Opioid Awareness

MARCH 2018 | FUTUREOFPERSONALHEALTH.COM

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Opioid Awareness DISCOVER

the U.S. Department of Health and Human Services’ effort to balance policy and practice while finding alternative pain treatments.

United States Surgeon General Dr. Jerome M. Adams outlines the fight for treatment and prevention and shares his personal connection to the opioid crisis.

EXPLORE

how FDA commissioner Scott Gottlieb is broadening the scope of his agency’s work beyond bringing medicine to market.

2 | FUTUREOFPERSONALHEALTH.COM | IN THIS ISSUE

FIND SUPPORT As we form a deeper understanding of opioId abuse, so too do we develop resources to help those struggling with addiction.

To help yourself or someone you know: CALL SAMHSA’s National Helpline 1-800-662-HELP (4357) TTY: 1-800-487-4889

5 Ways to Find the Best Treatment for Opioid Addiction

Parent Helpline 1-855-DRUGFREE DOWNLOAD Opioid Overdose Prevention Toolkit www.samhsa.gov/ capt/tools-learningresources/opioidoveruse-preventiontoolkit VISIT SAMHSA’s Prescription Drug Misuse and Abuse Website www.samhsa.gov/ prescription-drugmisuse-abuse SAMHSA’s Behavioral Health Treatment Services Locator ww.samhsa.gov/ find-help Other Online Resources www.drugfree.org

Elinore F. McCance-Katz, M.D., Ph.D. Assistant Secretary, Substance Abuse and Mental Health Services Administration (SAMHSA)

To ensure you or your loved one receives effective, long-term care for substance use disorder, make sure to ask these questions of any treatment program you’re considering.

More than two million Americans have a disease called opioid addiction (or opioid use disorder) that affects the brain and body. It’s a chronic disease, like diabetes or heart disease. Just

like with other treatable chronic diseases, there are medications and therapies that can reduce symptoms, help you or a family member return to normal life, reduce the chance of relapse and make recovery possible.

In fact, many people are in recovery from opioid addiction. Finding a quality treatment program and provider is an important first step in achieving recovery, so it is critical to do some research before choosing the program that is right for you.

Here are five things to ask for in a quality opioid addiction treatment program: 1. Is it accredited, licensed or certified by the state?

State licenses and certifications mean you can count on quality, safe care.

2. Does it offer medications for opioid addiction?

Three U.S. Food and Drug Administration-approved medications — methadone, buprenorphine

and naltrexone — are used to successfully treat opioid use disorders. Quality programs will offer these medications.

3. Does it use treatments that are proven to work?

For example, we know from the latest scientific studies that medication-assisted treatment, or MAT — which combines medications with behavioral counseling — is effective in treating opioid use disorder. Be sure to choose a program that offers proven treatments.

Finding a quality treatment program and provider is an important first step in achieving recovery.

4. Does it include family and friends in the treatment process?

Opioid addiction affects the whole family. Finding a program that involves family and friends improves the chances for recovery.

5. Does it provide long-term treatment and support?

The best treatment programs provide ongoing treatment for this chronic disease as well as help with other needs beyond the person’s addiction, like sober housing and employment assistance.

Remember: getting into treatment as quickly as possible is key to successful recovery. Look for programs that can quickly screen you or a family member and get you or your loved one into treatment within 48 hours of contacting them.

Take the first step. Call 1-800662-HELP (4357) or visit SAMHSA’s online Behavioral Health Treatment Locator to find treatment programs and providers nationwide. n

Publisher Gretchen Pancak Business Developer Jourdan Snyder Managing Director Luciana Olson Content and Production Manager Chad Hensley Senior Designer Celia Hazard Designer Tiffany Pryor Copy Editor Emily Gawlak Production Coordinator Josh Rosman Contributors Scott Gottlieb, Tom Hill, Christopher Jones, Elinore McCance, Gary Mendell, Cindy Riley, Vanila Singh, Jeffrey Somers, Nora Volkow Cover Photo U.S. Department of Health and Human Services All photos are credited to Getty Images unless otherwise credited. This section was created by Mediaplanet and did not involve USA Today.

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Innovating Prescription Monitoring Programs to Combat Opioid Misuse analytics, scores, red flags and visualizations to indicate various risk-levels. “With these advancements, those data summaries become an important part of decision support,” says Miller. “If you have this information at the time of seeing your patient, it can help coordinate care between a pharmacist and a physician or nurse practitioner as all eyes are on the controlled substance data for the patient.”

Innovations in prescription drug monitoring programs increase their value as a tool to combat the opioid epidemic and offer hope for wider-spread utilization.

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s the opioid crisis looms large, prescription monitoring programs (PMPs) have emerged as a growing, state-driven force for intervention. With slight variation in administration and access to data, their existence is now nationwide: 49 states, Washington D.C., and Missouri’s St. Louis

County have an established and operational program to collect and track prescribing and dispensing data on designated medications.

Those data — including prescriber, dispenser and patient information as well as information about the prescription itself, including quantity, strength and dates written and filled — can be harnessed by pharmacy and health care prescribers for a number of purposes, including as a deterrent for abuse and diversion, an educational resource and a public health tool to inform prescribing decisions.

Identifying the weaknesses Yet by 2016, even as a greater number of states opted to share PMP information across state lines through secure data shar-

ing networks and implement mandatory enrollment, a trend was becoming increasingly clear: health care professionals were not fully utilizing the programs. “They just weren’t looking at the data at a rate you would expect,” recalls Dr. Lisa Miller, Head of Corporate Social Responsibility for Purdue Pharma. “We commissioned surveys with health care professionals, and it was revealing to hear them say repeatedly — it’s clunky, it’s time-consuming, it’s not that user-friendly.”

They found that the dilemma was two-fold. First, accessing the PMP disrupted workflow, requiring doctors to step out of the exam room and use their credentials to log-in on a web browser, wasting precious minutes with a patient.

Further, when doctors accessed the data, it was presented in an unwieldy, dense and difficult to interpret manner.

Strengthening the program Purdue set out to seek solutions to these challenges and learn about technology platforms that can integrate PMP data directly into electronic health record or pharmacy dispensing systems. This essentially could provide a practical, clinical decision-making solution by delivering the information to health care practitioners within their clinical work-flow as they’re seeing patients.

These technological advancements can also package the data in a much more user-friendly way, delivering a summary of the findings and employing

A promising test case In 2017, the Commonwealth of Virginia launched a public-private partnership with Purdue, endeavoring to employ PMP innovations in an effort to boost prescriber and pharmacist utilization of their PMP data. “Our idea was,” Miller explains, “let’s take a look at one state-based PMP demographic, apply all of latest innovations to their system and see if it makes a difference in the utilization rates of PMP’s and ultimately in prescribing and patient care.”

Since the project’s inception in 2017, the utilization rate is already up 205 percent. “We’re very encouraged by Virginia and other states that are taking an innovative, forward-thinking view on how to deliver PMP data,” Miller notes. “We hope that progress will continue on across the nation.”

Early results inspire hope for the great potential of PMPs as they are sharpened and expanded.

Through a commitment to research and exploration of these exciting innovations, all states, pharmacies and health care systems have the capacity to adopt smarter PMP utilization practices and increasingly empower doctors with the real-time decision making tools they need to help in addressing opioid abuse. n

By Emily Gawlak

4 | FUTUREOFPERSONALHEALTH.COM | INSPIRATION

How MedicationAssisted Treatment Is Driving Hope for Long-Term Addiction Recovery

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PHOTO: ALEXANDER LAM

By Emily Gawlak

or decades, stigma — driven in large part by the false belief that opioid use disorder is simply a moral failing — has made patients afraid or ashamed to seek help and has slowed their access to effective treatment.

But public understanding is finally catching up with scientific findings — findings that show addiction is a chronic, relapsing brain disease. As with other chronic diseases, opioid use disorder cannot yet be cured, but it can and should be effectively managed with continuing outpatient care and monitoring. That care should also be personalized — just as diabetes care is personalized — using the right combination of medications, therapies and supports that will reduce drug use and improve health and function. That’s called recovery.

