Opioid Awareness

A Mediaplanet Guide to Pain Management

Opioid Awareness

Timbaland Grammy-winner Timbaland has an inspiring message for those battling opioid addiction Discover how one primary care doctor battled opioid addiction, as well as societal stigma Learn more about the evolutions of pain management during the COVID-19 pandemic

SEPTEMBER 2020 | FUTUREOFPERSONALHEALTH.COM

If you’re struggling with prescription opioids, there is hope. Recovery is possible. cdc.gov/RxAwareness

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FINDING SUPPORT FOR OPIOID ADDICTION 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:

Amid the COVID-19 Pandemic, the Opioid Epidemic Persists Assistant Secretary McCance-Katz advises the U.S. Department of Health and Human Services (HHS) Secretary on improving behavioral healthcare in the United States. She also leads the Substance Abuse and Mental Health Services Administration (SAMHSA) in HHS.

Call SAMHSA’s National Helpline: 1-800-662-HELP (4357) TTY: 1-800-487-4889 Parent Helpline: 1-855-DRUGFREE Visit American Society of Addiction Medicine –Physician Finder: https://www.asam. org/resources/patientresources SAMHSA’s Prescription Drug Misuse and Abuse Website: www.samhsa.gov/ prescription-drugmisuse-abuse

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Elinore McCance-Katz, M.D., Ph.D., HHS Assistant Secretary of Mental Health and Substance Use

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s one pandemic grips the nation’s focus and attention, the already existing scourge of opioid addiction continues to impact millions of Americans.

Unfortunately, the existence

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of one crisis, albeit overshadowing, does not eliminate the existence of another. The crises exist concurrently, and we must not lose sight of the pain and damage caused by any public health crisis facing our nation.

An epidemic persists The burden that the COVID19 response has placed on our people takes a tremendous toll on individuals, families, and communities. The stresses of what was everyday life have been far outdistanced by the stressors of today’s life. For many, COVID-19 has meant isolation, loneliness, fear, anxiety, financial stress, and

unemployment. The promise of opioids to ease these burdens tempts many. We must remind Americans that opioid misuse can potentially lead to lifelong, damaging health consequences, including death. Turning to opioid misuse is not an answer.

Help is available For those Americans struggling with opioid-use disorder, we must continue to promote the use of FDA-approved medications that are an essential and effective component of treatment. The Substance Abuse and Mental Health Services Administration (SAMHSA) has put unprecedented resources

into making these lifesaving treatments widely available in all American communities.

Access to these medications, and the psychosocial and community recovery services that accompany them, has been a major priority of the administration. The current pandemic has not changed that focus.

We must also do all we can to ensure Americans everywhere know that a life lost to substance use and overdose is just as important as one lost to the coronavirus. Just as a first responder would not hesitate to administer lifesaving CPR to someone who has suffered a heart attack, a first responder must not fear administering lifesaving naloxone — the opioid-overdose antidote — to an individual experiencing an opioid overdose.

The struggle for millions of Americans is quite serious, but the good news is that help is available. It is available to those seeking treatment, and it is available to those who may experience overdose. We must take collective action to ensure our loved ones make use of available resources.

These resources can and will save lives. n

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Publisher Nellie Dubin Business Developer Gretchen Pancak Managing Director Luciana Olson Lead Designer Tiffany Pryor Designer Keziah Makoundou Lead Editor Mina Fanous Copy Editor Lauren Hogan Director of Sales Stephanie King Director of Product Faye Godfrey Cover Photo Eric Ray Davidson All photos are credited to Getty Images unless otherwise specified. This section was created by Mediaplanet and did not involve USA Today.

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Grammy-Winner Timbaland’s Inspiring Message to People Struggling With Addiction Musician, rapper, DJ, and super-producer Tim Mosley, better known as Timbaland, overcame his opioid addiction and wants to inspire other addicts to get clean, too.

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imbaland, who has worked with Beyoncé, Missy Elliott, Jay-Z, Justin Timberlake, Sam Smith, and other artists, started taking OxyContin and Percocet following a root canal back in 2011. He says he did not receive any doctor or pharmacist warnings about the potential for addiction when he was prescribed the highly addictive opioids.

