the death rate will continue to rise. Overall, California’s opioid death rate is relatively low: 4.73 deaths per 100,000 people. Still, 1,966 Californians died of an opioid overdose in 2015. \u003ca href=\"https://pdop.shinyapps.io/ODdash_v1/\" target=\"_blank\" rel=\"noopener noreferrer\">Kern County’s rate\u003c/a> was nearly double the state’s in 2015, and some sparsely populated rural counties, mostly up north, have rates that are far higher.\u003c/p>\n\u003cp>Policymakers fear the death risk is growing as use of fentanyl moves west. A synthetic opioid \u003ca href=\"https://www.drugabuse.gov/drugs-abuse/fentanyl\" target=\"_blank\" rel=\"noopener noreferrer\">estimated to be 50 to 100 times stronger\u003c/a> than morphine, fentanyl has caused numerous overdoses and deaths on the \u003ca href=\"http://khn.org/news/another-circle-of-hell-surviving-opioids-in-the-fentanyl-era/\" target=\"_blank\" rel=\"noopener noreferrer\">East Coast\u003c/a>. Some policymakers fear the fentanyl monster is heading to California, a potentially vast market of addicts.\u003c/p>\n\u003cp>“We really feel an urgency in California to increase access to services so if and when fentanyl arrives, we are more prepared to deal with it,” said Marlies Perez, chief of the Substance Use Disorder Compliance Division at DHCS.\u003c/p>\n\u003cp>Immediate, convenient access to these treatments is key. “It is very important for someone in the middle of addiction to access treatment when they are ready,” said Pfeifer. “There are these moments when people have wake-up calls — when they are ready to seek care and get out of the chaos of trying to get drugs to feel normal again.”\u003c/p>\n\u003cp>\u003cstrong>‘What Do I Do?’\u003c/strong>\u003c/p>\n\u003cp>Menzel’s wake-up happened when she noticed that she was still sick after a morning heroin injection. After an angry call to her drug dealer to accuse him of ripping her off, Menzel soon realized it wasn’t fake heroin — she was pregnant.\u003c/p>\n\u003cp>She took the bus to the emergency room in Bakersfield. “I’m fully addicted to heroin,” she blurted out to the ER doctor. “What do I do?” The doctor told her, “If you want to save your baby, you need to get on methadone.”\u003c/p>\n\u003cp>Affording methadone wasn’t a problem for Menzel. Medi-Cal, the state’s version of the Medicaid program for the poor, covered the costs. What impeded her was the daily trip from Lake Isabella to Bakersfield — an hour-plus bus ride down the curving canyon road. A round-trip ticket cost $5, more than she could spare. And if she missed an early bus back, she had to stay most of the day in Bakersfield to catch the next one.\u003c/p>\n\u003cfigure id=\"attachment_360816\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-360816 size-large\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">After receiving her methadone dose at a clinic in Bakersfield, Calif., Heather Menzel waits for the bus to take her back home to Lake Isabella on June 6, 2016. The bus ride takes about an hour and goes through a twisty canyon into the Sierra Nevada foothills. (Brian Rinker for KHN) \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For safety’s sake, the clinic started her at a low dose, increasing the amount until it was just right for her. But that beginning dose didn’t stave off the withdrawals, so she continued to use heroin and meth. She started to miss too many days of treatment and was kicked out of the program.\u003c/p>\n\u003cp>Menzel’s mother got her back in, promising the clinic that she would drive her daughter there every day. That meant quitting her job at Meals on Wheels.\u003c/p>\n\u003cp>“The fact you have to travel an hour to two hours every day to receive treatment requires somebody to operate a vehicle, pay for gas, and for some of our patients that is impossible,” said Javier Moreno, who manages the narcotics treatment programs in the Central Valley for Aegis Treatment Centers, the state’s largest methadone provider.\u003c/p>\n\u003cp>His Bakersfield clinics serve about 20 people in the Lake Isabella area, but Moreno thinks many more residents could benefit from MAT.\u003c/p>\n\u003cp>\u003cstrong>‘I Made it’\u003c/strong>\u003c/p>\n\u003cp>Menzel didn’t take the ideal path to getting clean. But she eventually began to feel the groove of methadone, and her cravings for heroin subsided. After a couple of months, she was able to get methadone “take-home” doses for the weekend. She started riding the bus again to give her mother, who has the autoimmune disease lupus, a break.\u003c/p>\n\u003cp>“I was big and pregnant,” said Menzel, who woke up Monday through Friday at 5:30 a.m. to catch the bus. “I had to ask the bus driver to pull over and pee a lot. But I made it.”\u003c/p>\n\u003cfigure id=\"attachment_360817\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-360817\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg\" alt=\"Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction.\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In May 2015, Menzel gave birth to a healthy girl and named her Bella. She said she hasn’t used heroin or any other drug, besides methadone, in more than two years. She’s on a maintenance methadone dose, just 39 milligrams compared with 140 mg she used to take and plans to cut back until she is off it completely. Now she drives herself to the clinic every other week and has enrolled in community college, hoping to become a certified drug and alcohol counselor.\u003c/p>\n\u003cp>“I don’t know if there will ever be a methadone clinic in the Kern River Valley,” Menzel said. But if one ever arrives, she said, she’d love to work there.\u003c/p>\n\u003cp>“I really want to work with other pregnant women who will be going through the same thing that I went through.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"One woman returns to her rural hometown to kick an addiction, but finds no medical treatment options.","status":"publish","parent":0,"modified":1502827229,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":39,"wordCount":1877},"headData":{"title":"A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’ | KQED","description":"One woman returns to her rural hometown to kick an addiction, but finds no medical treatment options.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’","datePublished":"2017-08-15T20:00:29.000Z","dateModified":"2017-08-15T20:00:29.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"360808 https://ww2.kqed.org/stateofhealth/?p=360808","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/08/15/a-long-and-winding-road-kicking-heroin-in-an-opioid-treatment-desert/","disqusTitle":"A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’","nprByline":"\u003ca href=\"http://khn.org/news/author/brian-rinker/\">\u003cstrong>Brian Rinker\u003c/strong>\u003c/a>","path":"/stateofhealth/360808/a-long-and-winding-road-kicking-heroin-in-an-opioid-treatment-desert","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Heather Menzel squirmed in her seat, unable to sleep on the Greyhound bus as it rolled through the early morning darkness toward Bakersfield, in California’s Central Valley. She’d been trapped in transit for three miserable days, stewing in a horrific sickness only a heroin addict can understand. Again, and again, she stumbled down the aisle to the bathroom to vomit.\u003c/p>\n\u003cp>She hadn’t used since Chicago. She told herself that if she could just get through this self-prescribed detox, if she could get to her mother’s house in her hometown of Lake Isabella, Calif., all her problems would be solved.\u003c/p>\n\u003cp>“I’ve been through a lot of horrible, crazy stuff,” said Menzel, now 34. “I’ve been raped. I’ve been beaten up. I’ve been in prison. But trying to kick heroin on the Greyhound on the way home was the worst experience of my entire life.”\u003c/p>\n\u003cp>When Menzel finally arrived at the Bakersfield bus station at 6 a.m. that day in February 2014, her mother and stepfather were there waiting. The two women hadn’t seen each other in years, not since Menzel stole her mom’s jewelry and fled the area. They didn’t talk much as they drove east though the twisty canyon on State Route 178 toward Lake Isabella, a two-stoplight town with a population of 3,500, nestled in the golden Sierra Nevada foothills.\u003c/p>\n\u003cp>Menzel hoped that the worst of the withdrawal was over — that a new life without heroin awaited. What she didn’t know was that heroin was now cheap and plentiful in Lake Isabella, as in so many small towns in the U.S., and that her best hope for treatment was far away.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>32 Churches, No Methadone Clinic\u003c/strong>\u003c/p>\n\u003cp>Experts recommend medication-assisted treatment for drug users like Menzel, one of nearly 2 million Americans struggling with opioid addiction, whether to prescription pills or heroin. MAT, as the therapy is known, has been proven far more effective — and less dangerous and miserable — than cold-turkey quitting. Drugs like methadone and buprenorphine can help suppress opioid cravings and stave off the physical and psychological symptoms of withdrawal.\u003c/p>\n\u003cp>When carefully managed, MAT can cut the risk of overdose death by half, research shows. But not all medical providers \u003ca href=\"http://californiahealthline.org/news/one-major-force-lacking-in-fight-against-opioid-addiction-in-rural-california-doctors/\" target=\"_blank\" rel=\"noopener noreferrer\">are properly trained\u003c/a> and approved to provide the treatments, which themselves are opioids (albeit less likely to be abused). Only state-licensed and federally approved clinics can provide methadone, and doctors need to apply for a federal Drug Enforcement Administration waiver to prescribe buprenorphine.\u003c/p>\n\u003cp>Lake Isabella sits in the Kern River Valley, home to 32 churches but not a single methadone clinic or doctor able or willing to prescribe buprenorphine. Like half the counties in California, the valley is an opioid “treatment desert.”\u003c/p>\n\u003cfigure id=\"attachment_360811\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360811\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg\" alt=\"After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In rural areas, historically, there has been a lot of stigma around addiction treatment,” said Kelly Pfeifer, a primary care doctor and opioid project director at the California Health Care Foundation. “Although the state is trying to remedy this, there are still wide treatment deserts across California.” (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>In July, the California Department of Health Care Services awarded 19 applicants part of a $90 million federal grant to improve MAT access. In addition, $6 million was dedicated to support treatment in tribal communities. The agency hopes to create a network of “oases” in the state’s vast treatment deserts, many of which are in far Northern California, as well as eastern Kern County, which encompasses Lake Isabella.\u003c/p>\n\u003cp>The grants aim to pay for clinical and educational support to rural physicians, many of whom have never been trained in addiction medicine. Local doctors will handle most buprenorphine prescriptions, and in some towns, a mini-methadone program may set up shop.\u003c/p>\n\u003cp>But eastern Kern didn’t make the cut. For now, expanding opioid treatment in this area, and eastward, will have to wait.\u003c/p>\n\u003cp>Without such help, many experts say people like Heather Menzel — whose story a reporter followed over the course of a year — barely stand a chance.\u003c/p>\n\u003cp>\u003cstrong>Hooked Again\u003c/strong>\u003c/p>\n\u003cp>From the beginning, Menzel struggled to stay clean at her mother’s. She soon fell back in with her old drug-abusing friends. Within two months of arriving home, her grand plan for getting clean slid into her veins and disappeared with the push of a plunger. She was hooked on heroin again, smoking methamphetamine and, once her mom kicked her out, homeless.\u003c/p>\n\u003cfigure id=\"attachment_360813\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"wp-image-360813 size-full\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_7_1170.jpg\" alt=\"After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cp>She was risking death, and she knew it. On average, 91 people a day in the United States died of an opioid overdose in 2015, the latest figures available \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">from the Centers for Disease Control and Prevention\u003c/a>, and \u003ca href=\"https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?_r=0\" target=\"_blank\" rel=\"noopener noreferrer\">projections show\u003c/a> the death rate will continue to rise. Overall, California’s opioid death rate is relatively low: 4.73 deaths per 100,000 people. Still, 1,966 Californians died of an opioid overdose in 2015. \u003ca href=\"https://pdop.shinyapps.io/ODdash_v1/\" target=\"_blank\" rel=\"noopener noreferrer\">Kern County’s rate\u003c/a> was nearly double the state’s in 2015, and some sparsely populated rural counties, mostly up north, have rates that are far higher.\u003c/p>\n\u003cp>Policymakers fear the death risk is growing as use of fentanyl moves west. A synthetic opioid \u003ca href=\"https://www.drugabuse.gov/drugs-abuse/fentanyl\" target=\"_blank\" rel=\"noopener noreferrer\">estimated to be 50 to 100 times stronger\u003c/a> than morphine, fentanyl has caused numerous overdoses and deaths on the \u003ca href=\"http://khn.org/news/another-circle-of-hell-surviving-opioids-in-the-fentanyl-era/\" target=\"_blank\" rel=\"noopener noreferrer\">East Coast\u003c/a>. Some policymakers fear the fentanyl monster is heading to California, a potentially vast market of addicts.\u003c/p>\n\u003cp>“We really feel an urgency in California to increase access to services so if and when fentanyl arrives, we are more prepared to deal with it,” said Marlies Perez, chief of the Substance Use Disorder Compliance Division at DHCS.\u003c/p>\n\u003cp>Immediate, convenient access to these treatments is key. “It is very important for someone in the middle of addiction to access treatment when they are ready,” said Pfeifer. “There are these moments when people have wake-up calls — when they are ready to seek care and get out of the chaos of trying to get drugs to feel normal again.”\u003c/p>\n\u003cp>\u003cstrong>‘What Do I Do?’\u003c/strong>\u003c/p>\n\u003cp>Menzel’s wake-up happened when she noticed that she was still sick after a morning heroin injection. After an angry call to her drug dealer to accuse him of ripping her off, Menzel soon realized it wasn’t fake heroin — she was pregnant.\u003c/p>\n\u003cp>She took the bus to the emergency room in Bakersfield. “I’m fully addicted to heroin,” she blurted out to the ER doctor. “What do I do?” The doctor told her, “If you want to save your baby, you need to get on methadone.”\u003c/p>\n\u003cp>Affording methadone wasn’t a problem for Menzel. Medi-Cal, the state’s version of the Medicaid program for the poor, covered the costs. What impeded her was the daily trip from Lake Isabella to Bakersfield — an hour-plus bus ride down the curving canyon road. A round-trip ticket cost $5, more than she could spare. And if she missed an early bus back, she had to stay most of the day in Bakersfield to catch the next one.\u003c/p>\n\u003cfigure id=\"attachment_360816\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-360816 size-large\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">After receiving her methadone dose at a clinic in Bakersfield, Calif., Heather Menzel waits for the bus to take her back home to Lake Isabella on June 6, 2016. The bus ride takes about an hour and goes through a twisty canyon into the Sierra Nevada foothills. (Brian Rinker for KHN) \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For safety’s sake, the clinic started her at a low dose, increasing the amount until it was just right for her. But that beginning dose didn’t stave off the withdrawals, so she continued to use heroin and meth. She started to miss too many days of treatment and was kicked out of the program.\u003c/p>\n\u003cp>Menzel’s mother got her back in, promising the clinic that she would drive her daughter there every day. That meant quitting her job at Meals on Wheels.\u003c/p>\n\u003cp>“The fact you have to travel an hour to two hours every day to receive treatment requires somebody to operate a vehicle, pay for gas, and for some of our patients that is impossible,” said Javier Moreno, who manages the narcotics treatment programs in the Central Valley for Aegis Treatment Centers, the state’s largest methadone provider.\u003c/p>\n\u003cp>His Bakersfield clinics serve about 20 people in the Lake Isabella area, but Moreno thinks many more residents could benefit from MAT.