Among those who experience a mental health illness, more than half do not receive treatment.[1] The 2019 National Survey on Drug Use and Health reveals no treatment was received by:

• 90% of the 20.4 million individuals aged 12+ who have a substance use disorder (SUD)
• 55% of the 51.5 million individuals aged 18+ who have any mental illness (AMI)
• 35% of the 13.1 million individuals aged 18+ who have a serious mental illness
• 90% of the 9.5 million individuals aged 18+ who have a co-occurring SUD and AMI
• 57% of the 3.8 million individuals aged 12-17 who have had a major depressive episode

In fact, what we’ve seen in our data is that 60% of patients who are admitted to inpatient care were first seen in a primary care setting within 6-12 months of the admission and the mental health condition was either missed or not addressed.

Through effective screening for mental health conditions on your own or through a physician or mental health professional, it is possible to identify problem areas and get help, so you can live a happier and healthier life.

Mental health self-screening tools

Magellan Healthcare provides links to reputable, free self-assessments of behavioral/mental health, substance use and more.* Once you complete an assessment, be sure to review your results and any recommendations with your doctor.

• Addiction(CAGE-AID)
• Alcohol consumption (AUDIT-10)
• Anxiety (GAD-7)
• Bipolar disorder
• Child depression (CES-DC)
• Child trauma (CTS)
• Depression (PHQ-8)
• Drug abuse (DAST-10)
• Eating disorder (SWED)
• Insomnia (ISI-7)
• Obsessive compulsive disorder (OCD) (Y-BOCS)
• Pain (PEG-3)
• Parent mental health
• Postpartum depression
• Post traumatic stress disorder (PTSD) (PC-PTSD)
• Psychosis (PQ-B)
• Youth mental health

*Note these are links to outside websites that are not monitored by or affiliated with Magellan Healthcare. If your screening results indicate you are at high risk, call 911 or go to the emergency room immediately.

We encourage you to watch a recording of our webinar, “Depression is more than just a rough patch,” and find additional resources addressing depression at MagellanHealthcare.com/Mental-Health.

[1] https://www.samhsa.gov/data/sites/default/files/reports/rpt29392/Assistant-Secretary-nsduh2019_presentation/Assistant-Secretary-nsduh2019_presentation.pdf

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

“Strung out. Looking for the next fix. A full time job that doesn’t pay, but just takes.”

That’s how one of Magellan’s Recovery Support Navigators defined her addiction to opiates. She has since overcome the stranglehold of addiction and is now in long term recovery.  Her experiences, and those of her fellow Recovery Support Navigators, provide the credibility needed to influence their peers who are still struggling with addiction and mental illness that recovery is possible and that desperation does not have to define a life.

An estimated 20.2 million Americans live with a substance use disorder[1]. That’s the population of my home state of Florida. Of that, 2.1 million Americans live with an opioid disorder. Similar to serious mental illnesses, substance use disorders can be difficult to address. Those with the lived experience of walking the path from hopelessness to wellness are experts at engaging individuals with the services and supports that foster the recovery process. Stories of changed lives are not the only proof.

A January 2018 study of our internal recovery support navigation program at Magellan Health found statistically significant improvements for individuals living with substance use and mental health disorders. A key component of the Magellan’s internal peer support program is meeting people where they are. The first engagement with members often happens in an emergency room, inpatient setting, or on the streets. Members then choose where future meet-ups happen. Often, that choice is in the comfort of their own home.  If they are experiencing homelessness, the member chooses a safe place.

The study compared utilization of services six months prior to receiving peer support services and six months following the completion of peer support services. Seventy-five percent of the members in the study had a co-occurring mental health and substance use disorder and 50 percent had a co-occurring substance use disorder, mood disorder and psychotic disorder. The study found that members in Magellan’s internal peer support program cost the health plan significantly less in the six months following completion of the peer support program than members who only had care management or who did not receive any intervention from the health plan. The study also found that six months after completing peer services, peer support decreased emergency room and inpatient hospitalizations.

The role modeling by a peer specialist of a life lived well in recovery is evidence for the individual struggling that there can be long term sustainment of recovery. In addition, the data from this study replicates prior findings that peer support has a lasting impact on the lives of those living with substance use and mental health disorders.

[1] Substance Abuse and Mental Health Services Administration. (2017). Mental and substance use disorders. Retrieved from https://www.samhsa.gov/disorders

Opioid addiction has grown over the past fifteen years from a personal issue to a national emergency. A new infographic from Magellan Healthcare reveals the devastation that this epidemic is causing.

