Asbury Park Press, 9/13/2018
By Robert J. Budsock & Aakash Shah
The use of the overdose reversal drug, naloxone (Narcan), has nearly tripled in New Jersey since emergency responders began carrying it in 2014, a statistic that highlights just how devastating the impact of the opioid crisis has gotten. And no end appears in sight.
NJCARES reports that as of July 31, 2018, there have been 7,812 naloxone administrations and more than 1,700 suspected opioid overdose deaths in New Jersey this year. Those numbers cry out for a long-term, comprehensive solution to the problem.
Naloxone has been a Godsend to thousands, including in the recent tragic overdose of pop icon Demi Lovato. But make no mistake: it only reverses the overdose in that moment. It does not address the underlying disease of addiction, and the almost inevitable recurring overdoses.
As leaders in the treatment and recovery space, we strongly believe an effective and sustainable solution to the opioid crisis requires a comprehensive, coordinated response. This would include increased access to medication-assisted treatment, an exploration of long-term treatment models and better and more centralized communication and coordination among all care providers to enable a stronger, more robust continuum of care.
An increase in access to medication-assisted treatment (MAT) would be one of the most effective ways to address opiate overdoses and the opiate addiction problem. Regulated medications like Buprenorphine, Buprenorphine-naloxone, Methadone and Naltrexone help reduce cravings and prevent the body from responding to opioids. In the medical field, MAT coupled with treatment is considered the gold standard of treatment for those with a substance use disorder.
However, current restrictions on providing access to MAT prevents many from accessing this medical standard of care. Insurance companies and prisons often obstruct access to MAT. When taken to an emergency room following a drug overdose, complicated conditions that insurance plans require before MATs can be prescribed means many who would benefit from this care are denied coverage.
Likewise, too often in states across the country, MAT is withheld upon incarceration — all but ensuring relapse and overdose. While New Jersey has made progress in introducing MAT behind prison walls, we still have much work to do to expand availability of this life-saving treatment. In both cases, individuals who are already in a medically supervised setting, and who need care most, are denied access.
In addition, we must accept the evidence that longer-term treatment models for substance abuse treatment is essential. Current policy in New Jersey drives shorter lengths of stay in residential care. However, the best practices in achieving long-term recovery point to the need for longer-term treatment models that encompass a few months, and when necessary, even a year.
While the appropriate duration depends on the needs of the individual, research shows that most people coping with substance abuse need, at minimum, three months in treatment to reduce or stop drug use, while some studies show that receiving care for up to 12 months is essential. Shorter-term treatment focuses heavily on detoxification and stabilization. And while that’s an essential step in recovery, longer-term treatment focused on changing one’s behavior is necessary to maintaining long-term recovery.
Finally, in order to ensure long-term success and build a stronger continuum of care, we must establish better coordination among providers. Often substance abuse care and treatment are conducted across various fields including emergency responders, hospitals, primary care, behavioral health, and recovery and treatment. Coordination across these fields often becomes too fragmented to ensure effective delivery of care.
To optimize the coordination of care efforts we recommend numerous changes to how we treat those coping with substance abuse, including a standardization of screening and health indicators for patients, patient information sharing between respective providers, and an integration of care in treatment facilities when possible. A coordinated effort among the providers will lead to more effective, long-term recovery.
As leaders in the recovery space, we are aware that there is a role for each of us to combat the opioid crisis. To truly address this insidious epidemic, we must work toward solutions that will prevent and treat addiction through expanding access to proven, evidence-based solutions and coordinated care models that provide the most effective treatment and recovery models.
Robert J. Budsock is president and CEO of Integrity House. Dr. Aakash Shah is an emergency room doctor at Rutgers-Robert Wood Johnson University Hospital. Shah’s views do not reflect those of the Rutgers-Robert Wood Johnson University Hospital.