Friday, October 28, 2016

In Preparation for the 2017 Legislative Session:

Hospitals Can Help Solve Drug Problem
 Editorial from The Baltimore Sun      Originally published on May 5 2000

By Dan Morhaim

It's time to get serious and step up to the plate with the required money and commitment to reduce the crisis that addiction in Maryland causes. The 100,000 addicts in Baltimore City and surrounding counties cost us in many ways.

Addicts are responsible for 80 percent of our region's crime. Their injuries -- inflicted on themselves and their victims -- drive up health care costs, jam the courts and 
criminal justice system and disrupt the lives of their families and our communities. Estimates of the cost of their criminal behavior alone exceed $2.3 billion a year.

Yet it has been proved that 
addiction treatment programs are effective in promptly reducing these fiscal and social costs. What will it take to get the job done? Can local hospitals help?

First, we must acknowledge that addiction treatment is often not a cure, just as treatments for cancer or asthma may not result in a cure. A 28-year habit will not be solved in a 28-day drug program. For treatment to work, we need a community commitment to tackle this problem head-on, with compassion but without illusions that it will be easy or quick. And as we pursue treatment, we should intensify our efforts at interdiction and prevention education.

Second, we need a substantial and sustained funding mechanism. Addiction treatment costs money, and counselors are woefully underpaid. Because each dollar spent on addiction treatment saves $7 in taxpayers' costs, this expenditure is a sound investment and deserves protection from political whims and economic fluctuations.

If one-third of the total number of addicts in the Baltimore area enter programs, about $200 million a year will be needed. And we can anticipate spending this annually for at least a decade. Several funding plans have been proposed. One suggestion is an across-the-board fee on all 
insurance carriers; another is an independent funding mechanism similar to that used for Maryland Shock Trauma Center. But whatever method is used, it must be sufficient and ongoing.

Third, such a vast expenditure demands tight fiscal accountability. Different types of programs work for different addicts. Some respond to methadone, others need a faith-based approach; some need in-patient care, some out-patient; some need job skills and others child care. Whatever programs we fund must be held accountable and must have results. Studies have shown that the key element for success is treatment on demand. The addict must be able to immediately enter a program when the opportunity -- whether voluntary or coerced -- presents itself.

Lastly, we need to use one resource that has been overlooked in our treatment approach: our community hospitals. These hospitals already take care of every problem an addict might have except the addiction itself. Community hospitals could provide treatment on demand. They are open 24 hours a day, are secure, safe -- often with a police presence -- and are near public transportation. They have the range of personnel -- from physicians and nurses to social workers -- to deal with the myriad physical and mental challenges addicts present.

Fiscal systems of accountability are already in place at hospitals, as are regulatory systems and quality-of-care review. Most hospitals have space available, and putting addiction programs there would avoid the "not-in-my-backyard" problems often faced by new 
drug treatment centers. So why don't hospitals already treat addiction?

Very simply, because they are not reimbursed to do so, regardless of whether the patient is insured. Therefore, let's add these hospitals to the addiction care system and have them work in concert with the other programs and community efforts that are available.

We've been paying the price of drug addiction for a long time: in wasted lives, shattered families, the spread of AIDS and other diseases and the constant impact of crime and violence on our streets.

It's time to get serious and step up to the plate with the required money and commitment to reduce the crisis that addiction in Maryland causes. Let's spell out the costs and demand results. We know how to get the job done. The only question is whether we have the will to do so.

Del. Dan Morhaim is an emergency physician at Sinai and University Hospitals and has represented the 11th District in the Maryland House of Delegates.

Tuesday, October 4, 2016

On Behalf of the 129 Who Died Today --A Thought for Avery Road

Today I testified at the Montgomery County Hearing in opposition to the 30 year lease with Avery Road Treatment Center.  I was the only one.  

Two others testified in favor --a parent testified, as well as a peer in recovery.  Avery Road had brought a van of peers holding signs about how ARTC had saved their lives. Following the testimonies of those in favor, the Avery Road crowd clapped and cheered.  

The testimony from the peer in recovery told his story about recovering at Avery Road after being a given a 2nd chance in lieu of jail --he was recently married with his first child and a good job.  Inspirational.  Compelling.  If he could do it --then those who went back out and used and died, made a poor choice.  Avery Road cannot be held responsible.  George Leventhal and other Council members smiled and nodded.  

