Help is on the way for those with opioid addiction
9/12/2022 by Benjamin Lai, M.B., B.Ch., B.A.O.
2021 was the deadliest year to date for drug overdoses in the U.S. More than 107,000 people died of a drug overdose between December 2020 and December 2021, according to the Centers for Disease Control and Prevention's National Center for Health Statistics. Put another way, one person died of an overdose every five minutes during this period.
Minnesota experienced an estimated 22% increase in overdose deaths in 2021, compared to the previous year. Most of those deaths involved an opioid drug, most often fentanyl.
Opioids are powerful and important pain medications. When used for an appropriate period of time under close medical supervision and in specific circumstances, such as after certain types of surgery or injury, opioids can be helpful. Examples of opioid medications include morphine, oxycodone, tramadol and fentanyl. Other forms of opioids include illegal drugs, such as heroin. Several herbal extracts and supplements, including kratom and poppy seed tea, which can be purchased online or in some health food stores, also contain opioidlike properties.
Most people who use opioids long term can develop tolerance and dependence. Tolerance means that a larger quantity of opioids is needed to achieve the desired effect, such as pain relief over time. Dependence means that if opioids are discontinued abruptly, a person may experience withdrawal symptoms.
Some people can develop an addiction to opioids. An addiction occurs when a person struggles to control the use of a drug and continues to use the drug despite having negative physical, psychological or social consequences.
Addiction involves biochemical changes in the brain. Patients with opioid addiction — more appropriately termed opioid use disorder, or OUD — experience cravings for opioids.
An estimated 2.7 million people in the U.S. have opioid use disorder. Effective treatments are available, including a combination of medications and behavioral health therapies.
Methadone can only be dispensed in federally qualified opioid treatment programs, known as methadone clinics. People usually need to go to these clinics daily to take their methadone, which can be time-consuming and inconvenient.
Buprenorphine, marketed as suboxone and Subutex, can be prescribed by outpatient medical professionals and taken at home by patients. This medication can significantly reduce cravings and withdrawal symptoms.
Naltrexone, marketed as Vivitrol, is a monthly intramuscular injection. It does not treat a person's withdrawal symptoms, but it can reduce cravings. Unfortunately, this medication can be difficult to access because insurance does not always provide adequate coverage.
Together with behavioral therapies, including counseling and support groups, research has found that opioid use disorder patients taking one of these medications are much less likely to relapse and overdose. Patients who are treated are more likely to sustain employment, have stable housing and have a better quality of life. By reducing the risk of using street drugs, medications to treat opioid use disorder also can reduce the rates of infectious diseases associated with IV drug use, such as bloodstream bacterial infections, skin infections, hepatitis C and HIV.
Medications are now considered the gold standard to treat patients struggling with opioid use disorder. Unfortunately, only 20%–40% of patients with opioid use disorder are receiving treatment.
One of the barriers to buprenorphine treatment is a shortage of health care professionals who can prescribe the medication. Health care professionals need a special license, called a waiver, to prescribe buprenorphine. Most health care professionals do not have the waiver.
The situation is more pronounced in rural areas, as more than half of rural counties do not have a health care professional with a buprenorphine waiver. These areas also often lack access to opioid treatment programs where patients can access methadone.
Mayo Clinic is taking action to address the opioid epidemic and help patients struggling with opioid use disorder. An increasing number of Mayo Clinic primary care clinicians can now prescribe buprenorphine to treat opioid use disorder. Primary care clinicians and nurses at Mayo Family Clinic Kasson have received additional training and can treat patients with opioid use disorder with buprenorphine. This service is limited to patients with a primary care clinician at Mayo Family Clinic Kasson.
If you or someone you know are struggling with opioid use disorder and would like to receive treatment, talk to your primary care clinician.
Mayo plans to gradually expand this service to other locations at Mayo Clinic in Rochester and across Mayo Clinic Health System in Southeast Minnesota in the near future.
Benjamin Lai, M.B., B.Ch., B.A.O., is a physician in Primary Care in Rochester and Kasson's Department of Family Medicine. He is the assistant medical director of Mayo Clinic's Opioid Stewardship Program and is involved in medical student and resident education.