Helping clinicians curb the opioid crisis with more training

The New Jersey medical examiner recorded close to 1,600 drug-related deaths in 2015, the most recent year data was collected — a 16 percent increase from the year prior that has prompted the Centers for Disease Control and Prevention to list New Jersey as having a “statistically significant” increase in the overdose death rate. Most of these overdose deaths involve opioids, including heroin and now fentanyl — a particularly strong prescription opioid.

Part of the solution to curbing this rate, say experts at Rutgers New Jersey Medical School, is to train and give clinicians — who are often on the front line of detecting opioid use disorders – the tools to act immediately when they encounter a patient in their office who needs treatment. On November 3, during its annual Urban Mental Health Conference, the medical school is partnering with the American Academy of Addiction Psychiatry to provide a course on the state of the opioid crisis. It will highlight recent developments in the field of addiction, such as breakthrough medical and psychosocial approaches for the treatment of opioid use disorders, and provide hands-on experience with mindfulness and meditative practices. This conference will also serve as a buprenorphine training course for physicians, physician assistants, advanced practice nurses and medical students and residents.

Rutgers Today spoke to conference organizer Erin Zerbo, an assistant professor in the medical school’s department of psychiatry who also has a large outpatient buprenorphine practice, about the important role that clinicians have in addressing the rising death rate attributed to opioid use.

What is being done currently to address the opioid crisis in New Jersey?

Nationwide, drug overdoses are the leading cause of death — surpassing motor vehicle accidents and deaths involving guns. New Jersey is a leader in distributing and training law enforcement in the administration of naloxone, an immediate treatment to reverse an overdose. However, not enough attention or money has been put toward long-term treatment: Once an overdose is reversed, that person goes to the emergency department, where he or she subsequently faces challenges in starting treatment due to insurance restrictions and a lack of bed availability.

Even after people leave a rehabilitation facility, they still require ongoing treatment. The unfortunate reality is that the majority of people will relapse on opioids if they are not maintained on medication, which has been termed “medication-assisted treatment” or MAT. There are three medications that considered MAT: methadone, buprenorphine — most commonly known by its brand name Suboxone — and naltrexone. Methadone must be dispensed by methadone clinics, but buprenorphine and naltrexone can be prescribed from an individual clinician’s office. To see better outcomes, we need more clinicians to incorporate buprenorphine and naltrexone prescribing into their regular practice.

Why is it important for clinicians to educate themselves about opioid use disorders, especially if they don’t normally work with addiction?

Clinicians should learn how to assess a patient’s opioid use disorder in order to determine their risk level. If they get familiar with resources in their community, it will be much easier to refer a patient. For example, they could learn the location of the closest methadone clinic or syringe exchange program, find local naltrexone or buprenorphine providers, and send patients to nearby pharmacies to pick up a take-home naloxone kit to help prevent overdose. Anyone who has an opioid use disorder should have a take-home naloxone kit in his or her home; New Jersey state law permits pharmacies to sell the kits without a prescription.

It’s important for clinicians to know that psychotherapy alone has not been proven effective with opioid use disorders. The relapse rate is incredibly high: After inpatient detoxification, the relapse rate is 90 to 95 percent. A lot of people will do well in treatment, only to come out and go right back to using. We need to have our entire outpatient treatment system equipped to provide MAT for people with opioid use disorders, which is not currently happening. As clearly seen in the research literature, this is the way to keep people sober and reduce overdose deaths. Patients can continue psychotherapy — including mindfulness and meditation — as adjunct treatments, but should not expect to use that alone.

What can family members do if they suspect a loved one has an opioid use disorder?

Family members should get their loved ones assessed as quickly as possible. including going to a primary care physician to get a referral for treatment.

The biggest mistake is for family members to allow a loved one to be released from a rehabilitation facility without MAT. We see the highest spike in overdose deaths after discharge from a facility because that is when the person’s opioid tolerance is at an alltime low. Even a small relapse on opioids could be deadly. If your loved one prefers not to be on methadone or buprenorphine, he or she can instead opt for naltrexone, an opioid blocker, which is administered as a monthly injection under the brand name Vivitrol. This injection will block the effect of opioids if there is a relapse and will also prevent an overdose.

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