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Opioid Crisis in New England

Opioid epidemic now a National crisis

By Timothy Aurelio 16 Sep, 2017

From Rhode Island Department of Health:  Governor Gina Raimondo’s Overdose Prevention and Intervention Task Force has recognized South County Health and CharterCARE Health Partners for their leadership in providing consistent, comprehensive care for opioid-use disorder in hospitals and emergency departments in Rhode Island. The South County Health recognition took place at this morning’s Task Force meeting. The recognition of CharterCARE Health Partners took place at the July meeting. This recognition was based on treatment criteria met at Roger Williams Medical Center and Our Lady of Fatima Hospital (both CharterCARE facilities), and South County Hospital.

These criteria were established in March by the Rhode Island Department of Behavioral Healthcare Developmental Disabilities and Hospitals (BHDDH) and Rhode Island Department of Health (RIDOH) in a document titled Levels of Care for Rhode Island Emergency Departments and Hospitals for Treating Overdose and Opioid Use Disorder .

The aim of these first-in-the-nation standards is to ensure that best practices in the treatment of opioid-use disorder are in place at emergency departments (EDs) and hospitals throughout the state. “We are pleased that hospitals have begun enacting Levels of Care for those suffering from overdose or opioid use disorder,” said Director Rebecca Boss of the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities & Hospitals. “Levels of Care standardizes treatment across all emergency rooms and hospitals to ensure a high level of care for people throughout the state. With these newly designated ‘levels’ we hope to lower the rate of overdose deaths by allowing emergency rooms to become one of the first steps towards recovery.”

“Rhode Island is the leader in the nation for establishing qualifications, called Levels of Care, to treat people with opioid-use disorder in hospitals and EDs. CharterCARE Health Partners and South County Health are the first health systems in our state to be recognized for achieving Levels of Care designations, and we hope that the other healthcare facilities throughout the state follow their lead,” said Director of Health Nicole Alexander-Scott, MD, MPH.

“Every single overdose death is preventable. We need all EDs and hospitals in Rhode Island to attain Levels of Care designations so people have access at every possible opportunity to the treatment and recovery resources they need to live lives free of addiction.” The Levels of Care document established a three-tiered system. Designations are made through an application process submitted to RIDOH and BHDDH. All hospitals must qualify for at least a level three, with the expectation that many will attain higher designations, which involve expanded capacity to provide care for opioid-use disorder (i.e., medication-assisted treatment), recovery services, and more.

By Timothy Aurelio 03 Sep, 2017

Nothing seemed to help the patient — and hospice staff didn’t know why.

They sent home more painkillers for weeks. But the elderly woman, who had severe dementia and incurable breast cancer, kept calling out in pain.

The answer came when the woman’s daughter , who was taking care of her at home, showed up in the emergency room with a life-threatening overdose of morphine and oxycodone. It turned out s he was high on her mother’s medications, stolen from the hospice-issued stash.

Dr. Leslie Blackhall handled that case and two others at the University of Virginia’s palliative care clinic, and uncovered a wider problem: As more people die at home on hospice, some of the powerful, addictive drugs they are prescribed are ending up in the wrong hands.

Hospices have largely been exempt from the national crackdown on opioid prescriptions because dying people may need high doses of opioids. But as the nation’s opioid epidemic continues, some experts say hospices aren’t doing enough to identify families and staff who might be stealing pills . And now, amid urgent cries for action over rising overdose deaths, several states have passed laws giving hospice staff the power to destroy leftover pills after patients die.

Blackhall first sounded the alarm about drug diversion in 2013, when she found that most Virginia hospices she surveyed didn’t have mandatory training and policies on the misuse and theft of drugs. Her study spurred the Virginia Association for Hospices and Palliative Care to create new guidelines, and prompted national discussion.

Most hospice patients receive care in the place they call home. These settings can be hard to monitor, but a Kaiser Health News review of government inspection records sheds light on what can go wrong. According to these reports:

In Mobile, Alabama, a hospice nurse found a man at home in tears, holding his abdomen, complaining of pain at the top of a 10-point scale. The patient was dying of cancer, and his neighbors were stealing his opioid painkillers, day after day . In Monroe, Michigan, parents kept “losing ” medications for a child dying at home of brain cancer, including a bottle of the painkiller methadone. In Clinton, Missouri, a woman at home on hospice began vomiting from anxiety from a tense family conflict: Her son had to physically fight off her daughter, who was stealing her medications . Her son implored the hospice to move his mom to a nursing home to escape the situation. In other cases, paid caregivers or hospice workers, who work largely unsupervised in the home, steal patients’ pills. In June, a former hospice nurse in Albuquerque, New Mexico, pleaded guilty to diverting oxycodone pills first by recommending prescriptions for hospice patients who didn’t need them and then intercepting the packages with the intention of selling the drugs herself.

