John Oliver VS Big Pharma
This is definitely not the first time John Oliver has taken on Big Pharma and the issues with the opioid crisis in America. In fact, at the start of this recent segment, he acknowledges his previous episode before setting his focus on the changes since then, or lack thereof. On another hard-hitting episode of Last Week Tonight the well-known English comedic commentator takes on the Sackler Family, Mckesson Corporation, and the failed attempts to curb the influx of prescription opioids into an already volatile environment.
A Comedian on a Mission
As a writer for The Daily Show With Jon Stewart John Oliver won an Emmy for his work with taking a comedic yet impactful look into important political and social issues. As a host on his own HBO series, Last Week Tonight, Oliver has made a name for himself by taking deeper dives into the details of certain issues. Each moment of troubling truth or eye-opening examination is balanced with jokes that are either intensely ironic or ridiculously abstract. For instance, in this latest episode, Oliver steps off the serious discussion of Big Pharma corruption to deliver a few bits about the true nature of bears, with comical and cartoon-ish visual aids.
Moreover, Oliver tends to deliver some relatively detailed arguments, regardless of the topic at hand. While some may consider him a more liberal voice in the media, with open criticism of the Trump administration and other prominent conservative voices, he also criticizes other media outlets also considered to be more liberal. Recently, we questioned CNN for their coverage on the arrest of Julian Assange.
Needless to say, his take on the opioid crisis is a sound and even hilarious dissection of everything wrong with Big Pharma and the policies that allowed them to flourish.
Taking on Distributors
First, Oliver took on companies that are responsible for dispensing drugs from manufacturers to hospitals and pharmacies. These companies are supposed to alert authorities in the event that they notice suspicious quantities of control substances being ordered. However, several have been called out in recent years for failure to fulfill that responsibility.
John Oliver begins his take on distributors by talking about the story of Kermit, West Virginia. In the year 2016, more than 3 million doses of hydrocodone were ordered in one year, by just one pharmacist, in a city of only 400 people. That is around 7,500 doses for every resident!
For some background, McKesson Corporation is an American pharmaceutical distributor based out of San Francisco. In 2018, the company revenues were counted at $208.4 billion. In 2008, the DEA claimed that McKesson had failed to properly control their controlled substances. At the time, the Big Pharma distributor was allowed to avoid any admittance of wrongdoing as long as they agreed to pay a fine of $13,250,000. They were also required to develop and implement a controlled drug monitoring program.
However, by many accounts, McKesson failed to live up to that pledge. Oliver points out that one DEA agent wrote of the company:
“Their bad acts continued and escalated to a level of egregiousness not seen before.”
John Oliver points out how the strategy of expecting pharmaceutical companies to monitor themselves seems to consistently fall short of effective. In the case of Kermit, the McKesson Corp was responsible for distributing over 5 million doses of opioids in only two years.
In 2017, McKesson ended up having to make another settlement of $150 million. However, as Oliver points out,
“Which yes, sounds like a lot… until you realize that it is less than 1/1,000th of their revenue for one year.”
Which brings around Oliver’s point about how companies who profit from the opioid crisis are dealt with. He notes that for Big Pharma giants like McKesson, paying a fine is “just the cost of doing business.”
Trouble for Purdue Pharma
Kicking off the piece of the segment about the infamous opioid empire of Purdue Pharma, Oliver notes the history of Purdue’s aggressive and egregious marketing tactics for OxyContin. The company faced massive backlash after years of marketing the opioid painkiller as a less addictive painkiller that was safe to use for the treatment of common conditions like backaches.
Here, Oliver hits us with one of the clever comparisons, reminding us that once upon a time companies used to marketing cocaine for toothaches.
Next, Oliver takes on the Sackler Family, citing a 2017 article from The New Yorker stating the family has a collective net worth of $13 billion. As the battle against corporations tied to the opioid crisis intensifies, this family name has been pulled into the fray with protests and lawsuits calling out their involvement in Purdue Pharma’s business plan. On Last Week Tonight, Oliver also takes a look at one individual from the Sackler Family in particular.
