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.

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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.


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