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“I’m thrilled, because this new policy focuses on all areas of need, not only treatment, but also education, prevention and research,” says Basch, director of the Addiction Medicine Program in the Rush Department of Psychiatry. “Until now, delivering proper care has been as much a battle as the opioid epidemic itself. We haven’t been able to do our best to respond to what is a very treatable disease.”
On March 29, the White House made official the set of new measures announced last fall in response to what has been described as an epidemic of addiction to opioids. A class of drugs that includes prescription pain medications and heroin, opioids were involved in more than 28,000 deaths in 2014, according to a White House fact sheet.
More than six out of 10 drug overdose deaths in 2014 involved opioids. The U.S. Centers for Disease Control and Prevention found a continued sharp increase in heroin-involved deaths and an emerging increase in deaths related to synthetic opioids such as fentanyl.
‘The problem can no longer be ignored’
As of 2011, 4.2 million people in the U.S. age 12 or older had used heroin at least once, according to the CDC, which notes that “about 23 percent of individuals who use heroin become dependent on it.” Four out of five people who use heroin begin by first misusing painkillers, according to a White House fact sheet.
Between 1991 and 2011, the number of opioids prescribed tripled, as did the number of opioid related deaths. Nationwide, more than 16,000 people died of opioid painkiller overdoses in 2013, according to the CDC. In addition, heroin overdoses nearly doubled from 2011 to 2013, according to the White House.
“Opioid addiction is widespread and is crippling our nation. It spares no race, no neighborhood, no income level,” Basch says. “The problem can no longer be ignored.”
Obama intervention stresses prescriber training
The $133 million initiative Obama announced includes providing training on the prescription of opioid pain medications. Additionally, 540,000 providers will receive prescriber training through state, local and private sector efforts.
This training is aimed at ensuring these medications are being prescribed appropriately. “Health care providers wrote 259 million prescriptions for opioid pain medications in 2012 – enough for every American adult to have a bottle of pills,” the White House announcement says.
“Narcotic pills were once less understood and falsely advertised as better than they were,” Basch explains. “When narcotic prescribing became second nature, some patients rapidly became addicted to them.”
Putting addiction and overdose treatments into more hands
The new efforts include doubling the patient limit for qualified physicians who prescribe the medication buprenorphine to treat opioid use disorders, from 100 to 200 patients. The effort also aims to double the total number of physicians certified to prescribe buprenorphine.
The federal government also is making $11 million available to states to obtain naloxone, which is used to treat life-threatening opioid overdoses, and to train first responders to use it.
“I can’t overstate what a watershed moment this is,” Basch says. “Finally, first responders are going to have the tools to literally save more lives.”
“One of the common misunderstandings with opioids in particular is that treatment should be abstinence based. ‘Just stop, just say no, use support meetings alone,'” Basch says. “With opioids, these chemicals are so strongly addictive that they change the brain and influence behavior.”
Under the Affordable Care Act, substance use disorder services are essential health benefits, comparable to medical and surgical benefits, and required to be covered by health plans in the Health Insurance Marketplace. Obama’s new initiatives include establishing a task force to help ensure this coverage is provided. “All Americans who want treatment can now get the help they need,” Basch says.
Catching the problem at the start
In addition to these efforts, Basch also wants to see screening for drug and alcohol misuse starting at age 12 (0.9 percent of eighth-graders nationwide had used heroin at some point, according to 2014 figures from the CDC).
Basch currently is participating in an SBIRT research grant-funded program that trains providers how to screen patients at risk for substance use. SBIRT stands for screen, briefly intervene and referral to treatment.
“All patients at Rush University Medical Center will soon be quickly and efficiently screened for risky substance use,” she says. Basch notes that treating the early stages of addiction is less expensive and spares society the additional costs of lost health, jobs, relationships and lives.
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