Actors Try on Richard Sackler
Richard served as President of Purdue Pharmaceuticals from 1999 to 2003 and spent several years on the board with seven other members of the family. Overall, he was with the company throughout the opioid crisis. Richard Sackler is named in several lawsuits brought by different states.
In Massachusetts, one lawsuit asserts that Richard demanded to be sent into the field with sales reps on visits to doctors. This is something John Oliver believes is in correlation with a very specific purpose. He cites statements made by Richard at a company event that the launch of OxyContin would be followed by “a blizzard of prescriptions that will bury the competition.”
Even as the imminent threat presented by OxyContin became apparent, Oliver adds that Richard Sackler pushed forward with this attitude of selling more opioids, with very little concern for the impact. In an attempt to make the points of this segment feel more meaningful, John Oliver even enlists the help of several actors to deliver quotes attributed to Richard Sackler.
First, there is the American actor and 1989 Batman, Michael Keaton. Oliver points out that when evidence was mounting that OxyContin was causing widespread addiction, Sackler urged the company to blame people suffering from addiction to take the focus off of their product. When quoting the actual words of Sackler, the amazing Michael Keaton states:
“We have to hammer on the abusers in every way possible. They are the culprits and the problem. They are reckless criminals.”
Here John Oliver acknowledges that the Sacklers and Purdue vigorously deny these claims. They insist that these quotes are being taken out of context and that they did not cause the opioid crisis.
Probably one of the most troubling revelations to come from the segment is Oliver’s argument that the Sackler family has fought hard to avoid true transparency regarding their involvement in the opioid crisis. More specifically, how the company has settled many of the lawsuits against them by demanding the stipulation that evidence is sealed and unavailable to the public. For instance, one lawsuit against Kentucky was settled on the condition that the states Attorney General destroy 17 million pages of documents pertaining to the allegations against Purdue.
A leak from this case actually included the transcript from a video deposition with Richard Sackler. While the video itself is unavailable, John Oliver again found a way to make a powerful statement by having Breaking Bad star Bryan Cranston get in on the action. Suffice it to say, the dramatization of that interview does not play very well for the Sackler in question. One part they highlight was a speech given by Sackler supposedly bragging about how quickly they had gotten the DEA to approve OxyContin. And as Oliver says, Cranston goes “full Walter White” on this video.
The segment also enlists Michael K. Williams, who famously portrayed Omar Devone Little on The Wire, to give an intense reading of the transcript. And finally, Richard Kind from Spin City and A Bug’s Life gave some goofy “I don’t know” answers from the over 100 times it was mentioned in the real deposition.
At the end of the day, John Oliver and Last Week Tonight make a call for transparency with Big Pharma companies. He acknowledges that while his show tries to find some way to laugh through the pain of the opioid crisis, it is important that more be done to hold opioid makers and distributors accountable. This seems to be a growing sentiment, as the Sacklers prepare to face numerous lawsuits. More lawmakers, public health officials, and advocacy groups are calling for transparency and culpability for any business that profited from the opioid crisis. Meanwhile, the fight against addiction and overdose death rates continues.
For those who are struggling, comprehensive addiction treatment is a vital resource to overcoming opioid addiction. If you or someone you love is suffering, please call toll-free now. We want to help.
CALL NOW 1-888-922-5398
Help for Today, Hope for Tomorrow
While the first of April is typically reserved for pranks and practical jokes, the rest of the month is also for some more serious observances. One of those being Alcohol Awareness Month. For the year 2019, the focus is underage drinking, and reports show the theme is “Help for Today, Hope for Tomorrow.” The hope is that we can take this chance to spread education to young people about the dangers of alcohol abuse, and share ways to get help.
Despite the fact that most of the headlines these days focus on the opioid crisis, alcohol abuse and addiction continue to rise all over the country. While alcohol may not be as notorious today as fentanyl or heroin, death rates relating to alcohol are still staggering, and the health problems associated with excessive alcohol use are steadily growing.
