YouTube: https://youtube.com/watch?v=GXQayRGILK4
Previous: Can Marijuana Help with Opioid Addiction?
Next: Do People with Certain Blood Types Have Worse Covid-19 Symptoms?

Categories

Statistics

View count:490
Likes:50
Dislikes:1
Comments:5
Duration:10:04
Uploaded:2020-08-20
Last sync:2020-08-20 18:00
This is part 4 in our series on the opioid crisis, presented with support from the NIHCM Foundation.

We've talked about the state of the opioid crisis, deaths of despair, and the disappointing evidence about marijuana as a treatment for opioid dependence. But the outlook doesn't have to be entirely bleak. There are concrete policy changes we could make that might help stem the crisis. One of the most prominent is the use of MAT, or medication assisted treatment.

Related HCT episodes:
The Opioid Crisis in 2020: https://youtu.be/GOOU_kXUdj0
Marijuana and Opioid Use Disorder: https://youtu.be/rfdU8DcpX7c

Be sure to check out our podcast!
https://www.youtube.com/playlist?list=PLkfBg8ML-gInFaYyYhKLBp2u7h5IojTw4

Other Healthcare Triage Links:
1. Support the channel on Patreon: http://vid.io/xqXr
2. Check out our Facebook page: http://goo.gl/LnOq5z
3. We still have merchandise available at http://www.hctmerch.com
4. Aaron's book "The Bad Food Bible: How and Why to Eat Sinfully" is available wherever books are sold, such as Amazon: http://amzn.to/2hGvhKw

Credits:
Aaron Carroll -- Writer
Meredith Danko – Social Media
Tiffany Doherty -- Writer and Script Editor
John Green -- Executive Producer
Stan Muller -- Director, Producer
Mark Olsen – Art Director, Producer

Images and Footage
Videoblocks/TheSceneLab
Videoblocks/made360
Videoblocks/emiryorda
Videoblocks/barselona_dreams


#healthcaretriage #opioids #addiction
It's the last episode of our four part update on opioids. With support from the National Institute for Healthcare Management Foundation, we've talked about the crisis and new regulations are affecting the healthcare system, its workers, and the patients it serves. We've talked about deaths of despair and how they've contributed to decreased life expectancy in the United States. And we've talked about how marijuana might not be the answer we once thought it might be. In this last episode, we'll shine a light on where we're still failing to stop the crisis, and what the data say about our ability to turn that around. That's the topic of this week's Healthcare Triage.

[Healthcare Triage intro music]

We're still largely failing to stem the opioid crisis. This failure is happening on many levels, not the least of which is lack of access to medication assisted therapy, or MAT. MAT is the use of drugs such as methadone, naltrexone, or buprenorphine to treat opioid use disorders. These are well-established treatments that are associated with significantly improved opioid abstinence and decreased mortality.

But access barriers are rampant. For starters, we aren't turning to MAT when addicted patients show up at the hospital. When compared with opioid-dependent patients placed on a detoxification regimen upon admission, those placed on a buprenorphine induction protocol and treatment upon discharge reported significantly less illicit opioid use six months later. Other data suggests that initiating buprenorphine treatment at hospital admission significantly reduces the chances of both 30- and 90-day re-admissions. But despite these and other data, a 2016 study reported that among 102 patients hospitalized with heart infections related to injection drug use, fewer than 25% were given addiction consultations and fewer than 8% were discharged with a plan for MAT. 

This could be due in part to low MAT availability. Medication for opioid addiction is offered at fewer than half of US addiction treatment facilities. In addition, there are huge portions of the United States where there are few to no doctors that can prescribe buprenorphine, leaving an enormous number of addicted individuals without this treatment options.

It seems like there's tighter regulation of the medications that treat opioid use disorder than there are of the medications that cause it. Physicians with licenses from the Drug Enforcement Administration can write prescriptions for oxycodone and fentanyl, but they need extra training before they're given a waiver that allows them to prescribe buprenorphine. Among other things, physicians cite this 8-hour training is a significant barrier to being an MAT provider.

Addiction specialists have argued against the waiver requirement, citing outcomes in countries like France, where a substantial decrease in opioid deaths was seen after regulations on buprenorphine administration were eased. As of now, though, the waiver remains a requirement here in the United States.

Other moves have been taken to address barriers to MAT. The California BRIDGE program is working to make hospitals and emergency rooms primary access points for addiction treatment, and a handful of universities and medical centers are working to ensure in-hospital addiction treatment.

Let me be clear, though, that a lot more effort is required. To repeat something I said just a minute ago, the majority of addiction treatment centers in the United States do not offer MAT, and effective, evidence-based treatment for addiction. This could be due in part to stigma. We'll discuss that in just a minute, but first we want to talk about policy.

A paper released in 2018 used a modeling approach to project addiction-related deaths in the United States in response to potential policy fixes to the opioid epidemic. They examined policy changes aimed at preventing new cases of opioid use disorder, like reducing prescription rates, expanding opioid disposal programs to reduce inappropriate use of leftover prescriptions, and reformulation of opioids to deter tampering and abuse. They also examined policy changes aimed at existing cases of opioid use disorder, like expanding availability of MAT, psychosocial treatment, naloxone availability, and needle exchange programs, which prevent deaths from things like HIV contracted via needle sharing. They also projected the effects of enhancing provider access to and use of prescription drug monitoring programs to support appropriate prescribing and to identify misuse among patients. 

Over a ten-year period, changes to opioid prescription policies related to acute pain were projected to prevent around 9,000 deaths, whereas changes related to chronic pain and prescription monitoring programs were actually projected to increase deaths. As we discussed in the first episode of this series, it's critical to change the way we prescribe opioids, but caution and awareness of individual circumstances will also be critical to avoid making things worse. The projected number of lives saved due to drug reformulation was 3,900. Disposal of excess opioids accounted for a projected 2,400. Expanding needle exchange programs was projected to save almost 6,000 lives, and expanding psychosocial treatment could save another 7,500. Expanding access to MAT was projected to save 12,500 lives, and expanding naloxone availability made the biggest impact at a projected 21,200 lives saved over the ten-year period. 

The authors project that without intervention, we would see upwards of 500,000 opioid-related deaths over ten years. When combining the appropriate policy approaches, they project we could reduce that by around 11%. That's a lot.

The important takeaway is that no single approach will do it. Rather, a combination of the most effective policies is the key to saving a significant number of lives. Multifaceted problems require multifaceted solutions. We need to take action where possible to halt addiction before it starts, reducing unnecessary exposure to opioids, and taking steps to screen for and safeguard at-risk individuals, including the steps mentioned in our episode on deaths of despair.