Opioid Utilization and Misuse

Prescription opioids can and are used to treat acute and chronic pain and are often prescribed following surgery or injury and for a subset of patients with chronic pain from medical conditions such as cancer and inflammatory, neurological, and musculoskeletal conditions.

More than 11.5 million Americans, aged 12 or older, reported misusing prescription opioids in 2016. An estimated 11% of adults experience daily pain and millions of Americans are treated with prescription opioids for chronic pain. Primary care providers are concerned about patient addiction and report insufficient training in prescribing opioids.

Significant public awareness through education and guidelines from regulatory and government agencies and other stakeholders to address the opioid crisis have in part resulted in reduced opioid prescriptions. Improving education about pain conditions and their treatment for patients, families, caregivers, clinicians, and policymakers is vital to enhancing pain care.

Goals:

Decrease opioid overdoses, deaths and related adverse drug events.

Decrease opioid prescribing by utilizing a patient centered approach and increase the use of pain management and opioid best practices.

For questions or to request technical assistance contact Tanya Vadala at tvadala@ipro.org

Click here to access our Behavioral Health page.

According to the DSM-5 Opioid Use Disorder will be diagnosed if two or more of the following symptoms are present and recurring over a 12 month period.

• Opioids are often taken in higher quantities than intended.
• Unable to stop or reduce opioid use.
• Significant time is spent in obtaining, using or recovering from the effects of opioids
• An intense craving and desire for opioids.
• Recurrent opioid use resulting in failure to fulfill major role obligations at work, school or home.
• Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
• Important social, occupational or recreational activities are given up or reduced because of opioid use.
• Recurrent opioid use in situations in which it is physically hazardous.
• Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids.
• Tolerance, as defined by either of the following:
  • Need for markedly increased amounts of opioids to achieve intoxication or desired effect
  • Markedly diminished effect with continued use of the same amount of an opioid
• Withdrawal, as manifested by either of the following:
  • The characteristic opioid withdrawal syndrome
  • The same (or a closely related) substance are taken to relieve or avoid withdrawal symptoms

Opioid Use Disorder is not diagnosed when an individual is under medical care and opioids are prescribed (unless the prescription is being abused as described above). The DSM-5 also explains that proper diagnosis depends on the stage at which the individual is in along the continuum of withdrawal – early remission, sustained remission, or maintenance therapy – and if the individual is in an environment where access to opioids is restricted. As well, the diagnosis is mild if there are two or three symptoms, moderate with four or five symptoms and severe with six or more symptoms.

Health and Human Services (HHS) Opioid 5 Point Strategy – In 2017, HHS launched a comprehensive 5-Point Strategy to empower local communities on the frontlines. The opioid epidemic is one of the Department’s top priorities; through the 5-Point Strategy and HHS’s Agency Priority Goal of Reducing Opioid Morbidity and Mortality, the Department continues to focus on most effective efforts for addressing opioid use disorder.

Medication Assisted Treatment (MAT) – MAT is considered a gold standard in treating opioid use disorders when combined with psychotherapy and toxicology screenings. MAT is a proven pharmacological treatment for opioid use disorder. The backbone of this treatment is FDA approved medications. Agonist drugs, methadone and buprenorphine, activate opioid receptors in the brain, preventing painful opioid withdrawal symptoms without causing euphoria; naltrexone blocks the effects of opioids. MAT is effective at reducing use and helping people to lead normal lives.

Click HERE for resources for Opioid Treatment Providers

Training Materials and Provider Resources for Medication-Assisted Treatment (MAT)
Collection of training materials and data for medical professionals including OTP certification application information and other resources on MAT.

• Medication-Assisted Treatment of Opioid Use Disorder: Pocket Guide
• Mobile App for Practitioners Who Provide Medication-Assisted Treatment
• All SAMHSA publications for Medication-Assisted Treatment

TIP 63: Medications for Opioid Use Disorders
Guidance for healthcare professionals and addiction treatment providers on appropriate prescribing practices for the treatment of OUD. TIP 63 also educates patients, families, and the general public about how OUD medications work and the benefits they offer.

Initiating Buprenorphine-based MAT in Emergency Departments – Patients receiving care in emergency departments who have untreated opioid use disorder are referred to a provider for long-term buprenorphine-based MAT. This referral is accompanied by initial doses of buprenorphine or a short-term prescription that can be filled right away. The patient can begin treatment immediately, instead of waiting several days for their appointment with a new provider.

Targeted Naloxone Distribution – Naloxone is an opioid antagonist that can quickly and safely reverse the potentially fatal effects of an opioid overdose. Naloxone is a drug that carries no risk of abuse and has no effect on individuals who do       not already have opioids in their system. Targeted distribution programs seek to train and equip individuals who are most likely to encounter or witness an overdose—especially people who use drugs and first responders— with naloxone kits, which they can use in an emergency to save a life.

911 Good Samaritan Laws – The 911 Good Samaritan Law provides overdose victims and/or overdose bystanders with limited immunity from drug-related criminal charges that may otherwise result from calling first responders to the scene.  The scope of 911 Good Samaritan Laws varies across U.S. states, but each is written with the goal of reducing barriers to calling 911 in the event of an overdose.

Naloxone Distribution in Treatment Centers and Criminal Justice Settings – Naloxone distribution programs in criminal justice and treatment facilities (both inpatient and outpatient) target individuals who are about to be released from supervision and/or cease treatment to receive overdose response training and naloxone kits prior to their exit from the program or facility.

Syringe Services Programs – Sometimes called “needle exchange” or “syringe exchange,” syringe services programs provide access to clean and sterile equipment used for the preparation and consumption of drugs as well as tools for the prevention and reversal of opioid overdose, such as naloxone training and distribution, fentanyl testing strips, and more. Comprehensive syringe services programs also provide additional social and medical services such as: safe disposal of syringes and needles; testing for HIV and hepatitis C infection and linkage to treatment; education about overdose and safer injection practices; referral and access to drug treatment programs, including MAT; tools to prevent HIV and other infectious disease, such as condoms, counseling, or vaccinations; and linkage to medical, mental health, and social services.

Source: Centers for Disease Control and Prevention | National Center for Injury Prevention and Control

The HHS Overdose Prevention Strategy’s four main topics of focus include:

Primary Prevention

• Expanded research of new and improved prevention efforts
• Investing in community resources to help prevent harms related to substance use
• Increasing access to high-quality pain management to reduce preventable suffering
• Promoting responsible prescription of medications to protect patient safety

Harm reduction

• Increasing the availability and access to high-quality harm reduction services
• Decreasing negative effects of substance use
• Reducing stigma related to substance use and overdose

Evidence-Based Treatment

• Reducing barriers to accessing the most effective treatments
• Using motivational and cultural enhancements to encourage those who might be reluctant
• Advancing strategies to improve engagement and retention
• Continuing to develop new therapeutic approaches

Recovery Support

• Improve recovery support by developing different types of support throughout the lifespan
• Increasing the quality of services
• Supporting the recovery workforce
• Expanding access to ongoing, affordable, and effective recovery support services

Learn more at: Overdose Prevention Strategy (hhs.gov)