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Some Doctors Say Focus Of Opioid Addiction Treatment Must Shift From Medication To Long-Term Recovery

While most say medication-assisted treatment for opioid addiction improves patient outcomes, some doctors are questioning seeking a cure from the same industry they say caused the problem. Pictured here, OxyContin, an opioid, is seen in a pharmacy in 2013. (Toby Talbot/AP/File)

While most say medication-assisted treatment for opioid addiction improves patient outcomes, some doctors are questioning seeking a cure from the same industry they say caused the problem. Pictured here, OxyContin, an opioid, is seen in a pharmacy in 2013. (Toby Talbot/AP/File)

While addiction treatment providers are increasingly recommending that medication be used to help wean people off opioids, some doctors are concerned there is now too much of a focus on medication and not enough on the harder work of long-term recovery from substance use disorder.

During the annual American Society of Addiction Medicine conference in Baltimore last month, a frequently heard statistic was that every 20 minutes someone in the U.S. dies from an opioid overdose.

“Imagine if we had someone in America dying from terrorism every 20 minutes,” Vermont Gov. Peter Shumlin said. “You wouldn’t have to just take your shoes off at the airport, you’d have to take everything off.”

Shumlin became a leading political voice on the opioid epidemic after dedicating his 2014 state of the state address to the problem in Vermont. Shumlin told the 1,800 people at the Baltimore conference that the nation needs their help to reduce the 250 million prescriptions written for opioid painkillers every year.

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Weight Gain, Heart Disease, Back Pain: Longer Car Commutes May Harm Your Health

The worsening traffic in Boston -- or any metropolitan area -- does not just cost drivers time. It may also cost them health. Here's early afternoon bumper-to-bumper traffic on 93 in Milton (Jesse Costa/WBUR)

The worsening traffic in Boston — or any metropolitan area — does not just cost drivers time. It may also cost them health. Here’s early afternoon bumper-to-bumper traffic on 93 in Milton (Jesse Costa/WBUR)

Four years ago, Barbara Huntress-Rather got a great job, as director of quality improvement for a health care company that serves fragile seniors. Just one problem: She lived in Lawrence, and the new job was in Lynn.

“The first day I drove to work and said, ‘Oh, Lord, what have I done?’ ” she recalls. “After having a short commute for quite a few years, I hadn’t done the commute before in rush hour traffic and I was absolutely stunned at how long it took — it was over an hour.”

A harrowing hour, or more, hunched at the wheel, watching out constantly for aggressive or distracted drivers. In the months that followed, the effects on her health were dramatic: “I gained back 40 pounds that I had lost, developed low back pain and high blood pressure,” she says.

Huntress-Rather didn’t immediately blame her commute; she blamed herself for eating too much and feeling too tired to exercise. But she hit a turning point when her nurse practitioner told her she’d need blood pressure medication.

“I had always prided myself in being in good physical shape and meditating and doing all the things that would keep me from having high blood pressure,” she says. “And I immediately made the connection between not working out, spending endless hours in the car and feeling totally stressed most of the time. I was either commuting or worrying about commuting.”

Barbara Huntress-Rather found that her long commute led to weight gain, high blood pressure and back pain. She aims to retire soon and get her good health back. (Jesse Costa/WBUR)

Barbara Huntress-Rather found that her long commute led to weight gain, high blood pressure and back pain. She plans to retire earlier than she would have otherwise and get her good health back. (Jesse Costa/WBUR)

Huntress-Rather is practically a textbook case of what longer car commutes can do to bodies and minds. The evidence has been mounting in study after study in recent years, adding up to strong reason to believe that the worsening traffic in Boston — or any metropolitan area — does not just cost drivers time. It may also cost them health.

Let’s begin with the No. 1 killer of Americans: heart disease. Continue reading

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Simmons College Course Prepares Future Social Workers To Address Suicide

Justin Marotta, right, takes his oral mid-term exam for his course -- "Understanding Suicide: Prevention, Intervention, and Postvention" -- at the Simmons College School of Social Work. Laura Goodman, left, role-plays as the client, as instructor Kim O'Brien observes. (Jesse Costa/WBUR)

Justin Marotta, right, takes his oral mid-term exam for his course — “Understanding Suicide: Prevention, Intervention, and Postvention” — at the Simmons College School of Social Work. Laura Goodman, left, role-plays as the client, as instructor Kim O’Brien observes. (Jesse Costa/WBUR)

In a conference room at Simmons College, two young adults sit across from each other at a table. One of them is sharing details of a very personal mental health struggle.

“I was on the inpatient unit for like a week or so,” the woman says. “My parents brought me into the emergency room because I was pretty depressed and was, like, cutting myself with a scissor.”

It isn’t a real counseling session. It’s a mid-term exam.

Laura Goodman and Justin Marotta are second-year students working toward master’s degrees in social work at Simmons. They’ve been learning how to determine whether a client is suicidal and how to respond. They found out early in this course to come right out and ask clients whether they’re thinking about suicide or have a suicide plan in place. Continue reading

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‘Can’t Imagine Life Without It’: 10 Years After Mass. Health Reform, Residents Speak About Law’s Impact

On this day, 10 years ago, the hottest ticket in town was for a seat in Faneuil Hall, to watch then-Gov. Mitt Romney sign the state’s new health coverage law and describe its goals.