Afterward, I spoke with a girl outside.  I thought about a young man whose girlfriend had called me just yesterday --who had been on the waiting list for two weeks, but had missed calling at 11:00 for just one day and had been bounced to the back of the waiting list.  I asked the girl about him.  She said that Avery Road only lets in "those who really want it --who are really serious."  She should know, she says --she has been to ARTC nine times.  "If you are really serious --you will not miss an 11:00 call."  

I looked at all the hopeful freshly recovered faces around me, signs in support of ARTC under their arms.  I asked them about the success rate of Avery Road.  "Only 10%" offered one.  When I pointed out that those who get into a halfway house and stay for 3 months have a success rate of 30% to 50%, and asked him why Avery Road discharges to homeless shelters instead of halfway houses, he told me that "people who really work at finding halfway houses get help".

These were the strong swimmers.  The ones who had made it through the myriad of barriers and swam the gauntlet.  The ones to be cheered and patted.  The ones to receive the prize of recovery.  

I spoke today for the weaker swimmers.  The ones to be shunned and forgotten by their peers because they were not strong enough swimmers to make it.  The one who was passed out at 11:00.  The one that was too depressed to try again.  The one who was lost to the streets of Baltimore --all family contacts severed and bridges burned.  The one who shoots dope to stop the voices in their head --the voices they are too scared to talk about.  The one who can't go back to rehab for the ninth time and instead buys a gun.  

I spoke for the 129 across our nation who died today.  The weak ones.  

The ones that might have survived had Avery Road simply called them.  The ones that might have survived had they been discharged to a halfway house, rather than a homeless shelter.  The ones that might have survived had they received family counseling.  The ones who might have survived had they not been kicked out prematurely.  The ones who might have survived had their mental health issues been addressed.  The ones who might have survived had they not been too disorganized, or too immature, or too depressed, or too sick, or too confused, or too battered, or too hopeless.  

I spoke for them today and I was alone.  

Friday, September 30, 2016

Town Hall Meeting
to Discuss Avery Road Treatment Center
at J&P Pizza, Damascus
(26027 Ridge Rd - in Weis Shopping Center)
Sunday 10/2, from 9:30 a.m. to 11:00 a.m.
Light Breakfast & Coffee Provided

On October 4th, The Montgomery County Council will hold a public hearing to gather information on whether they should vote to enter into a 30 year lease agreement with Avery Road Treatment Center (ARTC).  Advocates OPPOSE this long-term contractual agreement on the grounds that numerous serious complaints by consumers of treatment services against ARTC have never been resolved, despite on-going efforts on the part of advocates to engage in resolution strategies.  

Please attend the Town Hall to learn more about this issue and why it matters to every single County tax payer; find out how you can participate in the democratic process to bring about necessary and critical changes in order to save lives; and enjoy breakfast pizza, doughnuts, and coffee gratis of J&Ps --home of authentic Italian cuisine in Damascus.  

PLEASE R.S.V.P. to or call / text Lisa Lowe at 301-525-6183 for more information.  

Wednesday, September 28, 2016

PROTEST TO OPPOSE "Resolution to Approve Declaration of No Further Need: Disposition of Avery Road Treatment Center"

WHO:       You

WHAT:      Protest to OPPOSE Montgomery County entering into a 30 year lease agreement with Avery Road Treatment Center until Consumer Complaints are resolved.

WHERE:   Council Hearing Room, 100 Maryland Avenue, Rockville, Maryland 20850 

WHEN:     October 4th at 1:30

WHY:        See below

HOW:        Plan to attend the hearing.  Bring an 8 1/2 X 11 sheet of paper with the word oppose on it --written in black marker.  Every time an individual testifies in opposition to the proposal, raise your sign so that it is visible to Councilmembers.  If you wish to tell your story about Avery Road and why corrections need to be made --sign up to testify (follow the link at the bottom of the email).  

While we applaud the County Council for making necessary improvements to the building and structure of Avery Road Treatment Center (ARTC), we feel that a 30 year lease agreement with Maryland Treatment Center (parent company), binds county tax payers to an agreement with a single provider without sufficient oversight of performance or adherence to successful outcomes.

According to reports from consumers of Substance Use Disorder (SUD) treatment services at ARTC there are discrepancies between the services contracted for by Montgomery County Health & Human Services (HHS), as specified within the License Agreement, and the services that are actually received by consumers.  Contractual noncompliance has been a long-standing issue with Avery Road / Maryland Treatment Center, and at times, contributes to increased relapse rates and/or the fatal overdose of their patients.  According to the License Agreement, ARTC must provide specific services, which consumers report they are not receiving. 

