Dr. and DA Take on Opioids
WESTMINSTER – The health community has been trying to figure out how addiction works for ages, how to treat it and how to erase the stigma. There are many paths towards recovery. One method was presented on Thursday at the Recovery Centers of America to an audience seeking the answer to a crisis out of control.
Dr. Laura Kehoe, medical director of the Substance Use Disorder Bridge Clinic at Mass General Hospital in Boston, gave a talk on using the medications methadone and Suboxone to treat addiction.
Kehoe is director of a program that provides patients dealing with opioid abuse immediate access to a transitional addiction program. Mass General’s emergency department has become the first one in Massachusetts to offer buprenorphine (Suboxone) to patients with an opioid use disorder who want to start treatment on the spot.
Worcester District Attorney Joseph Early Jr. said during the presentation that he learned many things recently after attending a National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia.
Early said there are new and innovative ideas going on throughout the country. He said there were several things that came out of it, especially education about addiction. He said that the most important thing in treating addiction is compassion and collaboration.
“They talked about getting rid of the silos,” (which is when people all work independently) he said and added something else he learned from the trip. “We must have services in place when someone has an overdose, and it should be considered medical malpractice to release a patient from the hospital after an overdose without access to treatment because they will overdose again.”
Early said that drug overdoses are the leading cause for death for those under 50. Between June 2016 to June 2017, 67,000 people died of overdose.
“What is an incredible statistic is that life expectancy has actually gone down in the United States because of this,” he said. “It is not a rich problem, it’s not a poor problem, it’s not a black problem or a white problem, it’s everyone’s problem.”
Early said that it is not the drudges of the earth, the menial laborers, that become addicts.
“These are your neighbor’s kids,” he said.
Early said that a Central Mass Opioid task force was formed and they are making progress. There are more than 300 people on the task force.
“Three hundred wonderful people (are) helping to remove the stigma and helping to remove the dividers,” he said.
Kehoe said she has been treating people for 20 years for substance abuse disorder. She said that since 2005 opioid-related inpatient stays have seen a 64 percent increase, and emergency room visits have seen a 99.4 percent increase. She said one in seven Americans has this illness, which is more than the number of Americans with heart conditions, diabetes or cancer.
Kehoe defines addiction as a primary chronic brain disease characterized by compulsive drug seeking and use despite harmful consequences, adding that 40 to 60 percent can be traced back to genetics.
Kehoe said nobody, when asked about childhood dreams and aspirations, would say they dreamed of growing up to become an addict.
The natural history of opioid disorder is that people use it to feel good, then begin to use just to feel normal, then must use to keep from getting sick.
“When we can stop, we don’t want to, and when we want to stop, we can’t,” she said.
Kehoe talked about effective treatment. She said a combination pharmacotherapy using methadone, or Suboxone is used. She said there is a stigma about using these drugs but added that there is an overwhelming majority of addicts that get their lives back through such treatment. She said social and emotional support are critically important.
Kehoe said currently there are not enough treatment centers offering methadone programs, and less than 38 percent of eligible patients are offered medications.
“There is a huge gap in the need and what actually happens, so 10 percent of the people who have this illness receive treatment. That means 90 percent don’t,” she said.
Kehoe said that many people believe that one addiction is being traded for another when a patient receives methadone or Suboxone. She said it is a different notion of treatment versus addiction. She said detox is not effective because the disorder is not addressed.
Long-term treatment could be for life, and people should not be concerned as long as the person is alive and functioning.
“It’s important to look at this through the lens of other chronic illnesses,” she said.
There were many first-responders and hospital staff members in the audience who asked questions, expressed frustrations and spoke of the stigma still affecting those seeking treatment in one way or another.
One person asked if Kehoe supported safe places for addicts to use. She said she did support the idea, and added that it would be a perfect way to offer a recovery method to someone with an addiction.
Michelle Dunn, founder of the AED Foundation in Gardner, was impressed with the presentation, but did not agree fully that treatment with drugs was the answer for all people that suffer from addiction.
“The program was awesome, but I don’t think that this is going to fit everybody,” she said. “This is from a medical perspective as opposed to a personal recovery prospective.”
Dunn said that she was aware that some who receive Suboxone treatment end up selling it.
“I have people who do really well on methadone and others who don’t do well. I have people that really do well abstinence-wise,” she said. “I don’t see this working for everybody,” she said. “It’s just trying to figure out what works best for the person.”