HOUSE CAUCUS ON ADDICTION, TREATMENT, AND RECOVERY

On Friday, April 4^th, Margot and I spoke at a briefing held by the House Caucus on Addiction, Treatment, and Recovery.  We are grateful to Congressmen Ryan, Fleming, and Tonko for holding this important discussion.  The texts of our presentations are below.  We can only hope this appearance sparks more discussion and awareness everywhere.

Margot Head to House Caucus on Addiction, Treatment and Recovery

                                                                                                        April 4, 2012

Health insurance companies are killing our children; I use children in the sense that everyone, regardless of age, is the child of someone.  And the understudies to the killer insurance companies are the hospitals and the so-called rehab places.

Our 24 year old son William had a substance use disorder; or as the population at large would say, “He was an addict”. In this case a heroin addict.  His case happened not to be related to prescription opioids..plain street heroin in the little plastic glassine bags.

William had had at least 15 overdoses in 2012 and 19 emergency transports to hospitals in 2012.  In October of that year William succumbed to a final and ultimately fatal overdose.  Following that overdose William spent six weeks in a NYC hospital until it was absolutely confirmed that he would never wake up and was consigned to a “persistent vegetative state”. William’s brain had been deprived of oxygen for too long in that overdose.

Here’s what else:  4 days prior to that last overdose William had gone to the chemical dependency unit of another  hospital and asked to be admitted for INpatient detoxification..The lab work at that particular hospital gave Will the diagnosis of 304.80 which means polysubstance dependence. In our son’s case polysubstance meant heroin and Benzodiazepines.  Our son’s other substances were marijuana and alcohol; all of these drugs are “downers”…in his case anxiety –palliatives.  There can be no doubt that William was self- medicating.

Back to the request for INpatient detox at this one hospital. William spent hours there waiting for pre approval from his insurance company. Despite William’s DX of polysubstance abuse, some functionary at insurance, who probably didn’t know how to read, or interpret records, DENIED William authorization for INpatient detox, and would only approve outpatient methadone maintenance.  Will  had already flunked at least 4 outpatient rehabs/detoxes. He declined their offer of oupatient methadone maintenance. William knew methadone is harder to get off of than heroin and  I suspect that he knew that this outpatient bit was killing him.  I did NOT know these health insurance companies had a license to practice medicine.

When the hospital found out it was not going to get paid, it sent William to a public hospital to get detox. William ‘yessed’ them, left and called his dealer; we know that from his cell phone record. He got high and came home 10 hours with heroin raccoon eyes..big black circles.  I have heard a rule that if an addict requests help, the help has to be done in  the moment, not 2 seconds, minutes, hours, days or months  later.  Substance abuser’s brains are hijacked by the craving for their drug or drugs.

One other true story: A mere 6 hours before William requested that denied INpatient detox, he had been released from another hospital emergency room. The attending doctor at that hospital wrote, “I do believe patient is at risk of overdosing on heroin, however he does not meet criteria for involuntary psychiatric hospitalization and rather should pursue inpatient rehab which he is refusing. Discharged from ER. Axis 1 Opioid dependence.”

One more similar narrative, of many, is that one month before all of the above happened, William had been in yet a different emergency room. A wise and experienced doctor wrote on his records that he “was a danger to himself and others” and told me on the phone that he should be detained against his will.  The young ATTENDING physician released him anyway. William , I and his dad had a meeting w/ this doctor prior to the discharge; we think he knew nothing about addiction.

And the only reason I have a lot of the above information is that I had to get a court order to obtain records.  I also know that insurance paid hundreds of thousands of dollars on our son and was billed in the area of half a million. It certainly was good they saved money on that INpatient detox.

Bill Williams’ Presentation to House Caucus on Addiction Treatment and Recovery  4/4/14

In early December of 2012 our son, William, entered Columbia University’s College of Physicians and Surgeons at the age of 24.  His arrival there was off the beaten track, beginning with visits to a psychotherapist. Over the next two years stops on the way included an addiction psychiatrist, out-patient treatment, treatment with Suboxone, in-patient detox, in-patient treatment, out-patient treatment, out-patient detox, treatment with Vivitrol, more out-patient treatment, another in-patient treatment, more out-patient treatment, a revolving door of well over a dozen trips to and from the emergency rooms of at least four different hospitals, an attempt to work with another addiction psychiatrist, Alcoholics Anonymous, Narcotics Anonymous, and a home life fraught with tension and despair, sometimes hopeful during intermittent periods of sobriety, and always filled with the apprehension of misfortune.