Hospice, available to patients who are expected to die within six months, is seeing a dramatic rise in enrollment as more patients choose to focus on comfort, instead of a cure, at the end of life.

The fast-growing industry serves more than 1.6 million people a year. Most of hospice care is covered by Medicare, which pays for hospices to send nurses, aides, social workers and chaplains, as well as hospital beds, oxygen machines and medications to the home.

There’s no national data on how frequently these medications go missing. But “problems related to abuse of, diversion of or addiction to prescription medications are very common in the hospice population , as they are in other populations,” said Dr. Joe Rotella, chief medical officer of the American Academy of Hospice and Palliative Medicine, a professional association for hospice workers.

“It’s an everyday problem that hospice teams address, ” Rotella said. In many cases, opioid painkillers or other controlled substances are the best treatment for these patients, he said. Hospice patients, about half of whom sign up within two weeks of death, often face significant pain, shortness of breath, broken bones, or aching joints from lying in bed, he said. “These are the sickest of the sick.”

Earlier this year in Missouri, government investigators installed a hidden camera in a 95-year-old hospice patient’s kitchen to investigate suspected theft. A personal care aide was charged with stealing the patient’s hydrocodone pills, opiate painkillers, and replacing them with acetaminophen, the active ingredient in Tylenol . Hospice nurses in Louisiana and Massachusetts also have been charged in recent years with stealing medication from patients’ homes.

But many suspected thefts don’t get caught on hidden cameras, or even reported.

In Oxnard, Calif., in 2015, a person claiming to be a hospice employee entered the homes of five patients and tried to steal their morphine, succeeding twice. The state cited the hospice for failing to report the incidents.

In Norwich, Vermont, in 2013, a family looked for morphine to ease a dying patient’s shortness of breath. But the bottle was missing from the hospice-issued comfort care kit. Family members suspected that an aide, who no longer worked in the home, had stolen the drug, but they had no proof. State inspectors cited the hospice, Bayada Home Health Care, for failing to investigate.

David Totaro, spokesman for Bayada Home Health Care, told KHN that situations like that are “very rare” at the hospice, which takes precautions, such as limiting medication supply, to prevent misuse.

There is no publicly available national data on the volume of opioids hospices prescribe. But OnePoint Patient Care, a national hospice-focused pharmacy, estimates that 25 percent to 30 percent of the medications it delivers to hospice patients are controlled substances, according to Erik Jung, a vice president of pharmacy operations.

In relationship to other professions, people working in the medical field have an increased risk of addiction to opioids because of the increased access to the medications and high stress working conditions.  Many medical professionals divert medications from patients every day. It's difficult to fathom the recklessness and disregard for human suffering by switching a pt's morphine with a Tylenol. However, the grips of addiction has NO boundaries . The addicted person uses,  or get sick. One's moral compass does not function well once the disease progresses to this point. 

I have witnessed the devastation professional nurses and doctors experience during the "compulsion to use,  despite negative consequences"; such as loss of licensure and prosecution.  Never Mind the endless depths of shame and guilt that follows once clean and sober. Here's the thing about addiction- You don't need to take the elevator ALL the way down to the bottom floor, you can step out at any time. There are moments of brief clarity before one chooses to use for another day- versus calling for help. Oftentimes,  fear, shame and guilt prohibit us from reaching out for help. Also, some of us continue to believe that " I can do this alone " or " my way ", or " I have it under control "  This is exactly what an impaired brain says and does.  This disease is to powerful to be doing it "your way".  

NursesinRI is committed to linking RI residents under the weight of the opioid crisis to treatment, there is never a fee for our services and your information is protected by Federal confidentiality laws. NursesinRI is  nonprofit corporation operating in South County, RI. Our toll free number is 1-800-264-3752


By Timothy Aurelio 29 Aug, 2017
There are powerful painkillers that are legal if prescribed by a doctor, but there are also drugs like heroin that are not legal. Heroin and morphine come from opium, along with painkillers like Percocet, Oxycodone, and Vicodin. There are also opioids that are completely or partially synthetic like fentanyl and methadone. Fentanyl is a drug 100 times more powerful than morphine. MoneyWeek reports that about 97 million Americans take opioids , and 12 million get them illegally . The same source states that no less than 2.6 million Americans are addicted to them , while deaths related to fentanyl and heroin are growing.

In Pennsylvania, Rhode Island, and Massachusetts we can see that fentanyl is responsible for many deaths.  The President  has declared this a national emergency .

