<![CDATA[RICares - News & Events]]>Wed, 13 Sep 2017 19:12:46 -0400Weebly<![CDATA[Active Issues]]>Thu, 24 Aug 2017 20:52:50 GMThttp://ricares.org/news--events/active-issuesRICARES hopes to have a page in the future with all active issues at a local level and a national level that need to be acted on. We are working towards that. In the meantime check our advocacy page for local agencies working on issues that matter to us.

Faces & Voices of Recovery track all national issues that need our attention. Please keep checking back for updates!]]>
<![CDATA[An interfaith memorial service for the 1,250 Rhode Islanders who have died of opioid overdose in the last five years was held Thursday at the First Baptist Church in America in Providence.]]>Fri, 30 Jun 2017 17:49:31 GMThttp://ricares.org/news--events/an-interfaith-memorial-service-for-the-1250-rhode-islanders-who-have-died-of-opioid-overdose-in-the-last-five-years-was-held-thursday-at-the-first-baptist-church-in-america-in-providenceAn interfaith memorial service for the 1,250 Rhode Islanders who have died of opioid overdose in the last five years was held Thursday at the First Baptist Church in America in Providence. The service was a collaboration of clergy, the St. Matthias Ministry of the Roman Catholic Diocese of Providence and a group known as FIRE, which stands for Faith Infused Recovery Efforts. Besides music and prayer, speakers including personal family stories of the affliction of addiction.

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<![CDATA[First, invest in reducing harm]]>Mon, 26 Jun 2017 17:41:17 GMThttp://ricares.org/news--events/first-invest-in-reducing-harm
A jarring comment at the close of the June 14 Governor’s Overdose Prevention and Intervention Task Force meeting challenged the way that strategies are being implemented, and whether they benefit the people seeking treatment and recovery
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PHOTO BY RICHARD ASINOF Gov. Gina Raimondo talks at the opening of the new Lifespan Recovery Center on June 19, as Dr. Timothy Babineau, president and CEO of Lifespan, listens attentively.
WHY IS THIS STORY IMPORTANT?

Despite the best efforts of the Governor’s Task Force, people keep dying at an alarming rate in Rhode Island from overdose deaths. What has not yet made it onto the agenda of the Task Force and into the public conversation are harm reduction strategies to save lives. At the opening of the new Lifespan Recovery Center, the senior vice president of Psychiatry and Behavioral Health said that the only thing he knew about safe injection sites is what he had read in the newspaper.
THE QUESTIONS THAT NEED TO BE ASKED

Why are harm reduction strategies not at the top of the agenda of the Governor’s Task Force, if the goal is to save lives? How can the recovery community make its voice heard, both at the Task Force in devising strategy, and in the larger public conversation? Will R.I. Attorney General Peter Kilmartin be willing to explore potential legal action against the Purdue Pharma division in Cumberland, seeking to recover the costs of public funds spent on treating patients with substance use disorders caused by prescription painkillers? Will the U.S. Senate be able to muster 50 votes needed to pass the Republican version of Trumpcare to repeal and replace Obamacare, or will Republican Senators be willing to stand up and say no to Sen. Mitch McConnell?
UNDER THE RADAR SCREEN

As more and more evidence mounts about the links between the economic disenfranchisement and the disease of despair – deaths from alcohol, suicide and drugs, the question remains how to have a public conversation about the issues that does not feature clinical experts talking at the audience. Recent research looking at the numbers form the Centers for Disease Control and Prevention on the numbers of deaths from 2010 to 2014 found that for the demographic of young white adults, male and female, between the ages of 25-34, Rhode Island led the nation with the highest rate of deaths caused by suicide, alcohol and drugs, at 59.8 percent.
MIND AND BODY
By Richard Asinof
Posted 6/26/17

PROVIDENCE – Was it sardonic, spot on, or both? At the close of the June 14 meeting of the Governor’s Overdose Prevention and Intervention Task Force, numerous sources told ConvergenceRI, Jonathan Goyer stood up and said: If you’re going to OD, make sure you do it during 9 a.m. and 5 p.m. on weekdays, because services for treatment and recovery are hard to access on weekends.

For the last few years, Goyer has very much been a public face of the efforts to prevent overdose deaths and to promote recovery efforts, having survived an overdose and been revived by Narcan. 

Goyer is one of the people featured in the advertising efforts around the messaging: addiction is a disease; recovery is possible. [See link to ConvergenceRI story below, “Revised action plan released to tackle overdose epidemic, spur recovery.”

Goyer’s comment, which closed the Task Force meeting without any further discussion, revealed what he saw as the difficulties in accessing treatment in a timely fashion in Rhode Island: there is a minimal waiting period of 48 hours to get an appointment, and residential treatment has about a three-week waiting list, according to Goyer.

