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Her work can also be heard on NPR, \u003cem>Here & Now, \u003c/em>and PRI. Before working in audio, she taught, leading groups of students abroad. One of her favorite jobs was teaching on the Thai-Burmese border, working with immigrants and refugees.\r\n\r\nLaura has won three Northern California Area Emmys along with her Deep Look colleagues. She's won the North Gate Award for Excellence in Audio Reporting and the Gobind Behari Lal Award for a radio documentary about adults with imaginary friends. She's a fellowship junkie, completing the USC Center for Health Journalism's California Fellowship, UC Berkeley's Human Rights Fellowship and the Coro Fellowship in Public Affairs. Laura has a master’s in journalism from UC Berkeley and a master’s in education from Harvard.\r\n\r\nShe likes to eat chocolate for breakfast. She's also open to eating it all day long.","avatar":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g","twitter":"lauraklivans","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["editor"]},{"site":"stateofhealth","roles":["contributor","editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"Laura Klivans | KQED","description":"Reporter and Host","ogImgSrc":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lklivans"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_363838":{"type":"posts","id":"stateofhealth_363838","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"363838","score":null,"sort":[1529600880000]},"guestAuthors":[],"slug":"bartenders-learn-how-to-spot-and-reverse-opioid-overdoses","title":"Bartenders Learn How to Spot – and Reverse – Opioid Overdoses","publishDate":1529600880,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Health educator Kristen Marshall made herself comfortable on a bright red, pleather sofa at St. Mary’s Pub in San Francisco. She welcomed a group of 10 people who trickled inside from the midday sun. Some wore funky glasses, others had sleeve tattoos.\u003c/p>\n\u003cp>Marshall unloaded a few items from a shoulder bag onto a two-top table in front of her, including a nasal sprayer of the drug Narcan – the brand name for naloxone, a drug that reverses opioid overdoses.\u003c/p>\n\u003cp>Typically, Marshall educates an audience of people who use drugs. But as the opioid crisis continues to devastate communities, Marshall and her colleagues from the \u003ca href=\"http://harmreduction.org/\" target=\"_blank\" rel=\"noopener\">Harm Reduction Coalition\u003c/a> are getting more creative in their approach to saving lives. At this training, Marshall’s assembled a group of bartenders and club and festival employees.\u003c/p>\n\u003cp>Immediately, Marshall fielded a question about a famous scene from the movie “Pulp Fiction,” in which actress Uma Thurman's character overdoses on drugs and is dramatically revived. Instead of naloxone, her rescuers stab her directly in the heart with a large needle full of adrenaline.\u003c/p>\n\u003cp>“Two things,” Marshall said to the group. “Adrenaline doesn’t work to reverse an opioid overdose, and please don’t stab anybody in the heart with anything.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The audience laughed as Marshall raised her hand in a fist and yelled, “Quentin Tarantino!” in a feigned rage.\u003c/p>\n\u003cfigure id=\"attachment_363843\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363843\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/IMG_8287-e1528757591523-800x525.jpg\" alt=\"A dose of Narcan, the brand name of naloxone, a drug that can reverse opioid overdoses. Narcan also comes as an injection.\" width=\"800\" height=\"525\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-800x525.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-160x105.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-768x504.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-1020x670.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-1200x788.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-1180x775.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-960x630.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-240x158.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-375x246.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-520x341.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A dose of Narcan, the brand name of naloxone, a drug that can reverse opioid overdoses. Narcan also comes as an injection. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Marshall then moved into more serious territory, speaking from her years of experience working at a needle exchange and sometimes administering naloxone to reverse an overdose.\u003c/p>\n\u003cp>She described telltale signs of what it looks like when someone is overdosing on opioids, such as heroin or fentanyl.\u003c/p>\n\u003cp>“Unable to maintain consciousness,” Marshall said. “Or they’re gonna be real hard to wake up, especially if alcohol is involved. And they’re not going to be breathing enough.”\u003c/p>\n\u003cp>A person’s body will droop, their skin will become ashen or bluish gray, she said.\u003c/p>\n\u003cp>Marshall instructed her pupils to call 911 as soon as they suspect an opioid overdose, and to use pain to try to wake an overdosing individual, like a knuckle rub to the sternum.\u003c/p>\n\u003cp>“If they go right back out or they just are not responsive, the next thing is the Narcan,” she instructed while picking up her Narcan nasal sprayer.\u003c/p>\n\u003cp>“Then you’re going to take this all the way up their nose,” Marshall said, pointing to a white plastic tip at the top of the tool. “One click. That’s it.”\u003c/p>\n\u003cp>Each attendee left with a box of Narcan to take to their next work shift.\u003c/p>\n\u003cfigure id=\"attachment_363842\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363842\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/IMG_8660-800x600.jpg\" alt=\"Amy Rothbauer, a bartender at St. Marys Pub, poses with the box of Narcan that she keeps behind the bar, next to the first aid kit.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-1200x900.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Amy Rothbauer, a bartender at St. Marys Pub, poses with the box of Narcan that she keeps behind the bar, next to the first aid kit. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This training was Marshall’s tenth for the nightlife industry, including one for the entire staff of \u003ca href=\"https://www.facebook.com/HUSHconcerts/\" target=\"_blank\" rel=\"noopener\">HUSH Concerts\u003c/a>, a music production company in San Francisco. The initiative is funded by \u003ca href=\"https://www.sfdph.org/dph/default.asp\" target=\"_blank\" rel=\"noopener\">San Francisco’s Department of Public Health\u003c/a>.\u003c/p>\n\u003cp>At the HUSH offices on Treasure Island, creative director Robbie Kowal pointed to a photo on the wall of a good friend and DJ he worked with a lot.\u003c/p>\n\u003cp>“You can just see how effervescent a person he was,” Kowal said.\u003c/p>\n\u003cp>Kowal's friend died three years ago, and his colleagues still don’t know the cause.\u003c/p>\n\u003cp>After Kowal took a Narcan training, however, he began to suspect his friend died from an opioid overdose.\u003c/p>\n\u003cp>The signs were really all there, Kowal said. “Had people on that site had that kind of training, they might have been able to intervene.”\u003c/p>\n\u003cfigure id=\"attachment_363865\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-363865 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/IMG_8767-e1528937107471-800x565.jpg\" alt=\"Robbie Kowal, creative director of HUSH Concerts in San Francisco, stands in front of a wall of concerts his company's produced.\" width=\"800\" height=\"565\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-800x565.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-160x113.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-768x542.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-1020x720.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-1200x848.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-1180x833.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-960x678.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-240x170.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-375x265.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-520x367.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Robbie Kowal, creative director of HUSH Concerts in San Francisco, stands in front of a wall of concerts his company's produced. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At many events, Kowal’s employees are often the only sober people present, working the after-hours shift from midnight to six or seven in the morning. Lots of patrons experiment with new substances, sometimes not knowing what’s in them.\u003c/p>\n\u003cp>That’s why Kowal had Kristen Marshall train his company. He hopes that someday, if needed, they can save a life.\u003c/p>\n\u003cp>HUSH Concerts has always sent emergency bags to each event they staff. Inside, there are adapters, plugs, anything a DJ may forget. Now, the first aid kit they carry includes two doses of Narcan.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We, who are of the after-hours community, who live this beautiful life that's very undersung, can actually make a difference for people,” Kowal said.\u003c/p>\n\n","blocks":[],"excerpt":"More people working at bars, clubs and festivals are now armed with naloxone, the drug that reverses opioid overdoses.","status":"publish","parent":0,"modified":1529600880,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":26,"wordCount":805},"headData":{"title":"Bartenders Learn How to Spot – and Reverse – Opioid Overdoses | KQED","description":"More people working at bars, clubs and festivals are now armed with naloxone, the drug that reverses opioid overdoses.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Bartenders Learn How to Spot – and Reverse – Opioid Overdoses","datePublished":"2018-06-21T17:08:00.000Z","dateModified":"2018-06-21T17:08:00.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"363838 https://ww2.kqed.org/stateofhealth/?p=363838","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/06/21/bartenders-learn-how-to-spot-and-reverse-opioid-overdoses/","disqusTitle":"Bartenders Learn How to Spot – and Reverse – Opioid Overdoses","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2018/06/NarcaninBarsKlivans180621.mp3","path":"/stateofhealth/363838/bartenders-learn-how-to-spot-and-reverse-opioid-overdoses","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Health educator Kristen Marshall made herself comfortable on a bright red, pleather sofa at St. Mary’s Pub in San Francisco. She welcomed a group of 10 people who trickled inside from the midday sun. Some wore funky glasses, others had sleeve tattoos.\u003c/p>\n\u003cp>Marshall unloaded a few items from a shoulder bag onto a two-top table in front of her, including a nasal sprayer of the drug Narcan – the brand name for naloxone, a drug that reverses opioid overdoses.\u003c/p>\n\u003cp>Typically, Marshall educates an audience of people who use drugs. But as the opioid crisis continues to devastate communities, Marshall and her colleagues from the \u003ca href=\"http://harmreduction.org/\" target=\"_blank\" rel=\"noopener\">Harm Reduction Coalition\u003c/a> are getting more creative in their approach to saving lives. At this training, Marshall’s assembled a group of bartenders and club and festival employees.\u003c/p>\n\u003cp>Immediately, Marshall fielded a question about a famous scene from the movie “Pulp Fiction,” in which actress Uma Thurman's character overdoses on drugs and is dramatically revived. Instead of naloxone, her rescuers stab her directly in the heart with a large needle full of adrenaline.\u003c/p>\n\u003cp>“Two things,” Marshall said to the group. “Adrenaline doesn’t work to reverse an opioid overdose, and please don’t stab anybody in the heart with anything.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The audience laughed as Marshall raised her hand in a fist and yelled, “Quentin Tarantino!” in a feigned rage.\u003c/p>\n\u003cfigure id=\"attachment_363843\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363843\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/IMG_8287-e1528757591523-800x525.jpg\" alt=\"A dose of Narcan, the brand name of naloxone, a drug that can reverse opioid overdoses. Narcan also comes as an injection.\" width=\"800\" height=\"525\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-800x525.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-160x105.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-768x504.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-1020x670.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-1200x788.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-1180x775.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-960x630.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-240x158.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-375x246.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-520x341.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A dose of Narcan, the brand name of naloxone, a drug that can reverse opioid overdoses. Narcan also comes as an injection. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Marshall then moved into more serious territory, speaking from her years of experience working at a needle exchange and sometimes administering naloxone to reverse an overdose.\u003c/p>\n\u003cp>She described telltale signs of what it looks like when someone is overdosing on opioids, such as heroin or fentanyl.\u003c/p>\n\u003cp>“Unable to maintain consciousness,” Marshall said. “Or they’re gonna be real hard to wake up, especially if alcohol is involved. And they’re not going to be breathing enough.”\u003c/p>\n\u003cp>A person’s body will droop, their skin will become ashen or bluish gray, she said.\u003c/p>\n\u003cp>Marshall instructed her pupils to call 911 as soon as they suspect an opioid overdose, and to use pain to try to wake an overdosing individual, like a knuckle rub to the sternum.\u003c/p>\n\u003cp>“If they go right back out or they just are not responsive, the next thing is the Narcan,” she instructed while picking up her Narcan nasal sprayer.\u003c/p>\n\u003cp>“Then you’re going to take this all the way up their nose,” Marshall said, pointing to a white plastic tip at the top of the tool. “One click. That’s it.”\u003c/p>\n\u003cp>Each attendee left with a box of Narcan to take to their next work shift.\u003c/p>\n\u003cfigure id=\"attachment_363842\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363842\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/IMG_8660-800x600.jpg\" alt=\"Amy Rothbauer, a bartender at St. Marys Pub, poses with the box of Narcan that she keeps behind the bar, next to the first aid kit.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-1200x900.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Amy Rothbauer, a bartender at St. Marys Pub, poses with the box of Narcan that she keeps behind the bar, next to the first aid kit. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This training was Marshall’s tenth for the nightlife industry, including one for the entire staff of \u003ca href=\"https://www.facebook.com/HUSHconcerts/\" target=\"_blank\" rel=\"noopener\">HUSH Concerts\u003c/a>, a music production company in San Francisco. The initiative is funded by \u003ca href=\"https://www.sfdph.org/dph/default.asp\" target=\"_blank\" rel=\"noopener\">San Francisco’s Department of Public Health\u003c/a>.\u003c/p>\n\u003cp>At the HUSH offices on Treasure Island, creative director Robbie Kowal pointed to a photo on the wall of a good friend and DJ he worked with a lot.\u003c/p>\n\u003cp>“You can just see how effervescent a person he was,” Kowal said.\u003c/p>\n\u003cp>Kowal's friend died three years ago, and his colleagues still don’t know the cause.\u003c/p>\n\u003cp>After Kowal took a Narcan training, however, he began to suspect his friend died from an opioid overdose.\u003c/p>\n\u003cp>The signs were really all there, Kowal said. “Had people on that site had that kind of training, they might have been able to intervene.”\u003c/p>\n\u003cfigure id=\"attachment_363865\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-363865 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/IMG_8767-e1528937107471-800x565.jpg\" alt=\"Robbie Kowal, creative director of HUSH Concerts in San Francisco, stands in front of a wall of concerts his company's produced.\" width=\"800\" height=\"565\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-800x565.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-160x113.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-768x542.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-1020x720.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-1200x848.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-1180x833.