Rebuilding Place in the Urban Space

"A community’s physical form, rather than its land uses, is its most intrinsic and enduring characteristic." [Katz, EPA] This blog focuses on place and placemaking and all that makes it work--historic preservation, urban design, transportation, asset-based community development, arts & cultural development, commercial district revitalization, tourism & destination development, and quality of life advocacy--along with doses of civic engagement and good governance watchdogging.

Friday, January 05, 2024

Big omission in blog series on advance hospital/health and wellness planning, public health planning: addiction services

The Denver Post has just published a four-part series on the cost of alcohol-related deaths in the state.

From the article:
Part 1: Colorado alcohol deaths surged 60% in 4 years, but there’s been no public outcry or push to save lives Coloradans die from the effects of alcohol at one of the highest rates in the country, but, in comparison to fentanyl, the state’s reaction has been a shrug. Legislators haven’t seriously considered measures to discourage drinking, and voters expanded access to alcohol in grocery stores. 

Part 2: Colorado has some of the lowest alcohol taxes and highest drinking deaths. That’s no coincidence, experts say. Experts say raising state alcohol taxes also would make more money available for programs aimed at preventing unhealthy drinking and to enforce the state’s liquor laws. Currently, the department charged with regulating Colorado’s alcohol outlets can’t afford to fill all its open positions. 

Part 3: Beer and wine became more widely available in Colorado even as drinking deaths rose. Five years ago, a workgroup tasked with finding ways to reduce Colorado’s rate of drinking-related deaths issued a simple recommendation: cut back on when and where people can buy alcohol. Since then, however, the state has only expanded access to alcohol.

Part 4: Alcohol addiction treatment is available in Colorado, but people struggle to get the help they need. Despite the availability of addiction programs, people who are concerned about their own drinking or a loved one’s don’t always know where to turn. Treatment options may not meet patients’ preferences, aren’t easily accessible in certain parts of the state, or don’t necessarily accept all forms of insurance, including Medicare and Medicaid. 

From the first article:

Alcohol killed 1,547 people statewide in 2022 — fewer than the 1,799 who died of overdoses. 

This table from the first article lists the leading causes of death in Colorado as of 2022.  It didn't list the 387 murders, nor 754 traffic fatalities statewide that year.

We think of murder rates as high, and yet traffic- related deaths tend to be much higher.  

But these numbers are significantly eclipsed by addiction related deaths, and deaths from disease, including chronic health conditions.

One of the interesting points in the first article is how alcohol increases inflammation, and inflammation is an accelerator of many health problems.  Inflammation over all isn't countered by the benefits of antioxidants in wine.

In the article on addiction services, it took me a long time to recognize and they don't exactly emphasize it, is that failure is part of the process, that it likely takes people more than one attempt to succeed.  

The article discusses how health insurance is supposed to cover addiction treatment equal to other elements, and when in-network services aren't available, people are supposed to have insurance cover out of network services.  It also discusses how traditional 12-step and similar programs don't work for a lot of people, and prescription drug support that can reduce cravings often isn't available.

In 2017 I wrote a bunch of articles, and then some follow ups, on broader health, wellness and public health planning and programming that could be integrated into a hospital complex and more broadly across the community, given DC's commitment to build a new hospital to replace the United Medical Center (formerly Greater Southwest Hospital) in Ward 7, "East of the River."  

Oh, DC isn't really doing this, although the city does have a good commitment to health insurance coverage access, and support for community health clinics.  In addition the city is adding more clinics, I can't remember exactly how, to Wards 7 and 8.  Some are affiliated with the new hospital ("Mayor Bowser Celebrates the Topping Out of Cedar Hill Regional Medical Center GW Health on the St. Elizabeths East Campus," press release).

In 2020, with onset of covid I wrote two related articles about gaps in the original series in terms of disaster planning, including pandemics/epidemics and public health:

And there are two articles relevant to the second article on creating a graduate health and biotechnology research initiative:

And one last year, applying these concepts to two hospital projects in Salt Lake City and West Valley City here in Utah.

DC is worse than Colorado  |  Writing biases reflect "lived experience": failure to mention the need for expanded addiction treatment services as a public health measure.  I drink very little, especially now, and I don't use illegal drugs.  E.g., I haven't touched marijuana in about 30 years.  

So it's unfortunate, given that DC's overdose deaths and alcohol deaths in DC are actually worse than Colorado, the focus of the Denver Post series--if Colorado had DC's rate of alcohol deaths, it would be close to 2,100 deaths, almost 50% higher that it is, that I didn't mention specialized and expanded addiction treatment services as part of a broader health, wellness, and public health approach for what is now being called the Cedar Hill Regional Medical Center.  

