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The Something Awful Forums > Discussion > Debate & Discussion > The American Opioid Epidemic 20XX: Dropping the H-Bomb
 
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sat on my keys!
Oct 2, 2014

 Hopefully this isn't too tangential for this thread.

A recent NYT piece focused on the proliferation of (mostly) unregulated and untested eating disorder treatment centers. Why am I posting this in the opioid thread?

- Opioid dependence and EDs are both highly stigmatized conditions that are hard to treat successfully, partly because sufferers are "doing it to themselves"
- Much like opioids, many people argue that for (some, not all) people with EDs, the ED is a powerful coping mechanism to deal with terrible life situations
- It can be very hard to get insurers to pay for a full course of what we think is the most effective treatment.

A lot of the residential ED treatment centres can be like "vacation time" from the real world (I've heard drug rehab can be like this too). In particular, I thought these quotes:

NYT posted:

The rapid growth of the industry — there are more than 75 centers, compared with 22 a decade ago, according to one count — has been propelled by the Affordable Care Act and other changes in health insurance laws that have increased coverage for mental disorders, as well as by investments from private equity firms.

NYT posted:

Many eating disorders specialists agree that some patients require the supervision of residential programs and benefit from the treatment. But studies showing the programs’ effectiveness are scant, Dr. Guarda and other experts said. The methods of the handful of studies that exist have been criticized.

The quality and form of treatment varies widely across centers, and in some cases includes approaches — equine therapy, for example, or “faith-based” treatment — with little or no scientific evidence behind them. Some programs have full-time psychiatrists and medical doctors on staff, but others lack the expertise to handle emergencies or treat patients with coexisting medical or psychiatric problems.

The perks offered to outside clinicians who might refer patients, the experts say, include free trips, restaurant meals, educational seminars and small gifts like pens and key chains dispensed at professional meetings. Critics liken them to pharmaceutical industry tactics that led to laws and policies requiring financial disclosure, though on a smaller scale. Studies had shown that even small gifts from drug companies, like free medication samples, affected doctors’ prescription practices.

gave me some real deja-vu to the (Atlantic?) article someone posted about the failure of our rehab industry. EDs actually have pretty high comorbidity with substance issues as well.

Does anyone have policy proposals for how we can effectively evaluate/regulate these sorts of residential programs (for substances or for EDs)? I posted this because I think there is pretty significant overlap in terms of insurance fuckery, lots of money to be made with basically no oversight, and a very weak evidence base.

* # ¿ Apr 1, 2016 18:52
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sat on my keys!
Oct 2, 2014

Spacman posted:

Why the gently caress are you posting this in the opioid thread?

I thought I answered this in the post itself? I think there are similarities in the (failures) of the treatment models between both sets of conditions.

* # ¿ Apr 1, 2016 19:14
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sat on my keys!
Oct 2, 2014

PT6A posted:

Is that happening across North America now? It was a huge thing in Western Canada this year, but I didn't know it was a more widespread problem than that.

I'm quoting the NYT a lot today, it seems. They had a recent article about it.

quote:

In some areas in New England, fentanyl is now killing more people than heroin. In New Hampshire, fentanyl alone killed 158 people last year; heroin killed 32. (Fentanyl was a factor in an additional 120 deaths; heroin contributed to an additional 56.)

quote:

Nationally, the total number of fentanyl drug seizures reported in 2014 by forensic laboratories jumped to 4,585, from 618 in 2012. More than 80 percent of the seizures in 2014 were concentrated in 10 states: Ohio, followed by Massachusetts, Pennsylvania, Maryland, New Jersey, Kentucky, Virginia, Florida, New Hampshire and Indiana.
* # ¿ Apr 2, 2016 00:36
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The Something Awful Forums > Discussion > Debate & Discussion > The American Opioid Epidemic 20XX: Dropping the H-Bomb