Video: Physician Discusses Importance of MAT

Dr. Hillary Kunins, a Providers Clinical Support System Clinical expert, discusses the importance of treating opioid use disorder using medications. If the video below does not open or play properly, please visit: https://www.youtube.com/watch?v=E17A2F-ZvQA

The content on this site is intended solely to inform and educate medical professionals. This site shall not be used for medical advice and is not a substitute for the advice or treatment of a qualified medical professional.

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Additional video from PCSSnow.org on BrightViewhealth.com titled “Respect and Dignity Key in Treating Substance Use Disorders” can be found here.

Original article/link to above video here.

More videos on PCSSnow.org.

To understand why America’s opioid epidemic keeps getting worse, just look at this map

America’s opioid epidemic keeps getting worse, with the latest data showing that drug overdose deaths in the US climbed by roughly 21 percent between 2015 and 2016 — from a record high of more than 52,000 to a new record of nearly 64,000. About two-thirds of those overdoses were linked to opioids.

To understand how this crisis keeps growing, take a look at an insightful map by amfAR, an advocacy group dedicated to the fight against HIV/AIDS. The map shows three things: the availability of facilities that treat drug addiction, the facilities that provide at least one medication for opioid addiction (marked as MAT, or medication-assisted treatment, on the map), and the facilities that provide all three kinds of medications for opioid addiction.

Map Of States MAT

Clearly, there are a lot of gaps in coverage. In a post on Health Affairs, Austin Jones, Brian Honermann, Alana Sharp, and Gregorio Millett of amfAR looked at 2016 data from the Substance Abuse and Mental Health Services Administration and found that only 41.2 percent of the more than 12,000 drug addiction treatment facilities in the US offered at least one kind of medication for opioid addiction. Only 2.7 percent offered all three.

These medications are widely considered by experts to be the gold standard in opioid addiction care. Studies, including systematic reviews of the research, have found that opioid addiction medications in general cut all-cause mortality among opioid addiction patients by half or more. The Centers for Disease Control and Prevention, National Institute on Drug Abuse, and World Health Organization acknowledge their medical value. That doesn’t mean these medications are for everyone (they’re not), but there’s a lot of good evidence for their general efficacy.

So it is pretty bad that a majority of addiction treatment facilities don’t provide access to any of these medications. It is similarly bad that even more of these facilities don’t offer access to more than one kind of medication; the individual types of medications don’t work for everyone — nothing in addiction treatment does — so it’s important to provide multiple options.

We are, as a country, nowhere close to that goal.

If the US isn’t making good use of even the bare minimum of evidence-based treatment, it’s no wonder the opioid crisis keeps getting worse.

One caveat: The map likely understates the amount of addiction treatment that is available in some parts of the US. For one, physicians can gain the ability to prescribe buprenorphine through a special waiver, but those kinds of practices wouldn’t appear in a map solely dedicated to drug addiction treatment facilities. Still, other data collected by amfAR shows that there are big swathes of the country without doctors who can prescribe buprenorphine.

There’s also other data that exposes America’s big gaps in addiction treatment. According to a 2016 report by the surgeon general, just 10 percent of Americans with a drug use disorder obtain specialty treatment. The report attributed the low rate to severe shortages in the supply of care, with some areas of the country lacking affordable options for any treatment — which can lead to waiting periods of weeks or even months.

The map exposes America’s inaction in the opioid epidemic

More than showing the specific counties and states that don’t have access to some kinds of treatment and medications, amfAR’s map shows that America isn’t truly serious about dealing with its opioid epidemic.

Given that we know these medications are highly effective for opioid addiction, providing access to them should be the low-hanging fruit for dealing with a drug overdose epidemic fueled by opioids. Coverage remains sparse, and there’s been little attention to changing that.

A major reason for that is stigma. These medications are often characterized as “replacing one drug with another” — say, replacing heroin use with methadone use.

This fundamentally misunderstands how addiction works. The problem is not drug use per se; most Americans, after all, use caffeine, alcohol, and medications without major problems. The problem is when drug use becomes a personal or social burden — for example, putting someone at risk of overdose or leading someone to commit crimes to obtain drugs.

Medications for opioid addiction, by staving opioid withdrawal and cravings without leading to a significant risk of overdose, mitigate or outright eliminate those problems — treating the core concerns with addiction.