There is extensive evidence supporting the use of FDA-approved medications, combined with psychosocial support and counseling, as a path to long-term recovery. Medications are now recognized as part of the “first line” of treatment for opioid addiction by the Substance Abuse

The Panel of Industry Leaders:

GARY MENDELL is the founder, chairman and CEO of Shatterproof™, a national nonprofit organization “dedicated to ending the devastation that addiction causes families.”

In 2011, Mendell lost his son Brian to addiction, resigning from his job not long after to build Shatterproof. The community of advocates works to implement state and federal policy change and has already passed life-saving legislation in 14 states. Shatterproof’s Community Alliance Program numbers nearly 650 local ambassadors, and the Shatterproof Challenge Rappel and Shatterproof Rise Up Against Addiction 5K Run/Walk are the largest peerfocused addiction event series in the nation. www.shatterproof.org

A. THOMAS MCLELLAN is the founder of the Treatment Research Institute, a Philadelphia-based nonprofit research and development organization. McLellan currently serves as non-executive director on the board for Indivior PLC, the parent company of Indivior Inc., a U.S.based pharmaceutical company that markets and distributes medications to treat opioid use disorder and the sponsor of this industry perspective. Over nearly four decades of research, McLellan has published 450 articles and chapters on addiction research, and in 2003 he was presented with the American Society of Addiction Medicine’s Lifetime Achievement Award.

MEDIAPLANET | 5

Another Perspective: Listening to a Voice of Recovery and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC) and the American Medical Association (AMA).

Recent remarks by secretary of Health and Human Services Alex Azar further reinforce that “medication-assisted treatment works. The evidence on this is voluminous and ever growing.”

We gathered a panel of experts in substance use disorders to discuss the path to effective addiction treatment and the barriers still in the way.

to help patients regain control of their lives and counteract the powerful disruptive effects addiction has on the brain and behavior. Also key is that treatment should be accompanied by monitoring, like urine testing, as well as efforts to strengthen and adjust the treatment when it needs to be strengthened. Support from family and friends throughout treatment is critical. It is so important that they know that recovery is possible with comprehensive, continuous care.

Gary Mendell:

How can you approach a loved one and help them get treatment?

A. Thomas McLellan:

The first thing you need to do is arm yourself with some facts and get rid of some very common but inaccurate prejudices and preconceptions. This can be very hard, especially for parents. If a child has this disorder, it doesn’t mean you have been bad parents or that the child is weak-willed or immoral. Understanding this will shape the conversation, which should include helping them understand that medication-assisted treatment uses effective medications in combination with counseling and behavioral therapies and that this has been shown

I almost can guarantee that your loved one wakes up every morning feeling a lot of shame and fearing the stigma of addiction. They can’t understand why they’re failing.

Why can’t they stop using drugs?

Why are they caught in this cycle?

The first thing you should do is tell them: I want you to know how proud I am of you for fighting a difficult disease and how much I admire your courage. That is fundamental to everything. If I could live life all over again with my son, I would put a yellow sticky note on my mirror, and it would say “Empathy toward Brian.” It’s difficult, because they may do things like lie and steal that make it hard to empathize, but that’s what their brain is telling them to do.

How can we clarify misconceptions about medication-assisted treatment (MAT) and expand access?

In 2014, after nearly a decade of struggling with heroin addiction, Amy Parker became a certified chemical dependency counselor assistant and the first certified peer recovery supporter at an outpatient medication-assisted treatment facility for substance use disorder.

Jessica Hulsey Nickel:

How can MAT support recovery?

It starts with accepting that substance use disorder is a health condition. It’s a disease not a decision, just like heart disease. We need to educate ourselves, we need to understand the science and we need to have the tools ready to help our loved ones seek treatment.

MAT saved my mother’s life.

She had 19 years in recovery before I lost her way too early because of the long-term health consequences of addiction. We have FDA approved medications for MAT. We need to get our own preconceived notions out of the exam room and make sure patients are prescribed the medication that best suits them, or more likely, the sequence of medicines that are going to be necessary for their treatment and recovery plan. We need to tackle not just the stigma of addiction but stigma about the medications available to treat it. If we bring our own biases to the treatment options, we are doing an immense disservice to the millions of patients who are struggling with this disease. n

Amy Parker: Some people believe that MAT is trading one addiction for another, but addiction is a disease, and MAT treats the disease. And the big point is that it’s medication assisted treatment. Counseling and support are key to establishing coping skills and changing behaviors. The medication helps manage the reasons why so many people don’t stop using, which, in turn, have a whole lifestyle around them. MAT supports you to change your life and your behavior.

What do you do in your peer-recovery work, and what is the importance of psychosocial support in long-term recovery?

Parker: I meet with patients and I introduce myself as their peer recovery supporter. I tell them right then and there that means I’m in recovery, too. I’ve been in this place, I understand because I’ve lived through it. Everything I ask or say to them is from a place of encouragement, inspiring hope, and helping them understand that communication is key. Telling them, no matter what happens when you walk out of that door, come back, communicate with us.

As long as you’re alive, we can do that. For them, it’s about having someone look at them in the eye and say: It’s ok.

You’re not a horrible person, you matter. Your life has value and you are cared about. I will lead you. Lean on me until you’re strong enough to be able to do it yourself.

If you or a loved one is struggling with SUD, you are not alone:

JESSICA HULSEY NICKEL is the president and CEO of the Addiction Policy Forum, “a diverse partnership of organizations, policymakers and stakeholders committed to working together to elevate awareness around addiction and to improve national policy through a comprehensive response.” Driven by a personal passion — Nickel has lost several family members to addiction — she has spent over two decades on Capitol Hill, working in areas of the addiction field including prevention, treatment and criminal justice reform. The Addiction Policy Forum formed a Families Committee, which now has over 1,400 members nationwide who champion addiction awareness, share resources in their local communities and meet with their legislators to encourage a legislative response to addiction. www.addictionpolicy.org

To find both inpatient and outpatient options for specialized drug treatment facilities in your area, call the U.S. Department of Health and Human Services helpline.

1-800-662-HELP (4357) | www.findtreatment. samhsa.gov For additional questions and resources, call the SAMHSA (Substance Abuse and Mental Health Services Administration) National Helpline or the Behavioral Health Treatment Service Locator online.

1-800-662-HELP (4357) | www.findtreatment. samhsa.gov

6 | FUTUREOFPERSONALHEALTH.COM | INSIGHT

The Partnership for Drug-Free Kids offers a six-part guide for families to help protect their loved ones from one of the scariest possibilities of opioid use disorder.

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t can be terrifying when your son or daughter is using drugs. When they are using heroin, fentanyl or other opioids like prescription pain pills, however, the fear is even greater, since these substances pose a much higher risk of fatal overdose.

Your first goal is of course to encourage your son or daughter to seek treatment for their drug use.

But there are things you can do to help prevent your child from overdosing in the meantime.

1. Have a safety plan.

While not endorsing the use of substances, it’s important to accept the reality of it and focus on reducing harmful consequences. Discussing a safety plan with your son or daughter as a precautionary measure can help reduce those opportunities for accidental overdose. “When you are the parent of someone using drugs, you are so busy trying to get them to stop that you don’t give advice on how to stay alive while they are using,” says Robin Elliott in an article in the Huffington Post. A safety plan

While not endorsing the use of substances, it’s important to accept the reality of it and focus on reducing harmful consequences.

can contain the advice listed here, as well as letting your child know that you care and you want to stay involved in their life in a positive way.

2. Get naloxone for both you and your child.

Naloxone (brand name Narcan) is a life-saving medication that can stop an opioid overdose. It’s easy to administer and available at most pharmacies and from many community organizations across the country. You should always have naloxone available to both you and your child, just as you would a first-aid kit.

3. Educate your child of the risks of overdosing once any period of time has lapsed.

If your child is abstinent from using opioids for any period of time, regardless of the reason, they are at greater risk of overdosing, as their tolerance isn’t what it once was. A change in tolerance can happen as a result of detoxing, completing a treatment program, spending a period incarcerated, prematurely discontinuing certain

forms of medication-assisted treatment or simply choosing not to use substances. As a result, your child’s “usual” dose could be life threatening. It’s important to have on-going conversations about the risks associated with lowered tolerance as part of the overall safety plan.