A dangerous road Abusing painkillers became a serious problem for Timbaland, which resulted in him feeling sluggish and fatigued, as well as “ignorant” to what was happening around him.

“I was falling asleep in the middle of conversations, I missed the more important moments in life, like watching my kids grow up,” he says.

A new chapter Timbaland’s turning point came a few years later when he had a nightmare that his death was near. He woke up panicked and realized he

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wanted to change his habits.

He quit taking painkillers and decided to focus on staying alive for his three kids.

Now 48, he is sharing his inspiring story to help others overcome their addictions.

“Understand that addiction is a disease and needs to be taken seriously,” Timbaland says. “I was fortunate enough to be able to put my mind to it and stop cold turkey on my own, but millions of people need professional help. If my story can help even one person, that’s a life saved.”

Timbaland did not receive any outside help when quitting taking painkillers. He beat his addiction, focused on his health, and has lost over 130 pounds. His life is back on track, and he knows others struggling with addiction can turn their lives around too.

“I’ve realized millions of people are going through this and not talking about it,” he says. “I want people to know that it is okay to talk about it.

Get help!” n Kristen Castillo PHOTO: ERIC RAY DAVIDSON

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Why Reducing Addiction Stigma Is More Important in 2020 Than Ever

One Primary Care Doctor’s Battle With Addiction and Recovery

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Healthcare professionals face higher rates of addiction compared to the general public.

Many feel that there are barriers between them and recovery.

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am 13 years free of opiates and 12 years back as a practicing primary care doctor.

Addiction among healthcare professionals is more common than it is in the general population. The only unusual thing about my story is that I went public with it in order to try to reduce the stigma surrounding addiction in the healthcare industry.

A perfect storm Healthcare professionals are under tremendous stress. More than half are reporting symptoms of burnout. We have access to controlled substances. This combination of stress and access is the perfect storm for addiction.

As addictions invariably do, mine worsened over time. It culminated in writing myself bad prescriptions to fend off my crip-

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pling withdrawal symptoms. This inevitably ended with the Drug Enforcement Administration and the State Police visiting my office.

As my addiction worsened, I felt increasingly trapped and isolated.

The expectations of society and the demands of our job are so high that it was difficult to admit to myself that I had a problem, and even harder to find the time to get help. The way in which the medical boards regulate us strongly discourages doctors from getting the care they need for mental health issues. We get punished instead of treated if we show signs of not functioning in a flawless way. This is cruel and inhumane and needs to change. A doctor who is getting help is safe. A doctor who is afraid to get help is not.

in my journey from addicted and hopeless back to a state of being employed and healthy. I can list off the drug tests, the threat of a permanent loss of my medical license, the threat of criminal charges, the physician support groups, the hours of therapy, and the healthier lifestyle habits — all of this helped. However, the most important component in my recovery was the people.

Addiction is a disease of isolation and the opposite of addiction is connection. No one gave up on me. My family, my friends, and my colleagues all realized that no matter how bad my behavior was, my true self was still in there.

They were all willing to give me a second chance. Now that I am healthy, I am able to help others. n

The journey back There were many factors involved

Peter Grinspoon, M.D., Massachusetts General Hospital

Today, in the United States, 1 in 4 preventable deaths are attributable to addiction. For Black Americans, the trend is more troubling: between 2015 and 2016, the rate of increase of drug overdose deaths increased 40 percent compared to the overall increase of 21 percent.

Unfortunately, due to COVID-19, the addiction epidemic will worsen.

Rising unemployment and a decline in mental health will drive overdoses.

Suspected overdoses increased 29 percent in April and 42 percent in May compared to last year.

Social isolation is driving the addiction crisis further. Stigma partially or entirely contributes to most of these drivers.

This year we have seen how an inadequate healthcare infrastructure has failed to address a national health crisis, and how that disproportionately affects Black Americans.

The addiction epidemic has shown this insufficiency for years.

We already see this impact. There are several well-documented drivers of the addiction crisis including an insufficient treatment system and social isolation. Approximately 20 percent of those who needed treatment at a specialty facility did not seek it out because they felt it would alienate them from their employers, neighbors, or family.