Although this issue has been brought to the attention of both the County Council and HHS repeatedly during the past three years, neither the elected body, nor the appointed body, has been inclined to make the necessary corrections that would heighten quality of care –thereby saving lives.  ARTC is simply not providing the services on a consistent basis that tax payers believe they are paying for and which are outlined within the License Agreement.  Patients who need and deserve quality treatment should receive it. 

Therefore, we are asking that consumers and family members respectfully request that the County Council DOES NOT enter into a 30 year lease agreement with Maryland Treatment Center until certain requirements are met, and that ALL stakeholders are invited to participate in an open and on-going dialogue with members of County Council, HHS, Avery Road Treatment Center and any other interested party until the issue of contract discrepancies regarding quality of care is resolved. 

These discrepancies include, but are not limited to the following:

1)  ARTC is supposed to provide "family counseling sessions" or a "Family Care Plan".  In reality, many parents report that they are often excluded from discharge planning even when the patient is returning home.  This is NOT evidence-based and is a factor in overdose death.

2)  ARTC is supposed to support patients who are seeking access to treatment.   In reality, many patients still report that they must call every morning at 11:00 to maintain their spot on the waiting list or they are removed.  There is no triage available for chronically addicted patients.  This is NOT evidence-based and is a factor in overdose death.

3) ARTC is supposed to refer prematurely discharged patients back to the County so that they are able to continue to receive equivalent services for their often fatal behavioral health disorder at another facility.  In reality, patients are prematurely discharged for a variety of often trivial reasons without a referral to any other level of care, much less an equivalent level of care as determined by their ASAM assessment.  This is NOT evidence-based and is a factor in overdose death.

4)  ARTC is supposed to coordinate with other agencies, which offer mental health, legal, housing, vocational, or family services necessary to support patient recovery.  In reality, these links to outside providers are rarely made, and service providers that clients already have are denied access to their clients while at ARTC.  This is NOT evidence-based and is a factor in overdose death.

5)  ARTC is supposed to plan a discharge based on a patient’s assessed needs.  In reality, many patients are discharged to homeless shelters, even though there are many halfway houses and recovery residences throughout Maryland and across the country that would provide the level of residential care that the patient needs and wants.  Because homelessness is the single highest factor leading to relapse, this is NOT evidence-based and is a factor in overdose death.

5)  ARTC is supposed to have a clear grievance process with external oversight.  In reality, consumers report that the grievance process is unclear, time consuming, or non-existent.  This is NOT evidence-based and is a factor in overdose death.

6)  ARTC is supposed to collect and report on measures of patient success within 90 days of discharge.  In reality, consumers report that ARTC rarely makes any calls to patients after discharge.  This is NOT evidence-based and is a factor in overdose death.

7)  ARTC is supposed to maintain a drug-free environment.  In reality, consumers report that illicit drugs enter the facility in numerous ways and that very little is done to maintain a drug-free environment.  This is NOT evidence-based and is a factor in overdose death.

8)  ARTC is supposed to explain the consent for Release of Information to patients and their families.  In reality, this is rarely done.  When a patient does consent to release information to family members or advocates, consumers report that ARTC staff either does not comply with their wishes or coerces and pressures them into rescinding the agreement.  This is NOT evidence-based and is a factor in overdose death.

The hearing is on Oct 4, 2016 at 1:30, in Rockville.  Sign up to testify in opposition of "Declaration of No Further Need: Disposition of Avery Road Treatment Center" at the following website.  If you cannot attend, please write to all members of the Montgomery County Council, as well as Executive Isiah Leggett.  

Public hearing: 

Letters should include why you are opposing the 30 year lease with ARTC / Maryland Treatment Centers, pending resolution of consumer issues, and should include personal anecdotes if you have them.  

Please feel free to contact me with questions or concerns.  Thank you for your advocacy and participation in ensuring that patients with an often fatal behavioral health disorder get the highest quality of care possible.  


Friday, September 23, 2016

How Oxy was marketed to make billions & kill 78 people / day



Take a look at the attached article: --here are some highlights:

"The documents include internal Abbott and Purdue memos, as well as sales documents and marketing materials. They show that Abbott sales reps were instructed to downplay the threat of addiction with OxyContin and make other claims to doctors that had no scientific basis. The sales reps from the two companies closely coordinated their efforts, met regularly to strategize, and shared marketing materials."

