As the National Institute on Drug Abuse points out, “Years of research have shown that substance use disorders are brain disorders that can be treated effectively.” There are behavioral approaches such as contingency management and cognitive-behavioral therapy and medications including including buprenorphine, methadone, and naltrexone. People now have a better chance of getting out of Herointown, as illustrated above.
Although the emphasis in this “people” crisis is often on the problem – the “disorder” and accompanying “co-morbidities,” it is useful also to think in terms of “wellness.” We all seek wellness but have some disorders. Stigma too long has been a barrier. However, looking at the whole person, we can better understand his or her social context and stage of readiness for assistance, and devise a suitable plan with the connective tissue of different services most suitable for him or her.
A problem in NJ and most other states is gaining access to the needed services. Unless one is wealthy or has a robust health insurance plan, he or she encounters difficulties. To gain access to treatment beds, people first need to undergo in-patient detoxification, but there are insufficient such facilities in NJ and even before that clients must have ID documents which they may have lost and which take time to re-obtain. Likewise we don’t have enough state or federal funded treatment centers, and even with them, patients who have at least some health insurance coverage or Medicaid will likely receive preference over charity care. The best of plans fall apart without access. Governor Murphy is aware of the issue and is addressing it, but with limited funds. Activists should activate on this matter.
Under continuing threat from the Trump administration is Medicaid – the essential bulwark for those with low income. The program itself should take a more wholistic approach in terms of the length of time permitted for specific services, adding funding for essential case managers, and moving to expect quality outcomes rather than just paying a set fee for each procedure. Unfortunately, many in congress want to shrink the program. Officials in some other states seek to create impediments by limiting the duration one can be on Medicaid or imposing onerous work requirement for recipients.
One of the best things Gov. Christie did was to join the Medicaid Expansion program. The result: It increased our insured population, yielded a reduction in uncompensated care costs, and decreased state spending fully or largely offset by savings in other areas. Gov. Murphy’s budget focuses on modernizing NJ Medicaid with new benefits for autism spectrum disorders, diabetes, Hepatitis C, and family planning services; and implements a waiver to expand opioid use disorder treatment.
An important new initiative derived from the Albany NY Law Enforcement Assisted (LEAD) program now exists in Bergen and Ocean Counties. AG Grewal is looking to help expand it to other counties. In LEAD individuals who would typically be arrested or otherwise punished for non-violent offenses driven by psycho-social challenges are instead diverted to harm reduction-based case management and outreach services. In NJ we already have drug courts which can divert those already arrested for minor drug crimes into programs, but this harm reduction innovation starts the process even earlier.
One place where the effort to reduce prescribed opioid dependence can begin is in the emergency room. St. Joseph’s Medical Center in Paterson has been exploring alternative painkillers and methods. That strategy has led to a 58 percent drop in the ER’s opioid prescriptions in the program’s first year. Addiction to prescription opioids can be treated with medications including buprenorphine, methadone, and naltrexone in combination with psychosocial supports or behavioral treatments. Too many people today suffering pain from illnesses and past accidents continue receiving addictive opioids as a result of inattentive medical care. Physicians, duty-bound to “do no harm,” need to increase their efforts to provide the alternatives. Gov. Murphy’s reforms for the Medical Marijuana program, another suitable alternative in many cases, include the addition of medical conditions, lowered patient and caregiver fees, allowing dispensaries to add satellite locations, and proposed legislative changes.
Many individuals (about half) who develop substance use disorders are also diagnosed with mental disorders, and vice versa. Integrated treatment of both illnesses has been found to be consistently superior. It often involves strategies to boost interpersonal and coping skills and approaches that support motivation and functional recovery. It typically must address issues such as homelessness, physical health, vocational skills, nutrition, and legal problems. It imposes increased stress on family and friends who also need support lest they lose patience and disavow the afflicted. Governor Murphy’s current opioid plans do not provide specific new initiatives for people with this difficult combination of illnesses.
Wellness is what we all want to achieve: SAMHSA defines wellness not as the absence of disease, illness, or stress but “the presence of purpose in life, active involvement in satisfying work and play, joyful relationships, a healthy body and living environment, and happiness.” Achieving this goal remains a work in progress, and while difficult for those addicted, there are signs of steady movement forward. Nonetheless, continued advocacy is essential.
Particular thanks in preparing this post to the numerous suggestions from John V. Jacobi, Dorothea Dix Professor of Health Law & Policy, Seton Hall Law School, and Board Chair, NJCRI.
SAVE THE DATE: June 5: Conference: Better Together: An integrated Approach to Address the Opioid Epidemic, at Bridgewater Marriott Hotel sponsored by the NJ Department of Health.
For prior parts of this series enter NJ’s Opioid Crisis: Part in the SEARCH function above and click. Or on the front page in the top slider, click when the image of Opioid Crisis appears.