Recovery Michigan

The complexity of the opioid crisis requires medical, legislative, behavioral, educational, and legal changes, and it requires that these changes be made in coordination with each other, at the same time.

States and communities will succeed only if they engage and align all actors to create systems that can prevent new individuals from becoming dependent on opioids, while supporting the recovery of those who already are. Failing to take such an approach will result in burnout among those working individually to improve the current situation and a rate of progress that is too slow to keep up with the velocity of this crisis and the power of opioid addiction.

States are implementing drug courts; narcotics detectives and emergency medical technicians (EMTs) are becoming trusted case managers helping guide individuals to treatment rather than arresting them; and some medical examiners are serving as physician educators when overdoses occur. Again, although these efforts are necessary, they are not sufficient to reverse this crisis.

We have identified six key components to develop a system-wide community solution.

Recognize That Everyone In Your Community Has A Role To Play
Work Together
Work On Multiple Parts Of The System Simultaneously
Be Unambiguous About The Risks Of Prescription Opioids
Re-Train The Medical Community
Recognize That Addiction Is A Chronic Disease, And Treat It Accordingly

I used to think that passive aggressiveness was simply some people’s way of being obnoxious. But while exercising for 40 minutes in my little, confined space, I experienced the cause of a lot of passive aggressiveness: the feeling of powerlessness that grows in the fertile ground between anger and silence.

Passive aggressiveness is an attempt to regain power and relieve the tension created by that gap between anger and silence. People complain to each other. They withdraw, use sarcasm, and resist the person in quiet, insidiously defensible ways.

Dealing with a passive-aggressive person is one thing. But what if it’s you who’s the passive aggressive person?

I ran through a number of ways to respond to Mary. Everything I considered fell into one of four categories.

Results demonstrate that more than 47 percent of female veterans reported symptoms of insomnia that resulted in functional impairment. Of this sample group, less than one percent had a diagnosis of a sleep disorder based on medical records.

"Results from the analysis provide a clinical decision tree identifying subgroups of women with high and low risk for insomnia symptoms," said lead author Kimberly Babson, PhD, Research Health Science Specialist at the National Center for PTSD - Dissemination & Training Division, VA Palo Alto Health Care System. "These results can be used by primary care clinicians to identify women that fit within these subgroups for referral, assessment and intervention of insomnia symptoms in order to decrease risk for the psychological, physical, and psycho-social consequences associated with insomnia."

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended by the Affordable Care Act, requires that group health plans and insurers in the group and individual markets ensure that financial requirements and treatment limitations on mental health and substance use disorder (MH/SUD) benefits are no more restrictive than requirements and limitations imposed on medical and surgical benefits. This prohibition applies both to quantitative (numerical) limitations, like visit limits, and to non-quantitative (NQTL-non-numerical), limitations such as pre-authorization requirements.

On June 1, 2016, the departments of HHS and Labor issued a list of plan provisions identified as “warning signs” that should “trigger careful analysis” to compare terms applied to medical/surgical coverage to determine whether a violation of the MHPAEA might be present. The provisions do not automatically violate the law, as long as they are applied equally to medical/surgical benefits, and the list is not exhaustive. Each term is described in greater detail in the guidance than appears here.

The listed terms include:

• Pre-authorization and pre-service notification requirements, including blanket preauthorization requirements for all MH/SUD services, treatment facility preauthorization requirements not applied to medical/surgical services, or more stringent medical necessity review or prescription drug preauthorization requirements or extensive pre-notification requirements than those applied to medical/surgical services;
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• Fail-first protocols, requiring an individual to fail to achieve progress with a less intensive form of treatment before a more intensive form is covered;
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• Probability of improvement requirements, for example, offering coverage of continuing treatment only if improvement is demonstrated or probable;
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• Written treatment plans, requiring treatment plans completed by specified professionals, within a certain time, or on a regular basis where similar requirements are not applied equally to medical/surgical coverage;
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• Other limits or exclusions, including
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  • Excluding chemical dependency services in event of noncompliance,
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  • Excluding coverage for residential treatment,
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  • Geographical limitations on MH/SUD services not imposed on medical and surgical services, or
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  • Facility licensure requirements not imposed on medical/surgical facilities.

Highlights

Of the trials included in the analysis, 65 percent of them were funded by drug companies, 29 percent were rated as having high risk of bias, 59 percent had moderate risk of bias, and 12 percent had low bias risk.

In 34 of the trials - including 5,260 participants of average age 9-18 years - the researchers identified only one antidepressant, fluoxetine, for which the benefits outweighed the risks when it came to efficacy and tolerability.

Compared with placebos and seven other antidepressants, nortriptyline was found to have lower efficacy.

The antidepressants imipramine, venlafaxine, and duloxetine fared worst when it came to tolerability, the researchers found; there were many more discontinuations with these drugs than with placebos.

Compared with placebos and five other antidepressant medications, venlafaxine was found to increase the risk of suicidal thoughts and attempts.

These results, say the authors, suggest that the vast majority of antidepressants are ineffective for children and adolescents with major depression, and many of them may be unsafe.

When I sought a diagnosis in spring of 2015, there was some magical thinking involved in my expectations for psychological diagnosis and therapy. My goal was to go from being a flailing, falling-apart passing-as-neurotypical person to a thriving autistic person, which I still think is an excellent goal. However, it doesn’t happen by magic and as it turns out my psychotherapist was not the Blue Fairy.

It’s been a gradual, trial-and-error filled journey, but I’m finally getting to a place where I know what kind of supports I need in order to thrive, and can access them. By no means should anyone assume that what works for me will work for them, which I’m sure my readers already understand. But here are some of the supports that have been integral to my ability to cope with ordinary life without feeling like I am overdrawing my energy bank every single day. These things have gotten me out of survival mode and made me feel more like myself again.