Many have been watching the jaw-dropping numbers regarding opiate deaths and overdoses with a sense of horror, disbelief, and urgency. The article indicates that hospital and emergency room treatment for prescription opioid overdose deaths have decreased while heroin overdoses have “skyrocketed”.
“Broader adoption of rational opioid prescribing practices is a good thing. However, as the availability of prescription opioids diminishes, unintended consequences may start to emerge”, says Victor Kogler, Vice President SUD services, California Institute for Behavioral Health Solutions (CIBHS). Mr. Kogler further noted that “We need to know more about the population of prescription opioid patients.” “This is a diverse group with regard to their health care needs, the experience of pain, substance use history, and a wide range of psychosocial factors. Not all of them will automatically switch to heroin if access to prescription opioids is diminished or denied.”
From an addiction perspective, this is understandable. The brain wants what it wants and will take the path of least resistance to find the drug of choice. The body aches and longs for that “feeling”, the “feeling” that is often fleeting. The search is on for prescription opiates, heroin, fentanyl (synthetic opioids), morphine, oxycontin, and painkillers.
Regarding Addiction treatment, the article points out “. “People who are already addicted to prescription opioids are not being connected to treatment, and therefore moving to other forms of opioids,”.
Many who become addicted to opiates remain outside of the substance use disorder (SUD) treatment system.
Even in the light of the aforementioned challenges, the implementation of the Drug-Medi-Cal Organized Delivery System (DMC-ODS) provides new opportunities to increase admissions. The 40 counties that opted into the DMC-ODS waiver represent 97% of the Medi-Cal population of California.
Counties are creating a system of care that includes withdrawal management, outpatient, intensive outpatient, narcotic treatment programs/OT, medication-assisted treatments, residential recovery services, and case management services. These services are required to utilize evidence-based practices.
The Department of Health Care Services (DHCS) has mandated that “All counties shall have a 24/7 toll-free number for prospective beneficiaries to access DMC-ODS services”. This line is to be provided with oral interpretation. There is a “requirement for providers to meet Departmental standards for timely access to care and services as specified in the County Implementation Plan and State-County Intergovernmental agreements”. Timely access requirements can be utilized to reduce wait times. Another requirement is that “Medical attention for emergency and crisis medical conditions must be provided immediately”. “Counties must describe (in their implementation plans) how they will guarantee access to Medication Assisted Treatments”.
Despite the opportunity the DMC-ODS provides, we need to make treatment enhancements and develop new curricula for services and interventions to address the increasing number of opiate primary admissions. Increasing use of substance abuse treatment for those who are addicted must be a primary strategy to deal with the opiate crisis. We need to increase the use of buprenorphine prescriptions for those engaged in the SUD system and increase the availability of the overdose reversal agent naloxone
Looking back . . .
I remember leaving restaurants and lounges smelling, reeking, of cigarette smoke from being in an environment where the majority were smoking for hours on end. I remember thinking “this will never change”. I remember the early days of AIDS/HIV when so many were experiencing their friends, family, co-workers becoming sick and dying. It was hard to see through the pain, grief, and fear. It was a time marked by more funerals than celebrations. I remember when the criminal justice system saw its mission limited to punishment, in an era before drug courts, deferred entry of judgment, and treatment in lieu of incarceration. I remember when most viewed addiction as a moral or character weakness; simply a bad choice. There were few treatment options and even fewer effective treatments for opiate primary addictions.
Things changed because people stuck together. They used the data to fight with the facts. They were advocates. They created services. They created multi-disciplinary groups, and coalitions. They shared their stories in their own words. They were bold and they didn’t give up because … it’s all about that hope.
Watch the changes in opiate deaths and overdoses by following these link: