In the states

The Coalition of Medication‐Assisted Treatment Providers and Advocates of New York State (COMPA) issued support and further encouragement to New York legislators last week for the passage of a package of bills to combat the opioid addiction epidemic by increasing access to medication‐assisted treatment (MAT). “We applaud the Senate and Assembly passing A2904 Quart/S4808 Harckham, which eliminates prior authorizations for all MAT medications for commercial insurance policies,” said Allegra Schorr, president of COMPA. “This will increase access to treatment and reduce barriers for delivering care.” She added, “We urge the passage of A7246 Rosenthal/S5935 Harckham, which provides critical access to all medications to vulnerable Medicaid populations during this opioid crisis. Moreover, in order to ensure that all New Yorkers can access care, we urge the state to implement the policy outlined in A833 Rosenthal/S2161 Bailey that would establish a patient‐centered MAT program for incarcerated individuals in jails and prisons, and COMPA supports A972A Rosenthal/S4643A Harckham, which would prohibit copays during the course of treatment at an opioid treatment program.” COMPA is a nonprofit membership organization dedicated to treating addiction through the use of pharmacotherapy as a part of a comprehensive biopsychosocial approach to treatment. COMPA's program members include both opioid treatment programs and office‐based opioid treatment providers. COMPA is the New York state member program of the American Association for the Treatment of Opioid Dependence.     

Stewardship of public assets under nonprofit conversion models: New York's Empire Blue Cross Blue Shield case study

This research describes a case study of the Empire Blue Cross Blue Shield conversion under way in New York. In January 2002, legislation approved the conversion and the disposition of $1 billion in assets: 95 percent for health care salaries and expenses and 5 percent for a foundation to promote health care for the poor. New York's approach is controversial. According to Greene and Sommerfield (2002), the New York Times considers it the largest fiscal gimmick in New York's history, and Consumers Union is challenging it in the courts, asserting the plan is illegal. This article describes New York's approach to nonprofit conversion, proposing that more research on conversions is needed and that case study research illustrating the way different states approach the issue has the potential to bring together researchers, practitioners, and policymakers in an important debate that will advance public policymaking that furthers the public good. Subsequently, on June 20, 2005, New York State's highest court dismissed the Consumers Union lawsuit, affirming the actions of the New York State legislature and bringing to an end nearly three years of state‐level litigation.     

Briefly Noted

The National Institutes of Health (NIH) will award 12 grants to form the Justice Community Opioid Innovation Network (JCOIN) to support research on quality addiction treatment for opioid use disorder (OUD) in criminal justice settings nationwide, with a total of $155 million from the National Institute on Drug Abuse. One focus will be on finding new medications. There will be 10 research institutions and two centers. JCOIN is part of the NIH HEAL (Helping to End Addiction Long‐term) initiative launched last year. Funded institutions and the site locations are: the New York State Psychiatric Institute (New York), Baystate Medical Center (Massachusetts), Friends Research Institute Inc. (Maryland), Texas Christian University (Illinois, New Mexico, Texas), the New York University School of Medicine (Connecticut, Delaware, New Hampshire, New York, Oregon), Brown University (North Carolina, Pennsylvania, Rhode Island), the University of Chicago (Illinois), Chestnut Health Systems Inc. (Illinois), the University of Kentucky (Kentucky), and Yale University (Connecticut, Minnesota, New York, North Carolina, Puerto Rico). George Mason University in Fairfax, Virginia, will serve as the JCOIN coordination and translation center. For more information, go to https://www.nih.gov/research‐training/medical‐research‐initiatives/heal‐initiative/justice‐community‐opioid‐innovation‐network .     

Public relations or “grassroots lobbying”? How lobbying laws are re-defining PR practice

This research examines the legal implications of having an expansive definition of public relations practice. Specific attention is given to the 2016 New York lobbying regulations that mandated traditional public relations practitioners register as lobbyists. The examination of this law and the lawsuit that followed highlights how the public relations practitioners may inadvertently be subject to restrictive laws because of modern definitions of PR practice.     

OTPs in NY to help study telemedicine to treat hepatitis C

Seven opioid treatment programs (OTPs) at 12 locations in New York state will participate in a study that uses telemedicine to integrate the treatment of opioid use disorder (OUD) and hepatitis C virus (HCV). The goal is to achieve better outcomes by delivering HCV treatment on‐site via telemedicine, instead of referring out. It makes sense that this would be more effective than sending patients elsewhere, but the study needs to be done.     