Talk about honesty and courage. By standing up and saying what he did, when he did, Goyer punctured an illusion that the Governor’s Task Force’s strategic approach was working smoothly.

Goyer’s comment also shined a spotlight on a more fundamental challenge: how and when does the recovery community’s voice get heard as part of the deliberations of the Task Force, in particular when it comes to harm reduction strategies becoming part of the agenda?

Being heard
What Goyer had to say was not part of the scheduled agenda of the task force, according to Jenna Mackevich, communications coordinator with the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, in response to questions from ConvergenceRI. Rather, it occurred as part of the open public comment. 

“The open comment period at the end of our Task Force meeting is vital because we’re able to hear this kind of critical feedback,” Mackevich said, in a positive reframe.

Goyer’s comments did result in an immediate reaction from Rebecca Boss, the director of BHDDH, who instructed her staff to convene a weekly call with detox managers to evaluate on an ongoing basis any issues that could arise related to access to treatment, according to Mackevich.

“They are specifically discussing the issue that Jonathan [Goyer] raised [about weekend access] to determine what gaps, if any, need to be filled,” Mackevich explained, in response to a question from ConvergenceRI.

Lost in translation
However, five days later, Goyer’s critical observation was not part of the conversation when the ribbon was cut on June 19 at the new Lifespan Recovery Center, which featured Gov. Gina Raimondo, Sen. Jack Reed, Rep. Jim Langevin and State Sen. Joshua Miller, among others. 

After the formal ribbon cutting, ConvergenceRI spoke with Sen. Joshua Miller and Dr. Josiah “Jody” Rich, both members of the Task Force, to ask what they thought about Goyer’s comments. Did they see it as sardonic? 

Miller and Rich disputed the idea that the comment should be termed “sardonic,” calling it “accurate” instead. 

When ConvergenceRI asked Rich about how the Task Force planned to address harm reduction strategies, he demurred, saying ConvergenceRI should ask Traci Green instead.

Further explanation
ConvergenceRI reached out to Goyer, to get a further explanation of the context and meaning of what he said.

“We must capitalize on people’s willingness [to seek treatment] if we are to find our way out of this epidemic,” Goyer told ConvergenceRI.

Was it sardonic?

“Sardonic? I won’t argue that,” Goyer explained. 

His comment, Goyer continued, was along the lines of commending the state for their treatment initiatives, expansion of services and the center of excellence.

“However, these services only operate on a typical Monday through Friday, 9 a.m.-to-5 p.m. model,” Goyer said. “The disease of addiction does not operate on a schedule, nor does someone’s window of willingness when asking for help.”

For example, let’s take medication-assisted treatment, Goyer explained. “Treatment facilities only initiate folks onto MAT during normal business hours [typically 35 hours a week],” he said. “There are actually 168 hours in every week. Mathematically speaking, we therefore only accommodate about 21 percent of the time. Most times, there is a minimal waiting period of 48 hours to get an appointment. Residential treatment has about a three-week waiting list.”

The problem, Goyer continued, is that the schedule of someone using drugs does not fit into the typical business workweek.

“People use opiates 24 hours a day; people decide to get help 24 hours a day. When someone reaches out for help, it’s our job to get help to them,” Goyer said. “They want to feel better now, to get help now. They don’t want an appointment for next week, or even an appointment the next day. In the waiting period, people’s addiction resurfaces and they lose interest.”

New recovery center messaging
The opening of Lifespan’s Recovery facility brought with it a common thread when it came to messaging from elected officials and medical experts: too many people were dying in Rhode Island and in the nation, with almost every speaker quoting the number of overdose deaths, 336 in Rhode Island in 2016, and with it, an admission that current strategies were not working.

•  Steven Pare, Providence’s Commissioner of Public Safety and a Lifespan board member: “There are too many people dying, over 300 last year, and it’s going to continue. It’s not working the way we’re doing it.”

In his speech, Pare cited the fact that Providence’s EMS had picked up one individual 250 times in one calendar year from the streets of Providence. Afterward, when questioned by ConvergenceRI, Pare clarified that the individual had problems with mental health and alcohol, not opioids. 

Unmentioned in Pare’s speech was the fact that the new Lifespan Recovery Center was designed to deal with patients using drugs, not alcohol, according to Dr. Richard Goldberg, Lifespan’s senior vice president of Psychiatry and Behavioral Health.

•  Sen. Jack Reed: “This is an epidemic, it’s a scourge. Over 330 Rhode Islanders lost their lives last year. We just can’t sit back and do nothing. So I commend Lifespan for taking the lead on this effort.”

Reed called attention to the fact that the Republican Senate version of the Trumpcare to repeal and replace Obamacare promised to gut Medicaid, the primary source of accessing health care for mental health and recovery services.

