Prescription refills disappearing, moving to mail order facilities

https://www.wandtv.com/news/prescription-refills-disappearing-moving-to-mail-order-facilities/article_61287a4c-0663-11ea-806d-f3e1d04c6bc3.html

NOKOMIS, Ill. (WAND) – Independent pharmacists tell WAND News they are seeing patients request prescription drug refills only to find the prescription has been transferred to a mail order facility without their knowledge.

David Falk of the Sav-Mor pharmacy in Nokomis and Lauren Young of Dale’s Southlake Pharmacy in Decatur tell similar stories: customers requesting a prescription drug refill and then the pharmacist having the refill rejected. It’s then determined the request is being filled through mail order. When the customer is contacted, the customer says they did not request the prescription be transferred from their local pharmacy.

Falk cites a case over the summer where a customer wanted her prescription refilled at his pharmacy.  She is signed up to a plan through Medicare Part-D.  She received a letter from a Pharmacy Benefit Manager, PBM, and was told her the order was on hold and she needed to call the PBM to confirm the order.  PBMs are the middleman between the pharmacist and insurance companies.

Falk tells WAND News the patient did not ask her doctor to transfer the prescription to the PBM.  Her order was eventually cancelled and the prescription has been reestablished with Sav-Mor.

The PBM, CVS/Caremark, tells WAND it received the prescription from the healthcare provider

and attempted to contact the customer by phone.  When Caremark could not reach the customer it sent out a letter requesting verification.  The order, according to Caremark, was cancelled at her request.

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CDC: Antibiotic resistance causes 1 death every 15 minutes in US

https://www.healio.com/infectious-disease/antimicrobials/news/online/%7Bf30ac0ff-2016-47dc-8fd1-0cd729f0a3e8%7D/cdc-antibiotic-resistance-causes-1-death-every-15-minutes-in-us

According to newly updated estimates published by the CDC, more than 2.8 million infections are caused by antibiotic-resistant pathogens annually in the United Sates, resulting in at least 35,000 deaths.

That is one infection every 11 seconds and one death every 15 minutes.

“We must remain vigilant,” CDC director Robert R. Redfield, MD, said during a news conference. “Antibiotic resistance threatens both our nation’s health and our global security, and that’s why we all play an important role in stopping it.”

New numbers

Based on several data sources, the report — Antibiotic Resistance Threats in the United States, 2019 — updated oft-cited estimates published by the CDC in 2013 that had recently been called into question.

The 2013 report estimated that drug-resistant infections caused more than 2 million illnesses and at least 23,000 deaths in the U.S. each year.

“CDC used the best data available at the time, but we knew that our estimate was likely conservative and underestimated the true burden of antibiotic resistance,” Michael Craig, MPP, of the CDC’s Antibiotic Resistance Coordination and Strategy Unit, said in the news conference.

A revision of the 2013 estimates using the 2019 methodology, which included data from more than 700 hospitals, revealed that drug-resistant infections actually caused more than 2.6 million illnesses and 44,000 deaths each year when the 2013 report was published. According to the 2019 report, deaths attributed to antibiotic-resistant infections have decreased 18% overall and 30% in hospitals since 2013.

The Society for Healthcare Epidemiology of America said the report shows that prevention efforts in hospitals are working.

“We must continue to fund and support effective infection prevention and antibiotic stewardship programs in every health care setting and use every tool we have to prevent the spread of antibiotic resistance,” SHEA president Hilary M. Babcock, MD, MPH, said in a statement.

The report also noted the burden of Clostridioides difficile infections (CDI) because, although the pathogen is not “typically resistant,” CDI is caused by antibiotic use and the spread of bacteria, which are factors that also drive resistance. When including C. difficile, the burden exceeded 3 million infections and 48,000 deaths.

“The report is a major public service that’s been provided by CDC, which provides both a stern warning — antibiotic resistance continues to increase in the U.S., including among people in good health who are not in hospitals — and some encouragement — even as numbers of resistant infections have increased, the percentages of patients who have died as a result of these infections has decreased,” Cornelius (Neil) J. Clancy, MD, associate professor of medicine and director of the extensively drug-resistant pathogen lab and mycology program at the University of Pittsburgh, told Infectious Disease News.

Jason P. Burnham, MD, assistant professor of medicine in the division of infectious diseases at Washington University School of Medicine in St. Louis, called the report “a great and massive undertaking, including additional data sources to more accurately estimate the burden of drug-resistant infections.”

