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April 20, 2023

Most Americans turn to addictive behaviors during crisis: survey

An estimated 77{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of Us citizens are engaging in addictive behaviors to cope with psychological wellbeing issues — normally in spite of endeavours to uncover efficient clinical therapies.

The GeneSight Psychological Well being Keep track of examine, executed by Myriad Genetics in Salt Lake Metropolis, Utah, counted a number of possibly significant-threat behaviors amongst these made use of to cope with stress and melancholy, together with alcohol use, drug use, gambling, food usage, binge-seeing media, oversleeping, excessive physical exercise and partying.

Notably, even those people who have actively sought mental well being treatment are turning to the aforementioned practices to cope as a consequence of treatment failure or other ineffective treatment options.

And nearly all people surveyed — 94{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} — concur that these addictions could also be covering up underlying mental health and fitness concerns.

“Many of my individuals have struggled with depression and/or stress and anxiety but unsuccessful to find a cure that built them truly feel greater. So, they resorted to alcoholic beverages, medicine or harmful behaviors to soothe on their own, as these offered quick-phrase aid,” Dawn Johnson, a psychiatric mental health nurse practitioner at the Indiana Center for Recovery in South Bend, stated in a news launch.

“However, this behavior resulted in worsening mental well being and destruction of their lives.”

More than three-quarters of Americans knowingly engage in unhealthy coping habits, a study suggests. — Fifty-8 percent of individuals diagnosed with melancholy and/or stress shared that correct mental wellbeing treatment method helped reduce any issues about addiction.

Two-thirds of survey contributors with anxiety or depression have absent through a trial-and-error process of obtaining a medication that will work for them. Sadly, 45{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of the patients for whom meds did not do the job admitted to falling back on the aforementioned harmful behaviors to regulate their illness.

For example, 77{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of respondents diagnosed with despair or anxiousness agreed that ingesting liquor solo is an addictive and harmful coping habits, inspite of the point that 41{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of them preserve up the harmful habit, whilst just a quarter of those people who seriously drink on your own acknowledged that they may possibly have a challenge.

Other respondents identified with melancholy and stress and anxiety confessed to sleeping as well considerably or far too little (70{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc}), withdrawing from social pursuits (64{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc}), binge-watching Tv or movies (49{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc}) and skipping function, college or household tasks (48{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc}) to cope with psychological worry.

More than fifty percent of melancholy or panic clients, 58{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc}, who have been told they have a trouble consider that appropriate psychological overall health cure served reduce any concerns about habit.

At the Indiana Middle for Recovery, Johnson works by using genetic tests to identify how her individuals may respond to various medications prescribed for mental wellbeing disorders, this kind of as not currently being ready to metabolize the drugs thoroughly, not enduring any symptom aid or dealing with undesirable facet outcomes.

“The GeneSight report reassures them that we’re not just throwing prescription drugs at them, we’re essentially customizing their program based on their genetic make-up,” she defined.

“Mental overall health and addiction typically go hand-in-hand,” reported Morgan Freas, a senior professional medical science liaison with Myriad Genetics. “Yet the stigma involved with admitting psychological well being troubles is often bigger than escaping into compound or behavioral abuse.”

January 30, 2023

Some addiction treatment centers turn big profits by scaling back care

Near the stop of his scheduled a few-thirty day period keep at a rehab center exterior Austin, Texas, Daniel McKegney was forced to explain to his father in North Carolina that he necessary extra time and far more funds, he not too long ago recalled.

His father had presently received payments from BRC Restoration totaling about $150,000 to go over McKegney’s remedy for dependancy to the powerful opioid fentanyl, in accordance to insurance coverage statements shared with KHN. But McKegney, 20, reported he located the software “suffocating” and was not happy with his care.

He was encouraged from the extended-time period use of Suboxone, a medicine frequently advisable to treat opioid dependancy, for the reason that BRC does not contemplate it to be a type of abstinence. Just after an initial 5-working day detox period of time previous April, McKegney’s treatment plan generally bundled a weekly remedy session and 12-phase group conferences, which are obtainable for free of charge all around the state.

McKegney explained a BRC staffer advised he remain a fourth thirty day period and even sat in on the phone to his dad.

“They utilized my daily life and [my] father’s adore for me to pull a different 20 grand out of him,” mentioned McKegney, who told KHN he commenced employing fentanyl all over again right after the high-priced stay.

BRC did not react to certain concerns lifted by McKegney. But in an emailed assertion, Mandy Baker, president and chief clinical officer of BRC Healthcare, stated that a lot of of the complaints patients and former staff shared with KHN are “no for a longer period exact” or ended up connected to COVID basic safety measures.