•  Rep. Jim Langevin: “Rhode Island had 336 drug related deaths in 2016, 15 percent more than the previous year. It has to stop, and we have to do more to turn this around.”

•  Margaret Van Bree, president of Rhode Island Hospital: “[There were] 336 people who died in 2016 in Rhode Island. It is important to know, addiction doesn’t discriminate; it crosses all boundaries.

Van Bree said, on a personal note, that her nephew died two years ago from a heroin overdose.

 Gov. Gina Raimondo: “The opioid overdose crisis is the greatest public health crisis that we face. We’re trying everything we can, but it isn’t working. I am more motivated than ever to work to [achieve] the goals that I set out, which is reducing the deaths by a third within three years.”

Moving in the wrong direction
When Raimondo made that pledge, in May of 2016, the number of confirmed OD deaths in Rhode Island for 2015, as tabulated by the R.I. Department of Health, was 258. A one-third reduction, a drop of 86 deaths, would have set the goal to achieve as 172 deaths by 2019.

Even though Raimondo said she was committed to achieving that promise, the numbers keep moving in the wrong direction. As almost every speaker noted, the number of overdose deaths in Rhode Island reached 336 in 2016, more than a 20 percent increase from the initial 258 figure. 

In December of 2016, the number for 2015 deaths was revised upward to 290, for which 336 deaths in 2016 represented a 14 percent increase.

Why do the number of deaths keep increasing? The answer, also provided at the June 14 meeting of the Governor’s Task Force on Overdose Prevention and Intervention, in a presentation by Traci Green in her Multidisciplinary Review of Overdose Deaths Evaluation team report was clear: “Fentanyl continues to be a causal agent in the majority of unintentional drug overdose deaths [in Rhode Island].”

During the third and fourth quarters of 2016, Green continued, some “65.5 percent of unintentional drug overdoses were attributed to fentanyl [103 out of 157 deaths].”

As reported by ConvergenceRI: “That data reinforces two studies by Brown University researchers that were recently published in the International Journal of Drug Policy, that underscored the urgency of combating the misuse of fentanyl and contradicted a common perception that many users court the drug for its potency, according to an article written by David Orenstein for Brown University.

“Most people are not asking for it,” said Jennifer Carroll, the lead author of one of the studies and an adjunct assistant professor of medicine at the Warren Alpert Medical School of Brown University, according to Orenstein’s story. “They can’t avoid it, and their desire to avoid it is not reducing their risk, Carroll said.”

Harm reduction: not yet on the task force agenda
At that same June 14 Task Force meeting, Green presented nine new recommended changes in strategies, including two that specifically addressed harm reduction, one that recommended that the development of a safe injection site in Rhode Island be explored.

After the ribbon-cutting ceremony, ConvergenceRI asked Dr. Richard J. Goldberg, about harm reduction strategies, and if and when they would become part of the Lifespan approach at its new facility. In particular, whether Lifespan would become involved with a safe injection site or with providing access to fentanyl testing strips for users to determine if there was fentanyl in their “illicit” drugs.

In regard for testing for fentanyl, Goldberg said: “We don’t have that capability now, but that’s an interesting thought that we would have to discuss with our pharmacists.”

What about the potential for Lifespan to operate a safe injection site?
Goldberg responded: “I saw that in the paper. We don’t have that.”

Would you consider it as an outgrowth of this new facility?
Goldberg: “We would [need to] work with the city. More likely, in an analogy to sober housing, it’s a community resource, a public health resource. We might have input, and provide some medical liaison, but we’d be happy to work and [enter into] discussions with the city about that.”

Goldberg continued: “I was just reading about these safe injection sites. It makes sense. Some data will emerge to see what impact it is.”

Will alcohol treatment and detox be part of the program offered at this new center?
“We are not treating alcohol addiction here.”

The responses by Goldberg to potential harm reduction strategies, particularly the fact that he said he had read about safe injection sites in the paper, but apparently had not yet been engaged by the Governor, by members of the Task Force, or by the medical professionals about such strategies, identified a big gap in the current approaches that a number of trucks could roar through.

ConvergenceRI posed the question: Is the Task Force a place where harm reduction strategies in Rhode Island will ever be put on the agenda for a full-fledged public discussion?

BHDDH’s Mackevich responded: “I can say definitively that ‘harm reduction strategies’ is not an item on the agenda for July’s meeting of the Governor’s Task Force. The agendas for the meetings are created roughly two weeks in advance, so I cannot speak to what specifically will be on agendas for meetings after July. However, there is a public comment period at every Task Force meeting. This is an opportunity for community members to voice their opinions about what else we can be doing to prevent overdoses.”

