The Opioid Epidemic and Substance Use Disorder has aligned itself as one of the most pressing public health concerns in the United States. It has reached such a critical stage that the epidemic has been addressed by all levels of government, and even the Surgeon General, himself, voiced his concerns for the future generations.
Currently, there are over 20 million people in the United States who are both active and former addicts. According to the Centers for Disease Control and Prevention (CDC), from 2000 to 2015, more than half a million individuals died from drug overdoses. 91 Americans die every day from an opioid overdose. In 2017, the number of opiate overdose deaths has jumped to 144 per day. Addiction plays a multi-faceted role in how it affects society. Not only is it detrimental for the abuser’s overall health and risk of developing disease, it affects incarceration rates, vehicle accidents, employment and the overall financial burden placed on the government and health insurers. The National Institute on Drug Abuse has estimated that the annual financial burden to be in excess of $78.5 billion, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.
There is clearly a large-scale issue which is affecting the populations at-large. From the detoxification and rehabilitation/treatment aspect, there are mainstay treatment modalities which have been tried and tested to ensure that patients do not develop life-threatening withdrawals, and can get out of the danger zone, when attempting to lead a life of sobriety. Those treatment modalities target both the withdrawal symptoms, and break-through anxiety associated with using numerous substances of abuse.
However, in this “traditional stream”, patients who suffer from opioid/anxiolytic dependence are tapered off of their substances of abuse, expected to maintain sobriety, fight the urges and cravings while, at the same time, re-integrate into society as a productive, contributing member. This can have its toll on the patient, both physically, and psychologically. As a result of this, relapse rates remain high amongst this demographic, and many of them just fall into a vicious cycle.
The field of Medicine is ever expanding, day-by-day, due to the constant advancements in medical knowledge. Diseases that were once considered to be incurable now have treatments that allow patients to live long, healthy lives, without the hindrance of disease processes. Due to this, it is important to take advantage of the wealth of information present and translate that into something meaningful which could have a positive impact on patient outcomes, reducing both morbidity and mortality rates. Research and innovation is the future of medicine, and a guiding principle of Evidence-Based Medicine (EBM).
Dynamics have now been changing in the approach healthcare providers are taking towards the opioid epidemic and addictions in general. Emerging research reveals certain genetic and physiological roots as causes of addiction, for which medical treatments are proving more effective than 12-step programs (though they can be done in conjunction). It is also now widely accepted and understood that Addiction is a disease state which requires therapeutic interventions in order to attain desirable outcomes. Medication-Assisted Treatment (MAT) programs are gaining increasing popularity and recognition as an effective way to aide patients on their path of sobriety. Many of the insurance providers, who were not too long ago skeptical, have now embraced the idea of MAT and even promote it as a part of patient care. By being placed on long-term “maintenance” doses of opiates, such as Subutex/Suboxone, the patient is able to have a temporary “crutch” which will aide them in fighting cravings and moving towards their long-term goals.
Through research and innovation, novel treatment modalities can be discovered which can have a meaningful effect on patient outcomes. As patient outcomes are an important gauge in determining whether a therapeutic/ treatment modality is working, it is imperative that time energy and resources be dedicated to this field of expertise. Within the realms of Addiction medicine, there is much opportunity to discover effective therapeutic modalities which can help curb relapse rates and help assist those struggling with addiction to fight cravings.
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