4. Wave the red flags related to combining opioids with other substances.

People who use opioids often do so in combination with other substances, such as stimulants (i.e. cocaine or meth) and depressants (i.e. benzodiazepines, alcohol and sleep medications), placing them at greater risk of an overdose. In combination, these substances can tax the heart and/or the respiratory system, greatly com-

promising your child’s health, so making sure your child is aware of the dangers is crucial.

5. Emphasize the dangers of fentanyl.

Make sure your child knows about fentanyl, a drug that is 50 to 100 times more potent than morphine and can be deadly.

Because it is relatively cheap, it is often mixed in with heroin and pressed into what is perceived to be prescription pain pills.

6. Encourage your child to avoid using opioids alone, as no one would be available to help if needed.

If all else fails and an overdose occurs, it’s primarily going to be up to those present to do something to help. If your child is the

one experiencing distress, people around him or her must be able to recognize the signs of an overdose — especially unresponsiveness, slow or erratic breathing, and blue lips and fingertips — then call 911 and administer naloxone. Encourage your son or daughter to surround him or herself with trustworthy people who understand that Good Samaritan laws offer protection in most states should something go wrong.

If you need help in determining a course of action or addressing waitlists for treatment or gaps and denials in services, please reach out to one of the Partnership for Drug-Free Kids’ trained and caring parent specialists on our Parent Helpline (855-DRUGFREE). ■ SOURCE: PARTNERSHIP FOR DRUG-FREE KIDS

PHOTO: DAVID WERBROUCK

How Can I Prevent My Child From Overdosing?

BIG IDEAS | MEDIAPLANET | 7

How Teen Filmmakers Are Creating a Movement to Educate Their Peers About the Risks of Opioid Misuse SPONSORED

One of last year’s most powerful PSAs about the opioid epidemic came from an unexpected source: three Connecticut teens.

Hard work, big payoff What started as a class assignment quickly became a passion project of long hours, rewrites and late nights that extended past the completion of the course. It was also an education in the opioid epidemic. “I didn’t realize it was that big of a problem until we started getting into research for the video,” shares Kyle, the film’s director. “We were shocked.”

Their video conveys all-too-real truths about an epidemic that cuts across socioeconomic lines.

In the boys’ minute-long PSA, “The Cork Board,” a teenager is pulled away from time with his younger brother because of an addiction to prescription pills.

“Life is a collection of memories,” says the narrator. “Using opioids distracts you. They pull you away from what’s important ... Don’t

PHOTO:COURTESY OF DISCOVERY EDUCATION

Kyle Citrin, Clay Knibbs and Carter Soboleski learned about Operation Prevention’s video challenge in a video production class at Daniel Hand High School in Madison, Connecticut.

let your life get swallowed up by an opioid addiction.”

The power of peer learning The annual video challenge is part of a joint prevention effort

by Discovery Education and the Drug Enforcement Administration (DEA). The initiative, called Operation Prevention, is available to every school, home and state in the nation to help fight prescription opioid misuse and heroin use through free to access and easy-touse educational resources tailored for elementary, middle and high

schoolers. The goals, notes Marty Creel, vice president of curriculum and instruction for Discovery Education, are to “inspire teens to research the opioid epidemic, document its widespread impact and spark a social movement that deepens the conversation about this critical issue.”

The video challenge in particular relies on an age-old principle: the power of peer-to-peer learning.

“Teens often look to other teens to form their opinions and can help discourage prescription drug abuse before it starts,” explains Creel.

To Kyle, Carter and Clay, that made sense. “Coming from an adult, [messaging about the opioid epidemic] can go in one ear and out of the other,” says Clay, who portrayed the older brother in the film. “They’re just telling you statistics.” “Teens can relate more to hearing a message from other teens,” Kyle adds. “It’s not just adults saying ‘don’t do this.’ It’s a closer relationship.”

A winning message The challenge also strives for inclusivity by meeting teens on a

platform they’re used to — their cell phones. “Students seem to enjoy viewing videos more than texting,” says TJ Salutari, the principal of Daniel Hand High School. “The video challenge allows students to use technology and create a powerful message while using a platform that is of high interest.”

To create a message that would truly impact their peers, the students knew they needed a unique angle. “We had to make it so teens didn’t just see this and think ‘whatever,’” notes Clay.

“We had to make it seem like, ‘this could happen to me because I have a sibling,’ or ‘I could do this to my siblings.’ And we learned that it’s not just the siblings who are affected, it’s friends and families, too.”

The “Cork Board” beat out hundreds of submissions to win its creators a first place prize of $10,000. Additionally, it beat out nine other finalists for the People’s Choice Prize, an exclusive tour of the DEA Training Academy.

When teens engage with one another on difficult topics, they have the power to send waves across an entire student body that resisting drugs is what’s truly cool. “In addition to several of their family members, more than 600 students attended an assembly where the results were announced,” recalls Salutari. “The audience was electric. Kyle, Clay and Carter received a well-deserved standing ovation that lasted for several minutes.”

You can get involved and take the pledge to prevent opioid misuse today at OperationPrevention.com. n

By Emily Gawlak

8 | FUTUREOFPERSONALHEALTH.COM | CONVERSATION

Using Language and Science to Better Understand Addiction A more thorough understanding of the science of addiction as well as changing the language used to describe it can lead to more compassionate and effective treatment.

Advances in brain imaging technologies and other related sciences continue to improve our understanding of addiction.

Rather than a moral failing, we now know that substances such as nicotine, alcohol, opioids and

even sugar change the biology of the brain. For some, these biological stresses can be difficult to overcome without medical assistance, particularly in the case of opioid addiction.

The definition of addiction Addiction is a chronic brain disease that causes a person to compulsively seek and use substances. Just as leaving cardiovascular disease untreated can damage the heart or lead to death, addiction that

is not addressed can have a dramatic negative impact on the brain’s structure. Imaging studies of brains in people with addiction compared to those without show changes in the regions critical to decisionmaking, learning and memory.

Because addiction hijacks the brain’s ability to appropriately respond to pleasure or pain, the classic symptom of addiction is impaired self-control. This helps explain why people with addictions continue to use

drugs even when they know the inherent harm.

Not everyone who uses drugs will become addicted. Some studies suggest about half the risk is genetic, but tends to increase when combined with a range of other environmental and developmental factors. Adolescents are at greater risk because their developing brains are more vulnerable to structural changes.

People with serious mental disorders such as schizophrenia, which implicates some of the

same circuitry as addiction, are also at greater risk.

Vocabulary of addiction As the view of addiction shifts from a moral failing to a medical condition, the language used to describe addiction is also changing. Saying “a person with an addiction” instead of “an addict” helps separate the person from the disease and is not punitive. ■

By Tom Hill, M.S.W., Vice President, Addiction and Recovery, National Council for Behavioral Health

STRATEGY | MEDIAPLANET | 9

To Stem a Crisis, Bringing Medication to Market Is Only the Beginning The U.S. Food and Drug Administration (FDA) is working to prevent new cases of opioid addiction and help treat those already suffering from an opioid use disorder.

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Increasing treatment access The FDA plays a critical role in the approval of opioid addiction treatment medications. There are currently three FDA-approved medication-assisted treatment drugs — methadone, buprenorphine and naltrexone — that have been demonstrated to be safe and effective in combination with counseling and psychosocial support, and we also intend to issue new guidance to spur additional treatment options.

But ensuring high-quality, effective treatments are on the market is only the beginning.

These proven medications are only effective if we can get them to those in need. Unfortunately, many people suffering from addiction aren’t offered an ade-

PHOTO: COURTESY OF THE FDA

illions of Americans are suffering from addiction to opioid drugs, and millions more live in fear that a friend or loved one could succumb to an overdose. While we need to take new steps to prevent new cases of addiction and break the cycle of opioid abuse, the staggering scope of this crisis underscores the immediate need to help those already suffering from an opioid use disorder transition to lives of sobriety.

quate opportunity for treatment.