Another reason for the treatment gap is a lack of federal attention. In the past few years, for example, the only new federal effort to dedicate a serious amount of money to the opioid crisis was the Cures Act, which committed $1 billion over two years.

Even that sum fell woefully short of the tens of billions annually that experts argue is necessary to deal with the opioid epidemic. For reference, a 2016 study estimated the total economic burden of prescription opioid overdose, misuse, and addiction at $78.5 billion in 2013, about a third of which was due to higher health care and addiction treatment costs. So even an investment of tens of billions could save money in the long run by preventing even more in costs.

As Stanford drug policy expert Keith Humphreys previously told me, “Crises in a nation of 300 million people don’t go away for $1 billion. This is the biggest public health epidemic of a generation. Maybe it’s going to be worse than AIDS. So we need to go big.”

America has not gone big, at least yet. So the opioid epidemic continues, killing tens of thousands of people in the process every single year.

Original Article here: To understand why America’s opioid epidemic keeps getting worse, just look at this map

8 Care Principles to Improve Substance Use Disorder Treatment

Task force cites medication-assisted treatment, universal screening as key to better outcomes.

More than 20 million Americans struggle with substance use disorder (SUD), and upwards of 33,000 people died from opioid overdose in 2015. Fortunately, effective treatment exists. Medication-assisted treatment (MAT), which pairs U.S. Food and Drug Administration-approved drugs with behavioral therapies, reduces both illicit opioid use and overdose fatalities.

But access to MAT remains elusive for many people largely because treatment providers do not always provide their patients with the evidence-based care shown to be most effective. Public and private payers can play a key role in addressing this problem by encouraging their enrollees to use providers who deliver high-quality, evidence-based care and rewarding those who do.

As a needed step in this direction, the new Substance Use Disorder Treatment Task Force— launched last spring by Shatterproof, a national nonprofit organization dedicated to the implementation of evidence-based solutions to address the SUD epidemic—created a list of national principles of care for SUD treatment to help guide effective care. These eight evidence-based principles have been shown to improve health outcomes and save lives. Sixteen insurance companies have agreed to identify, promote, and reward SUD treatment that aligns with these principles, which are:

  1. Universal screening for SUD across medical care settings.
  2. Personalized diagnosis, assessment, and treatment planning.
  3. Rapid access to appropriate SUD care.
  4. Engagement in continuing long-term outpatient care, with monitoring and adjustments to treatment.
  5. Concurrent, coordinated care for physical and mental illness.
  6. Access to fully trained and accredited behavioral health professionals.
  7. Access to FDA-approved medications.
  8. Access to nonmedical recovery support services.

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The task force brings together public and private payers as well as advocates, policymakers, and other stakeholders. The Pew Charitable Trusts hosted the inaugural meeting of the task force this fall, during which members met to outline and discuss principles of care. Following that meeting, the group refined and reached consensus on the final list, with principles based on research from the past 30 years, including recommendations from the 2016 “Facing Addiction in America: Surgeon General’s Report on Alcohol, Drugs, and Health.”

The task force will continue its work by focusing on implementing the principles, providing a platform to learn and share innovative strategies, and measuring the initiative’s success. In particular, the task force will examine the possibility of establishing a process for certifying providers who have implemented the principles. It will also engage with the broader stakeholder community in the next phases of work.

By joining together, patients, providers, and payers have the opportunity to dramatically increase the quality of substance use treatment in the United States. Incorporating these evidence-based principles of care in insurance programs is a much needed step forward in addressing the opioid epidemic and improving the lives of people with SUD and their families.

Link to original article here: 8 Care Principles to Improve Substance Use Disorder Treatment

Route to recovery: how people overcome an opioid addiction

More and more people in the US are able to identify a friend, relative or neighbor who has succumbed to opioid addiction as it increasingly damages the nation.

It’s a frightening reality, but there are options available for people hoping to gain control of their condition and live a life that isn’t dictated by these potent drugs.

What are the routes to recovery from addiction? The Guardian explored that question and more as part of a series of pieces this week looking at survivors of addiction and how to tackle it.

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Can opioid addiction be cured?

There is no cure for addiction, but the disease can be managed just like other chronic medical conditions including diabetes and high blood pressure.

That’s one of the reasons people who are no longer addicted to drugs or alcohol might describe themselves as being “in recovery”. Recovery means different things to different people but generally describes someone who is able to live life without it being disrupted by addiction.

