The Aspenti Health Blog - Page 3 of 4

Our Prevention Programs are working. At a recent teleconference I attended led by Dr. Nora Volkow, NIDA Director, I learned adolescent tobacco use is at an all-time low since 1979. Dr. Johnson of the University of Michigan, the Principal Investigator of this study for 42 years, stated that there has been a “tremendous decline in cigarette smoking since the mid-90s, the most prevalent cause of preventable death and disease in America.” Dr. Volkow also noted significant decreases in alcohol and pain-medication use. Reasons For Celebration

Alcohol consumption among school-age children has shown a significant decrease, especially binge-drinking;
High School Seniors reflect an historic low in pain-medication use, with past year use among 12^th graders declining from 9.5 % in 2004, to 4.2 % in 2017;
Reported heroin and methamphetamine use remain very low….at less than 0.5%;
An historic low amongst high school seniors of Oxycontin, decreased by 50% since 2005;
Non-medical use of Ritalin among 12^th graders is at a record low since 2001;
Hookah smoking has dropped for the second year in a row.

Reasons For Concern Going Forward While these gains have been hard-won over time by the development of effective prevention and education programming for students, parents, and the general public, this deserved affirmation of our efforts must always be balanced by the nature of the many threats to our school-age children that remain. Vaping, with a “ground-zero” of 2006, has very rapidly transitioned from a nicotine cessation device to a delivery system for nicotine, flavoring and THC. Approximately 1/3 of 12^th graders report past year use of a vaping device. Dr. Volkow warns that vaping for some teens has become an introduction to nicotine. Dr. Volkow is advocating that “we intervene with evidence-based efforts to prevent youth from using these products.” Youth who vape are likely to use nicotine, which begins to present a threat to progress being made regarding smoking. Vaping THC usually involves very high levels of concentration, which is likely to cause brain impairment/addiction more rapidly. Marijuana use continues to be reason for concern. The survey reports that:

Past year marijuana use (three grades combined) is up from 22.6 % to 23.9%;
Significantly fewer teens now disapprove of regular marijuana use;
7% of 12^th graders in states with medical marijuana laws report consuming edibles, compared to 8.3% in states without such laws.

Each new cohort of adolescents needs to be taught and nurtured anew, guided through a developmental period that is both replete with wonder, challenge and opportunity, but also fraught with vulnerability to the development of Substance Use Disorder. We, as adults, parents and leaders cannot let them down. We owe it to them and to their children to conclusively shape their environment in ways that encourage healthy development and decision making, and the opportunity to thrive. We know how to accomplish this. We have been learning for a long time now. Let’s make 2018 a pivotal year in our country! Check out the link to the 2017 Monitoring The Future Survey, with a short summary video featuring Dr. Nora Volkow, NIDA Director. https://www.drugabuse.gov/news-events/news-releases/2017/12/vaping-popular-among-teens-opioid-misuse-historic-lows [post_title] => Starting The New Year On A Positive Note: NIH’s 2017 Monitoring The Future Survey [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => starting-new-year-positive-note-nihs-2017-monitoring-future-survey [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:31:56 [post_modified_gmt] => 2019-10-21 20:31:56 [post_content_filtered] => [post_parent] => 0 [guid] => http://localhost/aspenti/?p=58021 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 2 [filter] => raw ) [2] => WP_Post Object ( [ID] => 57968 [post_author] => 6 [post_date] => 2017-12-07 09:40:12 [post_date_gmt] => 2017-12-07 14:40:12 [post_content] => I came away from President Trump’s declaration of the present opioid crisis as a Public Health Emergency instead of a National Emergency rather disappointed. The latter would have made funding for initiatives accessible; it was his Commission’s primary recommendation. The President’s declaration included no funding at all. (Please see my blog “Listening To What Is Not Said” Nov. 1 2017)

