Connecticut

Connecticut has seen a staggering loss of life. Methadone, other meds are changing that.

Published

7 months ago

December 3, 2023

Connecticut has seen a staggering loss of life. Methadone, other meds are changing that.

By the time Belmarie Lugo stepped into the treatment clinic in January 2022, her body was malnourished.

Her connections to her family had fractured, and she estimates she had overdosed on heroin and fentanyl more than a dozen times.

Now, nearly two years later, Lugo is in recovery. She’s mended her relationships with her parents and brother, and she is finally able to contemplate her future — something that was not possible in the past when she was under the influence of illicit opioids.

Lugo, a resident of East Hartford, attributes much of her turnaround to the methadone maintenance program she enrolled in at the Root Center, which is the largest provider of medication-assisted treatment services in Connecticut.

“I’m victorious because of this place,” Lugo said, as she sat in one of the counseling rooms at the Root Center’s Manchester office. “It’s so easy to go backwards.”

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Methadone is one of several medications that are used to help people with opioid use disorders to lessen their dependence on lethal narcotics while limiting the pain and most severe symptoms that can accompany opioid withdrawal.

The precisely measured dosages of methadone that are prescribed to patients at places like the Root Center have been proven to lessen people’s chances of relapsing and dying from an overdose.

Even more, the health professionals who administer methadone — and another commonly used treatment drug called buprenorphine — say the medications enable people to find new jobs, to regain custody of their children and to more easily recover from the mind-altering effects of opioids.

Lugo is just one of the tens of thousands of people who benefitted from a methadone treatment program in Connecticut in recent years, but state officials want to see that number increase even more to combat the state’s ongoing epidemic.

A special advisory committee, set up to manage roughly $600 million in opioid settlement funds for Connecticut, published a report earlier this year that laid out several key strategies for curtailing opioid overdoses in the state, and it argued that increasing the accessibility and use of methadone and buprenorphine would be the most effective approach to stemming the mounting death toll.

Evidence-based

That wasn’t the first time that Connecticut officials received that advice.

A state report that was published in 2016 made the exact same recommendation, citing the mountain of medical evidence surrounding the two opioid treatment medications and the comparative success of those medications when compared to abstinence-based recovery programs.

“There is very strong evidence for treatment using medications. And I don’t say ‘very strong’ lightly,” said Dr. Joshua Sharfstein, the vice dean of the Johns Hopkins University school of public health.

Sharfstein helped organize a coalition of more than 30 health organizations to create several basic principles that states and local governments can rely on when spending their settlement funds, which they are receiving through several lawsuits that were filed against major opioid manufacturers, distributors and retailers.

Two of those principles are that the settlement money should be used to save lives and that it should be directed toward efforts that are backed up by medical evidence.

Women with opioid use disorder face stigma in getting help, seeking treatment

Sharfstein, who also cowrote a book titled “The Opioid Epidemic: What Everyone Needs to Know,” said treatment programs that incorporate methadone and buprenorphine meet both of those principles.

The effectiveness of medication-assisted treatment, Sharfstein said, has been reviewed by the American Medical Association, the American Psychiatric Association and the National Academies of Sciences, Engineering, and Medicine.

And research has suggested that the use of methadone and buprenorphine in treating opioid use disorders can substantially reduce people’s chances of fatally overdosing — some studies suggest by up to 50%.

“For a disease that is killing many Americans, that is a significant reduction in mortality that you can get with appropriate treatment that includes medications,” Sharfstein said. “And that I think is just an incredibly important point to keep in mind as officials are thinking about expanding access to treatment.”

Loosening the regulations

Connecticut saw a significant increase in patients who were receiving methadone or buprenorphine over the past decade as part of their treatment for opioid use disorders.

The number of people receiving methadone at a federally regulated clinics in Connecticut jumped between 2012 and 2017 from roughly 14,000 to more than 21,000. And the number of people who were prescribed buprenorphine through a licensed medical provider grew from roughly 21,000 in 2015 to an estimated 30,000 in 2020.