Sure part of that is captured indirectly in how the series focuses on addressing chronic medical conditions.  But it's also ironic in that my first DC job was for a public health related group, which had an alcohol policies project, and for awhile a program on Hispanic health which included a focus on tobacco consumption.  (For the most part the group didn't focus on tobacco because it was and is covered so well by other organizations.)

Since all those articles, I do update them with relevant programs and information I come across in the comments, and addiction treatment programs were mentioned there.  But it's a major oversight in a city like DC, where addiction is high, for example 461 opioid-related overdose deaths in 2022.  With a minimum estimated number of 311 alcohol-related deaths, based on the imputed rate by an NIH related institute and the total adult population.  Colorado has an adult population 6.67x greater than that of DC.

In the next iteration of the main article, e.g., the last iteration was on Utah, I will be sure to add addiction treatment services to the main set of programs.

An article in the Guardian mentions public health as an economic development lever  ("his article is more than 11 months old Without health there is no wealth. Why do so few governments understand this?"), in an article on the failures of the National Health Service there to keep up with demand, especially as Tory austerity has resulted in significantly poorer health outcomes and premature deaths on the part of a significant proportion of the population ("Austerity blamed for life expectancy stalling for first time in century") even before covid.

Labels: , , , , ,


At 9:39 PM, Blogger Richard Layman said...

‘A Monster’: Super Meth and Other Drugs Push Crisis Beyond Opioids

Millions of U.S. drug users now are addicted to several substances, not just opioids like fentanyl and heroin. The shift is making treatment far more difficult.

Dr. Helmstetter, who makes weekly primary care rounds with a program called Street Medicine Kalamazoo, carried medications to reverse overdoses, blunt cravings and ease withdrawal-induced nausea.

But increasingly, the utility of these therapies, developed to address the decades-old opioid crisis, is diminishing. They work to counteract the most devastating effects of fentanyl and heroin, but most users now routinely test positive for other substances too, predominantly stimulants such as cocaine and methamphetamine, for which there are no approved medications.

... The United States is in a new and perilous period in its battle against illicit drugs. The scourge is not only opioids, such as fentanyl, but a rapidly growing practice that the Centers for Disease Control and Prevention labels “polysubstance use.”

Over the last three years, studies of people addicted to opioids (a population estimated to be in the millions) have consistently shown that between 70 and 80 percent also take other illicit substances, a shift that is stymieing treatment efforts and confounding state, local and federal policies.

“It’s no longer an opioid epidemic,” said Dr. Cara Poland, an associate professor at the Michigan State University College of Human Medicine. “This is an addiction crisis.”

... A decade or so ago, Mexican drug lords figured out how to mass-produce a synthetic “super meth.” It has provoked what some researchers are calling a second meth epidemic.

... People addicted to multiple substances are far more resistant to going into treatment than single-substance users, addiction medicine experts say.

Dr. Trowbridge said some opioid patients can become stable enough to progress to monthly injectable buprenorphine. But if they are also using meth, that treatment plan often collapses.

The paranoia and hallucinations caused by meth disorient them, he said. One patient threw himself in a river to escape nonexistent people who were chasing him. Others insisted that dumpsters were talking to them, that color-coded cars were sending them messages.

So they skip appointments, returning only “when they start to hit withdrawal and realize their opioid injection is wearing off,” he said.

... Like many patients who use multiple substances, Sami has mental disabilities, including attention deficit disorder and bipolar disorder. According to federal data, more than one in four adults with serious mental disorders turns to illicit drugs. A.D.H.D. that has been poorly managed or undiagnosed is particularly common in meth patients.

At 7:25 PM, Blogger Richard Layman said...

Minnesota addiction treatment centers closing, despite high demand
As drug overdose deaths remain high, treatment providers said 2023 stood out for the number of program closures.


Addiction treatment providers stopped services in at least 10 Minnesota locations in 2023, often citing a lack of staff and perilously thin margins. Others scaled back.

Program closures in 2023 surpassed any year that several providers said they can recall, and the closures are coming as deadly overdoses and demand for services remain high. On average, more than three people died every day in Minnesota from an overdose, according to Minnesota Department of Health data on confirmed deaths in 2023.

... It's hard to find and hang onto workers willing to do the challenging jobs, state administrative requirements are burdensome and companies are still limping from pandemic setbacks and inflation, he said.

Then there's the state's reimbursement rates. A recently released state study showed the rates the state pays providers do not line up with what they are spending to do the work. DHS officials recommended widespread increases, and both Democrats and Republicans stressed the need for rate changes at a January hearing.

... It's not just adolescent centers shutting down: Providers offering various levels of service – from residential inpatient treatment to outpatient therapy services to clinics offering medication-assisted treatment – have closed their doors.