I tuned in to the President’s Commission on Combating Drug Addiction and the Opioid Crisis’ announcement of its Final Report on November 1, with the hope that the Commission had independently done its homework and arrived at meaningful recommendations for our country’s health. I was not disappointed. While the broadcast itself lasted much longer than I had planned, (over two hours), I found myself thoroughly engaged from the opening comments to the unanimous vote to adopt the committee’s recommendations. What was striking about the broadcast was the human emotion expressed by the committee, the empathy in the chamber, and the scientific data and decades of experience in this field available to the leadership. If the Administration chooses to fully utilize the potential at its disposal, as recommended by the Commission, we will be looking back at this era someday as history, rather than wondering why “history repeats itself”. Dr. Bertha Madras, well-noted chair of the Division of Neurochemistry at Harvard Medical School, was the lead author of the 131-page final report. Dr. Madras advised “If we don’t stop the pipeline into substance use, if we don’t promote prevention, we are going to have an open-ended catastrophe that goes on for generations.” The human tragedy and immeasurable anguish associated with this crisis was poignantly and powerfully communicated by Doug Griffin. Mr. Griffin, a father from Newton, NH, talked about how his daughter, Courtney, struggled with opioids. Courtney died at age 20, from an overdose. Mr. Griffin, sobbing, ended his testimony with, “I pray your children are spared from this plague, and that you never know what it’s like to be me.” As unimaginable as it may seem, to really understand the depth and magnitude of America’s drug crisis, we need to multiply Mr. Griffin’s pain by 64,000 in 2016; this is the estimated number of drug overdose deaths for that year according to preliminary data from the Centers for Disease Control and Prevention. One death every seven minutes. The Commission’s Final Report was issued November 1, 2017… This Blog was written on November 20, 2017… One death every seven minutes equals 3,908 overdose deaths since the Commission’s Report. Yet there have been 0 words from the Administration regarding funding intentions or planning in response to the Report. A link to the Commission’s Full report, and a link to a PBS analysis of the Commission’s formal announcement, including the video, are noted below. These are both worth a very close look when time permits. Only a well-informed public can influence its leaders in meaningful and appropriate ways. Commission’s Final Report https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Meeting%20Draft%20of%20Final%20Report%20-%20November%201%2C%202017.pdf PBS NEWSHOUR Summary and Video of the Commission’s announcement (Please note there is a 44 ½ minute delay in the video’s beginning. Viewers can easily advance to the starting point) https://www.pbs.org/newshour/health/watch-live-trumps-opioid-commission-slated-to-release-final-report [post_title] => Opportunity Knocks: The President’s Commission On Combatting Drug Addiction And The Opioid Crisis’ Final Report [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => opportunity-knocks-presidents-commission-combatting-drug-addiction-opioid-crisis-final-report [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:32:21 [post_modified_gmt] => 2019-10-21 20:32:21 [post_content_filtered] => [post_parent] => 0 [guid] => http://localhost/aspenti/?p=57968 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 57876 [post_author] => 13 [post_date] => 2017-11-16 09:30:11 [post_date_gmt] => 2017-11-16 14:30:11 [post_content] => When I pull into my driveway after work, there is a sense of serenity and joy. The stressors of the day often fade before the garage door even opens. My home is not the house: it is defined by my family and the love and support we share. For many individuals after inpatient treatment for Substance Use Disorder(s), there is no home to return to, or it is the same one which played a significant role fueling their substance use.