Deaths related to overdoses are a big number

Roughly 60,000 Americans perished as a result of overdoses last year -- according to MoneyWeek -- and about half of those deaths were due to medical prescriptions . This is more than the number of people killed by guns and car accidents in the same year. For Americans under 50, the opioid crisis has become the leading cause of death.

The life expectancy declined

The drug crisis is so severe in America that it made the #Life Expectancy decline in 2015 according to MoneyWeek, which is a negative for the US Labor Market because many men decide not to work, and they are mainly men between 25 and 54 years old.

As we can see, opioids affect the health of the nation, and this is having devastating consequences.

Roots of the crisis

Many specialists believe that the crisis is related to unemployment, stagnating wages, and other economic problems. This could be a possible cause, but not the main one . The most important factor is that the pharmaceutical industry markets the painkillers heavily. A report by the presidential commission states that the problem doesn't begin on the streets, it begins in the healthcare system of the United States  Besides, the price of heroin has fallen a lot, and fentanyl has become more accessible -- all of which has made the situation worse.

A public health crisis

This drugs problem is seen as a national emergency by Donald Trump. The Republican governor of New Jersey, Chris Christie, wants the US President to treat this problem as a #Public Health Crisis, not as a war on drugs. There must be great changes; Medications like Suboxone and Vivitrol can make a significant impact on the quality of life, reduce overdose deaths, decrease the spread of disease, reduce crime and assist with managing this awful brain disease.

NursesinRI is committed to helping RI residents under the weight of the opioid crisis find treatment. 


By Timothy Aurelio 13 Aug, 2017

When 55-year-old Sheila Bartels left her doctor's office in Oklahoma, she had a prescription for 510 painkillers.

She died the same day of an overdose.

Her doctor, Regan Nichols, is now facing five second-degree murder charges—one for each patient who overdosed after she prescribed them opioid drugs, such as Oxycontin—prescriptions that can lead to addiction.

"Doctors bear enormous responsibility for the opioid crisis," said David Clark, a professor of anesthesiology at Stanford University who worked on a government-sponsored panel that studied the crisis, and recommended new training and guidelines for health care providers and regulators.

"We didn't have (a crisis) until doctors became enamored with what they imagined to be the potential for opioids in controlling chronic pain," Clark told AFP.

An estimated two million Americans are addicted to opioid drugs—many forced to buy pills illegally when prescriptions run out. Some, in desperation, resort to heroin and synthetic opioids smuggled into the US by Mexican drug cartels.

Ninety people die every day in the United States from opioid overdoses.

More than 180,000 have died since 1999, including pop icon Prince, who passed away in April 2016 at age 57 after an accidental overdose of fentanyl, a powerful opioid painkiller.

Doctors in the United States prescribe more opioids than in any other country—enough to medicate every American adult.

While those physicians who are prosecuted for overprescribing make headlines, experts say they are not solely to blame, and that the US health care system as a whole must be held accountable for the country's spiralling opioid epidemic.

"Pharmaceutical companies targeted general practitioner doctors, the ones who see most of the people who have pain," Ohio attorney general Mike DeWine, whose state has been hard hit by the crisis, told AFP.

"I think they certainly were misled, and they were told things that were not true."

Years in the making

The problem is not a new one—it began two decades ago, as doctors were being taught to better manage their patients' pain and drug companies were touting the efficacy of opioid painkillers.

The painkillers—meant only for patients in the most dire need—started getting into the hands of those with chronic conditions that had been treated with simple over-the-counter drugs like aspirin.

And they didn't know they were addictive.

"You had people with a simple toothache, or knee surgery, or back surgery, that were on these opioids for too long a period of time or prescribed a higher dosage than they needed," said Robert Ware, chief of police in the town of Portsmouth, Ohio, which became a sort of ground zero for the crisis.

As more and more people were getting addicted, "pill mills" began to pop up in Portsmouth and across the nation to meet demand. These clinics were run by doctors who would prescribe opioid drugs to anyone who could pay.

In Portsmouth, a struggling Ohio town bordering two other states where the steel industry was once king, Ware was seeing pill mills become part of the economy, as addicts from nearby states traveled there to get their fix.

Eventually, state regulators and local law enforcement shut down the pill mills by arresting doctors and requiring that clinics be associated with established, reputable medical programs.

The Justice Department has promised a further crackdown on unscrupulous doctors and pharmacists.

On Tuesday, President Donald Trump—hosting a meeting on the crisis during his summer vacation—suggested more prosecutions as a whole may be necessary.

Arrests not the only answer

But in Portsmouth, Ware said the community has learned a tough lesson.