But dependancy researchers and personal fairness watchdogs explained types like the a single used by BRC — charging higher individual expenses without having guaranteeing access to proof-based mostly treatment — are frequent throughout the country’s habit therapy field.

The design and expanding demand from customers are why addiction treatment has grow to be significantly beautiful to personal fairness firms seeking for significant returns. And they’re banking on forecasts that forecast the industry will improve by $10 billion — doubling in dimensions — by the conclude of the ten years as drug overdose and liquor-induced dying rates mount.

“There is a ton of dollars to be manufactured,” said Eileen O’Grady, investigation and marketing campaign director at the Private Fairness Stakeholder Venture, a watchdog nonprofit that tracks personal fairness investment decision in health and fitness care, housing, and other industries. “But it truly is not automatically dovetailing with high-quality therapy.”

In 2021, 127 mergers and acquisitions took location in the behavioral well being sector, which features treatment method for substance use disorders, a rebound just after various decades of decline, in accordance to investment decision banking firm Capstone Companions. Personal equity expense drove much of the activity in an field that is hugely fragmented and quickly developing, and has traditionally experienced few guardrails to be certain people are finding acceptable care.

Nashville Recovery Center building — BRC Restoration, a private fairness-backed dependancy treatment company, purchased Nashville Restoration Middle in 2021. Personal fairness investment decision has driven significantly of the latest action in compound abuse therapy, an industry that is highly fragmented and has historically had number of guardrails to make certain individuals are having proper care.

Blake Farmer for KHN

Approximately 14,000 procedure facilities dot the state. They have proliferated as addiction fees rise and as health coverage strategies are needed to offer much better coverage of drug and liquor remedy. The treatment solutions change extensively and are not normally dependable with individuals advisable by the federal Compound Abuse and Psychological Overall health Companies Administration. Even though attempts to standardize cure advance, sector critics say private equity groups are investing in centers with unproven practices and slicing expert services that, when unprofitable, may possibly guidance long-term recovery.

Baker stated the business treats men and women who have been unsuccessful in other services and does so with enter from both of those clientele and their people.

Non-public fairness skimps on the identified expectations

Centers that discourage or prohibit the use of Fda-accredited medicines for the treatment of compound use problem are abundant, but in accomplishing so they do not align with the American Modern society of Habit Medicine’s rules on how to regulate opioid use ailment over the extended phrase.

Suboxone, for illustration, brings together the discomfort reliever buprenorphine and the opioid-reversal medicine naloxone. The drug blocks an overdose whilst also minimizing a patient’s cravings and withdrawal indications.

“It is inconceivable to me that an habit cure service provider purporting to tackle opioid use ailment would not supply prescription drugs,” reported Robert Lubran, a previous federal official and chairman of the board at the Danya Institute, a nonprofit that supports states and treatment suppliers.

Household inpatient facilities, exactly where individuals remain for weeks or months, have a function in habit therapy but are frequently overused, stated Brendan Saloner, an associate professor of overall health plan and management at Johns Hopkins Bloomberg Faculty of General public Overall health.

Many individuals return to drug and liquor use immediately after staying in inpatient configurations, but research clearly show that the use of medicines can decrease the relapse rate for sure addictions. McKegney stated he now routinely takes Suboxone.

“The past 3 a long time of my lifestyle were being hell,” he reported.

Alongside with obtain to medicines, high-high quality dependancy procedure normally involves lengthy-phrase care, in accordance to Shatterproof, a nonprofit concentrated on bettering dependancy therapy. And, ideally, treatment is customized to the individual. Even though the “Twelve Techniques” plan made by Alcoholics Anonymous could help some sufferers, other people may possibly need distinctive behavioral wellness therapies.

But, when hunting for investments, personal fairness groups concentration on gain, not automatically how very well the program is designed, mentioned Laura Katz Olson, a political science professor at Lehigh University who wrote a e-book about private equity’s financial investment in American well being care.

With health and fitness treatment businesses, buyers usually cut providers and trim staff fees by utilizing much less and much less experienced workers, she claimed. Usually, non-public equity organizations purchase “a put that does actually superb function, and then slice it down to bare bones,” Olson claimed. Throughout his continue to be, McKegney claimed, outings to see movies or go to a lake abruptly stopped, meals went from poke bowls and pork tenderloin to chili that tasted like “dish cleaning soap,” and staff members turnover was large.

