The mission of Haymarket Center is to aid people with substance use disorders in their recovery by providing comprehensive behavioral health solutions.
"5-part plan to reverse the opioid epidemic"
A sound plan by Arthur Lurigio & Dr. Sidney Weissman that places treatment front and center.
Opioid-related overdoses end the lives of more than 100 Americans each day on average. Here's a five-part plan to alleviate the opioid epidemic.
The first task in addressing opioid abuse is treating overdose victims. First responders must be equipped with and trained in the use of naloxone. Once victims are stabilized, their treatment can begin. Much scientific evidence shows that opioid use disorder (a medical condition that in common parlance would be called opioid abuse or addiction) can be effectively treated, with recurrence rates no greater than those for other chronic illnesses such as diabetes, asthma and hypertension. The Food & Drug Administration has approved three medications for treatment—methadone, buprenorphine and naltrexone—that block opioid cravings and effects. All three also significantly increase the likelihood that opioid users can recover to live healthy and sober lives.
Medications are most effective when they are combined with non-medical therapies, including short- and long-term residential programs and follow-up care that includes recovery management. Intensive outpatient programs help opioid addicts acquire the competencies and skills to resist future drug use. Offered in community-based settings with comprehensive long-term care, such programs ensure that recovery is an achievable goal, especially when they involve sober housing, supportive services (job development and training) and peer mentorship (e.g., Narcotics Anonymous sponsors).
State and federal governments must fund educational programs that show the limitations and dangers of opioid use. These messages should be directed at the general public, customized to reach groups at a higher risk for opioid use disorders (e.g., rural residents) and crafted along the lines of public health advertising campaigns concerning the risks of tobacco and unsafe sex practices. Educational initiatives also should contain school-based platforms for youths 12 to 17, who are prone to opioid experimentation.
Furthermore, patients should receive informational packets with every opioid prescription to be reviewed with both their prescribers and the pharmacists. Strict adherence to dosage and prescription regimen requires the firm commitment of the physician and the patient to ensure that the type, duration and dosage of the medication are properly and prudently administered. Doctors must be fully informed about the dangers of over-prescribing. Opioid-based instruction should become embedded in standardized medical school curricula.
Medical students must also become familiar with varied pain treatment modalities that are based on established guidelines and evidence-based practices. Medical residents with direct patient care responsibilities should have hands-on training experiences with the administration of opioids. Physicians should be required to attend accredited continuing medical education programs on the latest guidelines for opioid prescribing.
Pain management practices should consist of options that work more effectively and are much safer and cheaper than opioids. Alternatives include guided imagery, meditation, over-the-counter pain relievers (such as acetaminophen, ibuprofen and naproxen), physical therapy, antidepressants, massage and manipulation and exercise. When all else fails, opioids should be used only when their benefits outweigh their risks. With few exceptions, opioid prescriptions should be limited to one-week supplies for each patient.
A CNN/Harvard University study published in March reported that in exchange for prescribing opioids some physicians have accepted large payments in the form of fees for consulting, speaking, educating and training engagements directed at other physicians. Whether these doctors were selected as spokespeople or so-called opinion leaders because they already wrote large numbers of opioid prescriptions or whether the money paid to them led to changes in their prescription-writing practices is unclear. In any case, the correlation between opioid prescribing and physician earnings is appreciable and troubling.
Recent changes in the development of accredited continuing medical education programs have curtailed this practice. Furthermore, states such as Ohio and Mississippi have sued major drug companies, including Purdue Pharma and Endo Health Solutions, for wantonly extolling the benefits of opioid painkillers while purposely downplaying their risk of addiction.
Nationwide, computer networks should be established to track the issuance of opioid prescriptions, and those retrieving an opioid prescription should be required to show a valid ID card. Controlling prescriptions will reduce the quantity of drugs being deflected into illicit use. However, this alone will not substantially diminish the availability of opioids through other channels. For example, untold numbers of small labs in China are producing and mailing fentanyl and its derivatives to the U.S. The Chinese government must be enlisted in our efforts to stem this drug flow. New methods of enforcement also will be needed to reduce the smuggling of heroin, which comes mainly from Mexico and Afghanistan.
The opioid epidemic developed over several years and will take long-term, concerted and coordinated public health efforts to reverse the trend of new addictions and to treat victims in the recovery process. We must fortify our will to act before more lives are lost.
Arthur Lurigio is a professor of psychology and of criminal justice and criminology at Loyola University Chicago, where he is the senior associate dean for faculty, a faculty scholar and a master researcher in the College of Arts & Sciences.
Dr. Sidney Weissman is a clinical professor of psychiatry and behavioral sciences at Northwestern University's Feinberg School of Medicine. He is also on the faculty of the Chicago Institute for Psychoanalysis.
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