• In 2014, there were 18,893 overdose deaths related to prescription pain relievers
• There was a 3,203% rise insurance claims for opioid dependence diagnosis from 2007-2014
• Prescription opioid abuse is costing employers $25,000,0000 a year

The opioid addiction crisis is causing such an unprecedented amount of harm precisely because it is such a complex, multi-faceted issue. Those looking for answers as to how such an epidemic could have happened, will need to examine a swath of individual problems, including:

• The enormous quantity of prescription opiates
• The limited patient knowledge of opiate risk
• That diversion of opiates to family and friends is so common that only 20% of those with opioid abuse problems are actually using opioids prescribed to them
• The struggle to adequately assess patient’s substance use history and risk of addiction when prescribing opiates
• The lack of clear guidance as to who should receive opiates and for how long
• The difficulty in maintaining patient adherence to withdrawal management treatment plans.

New solutions are needed to tackle each of these individual issues. At Magellan Health, we intend to do precisely that. The opioid addiction crisis has already taken a huge toll and it grows worse every day. It is manifesting itself in myriad ways among thousands of communities across the nation. At Magellan Health, we have an unyielding commitment to ending this epidemic.

Magellan Health marked October as Substance Abuse Prevention Month, with its chief medical officer, Dr. Karen Amstutz, releasing the following statement:

“Substance abuse does not discriminate. It pays no mind to gender, race, age or income level. According to the National Institute on Drug Abuse, the abuse of alcohol, tobacco and illicit drugs costs the United States more than $700 billion annually related to crime, lost work productivity and healthcare. Substance abuse, and in particular, our nation’s opioid epidemic, is gripping families and communities all across the country. Chances are, you know someone who is coping with substance abuse, though they might be doing so in silence.

“Magellan Health has worked in the field of behavioral health management for over 40 years, and we believe strongly that the treatment of substance abuse, including opioid misuse and addiction, is possible. Magellan Health advocates for medication assisted treatment (MAT), a well-researched and highly effective approach combining medication to treat the physical effects of opiate dependence, with counseling and recovery support services. Magellan Health is poised to support treatment professionals, legislators, third-party payers and patient advocates in the implementation of prevention efforts, best clinical practices, and elimination of potential barriers to treatment and recovery. Working together, it is important to shine a light on this dark epidemic and provide hope to people seeking to live a healthier, more vibrant life.

“If you or someone you know is dealing with substance, please call the Substance Abuse and Mental Health Services Administration’s Help Line at 1-800-662-HELP (4357). For Magellan’s resources related to substance abuse, please visit http://magellanhealthcare.com/opioids“

Painkillers, Heroin and Addiction: The Opiate Crisis Laid Bare

From East to West, North to South, the Opiate addiction continues, almost unchecked, to claim lives, destroy families and ruin communities.

Opiate Addiction: The Overdose Emergency

Fueled by both prescription painkillers and illegal substances, opiate addiction kills thousands every year. In 2014, for example:

• There were 18,893 overdose deaths related to prescription painkillers
• There were 10,574 overdose deaths related to heroin

Despite those shocking numbers, the problem continues to grow. (It quadrupled in the first decade of this century and continues to explode). In the past twelve months, the Drug Enforcement Agency (DEA) has been forced to issue warnings on new drugs such as Fentanyl, a potent opiate more than 100 times more powerful than morphine and 30-50 times stronger than heroin. While Fentanyl has killed thousands of people over the past few years, many only heard of it recently, when it was attributed to the death of the musician Prince.

Still, by far the most prevalent cause of overdose is prescription painkillers. This encompasses a much broader swath of the Opioid family (Opiates and their synthetic and semi-synthetic variants). The most common culprits are:

• Methadone
• Oxycodone (such as OxyContin®)
• Hydrocodone (such as Vicodin®)³

In 2014, the United States saw nearly 4.3 million people ages 12 or older using prescription painkillers non-medically. To put that into perspective, that is almost 2% of the entire population. According to the Centers for Disease Control, more than 1,000 people are treated in emergency departments for misusing prescription opioids every day. Finally, almost 2 million Americans either abused or were dependent on prescription opioids in 2014.

Painkillers, Addiction and the Economy: What the Opiate Crisis is Costing America

The opiate addiction crisis has an obvious and tragic human cost. Addiction to painkillers and illegal opiates cause death and healthcare emergencies every day. But they also have a profound economic cost that affects people, employers and governments all over the country.