We must confront the pervasive stigma facing those with a substance use disorder. As the addiction epidemic becomes even more tragic due to COVID-19, it is more critical than ever that addiction stigma is eliminated.

Matthew Stefanko, Director, National Stigma Initiative, Shatterproof

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Addiction and COVID-19: Specialized Treatment Matters Addiction, like COVID-19, is a complex disease that affects the entirety of a person. Both can cause lasting harm.

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lthough the pandemic on everyone’s mind is COVID-19, this country is also in the midst of an addiction pandemic. Both are destructive, affect entire communities, and claim lives. Both have unintended and often misunderstood symptoms and side effects, and both can cause lasting harm.

Addiction is a brain disease. Only licensed or credentialed addiction professionals are trained to properly recognize and treat the complexity of addiction, as well as any potential co-occurring disorders.

Going to a professional Addiction professionals have special6

ized competencies, knowledge, and skills. They understand addiction, and have demonstrated through education, experience, and examination that they are uniquely qualified to provide prevention, screening, intervention, and treatment for substance misuse and addiction.

Failing to properly identify, diagnose and treat an addiction can be fatal. NAADAC’s National Certification Commission for Addiction Professionals has the most up-to-date tests and eligibility requirements for addiction professionals to evidence their competencies, knowledge, and skills in treating the complex disease of addiction.

As 2020 goes on and the pan-

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demics wage, there is ongoing and ever-evolving stress in daily life. We know that stress makes people more vulnerable to addiction or relapse.

Now more than ever, it is imperative that at-risk individuals seek the specialized treatment that they need.

A silver lining The good news to be found in this pandemic age is that treatment via telehealth is becoming increasingly permitted and available. Licensed and credentialed addiction professionals across the country are increasingly utilizing telehealth, which allows more immediate access and less restrictions to reaching and receiving treatment. Not only does telehealth

allow individuals with addiction to receive the specialized treatment they need without potential exposure to COVID-19, it also removes hurdles such as the need for transportation and childcare.

Treatment by a licensed or certified addiction professional is the best choice for an at-risk person with a substance use disorder. Addiction-specific education, training, and clinical supervision matters. It can make the difference in creating successful pathways to recovery for those affected by substance use disorder and can ultimately be the difference between life and death. n Cynthia Moreno Tuohy, B.S.W., Executive Director, NAADC

The Pandemic’s Uncounted Victims tions. Suspected overdoses tracked by the Overdose Detection and Mapping Application Program (ODMAP) have risen over 16 percent per year.

ODMAP data also shows that overdose clusters have shifted from urban areas to rural and adjacent localities.

Data from nationwide drug screening programs also demonstrates increasing polysubstance use of both methamphetamines and illicit fentanyl or fentanyl analogs — a particularly deadly combination.

Therefore, it is clear that the COVID19 pandemic has silent victims, uncounted in the numbers, but just as real and just as tragic.

As the public health landscape changes and the overdose crisis evolves, we must understand the new challenges presented by COVID-19.

We live in unprecedented times, united together against COVID-19.

The times are also unprecedented for those suffering with substance use disorders (SUDs), as they experience new stressors, societal disruptions, and reduced opportunities for treatment and recovery services.

Unaccounted victims Unfortunately, even before the COVID-19 pandemic, America’s prog-

ress was slowing; overdoses were threatening to take the lives of even more Americans this year than last.

From 2017-2018, deaths involving synthetic opioids increased by 10 percent, deaths involving cocaine increased by 5 percent, and deaths involving psychostimulants (like methamphetamine) increased by over 20 percent. These trends continued throughout 2019. Psychostimulants now surpass prescription drugs and cocaine as the second most fatal category of abused drugs.

We also know that during the COVID-19 pandemic, people have been using more drugs, more frequently, and in deadlier combina-

Ending the crisis The U.S. Department of Health and Human Services (HHS) continues to act aggressively to support recovery from SUDs, exercising regulatory flexibility to support alternatives to traditional care, such as telemedicine. We continue to emphasize the importance of medication-assisted treatment and social support services. Every day, we fight to break down stigma and prejudice and work to prevent infectious consequences of intravenous drug use, such as HIV and viral hepatitis. We are relentless in our research for new treatments and prevention strategies, including potential vaccines against particularly deadly illicit drugs.

