Medication Treatments Led to 80 Percent Lower Risk of Fatal Opioid Overdose for Patients

Patients with opioid use disorder (OUD) receiving treatment with opioid agonists (medications such as methadone or buprenorphine) had an 80 percent lower risk of dying from an opioid overdose compared to patients in treatment without the use of medications.

The new findings, published online February 25 in the journal Addiction, are a collaboration between researchers at NYU Grossman School of Medicine, Johns Hopkins Bloomberg School of Public Health, the Maryland Department of Health, and multiple Maryland State agencies.

The majority of research examining the effectiveness of medication treatment for OUD in population-based studies has been conducted outside of the U.S. and compares patients receiving treatment to those receiving no treatment. This is one of the first U.S. population-based studies, the researchers say, to compare overdose risk among two patient populations across an entire state—one whose treatment includes agonist medications, and a control group receiving psychosocial interventions without agonist medication.

The team of researchers additionally found that being in any kind of treatment for OUD (with or without medication) is protective against overdose compared to not being in treatment at all. However, neither treatment type offers any additional protections against lethal overdose once patients leave treatment.

Nationally, approximately 60 percent of patients entering specialty treatment for OUD do not receive medication, and many patients with access to medication treatment prematurely discontinue care. This is often due to persisting stigma around the use of medication to treat OUD along with logistical barriers involved in accessing medication treatment, which can, in turn, lead to relapse and overdose.

The researchers also found that taking medication while in treatment offered no protection against fatal opioid overdose once patients left treatment. “This lack of post-treatment protection highlights the need to promote better retention strategies so that patients can remain in treatment as long as it continues to help them,” said Noa Krawczyk, PhD, assistant professor, Center for Opioid Epidemiology and Policy in the Department of Population Health at NYU Langone Health, and lead author of the study.

They also found that overdose risk was highest in the first month after leaving treatment, for both medication and non-medication treatment groups.

How the Study Was Conducted

Krawczyk and colleagues examined administrative claims records for publicly-funded outpatient specialty treatment programs in 2015 to 2016 for 48,274 patients with primary diagnosis of opioid use disorder. The research team then linked these claims to mortality data provided from Maryland’s Office of the Chief Medical Examiner. Seventy-two percent of the patients in treatment received medication during the study period, while 28 percent did not (a breakdown that differs significantly from the national landscape, where less than 40 percent of patients in treatment receive medication for OUD).

Accounting for time, the researchers compared four distinct groups: people receiving non-medication treatment, people receiving treatment with medication, people no longer in treatment but who left non-medication treatment, and people who left medication treatment.

“Getting people in the door and started on medication treatment is a great first step, but retention in treatment is equally important,” says Krawczyk. “Because of this, we need to remove barriers to continuation of care, adopt more harm reduction approaches and employ better strategies to encourage and enable people to stay in treatment.”

Study Limitations 

Krawczyk and colleagues identify a number of study limitations. Findings relied on administrative data used for payment and not research, which limits clinical information available. The investigators also clustered all types of non-medication treatment together and were unable, for example, to distinguish between specific non-medication treatment types such as counseling relative to detox. Similarly, they grouped buprenorphine and methadone together; they did not compare patients using different opioid agonists. Finally, the study focuses only on patients receiving outpatient specialty treatment and does assess overdose risk among patients receiving buprenorphine in primary care settings.

In addition to Krawczyk, study co-authors from Johns Hopkins Bloomberg School of Public Health Public and Johns Hopkins School of Medicine include Ramin Mojtabai, PhD, Elizabeth Stuart, PhD, Michael Fingerhood, MD, Deborah Agus, JD, Jonathan Weiner, DrPH, and Brendan Saloner, PhD. Co-authors from the Maryland Department of Health include Casey Lyons, MPH.

Funding for the study was supported by Grant No. 2015-PM-BX-K002 awarded to the Maryland Department of Health by the Bureau of Justice Assistance of the U.S. Department of Justice. This research was also supported by the National Institute on Drug Abuse (F31DA047021, NK supported).