We believe that everyone who seeks treatment should have the ability to work with their health care provider to select the treatment best suited to their needs, and our Substance Abuse and Mental Health Services Administration colleagues are doing important work on this front.

At the same time, we’re also taking action against those selling unproven, unapproved products

claiming to treat or cure opioid addiction and withdrawal, which may delay real treatment or cause undue harm.

Changing false perception Part of our work to ensure access to, and wider use of, approved treatments is also using our platform to tackle the unfortunate stigma that is sometimes associated with their use. The stigma reflects a view

some have: that a patient is still suffering from addiction even when they’re in full recovery, just because they require medication to treat their illness, craving and withdrawal symptoms.

Addiction is defined as more than physical dependence; it often includes psychological craving and ongoing use despite harmful consequences. Among other effects, medication-assisted treatment can help manage these

dangerous symptoms, which can in turn help prevent relapse and help return patients to their jobs and families.

Given the scale of the opioid epidemic, we must devote equal vigor to both preventing new addiction and ensuring access to potentially lifesaving treatment for those currently addicted. n

By Scott Gottlieb, M.D., Commissioner, Food and Drugs, U.S. Food and Drug Administration

10 | FUTUREOFPERSONALHEALTH.COM | SPOTLIGHT

In the short time he’s held office, the nation’s doctor has proven himself a fierce opponent of the nation’s opioid crisis. He addresses the work being done to eradicate stigma and save lives.

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n September 5, 2017, Jerome M. Adams, M.D., M.P.H., was sworn in as the 20th Surgeon General of the United States. In the months since, Adams has not only addressed the growing magnitude of opioid addiction, he’s developed and committed his office to a threepart approach to take aim at our nation’s unprecedented, indiscriminating epidemic.

A personal connection to crisis “The role of the surgeon general

is to educate the American people about the severity of the opioid epidemic and the steps that each and every person can take to respond,” Adams told Mediaplanet.

“We know that the only way we’re going to turn this thing around is by everyone owning their part of it and not pointing fingers. One of the things I’ve tried to help people understand is that addiction touches all of us. People with opioid use disorder are our friends, our neighbors, our family.”

For Adams, this isn’t just a political talking point. His

PHOTO: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Surgeon General Jerome Adams Outlines His Plan to Halt an Epidemic

Adams worked as an anesthesiologist before beginning his career in public office as Indiana State Health Commissioner in 2014, and shares a principle learned during his time spent at a level one trauma center. “You come across a person in the street bleeding, you’ve got to put a tourniquet on them to stop the bleeding before you can get them into surgery. Naloxone is that tourniquet for someone who’s suffering from an overdose. It allows us to get them into a more definitive and long term treatment.”

Currently, 49 out of 50 states have laws that make naloxone available through standing order at a pharmacy, which breaks down barriers to access and, Adams stresses, means “everyone can save a life by understanding and possessing naloxone.”

younger brother, Phillip, has been in and out of prison due to crimes stemming from substance use disorder. “Even as the Surgeon General, I’m not immune to this,” he shares. “I was not able to prevent my family from going down the pathway of addiction.”

Step one: normalize naloxone The first step in Adams’s plan is increasing public awareness about naloxone, a medication that exists as both an injectable and a nasal spray and rapidly reverses the effects of an opioid overdose.

Step two: educate To Adams, the second step of his plan goes beyond spreading statistics and fact sheets. Through education, Adams believes we can lower the deadly impact of the stigma that surrounds substance use disorder. “Addiction is a chronic disease that must be treated with skill, urgency and compassion,” he explains. “The same way we look at other diseases like diabetes, hypertension and cardiovascular disease.”

Adams cites a statistic that half of Americans say they know someone addicted to prescription painkillers. Yet half of Americans also don’t believe there’s effective, long-term treatment — and stigma plays a role in that discrepancy. Evidence validates medication-assisted treatment, or MAT, which combines medication with behavioral support. “For opioid use disorder, the standard of care is medication-assisted treatment,” Adams notes. “But of the hundreds of specialty treatment programs in the United States, only about 1 in 3 offers MAT.” “Stigma that’s attached to addiction makes people think of MAT as enabling drug use,” he explains.

“They want people to quit cold turkey.” But, he points out, “we don’t tell someone who has diabetes,

‘You can’t have insulin. You’ve just gotta deal with it on your own without any medical support.’ We’ve got to turn that around.”

Step three: prevent The final step, Adams explains, is prevention. This includes “working with health professionals to promote safe prescribing practices and trying to help patients and providers understand the benefits of opioid alternatives, as well as how to safely dispose of and to store prescription opioids.”

“We all have a role in preventing drug use before it starts,” Adams adds. “That starts with acknowledging that opioid misuse is dangerous for kids and adults. We tend to think that because these pills came from a doctor at some point, they’re somehow safer than heroin.

We now know that’s not true.”

Compassion as cure Over the course of his brief time in office, Adams has traveled the country, observing first hand stories of both tragedy and triumph.

“Although we face tremendous challenges as a nation, there is hope. People can and do recover.”

He shares the story of Jonathan from Rhode Island, whose father and brother both died of an opioid overdose. Jonathan would have died too, but was brought back from a near-fatal overdose with naloxone. Now he works at a recovery outreach program, helping others through the lifelong process of recovery.

“Jonathan said to me,” recalls Adams, “‘The opposite of addiction is not sobriety, it’s connectedness.’” To Adams, this message is key. “Have the courage to talk about opioid addiction,” he says.

“Just bring it up. You don’t have to have all of the answers, but you at least need to have a discussion.”

If, as a nation, we can reach out to those suffering with empathy and support, we just may be able to overcome crisis. And with his intellect, compassion and sense of urgency, Adams just may be the man to lead the way. ■

By Emily Gawlak

WHAT’S TRENDING | MEDIAPLANET | 11

No Pain, All Gain: The Movement Away From Opioids After Surgery As the opioid crisis generates alarming stats, surgeons radically rethink their pain management approach with new tools.

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program because the patient asked for it.’”

Patients have options and the right to make informed decisions about their care and pain management. If you or a loved one is considering surgery, ask about a pain management plan and what can be done to minimize exposure to opioids.

Learn more about reducing opioids after surgery at https://www. exparel.com/patient/index. n

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he opioid epidemic is an emergency in this country — according to the U.S. Department of Health and Human Services, in 2016 more than 100 people died every day from opioid-related drug overdoses. One of the most common vectors for addiction isn’t as widely-known: the operating room. Ninety percent of patients receive opioids for pain management after surgery, and studies have shown that 1 in 10 of them will go on to long-term opioid use. That means nearly 3 million new opioid users are emerging from the operating room every year — many of whom are overprescribed to begin with.

The medical community is taking notice, however, and adopting new, effective non-opioid pain management solutions.

The problem with overprescribing Paul Sethi, M.D., an orthopedic surgeon specializing in sports medicine and president of the ONS Foundation for Clinical Research and Education, says doctors overprescribe opioids out of a desire to ensure the needs of their patients are covered, “But then we over-prescribe and contribute to the problem of diverted medications,”

By Jeffrey Somers

Important Safety Information

he notes. “I said, ‘I need to look at strategies where I can have fewer pills from prescriptions that I write get into circulation.’”

The subject is a personal one for A. Omar Abubaker, D.M.D., Ph.D., an oral and maxillofacial surgeon and professor and S. Elmer Bear chair at Virginia Commonwealth University. His own son, Adam, became addicted to opioids after a surgery and died of an overdose at the age of 21. Dr. Abubaker agrees that over-prescribing is part of the problem.

“Almost every study done shows the average oral surgery patient consumes only between 6 to 8 tablets of opioids,” says Dr. Abubaker. “If I anticipate a patient will have pain because of a difficult procedure, or if they’re lower-risk of addiction, then I give a prescription for an opioid. But I have not written a prescription for more than six to eight tablets over the

last six months, and I have not had people coming back.”

Moving away from opioids Richard Chudacoff, M.D., OB/ GYN, of Moore County Obstetrics and Gynecology in Dumas, Texas, has avoided opioid use when appropriate, using a local anesthetic made by Pacira Pharmaceuticals called EXPAREL (bupivacaine liposome injectable suspension) when he performs cesarean sections. When injected during a procedure, the product releases a numbing medication directly at the surgical site to control pain over a prolonged period of time to reduce, or in some cases, eliminate, the need for opioids.

