WASHINGTON -- A fervor of bipartisan interest in the opioid addiction epidemic and President Barack Obama's final year "moonshot" attitude mean new policies and new money are heading to Alaska's struggling health care practitioners.
New federal funding is already headed to Alaska to help expand substance abuse treatment. As part of a $94 million injection of funding to local clinics, five clinics in the state will see a combined total of more than $1.76 million. They include the Aleutian Pribilof Islands Association in Anchorage; the Front Street Community Health Center in Juneau; the Kodiak Area Native Association in Kodiak; the Southcentral Foundation in Anchorage; and the Sunshine Community Health Center, which has locations in Talkeetna and Willow.
The aim of those grants is to boost the number of patients screened for substance abuse problems, and to provide more access to medication-assisted treatment, which is increasingly considered critical for managing an addiction to opioids and heroin.
And more federal funding will be made available soon to expand treatment, for first-responders to be trained and equipped with the life-saving overdose reversal drug, naloxone, for police departments to track down prescription pill and heroin traffickers, and for rural communities to deal with their own opioid challenges.
In recent weeks, the U.S. Senate passed legislation aimed at boosting treatment options for addicts by a vote of 97-0, and the House is likely to take up similar legislation soon.
Over the last several weeks, new initiatives have been pouring out of the White House:
- On March 15, the Centers for Disease Control and Prevention issued new guidelines for doctors prescribing opioids in hopes of addressing growing addiction rates.
- U.S. Department of Health and Human Services issued a proposed regulation that would boost the number of patients receiving medication-assisted treatment a doctor can supervise, from 100 to 200.
- Obama announced a new interagency task force aimed at making sure insurance programs treat medical and mental health coverage equally.
- The Defense Department issued its own proposed rule that would ensure TRICARE, the militarys health program, makes opioid treatment available to an estimated 15,000 to 20,000 people in need of help.
- The Food and Drug Administration announced new label requirements for opioid pain medications, warning of the risks of misuse and abuse.
Obama even went down to Atlanta on March 29 for the National Prescription Drug Abuse and Heroin Summit -- a program organized by a group founded supported by Rep. Hal Rogers, R-Ky. Sen. Dan Sullivan is working to pull together a similar substance abuse summit in Alaska in the coming months.
More than 2 million Americans are addicted to opioid painkillers, and half a million to heroin, according to the CDC.
More people in the U.S. are dying of opioid overdoses than car accidents, Obama said at the summit. "It's heartbreaking. And the fact is that for too long, we have viewed the problem of drug abuse generally in our society through the lens of the criminal justice system."
Politicians are now focusing on prevention, treatment and training for doctors to change the way highly addictive pain medications are subscribed in the United States, where 5 percent of the world's population consumes 85 percent of the world's pain pills.
Prescriptions and sales of opioids have quadrupled since 1999, and opioid overdoses multiplied at the same rate, according to the CDC. More than 40 Americans overdose on prescription opioids and die every day, according to CDC Director Tom Frieden. "Overprescribing opioids — largely for chronic pain — is a key driver of America's drug overdose epidemic," Frieden said.
In Alaska, deaths from prescription opioid overdoses have actually gone down in recent years -- dropping from 104 deaths in 2009 to 83 in 2015. But heroin deaths have spiked: Seven people died from heroin overdoses in 2009, and 36 in 2015. In that six-year period, 774 people died from overdoses in Alaska, and the vast majority were from either heroin or prescription drugs, according to the state's latest report on the issue.
Integrated treatment in Alaska
With the new federal funding at five clinics in Alaska, doctors hope more integrated care will allow them to find and treat people who are addicted to prescription opiates, and those who have already turned to the street version -- heroin.
Meara Baldwin is the behavioral health director at the Kodiak Area Native Association, which just received a $325,000 grant from the federal government to expand its substance abuse treatment offerings.
Despite the island's small population -- about 14,000 people in the city of Kodiak and nearby, as well as six rural villages only accessible by boat and plane -- there's a growing need for opioid addiction treatment.
KANA is "seeing is a real increase in the amount of clients that we have [who] are using heroin," Baldwin said. The issue is arising "mostly in our younger adult population" -- people in their 20s and 30s, she said.
With the new funding in hand, KANA is barreling forward with efforts to integrate its medical treatment with newly available opioid treatment options.
They've changed the screening process for patients, are training physicians so they are legally allowed to provide medication-assisted therapy, and substance abuse counselors are getting specialized training.
KANA already has some integrated treatment in place. The mental health treatment program works closely with physicians, and they try to group doctors of different disciplines together. For the last two years, the program has been screening for mental health symptoms in medical exams. If someone is dealing with depression or anxiety, or perhaps reports "risky" behavior with drugs, alcohol or tobacco, they provide an "almost instant referral for care," Baldwin said. Really, she added -- it's more of a "warm hand-off" to another doctor.
