Expand Early Intervention in Communities for Substance Use Disorder

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Enable People who Start Misusing Opioids to Quickly Quit

Return to Opioid Top-Level Strategy Map

Background

Policymakers and insurers have been pushing people addicted to opioids into abstinence-based detox programs, but a new study concludes that methadone and similar drug-maintenance treatments save lives and money. If the nearly 47,000 Californians who began treatment for opioid-use disorder in 2014 had received immediate access to methadone or another opioid-agonist treatment – instead of first being forced to completely withdraw from opioids – the healthcare and criminal-justice systems would have saved $3.8 billion, researchers estimate.[1] Moreover, 1,262 lives would have been spared. “If you offer opioid-agonist treatment from the outset, people live longer, and they incur lower costs on society,” said senior author Bohdan Nosyk, a health economist and professor at Simon Fraser University.[2]

OAT - Opioid Agonist Treatment

  • International addiction experts consider initial opioid-agonist treatment, or OAT, with no duration restrictions, the evidence-based standard of care for opioid-use disorder, the authors write online November 20 in Annals of Internal Medicine.
  • But in California, where more people have been diagnosed with opioid disorder than in any other U.S. state, publicly funded treatment programs require patients to “fail” - twice - at a three-week course of medically supervised withdrawal before they become eligible for OAT. Policymakers likely maintained this medically managed withdrawal requirement under the false belief it was saving money. The study demonstrates, however, that the policy creates significantly greater long term costs for criminal justice and healthcare systems.
    • The study concludes OAT would have saved as much as $850 million over five years, not including savings to the criminal-justice system, and more than $2 billion, including the cost of arrests and prosecutions. Over 10 years, the total savings would rise to $2.87 billion.[3]
    • “If we want to see overdose deaths come down, we need to make sure people who have opioid addiction are able to access effective treatment more easily than they can access heroin, fentanyl or pain pills."
    • "We need a model whereby patients can get immediate access to opioid-agonist treatment, a lifesaving intervention, without obstacles."
    • “Among experts in the field of addiction, we already know that detox doesn’t work, that they’re going to relapse and when they relapse, they’re going to be at great risk for an overdose, that they’ll be at great risk for hepatitis,” Kolodny said. “Opioid addiction is a life-threatening illness.”


Access the study here: [1]

Public Health Imperative

  • In terms of public health, research has shown the mortality rate for long-term opioid users is 6-20 times higher than the rate among non-users.[4]
  • Relapse rates amongst opioid users are high (less than 30% report stable abstinence after 10-30 years of observation).[5]
  • Developing and implementing practices to help new users and long-term users quit and stay clean will be an important step to reduce the number of deaths and prevent further monetary losses due to workplace and healthcare costs.


The 2014 National Survey on Drug Use and Health[6] demonstrated that opioid misuse is more widespread than realized:

  • Approximately 1.9 million Americans met criteria for prescription painkillers use disorder based on their use of prescription painkillers in the past year.
  • 1.4 million people used prescription painkillers non-medically for the first time in the past year.
  • The average age for first-time prescription painkiller misuse was 21.2 years old.

(as cited by the Substance Abuse and Mental Health Services Administration).

Signs and Symptoms

Quitting opioids begins with recognition of signs and symptoms of misuse.
  For those taking prescription painkiller medications, these may be signs you are becoming dependent on the drug[7] :
  • Feeling that you have to use the drug regularly — this can be daily or even several times a day
  • Having intense urges for the drug
  • Over time, needing more of the drug to get the same effect
  • Making certain that you maintain a supply of the drug
  • Spending money on the drug, even though you can't afford it
  • Not meeting obligations and work responsibilities, or cutting back on social or recreational activities because of drug use
  • Doing things to get the drug that you normally wouldn't do, such as stealing
  • Driving or doing other risky activities when you're under the influence of the drug
  • Focusing more and more time and energy on getting and using the drug
  • Failing in your attempts to stop using the drug
  • Experiencing withdrawal symptoms when you attempt to stop taking the drug


For family members, these may be signs a loved one is struggling with a substance use disorder[8] :

