Saturday, February 9, 2013
Too many people are hooked. Too many are dying. The problem is too big to ignore.
Over the past decade, America has experienced a rampant rise in the number of people addicted to prescription painkillers, heroin and other opioids. We truly face an epidemic.
According to the Centers for Disease Control (CDC), the death toll from prescription painkillers has increased from 3,000 overdose deaths in 1999 to 15,500 in 2009. The CDC also reported almost 500,000 opioid-related emergency room visits in 2009, and found that about 12 million Americans reported nonmedical use of prescription opioids in 2010.
At Hazelden, we are on the front line of this crisis, which is hitting youth particularly hard. At our youth facility in Plymouth, Minn., opioid addiction increased from 15 percent of patients in 2001 to 41 percent in 2011.
The problem deserves a vigorous response. That’s why Hazelden has introduced a new treatment protocol specifically for opioid-dependent patients.
The new protocol builds on our traditional care in two ways: by weaving the specific features and challenges of opioid addiction into all aspects of treatment, and by incorporating certain medications. We now assess opioid-dependent patients to determine the need for medication assistance. Some patients get none, particularly those who refuse it or whose addiction is less severe. Some receive buprenorphine/naloxone. Others utilize extended-release naltrexone. In all cases, medication is adjunct to, and never a substitute for, our usual evidence-based approach, which includes: psychological and psychiatric care; Twelve Step-based individual and group therapy; lectures; and a focus on peer, family and recovery community support for additional structure and accountability. All of those care components, in turn, now have an opioid emphasis. For example, we provide opioid-specific groups, lectures and individual therapy to our opioid-dependent patients.
Buprenorphine — an opioid itself — is a partial agonist, meaning its effect is significantly less than the full agonists to which so many are addicted, such as morphine, Vicodin® and heroin. It’s a safe and proven means of helping people recover from their opioid of choice on the way to complete abstinence. Taken daily, buprenorphine inhibits craving, improves treatment retention, reduces relapse and improves support group attendance. Naltrexone, our other available medication, is an opioid antagonist. Injected once a month, it blocks the brain’s opioid receptors, eliminating the ability for opioids to produce intoxication or reward.
The adjunctive medication assistance helps address this population’s hypersensitivity to physical and psychic pain, which puts them at higher risk of leaving treatment early, relapsing and accidentally overdosing. While abstinence remains the ultimate goal, medication helps to ensure patients stay in treatment long enough to acquire new information, establish new relationships and become solidly involved in recovery.
Research shows medication-assisted treatment is both effective and safe. As such, it has been endorsed by health regulators and policy advocates throughout America. In our view, medication taken to treat the disease of addiction is not unlike pain medication given to post-surgery patients: if used as directed, under the care of a physician and not as a means of intoxication, it greatly assists in recovery.
One of Hazelden’s values is to “remain open to innovation.” Another is to “continue a commitment to Twelve Step fellowship.” This new program reflects those values and, as a response to the opioid epidemic, offers additional hope, healing and health to those who need it.
Marvin D. Seppala, MD, is Chief Medical Officer at Hazelden, and an adjunct Assistant Professor at the Hazelden Graduate School of Addiction Studies. His responsibilities include overseeing all interdisciplinary clinical practices at Hazelden, maintaining and improving standards, and supporting growth strategies for Hazelden’s residential and nonresidential addiction treatment programs. Dr. Seppala obtained his M.D. at Mayo Medical School in Rochester, Minnesota, and served his residency in psychiatry and a fellowship in addiction at University of Minnesota Hospitals in Minneapolis. He is author of Clinician’s Guide to the Twelve Step Principles, and Prescription Painkillers: History, Pharmacology and Treatment, and a co-author of When Painkillers Become Dangerous, and Pain-Free Living for Drug-Free People.