The Interview: Tackling the opioid epidemic.
The U.S. is in the grip of an opioid epidemic, and Florida is among the worst hit — suffering from low treatment rates, a shortage of psychiatrists and access to addiction programs. To learn more about the crisis, the Orlando Sentinel Editorial Board consulted with Jeff Zornitsky, director of strategic initiatives at Advocates for Human Potential. For the complete transcript, go to OrlandoSentinel/Opinion.com
Q: What accounts for the emergence of the opioid epidemic and how strong are opioid drugs compared to the drugs of choice in the past, such as cocaine?
A: The opioid epidemic has its roots in the late 1990s when pain management became the “fifth vital sign,” essentially adding pain to the conventional four health indicators that are routinely monitored — blood pressure, temperature, heart rate and respiration. Prominent organizations such as the American Pain Society argued that pain was undertreated and that patients’ backaches could benefit from opioid prescriptions. This contrasted with prior prescribing practices that focused opioid drugs on the most extreme types of pain, such as cancer . ...
The problem was and remains that the use of prescription opioids, such as OxyContin, have high rates of dependency, after even short durations of prescribing. Individuals may experience withdrawal symptoms after just one to two weeks of taking prescribed opioids. This coupled with the rise in opioid prescriptions has led to a steady increase in the number of people who use their opioid medications as prescribed, develop a higher tolerance for opioids, and become dependent and at risk to overdose. When faced with limits on their prescriptions or dosage levels, they turn to family members or illegal markets to purchase opioids to avoid withdrawal and maintain normal functioning . ...
Q: What do we know about the need for substance-abuse services in Florida?
A: It is significant, affecting a broad array of demographic and socioeconomic groups, and indicative of a pressing need for treatment services. Between 2014 and 2015, the death rate due to opioid overdoses increased by 31 percent in Florida . ... [There were] 410,000 Floridians aged 12 or older, or 2.4 percent of the population, ... dependent on or abused illicit drugs in 2013, the most recent year for which reliable state estimates are available. And the use of illicit drugs is not limited to adults — for many, it starts at a young age. In 2013, roughly 61,000 adolescents aged 12-17, or 4.4 percent of all adolescents in Florida, used nonmedical pain relievers.
Q: Florida provides a low level of services for to treat addictions. Why?
A: There are many reasons for this low level of services. One is that receiving services starts with seeking services, and in Florida, like most states, the majority of individuals not receiving services do not perceive a need for them . ...
... Also many individuals with an opioid dependency do not have the resources to cover the costs of services, and Florida does not necessarily have the capacity to serve them. For one thing, Florida has a relatively high rate of uninsurance. Twenty percent of nonelderly Floridians between the ages of 19 and 64 do not have health insurance, compared to 14 percent for the U.S. [Also], there are approximately 600 psychiatrists and 4,000 psychologists in Florida. Across these two professions, it is estimated that between 2010 and 2020, there will be nearly 2,000 job openings that will have to be filled, 126 for psychiatrists, and the balance for psychologists. The challenge, especially for psychiatrists, is that the vast majority of these openings (80 percent) are due largely to the aging-out of the labor force, or approaching retirement age. Moreover, most psychiatrists are in private solo practice and, compared to physicians in other specialty practices, do not accept third-party insurance payments, whether it be private fee-for-service insurance, Medicare, or especially Medicaid.