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-960x678.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-240x170.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-375x265.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-520x367.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Robbie Kowal, creative director of HUSH Concerts in San Francisco, stands in front of a wall of concerts his company's produced. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At many events, Kowal’s employees are often the only sober people present, working the after-hours shift from midnight to six or seven in the morning. Lots of patrons experiment with new substances, sometimes not knowing what’s in them.\u003c/p>\n\u003cp>That’s why Kowal had Kristen Marshall train his company. He hopes that someday, if needed, they can save a life.\u003c/p>\n\u003cp>HUSH Concerts has always sent emergency bags to each event they staff. Inside, there are adapters, plugs, anything a DJ may forget. Now, the first aid kit they carry includes two doses of Narcan.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We, who are of the after-hours community, who live this beautiful life that's very undersung, can actually make a difference for people,” Kowal said.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/363838/bartenders-learn-how-to-spot-and-reverse-opioid-overdoses","authors":["8648"],"categories":["stateofhealth_11","stateofhealth_2746"],"tags":["stateofhealth_2808","stateofhealth_3254","stateofhealth_3253","stateofhealth_2519","stateofhealth_2656","stateofhealth_3255"],"featImg":"stateofhealth_363841","label":"stateofhealth"},"stateofhealth_363681":{"type":"posts","id":"stateofhealth_363681","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"363681","score":null,"sort":[1527293376000]},"guestAuthors":[],"slug":"california-deaths-from-powerful-opioid-fentanyl-triple-in-2017","title":"California Deaths From Powerful Opioid Fentanyl Rise in 2017","publishDate":1527293376,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cem>Updated June 18.\u003c/em>\u003c/p>\n\u003cp>Preliminary numbers show California's overdose deaths from the synthetic opioid fentanyl increased by 57% in 2017, according to the state's \u003ca href=\"https://discovery.cdph.ca.gov/CDIC/ODdash/\" target=\"_blank\" rel=\"noopener\">Opioid Overdose Surveillance Dashboard\u003c/a>.\u003c/p>\n\u003cp>Fentanyl overdoses claimed 373 Californians, according to the Dashboard, an online tool that gathers data from the \u003ca href=\"https://www.cdph.ca.gov/\" target=\"_blank\" rel=\"noopener\">California Department of Public Health\u003c/a>, the \u003ca href=\"https://www.oshpd.ca.gov/\" target=\"_blank\" rel=\"noopener\">Office of Statewide Health Planning and Development\u003c/a>, and the \u003ca href=\"https://oag.ca.gov/cures\" target=\"_blank\" rel=\"noopener\">Controlled Substance Utilization Review and Evaluation System\u003c/a>.\u003c/p>\n\u003cp>Fentanyl is up to 50 times more powerful than heroin and can be 100 times more potent than morphine. It's often added to other street drugs, and can overwhelm and kill someone who has no tolerance.\u003c/p>\n\u003cp>The number of overdose deaths last year could rise, however, according to \u003ca href=\"http://cfar.ucsf.edu/people/phillip-coffin\" target=\"_blank\" rel=\"noopener\">Dr. Phillip Coffin\u003c/a> of the \u003ca href=\"https://www.sfdph.org/dph/default.asp\" target=\"_blank\" rel=\"noopener\">San Francisco Department of Public Health\u003c/a>. He said determinations on causes of death are still being closed in some 2017 cases.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Fentanyl has long been behind high rates of opioid deaths in the eastern U.S., but the potent drug has not brought the same crisis to the West, including California, Coffin said. But that's changing.\u003c/p>\n\u003cp>\"We're definitely seeing a change in the market. We definitely are seeing fentanyl sold as fentanyl on the street. And that's new over the last couple of years,\" Coffin said.\u003c/p>\n\u003cp>The number of total opioid deaths -- including from heroin, prescription pain medication, morphine and fentanyl -- is down slightly from 2016.\u003c/p>\n\u003cp>Coffin attributes this to prevention efforts across the state, which include distribution of naloxone, a drug that reverses opioid overdoses, \u003ca href=\"https://www.kqed.org/stateofhealth/363143/san-franciscos-newest-tool-to-prevent-opioid-overdoses-tests-drugs-starts-conversations\" target=\"_blank\" rel=\"noopener\">fentanyl test strips\u003c/a>, and safer prescribing practices by doctors.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The number of overdose deaths from fentanyl has been changed to reflect the latest information released from the California Department of Public Health. Their original numbers erroneously stated that 746 people had died from fentanyl overdoses. The actual number is 373. \u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"While overall opioid deaths are holding steady, one dangerous drug is cause for concern.","status":"publish","parent":0,"modified":1529372315,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":12,"wordCount":306},"headData":{"title":"California Deaths From Powerful Opioid Fentanyl Rise in 2017 | KQED","description":"While overall opioid deaths are holding steady, one dangerous drug is cause for concern.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"California Deaths From Powerful Opioid Fentanyl Rise in 2017","datePublished":"2018-05-26T00:09:36.000Z","dateModified":"2018-06-19T01:38:35.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"363681 https://ww2.kqed.org/stateofhealth/?p=363681","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/05/25/california-deaths-from-powerful-opioid-fentanyl-triple-in-2017/","disqusTitle":"California Deaths From Powerful Opioid Fentanyl Rise in 2017","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/2018/05/2wayFentanylOverdosesRise.mp3","path":"/stateofhealth/363681/california-deaths-from-powerful-opioid-fentanyl-triple-in-2017","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Updated June 18.\u003c/em>\u003c/p>\n\u003cp>Preliminary numbers show California's overdose deaths from the synthetic opioid fentanyl increased by 57% in 2017, according to the state's \u003ca href=\"https://discovery.cdph.ca.gov/CDIC/ODdash/\" target=\"_blank\" rel=\"noopener\">Opioid Overdose Surveillance Dashboard\u003c/a>.\u003c/p>\n\u003cp>Fentanyl overdoses claimed 373 Californians, according to the Dashboard, an online tool that gathers data from the \u003ca href=\"https://www.cdph.ca.gov/\" target=\"_blank\" rel=\"noopener\">California Department of Public Health\u003c/a>, the \u003ca href=\"https://www.oshpd.ca.gov/\" target=\"_blank\" rel=\"noopener\">Office of Statewide Health Planning and Development\u003c/a>, and the \u003ca href=\"https://oag.ca.gov/cures\" target=\"_blank\" rel=\"noopener\">Controlled Substance Utilization Review and Evaluation System\u003c/a>.\u003c/p>\n\u003cp>Fentanyl is up to 50 times more powerful than heroin and can be 100 times more potent than morphine. It's often added to other street drugs, and can overwhelm and kill someone who has no tolerance.\u003c/p>\n\u003cp>The number of overdose deaths last year could rise, however, according to \u003ca href=\"http://cfar.ucsf.edu/people/phillip-coffin\" target=\"_blank\" rel=\"noopener\">Dr. Phillip Coffin\u003c/a> of the \u003ca href=\"https://www.sfdph.org/dph/default.asp\" target=\"_blank\" rel=\"noopener\">San Francisco Department of Public Health\u003c/a>. He said determinations on causes of death are still being closed in some 2017 cases.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Fentanyl has long been behind high rates of opioid deaths in the eastern U.S., but the potent drug has not brought the same crisis to the West, including California, Coffin said. But that's changing.\u003c/p>\n\u003cp>\"We're definitely seeing a change in the market. We definitely are seeing fentanyl sold as fentanyl on the street. And that's new over the last couple of years,\" Coffin said.\u003c/p>\n\u003cp>The number of total opioid deaths -- including from heroin, prescription pain medication, morphine and fentanyl -- is down slightly from 2016.\u003c/p>\n\u003cp>Coffin attributes this to prevention efforts across the state, which include distribution of naloxone, a drug that reverses opioid overdoses, \u003ca href=\"https://www.kqed.org/stateofhealth/363143/san-franciscos-newest-tool-to-prevent-opioid-overdoses-tests-drugs-starts-conversations\" target=\"_blank\" rel=\"noopener\">fentanyl test strips\u003c/a>, and safer prescribing practices by doctors.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The number of overdose deaths from fentanyl has been changed to reflect the latest information released from the California Department of Public Health. Their original numbers erroneously stated that 746 people had died from fentanyl overdoses. The actual number is 373. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/363681/california-deaths-from-powerful-opioid-fentanyl-triple-in-2017","authors":["8648"],"categories":["stateofhealth_11","stateofhealth_2746"],"tags":["stateofhealth_2808","stateofhealth_3237","stateofhealth_2519","stateofhealth_2656"],"featImg":"stateofhealth_363684","label":"stateofhealth"},"stateofhealth_361907":{"type":"posts","id":"stateofhealth_361907","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361907","score":null,"sort":[1510218031000]},"guestAuthors":[],"slug":"what-vets-want-at-the-end-of-life-is-very-different-from-what-civilians-want","title":"What Vets Want at the End of Life Is Very Different From What Civilians Want","publishDate":1510218031,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>A lot of Ron Fleming’s fellow soldiers spent the last five decades trying to forget what they saw and did in Vietnam. Now 74, Fleming has spent most of that time trying to hold on to it. He has never been as proud as he was when he was 21.\u003c/p>\n\u003cp>“I take issue with those who say we lost. We didn’t lose that war,” he said, sitting on the edge of his hospital bed at the \u003ca href=\"https://www.sanfrancisco.va.gov/\" target=\"_blank\" rel=\"noopener\">San Francisco VA medical center\u003c/a>. “Everywhere I went, we literally kicked the crap out of them.”\u003c/p>\n\u003cp>Fleming was a door gunner in the war, hanging out of a helicopter on a strap with a machine gun in his hands. He fought in the Tet Offensive, sometimes 40 hours straight, firing 6,000 rounds a minute. But he never gave much thought to catching one himself.\u003c/p>\n\u003cp>“You see, at 21, you’re bulletproof,” he said. “Dying wasn’t on the agenda.”\u003c/p>\n\u003cp>But now, it is. Fleming has congestive heart failure, arthritis and breathing problems. He often lands in the VA hospital with asthma attacks, and the palliative care team visits him regularly. He thinks about death.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I wish it’d get off its ass and come on me. I’m sick of this crap,” he said, as his heart rate monitor ticked up. “You see, dying’s the easy part. Living is what’s hard.”\u003c/p>\n\u003cp>Fleming has had trouble holding down a job since he got back from the war. He had a girl he lived with for 10 years, but they never married, never had kids. He lives alone in Oakland now. He says he angers easily and is always hypervigilant. About 10 years ago, he was diagnosed with PTSD. More than anything, he says, he suffers from a \"rotten outlook\" on life.\u003c/p>\n\u003cp>“Sometimes I think that now I’m being paid back for all the men I killed,” he said. “I killed a lot of them. More than I can count.”\u003c/p>\n\u003cp>Unlike Fleming, some Vietnam vets don’t find out they have PTSD until they have just months or weeks left to live. Symptoms of terminal illnesses, like pain or breathlessness, can trigger flashbacks, making vets feel as threatened as they did on the battlefield.\u003c/p>\n\u003cp>“The war memories start coming back, they start having nightmares,” said \u003ca href=\"https://profiles.stanford.edu/vj-periyakoil\" target=\"_blank\" rel=\"noopener\">VJ Periyakoil\u003c/a>, a palliative care physician at the VA in Palo Alto. She says opioid medications, like morphine and oxycodone, that are often used for treating pain and breathlessness can make PTSD symptoms worse.\u003c/p>\n\u003cp>“The side effect of those medications, they make you fuzzyheaded,” she said. “Your defenses that you use to cope with the PTSD, which might help repress a lot of the difficult memories, that coping strategy starts to come apart.”\u003c/p>\n\u003cp>She has had patients tell her: “I would much rather tolerate the physical pain, the cancer pain, than take opioids and my defenses crumble.”\u003c/p>\n\u003cp>Some vets see their pain or PTSD as retribution for their work in the line of duty.\u003c/p>\n\u003cp>“Sometimes I’ve had patients refuse medications that might ease their experiences because they feel that they deserve to suffer,” Periyakoil said. “This is redemptive.”\u003c/p>\n\u003cp>The best thing to do in these situations can be to stand down, she said. With weeks left to live, there isn’t enough time to resolve the mental anguish, and staff have to let patients set the pace and tone for their care.\u003c/p>\n\u003cp>But doctors and nurses, just like soldiers, hate doing nothing.\u003c/p>\n\u003cp>“We talk about the moral distress that \u003cem>we \u003c/em>have sometimes about really knowing that we’re doing the right thing for this individual, so that we can be present for \u003cem>their \u003c/em>suffering, the way \u003cem>they\u003c/em> need to do it,” said Patrice Villars, a hospice nurse at the San Francisco VA.\u003c/p>\n\u003cp>For Ron Fleming, death is still likely a couple of years out. His doctors have been begging him, gently, to consider mental health counseling or antidepressants. But he has refused.\u003c/p>\n\u003cp>“I don’t want to take psychiatric drugs. The vets call them the happy pills,” he said. “I don’t want any of those, because they change you. I don’t want to change.”\u003c/p>\n\u003cp>He’s not sure if he deserves to be happy.\u003c/p>\n\u003cp>“That I don’t know,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>His pain is what connects him to the past. Fleming was awarded 18 air medals for acts of meritorious achievement and heroism. The loss and grief he experienced in Vietnam are woven into the same memories of victory and glory. He doesn’t want treatment that might make that go away.\u003c/p>\n\n","blocks":[],"excerpt":"Honor and respect can be much more important for dying vets than being comfortable or free of pain.","status":"publish","parent":0,"modified":1510279371,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":817},"headData":{"title":"What Vets Want at the End of Life Is Very Different From What Civilians Want | KQED","description":"Honor and respect can be much more important for dying vets than being comfortable or free of pain.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"What Vets Want at the End of Life Is Very Different From What Civilians Want","datePublished":"2017-11-09T09:00:31.000Z","dateModified":"2017-11-10T02:02:51.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"361907 https://ww2.kqed.org/stateofhealth/?p=361907","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/11/09/what-vets-want-at-the-end-of-life-is-very-different-from-what-civilians-want/","disqusTitle":"What Vets Want at the End of Life Is Very Different From What Civilians Want","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/2017/11/DemboskyVetsEndofLife.mp3","path":"/stateofhealth/361907/what-vets-want-at-the-end-of-life-is-very-different-from-what-civilians-want","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>A lot of Ron Fleming’s fellow soldiers spent the last five decades trying to forget what they saw and did in Vietnam. Now 74, Fleming has spent most of that time trying to hold on to it. He has never been as proud as he was when he was 21.\u003c/p>\n\u003cp>“I take issue with those who say we lost. We didn’t lose that war,” he said, sitting on the edge of his hospital bed at the \u003ca href=\"https://www.sanfrancisco.va.gov/\" target=\"_blank\" rel=\"noopener\">San Francisco VA medical center\u003c/a>. “Everywhere I went, we literally kicked the crap out of them.”\u003c/p>\n\u003cp>Fleming was a door gunner in the war, hanging out of a helicopter on a strap with a machine gun in his hands. He fought in the Tet Offensive, sometimes 40 hours straight, firing 6,000 rounds a minute. But he never gave much thought to catching one himself.\u003c/p>\n\u003cp>“You see, at 21, you’re bulletproof,” he said. “Dying wasn’t on the agenda.”\u003c/p>\n\u003cp>But now, it is. Fleming has congestive heart failure, arthritis and breathing problems. He often lands in the VA hospital with asthma attacks, and the palliative care team visits him regularly. He thinks about death.