But those numbers have largely plateaued since then.

The same cannot be said for the number of overdoses linked to heroin, fentanyl and prescription painkillers, which have claimed the lives of nearly 5,000 Connecticut residents since 2020.

The researchers who put together the report this year for the state’s Opioid Settlement Advisory Committee said that staggering loss of life is evidence enough that more needs to be done to connect people with medication-assisted treatment and to retain those patients once they enroll in a program.

If there is any benefit of the COVID pandemic, it’s that the federal government has allowed the relaxed policies to remain in place.

“There are no reliable estimates of the number of people in the state at risk for overdose who would benefit from treatment with medication for opioid use disorder,” the researchers wrote. “Nonetheless, the rising number of opioid overdoses indicates there is an unmet need for these treatments in the state.”

There have been several big changes in recent years to make it easier for people in Connecticut and the rest of the United States to access medications for opioid use disorders and to continue using those medications once they start.

Federal legislators passed a law late last year that removed a long-standing requirement for doctors to have a special waiver if they wanted to prescribe buprenorphine to patients with opioid use disorders.

That waiver requirement severely restricted the number of physicians who could legally administer buprenorphine to their patients in the past.

The federal government also lowered one of the biggest barriers that patients often encountered once they were enrolled in a methadone treatment program: how much methadone someone could take home with them from a clinic.

Prior to the coronavirus pandemic, most patients receiving methadone had to report to a federally licensed clinic nearly every day to receive their dose of the medication under the supervision of staff. It was part of a tightly regulated system that had been erected around methadone in the United States over decades.

The public health emergency in 2020, however, prompted the federal government to allow a larger number of people to take home up enough bottles of the liquid methadone to last them up to 28 days, and federal officials are now pushing for a permanent regulatory change that would allow patients to continue to benefit from that practice.

Dr. Robert Heimer, a professor at Yale University who has widely studied opioid addiction, said the loosening of the federal rules surrounding methadone and buprenorphine is likely to have a positive effect.

“We’re finally moving away from that. Thank goodness,” Heimer said of the federal regulations. “If there is any benefit of the COVID pandemic, it’s that the federal government has allowed the relaxed policies to remain in place.”

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Unmet needs

Even so, Heimer and other medical professionals argue there are still barriers that limit how many people are utilizing methadone and buprenorphine in Connecticut.

The new report that Heimer helped to produce for Connecticut’s opioid settlement advisory committee listed several of those obstacles.

There is still an inadequate number of physicians willing to prescribe buprenorphine to their patients, the report noted, and some pharmacies don’t even stock it.

Adequate transportation to the state’s licensed methadone clinics, which are largely concentrated in the state’s urban centers, can still be a problem for newer patients who need to show up in-person on a daily basis at the beginning of their treatment.

Additionally, Heimer said, some of the methadone clinics in the state have operating hours that don’t accommodate patients who have jobs at odd hours, or other methadone providers don’t have physicians at all of their sites who are capable of performing the required physicals on patients who are starting methadone treatment.

Steven Zuckerman, the CEO of the Root Center, which operates more than 10 sites in Connecticut, said his organization has the capacity to treat more people.

Even though the Root Center already serves nearly 6,000 patients a day, Zuckerman said his staff is capable of administering the first dose of methadone to someone the same day they walk in.

Medicaid and Medicare, which insures more than 90% of the Root Center’s patients, covers the cost of that treatment, he said.

The bigger issue, Zuckerman said, is addressing all of the other related issues that many of the patients have.

People with opioid use disorders may be unemployed. They may be fighting to regain custody of their kids. They might be facing legal charges. Some have other mental health disorders that have gone untreated. And many don’t have reliable housing.

Data collected by the state last year found that nearly 8% of the people who overdosed in 2022 in Connecticut were either homeless or struggling with housing instability.

Zuckerman argued that the nearly $600 million in settlement funds that the state is expecting to receive over the next two decades could be used to help correct some of those issues for people entering treatment.

