THE SERIOUS PROBLEM of opiate addiction has finally pierced New England’s provincial bubble of denial. Within the last several months, the governors of Massachusetts and Vermont attributed public health emergencies to opiate addiction. Similarly, Connecticut, New Hampshire, Rhode Island, and Maine all report opiate epidemics.
Experts agree that opiate pain killers, obtained legally or illegally, are often a precursor to heroin addiction. Prescription medications such as Vicodin and Oxycodone, prescribed for pain management, often end up in our personal medicine cabinets readily available to family members. Users of pain medications, which are powerfully addictive, find that they can ill afford to buy opiates with a street value of roughly eighty dollars per pill on the street. A similar dose of heroin, at only five to ten dollars, becomes economically attractive and trumps all other concerns, including overdose and the risks inherent in needle use, including HIV/AIDS and Hepatitis C.
Recently, much has been made of efforts to arm first responders with Narcan, a highly effective antidote to opiate overdose. While Narcan can be easily administered via a nasal spray or injection to reverse the deadly effects of an overdose, it does nothing to break the powerful grip of addiction. Although necessary in overdose emergencies, it is an insufficient response.
Prevention is the first step in thwarting opiate addiction, and encompasses multiple levels of intervention. Universal prevention strategies focus on whole populations or communities working together to reduce drug use. One example is National Prescription Drug Take Back Day, a dedicated day when local police departments accept and dispose of old prescription medications. Other prevention strategies target groups at higher risk of opiate addiction than the general public. For example, as a group chronic pain sufferers need specific education and monitoring to guard against the misuse of their medications.
Screening and assessment are the next steps in the intervention hierarchy. The former is a universal process that quickly evaluates people for high risk alcohol or drug use. Screening instruments are widely available and should be implemented in primary care and dental offices, hospitals, mental health facilities, and other health and human service settings. Individuals “screened in” for substance misuse receive a brief intervention with a care provider who establishes acceptable guidelines for use, recommends decreasing use and monitors the process on an ongoing basis. Individuals screened in for more serious addictive behaviors are referred to a drug treatment program for a comprehensive assessment and ongoing treatment.
Treatment options for opiate addiction have grown over the past few years thanks to the growing body of scientific evidence establishing addiction as a brain disease. In the past, individuals addicted to opiates had limited treatment options. They could withdraw from opiates alone, suffering severe flu-like symptoms that generally resulted in immediate relapse, or could enroll in a methadone treatment program on a short- or long-term basis. Methadone remains a feasible treatment option, but has the drawback of being dispensed on a daily basis, requiring individuals to travel back and forth to a clinic each day. Inpatient detoxification is a theoretical alternative, however the under supply of beds, especially for youth, makes it nearly impossible to realize this treatment approach.
Newer treatment options include a medication sold with the trade name Suboxone. Suboxone effectively eliminates cravings for opiates and is nearly impervious to overdose. Because Suboxone is prescribed by trained physicians in traditional health care settings, it reduces stigma and increases access to treatment. Another medication recently approved by the FDA, called Vivitrol, is administered as a monthly injection to block the pleasurable effects of opiates, rendering their use meaningless.
Clearly, medication alone is inadequate for the treatment of opiate addiction. Successful treatment must be combined with counseling to develop coping and relapse prevention skills; a supportive community; professional mental health care; and resources for living such as drug-free housing, child care, employment, and ongoing health care. We also need to increase the number of detoxification and treatment beds in the region to help those caught in the grip of this deadly disease.
The rise in opiate addiction has already caused devastating loss and pain across New England. It’s time we meet this epidemic with proven strategies of prevention, screening, assessment and treatment.
Shelley Steenrod is an associate professor in the School of Social Work at Salem State University in Salem, Mass.