“As you continue to carry the OxyContin banner onto the field of battle, it’s important to keep highlighting OxyContin benefits to your doctors,” Abbott urged its sales staff in a memo contained in the court records.

"But some of the benefits the sales reps were instructed to highlight lacked scientific support, and in some cases were similar to claims made by Purdue."

"In 2007, Purdue pleaded guilty to a criminal charge of misbranding OxyContin in an effort to mislead doctors and consumers. The company paid more than $600 million in fines."

A central charge in the US Department of Justice’s case was that Purdue “sales representatives falsely told some health care providers that OxyContin had less euphoric effect and less abuse potential than short-acting opioids.”

In an Abbott memo, sales staff were instructed that if a doctor was concerned about the euphoria a patient was experiencing on the shorter-acting painkiller Vicodin, they should tell the physician, “OxyContin has fewer such effects.”

Tuesday, July 26, 2016

Maryland Residents --SPEAK UP!

Comments on the FY 2017 Behavioral Health Plan

1)  Expansion of Pharmacological Treatment for SUD: Despite the fact that Objective 1.3. seeks to “Improve access and quality of services throughout the continuum of care” (p. 18), The Plan focuses only on Pharmacological treatments for SUD, without any mention of improved access and quality for ASAM 3.1 –3.7 levels of residential care for SUD patients.  While DHMH talks about expanding access to pharmacological medications (p.13 1-1D); working to reduce stigma surrounding Medication-Assisted Treatment (MAT) (p.56 7-1F); updating educational materials regarding research around MAT (p.56 7-1F); promoting MAT via media outlets (p.56 7-1F); implementing a campaign to change public perception of MAT as “medical treatment vs. drug substitution” (p.56 7-1F); and gaining physicians’ support for MAT (p.56 7-1F); DHMH has hog-tied Abstinence-Based Residential Treatment (ABRT) programs by failing to resolve the IMD exclusion dilemma for 3.5—3.7 (detox) level of care until 2017, and for 3.1 (halfway house) level of care until 2019.  ABRT programs typically use a finite buprenorphine taper and a structured therapeutic program which provides the patient with recovery supports to assist in abstinence maintenance. 

WE PROPOSE THAT DHMH support “Consumer Choice” by ensuring that individuals are able to access ALL paths to recovery, rather than using public money to support one path to recovery over another.  We also support an unbiased analysis of existing research and data by a consortium of stakeholders whose increased economic gain is in no way dependent upon the research outcomes.   

2)  Standards for Quality of CareWe wholeheartedly approve Goal IV. –“Utilize data and health information technology to evaluate, monitor, and improve the quality of service delivery and outcomes.”  The problem is that there is no mention of the development of universal quality standards for SUD programs, or a mechanism for resolving grievances when service delivery does not meet even basic logical assumptions for what standards and outcomes should be.  There are no enforcement provisions for sanctioning providers who do not provide even basic standards of care.  Consumers of SUD services throughout the state continue to experience grievous obstacles to their successful recovery that consumers of mental health services do not experience due to regulated protections.  This inequality is particularly obvious in the area of family engagement and support services, discharge planning, recovery support and housing, supportive recovery services in schools, involuntary commitment statutes, billable services, and program oversight. 

Consumers continue to report a serious lack of family engagement and support services in SUD programs which often contributes to or exacerbates family disconnection; premature discharges which lead to death; unregulated and predatory halfway house programs which contribute to the physical, mental and emotional abuse and subsequent trauma of patients; lack of even basic recovery supports in schools which leads to the relapse of young people; lack of the mental health equivalent of involuntary commitment which contributes to preventable overdose death; lack of a rich treatment milieu of billable ancillary services which contribute to wellness; and a severe lack of anything resembling a formalized patient grievance process with oversight or remedy provisions.  Additionally, patient referrals from one level of care to another level, based on an assessment per ASAM criteria, are haphazard and fractured at best.  Fatal overdose is currently the most frequent cause of unexpected death in Maryland.  The lack of a visible and formal plan, driven by stakeholder input, to raise quality of care in our treatment system continues to be increasingly irresponsible and unacceptable. 