\u003c/p>\n\u003cp>\u003cstrong>‘I Made it’\u003c/strong>\u003c/p>\n\u003cp>Menzel didn’t take the ideal path to getting clean. But she eventually began to feel the groove of methadone, and her cravings for heroin subsided. After a couple of months, she was able to get methadone “take-home” doses for the weekend. She started riding the bus again to give her mother, who has the autoimmune disease lupus, a break.\u003c/p>\n\u003cp>“I was big and pregnant,” said Menzel, who woke up Monday through Friday at 5:30 a.m. to catch the bus. “I had to ask the bus driver to pull over and pee a lot. But I made it.”\u003c/p>\n\u003cfigure id=\"attachment_360817\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-360817\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg\" alt=\"Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction.\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In May 2015, Menzel gave birth to a healthy girl and named her Bella. She said she hasn’t used heroin or any other drug, besides methadone, in more than two years. She’s on a maintenance methadone dose, just 39 milligrams compared with 140 mg she used to take and plans to cut back until she is off it completely. Now she drives herself to the clinic every other week and has enrolled in community college, hoping to become a certified drug and alcohol counselor.\u003c/p>\n\u003cp>“I don’t know if there will ever be a methadone clinic in the Kern River Valley,” Menzel said. But if one ever arrives, she said, she’d love to work there.\u003c/p>\n\u003cp>“I really want to work with other pregnant women who will be going through the same thing that I went through.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/360808/a-long-and-winding-road-kicking-heroin-in-an-opioid-treatment-desert","authors":["byline_stateofhealth_360808"],"categories":["stateofhealth_1"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_2972","stateofhealth_2519","stateofhealth_2656"],"affiliates":["stateofhealth_3007"],"featImg":"stateofhealth_360810","label":"stateofhealth_3007"},"stateofhealth_353704":{"type":"posts","id":"stateofhealth_353704","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"353704","score":null,"sort":[1499860839000]},"guestAuthors":[],"slug":"in-rural-california-this-new-addiction-treatment-is-being-ignored-by-the-doctors","title":"In Rural California, This New Addiction Treatment Is Being Ignored -- by the Doctors","publishDate":1499860839,"format":"standard","headTitle":"California Healthline | State of Health | KQED News","labelTerm":{"term":3036,"site":"stateofhealth"},"content":"\u003cp>If you want to quit heroin and you live in Quincy, California, a small pioneer town up in the Northern Sierra Nevada mountains, you’ll probably go see Dr. Mark Satterfield.\u003c/p>\n\u003cp>As far as he knows, Dr. Satterfield is the only health care provider in Plumas County who is able and willing to treat heroin users with buprenorphine, a medication that has become the new standard of care in fighting opioid addiction.\u003c/p>\n\u003cfigure id=\"attachment_353727\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-353727\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Quincy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Downtown Quincy, California.\u003c/figcaption>\u003c/figure>\n\u003cp>Before Satterfield started prescribing buprenorphine late last year, anyone seeking treatment had to travel a long way to a clinic in a more urban setting. The one in Chico is a 1½- hour drive down a windy canyon road, which can be closed off during bad weather.\u003c/p>\n\u003cp>So Satterfield, 65, embarked on a pilot program to provide medication-assisted treatment for heroin users and those with other addictions. Satterfield, Plumas County’s public health officer, squeezed the program in between his other duties, including shifts as an emergency physician at a local hospital.\u003c/p>\n\u003cp>“The need is great, and we had a sense it was not going to be easy to get other providers to do it,” said Satterfield, a tall man with delicate rimmed glasses, who has lived in the region for 28 years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Unlike methadone, which is only dispensed at substance abuse treatment facilities and requires daily visits from patients, buprenorphine can be prescribed by any local doctor who has a special license. The patient can take the medication at home.\u003c/p>\n\u003cp>The California Department of Health Care Services hopes buprenorphine will become much more widely available under a new \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=W1eCmud6DtHf6F2ciFehwsOa-Lf2xOaEtColIuEDqGwzJ7i09MjUCA..&URL=http%3a%2f%2fwww.dhcs.ca.gov%2fformsandpubs%2fpublications%2fopa%2fDocuments%2f17-01%2520SAMHSA%2520MAT%2520Grant%2520FINAL.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">$90 million dollar federal\u003c/a> grant to combat opioid misuse and expand access to addiction.\u003c/p>\n\u003cp>But many health care providers in Plumas and other rural areas of California have thus far not taken the steps required to offer the addiction treatment. Because buprenorphine is itself an opioid, doctors who want to prescribe it for addiction must get eight hours of training and register with the federal Drug Enforcement Agency.\u003c/p>\n\u003cp>James Wilson, health education coordinator with Plumas County, is working as the lead coordinator for the Northern Sierra Opioid Safety Coalition. He said he has reached out to about 30 doctors in Plumas and surrounding counties ,to ask them to get authorized to offer buprenorphine. He got a lot of “nos.”\u003c/p>\n\u003cp>“For the most part, they kind of recognize the need for medication-assisted addiction treatment -- but they don’t necessarily want to be the doctors themselves that are doing it,” Wilson said.\u003c/p>\n\u003cp>Wilson said doctors or their office staffers have told him they don’t want people withdrawing from heroin or other drugs sitting in their waiting rooms, or that they are uncomfortable with the drug-seeking behaviors of that clientele.\u003c/p>\n\u003cp>That doesn’t surprise Dr. David Kan, president-elect of the California Society of Addiction Medicine.\u003c/p>\n\u003cp>“Most physicians don’t see [treating addiction] as part of their regular and routine practice,” said Kan, adding that many health care providers can’t identify the signs of addiction in a patient.\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/07/2017-07-13e-tcr.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Satterfield_patientsmall-768x512.jpg\" Title=\"In Rural California, This New Addiction Treatment Is Being Ignored -- by the Doctors\" program=\"The California Report\"]\u003c/p>\n\u003cp>A spokesperson for the California Medical Association said some physicians fear being overwhelmed by patients if they start treating addiction. Treatment also involves a good bit of coordination, such as linking patients to other services such as mental health treatment and case management.\u003c/p>\n\u003cp>That’s one of the reasons a local hospital system in Plumas County hasn’t incorporated buprenorphine into its in-house services.\u003c/p>\n\u003cp>Lindsey Morrison, care coordinator at Plumas District Hospital, said that for a few hours a month, an out-of-town physician is available via telemedicine to treat chronic pain patients addicted to prescription opioids. But the rural health system doesn’t have the time or resources to start prescribing buprenorphine to heroin users.\u003c/p>\n\u003cp>“That’s a really difficult population to work with,” said Morrison, adding that they don’t have the necessary mental health care providers and staffers to work with those patients.\u003c/p>\n\u003cp>Even if a handful of the hospital’s doctors got the training to provide buprenorphine, Morrison said “it would be like… 'Oh my god, we have a ton of work ahead of us, we got to hire more people to help with these services!'”\u003c/p>\n\u003cp>A \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=EwnaTcFvGhNZbHF-Ixw-DRgQV32IWTS-7CiyVZaVJ_ozJ7i09MjUCA..&URL=http%3a%2f%2fkhn.org%2fnews%2famount-of-opioids-prescribed-in-u-s-has-been-falling-since-2010%2f\" target=\"_blank\" rel=\"noopener noreferrer\">recent study \u003c/a>by the Centers for Disease Control and Prevention suggests Northern California doctors’ were prescribing painkillers at higher-than-average rates. In rural counties like Plumas, the rates far exceed those seen in the rest of California. More prescriptions were written in Plumas in 2015 than there were people in the county, according to California Department of Public Health \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=ZEm8Va8AOA3fXLWs-VHDmFu28svb9LiHZ2u4vAR_rrIzJ7i09MjUCA..&URL=https%3a%2f%2fpdop.shinyapps.io%2fODdash_v1%2f\">data.\u003c/a>\u003c/p>\n\u003cp>Although Plumas county is sparsely populated, it also has one of \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=ZEm8Va8AOA3fXLWs-VHDmFu28svb9LiHZ2u4vAR_rrIzJ7i09MjUCA..&URL=https%3a%2f%2fpdop.shinyapps.io%2fODdash_v1%2f\">the highest rates of opioid-related\u003c/a> deaths in the state.\u003c/p>\n\u003cp>State health officials say they hope the federal grant to combat opioid abuse will help expand treatment options and bump up the state’s overall use of buprenorphine as a treatment, \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=bmd9kdJyhZkWZei-TJRIKaaN05es5NlFSeYVV39Ae34zJ7i09MjUCA..&URL=http%3a%2f%2fcaliforniamethadone.org%2fwp-content%2fuploads%2f2017%2f02%2fCOMP-PDF.pdf\">which is low compared\u003c/a> to the rest of the U.S.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Satterfield said he would be glad if just one more doctor in his area got trained to treat addiction in this way – he said it’s a tough, but rewarding, job.\u003c/p>\n\n","blocks":[],"excerpt":"Buprenorphine is effective and can be prescribed by general practitioners, but they're reluctant to work with addicted patients.","status":"publish","parent":0,"modified":1499987354,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":954},"headData":{"title":"In Rural California, This New Addiction Treatment Is Being Ignored -- by the Doctors | KQED","description":"Buprenorphine is effective and can be prescribed by general practitioners, but they're reluctant to work with addicted patients.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"In Rural California, This New Addiction Treatment Is Being Ignored -- by the Doctors","datePublished":"2017-07-12T12:00:39.000Z","dateModified":"2017-07-13T23:09:14.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"353704 https://ww2.kqed.org/stateofhealth/?p=353704","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/07/12/in-rural-california-this-new-addiction-treatment-is-being-ignored-by-the-doctors/","disqusTitle":"In Rural California, This New Addiction Treatment Is Being Ignored -- by the Doctors","nprByline":"\u003cstrong> \u003ca href=\"http://californiahealthline.org/news/author/pauline-bartolone/\" target=\"_blank\">Pauline Bartolone\u003c/a>\u003c/strong>\u003c/br>California Healthline","path":"/stateofhealth/353704/in-rural-california-this-new-addiction-treatment-is-being-ignored-by-the-doctors","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you want to quit heroin and you live in Quincy, California, a small pioneer town up in the Northern Sierra Nevada mountains, you’ll probably go see Dr. Mark Satterfield.\u003c/p>\n\u003cp>As far as he knows, Dr. Satterfield is the only health care provider in Plumas County who is able and willing to treat heroin users with buprenorphine, a medication that has become the new standard of care in fighting opioid addiction.\u003c/p>\n\u003cfigure id=\"attachment_353727\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-353727\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Quincy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Downtown Quincy, California.\u003c/figcaption>\u003c/figure>\n\u003cp>Before Satterfield started prescribing buprenorphine late last year, anyone seeking treatment had to travel a long way to a clinic in a more urban setting. The one in Chico is a 1½- hour drive down a windy canyon road, which can be closed off during bad weather.\u003c/p>\n\u003cp>So Satterfield, 65, embarked on a pilot program to provide medication-assisted treatment for heroin users and those with other addictions. Satterfield, Plumas County’s public health officer, squeezed the program in between his other duties, including shifts as an emergency physician at a local hospital.\u003c/p>\n\u003cp>“The need is great, and we had a sense it was not going to be easy to get other providers to do it,” said Satterfield, a tall man with delicate rimmed glasses, who has lived in the region for 28 years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Unlike methadone, which is only dispensed at substance abuse treatment facilities and requires daily visits from patients, buprenorphine can be prescribed by any local doctor who has a special license. The patient can take the medication at home.\u003c/p>\n\u003cp>The California Department of Health Care Services hopes buprenorphine will become much more widely available under a new \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=W1eCmud6DtHf6F2ciFehwsOa-Lf2xOaEtColIuEDqGwzJ7i09MjUCA..&URL=http%3a%2f%2fwww.dhcs.ca.gov%2fformsandpubs%2fpublications%2fopa%2fDocuments%2f17-01%2520SAMHSA%2520MAT%2520Grant%2520FINAL.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">$90 million dollar federal\u003c/a> grant to combat opioid misuse and expand access to addiction.\u003c/p>\n\u003cp>But many health care providers in Plumas and other rural areas of California have thus far not taken the steps required to offer the addiction treatment. Because buprenorphine is itself an opioid, doctors who want to prescribe it for addiction must get eight hours of training and register with the federal Drug Enforcement Agency.\u003c/p>\n\u003cp>James Wilson, health education coordinator with Plumas County, is working as the lead coordinator for the Northern Sierra Opioid Safety Coalition. He said he has reached out to about 30 doctors in Plumas and surrounding counties ,to ask them to get authorized to offer buprenorphine. He got a lot of “nos.”\u003c/p>\n\u003cp>“For the most part, they kind of recognize the need for medication-assisted addiction treatment -- but they don’t necessarily want to be the doctors themselves that are doing it,” Wilson said.\u003c/p>\n\u003cp>Wilson said doctors or their office staffers have told him they don’t want people withdrawing from heroin or other drugs sitting in their waiting rooms, or that they are uncomfortable with the drug-seeking behaviors of that clientele.\u003c/p>\n\u003cp>That doesn’t surprise Dr. David Kan, president-elect of the California Society of Addiction Medicine.\u003c/p>\n\u003cp>“Most physicians don’t see [treating addiction] as part of their regular and routine practice,” said Kan, adding that many health care providers can’t identify the signs of addiction in a patient.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"audio","attributes":{"named":{"src":"http://www.kqed.org/.stream/anon/radio/tcr/2017/07/2017-07-13e-tcr.mp3","image":"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Satterfield_patientsmall-768x512.jpg","title":"In Rural California, This New Addiction Treatment Is Being Ignored -- by the Doctors","program":"The California Report","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A spokesperson for the California Medical Association said some physicians fear being overwhelmed by patients if they start treating addiction. Treatment also involves a good bit of coordination, such as linking patients to other services such as mental health treatment and case management.\u003c/p>\n\u003cp>That’s one of the reasons a local hospital system in Plumas County hasn’t incorporated buprenorphine into its in-house services.\u003c/p>\n\u003cp>Lindsey Morrison, care coordinator at Plumas District Hospital, said that for a few hours a month, an out-of-town physician is available via telemedicine to treat chronic pain patients addicted to prescription opioids. But the rural health system doesn’t have the time or resources to start prescribing buprenorphine to heroin users.\u003c/p>\n\u003cp>“That’s a really difficult population to work with,” said Morrison, adding that they don’t have the necessary mental health care providers and staffers to work with those patients.\u003c/p>\n\u003cp>Even if a handful of the hospital’s doctors got the training to provide buprenorphine, Morrison said “it would be like… 'Oh my god, we have a ton of work ahead of us, we got to hire more people to help with these services!'”\u003c/p>\n\u003cp>A \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=EwnaTcFvGhNZbHF-Ixw-DRgQV32IWTS-7CiyVZaVJ_ozJ7i09MjUCA..