Risks of Underage Drinking
Underage drinking is one of the most important issues we face when talking about alcohol abuse. Despite the fact the is it illegal for people under 21 years old to consume alcohol, people aged 12 to 20 years actually drink 11% of all alcohol consumed in the United States.
Not to mention, underage drinkers on average consume more drinks per occasion than adult drinkers. So it is no surprise that 90% of alcohol consumed by underage drinkers meets the criteria of binge-drinking.
According to a 2017 Youth Risk Behavior Survey of high school students, during the past 30 days:
- 30% report drinking some amount of alcohol
- 14% binge drank
- 6% admit to driving after drinking alcohol
- 17% admit to riding with a driver who had been drinking
Every year, approximately 6,500 people age 21 and under die due to alcohol-related accidents. Many of these young people are not even drinking themselves. Another nationwide survey in 2017, the Monitoring the Future Survey, shows that:
- 8% of 8th graders admit to drinking in the past 30 days
- 2% of 8th graders admit to binge-drinking in the past 30 days
- 33% of 12th graders admit to drinking in the past 30 days
- 19% of 12th graders admit to binge-drinking in the past 30 days
For parents, these statistics can be unsettling, to say the least. While most parents want to believe that their kids are the exception to the rule, it is still vital that families talk about the risks of alcohol use, binge-drinking, and drunk driving.
According to the Center for Disease Control and Prevention (CDC), there is a range of severe side-effects relating to underage drinking, including:
- Memory problems
- Changes in brain development
- Trouble at school, such as poor grades or increased absences
- Social problems, like fighting or lack of participation in youth activities
- Legal issues relating to drinking
- Hangovers and other physical illnesses
- Disruption of normal growth and sexual development
- Unwanted, unplanned, and unprotected sexual activity
- Physical and sexual assault
- Higher risk of depression and suicide
- Abusing other drugs
- Death due to alcohol poisoning
For underage drinkers, the risk of experiencing these issues is far greater for those who participate in binge-drinking. Additionally, those who engage in excessive drinking earlier in life are more likely to develop alcohol use disorder later on.
History of Alcohol Awareness Month
Firstly, we believe it is important to acknowledge the history of Alcohol Awareness Month. The annual observance was first established back in 1987, created to reduce the stigma of alcoholism and support local communities in their efforts to address alcohol-related issues.
The program began with the intention of targeting college-age students. Many young people at the point in life tend to drink too much as part of their independence. Meanwhile, many parents mistakenly shrug excessive alcohol use off as a ‘rite of passage’ for young people. However, the true nature of their drinking can be far more dangerous.
Over the last several decades, alcohol abuse among teens has not gone away. That is why Alcohol Awareness Month is just as important today as it was the day it began.
Defining Alcohol Use Disorder
Since the conversation around alcohol awareness will frequently reference alcohol use disorder, it is also important to establish a clear definition of AUD. The National Institute on Alcohol Abuse and Alcoholism (NIDAA) defines alcohol use disorder as:
“A chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using.”
Furthermore, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in May of 2013 made some updates to the diagnostic criteria. Some of the symptoms of Alcohol Use Disorder listed in the DSM-5 include, but are not limited to:
- Periods of drinking more, or longer, than you intended
- More than once wanted to cut down or stop drinking, or tried to, but couldn’t
- Spend a lot of time drinking, being sick, or getting over the aftereffects
- Wanting to drink so badly you could not think of anything else
- Drinking, or being sick from drinking, often interferes with taking care of responsibilities
- Continued drinking despite causing problems with family or friends
- Needing to drink more than usual for the same effects
- Giving up important or pleasurable activities in order to drink
It also categorizes AUD with different levels of severity, including:
- Mild– the presence of 2 to 3 symptoms
- Moderate– the presence of 4 to 5 symptoms
- Severe– the presence of 6 or more symptoms
Alcohol use disorder is incredibly dangerous, and the withdrawals can range from uncomfortable to life-threatening for those with severe physical dependence. That is why it is critical for those who struggle with alcohol use disorder to seek out a safe medical detox when trying to quit drinking.