The voice of the recovery community
On Monday, June 26, RICARES will release its report to the community, entitled: “The Opioid Accidental Overdose Epidemic.” The report also includes the results of a series of focus groups recently conducted with members of the recovery community.

The report is organized around asking and answering some direct questions: how did we get here, what is being done now, and what can be done, offering a series of recommendations. 

The opening section, “How did we get here?” is a comprehensive, concise re-telling of the story of the roots of the epidemic as has been written.

Under the section, “What has been done?” the report provides, once again, a comprehensive overview of the actions on both the national and state levels.

Unlike many of the current narratives, the report gives credit to the work done by Dr. Michael Fine, who, as the director of the R.I. Department of Health, changed the state’s public health priorities in 2012 to begin to address the threat of overdose deaths. 

Fine formed the Drug Overdose Prevention and Rescue Coalition, comprised of a wide range of more than 100 stakeholders, working in collaboration with Traci Green, establishing a number of workgroups, including: first responders, naloxone, treatment/recovery, and data/surveillance.

Fine’s work provided the foundation for the establishment of the Governor’s Overdose Prevention and Intervention Task Force in 2015. 

Running out of words
In the introduction to the Recommendations section, the report begins with a poignant analysis: “We have about run out of words to describe how bad the situation is. Despite the power of intellect and experience applied in the last few years, despite the virtually unprecedented stakeholder collaborations, despite the progress toward and attainment of benchmarks of the strategic plan, and despite the fact that deaths caused by prescription drugs have leveled in the last few years: The number of deaths are increasing.” 

In its recommendations, the report talks about the need to put more emphasis on recovery, including recovery housing, saying: “We view recovery as the most critical, but least emphasized, element of the Task Forces strategies. This is due in part to the relative dearth of recovery research. It is also due in part to the failure of those of us in recovery to adequately educate the public and policy makers about recovery.”

The report continued: “We know that, as with the other chronic medical conditions, [the effects of] treatment decay over time if not reinforced and enhanced by recovery management work. We know that recovery occurs in the community. We know that treatment can be the beginning of recovery for many, especially for those with opioid use disorders for whom treatment is necessary, but not sufficient.”

Focus group takeaways
In May and June, RICARES conducted three focus groups, one with seven patients in treatment at CODAC, a second with eight patients at SStarbirth, and a third with seven peer recovery specialists at the Parent Support Network.

The results, as published in the report, offer insights that the Task Force should consider putting on its future agenda.

•  Have you heard of the Governor’s Overdose Prevention Task Force?
Yes, 10; No, 12. 

•  If yes, do you know any elements of the strategic plan? 
No, 22

[If none of the members of the focus groups could identify any elements of the strategic plan, does it reveal a serious problem about whom the strategic plan is targeted to reach?]

•  What is your opinion about widely distributing fentanyl test strips?
Like, 19; Don’t like, 3. 

 What is your opinion about having safe, supervised injection sites?
Like, 17; Don’t Like, 4; Maybe, 1. 

•  What is your opinion about having 24/7 on demand treatment?
Like, 22. Comments: “If I have to wait to get into treatment, then fuck it, I’ll get high. It’s a right-here, right-now thing.”

The results from the last question from the focus groups strongly supports what Jonathan Goyer had to say. 

The question is: are the detox facilities and treatment centers in Rhode Island designed for the convenience of the medical professionals or around the needs of the patients struggling with substance use issues?

Pursuing legal recourse
We have an opioid epidemic engulfing our nation that has killed more Americans from overdose deaths in 2016 [more than 59,000] than during the entire Vietnam War [58,220], according to a recent analysis published by The New York Times

The epidemic has been caused in large part by “greedy” corporate pushers of addictive prescription painkillers, in apparent collusion with doctors, pharmacies and health insurance companies, as has been documented in numerous investigative news reports in West Virginia and Florida, among others. [The story about what happened in West Virginia won the 2017 Pulitzer Prize.]

A number of states, such as Ohio, are pursuing legal recourse, suing the drug manufacturers for flooding the market with painkillers. 

What could Rhode Island do? A division of Purdue Pharma in Cumberland, the manufacturer of OxyContin, produces some 750 tons a year of the generic of its prescription painkiller, oxycodone. Would the R.I. General Assembly consider taxing the company as a way to recoup the public monies spent on addiction prevention, intervention and recovery, in emergency rooms and in treatment centers, similar to what was done under the tobacco legislation?