WE PROPOSE THAT DHMH must do more than simply monitor for infectious diseases (p.42 4-2B), medication diversion (p.42 4-2C), and overdose death (p.42 4-2C).  These are very low standards.  DHMH must meet with consumers of services, their families, and other stakeholders to remedy the very serious and life-threatening problems outlined above.  In addition, we must work together to raise our program standards to ensure that those individuals with SUD have the supports they need to fully recover and engage in the same quality of life measures as anyone else.  Those measures include job, housing, family, recreational pursuits, health and wellness, and basically –HAPPINESS!

3)  Protecting Consumer ChoiceWhile DHMH seeks to “enhance the role and responsibilities of the Health Departments, Core Service Agencies, Local Addiction Authorities, and Local Behavioral Health Authorities as system managers to assure access to quality services” (p.17 1-2D), that cannot at the same time limit Consumer Choice.  While the only place in The Plan where County “referral agreements”, “Memorandum of Understanding (MOUs)”, and “collaboration with …community providers” is mentioned is in section (2-1G), SUD advocates are aware that many individuals with Medicaid, Medicare, or grant funding are told by local LAAs / LBHAs that they can only enter a “County-contracted” treatment program.  By the same token, individuals seeking treatment in areas of the state outside of their home counties are denied access to programs when their County-of-residence does not contract with that specific provider –even though their method of payment is public state dollars.  There is no other healthcare diagnosis where the County government is able to control or dictate which healthcare provider an individual chooses.  This system of county contracting through referral agreements, limits or in some cases, entirely removes Consumer Choice. 

WE PROPOSE THAT county LAAs/LBHAs are disallowed from developing referral agreements and MOUs with favored providers or else they develop these agreements with ALL providers in the state.  LAAs and LBHAs should be able to provide Maryland residents with a complete list of all providers in the state and the services they offer.  Furthermore, we suggest that Maryland enter into dialogs with surrounding states –particularly Pennsylvania, where there is an abundance of SUD programs without wait lists, and set up formal agreements to honor each other’s Medicaid and Medicare clients –similar to the pact entered into by several Northeast states in 2014.  This would go far to expand capacity until such a time as Maryland is able to expand its own in-state capacity to meet the demand for SUD treatment. 

4)   Credentialing Family Peer SupportWe applaud DHMH for implementing peer support credentialing in Maryland and hope this becomes a Medicaid billable service in the near future.  We are especially supportive of DHMH focus on “the development of peer supports specifically for special populations”, including families (p.58 7-2A) and its acknowledgement of the important role of “family participation on policy and planning committees across the state” (p.58 7-2A). 

In 2014, family peer support specialists affiliated with F.A.C.E. Addiction, provided thousands of Marylanders with parent-peer support and navigation services, as well as court advocacy and diversion support services.  They held family-peer support and bereavement groups, as well as Naloxone trainings throughout their communities.  They offered treatment scholarships, organized awareness and anti-stigma events, and served frequently as spokespeople for the media.  The Directors of these non-profits developed, implemented, managed and supervised this work themselves.  Since these volunteer leaders stepped in to fill a severe service gap in order to assist the state in quickly responding to the opioid dependence and overdose epidemic –there was no one to supervise them.  However, the requirement that they now complete 500 additional hours of “supervised” work before they can become eligible for peer certification is short-sighted and unfair. 

WE PROPOSE THAT DHMH work with family peer specialists to resolve this issue and accept proof of 500 hours of service regardless of that work being “supervised”. 

5)  Family Support Navigation SystemMany Maryland SUD advocates are confused by (7-2E) on page 61, regarding DHMH plans for “developing and implementing a family support navigation system to empower and inform families caring for youth, adolescents, and young adults facing challenges related to substance-use disorders”, since (as outlined above) this system has already been developed and implemented for more than ten years. 

Without any type of bid process, DHMH handed $350,000 to Maryland Coalition of Families for Children’s Mental Health (MCF), to “develop and implement” this system –which already exists.  MCF was charged with collaborating, cooperating, partnering, and sharing ideas, in an open and transparent dialog, with the already existing network of organizations across Maryland that provide support services to families with children challenged by SUD, in order to build upon and expand the existing system.  This collaborative process never occurred. 

For an extraordinarily high cost, the MCF proposal delivers only a quarter of the services that are currently being provided by the existing network on a very limited and much lower budget.  Based on their initial proposal (MCF was unwilling to share the final proposal), only 53% of public money was allocated for direct services provided by staff, while 47% was allocated to "infrastructure".  According to Charity Watch and other standards for non-profit spending, those allocations would earn a score of zero in rankings for being a good, fiscally responsible charity.  According to Charity Watch, 7 out of 10 charities spend 75% on services, and 9 out of 10 spend 65% on services.  