Virtually 3 yrs in the past, BRC landed backing from NewSpring Cash and Veronis Suhler Stevenson, two private fairness corporations with wide portfolios. Their holdings involve a payroll processor, a bridal dress in designer, and a doughnut franchise. With the fresh new cash, BRC commenced an expansion drive and bought many Tennessee therapy amenities.

NewSpring Funds and Veronis Suhler Stevenson did not answer to email messages and cellphone calls from KHN.

Higher selling prices and lower overhead = massive enterprise

Before the sale to BRC, Nashville Recovery Center co-founder Ryan Cain said, roughly 80{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of the center’s choices were free. Anyone could fall by for 12-move meetings, to satisfy a sponsor, or just perform pool. But the new homeowners targeted on a new substantial-close sober residing system that price 1000’s of dollars for every month and relied on staffers who were in recovery them selves.

“You have a great breeding floor to be ready to take advantage of a ton of really good-hearted, nicely-intentioned individuals,” stated former Nashville Recovery Heart staffer Mitzi Dawn, who is in restoration and now will work at another therapy facility. Dawn hosted a “Sing and Share” that was canceled before long just after the takeover.

Mitzi Dawn was on staff at Nashville Restoration Middle and still left soon after the middle was acquired by BRC Restoration and her well-liked “Sing and Share” celebration was canceled. She suggests she fearful about her colleagues, given that most are in recovery as she is.

Blake Farmer for KHN

In 2021, Nanci Milam, 48, emptied her 401(k) retirement fund to go by way of the sober dwelling application and tackle her alcoholic beverages dependancy. She had been sober for only six months when she was hired as a home manager, overseeing some of the exact citizens she had absent as a result of the application with. She had to deal with other residents’ medicines, which she stated she could have abused. Milam said she was fortunate to sustain sobriety.

“I assume it served their will need. And I was ambitious. But it ought to not have occurred,” said Milam, adding that she still left because the organization hadn’t assisted her start out her certification as a drug counselor as promised.

A licensing violation described to Tennessee regulators in late 2021 associated a staffer who was later on fired for owning sexual intercourse with a resident in a storage location. And KHN acquired a duplicate of a 911 connect with positioned in August 2022 — soon after a resident drank 50 percent a bottle of mouthwash — through which a staffer admitted there was no nurse on-site, which some other states require.

Taking away the load from shoppers

The rules of therapy suppliers mainly concentrate on wellness and safety relatively than scientific tips. Only a handful of states, which includes New York and Massachusetts, demand that certified dependancy cure facilities offer you medication for opioid use problem and comply with other very best techniques.

“We have a big situation in the field the place licensing specifications will not comport with what we know to be the most productive top quality-of-care specifications,” stated Michael Botticelli, previous director of the Workplace of Countrywide Drug Handle Policy in the course of the Obama administration and a member of a scientific advisory board for non-public fairness-backed Behavioral Wellbeing Team. Some businesses, which includes Shatterproof, manual individuals toward appropriate care. The federal and state governments mainly immediate public money to centers that meet up with medical top quality-of-care criteria.

But access to remedy is restricted, and desperate patients and their people generally do not know the place to change. Point out or federal regulators are not policing promises from rehab services, like the “99{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} accomplishment level” touted by BRC.

“We can not set the burden on people and their people” to navigate the program, explained Johns Hopkins’ Saloner. “My heart actually breaks for men and women who have thrown countless numbers of their pounds at systems that are bogus.”

When her niece was ready for inpatient rehab in summer 2020, Marina reported that sending her to BRC was a “knee-jerk response.” Marina, a health practitioner in Southern California, asked for to be identified only by her center title to defend the privateness of her niece, who suffers from alcohol dependancy.

She experienced researched the facility three a long time previously but did not look into further simply because she was worried her niece would transform her thoughts. BRC advertised results stories on the tv clearly show “Dr. Phil” and posted affirmations on social media.

Marina agreed to BRC’s upfront price of $30,000 a thirty day period for a a few-thirty day period continue to be in Texas, which she compensated for out-of-pocket due to the fact her niece lacked insurance plan. She permitted KHN to evaluate some of her niece’s pharmacy and cure expenditures.

Marina reported she compensated for a fourth month, but claimed finally the plan failed to assistance her niece, who remains “horribly unwell.” She reported her niece felt regular guilt and shame at rehab. Marina imagined there was insufficient health care oversight, and mentioned the method “nickeled and dimed” her for added companies, like physicians’ visits, that she considered would be incorporated.

“It almost isn’t going to make a difference if you are educated and intelligent,” Marina claimed. “When it’s your beloved 1, you are just desperate.”