His credentials for Columbia were unorthodox, “acute and chronic substance abuse” which caused “complications of acute heroin intoxication”.  William was admitted, not as a medical student, but as an anatomical donation. A cadaver.  His credentials came from his death certificate, not any academic transcript.  

As a result of his acute intoxication, when his heart stopped beating for too long, when he was hospitalized for six weeks until it became clear that William had withered to a vegetative state, we made the decision to remove him from life support and have him become an organ donor.  Organ donation for someone in a vegetative state requires an expedient demise.  William did not expire within the necessary one-hour time frame, though his mother, sister and I were with him in the operating room, telling him he could let go.  Rather, he lasted another 21 hours before drawing his last breath in our arms.

Determined that his death not be in vain, his mother, sister and I made the following pledge:  “We promise to do everything in our power to educate and inform people about drug abuse and its prevention, to provide ever more enlightened treatment for addicts, to help make treatment options for addicts more readily available, and to remove the stain of shame surrounding this disease.”  A very first step to honor that pledge was the anatomical donation of William’s body.  We continue to honor that pledge by appearing before you today.

Shortly after we were invited to appear at this briefing we received another invitation.  William’s contribution at Columbia has reached an end.  This coming Wednesday his family, including his seven week old niece who will only know him by story and photographs, has been invited to a ceremony at Columbia honoring those whose bodies helped train and educate this year’s class of medical students.  We will meet and hear from these medical students, their professors, and other families who have donated kin.  We will have an opportunity to speak to them.  What we say to them will differ little from what we say to you today, which is to say that ignorance about substance use disorder remains the order of the day. It is the plague of our time.  Anything we say that is repetition bears repetition until it manifests itself as policy change and practice of substance and consequence.

Parity is about more than receiving equal health care insurance for substance use disorder and mental health issues.

·      Parity means an individual can say, “I have a substance use disorder,” without discrimination, judgment or censure.  Parity is when family members can stand beside the afflicted and say, “…and we are all getting counseling and support to aid in our loved one’s recovery.”

·      Parity means that substance use disorder is recognized by laymen and professionals alike as a brain disease.

·      Parity means that funding for research for substance use disorder is on the same level as that for heart disease, cancer, or diabetes.

·      Parity means that people with substance abuse disorder are treated with the same compassion and understanding, treated with the same urgency, accorded the same dignity, as any other patient with any other medical or surgical need. 

·      Parity is when physicians, not health insurers practice addiction medicine, when physicians, not actuaries determine the best course of treatment.

·      Parity is when physicians are trained to recognize and treat substance use disorder in medical school with the same rigor given to any other disease. 

·      Parity will be when physicians in any specialty can recognize, treat, or refer patients to a proper source of treatment. 

·      Parity will be when there are sufficient numbers of physicians board certified in addiction medicine.

·      Parity will become practice when more than a mere 10% of the 23 million plus Americans who suffer from substance abuse disorder are properly diagnosed and treated.

·      Parity will come about when rehabilitation facilities have medical doctors on staff, all the time.

·      Parity is when physicians, politicians, school principals, police and parents all realize that not only are they responsible for helping to treat this disease, but also that they and their families are as susceptible as anyone else to being afflicted by the disease.

·      Parity will arrive when we stop pretending will power is a cure for a neurological problem.  Will power needs to be exercised, not by the afflicted, but by policy makers who can help change the course of this epidemic.

We are, indeed, in the midst of an epidemic.  Data, like much else in the treatment of substance use disorder, is slow to arrive.  However, we do know that overall, overdose deaths from pills and heroin now exceed automobile deaths in this country.  Every day, 105 people die of drug and alcohol overdoses in this country.  While the latest data is from 2010, it is most likely that the number of drug deaths in 2014 exceeds the number of deaths at the height of the AIDS epidemic. 

William’s cause of death could have been listed as “Institutional Indifference”.  Failed insurance, clumsy coordination between health care providers, and antiquated treatment practices doomed him. 

In another time, in a better era, William might have entered the College of Physicians and Surgeons, not as a cadaver, but as a gifted and talented young man, prepared to serve others. 

We ask you as a body to summon the will power to make these possibilities realities.

 We WILL prevail.

Thank you.