New Jersey has been struggling with its opioid epidemic for years, and while recent numbers released by the federal government show a positive trend toward easing the state’s crisis, healthcare professionals say much more needs to be done.
Gov. Chris Christie’s 2014 opioid task force was commended for expanding drug courts, implementing a Prescription Drug Monitoring Program, and extending the availability of naloxone (Narcan), which quickly and safely ends the effects of an overdose. The state is also expecting to receive federal funding for addiction programs.
While Christie’s efforts have come quickly and effectively (over 7,500 lives have been saved by access to Narcan alone) Christie said in his 2016 State of the State address that experts now say what really works in opioid treatment requires playing the long game. The best outcomes are achieved when doctors look at the “whole patient” — meaning considering behavioral as well as physical issues — and swap opioids for medications meant to reduce addiction.
While popular legislative tactics include increasing access to Narcan and by limiting the size of prescription doses, addiction specialists at a panel discussion hosted by the Mental Health Association in New Jersey (MHANJ) said the best solutions take the most time. Carolyn Beauchamp, president of the MHANJ said the most important treatment method — medication-assisted treatment — has also been the most controversial.
“Medically-assisted treatment has been pushed aside,” Beauchamp said. “Now we have Suboxone, Vivitrol and some of these other (new) medications that are so important to helping people manage the physical effects of their addictions. But in what I’ve been studying, it’s so different for each person.”
Medication-assisted treatment (MAT) is an approach that combines behavioral therapy and medication like buprenorphine, methadone, and naltrexone to treat the addiction. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) these work to “normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug.” These medications have been approved by the FDA and are subject to several other accreditation processes and certifications.
A study conducted by the National Institute on Drug Abuse found MAT efforts to be effective. In a long-term follow-up of patients treated with buprenorphine or naloxone for an opioid addiction, about half reported that they were clean 18 months after starting therapy. This number swelled to 61 percent after three years.
However, SAMHSA research also shows that MAT is severely underused. A national data set put out by the organization showed the proportion of heroin admissions with MAT fell from 35 percent in 2002 to 28 percent in 2010. These numbers demonstrate a level of discomfort among families and those advising addicts who feel uneasy about the concept of substituting one drug for another. Although New Jersey law currently prohibits discrimination against MAT patients, popular opinion still trends toward a perception of “getting clean” which rejects all addictive acts including alcohol and addiction medicine.
But even as support slowly grows for medication-assisted treatment within the field of addiction research, the persistence of stigmas outside of clinics and hospitals keeps those suffering from seeking help. Kaitlan Baston, the medical director at Cooper University Hospital’s newly established Department of Addiction Medicine, said at the event, that opioid recovery is a lifetime journey and requires a change in public opinion.
“One of the things that I think we should really stress is de-stigmatization of addiction,” Baston said. “That’s using the right language and using empathy but its also keeping people on a path to recovery. So often I’ll see people on medication-assisted treatment asking ‘how soon can we get them off of it’? I really think that we have a hard time with the idea that its not going away. We really are going to need a much bigger rug if we’re going to keep trying to sweep it under there.”
Along with de-stigmatizing addiction, Carolyn Beauchamp said what works is more open, honest dialogue. Her organization, MHANJ, recently launched a call line called Connect for Recovery that helps those struggling with addiction and their families get in contact with treatment resources. But Beauchamp said efforts should be focused on starting these conversations earlier.
“We’ve got to intervene much sooner,” Beauchamp said. “We’ve got to start very young with very young children. We have to educate them about this reality.”
Baston said adverse childhood events, traumas and other social and environmental factors can impact and change genetic expression, which can predispose a child for diseases like depression and anxiety. When these kids are prescribed medication to alleviate these mental health issues, they’re even more at risk for developing dependence and addiction.
“We’re trained to try and take the pain away,” Baston said. “Doctors are really bad at saying ‘no’ because we’re trained to diagnose and fix with medication or a band aid. And opioids are a band aid. They don’t fix pain, they cover it up.”
Gov. Christie’s opioid task force also emphasized starting early. The Governors Council on Alcohol and Drug Abuse (GCADA) in its recommendations lists updating school curricula, implementing peer-to-peer programs, and training all school staff members on prescription drug protocols. But, one year later, little has been done to implement any of these programs.
Above all, Baston said, addiction recovery is an ongoing process that can’t be quickly treated or solved. She emphasized the need to follow patients through treatment processes to really see what works for them. “Relapse is part of recovery,” Baston said “and that’s something we need to take into account and not shame people for.” Part of that recovery journey, Baston said, is having an advocate or treatment advisor with patients as they try different resources.
“When someone overdoses, people are in crisis, families are in crisis, and that person is in survival mode,” Baston said. “We’re talking about giving someone Narcan — which is a wonderful lifesaving medication — but not treatment. It’s like trying to make a plan with a woman while she’s in labor about what she wants to do after labor. It just doesn’t work.”