First OpinionAmerica’s addiction crisis, compounded by Covid-19, requires immediate action to save lives linkedin.com/in/paul-earley-m-d-dfasam-b4360445 A nurse holds tabs of buprenorphine, which is used to treat opioid use disorder. Elise Amendola/AP Combination of two drugs can help treat methamphetamine addiction for some, new clinical trial data shows Paul H. Earley Trump administration will let nearly all doctors prescribe addiction medicine buprenorphine About the Author Reprints There is also a nationwide shortage of clinicians who specialize in addiction medicine. The Office of National Drug Control Policy says that only about 5,000 medical doctors have addiction medicine or addiction psychiatry credentials. One good starting point is immediately enacting legislation to ensure that clinicians who prescribe controlled medications of any kind — not just those for addiction — receive baseline education about treating patients with SUD through health care professional schools, residency programs, or continuing education.Another would be expanding federal programs such as the Loan Repayment Program for SUD Treatment Workforce authorized under the SUPPORT Act, the Mental Health and Substance Use Disorder Workforce Training Demonstration program, and the Practitioner Education program. These programs would bolster the medical workforce and provide the nation with an enormous return on its investment.Remove frustrating barriers to evidence-based addiction treatmentIn addition to training frontline medical workers, the nation must build its capacity and its willingness to deliver evidence-based addiction care. While therapies must be individualized to each patient’s unique needs, treatment practices should be consistent with generally accepted standards of care. The current lack of standardization in addiction treatment, on the one hand, and in health insurance coverage for it, on the other, has made it incredibly difficult for policymakers, payers, patients, and families to identify addiction treatment backed by science and evidence.High-quality addiction care is driven by thorough assessment of an individual’s medical, psychiatric, social, and addiction factors. This assessment then leads to a patient-specific treatment plan that delineates a sufficient intensity and duration of care to produce the best possible outcome. Addiction care should be measured in months or years, not in days or weeks.Yet even where high-quality addiction treatment services that are consistent with nationally recognized standards of care and clinical practice, such as the ASAM Criteria, are available, third-party payer policies that limit coverage or payments can prevent patients from accessing those services.Narrow networks, onerous utilization management policies, limitations on Medicaid coverage for incarcerated individuals, and high cost-sharing requirements are just some of the hurdles that Americans face when attempting to access addiction treatment. Reforming current payment policies and ensuring mental health and addiction parity would dramatically expand access to life-saving treatments. Finally, it is still too difficult for people with opioid use disorder to find clinicians and treatment programs providing FDA-approved medications for their disorder due to stigma and overregulation. Medications including buprenorphine, methadone, and intramuscular naltrexone should be available to all patients, no matter where they seek treatment. To accomplish that, laws and regulations that impose unnecessary restrictions on these medicines must be reformed, including eliminating buprenorphine-specific training requirements and patient limits. Otherwise, future federal investments will continue to be limited in their ability to save lives.Moving forwardAs Congress works with the Biden administration to address Covid-19, prioritizing the U.S.’s national response to the other ongoing epidemic of drug overdoses will be essential. This will require strengthening the medical workforce to prevent and treat addiction and removing the barriers Americans face every day when trying to access evidence-based addiction care.Only if we are willing to take these actions will we begin to stem the tide of overdose deaths that have cut short so many promising lives and devastated a nation.Paul H. Earley is an addiction medicine physician who specializes in the assessment and treatment of health care professionals, and currently serves as president of the American Society of Addiction Medicine. Despite hard-fought progress in recent years, new data from the Centers for Disease Control and Prevention show that drug overdose deaths in the U.S. are now at their highest level ever, soaring to more than 81,000 in the 12-month period between June 2019 and June 2020. At the same time, unprecedented challenges during the Covid-19 pandemic have illuminated existing weaknesses in our health care infrastructure when it comes to preventing and treating addiction.While past presidents and members of Congress have enacted a series of bipartisan bills with important provisions that contributed to a temporary national dip in the overdose death rate, policymakers must now take action to address the remaining structural and financial roadblocks that hinder widespread addiction education and training, access to lifesaving medications, and health insurance coverage for evidence-based addiction care.Strengthen the medical workforce to treat addiction and save livesOne of the biggest barriers to accessing evidence-based addiction treatment in the U.S. is a widespread lack of education and training in addiction medicine. Too few clinicians know how to identify and treat patients with addiction. Only 1 in 4 health care professionals receive training about addiction during medical education, according to a recent survey by Shatterproof, which also shows that a shocking number of physicians believe — incorrectly — that opioid use disorder cannot be treated at all.advertisement Related: With more than 20 million Americans living with substance use disorder (SUD), and an overdose epidemic exploding to record levels, much more must be done train clinicians in addiction medicine and give them incentives to practice it.advertisement By Paul H. Earley Feb. 10, 2021 Reprints Related: Tags addicitionCoronaviruspolicy
