Getting involved with patients’ substance abuse issues before they reach the point of addiction is pivotal
Heroin and Vicodin appear to be two very different substances. Vicodin is a common medication prescribed to patients by their doctors for the treatment of pain, while heroin is a notoriously addictive and dangerous street drug. When it comes to addiction, however, the two drugs function almost exactly the same way.
According to the American Society of Addiction Medicine, over 2 million Americans have substance-abuse disorders involving prescription painkillers. The majority of these addictions began as legitimate prescriptions from doctors for the treatment of pain. Many of them may have been prevented by early intervention efforts.
The Facts on Opioids
Opioids are a class of drugs that interact with receptors in the brain. These include heroin, synthetic opioids, and many prescription pain relievers. Since all of these drugs affect the same areas of the brain and produce similar feelings of euphoria, it is common for one drug to lead to another. In fact, abuse of pain relievers and heroin go hand-in-hand.
In December of 2015, Dr. Eric C. Strain, Executive Vice Chair of Johns Hopkins Bayview Medical Center’s Department of Psychiatry and Behavioral Sciences and Director of the Center for Substance Abuse and Research said, “It appears we’re seeing some stabilization or even a decrease in prescription opioid misuse… we’re seeing a shift from prescription painkillers to heroin.”1
This correlation may be best illustrated through numbers:
- Between 1991 and 2012, the number of opioid prescriptions dispensed in the U.S. rose from 76 million to 259 million.2
- Fatal overdoses through the use of opioid pain relievers went from 4,030 in 1999 to 19,000 in 2014.2
Recognizing the dangers of skyrocketing prescription and addiction rates, various regulatory agencies began taking decisive action within the last 10 years. The results are positive in some ways, but devastating in other respects.
- According to the Centers for Disease Control and Prevention, in 2012 fatal overdoses from opioid medications declined for the first time in 10 years.
- Prescriptions to opioid medications have dropped 18% in the past five years, according to Symphony Health Solutions.
This sounds positive, but the result is that users who no longer have access to prescriptions turn to something potentially more dangerous:
- Between 2013 and 2014, the number of self-reported heroin users rose from 681,000 to 914,000.2
- Between 2002 and 2014, the rate of fatal heroin overdose almost quadrupled.3
- Four out of every five heroin users reportedly began with the misuse of opioid medications.3
Despite the fact that prescription numbers are decreasing, opioid addictions are not. In 2016, over 3.5 million users reported having misused some type of opioid within the past 30 days.4
Early Intervention is Key
Addiction to opioids creates considerable and often irreversible chemical and structural changes within the brain that make logical reasoning impossible. For this reason, it is vital to identify and treat the problem before the addiction stage. Early recognition of drug misuse can occur most easily in the home, at work, or at routine doctor visits. Research shows that the most effective early intervention techniques are often performed by a trusted doctor or medical professional that is treating the user for something unrelated to drug use.
Who is Most at Risk?
According to the Substance Abuse and Mental Health Services Administration, individuals who could most benefit from early intervention include:
- Adolescents ages 12-17 who may be prevented from forming lifelong addictions.
- Those who consume substances while driving and endanger the lives of others.
- Women who use substances while pregnant, endangering the well-being of their unborn children.
However, anyone heading down the path of opioid misuse has a better chance of recovery if the problem is treated before they develop an addiction.
Screening for Drug Use in General Medical Settings
Ideally, substance misuse screening could occur for all individuals who present for general health care appointments, such as wellness checkups, counseling/psychiatric appointments, or emergency care. Any individual from adolescence onward may be screened for drug use easily through a variety of testing measures, such as simple questionnaires, evidence-based screening tools, or even a few direct questions from the attending physician.
Professional organizations, including the American College of Obstetricians and Gynecologists, the American Medical Association, the American Academy of Family Physicians, and the American Academy of Pediatrics, all recommend universal and ongoing screening of every adolescent and adult patient, regardless of the patient’s reasons for the office visit. This one simple requirement would potentially prevent millions of opioid users from becoming addicts.
Recognizing Opioid Misuse in Other Settings
Unfortunately, many general medical facilities have yet to implement screening and early intervention measures for all patients. However, such measures may also be effective when enacted by family members, friends, or coworkers. If those individuals closest to the user know the warning signs, treatment could be recommended before an addiction to the drug is formed. Some of these warning signs include:
- The individual is mellow at times, but very irritable at others.