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I wish it’d get off its ass and come on me. I’m sick of this crap,” he said, as his heart rate monitor ticked up. “You see, dying’s the easy part. Living is what’s hard.”\u003c/p>\n\u003cp>Fleming has had trouble holding down a job since he got back from the war. He had a girl he lived with for 10 years, but they never married, never had kids. He lives alone in Oakland now. He says he angers easily and is always hypervigilant. About 10 years ago, he was diagnosed with PTSD. More than anything, he says, he suffers from a \"rotten outlook\" on life.\u003c/p>\n\u003cp>“Sometimes I think that now I’m being paid back for all the men I killed,” he said. “I killed a lot of them. More than I can count.”\u003c/p>\n\u003cp>Unlike Fleming, some Vietnam vets don’t find out they have PTSD until they have just months or weeks left to live. Symptoms of terminal illnesses, like pain or breathlessness, can trigger flashbacks, making vets feel as threatened as they did on the battlefield.\u003c/p>\n\u003cp>“The war memories start coming back, they start having nightmares,” said \u003ca href=\"https://profiles.stanford.edu/vj-periyakoil\" target=\"_blank\" rel=\"noopener\">VJ Periyakoil\u003c/a>, a palliative care physician at the VA in Palo Alto. She says opioid medications, like morphine and oxycodone, that are often used for treating pain and breathlessness can make PTSD symptoms worse.\u003c/p>\n\u003cp>“The side effect of those medications, they make you fuzzyheaded,” she said. “Your defenses that you use to cope with the PTSD, which might help repress a lot of the difficult memories, that coping strategy starts to come apart.”\u003c/p>\n\u003cp>She has had patients tell her: “I would much rather tolerate the physical pain, the cancer pain, than take opioids and my defenses crumble.”\u003c/p>\n\u003cp>Some vets see their pain or PTSD as retribution for their work in the line of duty.\u003c/p>\n\u003cp>“Sometimes I’ve had patients refuse medications that might ease their experiences because they feel that they deserve to suffer,” Periyakoil said. “This is redemptive.”\u003c/p>\n\u003cp>The best thing to do in these situations can be to stand down, she said. With weeks left to live, there isn’t enough time to resolve the mental anguish, and staff have to let patients set the pace and tone for their care.\u003c/p>\n\u003cp>But doctors and nurses, just like soldiers, hate doing nothing.\u003c/p>\n\u003cp>“We talk about the moral distress that \u003cem>we \u003c/em>have sometimes about really knowing that we’re doing the right thing for this individual, so that we can be present for \u003cem>their \u003c/em>suffering, the way \u003cem>they\u003c/em> need to do it,” said Patrice Villars, a hospice nurse at the San Francisco VA.\u003c/p>\n\u003cp>For Ron Fleming, death is still likely a couple of years out. His doctors have been begging him, gently, to consider mental health counseling or antidepressants. But he has refused.\u003c/p>\n\u003cp>“I don’t want to take psychiatric drugs. The vets call them the happy pills,” he said. “I don’t want any of those, because they change you. I don’t want to change.”\u003c/p>\n\u003cp>He’s not sure if he deserves to be happy.\u003c/p>\n\u003cp>“That I don’t know,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>His pain is what connects him to the past. Fleming was awarded 18 air medals for acts of meritorious achievement and heroism. The loss and grief he experienced in Vietnam are woven into the same memories of victory and glory. He doesn’t want treatment that might make that go away.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361907/what-vets-want-at-the-end-of-life-is-very-different-from-what-civilians-want","authors":["3205"],"categories":["stateofhealth_3012","stateofhealth_1"],"tags":["stateofhealth_2847","stateofhealth_2808","stateofhealth_3023","stateofhealth_2519","stateofhealth_2656","stateofhealth_3194","stateofhealth_136","stateofhealth_3193"],"featImg":"stateofhealth_361951","label":"stateofhealth"},"stateofhealth_360808":{"type":"posts","id":"stateofhealth_360808","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"360808","score":null,"sort":[1502827229000]},"guestAuthors":[],"slug":"a-long-and-winding-road-kicking-heroin-in-an-opioid-treatment-desert","title":"A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’","publishDate":1502827229,"format":"standard","headTitle":"Kaiser Health News | State of Health | KQED News","labelTerm":{"term":3007,"site":"stateofhealth"},"content":"\u003cp>Heather Menzel squirmed in her seat, unable to sleep on the Greyhound bus as it rolled through the early morning darkness toward Bakersfield, in California’s Central Valley. She’d been trapped in transit for three miserable days, stewing in a horrific sickness only a heroin addict can understand. Again, and again, she stumbled down the aisle to the bathroom to vomit.\u003c/p>\n\u003cp>She hadn’t used since Chicago. She told herself that if she could just get through this self-prescribed detox, if she could get to her mother’s house in her hometown of Lake Isabella, Calif., all her problems would be solved.\u003c/p>\n\u003cp>“I’ve been through a lot of horrible, crazy stuff,” said Menzel, now 34. “I’ve been raped. I’ve been beaten up. I’ve been in prison. But trying to kick heroin on the Greyhound on the way home was the worst experience of my entire life.”\u003c/p>\n\u003cp>When Menzel finally arrived at the Bakersfield bus station at 6 a.m. that day in February 2014, her mother and stepfather were there waiting. The two women hadn’t seen each other in years, not since Menzel stole her mom’s jewelry and fled the area. They didn’t talk much as they drove east though the twisty canyon on State Route 178 toward Lake Isabella, a two-stoplight town with a population of 3,500, nestled in the golden Sierra Nevada foothills.\u003c/p>\n\u003cp>Menzel hoped that the worst of the withdrawal was over — that a new life without heroin awaited. What she didn’t know was that heroin was now cheap and plentiful in Lake Isabella, as in so many small towns in the U.S., and that her best hope for treatment was far away.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>32 Churches, No Methadone Clinic\u003c/strong>\u003c/p>\n\u003cp>Experts recommend medication-assisted treatment for drug users like Menzel, one of nearly 2 million Americans struggling with opioid addiction, whether to prescription pills or heroin. MAT, as the therapy is known, has been proven far more effective — and less dangerous and miserable — than cold-turkey quitting. Drugs like methadone and buprenorphine can help suppress opioid cravings and stave off the physical and psychological symptoms of withdrawal.\u003c/p>\n\u003cp>When carefully managed, MAT can cut the risk of overdose death by half, research shows. But not all medical providers \u003ca href=\"http://californiahealthline.org/news/one-major-force-lacking-in-fight-against-opioid-addiction-in-rural-california-doctors/\" target=\"_blank\" rel=\"noopener noreferrer\">are properly trained\u003c/a> and approved to provide the treatments, which themselves are opioids (albeit less likely to be abused). Only state-licensed and federally approved clinics can provide methadone, and doctors need to apply for a federal Drug Enforcement Administration waiver to prescribe buprenorphine.\u003c/p>\n\u003cp>Lake Isabella sits in the Kern River Valley, home to 32 churches but not a single methadone clinic or doctor able or willing to prescribe buprenorphine. Like half the counties in California, the valley is an opioid “treatment desert.”\u003c/p>\n\u003cfigure id=\"attachment_360811\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360811\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg\" alt=\"After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In rural areas, historically, there has been a lot of stigma around addiction treatment,” said Kelly Pfeifer, a primary care doctor and opioid project director at the California Health Care Foundation. “Although the state is trying to remedy this, there are still wide treatment deserts across California.” (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>In July, the California Department of Health Care Services awarded 19 applicants part of a $90 million federal grant to improve MAT access. In addition, $6 million was dedicated to support treatment in tribal communities. The agency hopes to create a network of “oases” in the state’s vast treatment deserts, many of which are in far Northern California, as well as eastern Kern County, which encompasses Lake Isabella.\u003c/p>\n\u003cp>The grants aim to pay for clinical and educational support to rural physicians, many of whom have never been trained in addiction medicine. Local doctors will handle most buprenorphine prescriptions, and in some towns, a mini-methadone program may set up shop.\u003c/p>\n\u003cp>But eastern Kern didn’t make the cut. For now, expanding opioid treatment in this area, and eastward, will have to wait.\u003c/p>\n\u003cp>Without such help, many experts say people like Heather Menzel — whose story a reporter followed over the course of a year — barely stand a chance.\u003c/p>\n\u003cp>\u003cstrong>Hooked Again\u003c/strong>\u003c/p>\n\u003cp>From the beginning, Menzel struggled to stay clean at her mother’s. She soon fell back in with her old drug-abusing friends. Within two months of arriving home, her grand plan for getting clean slid into her veins and disappeared with the push of a plunger. She was hooked on heroin again, smoking methamphetamine and, once her mom kicked her out, homeless.\u003c/p>\n\u003cfigure id=\"attachment_360813\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"wp-image-360813 size-full\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_7_1170.jpg\" alt=\"After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cp>She was risking death, and she knew it. On average, 91 people a day in the United States died of an opioid overdose in 2015, the latest figures available \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">from the Centers for Disease Control and Prevention\u003c/a>, and \u003ca href=\"https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?_r=0\" target=\"_blank\" rel=\"noopener noreferrer\">projections show\u003c/a> the death rate will continue to rise. Overall, California’s opioid death rate is relatively low: 4.73 deaths per 100,000 people. Still, 1,966 Californians died of an opioid overdose in 2015. \u003ca href=\"https://pdop.shinyapps.io/ODdash_v1/\" target=\"_blank\" rel=\"noopener noreferrer\">Kern County’s rate\u003c/a> was nearly double the state’s in 2015, and some sparsely populated rural counties, mostly up north, have rates that are far higher.\u003c/p>\n\u003cp>Policymakers fear the death risk is growing as use of fentanyl moves west. A synthetic opioid \u003ca href=\"https://www.drugabuse.gov/drugs-abuse/fentanyl\" target=\"_blank\" rel=\"noopener noreferrer\">estimated to be 50 to 100 times stronger\u003c/a> than morphine, fentanyl has caused numerous overdoses and deaths on the \u003ca href=\"http://khn.org/news/another-circle-of-hell-surviving-opioids-in-the-fentanyl-era/\" target=\"_blank\" rel=\"noopener noreferrer\">East Coast\u003c/a>. Some policymakers fear the fentanyl monster is heading to California, a potentially vast market of addicts.\u003c/p>\n\u003cp>“We really feel an urgency in California to increase access to services so if and when fentanyl arrives, we are more prepared to deal with it,” said Marlies Perez, chief of the Substance Use Disorder Compliance Division at DHCS.\u003c/p>\n\u003cp>Immediate, convenient access to these treatments is key. “It is very important for someone in the middle of addiction to access treatment when they are ready,” said Pfeifer. “There are these moments when people have wake-up calls — when they are ready to seek care and get out of the chaos of trying to get drugs to feel normal again.”\u003c/p>\n\u003cp>\u003cstrong>‘What Do I Do?’\u003c/strong>\u003c/p>\n\u003cp>Menzel’s wake-up happened when she noticed that she was still sick after a morning heroin injection. After an angry call to her drug dealer to accuse him of ripping her off, Menzel soon realized it wasn’t fake heroin — she was pregnant.\u003c/p>\n\u003cp>She took the bus to the emergency room in Bakersfield. “I’m fully addicted to heroin,” she blurted out to the ER doctor. “What do I do?” The doctor told her, “If you want to save your baby, you need to get on methadone.”\u003c/p>\n\u003cp>Affording methadone wasn’t a problem for Menzel. Medi-Cal, the state’s version of the Medicaid program for the poor, covered the costs. What impeded her was the daily trip from Lake Isabella to Bakersfield — an hour-plus bus ride down the curving canyon road. A round-trip ticket cost $5, more than she could spare. And if she missed an early bus back, she had to stay most of the day in Bakersfield to catch the next one.\u003c/p>\n\u003cfigure id=\"attachment_360816\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-360816 size-large\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">After receiving her methadone dose at a clinic in Bakersfield, Calif., Heather Menzel waits for the bus to take her back home to Lake Isabella on June 6, 2016. The bus ride takes about an hour and goes through a twisty canyon into the Sierra Nevada foothills. (Brian Rinker for KHN) \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For safety’s sake, the clinic started her at a low dose, increasing the amount until it was just right for her. But that beginning dose didn’t stave off the withdrawals, so she continued to use heroin and meth. She started to miss too many days of treatment and was kicked out of the program.\u003c/p>\n\u003cp>Menzel’s mother got her back in, promising the clinic that she would drive her daughter there every day. That meant quitting her job at Meals on Wheels.\u003c/p>\n\u003cp>“The fact you have to travel an hour to two hours every day to receive treatment requires somebody to operate a vehicle, pay for gas, and for some of our patients that is impossible,” said Javier Moreno, who manages the narcotics treatment programs in the Central Valley for Aegis Treatment Centers, the state’s largest methadone provider.\u003c/p>\n\u003cp>His Bakersfield clinics serve about 20 people in the Lake Isabella area, but Moreno thinks many more residents could benefit from MAT.\u003c/p>\n\u003cp>\u003cstrong>‘I Made it’\u003c/strong>\u003c/p>\n\u003cp>Menzel didn’t take the ideal path to getting clean. But she eventually began to feel the groove of methadone, and her cravings for heroin subsided. After a couple of months, she was able to get methadone “take-home” doses for the weekend. She started riding the bus again to give her mother, who has the autoimmune disease lupus, a break.\u003c/p>\n\u003cp>“I was big and pregnant,” said Menzel, who woke up Monday through Friday at 5:30 a.m. to catch the bus. “I had to ask the bus driver to pull over and pee a lot. But I made it.”\u003c/p>\n\u003cfigure id=\"attachment_360817\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-360817\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg\" alt=\"Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction.\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In May 2015, Menzel gave birth to a healthy girl and named her Bella. She said she hasn’t used heroin or any other drug, besides methadone, in more than two years. She’s on a maintenance methadone dose, just 39 milligrams compared with 140 mg she used to take and plans to cut back until she is off it completely. Now she drives herself to the clinic every other week and has enrolled in community college, hoping to become a certified drug and alcohol counselor.\u003c/p>\n\u003cp>“I don’t know if there will ever be a methadone clinic in the Kern River Valley,” Menzel said. But if one ever arrives, she said, she’d love to work there.\u003c/p>\n\u003cp>“I really want to work with other pregnant women who will be going through the same thing that I went through.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"One woman returns to her rural hometown to kick an addiction, but finds no medical treatment options.","status":"publish","parent":0,"modified":1502827229,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":39,"wordCount":1877},"headData":{"title":"A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’ | KQED","description":"One woman returns to her rural hometown to kick an addiction, but finds no medical treatment options.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’","datePublished":"2017-08-15T20:00:29.000Z","dateModified":"2017-08-15T20:00:29.