With the help of treatment covered by Medicaid, Emily Keener kept her family together while she fought opioid addiction.
Emily Keener describes her battle with drug abuse during an opioid summit hosted by the Institute for Medicaid Innovation.
Keener, now 31, described her experiences in detail during a June summit titled "Opioid Epidemic: Crisis to Care in Medicaid"(www.medicaidinnovation.org) hosted by the Institute for Medicaid Innovation.
Her struggle represents a case study of what can go wrong with opioid prescriptions and what can go right with appropriate addiction treatment.
It's a timely issue, because the rate of hospital visits related to opioid misuse doubled between 2000 and 2012, and Medicaid provided coverage for the majority of such visits between 1993 and 2012. However, Medicaid pays for only six months of addiction treatment, which is often not enough.
After Keener's second child was born via C-section when she was 23, she was sent home with an opioid prescription. She quickly became addicted and started a cycle of drug use that she hid from friends and family. She began to use heroin when she could no longer obtain prescription medication, and spending so much money on drugs meant she could no longer afford her car, a home or her bills.
- Panelists at a recent summit on the opioid epidemic and Medicaid discussed the scope of the problem and how physicians can help.
- Drug overdose is now the leading cause of injury death in the nation, and the rate of opioid misuse among pregnant women grew from 1.2 cases per 1,000 births in 2000 to 5.7 per 1,000 births in 2009.
- Only 13 percent of drug treatment facilities offer programs designed for pregnant and postpartum women.
Keener's first recovery occurred with the help of Medicaid through Missouri's Comprehensive Substance Abuse Treatment and Rehabilitation program.(dmh.mo.gov) Then her father died from cirrhosis after failing to overcome his problems with alcohol, and her mother died from a drug overdose soon afterward. Struggling with these losses, Keener began using drugs again.
She later became pregnant for a third time and faced the prospect of losing the child if her addiction was not addressed. She obtained additional treatment from the Women in Shared Healing (WISH) program(www.chausa.org), which is affiliated with St. Mary's Hospital-St. Louis. The program is covered by a Medicaid contractor.
"I know nobody wants to think it's a disease," Keener said. "But nobody wakes up wanting to be like that."
She has been clean for 11 months.
"Medication can't do everything, but it is a good first step," Keener said. "Counseling and wellness will help you love yourself again. They are all key to staying sober."
Rising Incidence of Abuse Requires Changes
Corey Waller, M.D., M.S., senior medical director for education and policy for the National Center for Complex Health and Social Needs and chair of the American Society of Addiction Medicine's legislative advocacy committee, said that despite the rising occurrence of drug overdose, medical residents receive only one hour of training in addiction medicine. The medical school curriculum needs to change to reflect the reality of drug abuse, Waller added.
Drug overdose is now the leading cause of injury death in the nation. Among pregnant women, the rate of opioid misuse grew from 1.2 cases per 1,000 births in 2000 to 5.7 per 1,000 births in 2009. But women are dissuaded from seeking help by the social stigma attached to addiction and other factors. For example, in 44 states, pregnant women who seek treatment for opioid abuse face legal consequences.
David O'Gurek, M.D., assistant professor of family medicine at the Lewis Katz School of Medicine at Temple University in Philadelphia and chair of the AAFP's Commission on Health of the Public and Science, also participated in the panel discussion. He said physicians should address the risk of opioid addiction in preconception care.
Besides asking patients of childbearing age about their conception plans, physicians should discuss any chronic pain issues and pose questions to determine patients' mental health regarding children. If a patient is already taking prescription medication, the physician should adjust the dosage, if necessary.
"We can address multiple issues that can affect a healthy pregnancy, but often this doesn't happen because we don't find out about it (the pregnancy) until they come in," O'Gurek said.
Address Potential for Substance Abuse
Only 13 percent of drug treatment facilities offer programs designed for pregnant and postpartum women, but this is improving slowly. Twenty-seven states developed such drug treatment programs in 2017.
Still, this paucity means consultations to help prevent drug abuse during or after a pregnancy are especially important. Craig Martin, M.D., chief medical officer at Vaya Health in North Carolina, emphasized that the first step is evaluating a patient's condition and potential vulnerability to substance abuse, not simply focusing on whether the patient is currently abusing alcohol or narcotics.
"Substance abuse is integrated with every other health issue and should be part of every doctor/patient encounter," Martin said. "It should be an assessment, not a screening."
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