“Studies show us that patients who get up and moving and out of the hospital quicker do better than patients who stay in the hospital. This is particularly import-

ant for new mothers, and opioids often get in the way of this goal.”

Dr. Sethi also incorporates EXPAREL as part of a low-opioid p a i n m a n a g e m e n t s t r a t e g y. “ We’re using non-opioid oral medications, anti-inflammatory medications and then EXPAREL as an adjunct solution,” he says.

“My experience is that the pain is just as effectively managed with opioid alternatives.”

Patients who know what their non-opioid options are after surgery — or that there even are such options — are in a much better position to drive the conversation with their health care providers. Based on his own experience, Dr. Chudacoff agrees that educated patients are key to advocating for better pain management in the future. “I had one doctor call me up who said, “I need to know how to implement a non-opioid pain management

EXPAREL should not be used in obstetrical paracervical block anesthesia. In studies with EXPAREL, the most common side effects were nausea, constipation, and vomiting.

EXPAREL is not recommended for use in patients younger than 18 years of age or in pregnant women.

Tell your healthcare professional if you have liver disease as this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from your body. EXPAREL should not be injected into the spine, joints, or veins. Other local anesthetics should not be injected immediately after injecting EXPAREL; this may lead to an immediate release of the active ingredient in EXPAREL. The active ingredient in EXPAREL can affect your nervous and cardiovascular system, may cause an allergic reaction, and/or if injected into your joints may cause damage to the joints. © 2018 Pacira Pharmaceuticals, Inc. PP-EX-US-3465 3/18

12 | FUTUREOFPERSONALHEALTH.COM | TIPS & TRICKS

4 Ways Patients Can Push for Safer Pain Management Drug overdose is the number one cause of preventable death in the United States, and opioids remain at the heart of this epidemic. Become a smarter patient with these tips.

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pioid-related misuse, addiction, overdose and death can happen to anyone, even when these medications are used under the care of a doctor. In fact, 4 out of 5 new heroin users started by misusing opioid pain medications.

But a few simple steps can make a difference and help keep you and your loved ones safe.

Here are four ways patients can take action to help fight this epidemic.

1. Use an “Opioids: Warn Me” label.

One in 3 Americans surveyed by the National Safety Council d i d n o t k n ow tha t the m ed i c i n e s t h ey we re p re s c r i b e d were opioids. You can start a conversation with your doctor by placing an “Opioids: Warn Me” label on your insurance and pharmacy cards. These labels tell your doctor you want to know what you are being prescribed.

Order your “Warn Me” label at nsc.org/takeaction.

2. Ask about alternatives.

Once you start the conversation, ask your doctor about alternatives to opioid pain medications and compare your options. For example, one ibuprofen and one extrastrength acetaminophen, when taken together, are just as effective as opioids at treating acute pain.

3. Ask for a short prescription.

If opioids are necessary, ask for the minimum amount required for the shortest duration. Many

doctors prescribe a 7 to 10 day supply, but a three-day prescription of opioid pain relievers is typically sufficient.

4. Safely dispose of unneeded and expired opioids.

Most opioid misusers get the drugs from family and friends, making it crucial that you remove these drugs from your medicine cabinet, rather than keeping them for future use.

Look for a safe disposal site at your local pharmacy or police station.

Though you might not see yourself as a part of the opioid crisis, you, your neighbors and your loved ones could easily become involved.

To stay safe, don’t be afraid to speak up about these risks, ask your doctor about alternatives and encourage your family and friends to do the same. This epidemic claims more than 100 lives every day, and it will take all of us to end it. To learn more, go to stopeverydaykillers.org. ■

By Jenny Burke, Senior Director, Advocacy, National Safety Council

16 | FUTUREOFPERSONALHEALTH.COM | POSSIBILITY

MEDIAPLANET

PHOTO: MARANATHA PIZARRAS

A Private Sector Solution to the Opioid Epidemic

As the opioid epidemic continues to ravage our country, the private sector is working to change the landscape of addiction treatment in the United States.

In 2016, 20.1 million Americans had a substance use disorder. Two million of them were addicted to

opioids — including prescription and illicit drugs. Opioid overdoses ravaged America, taking the lives of over 42,000 people in 2016 alone, marking a 25 percent increase from 2015 and the worst year on record.

This isn’t just another statistic. It’s lost children, moms and dads. And it’s an added reminder

of how addiction differs from other chronic illnesses. Even though addiction can be managed effectively with medical treatment, only 1 in 10 Americans with this disease ever receives care. And the few who do often receive substandard care or advice that is not based on research.

Incentivizing quality Recognizing this gap, Shatterproof adopted a businesslike approach and brought together insurers, providers, advocates and other stakeholders to improve access to quality treatment. As a result of the work of this Task Force, 16 insurance companies representing more than 248 mil-

lion individuals agreed to adopt eight National Principles of Care for the treatment of addiction.

By signing-on to these standards, insurers have committed to identify, promote and reward addiction treatment that is shown to improve a patient’s life. Together, they will use their market influence to incentivize high-quality practices while making a strong statement: addiction will be treated with the same urgency and respect as other diseases.

Modeling better care Shatterproof is also working to bring transparency and credibility to the system of addiction treatment. Recognizing that family members and friends often don’t know where to direct a person in crisis for the best type of treatment, we are adapting strategies from other health care sectors. This will help consumers locate care, help insurers decide which providers to include in their networks and help programs identify any areas for improvement.

Addiction is not a moral failing or a character flaw, and it is necessary that we take steps as a society to reverse the long-engrained stigma associated with this disease. Improving access to treatment that saves lives is the only way to prevent more tragedy. Shatterproof is changing the landscape of addiction treatment in the United States by removing barriers and moving toward proven medical treatment. n

By Gary Mendell, Founder and CEO, Shatterproof

18 | FUTUREOFPERSONALHEALTH.COM | BRIDGING GAPS

Understanding the WholeFamily Impact of Addiction With the opioid crisis hitting epidemic proportions, the effects of the mounting casualties are far-reaching.

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or every person battling a dependency on opioids, there are likely loved ones suffering in silence. All should be part of the treatment equation.

“Addiction is a family disease, and family education and therapy are critical for recovery,” explains Joseph Garbely, D.O., the vice president of medical services and medical director of Caron Treatment Centers. “Treatment works best when it is structured to care for the health of the entire family system.”

Troubling statistics According to the National Institute on Drug Abuse, approximately 21 to 29 percent of patients prescribed opioids for chronic pain misuse them. Between eight

and 12 percent develop an opioid use disorder.

“Every day, more than 115 Americans die after overdosing on opioids,” says Dr. Garbely. “All facets of society are impacted, from criminal behavior to productivity in the workplace. We need to expand education, prevention, research and improved access to treatment.”

Understanding the problem Opioid addiction is complex and chronic, affecting individuals from all walks of life. Each case is unique, with no room for stereotypes or judgments.

“Addiction is not a sign of weakness or a moral failing,” Garbely points out. “It’s critical we remove the stigma and shame associated with addiction because it often prevents people from asking for

MEDIAPLANET | 19

help and getting the treatment they so desperately need.”

No shortcuts Garbely says medication-assisted treatment can provide patients with relief, but it’s not a panacea.

“Medication must be used as a supportive tool and managed by qualified health care professionals in collaboration with a patient’s treatment specialists, as part of a comprehensive therapeutic program.

“There’s no silver-bullet solution, but we can continue to save tens of thousands from death and offer hope to millions of families across the country watching their loved ones struggle with this disease. To do this, we need to make the most successful solutions available to as many people as possible.” n

By Cindy Riley

20 | FUTUREOFPERSONALHEALTH.COM | INNOVATION

MEDIAPLANET

These Scientific Advances Could Be the Solution to the Opioid Overdose Epidemic In the battle against opioid addiction and overdose, scientists are exploring every avenue and making important strides.