How do you get to be in recovery from opioid addiction?

There are many routes for addiction treatment but the one with the most scientific support combines medication, counseling and recovery meetings.

“If people do those three things together, their chances of getting onto a path of recovery are significantly better than if they try to detoxify off the heroin or the pills they are taking and try to go immediately go to an abstinence-oriented program, where they are not taking any medication to help them during the early stage of their recovery,” said Samuel Ball, president and CEO at the National Center on Addiction and Substance Abuse.

How does medication help treat drug addiction?

Medication is used to stabilize people when they quit using opioids. These drugs include opioids like methadone and buprenorphine, which can reduce the painful effects of withdrawal by lowering the amount of opioids people are taking. They can also help people who want to quit using stave off overwhelming cravings.

A third medication treatment, naltrexone, is different in that it blocks the effect of opioids and it has been studied less closely than the other two drugs.

Isn’t using these drugs just substituting one type of opioid drug for another?

No, though the US health secretary Tom Price said it was last month. Price’s comment sparked a furor among health professionals – nearly 700 researchers and practitioners sent a letter urging Price to “set the record straight”.

“The perception that persons receiving long-term therapy with medications – especially with buprenorphine and methadone – are not actually in recovery is widespread but grossly inaccurate,” the letter said.

The Department of Health and Human Services then clarified that expanding access to medication-assisted treatments is a key element of the federal government’s plans to curb opioid addiction.

That said, these drugs aren’t perfect. Buprenorphine and methadone can and have been abused by opiate users, which is why it is recommended these drugs be taken alongside other therapies.

What happens if people quit using opioids without medication?

For people who abruptly quit, a cluster of unpleasant symptoms can occur as part of withdrawal: anxiety, body aches, nausea, vomiting, diarrhea, agitation.

There is a school of thought that the sheer unpleasantness of withdrawal will push someone out of addiction for good, and that certainly works for some people, but Ball warned it is not something worth betting on.

“I think If you asked me 10 years ago, I might have said detoxing and trying an abstinence-oriented approach, maybe that’s worth a try one time,” said Ball. “And then if that doesn’t work try one of the medications.”

These days, however, Ball said the addiction crisis has “become so life and death” that he thinks medication should be incorporated from the beginning of addiction treatment.

Why can’t people just decide to quit?

There is a narrative, often perpetuated by the media, of people becoming stubborn and quitting on their own once and for all – whether it’s because of a revelation triggered by an emotional low point or, in the case of one person the Guardian spoke with, spending some time in jail where they were forced to withdraw without any support.

“It’s miraculous, and great stories to hear, but I think for many people with opioid addiction, it’s not a realistic thing to plan for, if that kind of epiphany happens for you, it’s wonderful, but you can’t make it happen,” Ball said.

He said the “chances of you staying alive for a longer period of time” are much higher if you access other forms of treatment, particularly medication.

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How effective is rehab at treating addiction?

If pop culture is your guide, the answer to addiction can be found at a swanky beach house rehab center in Malibu, California, or sunny Florida.

These centers – just like residential centers in less idyllic locations across the US – can certainly be effective, but they aren’t required to provide evidence-based treatment, so the efficacy varies wildly.

Some centers don’t have a trained physician or psychiatrist on staff around the clock or only offer a couple hours of therapy each week – an insufficient amount for someone who has deemed their problem so severe they aren’t safe at home.

Also, there is a potentially enormous cost tied to rehab that do not always reflect the quality of service. Insurers don’t always cover these programs, and if they do, they limit how long they will cover the service for.

That is a huge problem because addiction experts agree that addiction can’t be resolved in a short period of time.

How long does it take to recover?

This is obviously different from everyone, and must be considered alongside the fact that relapse is common.

Though it would seem like taking up drugs again is a failure, the US National Institute of Drug Abuse (Nida) said relapse is a sign that treatment needs to be adjusted or started again and is certainly not an indication that someone has irreparably harmed their chances of living a life free from addiction.

Relapse is common for 40% to 60% of patients being treated for addiction and 50% to 70% of people with asthma and hypertension, according to the Nida. The agency notes those disease also have physiological and behavioral components people must manage, particularly when experiencing a relapse.

Written by: Amanda Holpuch 6/22/2017

Link to article here: Route to recovery: how people overcome an opioid addiction