New Study Emphasizes the Importance of Specialized Care for Opioid Addiction

The opioid crisis is raising important questions about how and where people struggling with addiction should get help. Now, a new study highlights the need for specialized addiction treatment. It’s important to understand the discrepancies in outcomes between those who receive care in specialized vs. general health settings in order to make the best choice regarding where to seek treatment for your opioid addiction.

Twenty-five years ago, opioid addiction meant heroin. Marginalization and glamorization seemed to be the two available narratives, one telling a tale of street-involved junkies and the other of troubled but fantastic artists, writers, and musicians who stumbled in and out of rehab or overdosed and died. Sure, heroin wasn’t the only opioid around—there were prescription pain medications, too, and people did get hooked on them.

But it was nothing like today, when opioid addiction most commonly comes in the form of a little white pill, a patch given to you in the bright light of a pharmacy, a lollipop. Twenty-five years ago, opioid addiction wasn’t knocking on doors in middle America or taking the lives of our grandparents. Twenty-five years ago, people didn’t carry Naloxone just in case someone at a party overdosed.

This is our reality now. Opioid addiction is an undeniable public health crisis, and it doesn’t seem to be going away anytime soon. But while there is widespread awareness that the opioid epidemic needs to be dealt with, there are still important questions about exactly what “dealing with it” means and what effective opioid addiction treatment looks like.

Where should you turn for help? Should primary care physicians (PCPs) be tasked with diagnosing and helping people manage addictions? Is a general health care setting an appropriate place for treatment to begin? As more and more people turn to PCPs for support, these questions are more pressing than ever before. Now, researchers are finding answers, illuminating the path to healing.

New Study Highlights Need for Specialized Addiction Treatment

A study released earlier this year by researchers at UCLA set out to investigate health outcomes for people who received care for the addictions in a general health care setting compared to those who received specialized opioid addiction treatment in dedicated substance abuse programs as well as the general population.

The research team, led by Dr. Yih-Ing Hser, professor of psychiatry and behavioral sciences at UCLA’s David Geffen School of Medicine, examined “electronic health records, and an associated death index system, for 2,576 patients diagnosed with opioid use disorder from 2006 to 2014.” Once analyzed, the data revealed that “people who are addicted to opioids and receiving medical care in a general health care setting were more than 10 times as likely to die during a four-year period than people without substance abuse problems.”

While part of this discrepancy in mortality rates is undoubtedly due to the inherent damage of addiction itself, Dr. Hser’s team also discovered something else: the mortality rate of those receiving care in a general health setting was more than twice as high as those who received treatment in specialized opioid addiction clinics. The researchers noted that this may be partially explained by the fact that those receiving care in general health settings were older at diagnosis and “had a higher rate of other diseases and disorders” compared to those in specialized treatment.

But even taking these factors into account, the differences were unexpected and alarming. “The high rates of death among patients with opioid use disorder in a general health care system reported in this study suggest we need strategies to improve detection and treatment of this disorder in primary care settings,” says Dr. Hser. “The findings were surprising because one would potentially expect better healthcare outcomes for patients being served by a large health care system.”

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Dissecting Discrepancies

What could explain these discrepancies? The answers are multiple and often overlapping:

Lack of Training

Most PCPs have limited or no training in addiction treatment. As such, they may miss critical early warning signs of opioid addiction, resulting in delayed diagnosis and intervention, particularly if they have participated in prescribing opioid pain relievers to the patient. Interventions themselves are typically inadequate to address the complex illness opioid addicts face due to lack of knowledge regarding best practices. Furthermore, a significant proportion of people struggling with opioid addiction also experience a co-occurring mental health disorder, complicating both diagnosis and treatment beyond the scope of most PCPs.

Lack of Will

The vast majority of physicians are not authorized to prescribe relapse prevention medications, such as buprenorphine, and even those with authorization are often reluctant to prescribe it. A study published in the American Journal of Public Health in 2015 found that “43 percent of potential patients who could have received [buprenorphine] were not offered it.” According to Dr. Mina Kalfas, a certified addiction specialist, the reasons for this are multiple and include a general lack of understanding of addiction as a disease, blaming the patient for their illness, reluctance to take on addiction management for patients with complex needs, heightened scrutiny by the DEA, and disapproval by peers.

“They’re very, very worried an opioid they prescribe is going to be misused in some way, and this population is more likely to misuse it,” adds Dr. Anna Lembke, chief of the Stanford Addiction Medicine Dual Diagnosis Clinic at Stanford University. This reluctance to prescribe the medication that holds the most promise for opioid addicts keeps millions of people from recovery.

Lack of Resources

Addiction is a multifaceted illness that affects the mind, body, and spirit. Attempting to craft a treatment program that will identify and address all the components of a person’s experience with addiction within a general health care environment is extraordinarily difficult. General medicine hospitals and primary care physicians simply don’t have the resources to replicate the specialized residential treatment programs that are currently the gold standard in opioid addiction treatment. This includes medically supervised detox, a comprehensive array of therapies, constant monitoring, ongoing clinical and peer support, and a tranquil milieu removed from the stresses of everyday life to minimize triggers.

Piecemeal referrals that require you to seek care from a number of different providers on an outpatient basis fail to approximate the services of a dedicated, residential addiction treatment program. This approach also relies on a high degree of personal motivation to make and keep appointments, which can be exceedingly difficult for those in early recovery from opioid addiction.

Seeking Specialized Opioid Addiction Treatment

Specialized opioid addiction treatment programs do not have to contend with the limits of general health care settings. Designed for the express purpose of helping people find freedom from substance abuse using the most advanced interventions available, these programs provide real paths to lasting sobriety and significantly improve both short and long-term outcomes.

Experts in the field of addiction medicine will craft a personalized treatment plan based on extensive diagnostic testing that can identify any co-occurring mental health disorders and determine how to best engage you in the healing process. This treatment plan spans everything from medically supervised withdrawal to comprehensive aftercare planning, all delivered in a monitored environment to ensure that you remain safe and comfortable as you delve into the work of recovery. For people struggling with opioid addiction, it typically also includes relapse prevention medication administered by compassionate clinicians to help you minimize cravings and more fully participate in treatment.

But specialized treatment programs go beyond the formalities of treatment. By providing private, serene spaces, you can fully devote yourself to healing removed from your everyday environmental triggers. They also provide important opportunities to break through the isolation faced by so many addicts, allowing you to connect with peers who understand what you are going through and can offer both their wisdom and support. At the same time, your family may be invited to participate in your care via dedicated family programming, helping you heal collectively as well as individually. The support of your family and peers can be an invaluable part of the recovery process, nourishing your sense of belonging and fortifying your spirit.

The UCLA study is an important starting point to identify the gaps in care present within general healthcare settings. While corrective measures may improve this care in the future and make it possible for more people to find relief from addiction, for now, specialized opioid treatment programs remain the best place to start your recovery journey. Here, you can truly discover who you really are without the influence of opioids and, more importantly, become the person you want to be.

Alta Mira is a residential opiate addiction treatment center focusing on the treatment of drug and alcohol addiction and co-occurring mental health disorders. Contact us to learn more about our renowned Bay Area programs and how we can help you or your loved one start the journey toward recovery.