Opioid addiction in the United States has reached an epidemic scale. A growing number of people have become addicted to prescription painkillers like morphine, oxycodone and hydrocodone and illegal drugs like heroin and illicitly made fentanyl. Among 70,200 drug overdose deaths estimated in 2017, 47,600 deaths involved opioids.
But the issue is not new. America has had a problem with opioids for nearly 30 years. The drug misuse that was kept hidden in private homes, on dark streets, and in empty buildings has eventually come out.
A survey conducted by the SAMHSA found that as many as 90 percent of people who need substance abuse treatment do not receive it. Perhaps, access to no cost drug abuse treatment might change this sad statistic for the better.
On November 18, during the 7th Annual Healthcare of Tomorrow conference, a panel discussion on “The Hospital’s Critical Role in Battling the Opioid Epidemic” was held. Physicians from across the country discussed reconstructing the approaches to treating pain and addiction. They addressed such important issues as introducing new prescription guidelines, providing individually adapted systems of care, and understanding addiction as a disease rather than a moral failing.
Dr. Halena M. Gazelka who chairs the Mayo Clinic Opioid Stewardship Program started her presentation by emphasizing the need of joint efforts all health organizations must take in order to beat the opioid crisis. She said that at the time the problem attracted everyone’s attention, “there was no pattern, there was no game plan to follow when we’ve all kind of had to work at it along the way.”
Another participant of the panel was Dr. Alicia Jacobs, vice chair of clinical operations and a family medicine physician with the University of Vermont Medical Center. Jacobs shared a critical approach that must be taken by physicians to counter the opioid crisis. It’s about changing the mindset and understanding that addiction “…is a chronic, relapsing, remitting disease…”. Jacobs compared it to diabetes, a disease with chronic relapsing. Professionals that provide free drug addiction treatment should understand that.
Dr. Jacobs and her colleagues developed and implemented a new model of an addiction treatment program. It’s called the hub-and-spoke system for opioid addiction.
The primary medical care is provided for patients in the hub. There, the staff addresses patients’ health issues and promotes a healthy lifestyle. They are stabilized and prepared for their future treatment. And after this, they go to see the specialists for additional treatment.
This program turned out to be so effective that even the most skeptical physicians have said that it is “the most meaningful care” they do. They understood that they help a community that was totally underserved. And they can see the change.
In fact, the program helped contribute to a 50% reduction in Vermont’s opioid overdose rate. This and the next practice may be borrowed by free substance abuse programs.
Christopher Freer, chairman of Saint Barnabas Medical Center’s emergency department in New Jersey, continued the discussion by describing peer recovery specialist programs.
Peer recovery specialists are ex-patients with substance use disorder who lead a drug-free life for more than 4 years. Peer recovery specialists arrive at the physician’s request. They “lovingly stalk” the patient and help remove barriers in the communication with the physician. The patient lowers their guard, gets involved in inpatient treatment services, and allows healing to occur.
Dr. Freer called the introduction of peer recovery specialists a “game-changing” moment. These specialists explained care providers at emergency departments (EDs) that opioid use disorder should be understood as a disease. Patients should not be labeled as “addicts” or “junkies” and sent home from EDs without additional treatment.
Freer said that the way these peer recovery specialists interact with patients and providers, and a loyal attitude to sick people they promote is “contagious for the rest of the staff. So it’s really been a cultural shift.”
Dr. Gazelka underlined the importance of reforming hospitals’ prescription patterns. The problem is, America is shifting away from illegal drugs and towards prescription painkillers. The National Survey on Drug Use and Health published a 2018 Annual National Report which had the following numbers. 10.3 million Americans aged 12 and older misused opioids in the last year. 808,000 people used heroin, and 9.9 million abused prescription pain reliever.
Gazelka said that Mayo Clinic has developed its own recommendations for pain prescriptions based on guidelines provided by the Centers for Disease Control and Prevention. These recommendations are created for primary care providers who monitor patients receiving chronic opioid therapy. If used correctly, they are reasonable.
However, the differences in states’ laws make it difficult or confusing for providers. They can only prescribe for three days, and they can prescribe many pills. It looks like laws were made by misusing the numbers from the CDC guide. Establishing common and reasonable prescription drug guidelines and monitoring programs in all 50 states is crucial.
Combatting the opioid crisis goes beyond changing prescribing practices. Free drug and alcohol classes should educate health care providers, patients, parents, and youth in order to prevent cases of opioid use disorder.
Jay Bhatt, senior vice president and chief medical officer of the American Hospital Association, added that support for people who struggle with opioid addiction shouldn’t stop once a person leaves the hospital.
In the literature, participation in 12- Step program (AA and NA) has continuously been established as related to, or predictive of abstinence and better post-treatment outcomes.
Medical professionals can put an end to this national epidemic. Hospital-based physicians have a unique opportunity to identify and test innovative programs and services and combine them with proven practices of the healthcare system. The medical community initiates changing opioid prescribing patterns. And higher accessibility to a free drug rehabilitation center can increase the percentage of those who get so much needed-help.