The first step in caring for patients with an opioid use disorder is to provide them with medication

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The United States has lost one million people to drug overdoses since oxycodone HCl (OxyContin; Purdue Pharma) became available in 1996, explained Beth Macy, author of New York Times– bestselling book Dopesick: Dealers, Doctors, and the Pharmaceutical Company that Made America Addicted (2018) and executive producer and writer of the Hulu limited television series “Dopesick”, based on the aforementioned book.

“And we know that’s an undercount, because that number doesn’t take into account people who died of end-stage endocarditis, hepatitis C, and HIV,” Macy said.

At the opening lecture for the American Society of Consultant Pharmacists conference, Macy explained that she started writing about the opioid epidemic as a journalist in Roanoke, Virginia. She had observed in her community that the opioid crisis was simmering and growing due to long-standing fissures in American society.

“We still don’t have universal health [care], and in the rural communities where I was reporting from, jobs had disappeared due to globalization, and the government did nothing for those left behind. At the same time, Purdue is introducing its medicine and changing the way we treat pain,” Macy said.

Opioid addiction has increased due to the availability of Oxycodone HCl, often with the original source of this addiction beginning with a prescription for pain or other healthcare related issues. To manage this crisis, the country has turned to the prison system as the primary solution, Macy explained.

“We were just using the tool of putting people in jail rather than treating them like people with a treatable disease,” Macy said. “Today, a third of the families in our country have been affected. [by opioid use disorder (OUD)].”

Macy explained that over the past year, there has been an 87% treatment gap for people with OUD, despite there being evidence-based treatment available for these people. With only 13% of patients with OUD receiving this evidence-based treatment, Macy noted that something was wrong with our current approach.

“If we got 13% in school, we would be expelled. We fail. What we’re doing now in that regard just isn’t working,” Macy said. “I visited the White House a few weeks ago, and the drug czar [explained] only 5% of people are on [medicines for OUD (MOUD)].”

Years of data and every governing body in the country has reported that buprenorphine, buprenorphine and naloxone (Suboxone; Indivior PLC), or methadone are the gold standard of care treatments for OUD, according to Macy; however, 95% of people with OUD did not have access to MOUD.

“We all know parents who have had to remortgage their home to send their child to out-of-state treatment, spending $30,000 or $50,000 a month and it just doesn’t work out,” Macy said. “That’s because most rehabs don’t offer these drugs.”

Additionally, research has shown that every dollar spent to make MOUD available to patients with OUD can save $12 or more in reduced criminal justice and healthcare costs, Macy explained. This has become more important than ever to recognize, because there is money for opioid settlement in the communities that were part of this lawsuit, most of whom don’t know what to do with that money to solve the underlying problem. underlying, according to Macy.

“My fear, and that of many people, is that this [money] will go the way of tobacco settlement money, which remains the largest settlement in American history. Only 3% of these 200 billion dollars [tobacco] the settlement even went to what it was supposed to do, which is to help in the prevention and treatment of cigarette smoking,” she said.

Macy noted that one of the victims of the opioid epidemic she knew best while reporting on the outbreak in Roanoke, Virginia was a woman named Tess Henry.

“She was a young lady when I first met her, and she had this little boy named Ronin — he’s about 7 now,” Macy said. “But Tess Henry is kind of the prototypical person with OUD. I met her when she was 5 in it. Her father is a hospital surgeon; mum is a nurse at the hospital – they had a vacation home growing up. [She] should have had every means to improve—[she had] all the money she needed [and] all resources. Yet when I met her, she continually ran into barriers. She sometimes lived homeless on the streets by prostituting herself to buy her heroin so as not to be drugged.

Macy further explained that Tess’ initiation to opioids came from an urgent care center, where she was prescribed two 30-day opioids for a case of bronchitis: hydrocodone for sore throat and l oxycodone (Percocet; Endo Pharmaceuticals) for his cough. At the end of her 30-day prescription, Tess told Macy that she quickly realized she had become addicted.

“One thing led to another, and she’s doing sex work on the streets of Roanoke, Virginia,” Macy said. “She made a few attempts at rehab, and her grandfather eventually sent her to abstinence rehab in Las Vegas. When she gets out of there because she can’t get medication for her cravings , she finds herself homeless on the streets of Las Vegas, which is very different.

One evening, while waiting to hear from Tess at the facility, they received a call from Nevada.

“I had been reporting his story the whole time I worked on Sick. I even originally wrote the ending of her mother sleeping with a phone waiting to hear that Tess was going to be able to come home. Instead, I got a call saying Tess was murdered on Christmas Eve. His body found in a dumpster. His mother Pat is now raising Tess’ son,” Macy said.

Macy explained that even today, Tess’ spirit hovers over all of her work covering the opioid epidemic.

“When she told me how she was originally prescribed and how it made her addicted, she said, ‘Well, what we need is urgent care for addicts,'” Macy said. “She didn’t know what that meant. It’s not like she thought she’d just go to CVS emergency care and get it — although that’s not really a bad idea — she just knew that every time she wanted to take those lifesaving drugs there was a waiting list, or there was only someone who accepted cash and it costs $500 on the first visit, and $100 per week thereafter.

Macy noted that Tess’ experience trying to get FDA-approved MOUDs was common, though things improved after Virginia embraced Medicaid expansion; however, by then it was too late for Tess.

“Two months in [to one rehab program], she was fine at one point,” Macy said. “They tested her and when she tested positive for marijuana, instead of increasing her treatment and increasing our counseling, they kicked her out.”

According to Macy, urgent care for drug addicts must begin with enabling patients with OUD to access MOUDs. However, many healthcare professionals working in the field of treating patients with TOU have yet to adopt this model in their practice, despite years of data demonstrating its effectiveness.

Macy explained that in 2017, she spoke with the head of an emergency department (ED) at a hospital in Virginia and asked him why they weren’t offering buprenorphine to patients with OUD at the hospital. Ed. ER chief Berkman told Macy, “Well, that’s just treating a drug addiction with another drug.”

However, when she spoke to Berkman in 2019, he explained that he had obtained all waivers from his emergency physicians to prescribe buprenorphine.

“‘And it’s going well,’ and you can hear the tone of her voice change,” Macy said. “Before, he was so desperate about it. I said, ‘Well, what happened?’ He said, ‘Well, we read your book. And then we looked at the data.

Reference

General Opening Session of Macy B.: Dopesick: America’s Epidemic. Presented at the 2022 American Society of Consultant Pharmacists (ASCP) Annual Meeting in San Antonio, TX; November 4, 2022.

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