The opioid crisis is a big issue in many states of the US. In fact, it is now more widespread than diabetes and cancer. As of 2019, data from the National Academy of Sciences indicate that more than 2 million Americans suffer from opioid use disorder.
In California, about 2,400 people died of opioid overdoses in 2018. This accounted for nearly half of drug overdose-related deaths in the state.
Prescription opioids are responsible for the highest death toll. But synthetic opioids and heroin took a number of lives as well. Among synthetic opioids, the usual suspects are mainly fentanyl and its variants.
This is despite the fact that California prescribed the least number of opioids compared to other states in 2018. California doctors gave a little over 35 opioid prescriptions per 100 people, compared to the national average of about 51.
What kinds of opioids are commonly abused?
Both prescription and non-prescription opioids are responsible for this serious public health crisis. They include:
- Natural opioids like morphine and codeine
- Semi-synthetic opioids like hydrocodone, oxycodone, oxymorphone, and hydromorphone
- Synthetic opioids like methadone, fentanyl, and tramadol
- Illegal opioids like heroin or “counterfeit” fentanyl
How did the opioid crisis happen?
At first, no one thought that it would come to this. “Historically, we were taught to prescribe opiates as the best method to treat pain,” says Alexa Curtis, PhD, MPH, FNP-BC, and a member of the board of directors for the California Association for Nurse Practitioners (CANP).
She also mentions that since the 1980s, doctors gave out a lot of opiate prescriptions with the best of intentions. Eventually, patients became addicted and the supply of prescription opiates ran out. Addicted patients then switched over to heroin just to avoid withdrawal.
What’s the opioid crisis like in California now?
In 2018 and 2019, the synthetic opioid fentanyl was the biggest culprit for a spike in overdoses in the state. In addition, medical professionals have also expressed concerns for heroin and meth laced with fentanyl.
Despite these alarming numbers, there is hope for those suffering from OUD.
The Medication-Assisted Treatment Expansion Project
Medication-assisted treatment (MAT) is shown to be highly effective in combating opioid addiction. MAT uses a “whole patient” approach, which combines medications with behavioral therapies.
To help fight the opioid epidemic in California, Governor Gavin Newsom has recently slated a budget of about $89 million for the MAT Expansion Project.
Mainly, it aims to provide Naloxone to patients to reduce cases of opioid overdoses. Additionally, MAT uses three other drugs – which themselves are opioids – to help treat addiction:
- Naltrexone, which blocks the effects of other opioids and reduces cravings.
- Methadone, which prevents withdrawal symptoms.
- Buprenorphine, which blocks other opioids while minimizing withdrawal and preventing overdose. It also reduces opioid cravings. This is the most commonly used medication in MAT.
At the end of the process, MAT aims to give back patients control over their lives again. Based on data, the method has been shown to be effective in:
- Helping patients stay in therapy
- Increasing the chances of survival
- Decreasing the tendency to get involved in crimes
- Helping patients keep new jobs
- Improve births in pregnant women who suffer from OUD
Despite the mounting evidence that MAT works, there are still some obstacles to overcome.
Challenges of adopting MAT
Some people think that MAT is just substituting one drug for another. In turn, they fear that it may create another addiction.
This is just not true, as the medications used in MAT do not lead to an extra addiction. Instead, they help curb patients’ existing opioid addictions and allow them to take less and less of the drugs. The medications also help patients manage otherwise painful withdrawal symptoms.
There is also the issue of discrimination against MAT patients, despite having laws that prohibit it.
Even among healthcare providers, the sentiment towards MAT is typically negative. Moreover, another huge roadblock is the lack of MAT training provided to healthcare professionals.
There are also a few greedy people who take advantage of opioid abusers who want to recover. They recruit clients but do not use evidence-based approaches like MAT. Instead, they keep their patients in rehab to get as much money from them as possible.
COVID-19: An additional roadblock
This year’s COVID-19 pandemic presents an extra obstacle for MAT practitioners. Because of the need for social distancing, they cannot accommodate as many patients as before.
One solution, says Eric Hill of Marshall Medical Center, is to give patients MAT prescriptions that last up to a month instead of just a week. Also, Hill is following up with his patients by phone rather than in person. He’s also working with his colleagues to arrange video calls with patients once they need to renew their prescriptions.
MAT patients facing stigma
Patients undergoing MAT are having a hard time finding housing and therapy. These are important parts of their treatment, so it’s a must for them to find those resources.
But they run into another problem: most therapy providers, like those who use 12-step programs, require patients to be free of any kind of drug, including MAT drugs. In other words, traditional therapy providers still think of MAT patients as active addicts.
One of the most challenging parts for recovering MAT patients is finding a place to live. They are usually shunned because others think that they are still on drugs.
In desperation, some MAT patients have even stopped taking their medications just to get a place to live. But many of them have relapsed, according to Hill.
Thankfully, the state government is on the side of the patients.
Standing with MAT patients
Marlies Perez, a division chief at California’s health care department, mentioned that they are “taking a strong stand against such stigma that prevents patients from their continued recovery.”
The department created a media campaign, which they dubbed Choose Change California. Through it, Perez’s agency hopes to change how people perceive MAT. They also aim to persuade more doctors and patients to use MAT.