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"360808 https://ww2.kqed.org/stateofhealth/?p=360808","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/08/15/a-long-and-winding-road-kicking-heroin-in-an-opioid-treatment-desert/","disqusTitle":"A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’","nprByline":"\u003ca href=\"http://khn.org/news/author/brian-rinker/\">\u003cstrong>Brian Rinker\u003c/strong>\u003c/a>","path":"/stateofhealth/360808/a-long-and-winding-road-kicking-heroin-in-an-opioid-treatment-desert","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Heather Menzel squirmed in her seat, unable to sleep on the Greyhound bus as it rolled through the early morning darkness toward Bakersfield, in California’s Central Valley. She’d been trapped in transit for three miserable days, stewing in a horrific sickness only a heroin addict can understand. Again, and again, she stumbled down the aisle to the bathroom to vomit.\u003c/p>\n\u003cp>She hadn’t used since Chicago. She told herself that if she could just get through this self-prescribed detox, if she could get to her mother’s house in her hometown of Lake Isabella, Calif., all her problems would be solved.\u003c/p>\n\u003cp>“I’ve been through a lot of horrible, crazy stuff,” said Menzel, now 34. “I’ve been raped. I’ve been beaten up. I’ve been in prison. But trying to kick heroin on the Greyhound on the way home was the worst experience of my entire life.”\u003c/p>\n\u003cp>When Menzel finally arrived at the Bakersfield bus station at 6 a.m. that day in February 2014, her mother and stepfather were there waiting. The two women hadn’t seen each other in years, not since Menzel stole her mom’s jewelry and fled the area. They didn’t talk much as they drove east though the twisty canyon on State Route 178 toward Lake Isabella, a two-stoplight town with a population of 3,500, nestled in the golden Sierra Nevada foothills.\u003c/p>\n\u003cp>Menzel hoped that the worst of the withdrawal was over — that a new life without heroin awaited. What she didn’t know was that heroin was now cheap and plentiful in Lake Isabella, as in so many small towns in the U.S., and that her best hope for treatment was far away.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>32 Churches, No Methadone Clinic\u003c/strong>\u003c/p>\n\u003cp>Experts recommend medication-assisted treatment for drug users like Menzel, one of nearly 2 million Americans struggling with opioid addiction, whether to prescription pills or heroin. MAT, as the therapy is known, has been proven far more effective — and less dangerous and miserable — than cold-turkey quitting. Drugs like methadone and buprenorphine can help suppress opioid cravings and stave off the physical and psychological symptoms of withdrawal.\u003c/p>\n\u003cp>When carefully managed, MAT can cut the risk of overdose death by half, research shows. But not all medical providers \u003ca href=\"http://californiahealthline.org/news/one-major-force-lacking-in-fight-against-opioid-addiction-in-rural-california-doctors/\" target=\"_blank\" rel=\"noopener noreferrer\">are properly trained\u003c/a> and approved to provide the treatments, which themselves are opioids (albeit less likely to be abused). Only state-licensed and federally approved clinics can provide methadone, and doctors need to apply for a federal Drug Enforcement Administration waiver to prescribe buprenorphine.\u003c/p>\n\u003cp>Lake Isabella sits in the Kern River Valley, home to 32 churches but not a single methadone clinic or doctor able or willing to prescribe buprenorphine. Like half the counties in California, the valley is an opioid “treatment desert.”\u003c/p>\n\u003cfigure id=\"attachment_360811\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360811\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg\" alt=\"After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In rural areas, historically, there has been a lot of stigma around addiction treatment,” said Kelly Pfeifer, a primary care doctor and opioid project director at the California Health Care Foundation. “Although the state is trying to remedy this, there are still wide treatment deserts across California.” (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>In July, the California Department of Health Care Services awarded 19 applicants part of a $90 million federal grant to improve MAT access. In addition, $6 million was dedicated to support treatment in tribal communities. The agency hopes to create a network of “oases” in the state’s vast treatment deserts, many of which are in far Northern California, as well as eastern Kern County, which encompasses Lake Isabella.\u003c/p>\n\u003cp>The grants aim to pay for clinical and educational support to rural physicians, many of whom have never been trained in addiction medicine. Local doctors will handle most buprenorphine prescriptions, and in some towns, a mini-methadone program may set up shop.\u003c/p>\n\u003cp>But eastern Kern didn’t make the cut. For now, expanding opioid treatment in this area, and eastward, will have to wait.\u003c/p>\n\u003cp>Without such help, many experts say people like Heather Menzel — whose story a reporter followed over the course of a year — barely stand a chance.\u003c/p>\n\u003cp>\u003cstrong>Hooked Again\u003c/strong>\u003c/p>\n\u003cp>From the beginning, Menzel struggled to stay clean at her mother’s. She soon fell back in with her old drug-abusing friends. Within two months of arriving home, her grand plan for getting clean slid into her veins and disappeared with the push of a plunger. She was hooked on heroin again, smoking methamphetamine and, once her mom kicked her out, homeless.\u003c/p>\n\u003cfigure id=\"attachment_360813\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"wp-image-360813 size-full\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_7_1170.jpg\" alt=\"After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cp>She was risking death, and she knew it. On average, 91 people a day in the United States died of an opioid overdose in 2015, the latest figures available \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">from the Centers for Disease Control and Prevention\u003c/a>, and \u003ca href=\"https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?_r=0\" target=\"_blank\" rel=\"noopener noreferrer\">projections show\u003c/a> the death rate will continue to rise. Overall, California’s opioid death rate is relatively low: 4.73 deaths per 100,000 people. Still, 1,966 Californians died of an opioid overdose in 2015. \u003ca href=\"https://pdop.shinyapps.io/ODdash_v1/\" target=\"_blank\" rel=\"noopener noreferrer\">Kern County’s rate\u003c/a> was nearly double the state’s in 2015, and some sparsely populated rural counties, mostly up north, have rates that are far higher.\u003c/p>\n\u003cp>Policymakers fear the death risk is growing as use of fentanyl moves west. A synthetic opioid \u003ca href=\"https://www.drugabuse.gov/drugs-abuse/fentanyl\" target=\"_blank\" rel=\"noopener noreferrer\">estimated to be 50 to 100 times stronger\u003c/a> than morphine, fentanyl has caused numerous overdoses and deaths on the \u003ca href=\"http://khn.org/news/another-circle-of-hell-surviving-opioids-in-the-fentanyl-era/\" target=\"_blank\" rel=\"noopener noreferrer\">East Coast\u003c/a>. Some policymakers fear the fentanyl monster is heading to California, a potentially vast market of addicts.\u003c/p>\n\u003cp>“We really feel an urgency in California to increase access to services so if and when fentanyl arrives, we are more prepared to deal with it,” said Marlies Perez, chief of the Substance Use Disorder Compliance Division at DHCS.\u003c/p>\n\u003cp>Immediate, convenient access to these treatments is key. “It is very important for someone in the middle of addiction to access treatment when they are ready,” said Pfeifer. “There are these moments when people have wake-up calls — when they are ready to seek care and get out of the chaos of trying to get drugs to feel normal again.”\u003c/p>\n\u003cp>\u003cstrong>‘What Do I Do?’\u003c/strong>\u003c/p>\n\u003cp>Menzel’s wake-up happened when she noticed that she was still sick after a morning heroin injection. After an angry call to her drug dealer to accuse him of ripping her off, Menzel soon realized it wasn’t fake heroin — she was pregnant.\u003c/p>\n\u003cp>She took the bus to the emergency room in Bakersfield. “I’m fully addicted to heroin,” she blurted out to the ER doctor. “What do I do?” The doctor told her, “If you want to save your baby, you need to get on methadone.”\u003c/p>\n\u003cp>Affording methadone wasn’t a problem for Menzel. Medi-Cal, the state’s version of the Medicaid program for the poor, covered the costs. What impeded her was the daily trip from Lake Isabella to Bakersfield — an hour-plus bus ride down the curving canyon road. A round-trip ticket cost $5, more than she could spare. And if she missed an early bus back, she had to stay most of the day in Bakersfield to catch the next one.\u003c/p>\n\u003cfigure id=\"attachment_360816\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-360816 size-large\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">After receiving her methadone dose at a clinic in Bakersfield, Calif., Heather Menzel waits for the bus to take her back home to Lake Isabella on June 6, 2016. The bus ride takes about an hour and goes through a twisty canyon into the Sierra Nevada foothills. (Brian Rinker for KHN) \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For safety’s sake, the clinic started her at a low dose, increasing the amount until it was just right for her. But that beginning dose didn’t stave off the withdrawals, so she continued to use heroin and meth. She started to miss too many days of treatment and was kicked out of the program.\u003c/p>\n\u003cp>Menzel’s mother got her back in, promising the clinic that she would drive her daughter there every day. That meant quitting her job at Meals on Wheels.\u003c/p>\n\u003cp>“The fact you have to travel an hour to two hours every day to receive treatment requires somebody to operate a vehicle, pay for gas, and for some of our patients that is impossible,” said Javier Moreno, who manages the narcotics treatment programs in the Central Valley for Aegis Treatment Centers, the state’s largest methadone provider.\u003c/p>\n\u003cp>His Bakersfield clinics serve about 20 people in the Lake Isabella area, but Moreno thinks many more residents could benefit from MAT.\u003c/p>\n\u003cp>\u003cstrong>‘I Made it’\u003c/strong>\u003c/p>\n\u003cp>Menzel didn’t take the ideal path to getting clean. But she eventually began to feel the groove of methadone, and her cravings for heroin subsided. After a couple of months, she was able to get methadone “take-home” doses for the weekend. She started riding the bus again to give her mother, who has the autoimmune disease lupus, a break.\u003c/p>\n\u003cp>“I was big and pregnant,” said Menzel, who woke up Monday through Friday at 5:30 a.m. to catch the bus. “I had to ask the bus driver to pull over and pee a lot. But I made it.”\u003c/p>\n\u003cfigure id=\"attachment_360817\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-360817\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg\" alt=\"Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction.\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In May 2015, Menzel gave birth to a healthy girl and named her Bella. She said she hasn’t used heroin or any other drug, besides methadone, in more than two years. She’s on a maintenance methadone dose, just 39 milligrams compared with 140 mg she used to take and plans to cut back until she is off it completely. Now she drives herself to the clinic every other week and has enrolled in community college, hoping to become a certified drug and alcohol counselor.\u003c/p>\n\u003cp>“I don’t know if there will ever be a methadone clinic in the Kern River Valley,” Menzel said. But if one ever arrives, she said, she’d love to work there.\u003c/p>\n\u003cp>“I really want to work with other pregnant women who will be going through the same thing that I went through.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/360808/a-long-and-winding-road-kicking-heroin-in-an-opioid-treatment-desert","authors":["byline_stateofhealth_360808"],"categories":["stateofhealth_1"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_2972","stateofhealth_2519","stateofhealth_2656"],"affiliates":["stateofhealth_3007"],"featImg":"stateofhealth_360810","label":"stateofhealth_3007"},"stateofhealth_238941":{"type":"posts","id":"stateofhealth_238941","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"238941","score":null,"sort":[1474307698000]},"guestAuthors":[],"slug":"how-drugmakers-used-money-and-influence-to-shape-the-national-response-to-opioid-abuse","title":"How Drugmakers Used Money and Influence to Shape the National Response to Opioid Abuse","publishDate":1474307698,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>For more than a decade, members of a little-known group called the Pain Care Forum have blanketed Washington with messages about prescription painkillers' vital role in the lives of millions of Americans, creating an echo chamber that has quietly derailed efforts to curb U.S. consumption of drugs like OxyContin, Vicodin and Percocet.\u003c/p>\n\u003cp>In 2012, drugmakers and their affiliates in the forum sent a letter to U.S. senators promoting a recent report on a \"crisis of epidemic proportions\": pain in America. Few knew the report stemmed from legislation drafted and pushed by forum members and that their experts had helped author it. The report estimated more than 100 million Americans — roughly 40 percent of adults — suffered from chronic pain, an eye-popping statistic that some researchers call deeply problematic.\u003c/p>\n\u003cp>The letter made no reference, however, to another health issue that had been declared an epidemic by federal authorities: drug overdoses tied to prescription painkillers. Deaths linked to addictive opioid drugs had increased more than fourfold since 1999, accounting for more deaths in 2012 than heroin and cocaine combined.\u003c/p>\n\u003cp>An investigation by the \u003cem>Associated Press\u003c/em> and the \u003cem>Center for Public Integrity\u003c/em> reveals that similar feedback loops of information and influence play out regularly in the nation's capital, fueled by money and talking points from the Pain Care Forum, a loose coalition of drugmakers, trade groups and dozens of nonprofits supported by industry funding that has flown under the radar until now.\u003c/p>\n\u003cp>Hundreds of internal documents shed new light on how drugmakers and their allies shaped the national response to the ongoing wave of prescription opioid abuse, which has claimed the lives of 165,000 Americans since 2000, according to federal figures.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Painkillers are among the most widely prescribed medications in the U.S., but pharmaceutical companies and allied groups have a multitude of legislative interests beyond those drugs. From 2006 through 2015, participants in the Pain Care Forum spent over $740 million lobbying in the nation's capital and in all 50 statehouses on an array of issues, including keeping opioids accessible, according to an analysis of lobbying filings.\u003c/p>\n\u003cp>The same organizations reinforced their influence with more than $140 million doled out to political campaigns, including more than $75 million alone to federal candidates, political action committees and parties.\u003c/p>\n\u003cp>\"You can go a long, long way in getting what you want when you have a lot of money,\" said Professor Keith Humphreys of Stanford University, a former adviser on drug policy under President Barack Obama. \"And it's only when things get so disastrous that finally there's enough popular will aroused to push back.\"\u003c/p>\n\u003cp>Opioids were long reserved for severe pain due to surgery, injury or terminal diseases like cancer. That changed in the 1990s, with a surge in prescribing for more common ailments like back pain and arthritis. Marketing for new long-acting painkillers like OxyContin helped fuel the trend, along with other factors.\u003c/p>\n\u003cp>OxyContin-maker Purdue Pharma pleaded guilty and agreed to pay more than $600 million in fines in 2007 for misleading the public about the risks of its drug. But the painkiller continued to rack up blockbuster sales, generating more than $22 billion over the last decade.\u003c/p>\n\u003cp>Purdue's Washington lobbyist, Burt Rosen, co-founded the Pain Care Forum more than a decade ago and coordinates the group's monthly meetings in Washington. Purdue declined to make Rosen available for interviews and did not answer questions about its specific lobbying activities.\u003c/p>\n\u003cp>The company said it supports a range of advocacy groups, including some with differing views on opioids.\u003c/p>\n\u003cp>\"In practice and governance, the Pain Care Forum is like any of the hundreds of policy coalitions in Washington and throughout the nation,\" the company said in a statement, adding: \"Purdue complies with all applicable lobbying disclosure laws and requirements.\"\u003c/p>\n\u003cp>By spring 2014, even the head of the Food and Drug Administration was citing the statistic that 100 million Americans suffered from chronic pain.