Monday, September 11, 2017

Here is How Cities Can Deal With Opioid Addiction And Mental Health

http://www.citylab.com; August 22, 2017


Hello Everyone:

 Welcome to a new week on the blog.  A few agenda items before we get going on today's subject-the  option crisis and mental health-First, new week, new hurricane.  Over the weekend, Hurricane Irma landed with a mighty force on the state of Florida.  Florida and Texas are now faced with the overwhelming task of cleaning up and rebuilding the affected areas.  If you would like to donate to hurricane relief, please text 90999 (minimum 10 dollars).  Second, if you are a DACA-recipient, you have until October 5, 2017 to renew your application.  For more information, go to uscis.gov immediately.  Finally, it may be early but the mid-term elections are looming in the horizon and naturally Blogger Candidate Forum will be blogging away.  Remember, if you have not done so already, register to vote.  Check with your state's Secretary of State website.  Thanks and onto opioid crisis and mental health.

The opioid crisis has reached national emergency levels.  Although, Mr. Donald Trump has yet to do anything of substance about, like he promised during the campaign, the cities have begun to take the lead in addressing this matter.  Brentin Mock writes in his CityLab article "What Cities Really Need to Tackle the Opioid and Mental Health," "In November 2015, New York City First Lady Chirlane McCray launched ThriveNYC [thrivenyc.cityofnewyork.us; date accessed Sept. 11, 2017], a comprehensive mental health prevention and treatment program funded by the city..."  The program is responsible for outreach campaigns (http://www.citylab.com; Apr. 19, 2016; date accessed Sept 11, 2017) around New York City with slogans like Anxiety doesn't define me (cdc.theatlantic.com; date accessed Sept. 11, 2017) and available training for 250,000 mental health "First Aid responders" (mentalhealthfirstaid.org; date accessed Sept. 11, 2017) to assist people with mental illness and substance abuse disorders.  So far, so good.  Good enough that Ms. McCray has expanded her campaign to 185 cities, under the banner "Cities Thrive Coalition."

Ms. McCray's initiative comes at the right when the White House and Congress have been trying to cut back funding for mental health (theatlantic.com; May 23, 2017; date accessed Sept. 11, 2017), alcohol-addiction treatment (nytimes.com; May 5, 2017; date accessed Sept. 11, 2017), provided by the American Healthcare Act, Medicaid, and related federal programs.  Mr. Mock observes, "Which is to say the Cities Thrive Coalition is congealing at a time when these 180-plus cities may only have each other to count on in the fight for mental wellness."

The initiative also comes at a time when police are under the microscope for responding violently to mentally ill people (treatmentadvocacycenter.org; date accessed Sept. 11, 2017), and as opioid overdose reaches national epidemic proportion (citylab.com; Dec. 27, 2016; date accessed Sept. 11, 2017).  Luckily ThriveNYC has made progress (nyc.gov; date accessed Sept. 11, 2017) on substance abuse and overdose, despite "flying into the federal headwinds of healthcare cuts."  Thus far, New York City has "...trained has trained over 2,500 NYPD officers in Crisis Intervention Training, so they can deploy tools other than guns and handcuffs when encountering people who might be suffering mental or drug-induced breakdowns."  Just as many New Yorkers (2,300 to be more precise) have been trained to identify the signs symptoms of a person having a depression episode, psychosis, or an overdose.

CityLab sat down with Chirlane McCray in New Orleans, where she and a Cities Thrive delegation spoke to the U.S. Conference of Mayors about the urgency of addressing this matter.  Her presentation coincided with the president finally declaring the opioid crisis a national emergency (theatlantic.com; Aug. 10, 2017; date accessed Sept. 11, 2017) after days he said he would not (washingtonpost.com; Aug. 8, 2017; date accessed Sept. 11, 2017).  What form this will take has yet to be seen, Ms. McCray  told CityLab that "...New Jersey Governor Chris Christie, who headed Trump's opioid commission, didn't reach out to her, despite her work in this area."  Below are excerpts of what Ms. McCray had to say about the subject:

CL: "Why is it important that cities pay special attention to mental health and substance abuse problems?"

CMcC: We're working hard to change how people talk about and think about it.  The whole substance misuse and addiction problem should be under the umbrella of mental health for political and funding reasons...I'd say in at least half of the cases, mental illness and substance abuse go together because people often medicate to compensate for what's going on in the brain.

Thrive is about making change in those areas, but also, changing in the way people access services making it easier for people to get services where they live...because people don't want to go outside of their neighborhoods.  They don't want to talk to someone they don't trust or don't know.  And this is important background because people delay seeking help an average of ten years when they find themselves in mental distress...In poorer communities and communities of color, that can often be ten years or more.