One of the first acronyms someone in early recovery might hear is SOBER (Son of a B****, Everything’s Real). It can be a time of terror and uncertainty, extreme loneliness, and not knowing who to turn to for support. Paying bills, making appointments, job applications and many other day-to-day tasks can be overwhelming. Without proper support, the danger of relapse is significant and may lead to tragedy and death. Katherine Thom, in her SAMSHA (Substance Abuse and Mental Health Services Administration) article, Recovery Homes Help People in Early Recovery, offers hope. She begins by quoting Lori Criss, Associate Director of the Ohio Council of Behavioral Health & Family Services Providers, who explains why the phrase, “People, Places and Things” has so much influence in the recovery community. “Who we spend our time with, where we go, and the things we surround ourselves with all impact who we are and the decisions that we make. Many times, people in early recovery have to give up everything they’ve known… because those people, places, and things put them at risk for relapse or continued use. Early recovery can be painful and isolating. Recovery housing can fill that void with a safe place, compassionate people, and a life full of purpose and fun that doesn’t involve alcohol or drugs,” says Criss (Thom, 2013). The idea is not a new one. It is gaining traction nationally and here in Vermont. And there is a desperate need to expand access. Recovery homes are an effective and reasonably priced option. They provide a safe environment that empowers residents on their journey of recovery. Empowerment through support to achieve independence is what we as parents try to provide for our children. And the sober home model offers that second chance where one can redefine their life, make a difference, view one’s contribution as valuable, and consequently, feel valuable. According to Thom, Criss is proposing private-public partnerships to create more recovery homes which offer services for lower socio-economic individuals with Substance Use Disorder(s). Criss suggests, “A responsive system will provide access to affordable, mainstream housing where people can be safely housed and supported in recovery at their own pace. The strength of recovery-focused housing is its ability to provide ongoing peer support while promoting sobriety in a natural home environment” (Thom, 2013). No one willingly chooses a life dominated by substance use, just as no one willingly agrees to the return of cancer after treatment. We should embrace and treat those striving for a life of recovery as the truly remarkable and deserving survivors they are. Substance Use Disorder is not a choice. It is an illness, period! Unintentionally, I take for granted just how privileged I am. It is something everyone should have and what every home should feel like. Learn about the National Alliance for Recovery Residences (NARR) at: National Association of Recovery Residences (NARR) Their mission is “To support persons in recovery from addiction by improving their access to quality recovery residences through standards, support services, placement, education, research and advocacy.” And learn about the Vermont Association of Recovery Residences at: https://narronline.org/cm-business/vermont-association-of-recovery-residences/ Reference Thom, K. (2013). Recovery Homes Help People in Early Recovery. SAMSHA. Retrieved October 16, 2017 from: https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/recovery-homes-help-people[ [post_title] => Creating Sober Homes Through Private-Public Partnerships [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => creating-sober-homes-private-public-partnerships [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:33:03 [post_modified_gmt] => 2019-10-21 20:33:03 [post_content_filtered] => [post_parent] => 0 [guid] => http://localhost/aspenti/?p=57876 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 57898 [post_author] => 6 [post_date] => 2017-11-13 10:45:07 [post_date_gmt] => 2017-11-13 15:45:07 [post_content] => As we saw in Part 1 of this series, the tendency toward impulsive decision-making as a response to stress is a risk factor in developing substance use disorder. The opposite of impulsive behaviors are behaviors that are consciously chosen as a response to stress because they are likely to result in healthy, or positive, outcomes. Deliberative, weighed out responses to stress are a product of “executive function processes” carried out by the pre-frontal-cortex. These are learned during childhood and adolescence, primarily. This is the key component to what is known as “Resilience”. When a concerned, committed adult supports a child’s coping with stressful situations, there is an actual effect on the development of the child’s brain, on their learned ability to cope with stress in a productive manner. This skill or function, once developed, can last a lifetime. This is Resilience.

Resilience can be defined as:

The ability to overcome serious hardship/stress, or,
The ability to cope successfully in the face of adversity.

