Wednesday, September 30, 2015

APA Opposes Insurance Company Mergers

Under the Affordable Care Act (ACA) patients who were formerly uninsurable were given access to coverage for the first time. In conjunction with the Mental Health Parity Act (MHPA), which required insurers to cover mental health care and access to treatment, millions of Americans could finally get the care they desperately required. Mental health conditions plague millions of Americans from every demographic, access to effective evidence based treatments is crucial for the welfare of society as a whole.

Unfortunately, access to mental health care services may be negatively affected if two major insurance company mergers are allowed to come to fruition. The American Psychiatric Association (APA), which represents 36,000 physicians, has major concerns about the proposed mergers and has sent a letter to U.S. Assistant Attorney General William J. Baer pointing out the insurers’ history of denying mental health benefits, Reuters reports. The APA has warned antitrust regulators.

The two mergers in question are Anthem acquiring Cigna for $47 billion, making Anthem the largest U.S. health insurer. The second merger involves Aetna acquiring Humana; if this deal is allowed Aetna would become the largest provider of Medicare plans for older people. The APA notes that the insurers’ networks for mental health care are already sub-par, and would most likely get worse, according to the article.

The APA is not the only medical association with concerns about the proposed mergers. Government regulators have been asked to review the deals by:
  • The American Medical Association
  • The American Hospital Association
  • The American Academy of Family Physicians
“APA agrees with the American Medical Association, the American Hospital Association, and the American Academy of Family Physicians and shares their concern that these proposed consolidations will functionally leave the vast majority of health care administration in the United States to three major insurers, thereby eliminating consumer choice and encouraging insurers to raise prices and reduce quality of care in most markets,” the APA wrote.

“Furthermore, individuals with mental illness, including substance use disorders, are uniquely affected by the impact these mergers will have on access to psychiatric care in insurance plan provider networks. We request that the Department of Justice [DOJ] focus attention in its review of the proposed mergers on each company’s history of restricting access to clinically appropriate psychiatric care, as well as their ability to more severely restrict access to care if such acquisitions are permitted.”

Tuesday, September 29, 2015

College Students Less Likely to be Advised by Doctors on Substance Use

Screening college students for drug and alcohol use is of the utmost importance, crucial for spotting problems early and referring students toward appropriate assistance. Unfortunately, substance use problems often go unnoticed; problems get out of hand and serious consequences can result.

It is no secret that college campuses can be hotbeds of reckless drinking and illicit drug use; students find themselves in foreign environments and around new faces - the desire to fit in with one’s peers is great. Fitting in often involves drugs and alcohol, and in many cases at unsafe levels. Campus faculty and health centers work hard to address the issue, hosting educational seminars and encouraging students to ask for help.

While it may seem like educating and screening college students about and for substance use is a common occurrence among doctors, research suggests that that may not always be the case. A new survey indicates that college students are less likely than their non-academic peers to be warned about the dangers of substance use by their doctors, Reuters reports. About 2,100 college students and other young adults participated in the survey.

"Despite consistent evidence of the effectiveness of brief alcohol counseling, only a small percentage of young adults are actually receiving brief alcohol counseling from their physicians," said Emily E. Tanner-Smith of Vanderbilt University in Nashville, Tennessee. 

The participants were asked if they had seen a doctor within the past year, and if their doctor had cautioned them about the risks of drug and alcohol use. The findings showed that less than half of those in college had been advised by their doctor, according to the article. Whereas, 53 to 57% of those not in school had been counseled about the dangers of excessive alcohol and drug use.

The researchers from the National Institutes of Health (NIH) found the results concerning, considering that college students report binge drinking or driving under the influence more often than those not in school. Brief screenings and interventions reduce alcohol problems among young people, says Dr. Ralph Hingson of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and co-author.

"(But) they don't always happen because providers, physicians, nurses and social workers don't routinely ask every young person about their drinking, drug use or smoking,"  Hingson said.

A letter from the researchers was published in JAMA Pediatrics.

Thursday, September 24, 2015

75 Percent of Smokers Are Not Thinking About Quitting

Quitting smoking is often times a process that can go on for years; few smokers successfully quit at their first attempt. A large percentage of smokers are fully aware of the dangers that cigarettes pose to their health, yet they continue to smoke anyway. While smoking rates have dropped significantly worldwide, the majority of smokers who consider giving up the habit do not take steps to make it happen, HealthDay reports. In fact, a new study has found that 75 percent of smokers in 21 countries are not considering quitting.