KHN (Kaiser Overall health Information) is a national newsroom that makes in-depth journalism about health concerns. Alongside one another with Plan Investigation and Polling, KHN is just one of the three main running applications at KFF (Kaiser Spouse and children Foundation). KFF is an endowed nonprofit business supplying information and facts on overall health difficulties to the nation.

November 26, 2022

Covid long-haulers turn to unproven treatments in desperation

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For the burgeoning population of covid long-haulers, there is an abundance of new treatment options: Specially formulated nutraceuticals imported from India that promise to “get you life back from covid.” Pure oxygen delivered in a pressurized chamber. And, if time and money are no obstacle, a process known as “blood washing” that’s available in Cyprus, or $25,000 stem cell treatments in the Cayman Islands.

Months-long waits at long-covid clinics combined with the sluggish pace of research have left vulnerable patients clamoring for immediate care as manufacturers bring novel remedies to market, often with little data behind them.

“I have tried, I would say, as many different things as anyone could do in my situation,” said Donna Davis-Doneghy, a 62-year-old accountant with Hearthside Food Solutions in London, Ky., who has been tormented by headaches since coming down with covid in November 2020.

“People will say to me, ‘Here’s a phone number,’ and off I go chasing something different,” said Davis-Doneghy, whose treatment regimen has ranged from acupuncture and Botox to nerve-block injections and vitamin infusions.

Long covid has taken to new heights a medical conflict that shows up with cancer and other dire diagnoses: the tension between the desire for evidence and the pressing needs of patients who are suffering. In their rush for relief, patients are turning to unproven treatments, putting them at risk of potentially harmful health effects as well as having their hopes dashed and their wallets emptied. Doctors often follow the practice of prescribing drugs off-label, not for the purpose the Food and Drug Administration originally approved them for.

What you need to know about the latest on long covid

“You want to protect people from charlatans,” said Harlan Krumholz, a professor of medicine at the Yale School of Medicine. “We need to resist the temptation to adopt tests and treatments without sufficient evidence to justify their use.”

But until researchers discover the mechanism — or, more likely, mechanisms — that cause long covid, clinicians are having to rely on their experience treating other illnesses.

“We’re kind of stuck,” said Michelle Haddad, a neuropsychologist who runs a long-covid clinic at Emory Rehabilitation Hospital in Atlanta. “I can define areas where you have impairments and how impaired you are. I can tell you what works in other, similar conditions. But I don’t have a magic pill.”

The scale of the problem — and opportunities for profiteering — are increasing as the number of Americans reporting long-lasting symptoms ramps up to as many as 15 million adults. Data released this summer by the Centers for Disease Control and Prevention suggests that almost 15 percent of the population has had long covid, or symptoms that lasted three months or longer after the acute infection.

Many long-haulers describe being devastated by disabilities that range from fatigue to brain fog and body-wracking tremors. Facing disbelief from their families and physicians, and frustrated by the slow pace of science, they are turning to social media to share ideas for relief.

While some patients report getting insurance coverage for the treatment of some symptoms, such as migraines, many end up spending thousands of dollars, out of pocket. Robert Harris, a 48-year-old veteran in Texas, estimates he has paid $25,000 for treatments, from over-the-counter supplements to the horse dewormer ivermectin and hyperbaric oxygen. “I can’t figure out what research is being done, what treatments have been approved,” he said.

The $1.15 billion Recover program, awarded nearly two years ago to the National Institutes of Health, is aimed at understanding the biological basis of long covid. Establishing the safety and efficacy of potential treatments involves a further step — setting up randomized controlled trials. Although NIH recently announced its intent to investigate the potential impact of the antiviral Paxlovid, results are not expected until 2024, reinforcing some scientists’ argument for a more agile research model to match the urgency of the moment.

“Government-sponsored and government-funded mechanisms are designed for incremental innovation — for steady and safe discoveries,” said David Putrino, director of rehabilitation innovation for Mount Sinai Health System in New York.

Under the swiftly changing circumstances of the pandemic, smaller research teams, advocacy groups and private companies with a variety of standards have stepped in — often without robust scientific evidence that the products actually work.

“We are the ETSY of long covid — DIY but giving you something the establishment can’t,” tweeted Ram Yogendra, an anesthesiologist with the California company IncellDx, referring to the company’s do-it-yourself approach, modeled on the online craftsmanship marketplace. IncellDx purports to have developed a diagnostic blood test for long covid.

Using machine learning to identify what is unusual in long-haulers’ blood, IncellDx claims to have found an immune signature or “cytokine profile” for the condition. The company, which has received a patent for using the HIV drug maraviroc to treat coronaviruses, has published three studies, enrolling more than 700 patients.