&URL=http%3a%2f%2fkhn.org%2fnews%2famount-of-opioids-prescribed-in-u-s-has-been-falling-since-2010%2f\" target=\"_blank\" rel=\"noopener noreferrer\">recent study \u003c/a>by the Centers for Disease Control and Prevention suggests Northern California doctors’ were prescribing painkillers at higher-than-average rates. In rural counties like Plumas, the rates far exceed those seen in the rest of California. More prescriptions were written in Plumas in 2015 than there were people in the county, according to California Department of Public Health \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=ZEm8Va8AOA3fXLWs-VHDmFu28svb9LiHZ2u4vAR_rrIzJ7i09MjUCA..&URL=https%3a%2f%2fpdop.shinyapps.io%2fODdash_v1%2f\">data.\u003c/a>\u003c/p>\n\u003cp>Although Plumas county is sparsely populated, it also has one of \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=ZEm8Va8AOA3fXLWs-VHDmFu28svb9LiHZ2u4vAR_rrIzJ7i09MjUCA..&URL=https%3a%2f%2fpdop.shinyapps.io%2fODdash_v1%2f\">the highest rates of opioid-related\u003c/a> deaths in the state.\u003c/p>\n\u003cp>State health officials say they hope the federal grant to combat opioid abuse will help expand treatment options and bump up the state’s overall use of buprenorphine as a treatment, \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=bmd9kdJyhZkWZei-TJRIKaaN05es5NlFSeYVV39Ae34zJ7i09MjUCA..&URL=http%3a%2f%2fcaliforniamethadone.org%2fwp-content%2fuploads%2f2017%2f02%2fCOMP-PDF.pdf\">which is low compared\u003c/a> to the rest of the U.S.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Satterfield said he would be glad if just one more doctor in his area got trained to treat addiction in this way – he said it’s a tough, but rewarding, job.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/353704/in-rural-california-this-new-addiction-treatment-is-being-ignored-by-the-doctors","authors":["byline_stateofhealth_353704"],"categories":["stateofhealth_3012","stateofhealth_2746","stateofhealth_1"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_3126","stateofhealth_2519","stateofhealth_3127","stateofhealth_3128"],"affiliates":["stateofhealth_3036"],"featImg":"stateofhealth_353725","label":"stateofhealth_3036"},"stateofhealth_238941":{"type":"posts","id":"stateofhealth_238941","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"238941","score":null,"sort":[1474307698000]},"guestAuthors":[],"slug":"how-drugmakers-used-money-and-influence-to-shape-the-national-response-to-opioid-abuse","title":"How Drugmakers Used Money and Influence to Shape the National Response to Opioid Abuse","publishDate":1474307698,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>For more than a decade, members of a little-known group called the Pain Care Forum have blanketed Washington with messages about prescription painkillers' vital role in the lives of millions of Americans, creating an echo chamber that has quietly derailed efforts to curb U.S. consumption of drugs like OxyContin, Vicodin and Percocet.\u003c/p>\n\u003cp>In 2012, drugmakers and their affiliates in the forum sent a letter to U.S. senators promoting a recent report on a \"crisis of epidemic proportions\": pain in America. Few knew the report stemmed from legislation drafted and pushed by forum members and that their experts had helped author it. The report estimated more than 100 million Americans — roughly 40 percent of adults — suffered from chronic pain, an eye-popping statistic that some researchers call deeply problematic.\u003c/p>\n\u003cp>The letter made no reference, however, to another health issue that had been declared an epidemic by federal authorities: drug overdoses tied to prescription painkillers. Deaths linked to addictive opioid drugs had increased more than fourfold since 1999, accounting for more deaths in 2012 than heroin and cocaine combined.\u003c/p>\n\u003cp>An investigation by the \u003cem>Associated Press\u003c/em> and the \u003cem>Center for Public Integrity\u003c/em> reveals that similar feedback loops of information and influence play out regularly in the nation's capital, fueled by money and talking points from the Pain Care Forum, a loose coalition of drugmakers, trade groups and dozens of nonprofits supported by industry funding that has flown under the radar until now.\u003c/p>\n\u003cp>Hundreds of internal documents shed new light on how drugmakers and their allies shaped the national response to the ongoing wave of prescription opioid abuse, which has claimed the lives of 165,000 Americans since 2000, according to federal figures.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Painkillers are among the most widely prescribed medications in the U.S., but pharmaceutical companies and allied groups have a multitude of legislative interests beyond those drugs. From 2006 through 2015, participants in the Pain Care Forum spent over $740 million lobbying in the nation's capital and in all 50 statehouses on an array of issues, including keeping opioids accessible, according to an analysis of lobbying filings.\u003c/p>\n\u003cp>The same organizations reinforced their influence with more than $140 million doled out to political campaigns, including more than $75 million alone to federal candidates, political action committees and parties.\u003c/p>\n\u003cp>\"You can go a long, long way in getting what you want when you have a lot of money,\" said Professor Keith Humphreys of Stanford University, a former adviser on drug policy under President Barack Obama. \"And it's only when things get so disastrous that finally there's enough popular will aroused to push back.\"\u003c/p>\n\u003cp>Opioids were long reserved for severe pain due to surgery, injury or terminal diseases like cancer. That changed in the 1990s, with a surge in prescribing for more common ailments like back pain and arthritis. Marketing for new long-acting painkillers like OxyContin helped fuel the trend, along with other factors.\u003c/p>\n\u003cp>OxyContin-maker Purdue Pharma pleaded guilty and agreed to pay more than $600 million in fines in 2007 for misleading the public about the risks of its drug. But the painkiller continued to rack up blockbuster sales, generating more than $22 billion over the last decade.\u003c/p>\n\u003cp>Purdue's Washington lobbyist, Burt Rosen, co-founded the Pain Care Forum more than a decade ago and coordinates the group's monthly meetings in Washington. Purdue declined to make Rosen available for interviews and did not answer questions about its specific lobbying activities.\u003c/p>\n\u003cp>The company said it supports a range of advocacy groups, including some with differing views on opioids.\u003c/p>\n\u003cp>\"In practice and governance, the Pain Care Forum is like any of the hundreds of policy coalitions in Washington and throughout the nation,\" the company said in a statement, adding: \"Purdue complies with all applicable lobbying disclosure laws and requirements.\"\u003c/p>\n\u003cp>By spring 2014, even the head of the Food and Drug Administration was citing the statistic that 100 million Americans suffered from chronic pain.\u003c/p>\n\u003cp>Then-commissioner Margaret Hamburg used the figure to illustrate the importance of keeping painkillers accessible — despite the escalating toll of opioid addiction and abuse. Yet a researcher whose work contributed to the number said it was being misquoted, since most people included in the figure had common pain ailments and managed them without opioids.\u003c/p>\n\u003cp>Hamburg said in an emailed response that the report was \"another piece of scientific literature that helped inform the broader field,\" and that her agency had no role in writing it.\u003c/p>\n\u003cp>When the FDA began developing plans to reduce misuse of long-acting, the Pain Care Forum intervened with a \"strategy to inform the process,\" according to an internal memo from the American Pain Foundation, a now-defunct forum member.\u003c/p>\n\u003cp>The FDA's initial proposals included requiring doctors to undergo certification training to prescribe opioids and tracking opioid prescriptions via databases. But when the FDA sought public comment on how to proceed, the forum helped generate more than 2,000 comments against new barriers to opioids and a 4,000-signature petition opposing electronic registries, according to another pain foundation memo.\u003c/p>\n\u003cp>Ultimately, the agency announced far milder steps than its initial ideas: Drugmakers would fund optional classes for doctors and supply brochures to patients about opioid risks. FDA leaders said they decided requiring certification for prescribers would have been overly burdensome, disrupting care for patients and doctors.\u003c/p>\n\u003cp>But experts said regulators had missed a pivotal chance to curb deadly misuse and abuse with the drugs.\u003c/p>\n\u003cp>\"The FDA failed to make a decision that could have averted many of the thousands of deaths we're seeing per year,\" said Dr. Nathaniel Katz, a former FDA adviser who urged the agency to make training mandatory for prescribers.\u003c/p>\n\u003cp>Today, the FDA is taking another look at requiring training for opioid prescribers, following a recommendation by a panel of expert advisers in May.\u003c/p>\n\u003cp>It was a federal agency hundreds of miles from Washington that finally sidestepped the influence of the Pain Care Forum.\u003c/p>\n\u003cp>Earlier this year, the Centers for Disease Control and Prevention, located in Atlanta, overcame threats of congressional investigation and legal action to publish the first federal guidelines intended to reduce opioid prescribing.\u003c/p>\n\u003cp>Essentially, the agency said the risks of painkillers outweigh the benefits for the vast majority of patients with routine chronic pain and that doctors instead should consider alternatives like physical therapy.\u003c/p>\n\u003cp>When draft guidelines emerged in September, forum members said they were not based on solid evidence, and criticized the CDC for not disclosing outside experts who had advised its effort. One pharma-aligned group, the Washington Legal Foundation, said the lack of disclosure constituted a \"clear violation\" of federal law. A longtime Pain Care Forum participant — now known as the Academy of Integrative Pain Management — asked Congress to investigate how the CDC developed the guidelines, though investigators found no violations.\u003c/p>\n\u003cp>After months of scrutiny, the CDC in December released a list of its advisers. One of 17 \"core experts\" had served as a paid consultant to a law firm suing opioid drugmakers.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>The final guidelines appeared in March. The first recommendation for U.S. doctors was unequivocal: \"Opioids are not first-line therapy\" for routine chronic pain. It was a statement considered common practice by many doctors as recently as the early 1990s, a decade before the Pain Care Forum formed in Washington.\u003c/p>\n\n","blocks":[],"excerpt":"An investigation reveals that drug companies have deployed hundreds of lobbyists and millions in campaign contributions to help kill or weaken efforts to limit prescription opioids.","status":"publish","parent":0,"modified":1474307698,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":1227},"headData":{"title":"How Drugmakers Used Money and Influence to Shape the National Response to Opioid Abuse | KQED","description":"An investigation reveals that drug companies have deployed hundreds of lobbyists and millions in campaign contributions to help kill or weaken efforts to limit prescription opioids.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"How Drugmakers Used Money and Influence to Shape the National Response to Opioid Abuse","datePublished":"2016-09-19T17:54:58.000Z","dateModified":"2016-09-19T17:54:58.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"238941 http://ww2.kqed.org/stateofhealth/?p=238941","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/09/19/how-drugmakers-used-money-and-influence-to-shape-the-national-response-to-opioid-abuse/","disqusTitle":"How Drugmakers Used Money and Influence to Shape the National Response to Opioid Abuse","nprByline":"Associated Press and Center for Public Integrity","path":"/stateofhealth/238941/how-drugmakers-used-money-and-influence-to-shape-the-national-response-to-opioid-abuse","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>For more than a decade, members of a little-known group called the Pain Care Forum have blanketed Washington with messages about prescription painkillers' vital role in the lives of millions of Americans, creating an echo chamber that has quietly derailed efforts to curb U.S. consumption of drugs like OxyContin, Vicodin and Percocet.\u003c/p>\n\u003cp>In 2012, drugmakers and their affiliates in the forum sent a letter to U.S. senators promoting a recent report on a \"crisis of epidemic proportions\": pain in America. Few knew the report stemmed from legislation drafted and pushed by forum members and that their experts had helped author it. The report estimated more than 100 million Americans — roughly 40 percent of adults — suffered from chronic pain, an eye-popping statistic that some researchers call deeply problematic.\u003c/p>\n\u003cp>The letter made no reference, however, to another health issue that had been declared an epidemic by federal authorities: drug overdoses tied to prescription painkillers. Deaths linked to addictive opioid drugs had increased more than fourfold since 1999, accounting for more deaths in 2012 than heroin and cocaine combined.\u003c/p>\n\u003cp>An investigation by the \u003cem>Associated Press\u003c/em> and the \u003cem>Center for Public Integrity\u003c/em> reveals that similar feedback loops of information and influence play out regularly in the nation's capital, fueled by money and talking points from the Pain Care Forum, a loose coalition of drugmakers, trade groups and dozens of nonprofits supported by industry funding that has flown under the radar until now.\u003c/p>\n\u003cp>Hundreds of internal documents shed new light on how drugmakers and their allies shaped the national response to the ongoing wave of prescription opioid abuse, which has claimed the lives of 165,000 Americans since 2000, according to federal figures.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Painkillers are among the most widely prescribed medications in the U.S., but pharmaceutical companies and allied groups have a multitude of legislative interests beyond those drugs. From 2006 through 2015, participants in the Pain Care Forum spent over $740 million lobbying in the nation's capital and in all 50 statehouses on an array of issues, including keeping opioids accessible, according to an analysis of lobbying filings.\u003c/p>\n\u003cp>The same organizations reinforced their influence with more than $140 million doled out to political campaigns, including more than $75 million alone to federal candidates, political action committees and parties.\u003c/p>\n\u003cp>\"You can go a long, long way in getting what you want when you have a lot of money,\" said Professor Keith Humphreys of Stanford University, a former adviser on drug policy under President Barack Obama. \"And it's only when things get so disastrous that finally there's enough popular will aroused to push back.\"\u003c/p>\n\u003cp>Opioids were long reserved for severe pain due to surgery, injury or terminal diseases like cancer. That changed in the 1990s, with a surge in prescribing for more common ailments like back pain and arthritis. Marketing for new long-acting painkillers like OxyContin helped fuel the trend, along with other factors.\u003c/p>\n\u003cp>OxyContin-maker Purdue Pharma pleaded guilty and agreed to pay more than $600 million in fines in 2007 for misleading the public about the risks of its drug. But the painkiller continued to rack up blockbuster sales, generating more than $22 billion over the last decade.\u003c/p>\n\u003cp>Purdue's Washington lobbyist, Burt Rosen, co-founded the Pain Care Forum more than a decade ago and coordinates the group's monthly meetings in Washington. Purdue declined to make Rosen available for interviews and did not answer questions about its specific lobbying activities.\u003c/p>\n\u003cp>The company said it supports a range of advocacy groups, including some with differing views on opioids.\u003c/p>\n\u003cp>\"In practice and governance, the Pain Care Forum is like any of the hundreds of policy coalitions in Washington and throughout the nation,\" the company said in a statement, adding: \"Purdue complies with all applicable lobbying disclosure laws and requirements.\"\u003c/p>\n\u003cp>By spring 2014, even the head of the Food and Drug Administration was citing the statistic that 100 million Americans suffered from chronic pain.\u003c/p>\n\u003cp>Then-commissioner Margaret Hamburg used the figure to illustrate the importance of keeping painkillers accessible — despite the escalating toll of opioid addiction and abuse. Yet a researcher whose work contributed to the number said it was being misquoted, since most people included in the figure had common pain ailments and managed them without opioids.\u003c/p>\n\u003cp>Hamburg said in an emailed response that the report was \"another piece of scientific literature that helped inform the broader field,\" and that her agency had no role in writing it.