We hear stories almost daily about the crisis involving addiction to pain pills. The numbers are as astonishing as they are alarming. The bottom line: people who abuse opiates (hydrocodone, Vicodin, Oxycodone, oxycontin, and similar pain killers) are ten times more likely to die than non-addicted patients.

According to an article in the Journal of Addiction Medicine, individuals with opioid use disorder receiving care in a university health system were ten times more likely to die, indicating significant room for improvement in identification and treatment of opioid use disorders in large health care systems.

“The high rates of death among patients with opioid use disorder in a general health care system reported in this study suggest we need strategies to improve detection and treatment of this disorder in primary care settings,” Yih-Ing Hser, PhD, of the University of California, Los Angeles, said in a press release.

"My original thinking was that the mortality rate could not be very high in the general healthcare setting because general healthcare centers are supposed to have more comprehensive health services, and most people are insured. But when I saw such a high mortality rate, I was shocked," lead investigator Yih-Ing Hser, PhD, professor of psychiatry and behavioral sciences, David Geffen School of Medicine at the University of California, Los Angeles, told Medscape Medical News.

Healthcare journalist Casey Hower of Healio Family Medicine has published an excellent summary of recent research on marijuana and other drug use among college students.
INCREASE IN MARIJUANA USE
Between 2006 and 2014, use of any illicit drugs, including marijuana, fluctuated. In 2006, use of illicit drugs in the previous 12 months was at 34%, and then increased to 41% in 2013. In 2014, use decreased slightly, to 39%. The researchers noted that marijuana was the drug most driving this increase.
OTHER DRUGS
Illicit drug use in the previous 12 months that did not include marijuana also increased. In 2014, 21% of college students used illicit drugs, compared to only 15% in 2008, with the main increases being seen in amphetamine and ecstasy use, according to the study.
AMPHETAMINES, ADDERALL, RITALIN & RELATED DRUGS
The use of nonmedical amphetamines almost doubled from 2008 to 2012, and then slightly decreased by 2014, according to a press release. In the release, Johnston suggested that this increase in use could be attributed to students’ desire to improve their studies and test performance.
ECSTASY
Despite ecstasy use decreasing between 2004 and 2007, usage rose to 5.8% in 2012 from only 2.2% in 2007. A significant increase in use of cocaine within the past 12 months was also seen, rising from 2.7% in 2013 to 4.4% in 2014.
FAKE MARIJUANA, NARCOTICS, SALVIA
Use of synthetic marijuana, narcotic drugs and salvia decreased significantly by 2014. The researchers noted that use of bath salts was negligible among college students.
CIGARETTE SMOKING
Rates of cigarette use within the past 30 days decreased significantly among college students, dropping from 31% in 1999 to only 13% in 2014. Daily smoking also decreased significantly, from 19% in 1999 to only 5% in 2014.
HOOKAHS
However, while cigarette rates have dropped significantly, use of hookahs increased significantly to 33% in 2014, up from 26% in 2013. No significant change in cigar use was seen, according to the researchers.
ALCOHOL
In 2014, 63% of college students reported having had an alcoholic drink within the past 30 days, a decrease from 67% in 2000 and 82% in 1981. A decrease was also seen in the proportion of students reporting they had been drunk within the past 30 days, from 48% in 2006 to 43% in 2014. Rates of binge drinking, as defined by five or more drinks in a row within the previous 2 weeks, decreased from 44% in 1980 to 35% in 2014, among college students.
THE ORIGINAL REFERENCE ARTICLE (PDF File)
Johnston LD, et al. Monitoring the Future national survey results on drug use: 1975-2014: Volume 2, College students and adults aged 19-55. Ann Arbor: Institute for Social Research, The University of Michigan; 2014. http://www.monitoringthefuture.org/pubs/monographs/mtf-vol2_2014.pdf.

Internists say substance use disorders related to illicit and prescription drugs, including opioids, are chronic medical conditions treatable through public and individual health interventions.

Philadelphia, March 28, 2017 -- The American College of Physicians (ACP) today released a paper with a comprehensive set of public policy recommendations for the prevention and treatment of substance use disorders involving illicit and prescription drugs. The paper is published in Annals of Internal Medicine.

“Drug overdose deaths, particularly from opioids such as prescription pain relievers and heroin, is a rising epidemic,” said Nitin S. Damle, MD, MS, MACP, president, ACP. “Substance use disorders are treatable chronic medical conditions, like diabetes and hypertension, that should be addressed through expansion of evidence-based public and individual health initiatives to prevent, treat, and promote recovery.”

