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New options available for treating opioid addiction
Oregon is experiencing an epidemic of opioid overdose and addiction — a crisis that also is impacting every other corner of the nation.
Drug overdose is now the leading cause of accidental death in America, even ahead of car crashes. The latest data from the Centers for Disease Control and Prevention reveal that overdose deaths involving opioids — the class of drugs that includes prescription pain medications and illegal drugs like heroin — increased yet again in 2015 to roughly 33,000, up from 29,000 in 2014.
Closer to home, a recent report by the Oregon-Idaho High Intensity Drug Trafficking Area notes that Oregon ranked fourth in the entire United States during 2013 and 2014 for reported rates of non-medical use of pain relievers by people ages 12 or older.
Yes, prescription opioids are a major part of the overdose and addiction problem. As a result, the medical community — which sincerely values the health of its patients — is re-examining the pros and cons of using opioids for chronic, non-cancer pain.
Physicians are becoming more aware of and concerned about the risk of adverse events like accidental overdose from opioids. And, new studies suggest the benefits from perpetual use of opioids for pain not caused by cancer may yield, at best, modest benefits and can even make the pain worse.
Doctors also are becoming concerned about the apparent connection between the length of a prescription for an acute (new) pain problem and the likelihood of a problem being prolonged due to the use of opioid medications. A new national survey found one-third of Americans who have taken prescription opioids for at least two months say they became addicted to, or physically dependent on, the painkillers.
At the Hazelden Betty Ford Foundation, almost 25 percent of our patients have an opioid use disorder, a 250 percent increase since 2001. Addiction is a complex, difficult-to-treat disorder, and recovery from opioid addiction is especially challenging.
Anxiety, depression and craving for the drug can continue for months, even years, after being free of opioid use. Patients with opioid-use disorders have an increased sensitivity to real or imagined pain and are more vulnerable to stressful events. A desire to feel "normal" again, to escape this seemingly permanent state of dysphoria, puts them at a high risk of relapse, and, even more tragically, at a high risk of accidental overdose and death during relapse. An opioid user who returns to the same dosage after losing his or her tolerance to that drug risks respiratory suppression and death.
To best treat these patients, the Hazelden Betty Ford Foundation developed our unique "COR-12: Comprehensive Opioid Response with the Twelve Steps" treatment protocol.
When clinically appropriate, COR-12 includes the use of certain medications as a component of our evidence-based Twelve Step Facilitation treatment model. We know this approach is effective because our data shows that patients stay in treatment longer and have better outcomes when their treatment includes the use of certain medications.
Medications such as Suboxone and Vivitrol can ease the discomfort of withdrawal symptoms and can reduce cravings so that patients are better able to participate in the recovery process.
The often intense physiological withdrawal and cravings that occur when quitting opioids can drive a return to opioid use and interfere with a patient feeling well enough to participate in treatment. With the assistance of medications, our patients are able to stabilize, freeing them up to engage more successfully in other aspects of treatment like individual therapy, educational sessions, group therapy, opioid-specific focus groups and Twelve Step fellowship.
While medication alone is often not sufficient to achieve recovery, research suggests that when used in conjunction with evidence-based therapies such as we provide, medications can dramatically increase a person's chances of staying sober long term. At our treatment centers, patients use medications on the path to abstinence and a new life.
Though this epidemic is devastating our country, there is hope. Treatment is effective and recovery is possible. I have the great privilege of seeing living proof of that every day.
Dr. Jeffery Young is medical director of the Hazelden Betty Ford Foundation's outpatient center in Beaverton and the Springbrook residential treatment campus in Newberg, where he also serves as director of the Health Care Professionals Program.