Part 2 The Opioid Crisis

Americans are mostly good-hearted people and rush to make food or visit their neighbors who return from a hospital stay.

But what about when someone returns home from a drug-rehabilitation stint after an opioid abuse incident?

Any balloons around the mailboxes? Any proposed get-togethers to celebrate?

Don’t count on it, says Leslie R. Dye, MD, FACMT, Editor-in-Chief, Point of Care Content for Elsevier and President of the Medical Toxicology Foundation.

“Much of the public and medical community still does not realize that addiction is a disease and not a moral failing,” she says. “Addiction is not a casserole disease. When someone has cancer the neighbors bring casseroles; when someone goes to treatment for addiction, the family is often ashamed and shamed.”

“If we try to treat hypertension by telling people that they’re bad people and need medication, how effective would that be? An addict also needs medication, even if it is going to regular 12 step meetings.”

“The fact that addiction is a disease does not excuse the problem. Those with the disease have the responsibility to treat it,” Dye says.”

Opioid involved deaths have continued to increase and overdose deaths have quadrupled since 1999. In Part 1 Dye discussed many factors surrounding the national epidemic of opioid and heroin abuse,  including over-treatment of pain, the explosive marketing of pharmaceuticals, and uneven regulations. Dye continues her conversation with HealthDataBuzz about the wide-ranging problem. She focuses on attitudes in the opioid crisis, which has riveted the nation’s attention but the discussion often has not often focused on our day-to-day human perception about the issue.

“Attitudes must change if we are to overcome and treat the opioid epidemic,” says Dye, also past president of the American College of Medical Toxicology

“There is a difference between ‘calling something’ a chronic disease and having evidence to support that it is,” she said. “Addiction is a chronic, relapsing, progressive and often fatal disease. There is medical evidence to support that. Until we recognize and accept that, the solution will be elusive,” she says

That ignorance also extends to the doctor’s office as well, she adds.

“One of the big issues now is that doctors are advised to be very careful when prescribing opioids. Therefore, a person with the addiction will turn to street drugs. They are also cheaper,” she says.

A year ago, the Centers for Disease Prevention and Control issued new guidelines recommending that doctors first prescribe non-opioid medications or non-drug treatments for pain, such as physical therapy, the Boston Globe reported.

“The policy-makers seem to think that we can apply a simple solution, and that creates a lot of adverse and unintended consequences,” said Bob Twillman, director of the American Academy of Pain Management,  according to ClinicPainAdvisor.

Sometimes the medical community feels caught in the middle. When doctors don’t prescribe opioids they are seeking, some patients with addictions may lash out, or turn to the streets for heroin. Derivatives of fentanyl are also becoming an increasing concern; they are more deadly and cheaper than prescription drugs, Dye says.

There’s still a way for physicians to take steps that can improve prescribing patterns and concerns, Dye says.

“Perhaps by affecting prescribing habits, we can decrease the initial trigger for addiction, but the disease model suggests that even short- term use can uncover the disease,” Dye says. “We definitely need to consider alternatives to opioids for pain.”

The many tentacles of the abuses of opioids and impacts are well documented. Questions also surround the ramifications of the key medications for opioid addiction. “There are really no good alternative antidotes for the treatment of acute overdose,” she says. First responders to opioid emergency cases administer Narcan, and the antidote also is sent home with addicts and their families.

“I have heard physicians complain that, by administering Narcan or sending it home with patients, we are ‘enabling’ addicts. That’s nonsense”, she says. “Should we withhold inhalers to those with emphysema if they continue to smoke? Should we withhold insulin from a patient because they don’t follow the appropriate diet?”

“Unfortunately, many in healthcare could be called people who “enable.” Yet there is power to that, in a positive way. “I always saythe EM (mergency medicine) could be called “enabling medicine.’”

Training and Education Needed

The American Society of Addiction Medicine is trying to train more physicians to treat addiction, which is much-needed, as well as others in the medical workforce, Dye says. “We also need to improve access to and availability of treatment.

At the White House, Congress and elsewhere, opioid abuse is a continual focus, although some are concerned it may be out-of-focus.

President Trump’s  budget was criticized for putting more people at risk. His budget calls for $500 million increase from the 2016 funding levels for opioid abuse prevention efforts, and to expand treatment. “But the budget never provides specifics as to how much the administration would like to see invested in mental health or where the money it calls to fight opioid addiction CDC block grants would come from,” says Modern Healthcare.

Trump has signed an executive order creating a high-level opioids commission led by New Jersey Gov. Chris Christie, prioritizing treatment, yet the panel includes Attorney General Jeff Sessions, who maintains a strict tough-on-crime approach.

“I don’t want to get political, nor do I think this epidemic is about politics,” Dye says. “However, I fear that it will get politicized.”

Dye says the country has no choice but to confront the opioid issue, with education a vital element.

“I do think that this epidemic MUST be addressed head-on,” Dye says. “I don’t think we need any more evidence that the problem exists. What we do need is a focus on prevention and treatment. Education and experience (from addicts and those who treat them) need to be provided to parents and children, even as young as grade school.”

She adds: “I think that the more children are educated, they will not only be better equipped to address their own problems but more importantly, may be able to more effectively help a peer. Scare tactics don’t generally work, especially when employed by parents.”

Dye wrote to the White House and offered to help in any way to address the problem. So far there’s been no answer. No matter what, Dye continues to deliver a message that the nation can work together to meet the tyranny of opioid abuse, starting with attitude readjustments, a day at a time.

.– Joe Cantlupe