Without the guidance of an attentive, committed adult, the child exposed to toxic stress is likely to not develop Resilience. Resilience is a potential, it is learned, as are other life-skills. It is taught and modeled for a child by consistent and committed adults in the child’s environment: family members, or, perhaps, other care providers. At the same time children are being supported through stressful experiences, and therefore learning to cope through both instruction and modeling, their brain development is also being influenced in ways that encourage connectivity between areas crucial to the delay of impulsive action. This allows for the consideration of alternatives, and the choice of healthy solutions to stressful challenges, all pre-frontal cortex functions. It is these innumerable purposeful interactions with attentive, committed adults that tip the balance in a child’s development toward the internalization of Resilience. If these same children are educated regarding the very real dangers inherent in any psychoactive substance use, especially during the development of the brain, usually through adolescence to the mid-20s, they are likely to make healthy decisions and not engage in unhealthy behaviors, such as substance use to relieve stress. An ultimate profound reduction in the demand for drugs is the inevitable result. Teaching Resilience, institutionalizing programs that reach every child and parent, is a very long-term investment we must make in our children, so our children’s children can live in a different world. If you are interested in learning more about Resilience, please visit Harvard University’s Center on the Developing Child:

[post_title] => Resilience Part 2 [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => resilience-part-2 [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:33:11 [post_modified_gmt] => 2019-10-21 20:33:11 [post_content_filtered] => [post_parent] => 0 [guid] => http://localhost/aspenti/?p=57898 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 2 [filter] => raw ) [5] => WP_Post Object ( [ID] => 57865 [post_author] => 6 [post_date] => 2017-11-01 14:48:32 [post_date_gmt] => 2017-11-01 18:48:32 [post_content] => I listened attentively to the speech, pulled over to the side of the road, taking notes. I heard the President declare there were over 64,000 deaths attributable to drug overdose in 2016, with 2/3 of these being caused by opioids. Overall about 7 deaths per hour. I heard him say that in West Virginia 1 of 5 newborns come into this life with Neonatal Abstinence Syndrome as a health consequence of the birthmother’s addiction to opioids. I heard him elaborate on the importance of Substance Use Counseling being provided to people with addiction who are incarcerated. And I listened as he underlined the inestimable significance of demand reduction over the foreseeable future, the cultural mandate to protect our children by educating them and supporting them, fully equipping them with the cognitive, emotional and social skills necessary to choose healthy behaviors, and avoid the allure of psychoactive chemicals. I couldn’t have agreed more with every point he made.

What I didn’t hear was the “first and most urgent recommendation” of the Interim Report of the Commission on Combating Drug Addiction and the Opioid Crisis*: to “declare a national emergency under either the Public Health Service Act or the Stafford Act”. This would have created a wide avenue for the quick release of funds to support initiatives, which the declaration of a public health emergency fails to do. The National Council For Behavioral Health stated “ While the National Council is pleased to see the President recognize the opioid crisis as a public health emergency , the announcement comes without any new funding to respond to the epidemic and the specifics of the declaration are still unclear”. It’s important to note that the following major recommendations of the President’s Commission’s Interim Report all included funding:

Establish and fund a federal incentive to enhance access to Medication Assisted Treatment;
Prioritize funding and manpower to Department of Homeland Security, Customs and Border Protection, FBI, DEA, and USPS to staunch the supply of fentanyls to our country;
Provide federal funding … to states to enhance interstate data sharing among prescription drug monitoring programs.

Without adequate funding great ideas remain ideas, intentions remain intentions. 7 people die each hour from drug overdoses in our country, 2/3 of this number specifically attributable to opioid overdose. 1 in 5 newborns begins life with Neonatal Abstinence Syndrome in W Virginia. Millions of incarcerated individuals in America do not receive Substance Use Counseling to equip them to thrive upon release and the freedom to succeed in life. And so it goes. These people do not need great ideas or intentions. We, as Americans, do not need rhetoric and bare minimum responses from our leadership. I ask you, “what will it take to declare a national emergency under the Public Health Service Act or the Stafford Act? What will it take to prompt the administration’s willingness to follow the clear recommendations of its own appointed Commission on Combating Drug Addiction and the Opioid Crisis? What will it take to muster the willingness, the resources to transform great ideas and intentions into even greater realities for all Americans?” We will have to wait until 11/1, just around the corner, to see what the formal response to the Commission’s final recommendations are. Hopefully, there will be adequate funding for programs and services focused upon prevention, treatment, recovery support services and interdiction, the level of funding necessary to change an unacceptable reality. * Interim Report: https://www.whitehouse.gov/sites/whitehouse.gov/files/ondcp/commission-interim-report.pdf [post_title] => Listening to What is Not Said: President Trump’s Declaration Of a Public Health Emergency [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => listening-not-said-president-trumps-declaration-public-health-emergency [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:33:23 [post_modified_gmt] => 2019-10-21 20:33:23 [post_content_filtered] => [post_parent] => 0 [guid] => http://localhost/aspenti/?p=57865 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 2 [filter] => raw ) [6] => WP_Post Object ( [ID] => 57856 [post_author] => 5 [post_date] => 2017-10-31 15:24:18 [post_date_gmt] => 2017-10-31 19:24:18 [post_content] =>