‘We are in trouble’: Study raises alarm about impacts of long covid

Krumholz said immune signatures are likely to become important for diagnosis and treatment. But after reviewing the data on the IncellDx website, he warned about the dangers of researchers rushing to adopt tests before the evidence is sufficient. “The evidentiary standards need to be much higher and the transparency about the science much greater than we have today to justify widespread use,” he said.

The $415 diagnostic test has been used by about 10,000 people, creating a “tremendous database,” according to Bruce Patterson, the former Stanford virologist who leads the company. The results, Patterson said, can be used to inform personalized treatment protocols typically administered by the patients’ primary care providers. A company spokeswoman said many long-haulers pay an additional $250 for a follow-up consultation and buy additional tests to check how the therapy is working. She said the company recognizes that the data need to “evolve” and said that IncellDX is helping people in the meantime.

Patterson, who said he is working on contracts for clinical trials of a “drug combination that we think works,” said it is up to patients and their doctors to decide how to proceed with treatment. “We do what clinical pathologists should do: ‘Here is a test report, you treat accordingly,’” he said. Company doctors are available to offer guidance, Patterson said.

But Alba Azola, a physical medicine and rehabilitation specialist at Johns Hopkins Medicine, said she has treated patients who report having spent hundreds of dollars for the tests and then don’t know what to make of the results.

“They bring it to me, like, ‘Look at this,’” Azola said. “And I’m, ‘I don’t know what to do with that.’”

Other long-haulers, including Harris, have paid for treatments promoted by groups linked to vaccine hesitancy and anti-science messaging.

Among them is the Front Line Covid-19 Critical Care Alliance, a nonprofit that promotes the anti-parasitic ivermectin not only for the prevention and treatment of acute covid but also as part of its long-covid protocol. The alliance publishes a list of pharmacies that will supply ivermectin, approved by the FDA to treat some parasitic worms, head lice and skin conditions like rosacea in humans. But the drug has not been shown to be effective in the treatment of acute covid illness. The American Medical Association and other professional groups oppose using the drug for covid outside of clinical trials because of its potential toxicity.

How long covid is accelerating a revolution in medical research

The alliance was co-founded by Pierre Kory, a critical-care physician who touted ivermectin as a “miracle drug” in Senate testimony and also runs a private telemedicine practice where he treats long-haulers. Kory, who charges $1,650 for an initial video consultation, follow-ups and check-in calls according to patients’ needs, said the drugs he prescribes, including ivermectin, steroids and anti-inflammatories, are safe.

In an interview, Kory said he does not follow the AMA’s position on ivermectin because the association provides general guidance but does not treat people. Other researchers say that the risks of the drug are known and that its benefits have not been shown.

“Based on the lack of effectiveness in acute covid, combined with what we know about long covid, it is extremely unlikely that ivermectin would be beneficial for someone suffering from long covid,” said Francesca Beaudoin, head of the Brown University School of Public Health’s Long Covid Initiative.

Kory also criticized the research community for being too slow to keep up with patient needs.

“We’re stuck right now trying to help patients with trial and error until the science evolves,” he said. “All of my patients get better to some extent.”

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Among the most common online offerings are dietary supplements, which do not have to meet the same regulatory standards as pharmaceuticals. While drugs must be shown to be safe and effective before they reach the consumer, there are no such provisions for the FDA to regulate vitamins, herbs and amino acids.

One of the most widely touted supplements among long-haulers is Vedicinals-9, a new herbal suspension that purports to support “the human organism in the recovery phase from viral infections.”

The nutraceutical is made in India, where it is regulated as a food for special medical purpose, or FSMP, and then shipped around the world. A 42-day supply costs $95, according to the product website.

Harris said he bought several boxes but that the solution didn’t reduce the muscle spasms and pain he has suffered since testing positive 10 months ago. Other patients have reported benefits.

The company’s founder, retired German businessman Joachim Gerlach, said he had long been interested in finding natural remedies for chronic illness, which he has witnessed among family members. He turned his attention to acute covid in early 2020, Gerlach said, hoping, as long covid emerged, to find a common approach that would help large numbers of people. He believes that many symptoms stem from an imbalance of the gut bacteria that can help combat disease.

Gerlach, who has reached out to prominent long-covid researchers around the world to plan research next year, said his progress on long covid was “lacking a little bit on the side of publishing.” But by financing Vedicinals out of his own pocket, he said, he can “act fully in the patient’s interest” without pressure from shareholders.

Paxlovid may reduce long covid risk for some patients, VA study finds

New tests and products keep cropping up.