RelatedDrug ODs
Revised action plan released
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<![CDATA[Sarah J. Fessler: Making progress in fight against R.I. opioid addiction]]>Thu, 25 May 2017 18:37:57 GMThttp://ricares.org/news--events/sarah-j-fessler-making-progress-in-fight-against-ri-opioid-addictionPicture
There is good news in the campaign to reduce opioid deaths in Rhode Island. Newly released data show the Ocean State is at the top in New England and second best in the nation in reducing the number of opioid prescriptions filled within the past three years. Rhode Island’s numbers fell by 24.8 percent, second only to West Virginia’s 27.6 percent decline. Massachusetts, Maine and New Hampshire all brought their numbers down by better than 20 percent, while Vermont and Connecticut achieved slightly smaller decreases. Nationally, the average decrease was 14.6 percent, but for first time, every state in the union showed a decline.

That’s all great news, because prescription drugs are often where opioid addiction starts. The tragic social and personal cost of the opioid epidemic cuts across all demographics in every community across the entire country. Credit for the recent impressive progress goes to Rhode Island physicians, dentists, podiatrists, physician assistants, advance practice nurses and state officials, who have worked together to reduce the number of prescriptions for opioid analgesics and promote the use of alternative means to manage pain. Rhode Island’s professional health-care community is committed to working together with patients, with the Governor’s Overdose Prevention Task Force and with the General Assembly to further limit the unnecessary proliferation of opioid prescriptions and to meet the new scourge of street drugs laced with deadly fentanyl, which has quickly become the primary cause of overdose deaths in Rhode Island.

Sarah J. Fessler, M.D.

Providence

The writer is president of the Rhode Island Medical Society. This letter was also signed by: George Gettinger, president of the Rhode Island Dental Association; Donna M. Policastro, executive director of the American Nurses Association of Rhode Island; Emma Banks, president of the Rhode Island Academy of Physician Assistants; and Tammy L. Van Dine, president of the Rhode Island Podiatric Medical Association.


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<![CDATA[The recovery community wants its voice to be heard]]>Tue, 23 May 2017 15:41:42 GMThttp://ricares.org/news--events/the-recovery-community-wants-its-voice-to-be-heardPicture
PROVIDENCE – Monica Smith, the new executive director at RICARES, the Rhode Island Communities for Addiction Recovery Efforts, newly arrived from Oregon, admits that she is still learning how best to navigate her way around the policy labyrinths of Rhode Island – and how to properly pronounce the names of towns and cities.

In turn, what she brings to the conversation is a fresh perspective on the dynamics of the recovery movement, one that places an emphasis on building relationships.

Before coming to Rhode Island, Smith served as operations director at the Portland Homeless Family Solutions in Oregon. Her expertise is in developing and implementing processes and programs with a focus of relationships, working with innovative nonprofits. It was her first visit to that hub of innovation and convergence that is Olga’s Cup + Saucer, where Rep. Aaron Regunberg was busy holding back-to-back conversations a few table away in the outdoor patio oasis. Smith and RICARES board member Steve Gumbley, who served as board chair for the national Faces and Voices of Recovery organization from 2008 to 2014, sat down to talk with ConvergenceRI, sketching out their plans and ideas for how to make the recovery community in Rhode Island more visible – and more vocal. “By our silence,” Gumbley explained, “we’ve let other people define us.” There has been a tendency sometimes, he continued, to be too nice, and to not rock the boat. The first step in redefining what it means to be a constituency of consequence, a phrase often voiced by the late Jim Gillen, a leader in the Rhode Island recovery community efforts, is to engage with the recovery community itself in a series of focus groups, to ask them to say what they want to do, according to Smith. The first focus group will take place in Newport on May 26 at CODAC, she said.

[Both Gumbley and Smith turned the tables on ConvergenceRI, asking for a definition of what the phrase “constituency of consequence” meant to the reporter.]

Reducing harm
Another strategy that Smith wants the recovery community and the Governor’s Task Force to discuss and grapple with is harm reduction.  One idea to talk about, Smith continued, is whether or not to create a safe space in Rhode Island for illicit drug users to test for the presence of fentanyl, similar to the pilot program to test illicit drugs at Vancouver, British Columbia’s supervised-injection site. Vancouver Coastal Health began offering its Insite clients fentanyl test strips in July of 2016, enabling them to find out, within a minute, whether there is fentanyl in the drug they are about to inject, according to CBC News. As a result, clients are 25 times less likely to overdose, according to Mark Lysyshyn, a medical health office with Vancouver Coastal Health, according to a May 15 story by reporter Matt Meuse. About 80 percent of the samples tested positive for fentanyl, according Lysyshyn. The limitations of the inexpensive test strip, which cost about $1, were that they currently test for the presence of fentanyl but not the amount. The strips are also not able to test for the presence of fentanyl analogues, such as carfentanil, many times more potent than fentanyl.

Lysyshyn told Meuse that the next steps for his team at Vancouver Coastal Health include getting more people to test their drugs before consumption, and to work with the strip vendor to improve the test for fentanyl analogues. Lysyshyn also said that they are exploring the possibility of using the testing strips outside of the safe injection site, in coordination with the health authority’s take-home naloxone program.