By declaring the opioid crisis as a public health emergency, this past week President Trump joined the millions of voices who cry out from the heartbreak of addiction, who mourn lost lives, and who witness the insidious nature of this disease’s impact on our families and communities.

We can debate whether or not this initiative leverages the full scope of governmental authority to support this crisis. For this, I will defer to my more politically savvy friends. Instead, I remain grateful that our government has symbolically lent its voice to this cause. I am reminded of a recent Aspenti community initiative at the Burlington Airport in which we acknowledge that "the only choice in addiction is how we choose to address it together."

Through this designation, President Trump identified some key avenues for governmental support and focus. These include: - Directing additional grant funding to support opioid-related work - Prevention advocacy for youth - Expanding treatment access to rural settings via telemedicine - Supporting additional safe prescribing practices - Increase Substance Use Disorder (SUD) treatment for those with HIV/AIDS - Encouraging further initiatives centered on alternative, nonaddictive pain medication - Thwarting fentanyl influx into the US from foreign sources - Expanding Medicaid funding to certain treatment centers There are many ways in which the government could choose to exert its influence such as safe and sober housing, gainful employment, or advocacy for medication-assisted treatment. The strategies outlined by President Trump include a few particularly impactful steps including an emphasis on rural access and increased surveillance for fentanyl importation. In addition to limited funding left in the budget this year, all public health emergencies expire in 90 days. With farther-reaching initiatives such as support for the development of nonaddictive pain medications, let us hope for a continued commitment to this work and ongoing renewals to this public health emergency designation. Nonetheless, these initiatives represent first, albeit small, steps in the march towards conquering this disease as an individual, a family, a community and a nation.

References:

https://www.nytimes.com/2017/10/26/us/politics/trump-opioid-crisis.html, accessed 10/27/17

[post_title] => Key Strategies in a Public Health Emergency [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => key-strategies-public-health-emergency [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:33:43 [post_modified_gmt] => 2019-10-21 20:33:43 [post_content_filtered] => [post_parent] => 0 [guid] => http://localhost/aspenti/?p=57856 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [7] => WP_Post Object ( [ID] => 57835 [post_author] => 13 [post_date] => 2017-10-27 11:08:20 [post_date_gmt] => 2017-10-27 15:08:20 [post_content] => The opioid crisis has changed our communities dramatically across the country. With so many different channels for Americans’ to become addicted to opioids, it’s at the point where those who have taken an oath to do no harm, might be doing the most long-term harm with their prescribing practices. With the addition of the instant life and death consequences fentanyl attributes to the equation, the fight many healthcare entities are now facing is a completely new, complicated and ever-evolving task at hand. As healthcare companies, treatment facilities, recovery organizations, drug testing labs, and everyday communities across the nation we must now rapidly accelerate our views on how we view Substance Use Disorder. At Aspenti Health we have a dedicated social mission focused on this very cause.

“We enhance the quality of life for our patients and their communities. We acknowledge the responsibility of social stewardship and the importance of partnership and collaboration, as we promote positive change, improve well-being, and create a better world for all.”