It is true that one of the most devastating drug epidemics in America is the opioid crisis. However, one could argue that an alcohol epidemic just as pervasive and devastating has been happening in the background. While it may be different because it is legal and far more socially acceptable, alcohol is behind staggering numbers of deaths across the country. Likewise, alcohol use and abuse are far more prominent than most people realize.
Needless to say, one of those ever-important alcohol-related issues is the prevalence of underage drinking. Just a few years ago in 2015, the National Survey on Drug Use and Health (NSDUH) conducted a number of studies. According to the data:
- 623,000 adolescents between 12 and 17 years old fit the criteria for alcohol use disorder (AUD)
- Over 15 million adults age 18 and older suffered from AUD
- 8 million of them were men
- 3 million were women
Overall, approximately 88,000 people die from alcohol-related causes every single year. To put that in perspective, 70,200 people died due to drug overdose deaths in 2017.
The alcohol epidemic also contributes to other serious issues around the world, including:
- Domestic abuse
- Sexual assault
- Violent crimes
- Driving fatalities
Needless to say, if we look at alcohol the way we look at most drugs, we’d probably see these statistics a lot differently. The alcohol epidemic is all around us. Every year tens of thousands of people are losing their lives, but because we see beer commercials on television and drive past liquor stores every day we don’t realize how serious it is.
Alcohol Awareness Month is also about shedding some light on this tragic reality in hopes that we can turn it around.
Increases in Alcohol Illness and Death
In addition to alcohol abuse and AUD, there are a number of health concerns that arise from excessive and prolonged alcohol use. In fact, some researchers have noticed an influx of alcohol-related health programs, including:
- A 40% spike in alcohol-related liver disease
- 60% spike in drinking-related emergency room visits
Some have even attributed these new rates to an increase in the potency of some alcoholic beverages. During Alcohol Awareness Month, we should also bring attention to the multitude of serious health risks associated with the substance. Some of the most common health problems associated with alcohol use include:
Excessive drinking can cause lower numbers of oxygen-carrying red blood cells. This condition, commonly known as anemia, can create a variety of symptoms, including:
- Shortness of breath
Heavy drinking, especially binge-drinking, can cause blood pressure to surge. Over time, this effect can become chronic and lead to other serious health issues, such as:
- Kidney disease
- Heart disease
According to the American Heart Association, 1 in every 3 deaths is related to cardiovascular disease. The AHA states that on average, 1 American dies every 40 seconds from cardiovascular disease. Furthermore, excessive alcohol use is one common factor that leads to an elevated risk of heart disease.
Physicians and scientists agree that habitual drinking increases the risk of cancer. Most believe this risk comes from the body converting alcohol into acetaldehyde. Cancer sites frequently attributed to alcohol use include:
Cancer risk is only further exacerbated by tobacco use.
Alcohol is toxic to liver cells. As a result, heavy drinkers often develop cirrhosis. With this condition, the liver is so heavily scarred that it is unable to function, which can be lethal.
On one hand, heavy alcohol consumption can actually cause epilepsy. Conversely, it can also trigger seizures in people who don’t have epilepsy or interfere with medications used to treat convulsions.
Addressing Underage Drinking
In order to address underage drinking, families, and communities have to work together to spread education and prevention. Alcohol Awareness Month helps highlight these efforts and bring the conversation to the forefront. Not only does this mean promoting prevention for young people, but also offering treatment opportunities for those in need.
Reducing underage drinking means community-based efforts to monitor the activities of youth and decrease youth access to alcohol. Alcohol Awareness Month also promotes additional prevention strategies, such as:
- Enforcement of minimum legal drinking age laws
- National media campaigns targeting youth and adults
- Increasing alcohol excise taxes
- Reducing youth exposure to alcohol advertising
- Development of comprehensive community-based programs
With alcohol use disorder being such a significant aspect of this issue, it is crucial that young adults and their families understand the importance of comprehensive alcohol addiction treatment. Not only is it the safest and most effective way to safely discontinue alcohol use, but a personalized treatment program can help an individual establish a strong foundation for continued recovery. Long-term sobriety is about more than just surviving the physical withdrawals and health problems. Recovery is also about developing the life skills and coping mechanisms that support a healthy lifestyle beyond addiction.
