The Courier-Journal’s community forum on the region’s prescription pill and heroin crisis, “A Way Forward,” drew more than 400 people July 21 with dozens of questions for featured panelists. Here are answers to more of your questions.
Question: People do not seem to be aware of the opportunity to use Casey’s Law for involuntary treatment of their loved ones in Jefferson County. Is there a way to help families become educated about how to use the law and equip the treatment community towards that same end?
You’re right that Casey’s Law, which allows parents and other loved ones of alcoholics and drug addicts to file a petition asking a judge to order treatment, is not widely used either in Jefferson County or across the commonwealth. Judges in Jefferson County issued just seven “Casey’s Law” orders last year – in a county where drug-related deaths spiked to 1,248.
And 40 percent of the state’s 120 counties have never ordered someone to treatment in a Casey’s Law case, which is civil not criminal, even though the state law has been in place for more than 12 years. The law can be confusing, but more information can be found at http://caseyslaw.org/.
County Attorney Mike O’Connell, who lost his son to a drug overdose, is spreading awareness about the law and assigned Claudia Smith, one of his prosecutors to handle Casey’s Law cases and shepherd the petitioners through the process. The orders for treatment are already up to 11 this year.
His office also is promoting the law as “another tool in the toolbox” by creating a guide for anyone thinking of filing a petition available online at https://louisvilleky.gov/government/county-attorney/caseys-law or at the County Attorney’s office in the Hall of Justice, 600 West Jefferson Street., 502-574-6336.
Can you do Casey’s Law on someone in a 30-day recovery program?
Yes, according to Cameron Blau who successfully lobbied to extend some addicts 30-day treatment stints during his years as the chief assistant county attorney in Campbell County, an area ravaged by heroin.
First, two qualified health professionals would need to do an assessment of the addict and find that they needed more treatment.
And, both would need to agree that based on the person’s overdose and relapse history, there is a “substantial likelihood” the person would continue to present a danger to themselves or others, said Blau, now a District Court judge.
“Thirty days? It’s like firing a BB at a freight train,” he said of short treatment stints for heroin addiction. “It’ll barely scratch the service of the underlying problem.”
Some states require a thorough psychological assessment prior to prescribing opioids. What would it take to enact this form of integrated health care in Kentucky?
There is a major focus on prescriber education regarding opiate prescribing, said Dr. Allen Brenzel, medical director for the Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities. The U.S. Centers for Disease Control and Prevention has issued new guidelines, and the Kentucky Board of Medical Licensure has issued “scope of practice” regulations regarding appropriate evaluation and prescribing of opiates.
Brenzel said the idea of mandating a psychological evaluation merits exploration but would be complicated because many opiates are prescribed short-term for acute or post-surgical pain. For chronic pain, a psychological evaluation may be more practical, he said, but complicated by cost and a lack of psychologists.
“The other issue that would need to be explored is that do we have sophisticated enough psychometric tools to determine with any certainty who would be at high risk for dependence?” Brenzel said. “In other words, would the evaluation prove helpful and worth the costs?”
Ensuring Kentuckians have better access to chronic pain treatment that focuses on alternatives to opiates is the priority, he said.
After an addict leaves a recovery center, what suggestions are given to them to help them maintain their ‘clean time’?
“Residential programs can begin to lay the groundwork for recovery from drugs and alcohol, but people really need continuing care for strong recovery,” that may include medical and mental healthcare, said Susanne Binford, clinical manager for The Morton Center, a treatment program in Louisville. “Ongoing outpatient treatment provides solid support for people with addiction during their adjustment to a different way of life while they build a network of support.”
Some programs educate addicts on how addiction effects the brain and strategies for handling cravings, stress, boredom and everyday life, Binford said.
“Longer-term programs can help people develop relapse-prevention plans – learning to recognize triggers and warning signs and how to reach out for help in times of crisis,” she said.
Families of addicts and peers – through programs like Alcoholics Anonymous and Narcotics Anonymous – can provide invaluable support.
“Addiction affects the entire family and outpatient treatment can assist with healing families and strengthening those bonds,” said Binford, adding that The Morton center focuses on involving families in the recovery process.
Visit www.courier-journal.com/wayforward for previous Q&A sessions and other heroin-related coverage.
Reporter Laura Ungar, who also reports for USA TODAY, can be reached at 502-582-7190 or [email protected]. Reporter Beth Warren can be reached at 502-582-7164 or [email protected].