“Every citizen with affordable, comprehensive health insurance, small businesses able to conveniently buy insurance for their employees at a cost that’s competitive with big businesses, medical transparency bringing marketplace dynamics to health care — really for the first time — and finally, beginning to rein in health care inflation,” Romney said in 2006.

Today, we have compiled some facts and figures on the 10th anniversary. There’s also a collection of essays from health care experts of all stripes assessing the law’s first decade.

On Morning Edition today, we hear from a different group: Massachusetts residents, including several who did not have insurance before the state’s first-of-its-kind law.

Should Docs Ask Patients About Guns? AG Healey, Mass. Medical Society Take Up Issue

“For God’s sake, you mean, physicians should be precluded from asking about the most lethal consumer product out there: a gun? That’s just wrong," Attorney General Maura Healey, seen here in a file photo, said at a forum Tuesday. (Jesse Costa/WBUR)

“For God’s sake, you mean physicians should be precluded from asking about the most lethal consumer product out there: a gun? That’s just wrong,” Attorney General Maura Healey, seen here in a file photo, said at a forum Tuesday. (Jesse Costa/WBUR)

Every year, the Massachusetts Medical Society picks an important public health topic of the day and tries to figure out how to make a difference.

This year, it’s guns.

Dr. Georges Benjamin, director of the American Public Health Association, warned physicians at a forum here Tuesday afternoon to be ready for pushback.

“‘Cause you will be asked, ‘Why do doctors care about this?’ I’d love for you all to say: ‘It’s mine, because it hurts people or kills people, it’s a physician’s prerogative,’ ” he said.

According to the Centers for Disease Control, about 90 Americans are killed with guns every day.

Attorney General Maura Healey hopes to partner with the medical society to reduce gun deaths.

“Now’s the time for us to seize this and take it back and reframe this issue,” Healey said. “We can begin to treat gun violence as the public health crisis that it is.”

Healey and the medical society plan to craft uniform questions doctors would ask patients about guns. But, the answers may create new problems for doctors. Continue reading

‘Not Unlike A Mortgage’: Health Care Loans Proposed For Pricey Treatments

Robert Deckman, at his home in Gloucester (Jesse Costa/WBUR)

Robert Deckman, at his home in Gloucester (Jesse Costa/WBUR)

About three years ago, right around his 50th birthday, Robert Deckman found out he qualified for MassHealth. So this carpenter from Gloucester did something he hadn’t done in years: He went to the doctor.

“I’m like, well, let’s get the 50-year tuneup, the whole nine yards, just everything,” Deckman said recently, tossing his hands in the air. “The blood work was the last thing I did.”

The blood work showed Deckman had hepatitis C, a virus that damages the liver. His doctor delivered good news: A drug coming on the market would almost certainly cure his disease. And bad news: One bottle of the pills would cost $37,000. Deckman would probably need two.

“‘I can’t pay that, so I guess I’ll just die,’ ” Deckman recalled telling the doctor.

The doctor told Deckman insurance should cover Harvoni, the medicine the physician would prescribe, but his insurance provider might make him “jump through hoops,” the doctor said.

Deckman was denied the very expensive life-saving drug twice. His skin turned yellow, his pony tail thinned, he developed a skin infection and problems with his teeth. Deckman’s family grew desperate. His sister, Viki Deckman-Moeller, laid out a strategy.

“Plan A was to put a fundraiser together for my brother, and see if we could, just through friends and family, get some donations,” Deckman-Moeller said. “And then, we were looking at, or I was looking at, going out and getting a loan of some type at a low interest rate, for — it would have been about $50,000 I guess.”

Taking out a loan or pulling out a credit card to pay a health bill is not new. But now, with hep C pills that are $1,000 apiece, cancer drugs priced at $100,000 a year, and gene therapy at almost $1 million per treatment, credit cards or a line of credit at your bank will not be adequate.

Dr. David Weinstock, left, and professor Andrew Lo (Courtesy)

Dr. David Weinstock, left, and professor Andrew Lo (Courtesy)

MIT professor Andrew Lo and Dr. David Weinstock at the Dana-Farber Cancer Institute say it’s time to create a long-term health care loan.

“The basic idea is for individual patients to have access to health care loans, not unlike a mortgage or auto loan or student loan,” Lo said. Patients would “borrow from a loan company to pay for these extremely expensive therapies and amortize the payments over a period of time, say five to 10 years.”

The loans would be available for drugs or treatment that would cure a disease or improve a patient’s health over the length of the loan.