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Preventing mental health disorders may be key to thwarting the opioid crisis

What constitutes mental illness is widely misunderstood. Many people immediately think of schizophrenia or other forms of psychotic or dissociative diseases (e.g., multiple personality disorder), as portrayed in the movies. Sufferers of these illnesses are relatively easy to detect, given obvious alterations in thinking, emotion and behavior. Other disorders such as depression and anxiety, however, are not often readily apparent, even though they are much more common.

Regardless, the opioid crisis has raised our consciousness about the role of these disorders in addiction; science tells us that one begets the other. Given that there are more overdose deaths each year than the number of homicides and suicides combined, we must invest in policies that promise to prevent addiction, not simply treat it after it rears its ugly head. Prevention policies imbedded into national strategies promise to ensure that these problems do not continue to become entrenched, unabated, costing countless lives and precious dollars.

I grew up in a low-income neighborhood outside of Washington, D.C., that was riddled with child abuse, violence, and crime.

I watched as my best friend, Gloria, was beaten down by both physical abuse and neglect by her parents. In her mind, Gloria believed she was defective, unworthy of her parents’ love. She was confused and angry. She was severely depressed. As a teenager, she turned to drugs to cope and alleviate her pain. Eventually, Gloria became addicted and, in adulthood, overdosed.

Gloria is representative of just one of the many people I knew who traveled along a pathway from trauma to depression, including subsequent attempts to stem the pain through drug use, and in far too many cases — debilitating addiction. And because it was so clear to me that these pathways to addiction could be avoided, I decided to devote my career to the field of prevention, which has documented the ability to avert these pathways toward more positive outcomes using science-informed strategies

Today, it is well established that adverse childhood experiences, such as those Gloria endured, significantly increase the likelihood of a person developing mental illness, addiction, or both. People exposed to early adversity such as child abuse, poverty, or caregiver addiction disproportionately develop opiate use problems at a rate twice that found in the general population.

The use of painkillers is 50 percent higher in middle and high school students who grow up in toxic environments. And once teens start misusing prescription painkillers (oxycodone and morphine), approximately 80 percent will transition to opiate dependence.

Although a healthy mix of both prevention and treatment has been recommended by scientific experts to tackle the opioid crisis, treatment has been vastly underfunded and prevention has been virtually ignored.

Scientific evidence from prevention science, amassed over the past 50 years, shows that the most effective approach to promoting behavioral and mental health is comprehensive, and involves a collaboration between child- and family-serving agencies, community organizations, health care providers, and schools.

Effective prevention practices are substantially more cost-beneficial than treatment alone over the long haul. Economic studies consistently report the cost-effectiveness of early, sustained prevention efforts embedded in public health systems.

Noteworthy examples include PROSPER (middle school programs in rural Pennsylvania) shown to reduce opioid use by 10-35 percent, suicide prevention programs targeting Native American Youth (for every dollar spent, $10.67 are saved), and programs to reduce youth risk factors for mental illness such as the Good Behavior Game (for every dollar spent, $81 are saved) by addressing underlying problems before it is too late.

Current policies, however, prioritize the treatment of mental disorders after they have taken root. An example of this reactive policy-driven approach is that insurance coverage is not generally provided until the individual qualifies for a specific diagnosis.

Our health care systems are geared towards medical models of diagnosing “diseases” and only treating them after they manifest as full-blow disorders.

Courtesy of TheHill.com

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Addiction Treatment for Couples

Call Turning Point Treatment Center’s at 949-383-4439 #CouplesDrugRehab

Seeking addiction treatment together in a rehab for couples can be beneficial for a number of reasons, especially when both partners are committed to the relationship and to becoming clean and sober. Providing that both partners are willing to start the recovery process, couples rehab can help not only break the cycle of addiction, but also fortify the relationship by helping the couple examine and change the issues that led to their addiction in the first place.

Turning Point Treatment Center is Pet Friendly

Couples who are addicted to drugs or alcohol often experience difficulties with setting boundaries, expressing feelings, making decisions, parenting, and handling finances. Couples rehab provides education, skills, training, and counseling to help partners achieve improved ways of handling these difficulties. Even if just one partner has an addiction, the other partner can benefit from couples rehab by learning to manage specific triggers and helping the other stay sober. Whether one or both partners require addiction treatment, specialized couples rehab teaches the tools needed to overcome obstacles, prevent relapse, and achieve long-term recovery.

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