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🔢 Key Takeaways

  1. The opioid crisis in the US is fueled by the promotion of pain as a vital sign, government subsidies, and the risk of transitioning to deadlier drugs. Addiction is treatable, but universal acceptance of addiction treatment is lacking.
  2. Opioids are still dangerous and can cause devastating consequences. Factors such as deprescribing, prescription drug monitoring programs, public awareness efforts, and Narcan availability have contributed to declining opioid deaths. However, continued efforts are necessary to combat the opioid epidemic.
  3. Overdose patients need more than just Narcan to survive. Effective addiction treatment and ongoing support are crucial for breaking the cycle of drug use and reducing the impact of drug addiction on individuals and communities.
  4. There are three models of care for opiate use disorder: the "crumpled piece of paper" model, motivational enhancement with a facilitator referral, and motivational enhancement with brief intervention and buprenorphine. Buprenorphine is a safer alternative to methadone and can be prescribed from a doctor's office.
  5. Buprenorphine is a safe and effective treatment for opioid addiction, but prescribing it requires extra training and a special waiver, creating a barrier to expanding access to treatment.
  6. Easing restrictions on buprenorphine could significantly reduce deaths from opioid overdose, and it's time to reconsider the X-waiver process to make it more accessible to those who need it most.
  7. Prescribing buprenorphine is more difficult than other opioids and repealing the X-waiver won't solve all the problems. Education and stigma surrounding buprenorphine need to be addressed while modern solutions need to be improved to make it easier for doctors to prescribe.
  8. Stigma attached to medication-assisted treatment (M.A.T.) for opioid addiction makes it difficult for people to access effective treatment. Overcoming this stigma is essential for successful addiction treatment.
  9. Opioid addiction involves biological, psychological, and social factors, as well as genetics, adverse childhood experiences, and easy access to opioids. Pharmaceutical companies can be involved in solutions, but a comprehensive approach is needed to tackle the disease.
  10. Addiction may start as a behavioral problem, but it ultimately changes the way the brain functions. For effective treatment, a focus on improving quality of life and access to medication-assisted treatment and harm reduction services is essential.
  11. Combining buprenorphine and warm handoff strategy with peer counselors increases engagement with patients, reduces stigma and ensures continued support for successfully transitioning into the next phase of treatment.
  12. Addiction is a difficult cycle to break, even after years of sobriety. The availability of drugs can easily re-ignite the addiction. Compassion and understanding can help addicts get on the path to recovery.
  13. Suboxone can be an effective tool in treating addiction, but it's important to combine it with therapy and support to fully recover. Don't let stigma prevent you from seeking the best treatment for your unique path to recovery.
  14. Harm reductionists recommend safe injection practices and needle exchanges, but official safe-drug-use sites are being considered to reduce overdose risk. Safehouse nonprofit provides medical staff and peers to guide patients towards treatment. Community support is crucial in addiction recovery.
  15. Reducing the stigma around addiction and offering warm-handoff programs with potential for medication-assisted therapy can improve treatment outcomes. Treatment for opiate use disorder is achievable and not overly complicated.

📝 Podcast Notes

Factors contributing to the opioid crisis in the US & the need for addiction treatment

The opioid crisis in the US is a result of various factors, including the pharmaceutical industry's promotion of pain as a vital sign and government subsidies for opioids. Dependency on prescription opioids often leads to a dependence on deadlier drugs like heroin and synthetic fentanyl. Approximately 2 million people in the US have opioid-use disorder. While prescribing protocols for opioids have changed, over 20% of Americans still get at least one prescription or refill per year. However, addiction is treatable, and some believe addiction treatment should be as routine as any other aspect of medical care. Yet, universal acceptance has been lacking.

One Physician's First-Hand Experience with the Opioid Crisis and the Importance of Wide-Spread Narcan Availability.

As an emergency-medicine physician and medical toxicologist, Dr. Perrone has seen the devastating impact of the opioid crisis first-hand. Despite declining opioid deaths in the U.S., Perrone warns against the dangers of opioids and advises others to avoid them whenever possible. She attributes the decline in deaths to factors such as deprescribing, prescription drug monitoring programs, public awareness efforts, and the availability of Narcan. Perrone herself has administered Narcan to save overdose victims on several occasions. Her experiences highlight the importance of widespread Narcan availability and the need for continued efforts to combat the opioid epidemic.