In a 2018 paper, Burnham and colleagues suggested that the number of deaths caused by drug-resistant infections may be nearly seven times higher than the old CDC estimate. Comparatively, the CDC estimates are still low, but Burnham explained that this is because his study had a more expansive definition of drug-resistant infection and the CDC used more recent data.

“The rates of hospital-acquired infections have been decreasing over the last 10 years, so this explains some of the difference,” Burnham, who was not involved in the CDC report, told Infectious Disease News. “In addition, they are calculating mortality attributable directly to a drug-resistant infection — ie, it is the primary cause of death — whereas with our estimates, a patient may have died with a drug-resistant infection, but it was not necessarily the primary cause.”

Clancy, who was also not involved in the CDC report, noted that the methodology the agency used to calculate the infection estimates is “very conservative,” and believes that the numbers are still higher than what has been reported.

“For example, our group at the University of Pittsburgh and the DRIVE-AB consortium independently have used other methodologies to estimate that there are about 35,000 carbapenem-resistant Enterobacteriaceae (CRE) infections — one of the ‘urgent threats’ in the report — annually in the U.S., rather than 13,100 as estimated by CDC,” he said. “These discrepancies highlight the need for better national and global reporting and surveillance of antibiotic resistance, so we can make plans based on definitive numbers and don’t have to rely upon estimates.”

Infectious Diseases Society of America member Sarah Doernberg, MD, MAS, associate professor of clinical medicine and medical director of adult antimicrobial stewardship at the University of California, San Francisco, also characterized the CDC estimates as “conservative” and said they were “based on detection of resistant bacteria meeting specific definitions and reported in the electronic health record.”

“The discrepancy, though, highlights the need for a more robust system for surveillance for drug-resistant bacteria,” she said.

The report included a list of pathogens considered “urgent” threats to public health — carbapenem-resistant Acinetobacter, Candida auris, C. difficile, CRE and drug-resistant Neisseria gonorrhoeae — as well as a watch-list of pathogens that “have yet to spread resistance widely or are not well understood in the United States, but that CDC and other public health experts closely monitor,” the CDC explained. Those included azole-resistant Aspergillus fumigatus, drug-resistant Mycoplasma genitalium and Bordetella pertussis. Another 13 pathogens were included as “serious” or “concerning” threats.

Antibiotic resistance does not only concern those who are already sick or hospitalized. Rates of extended-spectrum beta-lactamase-producing Enterobacteriaceae increased between 2013 and 2018 and, according to the report, 47% of these infections were community-associated.

“The report makes abundantly clear that antibiotic resistance is a major problem now, not only something to worry about for the future; in the U.S., not solely in other countries; and in everyone, not just people with serious diseases or being treated in hospitals,” Clancy said.

Taking action

Although the report shows that there have been some gains in the fight against drug resistance, more action is needed. According to Clancy, continued investment is needed in antibiotic development, surveillance and prevention.

“I would encourage people who want to get involved in the fight against superbugs to get their congressional representatives to support the DISARM Act, which has gotten bipartisan sponsorship in both chambers of Congress, as a critical piece of legislation that would assure hospital reimbursements for use of new antibiotics cover the costs of developing and using these drugs,” he said.

The CDC report outlined ways that the public can protect against resistance, including getting vaccinated, practicing good hand hygiene, preventing STDs and using antibiotics appropriately. It also included action items for veterinarians.

Burnham imparted how doctors in clinical practice can utilize the information from this report to improve their practice and fight resistance.

“We have to continue to be diligent about prescribing antibiotics only when necessary to reduce drug resistance as much as we can,” he said.

Craig called the report a “snapshot” and said it shows that “we cannot rely on antibiotics alone.”

“But we can take action against resistance,” he said. “Infection prevention and control in health care facilities works. Improving the use of antibiotics we already have works. Proper food handling works, safe sex works, vaccines and keeping hands clean works.” – by Marley Ghizzone

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Let’s admit it federally … we are spending ONE TRILLION more than we are taking in… have been doing it for over a decade..  our total national debt is some 22-23 TRILLION DOLLARS and while most states have some sort of law on the books that requires them to have a balanced budget… most use “creative accounting” to demonstrate that they are meeting those laws.

The oldest baby boomer will turn 74 Jan 1, 2020 and the youngest will turn 56 in 2020… so in another 9 yrs… all living baby boomers will be on Medicare and will – or could be – drawing a monthly check from social security.