Another thing that is not talked about enough is the fact that the signs and symptoms of mental illness in half of all case emerge before the age of 14-in 75 percent of the cases, it's before the age of 24.  So we have the opportunity to prevent some cases...and certainly an opportunity to intervene before mental illness continues,...What happens when you let diseases progress?  You end up spending more money, and people get more ill.  

CL: "How do you feel about the current Trump administration's response to the opioid crisis?"

CMcC:  Well, his response has been law and order.  They're talking about an epidemic and his first words are, "We're gonna get tough."  I want to see this talked about primarily as a public health problem because we know that addiction is a disease that can be treated.  Is there a role for law enforcement?  Absolutely...We want to work on the root causes of addicition, which we know and can address.  We can't in the current structure, and we can't if we have a repeal of the ACA.

On the one hand I'm excited that Trump is declaring it a national emergency.  On the other hand, I don't know what that means.  Does that mean more funding?  Does that mean more of the ability for people who are getting substance abuse treatment or are being treated for addiction, that they will be able to go other place places for treatment?

CL: "What would you like it to mean?"

CMcC: I would love for it to mean more funding, more flexibility so that people who have addictions can have have more outpatient services...I would like more encouragement for physicians to be able to administer buprenorphine [samhsa.gov; date accessed Sept. 11, 2017]...It stops the cravings and it allows someone to go to work or go to school and live their life, because addiction is a chronic disease, just l;Ike diabetes or asthma.  There should not be a stigma about that.

This particular epidemic requires outpatient care...the reality is because addicition is a chronic disease you can't live in a bed.  You can go and get your detox and rehab but at some point you have come out...that requires outpatient counseling, that requires medication-assisted treatment [theatlantic.com; Dec. 7, 2015; date accessed Sept. 11, 2017], which is the best evidence-based treatment we have.  And we don't don't have the resources that we need to provide it properly...

I hope they can go to their primary care doctors who have been trained and coached to administer buprenorphine.  I hope here are some kind of waivers so that people who are suffering from addiction can go some place other than a substance abuse clinic to get services because there's still such a stigma about these facilities...

CL: "The ACA seems to stand on fragile ground under the current Congress and White House.  How might its repeal impact the way cities deal with these problems?"

CMcC: We worked very hard to make sure that it wasn't repealed because the ACA has given parity to mental health treatment, by including addiction and substance abuse in its coverage, which we never had before...There's been an artificial separation in our healthcare system for way too long between physical health and mental health.  It's an artificial disconnect because what can you do without your brain?...it's important that people be able to access their health plan so that we would be affected of course if the ACA were repealed.

CL: "What about non-opiate addiction problem, that affect more people of color?"

CMcC: I think our plan addresses them all.  K2 as once a big problem, the synthetic drug that popped in the bodegas and in the streets and that's something we had to deal with...And of course we have alcohol, a huge problem that nobody talks about.  In fact it often works out that people have overdoses not just because they used opioids, but because they were also drinking...

We know this epidemic has been heavily to focused on white working-class communities but the numbers in communities of color is rising, so we have to be attentive and be ready to respond to that...When it was the crack epidemic, it was all brown and black people but our faces have been erased this time around...We have to take many paths to address all the different populations.

CL: "So how do you feel about the change in response based on race?  Obviously when crack was pervasive, there was no national outcry of empathy, there was the opposite"

CMcC: Right.  On one hand, I'm glad there is this response because if any assistance is coming down the pike and it's universal then we will still benefit.  But it's, of course, sad to see the disparity in terms of the inequities and attention that we received in the past.  I think there is another factor though: I have to say that people are recognizing addiction as a disease...even now there is still this perception that [addiciton is about] a lack of discipline or poor moral character...Ten, 15 years ago there was a lot more that and connected with black, brown people and low-income people that just multiplied that perception...

CL: "Do you think the opioid crisis would be called a national emergency if the face of the crisis was a black or brown faces?"

CMcC: To the extent that it is now?  No, I don't think so.  But if there were the same numbers of people dying, there would be some kind of outcry.

CL: "How have smaller cities in the Thrive coalition received these plans, especially in terms of coming up with funding to execute or put together plans like this?"

CMcC: I' please to say we have close to 200 mayors from around the country in coalition from both big cities and small cities.  This is a bipartisan effort and the reception has been fantastic. ThriveNYC is city-funded, but what we're doing with smaller cities and other cities in general is sharing our best practices,...For example, we had our health commissioner write an executive order that would allow anyone to go into into any of our chain pharmacies,...,to buy naloxone without prescription.

That doesn't cost any money, but it's a change of policy.  It's very import though because usually family members and friends know if someone close to them is using, and so if they have naloxone they could save a life.

We are working on creating a hub so that we can share our best practices and ideas, and we have monthly conference calls where we talk about what we're doing so that we can learn from one another.  it's not happening on the federal level, so we have to do it ourselves.