Aspenti Health ™ Social Mission Since the launch of the Aspenti Health brand in July of this year, our drug testing lab has done everything it can to enhance the quality of life for our patients and communities we serve. With a focus on patient care, this September’s Recovery Month we hosted Patient Appreciation Day Lunches across our 10 state-wide Patient Service Centers, providing a meal for our patients who may be experiencing food insecurity. To open the eyes of the public through mainstream media this fall Aspenti sponsored a content campaign with Seven Days to shed light on the incredible efforts the VT recovery community is doing while the shadow of the opioid crisis blankets the state. Seven Days worked in close coordination with Aspenti as an incredible editorial partner in helping elevate the narrative of the committed work of Vermont’s Recovery Community partners. With the launch of our new brand we shared our story and our mission of social impact, remaining open to opportunities on how to best contribute to the reduction of stigma surrounding Substance Use Disorder, an opportunity presented itself to us in the form of a challenge. That challenge was granted by Gene Richards, Director of Aviation at the Burlington International Airport. Earlier in the summer Aspenti purchased ad space at the airport to build awareness on our new brand and share the story of our company, once a pillar of the recovery community relaunched to a continue to serve. As we worked with Gene and the airport staff on the awareness campaign, Gene learned more about Aspenti’s social mission initiatives. Gene quickly became inspired and challenged us to collaborate with community members on how to turn a wing outside of the north terminal into a message of hope and change. Without a doubt in our minds, we accepted the challenge to transform the space. We quickly got to work inviting a variety of recovery community members, behavior change experts, and city officials to a discussion group to best develop the message conscience Vermonters would hear and respond to. The discussion group soon agreed; Substance Use Disorder knows no race, lifestyle, economic status, age, or religion. The stigma surrounding Substance Use Disorder prevents many from seeking treatment as they believe they don’t fit the “junkie” or “addict” stereotype. In close collaboration with our community partners, Aspenti developed the messaging; “the only choice in addiction is how we choose to address it together.” Vermonters are special. When our neighbors are stranded by tragedy we rally around them, whether it be hurricane Irene or the everyday occurrence of helping pull a car out of a snowbank in the middle of a Vermont winter. Unfortunately, the stigma surrounding Substance Use Disorder tends to alter the way people react to someone who may be suffering from an opioid addiction.

After months of coordinated work with community partners and the Burlington International Airport, “The Change Corridor” opened on Monday October 2^nd. Proudly attending the opening were our community partners, our congressional leaders Senator Leahy and Congressman Welch and City of Burlington leaders Mayor Weinberger, Burlington Chief of Police Del Pozo, and Gene Richards.With almost no branding insight, “The Change Corridor” is a prime example of how Aspenti Health puts our community first in addressing our social mission. We focus our efforts on the welfare of our patients, collaborations with communities, and most importantly impacting measurable change. We invite everyone to take a few minutes of their day to stop at the airport, open to the public to observe the exhibit and how people react to a heartening message of choice. We invite everyone in the presence of the Change Corridor to reflect on how the messaging and reactions make us feel about our own views on Substance Use Disorder and if they align with other health issues plaguing the nation. When we choose to engage we can make real change.

[post_title] => How a Lab Ended Up at an Airport [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => brand-social-mission [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:34:18 [post_modified_gmt] => 2019-10-21 20:34:18 [post_content_filtered] => [post_parent] => 0 [guid] => http://localhost/aspenti/?p=57835 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [8] => WP_Post Object ( [ID] => 57799 [post_author] => 6 [post_date] => 2017-10-20 16:15:59 [post_date_gmt] => 2017-10-20 20:15:59 [post_content] =>

A Sure-Fire Way to Protect Our Children from Substance-Use-Disorder

Investigative Journalism, professional publications, expert Speakers in the Addictions field, and good old common sense tell us that we will never control the occurrence of Substance Use Disorder in our country by “supply side” solutions only. Although interdiction, strict regulation and law-enforcement are crucial, the demand for drugs will always be met by the supply of both criminal and legitimate entrepreneurs. We must, as a culture, over time, devote our resources to substantially reducing the demand for all psychoactive chemicals. This will occur over the coming generations, accomplished by our children. We must prepare them for this. What’s known as “resilience” is the key.