Organizations are also mothballing programs, having staff take on more cases or selling real estate to stay viable, said Brian Zirbes, executive director of the Minnesota Association of Resources for Recovery and Chemical Health. He said the association surveyed more than 120 of its members last summer and found a number of them were "on the ropes."

At 5:34 PM, Blogger Richard Layman said...

What Does Being Sober Mean Today? For Many, Not Full Abstinence.

More younger Americans are shunning alcohol while embracing cannabis, ketamine and psychedelics, shaking up the field of addiction medicine.

As some drugs come to be viewed as wellness boosters by those who use them, adherence to the full abstinence model favored by organizations like Alcoholics Anonymous is shifting. Some people call themselves “California sober,” a term popularized in a 2021 song by the pop star Demi Lovato, who later disavowed the idea, saying on social media that “sober sober is the only way to be.”

Approaches that might have once seemed ludicrous — like treating opioid addiction with psychedelics — have gained broader enthusiasm among doctors as drug overdoses kill tens of thousands of Americans each year.

“The abstinence-only model is very restrictive,” said Dr. Peter Grinspoon, a primary care physician at Massachusetts General Hospital who specializes in medical cannabis and is a recovering opioid addict. “We really have to meet people where they are and have a broader recovery tent.”

... At the same time, the use of cannabis and psychedelics has risen as state laws and attitudes grow more permissive, even as both remain illegal under federal law.

A survey found that 44 percent of adults aged 19 to 30 said in 2022 that they had used cannabis in the past year, a record high. That year, 8 percent of adults in the same age range said they had used psychedelics, an increase from the 3 percent a decade earlier.

At 9:04 AM, Blogger Richard Layman said...

Fentanyl crisis in WA needs a turning point, so what is being done?


1. A rising tide of pills – and overdoses

Overdose numbers in the past few years have been “staggering,” Banta-Green said, and will have to peak at some point — though he’s not sure it will be this year.

“It’s hard to imagine we’d be still increasing at the rate we’ve been going at,” Banta-Green said. “You’d think it would slow down. But I don’t think it’s going to slow because of improved services; I think it’s going to slow because people are dying.”

Based on what Seattle police are seeing on the streets, police Chief Adrian Diaz said he won’t be surprised if 2024 ends with another 1,000 overdose deaths countywide from the synthetic opioid, given the drug’s broadening availability, declining cost and growing potency.

Five years ago, when fake M30 pills laced with fentanyl first started showing up in the local drug supply, the blue pills sold for $15 apiece, Diaz said. By fall 2022, the price had fallen to $2 or $3 per pill. Now, it costs about $1 per pill — an indication of just how much fentanyl is being smuggled into the area, he said.

2. ERs become increasingly taxed

In Washington, about 1 in 10 ER visits are by people experiencing homelessness, the majority of whom seek care for a substance-use disorder alone or in combination with a mental health condition, according to a report from the Washington State Hospital Association and Challenge Seattle, a consortium of the region’s business leaders.

The report called for more street medicine teams and low-barrier, 24/7 sites where people can stabilize and receive treatment. It also recommended accelerating the development of new behavioral health facilities with a focus on the fentanyl crisis and securing more sustainable funding for these efforts.

3. A fight over ownership of the problem

The city says more police and jail involvement for fentanyl users could be coming.

Nelson said an arrest is “a chance for people to sober up for a little bit and consider a different path” and can wear people down to accept treatment.

Diaz and the Seattle City Attorney’s Office are in talks to potentially create a threshold of how many times a person can overdose and refuse treatment before it becomes a bookable offense. He said officers are seeing the same people multiple times a day, and he wants a way to get them to accept treatment.

Jail might not be an option for most people arrested, though.

5. Better treatment and outreach to youth

School districts with 2,000 or more students are already required by law to stock the opioid-reversal drug naloxone. In January, the state’s health department said it planned to make it easier for schools to get the medication by offering two free intranasal naloxone kits to any public high school that wanted them.

At 6:50 AM, Blogger Richard Layman said...

At 10:38 AM, Blogger Richard Layman said...

‘In a way, stigma is the leading cause of death’: the radical plan to tackle British Columbia’s overdose epidemic

In 2022, the Drug User’s Liberation Front announced it would offer pure cocaine, methamphetamine and heroin to users as part of a “compassion club” to prevent overdose deaths.

“If you label people’s drugs such that they clearly indicate what a person is putting into their body, people won’t be overdosing,” Eris Nyx, a co-founder of the group, told the Guardian at the time. “No one takes more than they intend to take.”

British Columbia has decriminalized – but not legalized – the possession of small amounts of illicit drugs. There are also safe injection sites in Vancouver, which give a space for users to consume drugs with the resources at hand to test drug purity and reverse overdose.

