Medical experts weigh in on state opioid crisis
KTVA hosted a special Town Hall to discuss Alaska's opioid epidemic in October. The panel of guests included representatives from state and local government, doctors and the Anchorage Police Department.
Due to time constraints, not all questions were answered. Dr. Jay Butler, Alaska’s chief medical officer, and Dr. Anne Zink, the emergency medicine director at Mat-Su Regional Hospital, answered those questions through email and recently visited KTVA to discuss Alaska's opioid crisis in live interviews on KTVA News Extra -- both interviews can be viewed below.
Opioid Town Hall Q/A – (Dr. Jay Butler):
Jennifer Rostvold-Stukey: I’d like the panel to speak about evidence-based treatment options in our communities. What forms of treatment do the experts recommend?
For opioid addiction, medication-assisted treatment (MAT) has a much better success rate that abstinence alone. This should not be surprising because opioid addiction is not simply a lack of willpower. Opioid addiction causes changes in the brain—these changes drive destructive behaviors and these changes can persist for years after cessation of use. Medications can help break the desperate cycle of intoxication and withdrawal and allow stabilization of brain function and return to a normal life, even while receiving MAT. There are three basic tools in the MAT toolbox:
- Methadone—a long-acting opioid that has been used to treat opioid addiction for over 50 years and which allows the brain to avoid the wild swings of intoxication and withdrawal, facilitating a return to a normal life.
- Buprenorphine—an opioid that also has partial opioid-blocking properties. The partial blockade with buprenorphine reduces its potential for use to get high and risk of overdose. Buprenorphine comes in several forms: pills, strips that dissolve under the tongue, and a slow release form that is implanted under the skin and slowly releases the drug for up to 6 months. Additionally, a formulation which is administered monthly by injection is under final review by the FDA.
- Naltrexone—is the newest tool in the toolbox. Naltrexone is an opioid receptor blocker; thus, if someone on naltrexone uses opioids, the effects will be blocked, so there is no reward for using. Naltrexone come in pill form, which has to be taken daily, and in a monthly, injectable form (tradename, Vivitrol)
Because each of these medications has pros and cons, the decision of which form of MAT Is best for the individual seeking treatment is a decision that should be made between the patient and their care provider.
Dr. Melinda Hansen (psychiatric physician): What is being done at a state level to engage physicians to become part of the solution by offering medication-assisted treatment for opioid use disorder such as suboxone and Vivitrol?
With the passage of Governor Walker’s omnibus opioid response bill, HB159, this past year, it is now required that a portion of continuing education already required of all licensed provider in Alaska be committed to training in addiction medicine or pain management. Receiving the training required by the Federal Government to prescribe Suboxone (trade name for a form of buprenorphine that is combined with the opioid blocker naloxone in a strip that dissolves under the tongue) provides continuing education credits. Information on MAT is available from the state at http://dhss.alaska.gov/dbh/Documents/TreatmentRecovery/Opioids%20FACT%20SHEET.pdf
Rep. Paul Seaton, Homer: What specific prevention strategies other than restricting a doctor’s ability to prescribe opioids are you proposing for Alaska?
Prevention can be thought of as occurring at 3 levels, all of which are important:
Harm reduction: preventing life-threatening complications of opioid misuse. Examples include Alaska Project HOPE, which is saving lives by providing naloxone in our communities to reverse overdoses, and syringe and needle service programs, which reduce the risk of hepatitis C and HIV by providing clean needles and syringes, as well as providing contact for persons with addiction to receive information on treatment. However, these measures may prevent bad outcomes in the short-term, they will not alone end the opioid crisis.
Treatment: including MAT, as described above. Two barriers that we must address to improve access to treatment are increasing the number of providers and facilities providing treatment and reducing the stigma that can make persons who want to get well avoid treatment or seek self-treatment with diverted medications.
Primary Prevention: this involves addressing supply and demand. On the supply side, more judicious prescribing of opioids is one measure, as you have described. Also, the flow of illicit opioids needs to be addressed through law enforcement measures. The most lasting impact will involve addressing the demand side—effective education of the public and healthcare providers will help, but our response must also include addressing the drivers of substance misuse, including preventing and mitigating the effect of adverse childhood experiences, as well as promoting emotional wellness and resiliency at the individual and community level.
For more information on the 3-level approach, please see: http://journals.lww.com/jphmp/Citation/2017/09000/2017_ASTHO_President_s_Challenge___Public_Health.17.aspx
Pain management Q/A – (Dr. Anne Zink)
Evanne Katasse Roberts: Why continue to issue Suboxone when people abuse it just as much?
Suboxone can be abused like other opioids but it much less likely to cause an overdose like heroin and other opioids because of the way it is formulated. It also does not cause the same high. Data shows suboxone works better than almost any other treatment option for severe opioid dependence and abuse. From a harm reduction standpoint, it is better to have people abusing suboxone than heroin and other opioids, although avoiding the addiction in the first place is always preferable.
Leslie Vines: What treatment facilities are available to assist people seeking treatment?
This is a complex question because it depends on where you live and what sort of treatment people need. There is a wide range of treatment from counseling, to intensive day services to inpatient assistance. 211 or your local emergency department may be able to give you a better idea of options in your community.
Judy Leniu: What can we do to help as residents?
- Avoid opioids whenever possible and talk to your provider about non-opioid treatment options for pain.
- If you are prescribed opioids, realize everyone is at risk for addiction and use them for the shortest time possible and dispose of all unused medication.
- Never takes someone else’s medication.
- If someone you know or love is addicted, be direct with them about your concern. Recognize addiction is a real disease and they may not realize they have it. Seek help for them and yourself to know how to set boundaries and get help.
KTVA News Extra interviews:
According to a new state report by the Dept. of Health and Social Services, meth deaths are up four times compared to nine years ago. Dr. Jay Butler, Alaska’s chief medical officer joined KTVA Extra to discuss the report.
Dr. Anne Zink, the emergency medicine director at Mat-Su Regional Hospital joined KTVA News Extra to discuss a new study out of the Journal of the American Medical Association about the differences between over the counter drugs vs. opioids.
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