The emergence of synthetic opioids has compounded the addiction crisis because these drugs are easy to manufacturer and are incredibly potent. Fentanyl and its various even stronger analogues — used in a pure form or laced into drugs like heroin — are an exceptional challenge. Dr. Volkow stated that the northeastern part of the US has seen a doubling or tripling of overdose deaths due to the addition of Fentanyl.
Dr. Volkow and NIDA are working to research different treatments for chronic pain management, but it is a very complex challenge to address. Additionally, she stated that we need to develop treatments for individuals who become addicted, so they don’t turn to heroin. Equally important, NIDA is taking into consideration differences in pain and treatment outcomes between women and men. Women release a larger inflammatory response from pain versus men, which is important to understand when addressing treatment options.
Another consequence of the opioid crisis is neonatal abstinence syndrome (NAS). Dr. Volkow stated that 17-19 percent of pregnant women in the US receive an opioid prescription, which further validates the need to change prescribing practices. The babies born with NAS and treated improperly can lead to death or poor health outcomes. There are multiple areas where we can address the issue of the opioid crisis as it relates to pregnant women. For example, a recent study has shown that the use of Buprenorphine in the treatment of NAS resulted in a shorter duration of treatment and length of hospital stay for the newborn versus a morphine treatment.
Dr. Volkow concluded her presentation by stating the importance of pain education among doctors, nurses, and pharmacists to prevent overprescribing of medication that could lead to addiction.
Jerome M. Adams, MD, MPH
The second speaker was Dr. Jerome M. Adams, Indiana State Health Commissioner, who was introduced by Rep. Brooks. In this role, he oversees the Public Health Protection and Laboratory Services, Health and Human Services, Health Care Quality and Regulatory, and Tobacco Prevention and Cessation Commissions. Dr. Adams has been nominated to become the next Surgeon General of the United States.
Additionally, he serves as secretary of the Indiana State Department of Health’s executive board, as chairman of the Indiana State Trauma Care Committee, and as co-chairman of the Indiana Perinatal Quality Improvement Collaborative Governing Council.
Dr. Adams began his presentation by imploring the audience to reach out to their state health departments to get a better understanding of how federal laws present challenges, opportunities, and change on the state and local levels. Over-prescribing is harmful and has led to overdose, Hepatitis C, and HIV, and we must work harder to address this crisis.
In Indiana, unintentional drug poisoning has seen an 894.6 percent increase as a leading cause of death. Similarly, from 2003-2015 the unintentional drug poisoning rate in Indiana increased by 771 percent. Around 2005, Indiana had surpassed the US in unintentional drug poisoning deaths.
Dr. Adams restated Dr. Volkow’s earlier assertion that painkillers affect women differently as women are more likely to:
have chronic pain
be prescribed a prescription painkiller
be given higher doses
use them for longer periods of time than men
engage in 'doctor shopping'
become dependent more quickly
During his presentation, Dr. Adams stated that the opioid crisis is significantly impacting people during their prime parenting years with the largest number of deaths occurring in the 25-54 year age range. Moreover, women are surpassing men in drug poisoning deaths after the age of 65 years. From 2009- 2015, there was a 621.4 percent increase in the number of non-fatal emergency department visits by women due to heroin use. These statistics are clear evidence that the epidemic affects women and men differently.
Given the alarming statistics, it is no surprise that Indiana was the location of the largest HIV outbreak related to injection drug use in US history. Scott County now has 219 confirmed cases of HIV — 132 men and 87 women. 95 percent of the 219 cases are co-infected with Hepatitis C. All of the individuals are white, experience poverty, have a limited education, high unemployment, a lack of insurance, and live in a rural setting. Dr. Adams underscored the importance of studying the societal impacts that put individuals at higher risk for developing drug misuse.
Dr. Adams further explained the environmental impacts of this particular outbreak by noting that the infected community was immediately next to a major highway truck stop. There is a complex interplay between opioids and the victimization of women and the easy money women can receive from sex work. Additionally, there is intergenerational drug misuse occurring in the county in which families use together, teaching each other how to use and/or inject their young children as a calming method.
Dr. Adams and his colleagues have been working hard to treat the individuals in Scott County and the surrounding counties in Indiana with evidence of significant progress being made. For example, 73 percent of the individuals with HIV are virally suppressed, meaning they are unable to transmit the disease to others. This percentage is significantly higher than the CDC goal of 25-50 percent viral suppression of a community. Dr. Adams stated that this figure is important because it is evidence that the problem can be tackled in communities that are resource-impoverished.
Another consequence of the opioid epidemic is that infant mortality rates have increased in the state. Infants born with neonatal abstinence syndrome (NAS) has been another development. Dr. Adams noted that there is no single definition of NAS across states or a common practice to assess risk factors. A hospital pilot program to identify the number of cases of NAS was conducted in the state and some of the findings included:
Drug of choice changes depending on location
Comorbidities can affect the outcomes
Lack of treatment programs
Interruption in care when a referral is made
Lack of support services during and after pregnancy
Culture of providers and pregnant women need improvement
Dr. Adams concluded his presentation by addressing how substance use disorders affect children and families. The number of children in need of services through the Department of Child Services in Indiana increased from 13,048 in June 2012 to 23,950 in June 2017, which is an 84 percent increase. Almost 53 percent of children removed from the home in 2016 were the result of an alcohol and/or substance use disorder. A number of strategies to tackle this problem include:
Supporting implementation of evidence-based practices and interventions for children and families with substance use disorders.
Contracting for specialized residential treatment services that enable mothers with substance use disorders to receive treatment while remaining with their children.
Contracting for transitional housing programs for clients transitioning from residential treatment programs.
Expanding the Sobriety Treatment and Recovery Teams (START) model to additional communities.
Editor's Note: Thanks to The Women's Congressional Policy Institute (WCPI) who provided information from their briefing, "Chronic Pain in Women and Its Relationship to Opioid Addiction."
Pages: 1 · 2
More Articles
- Women's Congressional Policy Institute: Special Supplemental Nutrition Program for Women, Infants, and Children, Health Coverage of Newborns
- Veterans Health Care: Efforts to Hire Licensed Professional Mental Health Counselors and Marriage and Family Therapists
- Adrienne G. Cannon Writes: Those Lonely Days
- Surgeon General Vivek Murthy to Grads: Love Is the World’s Oldest Medicine
- Coronavirus Aid, Relief, and Economic Security Act; Chair Jerome H. Powell Before the Committee on Financial Services, House of Representatives
- Jill Norgren Reviews a New Inspector Gamache Mystery: All the Devils Are Here
- Federal Reserve: Optimism in the Time of COVID; Businesses Seem Much Better Adapted to Remaining Open
- Rose Madeline Mula Writes: Look Who's Talking
- Celebrating 100 Years of Women Voting; Virtual Sessions: United States Capitol Historical Society
- Supreme Court Surprises The Public in LGBTQ Ruling: What is Sex Discrimination?