Drug use prevention, in part, means equipping all of our children, as they move into adolescence, with the cognitive, emotional and social stability necessary to cope and manage stress in healthy ways. These capacities are brain functions, they are learned, they are a product of the child’s brain’s interaction with the environment, or, more specifically, with the adults in their world. All too often many of our children find themselves in situations which ill-equip them developmentally to constructively respond to the inevitable stressors of adolescence and young-adulthood. These children are at-risk for the development of substance use disorder, as well as a host of other unhealthy behaviors which cause serious health-related problems. The situations I’m referring to are ACEs, or Adverse Childhood Experiences, such as, but not limited to (see sources*): • Child abuse or neglect • Violence in the home • Chaotic family conditions • Unsafe neighborhood conditions • Cumulative effects of developmental needs not being met ACEs are environmental conditions likely to create what’s known as “toxic stress”. Toxic stress is the “prolonged activation of the brain’s stress response systems in the absence of protective relationships.” What occurs as a result of exposure to toxic stress is nothing short of impaired brain development. Children learn to manage stress from attentive adults. Without the continued support of an attentive adult to mediate and buffer stress, children are likely to develop what is called “rapid stress response”. Rapid stress response is the tendency to react to stress impulsively. Toxic stress actually effects the manner in which genes regulate the development of organs, in this case the brain. This is known as epigenetics. The developing brain of a child or adolescent, exposed to continued high levels of environmental stress, unfiltered or mediated by an adult, will be conditioned to respond in ways that are impulsive, or relief seeking, rather than deliberate and considered. This tendency toward impulsive decision making puts the individual at-risk for developing substance use disorder. Part 2 of this series will explain resiliency, and the many ways parents and caretakers can actually affect the developing brain of a child in ways that will serve to protect the child from the consequences of impulsive decision making later in life.*Sources for ACEs data https://www.cdc.gov/violenceprevention/acestudy/about_ace.html https://www.cdc.gov/violenceprevention/childmaltreatment/essentials.html [post_title] => Resilience [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => resilience [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:34:28 [post_modified_gmt] => 2019-10-21 20:34:28 [post_content_filtered] => [post_parent] => 0 [guid] => http://localhost/aspenti/?p=57799 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [9] => WP_Post Object ( [ID] => 57767 [post_author] => 4 [post_date] => 2017-10-10 13:38:49 [post_date_gmt] => 2017-10-10 17:38:49 [post_content] => The Protecting Access to Medicare Act (PAMA) would save government payors an estimated $670 million, nearly 10 percent of the $7 billion that it currently pays annually for lab tests. In draft form, the proposed reduction in the fee schedule for clinical lab tests will significantly impact labs overall and the smaller, regional toxicology labs to an even greater extent. If the proposed reimbursement reductions are adopted, they will negatively impact how Aspenti Health will be able to provide services to our patients at the height of the opioid epidemic in America.

Aspenti Health ™ is a toxicology lab in Burlington, Vermont. Serving a rural state with a population of just over 600,000. Like most of the nation, we are in the grips of the opioid crisis with people suffering from substance use disorder. The combination of many of our patients residing in hard to reach rural communities and the state's limited economic base offers a host of complexities to care for the patients we serve and their struggles to reach long-term recovery. The Surgeon’s General Report cites “The Treatment Gap” as one of major contributors to the opioid crisis today. Two of the major causes of that gap are the inability to access care and lack of screening for substance misuse. Toxicology labs like Aspenti fill that very gap. Our patient service centers serve as collection locations increasing recovery services, testing access to rural communities, and critical checkpoints in our patient’s substance use disorder treatment plan. The PAMA draft rates would deter toxicology labs from expanding to ease access for those in rural America and only increase “The Treatment Gap” that contributes to this nation's opioid crisis.

