Pubdate: Mon, 28 Sep 2015
Source: Cincinnati Enquirer (OH)
Copyright: 2015 The Cincinnati Enquirer
Author: Deirdre Shesgreen


We all know heroin use is an epidemic in our area. But what are our 
local leaders and institutions doing  or not doing  to fight it? This 
year the Enquirer will be focusing on accountability and solutions to 
the region's heroin problems.

WASHINGTON - Shawn Ryan needs Congress to lift the federal cap on the 
number of heroin addicts he can treat, so he and other 
Cincinnati-area physicians don't have to turn away patients desperate 
to stop using.

Charmaine McGuffey needs funding for a medical detox unit, so she and 
other officials at the Hamilton County Jail don't have to rely on flu 
medicine for inmates in severe withdrawal.

Kimberly Wright needs more treatment beds, so she and other Northern 
Kentucky advocates don't have to tell terrified parents there's a 
three-to-six month wait for their sick children.

What is Congress doing to respond to these people on the front lines 
of the heroin epidemic that has Cincinnati in its grip?

None of the above. At least, not yet.

"This is the No. 1 public health epidemic right now, and I've seen 
very little from our leaders in Washington," said Hamilton County 
Commissioner Greg Hartmann.

As heroin use has doubled over the last decade and the fatal overdose 
toll has climbed in every state, Congress and the administration have 
started paying attention. But their response has been slow and 
sometimes counterproductive.

That's partly because the heroin epidemic is a complex problem, 
requiring difficult and sometimes controversial solutions. Treatment 
is expensive, and lawmakers are reluctant to shift limited federal 
dollars from law enforcement to public health programs.

And there's no powerful lobby for addicts, most of whom want to stay 
anonymous and rebuild broken lives, not become a poster child for 
drug policy reform.

"We don't have a pink ribbon," says Stuart Gitlow, past president of 
the American Society of Addiction Medicine and a physician in Rhode 
Island. "There is no nationwide 'Walk for Addiction,' no celebrity 
spokesperson. We're not that kind of disease."

Without that kind of political pull, Gitlow adds, "we often lack the 
ability to get even the most basic legislation passed."

The role that stigma plays in stalling congressional action seems 
obvious to Wright, who started Kentucky Parents Against Heroin after 
her daughter fell into the grip of the drug.

"We get one case of Ebola and everybody's going nuts (in 
Washington)," says the Cold Spring, Ky., mother, who spends most days 
trying to help parents in Northern Kentucky find treatment beds for 
their children. "But we're losing all these kids (to heroin), and 
nobody's doing anything."

Or at least nothing very effective so far.

Lawmakers have convened hearings, issued press releases, and 
introduced a slew of legislative proposals. At least 20 bills aimed 
at curbing opioid and heroin addiction are now pending in Congress.

Ohio's congressional delegation has been at the forefront of the 
legislative push. Republican Sen. Rob Portman is championing a bill 
that would increase funding for prevention and treatment, among other 
steps. And Democratic Sen. Sherrod Brown is pressing legislation that 
would lift the federal cap that limits doctors to treating 100 opioid 
addicts at a time with buprenorphine, which has been proven far more 
effective than detox or abstinence.

Advocates say both bills would make a significant impact on the 
epidemic by expanding access to evidence-based treatment. And the 
federal Health and Human Services Department has moved to sidestep 
Congress in lifting the buprenorphine cap, saying it will issue a new 
rules for that medication, though that could be a long and contentious process.

"I'm excited to see significant movement from multiple political 
forces in the right direction," said Ryan, an addiction expert at 
BrightView Health and an emergency room physician at the University 
of Cincinnati. "What I would love to see is meaningful action and 
delivery of financial support that results in true expansion of 
treatment access."

Ryan said he understands the issue is a tough sell politically, and 
there's not a lot of public support for spending money on patients 
with drug addiction.

"It's almost easier to avoid it than to address it," he said, except 
that "people are dying every day in every major city and we need 
(action) yesterday."

In the meantime, Congress has continued to pour money into 
interdiction and enforcement, even though experts say incarceration 
is not an effective solution to the heroin crisis. They say the 
buprenorphine limit has fueled a crisis in treatment access, and 
lawmakers have avoided big solutions in favor of legislative tweaks 
that make little or no difference.

"It's quite often one step forward and two steps back," said Michael 
Collins, policy manager at the Drug Policy Alliance, an advocacy group.

Take, for example, the White House's latest initiative targeting the 
surge in heroin trafficking. Unveiled last month, White House 
officials said the effort would channel $5 million to combating 
trafficking, distribution and use of heroin, and would foster new 
partnerships between police and health policy experts to better track 
the flow of heroin.

The announcement was met with a shrug in Cincinnati.

"That kind of funding level is almost insulting to the crisis we 
face," said Hartmann. It will accomplish "little to nothing."

Dr. Mina Kalfas, an addiction expert and family physician in Northern 
Kentucky, said the White House plan recalls policymakers' approach to 
another drug scourge: abuse of prescription drugs such as OxyContin 
and Vicodin. As law enforcement cracked down on the availability of 
those powerful opioids, they became more expensive -- and heroin 
emerged as a cheaper option.

"We asked law enforcement to get OxcyContin off the streets... and 
they did that very effectively," Kalfas said. "But that created a 
problem because there was not treatment for (prescription drug 
addicts)." Those addicts moved to heroin.

"Now here we are 15 years later," Kalfas said, "and our jails are 
overcrowded, our treatment system is overwhelmed, and we've got a 
bigger problem than we had to start with... The way we've attacked 
this problem from the get-go is 'We'll just lock 'em up until they're 
ready to quit using. We'll punish this away.' The years we have spent 
not treating (addiction) as a disease are coming back to haunt us."
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MAP posted-by: Jay Bergstrom