High acuity pts – the sickest of the sick – many times ends up on Medicare disability and/or on Medicaid. Costing both the Feds and the states money to support these people. As the numbers and dollars expended grows… the bureaucrats only view these people as $$$ signs on the Fed/state balance sheet.

From the insurance/PBM perspective… it is a financial (bottom line) benefit for requiring Prior Authorizations , imposing quantity limits or days supply limits, and just out right denial of coverage.

As the many entities that have the authority – or takes the authority – to limit/deny therapy increases… the more pts that will become house, chair, bed confined and by the vary nature these people become PASSIVE PTS and generally PASSIVE PTS get POOR OUTCOMES.  Likewise, they are no longer physically capable to fight for a change in their health therapies.

In turn, the pt’s QOL deteriorates, many times their co-morbidity health issues are aggravated resulting if a premature death from “natural causes” or as in the case of a unknown number of suicides are committed by those pts.

Every person who dies prematurely … is one less expense on the various financial balance sheet both in the short and long term.

We have seen that two states NY and RI have implemented Rx opiate tax.. that is being imposed on pharmas, wholesalers and pharmacies and with NY being the first to implement… there are reports of wholesaler not operating in the state have stopped shipping into the state.  There has been no information if the pharmacies can pass this added cost along to the insurance/PBM or the pt, but most all contracts that pharmacies have with PBM’s mandate that the pharmacy not charge the pt more than the PBM states is due by the pt’s insurance policy, and PBM in general has not known to be a generous industry.  So the PBM industry may look at this as a means of adding to their bottom line as pharmacies decline to stock and fill opiates for chronic pain pts.

So there are many rumors that chronic pain pts are having increased difficulty in finding pharmacies that have stock and/or willing to fill their Rx and bill their insurance company.

The DEA considers it a RED FLAG for a pt to pay cash for a controlled substance when they have insurance and if a pt lives near a border… and thinks that they can go to an adjacent state to get their Rxs filled… DEA also consider it a RED FLAG if a pt travels a LONG DISTANT to get a controlled substance filled.  So some pts may find themselves painted into a corner.

Then it was announced today that CMS is implementing new requirements for pts to get their diagnostic tests paid for CMS to implement new appropriate use criteria for advanced diagnostic imaging in 2020

Are the various entities treating our entire healthcare system as a HUGE JENGA GAME… attempting to reduce the overall healthcare expenditures by pulling out pieces of the stack… trying to figure out how many they can pull out without the entire system imploding.  Every piece that they pull out… how many “dead bodies” will it represents.

Did you know that there is an increase in organ donations from opiate OD’s and suicides ???

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https://www.fiercehealthcare.com/practices/starting-january-1-cms-will-implement-new-appropriate-use-criteria-for-advanced

There’s a change coming for advanced diagnostic imaging services furnished in a physician’s office, hospital outpatient department or ambulatory surgery center.

Starting Jan. 1, the Centers for Medicare & Medicaid Services (CMS) will implement new appropriate use criteria (AUC) that will require ordering professionals to consult a qualified Clinical Decision Support Mechanism (CDSM) prior to ordering Medicare Part B advanced diagnostic imaging services for a patient that will take place in those settings.

Physician practices need to be aware of the change, said Robert Tennant, who provided a health IT policy update during the Medical Group Management Association (MGMA) annual conference last month.

CMS has been testing the program with voluntary participation but will start an educational and operating testing period next year, said Tennant, director of health information technology policy for MGMA’s government affairs. Full implementation of the program will occur in January 2021.

“We’ll continue to fight this,” said Tennant about the AUC program that eventually may mean more medical professionals will be subject to prior authorization when ordering these services for patients.

The requirement that physicians get prior authorization from insurers before providing a medical service, diagnostic test or medication is already a major headache for physicians.

But initially, the AUC program will require health professionals to report a code on their claims for advanced diagnostic imaging services covered by the program including diagnostic magnetic resonance imaging, computed tomography, nuclear medicine and positron emission tomography. Starting in 2021, without a code, the claim will be rejected.

As well as checking clinical decision support tools to help make appropriate treatment decisions for the specific clinical condition, medical professionals ordering the imaging services will also need to provide the information to furnishing professionals and facilities, because they must report an AUC consultation code on their Medicare claims, according to a CMS fact sheet (PDF).

The furnishing professional and facility will need to append a new HCPCS modifier to the CPT code on the claim to denote AUC consultation occurred.

A “QQ” code will indicate that the ordering professional consulted a qualified clinical decision support mechanism for this service and the related data were provided to the furnishing professional.

