Tack­ling Opi­oid Ad­dic­tion

Santa Fe New Mexican - Healthy Living - - NEWS - BY DEB­O­RAH BUSEMEYER

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.”

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