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The Need for Improvement in Substance Abuse Treatments

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For decades now, America has been in the midst of a substance abuse epidemic. In fact, recent Pew research indicates nearly half of U.S. adults have a close friend or family member who has been addicted to drugs at one point in their life. The experience is so universal the dataset cuts across sex, race, age, education level, and even partisan lines. In short, it’s safe to assume addiction is as American as apple pie.

Every day, more than 115 people in the United States die after overdosing on opioids. Alcohol abuse has increased by 50% since the start of the century to the point where today, one in eight Americans abuses alcohol. According to a 2017 survey, methamphetamine has become the world’s most dangerous drug, as 4.8% of users required hospitalization in order to avoid overdose.

Though substance abuse has become a worldwide phenomenon, affecting millions of people, treatment for addiction is not nearly as universal. Public health officials have drawn attention to the problem in more recent years, yet only 10.9% of individuals who needed treatment in a specialized facility for a substance use or a dependency concern received it in the year 2013.

It’s an epidemic policymaker’s, mental health experts, law enforcement, and others are acutely aware of. But solving the problem on a wide scale has so far proven to be fruitless. Individual states have taken specific measures, like opening up safe injection sites, which allow those who struggle with addiction to use in a safe space around medical experts. It’s a solution which definitely won’t solve the addiction crisis, but it does work as a harm-prevention space. Other states have taken to suing the pharmaceutical companies themselves, using similar tactics which were used against Big Tobacco nearly 20 years ago.

While these are no doubt necessary and useful tactics which will help presently and in the future (if successful), there are other avenues that largely have yet to be explored. Perhaps the most simple form of aid is given through the Primary Care Provider (PCP).

While all doctors and patients are supposed to share a therapeutic alliance, based on mutual trust and respect, PCPs are in a unique position in the healthcare field. Often, these doctors have known their patients for a number of years, have a big picture view of their overall health over a period of several years, and are able to check in on a patient’s progress with every visit.  

Evidence compiled by a University of Michigan medical team suggests primary care physicians and their teams of nurses, medical assistants, social workers, and pharmacists can — beyond providing basic services every patient needs — also provide effective care for addiction. Including each of these moving parts not only ensures the patient is receiving quality care but also helps to ensure the patient does not fall through the cracks at any point during their recovery.

They achieve this primarily through the anti-opioid medication buprenorphine and counseling — a combination known as medication-assisted treatment (MAT). The researchers have recently published a peer-reviewed paper on the subject, where they pose this is an effective method of treatment. They do not argue, however, that it is an easy process.

“There is a major need to do this,” says Pooja Lagisetty, M.D., M.Sc., the study’s lead author and a University of Michigan primary care doctor who provides MAT to her own patients at the VA Ann Arbor Healthcare System. “It’s hard to convince primary care physicians to do this work when they’re already busy and they don’t have additional addiction-related training or experience. But if we can learn from others and find a way to offer physicians logistical support, then maybe it’s possible.”

This support must come from other parts of the medical team. As the patient goes through the process, non-physician team members aid with dosing, monitoring the patient, and check-ins by phone and in person. If done successfully, Lagisetty argues this method can achieve similar results to specialized treatment facilities, and it might reach more people.

“Patients might be more willing to seek help in a primary care setting because of the lack of stigma and the ability to address their other health concerns,” she said. It’s also likely to be less devastating to patients financially. All in all, this kind of treatment in Primary Care facilities makes sense.

While it’s unlikely primary care physicians pursued medicine with a desire to focus on addiction treatment, it’s a reality many are going to have to embrace and develop a protocol for as the problem persists or worsens.

There are, of course, a number of other solutions which ought to be tested as America’s substance abuse problems continue to grow. Addressing the issue at its core will require effort from governing bodies, lawmakers, public health experts, mental health experts, and of course, the healthcare system. Until this happens, a collaboration between healthcare providers might be our best bet.

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Social Work and Helping Professions Must Take Action to End Child Separations at Border

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Today, House Judiciary Committee Ranking Member Jerrold Nadler (D-NY) led more than 190 House Democrats in introducing the Keep Families Together Act, H.R. 6135, legislation to end family separation at the U.S. border.

On June 8th, 2018, Congresswoman Carol Shea-Porter (NH-01), Congresswoman and Chair of the Congressional Social Work Caucus Barbara Lee (CA-13), Congresswoman Susan Davis (CA-53), Congressman Luis V. Gutiérrez (IL-04), and Congresswoman Karen Bass (CA-37) released a joint statement on the Trump Administrations zero tolerance policy which is separating children from their parents as an immigration deterrent strategy.