How to have that discussion?
For Smith and Gumbley, the challenge is how to have that discussion – both within the Governor’s Task Force and as part of a larger public dialogue.
If law enforcement is using a similar detection strip to determine the presence of fentanyl, good enough to use in a court of law, why not make that testing strip available? If the number-one goal is to save lives and prevent overdoses, wouldn’t access to a way to test for fentanyl make sense, from a public health perspective?

In 2016, there were 336 confirmed overdose deaths, with 195, more than 50 percent, involving fentanyl, according to the R.I. Department of Health. The goal that Gov. Gina Raimondo pledged – to reduce the number of overdose deaths by one-third, to 172 by 2018 [working from the 2015 numbers of 258 deaths when the pledge was made] – is unlikely to happen without a major change in strategy.

Not an either-or choice
Smith and Gumbley said it would be a mistake to get distracted by current argument around the value of medication-assisted that the new federal director of Health and Human Services, Dr. Tom Price, has questioned. The emphasis should be on recovery, a long-term effort, and not just on medication-assisted treatment. As Smith told ConvergenceRI, recovery is all about building relationships, in creating an engaged community of support. [Both Smith and Gumbley are in what they describe as long-term recovery.]

Moving forward
Gumbley pointed out what he called the lack of attention to alcohol-related use disorders as part of the larger conversation about substance use. Smith said that she wanted to focus more on they way that trauma affects decision-making and risk-taking. Both had questions about the limits of a clinical model in prevention. Gumbley pointed to the success of Act Up, a group that used political protest as a way to dramatize the need for better treatment and research around AIDS and HIV in the 1990s, as perhaps one model that RICARES may consider the future. Stay tuned.
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<![CDATA[America Drinks and goes home, and dies?]]>Mon, 22 May 2017 18:19:42 GMThttp://ricares.org/news--events/may-22nd-2017
An alleged intoxicated man transported to Rhode Island Hospital by rescue personnel for detox was reportedly released two hours after being seen, only to die early the next morning – the same day that new standards for emergency departments for treatment of substance use disorders were announced     
By Richard Asinof Posted 3/20/17

Why is this story important?
The story of an alleged intoxicated man transported by rescue personnel to the emergency room at Rhode Island Hospital for detox and reportedly released two hours later, who then died early the next morning, without evidence of foul play, raises questions about how alcoholism fits within the new standards for treatment of substance use disorders by emergency departments.
What were the outcomes for the 6,210 EMS transports in 2016 in which alcohol was either the primary or secondary impression? How many were referred for treatment? How many went? How many met with peer counselors at emergency departments? How many were repeats involving the same individual?
Will alcohol be added to the new standards of treatment for emergency departments in Rhode Island? What is the connection between alcohol abuse and domestic violence? What was the cause of death from the autopsy of the 35-year-old man who died?
Who will convene a public conversation to talk about the economics of despair and its connection to the high death rate among young Rhode Island adults from drugs, alcohol and suicide? Will Lifespan officials convene an internal review around emergency department practices around patients who present with alcohol as a primary or secondary impression by EMTs?
Under the radar screen

A potential factor in the reason behind releases in cases of patients presenting with alcohol intoxication at emergency departments, according to one professional who works in the substance use disorder field, is that detoxing from alcohol often creates a dangerous medical situation, both for the provider and the patient, requiring intensive and costly medical intervention.



BARRINGTON – Like many of the stories reported in the police logs published by weekly community newspapers, one cannot make this stuff up.
The headline for the online story posted on EastBayRI on March 16 read: “Police: Man sent to hospital for detox dies later than night.” The subhead continued: “Police say there was no sign of foul play.”
The story began: “Barrington police responded to a home in Barrington early Tuesday evening, March 7, after an Uber driver called the station to report that he was transporting a highly intoxicated man to a Barrington home.”
The story continued: “Police said the man, a 35-year-old West Warwick resident, had apparently passed out in the car while it was traveling to his girlfriend's home in Barrington; he was also carrying an unopened 12-pack of beer.” Next, the story said: “Police arrived at the Barrington home and later called for the fire department to transport the man to the hospital for detox.” The police chief in Barrington confirmed to ConvergenceRI that the man had been transported to Rhode Island Hospital for “detox.”

Story takes a twist
Here the story took a twist: “The man went to the hospital a little after 7 p.m. and was reportedly released around 9 [p.m.]. He then went back to the Barrington home and went to bed at 11 p.m.” The police were called back to the Barrington home early the next morning: “Police were then called to the home again at 4:30 a.m. the next morning after the homeowner reportedly found her boyfriend had died at some point during the overnight hours,” according to the story. The story concluded: “Police said an autopsy was conducted that revealed no evidence of foul play.”