"You cannot arrest your way out of this problem," the chief said.

The town's opioid addicts came from a cross-section of society, because most got hooked through legitimate prescriptions.

And addicts needed help to recover over the long run.

So Portsmouth beefed up its health care offerings and addiction treatment—and went from being a haven for pill mills to a refuge for recovery.

Overdoses there are now trending downward, in contrast to the rest of the country, Ware said.

"We are kind of ahead of the curve in getting out of the problem," he said.

A new target

Across the country, overall drug overdose deaths are rising to new highs—60,000 estimated fatalities in 2016. Certain states, like Ohio and West Virginia, have been harder hit than others.

DeWine is fighting the epidemic from another front—suing the drug companies. According to The Washington Post, at least 25 states, cities and counties are doing the same.

"These drug companies are primarily responsible for this drug opiate epidemic. They created the problem. It's about time that they did something to help clean the problem up," DeWine said.

The federal government has proposed a 20 percent reduction next year in the amount of opioids drug companies are allowed to produce.

But physicians still appear to be writing prescriptions with gusto.

While the numbers have declined, doctors still handed out nearly 250 million prescriptions for opioids in 2013 alone, according to the Centers for Disease Control.

"Physicians have not fully accepted their roles as individual prescribers in feeding this particular epidemic," said Clark.

"There was never good evidence that these drugs could reduce pain well," he added, "especially for prolonged periods of time."

https://medicalxpress.com/news/2017-08-doctors-heart-opioid-crisis.html

NursesinRI is committed to educating the public on opioid addiction, finding treatment, and erasing stigma.

By Timothy Aurelio 06 Aug, 2017

Essentially, the problem involves a cycle of judgment, separation and inadequacy: When we speak about “addicts,” we tend to use it with disdain. The label is used not as an attribute (especially an accidental one) of a person but as embodying the person’s being, much like we call someone involved with sports an athlete. But it’s an identity that’s implicitly hindering; unlike athletes, we don’t tend to think very highly of drug addicts, and they’re not “like us .” That judgment casts shame and social isolation onto the person labeled an “addict,” and when he or she assimilates that, that person is less likely to seek help.

Part of the problem here is that many likely won’t see themselves as part of the problem . But think about conversations you’ve had about those with substance abuse problems. If you’ve casually substituted the word “addict” with the more debilitating “junkie,” you’re part of the problem . If you’ve had pity on someone who abuses, you’re part of the problem . If you’ve talked about them like they’re in a subclass — perhaps saying “those people” — you’re part of the problem . Tone, body language, assumptions, conclusions drawn — all of these shape how we understand “addict.”


People are more than their addiction: Most all  people who "experienced addiction" are "highly talented" On the contrary to the belief of the general public, people experiencing addiction are doctors, nurses, engineers, teachers, scientists, actors, your neighbors, family members, etc. They are far from the label we give them as "junkies", or "drug addicts" When I hear this language, it makes me cringe inside.  We all need to monitor our language , especially the media, and start looking at addiction realistically, according to ASAM:  Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

NursesinRI is committed to erasing the stigma associated with people experiencing substance use disorder,  for help finding a qualified treatment provider, call us today.



By Timothy Aurelio 23 Jul, 2017

PROVIDENCE, R.I. (AP) — Gov. Gina Raimondo has signed three bills into law aimed at combating Rhode Island's opioid epidemic.

The legislation allows law enforcement access to an electronic database of prescription painkillers without a warrant; requires health care professionals to discuss the risks of addiction with patients when writing opioid prescriptions; and expands the type of pharmaceuticals that can be prescribed using electronic prescriptions, while ensuring patient privacy.

The state Department of Health said that mandating electronic prescriptions will reduce pharmacy errors and also the likelihood for fraudulent prescriptions because paper prescription pads have sometimes been stolen to obtain the drugs illegally.

The Democratic governor, who announced Wednesday she'd signed the bills, said the opioid epidemic is the "single greatest public health crisis of our time," with 1,200 Rhode Island residents dying of overdoses in five years.

"Every Rhode Island community has been touched by this crisis, and I'll take every step I can to fight back," she said in a statement.