ACP says that substance use disorders pose a heavy societal burden, endangering individual and family health and well-being, tearing through communities and sapping resources from the health care system. These disorders are common in the general population and at even higher rates among those who are incarcerated.

Access to care for substance use disorders is limited. In 2014, 22.5 million people in the U.S. needed treatment for an illicit drug or alcohol use problems but only 18 percent received any treatment, far below treatment receipt rates for those with hypertension (77 percent), diabetes (73 percent), or major depression (71 percent).

To combat the epidemic of prescription drug misuse, ACP recommends that physicians become familiar with and follow as appropriate clinical guidelines related to pain management and controlled substances such as prescription opioids as well as non-opioid drugs and non-drug interventions; the expansion of access to naloxone to opioid users, law enforcement, and emergency medical personnel; the expansion of access to medication-assisted treatment of opioid use disorders; improved training in the treatment of substance use disorders including buprenorphine-based treatment; and the establishment of a national Prescription Drug Monitoring Program and improvement of existing monitoring programs.

“ACP strongly urges prescribers to check Prescription Drug Monitoring Programs in their own and neighboring states as permitted prior to writing prescriptions for medications containing controlled substances,” Dr. Damle said.
Additional recommendations from ACP include emphasizing prevention and treatment of substance use disorders through public and individual health interventions rather than excessive reliance on criminalization and incarceration; requiring health insurance to cover mental health conditions including the evidence-based treatment of substance use disorders and abide parity rules; embedding training in the treatment of substance use disorders throughout the continuum of medical education; expanding the workforce of professionals qualified to treat substance use disorders; and studying the effectiveness of public health interventions to combat substance use disorders and associated health problems.

“Physicians can help guide their patients towards recovery by becoming educated about substance use disorders and proper prescribing practices, consulting prescription drug monitoring systems to reduce opioid misuse, and assisting patients in their treatment,” said Dr. Damle.

Although a number of states have legalized or decriminalized use and sale of medical and/or recreational marijuana, its use and possession remains illegal under federal law and in many states. Therefore, ACP included it as an illicit drug.

ACP recognizes that alcohol and tobacco use disorders are serious public health problems. Policies to address such issues are outside the scope of the paper.

Methods

The position paper was drafted by ACP’s Health and Public Policy Committee. The authors reviewed available studies, reports, and surveys on the prevention and treatment of substance use disorder from PubMed, Google Scholar, relevant news articles, policy documents, websites, and other sources. The authors largely excluded sources that were more than ten years old, with the exception of a number of federal government reports that were included for background purposes.

ACP’s recommendations are based on reviewed literature and input from the ACP's Board of Governors, Board of Regents, Council of Early Career Physicians, Council of Resident/Fellow Members, Council of Student Members, and Council of Subspecialty Societies and nonmember experts in the field.

About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States. ACP members include 148,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.

My good friend Doug Tieman, CEO of Caron Treatment Centers, was in town recently to give a talk on the opioid epidemic. Information about treatment for drug abuse can be found at Caron's website, and here is an excerpt from their well-written information section.

How does addiction affect the body?
Repeated drug and alcohol use causes chemical dependency, or lasting changes to the way the brain functions and operates. In fact, all abused substances alter the areas of the brain responsible for self-control, judgment, emotional regulation, motivation, memory and learning by hijacking the brain’s normal reward pathways. Although abused substances—including alcohol, heroin, benzodiazepines, methamphetamine, nicotine and prescription drugs—act on different pathways in the brain, they all necessitate increasingly higher doses to produce a high or simply allow the user to feel normal. Issues such as mental illness, multiple addictions and ancillary health problems may complicate substance addiction.

Addiction as a Disease [video] See and hear Doug Tieman on YouTube.

Why do people use alcohol and drugs?
Because many drugs act on the brain’s pleasure pathways, the user experiences intense euphoria followed by related emotional highs. Cocaine, for example, induces feelings of empowerment, confidence, high self-esteem and increased energy. People might chase these perceived emotional benefits for a variety of reasons, including:

Social: People use alcohol and drugs often as a way to fit in with a particular group or to feel more at ease in a social setting,

Stress: Substance abuse may be a means to escape problems or a way to reduce stress. The role of stress in beginning drug use, continuing drug abuse, or relapse in recovering patients should be addressed and approached holistically.

Psychological triggers: People suffering from anxiety disorders, trauma, depression or other psychological illnesses may begin using alcohol and drugs to reduce or numb personal distress. Individuals with alcohol or drug dependence are nearly twice as likely to have a co-occurring psychological disorder.

