Governors take executive action to protect youth from e-cigarettes
Amid a growing crisis of vaping-related illnesses and deaths, states are taking bold action to protect youth from e-cigarettes. Governors in Michigan, New York, and Rhode Island have taken executive action in recent weeks to prohibit the sale of flavored vaping products in their states. Massachusetts has banned the sale of all e-cigarette products.
Flavored e-cigarettes play a significant role in drawing young people to vaping as these products are often perceived to be "safer" and young users enjoy the candy, fruit and mint flavorings. Deliberate marketing of these qualities to young people has been disturbingly successful, and the numbers of America's youth using e-cigarette products is soaring. In addition to the harm that can be caused by e-cigarette use directly – which has been tragically demonstrated in recent weeks by the hundreds of people who have fallen ill with serious or fatal lung illnesses linked to vaping – e-cigarettes have the potential to undermine the public health gains that have been made over the years in combating the smoking epidemic. Evidence has demonstrated that youths who use e-cigarettes are at greater risk of subsequently initiating tobacco use.
The AMA has long recognized that the use of products containing nicotine in any form among youth, including e-cigarettes, is unsafe and the AMA House of Delegates has declared the skyrocketing use of e-cigarettes to be an "urgent public health epidemic." The AMA applauds state efforts to keep harmful e-cigarette products out of the hands of young people and prevent another generation from becoming dependent on nicotine.
Pennsylvania House committee makes right decision to pull bill from consideration
After direct advocacy from many different medical organizations, the Pennsylvania House Human Services Committee did not consider a bill that would have added additional barriers to care for patients with a substance use disorder. The Pennsylvania Medical Society, Pennsylvania Society of Addiction Medicine, AMA and multiple other state and national medical organizations strongly opposed Senate Bill 675.
The bill proposed to levy additional fees for certification of buprenorphine office-based prescribers and impose multiple additional regulatory requirements on physicians. It also would have imposed requirements on patients to prove, for example, that they were already being treated in a state-licensed addiction treatment facility before an office-based buprenorphine provider could treat a patient.
At a time when Pennsylvania is seeing decreases in opioid-related mortality, the AMA urged policymakers to continue to remove barriers to evidence-based care rather than take a step backward. The AMA strongly urged a "No" vote (PDF) on S.B. 675 to protect access to medication-assisted treatment for patients with opioid use disorder, and on Sept. 19 the bill was pulled from consideration.
Fighting stigma and building a career treating substance use disorders
When Alena Balasanova, MD, began her psychiatry residency at Boston University, she encountered patients with SUD the way all too many people do—with judgment: "I wanted to treat patients with depression and anxiety—I didn't sign up to treat people with a drug addiction, I held some very stigmatizing beliefs."
Over the course of her residency, however, she started working with patients who are on medication assisted treatment (MAT) and saw firsthand the transformation that occurs when a patient comes in the door very ill, is provided evidence-based care and begins to heal. Her perspective shifted drastically.
"My patients receiving MAT were repairing relationships, finding jobs, and becoming healthier," Dr. Balasanova said. "I began to understand how remarkable it was that I could participate in helping a patient turn his or her life around."
After completing her residency, Dr. Balasanova moved to Nebraska, where she was raised, because she saw an opportunity to improve the lives for patients with SUDs.
"There are so few MAT treatment providers in Nebraska," she said. "I wanted to fill that gap."
Filling the gap meant working to develop an outpatient addiction psychiatric clinic at the University of Nebraska Medical Center in 2017, where patients with SUD could get medication while also having their other psychiatric conditions treated. After the clinic was up and running, Dr. Balasanova then set her sights on something even bigger: an inpatient addiction psychiatry service where patients with SUDs could be seen in the hospital and medical intervention could begin immediately while clinic follow-ups are scheduled.
Dr. Balasanova did not stop there.
These new programs needed knowledgeable medical staff to run them, so she worked to develop a new rotation for psychiatry residents—Longitudinal Integrated MH/SUD Outpatient Clinic (LIMSOC). During the rotation, which lasts a year with a half a day per week in the clinic, residents learn how to use different treatment modalities and are encouraged to get their buprenorphine waivers. This means that no matter where residents choose to go after their residency, they are equipped to treat patients with SUDs.
"The journey I've taken has opened my eyes," said Dr. Balasanova. "But there is so much more work to do."
One of the biggest impediments to care for patients with SUDs Dr. Balasanova has faced is prior authorization for MAT. "Prior authorization for MAT has been a big problem for me and my residents. It's something we deal with on a regular basis," Dr. Balasanova said, "but it shouldn't be—MAT is evidence-based but the insurance companies don't seem to get that."
Looking ahead, Dr. Balasanova is encouraged that she is helping train another generation of physicians to treat SUDs. "I am very lucky to be back in my home state to literally help my neighbors, and I hope all my residents go on to help end the epidemic where they can as well."
To hear more from Dr. Balasanova, watch this video. To learn more about what physicians are doing to fight the opioid epidemic please visit the AMA End the Epidemic website.