“If the drug works, then all the payments would be made, but if it doesn’t, then payment would stop,” Weinstock said. “That creates more risk in the investment itself but it also incentivizes drug companies to develop drugs that really do work.” Continue reading

As Mass. Grapples With Opioid Crisis, More Babies Are Being Born Exposed To Drugs

Shortly after birth, James, who is now 1, was diagnosed with neonatal abstinence syndrome and given small doses of morphine to get him through the withdrawal. Here, James works with occupational therapist Victoria Peake at MGH's Newborn Developmental Follow-Up Clinic, as Dr. Leslie Kerzner, left, and James' adoptive mother, Kristen Fontaine, center, look on. (Jesse Costa/WBUR)

Shortly after birth, James, who is now 1, was diagnosed with neonatal abstinence syndrome and given small doses of morphine to get him through the withdrawal. Here, James works with occupational therapist Victoria Peake at MGH’s Newborn Developmental Follow-Up Clinic, as Dr. Leslie Kerzner, left, and James’ adoptive mother, Kristen Fontaine, center, look on. (Jesse Costa/WBUR)

Massachusetts hospitals are seeing evidence that the opioid epidemic is affecting the next generation, with an increasing number of babies being born exposed to drugs.

The most recent state hospital data suggest that the rate of drug-dependent newborns has skyrocketed to about 16 in every 1,000 births — about three times the national average.

At Massachusetts General Hospital, doctors started following drug-exposed babies about three years ago. Dr. Leslie Kerzner, director of the Newborn Developmental Follow-Up Clinic at MGH, tracks the babies until age 2. She says the vast majority of infants exposed to drugs in utero will experience withdrawal symptoms similar to those of an adult going through withdrawal. (Click here for a video from MGH of an infant displaying symptoms of withdrawal.) 

“A baby going through withdrawal is very disorganized,” Kerzner explained. “They go from state to state, from alert awake to crying, you know, it’s like zero to 60 in just a couple of seconds. They have increased muscle tone, a high-pitched cry. They’re not easy to soothe. They may be throwing up, have diarrhea, mottled skin. They are not healthy looking.”

Most of the moms that gave birth to exposed babies at MGH in the past year were white, their median age was about 30. More than 30 percent of the moms were prescribed opioids for chronic pain. Close to 90 percent of the pregnancies were not planned.

One of those babies was 1-year-old James. Shortly after birth he was diagnosed with what’s called neonatal abstinence syndrome and given small doses of morphine and another drug to get him through the withdrawal.

James crawls after a rubber duck during a recent checkup at the Newborn Developmental Follow-Up Clinic at MGH. (Jesse Costa/WBUR)

James crawls after a rubber duck during a recent checkup at the Newborn Developmental Follow-Up Clinic at MGH. (Jesse Costa/WBUR)

“James did go through neonatal abstinence syndrome, requiring medical therapy with both morphine and phenobarbital — which is not unusual when a baby might have been exposed to other things,” Kerzner said. “Many of the moms are poly-substance users.”

Doctors knew that James had been exposed to methadone. Kristen Fontaine and her husband got involved when they were contacted by a social worker caring for the infant. They were looking to adopt and came to see James at MGH’s special care nursery.

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Sudders: Combating Mass. Opioid Crisis ‘Is Going To Take Us Time,’ Even With New Law

Secretary of Health and Human Services Marylou Sudders speaks about the opioids legislation signed into law just moments earlier by Gov. Charlie Baker on Monday. (Jesse Costa/WBUR)

Secretary of Health and Human Services Marylou Sudders speaks about the opioids legislation signed into law just moments earlier by Gov. Charlie Baker on Monday. (Jesse Costa/WBUR)

A new law designed to stem the deadly opioid drug abuse crisis in Massachusetts was signed into law Monday by Gov. Charlie Baker. On Tuesday, the governor will also meet with his opioid working group to discuss implementing the new law.

Massachusetts Health and Human Services Secretary Mary Lou Sudders is part of that group and joined Morning Edition to discuss the new law. Continue reading

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Mass. Small Business Owners Dropping Health Coverage That’s Become Unaffordable

Ryan Cook wanted to help. The office manager at his small Raynham real estate office needed health insurance; her husband had lost his job and with it, the family’s coverage.

So Cook looked into adding the woman and her family to his self-employed plan. “And I was seeing prices at about $1,800 a month. That cost was ridiculous, quite frankly,” said Cook, president of FCRG, Inc.

Ridiculous, but not a complete surprise, as Cook’s own premiums have increased 50 percent in the last three years.

His office manager tried another option. She applied for subsidized coverage through the state Health Connector and was told she qualified. Her monthly contribution would be $250 a month.

“It just made no sense at that point for me to provide that benefit to my employee,” Cook said.

Cook says many small business owners he talks to at Chamber of Commerce luncheons and other meetings are struggling to stay competitive with larger firms when it comes to benefits.

“The one that everyone is choking on is the cost of health care,” Cook said. “They’d love to be able to offer it but it just becomes so cost prohibitive to the business that you can’t do it.” Continue reading

Ballot Initiative Seeks To Limit Cost Ranges For Medical Care At Mass. Hospitals

In Massachusetts, it can cost you or your insurance company two or three times more to deliver a baby at one of the big Boston teaching hospitals than at small- or medium-size facilities outside the city.

Is this a problem? Should the state try to fix it? That’s what you may have to decide when you vote in the fall. WBUR’s Martha Bebinger explains the issue for Morning Edition.

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