Earlier this month, QMC Health, a diagnostic testing technology company, announced its intention to produce a long-covid rapid test, based on blood biomarkers.

MDHyperbaric, a company in New York, offers oxygen therapy for a variety of conditions, from healing bones to slowing aging and improving long-covid symptoms, saying it plans to measure long-hauler outcomes.

And in October, Norman B. Gaylis, a Miami-based rheumatologist, collaborated with Tel Aviv researchers to release an “all-natural, patented formula RESTORE,” described on the company’s website as “proven by clinical study” to improve symptoms of covid long-haulers.

That study, published in Frontiers in Nutrition, involved 51 patients with positive coronavirus tests who reported lingering symptoms three to 11 months after infection. On average, the participants reported that their symptoms were milder after two weeks and better still after four, according to the study.

The study is small and lacked a control group to assess whether the patients’ symptoms would have improved anyway over time or whether their self-reported improvements resulted from a placebo effect.

“Obviously, a double-blind control is more valuable,” Gaylis said in a telephone interview. “Between time and cost and urgency, these things take so long, we felt it was sufficient.” The biggest endorsement of the product, he said, was that so many people who took part in the study asked to buy it.

Without solid data about treatments, some primary care physicians have fallen into a “kitchen-sink approach,” according to Haddad, the rehabilitation specialist at Emory.

Haddad saw one patient who had been prescribed Benadryl and several other sedating drugs in addition to an antidepressant that she was already taking. When the patient complained of brain fog, her doctor added Adderal, a stimulant — a little like chasing shots of hard liquor with double espressos.

“They kept throwing things at the post-covid,” Haddad said. “They didn’t step back and ask, ‘Could medications be part of the culprit?’”

Meanwhile, clinicians who are running long-covid clinics at major medical centers are drawing on their experience treating conditions with similar symptoms, such as ME/CFS, or chronic fatigue syndrome; POTS, a blood circulation disorder that causes a rapid heartbeat; and what’s known as post-ICU syndrome.

“We’re using a lot of experience, anecdotal evidence and related evidence with other conditions,” said Benjamin Abramoff, director of the Post-COVID Assessment and Recovery Clinic at Penn Medicine. “A lot of the things we do have not gone through trials.”

Mexico City gave ivermectin to thousands of covid patients. Officials face an ethics backlash.

Many rehab experts have been meeting at CDC-funded monthly webinars to pool the expertise they are gaining and come up with guidance published by the American Academy of Rehabilitation and Physical Medicine.

There are likely to be therapeutic benefits to some of the treatments long-haulers are trying. A few small studies have suggested hyperbaric oxygen may provide relief. The spice turmeric, or curcumin — an ingredient found in Vedicinals and the Front Line Covid-19 Critical Care Alliance’s protocols — has anti-inflammatory properties. The key, clinicians say, is to evaluate the risk/benefit ratio for every therapy, including potentially detrimental interactions with other medications.

“For things patients are interested in trying, I won’t dissuade them if the risk of harm is low,” said Jeffrey Fine, director of rehabilitation medicine at NYU Langone Hospital, who said he tries “to meet patients where they are.”

In the meantime, patients continue their own research, through online resources such as Twitter.

“It’s my social life, my family, my research library,” said Molly Gordon, a 69-year-old executive coach in Washington state who gradually pieced together a self-diagnosis of mast cell activation syndrome — a condition akin to allergic reactions — that she believes came from long covid. Gordon said she is putting about $500 a month of her retirement savings toward supplements and cannabis.

Those networks have turned long-covid care into an international free-for-all, as patients search for therapies overseas, often with little idea of the regulatory oversight — or lack thereof.

Laura Wright, 45, a reflexologist in England, joined Twitter to glean information from fellow sufferers around the world about how to combat the fatigue that has plagued her since she came down with covid a year ago. She tried hyperbaric oxygen and began taking “every supplement under the sun and adding new ones every month,” Wright said, including garlic, hawthorn, B-12 and magnesium, until she began wondering whether they were doing her more harm than good.

She went cold turkey. With one exception: Boluoke.

Wright has pinned her hopes on the earthworm extract that is thought to promote circulatory health. A bottle of 30 capsules, which she imports from Canada, costs about $55.

“If I can get back to working again, then it will be worth it,” Wright said.

October 1, 2022

To stop fatal overdoses, hospitals turn to addiction treatment teams : Shots

David Cave, a recovery coach who is part of an addiction specialty team at Salem Hospital, north of Boston, stands outside the emergency department.

