Tackling Opioid Addiction

Freddie Santistevan’s life changed the moment he was in a car crash and became one of the 100 million Americans living with chronic pain. To relieve that pain, he took legally prescribed opioids, which are the leading cause of drug overdose deaths in New Mexico and the United States, killing 91 Americans every day.

What happened to Santistevan after he started taking pain pills is a common tale — one the state is trying to prevent by investing in a three-pronged strategy that focuses on safer prescribing, medicationassisted treatment and distribution of Naloxone to reverse opioid overdoses.

Key data about prescribing practices and overdoses indicate that New Mexico may be reaping the benefits of intervening earlier than most states in the opioidoverdose epidemic; for the first time in 23 years, New Mexico is not in the top three for the highest rate of drug deaths in the country. New Mexico’s rate of overdose deaths dropped 7 percent in 2015 while the nation’s rate went up 11 percent.

“We’ve typically been recognized as a leader in policy interventions and innovations,” said Dr. Michael Landen, state epidemiologist at the New Mexico Department of Health. “We have to persist in these efforts because we’ve been a leading state for this problem since 1992.”

Today it is widely reported that a significant rise in the number of opioids prescribed is linked to drug overdose death rates quadrupling in the U.S. since 1999. But when Santistevan was hurt, the crisis was in its infancy.

Santistevan, 34, snuggles his 3-year-old son, Eloquence, and talks easily about his college classes in psychology and how his life unraveled before he became sober five years ago. He shares an apartment off Airport Road with his 24-year-old girlfriend, Joselle Sandoval, who has an equally common story of addiction. She misused pain pills before turning to a cheaper opiate — heroin — which was New Mexico’s leading cause of overdoses before pills surpassed it in 2006.

Many people in chronic pain rely on opioids such as morphine, fentanyl, oxycodone and codeine as part of their pain management. But some, like Santistevan, receive too many prescriptions with too little education about the potential danger.

Santistevan was initially reluctant to take pain medicine, but he relied on his doctor’s advice that it could help. He started with a half a pill a day. He didn’t consider the risks when a new doctor prescribed a stronger medication and doubled his dosage.

“I was having a lot of pain, and I trusted them,” he said with a shrug. “I thought it was okay if it came from a doctor.”

When he moved to Albuquerque, he became a patient of Dr. Barry Maron, who permanently surrendered his medical license in 2011 while under investigation for overprescribing opioids and endangering the public. Maron gave Santistevan a prescription for a more potent opioid — oxycodone — which was six times stronger than his first pain medication.

Requiring safer prescribing is one of New Mexico’s main strategies in its effort to combat drug overdoses. In 2005 the state was the first in the country to implement a prescription monitoring program, requiring pharmacists to report controlledsubstance prescriptions. Today all practitioners must check the computerized system every time they prescribe more than a fourday supply of opioids and other controlled substances that pose an overdose risk. Recent data show that the number of practitioners checking the system has risen by almost 28 percent, according to the New Mexico Medical Board, which attributes the increase to stricter regulations imposed last year.

In combination with the monitoring program, New Mexico is one of eight states that requires all health practitioners to take regular classes to learn about options for treating and managing pain. Recent trainings have also emphasized the importance of prescribing Naloxone, which successfully reversed 774 opiate overdoses in New Mexico in 2015.

“We found that shortly after taking the training, clinicians in New Mexico started prescribing less opiates, less high-dose opiates and less benzodiazepines [a sedative],” said Dr. Joanna Katzman, director of the University of New Mexico Pain Center.

For people already addicted, New Mexico has been working to increase access to medication-assisted treatment. Landen said that the state is now waiting for the federal government to issue regulations that would allow nurses and physician assistants to prescribe buprenorphine, thus increasing its availability.

Methadone and buprenorphine help stabilize brain chemicals, said Dr. Leslie Hayes, who treats patients at El Centro Family Health in Española. She became convinced that medications were a critical component of opioid-use-disorder treatment after studies showed patients who took buprenorphine were less likely to overdose. “It pays for itself,” she said. “It reduces crime, jail time, hospitalizations and ER visits, and it increases employment.”

Despite the medication’s proven success, Hayes added, most inpatient treatment programs in New Mexico won’t accept people on medicationassisted therapy unless they are pregnant. “I don’t know why people don’t regard it as real sobriety,” she said. “I certainly have many patients who are leading great lives on medication-assisted therapy.”

Santistevan and Sandoval are both on medication to curb cravings. Sandoval said she stayed at the Santa Fe Recovery Center only because she got medication to prevent withdrawal symptoms that made her feel like jumping out of her skin.

“Rehab, meeting each other and medication changed our lives,” she said.

In addition to its prevention and treatment efforts, the New Mexico Department of Health is increasing its surveillance of drug-related death rates — which are still much higher than the national average — so it can respond faster to any new trend.

“This is a long-term issue,” Landen said. “It’s not going away any time soon.”