\u003c/p>\n\u003cp>Then-commissioner Margaret Hamburg used the figure to illustrate the importance of keeping painkillers accessible — despite the escalating toll of opioid addiction and abuse. Yet a researcher whose work contributed to the number said it was being misquoted, since most people included in the figure had common pain ailments and managed them without opioids.\u003c/p>\n\u003cp>Hamburg said in an emailed response that the report was \"another piece of scientific literature that helped inform the broader field,\" and that her agency had no role in writing it.\u003c/p>\n\u003cp>When the FDA began developing plans to reduce misuse of long-acting, the Pain Care Forum intervened with a \"strategy to inform the process,\" according to an internal memo from the American Pain Foundation, a now-defunct forum member.\u003c/p>\n\u003cp>The FDA's initial proposals included requiring doctors to undergo certification training to prescribe opioids and tracking opioid prescriptions via databases. But when the FDA sought public comment on how to proceed, the forum helped generate more than 2,000 comments against new barriers to opioids and a 4,000-signature petition opposing electronic registries, according to another pain foundation memo.\u003c/p>\n\u003cp>Ultimately, the agency announced far milder steps than its initial ideas: Drugmakers would fund optional classes for doctors and supply brochures to patients about opioid risks. FDA leaders said they decided requiring certification for prescribers would have been overly burdensome, disrupting care for patients and doctors.\u003c/p>\n\u003cp>But experts said regulators had missed a pivotal chance to curb deadly misuse and abuse with the drugs.\u003c/p>\n\u003cp>\"The FDA failed to make a decision that could have averted many of the thousands of deaths we're seeing per year,\" said Dr. Nathaniel Katz, a former FDA adviser who urged the agency to make training mandatory for prescribers.\u003c/p>\n\u003cp>Today, the FDA is taking another look at requiring training for opioid prescribers, following a recommendation by a panel of expert advisers in May.\u003c/p>\n\u003cp>It was a federal agency hundreds of miles from Washington that finally sidestepped the influence of the Pain Care Forum.\u003c/p>\n\u003cp>Earlier this year, the Centers for Disease Control and Prevention, located in Atlanta, overcame threats of congressional investigation and legal action to publish the first federal guidelines intended to reduce opioid prescribing.\u003c/p>\n\u003cp>Essentially, the agency said the risks of painkillers outweigh the benefits for the vast majority of patients with routine chronic pain and that doctors instead should consider alternatives like physical therapy.\u003c/p>\n\u003cp>When draft guidelines emerged in September, forum members said they were not based on solid evidence, and criticized the CDC for not disclosing outside experts who had advised its effort. One pharma-aligned group, the Washington Legal Foundation, said the lack of disclosure constituted a \"clear violation\" of federal law. A longtime Pain Care Forum participant — now known as the Academy of Integrative Pain Management — asked Congress to investigate how the CDC developed the guidelines, though investigators found no violations.\u003c/p>\n\u003cp>After months of scrutiny, the CDC in December released a list of its advisers. One of 17 \"core experts\" had served as a paid consultant to a law firm suing opioid drugmakers.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>The final guidelines appeared in March. The first recommendation for U.S. doctors was unequivocal: \"Opioids are not first-line therapy\" for routine chronic pain. It was a statement considered common practice by many doctors as recently as the early 1990s, a decade before the Pain Care Forum formed in Washington.\u003c/p>\n\n","blocks":[],"excerpt":"An investigation reveals that drug companies have deployed hundreds of lobbyists and millions in campaign contributions to help kill or weaken efforts to limit prescription opioids.","status":"publish","parent":0,"modified":1474307698,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":1227},"headData":{"title":"How Drugmakers Used Money and Influence to Shape the National Response to Opioid Abuse | KQED","description":"An investigation reveals that drug companies have deployed hundreds of lobbyists and millions in campaign contributions to help kill or weaken efforts to limit prescription opioids.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"How Drugmakers Used Money and Influence to Shape the National Response to Opioid Abuse","datePublished":"2016-09-19T17:54:58.000Z","dateModified":"2016-09-19T17:54:58.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"238941 http://ww2.kqed.org/stateofhealth/?p=238941","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/09/19/how-drugmakers-used-money-and-influence-to-shape-the-national-response-to-opioid-abuse/","disqusTitle":"How Drugmakers Used Money and Influence to Shape the National Response to Opioid Abuse","nprByline":"Associated Press and Center for Public Integrity","path":"/stateofhealth/238941/how-drugmakers-used-money-and-influence-to-shape-the-national-response-to-opioid-abuse","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>For more than a decade, members of a little-known group called the Pain Care Forum have blanketed Washington with messages about prescription painkillers' vital role in the lives of millions of Americans, creating an echo chamber that has quietly derailed efforts to curb U.S. consumption of drugs like OxyContin, Vicodin and Percocet.\u003c/p>\n\u003cp>In 2012, drugmakers and their affiliates in the forum sent a letter to U.S. senators promoting a recent report on a \"crisis of epidemic proportions\": pain in America. Few knew the report stemmed from legislation drafted and pushed by forum members and that their experts had helped author it. The report estimated more than 100 million Americans — roughly 40 percent of adults — suffered from chronic pain, an eye-popping statistic that some researchers call deeply problematic.\u003c/p>\n\u003cp>The letter made no reference, however, to another health issue that had been declared an epidemic by federal authorities: drug overdoses tied to prescription painkillers. Deaths linked to addictive opioid drugs had increased more than fourfold since 1999, accounting for more deaths in 2012 than heroin and cocaine combined.\u003c/p>\n\u003cp>An investigation by the \u003cem>Associated Press\u003c/em> and the \u003cem>Center for Public Integrity\u003c/em> reveals that similar feedback loops of information and influence play out regularly in the nation's capital, fueled by money and talking points from the Pain Care Forum, a loose coalition of drugmakers, trade groups and dozens of nonprofits supported by industry funding that has flown under the radar until now.\u003c/p>\n\u003cp>Hundreds of internal documents shed new light on how drugmakers and their allies shaped the national response to the ongoing wave of prescription opioid abuse, which has claimed the lives of 165,000 Americans since 2000, according to federal figures.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Painkillers are among the most widely prescribed medications in the U.S., but pharmaceutical companies and allied groups have a multitude of legislative interests beyond those drugs. From 2006 through 2015, participants in the Pain Care Forum spent over $740 million lobbying in the nation's capital and in all 50 statehouses on an array of issues, including keeping opioids accessible, according to an analysis of lobbying filings.\u003c/p>\n\u003cp>The same organizations reinforced their influence with more than $140 million doled out to political campaigns, including more than $75 million alone to federal candidates, political action committees and parties.\u003c/p>\n\u003cp>\"You can go a long, long way in getting what you want when you have a lot of money,\" said Professor Keith Humphreys of Stanford University, a former adviser on drug policy under President Barack Obama. \"And it's only when things get so disastrous that finally there's enough popular will aroused to push back.\"\u003c/p>\n\u003cp>Opioids were long reserved for severe pain due to surgery, injury or terminal diseases like cancer. That changed in the 1990s, with a surge in prescribing for more common ailments like back pain and arthritis. Marketing for new long-acting painkillers like OxyContin helped fuel the trend, along with other factors.\u003c/p>\n\u003cp>OxyContin-maker Purdue Pharma pleaded guilty and agreed to pay more than $600 million in fines in 2007 for misleading the public about the risks of its drug. But the painkiller continued to rack up blockbuster sales, generating more than $22 billion over the last decade.\u003c/p>\n\u003cp>Purdue's Washington lobbyist, Burt Rosen, co-founded the Pain Care Forum more than a decade ago and coordinates the group's monthly meetings in Washington. Purdue declined to make Rosen available for interviews and did not answer questions about its specific lobbying activities.\u003c/p>\n\u003cp>The company said it supports a range of advocacy groups, including some with differing views on opioids.\u003c/p>\n\u003cp>\"In practice and governance, the Pain Care Forum is like any of the hundreds of policy coalitions in Washington and throughout the nation,\" the company said in a statement, adding: \"Purdue complies with all applicable lobbying disclosure laws and requirements.\"\u003c/p>\n\u003cp>By spring 2014, even the head of the Food and Drug Administration was citing the statistic that 100 million Americans suffered from chronic pain.\u003c/p>\n\u003cp>Then-commissioner Margaret Hamburg used the figure to illustrate the importance of keeping painkillers accessible — despite the escalating toll of opioid addiction and abuse. Yet a researcher whose work contributed to the number said it was being misquoted, since most people included in the figure had common pain ailments and managed them without opioids.\u003c/p>\n\u003cp>Hamburg said in an emailed response that the report was \"another piece of scientific literature that helped inform the broader field,\" and that her agency had no role in writing it.\u003c/p>\n\u003cp>When the FDA began developing plans to reduce misuse of long-acting, the Pain Care Forum intervened with a \"strategy to inform the process,\" according to an internal memo from the American Pain Foundation, a now-defunct forum member.\u003c/p>\n\u003cp>The FDA's initial proposals included requiring doctors to undergo certification training to prescribe opioids and tracking opioid prescriptions via databases. But when the FDA sought public comment on how to proceed, the forum helped generate more than 2,000 comments against new barriers to opioids and a 4,000-signature petition opposing electronic registries, according to another pain foundation memo.\u003c/p>\n\u003cp>Ultimately, the agency announced far milder steps than its initial ideas: Drugmakers would fund optional classes for doctors and supply brochures to patients about opioid risks. FDA leaders said they decided requiring certification for prescribers would have been overly burdensome, disrupting care for patients and doctors.\u003c/p>\n\u003cp>But experts said regulators had missed a pivotal chance to curb deadly misuse and abuse with the drugs.\u003c/p>\n\u003cp>\"The FDA failed to make a decision that could have averted many of the thousands of deaths we're seeing per year,\" said Dr. Nathaniel Katz, a former FDA adviser who urged the agency to make training mandatory for prescribers.\u003c/p>\n\u003cp>Today, the FDA is taking another look at requiring training for opioid prescribers, following a recommendation by a panel of expert advisers in May.\u003c/p>\n\u003cp>It was a federal agency hundreds of miles from Washington that finally sidestepped the influence of the Pain Care Forum.\u003c/p>\n\u003cp>Earlier this year, the Centers for Disease Control and Prevention, located in Atlanta, overcame threats of congressional investigation and legal action to publish the first federal guidelines intended to reduce opioid prescribing.\u003c/p>\n\u003cp>Essentially, the agency said the risks of painkillers outweigh the benefits for the vast majority of patients with routine chronic pain and that doctors instead should consider alternatives like physical therapy.\u003c/p>\n\u003cp>When draft guidelines emerged in September, forum members said they were not based on solid evidence, and criticized the CDC for not disclosing outside experts who had advised its effort. One pharma-aligned group, the Washington Legal Foundation, said the lack of disclosure constituted a \"clear violation\" of federal law. A longtime Pain Care Forum participant — now known as the Academy of Integrative Pain Management — asked Congress to investigate how the CDC developed the guidelines, though investigators found no violations.\u003c/p>\n\u003cp>After months of scrutiny, the CDC in December released a list of its advisers. One of 17 \"core experts\" had served as a paid consultant to a law firm suing opioid drugmakers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The final guidelines appeared in March. The first recommendation for U.S. doctors was unequivocal: \"Opioids are not first-line therapy\" for routine chronic pain. It was a statement considered common practice by many doctors as recently as the early 1990s, a decade before the Pain Care Forum formed in Washington.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/238941/how-drugmakers-used-money-and-influence-to-shape-the-national-response-to-opioid-abuse","authors":["byline_stateofhealth_238941"],"categories":["stateofhealth_14"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_2519","stateofhealth_2656"],"featImg":"stateofhealth_238960","label":"stateofhealth"},"stateofhealth_223727":{"type":"posts","id":"stateofhealth_223727","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"223727","score":null,"sort":[1470926452000]},"guestAuthors":[],"slug":"insurance-rules-put-up-roadblocks-to-opioid-addiction-treatment","title":"Insurance Rules Put Up Roadblocks to Opioid Addiction Treatment","publishDate":1470926452,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Twice a day, Angela and Nate Turner of Greenwood, Ind., put tiny strips that look like tinted tape under their tongues.\u003c/p>\n\u003cp>“They taste disgusting,” Angela says.\u003c/p>\n\u003cp>But the taste is worth it to her. The dissolvable strips are actually a drug called Suboxone, which helps control an opioid user’s cravings for the drug. The married couple both got addicted to prescription painkillers following injuries several years ago, and they decided to go into recovery this year. With Suboxone, they don’t have to worry about how they’ll get drugs, or how sick they’ll feel if they don’t.\u003c/p>\n\u003cp>“You can function, but you’re not high,” Angela says. “It’s like a miracle drug. It really is.”\u003c/p>\n\u003cp>A body of evidence now shows that medications such as Suboxone are effective in putting the brakes on opioid use disorder, when used in conjunction with counseling. For the Turners, the treatment means Angela can take care of their 3-year-old and Nate can hold down a job.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But because of some companies’ insurance rules, getting started on Suboxone — and staying on it — can be difficult.\u003c/p>\n\u003cp>Angela says after her doctor wrote her a prescription, she had to wait three days to get it filled. She spent those days in bed with nausea, diarrhea and muscle cramps — the intense symptoms of opioid withdrawal. For Nate, the wait was five days. On Day 3, he relapsed and used heroin.\u003c/p>\n\u003cp>“I just thought it was over, that I wasn’t going to make it back to the program,” he says.\u003c/p>\n\u003cp>Suboxone is covered through the Turners’ health plan, which is part of Indiana’s Medicaid expansion, the Healthy Indiana Plan. But before the couple’s insurance company, Managed Health Services, will pay for the drug treatment, their doctor has to get approval from the insurer — known as a prior authorization.\u003c/p>\n\u003cp>The prior authorization process adds work for doctors and their staff, said Dr. Andrew Chambers, a psychiatrist and addiction specialist in Indianapolis. With the phone calls, faxing and other paperwork, he said, three of his nurses spend about 30 hours a week going back and forth with the insurance companies.\u003c/p>\n\u003cp>“It’s almost like when you take on a patient to treat opiate addiction, you also have to take on another patient called the insurance company,” Chambers said.\u003c/p>\n\u003cp>Getting a prior authorization to prescribe one of these medications can take days or weeks, said Sam Muszynski, director of health care systems and financing with the American Psychiatric Association. He said the delays leave patients vulnerable to relapse.