\u003c/p>\n\u003cp>When the FDA began developing plans to reduce misuse of long-acting, the Pain Care Forum intervened with a \"strategy to inform the process,\" according to an internal memo from the American Pain Foundation, a now-defunct forum member.\u003c/p>\n\u003cp>The FDA's initial proposals included requiring doctors to undergo certification training to prescribe opioids and tracking opioid prescriptions via databases. But when the FDA sought public comment on how to proceed, the forum helped generate more than 2,000 comments against new barriers to opioids and a 4,000-signature petition opposing electronic registries, according to another pain foundation memo.\u003c/p>\n\u003cp>Ultimately, the agency announced far milder steps than its initial ideas: Drugmakers would fund optional classes for doctors and supply brochures to patients about opioid risks. FDA leaders said they decided requiring certification for prescribers would have been overly burdensome, disrupting care for patients and doctors.\u003c/p>\n\u003cp>But experts said regulators had missed a pivotal chance to curb deadly misuse and abuse with the drugs.\u003c/p>\n\u003cp>\"The FDA failed to make a decision that could have averted many of the thousands of deaths we're seeing per year,\" said Dr. Nathaniel Katz, a former FDA adviser who urged the agency to make training mandatory for prescribers.\u003c/p>\n\u003cp>Today, the FDA is taking another look at requiring training for opioid prescribers, following a recommendation by a panel of expert advisers in May.\u003c/p>\n\u003cp>It was a federal agency hundreds of miles from Washington that finally sidestepped the influence of the Pain Care Forum.\u003c/p>\n\u003cp>Earlier this year, the Centers for Disease Control and Prevention, located in Atlanta, overcame threats of congressional investigation and legal action to publish the first federal guidelines intended to reduce opioid prescribing.\u003c/p>\n\u003cp>Essentially, the agency said the risks of painkillers outweigh the benefits for the vast majority of patients with routine chronic pain and that doctors instead should consider alternatives like physical therapy.\u003c/p>\n\u003cp>When draft guidelines emerged in September, forum members said they were not based on solid evidence, and criticized the CDC for not disclosing outside experts who had advised its effort. One pharma-aligned group, the Washington Legal Foundation, said the lack of disclosure constituted a \"clear violation\" of federal law. A longtime Pain Care Forum participant — now known as the Academy of Integrative Pain Management — asked Congress to investigate how the CDC developed the guidelines, though investigators found no violations.\u003c/p>\n\u003cp>After months of scrutiny, the CDC in December released a list of its advisers. One of 17 \"core experts\" had served as a paid consultant to a law firm suing opioid drugmakers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The final guidelines appeared in March. The first recommendation for U.S. doctors was unequivocal: \"Opioids are not first-line therapy\" for routine chronic pain. It was a statement considered common practice by many doctors as recently as the early 1990s, a decade before the Pain Care Forum formed in Washington.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/238941/how-drugmakers-used-money-and-influence-to-shape-the-national-response-to-opioid-abuse","authors":["byline_stateofhealth_238941"],"categories":["stateofhealth_14"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_2519","stateofhealth_2656"],"featImg":"stateofhealth_238960","label":"stateofhealth"},"stateofhealth_234838":{"type":"posts","id":"stateofhealth_234838","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"234838","score":null,"sort":[1473378786000]},"guestAuthors":[],"slug":"half-of-americans-take-prescription-drugs-that-could-lead-to-addiction","title":"Half of Americans Take Prescription Drugs That Could Lead to Addiction","publishDate":1473378786,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Almost half of all Americans take prescription painkillers, tranquilizers, stimulants or sedatives, according to results of a \u003ca href=\"http://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm\">federal survey\u003c/a> released Thursday. The prevalent use of these drugs could help explain why millions of Americans end up misusing or abusing them.\u003c/p>\n\u003cp>Last year, for the first time, the government's National Survey on Drug Use decided to ask the people it interviewed about all uses of prescription medicines, not just inappropriate use. The survey found that 119 million Americans over the age of 12 took prescription psychotherapeutic drugs. That's 45 percent of the population.\u003c/p>\n\u003cp>Of those, about 19 million Americans didn't follow a prescription. Most misuse involved people who acquired the drugs from friends or family. More than a third had a prescription but took those drugs excessively. And about 5 percent bought drugs from a dealer or stranger.\u003c/p>\n\u003cp>All told, 16 percent of all prescription drug use was actually misuse, according to the report.\u003c/p>\n\u003cp>There's no question that these drugs help alleviate pain and suffering for millions of Americans. But it's also clear that the system encourages overuse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Any of us go to the doctor and feel like we don't get our money's worth if we don't come out with a prescription, right?\" Kim Johnson told Shots. She is director of the Center for Substance Abuse Treatment at the federal \u003ca href=\"http://www.samhsa.gov/\">Substance Abuse and Mental Health Services Administration\u003c/a>.\u003c/p>\n\u003cp>\"Just like any drug, the more it's out there, the more it's available, the more likely it is to be abused,\" she said. And many of these drugs pose an additional risk because of their physical effects, including in some cases their addictive properties.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention is trying to \u003ca href=\"https://www.cdc.gov/media/modules/dpk/2016/dpk-pod/rr6501e1er-ebook.pdf\">reform prescribing practices\u003c/a>, particularly for opioid drugs, to reduce the overuse of these pain medications. The new survey also documents the dire need for affordable and accessible treatment options.\u003c/p>\n\u003cp>\"One in 12 people aged 12 or over needed treatment for substance use disorder, yet nearly 90 percent of those people didn't get specialty treatment that could have helped them toward recovery,\" said Kana Enomoto, SAMHSA's principal deputy administrator, at a news conference.\u003c/p>\n\u003cp>That need for treatment pertains not just to prescription drug abuse but to street drugs such as heroin.\u003c/p>\n\u003cp>\"We need to expand access to treatment and we need to do it now,\" said Michael Botticelli, director of the White House \u003ca href=\"https://www.whitehouse.gov/ondcp\">Office of National Drug Control Policy\u003c/a>. \"Because, like every other disease, people who want treatment should be able to get it. And it should not be dependent on where they live or how much money they have.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>President Obama's budget for fiscal year 2017 called for more than $1 billion to expand access to drug treatment, but Congress has not acted on it.\u003c/p>\n\n","blocks":[],"excerpt":"There's no question that these drugs help alleviate pain and suffering for millions of Americans. But it's also clear that the system encourages overuse.\r\n","status":"publish","parent":0,"modified":1473378842,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":470},"headData":{"title":"Half of Americans Take Prescription Drugs That Could Lead to Addiction | KQED","description":"There's no question that these drugs help alleviate pain and suffering for millions of Americans. But it's also clear that the system encourages overuse.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Half of Americans Take Prescription Drugs That Could Lead to Addiction","datePublished":"2016-09-08T23:53:06.000Z","dateModified":"2016-09-08T23:54:02.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"234838 http://ww2.kqed.org/stateofhealth/?p=234838","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/09/08/half-of-americans-take-prescription-drugs-that-could-lead-to-addiction/","disqusTitle":"Half of Americans Take Prescription Drugs That Could Lead to Addiction","customPermalink":"2016/09/08/234838/","nprByline":"Richard Harris \u003cbr />\u003ca href=\"http://www.npr.org/sections/health-shots/\">NPR Shots\u003c/a>","path":"/stateofhealth/234838/half-of-americans-take-prescription-drugs-that-could-lead-to-addiction","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Almost half of all Americans take prescription painkillers, tranquilizers, stimulants or sedatives, according to results of a \u003ca href=\"http://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm\">federal survey\u003c/a> released Thursday. The prevalent use of these drugs could help explain why millions of Americans end up misusing or abusing them.\u003c/p>\n\u003cp>Last year, for the first time, the government's National Survey on Drug Use decided to ask the people it interviewed about all uses of prescription medicines, not just inappropriate use. The survey found that 119 million Americans over the age of 12 took prescription psychotherapeutic drugs. That's 45 percent of the population.\u003c/p>\n\u003cp>Of those, about 19 million Americans didn't follow a prescription. Most misuse involved people who acquired the drugs from friends or family. More than a third had a prescription but took those drugs excessively. And about 5 percent bought drugs from a dealer or stranger.\u003c/p>\n\u003cp>All told, 16 percent of all prescription drug use was actually misuse, according to the report.\u003c/p>\n\u003cp>There's no question that these drugs help alleviate pain and suffering for millions of Americans. But it's also clear that the system encourages overuse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Any of us go to the doctor and feel like we don't get our money's worth if we don't come out with a prescription, right?\" Kim Johnson told Shots. She is director of the Center for Substance Abuse Treatment at the federal \u003ca href=\"http://www.samhsa.gov/\">Substance Abuse and Mental Health Services Administration\u003c/a>.\u003c/p>\n\u003cp>\"Just like any drug, the more it's out there, the more it's available, the more likely it is to be abused,\" she said. And many of these drugs pose an additional risk because of their physical effects, including in some cases their addictive properties.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention is trying to \u003ca href=\"https://www.cdc.gov/media/modules/dpk/2016/dpk-pod/rr6501e1er-ebook.pdf\">reform prescribing practices\u003c/a>, particularly for opioid drugs, to reduce the overuse of these pain medications. The new survey also documents the dire need for affordable and accessible treatment options.\u003c/p>\n\u003cp>\"One in 12 people aged 12 or over needed treatment for substance use disorder, yet nearly 90 percent of those people didn't get specialty treatment that could have helped them toward recovery,\" said Kana Enomoto, SAMHSA's principal deputy administrator, at a news conference.\u003c/p>\n\u003cp>That need for treatment pertains not just to prescription drug abuse but to street drugs such as heroin.\u003c/p>\n\u003cp>\"We need to expand access to treatment and we need to do it now,\" said Michael Botticelli, director of the White House \u003ca href=\"https://www.whitehouse.gov/ondcp\">Office of National Drug Control Policy\u003c/a>. \"Because, like every other disease, people who want treatment should be able to get it. And it should not be dependent on where they live or how much money they have.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>President Obama's budget for fiscal year 2017 called for more than $1 billion to expand access to drug treatment, but Congress has not acted on it.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/234838/half-of-americans-take-prescription-drugs-that-could-lead-to-addiction","authors":["byline_stateofhealth_234838"],"categories":["stateofhealth_2746"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_2519","stateofhealth_2888","stateofhealth_2525","stateofhealth_2891","stateofhealth_2890","stateofhealth_2889"],"featImg":"stateofhealth_234857","label":"stateofhealth"},"stateofhealth_223727":{"type":"posts","id":"stateofhealth_223727","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"223727","score":null,"sort":[1470926452000]},"guestAuthors":[],"slug":"insurance-rules-put-up-roadblocks-to-opioid-addiction-treatment","title":"Insurance Rules Put Up Roadblocks to Opioid Addiction Treatment","publishDate":1470926452,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Twice a day, Angela and Nate Turner of Greenwood, Ind., put tiny strips that look like tinted tape under their tongues.\u003c/p>\n\u003cp>“They taste disgusting,” Angela says.\u003c/p>\n\u003cp>But the taste is worth it to her. The dissolvable strips are actually a drug called Suboxone, which helps control an opioid user’s cravings for the drug. The married couple both got addicted to prescription painkillers following injuries several years ago, and they decided to go into recovery this year. With Suboxone, they don’t have to worry about how they’ll get drugs, or how sick they’ll feel if they don’t.\u003c/p>\n\u003cp>“You can function, but you’re not high,” Angela says. “It’s like a miracle drug. It really is.”\u003c/p>\n\u003cp>A body of evidence now shows that medications such as Suboxone are effective in putting the brakes on opioid use disorder, when used in conjunction with counseling. For the Turners, the treatment means Angela can take care of their 3-year-old and Nate can hold down a job.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But because of some companies’ insurance rules, getting started on Suboxone — and staying on it — can be difficult.\u003c/p>\n\u003cp>Angela says after her doctor wrote her a prescription, she had to wait three days to get it filled. She spent those days in bed with nausea, diarrhea and muscle cramps — the intense symptoms of opioid withdrawal. For Nate, the wait was five days. On Day 3, he relapsed and used heroin.\u003c/p>\n\u003cp>“I just thought it was over, that I wasn’t going to make it back to the program,” he says.\u003c/p>\n\u003cp>Suboxone is covered through the Turners’ health plan, which is part of Indiana’s Medicaid expansion, the Healthy Indiana Plan. But before the couple’s insurance company, Managed Health Services, will pay for the drug treatment, their doctor has to get approval from the insurer — known as a prior authorization.\u003c/p>\n\u003cp>The prior authorization process adds work for doctors and their staff, said Dr. Andrew Chambers, a psychiatrist and addiction specialist in Indianapolis. With the phone calls, faxing and other paperwork, he said, three of his nurses spend about 30 hours a week going back and forth with the insurance companies.\u003c/p>\n\u003cp>“It’s almost like when you take on a patient to treat opiate addiction, you also have to take on another patient called the insurance company,” Chambers said.\u003c/p>\n\u003cp>Getting a prior authorization to prescribe one of these medications can take days or weeks, said Sam Muszynski, director of health care systems and financing with the American Psychiatric Association. He said the delays leave patients vulnerable to relapse.\u003c/p>\n\u003cp>“You may lose that opportunity right then and there,” he said. “They may never come back.”\u003c/p>\n\u003cp>Muszynski and policy analysts with the federal Substance Abuse and Mental Health Services Administration say requiring prior authorizations from insurers for addiction medication is a widespread practice in the U.S.\u003c/p>\n\u003cp>As of 2013, Medicaid in 48 states required a prior authorization for buprenorphine, the active ingredient in Suboxone. Chris Carroll, director of health care financing at SAMHSA, said that number likely has not changed much since 2013. He said treatment limitations like prior authorizations are part of “the dark shadows of the insurance industry.”\u003c/p>\n\u003cp>Prior authorizations are one way insurers limit what they pay for, Muszynski said, and they use prior authorizations more often with mental health and addiction treatments, compared to other medical treatments. That’s despite the 2008 passage of a federal law called the Mental Health Parity and Addiction Equity Act, which was supposed to end unequal insurance coverage for mental illness as compared to physical illness.\u003c/p>\n\u003cp>For instance, under the Turners’ plan, insulin treatments for diabetes don’t require a prior authorization. But Suboxone does.