Indra Cidambi, M.D.

Sure Recovery

How Will the White House Opioid Task Force Effect Change?

It should focus on prescribers and new treatments for success.

Posted Apr 06, 2017

With over 33,000 opioid overdose deaths in 2015, there is an acute need to find solutions to get the epidemic under control. One of the root causes of this addiction is legally prescribed opiate pain pills. The most recent news to come from the Washington is President Trump’s focus on addressing this issue. New Jersey Gov. Chris Christie has been appointed to lead a newly formed opioid task force. In order for his task force to make an impact, there are four main areas of focus that need to be addressed: enabling responsible prescribing habits, arming the public with information on addictive potential, embracing newer treatment modalities and decriminalization utilizing token economy.

While lawmakers are introducing new laws that restrict physicians' treatment options relative to treating pain, this might be counterproductive in the end, as prescribers might resist mandates and can develop workarounds. For serious conditions such as anxiety that require addictive medications as part of treatment, restrictions pose a problem. Experts are leaning toward a more comprehensive approach to treating and addressing this issue.

Enabling Responsible Prescribing Habits

There is already a lot of noise about legal prescriptions being a main cause of the opiate epidemic. A vast majority of opioid pain prescriptions are written by nurse practitioners and primary care physicians* (not pain management specialists) and they may not fully understand the addictive potential and diversion issues (others misusing a patient's pain pills) related to these medications.

All prescribers should be fully educated about the dangers of opioid pain pills. An effective and easy way to achieve this objective is by integrating prescribing guidelines and information on addiction potential into continuing education credits prescribers are required to take. Repetition is also guaranteed as prescribers complete continuing education credits every year. Future prescribers, physicians and nurses could receive this education through a mandated rotation at a substance abuse treatment facility while in school so they understand how people get addicted to pain pills. Such efforts will serve to significantly slow the creation of new addicts, as evidence suggests legal prescriptions paved the way to addiction for a large number of individuals.

Arming the General Public With Information on Addictive Potential

Although prevention campaigns that asked people to say “no to drugs” have been around since the 1980s, they have not helped to educate the public about the dangers of legally prescribed medications. A high profile, strongly funded campaign that not only informs the public about such dangers, but also encourages them to seek a full explanation from their prescriber about how the medications work could be impactful. Creating demand for such information will force prescribers to respond and, possibly, rethink their prescriptions. This could also mitigate the creation of new addicts.

Embracing Newer Treatment Modalities

The substance abuse treatment community, in general, has been resistant to new modalities of treatment, such as Ambulatory Detoxification and Medication Assisted Treatment, which deliver superior outcomes. Resistance to the utilization of Ambulatory (Outpatient) Detoxification comes from the fear that the individual suffering from substance use disorders returns to his/her home environment. Done correctly, it can deliver much better outcomes relative to inpatient detoxification as the patient learns to stay sober in his/her home environment. Family interventions elevate the level of support the patient receives at home, inhibiting relapse. The cost of Ambulatory Detoxification is also significantly lower relative to inpatient detoxification.

The criticism of medicated assisted treatment (specifically buprenorphine) is that the prescriber is just substituting one drug for another; it has been found that utilizing medication-assisted treatment provides the physical relief from cravings and withdrawal symptoms that enables an individual to engage in therapy and make the required lifestyle changes.

Decriminalization Utilizing Token Economy

Research showed that 4 out of 5 drug arrests (1.5 million/year) are for use/possession, while only 1 of 5 is for manufacturing/sales. This provides an opportunity to utilize the token-economy modality of treatment to incentivize individuals to enter treatment. Token-economy modality of treatment is already used to treat addiction. The money saved by decreasing the number of cases tried can be redirected to treatment. While marijuana possession has been decriminalized in a number of states, the possession of other illegal substances still fetches a felony or misdemeanor charge in most states. Not only will individuals suffering from addiction benefit from treatment, re-entering the workforce becomes easier when the charge(s) are lifted.

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