At no time has a whole-of-society approach been more critical to ending the overdose crisis. n ADM Brett P. Giroir, M.D., Assistant Secretary for Health, U.S. Department of Health and Human Services

Addressing Employee Substance Misuse During the Pandemic Employers must prepare for — and address — the increased substance use associated with the impact of COVID-19.

During the pandemic, more than 30 states have reported increases in opioid overdose deaths, and there is ongoing concern for those with mental illness and substance use disorders (SUDs). Additionally, the pandemic may lead to increased substance use and mental illness in the months and years to come.

In 2018, preventable opioid overdose deaths in the country began to decrease by 1 percent from the year prior, which was the first decrease seen since tracking started in 1999. COVID19 has impacted the prevention, treatment, and recovery options for those battling SUDs, including opioid use disorder. Decreased accessibility to treatment, limitations in harm-reduction services, fewer in-person social supports, and other changes may all be contributing to the reported rise in opioid overdose deaths we are now seeing and may continue to see in the future. In addition, social isolation, economic instability, and unemployment can impact one’s mental health and lead to increased risk of overdose and relapse.

Every organization’s returnto-work strategy needs to address employee substance misuse. Does yours?

Rachel Cooper, Senior Program Manager for Substance Use Harm Prevention, The National Safety Council

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SUBLOCADE® (buprenorphine extended-release) injection, for subcutaneous use (CIII) is a prescription medicine used to treat adults with moderate to severe addiction (dependence) to opioid drugs (prescription or illegal) who have received an

KEEP MOVING TOWARDS RECOVERY with once-monthly

SUBLOCADE continuously releases medicine all month with no real daily ups and downs.

SUMMARY OF IMPORTANT SAFET Y INFORMATION What is the most important information I should know about SUBLOCADE? Because of the serious risk of potential harm or death from self-injecting SUBLOCADE into a vein (intravenously), it is only available through a restricted program called the SUBLOCADE REMS Program.

• SUBLOCADE is not available in retail pharmacies.

• Your SUBLOCADE injection will only be given to you by a certified healthcare provider.

In an emergency, you or your family should tell the emergency medical staff that you are physically dependent on an opioid and are being treated with SUBLOCADE. Buprenorphine, the medicine in SUBLOCADE, can cause serious and life-threatening problems, especially if you take or use certain other medicines or drugs. Call your healthcare provider right away or get emergency help if you: • feel faint or dizzy • have mental changes such as confusion • have slower breathing than you normally have • have severe sleepiness • have blurred vision • have problems with coordination • have slurred speech

Individuals depicted are for illustrative purposes only.

• cannot think well or clearly • have a high body temperature • have slowed reflexes • feel agitated • have stiff muscles • have trouble walking These can be signs of an overdose or other serious problems.

Death or serious harm can happen if you take anxiety medicines or benzodiazepines, sleeping pills, tranquilizers, muscle relaxants, or sedatives, antidepressants, or antihistamines, or drink alcohol during treatment with SUBLOCADE. Tell your healthcare provider if you are taking any of these medicines and if you drink alcohol.

SUBLOCADE is a controlled substance (CIII) because it contains buprenorphine that can be a target for people who abuse prescription medicines or street drugs.

Death has been reported in those who are not opioid dependent who received buprenorphine sublingually.

Do not use SUBLOCADE if you are allergic to buprenorphine or any ingredient in the prefilled syringe (ATRIGEL® Delivery System, a biodegradable 50:50 poly(DL-lactide-co-glycolide) polymer and a biocompatible solvent, N-methyl-2-pyrrolidone (NMP)).

SUBLOCADE is a registered trademark of Indivior UK Limited. © Indivior PLC | INDIVIOR is a registered trademark of Indivior UK Limited | All rights reserved.

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oral transmucosal (used under the tongue or inside the cheek) buprenorphine-containing medicine at a dose that controls withdrawal symptoms for at least 7 days. SUBLOCADE is part of a complete treatment plan that should include counseling.