For over 20 years, Palm Healthcare Company facilities have provided the best in comprehensive treatment opportunities for those struggling with alcohol use disorder. If you or someone you love is struggling, do not wait. Please call toll-free now. We want to help.
CALL NOW 1-888-922-5398
The Cannabidiol and CVS Collaboration
Cannabidiol (CBD) and other cannabis-based products continue to become more mainstream as time goes on, and more conventional franchises seem to be embracing this wave of merchandising. Recently, the CEO of Whole Foods, the only USDA Certified Organic grocer in the United States, said he would be happy to sell cannabis supplements in his stores. Across America, legalization movements continue to build momentum. Meanwhile, commercial industries are starting to take advantage of the new market. So, of course, it was only a matter of time before a nationwide pharmacy chain like CVS got in on the action. Soon, a line of topical products derived from cannabis will be available for purchase in eight states in 800 CVS locations.
Working with Curaleaf Holdings
CVS is the largest pharmacy chain in the country, with over 9,900 locations all over the nation. Now, the company well-known for providing convenience store services while filling prescriptions will also carry cannabis-derived CBD products. The company has entered a deal with a cannabis retailer Curaleaf Holdings. For some background, Curaleaf operates 40 cannabis dispensaries in 12 states. As a result, reports indicate stock for Curaleaf spiked as high as 20% the day this deal was announced.
Joseph Lusardi, the CEO of Curaleaf, tells investors he hopes to see the number of CVS stores carrying these products to increase even more. For now, Curaleaf’s CBD products will be sold in CVS stores in:
Out of these states, only California and Colorado have legalized recreational cannabis. Maryland and Illinois have medical marijuana laws, but the other four states still prohibit both. Lusardi adds that Curaleaf is also in the process of establishing similar deals with other large consumer states around the country.
Larry Merlo, CVS Health CEO, made comments about the decision during an interview with CNBC. Merlo explained that for a while, the company has been receiving requests for CBD products. It seems not the pharmacy chain is willing to take a step toward meeting that demand. In the interview Merlo said,
“Anecdotally, we’ve heard from our customers that have used those products that, gee, it’s helped with pain relief for arthritis and other ailments.”
Mike DeAngelis, a spokesman for CVS Health, said in a statement that the stores will not carry any CBD-infused edibles, as it is illegal to introduce ingredients like CBD into the food supply or to market them as dietary supplements. For now, the Food and Drug Administration (FDA) still regards CBD as an illegal substance under federal law. Therefore, it remains banned from use in foods and beverages.
Still, the retailer maintains that it will be selling CBD products in accordance with the law. In a recent statement, the company said that it has “partnered with CBD product manufacturers that are complying with applicable laws and that meet CVS’s high standards for quality.”
It seems that CVS is taking that commitment to quality CBD products very seriously. In order to assure accurate labeling and safety for customers, CVS found a partner in Eurofins, a third-party laboratory that tests CBD topical products for:
- Tetrahydrocannabinol (THC)
- CBD content
- Other contaminants
CVS also saw a significant jump in stock prices following the announcement.
Ironically, the rival drug store chain Walgreens announced the following week that is will also be carrying CBD products. Not one to be outdone, Walgreens seemed to one-up CVS, saying nearly 1,500 of their stores will be selling similar products.
CBD Products Becoming More Popular
From a business perspective, capitalizing on the growing popularity of CBD products seems like a no-brainer. New projections for the CBD market size are becoming increasingly more optimistic. According to a new analysis by Cowen & Co., the global CBD market could reach up to $16 billion by the year 2025. With all these new deals going through, the budding industry seems well on its way.