[The official determination of what “drugs,” if any, may have been involved with the death could take up to three months, under current protocols at the R.I. Department of Health.]

America drinks and goes home – and dies
Ironically, on March 8, the same day that the 35-year-old man from West Warwick died, Gov. Gina Raimondo’s Overdose Prevention and Intervention Task Force released the first statewide standards in the nation for treating overdose and opioid use in hospitals and emergency settings. [See link to ConvergenceRI story below.]

As reported by ConvergenceRI: The new standards were driven in large part by the passage in 2016 by the R.I. General Assembly of the Alexander C. Perry and Brandon Goldner Law, which mandated comprehensive discharge planning by hospitals and emergency departments. Perry and Goldner both had visited emergency departments because of substance use disorder issues prior to their fatal overdoses.

The law reflected the anguish of prominent parents whose sons had died despite their frequent visits to hospital emergency rooms – Goldner was the son of Barbara and Brian Goldner, the CEO of Hasbro, and Perry was the son of former R.I. Senator Rhoda Perry.

The main goal of new levels of care “is to standardize humane, evidence-based care of patients with opioid use disorder in the state’s emergency and hospital institutions,” according to a 20-page document produced by the R.I. Department of Health and the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. But the new standards do not appear to explicitly cover protocols for alcoholism, except perhaps in a broader interpretation of “discharge planning” for those who have a substance use disorder diagnosis. Four professionals confirmed for ConvergenceRI that alcoholism could be considered a substance use disorder diagnosis. One further irony: March 7 was the day that Rep. Moira Walsh, appearing on the WPRO talk radio show hosted by Matt Allen, said that there was “an insane amount of drinking” that went on at the State House, a statement that created strong pushback from some state legislators.

Do the new standards cover alcohol?
At the crux of the story is the unanswered question: Why was a person, taken to the emergency room at Rhode Island Hospital by rescue personnel from Barrington for detox, seen around 7 p.m. and then reportedly released two hours later?

[Another question: Upon release and return to the home in Barrington, how many cans of beer from the 12-pack were consumed?]

ConvergenceRI reached out to the R.I. Department of Health to ask whether or not the new standards for emergency settings such as hospitals covered detox admissions for alcoholism.
 “The Hospital and Emergency Department Standards were conceptualized to address opioid-use disorder,” explained Joseph Wendelkin, communications spokesman with the R.I. Department of Health.
 Some of the Level Three components of the standards, Wendelken continued, “would affect someone with alcohol-use disorder [or any other substance issue], such as the screening requirement.” Wendelken added: “Some emergency departments already refer individuals to Anchor [Recovery Community Center, a division of The Providence Center], because of alcohol issues.” Wendelken clarified: “The standards are really aimed at overdose and opioid-use disorder.”

ConvergenceRI also asked about the number of emergency medical service transports that were involved with alcohol in Rhode Island in 2016.

“In 2016, there were 6,210 EMS transports in which ‘alcohol’ was either the primary or the secondary impression,” Wendelken said, explaining that EMS professionals do not make diagnoses. “They instead log impressions when responding.”

Translated, 6,210 EMS transports related to alcohol in 2016 is an average of 17 trips a day.

Diversion
Until recently, under state law, police departments and rescue personnel were required to take those suspected of being drunk to emergency rooms at hospitals for treatment. In many cases, the emergency room did not offer any specific treatment other than an opportunity for the person to dry out in a safe environment and then be discharged.

A new program begun recently by The Providence Center, called the Recovery Navigation Program, seeks “to provide intoxicated people a safe and supportive place to stabilize,” according to the agency website. The facility is located at the Emmanuel House homeless shelter in South Providence. The small-scale program works directly with EMS and hospitals for referrals. ConvergenceRI reached out to The Providence Center for details about the new initiative, asking if patient numbers could be shared.

“Unfortunately, I don’t have any patient numbers for you,” said Jake Bissaro, communications spokesman for The Providence Center. “The Recovery Navigation Program is still in its beginning stages, and we’d like to hold off on reporting any metrics for a few more months,” adding that the city of Providence does not make their ED numbers public. Bissaro also responded to the question ConvergenceRI asked about whether or not the new standards applied to alcoholism. “I’ve asked around a little bit, and I don’t believe that the new ER rules apply to alcohol intoxication,” he said.

Bissaro added: “At this time, Recovery Navigation is only taking people from the Providence area via EMS, walk in, other provider referrals, and shelters.”

The hospital’s perspective
ConvergenceRI also reached out to Rhode Island Hospital to ask about how the new standards for emergency departments were being applied to intoxicated individuals delivered by rescue personnel to the emergency room, speaking with David Levesque, a senior communications spokesman with Lifespan.

