This month, learn how sporadic sub-epidemics of different drugs are driving a growth of overdose deaths, according to new research; see how new legislation aims to facilitate access to opioid-use disorder (OUD) treatment and medication; and read about a new OUD treatment program aimed at new mothers.
Editor's note: The Opioid Monthly is compiled by OptumLabs. The Daily Briefing is published by Advisory Board, a division of Optum, which also owns OptumLabs.
Federal law: The Senate in a sweeping 98-1 vote passed the Opioid Crisis Response Act (H.R. 6), a bipartisan package of opioid crisis response legislation to be signed into law. The bill will expand programs and policies focused on an array of issues, including Medicare coverage of medication-assisted treatment (MAT) for beneficiaries with opioid-use disorder (OUD) and funding for research on non-addictive pain medication and innovative state prevention programs. The legislation does not lift the requirement of physicians to obtain a waiver to prescribe MAT, which remains a key barrier to broad evidence-based OUD treatment.
Synthetic opioids: The Synthetics Trafficking and Overdose Prevention (STOP) Act aims to help prevent unsafe opioid shipments by requiring the U.S. Postal Service to collect data about the senders and contents of inbound packages to help the Customs and Border Protection agency screen for fentanyl, which is largely coming through the mail from China. FedEx, United Parcel Service, and DHL are already doing this. The STOP Act is part of the Opioid Crisis Response Act.
Medication-assisted treatment: A 10% increase in the number of doctors who are certified to prescribe buprenorphine (a type of MAT) led to 10% more buprenorphine received by Medicaid patients in need and 1.2% less opioids were prescribed overall, according to a recent paper in JAMA Network Open. The study included Medicaid fee-for-service and managed care enrollees between 2011 and 2016. Findings emphasize that when more doctors are able to prescribe MAT, there is potential to effectively treat more patients with OUD and slow the opioid epidemic.
Medication-assisted treatment: Teens and young adults who use MAT are less likely to stop treatment for OUD compared with those who use behavioral therapy alone—42% less likely on buprenorphine, 46% less likely on naltrexone, and 68% less likely on methadone, according to a recent study in JAMA Pediatrics. The study included 4,837 youths aged 13 to 22 years with OUD and Medicaid insurance from 2014 to 2015. Strategies to ensure timely receipt of these MAT options are critical for success among young people with this difficult disease.
Overdose rates: Sporadic sub-epidemics of different drugs—each with its own demographic and geographic features—are driving the steady exponential growth of overdose deaths, revealing a more unpredictable public health issue than we thought, according to a new study in Science. Researchers analyzed nearly 600,000 overdose-related death records over 37 years (1979-2016) in the National Vital Statistics System. They found, for example, that until 2010, most overdose deaths were from cocaine and then prescription drugs (with highest rates among adults ages 40 to 50 in urban areas). Today, overdose deaths are mostly from heroin and fentanyl (with especially high impact among younger adults, aged 20 to 40, in the Northeast). Alarmingly, since 2010, the death curves for all drug types have increased (except for methadone and unspecified narcotics). The opioid epidemic may be the most recent example of an ongoing, longer-term issue for which understanding the root causes of these shifting patterns is needed to address our national crisis.
Chronic pain: More than 20% of U.S. adults (50 million) have chronic pain while 8% (19.6 million) have high-impact chronic pain (and income may play a role), according to a new CDC report based on the 2016 National Health Interview Survey (NHIS). Chronic pain was reported more often among people who were recently unemployed, living in poverty or rural areas, or who had public health insurance—suggesting that socioeconomic status should be considered in more targeted pain management planning.
Medication-assisted treatment: Despite growing proof that it works, MAT is still not allowed in more than half of recovery houses across the country—residents are instead encouraged to “go cold turkey.” In fact, sober-living homes often turn away people who are on MAT, potentially pushing them into homelessness. Dr. Nora Volkow, of the National Institute on Drug Abuse, says that it's an issue of society not treating addiction as a disease: "I don't see any other condition or disease … where you basically ask the person to forego the medication treatment.” Read/listen more on NPR about one recovery home owner who let research and experience change her mind about MAT.
You can also learn more about the benefits of MAT and how we can increase access for patients via this overview from the American Medical Association.
Maternal opioid-use disorder treatment: The Moms Do Care program is changing the way pregnant women and mothers with OUD are treated, using a team of peer recovery mothers, doctors, social workers, and mental health clinicians to support women with OUD in Massachusetts up to one year after giving birth. Services include pre-natal care, breast feeding, and infant massage for babies born with neonatal abstinence syndrome (NAS), as well as counseling and MAT for mothers in recovery. The team will even advocate for mothers in child custody cases with social services. Funded by a $1 million grant from the Massachusetts Health Policy Commission, nine women completed the program in 2017 (and are still in treatment), with 39 are currently enrolled.
Family opioid-use disorder treatment: Families, when educated about effective treatment, can be vital to the recovery of loved ones with OUD, as explained by experts Dr. Andrew Saxon of University of Washington School of Medicine and Dr. Sarah Wakeman of the Substance Use Disorders Initiative at Massachusetts General Hospital. They encourage families who have a loved one with OUD to support their use of MAT, continue to love that family member without guilt ("tough love" can be harmful), and to obtain and learn how to use naloxone (the opioid-overdose antidote) as an important safety precaution.
The opioid epidemic is a complex, multi-dimensional public health problem. Use this list of helpful resources on how hospitals and health systems can play a role to treat opioid addiction and prevent further increase in opioid abuse.
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