“Getting the medication-assisted treatment is the initial step. Obviously, that starts the whole ball rolling. But once sobriety comes for you, there’s so much else that’s needed to get you moving,” Zuckerman said.

The report produced for the state advisory committee this year suggested portions of Connecticut’s opioid settlement funding could help by expanding the operating hours at existing methadone clinics or by financing new mobile methadone clinics, which federal and state regulators also recently approved.

The report also suggested that the settlement funds could be used on a variety of related services for patients with opioid use disorders, including improved transportation services, help with insurance enrollment, employment assistance program and subsidized child care services.

In Lugo’s case, she was able to rely on her family members to help with many of her most basic needs once she entered treatment.

Her brother, who is also in recovery, provided her with a place to live above his barber shop in East Hartford. And her father was also available to support her.

“It takes an army just for one person to recover,” Lugo said.

Stopping the stigma

The biggest impediment to people accessing methadone and buprenorphine, however, isn’t caused by a government regulation, and it can’t be solved solely by spending opioid settlement funding.

It’s the public stigma that keeps many people from utilizing those treatment medications, several people told The Connecticut Mirror.

Heimer, the Yale professor, said there is still a misconception among large portions of the American population that taking methadone or buprenorphine to treat opioid use disorder is like trading one drug for another.

“The problem is that the 50 years of a very controlled, draconian approach to dispensing methadone has led to methadone being stigmatized,” Heimer said. “So even though it’s been easier to get, I don’t think there has been a huge increase in the number of people taking advantage of it.”

That stigmatization can persist even after people realize the benefits the treatment medications can have on someone who is struggling with an opioid use disorder.

Heimer recounted an interaction that he had a few years ago with a woman he met at a community event. The woman, who was in her twenties, was a strong advocate for methadone. She told Heimer that the medication allowed her to work through her opioid use disorder and to reconnect with her family and her child.

Eventually, she told him that she was doing so well on her treatment program that she was considering halting her use of methadone.

Heimer said he tried to persuade the woman not to do that, and he emphasized that if the treatment was working she should stay the course. He explained to her that using opioids for a significant period of time can change someone’s brain chemistry.

Despite that warning, Heimer later learned the woman died of an overdose within six weeks of their conversation after she stopped utilizing methadone as part of her treatment.

“There’s still this overwhelming belief — unsupported by data — that abstinence, not taking opioids, is the proper end goal for people with opioid use disorders,” Heimer said.

He said that is like arguing that a diabetic needs to stop using insulin, or that someone with high cholesterol needs to stop taking their statin medication.

Some advocates don’t even like to refer to methadone and buprenorphine as medication-assisted treatment for that very reason. They believe it makes those forms of treatment seem out of the ordinary, when, in fact, they are the gold standard for treating someone with an opioid use disorder.

Lugo said she’s seen people voice those negative perceptions in the past, but she said she wouldn’t have made it as far in her recovery without the methadone treatment she’s received over the past two years.

“They don’t see it as a disease,” Lugo said.

This story is part of an ongoing series on opioids in Connecticut. Want to share what you know? Send your tips and personal stories to tips@ctmirror.org.

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Connecticut

Connecticut officials look protect skills-based jobs as artificial intelligence expands

Published

22 mins ago

June 29, 2024

Press Room

Connecticut officials look protect skills-based jobs as artificial intelligence expands

HARTFORD, Conn — With many jobs expected to eventually rely on generative artificial intelligence, states are trying to help workers beef up their tech skills before they become outdated and get outfoxed by machines that are becoming increasingly smarter.

Connecticut is working to create what proponents believe will be the country’s first Citizens AI Academy, a free online repository of curated classes that users can take to learn basic skills or obtain a certificate needed for employment.

“This is a rapidly evolving area,” said state Democratic Sen. James Maroney. “So we need to all learn what are the best sources for staying current. How can we update our skills? Who can be trusted sources?”