Levesque said he reached out to his ED director but had not heard back by Friday afternoon, March 17, according to a voice mail message left with ConvergenceRI.

[Identifying which hospital that the intoxicated man had been transported to took a bit of legwork. In its story, The Barrington Times had not identified the hospital, and when asked, the editor told ConvergenceRI he did not know. Lifespan’s Levesque told ConvergenceRI he could not provide any confirmation without a name. When ConvergenceRI spoke to Barrington Police Chief John M. LaCross, he confirmed that the intoxicated man had been transported to Rhode Island Hospital.]

Can you read the signs?
The Rhode Island Department of Transportation has recently undertaken a series of what it described as blunt messaging around drunk driving, posted on some 25 digital billboards across the state, including one message recently, which said: “You drink, you drive = handcuffs!”

In 2015, 19 people died in alcohol-related car or motorcycle crashes, according to RIDOT statistics. In 2014, 17 people died in such accidents, and in 2013, 23 people died, according to agency figures, as reported by The Providence Business News and The Providence Journal. At first glance, the RIDOT warning signs, focused on drinking and driving, may appear to be somewhat of an effective educational effort.

In the case of the 35-year-old man who died after being seen for detox and then reportedly released two hours later, he was using an Uber driver for transportation [bringing with him an unopened 12-pack of beer]. And, the Uber driver apparently did the right thing, calling the police when the passenger had passed out in the car. But changes in behavior around drinking and driving do not address the underlying root problem of the continued use and abuse of alcohol by Rhode Islanders. The apparent omission of alcoholism from the new standards for emergency departments in responding to patients with potential substance use disorders reveals what appears to be a blind spot in the state’s strategic efforts. What is missing, according to Dr. Michael Fine, the former director of the R.I. Department of Health, is the lack of recognition around the magnitude of use.

“We are in deep denial,” Fine told ConvergenceRI as part of a recent wide-ranging interview. “We are not willing to own our use. We don’t want to talk about the dirty little secret,” reeling off the statistics around Rhode Island’s national leadership in the use of drugs and alcohol. “Too many Rhode Islanders are using one thing or another.” Rhode Island is not going to treat its way out of the current crisis, Fine continued. “It’s not just about death, it’s about use.”

Recent research
Once again, the research findings by Shannon Monnat resonate: her study in the 2017 winter edition of Carsey Research found that drugs, alcohol and suicide were the cause of over half the deaths of young white adults, ages 25-34, in 12 states, from 2010-2014, with Rhode Island having had the highest rate, at 59.8 percent. [See link to ConvergenceRI story below.]

In her research, Monnat has sought to connect the high rate of death from drugs, alcohol and suicide to economic stress, to what she has labeled the diseases of despair.

In “The Ghost Bosses,” an investigative story by Brian Alexander in The Atlantic, describes the consequences of private equity firms buying and selling companies and the resulting economic devastation. [See link to story below.] In his story, Alexander cites Monnat’s work to connect economic instability with the diseases of despair.

“Stability has been replaced by chaos,” Shannon Monnat, a sociologist and demographer at Penn State University who researches the interplay between economics and health, says of such situations. The longer the stress lasts, whether it involves family, community, or work, the more disheartened people become and the more faith they lose in the system, until, finally, they disconnect to survive.

Monnat has recently been studying “diseases of despair” – the plague of opioid addiction, alcoholism, and suicide afflicting places like Lancaster. She’s found that instability at work is strongly correlated with the prevalence of these problems as well as with social and family breakdown. Drug abuse is not solely due to the cheap availability of heroin or meth, nor some imagined weakness of the working class. Monnat believes it’s also caused by people’s loss of faith that they each occupy an important place in the American system.

Editor’s Note: The headline for this story references a song by Frank Zappa and the Mothers of Invention, “America Drinks and Goes Home.”

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<![CDATA[Investigation Into Opioid Crisis Targets Drug Companies]]>Thu, 11 May 2017 15:57:02 GMThttp://ricares.org/news--events/investigation-into-opioid-crisis-targets-drug-companiesSen Claire McCaskill (D, Missouri) has launched a Senate investigation into whether 5 drug companies marketed their opioid painkillers in a manner that may have contributed to the nation’s opioid epidemic.

In
letters to the companies, which include Mylan, Depomed, INSYS Therapeutics, Purdue Pharma, and Johnson & Johnson’s Janssen division, McCaskill demanded internal documents relating to the firms’ marketing tactics, studies the companies conducted that might have alerted them to the risk of addiction and lethal overdose, behind-the-scenes efforts to block increased regulation, and sales quotas that may have led drug representatives to use kickbacks to encourage physicians to prescribe the drugs.

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