Jesse Costa/WBUR

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Jesse Costa/WBUR

David Cave, a recovery coach who is part of an addiction specialty team at Salem Hospital, north of Boston, stands outside the emergency department.

Jesse Costa/WBUR

Marie lives in the coastal town of Swampscott, in Massachusetts. Last December, she began having more and more trouble breathing. One morning, three days after Christmas, she woke up gasping for air. A voice in her head said, “You’re going to die.” Marie dialed 911.

“I was so scared,” Marie said later. Describing that day, the 63-year-old’s voice filled with tension, and her hand clutched at her chest.

Marie was admitted to Salem Hospital, north of Boston. The staff treated her COPD, a chronic lung condition that includes emphysema and chronic bronchitis.

After her worst symptoms subsided, a doctor came the next day to check on her. He told Marie her oxygen levels looked good and that she was stable and ready to be discharged.

NPR is not using Marie’s last name because she, like 1 in 9 hospitalized patients, has a history of addiction to drugs or alcohol. Disclosing a diagnosis like that can make it hard to find housing, a job and even medical care in hospitals where patients with an addiction may be shunned.

But talking to the doctor that morning, Marie felt she didn’t have a choice. She had to tell him about her other medical problem.

“He said I could be released,” Marie recalled. “And I said, ‘I got to tell you something. I’m a heroin addict. And I’m, like, starting to be in heavy withdrawal. I can’t literally move, please don’t make me go.'”

Without care, discharged patients risk overdose

At many hospitals in Massachusetts and across the country, Marie would likely have been discharged anyway, while still in the pain of withdrawal. Perhaps she would leave with a list of local detox programs where she might — or might not — find help.

But a crucial opportunity to intervene and treat at the hospital would have been lost — partly because most hospitals don’t have specialists available who know how to treat addiction, and other clinicians don’t know what to do.

Hospitals typically employ all sorts of specialists who focus on critical organs like hearts, lungs and kidneys — or who treat systemic or chronic diseases of the immune system or the brain. There are specialists for children, for mental illness, for childbirth and hospice.

But if your illness is an addiction or a condition related to drug or alcohol use, there are few hospitals where patients can see a clinician — whether that be an M.D., nurse, therapist or social worker — who specializes in addiction medicine.

Their absence among hospital personnel is particularly striking at a time when overdose deaths in the U.S. have reached record highs, and research shows patients face an increased risk of fatal overdose in the days or weeks after they are discharged from a hospital.

“They’re left on their own to figure it out, which unfortunately usually means resuming [drug] use because that’s the only way to feel better,” says Liz Tadie, a nurse practitioner certified in addiction care.

In the fall of 2020, Tadie launched a new approach at Salem Hospital, using $320,000 from a federal grant that the hospital had worked for several years to secure. Tadie put together what’s known as an “addiction consult service.”

At Salem, that team included Tadie, a patient case manager, and three recovery coaches — who draw on their experience with addiction to advocate for patients and help them navigate their treatment options.

What an addiction consult service brings to the bedside

So on that day, when Marie said, “Please don’t make me go,” her doctor didn’t tell Marie she had to leave. He called Tadie for a bedside consult.

Tadie started out the treatment by first prescribing methadone, a medication to treat opioid addiction. Although many patients do well on that drug, it didn’t help Marie, so Tadie switched her to buprenorphine, with better results. After a few more days, Marie was eventually discharged and continued taking buprenorphine to manage her addiction to opioids.

But Marie continued seeing Tadie for treatment as an outpatient and was able to turn to her for support and reassurance:

“Like, that I wasn’t going to be left alone,” Marie said. “That I wasn’t going to have to call a dealer ever again, that I could delete the number. I want to get back to my life. I just feel grateful.”

Among Salem’s clinical staff, Tadie helped spread the word about the expertise she can offer and how it can help patients. Success stories like Marie’s helped her make the case for addiction medicine — which also meant unraveling decades of misinformation, discrimination and ignorance about patients with an addiction and their treatment options.

Part of the problem, according to Tadie, is that doctors, nurses and other clinicians get very little training in the physiology of addiction and withdrawal, the medications and treatment options, and the emerging science about what works for these patients. What little training that doctors and nurses do get is often unhelpful.

“A lot of the facts are outdated,” Tadie says. “And people are training to use stigmatizing language — words like ‘addict’ and substance ‘abuse.'”

Tadie gently corrected doctors at Salem Hospital, for example, who thought they weren’t ever allowed to start patients on methadone in the hospital.

“Sometimes I would recommend a dose and somebody would give pushback,” Tadie says. But “we got to know the hospital doctors and they, over time, were like, “OK, we can trust you. We’ll follow your recommendations.”