SUBLOCADE may not be right for you. Before starting SUBLOCADE, tell your healthcare provider about all of your medical conditions, including: • trouble breathing or lung problems • an enlarged prostate gland (men) • a head injury or brain problem • problems urinating • a curve in your spine that affects your breathing (scoliosis) • liver problems • gallbladder problems • adrenal gland problems • Addison’s disease • low thyroid hormone levels (hypothyroidism) • a history of alcoholism • mental problems such as hallucinations (seeing or hearing things that are not there).

• are pregnant or plan to become pregnant. If you receive SUBLOCADE while pregnant, your baby may have symptoms of opioid withdrawal at birth.

• are breastfeeding or plan to breastfeed. SUBLOCADE can pass into your breast milk and may harm your baby. Talk with your healthcare provider about the best way to feed your baby during treatment with SUBLOCADE. Watch your baby for increased drowsiness and breathing problems.

What are the possible side effects of SUBLOCADE? SUBLOCADE can cause serious side effects, including: See “What is the most important information I need to know about SUBLOCADE?” • Physical dependence and withdrawal. Your body can develop a physical need for SUBLOCADE (dependence). If you stop receiving SUBLOCADE, you could have opioid withdrawal symptoms such as: shaking, goose bumps, muscle aches, sweating more than normal, feeling hot or cold more than normal, runny nose and watery eyes, or diarrhea or vomiting. These symptoms may start weeks to months after your last dose of SUBLOCADE. • Liver problems. Call your healthcare provider right away if you notice any of these signs of liver problems: your skin or the white part of your eyes turns yellow (jaundice), urine turns dark, bowel movements (stools) turn light in color, decreased appetite, or stomach (abdomen) pain or nausea. Your healthcare provider may do tests before and during treatment with SUBLOCADE to check your liver.

• Allergic reaction. Call your healthcare provider or get emergency help right away if you get: rash, hives, itching, swelling of your face, wheezing or dizziness, or a decrease in consciousness.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. SUBLOCADE may affect the way other medicines work and other medicines may affect how SUBLOCADE works. Some medicines may cause serious or life-threatening medical problems when taken with SUBLOCADE. Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist each time you get a new medicine.

• Decrease in blood pressure. You may feel dizzy when you get up from sitting or lying down.

The doses of certain medicines may need to be changed if used during treatment with SUBLOCADE. Do not take any medicine during treatment with SUBLOCADE until you have talked with your healthcare provider. Your healthcare provider will tell you if it is safe to take other medicines during treatment with SUBLOCADE.

These are not all the possible side effects. Call your healthcare provider for medical advice about side effects.

You should not take anxiety medicines or benzodiazepines (such as Valium® or Xanax®), sleeping pills, tranquilizers, muscle relaxants, or sedatives (such as Ambien®), antidepressants, or antihistamines that are not prescribed to you during treatment with SUBLOCADE, as this can lead to slowed breathing, drowsiness, delayed reaction time, loss of consciousness or even death. If a healthcare provider is considering prescribing such a medicine for you, remind the healthcare provider that you are being treated with SUBLOCADE. You may have detectable levels of SUBLOCADE in your body for a long period after stopping treatment with SUBLOCADE. What should I avoid while being treated with SUBLOCADE? • Do not drive, operate heavy machinery, or perform any other dangerous activities until you know how this medicine affects you. Buprenorphine can cause drowsiness and slow reaction times. This may happen more often in the first few days after your injection and when your dose is changed.

• Do not drink alcohol during treatment with SUBLOCADE, as this can lead to slowed breathing, drowsiness, slow reaction time, loss of consciousness or even death.

Visit sublocade.com and ask your healthcare provider if SUBLOCADE is right for you.

• The most common side effects of SUBLOCADE include: constipation, headache, nausea, injection site itching, vomiting, increase in liver enzymes, tiredness, or injection site pain.

• Long-term (chronic) use of opioids, including SUBLOCADE, may cause fertility problems in males and females. Talk to your healthcare provider if this is a concern for you.

This is only a summary of important information about SUBLOCADE and does not replace talking to your healthcare provider about your condition and your treatment. Talk to your healthcare provider if you have questions about SUBLOCADE. Share this important information with members of your household.