We are concerned that while F.A.C.E. Addiction’s member organizations either do not have enough Naloxone to continue training families, have exhausted scholarship funds that ensure that clients without funding options get into halfway house beds, and are operating on such a shoestring budget that their continued work is jeopardized, that more than $156,000 dollars of public money is going to MCF “infrastructure”, regardless of service deliverables or cost.  This was not the original intent of this grant. 

Based on the MCF preliminary proposal, here is how they are electing to spend public money to support 6 part-time staffing positions working from home:

$1,792 for bank service charges                                                   $10,000 for printing
$8,961 for office supplies                                                             $7,706 for telephone
$7,800 for rent/occupancy                                                            $9,800 for equipment expenses
$2,160 for program supplies                                                         $28,436 for overhead

Many advocates view these costs as grossly inflated and therefore an egregious misallocation of public money.  We need to see the existing proposal and discuss how best to deliver these services throughout the state in order for the Maryland taxpayer to maximize services.  Since the assumption is that taxpayer dollars should be spent for the greatest good of all, we have a problem with the lack of transparency and open competition with which this grant was awarded.  Competitive bidding in a market economy is the means by which costs are kept within reasonable bounds.  When $350,000 dollar contracts are simply handed to a contractor who provides reduced outputs at inflated and exorbitant costs, our entire Maryland economy suffers. 

WE PROPOSE THAT DHMH ensures that MCF honors the spirit of the agreement they made at the outset of this contract to:

  • Partner with the existing incorporated non-profit network of F.A.C.E. Addiction Maryland members and affiliates (and any other family organizations) in a mutually collaborative process to expand upon a family support and navigation service delivery system that already exists across the state;
  • Develop resource materials in collaboration with existing F.A.C.E. Addiction partners to promote services that are in the highest interest of families caring for children and young adults with SUD; 
  • Collaborate with F.A.C.E. Addiction members in dispersing the $350,000 public grant dollars in ways that will have the greatest impact on helping the greatest number of Maryland families who have been devastated by SUD.

6)  Including “the Voice” for SUD in Public PolicyThe Plan includes 77 Behavioral Health initiatives and lists the “involved parties” on each initiative.  Of those 77 initiatives, independent organizations (OOMD, NAMI, MCF, MHAMD) and others were listed as an “involved party” only 33 times.  “Other stakeholders” and/or “advocates”, including the Behavioral Health Advisory Council were listed as an “involved party” on only 12 initiatives.  “Consumers” of services were listed as an “involved party” only 12 times.  And “families” were listed as an “involved party” only 10 times.  Not one of the incorporated non-profit SUD family organizations was listed.  In order to understand how policy is working at the ground level, DHMH must support a feedback loop empowering the voice of those who actually utilize the services –directly, as patients, or indirectly as caregivers and/or family members of those patients. 

Additionally, section 7—1B (p.54) specifies that DHMH will “continue to provide support, funding, and ongoing consultation to Maryland’s behavioral health advocacy groups,” and lists MCF, MHAMD, NAMI MD, OOOMD (all four of the traditional mental health organizations), but fails to list F.A.C.E. Addiction (an incorporated non-profit network of SUD member organizations throughout the state).

WE PROPOSE THAT DHMH include F.A.C.E. Addiction Maryland and/or any of its affiliated member organizations in all initiatives which impact them –so that a recovery peer or a family member impacted by SUD has the opportunity to participate in any policy which effects their lives –either directly as consumers or indirectly as caregivers of their consumer children.  In addition, we must have a representative that we select to “participate in oversight of the Consumer Quality Team (CQT) project for statewide expansion”.  (p.44, 4-2G)

WE ALSO PROPOSE that DHMH add “September is Recovery Month” to the bulleted list of initiatives to promote (perhaps following “May is Mental Health Month”) in section 7—1B (p.54). 

7)  Family Peer Support in Hospital ERsWe applaud DHMH’s provision for “peer support specialists and local outreach workers providing support, information, and referrals to treatment for individuals who are saved from an overdose …in hospital emergency departments.”  (p.28, 2-2C)  However, for teens and young adults –particularly those who live with their parents, it is the parent caregiver who is often instrumental in facilitating a young adult’s entry into treatment and also the most influential in supporting the teen or young adult in their recovery. 

