The conversation regarding addiction continues to garner the attention of healthcare professionals, policy makers and social media, as the number of individuals addicted to opioids devastates counties, communities and families across the country. According to the National Institute on Drug Abuse, an estimated 1.7 million people in the United States suffered from addiction related to prescription opioid pain relievers in 2017. It is time to change the conversation and refocus the dialogue so that we can more aggressively challenge stigma, acknowledge that treatment does work and remove barriers to whole-person care.
Addiction is a complex and often difficult topic to fully understand. However, it’s important to not only educate ourselves and our communities about the issue but understand ways we can help and advocate for those who are experiencing the vulnerabilities and challenges caused by addiction.
Debunking the stigma
Despite some public misconceptions, research indicates the science-based, physiological changes that happen within the body during addiction support that addiction is a chronic disease. Similar to other diseases such as type II diabetes and hypertension, addiction is not a personal choice and is often impacted or influenced by genetics and environmental factors.
I argue that our reluctance to acknowledge that addiction is a chronic disease is more related to how we define the concept of relapse. We have this idea with addiction that if an individual relapses, then treatment isn’t working, or the person isn’t working hard enough. There’s a misunderstanding that people aren’t truly committed to the treatment process, because if they were committed, they wouldn’t relapse. This is simply not true.
The relapse rates for addiction are no different than the relapse rates for diabetes, hypertension or any other chronic disease. All of the chronic diseases mentioned have a relapse rate of somewhere between 50% to 60%, which is in line with addiction. So why do we look at addiction relapses through such a critical lens? We wouldn’t pass judgement or put blame on an individual if their blood sugar levels were heightened for the past 30 days due to a relapse in diabetes treatment. We would have much more empathy and drive to help, looking at the medication and adjusting the treatment plan.
It’s crucial to maintain the same mindset for addiction in order to combat the stigma. Similar to other chronic diseases such as heart failure or asthma, as long as an individual undergoing addiction therapy follows the treatment plan and has the right support systems in place, they can live a happy and fulfilling life.
In addition to relapse rate, regulation related to privacy and the silos of primary care have contributed to stigmas against addiction. 42 CFR Part 2, which aims to protect individuals’ substance use information, placed a certain class on addiction. This tells the world that addiction is so different from other health-related issues that it deserves more stringent regulation. By putting addictions in its own entity, 42 CFR helped inadvertently perpetuate stigma related to addiction.
The healthcare industry must continue to integrate addiction treatment into the larger healthcare eco-system. In doing so, I believe we would be surprised of what would happen in the next five to seven years.
Words matter: Starting the conversation
It is evident that addiction is still misunderstood and as a result is often under treated. However, there are notable efforts we can do as a society to make an impact and remove the looming stigma. It starts with having an open conversation. No one is exempt from this issue. We all know someone, or know a loved one, who suffers from addiction or whose lives have been impacted by someone with an addiction. Yet, no one wants to talk about their struggles or how their lives have been impacted by those struggling with addiction.
Not long ago, we were whispering the word cancer. Today, we’re screaming it, and people are fully supporting it in a variety of ways: wearing cause-related colors, participating in fundraisers, social media movements, etc. We offer to help with transportation and meals for those that have a physical illness. We need to have the same impact with removing the addiction stigma by talking about it and educating the public. That’s when we’ll start to see real change.
The power of technology
There are a variety of technology advancements that should be utilized to help treat addiction and combat the opioid crisis. One of the best examples of how technology is enabling more informed care delivery is the Carequality interoperability framework. Each month, over 14 million documents are exchanged by more than 1,250 hospitals, 35,000 clinics and 600,000 providers.
Here is a real-life example of how access to this data can impact a person’s health outcome. Let’s say an individual presents in the emergency department (ED) with back pain. An integrated electronic health record (EHR) automatically queries Carequality and a Prescription Drug Monitoring Program (PDMP) for this person’s health history and sees they have a pattern of presenting at EDs with chronic pain. Now, the ED physician can determine if he or she wants to order labs or a urinalysis, as well as consult the behavioral health team for a substance use assessment. Without this comprehensive, longitudinal view of an individual’s previous visits and medications prescribed and filled, the attending physician may have prescribed this person an opioid for pain, perpetuating the addiction cycle.
To help combat the opioid crisis and curb addiction, healthcare providers need up-to-date tools and technology that support appropriate ordering and prescribing of opioids that utilizes a preventative and recovery approach to medication management. Electronic prescribing (e-prescribing) of controlled substances (EPCS) allows physicians to leverage technology to issue prescriptions to individuals in a secure manner necessary to prevent over-prescribing
In addition, HIT can enhance recovery by providing tools supporting medication assisted treatment (MAT). For organizations incorporating MAT, it’s important they can e-prescribe controlled substances, order medications to be dispensed, monitor dispensing activities, track inventory and monitor clinical outcomes. With robust medication management tools, providers can enhance safety, improve accuracy, reduce fraud and drug diversion, reduce drug misuse and abuse, which leads to reducing the number of individuals addicted to opioids and promotes recovery for those in treatment.
Another key technology asset that should be leveraged to serve individuals battling addiction is telehealth. There is a great need to eliminate barriers to accessing quality care. With telehealth, individuals can immediately access healthcare resources, versus waiting weeks for treatment. In other words, telehealth can be the difference between reaching recovery and a costly hospital stay, ED visit, or not receiving treatment services at all. Providing care remotely via live telehealth visits is just the first piece in the puzzle to expanding access and impacting addiction treatment.
When it comes to managing the opioid crisis and addiction treatment, it is vital to know a person’s complete health history, including behavioral and physical health. Unless all providers have equal access to technology that allows them to exchange and integrate healthcare information with other providers, we cannot achieve true integrated care or parity between behavioral and physical health.
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