To report pregnancy or side effects associated with taking SUBLOCADE, please call 1-877-782-6966. You are encouraged to report negative side effects of drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

To learn more about SUBLOCADE, go to SUBLOCADE.com.

For REMS information visit www.sublocadeREMS.com.

How the COVID-19 Pandemic Is Helping Advance Pain Management

As the experts in pain management, physician anesthesiologists know alternatives for pain management are safer and more effective than opioids.

Pain management is essential. This has become even clearer during COVID-19 as stress, isolation, and limited access to care add to the challenges for people in pain — especially those trying to avoid opioids. But the pandemic has also prompted some positive changes, bol10

stering innovations such as telehealth and minimally invasive treatments for long-lasting pain relief.

An insufficient solution Opioids can be effective for short-term relief, but they are not a long-term solution because they are highly addictive and have significant side effects, including sleepiness, constipation, and nausea. Some side effects can be life-threatening. The signs of an overdose include shallow breathing, slowed heart

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rate, and loss of consciousness. Unfortunately, early evidence suggests drug overdoses — including those from opioids — may be increasing as people try to cope with the pandemic.

Embracing alternatives Thankfully, pain management has evolved beyond these potentially risky medications. There are a variety of alternatives, including non-addictive medications, injections, exercises, and minimally invasive meth-

ods that block, redirect, or short-circuit pain for months at a time.

To reduce exposure to the virus and save patients from traveling to appointments and sitting in crowded waiting rooms, most pain medicine specialists are offering telehealth visits using secure face-to-face video or phone calls. Via telehealth, pain specialists work with patients to ask and answer questions and formulate a pain management plan that does not involve opioids.

Sometimes the answer may be one office visit — using safety protocols such as wearing masks — to provide treatments that relieve pain for six months or more. These treatments may include therapeutic injections, the implantation of a device in the back to disrupt pain signals, or radiofrequency ablation to silence nerves that carry pain signals from achy joints. n Mary Dale Peterson, M.D., MSHCA, FACHE, FASA, President, American Society of Anesthesiologists MEDIAPLANET

Educating Patients and Providers About Managing Pain Without Opioids

Nearly 450,000 people died from an opioid overdose between 1999–2018.

Now the American College of Surgeons is calling on surgeons and other providers to minimize prescribing opioids to patients for postoperative pain.

“Over the last 20 years, there’s been an increased focus on patient satisfaction and pain control,” says Dr. Jonah Stolberg, assistant professor of surgery at Northwestern Medicine, who is also on the opioid reduction task force for the

American College of Surgeons.

This focus on pain elimination was dangerous. Many patients became addicted to opioids, which were cheap to get and easy to take. The risks of taking opioids were downplayed. These factors combined led to a culture where patients expect to be relatively pain-free around the time of surgery.

Resetting expectations Dr. Stolberg, a funded independent researcher with National Institute on Drug Abuse and the director of opioid reduc-

tion practices for the Illinois Surgical Quality Improvement Collaborative, says now is the time to reset expectations both for patients and providers.

“The hardest thing that we need to overcome is this culture that’s built up around the elimination of pain,” he says.

Dr. Stolberg says 80 to 85 percent of patients are prescribed an opioid prescription following a procedure. According to Dr. Stolberg, this is the wrong approach. Instead, it is important that patients start with drugs that have the lowest risk of addiction, such as

acetaminophen or ibuprofen.

Then, additional medications can be introduced as needed.

Patients should also use ice and stretching techniques within the first 48 hours following surgery. Heat can be applied 3-5 days after surgery.

A positive outlook “Pain needs to be adequately treated but not eliminated,” Dr. Stolberg says, encouraging patients to talk with their doctor about pain management before their surgery.

When opioid prescriptions are written, doctors should

prescribe smaller amounts, such as 15 pills instead of 30.

Dr. Solberg is hopeful about the future. He says some promising non-opioid pain products in clinical trials may offer prolonged pain management for 3-5 days of pain control in the incision area. Plus, the healthcare community may start adjusting their pain management practices.

“If we can make that cultural shift, [it] will fundamentally do a lot of good for society,” he says. n Kristen Castillo MEDIAPLANET

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