An obscure federal rule may have serious and far-ranging impact upon substance abuse treatment in states where Medicaid coverage has been expanded under the Affordable Care Act.
Under the new law, states are allowed to expand Medicaid coverage to low-income individuals, including those struggling with drug and alcohol addictions. However, treatment centers across the country are discovering that due to a restriction established in 1965—the year of Medicaid’s inception—residential addiction treatment in community-based programs will only be covered if the facility has 16 or fewer beds. The ruling was initially set in place to encourage deinstitutionalization, as well as to shift the cost of caring for patients back to the states.
Patients in state psychiatric hospitals and other “institutions for mental diseases”—defined as a hospital, nursing facility or other institution of more than 16 beds, including residential treatment programs for substance abuse—were excluded from Medicaid coverage, spurring a massive transfer from state hospitals to nursing homes and community-based programs, which could be reimbursed by the program.
While effective during the 1960s, when addicts and individuals in need of psychiatric care could still be hospitalized for indefinite periods of time under sometime deplorable conditions, the restriction now serves as a roadblock for the promise of widespread, all-inclusive health care coverage as stated in the Affordable Care Act. Treatment centers in the 26 states where Medicaid coverage was expanded are now scrambling to accommodate the ruling while still providing services to new enrollees.
An article in the New York Times revealed the many ways that states are attempting to deal with this problem. For example, California and New York are hoping to obtain waivers from the government to allow Medicaid reimbursement in larger facilities, while Kentucky is attempting to determine if programs with multiple-bed units must be considered a single facility. Others, like Washington, have resorted to downsizing, while treatment facilities in Illinois, like Chicago’s Haymarket Center, have covered the costs for 40 new enrollees this year.
However, such generosity has a financial limit. As Haymarket Center spokesman Jeffrey Collard noted, “I don’t know how long we can continue to do that—to provide services and not get paid for them.”
Sixty-one percent of Americans who participated in the poll were in favor of Colorado Amendment 64, which allows the legal use of recreational marijuana but with heavy taxes and sale restrictions for people under the age of 21. Of that number, 68% were Democrats, 60% were independents, and 52% were Republicans. When asked if marijuana should be legalized in all 50 states, 51% of the participants said yes, while 37% said no. Of the yes votes, 62% were Democrats and 51% were independents, but only 36% of Republican participants agreed with full legalization.
The parties found more common ground on other related issues, most notably in regard to government efforts to police marijuana laws. A full 60% of Americans—including 60% of Democrats and 55% of Republicans—felt that these actions cost more than they were worth. A majority of respondents, including 55% of Democrats and 49% of Republicans, believe that the government should not be able to enforce federal laws regarding marijuana after states have declared it legal.
Some of the most interesting results came in regard to the long-ranging ramifications of legal marijuana. Fifty percent of respondents believed that marijuana use would not lead to the use of harder drugs, while 54% believed that legalizing pot will increase criminal activity. However, 38% of the respondents agreed that legalization might decrease road safety (39% disagreed), while 53% believe that legalization will either increase or encourage marijuana use in young people.
Contrary to popular stereotypes, marijuana dampens the brain’s reaction to dopamine, according to a study published on Monday in the journal Proceedings of the National Academy of Sciences.
A team led by Nora Volkow from the U.S. National Institute on Drug Abuse studied the brains of 24 marijuana abusers and how they reacted to methylphenidate, also known by its brand name Ritalin, a stimulant used to treat ADHD and narcolepsy. Marijuana abusers in the study smoked on average five joints a day, five days a week for a decade.
The research team used personality tests and brain imaging to monitor how the marijuana abusers react to methylphenidate, which elevates dopamine. They found that both groups produced just as much extra dopamine after taking the stimulant. However, the marijuana abusers had significantly dampened behavioral, cardiovascular, and brain responses to methylphenidate compared with the control group.
The marijuana abusers’ heart rate and blood pressure were lower in comparison, and they reported feeling restlessness and anxiety. The researchers concluded that marijuana not only dampens the brain's dopamine reaction to stimulants, but also influences the area of the brain involved in reward processing. The marijuana abusers’ weaker physical response to the same amount of dopamine suggests the reward circuitry in their brains is damaged.
The study “suggests that cannabis users may experience less reward from things others generally find pleasurable and, contrary to popular stereotypes, that they generally feel more irritable, stressed, and just plain crummy,” according to neuropsychologist at Florida International University Raul Gonzalez, who was not involved with the research.
