Family members can play an important role in helping a loved one with co-occurring mental health and substance use disorders get on the road to recovery. Support a loved one’s recovery by:

• Helping a loved one remember to take all prescribed medications for one or both disorders
• Listening to any concerns about medications – such as their purpose, benefits, and side effects – and helping address those concerns
• Making sure appointments with treatment providers are kept
• Working with the treatment team to stay informed and help address any issues related to medication

To learn more, visit Mind Your Mental Health.

Source: Behavioral Health Evolution

There is no mistaking that opioid addiction is a major social issue in the United States but there is also a lot of confusion and misinformation. We’ve included seven frequently asked questions about opioid addiction below.

1) What are opioid medications?

Opioids are medications prescribed to relieve physical pain. Opioid medications bind to the areas of the brain that control pain and emotions, driving up levels of the feel-good hormone dopamine in the brain’s reward areas, and producing intense feelings of euphoria. As the brain becomes used to the feelings, it often takes more and more of the drug to produce the same levels of pain relief and well-being, leading to dangerously high tolerance levels, dependence, and later, addiction.

2) What are the names of some common opioid medications?

• Codeine

• Fentanyl citrate

• Hydrocodone (e.g., Vicodin)

• Hydromorphone (e.g., Dilaudid)

• Mepedridine (e.g., Demerol)

• Morphine (e.g., Kadian, Avinza)

• Oxycodone (e.g., OxyContin, Percocet)

3) What are opioid medications used for?

Opioids are used to treat moderate to severe pain that may not respond well to other pain medications. They provide relief from an array of symptoms associated with respiratory illnesses, severe coughing, injuries, trauma, surgery, dental procedures and chronic pain.

4) How do people become addicted?

Taken as prescribed, opioids can be used to manage pain safely and effectively. However, since these drugs also affect the brain regions involved in reward, some people experience a euphoric response. Those who abuse opioids may seek to intensify their experience by taking the drug in ways other than those prescribed.

5) What is the difference between opioid dependence and opioid addiction?

Physical dependence on opioids means that the body relies on an external source of opioids to prevent withdrawal. Normally the body is able to produce enough endogenous opioids (i.e., endorphins) to prevent withdrawal. However, as tolerance increases over time, eventually the body’s ability to maintain its equilibrium is exceeded and the body becomes dependent on the outside source of opioids. Physical dependence is predictable, easily managed with medication, and is ultimately resolved with a slow tapering off of the opioid.

Unlike physical dependence, addiction is a change in behavior caused by biochemical changes to the brain after continued substance abuse and it is classified as a disease. Addiction takes the form of uncontrollable cravings, the inability to control drug use, compulsive drug use, and continued use despite doing harm to oneself or others. Strong cravings are common to all addictions. These cravings are rooted in altered brain biology. Recovery is the process of reversing, to the extent possible, these brain changes. This is accomplished through therapy and replacing the addictive behaviors with healthy alternative behaviors.

6)  What are the signs of an opioid addiction?

• Constricted pupils

• Nausea

• Itchiness

• Drowsiness

• Reduced social interaction

• Anxiety

• Poor memory and concentration

• Slowed breathing, movement and reactions

• Mood swings

• Apathy and depression

7) What does treatment involve?

Opioid addiction is a chronic disease, like diabetes, asthma and hypertension. While it can’t be cured, it can be treated to help the person regain a healthy, productive life. Treatment programs typically include detoxification, medication for opioid withdrawal, counseling and the support of family and friends. The goal of the treatment program is to help the person get through the withdrawal successfully and learn new coping skills to address addictive behaviors over the long-term.

Additional Resources

Centers for Disease Control and Prevention (CDC)

The CDC website features a section devoted to opioid information, data and FAQs. In addition, there are guidelines for prescribing opioids for chronic pain to help ensure patients have access to safer treatment options.

National Institute on Drug Abuse (NIDA)

NIDA provides information odrugabuse.govn commonly abused drugs, the latest science and treatments, trends and statistics to improve individual and public health.

The American Society of Addiction Medicine

A society of physicians aimed at increasing access to addiction treatment. They offer a nationwide directory of addiction medicine professionals.

The Substance Abuse and Mental Health Services Administration (SAMHSA) or 1-800-662-HELP

Find locations for residential, outpatient, and hospital inpatient treatment programs for drug addiction and alcoholism throughout the country.