For this first year, CMS will not require the AUC consultation code on advanced imaging orders or require the AUC consultation code on Medicare claims. However, starting January 2021, an AUC consultation must take place at the time of the order for imaging services that will be furnished in one of the designated settings and paid for under one of the designated payment systems that include the physician fee schedule, outpatient prospective payment system and ambulatory surgical center payment system.

But particularly worrisome for practices is that CMS will ultimately use data collected from the program to identify “outlier” ordering professionals who will become subject to prior authorization when ordering these services for patients. Advanced diagnostic imaging services covered by the AUC program include diagnostic magnetic resonance imaging, computed tomography, nuclear medicine and positron emission tomography.

Starting in 2021, CMS will collect a minimum of two years of AUC data in order to identify up to 5% of ordering professionals whose ordering patterns are considered “outliers” and subject them to prior authorization requirements. That outlier provider identification will start in 2023 at the earliest.

To help practices prepare for the changes, the MGMA has prepared a toolkit that explores how AUC can potentially alter practice workflows and action steps practices can take.

The AUC program was established by the Protecting Access to Medicare Act of 2014 legislation to reduce overutilization of services. The law included a provision seeking to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries.

The program applies to physicians, other practitioners and facilities ordering advanced diagnostic imaging services and/or furnishing Part B advanced diagnostic imaging services to Medicare beneficiaries and billing Medicare Administrative Contractors.

Ordering professionals will be required to consult a qualified CDSM—an interactive, electronic tool for clinicians—to determine whether the order adheres to appropriateness criteria. 

CMS identified eight priority areas that it may use in determining outlier ordering professionals in the future. The initial list of priority clinical areas, defined by the agency as clinical conditions, diseases or symptom complexes, released in the CY 2017 Physician Fee Schedule Final Rule include: coronary artery disease (suspected or diagnosed), suspected pulmonary embolism, headache (traumatic and nontraumatic), hip pain, low back pain, shoulder pain (to include suspected rotator cuff injury), cancer of the lung (primary or metastatic, suspected or diagnosed), and cervical or neck pain.

Is this more a GREEN LIGHT especially to the Medicare Advantage Programs… these are basically PRIVATE INSURANCE being provided for by FOR PROFIT CORPORATIONS to put more obstacles in place to hinder pts getting diagnostic procedures paid for. The above paragraph suggests that most targets diseases/conditions involve PAIN.  Are we approaching a point where if a practitioner can’t use a diagnostic test to confirm a reason for the pt’s complaint of pain… then the practitioner can’t prescribe opiates for the pt’s indicated pain ?

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Anyone else see this? Cardinal health no longer shipping opiods into the state of RI in protest over to new state opiod tax.

Here is the list meds they will no longer be shipping:

https://www.cardinalhealth.com/content/dam/corp/web/documents/spreadsheet/cardinal-health-ri-item-list.pdf

All pharmacies have contracts with the PBM’s and within those contracts the pharmacies are pretty much “hog tied”… these contracts are presented to pharmacies with a “take it or leave it”… which the true meaning is that if you don’t sign/take this contract … We (PBM) will make sure that your pts will have their prescriptions filled at one of your competitors..  In the legal world that sort of contract is labeled as “lacking mutuality”.

But there are certain laws that protect the insurance industry… allowing them to do things that is illegal for the rest of the business world.

Those PBM/pharmacy contracts prohibit the pharmacy for charging the pt any more than what the PBM states is suppose to be collected for a filled Rx, and it is highly unlikely that the PBM’s will reimburse the pharmacy for the increased cost from the wholesaler when they pass along the state imposed taxes.

And it is considered a RED FLAG by the DEA for a pt to pay cash for a controlled Rx when they have insurance.

So chronic pain pts in RI could experience a lot of “we are out of stock”…   There is only three major pharmacy wholesalers that control 80%+ of the entire USA market… and I expect those that have distribution centers outside of RI.. will just stop shipping to RI..   It recently happened in the state of NY…

New York state started levying an excise tax on opioids, pharmacies bear the burden some pharmacists have stopped filling the prescriptions

when NY passed a similar Rx opiate tax.

And if pts try to get their Rxs filled out of state of RI…. it is also a DEA RED FLAG when a pt travels a “long distance” from their home to get controlled meds filled.