Back in January, Cowen’s survey of approximately 2,500 adults determined:
- Nearly 7% of Americans are using CBD as a supplement
- CBD use is most common among people aged 18 to 34
- 44% of the CBD market is from CBD tinctures
- 26% of the CBD market is topical products
- 22% of the CBD market is attributed to capsules
- 19% of CBD market is beverages
Furthermore, Cowen says the use of CBD products will likely continue to grow. Yet, in the face of growing popularity, CBD still faces mild controversy. Many argue that cannabidiol is still in the legal grey area that makes it hard for the market to reach its potential.
Is the Cannabidiol Industry Good or Bad?
Meanwhile, two very different schools of thought battle over the safety of such a position on CBD. Some still believe that allowing CBD products to become acceptable in society will only encourage further drug use. On the other hand, advocates think that CBD could even be used to treat substance use disorder and other underlying conditions that lead to drug abuse. In the midst of the opioid crisis, some even assert that CBD could be used to treat opioid addiction.
For now, many experts believe there is still a need for more data to determine what CBD products can actually help treat. While some retailers make a lot of claims about their products, others argue that there is not enough evidence to support a lot of these claims. In order for the cannabidiol industry to become legitimate, it might still need to go through a period of growth and exploration.
Therefore, for now, there is still more to learn about how CBD could impact individuals struggling with addiction, for better or for worse.
Despite the fact that CBD and cannabis products are becoming increasingly accepted, it is still possible there are risks for those who struggle with substance use disorder. As with most medications, what is appropriate for some may not be appropriate for everyone. Those who continue to struggle with substance abuse have better chances of building a foundation for lasting recovery through comprehensive addiction treatment. Palm Healthcare Company believes in providing quality treatment options at all levels of care, and we want to help you or your loved one create a life worth being clean and sober for. If your or someone you love is struggling, please call toll-free now. We want to help.
CALL NOW 1-888-922-5398
Physical Health is Important to Lasting Recovery
There is no doubt that substance use disorder has a dramatic impact on health. Physical, mental and emotional well-being always suffer when an individual becomes dangerously dependent on harmful substances. Drugs and alcohol have a variety of adverse effects on the body, ranging from painful withdrawal symptoms to lasting impairment of vital organs. Therefore, it should not come as a surprise that patients recovering from addiction often suffer from chronic health conditions.
Now, a new study published in the Journal of Addiction Medicine suggests that more than one-third of people recovering from addiction continue to suffer from a physical disease.
Studying Chronic Health Conditions in Addiction Recovery
Researchers from the Massachusetts General Hospital (MGH) Recovery Research Institute are the first to examine the national prevalence of medical conditions typically created or magnified by chronic and excessive use of drugs or alcohol. The data in the study comes from a nationally representative sample of more than 2,000 American adults. Each of these individuals described themselves as recovering from a range of substance issues, including:
Researchers then looked for the presence of diseases known to be exacerbated by drugs and alcohol, such as:
- Liver disease
- Heart disease
- Sexually transmitted infections (STIs)
- Hepatitis C
- Chronic obstructive pulmonary disease (COPD)
What they found was that out of all the adults recovering from substance abuse issues, 37% of them had been diagnosed with one or more of these nine conditions.
Additionally, researchers conclude that significant reductions in the participants’ quality of life connect to these conditions. Not to mention, researchers note that each of these health problems is known to reduce life expectancy.
Trends Relating to Different Drugs
When looking at the details of the data, there are a few trends that stand out. For instance, when compared to the general population, individuals in recovery have much higher levels of:
- Hepatitis C
- Heart disease
And in many cases, certain diseases more often correlate with certain substances. For example:
Rates of this condition were significantly higher for those recovering from opioids or stimulants than those recovering from alcohol.
HIV/AIDS and STIs
Lifetime prevalence of these health conditions was significantly higher in the group of people recovering from stimulant abuse than in the alcohol group.
The lowest rates of this condition were actually found in individuals recovering from opioid addiction.