The Partnership at Drugfree.org or 1-855-378-4373

Provides information and resources on teen drug use and addiction for parents to help them prevent and intervene in their children’s drug use or find treatment for a child who needs it.

Help is available. For additional information, visit MagellanHealth.com/MYMH

Read more about opioid addiction here.

1. Those who abuse prescription opioids are 40% more likely to use heroin than those who don’t.
2. The United States consumes 80% of the world’s prescription painkiller supply, despite not even making up 5% of the world’s population.
3. It’s possible to die the first time you use cocaine, consumption quadruples the risk of sudden death.
4. An estimated 88,000 people die per year due to alcohol.
5. Only about 11% of those addicted to drugs or alcohol actually receive treatment for their substance abuse disorder.

Source: Drugabuse.com

October marks National Breast Cancer Awareness Month, which focuses on increasing awareness and highlights the importance of early detection. Breast Cancer is the leading cause of cancer-related death in women with 40,000 deaths related to breast cancer in 2016. However, millions of women are surviving and thriving with breast cancer when found and treated early.

Magellan Health is a proud supporter of National Breast Cancer Awareness Month.  Help spread the importance of conducting monthly breast self-exams and the powerful impact early detection can have on a woman’s life.

Learn more about the importance of early detection and how to conduct a self-exam.

Source: Surveillance, Epidemiology, and End Results (SEER) Program. Accessed July 14, 2017

On the 10^th anniversary of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), the Association for Behavioral Health and Wellness (ABHW), the national voice for payers that manage behavioral health insurance benefits for over 175 million people, and its member companies today declared continued support for, and further commitment to, creating parity in behavioral health treatment and coverage.

While MHPAEA was signed into law on Oct. 3, 2008, ABHW and its member companies’ efforts to address mental health and substance use disorder (MH/SUD) parity have a much longer history – decades. As an original member and Chair of the Coalition for Fairness in Mental Illness Coverage (Fairness Coalition), we worked with a diverse coalition of stakeholders to win equitable coverage of MH/SUD treatment, and were an avid advocate and supporter of the final bill that became law.

Mental health and substance use disorder parity is a right. Everyone deserves access to equitable, affordable, medically appropriate, high quality mental health and addiction services and treatment. ABHW member companies have diligently worked to drive consistent interpretation and enforcement of MHPAEA across the United States. We will continue our efforts through:

• Improved access to behavioral health treatment, services, and providers;
• Behavioral health co-payments that align with medical visit co-pays;
• Elimination of arbitrary treatment limitations on the number of days of coverage for a condition, as well as financial limits on annual and lifetime dollar caps;
• Adjustments to prior authorization requirements for mental health and substance use disorder services so that they are comparable to medical benefits; and
• Integration of medical, pharmacy, and behavioral health benefits to increase consumer engagement and reduce overall medical costs.

While great strides have been achieved, we acknowledge that more can be done to ensure that mental health and addiction parity is being implemented in the manner in which it was intended.

• Accreditation – Currently there is no parity accreditation standard that would deem a health plan parity compliant. Recognition of such an accreditation by consumers, federal and state governments, employers, and providers would support consistency of interpretation and assessment of parity compliance.
• Best Practice Examples – Additional illustrations from the federal regulatory agencies of health plans that are implementing MHPAEA correctly or states that are accurately enforcing MHPAEA would be very helpful in advancing parity compliance. If regulating agencies release de-identified information related to non-compliance issues it would provide interested parties with a thorough picture of the regulator’s intent related to MHPAEA and would lead to improved compliance.
• Substance Use Disorder – Currently, there is not parity in the way health care professionals access SUD records. This puts SUD patients at greater risk and inhibits integrated care for these individuals. Since SUD patients and their records are siloed from the rest of medicine, many individuals are receiving substandard, uncoordinated care.

ABHW and its member companies are committed to the full implementation and enforcement of the parity law. We will continue our efforts to work with consumers, employers, health plans, state Medicaid agencies, regulators, legislators, providers, behavioral health interest groups, and others to further parity compliance, educate consumers about the law, and provide the tools and resources needed to make informed decisions.