By Timothy Aurelio 15 Jul, 2017
Roger Williams Medical Center, Fatima Hospital, and CharterCARE Provider Group are the first institutions in Rhode Island to be certified as Level of Care 1 Facilities for treating overdose and opioid use disorders. The designation was granted by the Department of Health and Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals. Rhode Island Governor Gina Raimondo created the Overdose Prevention and Intervention Task Force to address the state’s addiction and overdose crisis. The task force created three levels of care for Emergency Departments and hospitals in Rhode Island. CharterCARE’s prevention, access to care, triage and assessment plans and documentation met all three levels of care, which allowed us to become the first and only hospital in the state to achieve the Center of Excellence designation. This week, team members were recognized with a certificate at a meeting with Governor Raimondo and Dr. Nicole Alexander-Scott, MD, Director of the Rhode Island Department of Health. Thank you to the entire clinical, administrative, support, and medical staff involved in achieving this designation.
By Kevin Mansfield 04 Jul, 2017
The opioid epidemic has reached health crisis proportions in Rhode Island, sparking the attention of local lawmakers. 
Gov. Gina Raimondo has boldly stepped up and called on others at the state and local level to do the same stating "Drug overdoses represent a public health crisis that is as urgent as any we have ever confronted in Rhode Island...We must demand and make swift change to address this crisis and promote treatment, prevention and recovery. We have a single focus in this work: Save lives."

In America, getting help for opioid treatment is often stigmatized and those who suffer are often marginalized as evidenced by the latest proposed healthcare bill .  As the leader of the smallest state in America though, Raimondo is boldly leading a charge to remove this stigma and get people the help that they need. On her website , Governor Raimondo, outlines the goals for the Overdose Prevention and Intervention Task Force. It states, "We need to continue to work together to remove barriers to effective treatment, including stigma, so the people at highest risk of overdose have a chance to make it in Rhode Island."

According to the Providence Journal , Ramondo hopes to have 420 people trained in medicated-assisted treatment by 2018. Medicated assisted treatment helps to lower the pain of treating opioid addiction. Although there is currently a lot of stigma associated with this sort of treatment, public opinion is rapidly changing. Timothy Aurelio, Rhode Island nurse and founder of Nurses in Rhode Island , explains it as treating a disease. "If you have a disease and the doctor prescribes you medicine, you take the medicine and no one judges you for doing so. Until we as a society start looking at addiction as a disease with underlying complications, we can't make true progress." You can read more on medicated assisted treatment here.  

A matter of great concern for those fighting to end addiction is the new healthcare bill which could potentially strip coverage of addiction treatment.

 In an interview with CNNDr. Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University stated "I would say the health care bill is more likely to make the opioid crisis worse...if people right now who have opioid-addiction treatment paid for, and the health care bill results in their loss of coverage, it means people could lose their lives."

Over 1000 people have died from overdose in Rhode Island in the last five years (approximately 0.1% of the state's population) and this was with health care systems in place. To lose so many people to one illness is a great concern to lawmakers and those in the health care industry. Recent changes in healthcare could make matters worse. Fortunately, while it seems the nation is taking a step backward, the leaders of Little Rhodie are committed to progress and betterment of their state. 


By Timothy Aurelio 01 Jul, 2017
A new study  finds that the number of Americans being diagnosed with opioid addiction continues to skyrocket, but still very few receive any treatment. This is in line with the rising trend documented in previous reports.

An analysis from Blue Cross Blue Shield of its members found that from 2010 to 2016, the number of people diagnosed with an addiction to opioids -- including both legal prescription drugs like oxycodone and hydrocodone, as well as illicit drugs -- climbed 493%. In 2010, there were just 1.4 incidences of opioid use disorder among every 1000 members. By 2016, that rate had climbed to 8.3 incidences for every 1000 members. Yet, at the same time, there was only a 65% increase in the number of people getting medication-assisted treatment to manage their addiction.

MAT: "gold standard"of treatment

    Medication-assisted treatment, MAT, includes the prescribing of medications like buprenorphine or methadone, along with behavioral therapy. MAT is considered the gold standard of treatment amongst doctors and there are a number of studies to back it up - one found that Suboxone, a combination of buprenorphine and naloxone could at least double a persons chances of remaining drug free  after 18 months; another found that increased buprenorphine use was accompanied by a reduction in the number of overdose deaths. Other treatments may include detox programs such as Narcotics Anonymous.
    "Opioid use disorder is a complex issue, and there is no single approach to solving it," Dr. Trent Haywood, senior vice president and chief medical officer for BCBSA said in a statement. "It will take a collaborative effort among medical professionals, insurers, employers, communities and all levels of government working together to develop solutions that effectively meet community needs," he added.

    Addiction climbs, but few get treatment

    While the rates of opioid addiction treatment have increased more than 6 fold   since 1999, few individuals struggling with addiction actually receive treatment. In fact, a 2016 Surgeon General's Report found that only one in 10 people receive any specialized treatment to manage their addiction. At the same time 40% of those who are addicted do not seek treatment. Of the 20 million Americans that had a substance abuse addiction in 2015, about 10% of them were addicted to opioids.
    In addition to that, few places provide MAT. According to the Pew Charitable Trusts , less than half of private sector treatment programs offered any medications approved by the Food and Drug Administration for substance use disorders, and just 23% of publicly funded treatment centers offered them.

