In addiction cases, treat the whole person

M uch to their credit, Connecticut’s lawmakers and health officials have reacted aggressively to the state’s heroin and opioid epidemic. After heroin overdose deaths began to dramatically increase several years ago, officials took steps to ensure first responders carry life-saving antidotes, and new laws aim for better control over the opioid painkiller prescriptions that have been connected to a rise in the deadly use of heroin.

New legislation further increases data sharing among state agencies about opioid overdose deaths, expands requirements for doctors to discuss risks and signs of addiction with adult patients, and reduces from seven to five days the maximum supply of opioid drugs that can be prescribed to minors.

This week, 16 U.S. senators, including Sen. Richard Blumenthal, urged the Drug Enforcement Administration to lower opioid production quotas for 2018.

Efforts are having some impact. A Centers for Disease Control and Prevention study released this month shows opioid prescription rates declining.

Overdose deaths continue, however. The New York Times reported in June that preliminary data indicate deaths rose about 19 percent nationwide from 2015 to 2016, and strong evidence shows 2017 numbers will be just as dire. Connecticut’s Office of the Chief Medical Examiner reported nearly 200 more deaths by accidental intoxication in 2016 than in 2015. The vast majority of those 917 deaths involved heroin, fentanyl or another opioid drug.

Dr. Frank Maletz, a member of New London’s Opioid Action Team, said in reaction to the CDC report, “We cannot take that data and from a societal standpoint feel good that we’ve done enough. We have to do much, much more.”

We agree. We have both moral and societal obligations to continue to seek solutions to this deadly problem.

Advocating for costly programs when the state struggles with a $5.1 billion deficit over the next two fiscal years may not make sense. Programming already available, however, might be made more effective if we change the way we think about addiction.

A promising new program in Pennsylvania strives to do this. The state established 45 socalled Centers for Excellence within existing medical, addiction and mental health facilities. The centers treat addicted individuals as whole beings whose associated physical, mental or social issues might be an underlying cause of their addictions.

Says Jason Snyder, who oversees the initiative, “Success is low if you treat addiction in isolation.”

Take the story of a 21-year-old woman who has been in drug treatment eight times and returned to drug use each time she was released. While her story might be used by some to reinforce the notion that treatment is a waste of resources, Snyder says there’s much more to it.

The woman began injecting heroin when she was 12 as an escape from the father who sexually abused her and the alcohol-addicted mother who didn’t intervene. Without treatment of her underlying trauma, drug rehabilitation alone is likely never to be successful, he said.

Pennsylvania’s program seeks to determine associated and underlying issues, which could include anything from joblessness, homelessness or domestic violence to untreated PTSD, anxiety or chronic physical pain. The client is referred to services and followed to ensure they actually get the help they need. This does much more than handing a patient a list of psychologists and telling them to start dialing.

Pennsylvania is spending $15 million in state funds and another $5.4 million in federal money. Yet parts of this program — which got 25 percent more patients into treatment in the first quarter of 2017, as compared to 2016 — could be implemented using existing programs, professionals and services.

Connecticut already has a fairly robust system of social service, mental and physical health providers. They would need to better communicate and coordinate their efforts.

Snyder, who was himself addicted to pain medication, recalls that health professionals treating him made little effort to consider his other physical or mental health needs beyond the immediate issue of his addiction.

Human beings are not a collection of isolated concerns and issues. Each physical, mental and social challenge interacts with others. Why does our health care approach so often treat only one problem at a time?

Snyder calls Pennsylvania’s program “anything but business as usual.”

Connecticut, too, must make changes to business as usual. Ensure treatment of the whole person, and the work is more likely to succeed.