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I have always heard stories about females tend to get poorer quality of care out of doctors whose ethnicity is from foreign countries. We have seemed to have experienced this personally…

Barb was having some shortness of breath and I suspected either a pulmonary embolism (PE) or pneumonia.. so she called to get an appt with her cardiologist.  The cardiologist that she normally sees was not in the office on Monday but his partner – who I have seen before  –  after the office visit – he suggested that she get admitted to the local hospital for some test, which she reluctantly agreed to.   This doctor’s ethnicity – IMO – appears to be from the middle east – in general.

She arrived at the hospital… and it took them over ONE HOUR to get a room clean… when her admission was called in from the doc’s office before we left. Our local hospital was acquired by a larger hospital system “across the Ohio river” in Louisville,KY and the entire system just upgraded to a EPIC electronic medical records.  This system is so large that all of the practitioners that we see are now EMPLOYEES of this large healthcare corporation and each office practice is connect to this EPIC system.

Part of this change is that our PCP no longer sees his pts when they are in the hospital… all pts are cared for by a HOSPITALIST – another employee of the larger healthcare system.

Of course, there are APRN’s involved in direct pt care and this stay was no exception… one of these two is telling her she has pneumonia and the other is saying that she has a PE. The hospitalist was being “stingy” on authorizing her regular pain meds and other controlled meds… and they said something that they had to check the state PMP (INSPECT) to make sure that she was taking her meds…

Apparently, since they don’t know us… they apparently saw a large gap in her getting her oral pain meds… BECAUSE we had been in at our Florida condo in Aug, Sept and first two weeks of Oct and our PCP had sent them Rxs for them to the pharmacy that we use in Florida and the Florida PMP is not linked to Indiana’s ….  I don’t know if they did a toxicology on her… because she should have had her pain meds filled abt 6 weeks ago – she gets 90 days supply at a time – but her toxicology would show that she is taking her pain meds BUT no records that they could see of her having them filled.

Via Barb’s nurse, I requested that this hospitalist come talk to me… he told me that her shortness of breath was because of her opiates… respiratory suppression … but I tried to explain to him that respiration in chronic pain pts taking long term opiates … disappears and not a issue – of course he denied… he mentioned that people were ODing … which I replied that people were committing suicide because of meds being pulled… which he denied… he then told me that HE treated all pts with objective facts/tests – which my reply was you can’t treat subjective disease with objective measurements.   It was obvious that he was going to quote “DEA’s medical opinions” and recommendations from Beer’s report   which generally SUGGESTS that any pts over 50 should not take most medications because of the POTENTIAL – often low potential and/or potential without a lot of scientific support.

I came away from this interaction was that this doc was a certified , card carrying, self-centered, narcissistic IDIOT and like the cardio doc… his ethnicity was from the same world geography.

So Barb was discharged.

She was handed a packet of 13 pages of “educational crap” that is generated from EPIC that – IMO – is mostly “cut/paste” from Beers and DEA medial opinions.

This EPIC system has the ability for pts to login to a “portal” and review various things concerning there medical records… Including all the medication(s) that have been prescribed by all the practitioners within the system.

As I was going thru Barb’s records… this ASSHOLE doctor – who was in charge of her care for some 18 -20 hrs DISCONTINUED ALL CONTROLLED MEDS – with the exception of one – probably because he didn’t know that it was a control or what she was taking it for… in this centralized EPIC database.  He even DISCONTINUED some OTC meds that was listed in her medical records.

These are medication that mainly her PCP has prescribed and her pain clinic – that manages her implanted pain pump – has full knowledge of her entire list… in fact she just had her pump refilled a couple of weeks ago and they go over her entire med list every time.

Today I talked to the nurse assistant to our PCP to make a followup appt and she said that Barb’s CAT SCAN showed that she had some PNEUMONIA in one lung… AND she was only given a single dose of antibiotic while in the hospital and discharged with NO ANTIBIOTICS.  I have ask the nursing assistant to see if one of the other practitioners in the practice to call in some antibiotics for her because we could not get an appt with our PCP until Monday.

This ASSHOLE doctor… failed to understand … is that the now President of the hospital is also a practitioner in the practice that we go to and his parents/family patronized our independent pharmacy years ago… I have known him FOR DECADES.

Since our PCP doesn’t come to the local hospital any more, we live in a metro area with about a population of about 1.6 million and the teaching hospital that Barb goes to for her pain clinic has the only LEVEL ONE TRAUMA CENTER for around 100 miles. and another major hospital complex two blocks away and both are about 10-12 miles from our house.

Of course,  I may just decide to go down the list of entities that oversees this ASSHOLE DOCTOR and the hospital complex and start filing complaints and I may have to explore the fact that he discontinued all her pain/anxiety controlled meds… may just be a discrimination under Americans with Disability and Civil Rights Act.