    Nurses In RI is here to help Rhode Island residents find qualified providers for addiction treatment. We don't just pull a name out of the phone book, or Google search, we have been working with trusted providers for the past 3.5 years and know theses providers do good work and care about people.  If you, or a loved one is struggling with addiction or mental health issue and are unable to find a qualified provider, are unhappy with your current provider ,or are contemplating managing your addiction now , call Nurses In RI to get linked to treatment today. We provide a confidential analysis of your needs and will get you on the path to wellness today. 

    We believe there is "NO" right way to get sober, do what works for you. Whether it's 12 step, residential, detox, outpatient counseling or medicated assisted treatment, Nurses In RI can provide you with evidence based solutions now. 

    Our toll free number is 1-800-264-3752                                                      Please visit our website @ WWW.NURSESINRI.COM    





    By Timothy Aurelio 29 Jun, 2017
    Nurses in Rhode Island wishes everyone a safe and fun holiday weekend. Remember, The 4th of July is a national holiday celebrating the anniversary of the adoption of the Declaration of Independence in 1776.  On this day, we should celebrate our freedom for our country as well as the freedom from addiction.
     

    Similar to many other holidays, the 4th of July is a day usually revolving around parties and alcohol   which can be extremely difficult for those in recovery. However, there are a few tips that can help you and your loved ones safely celebrate the holiday:

    • Bring your own non-alcoholic drinks from home: While many parties may involve alcohol, bringing your own non-alcoholic beverage from home can help keep temptation and peer pressure at bay.
    • Choose how you want to celebrate: While many 4th of July celebrations may revolve around alcohol, not all do. Don’t be afraid to turn down a party invite and instead find a celebration that will be supportive of your sobriety.
    • Bring a supportive friend: Support is essential in recovery and having a friend nearby can be an additional safety net when temptation rises.
    • Don’t completely avoid the holiday: While the negative connotations surrounding the holiday may seem daunting, getting out and being active can be essential in recovery.
    • Have an exit strategy in mind: Sometimes temptation will arise and having an exit strategy in mind ahead of time can greatly assist in avoiding relapse.
    We must protect our investment, recovery is hard work. Oftentimes, we spend years rebuilding our lives and relationships with ourselves and loved ones. It's ok to say NO when someone offers you an alcoholic drink. 

    Play the tape through. When you think about using, the fantasy is that you'll be able to control your use this time. You'll just have one drink. But play the tape through. One drink usually leads to more drinks. You'll wake up the next day feeling disappointed in yourself. You may not be able to stop the next day, and you'll get caught in the same vicious cycle. When you play that tape through to its logical conclusion, using doesn't seem so appealing.

    Have a safe and fun 4th of July and remember: Put your recovery first and everything else will fall into place...
    Warmest Regards, 
    Timothy Aurelio, RN
    President, Nurses In RI


    More Posts

    Opioid epidemic now a National crisis

    By Timothy Aurelio 16 Sep, 2017

    From Rhode Island Department of Health:  Governor Gina Raimondo’s Overdose Prevention and Intervention Task Force has recognized South County Health and CharterCARE Health Partners for their leadership in providing consistent, comprehensive care for opioid-use disorder in hospitals and emergency departments in Rhode Island. The South County Health recognition took place at this morning’s Task Force meeting. The recognition of CharterCARE Health Partners took place at the July meeting. This recognition was based on treatment criteria met at Roger Williams Medical Center and Our Lady of Fatima Hospital (both CharterCARE facilities), and South County Hospital.

    These criteria were established in March by the Rhode Island Department of Behavioral Healthcare Developmental Disabilities and Hospitals (BHDDH) and Rhode Island Department of Health (RIDOH) in a document titled Levels of Care for Rhode Island Emergency Departments and Hospitals for Treating Overdose and Opioid Use Disorder .

    The aim of these first-in-the-nation standards is to ensure that best practices in the treatment of opioid-use disorder are in place at emergency departments (EDs) and hospitals throughout the state. “We are pleased that hospitals have begun enacting Levels of Care for those suffering from overdose or opioid use disorder,” said Director Rebecca Boss of the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities & Hospitals. “Levels of Care standardizes treatment across all emergency rooms and hospitals to ensure a high level of care for people throughout the state. With these newly designated ‘levels’ we hope to lower the rate of overdose deaths by allowing emergency rooms to become one of the first steps towards recovery.”

