KERA’s Sam Baker talked with Dr. Karl Kleinschmidt, an Emergency Medicine professor at UT Southwestern Medical Center, about what contributed to the number of overdoses.
INTERVIEW HIGHLIGHTS:
What’s Causing The Increase In Overdoses?
The suspicion is that folks with addictions are suffering some of the same challenges as those who do not have addictions, which includes increased social isolation from others. If you have depression, psychiatric illnesses, or mood disorders, that isolation is not necessarily a helpful thing.
And since there is a big overlap between those with addiction and those who have psychiatric illnesses, everybody has found that to be more difficult and more stressful.
Stress is the underlying thing that results in so much substance use. So when you have an addiction and you are stressed, your addiction brain kicks into gear, the cravings become very great. And how do you handle that stress? You use your drugs.
Why Texas Has The Highest Overdose Rate
Possibly because it’s only in the last year or two that we’re having more of the synthetic opioids like fentanyl. They’re more potent than heroin. These are the ones that have been contributing to overall increased death rates. In recent times with the illicit opioids, we’ve not had much of the fentanyl variants, but that’s changing now in the last year or two.
The American Medical Association Has Called For Removing Barriers To Evidence-Based Care For Patients With Pain And Those With A Substance Use Disorder.
I certainly agree. We need to continue to make access to treatment easier for people that have addictions. Probably some of our biggest barriers are within the class of opioid addictions. We have three different FDA-approved medications to treat the disease of opioid addiction, methadone, the buprenorphine product of which there’s a number of brands out there, including Suboxone. And there’s another agent class, naltrexone.
Since the 1970s, when methadone gained its approval to be used to treat opioid addictions, the laws are set up. So that could only be done with the name methadone clinic. Any physician licensed with the DEA can use methadone to treat pain. However, if you’re using methadone to treat addiction, that can only be done at one of the federally registered methadone clinics. And methadone can not be prescribed to treat addiction by anybody.
Then, in the early 2000s, came buprenorphine. Any physician or advanced practice providers could, with additional training, prescribe buprenorphine to treat opioid addiction. This was a wonderful advancement.
However, you still have to do the extra training in order to use buprenorphine to treat addiction, and that certainly is an additional barrier.
In the final days of the Trump administration, we were very close to no longer having to do the extra training. That got changed very early in the Biden administration, even though the administration supports eliminating that barrier. We certainly anticipate that will happen at some point in time in the future here.
Would The Changes Be Enough To Deal With The Overdose Problem?
Our problem is that not just the lay public is ignorant relative to the disease of addiction, but most healthcare providers are ignorant also in terms of addiction and its optimal management. Not because the health healthcare providers don’t want to know, it just has never been a classic part of training. One of the biggest misunderstandings, both by the patients and healthcare providers alike, is asking the classic question of why would you ever do methadone? Or why would you ever do buprenorphine? Because aren’t you just trading out one drug for another? Most folks are unable to answer that question. And so, because of that question, that’s a huge barrier for people starting to change medicines.
I mean, I have patients all the time. We finally get them to change medicine and their family and friends are saying, don’t do that, man. Nobody can get off the methadone once you’re on methadone. And so there’s this huge misunderstanding.
So these are things that we teach healthcare providers and the lay public to help break the stigma of addiction to help people understand that addiction is a disease. This is not a willpower-type issue. And that’s a lot of education for lots of folks.
RESOURCES:
CDC: Provisional Drug Overdose Death Counts
2020 AMA Opioid Task Force Drug Overdose Report
Interview highlights were lightly edited for clarity.
Got a tip? Email Sam Baker at sbaker@kera.org. You can follow Sam on Twitter @srbkera.
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