Rethinking Support for Overdose Patients: Addressing Addiction to Save Lives

Overdose patients face high mortality rates even after receiving Narcan, which highlights the need for effective addiction treatment. Emergency departments traditionally provided minimal support, but new approaches are emerging to tackle drug addiction. Patients often struggle with withdrawal and require immediate, ongoing support to break their cycle of drug use. A “crumpled piece of paper” advising them to stop using drugs isn't sufficient, and patients must have access to addiction specialists for comprehensive care. It's time to rethink the way we support overdosing patients and tackle the root cause of the problem. Only then can we hope to reduce the devastating impact of drug addiction on individuals and communities.

Models of Care for Opiate Use Disorder: The Study Results

The opioid crisis prompted a study on different models of care for opiate use disorder. The study included 300 patients, divided into three treatment groups. The first group received the standard treatment at the time, the 'crumpled piece of paper' model. The second group received motivational enhancement along with a facilitator referral. The third group received motivational enhancement, brief intervention, and were started on buprenorphine. Unlike methadone, buprenorphine can be prescribed from a doctor’s office, making it less stigmatizing. It's also intended to be much safer since it’s a partial agonist at the opioid receptors with a ceiling effect, which decreases the risk of opioid overdose and death, even if a child accidentally ingests it.

The Benefits and Barriers of Buprenorphine Treatment for Opioid Addiction

Buprenorphine, an opioid, offers a safer and more flexible treatment for opioid addiction. Patients in the buprenorphine group are two times more likely to be in formal treatment at 30 days than patients in the referral or brief-intervention group. Buprenorphine is a wildly useful drug that stabilizes the cycle of withdrawal that patients are experiencing and can double the rate of engagement of patients who showed up for a follow-up meeting. However, prescribing buprenorphine requires an extra level of regulation, including an eight-hour training program and a special waiver. This extra level of regulation does not apply to prescribing medical opioids in the first place. This is a barrier to expanding the treatment of opioid addiction.

The Potential Impact of Buprenorphine in Treating Opioid Addiction

The prescription-opioid crisis has been perpetuated by addictive painkillers and the influence of pharmaceutical companies. Buprenorphine has been recognized as a transformative tool to treat opioid addiction, but restrictions on its dispensation have hampered its effectiveness. The X-waivering process is seen as onerous, outdated, and more focused on preventing diversion to the street than on helping patients manage and recover from opioid addiction. Yet, easing restrictions on buprenorphine in France helped reduce deaths from opioid overdose by nearly 80 percent, highlighting the potential impact in the US. While concerns about Suboxone diversion persist, it is not used to get high but to treat withdrawal symptoms. It is time to reconsider the X-waiver and make buprenorphine more accessible to those who need it most.

The Complexities of Prescribing Buprenorphine and the Challenges with the X-Waiver

Prescribing buprenorphine is much harder than prescribing other opioids like OxyContin. Repealing the X-waiver won't solve the problem entirely, as some education and stigma around buprenorphine still needs to be addressed. While an eight-hour training program may prove its worth, it could pose a barrier and discouragement for some physicians who want to prescribe buprenorphine for only a few patients. Some state governments and hospital chains are moving in the right direction to address this issue, but others, like the state of Pennsylvania, are implementing additional layers to the X-waiver, making it more difficult and expensive to prescribe buprenorphine. The modern response to this problem needs to be improved.

Overcoming Stigma to Make Medication-Assisted Treatment Accessible for Opioid Addiction

While buprenorphine is being held back from widespread use due to factors like X-waiver and training requirements and extra fees, the issue may also lie in the pushback from the recovery community due to their belief in total abstinence. Stephen Loyd, a physician in Tennessee who specializes in addiction, believes that medication-assisted treatment (M.A.T.) is the most effective solution for opioid addiction, as argued by organizations like the World Health Organization and the National Institute on Drug Abuse. However, the stigma attached to M.A.T. makes it difficult to get people into these programs, including parents who are worried about trading one drug for another. The success rate of traditional abstinence-based programs like Alcoholics Anonymous is hard to determine, but studies show that A.A. nearly doubles the success rate compared to addicts who quit on their own. Loyd's argument highlights the importance of M.A.T. and the need to overcome the stigma associated with it.