Blacks and earnings in New York State

This research seeks to explain why earnings differences among foreign‐born Jamaicans and native‐born blacks are significantly larger in New York State than they are throughout the United States. The findings indicate that the Jamaicans in New York State are less endowed in terms of earnings‐related attributes, relative to the native born, than they are nationwide. Furthermore, even though the Jamaicans in New York State definitely are more disadvantaged with respect to earnings, this is not a manifestation of more intense discrimination. In all actuality, discrimination accounts for a relatively smaller proportion of the earnings gap in the New York State case than in the national case.     

Family formation and marital selectivity among Colombian and Dominican immigrants in New York City

"Utilizing data from a 1981 survey of Dominican and Colombian immigrants to New York City, and from 1975 marriage certificates for the entire city, this article describes the extent of family formation in the U.S. and patterns of marital selectivity of recent Hispanic immigrants residing in New York City. A core goal of the analysis is the provision of indicators of the extent of and nature of integration processes at an early stage of the immigration." It is found first that "Hispanic immigrants in New York City are clearly long-term settlers, although not necessarily permanent ones. They are forming nuclear families in this country to a considerably greater extent than they are either transferring families from the origin country or residing as unattached temporary migrants. Second, a significant minority of marriages contracted in this country are with spouses of different national origin groups, indicating an openness in ethnic boundaries in the host society context."     

Kinship Care and Transnational Parenting: The Intersection of Cultural Values and Practices

This study uses ethnographic research to examine the phenomenon of transnational parenting by migrant mothers from the African Caribbean community and their family who care for the mothers’ children. Twenty women’s narratives demonstrate the complexity of relationships between migrant mothers living and working in New York City and their extended family or kinship caretakers who coparent their children in their countries of origin. The study reveals three main factors that contribute to the success of transnational parenting: (1) informal kinship care-child fostering, (2) remittances, and (3) social networks. Policy and practice implications are explored.     

ADA settlement exposes liability when providers refuse MAT patients

Gov. Andrew Cuomo of New York has added opioid use disorders (OUDs) to the list of approved conditions for which medical marijuana could be prescribed in the state, following the lead last month of New Jersey Gov. Phil Murphy, who limited such use as an “adjunct” to medications like methadone and buprenorphine (see ADAW, Jan. 28).     

Employment Day: Forty Years of Transitioning High School Seniors Into the Workforce

The author describes an innovative career development event that has endured for nearly 40 years: Employment Day. This is a consummate collaborative undertaking of school professionals, higher education participants, and the community of employers in the Greater Suffolk County, Long Island, New York, region. It embodies the principles of the American School Counselor Association (ASCA; 2000) national standards, the ASCA (2003) National Model, and the New York State Comprehensive Model (New York State School Counselor Association, 2004) as a culminating activity. Employment Day is an event worth replicating by professional counseling associations.     

States call on HHS to immediately change year‐1 bupe cap

A coalition of 22 states and territories is requesting that the federal Department of Health and Human Services (HHS) lift restrictions on providing buprenorphine, one of the only three federally approved medications to treat opioid use disorder (OUD). “Buprenorphine is an essential tool in the fight to end the opioid epidemic,” said Howard Zucker, M.D., commissioner of health for New York state, which is leading the initiative. “Removing federal restrictions on prescribing buprenorphine will ultimately save lives and eliminate unnecessary barriers that prevent people with opioid use disorder from having access to treatment,” he said.     

The Children's Aid Society community schools: a full-service partnership model

In 1989, the Children's Aid Society (CAS) created an unprecedented partnership with the New York City Board of Education by developing a comprehensive response to the pressing needs of children and families in the northern Manhattan neighborhood of Washington Heights. After three years of careful planning, CAS and the New York City public schools opened the first community school at Intermediate School 218, offering a full array of supports, services, and learning opportunities. Adding, on average, one partnership school per year and remaining very flexible in adapting its model to the individual needs of each community, CAS now has thirteen community schools around New York City. The model's flexibility is seen also in the success of its national and international adaptation-an intentional part of CAS's work.     

NY AG ends Emergent's exclusivity for Narcan nasal spray

Narcan, the lifesaving opioid overdose reversal drug, has been the only naloxone spray allowed on the market due to an exclusivity agreement between the pharmaceutical company that owns it — Emergent BioSolutions — and the company that makes the spray device. This deal is ending thanks to New York Attorney General Letitia James, who has made it possible, via an agreement with Emergent, for other companies to use the patented, proprietary spray technology. Emergent, which bought Adapt, the creator of Narcan, will have to renegotiate these terms, James announced on Jan. 2. “Given the tragic, devastating effects of the opioid crisis, and the urgent need for additional drugs for the emergency treatment of opioid overdoses, my office will do whatever possible to ensure that there are no unnecessary impediments to the development of additional lifesaving opioid overdose reversal drugs,” she said. “I'm proud to announce that, starting today, additional companies will be able to gain access to these nasal spray devices. With more companies able to access this easy‐to‐use technology, our hope is that we can reduce the number of opioid overdose deaths across New York and this nation and save millions of additional lives.” A little history here: Adapt Pharma launched Narcan in February 2016, a year before the State Targeted Response (STR) grants were issued. Narcan is patented, but naloxone had been used for decades in the emergency treatment of opioid overdoses, by first responders and medical workers. In October 2018, in the middle of the lucrative STR (which no longer had to be 80% treatment) and State Opioid Response funding cycles, Emergent bought Adapt — for Narcan. Adapt had already entered into the contract with the nasal spray device manufacturer. Other pharmaceutical companies had been trying to develop a nalmefene overdose reversal drug using the device.     