\u003c/p>\n\u003cp>“You may lose that opportunity right then and there,” he said. “They may never come back.”\u003c/p>\n\u003cp>Muszynski and policy analysts with the federal Substance Abuse and Mental Health Services Administration say requiring prior authorizations from insurers for addiction medication is a widespread practice in the U.S.\u003c/p>\n\u003cp>As of 2013, Medicaid in 48 states required a prior authorization for buprenorphine, the active ingredient in Suboxone. Chris Carroll, director of health care financing at SAMHSA, said that number likely has not changed much since 2013. He said treatment limitations like prior authorizations are part of “the dark shadows of the insurance industry.”\u003c/p>\n\u003cp>Prior authorizations are one way insurers limit what they pay for, Muszynski said, and they use prior authorizations more often with mental health and addiction treatments, compared to other medical treatments. That’s despite the 2008 passage of a federal law called the Mental Health Parity and Addiction Equity Act, which was supposed to end unequal insurance coverage for mental illness as compared to physical illness.\u003c/p>\n\u003cp>For instance, under the Turners’ plan, insulin treatments for diabetes don’t require a prior authorization. But Suboxone does.\u003c/p>\n\u003cp>“It’s just totally unfair,” Muszynski said. “There’s a continuing pattern of discrimination, which results in reduced access to people who need opioid addiction treatment.”\u003c/p>\n\u003cp>Prior authorization requirements can also pressure doctors to change how they prescribe a drug such as Suboxone. Sometimes an insurer will push for a lower dosage than the doctor wants, or it will require a patient to start tapering the use of a medication even when the doctor thinks the patient needs more time.\u003c/p>\n\u003cp>“These rules and regulations for us completely block the correct provision of care,” says Chambers. “And that’s crazy.”\u003c/p>\n\u003cp>For some insurers, a prior authorization expires after just a few months, forcing everyone involved to go back through the process of reauthorizing. In some cases, Chambers said, patients will even run out of medicine before a new prescription can be approved, which can force them into withdrawal.\u003c/p>\n\u003cp>Indiana Medicaid said it has started to allow some doctors to skip that initial back-and-forth with the insurance company. But Chambers said the changes haven’t helped him much yet.\u003c/p>\n\u003cp>Clare Krusing, press secretary with the trade association America’s Health Insurance Plans, said that prior authorizations are not in place to limit treatment for patients with opioid addiction. Rather, she said, they’re meant to ensure that patients receive proper care.\u003c/p>\n\u003cp>“Prior authorization is not just arbitrarily applied,” she said. “Plans look at what the clinical guidelines are. A plan is going to make sure that before a drug is prescribed, the patient meets those guidelines.”\u003c/p>\n\u003cp>Krusing added that the prior authorizations in place for buprenorphine don’t violate the parity law, because the treatment plan for addiction is different from the treatment plan for other chronic illnesses, such as diabetes.\u003c/p>\n\u003cp>Nate Turner has managed to stay in treatment despite the prior authorization process. He says there’s an irony here. He started taking opioids without a prior authorization — in fact, on his plan, the pain pills he used to be addicted to require no prior authorization. He says that sort of gatekeeping paperwork shouldn’t be a stumbling block when he’s trying to quit his opioid habit.\u003c/p>\n\u003cp>“I can assure you, if I were on regular pain medicine, I’d be able to get them, no problem,” he says. “No questions asked.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes Side Effects Public Media, NPR and Kaiser Health News.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Red tape makes it hard for patients to get started on recovery drug and stay on it.\r\n","status":"publish","parent":0,"modified":1470926658,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":1082},"headData":{"title":"Insurance Rules Put Up Roadblocks to Opioid Addiction Treatment | KQED","description":"Red tape makes it hard for patients to get started on recovery drug and stay on it.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Insurance Rules Put Up Roadblocks to Opioid Addiction Treatment","datePublished":"2016-08-11T14:40:52.000Z","dateModified":"2016-08-11T14:44:18.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"223727 http://ww2.kqed.org/stateofhealth/?p=223727","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/08/11/insurance-rules-put-up-roadblocks-to-opioid-addiction-treatment/","disqusTitle":"Insurance Rules Put Up Roadblocks to Opioid Addiction Treatment","nprByline":"Jake Harper\u003cbr />\u003ca href=\"http://sideeffectspublicmedia.org/\">Side Effects Public Media\u003c/a>","path":"/stateofhealth/223727/insurance-rules-put-up-roadblocks-to-opioid-addiction-treatment","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Twice a day, Angela and Nate Turner of Greenwood, Ind., put tiny strips that look like tinted tape under their tongues.\u003c/p>\n\u003cp>“They taste disgusting,” Angela says.\u003c/p>\n\u003cp>But the taste is worth it to her. The dissolvable strips are actually a drug called Suboxone, which helps control an opioid user’s cravings for the drug. The married couple both got addicted to prescription painkillers following injuries several years ago, and they decided to go into recovery this year. With Suboxone, they don’t have to worry about how they’ll get drugs, or how sick they’ll feel if they don’t.\u003c/p>\n\u003cp>“You can function, but you’re not high,” Angela says. “It’s like a miracle drug. It really is.”\u003c/p>\n\u003cp>A body of evidence now shows that medications such as Suboxone are effective in putting the brakes on opioid use disorder, when used in conjunction with counseling. For the Turners, the treatment means Angela can take care of their 3-year-old and Nate can hold down a job.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But because of some companies’ insurance rules, getting started on Suboxone — and staying on it — can be difficult.\u003c/p>\n\u003cp>Angela says after her doctor wrote her a prescription, she had to wait three days to get it filled. She spent those days in bed with nausea, diarrhea and muscle cramps — the intense symptoms of opioid withdrawal. For Nate, the wait was five days. On Day 3, he relapsed and used heroin.\u003c/p>\n\u003cp>“I just thought it was over, that I wasn’t going to make it back to the program,” he says.\u003c/p>\n\u003cp>Suboxone is covered through the Turners’ health plan, which is part of Indiana’s Medicaid expansion, the Healthy Indiana Plan. But before the couple’s insurance company, Managed Health Services, will pay for the drug treatment, their doctor has to get approval from the insurer — known as a prior authorization.\u003c/p>\n\u003cp>The prior authorization process adds work for doctors and their staff, said Dr. Andrew Chambers, a psychiatrist and addiction specialist in Indianapolis. With the phone calls, faxing and other paperwork, he said, three of his nurses spend about 30 hours a week going back and forth with the insurance companies.\u003c/p>\n\u003cp>“It’s almost like when you take on a patient to treat opiate addiction, you also have to take on another patient called the insurance company,” Chambers said.\u003c/p>\n\u003cp>Getting a prior authorization to prescribe one of these medications can take days or weeks, said Sam Muszynski, director of health care systems and financing with the American Psychiatric Association. He said the delays leave patients vulnerable to relapse.\u003c/p>\n\u003cp>“You may lose that opportunity right then and there,” he said. “They may never come back.”\u003c/p>\n\u003cp>Muszynski and policy analysts with the federal Substance Abuse and Mental Health Services Administration say requiring prior authorizations from insurers for addiction medication is a widespread practice in the U.S.\u003c/p>\n\u003cp>As of 2013, Medicaid in 48 states required a prior authorization for buprenorphine, the active ingredient in Suboxone. Chris Carroll, director of health care financing at SAMHSA, said that number likely has not changed much since 2013. He said treatment limitations like prior authorizations are part of “the dark shadows of the insurance industry.”\u003c/p>\n\u003cp>Prior authorizations are one way insurers limit what they pay for, Muszynski said, and they use prior authorizations more often with mental health and addiction treatments, compared to other medical treatments. That’s despite the 2008 passage of a federal law called the Mental Health Parity and Addiction Equity Act, which was supposed to end unequal insurance coverage for mental illness as compared to physical illness.\u003c/p>\n\u003cp>For instance, under the Turners’ plan, insulin treatments for diabetes don’t require a prior authorization. But Suboxone does.\u003c/p>\n\u003cp>“It’s just totally unfair,” Muszynski said. “There’s a continuing pattern of discrimination, which results in reduced access to people who need opioid addiction treatment.”\u003c/p>\n\u003cp>Prior authorization requirements can also pressure doctors to change how they prescribe a drug such as Suboxone. Sometimes an insurer will push for a lower dosage than the doctor wants, or it will require a patient to start tapering the use of a medication even when the doctor thinks the patient needs more time.\u003c/p>\n\u003cp>“These rules and regulations for us completely block the correct provision of care,” says Chambers. “And that’s crazy.”\u003c/p>\n\u003cp>For some insurers, a prior authorization expires after just a few months, forcing everyone involved to go back through the process of reauthorizing. In some cases, Chambers said, patients will even run out of medicine before a new prescription can be approved, which can force them into withdrawal.\u003c/p>\n\u003cp>Indiana Medicaid said it has started to allow some doctors to skip that initial back-and-forth with the insurance company. But Chambers said the changes haven’t helped him much yet.\u003c/p>\n\u003cp>Clare Krusing, press secretary with the trade association America’s Health Insurance Plans, said that prior authorizations are not in place to limit treatment for patients with opioid addiction. Rather, she said, they’re meant to ensure that patients receive proper care.\u003c/p>\n\u003cp>“Prior authorization is not just arbitrarily applied,” she said. “Plans look at what the clinical guidelines are. A plan is going to make sure that before a drug is prescribed, the patient meets those guidelines.”\u003c/p>\n\u003cp>Krusing added that the prior authorizations in place for buprenorphine don’t violate the parity law, because the treatment plan for addiction is different from the treatment plan for other chronic illnesses, such as diabetes.\u003c/p>\n\u003cp>Nate Turner has managed to stay in treatment despite the prior authorization process. He says there’s an irony here. He started taking opioids without a prior authorization — in fact, on his plan, the pain pills he used to be addicted to require no prior authorization. He says that sort of gatekeeping paperwork shouldn’t be a stumbling block when he’s trying to quit his opioid habit.\u003c/p>\n\u003cp>“I can assure you, if I were on regular pain medicine, I’d be able to get them, no problem,” he says. “No questions asked.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes Side Effects Public Media, NPR and Kaiser Health News.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/223727/insurance-rules-put-up-roadblocks-to-opioid-addiction-treatment","authors":["byline_stateofhealth_223727"],"categories":["stateofhealth_2442"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_2845","stateofhealth_2519","stateofhealth_2656"],"featImg":"stateofhealth_223728","label":"stateofhealth"},"stateofhealth_212218":{"type":"posts","id":"stateofhealth_212218","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"212218","score":null,"sort":[1468432153000]},"guestAuthors":[],"slug":"addiction-reframed-as-health-problem-not-a-crime-in-u-s-senate-bill","title":"Addiction Reframed as Health Problem, Not a Crime, in U.S. Senate Bill","publishDate":1468432153,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>The Senate is set to approve a bill intended to change the way police and health care workers treat people struggling with opioid addictions.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.congress.gov/bill/114th-congress/senate-bill/524/text\">bill\u003c/a> is an amalgam of \u003ca href=\"https://www.washingtonpost.com/news/powerpost/wp/2016/05/13/house-passes-opioid-bills-setting-up-negotiations-with-the-senate/\" target=\"_blank\">more than a dozen proposals\u003c/a> passed through the year in the House and Senate. And while it has lots of new policies and provisions — from creating a task force to study how best to treat pain, to encouraging states to create \u003ca href=\"http://www.cdc.gov/drugoverdose/pdmp/\">prescription drug monitoring programs \u003c/a>— it doesn't have much money to put them in place.\u003c/p>\n\u003cp>President Obama had requested $1.1 billion to help pay for more addiction treatment programs and other initiatives. But the version agreed to by House and Senate Republicans last week didn't include all that money. In the end, it will probably get about half that much.\u003c/p>\n\u003cp>\"It's clear that efforts to prevent and treat the opioid epidemic will fall short without additional investments,\" Sen. \u003ca href=\"http://www.murray.senate.gov/public/\">Patty Murray\u003c/a>, D-Washington, said in a statement after House and Senate negotiators hammered out the final bill.\u003c/p>\n\u003cp>But \u003ca href=\"http://www.alexander.senate.gov/public/\" target=\"_blank\">Sen. Lamar Alexander\u003c/a>, R-Tenn., argued that the money for treatment has been rising for three years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Our friends on the other side say, you have to fund it. We are funding it,\" he said in a statement on the Senate floor Friday. \"And they helped fund it. We've increased funding for opioids already by 542 percent.\"\u003c/p>\n\u003cp>Still, Democrats are expected to support the bill even without the additional money.\u003c/p>\n\u003cp>And that's a good thing, says \u003ca href=\"http://www.thenationalcouncil.org/about/national-mental-health-association/executives/\">Linda Rosenberg\u003c/a>, president of the National Council for Behavioral Health, because the bill helps expand treatment in significant ways.\u003c/p>\n\u003cp>For example, it allows nurses and physician assistants to treat people with addictions using medications, which is considered the evidence-based standard.\u003c/p>\n\u003cp>\"Treatment capacity is really a crisis. There just isn't enough,\" Rosenberg tells Shots. \"But what this bill does to address that — it expands the kinds of people who can prescribe medications for addictions. And that's a very big deal.\"\u003c/p>\n\u003cp>She says that provision alone can help because nonprofit treatment centers will be able to use nurse practitioners and physician assistants rather than trying to hire doctors, who are both scarce and expensive.\u003c/p>\n\u003cp>The bill also allows the Department of Health and Human Services to give grants to states and community organizations for improving or expanding treatment and recovery programs. It has several provisions that would allow police departments to send people with addiction problems to treatment rather than to jail.\u003c/p>\n\u003cp>In one of the few areas of the bill that includes funding, lawmakers authorized the Department of Justice to spend $100 million a year for five years to find alternatives to jail for opioid abusers, and to allow prisons to use methadone or buprenorphine to treat inmates with opioid addictions.\u003c/p>\n\u003cp>Rosenberg says these measures help change the definition of addiction from a crime to a health problem.\u003c/p>\n\u003cp>\"It's a health care issue and not a moral failing issue,\" she says. That's a big reversal from the \"war on drugs\" campaigns of a few decades ago.\u003c/p>\n\u003cp>And the legislation allows more people to have access to \u003ca href=\"https://medlineplus.gov/druginfo/meds/a612022.html\">naloxone,\u003c/a> the drug that can reverse an opioid overdose, reducing the risk of death. Access would be expanded for people working in schools and community centers.\u003c/p>\n\u003cp>The bill encourage pharmacies to fill standing orders for the drug so that those likely to come in contact with someone suffering an overdose will have the drug on hand, according to Mike Kelly. He is the U.S. president of \u003ca href=\"http://adaptpharma.com/\">Adapt Pharma\u003c/a>, which sells \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm473505.htm\">Narcan\u003c/a>, a nasal spray version of naloxone.