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DEA Is About to Demonstrate “How Little They Know About What They Imagine They Can Design”

https://www.cato.org/blog/dea-about-demonstrate-how-little-they-know-about-what-they-imagine-they-can-design

Last month the Drug Enforcement Administration, tasked with setting quotas for opioid production in the U.S, announced a proposal to reduce production levels another 10 percent, having already reduced production by 25 percent in 2017 and an additional 20 percent in 2018. This would bring down production levels to 53 percent of 2016 levels. Yesterday the DEA released a proposal to develop “use-specific” quotas. The DEA press release explains this as follows:

Today’s proposal amends the manner in which DEA grants quotas to manufacturers for maintaining inventories…The proposal also introduces several new types of quotas that DEA would grant to certain DEA-registered manufacturers. These use-specific quotas include quantities of controlled substances for use in commercial sales, product development, packaging/repackaging and labeling/relabeling, or replacement for quantities destroyed.

The rationale behind the production quotas is to reduce the amount of prescription opioids that can be diverted into the black market for non-medical use. But last month’s DEA quota proposal stated (Federal Register page 48172):

As a result of considering the extent of diversion, DEA notes that the quantity of FDA-approved drug products that correlate to controlled substances in 2018 represents less than one percent of the total quantity of controlled substances distributed to retail purchasers.

Therefore, it appears that diversion of prescription opioids into the black market is now a rare event. An obvious question then is why tighten quotas even further? Is the DEA on a mission to reduce or eliminate the use of opioids based upon this law enforcement agency’s belief that it knows best how health care practitioners should engage in pain management?

As I have pointed out many times, there is no correlation between per capita prescription opioid volume and misuse or opioid use disorder in persons age 12 and up. And opioid-related overdose rates soared while prescription volume plunged. In 2017, illicit fentanyl and heroin were involved in 75 percent of opioid-related overdose deaths, and 68 percent of all opioid-related overdoses were “polydrug,” i.e., involved multiple other drugs, including alcohol, cocaine, heroin, fentanyl, benzodiazepines, and barbiturates. In fact, less than 10 percent of opioid-related overdose deaths in 2017 were from prescription opioids that didn’t involve other drugs.

The DEA’s presumption to know just how many prescription opioids of all classifications and in all situations will be needed in the coming year for a nation of 325 million people is a great example of what FA Hayek called the “fatal conceit.” DEA prescription opioid quotas have already been tied to an acute shortage of injectable opioids that afflicted hospitals across the country in 2018.

Aside from that, these additional quotas will do nothing to stem the deaths from illicit fentanyl and heroin that comprise the overwhelming majority of opioid-related overdose fatalities.

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Addiction now defined as brain disorder…not behavior issue

http://www.nbcnews.com/id/44147493/ns/health-addictions/t/addiction-now-defined-brain-disorder-not-behavior-issue/

Addiction is a chronic brain disorder and not simply a behavior problem involving alcohol, drugs, gambling or sex, experts contend in a new definition of addiction, one that is not solely related to problematic substance abuse.

The American Society of Addiction Medicine (ASAM) just released this new definition of addiction after a four-year process involving more than 80 experts.

“At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviors manifest in all these other areas,” said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition. “Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions.”

The new definition also describes addiction as a primary disease, meaning that it’s not the result of other causes, such as emotional or psychiatric problems. And like cardiovascular disease and diabetes, addiction is recognized as a chronic disease; so it must be treated, managed and monitored over a person’s lifetime, the researchers say.

Two decades of advancements in neuroscience convinced ASAM officials that addiction should be redefined by what’s going on in the brain. For instance, research has shown that addiction affects the brain’s reward circuitry, such that memories of previous experiences with food, sex, alcohol and other drugs trigger cravings and more addictive behaviors. Brain circuitry that governs impulse control and judgment is also altered in the brains of addicts, resulting in the nonsensical pursuit of “rewards,” such as alcohol and other drugs.

A long-standing debate has roiled over whether addicts have a choice over their behaviors, said Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on addiction’s new definition.

“The disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them,” Hajela said in a statement. “Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.”

Even so, Hajela pointed out, choice does play a role in getting help.

“Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary,” Hajela said.

This “choosing recovery” is akin to people with heart disease who may not choose the underlying genetic causes of their heart problems but do need to choose to eat healthier or begin exercising, in addition to medical or surgical interventions, the researchers said.

“So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment,” Miller said.

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