Signed,

Association for Behavioral Health and Wellness

Aetna Behavioral Health

Anthem

Beacon Health Options

Centene Corporation

Cigna

Magellan Health

New Directions Behavioral Health

Optum

PerformCare
ABHW is the leading health plan association working to improve access and quality of care for mental health and substance use disorders. ABHW’s members include national and regional health plans who care for more than 175 million people. Together we work to reduce stigma and advance federal policy on mental health and addiction care. Member companies – Aetna Behavioral Health, Anthem, Beacon Health Options, Centene Corporation, Cigna, Magellan Health, New Directions Behavioral Health, Optum, and PerformCare.

Parity Progress

Ten years ago today, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was passed into law. This ground-breaking legislation required health plans to treat mental health and substance use conditions like physical medical conditions without treatment or financial limitations. For more than 40 years, Magellan has wholeheartedly supported and actively advocated for parity. Every day, we work together with our customers — health plans, employers, state Medicaid and military and government clients — to innovate new solutions on behalf of those we serve, which continues to advance the law and helps to reduce the stigma around mental health and substance use issues. At Magellan, mental health is fundamentally as important as physical wellness, but it’s just a start.

Beyond equal to individualized and integrated

While our country has made positive strides in parity, we know achieving a healthy, vibrant life is tied to many factors beyond parity – namely social determinants, such as housing, poverty, education and access to transportation and healthy food. One way we are addressing and accounting for these social determinants is by focusing on providing individualized, integrated care.

Complete Care-Person-centered. Community-focused. Evidence-based.

A great example is Magellan Complete Care, which operates person-centered health plans that provide complete care coordination for recipients in Medicare and Medicaid. In the state of Florida, we developed the first-in-the-nation Medicaid specialty health plan to integrate physical and behavioral healthcare and address the social determinants of health for individuals living with serious mental illness and substance use disorders. In Arizona, Massachusetts, New York and Virginia, our Medicaid health plans integrate the full continuum of healthcare services – including mental health and substance use disorder services and treatments individualized to help each member live their healthiest, most vibrant life.

Integrated Health Neighborhoods

Magellan Complete Care plan participants include many individuals who contend with complex conditions that impact their physical health and mental well-being every single day. These individuals need to stay connected to their families, friends, neighbors and others in their communities to maintain independence and achieve optimal health and well-being. Doing so makes the difference between surviving and thriving. To these ends, we have pioneered a care coordination model called the Integrated Health Neighborhood (SM).

This model challenges the definition of what you might think a traditional health plan does for its members. Instead of just focusing on physical and behavioral health treatment, Integrated Health Neighborhoods work within existing community support agencies and local public health systems to strengthen and extend their reach. Our local teams help each member navigate these systems and supports based on their needs as well as their preferences for connecting in their own communities. This helps minimize member disruption through the use of familiar local provider networks and support from trusted community organizations.

Our Integrated Health Network teams are comprised of Magellan associates who live in the same communities as the members they serve. Our assigned teams personally know people at agencies, organizations and local resources across their neighborhood, whom they can call on, person to person, to find the right resources for each member. They work collaboratively to help each individual member find his/her path to independence and well-being.

Recovery Support Navigators

A unique part of the team are the Recovery Support Navigators. These are certified peer support specialists who have lived experiences with some of the same challenges our members face – they have experienced substance use disorders or psychiatric disabilities and may have personally been homeless, had their utilities turned off or experienced food insecurity. They can relate to the members they support, empathize, and then draw on real-world solutions to help them.

For the past 20 years, Magellan has been a leader in increasing access to peer support through partnerships with the recovery community and providers.  We have assisted state customers in developing robust certified peer specialist capabilities, driven in large part by our depth and breadth of experience.   We create shared learning opportunities for the peer workforce and others to improve and enhance the knowledge, skills, and competencies of the peer workforce across the continuum.  Our Recovery Support Navigators represent our best practice approach to tapping the power and potential of peer support.

We know people are more than just a diagnosis – or multiple diagnoses. Truly living healthy, vibrant lives means seeing more than parity for the pieces. It’s seeing and caring for the whole person and bringing together the right resources across the community to help. Integration and individualization are the next steps, and I am proud to say Magellan is out front and on the ground in neighborhoods around the country, taking these steps with our partners and members – together!

In today’s complex healthcare environment, we continue to see a dynamic shift in managing complex chronic conditions with life-saving drugs. This introduces additional challenges for employers and their employees, especially in terms of access and affordability.