Understanding the Complex Components of Opioid Addiction

Opioid addiction is a complex problem with biological, psychological, and social components. Genetics plays a role in addiction, but so do adverse childhood experiences and chronic trauma. Availability of opioids also plays a significant role in the addiction epidemic. Although the pharmaceutical industry's involvement in medication-assisted treatment is controversial due to their contribution to the problem, it remains the most effective solution for saving patients' lives. Addiction is a disease, and it can happen to anyone, regardless of their background or circumstances. To combat this epidemic, society needs to tackle addiction from all angles and provide comprehensive support to those affected.

Addiction as a Brain Disease: The Importance of Medication-Assisted Treatment and Harm Reduction

Addiction can be compared to Type 2 Diabetes in that it is primarily behavioral but it still rewires the brain, making it a brain disease. Medication-assisted treatment and harm reduction should be more widely available to those suffering from addiction. The focus of recovery should not be solely on total abstinence from all drugs, but on improving the individual's overall quality of life.

Harm Reductionist Approaches to Opioid Addiction Treatment

By adopting harm reductionist approaches to treatment, like using buprenorphine combined with a 'warm handoff' strategy that connects patients with peer counselors, medical professionals can increase engagement with patients and reduce the stigma that comes with addiction. The warm handoff approach ensures that patients have continued support after leaving the emergency room and can easily transition into their next phase of treatment. Peer counselors, who are in recovery themselves, provide invaluable insight into the challenges of opioid addiction, giving patients hope that they too can overcome their addiction and lead healthy lives. It’s time to shift the narrative around opioid addiction and embrace more comprehensive, compassionate solutions that work.

Overcoming Addiction with Compassion and Understanding

Addiction is a vicious cycle, and getting clean requires a constant battle against withdrawal. Even after years of sobriety, the availability of opioid painkillers and other drugs can easily re-ignite the cycle. The cost of these drugs can make heroin an attractive option, despite its risks. The devastation of addiction is not limited to the individual; loved ones can also suffer from the repercussions. Losing a sibling to an overdose was a turning point for Nicole O’Donnell, and propelled her to help others struggling with addiction. With compassion and understanding, Nicole helped Eileen Richardson get on the path to recovery with Suboxone.

Combining Support and Suboxone for Effective Addiction Treatment

Suboxone is a highly effective medication, but its use is limited by the stigma surrounding it in the recovery community. While it helps with the physical aspects of addiction, it is important to combine it with therapy and support to become a new person. The traditional abstinence-based approach in the 12-step program has made it difficult for people to accept medication-assisted treatment (M.A.T.) as a viable option, but it is important to understand that every individual's path to recovery is unique. The tragic death of Eileen's friend highlights the importance of finding the right combination of treatment and support, and not risking relapse by going back to old habits.

Proposal of Safe-Drug-Use Sites Amid Opioid Crisis in the US.

The opioid crisis in the US has moved from prescription pills to heroin and synthetic fentanyl, resulting in a high risk of overdose. Harm reductionists advocate for safe injection practices and needle exchange, but an official safe-drug-use site that ensures people do not overdose is being proposed in several cities, including Philadelphia. The Safehouse nonprofit is leading in the U.S., providing medical staff and peers who can navigate patients into treatment in emergency cases. The US Justice Department filed a suit against this facility claiming it would be illegal to provide a facility for illegal drug use. However, the federal judge ruled in favor of Safehouse. The opposite of addiction is community and relationship. Patients need supportive environments to build this community to help keep them alive.

Harm Reduction Strategies for Treating Opiate Use Disorder

Harm reduction strategies including lessening the stigma associated with addiction can increase opportunities for people to seek help. The warm-handoff program at UPenn sees up to six patients a day, most of whom are willing to at least have a conversation about medication-assisted therapy. Opiate use disorder is treatable and not a death sentence; it's a medical condition. However, the topic is often overcomplicated in the political community. Eileen, who takes her medication, engages, and attends meetings, is an example of someone who is doing well with treatment. We need to remember that we don't always need to overcomplicate things.