“People ask why, with decriminalization, the overdose rate keep going up. And the answer is very simple and straightforward. It’s because the drug supply has become increasingly toxic,” said Thomas Kerr, a professor in the department of medicine at the University of British Columbia. “We’re in what I would argue is the most catastrophic public health crisis we’ve experienced in Canada in the modern era.”

At 5:17 AM, Blogger Richard Layman said...

Why Oregon’s Drug Decriminalization Failed

The sponsors of the law fundamentally misunderstood the nature of addiction.

The key elements of Measure 110 were the removal of criminal penalties for possession of small amounts of drugs such as methamphetamine, heroin, cocaine, and fentanyl, and a sharper focus, instead, on reducing the harm that drugs cause to their users. More than $260 million were allocated to services such as naloxone distribution, employment and housing services, and voluntary treatment. The original campaign for the measure was well funded by multiple backers, most prominently the Drug Policy Alliance, based in New York. Supporters hoped that ending penalties—and reducing the associated stigma of drug use—would bring a range of benefits. Once drugs were decriminalized and destigmatized, the thinking went, those who wanted to continue using would be more willing to access harm-reduction services that helped them use in safer ways. Meanwhile, the many people who wanted to quit using drugs but had been too ashamed or fearful to seek treatment would do so.

Measure 110 did not reduce Oregon’s drug problems. The drug-overdose-death rate increased by 43 percent in 2021, its first year of implementation—and then kept rising. The latest CDC data show that in the 12 months ending in September 2023, deaths by overdose
grew by 41.6 percent, versus 2.1 percent nationwide. No other state saw a higher rise in deaths. Only one state, Vermont, ranks higher in its rate of illicit drug use.

Neither did decriminalization produce a flood of help-seeking. The replacement for criminal penalties, a $100 ticket for drug possession with the fine waived if the individual called a toll free number for a health assessment, with the aim of encouraging treatment, failed
completely. More than 95 percent of people ignored the ticket, for which—in keeping with the spirit of Measure 110—there was no consequence. The cost of the hotline worked out to about $7,000 per completed phone call, according to The Economist. These realities, as well as associated disorder such as open-air drug markets and a sharp rise in violent crime—while such crime was falling nationally—led Oregonians to rethink their drug policy.

Oregon’s drug decriminalisation has had a troubled start

At 4:32 PM, Blogger Richard Layman said...

Addiction treatment and sober homes, with their spasms of chaos, prompt new bills
Column: ‘We should know if there are certified, qualified people running these facilities,’ neighbor says

At 9:44 PM, Blogger Richard Layman said...

Long wait times and a toxic drug supply make it difficult for Philadelphia patients to get addiction treatment

Patients told researchers that getting treatment is a daunting prospect, in part because of the long wait times built into the process.

The city has 60 programs outside of hospitals designed for drug users who are relatively stable, and more than 1,800 beds in residential rehabs. Hospitals and psychiatric hospitals have at least another 150 inpatient beds for those with more intense medical needs.

But securing a spot in these programs can be difficult, time-consuming, and physically painful, people in addiction told researchers in a series of focus groups.

The report’s authors recommended a series of reforms to Philadelphia’s treatment system that they said health officials should consider, including:

increasing the number of inpatient treatment beds for people on public insurance;

expanding outpatient care in more neighborhoods;

more effectively addressing withdrawal symptoms in people addicted to xylazine, the animal tranquilizer that has contaminated most of the city’s illicit opioids;

improving housing options for people with addiction

At 10:22 PM, Blogger Richard Layman said...

At 12:39 AM, Blogger Richard Layman said...

Our supervised consumption site saves lives. Now it's about to close
The provincial government has not responded to our plea for continued funding, and without it, more people will die, says Amber Fritz.

Supervised consumption services are grounded in nearly four decades of evidence. There has never been a single death at one of these sites. They reduce police and ambulance calls, keep people out of busy hospitals and offer vital supports. In 16 months since The Spot opened, we have seen its incredible impact. It is a place of safety, self-determination, community and support. People come to consume drugs with sterile supplies and supervision for safety, yes — but that's just one small part of what happens here. We connect people with housing services. If someone wants treatment for their substance use, we support them to access it. We connect people with medical appointments, dental work, winter clothing — whatever they need. The Spot offers care without judgment.
We have had more than 2,800 visits to our site. We have reversed every single overdose that has happened here. These are our sons, daughters, mothers, fathers, neighbours and workers. They are loved, every single one of them.

At 3:13 AM, Blogger vimal said...

Preethi Hospitals Madurai is considered as one of the leading and Best Neurology hospital in Madurai by providing various services and stupendous care with top-notch diagnosis for neuro related problems.


Post a Comment

<< Home