We need effective treatments to fight opioid crisis

The man experiencing homelessness was nodding off when a street medicine provider from Venice Family Clinic recognized the signs of an opioid overdose. The provider gave the man a dose of naloxone (Narcan®) and prevented another potential overdose death on the streets of Los Angeles.

With more than 130 people dying from overdoses each day, a person’s lifetime risk of death from an accidental opioid overdose is greater than the odds of dying in a car crash.

Of the more than 93,000 reported drug overdoses in 2020, nearly three-fourths were attributed to opioids — a group of chemically similar drugs that include heroin and fentanyl, as well as prescription medications, such as hydrocodone (Vicodin®), oxycodone (OxyContin®) and morphine.

Far too often, addiction starts with a legal pain medication prescription that spirals out of control.

August 31 is International Overdose Awareness Day, a time to remember people who died from overdoses and to underscore the urgent need to increase access to effective treatments to combat the opioid overdose crisis.

Far too often, addiction starts with a legal pain medication prescription that spirals out of control. The litigation and publicity surrounding the aggressive marketing and overprescribing of OxyContin has raised awareness of these risks among physicians and patients. It also has resulted in state and federal legislation that, among other things, regulates how physicians prescribe opioids.

But much more needs to be done.

Fentanyl, which is increasingly contaminating street drugs or being substituted for other street drugs, was responsible for 73% of all overdoses in 2019. This synthetic opioid poses a greater overdose risk because it is 50-100 times more potent than morphine, and users often don’t know it’s present in their drugs.

Questions about alcohol and drug use are a routine part of our health care visits for teens and adults.

Providing testing strips so users can detect fentanyl in their drugs can prevent overdoses. But this and other measures to reduce the harm caused by substance use are often controversial because they don’t require abstinence.

Addiction is a disease and, like other diseases, medical and public policy systems should embrace measures that reduce its harm and expand access to effective, evidence-based treatments so all substance users can get the help and care they need.

Venice Family Clinic, the nonprofit community health center where I serve as director of addiction services, partnered with the RAND Corporation to develop a model for providing effective, evidence-based substance use treatment in a primary care setting. Questions about alcohol and drug use are a routine part of our health care visits for teens and adults, and staff offers counseling and other assistance for substance users who feel they need it.

Our clinicians are trained to prescribe buprenorphine, a powerful tool for treating addiction that can reduce opioid cravings and be prescribed in a doctor’s office. Our staff can also provide test strips to detect fentanyl and naloxone to help prevent overdose deaths.

Many community health centers, which provide care to people in need around the country, have adopted similar models for providing substance use treatment in a primary care setting. But these models are not taught in most medical schools, and they have not been adopted by most physicians who work in other settings, like hospitals or private practice.

Our patients also tell us that outside pharmacies often decline to fill their prescriptions for naloxone and buprenorphine. Moreover, several studies have found significant disparities in treatment.

White and wealthier individuals (who had private insurance or could pay out of pocket) are more likely to be prescribed buprenorphine than people of color and poorer patients. Men are more likely to receive the medication than women.

As the world marks International Overdose Awareness Day this month, it’s time to eliminate these disparities and treat addiction as the disease it is. By reducing the harm it causes and increasing access to effective treatments, we can save our friends, children and other family members from being the next victims of these highly addictive substances.
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Editor’s Note: Gilmore Chung, MD, is the director of addiction services at Venice Family Clinic, a nonprofit community health center that provides primary health care to nearly 27,000 people in need, including about 4,500 people experiencing homelessness, in the greater Los Angeles area.