For their community’s benefit, Muslim leaders will have to adopt a pragmatic approach and identify path-breaking alternatives for the community’s progress.Fostering a Community psycheThe Indian Muslims, as a community, do not possess a common community psyche. They are divided in many factions and no faction is ready to tolerate the other. Unity in community, in spite of factionalism, is found in abundance in other minorities of the country like Sikhs and Parsis. We have to learn a lot from other minorities on how to develop a community psyche so that each and everyone considers them to be part of a larger whole, and the guiding spirit should be collectivism instead of individualism, every Muslim should be seen as contributing both physically and financially, for enhancing the community’s and lives of our brethren.All the above is easier said than done, and the big question remains, who is going to deliver it and how? The answer lies in our religious leaders. It is a fact that a vast percentage of the Muslims, still listens to and act upon the messages conveyed to them by our clergy. But most of the time the messages conveyed are not relevant in any manner to the development and progress of the community in the light of the Islamic teachings but on mundane issues. Instead, our clerics will have to work to contextualise the message of the Holy Quran and Ahaadith to the present era, only then they’ll be effective and remembered. For this purpose, the speech before the Juma Khutba can be a very important tool.Clergy’s RoleThe Muslim clergy should first try to modernise it. It would be good if it could start on a path of critical and scientific thinking or Ijtihad, on issues of importance to the community. Instead of harking back to old and irrelevant texts, it would be better if it could consider each and every issue in a pragmatic fresh perspective based on the correct interpretation of the Holy Quran and Ahaadith. As the Holy Quran is a dynamic not a static book and it offers new solutions as per the new information and analytic prowess gained by its followers with every passing day.We also bemoan the issue of lack of funding for establishing new educational institutes. Here we forget that if the Indian Muslims decide to contribute every paisa of the interest accrued in their bank accounts and the yearly Zakat to a single entity, then the fate of the community could be changed completely in the next 5 years. This sum could be utilised to establish and rejuvenate the educational institutes, orphanages, taking care of the needy and providing for medical facilities for the community and everyone else.In addition, we also have to present a modern image of the community to other faiths and countrymen. We sound hollow when we decry the increasing tide of Islamophobia in the country and elsewhere in the world. But how do we tackle the issue? In this age of information technology, many battles are being fought and won using social media tools. The latest example in this regard is the surge in Islamophobic messages on the social media and response of the Muslim nations. Due to the overwhelming response of the Muslim countries, many social media platforms had to issue guidelines on how to manage the Islamophobic content, besides immediate remorse shown and forgiveness sought by people who engaged in posting Islamophobic content on various social media websites.Muslims and the MediaIt would be better if the community should equip itself to counter the fake and biased news, first. A strong rebuttal and countering mechanism would serve the community well, as the cost for this would not be too high. The first step towards this could be to build a monitoring team, which could keep track of all anti-Muslim news, to be fed to a team of fact-checkers, who with strong research and messaging capabilities should be able to counter any anti-Muslim narrative promptly and professionally.A central team of Media Monitors based in Delhi should keep track of state monitors and should be equipped to work out a quick and coherent response to every issue, charge or misrepresentation on various social media platforms such as Twitter, Facebook, Instagram and WhatsApp.Next, a group of community spokesmen should be trained in the language of the states to which they belong. They should be coached in language nuances, debating skills and how to engage in a coherent and conclusive dialogue with their competitors, viz. every aspect of conducting a successful verbal communication process.Every state should have a small team of at least five people who could represent the community at every media opportunity. An effort should be made to constitute a panel of erudite and knowledgeable people to represent the community at various media outlets. The views espoused by this panel should be endorsed by leading clerics and social leaders beforehand.All this seems achievable and commendable, but the biggest requisite for this to succeed would be the coming together of different leaders representing various sects, outfits and schools within the Muslim community at one platform. We should have a panel of academics, researchers, ideologues, businessmen and entrepreneurs, activists and ground-level workers, who should be seen as the real face of the community.Way ForwardMoreover, it would be better if the Muslim community instead of turning the current concerns into an existential one, introspects and find the areas and issues, which beleaguers it and where it has floundered, besides trying to be seen as part of the county’s mainstream. Follow it with judicious and committed planning and strategising, so that these detriments could be overcome and after the next 25 years, when we’ll be celebrating the century of our independence, we can proudly say that the community has fulfilled the aspirations of its followers and countrymen, both.What we need is a clear-cut plan and a will to innovate and implement those programmes, which will take the community out of its slumber and apathy and take it on the path of progress. Until and unless the Muslim community as a whole decides to change its psyche and reform itself, nobody can help the community survive the present onslaught.——It becomes incumbent upon our religious leaders to forge unity amongst the Indian Muslims and lead them in their political, social, economic and religious life. And thus they’ll have to devise strategies on how to overcome obstacles in partnership with other religions also. For the current dispensation, religions like Parsis or Jews are considered as guests of India, while Christians and Muslims are considered as invaders, thus they deserve to be driven out or made second class citizens. As an enemy of your enemy could be your friend, Indian Muslims will have to forge amicable partnerships with religions like Christianity for their survival in India, and in this manner, they’ll also be able to gain the support of other countries, many of whom follow Christianity as the state religion. Thus, Indian Muslims have to reform themselves and forge new friendships and accords, besides striving hard to co-exist in the fast-changing scenario in the country.