\u003c/p>\n\u003cp>“It’s just totally unfair,” Muszynski said. “There’s a continuing pattern of discrimination, which results in reduced access to people who need opioid addiction treatment.”\u003c/p>\n\u003cp>Prior authorization requirements can also pressure doctors to change how they prescribe a drug such as Suboxone. Sometimes an insurer will push for a lower dosage than the doctor wants, or it will require a patient to start tapering the use of a medication even when the doctor thinks the patient needs more time.\u003c/p>\n\u003cp>“These rules and regulations for us completely block the correct provision of care,” says Chambers. “And that’s crazy.”\u003c/p>\n\u003cp>For some insurers, a prior authorization expires after just a few months, forcing everyone involved to go back through the process of reauthorizing. In some cases, Chambers said, patients will even run out of medicine before a new prescription can be approved, which can force them into withdrawal.\u003c/p>\n\u003cp>Indiana Medicaid said it has started to allow some doctors to skip that initial back-and-forth with the insurance company. But Chambers said the changes haven’t helped him much yet.\u003c/p>\n\u003cp>Clare Krusing, press secretary with the trade association America’s Health Insurance Plans, said that prior authorizations are not in place to limit treatment for patients with opioid addiction. Rather, she said, they’re meant to ensure that patients receive proper care.\u003c/p>\n\u003cp>“Prior authorization is not just arbitrarily applied,” she said. “Plans look at what the clinical guidelines are. A plan is going to make sure that before a drug is prescribed, the patient meets those guidelines.”\u003c/p>\n\u003cp>Krusing added that the prior authorizations in place for buprenorphine don’t violate the parity law, because the treatment plan for addiction is different from the treatment plan for other chronic illnesses, such as diabetes.\u003c/p>\n\u003cp>Nate Turner has managed to stay in treatment despite the prior authorization process. He says there’s an irony here. He started taking opioids without a prior authorization — in fact, on his plan, the pain pills he used to be addicted to require no prior authorization. He says that sort of gatekeeping paperwork shouldn’t be a stumbling block when he’s trying to quit his opioid habit.\u003c/p>\n\u003cp>“I can assure you, if I were on regular pain medicine, I’d be able to get them, no problem,” he says. “No questions asked.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes Side Effects Public Media, NPR and Kaiser Health News.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Red tape makes it hard for patients to get started on recovery drug and stay on it.\r\n","status":"publish","parent":0,"modified":1470926658,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":1082},"headData":{"title":"Insurance Rules Put Up Roadblocks to Opioid Addiction Treatment | KQED","description":"Red tape makes it hard for patients to get started on recovery drug and stay on it.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Insurance Rules Put Up Roadblocks to Opioid Addiction Treatment","datePublished":"2016-08-11T14:40:52.000Z","dateModified":"2016-08-11T14:44:18.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"223727 http://ww2.kqed.org/stateofhealth/?p=223727","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/08/11/insurance-rules-put-up-roadblocks-to-opioid-addiction-treatment/","disqusTitle":"Insurance Rules Put Up Roadblocks to Opioid Addiction Treatment","nprByline":"Jake Harper\u003cbr />\u003ca href=\"http://sideeffectspublicmedia.org/\">Side Effects Public Media\u003c/a>","path":"/stateofhealth/223727/insurance-rules-put-up-roadblocks-to-opioid-addiction-treatment","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Twice a day, Angela and Nate Turner of Greenwood, Ind., put tiny strips that look like tinted tape under their tongues.\u003c/p>\n\u003cp>“They taste disgusting,” Angela says.\u003c/p>\n\u003cp>But the taste is worth it to her. The dissolvable strips are actually a drug called Suboxone, which helps control an opioid user’s cravings for the drug. The married couple both got addicted to prescription painkillers following injuries several years ago, and they decided to go into recovery this year. With Suboxone, they don’t have to worry about how they’ll get drugs, or how sick they’ll feel if they don’t.\u003c/p>\n\u003cp>“You can function, but you’re not high,” Angela says. “It’s like a miracle drug. It really is.”\u003c/p>\n\u003cp>A body of evidence now shows that medications such as Suboxone are effective in putting the brakes on opioid use disorder, when used in conjunction with counseling. For the Turners, the treatment means Angela can take care of their 3-year-old and Nate can hold down a job.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But because of some companies’ insurance rules, getting started on Suboxone — and staying on it — can be difficult.\u003c/p>\n\u003cp>Angela says after her doctor wrote her a prescription, she had to wait three days to get it filled. She spent those days in bed with nausea, diarrhea and muscle cramps — the intense symptoms of opioid withdrawal. For Nate, the wait was five days. On Day 3, he relapsed and used heroin.\u003c/p>\n\u003cp>“I just thought it was over, that I wasn’t going to make it back to the program,” he says.\u003c/p>\n\u003cp>Suboxone is covered through the Turners’ health plan, which is part of Indiana’s Medicaid expansion, the Healthy Indiana Plan. But before the couple’s insurance company, Managed Health Services, will pay for the drug treatment, their doctor has to get approval from the insurer — known as a prior authorization.\u003c/p>\n\u003cp>The prior authorization process adds work for doctors and their staff, said Dr. Andrew Chambers, a psychiatrist and addiction specialist in Indianapolis. With the phone calls, faxing and other paperwork, he said, three of his nurses spend about 30 hours a week going back and forth with the insurance companies.\u003c/p>\n\u003cp>“It’s almost like when you take on a patient to treat opiate addiction, you also have to take on another patient called the insurance company,” Chambers said.\u003c/p>\n\u003cp>Getting a prior authorization to prescribe one of these medications can take days or weeks, said Sam Muszynski, director of health care systems and financing with the American Psychiatric Association. He said the delays leave patients vulnerable to relapse.\u003c/p>\n\u003cp>“You may lose that opportunity right then and there,” he said. “They may never come back.”\u003c/p>\n\u003cp>Muszynski and policy analysts with the federal Substance Abuse and Mental Health Services Administration say requiring prior authorizations from insurers for addiction medication is a widespread practice in the U.S.\u003c/p>\n\u003cp>As of 2013, Medicaid in 48 states required a prior authorization for buprenorphine, the active ingredient in Suboxone. Chris Carroll, director of health care financing at SAMHSA, said that number likely has not changed much since 2013. He said treatment limitations like prior authorizations are part of “the dark shadows of the insurance industry.”\u003c/p>\n\u003cp>Prior authorizations are one way insurers limit what they pay for, Muszynski said, and they use prior authorizations more often with mental health and addiction treatments, compared to other medical treatments. That’s despite the 2008 passage of a federal law called the Mental Health Parity and Addiction Equity Act, which was supposed to end unequal insurance coverage for mental illness as compared to physical illness.\u003c/p>\n\u003cp>For instance, under the Turners’ plan, insulin treatments for diabetes don’t require a prior authorization. But Suboxone does.\u003c/p>\n\u003cp>“It’s just totally unfair,” Muszynski said. “There’s a continuing pattern of discrimination, which results in reduced access to people who need opioid addiction treatment.”\u003c/p>\n\u003cp>Prior authorization requirements can also pressure doctors to change how they prescribe a drug such as Suboxone. Sometimes an insurer will push for a lower dosage than the doctor wants, or it will require a patient to start tapering the use of a medication even when the doctor thinks the patient needs more time.\u003c/p>\n\u003cp>“These rules and regulations for us completely block the correct provision of care,” says Chambers. “And that’s crazy.”\u003c/p>\n\u003cp>For some insurers, a prior authorization expires after just a few months, forcing everyone involved to go back through the process of reauthorizing. In some cases, Chambers said, patients will even run out of medicine before a new prescription can be approved, which can force them into withdrawal.\u003c/p>\n\u003cp>Indiana Medicaid said it has started to allow some doctors to skip that initial back-and-forth with the insurance company. But Chambers said the changes haven’t helped him much yet.\u003c/p>\n\u003cp>Clare Krusing, press secretary with the trade association America’s Health Insurance Plans, said that prior authorizations are not in place to limit treatment for patients with opioid addiction. Rather, she said, they’re meant to ensure that patients receive proper care.\u003c/p>\n\u003cp>“Prior authorization is not just arbitrarily applied,” she said. “Plans look at what the clinical guidelines are. A plan is going to make sure that before a drug is prescribed, the patient meets those guidelines.”\u003c/p>\n\u003cp>Krusing added that the prior authorizations in place for buprenorphine don’t violate the parity law, because the treatment plan for addiction is different from the treatment plan for other chronic illnesses, such as diabetes.\u003c/p>\n\u003cp>Nate Turner has managed to stay in treatment despite the prior authorization process. He says there’s an irony here. He started taking opioids without a prior authorization — in fact, on his plan, the pain pills he used to be addicted to require no prior authorization. He says that sort of gatekeeping paperwork shouldn’t be a stumbling block when he’s trying to quit his opioid habit.\u003c/p>\n\u003cp>“I can assure you, if I were on regular pain medicine, I’d be able to get them, no problem,” he says. “No questions asked.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes Side Effects Public Media, NPR and Kaiser Health News.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/223727/insurance-rules-put-up-roadblocks-to-opioid-addiction-treatment","authors":["byline_stateofhealth_223727"],"categories":["stateofhealth_2442"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_2845","stateofhealth_2519","stateofhealth_2656"],"featImg":"stateofhealth_223728","label":"stateofhealth"},"stateofhealth_217466":{"type":"posts","id":"stateofhealth_217466","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"217466","score":null,"sort":[1469641121000]},"guestAuthors":[],"slug":"more-addiction-training-at-stanford-med-school-as-opioid-epidemic-surges","title":"More Addiction Training at Stanford Med School as Opioid Epidemic Surges","publishDate":1469641121,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Jonathan Goodman can recall most of the lectures he's attended at the Stanford University School of Medicine. He can recite detailed instructions given more than a year ago about how to conduct a physical.\u003c/p>\n\u003caside class=\"pullquote alignright\">Stanford's medical school may offer an example of what change in teaching about addiction can look like.\u003c/aside>\n\u003cp>But at the end of his second year, the 27-year-old M.D.-Ph.D. student could not remember any class dedicated to addiction medicine. Then he recalled skipping class months earlier. Reviewing his syllabus, he realized he had missed the sole lecture dedicated to that topic.\u003c/p>\n\u003cp>\"I wasn't tested on it,\" Goodman says, with a note of surprise.\u003c/p>\n\u003cp>Americans are \u003ca href=\"http://www.npr.org/sections/health-shots/2016/06/01/479440834/in-opioid-crisis-it-s-important-to-know-which-drugs-caused-a-death\" target=\"_blank\">overdosing on opioids\u003c/a> such as heroin and prescribed painkillers at epidemic rates, and the nation's doctors appear to be inadequately prepared to help.\u003c/p>\n\u003cp>The problem begins in medical school.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A \u003ca href=\"http://www.centeronaddiction.org/addiction-research/reports/addiction-medicine\" target=\"_blank\">report\u003c/a> in 2012 by The National Center on Addiction and Substance Abuse revealed that medical schools devoted little time to teaching addiction medicine — only a few hours over the course of four years. Since then, the number of Americans overdosing from prescribed opioids has surpassed \u003ca href=\"http://www.cdc.gov/drugoverdose/data/overdose.html\" target=\"_blank\">14,000 per year\u003c/a>, quadrupling from 1999 to 2014.\u003c/p>\n\u003cp>But Stanford's medical school may offer an example of what faculty-driven change in teaching about addiction can look like.\u003c/p>\n\u003cp>The school began retooling its curriculum after the director of its addiction medicine fellowship, \u003ca href=\"https://med.stanford.edu/profiles/anna-lembke\" target=\"_blank\">Dr. Anna Lembke\u003c/a>, expressed concern about its meager offerings in that field.\u003c/p>\n\u003cp>Lectures on addiction will no longer be folded into the psychiatry series as a side note, but instead will be presented as a separate unit relevant to future doctors in any subspecialty, Lembke says. And that training will continue when the students leave the classrooms for clinical rotations.\u003c/p>\n\u003cp>\"We're at the very bottom of a very long uphill road,\" says Lembke, who gave the lecture Goodman missed.\u003c/p>\n\u003cp>Medical faculties have traditionally eschewed teaching the subject, in part because many physicians viewed addiction as a personal vice rather than a disease. And, even now, some doctors who specialize in addiction treatment are skeptical that the best care for the problem comes out of a medical model.\u003c/p>\n\u003cp>For example, \u003ca href=\"https://www.youtube.com/watch?v=0Ueb-7ZxltQ\" target=\"_blank\">Dr. Joe Gerstein\u003c/a>, a retired internist and clinical assistant professor at Harvard Medical School, is founding president of \u003ca href=\"http://www.smartrecovery.org/intro/\" target=\"_blank\">SMART Recovery\u003c/a>, an international program that emphasizes cognitive behavioral therapy and positive thinking to help people beat their drug habit.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\"Clearly, if you've got an addiction, you've been making a lot of bad choices,\" says Gerstein. Framing substance abuse strictly as a disease ignores the fact that some people are able to quit their use of a drug with willpower, he says.\u003c/p>\n\u003cp>Still, those who believe in the value of medical treatment for addiction say it can no longer be an afterthought in medical education. Because the current opioid epidemic is largely linked to prescribed opioid painkillers, many doctors are being forced to grapple with addicted patients in their practices. In March, the American Board of Medical Specialties \u003ca href=\"http://www.abms.org/news-events/abms-officially-recognizes-addiction-medicine-as-a-subspecialty/\">officially recognized\u003c/a> addiction medicine as a subspecialty.\u003c/p>\n\u003cp>In a March \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20R/PDF%20RecoveryReachMAT.pdf\" target=\"_blank\">report\u003c/a>, the California Health Care Foundation cited inadequate medical school training as one of the challenges in treating patients addicted to opioids.\u003c/p>\n\u003cp>The White House has also been pressuring medical schools to improve instruction on opioid addiction by issuing pledges for schools to sign, promising to change their curricula. But as recently as April, Lembke hadn't yet heard of any concrete plans to change Stanford's curriculum.\u003c/p>\n\u003cp>In late spring, however, she was asked to meet with the dean of the medical school about bolstering education in addiction medicine. Working with fellow faculty members, Lembke is now expanding addiction medicine beyond the lone talk she gives on opioids each year to a series of lectures that recommend and teach alternative treatments for pain, like acupuncture or massage.\u003c/p>\n\u003cp>Lembke will also seek an endorsement of her fellowship program by the Accreditation Council of Graduate Medical Education. Accreditation can help programs get additional funding.\u003c/p>\n\u003cp>One of Lembke's Stanford colleagues, \u003ca href=\"https://med.stanford.edu/profiles/jordan-newmark\" target=\"_blank\">Dr. Jordan Newmark\u003c/a>, who directs education in medical school's pain division, is seeking to increase medical students' training on opioids in their third and fourth years. His plans for clinical training sessions include having actors portray patients with opioid addictions.