Determining what skills are necessary in an AI world can be a challenge for state legislators given the fast-moving nature of the technology and differing opinions about what approach is best.

Gregory LaBlanc, professor of Finance, Strategy and Law at the Haas School of Business at Berkeley Law School in California, says workers should be taught how to use and manage generative AI rather than how the technology works, partly because computers will soon be better able to perform certain tasks previously performed by humans.

“What we need is to lean into things that complement AI as opposed to learning to be really bad imitators of AI,” he said. “We need to figure out what is AI not good at and then teach those things. And those things are generally things like creativity, empathy, high level problem solving.”

He said historically people have not needed to understand technological advancements in order for them to succeed.

“When when electricity came along, we didn’t tell everybody that they needed to become electrical engineers,” LeBlanc said.

This year, at least four states – Connecticut, California, Mississippi and Maryland – proposed legislation that attempted to deal with AI in the classroom somehow. They ranged from Connecticut’s planned AI Academy, which was originally included in a wide-ranging AI regulation bill that failed but the concept is still being developed by state education officials, to proposed working groups that examine how AI can be incorporated safely in public schools. Such a bill died in the Mississippi legislature while the others remain in flux.

One bill in California would require a state working group to consider incorporating AI literacy skills into math, science, history and social science curriculums.

“AI has the potential to positively impact the way we live, but only if we know how to use it, and use it responsibly,” said the bill’s author, Assemblymember Marc Berman, in a statement. “No matter their future profession, we must ensure that all students understand basic AI principles and applications, that they have the skills to recognize when AI is employed, and are aware of AI’s implications, limitations, and ethical considerations.”

The bill is backed by the California Chamber of Commerce. CalChamber Policy Advocate Ronak Daylami said in a statement that incorporating information into existing school curricula will “dispel the stigma and mystique of the technology, not only helping students become more discerning and intentional users and consumers of AI, but also better positioning future generations of workers to succeed in an AI-driven workforce and hopefully inspiring the next generation of computer scientists.”

While Connecticut’s planned AI Academy is expected to offer certificates to people who complete certain skills programs that might be needed for careers, Maroney said the academy will also include the basics, from digital literacy to how to pose questions to a chatbot.

He said it’s important for people to have the skills to understand, evaluate and effectively interact with AI technologies, whether it’s a chatbot or machines that learn to identify problems and make decisions that mimic human decision-making.

“Most jobs are going to require some form of literacy,” Maroney said. “I think that if you aren’t learning how to use it, you’ll be at a disadvantage.”

A September 2023 study released by the job-search company Indeed found all U.S. jobs listed on the platform had skills that could be performed or augmented by generative AI. Nearly 20% of the jobs were considered “highly exposed,” which means the technology is considered good or excellent at 80% or more of the skills that were mentioned in the Indeed job listings.

Nearly 46% of the jobs on the platform were “moderately exposed,” which means the GenAI can perform 50% to 80% of the skills.

Maroney said he is concerned how that skills gap – coupled with a lack of access to high-speed internet, computers and smart phones in some underserved communities – will exacerbate the inequity problem.

A report released in February from McKinsey and Company, a global management consulting firm, projected that generative AI could increase household wealth in the U.S. by nearly $500 billion by 2045, but it would also increase the wealth gap between Black and white households by $43 billion annually.

Advocates have been working for years to narrow the nation’s digital skills gap, often focusing on the basics of computer literacy and improving access to reliable internet and devices, especially for people living in urban and rural areas. The advent of AI brings additional challenges to that task, said Marvin Venay, chief external affairs and advocacy officer for the Massachusetts-based organization Bring Tech Home.

“Education must be included in order for this to really take off publicly … in a manner which is going to give people the ability to eliminate their barriers,” he said of AI. “And it has to be able to explain to the most common individual why it is not only a useful tool, but why this tool will be something that can be trusted.”

Tesha Tramontano-Kelly, executive director of the Connecticut-based group CfAL for Digital Inclusion, said she worries lawmakers are “putting the cart before the horse” when it comes to talking about AI training. Ninety percent of the youths and adults who use her organization’s free digital literacy classes don’t have a computer in the home.

