Cold Turkey to Warm Handoffs: Treating America’s Opioid Crisis
Addiction does not discriminate. It afflicts people from all walks of life: rich and poor, young and old, people from any race or background can fall victim to the opioid epidemic, and the number of those affected grows with each passing day.
The statistics associated with opioid-related deaths are staggering and show no signs of slowing. In 2017, there were more than 72,000 overdose-related deaths in the United States—more than 50 percent of those deaths are attributed to opioids. That equates to roughly 137 deaths per day.
Philadelphia is no exception. There were 1,200 overdose deaths in the city in 2017, and more than 80 percent of those deaths are attributed to opioid misuse. During this time period, Jefferson Methodist Hospital was treating upward of 40 overdoses per day.
Compared to other illnesses, addiction treatment is still in its infancy. A mere 50 years ago, many addicts were institutionalized or incarcerated. The next form of treatment was to kick the addiction cold turkey, which only works in 12 percent of patients; a better option than prison, maybe, but one that still neglects the underlying issue. Jefferson has now embraced a “warm handoff” methodology, which treats a patient’s physical, mental, and emotional needs while battling addiction.
Addiction is a medical disease, and the idea is to treat it as such.
While addiction has gained recognition as a chronic disease, it is still too often treated as an isolated incident. At Jefferson, help doesn’t end after a patient exits the emergency room. The Narcotic Addiction Rehabilitation Program (NARP) offers a full range of care options, from the initial acute treatment, to behavioral and psychiatric therapies, medically assisted treatment, and working with external rehabilitation programs within the surrounding communities.
Overcoming addiction requires more than simply treating the patient. To minimize potential relapses, it is vitally important that those around the patient—family members, friends, and significant others—are also equipped with the tools to help. That’s where Community Reinforcement and Family Training (CRAFT) intervention comes in. By providing an eight-hour intensive training class, friends and family are taught how to identify and treat addiction, prevent relapse, and encourage treatment for patients.
“Study after study after study demonstrates the efficacy of treatment,” Sterling says. “How you translate these ideas into changing an individual’s life, that’s the magic of treatment.”
It’s easy to simply dismiss the opioid crisis as an affliction of the uneducated and impoverished, but the truth is not so black and white. While heroin and fentanyl may be the face of the opioid crisis, the reality is that addiction can often start in the hospital with prescription drugs such as Vicodin, codeine, and oxycodone.
“I think it’s important to take responsibility as a healthcare system,” says Edmund Pribitkin, MD, chief medical officer for Thomas Jefferson University Hospital. “We’re actually getting out into the streets with our physicians, social workers, and with our crisis managers to help folks at the point of care.”
The Division of Substance Abuse Programs is working with departments throughout the Jefferson enterprise to proactively combat and prevent addiction. It only takes about a week to develop an opioid dependence, which can quickly snowball into addiction. That is why no doctor at Jefferson is permitted to prescribe a patient more than three days’ worth of narcotics.
While addiction treatment has progressed from incarceration as the preferred method, the nation still has a long way to go. The paradigm shift from user to patient is a monumental step in the right direction toward removing the stigma associated with substance use.
“There is no more rewarding moment as a physician than that ‘aha’ moment,” Sterling says with an optimistic smile. “Treatment is that moment of recognition that ‘my life can get better, my life can change.’”