\u003c/p>\n\u003cp>The next hurdle is to recruit doctors to specialize in addiction medicine, says \u003ca href=\"http://www.centeronaddiction.org/about/staff-biographies\" target=\"_blank\">Emily Feinstein\u003c/a>, director of health law and policy at the National Center on Addiction and Substance Abuse.\u003c/p>\n\u003cp>Among the challenges in getting young doctors interested in the field, Feinstein says, are low insurance reimbursement rates and having to deal with patients who can be difficult behaviorally because of their drug use.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It's best to reach doctors at the start of their careers, Lembke says — before they've established a practice and get set in their ways.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=As+Opioid+Epidemic+Surges%2C+Medical+Schools+Must+Change+To+Keep+Pace&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Most medical schools offer little teaching about opioid addiction. Stanford University's medical school is trying to change that.","status":"publish","parent":0,"modified":1469641227,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":819},"headData":{"title":"More Addiction Training at Stanford Med School as Opioid Epidemic Surges | KQED","description":"Most medical schools offer little teaching about opioid addiction. Stanford University's medical school is trying to change that.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"More Addiction Training at Stanford Med School as Opioid Epidemic Surges","datePublished":"2016-07-27T17:38:41.000Z","dateModified":"2016-07-27T17:40:27.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"217466 http://ww2.kqed.org/stateofhealth/?p=217466","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/27/more-addiction-training-at-stanford-med-school-as-opioid-epidemic-surges/","disqusTitle":"More Addiction Training at Stanford Med School as Opioid Epidemic Surges","customPermalink":"2016/07/27/opioid-epidemic-stanford-addiction-training/","nprImageCredit":"Matt Lincol","nprByline":"Natalie Jacewicz","nprImageAgency":"Getty Images/Cultura Exclusive","nprStoryId":"487394411","nprApiLink":"http://api.npr.org/query?id=487394411&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/07/27/487394411/as-opioid-epidemic-surges-medical-schools-must-change-to-keep-pace?ft=nprml&f=487394411","nprRetrievedStory":"1","nprPubDate":"Wed, 27 Jul 2016 05:00:00 -0400","nprStoryDate":"Wed, 27 Jul 2016 05:00:13 -0400","nprLastModifiedDate":"Wed, 27 Jul 2016 05:00:13 -0400","path":"/stateofhealth/217466/more-addiction-training-at-stanford-med-school-as-opioid-epidemic-surges","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Jonathan Goodman can recall most of the lectures he's attended at the Stanford University School of Medicine. He can recite detailed instructions given more than a year ago about how to conduct a physical.\u003c/p>\n\u003caside class=\"pullquote alignright\">Stanford's medical school may offer an example of what change in teaching about addiction can look like.\u003c/aside>\n\u003cp>But at the end of his second year, the 27-year-old M.D.-Ph.D. student could not remember any class dedicated to addiction medicine. Then he recalled skipping class months earlier. Reviewing his syllabus, he realized he had missed the sole lecture dedicated to that topic.\u003c/p>\n\u003cp>\"I wasn't tested on it,\" Goodman says, with a note of surprise.\u003c/p>\n\u003cp>Americans are \u003ca href=\"http://www.npr.org/sections/health-shots/2016/06/01/479440834/in-opioid-crisis-it-s-important-to-know-which-drugs-caused-a-death\" target=\"_blank\">overdosing on opioids\u003c/a> such as heroin and prescribed painkillers at epidemic rates, and the nation's doctors appear to be inadequately prepared to help.\u003c/p>\n\u003cp>The problem begins in medical school.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A \u003ca href=\"http://www.centeronaddiction.org/addiction-research/reports/addiction-medicine\" target=\"_blank\">report\u003c/a> in 2012 by The National Center on Addiction and Substance Abuse revealed that medical schools devoted little time to teaching addiction medicine — only a few hours over the course of four years. Since then, the number of Americans overdosing from prescribed opioids has surpassed \u003ca href=\"http://www.cdc.gov/drugoverdose/data/overdose.html\" target=\"_blank\">14,000 per year\u003c/a>, quadrupling from 1999 to 2014.\u003c/p>\n\u003cp>But Stanford's medical school may offer an example of what faculty-driven change in teaching about addiction can look like.\u003c/p>\n\u003cp>The school began retooling its curriculum after the director of its addiction medicine fellowship, \u003ca href=\"https://med.stanford.edu/profiles/anna-lembke\" target=\"_blank\">Dr. Anna Lembke\u003c/a>, expressed concern about its meager offerings in that field.\u003c/p>\n\u003cp>Lectures on addiction will no longer be folded into the psychiatry series as a side note, but instead will be presented as a separate unit relevant to future doctors in any subspecialty, Lembke says. And that training will continue when the students leave the classrooms for clinical rotations.\u003c/p>\n\u003cp>\"We're at the very bottom of a very long uphill road,\" says Lembke, who gave the lecture Goodman missed.\u003c/p>\n\u003cp>Medical faculties have traditionally eschewed teaching the subject, in part because many physicians viewed addiction as a personal vice rather than a disease. And, even now, some doctors who specialize in addiction treatment are skeptical that the best care for the problem comes out of a medical model.\u003c/p>\n\u003cp>For example, \u003ca href=\"https://www.youtube.com/watch?v=0Ueb-7ZxltQ\" target=\"_blank\">Dr. Joe Gerstein\u003c/a>, a retired internist and clinical assistant professor at Harvard Medical School, is founding president of \u003ca href=\"http://www.smartrecovery.org/intro/\" target=\"_blank\">SMART Recovery\u003c/a>, an international program that emphasizes cognitive behavioral therapy and positive thinking to help people beat their drug habit.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\"Clearly, if you've got an addiction, you've been making a lot of bad choices,\" says Gerstein. Framing substance abuse strictly as a disease ignores the fact that some people are able to quit their use of a drug with willpower, he says.\u003c/p>\n\u003cp>Still, those who believe in the value of medical treatment for addiction say it can no longer be an afterthought in medical education. Because the current opioid epidemic is largely linked to prescribed opioid painkillers, many doctors are being forced to grapple with addicted patients in their practices. In March, the American Board of Medical Specialties \u003ca href=\"http://www.abms.org/news-events/abms-officially-recognizes-addiction-medicine-as-a-subspecialty/\">officially recognized\u003c/a> addiction medicine as a subspecialty.\u003c/p>\n\u003cp>In a March \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20R/PDF%20RecoveryReachMAT.pdf\" target=\"_blank\">report\u003c/a>, the California Health Care Foundation cited inadequate medical school training as one of the challenges in treating patients addicted to opioids.\u003c/p>\n\u003cp>The White House has also been pressuring medical schools to improve instruction on opioid addiction by issuing pledges for schools to sign, promising to change their curricula. But as recently as April, Lembke hadn't yet heard of any concrete plans to change Stanford's curriculum.\u003c/p>\n\u003cp>In late spring, however, she was asked to meet with the dean of the medical school about bolstering education in addiction medicine. Working with fellow faculty members, Lembke is now expanding addiction medicine beyond the lone talk she gives on opioids each year to a series of lectures that recommend and teach alternative treatments for pain, like acupuncture or massage.\u003c/p>\n\u003cp>Lembke will also seek an endorsement of her fellowship program by the Accreditation Council of Graduate Medical Education. Accreditation can help programs get additional funding.\u003c/p>\n\u003cp>One of Lembke's Stanford colleagues, \u003ca href=\"https://med.stanford.edu/profiles/jordan-newmark\" target=\"_blank\">Dr. Jordan Newmark\u003c/a>, who directs education in medical school's pain division, is seeking to increase medical students' training on opioids in their third and fourth years. His plans for clinical training sessions include having actors portray patients with opioid addictions.\u003c/p>\n\u003cp>The next hurdle is to recruit doctors to specialize in addiction medicine, says \u003ca href=\"http://www.centeronaddiction.org/about/staff-biographies\" target=\"_blank\">Emily Feinstein\u003c/a>, director of health law and policy at the National Center on Addiction and Substance Abuse.\u003c/p>\n\u003cp>Among the challenges in getting young doctors interested in the field, Feinstein says, are low insurance reimbursement rates and having to deal with patients who can be difficult behaviorally because of their drug use.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It's best to reach doctors at the start of their careers, Lembke says — before they've established a practice and get set in their ways.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=As+Opioid+Epidemic+Surges%2C+Medical+Schools+Must+Change+To+Keep+Pace&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/217466/more-addiction-training-at-stanford-med-school-as-opioid-epidemic-surges","authors":["byline_stateofhealth_217466"],"categories":["stateofhealth_2746"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_2616","stateofhealth_2519"],"featImg":"stateofhealth_217467","label":"stateofhealth"},"stateofhealth_212218":{"type":"posts","id":"stateofhealth_212218","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"212218","score":null,"sort":[1468432153000]},"guestAuthors":[],"slug":"addiction-reframed-as-health-problem-not-a-crime-in-u-s-senate-bill","title":"Addiction Reframed as Health Problem, Not a Crime, in U.S. Senate Bill","publishDate":1468432153,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>The Senate is set to approve a bill intended to change the way police and health care workers treat people struggling with opioid addictions.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.congress.gov/bill/114th-congress/senate-bill/524/text\">bill\u003c/a> is an amalgam of \u003ca href=\"https://www.washingtonpost.com/news/powerpost/wp/2016/05/13/house-passes-opioid-bills-setting-up-negotiations-with-the-senate/\" target=\"_blank\">more than a dozen proposals\u003c/a> passed through the year in the House and Senate. And while it has lots of new policies and provisions — from creating a task force to study how best to treat pain, to encouraging states to create \u003ca href=\"http://www.cdc.gov/drugoverdose/pdmp/\">prescription drug monitoring programs \u003c/a>— it doesn't have much money to put them in place.\u003c/p>\n\u003cp>President Obama had requested $1.1 billion to help pay for more addiction treatment programs and other initiatives. But the version agreed to by House and Senate Republicans last week didn't include all that money. In the end, it will probably get about half that much.\u003c/p>\n\u003cp>\"It's clear that efforts to prevent and treat the opioid epidemic will fall short without additional investments,\" Sen. \u003ca href=\"http://www.murray.senate.gov/public/\">Patty Murray\u003c/a>, D-Washington, said in a statement after House and Senate negotiators hammered out the final bill.\u003c/p>\n\u003cp>But \u003ca href=\"http://www.alexander.senate.gov/public/\" target=\"_blank\">Sen. Lamar Alexander\u003c/a>, R-Tenn., argued that the money for treatment has been rising for three years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Our friends on the other side say, you have to fund it. We are funding it,\" he said in a statement on the Senate floor Friday. \"And they helped fund it. We've increased funding for opioids already by 542 percent.\"\u003c/p>\n\u003cp>Still, Democrats are expected to support the bill even without the additional money.\u003c/p>\n\u003cp>And that's a good thing, says \u003ca href=\"http://www.thenationalcouncil.org/about/national-mental-health-association/executives/\">Linda Rosenberg\u003c/a>, president of the National Council for Behavioral Health, because the bill helps expand treatment in significant ways.\u003c/p>\n\u003cp>For example, it allows nurses and physician assistants to treat people with addictions using medications, which is considered the evidence-based standard.\u003c/p>\n\u003cp>\"Treatment capacity is really a crisis. There just isn't enough,\" Rosenberg tells Shots. \"But what this bill does to address that — it expands the kinds of people who can prescribe medications for addictions. And that's a very big deal.\"\u003c/p>\n\u003cp>She says that provision alone can help because nonprofit treatment centers will be able to use nurse practitioners and physician assistants rather than trying to hire doctors, who are both scarce and expensive.\u003c/p>\n\u003cp>The bill also allows the Department of Health and Human Services to give grants to states and community organizations for improving or expanding treatment and recovery programs. It has several provisions that would allow police departments to send people with addiction problems to treatment rather than to jail.\u003c/p>\n\u003cp>In one of the few areas of the bill that includes funding, lawmakers authorized the Department of Justice to spend $100 million a year for five years to find alternatives to jail for opioid abusers, and to allow prisons to use methadone or buprenorphine to treat inmates with opioid addictions.\u003c/p>\n\u003cp>Rosenberg says these measures help change the definition of addiction from a crime to a health problem.\u003c/p>\n\u003cp>\"It's a health care issue and not a moral failing issue,\" she says. That's a big reversal from the \"war on drugs\" campaigns of a few decades ago.\u003c/p>\n\u003cp>And the legislation allows more people to have access to \u003ca href=\"https://medlineplus.gov/druginfo/meds/a612022.html\">naloxone,\u003c/a> the drug that can reverse an opioid overdose, reducing the risk of death. Access would be expanded for people working in schools and community centers.\u003c/p>\n\u003cp>The bill encourage pharmacies to fill standing orders for the drug so that those likely to come in contact with someone suffering an overdose will have the drug on hand, according to Mike Kelly. He is the U.S. president of \u003ca href=\"http://adaptpharma.com/\">Adapt Pharma\u003c/a>, which sells \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm473505.htm\">Narcan\u003c/a>, a nasal spray version of naloxone.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"This bill addresses getting Narcan out into the community, outside of emergency and first responders,\" Kelly says. \"The big thing here is this will fund recovery.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Opioid+Bill+Reframes+Addiction+As+A+Health+Problem%2C+Not+A+Crime&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The bill will expand access to medication-assisted treatment. It also will encourage police to send drug users to treatment rather than to jail.","status":"publish","parent":0,"modified":1468432202,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":20,"wordCount":639},"headData":{"title":"Addiction Reframed as Health Problem, Not a Crime, in U.S. Senate Bill | KQED","description":"The bill will expand access to medication-assisted treatment. It also will encourage police to send drug users to treatment rather than to jail.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Addiction Reframed as Health Problem, Not a Crime, in U.S. Senate Bill","datePublished":"2016-07-13T17:49:13.000Z","dateModified":"2016-07-13T17:50:02.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"212218 http://ww2.kqed.org/stateofhealth/?p=212218","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/13/addiction-reframed-as-health-problem-not-a-crime-in-u-s-senate-bill/","disqusTitle":"Addiction Reframed as Health Problem, Not a Crime, in U.S. Senate Bill","nprImageCredit":"Al Drago","nprByline":"Alison Kodjak\u003cbr />\u003ca href=\"http://www.npr.org/sections/health-shots/\">NPR Shots\u003c/a>","nprImageAgency":"CQ-Roll Call Inc.","nprStoryId":"485818449","nprApiLink":"http://api.npr.org/query?id=485818449&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/07/13/485818449/opioid-bill-reframes-addiction-as-a-health-problem-not-a-crime?ft=nprml&f=485818449","nprRetrievedStory":"1","nprPubDate":"Wed, 13 Jul 2016 12:33:00 -0400","nprStoryDate":"Wed, 13 Jul 2016 10:51:00 -0400","nprLastModifiedDate":"Wed, 13 Jul 2016 12:33:38 -0400","path":"/stateofhealth/212218/addiction-reframed-as-health-problem-not-a-crime-in-u-s-senate-bill","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate is set to approve a bill intended to change the way police and health care workers treat people struggling with opioid addictions.