WE PROPOSE THAT family members in the Emergency Department assisting a loved one should also be offered the opportunity for family-peer support. 

8)  Striving for Fully Integrated ModelsThe Center for Mental Health Services reveals that nearly 43% of youth who receive mental health services have been diagnosed with a co-occurring substance use disorder.  Some diagnoses have particularly high correlations, including post-traumatic stress disorder (85-90%), antisocial personality disorder (82%), bipolar disorder (71%), and schizophrenia (50%).  Adolescents with a conduct disorder, oppositional defiant disorder or attention deficit disorder are up to 7 times more likely to have a substance use disorder, while adolescents with depression are 4 times more likely to use substances. Given the high prevalence of SUD among individuals with a mental health disorder, DHMH must ensure that the “First Episode Psychosis model” provides detox protocol for accepting “youth and young adults who are within two years of initial onset of psychotic symptoms” who also have a co-occurring SUD.  (p.30, 2-3B)

WE PROPOSE THAT after approximately six years of integration planning, that any service, study, or model developed MUST be completely and fully integrated. 

9)   Justice System DiversionWe are in full support of DHMH efforts to “provide technical assistance and training to providers who serve individuals residing in the community who are in the court or corrections system,” particularly “judges, attorneys, law enforcement, and correctional professionals engaged with consumers of behavioral health services.”  (p.51, 6-2A) 

WE PROPOSE THAT mental health and SUD assessments are provided for all incarcerated offenders.  We suggest that all justice system professionals are trained in diversion measures, in order to alleviate the severe backlog of inmates awaiting 8-507 placements, or sitting in jails as a result of an untreated SUD or other mental health disorder at the expense of Maryland taxpayers. 

10)  Referral HotlineWhile “a statewide hotline to obtain a referral to treatment resources” is a great idea, when callers are given false or misleading information it is harmful to consumers or their caregivers who are likely in crisis due to their inability to locate treatment.  Giving them inaccurate information adds to their distress and utilizes precious time that could have been spent seeking valid and accurate information.  When advocates tested the hotline –repeating the test several times, we found that the information was accurate only 2 out of 11 times.  To test the hotline, advocates posed as parents seeking detox for a chronic intravenous heroin-using adult-age child.  They were given referrals to hospitals that did not provide opiate detox, to halfway houses that only accepted post-detox patients, to counseling centers without detox, and to residential housing providers. 

WE PROPOSE THAT call center staff is better trained to provide valid information, or that they refer callers to trained peer support specialists who only provide accurate and credible information regarding treatment options to callers. 

11)  Oversight for LDAACsWhile we applaud DHMH oversight of local Core Service Agencies and Behavioral Health Authorities via quarterly monitoring (p.43, 4-2D), DHMH must also have jurisdiction over the entire system of statewide information gathering in order to implement good policy that works.  Oversight and monitoring must begin with the Local Mental Health Advisory Committees and the Local Drug & Alcohol Advisory Councils (LDAACs).  Advocates and stakeholders in various counties report that LDAACs are easily hijacked by special interests, including specific providers or agency officers, and valuable stakeholder input is disallowed if it is perceived as reflecting negatively on the County Health Department or a specific contractor.  Therefore, DHMH does not receive the information from the local level that is reflective of the needs of the community.  When policy makers do not have the information they need to make good policy decisions, the Maryland constituency is ultimately harmed. 

WE PROPOSE THAT DHMH must devise a process for resolving conflicts between groups of stakeholders and LDAACs to ensure that these Councils are welcoming and inclusive of all divergent interests and competing issues.  In order to get accurate feedback regarding community needs, there must be an equal opportunity for community stakeholders to participate.  Consumer issues that conflict with local providers or agency agendas must not only be allowed, but equally and impartially weighed.  Stakeholder complaints involving the inability to bring valid and prove-able local issues to the table must be taken seriously by DHMH. 

Monday, July 4, 2016


The time is now!
On Wednesday, July 6, the full U.S. House of Representatives will vote on HR2646, the Helping Families in Mental Health Crisis Act.

Call your Congressional Representative on Tues, July 5

Say you are a constituent and ask that your representative:
VOTE YES ON 2646, the Helping Families in Mental Health Crisis Bill, when in comes to a vote on the floor of the House.  
Call (202) 224-3121 , Press #2
Enter in your zip code

Also send an email (as soon as possible) to your representative with the same message.
To find your representative go to
Clink on the representative (not senator) to go to their web page.
Clink on contact on the representatives web page to send an email.