Briefly Noted

Clayton Stafford died after using Vivitrol, and his family is suing Alkermes, the manufacturer, saying that the medication doesn't adequately treat addiction, compared to buprenorphine and methadone, and that the manufacturer knew this. In the lawsuit, California‐based law firm Lieff Cabraser alleges that Stafford, his parents and his treatment providers were misled into thinking Vivitrol was an appropriate treatment for his opioid use disorder. “Clayton Stafford's tragic death could have been avoided,” notes Lieff Cabraser partner Fabrice N. Vincent, who filed the lawsuit on behalf of the Stafford family. “The well‐reported defects in Vivitrol made Clayton's overdose a near‐foregone conclusion, and had the Staffords received accurate information about Vivitrol's risks and effective deficiencies from Alkermes, they would never have consented to its use by Clayton.” Naltrexone doesn't work to treat addiction and cravings, but just to block the effects of opioids, according to the lawsuit (and many others agree with this). “Because the patient's addiction is not adequately treated, the patient requires indefinite Vivitrol use to merely block the euphoric effects and keep the patient from seeking opiates,” Vincent said. “Patients therefore remain highly likely to relapse despite indefinite use of Vivitrol.” The lawsuit also makes note of Alkermes' direct‐to‐consumer marketing campaign, which extended into influencing the criminal justice system to use Vivitrol. Stafford had been mandated to use Vivitrol. Last year, the Food and Drug Administration issued a warning letter to Alkermes stating that its advertising did not state that stopping Vivitrol can lead to relapse and overdose, as is clearly stated by the label and package insert (see “FDA warns Alkermes about OD risk on Vivitrol ads,” ADAW, Dec. 16, 2019, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32566 ).     

Implementation of Congressional intent: a study of amnesty policy and the Immigration and Naturalization Service

Despite the passage of the Immigration and Control Act of 1986 (IRCA) the United States Border Patrol arrested about 1 million illegal aliens crossing the border in 1990. This phenomenon suggests that the IRCA has failed to control illegal immigration to the United States. Structural analysis of its implementation by the Immigration and Naturalization Service (INS) was analyzed. Under an agreement with the INS to process illegal workers, community-based organizations in Arizona and New York became certified Qualified Designated Entities (QDEs). In 1988 the INS carried out a study to measure the impact of IRCA and solicited data from 9 QDEs. Data were obtained from 308 illegal aliens who failed to apply for amnesty and another 286 temporary legal residents. In the New York study information was collected from the QDEs between 1987 and 1989, and also in the summer of 1989 a group of 171 amnesty applicants were surveyed. All QDEs stated that implementation was hampered by excessive documentation, lack of strong family unification provisions, the financial cost of seeking legalization, and a fear of the INS. The Arizona and New York studies indicated that excessive documentation, fear of the INS (46% in New York), and fear of family separation (47% in New York) were the major factors why the targeted people did not come forward. Instead of seeking a proper balance between the written words of IRCA and the intent of Congress, INS developed guidelines that ignored the relevant facts presented by respected QDEs and Latino groups. In reality, INS sought to prevent illegal entry through amnesty offices throughout the United States. The eligibility requirements issued by the INS for amnesty served to limit and constrain participation in that program.     

Integrating Social Justice into the Practice of CBFT: A Critical Look at Family Schemas

Many families come to therapy struggling with the negative consequence of social inequity. Family therapy modalities have been developed to address these negative consequences and attend to power and social equity (Transformative family therapy: Just families in a just society. Boston, MA: Pearson Education; Socio‐emotional relationship therapy. New York, NY: Springer). We argue that many family therapy modalities can be adapted to include social equity (Applying critical social theory in family therapy practice. AFTA Springer Series. New York, NY: Springer Publishing). Specifically, cognitive behavioral family therapy can be used to address the inequality in social systems that negatively affect the family system. We focus on schema formation and suggest an emphasis on societal schemas within the therapy milieu as a tool to help families see how societal inequality can affect the problems faced in family life.