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.congress.gov/bill/114th-congress/senate-bill/524/text\">bill\u003c/a> is an amalgam of \u003ca href=\"https://www.washingtonpost.com/news/powerpost/wp/2016/05/13/house-passes-opioid-bills-setting-up-negotiations-with-the-senate/\" target=\"_blank\">more than a dozen proposals\u003c/a> passed through the year in the House and Senate. And while it has lots of new policies and provisions — from creating a task force to study how best to treat pain, to encouraging states to create \u003ca href=\"http://www.cdc.gov/drugoverdose/pdmp/\">prescription drug monitoring programs \u003c/a>— it doesn't have much money to put them in place.\u003c/p>\n\u003cp>President Obama had requested $1.1 billion to help pay for more addiction treatment programs and other initiatives. But the version agreed to by House and Senate Republicans last week didn't include all that money. In the end, it will probably get about half that much.\u003c/p>\n\u003cp>\"It's clear that efforts to prevent and treat the opioid epidemic will fall short without additional investments,\" Sen. \u003ca href=\"http://www.murray.senate.gov/public/\">Patty Murray\u003c/a>, D-Washington, said in a statement after House and Senate negotiators hammered out the final bill.\u003c/p>\n\u003cp>But \u003ca href=\"http://www.alexander.senate.gov/public/\" target=\"_blank\">Sen. Lamar Alexander\u003c/a>, R-Tenn., argued that the money for treatment has been rising for three years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Our friends on the other side say, you have to fund it. We are funding it,\" he said in a statement on the Senate floor Friday. \"And they helped fund it. We've increased funding for opioids already by 542 percent.\"\u003c/p>\n\u003cp>Still, Democrats are expected to support the bill even without the additional money.\u003c/p>\n\u003cp>And that's a good thing, says \u003ca href=\"http://www.thenationalcouncil.org/about/national-mental-health-association/executives/\">Linda Rosenberg\u003c/a>, president of the National Council for Behavioral Health, because the bill helps expand treatment in significant ways.\u003c/p>\n\u003cp>For example, it allows nurses and physician assistants to treat people with addictions using medications, which is considered the evidence-based standard.\u003c/p>\n\u003cp>\"Treatment capacity is really a crisis. There just isn't enough,\" Rosenberg tells Shots. \"But what this bill does to address that — it expands the kinds of people who can prescribe medications for addictions. And that's a very big deal.\"\u003c/p>\n\u003cp>She says that provision alone can help because nonprofit treatment centers will be able to use nurse practitioners and physician assistants rather than trying to hire doctors, who are both scarce and expensive.\u003c/p>\n\u003cp>The bill also allows the Department of Health and Human Services to give grants to states and community organizations for improving or expanding treatment and recovery programs. It has several provisions that would allow police departments to send people with addiction problems to treatment rather than to jail.\u003c/p>\n\u003cp>In one of the few areas of the bill that includes funding, lawmakers authorized the Department of Justice to spend $100 million a year for five years to find alternatives to jail for opioid abusers, and to allow prisons to use methadone or buprenorphine to treat inmates with opioid addictions.\u003c/p>\n\u003cp>Rosenberg says these measures help change the definition of addiction from a crime to a health problem.\u003c/p>\n\u003cp>\"It's a health care issue and not a moral failing issue,\" she says. That's a big reversal from the \"war on drugs\" campaigns of a few decades ago.\u003c/p>\n\u003cp>And the legislation allows more people to have access to \u003ca href=\"https://medlineplus.gov/druginfo/meds/a612022.html\">naloxone,\u003c/a> the drug that can reverse an opioid overdose, reducing the risk of death. Access would be expanded for people working in schools and community centers.\u003c/p>\n\u003cp>The bill encourage pharmacies to fill standing orders for the drug so that those likely to come in contact with someone suffering an overdose will have the drug on hand, according to Mike Kelly. He is the U.S. president of \u003ca href=\"http://adaptpharma.com/\">Adapt Pharma\u003c/a>, which sells \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm473505.htm\">Narcan\u003c/a>, a nasal spray version of naloxone.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"This bill addresses getting Narcan out into the community, outside of emergency and first responders,\" Kelly says. \"The big thing here is this will fund recovery.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Opioid+Bill+Reframes+Addiction+As+A+Health+Problem%2C+Not+A+Crime&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/212218/addiction-reframed-as-health-problem-not-a-crime-in-u-s-senate-bill","authors":["byline_stateofhealth_212218"],"categories":["stateofhealth_11","stateofhealth_13"],"tags":["stateofhealth_643","stateofhealth_68","stateofhealth_2656"],"featImg":"stateofhealth_212219","label":"stateofhealth"},"stateofhealth_211809":{"type":"posts","id":"stateofhealth_211809","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"211809","score":null,"sort":[1468346198000]},"guestAuthors":[],"slug":"san-diegos-methamphetamine-problem-strains-criminal-justice-system","title":"San Diego's Methamphetamine Problem Strains Criminal Justice System","publishDate":1468346198,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Jose Escobedo got his first taste of methamphetamine when he was 11-years-old.\u003c/p>\n\u003cp>“I was offered a smoke,\" he says. \"I was just trying to fit in with these guys, and I take the first hit of smoke off some aluminum, and once I did that, it ... took me to another world.”\u003c/p>\n\u003cp>For Escobedo, that one hit was all it took.\u003c/p>\n\u003cp>“It boosted me up, and I felt ... like I was stronger, faster,\" Escobedo says. \"Then I started hallucinating, seeing things.”\u003c/p>\n\u003cp>Escobedo moved in with a dealer. In exchange for running drugs, Escobedo had a non-stop supply of meth at his fingertips.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I would just stay drugged out, I mean for weeks, weeks. And I would sleep for a week straight. ... I was smoking drugs. Smoking, smoking, smoking.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/273347823\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Eventually, Escobedo began committing crimes to support his habit. He was sent to prison four times.\u003c/p>\n\u003cp>When Escobedo first started using more than 20 years ago, most of the meth in San Diego County came from makeshift labs. Many of them were in East County.\u003c/p>\n\u003cp>These days, it’s different.\u003c/p>\n\u003cp>The methamphetamine on San Diego's streets today is largely produced in \u003ca href=\"http://news.sky.com/story/1515628/inside-mexicos-infamous-meth-super-labs\" target=\"_blank\">Mexican super labs\u003c/a> controlled by drug cartels.\u003c/p>\n\u003cfigure id=\"attachment_211827\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-211827\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM.png\" alt=\"The San Ysidro Port of Entry is the busiest land border crossing in the western hemisphere, with 50,000 vehicles and 25,000 pedestrians crossing from Mexico into the U.S. every day. \" width=\"770\" height=\"442\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM.png 770w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM-400x230.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM-768x441.png 768w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">The San Ysidro Port of Entry is the busiest land border crossing in the western hemisphere, with 50,000 vehicles and 25,000 pedestrians crossing from Mexico into the U.S. every day. \u003ccite>( Nicholas McVicker/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A lot of it is smuggled through the San Ysidro border crossing -- the busiest in the western hemisphere -- where an estimated 50,000 vehicles and 25,000 pedestrians cross every day from Mexico into the U.S.\u003c/p>\n\u003cp>Sidney Aki, director of \u003ca href=\"https://www.cbp.gov/\" target=\"_blank\">U.S. Customs and Border Protection\u003c/a> at the San Ysidro Port of Entry, said his agents have found meth hidden in virtually every part of a vehicle, from the trunk to the battery. They’ve even discovered liquid meth in gas tanks.\u003c/p>\n\u003cp>And pedestrians?\u003c/p>\n\u003cp>One woman, Aki recalls, \"had a brassiere formed out of narcotics, and actually used as a brassiere, walking across our border.”\u003c/p>\n\u003cp>\u003cstrong>Meth Seizures Up at the Border\u003c/strong>\u003c/p>\n\u003cp>In 2010, customs agents seized roughly 2,500 kilos of meth at the San Ysidro border crossing.\u003c/p>\n\u003cp>In 2014, they confiscated more than double that amount -- 5,800 kilos.\u003c/p>\n\u003cp>One hit of meth is about a quarter of a gram — 5,800 kilos equals 5.8 million hits.\u003c/p>\n\u003cp>That’s how much was confiscated. Nobody knows how much is actually getting in.\u003c/p>\n\u003cp>What's worse is the methamphetamine that’s coming across from Mexico is stronger than ever, and the price on the street is lower than ever. That leads to more meth use and more meth-related problems.\u003c/p>\n\u003cp>\u003cstrong>Meth Users Filling Jail Cells\u003c/strong>\u003c/p>\n\u003cp>Meth users also are taking up a lot of space in the county's jails.\u003c/p>\n\u003cp>According to the \u003ca href=\"http://www.sandag.org/uploads/publicationid/publicationid_1977_19736.pdf\" target=\"_blank\">San Diego Association of Governments\u003c/a> (SANDAG), of the people arrested and jailed in the county in 2014, 53 percent of the women and 40 percent of the men tested positive for meth.\u003c/p>\n\u003cp>“We find that on average, arrestees report that they’ve been using meth for about 16 years,\" Burke said. \"We know that they use it for an average of five days at a time, that they’re using a gram. Many of them smoke it. About one in four report that they’ve injected it.”\u003c/p>\n\u003cfigure id=\"attachment_211828\" class=\"wp-caption aligncenter\" style=\"max-width: 615px\">\u003cimg class=\"size-full wp-image-211828\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.42.03-AM.png\" alt=\"*A positive opiate drug test could indicate use of opiates other than heroin, including morphine, hydrocodone, hydromorphone and Codeine. Source: 2014 Adult Arrestee Drug Use in the San Diego Region from SANDAG \" width=\"615\" height=\"170\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.42.03-AM.png 615w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.42.03-AM-400x111.png 400w\" sizes=\"(max-width: 615px) 100vw, 615px\">\u003cfigcaption class=\"wp-caption-text\">*A positive opiate drug test could indicate use of opiates other than heroin, including morphine, hydrocodone, hydromorphone and Codeine. Source: 2014 Adult Arrestee Drug Use in the San Diego Region from SANDAG\u003c/figcaption>\u003c/figure>\n\u003cp>Besides U.S. Customs and Border Protection, other law enforcement agencies involved in the fight against meth include the San Diego County Sheriff’s Department, the county District Attorney's Office and the U.S. Justice Department.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.justice.gov/usao-sdca/meet-us-attorney\" target=\"_blank\">Laura Duffy\u003c/a>, San Diego's U.S. attorney, said others also need to step up.\u003c/p>\n\u003cp>“We are not going to be able to tackle this problem through law enforcement efforts alone,\" Duffy said. \"This is a community problem. This is a health epidemic problem that we all need to come together and put resources towards.”\u003c/p>\n\u003cp>\u003cstrong>Drug Court\u003c/strong>\u003c/p>\n\u003cp>Escobedo, the recovering meth addict, has one thing to show for his more than 20 years of using the drug: a rap sheet, which includes charges of assault with a deadly weapon, DUI, hit and run, burglary.\u003c/p>\n\u003cp>His latest arrest came in January 2014 when he was on parole.\u003c/p>\n\u003cp>The prosecutor on his case gave him a choice: go back to prison for 12 years or try to kick his habit through the county's Drug Court.\u003c/p>\n\u003cp>So Escobedo gave \u003ca href=\"http://www.sdcourt.ca.gov/portal/page?_pageid=55,1643578&_dad=portal\" target=\"_blank\">Drug Court\u003c/a> a shot.\u003c/p>\n\u003cp>[contextly_sidebar id=\"1USwXcMD0UiVMCJfrlMJbWL2ck2P4SP4\"]In March, Escobedo attended the court's 12-step meeting with other hard-core meth addicts. All of the men had criminal records. As part of the recovery process, they’re encouraged to be brutally honest about their addiction.\u003c/p>\n\u003cp>“My addiction is to heroin and methamphetamine,\" one man with heavily tattooed arms said.\u003c/p>\n\u003cp>“My focus was getting high, my focus was being around people who are getting high,\" another addict said.\u003c/p>\n\u003cp>After the men shared their stories, Arturo Molina, the lead substance abuse counselor in the Chula Vista Drug Court, weighed in.\u003c/p>\n\u003cp>“In Drug Court you want to learn how to live life without using drugs,\" he told the men. \"But not only that, OK? Drug Court is like a new way of life.”\u003c/p>\n\u003cp>Daniel Stone, the program manager at the Chula Vista court, said it's a different approach to getting people off of drugs.\u003c/p>\n\u003cp>“The concept of the Drug Court programs is a collaborative, team approach that involves a San Diego Superior Court judge, district attorney, public defender, and case management and treatment team, and law enforcement,\" Stone said.\u003c/p>\n\u003cfigure id=\"attachment_211830\" class=\"wp-caption aligncenter\" style=\"max-width: 798px\">\u003ca href=\"Members%20of%20the%20Drug%20Court%20program%20participate%20in%20a%2012-step%20meeting\">\u003cimg class=\"size-full wp-image-211830\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM.png\" alt=\"Members of the Drug Court program participate in a 12-step meeting.\" width=\"798\" height=\"437\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM.png 798w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM-400x219.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM-768x421.png 768w\" sizes=\"(max-width: 798px) 100vw, 798px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Members of the Drug Court program participate in a 12-step meeting. \u003ccite>(Nicholas McVicker/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>People convicted of non-violent drug offenses are eligible for Drug Court. There are four of the courts in San Diego County, and more than 1,600 nationwide.\u003c/p>\n\u003cp>Addicts go through 18 months of hard work and constant supervision.\u003c/p>\n\u003cp>They’re required to go to 12-step meetings five days a week, get individual counseling and get a job. They’re frequently drug tested.\u003c/p>\n\u003cp>And if they test positive? They go to jail.\u003c/p>\n\u003cp>The length of their jail stay “depends on how many times it’s happened,\" Stone said. \"Sometimes it’s a weekend. Sometimes it’s three weeks.”\u003c/p>\n\u003cp>If they screw up enough times, addicts have to serve their original sentence.\u003c/p>\n\u003cp>County officials say 90 percent of Drug Court graduates remain arrest-free two years after completing the program.\u003c/p>\n\u003cp>Escobedo said Drug Court has given him the tools and support to clean up his act. He said there were \"a lot of things I needed to do.\"\u003c/p>\n\u003cp>\"You can’t be in denial,\" Escobedo says. \"You can’t fight the program. You can’t cheat the program, because you’re not actually cheating the program. You’re cheating yourself.”\u003c/p>\n\u003cp>\u003cstrong>Drug Court Graduation\u003c/strong>\u003c/p>\n\u003cp>The Chula Vista Library auditorium is packed for graduation night for nine Drug Court participants. The court's judge welcomes each graduate to the stage.\u003c/p>\n\u003cp>The crowd of family members cheered loudly.\u003c/p>\n\u003cfigure id=\"attachment_211831\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-211831\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.51.51-AM-400x223.png\" alt=\"Jose Escobedo speaks at the Drug Court graduation ceremony in Chula Vista. \" width=\"400\" height=\"223\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.51.51-AM-400x223.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.51.51-AM.png 693w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Jose Escobedo speaks at the Drug Court graduation ceremony in Chula Vista. \u003ccite>(Matthew Bowler)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Some of the graduates cried, incredulous that they actually made it through the program.\u003c/p>\n\u003cp>Then Escobedo took the stage and talked about success. For the first time since he was a boy he’s gone 18 months completely clean and sober.