The opioid crisis is devastating American families and communities, claiming the lives of more than 100 people in America each day. The Director of the National Institutes of Health (NIH), Dr. Francis Collins, and I recently announced that we would leverage partnerships between NIH and private industry as well as regulatory agencies to cut the time it takes to develop new treatments in half to help end this crisis. Those include new medications to treat opioid addiction, new overdose-reversal and overdose-prevention tools, and effective, safer pain medications.

Improving medications In one or two years, we can anticipate new formulations of the existing addiction medications buprenorphine, methadone and naltrexone. This includes long-lasting “depot” injections so people who do not live close to a treatment facility can take advantage of these effective medications and better comply with their treatment. Vaccines, which bind to opioids in the bloodstream to prevent them from reaching the brain, are another innovative new tool that will take longer to develop. In addition, NIH remains committed to studying new and effective ways behavioral therapies can support adherence to medications and promote sustained recovery.

Also on the drawing board are new overdose-reversal tools, including stronger and longer-acting formulations of naloxone and other compounds.

These can reverse overdoses of powerful synthetic opioids like fentanyl. Other research will focus on the development of wearable devices that can detect an overdose when it is occurring and automatically intervene and signal for help.

Securing funding Freeing the medical field from its reliance on addictive opioid analgesics is especially urgent, and a combination of publicly and privately funded science will help us achieve this goal. New opioid compounds that block pain without addiction or overdose risk are already being studied.

Compounds targeting the body’s other pain-signaling systems, such as the endocannabinoid

system, are another promising approach. We have also been funding research into high-frequency repetitive transcranial magnetic stimulation and related technologies that could greatly improve quality of life for chronic pain patients without using medications at all.

The opioid crisis may look daunting, but there is much reason for hope. Science will find a solution — probably many solutions

— to this crisis. NIH and our industry partners are committed to an “all scientific hands on deck” approach to accelerate this work to prevent overdose deaths, support long term recovery from opioid addiction and ensure that pain treatment is not a pathway to addiction. n

By Nora D. Volkow, M.D., Director, National Institute on Drug Abuse, National Institutes of Health

22 | FUTUREOFPERSONALHEALTH.COM | CHALLENGES

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Diagnosing and Treating America’s Problem With Pain Management People with chronic pain need to be able to work with their health care providers to access complementary pain treatments that optimize quality of life.

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n estimated 25 million Americans experience chronic pain every day. For many, this pain interferes with their physical and mental health, work productivity and ability to engage in family and community activities. Some people with pain are prescribed opioids, when alternative pain treatments may be effective and safer. At the same time, some people suffer chronic and complex pain syndromes and are prescribed opioids, often after trying alternatives that fail to relieve pain. Understanding that these groups are different is important because they require

different approaches for pain management.

Rethinking pain management Better pain management is one strategy in the 5-Point Strategy to Combat the Opioid Crisis at the U.S. Department of Health and Human Services (HHS). Transforming how we treat pain and adjusting the role opioid medications play in pain care are critical components in our efforts to reduce opioid harms while improving the quality of life for people living with chronic pain.

As the nation seeks solutions to the complex opioid crisis, it is critical that we balance our policy and clinical practice strat-

egies to ensure people suffering with pain receive high-quality, evidence-based care while also working to reduce stigma, opioid misuse, addiction and overdose.

Physicians and other health professionals can help by better assessing social, psychological and other factors that can support successful pain management and improvement in quality of life; and then by identifying risk factors for adverse outcomes. A coordinated team of health professionals from diverse fields, together with patient and provider education, help people with chronic pain access more effective treatment plans and experience better outcomes.

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From research to practice As insurers start covering more non-opioid medications, medical procedures and medical devices to treat pain, increasing numbers of patients will have access to multiple and complementary treatments. To help inform coverage decisions, advancing evidence-based practices is needed.

This can include research to better understand how the brain is involved in pain and addiction, and to quickly translate that understanding into improved treatments that provide relief and restore function.

Addressing the complex opioid and pain crises in America requires patient-centered solu-

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tions. HHS is committed to bringing its expertise and resources to bear in this fight, including the creation of the Pain Management Best Practices Inter-Agency Task Force to identify gaps in pain management practices and propose recommendations on addressing gaps to relevant federal agencies and the general public. n

By Vanila M. Singh, M.D., M.A.C.M., Chief Medical Officer, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services; Christopher M. Jones, Pharm.D., M.P.H., Director, National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services

SOLUTIONS | MEDIAPLANET | 23

How Non-Opioid Pain Alternatives Are Providing Relief for Cancer Patients With the use of radiopharmaceuticals, pain from bone metastases in breast, prostate and lung cancer doesn’t have to come with severe side effects.

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pwards of 90 percent of patients with breast, prostate and lung cancer develop bone metastases at some point while battling their disease, according to an article in Pain Medicine News. And with that development comes unbearable, often unrelenting pain as the cancer spreads into the bone marrow.

While standard of care usually means using opioids, which provide relief by dulling the brain,

non-opioid alternatives for cancer exist — and they pose fewer side effects, last longer and, in some cases, are more effective than their opioid counterparts.

One such treatment, Strontium-89 Chloride, is an injectable non-opioid radiopharmaceutical for bone pain from metastasized cancer, and can offer benefits lasting several months as opposed to morphine’s effect of only a few hours, says Dr. Stanley Satz, co-founder of Bio-Nucleonics, Inc. and a developer of the drug.

“Patients see relief in one to two weeks that can last up to six months,” Satz says, “and they don’t have the side effects of opioids.”

How non-opioid cancer treatment works After an intravenous injection, Strontium-89 behaves like calcium, moving quickly from the blood and selectively localizing

in the bone and preferentially in sites of active growth and bone formation; the primary bone tumors and areas of metastatic involvement (blastic lesions) can accumulate significantly greater concentrations of strontium than surrounding normal bone.

Strontium-89 is retained in metastatic bone lesions much longer than in normal bone, where it selectively irradiates sites of primary and metastatic bone involvement with minimal effect on soft tissues distant from the bone lesions.

David Laskow-Pooley, vice president of product development at Q BioMed Inc., the specialty pharmaceutical company that has licensed and is commercializing Strontium-89, says, “When Strontium-89 is injected, the bone rapidly absorbs the drug. It releases its energy over a very small distance, which envelops the cancer with very

little of the adjacent tissue being affected. It is this energy that removes the pain and indeed where damage to cancer cells have been observed,” he says.

Other benefits of choosing opioid alternatives Satz says Strontium-89, which is FDA approved and Medicare reimbursed, provides benefits beyond those of other non-opioid solutions, such as thermal radiation, as this treatment isn’t appropriate if cancer has spread throughout the body. “Thermal radiation is good for a single lesion, but not if you have multiple metastases where Strontium-89 Chloride injection is a better treatment option.”

“Opioid therapy is not only addictive but also severely adversely affects the patient’s quality of life mentally and physically,” Pooley says. “Additionally, opioids depress the activity of a

large number of organs in the body.

These not only affect body function in the short term but can lead to consequential and catastrophic problems, severely impacting quality of life in the later stages of disease progression.”

In clinical trials, the number of patients classified at each visit as treatment successes (patients who were pain free at the index site and required no analgesics) was consistently higher in the Strontium-89 group and new pain sites were less frequent in patients treated with Strontium-89.

The United States faces an increasingly dire opioid abuse epidemic, with tens of thousands of drug overdoses reported overall in 2016, according to the Centers for Disease Control and Prevention.