- The individual begins to miss meals and family/work events on a regular basis.
- Money begins to inexplicably disappear.
- An injured individual continues to take prescription painkillers for more than a few days after the injury.
Early Intervention Treatment
Once opioid misuse has been identified, treatment will depend on the severity of the case. If the problem is recognized in early stages, the user may be deterred through a brief intervention. A brief intervention can range from informal counseling to structured therapies. Ideally performed by a trusted physician, psychologist, or counselor, the following protocol can prove highly effective in preventing further misuse:
- Introducing the issue in the context of the patient’s health.
- Screening, evaluating, and assessing the level of the patient’s drug use.
- Talking about change and setting goals.
- Summarizing and reaching closure.
During this process, the counselor would advise the patient on methods of abstaining from drug misuse and provide him or her with reading materials and resources to learn more. Follow-up phone conversations and screening appointments are important in maintaining sobriety and ultimately, providing closure.
In one study published in Addiction Journal, a group of medical researchers tested 334 primary care patients that had been screened and confirmed for minor substance abuse. 171 patients received brief intervention, while 163 patients in the control group received no treatment. Those 171 patients who received brief intervention treatment showed an average of 41% decline in drug use during the weeks following treatment.5
These results demonstrate the potential success of early intervention treatment when patients are screened and treated in general medical environments prior to developing an addiction.
Despite widespread efforts to initiate early intervention programs into medical facilities, as well as the introduction of education programs throughout the nation’s public schools, addiction to opioids is on the rise. According to the National Survey of Drug Use and Health, only one in 10 individuals with a substance abuse disorder will seek or receive any type of treatment. Once a full-blown addiction has set in, however, there is still hope.
Many programs exist for the treatment of severe opioid addiction and some studies exhibit a recovery rate as high as 70% for individuals who were able to complete treatment.6 A few treatment options for drug addiction include:
- Detox followed by abstinence – For highly motivated individuals with access to inpatient treatment programs and a drastic change in living environment, this method is the most difficult of treatment plans.
- Detox followed by once monthly shots of naltrexone – Naltrexone is a medication that blocks the effects of all opioids and must be administered once a month to remain effective.
- Medicated, assisted treatment with buprenorphine or methadone – Buprenorphine and methadone can both ease the symptoms of opioid withdrawal while simultaneously preventing the effects of opioids and addressing the chemical imbalances in the brain caused by addiction.
Whether it’s heroin, vicodin, or any other prescription painkiller, opioid addictions are affecting—and taking—millions of lives. The most effective prevention and treatment strategies are contingent on early screening and intervention methods. Nationwide efforts are underway to educate doctors and the public on these strategies, but there are still numerous health facilities and emergency clinics that have not adopted these approaches. Should every general and mental health care facility require substance misuse screening for all adult and adolescent patients?
- National Institutes of Health. Prescription Opioid Use May Be Decreasing, but Heroin Use Is Increasing. https://nihrecord.nih.gov/newsletters/2015/12_04_2015/story2.htm. Accessed Nov. 29, 2017.
- Substance Abuse and Mental Health Services Administration. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. https://www.samhsa.gov/data/sites/default/files/DR006/DR006/nonmedical-pain-reliever-use-2013.pdf. Accessed Nov. 29, 2017.
- American Society of Addiction Medicine. Opioid Addiction 2016 Facts and Figures. https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf. Accessed Nov. 29, 2017.
- Substance Abuse and Mental Health Services Administration. Results from the 2016 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.htm#tab1-27A. Accessed Nov. 29, 2017.
- Lillian Gelberg, MD, MSPH,1,2 Ronald M. Andersen, PhD, Abdelmonem A. Afifi, PhD, et al. Project QUIT (Quit Using Drugs Intervention Trial): A randomized controlled trial of a primary care-based multi-component brief intervention to reduce risky drug use. Addiction Journal. 2015 Nov;110(11):1777–1790.
- Rolley E. Johnson, Pharm.D., Mary Ann Chutuape, Ph.D., Eric C. Strain, M.D., Sharon L. Walsh, Ph.D., Maxine L. Stitzer, Ph.D., and George E. Bigelow, Ph.D. A Comparison of Levomethadyl Acetate, Buprenorphine, and Methadone for Opioid Dependence. N Engl J Med 2000;343:1290–1297.