Peer pressure: Some people, especially teenagers and adolescents, are vulnerable to group pressure or the rationale that “everyone is doing it.”

When does alcohol and drug become substance addiction?
Substance use becomes abuse and later addiction when the drugs or alcohol begin to take control over one’s life. For many substance addicts, this is the tipping point: seeking and using increasing amounts of drugs, despite the tremendous problems it causes for themselves and their families.
Individualized addiction treatment can help.
Though substance abuse and addiction affects millions every year, no two people experience addiction the same way. People suffer from substance abuse and addiction for a variety of reasons and usually face related challenges, such as life stressors, emotional burdens and psychological issues. Although the prospect of overcoming substance addiction may seem impossible, recovery is within reach for all addicted persons.

Tags: Addiction, Opiates, Opioids

People who are addicted to opioids and receiving their medical care in a general health care setting were more than 10 times as likely to die during a four-year period than people without substance abuse problems, UCLA researchers have found. The new study, published in the Journal of Addiction Medicine, suggests that health care systems should have better infrastructure and training for primary care physicians to diagnose and treat opioid use disorder, a condition that includes addiction to both prescription and illicit opioids.

The study, led by Yih-Ing Hser, professor of psychiatry and behavioral sciences at the David Geffen School of Medicine at UCLA, is the first to look at the mortality rate of people with opioid use disorder in a general health care system rather than those treated at specialty addiction clinics. The mortality rate among patients in this setting, which includes primary care offices and large research hospitals, was more than two times higher than what previous studies had found in specialty clinics.

“The high rates of death among patients with opioid use disorder in a general health care system reported in this study suggest we need strategies to improve detection and treatment of this disorder in primary care settings,” Hser said.

Opioids often are prescribed to treat acute and chronic pain, and include prescription medications such as oxycodone (or OxyContin), hydrocodone (or Vicodin), codeine, morphine and fentanyl, as well as illicit substances such as heroin. The number of opioid overdoses in the United States has quadrupled since 1999, leading some physicians and policymakers to declare the opioid problem a national crisis. The 21st Century Cures Act, legislation signed in December by former President Barack Obama, included $1 billion in funding to help states address opioid abuse.

As rates of opioid addiction have risen, patients with opioid abuse problems increasingly are being treated by generalists, such as internists and primary care physicians, in doctors’ offices. Until now, researchers had not gauged the impact of this influx of patients with opioid abuse and addiction in primary care settings.

Hser and colleagues studied electronic health records, and an associated death index system, for 2,576 patients, ages 18 to 64, diagnosed with opioid use disorder from 2006 to 2014. The individuals received health care at a major university hospital system. While all of those studied had diagnoses of opioid use disorder, not all were receiving treatment for it.

By the end of the study period, 465 people (18.1 percent of the study population) had died. Based on how long each person had participated in the study — an average of about four years for each individual — the researchers calculated a crude mortality rate of 48.6 deaths per 1,000 person-years, more than two times higher than the 20.9 deaths per 1,000 reported in previous studies done in specialty addiction clinics. The rate was also more than 10 times higher than the expected death rate for people of the same age and sex in the general U.S. population.

Overall, the patients in the new study were older at diagnosis and had a higher rate of other diseases and disorders compared to patients included in previous studies that took place at specialty clinics. Hser’s team noted higher rates of both simultaneously occurring health complications — including hepatitis C, liver disease, cardiovascular disease, cancer and diabetes — as well as other substance abuse disorders involving tobacco, alcohol, cannabis and cocaine — among the patients who died.

“The findings were surprising because one would potentially expect better health care outcomes for patients being served by a large health care system,” Hser said. “Late identification of opioid use disorder and lack of addiction treatment could contribute to these high rates of serious health conditions and death.”

Black or uninsured individuals were also more likely to die during the study period, the researchers said, a finding they noted highlights the need for additional research on disparities in addiction care.

Additional research will be needed, they concluded, to determine how to best curb the mortality rates among all individuals with opioid use disorder and better integrate substance abuse disorder screening and treatment into primary care.

The study’s other authors are UCLA psychiatrists Larissa Mooney and Karen Miotto; UCLA professor of medicine Douglas Bell; UCLA graduate students Yuhui Zhu and Di Liang; David Huang, the senior statistician at the UCLA Integrated Substance Abuse Programs; and Andrew Saxon of the Veterans Affairs Puget Sound Health Care System.

The research was funded by the National Institute on Drug Abuse’s Clinical Trials Network.

http://newsroom.ucla.edu/releases/opioid-addiction-raises-mortality-rate