Study finds providers lack resources to stem opioid crisis
New research suggests providers need mental health resources to address conditions and trauma that plague more than half of patients who visit emergency rooms for drug misuse. Experts say identifying and treating mental illness could effectively stop people who misuse drugs from relapsing in their recovery.
"In order to truly reach overdose survivors, we need a much better understanding of who they are and the many challenges they face when they seek care," said Dr. Krista Brucker, assistant professor of Emergency Medicine at Indiana University School of Medicine.
Brucker authored a study presented Monday at the annual meeting of the American College of Emergency Physicians. She found that 55% of patients who visited the ED for substance misuse had mental health issues and 60% were severely traumatized when they were children.
But a lack of mental health care professionals and continued struggles to have insurers cover the services they provide make the request to address behavioral issues a tall order.
Only 41% of adults with a mental illness received treatment over the past year, according to the National Alliance on Mental Illness, with around 63% of those with serious mental illness getting services over the same period.
Addressing the issues with young people also requires a sensitive conversation.
"It's hard to know if a child who has been very severely maltreated is on a direct crash course for substance abuse," said Dr. Matthew Price, assistant professor in the department of psychological science at the University of Vermont. "But we do know that they are at much, much higher risk if they came into contact with substances and there's a much higher risk that they could become long-term users."
Price co-authored a study published in March in the Journal of Addictive Behaviors that also flagged childhood abuse as a factor in opioid abuse. Price said providers should offer behavioral health alongside primary care or within the same patient visit to reduce the burden on a patient. That could also help destigmatize the care. Price says he's made it a practice to always ask patients dealing with substance abuse about past trauma.
"I think we're more focused on looking at the whole picture," Price said, referring to evidence that traumatized children engage in risky behavior that leads to poorer health.
The White House last week announced efforts to concentrate on preventing drug abuse early in life.
In his declaration of the opioid misuse epidemic as a public health emergency, President Donald Trump called for a 'massive' national campaign to dissuade children from using drugs. Critics argued that past similar campaigns like Just Say No didn't work.
Lacking the resources to intervene early on, some drug treatment experts say increasing access to the opioid-reversal medication naloxone would help. But a new study found that even as naloxone becomes more widespread, the number of opioid-related overdose deaths has risen, with more than 64,000 reported in 2016.
Findings from another ACEP study released Monday showed despite more than 90% of patients surviving an overdose if they are given naloxone, 10% of them die within one year after treatment. Half die within the first month.
"Patients who survive opioid overdoses are by no means 'out of the woods,'" said lead study author Dr. Scott Weiner, assistant professor at Harvard Medical School and director of the Brigham Comprehensive Opioid Response and Education Program at Brigham and Women's Hospital in Boston, Mass. "These patients continue to be at high-risk for overdose and should be connected with additional resources such as counseling, treatment and buprenorphine."
Those options become increasingly necessary as the rising price of naloxone makes it harder to obtain.
Shortages in Baltimore, one of the first to distribute it widely, have left the city with less than 10,000 doses of the medication. The city has had to ration the supply to the most-heavily hit areas.
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