With the evolution of prescription benefit management, it’s a critical best practice for employers to plan today for tomorrow’s challenges. This will help identify opportunities and strategies to ensure the best clinical and economic outcomes for their company and their employees while delivering high-value, cost-effective prescription benefits.

Now is the time when most employers are planning for 2019 budgets. Understanding what will drive costs creates the opportunity for strategies to ensure the right drug is used for the right patient at the right time.

We are noticing three key themes related to 2019 expected pharmacy costs:

1. Overall drug costs will continue to grow by single digits primarily through generic competition and slower growth of specialty drugs. Specialty drugs will continue to drive the overall drug trend, continuing to increase by double digits (around 11%).
2. Two conditions: Autoimmune (anti-inflammatory) and Diabetes – account for 30-35% of all pharmacy costs. Drugs used to treat complex chronic conditions such as rheumatoid arthritis, psoriasis, Crohn’s disease, and other autoimmune diseases, along with cancer and HIV/AIDS drugs, will account for about 60% of all specialty drug costs.
3. Specialty costs on the medical benefit are the most significant cost drivers today with little management. Injectable and infused drugs administered by providers to address conditions such as cancer and autoimmune disorders present unique challenges, with cancer and cancer-associated supportive drugs having a trend up to 25%; however, with less than 60% of employers having care management and prior-authorization programs for these top conditions.

Many people who die by suicide leave loved ones behind who suffer from a range of painful emotions.

When it happens to someone you know

Losing a loved one to suicide can be overwhelmingly painful for family members and friends. Unlike a death that occurs naturally from old age or illness, a death by suicide is usually sudden, unexpected, and sometimes violent. The shock and trauma for survivors is further complicated by the social stigma of suicide, possible police investigations, media coverage, lack of privacy, and judgment of others in the community.

How many people it impacts each year

Research shows that at least six people are directly affected by the death, including immediate family members, relatives, neighbors, friends, and co-workers.

Given that more than 43,000 people take their lives each year, approximately a quarter million survivors are left behind, traumatized by the loss.¹

Many people who die by suicide suffered from clinical depression or other mental health disorder. The survivors may also be at risk for depression and anxiety.

Common responses

The emotional pain of survivors can be complicated, intense, and prolonged. People may feel a sense of guilt and responsibility and blame themselves for not seeing the warning signs. They may feel a profound sense of betrayal, rejection, and abandonment. Other common responses are:

• Feeling a need to make sense of the death and understand why the person made the decision to die. Even if the person left a note or a message, there are often unanswered questions that can persist for years.
• Replaying the events that took place before the person’s death and constantly second-guessing different outcomes.
• Experiencing symptoms of post- traumatic stress disorder such as flashbacks and anxiety, particularly if they witnessed the suicide or discovered the body.
• Shame and anger due to the stigma of suicide and mental illness, and possible negative community responses.

Some individuals experience intense grief that does not heal with time.

The bereaved person may feel empty, preoccupied with the death and unable to resume the activities of daily life. This type of grief, known as complicated grief, can affect from 10 – 20% of the survivors of suicide loss. If left untreated, complicated grief often persists, resulting in significant impairment and poor health outcomes.

How you can help

Sometimes people struggle with what to say or how to help a family who has lost a loved one by suicide. Helping the survivors means being a good listener and avoiding any criticism or judgments. Try to:

• Be present and listen attentively without feeling the need to provide answers.
• Avoid speculating on the reasons for the suicide or the person’s state of mind.
• Be sensitive about what you say. Avoid clichés such as “I know how you feel” or “time will heal all wounds.”

Helping the survivors means being a good listener and avoiding any criticism or judgments.

• Be compassionate and understanding, and remember that grieving takes time.
• Take the initiative to be helpful. Bring a meal, mow the lawn, or pick up groceries for the family.
• Be aware of support groups and offer to find one if the family is interested.

The grief of suicide survivors is unique and complicated by the circumstances of the death. You can help by being present as a caring friend and sounding board. Let the family know you’re ready to listen if and when they want to share their thoughts and emotions.

Help is available. For additional information, visit MagellanHealth.com/MYMH

1. 2014 data, released December 2015, CDC Web Based Injury Statistics Query and Reporting System (WISQARS)

Sources: American Association of Suicidology; American Foundation for Suicide Prevention; Harvard Health Publications