While Connecticut is considered technologically advanced compared to many other states and nearly every household can get internet service, a recent state digital equity study found only about three-quarters subscribe to broadband. A survey conducted as part of the study found 47% of respondents find it somewhat or very difficult to afford internet service.

Of residents who reported household income at or below 150% of the federal poverty level, 32% don’t own a computer and 13% don’t own any internet enabled device.

Tramontano-Kelly said ensuring the internet is accessible and technology equipment is affordable are important first steps.

“So teaching people about AI is super important. I 100% agree with this,” she said. “But the conversation also needs to be about everything else that goes along with AI.”

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Connecticut

Another Prominent Bank Closing Locations In Connecticut: CT News

Published

8 hours ago

June 29, 2024

Press Room

Another Prominent Bank Closing Locations In Connecticut: CT News

On the weekend, we present some of the top stories and headlines from all across Connecticut.

Officials confirmed the bank will close two branches in Connecticut later this year, and they have released the precise date.>>>Read More.

A Hallmark movie that will premiere during the Christmas season is being shot locally.>>>Read More.

“He is the kind of guy that would do anything for anyone, a providing and loving family man, and an all-around great guy.”>>>Read More.

More than 350,000 cardiac arrests occur outside the hospital each year. One local teen has a plan to trim that number down a bit…>>>Read More.

The former local resident, an “American Ninja Warrior” winner, was sentenced for the sexual abuse of a 14-year-old victim, officials said.>>>Read More.

Police provided water safety tips after a 3-year-old was recently found floating face down in a pool before being rescued by an adult.>>>Read More.

Other top stories:

The Patch community platform serves communities all across Connecticut in Fairfield, New Haven, Middlesex, New London, Hartford, Tolland, and Litchfield counties. Thank you for reading.

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Connecticut

As AI gains a workplace foothold, states are trying to make sure workers don’t get left behind

Published

15 hours ago

June 29, 2024

Press Room

As AI gains a workplace foothold, states are trying to make sure workers don’t get left behind

HARTFORD, Conn. (AP) — With many jobs expected to eventually rely on generative artificial intelligence, states are trying to help workers beef up their tech skills before they become outdated and get outfoxed by machines that are becoming increasingly smarter.

Determining what skills are necessary in an AI world can be a challenge for state legislators given the fast-moving nature of the technology and differing opinions about what approach is best.

He said historically people have not needed to understand technological advancements in order for them to succeed.

“When when electricity came along, we didn’t tell everybody that they needed to become electrical engineers,” LeBlanc said.

This year, at least four states — Connecticut, California, Mississippi and Maryland — proposed legislation that attempted to deal with AI in the classroom somehow. They ranged from Connecticut’s planned AI Academy, which was originally included in a wide-ranging AI regulation bill that failed but the concept is still being developed by state education officials, to proposed working groups that examine how AI can be incorporated safely in public schools. Such a bill died in the Mississippi legislature while the others remain in flux.

One bill in California would require a state working group to consider incorporating AI literacy skills into math, science, history and social science curriculums.

“Most jobs are going to require some form of literacy,” Maroney said. “I think that if you aren’t learning how to use it, you’ll be at a disadvantage.”

Nearly 46% of the jobs on the platform were “moderately exposed,” which means the GenAI can perform 50% to 80% of the skills.

Maroney said he is concerned how that skills gap — coupled with a lack of access to high-speed internet, computers and smart phones in some underserved communities — will exacerbate the inequity problem.

Of residents who reported household income at or below 150% of the federal poverty level, 32% don’t own a computer and 13% don’t own any internet enabled device.

Tramontano-Kelly said ensuring the internet is accessible and technology equipment is affordable are important first steps.

“So teaching people about AI is super important. I 100% agree with this,” she said. “But the conversation also needs to be about everything else that goes along with AI.”

Source link