Fault in the market representation PAMA used to calculate new pricing models

We believe the data collection process was severely flawed including:

By having a narrow definition of “applicable labs” PAMA excluded most of hospital labs which left the remaining 34% of the lab market to be driven by the data of two major labs representing 80% of the volume. These major labs use their economies of scale to negotiate deeply discounted lab fee schedules in exchange for exclusive contracts with private payers. Using a weighted median vs weighted average further skews the pricing towards the two larger labs.
Smaller commercial laboratories typically have less favorable payor agreements than hospital labs. Therefore, the financial impact is felt far greater to these commercials labs as CMS reduces rates coupled with out of network denials with private commercial payers. We believe the greater financial pressure on smaller, regional labs like Aspenti Health will potentially negatively impact the 3 critical factors to improving patient care – cost, quality & access.
PAMA’s data collection efforts were flawed as the data collection guidelines were not published until after data submission had already commenced.
G code reimbursements are set to decrease by 10% in 2018, and even further in the years to come. CMS stated that data reported to them for definitive G codes reflected reimbursements that were 23-59% lower than Medicare reimbursements for the same codes. However, XIFIN, a leader in the healthcare/laboratory revenue cycle management market, has stated that according to their data, Medicare reimbursements were 15% lower than the commercial market average.

Toxicology Under-Represented

While some types of testing are generalized across the country through standard testing, there are a few forms of more niche fields of laboratory medicine. CMS through the PAMA regulations has appropriately constructed an advisory panel and a mechanism for culling specialized expertise through subcommittees. However, the extent of involvement of area experts appears to be limited to molecular pathology in the advisory panel and the creation of only two subcommittees focusing on Advanced Diagnostic Laboratory Tests and Automated Test Panels (5). The unique nature of the toxicology field, who plays a critical role in the opioid crisis and an ever-expanding incidence of substance use disorders, does not appear to have a representation. It is critical that all specialty laboratory care is represented on the advisory board.

Unique position of toxicology labs in healthcare

Clinical laboratories contribute 2.5% to health care costs but drive 70% of clinical decision-making (1). In this rapidly evolving era of value-based care and patient-centered outcomes, it is critical that the laboratory is not a derivative function. By using large volume-based laboratories' reimbursements to drive CMS fee schedules (2), a greater emphasis is placed on the transactional system rather than an integrative system of care. Clinical laboratories contribute 2.5% to health care costs but drive 70% of clinical decision-making. In the field of toxicology, most of testing remains in the hands of small toxicology laboratories who respond to regional needs (3). By potentially driving the closure of these businesses, access to an effective, inexpensive part of treatment at the time of a declared opioid emergency by the White House (4), we may be unwittingly driving increased health care costs through emergency room visits, increased risks for the consequences of intravenous drug use such as hepatitis C and HIV and an astounding number of unintended downstream consequences. This does not align with the intent of PAMA nor does this represent quality patient care.

Call to Action

We cannot stand by and let inaccurate data alter our ability to serve our patients. The immediate solution is for PAMA to delay implementation of the changes until more accurate data from all segments of the laboratory market is collected. CMS is accepting comments until October 23. Join us in submitting your comment electronically by October 23 to this CMS mailbox: CLFS_Annual_Public_Meeting@cms.hhs.gov

(1) Crawford JM, Shotorbani K, Sharma G, Crossey M, Kothari T, Lorey TS, Prichard JW, Wilkerson M and Fisher N. Improving American Healthcare Through “Clinical Lab 2.0”A Project Santa Fe Report. Acad Pathology 4: April 2017 (2) Four challenges of PAMA (from ACLA?) (3) Curran J. IBISWorld Industry Report OD5459 Toxicology Laboratories in the US, January 2017. (4) https://www.npr.org/sections/health-shots/2017/08/11/542767898/president-trump-to-declare-national-opioid-emergency (5) https://www.cms.gov/Regulations-and-Guidance/Guidance/FACA/AdvisoryPanelonClinicalDiagnosticLaboratoryTests.html