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"This bill addresses getting Narcan out into the community, outside of emergency and first responders,\" Kelly says. \"The big thing here is this will fund recovery.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Opioid+Bill+Reframes+Addiction+As+A+Health+Problem%2C+Not+A+Crime&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The bill will expand access to medication-assisted treatment. It also will encourage police to send drug users to treatment rather than to jail.","status":"publish","parent":0,"modified":1468432202,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":20,"wordCount":639},"headData":{"title":"Addiction Reframed as Health Problem, Not a Crime, in U.S. Senate Bill | KQED","description":"The bill will expand access to medication-assisted treatment. It also will encourage police to send drug users to treatment rather than to jail.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Addiction Reframed as Health Problem, Not a Crime, in U.S. Senate Bill","datePublished":"2016-07-13T17:49:13.000Z","dateModified":"2016-07-13T17:50:02.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"212218 http://ww2.kqed.org/stateofhealth/?p=212218","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/13/addiction-reframed-as-health-problem-not-a-crime-in-u-s-senate-bill/","disqusTitle":"Addiction Reframed as Health Problem, Not a Crime, in U.S. Senate Bill","nprImageCredit":"Al Drago","nprByline":"Alison Kodjak\u003cbr />\u003ca href=\"http://www.npr.org/sections/health-shots/\">NPR Shots\u003c/a>","nprImageAgency":"CQ-Roll Call Inc.","nprStoryId":"485818449","nprApiLink":"http://api.npr.org/query?id=485818449&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/07/13/485818449/opioid-bill-reframes-addiction-as-a-health-problem-not-a-crime?ft=nprml&f=485818449","nprRetrievedStory":"1","nprPubDate":"Wed, 13 Jul 2016 12:33:00 -0400","nprStoryDate":"Wed, 13 Jul 2016 10:51:00 -0400","nprLastModifiedDate":"Wed, 13 Jul 2016 12:33:38 -0400","path":"/stateofhealth/212218/addiction-reframed-as-health-problem-not-a-crime-in-u-s-senate-bill","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate is set to approve a bill intended to change the way police and health care workers treat people struggling with opioid addictions.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.congress.gov/bill/114th-congress/senate-bill/524/text\">bill\u003c/a> is an amalgam of \u003ca href=\"https://www.washingtonpost.com/news/powerpost/wp/2016/05/13/house-passes-opioid-bills-setting-up-negotiations-with-the-senate/\" target=\"_blank\">more than a dozen proposals\u003c/a> passed through the year in the House and Senate. And while it has lots of new policies and provisions — from creating a task force to study how best to treat pain, to encouraging states to create \u003ca href=\"http://www.cdc.gov/drugoverdose/pdmp/\">prescription drug monitoring programs \u003c/a>— it doesn't have much money to put them in place.\u003c/p>\n\u003cp>President Obama had requested $1.1 billion to help pay for more addiction treatment programs and other initiatives. But the version agreed to by House and Senate Republicans last week didn't include all that money. In the end, it will probably get about half that much.\u003c/p>\n\u003cp>\"It's clear that efforts to prevent and treat the opioid epidemic will fall short without additional investments,\" Sen. \u003ca href=\"http://www.murray.senate.gov/public/\">Patty Murray\u003c/a>, D-Washington, said in a statement after House and Senate negotiators hammered out the final bill.\u003c/p>\n\u003cp>But \u003ca href=\"http://www.alexander.senate.gov/public/\" target=\"_blank\">Sen. Lamar Alexander\u003c/a>, R-Tenn., argued that the money for treatment has been rising for three years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Our friends on the other side say, you have to fund it. We are funding it,\" he said in a statement on the Senate floor Friday. \"And they helped fund it. We've increased funding for opioids already by 542 percent.\"\u003c/p>\n\u003cp>Still, Democrats are expected to support the bill even without the additional money.\u003c/p>\n\u003cp>And that's a good thing, says \u003ca href=\"http://www.thenationalcouncil.org/about/national-mental-health-association/executives/\">Linda Rosenberg\u003c/a>, president of the National Council for Behavioral Health, because the bill helps expand treatment in significant ways.\u003c/p>\n\u003cp>For example, it allows nurses and physician assistants to treat people with addictions using medications, which is considered the evidence-based standard.\u003c/p>\n\u003cp>\"Treatment capacity is really a crisis. There just isn't enough,\" Rosenberg tells Shots. \"But what this bill does to address that — it expands the kinds of people who can prescribe medications for addictions. And that's a very big deal.\"\u003c/p>\n\u003cp>She says that provision alone can help because nonprofit treatment centers will be able to use nurse practitioners and physician assistants rather than trying to hire doctors, who are both scarce and expensive.\u003c/p>\n\u003cp>The bill also allows the Department of Health and Human Services to give grants to states and community organizations for improving or expanding treatment and recovery programs. It has several provisions that would allow police departments to send people with addiction problems to treatment rather than to jail.\u003c/p>\n\u003cp>In one of the few areas of the bill that includes funding, lawmakers authorized the Department of Justice to spend $100 million a year for five years to find alternatives to jail for opioid abusers, and to allow prisons to use methadone or buprenorphine to treat inmates with opioid addictions.\u003c/p>\n\u003cp>Rosenberg says these measures help change the definition of addiction from a crime to a health problem.\u003c/p>\n\u003cp>\"It's a health care issue and not a moral failing issue,\" she says. That's a big reversal from the \"war on drugs\" campaigns of a few decades ago.\u003c/p>\n\u003cp>And the legislation allows more people to have access to \u003ca href=\"https://medlineplus.gov/druginfo/meds/a612022.html\">naloxone,\u003c/a> the drug that can reverse an opioid overdose, reducing the risk of death. Access would be expanded for people working in schools and community centers.\u003c/p>\n\u003cp>The bill encourage pharmacies to fill standing orders for the drug so that those likely to come in contact with someone suffering an overdose will have the drug on hand, according to Mike Kelly. He is the U.S. president of \u003ca href=\"http://adaptpharma.com/\">Adapt Pharma\u003c/a>, which sells \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm473505.htm\">Narcan\u003c/a>, a nasal spray version of naloxone.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"This bill addresses getting Narcan out into the community, outside of emergency and first responders,\" Kelly says. \"The big thing here is this will fund recovery.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Opioid+Bill+Reframes+Addiction+As+A+Health+Problem%2C+Not+A+Crime&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/212218/addiction-reframed-as-health-problem-not-a-crime-in-u-s-senate-bill","authors":["byline_stateofhealth_212218"],"categories":["stateofhealth_11","stateofhealth_13"],"tags":["stateofhealth_643","stateofhealth_68","stateofhealth_2656"],"featImg":"stateofhealth_212219","label":"stateofhealth"},"stateofhealth_196569":{"type":"posts","id":"stateofhealth_196569","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"196569","score":null,"sort":[1465830019000]},"guestAuthors":[],"slug":"montanas-pain-refugees-find-relief-in-california","title":"Montana's 'Pain Refugees' Find Relief in California","publishDate":1465830019,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>They call themselves pain refugees.\u003c/p>\n\u003cp>Every 90 days, three patients from Montana fly to California to get a prescription for opioids.\u003c/p>\n\u003caside class=\"pullquote alignright\">“I just want humanitarian care, and I get that in California.”\u003ccite> Gary Snook, Montana resident \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>As the U.S. faces an epidemic of overdose deaths from prescription painkillers, some patients with chronic pain say doctors are less likely to prescribe them opioids. Some Montana patients say the only way they can get the treatment they need is to fly out of state.\u003c/p>\n\u003cp>On a mid-afternoon flight out of Missoula, Montana, Gary Snook pauses in the aisle in front of seat 17B. He stretches with a slight wince and sits down.\u003c/p>\n\u003cp>“My pain, it is all from my waist down. It’s like being boiled in oil 24-hours a day,” Snook said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>He has been in severe pain since he had surgery on his spine for a ruptured disk 14 years ago.\u003c/p>\n\u003cp>Snook says he's done all kinds of things to try to get better. “I got a surgery, epidural steroid injections, acupuncture, anti-inflammatories, physical therapy, pool exercises,” he said. “I’ve tried everything that anyone has ever suggested me to try.”\u003c/p>\n\u003cp>He says the only thing that works is opioids. But when he tries to get them in Montana, he says the doctors treat him like a criminal.\u003c/p>\n\u003cp>“I just want humanitarian care,\" Snook says. “And I get that in California.”\u003c/p>\n\u003cp>In the last 15 years, \u003ca href=\"http://www.cdc.gov/drugoverdose/epidemic/index.html\" target=\"_blank\">the rate of overdose deaths\u003c/a> from opioids has quadrupled in the U.S.\u003c/p>\n\u003cfigure id=\"attachment_196562\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-196562\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Waiting_Room-e1465662580220.jpg\" alt=\" Kathy Snook, Terri Anderson and Gary Snook waiting in Dr. Forest Tennant’s office in West Covina, California. Gary Snook travels from Montana to California every three months for a pain medication prescription.\" width=\"1920\" height=\"1382\">\u003cfigcaption class=\"wp-caption-text\">Kathy Snook, Terri Anderson and Gary Snook waiting in Dr. Forest Tennant’s office in West Covina, California. Gary Snook travels from Montana to California every three months for a pain medication prescription.\u003c/figcaption>\u003c/figure>\n\u003cp>The Centers for Disease Control and Prevention recently released\u003ca href=\"https://www.dea.gov/divisions/hq/2014/hq082114.shtml\" target=\"_blank\"> guidelines\u003c/a> to curb the overprescribing of opioids for chronic pain, and the Drug Enforcement Administration increased oversight and sanctions for doctors who overprescribe the drugs.\u003c/p>\n\u003cp>Some Montana doctors say these federal actions are scaring them away from taking on new pain patients.\u003c/p>\n\u003cp>“A lot of the chronic pain doctors are dropping out of the business, says Charles Farmer with the state’s medical board. \"One of the reasons is because they don't want the DEA following them around.”\u003c/p>\n\u003cp>The Montana medical board suspended the license of physician Mark Ibsen this year for overprescribing.\u003c/p>\n\u003cp>“We as physicians are terrified that we are going to go to prison or lose our license over prescribing pain pills to patients,” Ibsen said.\u003c/p>\n\u003cp>He denies he was overprescribing and is appealing the suspension of his license. But he shut down his practice in Helena anyway.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/268892215\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Pain management has always been hard, Ibsen says, and all the oversight is interfering with the doctor-patient relationship.\u003c/p>\n\u003cp>“The thing is there is no objective measurement of pain. If you don’t take people at their word that they are in pain, and you are suspicious of them, you can’t have a therapeutic relationship,” Ibsen says. “No miracles happen between you and me -- as a patient and a doctor -- if I suspect that you’re a scumbag.”\u003c/p>\n\u003cp>The Montana Board of Medical Examiners Executive Director Ian Marquand says he couldn’t say whether the board’s disciplinary actions have had an impact on patients’ access to opioids.\u003c/p>\n\u003cp>“The door is open in Montana for any qualified, competent physician to come in and practice,” Marquand said.\u003c/p>\n\u003cp>For some Montana pain patients, like Gary Snook, relief is only found at a strip mall clinic in suburban Los Angeles.\u003c/p>\n\u003cp>His doctor is Forest Tennant, a former army physician who opened his first pain clinic in 1975. Today, He has about 150 patients –- half of them are Californians and half are from out-of-state.\u003c/p>\n\u003cp>“The last week or two has just been unbearable,\" Tennant says. \"We hardly want to (answer) the phones, the number of people calling that want to come here.\"\u003c/p>\n\u003cfigure id=\"attachment_196563\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-196563\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Tennant_Office-e1465662716555.jpg\" alt=\"Dr. Forest Tennant treats pain patients from all over the country at his practice in West Covina, California.\" width=\"1920\" height=\"1339\">\u003cfigcaption class=\"wp-caption-text\">Dr. Forest Tennant treats pain patients from all over the country at his practice in West Covina, California.\u003c/figcaption>\u003c/figure>\n\u003cp>He says California has laws that Montana and other states don’t, including the \u003ca href=\"http://www.leginfo.ca.gov/cgi-bin/displaycode?section=hsc&group=124001-125000&file=124960-124961\" target=\"_blank\">Pain Patient’s Bill of Rights\u003c/a>. It allows a patient to request or reject the use of any technique in order to relieve their pain.\u003c/p>\n\u003cp>Tennant says that’s coupled with intensive physician training in all the other ways to treat pain before turning to opioids.\u003c/p>\n\u003cp>“They are the last resort, when there is no other option. You don’t use them until everything else has failed,” Tennant said.\u003c/p>\n\u003cp>He says opioids shouldn’t be stigmatized, they should be used responsibly.\u003c/p>\n\u003cp>A recent CDC report shows that California has the \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a2.htm\" target=\"_blank\">second lowest prescribing rate \u003c/a>for opioid pain relievers.\u003c/p>\n\u003cp>Tennant is now helping pain patients in Montana lobby lawmakers to guarantee more access to opioids in their home state, so people like Gary Snook don’t need to travel so far for a prescription.\u003c/p>\n\u003cp>“I mean, it’s life and death in that bottle. At least it’s my life,” Snook said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He says he just wants to visit a doctor near his home and be seen as patient, not a criminal.\u003c/p>\n\n","blocks":[],"excerpt":"Some Montana patients say the only way they can get the treatment they need is to fly out of state.","status":"publish","parent":0,"modified":1465851668,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":34,"wordCount":932},"headData":{"title":"Montana's 'Pain Refugees' Find Relief in California | KQED","description":"Some Montana patients say the only way they can get the treatment they need is to fly out of state.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Montana's 'Pain Refugees' Find Relief in California","datePublished":"2016-06-13T15:00:19.000Z","dateModified":"2016-06-13T21:01:08.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"196569 http://ww2.kqed.org/stateofhealth/?p=196569","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/06/13/montanas-pain-refugees-find-relief-in-california/","disqusTitle":"Montana's 'Pain Refugees' Find Relief in California","nprByline":"Corin Cates-Carney\u003cbr />\u003ca href=\"http://mtpr.org/post/montanas-pain-refugees-leave-state-treatment#stream/0\">MTPR\u003c/a>","path":"/stateofhealth/196569/montanas-pain-refugees-find-relief-in-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>They call themselves pain refugees.\u003c/p>\n\u003cp>Every 90 days, three patients from Montana fly to California to get a prescription for opioids.\u003c/p>\n\u003caside class=\"pullquote alignright\">“I just want humanitarian care, and I get that in California.”\u003ccite> Gary Snook, Montana resident \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>As the U.S. faces an epidemic of overdose deaths from prescription painkillers, some patients with chronic pain say doctors are less likely to prescribe them opioids. Some Montana patients say the only way they can get the treatment they need is to fly out of state.\u003c/p>\n\u003cp>On a mid-afternoon flight out of Missoula, Montana, Gary Snook pauses in the aisle in front of seat 17B. He stretches with a slight wince and sits down.\u003c/p>\n\u003cp>“My pain, it is all from my waist down. It’s like being boiled in oil 24-hours a day,” Snook said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>He has been in severe pain since he had surgery on his spine for a ruptured disk 14 years ago.