Despite the study’s unexpected findings, many questions remain unanswered. “[The study] probably tells you more about cannabis dependence than about recreational use,” said Paul Stokes, a psychiatrist at Imperial College London, also not involved in the research.
- British Cricket Coach Scolds Player For Dancing Drunk And Naked [The Guardian]
- Alabama County GOP Official Resigns After Pot Possession Arrest [Talking Points Memo]
- Drunk Guy Arrested For Posing As TSA Agent, Patting Down Two Women [Gawker]
- McDonald's Worker Calls Cops On Drunk Mom Driving Toddler To Drive-Thru [Fox News]
- Massachusetts Man On PCP Hospitalizes Cop After Assault [CBS3]
- D.C. Marijuana Decriminalization Law Goes Into Effect [USA Today]
- San Diego Lawyer Admits Laundering Drug Money For Client [Fox5]
- Pro-Pot Banking Bill Passes GOP-Controlled House [International Business Times]
Living in the dirt under coca plants in South American fields, a local bacteria is powered by an enzyme that actually eats cocaine. The enzyme breaks down quickly when exposed to body temperature so it has never been used to treat human overdoses or cocaine addiction.
A research team at the College of Pharmacy at the University of Kentucky has developed a mutant version of the enzyme which thrives at higher temperatures. The new mutant enzyme thrives to the point that its appetite for cocaine is doubled as well, making it twice as effective as a potential treatment option.
As the scientists explain in their published results, the version of cocaine esterase greatly improves both functioning and stability. Scientists have been investigating ways to harness cocaine esterase's drug-chugging power for therapeutic use, but the 12-minute half-life of the naturally occurring enzyme at human body temperatures proved a tough obstacle to overcome. Researchers at the University of Kentucky previously created an improved enzyme able to withstand body temperatures for 12 hours that already has made its way to clinical trials.
The new mutant enzyme is a huge step beyond that first prototype because it can survive over 100 days at body temperatures while dismantling and ingesting cocaine at a much faster rate. The goal of the research team is to engineer a more valuable therapeutic enzyme for cocaine abuse treatment. Such genetic engineering aims to simultaneously improve both the stability and function to make the enzyme feasible for rational protein drug design.
The team built a computer model of the naturally occurring enzyme, then simulated a high-temperature environment to see which part of the structure failed first. Once they determined the weak points, the research team sought genetic designs and adaptations to improve the survival structure without affecting the enzyme's functionality. In fact, rather than negatively affecting the enzyme’s functionality, the mutant version actually improved on it.
According to the research paper, the modified enzyme fully protected mice from lethal doses of cocaine for at least three days. At this point, the current mutant enzyme in clinical trails could be useful both as a short-term antidote, but not necessarily as a long-term addiction-fighting therapy. If the stability of the current development can be developed into an effective drug therapy, a long-term answer for cocaine addiction could be the incredible result.
A coroner in New South Wales, Australia, declared the cause of death for a 23-year-old woman as suicide while suffering from anorexia nervosa, which has been declared by authorities as the first time the disease has been officially mentioned in regard to a death certificate for suicide.
In 2011, Sydney resident Alana Goldsmith was receiving treatment for the eating disorder when she disappeared from the hospital; her body was found a few hours later on July 22 of that year. Goldsmith’s family had hoped that the coroner’s report would help to raise awareness of the lethal aspects of the disease, which has death rates estimated at 17%—the highest mortality rate of any psychiatric disorder.
Coroner Mark Douglass presented his conclusion at the inquest into Goldsmith’s death at the New South Wales coroner’s court in Sydney. The reasons for his findings have not been released, but are expected in the coming weeks.
Christine Morgan, chief executive of the Butterfly Foundation, an eating disorder awareness group, underscored the significance of the situation by stating, “Recognizing suicide risk is heightened for someone suffering from anorexia nervosa, this finding can jolt a seismic shift in the way governments resource communities to address eating disorders.” Data collected in 2012 shows more than 900,000 Australians suffer from an eating disorder, while an estimated eight million Americans contend with anorexia or bulimia.
In both countries, access to treatment is limited—only 20% of American women who receive treatment for eating disorders get the full three to six months of inpatient care doctors and health specialists say is required to stay in recovery from the disease. Many are sent home weeks earlier, or cannot afford the cost, which is estimated at $30,000 a month for inpatient treatment; New South Wales’ Fed Up campaign reports that only two public adult inpatient eating disorder beds are available in the state, while public outpatient treatment is relegated to four hours a week.