That kind of integrated medical and mental health treatment is what the doctors at the Sunshine Community Health Center in Talkeetna are hoping to add with some of their new grant funding.
That means if a man comes in because he has a cold, the doctor asks a few other questions to gauge if he might benefit from behavioral health care: for depression, substance abuse, or any other issues, temporary or not.
Sunshine's clinic doesn't have totally integrated care. But they do think it's a better option. Telling someone that "another team member" will come in to talk about something "while you're here" is better, said Shelis Jorgensen, the medical director at the Sunshine center in Talkeetna. Telling someone to come back in a month "is less impactful."
The clinic has three new grants -- two of them federal -- totaling about $750,000, Jorgensen said.
"We're very primed to do some good work, I believe," Jorgenson said.
Much of the focus of the new federal grants is also to "deepen the intensity of treatment options that we have, particularly for clients who" are struggling with prescription pain pills or heroin, Baldwin said.
With the help of the grant, KANA is adding medication-assisted treatment. The measure combines traditional substance abuse treatment -- such as therapy and meetings -- with medications like buprenorphine, methadone, naltrexone and naloxone.
"Probably the most familiar name to folks is suboxone," a combination of buprenorphine and naloxone, Baldwin said.
Physicians at the KANA health center are receiving training in the assisted treatment, and the clinic is expanding its staff to have a counselor dedicated to people undergoing this kind of therapy. The center is also using grant money to make sure the expansion of treatment option applies to the Kodiak population at large, not only Native people.
The Sunshine center provides suboxone for opiate dependent patients, along with group sessions and other medical and mental health treatment. So far about 70 patients have come through the program, and the current caseload includes around 40 patients, Jorgensen said.
"People are looking for this type of help and not finding it, statewide," Jorgensen said.
So far, federal intervention hasn't provided any solution to one of Alaska's biggest problems for opioid and heroin users: detox centers.
Detoxing is often extremely painful and difficult, and detox centers are few and far between in Alaska. Neither Kodiak or Talkeetna has any locally, nor are they likely to add them any time soon.
"So they're going through this at home," Baldwin said of her clinic's patients.
"We don't detox them" at the Sunshine center, Jorgensen said. "They have to have gone through that process before they can enter the program."
More changes coming
Alaska caregivers will also be impacted by some of the other changes that the federal and state government have rolled out in recent weeks.
The life-saving naloxone -- a drug that can quickly bring an overdosed patient back from the brink of death -- will be much more readily available in Alaska soon. In mid-March, Gov. Bill Walker signed into law a bill to make the drug easier to get.
Pharmacies at Fred Meyer, CVS and Walgreens could be selling it by summer in Alaska, and more emergency medical technicians will have the antidote on hand when someone calls for help. And after a "good Samaritan" law passed last year, drug users won't be prosecuted if they call for help when someone else overdoses.
In March, the CDC released a suite of guidelines and resources for doctors on when to prescribe opiates, how to set dosage levels, information on other prescription options for dealing with chronic pain, and an easy-to-use checklist for doctors prescribing opiates.
The guidelines advise doctors to avoid treating chronic pain with opiates, to avoid addiction risks, with the exception of treating active cancer and in the case of easing end-of-life pain. When they do prescribe opioids, doctors are advised to use the lowest effective dosage possible and to monitor patients closely.
Already, "Alaska is a great example of a state that's doing this well," because doctors in the state are prescribing opioids at a lower rate than their colleagues nationally, according to 2013 data, said Susan Johnson, HHS director of the region that covers Alaska.
Meanwhile, dealing with the opioid and heroin epidemic has gathered bipartisan support in Congress.
Sen. Dan Sullivan said his whole outlook on the issue changed after a "very powerful meeting" he had in Washington, D.C., "with a bunch of very courageous women from Juneau."
Afterward, Sullivan met with HHS Secretary Sylvia Mathews Burwell to discuss the issue, and encouraged her to send top-level staff to an addiction summit that the senator hopes to pull together in Alaska.
And the junior senator eventually co-sponsored the bill that recently passed the Senate, which would make naloxone more widely available to first responders, expand information available aimed at helping prisons better treat addicted inmates, increase disposal sites for unwanted drugs, and help states monitor the flow of opioid prescriptions.
The "numbers really are horrifying," Sen. Lisa Murkowski said recently on the Senate floor. "In Alaska, the mortality rates related to opioid and heroin abuse have more than tripled since 2008," she said. Hospitalization for heroin and opioid poisoning has nearly doubled since the same year, she said. "The cost is over millions of dollars."
And aside from all the financial costs, "we're talking about our friends. We're talking about our family. We're talking about neighbors," Murkowski said.
"We have to do something about it, and I'm not sure what that's going to be," Rep. Don Young said in an interview. But, he said, simply focusing on funding treatment is "not going to solve the problem. It may help out, but it's not going to solve the problem."
Alaska Dispatch Publishing