In this context, non-opioid solutions in cancer care serve a timely and valuable purpose. n

By Melinda Carter

INDICATIONS AND USAGE STRONTIUM CHLORIDE SR-89 INJECTION, USP IS INDICATED FOR THE RELIEF OF BONE PAIN IN PATIENTS WITH PAINFUL SKELETAL METASTASES. THE PRESENCE OF BONE METASTASES SHOULD BE CONFIRMED PRIOR TO THERAPY. CONTRAINDICATIONS NONE KNOWN. WARNINGS USE OF STRONTIUM-89 CHLORIDE INJECTION IN PATIENTS WITH EVIDENCE OF SERIOUSLY COMPROMISED BONE MARROW FROM PREVIOUS THERAPY OR DISEASE INFILTRATION IS NOT RECOMMENDED UNLESS THE POTENTIAL BENEFIT OF THE TREATMENT OUTWEIGHS ITS RISKS. BONE MARROW TOXICITY IS TO BE EXPECTED FOLLOWING THE ADMINISTRATION OF STRONTIUM-89, PARTICULARLY WHITE BLOOD CELLS AND PLATELETS. THE EXTENT OF TOXICITY IS VARIABLE. IT IS RECOMMENDED THAT THE PATIENT’S PERIPHERAL BLOOD CELL COUNTS BE MONITORED AT LEAST ONCE EVERY OTHER WEEK. TYPICALLY, PLATELETS WILL BE DEPRESSED BY ABOUT 30% COMPARED TO PRE-ADMINISTRATION LEVELS. THE NADIR OF PLATELET DEPRESSION IN MOST PATIENTS IS FOUND BETWEEN 12 AND 16 WEEKS FOLLOWING ADMINISTRATION OF STRONTIUM-89 CHLORIDE INJECTION. WHITE BLOOD CELLS ARE USUALLY DEPRESSED TO A VARYING EXTENT COMPARED TO PRE-ADMINISTRATION LEVELS. THEREAFTER, RECOVERY OCCURS SLOWLY, TYPICALLY REACHING PRE-ADMINISTRATION LEVELS SIX MONTHS AFTER TREATMENT UNLESS THE PATIENT’S DISEASE OR ADDITIONAL THERAPY INTERVENES. IN CONSIDERING REPEAT ADMINISTRATION OF STRONTIUM-89 CHLORIDE INJECTION, THE PATIENT’S HEMATOLOGIC RESPONSE TO THE INITIAL DOSE, CURRENT PLATELET LEVEL AND OTHER EVIDENCE OF MARROW DEPLETION SHOULD BE CAREFULLY EVALUATED. VERIFICATION OF DOSE AND PATIENT IDENTIFICATION IS NECESSARY PRIOR TO ADMINISTRATION BECAUSE STRONTIUM-89 DELIVERS A RELATIVELY HIGH DOSE OF RADIOACTIVITY.

24 | FUTUREOFPERSONALHEALTH.COM | INDUSTRY PERSPECTIVE

Experts Speak Up on the Scope of, Stigma Around and Solutions for Our Public Health Crisis

PHOTO: ALEC DOUGLAS

Mediaplanet gathered a panel of leading voices in the substance use space to discuss the impact of stigma, offer advice on discussing addiction with a loved one and inspire hope for recovery.

What is the scope of the opioid problem in the United States?

Deni Carise: The scope of the

opioid problem is tremendous.

Deaths in the United States from

drug overdose increased 21 percent last year alone, and for the second consecutive year, overdose deaths have reduced the average life expectancy in the United States.

Also, in the past year, fentanyl and

its analogues were responsible for more deaths than prescription pain medications and heroin. This is a major shift in the landscape, as 115 Americans die every day from an opioid overdose.

Ranndy Kellogg: The CDC reports that the issue has directly contributed to a drop in United States life expectancy, which fell by 0.1 years for the second year in a row to 78.6 years in 2016, and the CDC is concerned that the decline looks likely to continue for a third consecutive year. The estimated economic burden of prescription opioid misuse in the United States is $78.5 billion a year, including the costs of health care, productivity lost, addiction treatment and criminal justice involvement.

Opioid addiction has become a serious national crisis that affects public health as well as social and economic welfare.

Maria G. Guevara: According to the Substance Abuse Mental Health Services Administration’s (SAMHSA) annual National Survey on Drug Use and Health, in 2016, 21 million people needed treatment for an illicit drug or alcohol use problem, which accounts for 7.7 percent of the U.S. population aged 12 or older. Of these, only 2.2 million received treatment at a specialty facility, and 1.8 million reported opioids as their primary substance of choice. The Department of Health and Human Services (HHS) reports that 90 percent of Americans struggling with substance use disorders (SUDs)/addiction are not currently receiving treatment.

Javier

What solutions are being developed to address this public health crisis?

Francisco

Vilasuso:

The severity of the opioid crisis in today’s health care system cannot be overstated. In order to understand the impact, patients need to realize the toll it has taken on our population.

Over the last several years, the worsening of this trend was attributed to be a combination of heroin and illicitly made fentanyl. Due to the escalating use, abuse and diversion of opiate medications, a negative perception has grown, affecting the ability of patients with severe acute and chronic pain symptoms to achieve adequate pain control. Many patients today are not appropriately diagnosed and treated. Subsequently, they are mismanaged, rendering them susceptible to increased pain and dependence on opiates.

DC: Some aspects of the crisis

are getting better. The expansion and even interstate availability of Prescription Drug Monitoring Programs allows physicians to monitor whether their patients have been prescribed opioids and other medications from multiple physicians, thereby greatly decreasing the chances that a patient can get multiple prescriptions for the same medication by several providers. Additionally, physicians are being educated (by someone other than the pharmaceutical companies) on the true dangers and correct uses of opioid pain relievers as well as alternatives to opioid use for pain. As a result of both of these

MEDIAPLANET | 25

Deni Carise, Ph.D. Chief Scientific Officer, Recovery Centers of America

initiatives, prescribing of opioids is going down significantly.

RK: Pain management technology

now offers a clear alternative to opioid medication. There are currently many safe, effective, drug-free alternatives to pain management on the market. TENS (transcutaneous electrical nerve stimulation) technology has been used by physical therapists and pain specialists for years as a drug-free pain management alternative, and it’s now accessible to those seeking drug-free pain relief at home. This technology blocks pain signals to the brain, providing instantaneous and safe relief from pain. With more awareness of alternative options on the market, pain sufferers no longer need to see opioids as their only option for relief.

JFV: Through clear communica-

tion and education, potential side effects and dangers of overuse and abuse of opioid medication become minimized. Abuse deterrent medications are also a focus which our practice has adopted.

These medications are created to prevent overdose and aberrant use of opiates such as crushing or injecting. Interventional pain procedures have been used as a way to effectively treat and diminish the dependence of opioids. These techniques include but are not limited to epidural steroid injections, selective nerve root blocks, sympathetic nerve blocks, facet and peripheral nerve ablation.

MG: The solutions being created are multi-pronged in approach.

The HHS has focused its efforts on five major priorities. These

Ranndy Kellogg President and CEO, Omron Healthcare

include improving access to SUD treatment, promoting use of overdose-reversing drugs (such as naloxone), surveillance to better understand the epidemic, support for research in pain and addiction and advancement of pain management practices. There have been numerous state and federal committees formed in response to the crisis. Legislation has expanded access to medication-assisted treatment for SUDs, and programs at the state and community level are promoting the use of naloxone for emergency response teams and in some cases, for family members of opioid users.

What drives negative perception of the disease and those suffering from a substance use disorder? How does stigma create barriers to treatment and recovery — and what is the impact?

DC: The stigma associated with

substance use disorders is perpetuated by the history of the field, the language we use and by the intense focus on the activities of those who relapse as opposed to those who get well. The National Institute on Drug Abuse has defined addiction as a chronic, relapsing brain disease. Legislation in health care has deemed its treatment one of 10 essential benefits that must be covered by health insurance providers. Both of these have solidified its status as a medical problem. Keep in mind, it wasn’t that long ago that cancer and tuberculosis were heavily stigmatized diseases. When that stigma starts to decrease, more people seek treatment.

Javier Francisco Vilasuso, M.D. Member, American Board of Anesthesiology

RK: Addiction is often misunderstood. Fear of the stigma that comes with that misunderstanding may keep someone in the early stages of opioid addiction from seeking help. There is greater understanding behind the cognitive functions associated with addiction, but it can still be viewed as a personal weakness or a moral shortcoming. This association is reflected in recent statistics that show that only a small percentage of Americans with substance use disorders receive treatment.

For some, the ongoing stigma prevents them from seeking the medical attention they need, but for others, their access to addiction treatment may be limited.

JFV: Like many pain medicine practices throughout the country, we understand the difficulty of balancing pain control despite the social stigmas associated with pain medication. Non-opiate medications, which address nerve, musculoskeletal and inflammatory pain are also essential to effectively spare the necessity of solely relying on a single opiate based treatment. By adopting a multimodal approach including physical therapy, behavioral modification, medication management and procedural treatments, we are able to lessen dependence on pain medications.