One estimate, conducted in 2011, put the economic cost at $55.7 billion

• Workplace costs accounted for $25.6 billion (46%);
• Healthcare costs accounted for $25.0 billion (45%); and
• Criminal justice costs accounted for $5.1 billion (9%)

Of those figures, the study’s authors offered the following breakdown:

• Workplace costs were primarily driven by lost earnings from premature death ($11.2 billion) and reduced compensation/lost employment ($7.9 billion).
• Healthcare costs consisted primarily of excess medical and prescription costs ($23.7 billion).
• Criminal justice costs were largely comprised of correctional facility ($2.3 billion) and police costs ($1.5 billion).

To put that in perspective, the $55.7 billion that opiate addiction erases from the economy is roughly equivalent to the annual Gross Domestic Product of the entire state of Maine. It is greater than that of Alaska, North Dakota, Montana, South Dakota, Wyoming and Vermont.

Medication, Therapy and Shifting Thinking: Opiate Addiction Solutions

Opiate addiction is deadly, it’s costly, but it is anything but simple; especially when it comes to finding solutions or even identifying the root causes of this crisis. Some point to the high availability of opiates compared to the past — the number of prescriptions for opioids (like hydrocodone and oxycodone products) escalated from around 76 million in 1991 to nearly 207 million in 2013 — others point to socioeconomic factors or to the increased focus on pain management in recent decades.

The answer is, most likely, that all of these answers are correct, at least some of the time. Tackling opiate addiction and prescription painkiller abuse will take a multi-faceted approach which recognizes that while opiate addiction and overdoses are the hurdles, there are many different paths to overcoming them.

One such solution is increasing the availability of medication-based treatments for opiate addiction. Both Medication Assisted Treatment (MAT) and Office Based Opioid Treatment (OBOT) offer physician-supervised treatment options that use several medications to treat and even prevent addiction to opioid painkillers. These treatments combine medication with behavioral therapy to help ease a patient away from their opioid addiction over time and have been proven to be highly effective. However, both MAT and OBOT have obstacles to overcome before becoming more widely accepted for use.

There are challenges matching medication providers with supportive counselors as well as a lack of access to prescribing physicians. Furthermore, there is some opposition to MAT and OBOT from providers that support 12-step programs as well as among providers who view such methods as swapping one addiction for another. Both MAT and OBOT have been clinically proven to be an effective tool for overcoming addiction to both prescription painkillers and illegal analogs such as heroin as well as alcohol.

A second option for solving the opiate addiction crisis is to change techniques for pain management entirely. For example, back pain is one of the most common reasons Americans go to the doctor. From 2001 to 2011, the number of spinal fusions in U.S. hospitals increased 70 percent, making them more frequently performed than even hip replacements.

This reliance on surgery is controversial. Although many patients expressed satisfaction with the outcome of surgery, 51% of patients who were using opioids before the surgery still were using the drugs one year later, and among those who were not using the drugs before surgery, 18% were using them a year after their surgery.

An increasingly popular alternative is to channel more people, where appropriate, away from opioids and surgery and into more effective treatments such as physical-therapy. By reducing the number of people being introduced to opiate painkillers, the number of people who develop an addiction is reduced.

Thirdly, there is increased interest in deploying Cognitive Behavioral Therapy (CBT) to improve treatment response as a primary or conjunctive treatment option. CBT is a particularly appealing solution for some as it can be deployed in very innovative ways, both in-person and online and it remains just as effective. CBT can help people with an opiate addiction by teaching the patient to recognize and avoid negative and destructive thought patterns and behaviors.  This teaches the individual to recognize the triggers that cause a craving for drugs, then avoid or manage those triggers. CBT works well in conjunction with other treatments.

Other non-opiate based interventions for pain include mindfulness therapy, the use of non-addicting medications such as non-steroidal anti-inflammatory agents (NSAIDS) and anti-depressants to name a few.

A Pioneer in Substance Use Management

Magellan Health is a pioneer in offering integrated, comprehensive opioid risk and substance use management programs. We have an unyielding commitment to ending the current epidemic. And we are uniquely positioned to bring together behavioral, medical and pharmaceutical programs to positively impact overall population health and reduce cost.

We offer many substance use solutions, including medication assisted treatment (MAT), shown in the monograph as an invaluable tool in the fight against substance abuse. We continue to evolve our MAT program and other offerings to most effectively meet the needs of our customers and those they serve.