  • Problems at school or work — frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance
  • Physical health issues — lack of energy and motivation
  • Neglected appearance — lack of interest in clothing, grooming or looks
  • Changes in behavior — exaggerated efforts to bar family members from entering his or her room or being secretive about where he or she goes with friends; or drastic changes in behavior and in relationships with family and friends
  • Spending money — sudden requests for money without a reasonable explanation; or your discovery that money is missing or has been stolen or that items have disappeared from your home, indicating maybe they're being sold to support drug use

Intervention

  • Intervention can be an effective means for getting someone to accept treatment. [9]
  • Interventions are most successful when conducted with the help of addiction experts and when users are coming down from a high. [10]
  • During an intervention, close friends and family members tell their loved one how their drug use has affected them personally, and the person is presented with the opportunity to seek treatment. [11]


Case Studies

Project Engage - Delaware

Project Engage is an early intervention and referral to substance use disorder treatment program designed to help hospital patients who may be struggling with alcohol or drug use. Project Engage collaborates with hospital staff to identify and connect patients with community-based substance use disorder treatment programs and other resources. Project Engage has also formed a partnership with the construction industry to offer recovery support to employees from participating construction companies.
 
  As part of the initiative, its founder, Dr. Terry Horton, worked to make questions about opioid use standard protocol for patients admitted to the ER. The goal is to identify patients going through withdrawal very quickly in order to treat it rapidly and break the vicious cycle they're in by immediately administering drugs like Suboxone. Health care workers also pair patients with addiction counselors and get them enrolled in community-based drug treatment program before they've even left the hospital. And so far, Christiana Care has been able to steer two-thirds of patients with opioid addiction into drug treatment.[12]
 
  Project Engage integrates peers in recovery, who are called Engagement Specialists, into the clinical setting in the hospital to meet with patients at their bedside about their alcohol and/or drug use. The Engagement Specialists learn about the patient’s goals and coordinate treatment options that support the patient’s needs. The Engagement Specialists use motivational interviewing to empower each patient in the decision-making process, assisting them to take that critical first step to seek help for their substance use. Project Engage Social Workers are experts in community resources, in obtaining access to facilities in the area and in assisting the team to overcome barriers so patients can receive care and transition into treatment.
 
  Simply put, Project Engage goes beyond just screening people. It treats opioid addiction as a disease, with medicine and in-house specialists, which is not common in screening programs, nor the American health system in general. The programs founders agree: the best way to curb opioid addiction is to connect patients directly with treatment, instead of leaving it up to patients to follow up on referrals, which is typically how it's done.[13]
 
  In addition to working with the patient and the hospital clinical team, Project Engage also works with treatment providers and insurers to develop a discharge plan to achieve the best possible outcome for each patient. After leaving the hospital and engaging in treatment, patients may have the opportunity to continue to work with an Engagement Specialist to help them stay engaged in their treatment.
 
  Learn more about Project Engage here: [2]

Preventing Relapse


Tools + Resources

TR - Enable People Who Start Misusing Opioids to Quickly Quit

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Sources

  1. [3]
  2. [4]
  4. Hser YI, Evans E, Grella C, Ling W, Anglin, D. Long Term Course of Opioid Addiction. Harvard Review of Psychiatry. 2015 Mar-Apr;23(2):76-89.
                    • doi: 10.1097/HRP.0000000000000052.
                    • [5]
  5. Hser YI, Evans E, Grella C, Ling W, Anglin, D. Long Term Course of Opioid Addiction. Harvard Review of Psychiatry. 2015 Mar-Apr;23(2):76-89.
                    • doi: 10.1097/HRP.0000000000000052.
                    • [6]
  6. [7]
  7. Mayo Clinic Staff. "Drug Addiction Symptoms." Mayo Clinic. Mayo Foundation for Medical Education and Research (MFMER), n.d. Web. 26 Jan. 2017. <[8]>.
  8. Mayo Clinic Staff. "Drug Addiction Symptoms." Mayo Clinic. Mayo Foundation for Medical Education and Research (MFMER), n.d. Web. 26 Jan. 2017. <[9]>.
  9. Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016
  10. Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016
  11. Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016
  12. [10]
  13. [11]
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