\u003c/p>\n\u003cp>“I have my family here as a witness. I hurt them a lot,\" Escobedo said. \"I plan on staying clean and doing what I gotta do to stay clean, and just keep making them happy. They’re all here: my wife, my kids, ma, my sister Erica, Israel.\"\u003c/p>\n\u003cp>In his closing remarks, Escobedo talked about a new way of life.\u003c/p>\n\u003cp>“I’m happy with everybody who’s in the program. I was able to interact with a lot of people, you know what I mean, and make clean friends,\" he said. \"And it’s something different than going back to the old people, neighborhood, old ways, old ways of thinking. It’s a new way of life, and I plan on staying, and I will be staying clean. And I thank you guys all.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Amid thundering applause, Escobedo walked off the the stage with a big smile on his face.\u003c/p>\n\n","blocks":[],"excerpt":"Of people arrested and jailed in San Diego County in 2014, 53 percent of women and 40 percent of men tested positive for meth.","status":"publish","parent":0,"modified":1468349025,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":60,"wordCount":1493},"headData":{"title":"San Diego's Methamphetamine Problem Strains Criminal Justice System | KQED","description":"Of people arrested and jailed in San Diego County in 2014, 53 percent of women and 40 percent of men tested positive for meth.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"San Diego's Methamphetamine Problem Strains Criminal Justice System","datePublished":"2016-07-12T17:56:38.000Z","dateModified":"2016-07-12T18:43:45.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"211809 http://ww2.kqed.org/stateofhealth/?p=211809","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/12/san-diegos-methamphetamine-problem-strains-criminal-justice-system/","disqusTitle":"San Diego's Methamphetamine Problem Strains Criminal Justice System","nprByline":"Kenny Goldberg\u003cbr />\u003ca href=\"http://www.kpbs.org/news/2016/jun/27/san-diego-addicted-meth/#\">KPBS\u003c/a>","path":"/stateofhealth/211809/san-diegos-methamphetamine-problem-strains-criminal-justice-system","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Jose Escobedo got his first taste of methamphetamine when he was 11-years-old.\u003c/p>\n\u003cp>“I was offered a smoke,\" he says. \"I was just trying to fit in with these guys, and I take the first hit of smoke off some aluminum, and once I did that, it ... took me to another world.”\u003c/p>\n\u003cp>For Escobedo, that one hit was all it took.\u003c/p>\n\u003cp>“It boosted me up, and I felt ... like I was stronger, faster,\" Escobedo says. \"Then I started hallucinating, seeing things.”\u003c/p>\n\u003cp>Escobedo moved in with a dealer. In exchange for running drugs, Escobedo had a non-stop supply of meth at his fingertips.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I would just stay drugged out, I mean for weeks, weeks. And I would sleep for a week straight. ... I was smoking drugs. Smoking, smoking, smoking.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/273347823&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/273347823'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Eventually, Escobedo began committing crimes to support his habit. He was sent to prison four times.\u003c/p>\n\u003cp>When Escobedo first started using more than 20 years ago, most of the meth in San Diego County came from makeshift labs. Many of them were in East County.\u003c/p>\n\u003cp>These days, it’s different.\u003c/p>\n\u003cp>The methamphetamine on San Diego's streets today is largely produced in \u003ca href=\"http://news.sky.com/story/1515628/inside-mexicos-infamous-meth-super-labs\" target=\"_blank\">Mexican super labs\u003c/a> controlled by drug cartels.\u003c/p>\n\u003cfigure id=\"attachment_211827\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-211827\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM.png\" alt=\"The San Ysidro Port of Entry is the busiest land border crossing in the western hemisphere, with 50,000 vehicles and 25,000 pedestrians crossing from Mexico into the U.S. every day. \" width=\"770\" height=\"442\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM.png 770w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM-400x230.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM-768x441.png 768w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">The San Ysidro Port of Entry is the busiest land border crossing in the western hemisphere, with 50,000 vehicles and 25,000 pedestrians crossing from Mexico into the U.S. every day. \u003ccite>( Nicholas McVicker/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A lot of it is smuggled through the San Ysidro border crossing -- the busiest in the western hemisphere -- where an estimated 50,000 vehicles and 25,000 pedestrians cross every day from Mexico into the U.S.\u003c/p>\n\u003cp>Sidney Aki, director of \u003ca href=\"https://www.cbp.gov/\" target=\"_blank\">U.S. Customs and Border Protection\u003c/a> at the San Ysidro Port of Entry, said his agents have found meth hidden in virtually every part of a vehicle, from the trunk to the battery. They’ve even discovered liquid meth in gas tanks.\u003c/p>\n\u003cp>And pedestrians?\u003c/p>\n\u003cp>One woman, Aki recalls, \"had a brassiere formed out of narcotics, and actually used as a brassiere, walking across our border.”\u003c/p>\n\u003cp>\u003cstrong>Meth Seizures Up at the Border\u003c/strong>\u003c/p>\n\u003cp>In 2010, customs agents seized roughly 2,500 kilos of meth at the San Ysidro border crossing.\u003c/p>\n\u003cp>In 2014, they confiscated more than double that amount -- 5,800 kilos.\u003c/p>\n\u003cp>One hit of meth is about a quarter of a gram — 5,800 kilos equals 5.8 million hits.\u003c/p>\n\u003cp>That’s how much was confiscated. Nobody knows how much is actually getting in.\u003c/p>\n\u003cp>What's worse is the methamphetamine that’s coming across from Mexico is stronger than ever, and the price on the street is lower than ever. That leads to more meth use and more meth-related problems.\u003c/p>\n\u003cp>\u003cstrong>Meth Users Filling Jail Cells\u003c/strong>\u003c/p>\n\u003cp>Meth users also are taking up a lot of space in the county's jails.\u003c/p>\n\u003cp>According to the \u003ca href=\"http://www.sandag.org/uploads/publicationid/publicationid_1977_19736.pdf\" target=\"_blank\">San Diego Association of Governments\u003c/a> (SANDAG), of the people arrested and jailed in the county in 2014, 53 percent of the women and 40 percent of the men tested positive for meth.\u003c/p>\n\u003cp>“We find that on average, arrestees report that they’ve been using meth for about 16 years,\" Burke said. \"We know that they use it for an average of five days at a time, that they’re using a gram. Many of them smoke it. About one in four report that they’ve injected it.”\u003c/p>\n\u003cfigure id=\"attachment_211828\" class=\"wp-caption aligncenter\" style=\"max-width: 615px\">\u003cimg class=\"size-full wp-image-211828\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.42.03-AM.png\" alt=\"*A positive opiate drug test could indicate use of opiates other than heroin, including morphine, hydrocodone, hydromorphone and Codeine. Source: 2014 Adult Arrestee Drug Use in the San Diego Region from SANDAG \" width=\"615\" height=\"170\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.42.03-AM.png 615w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.42.03-AM-400x111.png 400w\" sizes=\"(max-width: 615px) 100vw, 615px\">\u003cfigcaption class=\"wp-caption-text\">*A positive opiate drug test could indicate use of opiates other than heroin, including morphine, hydrocodone, hydromorphone and Codeine. Source: 2014 Adult Arrestee Drug Use in the San Diego Region from SANDAG\u003c/figcaption>\u003c/figure>\n\u003cp>Besides U.S. Customs and Border Protection, other law enforcement agencies involved in the fight against meth include the San Diego County Sheriff’s Department, the county District Attorney's Office and the U.S. Justice Department.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.justice.gov/usao-sdca/meet-us-attorney\" target=\"_blank\">Laura Duffy\u003c/a>, San Diego's U.S. attorney, said others also need to step up.\u003c/p>\n\u003cp>“We are not going to be able to tackle this problem through law enforcement efforts alone,\" Duffy said. \"This is a community problem. This is a health epidemic problem that we all need to come together and put resources towards.”\u003c/p>\n\u003cp>\u003cstrong>Drug Court\u003c/strong>\u003c/p>\n\u003cp>Escobedo, the recovering meth addict, has one thing to show for his more than 20 years of using the drug: a rap sheet, which includes charges of assault with a deadly weapon, DUI, hit and run, burglary.\u003c/p>\n\u003cp>His latest arrest came in January 2014 when he was on parole.\u003c/p>\n\u003cp>The prosecutor on his case gave him a choice: go back to prison for 12 years or try to kick his habit through the county's Drug Court.\u003c/p>\n\u003cp>So Escobedo gave \u003ca href=\"http://www.sdcourt.ca.gov/portal/page?_pageid=55,1643578&_dad=portal\" target=\"_blank\">Drug Court\u003c/a> a shot.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In March, Escobedo attended the court's 12-step meeting with other hard-core meth addicts. All of the men had criminal records. As part of the recovery process, they’re encouraged to be brutally honest about their addiction.\u003c/p>\n\u003cp>“My addiction is to heroin and methamphetamine,\" one man with heavily tattooed arms said.\u003c/p>\n\u003cp>“My focus was getting high, my focus was being around people who are getting high,\" another addict said.\u003c/p>\n\u003cp>After the men shared their stories, Arturo Molina, the lead substance abuse counselor in the Chula Vista Drug Court, weighed in.\u003c/p>\n\u003cp>“In Drug Court you want to learn how to live life without using drugs,\" he told the men. \"But not only that, OK? Drug Court is like a new way of life.”\u003c/p>\n\u003cp>Daniel Stone, the program manager at the Chula Vista court, said it's a different approach to getting people off of drugs.\u003c/p>\n\u003cp>“The concept of the Drug Court programs is a collaborative, team approach that involves a San Diego Superior Court judge, district attorney, public defender, and case management and treatment team, and law enforcement,\" Stone said.\u003c/p>\n\u003cfigure id=\"attachment_211830\" class=\"wp-caption aligncenter\" style=\"max-width: 798px\">\u003ca href=\"Members%20of%20the%20Drug%20Court%20program%20participate%20in%20a%2012-step%20meeting\">\u003cimg class=\"size-full wp-image-211830\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM.png\" alt=\"Members of the Drug Court program participate in a 12-step meeting.\" width=\"798\" height=\"437\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM.png 798w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM-400x219.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM-768x421.png 768w\" sizes=\"(max-width: 798px) 100vw, 798px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Members of the Drug Court program participate in a 12-step meeting. \u003ccite>(Nicholas McVicker/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>People convicted of non-violent drug offenses are eligible for Drug Court. There are four of the courts in San Diego County, and more than 1,600 nationwide.\u003c/p>\n\u003cp>Addicts go through 18 months of hard work and constant supervision.\u003c/p>\n\u003cp>They’re required to go to 12-step meetings five days a week, get individual counseling and get a job. They’re frequently drug tested.\u003c/p>\n\u003cp>And if they test positive? They go to jail.\u003c/p>\n\u003cp>The length of their jail stay “depends on how many times it’s happened,\" Stone said. \"Sometimes it’s a weekend. Sometimes it’s three weeks.”\u003c/p>\n\u003cp>If they screw up enough times, addicts have to serve their original sentence.\u003c/p>\n\u003cp>County officials say 90 percent of Drug Court graduates remain arrest-free two years after completing the program.\u003c/p>\n\u003cp>Escobedo said Drug Court has given him the tools and support to clean up his act. He said there were \"a lot of things I needed to do.\"\u003c/p>\n\u003cp>\"You can’t be in denial,\" Escobedo says. \"You can’t fight the program. You can’t cheat the program, because you’re not actually cheating the program. You’re cheating yourself.”\u003c/p>\n\u003cp>\u003cstrong>Drug Court Graduation\u003c/strong>\u003c/p>\n\u003cp>The Chula Vista Library auditorium is packed for graduation night for nine Drug Court participants. The court's judge welcomes each graduate to the stage.\u003c/p>\n\u003cp>The crowd of family members cheered loudly.\u003c/p>\n\u003cfigure id=\"attachment_211831\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-211831\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.51.51-AM-400x223.png\" alt=\"Jose Escobedo speaks at the Drug Court graduation ceremony in Chula Vista. \" width=\"400\" height=\"223\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.51.51-AM-400x223.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.51.51-AM.png 693w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Jose Escobedo speaks at the Drug Court graduation ceremony in Chula Vista. \u003ccite>(Matthew Bowler)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Some of the graduates cried, incredulous that they actually made it through the program.\u003c/p>\n\u003cp>Then Escobedo took the stage and talked about success. For the first time since he was a boy he’s gone 18 months completely clean and sober.\u003c/p>\n\u003cp>“I have my family here as a witness. I hurt them a lot,\" Escobedo said. \"I plan on staying clean and doing what I gotta do to stay clean, and just keep making them happy. They’re all here: my wife, my kids, ma, my sister Erica, Israel.\"\u003c/p>\n\u003cp>In his closing remarks, Escobedo talked about a new way of life.\u003c/p>\n\u003cp>“I’m happy with everybody who’s in the program. I was able to interact with a lot of people, you know what I mean, and make clean friends,\" he said. \"And it’s something different than going back to the old people, neighborhood, old ways, old ways of thinking. It’s a new way of life, and I plan on staying, and I will be staying clean. And I thank you guys all.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Amid thundering applause, Escobedo walked off the the stage with a big smile on his face.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/211809/san-diegos-methamphetamine-problem-strains-criminal-justice-system","authors":["byline_stateofhealth_211809"],"categories":["stateofhealth_11"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_2811","stateofhealth_2519"],"featImg":"stateofhealth_211451","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/All-Things-Considered-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Consider-This-Podcast-Tile-703x703-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. 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One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.","airtime":"MON-FRI 7pm-8pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Fresh-Air-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/fresh-air/","meta":{"site":"radio","source":"npr"},"link":"/radio/program/fresh-air","subscribe":{"npr":"https://rpb3r.app.goo.gl/4s8b","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/Fresh-Air-p17/","rss":"https://feeds.npr.org/381444908/podcast.xml"}},"here-and-now":{"id":"here-and-now","title":"Here & Now","info":"A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.","airtime":"MON-THU 11am-12pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Here-And-Now-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"http://www.wbur.org/hereandnow","meta":{"site":"news","source":"npr"},"link":"/radio/program/here-and-now","subsdcribe":{"apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=426698661","tuneIn":"https://tunein.com/radio/Here--Now-p211/","rss":"https://feeds.npr.org/510051/podcast.xml"}},"how-i-built-this":{"id":"how-i-built-this","title":"How I Built This with Guy Raz","info":"Guy Raz dives into the stories behind some of the world's best known companies. 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Download Chris’s Song of the Week plus other highlights from the broadcast. Produced by American Public Media.","airtime":"SAT 6pm-8pm, SUN 11am-1pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Live-From-Here-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.livefromhere.org/","meta":{"site":"arts","source":"american public media"},"link":"/radio/program/live-from-here-highlights","subscribe":{"apple":"https://itunes.apple.com/us/podcast/id1167173941","tuneIn":"https://tunein.com/radio/Live-from-Here-Highlights-p921744/","rss":"https://feeds.publicradio.org/public_feeds/a-prairie-home-companion-highlights/rss/rss"}},"marketplace":{"id":"marketplace","title":"Marketplace","info":"Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. 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