“The Trump Administration’s policy of separating children from their parents is terrifying and frankly, abhorrent. Reports indicate that very young children– who are already fleeing dangerous conditions at home including domestic violence – are being taken from their parents. Families are often separated by hundreds of miles, and children are being housed in inadequate facilities. As social workers, we understand the profound impact that family separation has on a child’s developmental growth and on our society. These heartless policies instill a sense of helplessness and despair in children and could result in long-term trauma and health repercussions.

The American Academy of Pediatrics has stated that the separation of children from parents, and detention in DHS facilities that do not meet the basic standard of care for children, pose a significant threat to their long-term health and well-being. Their findings have led them to recommend that children in the custody of their parents should never be detained or separated from a parent unless a competent family court makes that determination.

Every passing day of separation has grave consequences for these children’s well-being. These are innocent children who have done nothing wrong. Forcing them to suffer at the hands of the US government is inhumane and un-American. We are taking all actions possible to end this brutal policy and reunite children with their families”, says social work members of Congress.

A release issued by the National Association of Social Workers also stated the “zero tolerance immigration policy that would prosecute families who attempt to cross the border and forcibly separate children from parents is malicious and unconscionable”.

In an effort to end child separations at the border, the Keep Families Together Act was developed in consultation with child welfare experts to ensure the federal government is acting in the best interest of children. The bill is supported by the American Academy of Pediatrics, Kids In Need of Defense (KIND), Coalition for Humane Immigrant Rights of Los Angeles (CHIRLA), Children’s Law Center, Young Center for Immigrant Rights and the Women’s Refugee Commission.

Key Elements of the Bill

  • Keep Families Together:  The bill promotes family unity by prohibiting Department of Homeland Security (DHS) officials from separating children from their parents, except in extraordinary circumstances.  In these limited circumstances, separation could not occur unless parental rights have been terminated, a child welfare agency has issued a best interest determination, or the Port Director or the Chief Border Patrol agent of Customs and Border Protection (CBP) have approved separation due to trafficking indicators or other concerns of risk to the child.  It requires an independent child welfare official to review any such separation and return the child if no harm to the child is present. It imposes financial penalties on officials who violate the prohibition on family separation.
  • Limit Criminal Prosecutions for Asylum Seekers: The majority of the parents separated at the border are being criminally prosecuted for illegal entry or re-entry.  This bill restricts the prosecution of parents who are asylum seekers by adopting the recommendation of the DHS Office of Inspector General.  The bill delays prosecutions for asylum seekers and creates an affirmative defense for asylum seekers.  It also codifies our commitment to the Refugee protocol prohibiting the criminal punishment of those seeking protection from persecution.
  • Increase Child Welfare Training: The bill requires all CBP officers and agents to complete child welfare training on an annual basis. Port Directors and Chief Border Agents, those who are authorized to make decisions on family separations, must complete an additional 90 minutes of annual child-welfare training.
  • Establish Public Policy Preference for Family Reunification: The bill establishes a preference for family unity, discourages the separation of siblings, and creates a presumption that detention is not in the best interests of families and children.
  • Add Procedures for Separated Families: The bill requires DHS to develop policies and procedures allowing parents and children to locate each other and reunite if they have been separated.   Such procedures must be public and made available in a language that parents can understand.  In cases of separation, it requires DHS to provide parents with a weekly report containing information about a child, and weekly phone communication.
  • Establish Other Required Measures:  In order to inform Congressional oversight and promote public understanding of the use of family separation, the bill requires a report on the separation of families every six months.

In addition to Senator Feinstein, the bill is also cosponsored by 31 senators, including Senators Chuck Schumer (D-N.Y.), Dick Durbin (D-Ill.), Patty Murray (D-Wash.), Patrick Leahy (D-Vt.), Kamala Harris (D-Calif.), Bernie Sanders (D-Vt.), Jeff Merkley (D-Ore.), Brian Schatz (D-Hawaii), Ed Markey (D-Mass.), Jack Reed (D-R.I.), Richard Blumenthal (D-Conn.), Michael Bennet (D-Colo.), Cory Booker (D-N.J.), Tom Carper (D-Del.), Amy Klobuchar (D-Minn.), Mazie Hirono (D-Hawaii), Elizabeth Warren (D-Mass.), Bob Menendez (D-N.J.), Tim Kaine (D-Va.), Angus King (I-Maine), Catherine Cortez-Masto (D-Nev.), Bill Nelson (D-Fla.), Ron Wyden (D-Ore.), Bob Casey (D-Pa.), Mark Warner (D-Va.), Jeanne Shaheen (D-N.H.), Chris Murphy (D-Conn.), Tammy Baldwin (D-Wis.), Kirsten Gillibrand (D-N.Y.), Tom Udall (D-N.M.), Martin Heinrich (D-N.M.) and Maria Cantwell (D-Wash.).

We must urge Congress to allow a vote on this important piece of legislation to help minimize trauma being inflicted on children and families. Sign the petition to support the Keep Families Together Act here.

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