Over time, addiction specialists help change the culture

Other members of Tadie’s team have also wrestled with finding their place in the hospital hierarchy. David Cave, one of the recovery coaches at Salem Hospital, is often the first person to speak to a patient who comes to the emergency room in withdrawal. He tries to help doctors and nurses understand what the person is going through and help navigate their care.

“I’m probably punching above my weight every time I try to talk to a clinician or doctor,” says Cave. “They don’t see letters after my name. It can be kind of tough.”

But naming addiction as a specialty, and hiring people with training in this particular disease, is shifting the culture of Salem Hospital, according to Jean Monahan-Doherty, a social worker who has referred patients to Tadie.

“There was finally some recognition across the entire institution that this was a complex medical disease that needed the attention of a specialist,” Monahan-Doherty says. “People are dying. This is a terminal illness unless it’s treated.”

Former director of substance use disorder services at Salem Hospital Liz Tadie (left) and social worker Jean Monahan-Doherty. Tadie is moving to a new job at another hospital, but Salem Hospital leaders say they are committed to continuing the program.

Jesse Costa/WBUR

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Jesse Costa/WBUR

This approach to treating addiction is winning over some Salem Hospital employees — but not all.

“Some of the medical staff continue to see it as a moral issue,” Monahan-Doherty says. “Sometimes you hear an attitude of ‘Why are you putting all this effort into this patient? They’re not going to get better.’ Well, how do we know? If a patient comes in with diabetes, we don’t say, ‘OK, they’ve been taught once and it didn’t work. So we’re not going to offer them support again.'”

Despite lingering reservations among some colleagues, the demand for their services is quite high. Many days, Tadie and her team have been overwhelmed with referrals.

With federal support, states experiment to stop overdose deaths

Four other Massachusetts hospitals also added addiction specialists in the past three years and experienced similar challenges and success. The additional staff were paid for by federal funding from the HEALing Communities study. This project is paying for a wide range of strategies across several states, to determine the most effective ways to reduce drug overdose deaths. They include mobile treatment clinics, street outreach teams, naloxone trainings and distribution, rides to treatment sites, and multilingual public awareness campaigns.

“You really do provide better care for patients and you make the care environment one that people are more satisfied working in,” says Dr. Jeffrey Samet, who leads the Massachusetts portion of this research effort. Samet practices primary care at Boston Medical Center and says adding addiction specialists in hospitals is a key piece of the solution.

Dr. Todd Kerensky, president of the Massachusetts Society of Addiction Medicine, has seen patients cry when they learn he specializes in addiction and wants to treat their disease, not shame them.

“It’s gut-wrenching to know there are a lot of institutions that don’t have this service,” says Kerensky. It’s not clear how many hospitals in Massachusetts have addiction experts on staff, but Kerensky says it’s a “distinct minority.”

There are many possible reasons. It’s a new field, so finding qualified staff members with the right certifications may be a hurdle. Some hospital leaders say they’re worried about the costs of addiction treatment and fear they’ll lose money on the efforts. Some doctors report not wanting to initiate a treatment medication while the patient is still in the hospital, because they don’t know where to refer patients after they’ve been discharged, whether that be outpatient follow-up care or a residential program. To address follow-up care, Salem Hospital started what’s known as a “bridge clinic,” where patients get help transitioning to outpatient care.

Despite these worries and reservations, hospitals that don’t have an addiction specialty team need to start one, says Dr. Honora Englander, a national leader in addiction specialty programs.

“People with substance use disorder are coming to our hospitals now,” said Englander, who directs an addiction care team at Oregon Health and Science University. “We can’t wait. We have to do better, and this is the time.”

Englander says the federal government could support the creation of more addiction consult services by offering financial incentives — or penalties for hospitals that don’t embrace them. The Centers for Medicare & Medicaid Services, which has regulatory authority over most U.S. hospitals, could require that hospitals stock the medications used to treat an addiction and track outcomes for patients hospitalized with a substance use disorder, in the same way that CMS already does when it comes to readmissions for other health conditions.

At Salem Hospital, the program is still new, and some staff worry about its future. Liz Tadie is moving to a new job at another hospital, and the federal grant ended June 30. But Salem Hospital leaders say they are committed to continuing the program, and the service will continue.

Compared to the other four Massachusetts hospitals that launched addiction consult teams using the same federal grant, Salem Hospital has helped the most patients. Over a 15-month period, its team helped 448 patients begin medication to treat their opioid use disorder.

This story comes from NPR’s health reporting partnership with WBUR and KHN (Kaiser Health News).