\u003c/p>\n\u003cp>Snook says he's done all kinds of things to try to get better. “I got a surgery, epidural steroid injections, acupuncture, anti-inflammatories, physical therapy, pool exercises,” he said. “I’ve tried everything that anyone has ever suggested me to try.”\u003c/p>\n\u003cp>He says the only thing that works is opioids. But when he tries to get them in Montana, he says the doctors treat him like a criminal.\u003c/p>\n\u003cp>“I just want humanitarian care,\" Snook says. “And I get that in California.”\u003c/p>\n\u003cp>In the last 15 years, \u003ca href=\"http://www.cdc.gov/drugoverdose/epidemic/index.html\" target=\"_blank\">the rate of overdose deaths\u003c/a> from opioids has quadrupled in the U.S.\u003c/p>\n\u003cfigure id=\"attachment_196562\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-196562\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Waiting_Room-e1465662580220.jpg\" alt=\" Kathy Snook, Terri Anderson and Gary Snook waiting in Dr. Forest Tennant’s office in West Covina, California. Gary Snook travels from Montana to California every three months for a pain medication prescription.\" width=\"1920\" height=\"1382\">\u003cfigcaption class=\"wp-caption-text\">Kathy Snook, Terri Anderson and Gary Snook waiting in Dr. Forest Tennant’s office in West Covina, California. Gary Snook travels from Montana to California every three months for a pain medication prescription.\u003c/figcaption>\u003c/figure>\n\u003cp>The Centers for Disease Control and Prevention recently released\u003ca href=\"https://www.dea.gov/divisions/hq/2014/hq082114.shtml\" target=\"_blank\"> guidelines\u003c/a> to curb the overprescribing of opioids for chronic pain, and the Drug Enforcement Administration increased oversight and sanctions for doctors who overprescribe the drugs.\u003c/p>\n\u003cp>Some Montana doctors say these federal actions are scaring them away from taking on new pain patients.\u003c/p>\n\u003cp>“A lot of the chronic pain doctors are dropping out of the business, says Charles Farmer with the state’s medical board. \"One of the reasons is because they don't want the DEA following them around.”\u003c/p>\n\u003cp>The Montana medical board suspended the license of physician Mark Ibsen this year for overprescribing.\u003c/p>\n\u003cp>“We as physicians are terrified that we are going to go to prison or lose our license over prescribing pain pills to patients,” Ibsen said.\u003c/p>\n\u003cp>He denies he was overprescribing and is appealing the suspension of his license. But he shut down his practice in Helena anyway.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/268892215&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/268892215'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Pain management has always been hard, Ibsen says, and all the oversight is interfering with the doctor-patient relationship.\u003c/p>\n\u003cp>“The thing is there is no objective measurement of pain. If you don’t take people at their word that they are in pain, and you are suspicious of them, you can’t have a therapeutic relationship,” Ibsen says. “No miracles happen between you and me -- as a patient and a doctor -- if I suspect that you’re a scumbag.”\u003c/p>\n\u003cp>The Montana Board of Medical Examiners Executive Director Ian Marquand says he couldn’t say whether the board’s disciplinary actions have had an impact on patients’ access to opioids.\u003c/p>\n\u003cp>“The door is open in Montana for any qualified, competent physician to come in and practice,” Marquand said.\u003c/p>\n\u003cp>For some Montana pain patients, like Gary Snook, relief is only found at a strip mall clinic in suburban Los Angeles.\u003c/p>\n\u003cp>His doctor is Forest Tennant, a former army physician who opened his first pain clinic in 1975. Today, He has about 150 patients –- half of them are Californians and half are from out-of-state.\u003c/p>\n\u003cp>“The last week or two has just been unbearable,\" Tennant says. \"We hardly want to (answer) the phones, the number of people calling that want to come here.\"\u003c/p>\n\u003cfigure id=\"attachment_196563\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-196563\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Tennant_Office-e1465662716555.jpg\" alt=\"Dr. Forest Tennant treats pain patients from all over the country at his practice in West Covina, California.\" width=\"1920\" height=\"1339\">\u003cfigcaption class=\"wp-caption-text\">Dr. Forest Tennant treats pain patients from all over the country at his practice in West Covina, California.\u003c/figcaption>\u003c/figure>\n\u003cp>He says California has laws that Montana and other states don’t, including the \u003ca href=\"http://www.leginfo.ca.gov/cgi-bin/displaycode?section=hsc&group=124001-125000&file=124960-124961\" target=\"_blank\">Pain Patient’s Bill of Rights\u003c/a>. It allows a patient to request or reject the use of any technique in order to relieve their pain.\u003c/p>\n\u003cp>Tennant says that’s coupled with intensive physician training in all the other ways to treat pain before turning to opioids.\u003c/p>\n\u003cp>“They are the last resort, when there is no other option. You don’t use them until everything else has failed,” Tennant said.\u003c/p>\n\u003cp>He says opioids shouldn’t be stigmatized, they should be used responsibly.\u003c/p>\n\u003cp>A recent CDC report shows that California has the \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a2.htm\" target=\"_blank\">second lowest prescribing rate \u003c/a>for opioid pain relievers.\u003c/p>\n\u003cp>Tennant is now helping pain patients in Montana lobby lawmakers to guarantee more access to opioids in their home state, so people like Gary Snook don’t need to travel so far for a prescription.\u003c/p>\n\u003cp>“I mean, it’s life and death in that bottle. At least it’s my life,” Snook said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He says he just wants to visit a doctor near his home and be seen as patient, not a criminal.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/196569/montanas-pain-refugees-find-relief-in-california","authors":["byline_stateofhealth_196569"],"categories":["stateofhealth_13"],"tags":["stateofhealth_2519","stateofhealth_2656","stateofhealth_141"],"featImg":"stateofhealth_196587","label":"stateofhealth"},"stateofhealth_177125":{"type":"posts","id":"stateofhealth_177125","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"177125","score":null,"sort":[1461713540000]},"guestAuthors":[],"slug":"fentanyl-overdoses-in-bay-area-linked-to-counterfeit-painkiller","title":"Fentanyl Overdoses in Bay Area Linked to Counterfeit Painkiller","publishDate":1461713540,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>An outbreak of poisonings linked to a counterfeit prescription painkiller — previously seen in the Sacramento region — has reached the Bay Area, according to the U.S. Centers for Disease Control.\u003c/p>\n\u003cp>The CDC \u003ca href=\"http://www.cdc.gov/mmwr/volumes/65/wr/mm6516e1.htm?s_cid=mm6516e1_e#T1_down\" target=\"_blank\">reported Tuesday\u003c/a> that seven patients were treated for overdoses in Bay Area hospitals in late March and early April after taking what they thought were tablets of Norco, a brand-name painkiller that combines acetaminophen and hydrocodone.\u003c/p>\n\u003cp>But the counterfeit Norco, which the patients bought off the street, mostly contained the opiate fentanyl, which is 100 times more powerful than morphine, according to the CDC.\u003c/p>\n\u003cp>In addition to the fentanyl, the pills contained promethazine, an allergy drug that’s believed to intensify the effects of fentanyl.\u003c/p>\n\u003cp>None of the patients died, but they suffered nausea, vomiting, breathing problems, lethargy and unconsciousness. Some needed treatment with naloxone, an antidote medication that can reverse the effects of an opioid overdose.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Sacramento County health officials in late March \u003ca href=\"http://www.dhhs.saccounty.net/PUB/Documents/AZ-Health-Info/ME-Fentanyl+Alert_20160401.pdf#search=norco\" target=\"_blank\">reported\u003c/a> at least 36 overdoses related to similar counterfeit Norco tablets laced with fentanyl. Nine of those 36 patients died.\u003c/p>\n\u003cp>Since then, another 16 overdoses, three fatal, \u003ca href=\"http://www.dhhs.saccounty.net/Pages/NR---Update-on-opioid-related-overdoses-(April-25,-2016).aspx\" target=\"_blank\">have been reported\u003c/a> in the county.\u003c/p>\n\u003cp>The California Poison Control System has been on alert for new cases but has not received any reports of counterfeit Norco overdoses elsewhere in the state, said Stuart Heard, the system’s executive director and a clinical professor at the University of California-San Francisco School of Pharmacy. Some of the pills analyzed by experts contained as much as 3.5 milligrams of fentanyl, a potentially lethal dose, he said.\u003c/p>\n\u003cp>“The only safe prescription to take is prescribed to you by your doctor and received from a legitimate pharmacy – not from a coworker, a friend or off the street,” said Casey Rettig, a spokeswoman for the Drug Enforcement Administration’s San Francisco division, which is investigating the counterfeit Norco.\u003c/p>\n\u003cp>Drug enforcement and health officials are increasingly concerned about fentanyl making its way into counterfeit versions of common prescription drugs.\u003c/p>\n\u003cp>Last year in California, seven people took fentanyl-contaminated counterfeit Xanax, an anti-anxiety drug; two of them died, according to the CDC. The addition of the booster promethazine — seen in the Bay Area but not Sacramento overdose cases — additionally worries public health officials, because it strengthens the effects of already powerful fentanyl.\u003c/p>\n\u003cp>The recent Bay Area cases may strengthen the arguments of some California lawmakers trying to pass a bill, SB 1323, which would increase prison sentences and fines for major traffickers of fentanyl. The bill remains in committee.\u003c/p>\n\u003cp>To aid its investigation, the DEA’s San Francisco division recently set up an anonymous tip line at 530-722-7577.\u003c/p>\n\u003cp>“Fentanyl is available, it’s relatively cheap, a little goes a long way and it’s very profitable,” the DEA’s Rettig said. She said could not comment on the progress of the DEA’s investigation. But typically, she said, fentanyl is purchased from China, shipped to Mexico and transported into the United States across its southwest border.\u003c/p>\n\u003cp>At some point in Mexico or in the U.S., the fentanyl is processed into counterfeit tablets that carry the markings of legitimate prescription medications, including hydrocodone drugs like Norco, Rettig said.\u003c/p>\n\u003cp>“Why these manufacturers are making it so potent and doing in their own customers is very puzzling,” Heard said. “To me, it speaks to amateurs doing this, or people who just don’t care.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated. \u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Authorities believe a painkiller was adulterated with a powerful opioid, similar to street drugs that have killed 12 in Sacramento. ","status":"publish","parent":0,"modified":1461780867,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":600},"headData":{"title":"Fentanyl Overdoses in Bay Area Linked to Counterfeit Painkiller | KQED","description":"Authorities believe a painkiller was adulterated with a powerful opioid, similar to street drugs that have killed 12 in Sacramento. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Fentanyl Overdoses in Bay Area Linked to Counterfeit Painkiller","datePublished":"2016-04-26T23:32:20.000Z","dateModified":"2016-04-27T18:14:27.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"177125 http://ww2.kqed.org/stateofhealth/?p=177125","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/04/26/fentanyl-overdoses-in-bay-area-linked-to-counterfeit-painkiller/","disqusTitle":"Fentanyl Overdoses in Bay Area Linked to Counterfeit Painkiller","nprByline":"Barbara Feder Ostrov\u003cbr />\u003ca href=\"http://californiahealthline.org/\">California Healthline\u003c/a>","path":"/stateofhealth/177125/fentanyl-overdoses-in-bay-area-linked-to-counterfeit-painkiller","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>An outbreak of poisonings linked to a counterfeit prescription painkiller — previously seen in the Sacramento region — has reached the Bay Area, according to the U.S. Centers for Disease Control.\u003c/p>\n\u003cp>The CDC \u003ca href=\"http://www.cdc.gov/mmwr/volumes/65/wr/mm6516e1.htm?s_cid=mm6516e1_e#T1_down\" target=\"_blank\">reported Tuesday\u003c/a> that seven patients were treated for overdoses in Bay Area hospitals in late March and early April after taking what they thought were tablets of Norco, a brand-name painkiller that combines acetaminophen and hydrocodone.\u003c/p>\n\u003cp>But the counterfeit Norco, which the patients bought off the street, mostly contained the opiate fentanyl, which is 100 times more powerful than morphine, according to the CDC.\u003c/p>\n\u003cp>In addition to the fentanyl, the pills contained promethazine, an allergy drug that’s believed to intensify the effects of fentanyl.\u003c/p>\n\u003cp>None of the patients died, but they suffered nausea, vomiting, breathing problems, lethargy and unconsciousness. Some needed treatment with naloxone, an antidote medication that can reverse the effects of an opioid overdose.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Sacramento County health officials in late March \u003ca href=\"http://www.dhhs.saccounty.net/PUB/Documents/AZ-Health-Info/ME-Fentanyl+Alert_20160401.pdf#search=norco\" target=\"_blank\">reported\u003c/a> at least 36 overdoses related to similar counterfeit Norco tablets laced with fentanyl. Nine of those 36 patients died.\u003c/p>\n\u003cp>Since then, another 16 overdoses, three fatal, \u003ca href=\"http://www.dhhs.saccounty.net/Pages/NR---Update-on-opioid-related-overdoses-(April-25,-2016).aspx\" target=\"_blank\">have been reported\u003c/a> in the county.\u003c/p>\n\u003cp>The California Poison Control System has been on alert for new cases but has not received any reports of counterfeit Norco overdoses elsewhere in the state, said Stuart Heard, the system’s executive director and a clinical professor at the University of California-San Francisco School of Pharmacy. Some of the pills analyzed by experts contained as much as 3.5 milligrams of fentanyl, a potentially lethal dose, he said.\u003c/p>\n\u003cp>“The only safe prescription to take is prescribed to you by your doctor and received from a legitimate pharmacy – not from a coworker, a friend or off the street,” said Casey Rettig, a spokeswoman for the Drug Enforcement Administration’s San Francisco division, which is investigating the counterfeit Norco.\u003c/p>\n\u003cp>Drug enforcement and health officials are increasingly concerned about fentanyl making its way into counterfeit versions of common prescription drugs.\u003c/p>\n\u003cp>Last year in California, seven people took fentanyl-contaminated counterfeit Xanax, an anti-anxiety drug; two of them died, according to the CDC. The addition of the booster promethazine — seen in the Bay Area but not Sacramento overdose cases — additionally worries public health officials, because it strengthens the effects of already powerful fentanyl.\u003c/p>\n\u003cp>The recent Bay Area cases may strengthen the arguments of some California lawmakers trying to pass a bill, SB 1323, which would increase prison sentences and fines for major traffickers of fentanyl. The bill remains in committee.\u003c/p>\n\u003cp>To aid its investigation, the DEA’s San Francisco division recently set up an anonymous tip line at 530-722-7577.\u003c/p>\n\u003cp>“Fentanyl is available, it’s relatively cheap, a little goes a long way and it’s very profitable,” the DEA’s Rettig said. She said could not comment on the progress of the DEA’s investigation. But typically, she said, fentanyl is purchased from China, shipped to Mexico and transported into the United States across its southwest border.\u003c/p>\n\u003cp>At some point in Mexico or in the U.S., the fentanyl is processed into counterfeit tablets that carry the markings of legitimate prescription medications, including hydrocodone drugs like Norco, Rettig said.\u003c/p>\n\u003cp>“Why these manufacturers are making it so potent and doing in their own customers is very puzzling,” Heard said. “To me, it speaks to amateurs doing this, or people who just don’t care.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/177125/fentanyl-overdoses-in-bay-area-linked-to-counterfeit-painkiller","authors":["byline_stateofhealth_177125"],"categories":["stateofhealth_11"],"tags":["stateofhealth_2519","stateofhealth_2656"],"featImg":"stateofhealth_177143","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. 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