This health problem was discovered to be least common for those reporting cannabis as their primary substance issue
Multiple Chronic Conditions
The odds of experiencing two or more chronic physical diseases were increased by 4%- 7% due to certain factors, such as:
- Each additional substance used 10 times or more
- Older age at onset of diseases
- Resolving alcohol or drug problems later in life
Reduced Rates of Disease
Researchers also note a few elements that appear to coincide with reduced rates of physical diseases. In general, such factors include being:
There were also social stability and economic factors linked to lower rates of physical disease for those recovering from substance abuse, including:
- Having a household income greater than $50,000
- Higher education
- Being Employed
- Married or living with a partner
Some of these may be a bit of a surprise, especially considering that women are typically considered more susceptible to serious health problems associated with substance abuse.
Highlighting the Importance of Health in Recovery
According to the researchers, this study is important to a larger conversation about the quality of life for those in recovery from addiction. The lead and corresponding author David Eddie, Ph.D., research scientist at the Recovery Research Institute is an MGH clinical psychologist and an instructor in Psychology at Harvard Medical School. He states,
“We’ve known for a long time that chronic and heavy substance use can cause a multitude of diseases directly and indirectly – The extent to which these diseases and health conditions continue to persist for the millions of Americans who achieve recovery remains to be clarified, but this study highlights the fact that these negative impacts may continue to affect quality of life even when people achieve addiction recovery.”
Eddie believes it is important to appreciate that even those who overcome their issues with substance use disorder and drug dependence still face real physical diseases. In some cases, men and women who manage to finally make progress away from abusing drugs or alcohol still have to live the rest of their lives with other life-altering conditions. If the evidence points toward a better chance at young people and those with a shorter history of drug use being able to avoid chronic illness, then, of course, more effort should be put toward early intervention. Eddie adds,
“In addition, addiction treatment needs to be more seamlessly integrated with primary health care, and more research is needed to explore the complex relationships between alcohol and other drug use and physical disease.”
Moreover, this would further support the idea that we must address addiction as a public health issue. If we want to effectively address not only substance abuse but the long-term adverse effects of drugs and alcohol, we have to offer more comprehensive treatment options.
Part of building a healthy and effective foundation for recovery is a personalized treatment plan. Every individual is unique, and each person struggling with substance use disorder faces different challenges. That is why Palm Healthcare Company believes in providing customized and comprehensive care to every client. From medical detox resources to medication management and nutrition, we believe better health and well-being make lasting recovery possible. If you or someone you love is struggling, please call toll-free now. We want to help.
CALL NOW 1-888-922-5398
Discrimination Through Denial of Coverage
Health insurance is probably going to be one of the great debates of this period in American history. There is already plenty of contention about how to properly provide coverage for those who need it. Some claim the changes made in the last decade have gone too far. Others argue it has not gone nearly far enough. Healthcare reform is a hot button issue in our world today. Needless to say, a big part of this conversation has to do with parity coverage for mental health. Now a new landmark court ruling is going to make a monumental difference for mental health and addiction treatment insurance coverage.
Simply put, the largest behavioral health care company in America has been denying coverage to some of its most vulnerable members to save money. And now, a federal court decision may put more of a spotlight on insurance companies.
Wit v. United Behavioral Health
The case was brought in front of a federal court in Northern California against United Behavioral Health (UBH). UBH is a company that manages behavioral health services for UnitedHealthcare and other health insurers. The court found that UBH denied claims of tens of thousands of people seeking mental health and substance use disorder treatment. The company was using defective medical review criteria in order to reject claims.
In Wit v. UBH, over 50,000 individuals were reportedly denied coverage based on the flawed review criteria. 11 plaintiffs sued UBH on the behalf of these victims. One victim, in particular, is Natasha Wit. Natasha had been seeking treatment for several chronic conditions, including:
Wit was repeatedly denied coverage for her treatment, despite the fact she did have healthcare benefits that should have offered coverage. Her family ended up paying out nearly $30,000 for treatment. And they are just one of the thousands of families to face the same discrimination.
Looking at the Marks Against UBH
According to recent reports, United Behavioral Health has been failing its members in more ways than one.