The voting is currently scheduled for 2:00pm on Wed, July 6, with discussion and any new proposed amendments before the time.  (I don't know what time that will start.)

It should be available live for view on the computer. Go to:

If you are interested in attending the voting session, you must call your representative's office to ask for a gallery pass, which you can pick up at their office the day of the vote.  I do not think our attendance will have much influence on the vote since we are in the balcony and the legislators are not facing us.  However, feel free to attend if you are interested.

Thanks for all your advocacy that has gotten us this far!!!

Best, Evelyn & Lisa

Saturday, May 28, 2016



Re:  1115 Waiver Renewal Initiative

Thanks to our legislators and stakeholders who worked to pass the Parity Compliance in Medicaid Bill (SB 899/HB 1217) supporting MD Medicaid/Medicare compliance with federal parity laws.  MD Department of Health & Mental Hygiene (DHMH) is now applying to Centers for Medicaid & Medicare Services (CMS) for a waiver to allow Medicaid/Medicare funds to cover the continuum of substance use disorder (SUD) services, INCLUDING RESIDENTIAL TREATMENT.  

Their current plan is to cover up to (2) non-consecutive 30 day stays at a 3.3 -- 3.7 level of care (detox) within a calendar year, effective July, 2017.  Then they plan to phase in coverage for level 3.1 (halfway house) by July, 2019.  

They are accepting stakeholder comments until this Tuesday, May 31st (see link below).  Please write a letter to let DHMH know that we cannot wait for three years for coverage for the full continuum of care --detox through halfway house (at least 90 days).  

The consistent message throughout the stakeholder community needs to be that MD Medicaid/Medicare needs to fund detox, plus at least 90 days residential treatment, by July 2017, in order to IMMEDIATELY address the rapidly rising overdose death rate.  Our loved ones need access to life-saving treatment when they want it, for as long as they need it.  This is a healthcare and budgetary crisis.  129 Americans die each day as a result of a fatal overdose --and approximately 3 of them are Marylanders!  

We cannot wait three more years for treatment that works!  

Please send all correspondence to: by Tuesday, May 31st.  Include your name, email and/or phone number.  

Thanks, Lisa

Lisa Lowe
Heroin Action Coalition

Thursday, March 24, 2016

Barriers to Recovery

Question: Why do some people recover from substance use disorders after treatment while others struggle and relapse?

Answer: This complicated question has perplexed people for a very long time. Even in this modern era, it is hard to answer the question with precision. While the American Medical Association considers substance use disorders as chronic diseases, and they are leading causes of death in the U.S., there is significantly less research conducted on treatment outcomes of these disorders when compared to other chronic conditions like heart disease and diabetes. Like most chronic conditions, many factors contribute to whether or not a person will experience a good recovery outcome. These factors interact with one another in complex ways. Here are a few factors to consider:

1) Severity of the substance use disorder (SUD) - Some people have more severe symptoms of addiction (i.e., craving, compulsion, mood instability, cognitive difficulties, dysphoria, and irritability). Functional changes in the brain cause these symptoms. Scientists have developed several medications to treat some of the more distressing symptoms, which continue even after substance use ends. Studies suggest that genetics can affect whether a person is likely to develop a SUD and the severity of the of course of the illness, but this is only a piece of the puzzle.

2) Co-occurring mental health conditions - People who have both mental health conditions and SUD experience worse outcomes with both conditions.

3) Lack of access to quality services - Most people with SUD will need an array of services to help support them as they recover from their condition. In addition to treatment, people may need help with finding and keeping housing, health care, employment, counseling, and recovery support.

4) Connection - People with fewer social connections and meaningful roles in the community tend to have more difficulty with recovery. Conversely, evidence shows that having significant connections to family, friends, and colleagues supports recovery. 

5) Level of stress - High level of daily stress is correlated with high rates of relapse.

These factors may explain why some people have a more difficulty recovering from substance use disorders. An ideal services system should include elements that address all of these factors; treatment to address distressing symptoms of substance use and mental disorders, opportunities to learn strategies for managing stress, making connections to others, meaningful activities, and interventions that serve to lift people out of poverty.

Author: Dr. Cheryl Gagne, posted in BRSS TACS March Monthly Update, 3/21/16