    “Rhode Island is the leader in the nation for establishing qualifications, called Levels of Care, to treat people with opioid-use disorder in hospitals and EDs. CharterCARE Health Partners and South County Health are the first health systems in our state to be recognized for achieving Levels of Care designations, and we hope that the other healthcare facilities throughout the state follow their lead,” said Director of Health Nicole Alexander-Scott, MD, MPH.

    “Every single overdose death is preventable. We need all EDs and hospitals in Rhode Island to attain Levels of Care designations so people have access at every possible opportunity to the treatment and recovery resources they need to live lives free of addiction.” The Levels of Care document established a three-tiered system. Designations are made through an application process submitted to RIDOH and BHDDH. All hospitals must qualify for at least a level three, with the expectation that many will attain higher designations, which involve expanded capacity to provide care for opioid-use disorder (i.e., medication-assisted treatment), recovery services, and more.

    By Timothy Aurelio 03 Sep, 2017

    Nothing seemed to help the patient — and hospice staff didn’t know why.

    They sent home more painkillers for weeks. But the elderly woman, who had severe dementia and incurable breast cancer, kept calling out in pain.

    The answer came when the woman’s daughter , who was taking care of her at home, showed up in the emergency room with a life-threatening overdose of morphine and oxycodone. It turned out s he was high on her mother’s medications, stolen from the hospice-issued stash.

    Dr. Leslie Blackhall handled that case and two others at the University of Virginia’s palliative care clinic, and uncovered a wider problem: As more people die at home on hospice, some of the powerful, addictive drugs they are prescribed are ending up in the wrong hands.

    Hospices have largely been exempt from the national crackdown on opioid prescriptions because dying people may need high doses of opioids. But as the nation’s opioid epidemic continues, some experts say hospices aren’t doing enough to identify families and staff who might be stealing pills . And now, amid urgent cries for action over rising overdose deaths, several states have passed laws giving hospice staff the power to destroy leftover pills after patients die.

    Blackhall first sounded the alarm about drug diversion in 2013, when she found that most Virginia hospices she surveyed didn’t have mandatory training and policies on the misuse and theft of drugs. Her study spurred the Virginia Association for Hospices and Palliative Care to create new guidelines, and prompted national discussion.

    Most hospice patients receive care in the place they call home. These settings can be hard to monitor, but a Kaiser Health News review of government inspection records sheds light on what can go wrong. According to these reports:

    In Mobile, Alabama, a hospice nurse found a man at home in tears, holding his abdomen, complaining of pain at the top of a 10-point scale. The patient was dying of cancer, and his neighbors were stealing his opioid painkillers, day after day . In Monroe, Michigan, parents kept “losing ” medications for a child dying at home of brain cancer, including a bottle of the painkiller methadone. In Clinton, Missouri, a woman at home on hospice began vomiting from anxiety from a tense family conflict: Her son had to physically fight off her daughter, who was stealing her medications . Her son implored the hospice to move his mom to a nursing home to escape the situation. In other cases, paid caregivers or hospice workers, who work largely unsupervised in the home, steal patients’ pills. In June, a former hospice nurse in Albuquerque, New Mexico, pleaded guilty to diverting oxycodone pills first by recommending prescriptions for hospice patients who didn’t need them and then intercepting the packages with the intention of selling the drugs herself.

    Hospice, available to patients who are expected to die within six months, is seeing a dramatic rise in enrollment as more patients choose to focus on comfort, instead of a cure, at the end of life.

    The fast-growing industry serves more than 1.6 million people a year. Most of hospice care is covered by Medicare, which pays for hospices to send nurses, aides, social workers and chaplains, as well as hospital beds, oxygen machines and medications to the home.

    There’s no national data on how frequently these medications go missing. But “problems related to abuse of, diversion of or addiction to prescription medications are very common in the hospice population , as they are in other populations,” said Dr. Joe Rotella, chief medical officer of the American Academy of Hospice and Palliative Medicine, a professional association for hospice workers.

    “It’s an everyday problem that hospice teams address, ” Rotella said. In many cases, opioid painkillers or other controlled substances are the best treatment for these patients, he said. Hospice patients, about half of whom sign up within two weeks of death, often face significant pain, shortness of breath, broken bones, or aching joints from lying in bed, he said. “These are the sickest of the sick.”

    Earlier this year in Missouri, government investigators installed a hidden camera in a 95-year-old hospice patient’s kitchen to investigate suspected theft. A personal care aide was charged with stealing the patient’s hydrocodone pills, opiate painkillers, and replacing them with acetaminophen, the active ingredient in Tylenol . Hospice nurses in Louisiana and Massachusetts also have been charged in recent years with stealing medication from patients’ homes.