Federal courts determined that UBH developed internal guidelines that were “unreasonable and an abuse of discretion” and “infected” by financial incentives designed to restrict access to care for those who should qualify for coverage. Essentially, UBH was manipulating internal guidelines to avoid providing coverage that members had every right to under the law.
For many of those struggling with substance use disorder, defective criteria for coverage can equate to a death sentence. When looking over the requirements set by UBH, it is no wonder why the courts say they are illegitimate.
Firstly, their medical-necessity criteria fail to provide coverage to those chronic and comorbid conditions. Generally accepted standards of care state these conditions should be effectively treated, even when those conditions:
- Respond slowly to treatment
- Require extended or intensive levels of care
However, UBH set guidelines that only approve coverage for what they labeled “acute” episodes or crises. For example, only individuals who were actively suicidal or suffering from severe withdrawal could be considered for coverage.
In other words, for someone who struggled with substance use disorder or mental illness, you had to be knocking on death’s door to get a chance at treatment. The court found that these guidelines were not acceptable.
Furthermore, UBH fails to use national evidence-based guidelines for covering different levels of care for mental health and substance abuse treatment, such as:
These are guidelines that have been developed by clinical specialty nonprofit organizations.
Additionally, UBH’s guidelines improperly required reducing the level of care, even if the providers who were treating them recommended maintaining a higher level of care. So patients would be removed from more intensive residential treatment programs and pushing into some form of outpatient therapy, even if the specialists argued that they were not ready.
This is a big deal. Most recovery advocates and healthcare providers agree that insurance companies should not be the ones telling treatment providers how to care for their patients.
State Mandated Guidelines
Furthermore, some states have mandated specific guidelines for evaluating the medical necessity for behavioral health services. UBH was also found to have violated these requirements for reviewing substance use disorder claims as well.
The case against United Behavioral Health was filed under the Employee Retirement Income Security Act of 1974 (ERISA). This is a federal mandate that governs group health insurance policies through private employers. More specifically, ERISA requires insurance plan administrators to function in a fiduciary capacity when overseeing employee benefit plans. This includes coverage for mental health and substance use disorder treatment.
In Wit v. UBH, the court determined that UBH was in breach of its fiduciary duties by developing and employing faulty medical necessity criteria for behavioral health services. Therefore, the court alleges that UBH is in violation of its obligations under this federal law.
What Does this Mean for Addiction Treatment Insurance Coverage?
This case is exposing insurers for refusing care to people at serious risk of death by overdose or suicide. It is important to remember that UBH is not the only insurance provider trying to find ways around federal and state coverage guidelines. Given the nature of these violations, advocates believe that regulators should immediately start examining the market conduct of all healthcare plans across the country.
Judge Joseph C. Spero in Wit v. UBH also points out that the company was circumventing the Mental Health Parity and Addiction Equity Act of 2008, also known as the Federal Parity Law.
Parity law actually requires insurers to cover illnesses of the brain, such as depression or addiction, the same as illnesses of the body, such as diabetes or cancer. In his ruling on Wit v. United Behavioral Health, Judge Spero highlights an abundance of evidence that guidelines created by the UBH were designed to diminish the impact of the 2008 Parity Act in order to keep benefit costs down. In other words, it is clear that the company was actively trying to work around federal law in order to avoid providing coverage to people with mental illnesses and addictions.
For those in the mental health and addiction communities, this brings new awareness to the discriminatory practices of treating mental health conditions differently than physical conditions. The new hope is that insurance providers will understand the consequences of discrimination against those who need help. With so much going on in healthcare, the Federal Parity Law must be protected.
Far too many people suffering from mental health and substance use disorders never get the help that they need. The last thing we need in a country devastated by an opioid crisis and rising overdose death rates is to create more roadblocks to treatment resources.
Palm Healthcare Company believes that if our country is ever going to overcome the damage of the opioid epidemic, we have to offer more comprehensive treatment options to those who still suffer. Insurance companies should not be keeping people from the care they deserve. Prevention is important, but we also believe in taking care of those who are already in the grips of substance use disorder by offering compassionate and effective care. If you or someone you love is struggling, please call toll-free now. We want to help.
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