Newt Gingrich, Advocate for Opioid Recovery

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Newt Gingrich, Advocate for Opioid Recovery

By Brian Whitney 10/07/16

The former Republican presidential candidate talks to us about buprenorphine, Medicaid, and how to reduce opioid overdoses.

Image: 
Newt Gingrich, Advocate for Opioid Recovery
Gingrich wants to alleviate the opioid crisis. via Christopher Halloran / Shutterstock.com

One might think that former Members of Congress Patrick Kennedy and Newt Gingrich might make strange bedfellows when it comes to public policy. But along with Van Jones, they are the founding advisors of Advocates for Opioid Recovery, a nonprofit organization whose mission is “advancing a science-based, evidence-based treatment system that can reduce death and suffering from opioid addiction, and produce more long-term opioid addiction survivors who are positively engaged in their families and communities.”

The organization recently funded a report by IMS Institute for Healthcare Informatics that shines a light on how states prescribe and reimburse opioid addiction recovery medications, and focuses on buprenorphine in particular. The report says that even though overdoses and opioid-related deaths continue to rise dramatically, the growth rate for addiction treatment with buprenorphine has slowed.  

According to the report, “Patient access to - and reimbursement for - buprenorphine medications used in addiction recovery varies widely across states and suggests inconsistent and suboptimal approaches in many parts of the country.”

Kennedy had this to say about the findings: “There is no better litmus test for mental health equality than medication assisted treatment. The evidence is undeniable that medication, along with behavioral counseling, is the best course of treatment. Restrictive policies, like ‘fail first’ or dosage and duration limits, should be a violation of the 2008 Mental Health Parity law. That was certainly my intention when I introduced the bill in the House. If that is not a violation, I’m not sure what is.”

The disparity in the share of prescriptions paid for by state Medicaid programs is rather stunning. It ranges from 68% in Vermont to 4% in Mississippi. According to the report, “In nine states at least 40% of the buprenorphine prescriptions were paid for by Medicaid between June 2015 and June 2016. In 12 states, the share of Medicaid payment was less than 10%. In four state programs, Mississippi, Utah, Florida and Alabama, Medicaid programs make up less than 5% of the payments and they also are among the states with the most out-of-pocket expenses for buprenorphine.”

Newt Gingrich, former Republican presidential candidate, 50th Speaker of the House of Representatives and founding advisor of Advocates for Opioid Recovery, talked to The Fix about the study and what we as a nation can do to fix this problem.

Mr. Gingrich, thanks for speaking with me. Can you talk a bit about how you got involved with Patrick Kennedy and the Advocates for Opioid Recovery? 

I have a very long involvement making sure mental health is treated as part of the entire health system, and have considerable involvement in brain research and brain science. Two years ago Patrick Kennedy asked me to come to speak about brain science at his annual conference, and out of that meeting we began to talk of the scale of the opioid crisis and how we could help with recovery.

This is a huge problem. Opioid overdose deaths have now passed automobile deaths as the leading cause of accidental death in America, so, for the first time since the invention of the automobile, it has fallen to number two as to accidental deaths.  

It turns out that if you have a partial recovery from addiction or overdose and detox, but you don’t really have the right support and you don’t have the right medication, there is a very real danger that if you backslide and start to use an opioid again, that the receptors in your brain have lost their customary ability to absorb it, which had built up over a long period of time. So when you detox, your brain goes back to where it was. Then if you take the amount that you were used to before you overdosed the first time, you can overdose again and this time it can kill you. It would not have been an overdose before you detoxed but now it is. So there is something profoundly wrong with the current strategy. 

It works for about 10 percent of people that go through it, much like Alcoholics Anonymous, but for a large amount of people this is a very different problem with a very different biological impact of a different biological nature. We know now because we have enough experience that having a medication support system dramatically increases the likelihood that you will truly recover and you will not die from an overdose. Part of our concern is that in the study we really look at how states respond to this, what they do and how they do it, and we discovered that there is a very wide-ranging difference between states. You range from a high of 68 percent in Vermont to a low of 4 percent in Mississippi. That gives you a sense of how dramatic the difference is. Our goal is to get people to understand that the CARA Act (Comprehensive Addiction and Recovery Act) is a first step, but is not by itself adequate. You need to include dealing with the brain parts of your being as much as you do the physical parts. We understand this if you are dealing with something like diabetes. If you need diabetes strips and you need to be tested regularly, we wouldn’t say, “Good luck, we hope you find a way to do that.” We would say that this is something we have to deal with. We are trying to bring opioid addiction into the same level of understanding because the fact is it is killing a lot of people.

Why do you think there is such disparity between states when it comes to this particular issue and how people receive treatment?

You have to start with the understanding that we really have not had much knowledge about active brains, everything we thought was supposition. We developed a pattern over the last 100 years. We gave enormous momentum to understanding bone structure and the physiology of your heart and understanding the nature of various communicable diseases, so each of these things increased our sense of certainty. Meanwhile up to around 20 years ago, the brain was this thing that we couldn’t measure. The only brains we analyzed, with very rare exceptions, were of people that were dead. Now we have all sorts of sophisticated capabilities that we are tracking down at the neuronal level. Just remember the brain is extraordinarily complicated, one human brain has about the same number of neurons as there are stars in the universe. Just imagine the amount of mathematics and astrophysics it takes. I was just talking to a couple guys who are true experts in this field and we were talking about computer problems. We don’t have enough computer capacity in either storage or processing speed to deal with the new information we are getting about the brain, so there is a lag. We still had people who had gone to medical school that don’t know anything about the brain, we had people that developed public policy that didn’t know anything about the brain. So there was a very long period of people not thinking it was something they needed to worry about.

In analyzing the study, some of the recommendations by Advocates for Opioid Recovery are that governors should review their Medicaid policies related to medication-assisted treatment, rectify any policies that are not promoting care based on clinical guidelines, and that states should require performance standards related to opioid addiction recovery. How do you see the individual states playing a role in fixing this?

Governors need to play a much bigger role in health care as we move beyond this current mess. As they do that, they should really look seriously at what is it that is killing people, what are we learning to enable us to save those lives and how do we implement it? That process of thought is really, really important. I am hoping that we can convince every governor and every state legislature to review how they deal with their own employees' state health plans, and how they deal with Medicaid in their state, and Medicaid is a huge part of this. If you read Dreamland by Sam Quinones—which is, in my opinion, the best single book on the opioid epidemic—in many ways Medicaid has been a major enabler of people becoming addicts, because it is administered so badly that people end up going to get a variety of pills from doctors and doing it commercially, so Medicaid becomes one of the devices by which people increase their addiction level. So it is very important for us to be able to work on this question of how we rethink at the state level all of these programs to make sure they have the most modern capabilities to save lives. If we were losing this many people each year to Zika, we would be panic stricken. We still underestimate how much we could fix it if we wanted to.

And of course, a lot of that aspect of things is because so many people still look at opiate addiction as a moral issue.

Exactly. It is like, “Why should I have to deal with this? If only you were a better person.” Well the objective reality is you end up with something that is a very human problem—you can either try to save their lives or let them die. A healthy rational society tries to save their lives.

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Brian Whitney has been a prisoner advocate, a landscaper, and a homeless outreach worker. He has written or coauthored numerous books in addition to writing for AlterNetTheFixPacific Standard MagazinePaste Magazine, and many other publications. He has appeared or been featured in Inside Edition, Fox News, People.com, Cracked.com, True Murder, Savage Love and True Crime Garage. He is appearing at CrimeCon in 2019. You can find Brian on Facebook or at Brianwhitneyauthor.com.

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