MG: Despite decades of research, there is still the perception that SUDs are a weakness, a choice and not a “real disease.” There is also a misconception that abstinence from a drug (simple sobriety) can cure a person of addiction. The American Society

of Addiction Medicine defines addiction (SUD) as a “primary, chronic disease of brain reward, motivation, memory related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.” Essentially, SUD is a chronic brain disease requiring a multi-pronged, lifetime, individualized approach to treatment, and should be approached as such by health care professionals and society.

Maria G. Guevara, Pharm.D. Director, Clinical Affairs Education and Training, Millennium Health

is difficult but necessary. Start with acceptance and an openness to provide encouragement and support. Do your research to support your loved one on their recovery journey, not only to understand what they are going through but also what options are available for them. There are professional therapists and support groups who can provide information on structured recovery programs and help those who are struggling with an opioid addiction make those important first steps to cessation and recovery.

JFV: As a society, it is crucial

How can family members and friends talk to individuals with an opioid addiction?

DC: People are often afraid to ask

others if they’re using opioids.

Their concerns range from saying the wrong thing, to having the person get angry, to worrying, “what if I ask and they say no, but they get so angry they start to use again?” Here’s the other side of that concern: what if you don’t ask and the answer is yes? The more you can state your concerns factually while not sounding judgmental, the better. I think the two most important things to remember are always ask if you have a concern and never give up. Recovery from substance use disorders is possible. In fact, the science says the more times in treatment predicts better success.

So keep voicing your concern in a loving and supportive way.

RK: Having those honest, hard

conversations with loved ones

that friends and family of opioid dependent pain patients maintain an open line of communication and seek the help of a trained pain medicine physician to optimally manage their pain.

By implementing this structured mindset in the health care community and the general population, there will be a light at the end of the tunnel for this challenging opioid crisis.

MG: It’s important to start the

conversation early. There are numerous resources available to help educate parents on the issues and equip them to discuss substance abuse with their children. For example, the Partnership for Drug-Free Kids has been educating the public on substance use for over 30 years.

Their website (drugfree.org) has a host of ideas on how to get involved in prevention efforts within the community and offer support for those who are currently facing a SUD.

26 | FUTUREOFPERSONALHEALTH.COM | ADVOCACY

For the Two Million People Suffering from Opioid Use Disorder, Help Is Out There Opioid overdose claims the lives of more than 100 people per day. But resources such as online toolkits and medication offer hope.

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eople across the country may not be aware that they’re part of an ongoing public health crisis: opioid addiction.

Take someone like Chris, who works at a local supermarket.

After surgery following a back injury, Chris’s doctor prescribed an opioid pain reliever. Chris continued to use the opioid pain reliever to feel more relaxed, to sleep and just to forget his worries. Before long, Chris developed a need for the medication even though he wanted to stop using it. When the doctor would

no longer prescribe the drug, Chris began feeling very sick without it and started using similar medications obtained from friends.

A chronic brain disorder Chris didn’t realize this was the beginning of a chronic brain disorder that, if left untreated, could be life-threatening. Opioid use disorder is a clinical diagnosis that a doctor gives to a person addicted to opioids such as prescription pain relievers or heroin. Chris is now one of two million Americans who have developed an opioid use disorder.

You or someone you care about may be like Chris, who is facing a critical situation. Preventing an overdose is the first priority, but no less important than being prepared if one should happen. In dire situations, naloxone is used as the antidote to opioid overdose. If it is administered promptly, it can reverse opioid overdose.

Getting treatment Opioid use disorder is treatable.

Don’t wait for an overdose to happen. The first step is to seek help. If you believe that you are suffering from this disorder, talk with your

doctor about your symptoms and if you are experiencing increased sensitivity to pain, constipation, nausea, sleepiness and dizziness, confusion, low sex drive and depression. Deciding whether to start medication to treat an opioid dependency and which medication to use are critical early decisions to make.

Many people with opioid use disorder may be addicted to other substances or have a mental disorder such as depression.

These health conditions need to be treated at the same time.

SAMHSA’s online tool, Decisions in Recovery, offers a wide vari-

ety of resources that can help you speak with your provider about treatment options. To learn how to recognize opioid overdose and use naloxone, download SAMHSA’s Opioid Overdose Prevention Toolkit. Share it with your health care provider so they can prescribe naloxone.

If you or someone you care about is concerned about opioids, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357) or visit www.samhsa.gov/find-help. n

By Anita Everett, M.D., Chief Medical Officer, Substance Abuse and Mental Health Services Administration (SAMHSA)

FYI | MEDIAPLANET | 27

Why Developing NonOpioid Pain Treatments Is More Important Than Ever With nearly 100 million people in the United States living with chronic and recurrent pain, the country is facing a societal and economic crisis.

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his is further complicated by the ongoing opioid crisis, which continues to take an enormous toll on families, communities and the health care system. Patients with pain need options, and with opioid abuse at an all-time high, expediting research and development for recurrent and chronic pain treatment is crucial The statistics are alarming.

According to the Centers for Disease Control and Prevention (CDC), on average, 115 Americans die every day from an opioid overdose. The CDC also notes deaths

from prescription opioids have more than quadrupled since 1999.

Families and communities have been shattered in the process.

“We’re at a critical juncture right now,” explains Rob Conley, M.D., global development leader and distinguished scholar of neuroscience at Eli Lilly and Company. “As more and more Americans are living with chronic pain, over the past decade there’s been a greatly increasing use of opioid medications, particularly to treat chronic pain, which has turned into a serious crisis.”

During the past 20 years, there’s been minimal innovation in the field of recurrent and chronic pain. Dr. Conley says it’s essential to move forward as quickly as possible the research and development of alternatives and to advance a patient-centered health care system.

A complex issue The common denominator underlying this crisis is not addiction, misuse or prescribing practices.

Rather, people living with unre-

solved pain depend on a health care system that offers few options for effective pain management. While physicians have used opioids to effectively treat acute pain, these treatments have not been shown to be very useful for chronic pain.

Further, diagnosing the problem can be challenging. Unlike with diabetes or high cholesterol, there’s no biomarker for pain.

“The trouble with pain is that it’s a perception,” says Conley. “Each of us doesn’t know how much pain another person is in. I think that’s one of the real difficulties.”

Understanding the challenges and unmet need of migraine For patients dealing with migraine, for example, the pain can be excruciating.

“These are very severe attacks that include a serious headache, but it’s more than that,” Conley explains. “Nausea and sensitivity to light and sound all can come together in this debilitating disease that usually lasts hours at a time.”

For years, Lilly has been committed to developing innovative

therapies for the treatment of migraine and disabling headache disorders. The currently available options provide limited efficacy and have issues with tolerability.

“I think we’re at the edge of something that has the potential to be big,” says Conley. “These drugs are not dulling your brain’s response to pain, they are really going after it at its source.”

Removing the stigma of recurrent and chronic pain Many people living with recurrent and chronic pain are judged unfairly in the health care system and by society, which can lead to delayed diagnosis, misdiagnosis, treatment biases and decreased effectiveness of care. There’s often concern that patients are faking their pain, while others may simply grow accustomed to it.

“We want to be tough and to be there for our family and friends,” notes Conley. “You feel weak if you have pain and should be able to power through it. We are dealing with it, getting used to it.”

Developing solutions for those in need Lilly’s goal is to make life better for people with migraine and chronic pain through ongoing research and development efforts for comprehensive solutions to address some of today’s biggest challenges in pain management.

“I feel very encouraged,” says Conley, who admits it’s been a long road. “We’ve made a huge commitment to do this work.

These are things that are really happening. We’re hoping if all goes well with the medicines, we’ll have a new drug each year for the next three years.

“This is tremendously different than things were 10 or 15 years ago, when the hope was that we in medicine would create opioid-like drugs that people wouldn’t abuse. Unfortunately, we failed at that. A lot of work has gone into making sure these things are genuinely working differently than current therapies.” n

By Cindy Riley