    But many suspected thefts don’t get caught on hidden cameras, or even reported.

    In Oxnard, Calif., in 2015, a person claiming to be a hospice employee entered the homes of five patients and tried to steal their morphine, succeeding twice. The state cited the hospice for failing to report the incidents.

    In Norwich, Vermont, in 2013, a family looked for morphine to ease a dying patient’s shortness of breath. But the bottle was missing from the hospice-issued comfort care kit. Family members suspected that an aide, who no longer worked in the home, had stolen the drug, but they had no proof. State inspectors cited the hospice, Bayada Home Health Care, for failing to investigate.

    David Totaro, spokesman for Bayada Home Health Care, told KHN that situations like that are “very rare” at the hospice, which takes precautions, such as limiting medication supply, to prevent misuse.

    There is no publicly available national data on the volume of opioids hospices prescribe. But OnePoint Patient Care, a national hospice-focused pharmacy, estimates that 25 percent to 30 percent of the medications it delivers to hospice patients are controlled substances, according to Erik Jung, a vice president of pharmacy operations.

    In relationship to other professions, people working in the medical field have an increased risk of addiction to opioids because of the increased access to the medications and high stress working conditions.  Many medical professionals divert medications from patients every day. It's difficult to fathom the recklessness and disregard for human suffering by switching a pt's morphine with a Tylenol. However, the grips of addiction has NO boundaries . The addicted person uses,  or get sick. One's moral compass does not function well once the disease progresses to this point. 

    I have witnessed the devastation professional nurses and doctors experience during the "compulsion to use,  despite negative consequences"; such as loss of licensure and prosecution.  Never Mind the endless depths of shame and guilt that follows once clean and sober. Here's the thing about addiction- You don't need to take the elevator ALL the way down to the bottom floor, you can step out at any time. There are moments of brief clarity before one chooses to use for another day- versus calling for help. Oftentimes,  fear, shame and guilt prohibit us from reaching out for help. Also, some of us continue to believe that " I can do this alone " or " my way ", or " I have it under control "  This is exactly what an impaired brain says and does.  This disease is to powerful to be doing it "your way".  

    NursesinRI is committed to linking RI residents under the weight of the opioid crisis to treatment, there is never a fee for our services and your information is protected by Federal confidentiality laws. NursesinRI is  nonprofit corporation operating in South County, RI. Our toll free number is 1-800-264-3752


    By Timothy Aurelio 29 Aug, 2017
    There are powerful painkillers that are legal if prescribed by a doctor, but there are also drugs like heroin that are not legal. Heroin and morphine come from opium, along with painkillers like Percocet, Oxycodone, and Vicodin. There are also opioids that are completely or partially synthetic like fentanyl and methadone. Fentanyl is a drug 100 times more powerful than morphine. MoneyWeek reports that about 97 million Americans take opioids , and 12 million get them illegally . The same source states that no less than 2.6 million Americans are addicted to them , while deaths related to fentanyl and heroin are growing.

    In Pennsylvania, Rhode Island, and Massachusetts we can see that fentanyl is responsible for many deaths.  The President  has declared this a national emergency .

    Deaths related to overdoses are a big number

    Roughly 60,000 Americans perished as a result of overdoses last year -- according to MoneyWeek -- and about half of those deaths were due to medical prescriptions . This is more than the number of people killed by guns and car accidents in the same year. For Americans under 50, the opioid crisis has become the leading cause of death.

    The life expectancy declined

    The drug crisis is so severe in America that it made the #Life Expectancy decline in 2015 according to MoneyWeek, which is a negative for the US Labor Market because many men decide not to work, and they are mainly men between 25 and 54 years old.

    As we can see, opioids affect the health of the nation, and this is having devastating consequences.

    Roots of the crisis

    Many specialists believe that the crisis is related to unemployment, stagnating wages, and other economic problems. This could be a possible cause, but not the main one . The most important factor is that the pharmaceutical industry markets the painkillers heavily. A report by the presidential commission states that the problem doesn't begin on the streets, it begins in the healthcare system of the United States  Besides, the price of heroin has fallen a lot, and fentanyl has become more accessible -- all of which has made the situation worse.

    A public health crisis

    This drugs problem is seen as a national emergency by Donald Trump. The Republican governor of New Jersey, Chris Christie, wants the US President to treat this problem as a #Public Health Crisis, not as a war on drugs. There must be great changes; Medications like Suboxone and Vivitrol can make a significant impact on the quality of life, reduce overdose deaths, decrease the spread of disease, reduce crime and assist with managing this awful brain disease.

    NursesinRI is committed to helping RI residents under the weight of the opioid crisis find treatment. 


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