The findings indicated that Nigeria had the lowest rate of smoking at 4 percent, compared to Russia at 39 percent. The research was conducted by the U.S. Centers for Disease Control and Prevention (CDC). The researchers analyzed data on more than 57,000 non-American smokers. The research team separated the participants into three groups based upon where they were individually in the quitting process:
  • Pre-contemplation: smokers who did not feel the need to quit.
  • Contemplation: smokers who knew they should quit, but were not ready.
  • Preparation: smokers preparing to quit
The research showed that only 7 percent of smokers worldwide were actually preparing to quit, according to the article. In Qatar, 31 percent of smokers were found to be in the contemplation stage, whereas only 7 percent of smokers in Indonesia were in that stage. Sadly, three out of four smokers were in the pre-contemplation stage.

The CDC researchers believe that countries can create more effective smoking cessation programs by using their findings.

"Strategies may also include public education activities and media campaigns to motivate smokers at [the pre-contemplation] stage to think of quitting," the researchers wrote.

Tuesday, September 22, 2015

HHS Will Rewrite Buprenorphine Rules

A shift in policy could mean increased access to buprenorphine, a partial opioid agonist drug used to treat opioid addiction. On Thursday, the Obama administration announced that the Health and Human Services (HHS) agency would rewrite regulations that have been preventing opioid addicts from getting the drug, The Huffington Post reports. The announcement was made at a conference on opioid addiction in Northern Virginia and was met with applause from doctors, treatment experts and public health officials.

"We have heard from many stakeholders and leaders that the current capacity does not meet the current demand. So today I’m proud to announce that our department will revise the regulations related to buprenorphine to safely and effectively increase access," said HHS Secretary Sylvia Burwell. 

In the past few months there have been a number of steps taken by the HHS to both deter and treat opioid addiction. In July, the agency announced that $100 million would be made available to expand access to treatment services. The funds, made available through the Substance Abuse and Mental Health Service Administration (SAMHSA), would also be use for expanding medication-assisted treatment access.

"We need to lift people out of opioid-use disorder through medication-assisted treatment," said Burwell. "This epidemic is multifaceted, and we need to respond with the best solutions that medicine and behavioral therapy can provide together." "So we need to increase the use of buprenorphine, which can help us treat opioid use disorder when combined with psycho-social support." 

The current rules for prescribing buprenorphine (sold as Suboxone ®) only allow doctors who are certified to write prescriptions for up to 30 patients initially and as many as a hundred patients after a year, according to the article. The HHS revisions are “to provide a balance between expanding the supply of this important treatment, encouraging the use of evidence-based [medication-assisted treatment], and minimizing the risk of drug diversion,” the department said in a press release.

Thursday, September 17, 2015

FDA Advisory Panel Approves New Oxycodone Drug

The Center for Disease Control and Prevention (CDC) estimates that 46 people lose their lives as the result of opioid overdoses every day. Despite the staggering death toll linked to prescription opioids, the Food and Drug Administration (FDA) continues to approve medicines that would seem contrary to the public's welfare. The FDA approved Zohydro ®, a pure hydrocodone painkiller, last year even though the agency’s own advisory panel of experts voted against releasing the drug to the public.

When people think about the prescription opioid epidemic, the two drugs that most commonly come to mind are hydrocodone (Vicodin ®) and oxycodone (OxyContin ®). Zohydro’s approval was met with staunch criticism and some lawmakers attempted to ban the sale of the controversial drug. What makes Zohydro more dangerous than Vicodin? Zohydro is pure hydrocodone, whereas Vicodin is hydrocodone mixed with acetaminophen.

Now, a year later, steps are being taken to introduce a new powerful opioid narcotic to the market. An FDA advisory panel has unanimously approved a long acting oxycodone drug called Xtampza, against the recommendation of FDA staff, Reuters reports. Last week, FDA staff voiced fears that Xtampza would be abused and lead to overdose.

Xtampza is an experimental long acting opioid analgesic made by Collegium Pharmaceutical Inc. The drug is designed to be taken after a meal in order to be safe and effective. The FDA is concerned that if the drug is taken without food it could lead to misuse and overdose, according to the article.

The advisory panel’s approval bodes well for other pharmaceutical companies who have opioid narcotics in development, despite a separate advisory panel voting against a Purdue Pharma fast acting opioid last week. Nevertheless, there are a number of drug manufacturers developing abuse-deterrent painkillers - drugs that make it more difficult (not impossible) to abuse. Those companies include:
  • Pernix Therapeutics Holdings Inc
  • Egalet Corp
  • KemPharm Inc
  • IntelliPharmaCeutics International Inc
  • Pain Therapeutics Inc
  • Acura Pharmaceuticals Inc
CARF - Commission on Accreditation of Rehabilitation FacilitiesNATSAP | National Association of Therapeutic Schools and ProgramsNBCCNAADAC