14
doc • Spring 2016
Kentucky
The Elephant in the Room
By Tuyen T. Tran, MD
Opioid addiction is an unfortunate epidemic which has recently surpassed motor
vehicle related injuries as the 4th leading
cause of death in the United States. In 2014,
CDC reported that 18,893 deaths were
related to overdose of opioid medications.
And, sadly, Kentucky is the most afflicted
state. (Graph 1 displays the rate of death
from overdoses of prescription opioids in the
United States more than quadrupled between
1999 and 2010.) These alarming trends triggered the Department of Health and Human
Services (HHS) to deem prescription-opioid
overdose deaths an epidemic and prompted
multiple federal, state, and local actions. The
objectives included 1) providing prescribers
with the knowledge to improve their prescribing decisions and the ability to identify
patients’ problems related to opioid abuse,
2) reducing inappropriate access to opioids,
3) increasing access to effective overdose
treatment, and 4) providing substance-abuse
treatment to persons addicted to opioids.
Unfortunately, the most crucial objective,
providing treatment to persons already
addicted to opioids, was not emphasized!
Opioid abuse and dependency causes a
significant social, economic, and biomedical
toll. Opioid substitution therapy has been
proven to reduce illicit opioid use, lower
rates of arrest and recidivism, decrease rates
of disease transmission, and increase treatment compliance for co-occurring morbidities. The gold standard for the treatment of
opioid addiction is Medication Assisted
Treatment (MAT). In 2014, SAMHSA
(Substance Abuse and Mental Health
Services Administration) sponsored the
investigation of evidence based practices (16
adequately designed Randomized Control
Trials and 7 meta-analyses) specifically looking at the effectiveness of Buprenorphine.
The conclusion was, “BMT [Buprenorphine
Medication Assisted Treatment] is associated with improved outcomes [greater than
80% depending upon dosage and duration
of treatment] compared with placebo for
individuals and pregnant women with opioid
use disorders.”1 The authors added, “BMT
should be considered for inclusion as a
covered benefit.”1 Additionally, the National
Safety Council warned, while “…detoxification seems to be the most attractive [it does
not involve the ongoing use of medications],
in fact, this method is the least effective and
may be the most dangerous [risk of overdose
is extremely high].”
In 2011, NIH conducted a world-wide
review, specifically examining the evidence
for Buprenorphine misuse. The authors
concluded, “Wherever there is access to any
Opioid Sales, Admissions for OpioidAbuse Treatment, and Deaths Due to
Opioid Overdose in the United States,
1999-2010.
Data are from the National Vital Statistics System of the Centers
for Disease Control and Prevention, the Treatment Episode Data
Set of the Substance Abuse and Mental Health Services Administration, and the Automation of Reports and Consolidated Orders
System of the Drug Enforcement Administration.