Harms of Prescription Opioids – TGA is finally starting the Fix!
Governments have now quantified just some of the short and long term harms of misuse of prescription opioids, particularly in the OST (Opioid Substitute Treatment) Arena. It is way past time to look at evidence-based and successful drug-use exiting recovery therapies.
In recent decades the range and patterns of opioids used for extra-medical purposes have changed. The use of pharmaceutical opioids exceeds the use of heroin. In 2017, 63 percent of opioid deaths were attributed exclusively to pharmaceutical opioids, 28 percent to illicit opioids and 8 percent to both illicit and pharmaceutical opioids (aged 15-64 years).
The objective of this report was to estimate the social costs arising from extra-medical opioid use in Australia for the financial year 2015/16. Due to data limitations in most cases we only estimated the costs occurring in this 12-month period. For example, on-going care of chronic conditions was not included. The exceptions to this were for certain harms which occurred in 2015/16 but which had longer-term ramifications, for example premature deaths, where discounted streams of future costs (lost economic activity and lost contributions to household chores) and partially offsetting savings (future health expenditure ’avoided’ by premature deaths) were estimated. The authors also included the long-term costs of road traffic accidents, as were the expected future costs of opioid attributable imprisonment for those sentenced in 2015/16.
For complete report go to APO - Quantifying the social costs of pharmaceutical opioid misuse
Policy Reflection – Dalgarno Institute: The misuse of OST (Opioid Substitute Treatments) or MAT (Medically Assisted Treatments) or any other pharmaceutical displacement mechanism that does not have a sunset clause to usage, will continue to be a major contributor to both morbidity and mortality. This can either occur over a longer time simply due to the toxic nature of persistent opioid use on the human biological unit; or short term, by direct misuse of the legal opioid for ‘recreational’ or self-harming purposes, by either the client or their network.
This growing issue continues to be overlooked or deliberately discounted by certain sectors. Which means that this, arguably well-meaning, but poorly implemented ‘harm reduction’ mechanism continues to add to the drug using cohort and the increasing harms this ‘pairing’ collectively bring.
The net result of a no-exit, perpetual use of opioids, whether licit or illicit, only causes harm, the very thing the policy pillar was supposed to reduce.
If sunset clauses and exit strategies are not harnessed to these chemical mechanisms, then we will only see these harms grow, along with an ever-burgeoning pressure and cost to the health-care system. This is not best practice health care, and no longer rates as a positive ‘net community benefit’ economic rationale either.
Reducing drug use is the primary objective of the National Drug Strategy, and in both its intent and specifics does not promote, or we would argue, condone this policy and people failing measure.
Drug use exiting recovery is not only possible, but consistently achieved when actively facilitated in its best practice format too.
We will leave you with a very provocative quote (now 14 years old) but perhaps even more relevant today? A statement that could have only been published then, but with the ‘cancel culture outrage’ in play at present, may well be ignored now and for the very reasons it confronts.
“The medical profession and the addicted community have a complex, symbiotic, mutually dependent relationship that does none of us any good. Basically, they pretend to be ill and we pretend to treat them. And thousands of public employees make a good living out of it. Prescribing for opiate addicts is like throwing petrol on a fire; pointless, counterproductive, stupid, self-defeating. And yet we keep doing it.”
Dr Phil Peverley, PULSE, 22 June 2006
We Do Recover – Excerpt from evidence-based review of N.A and 12 Step Facilitation Programs
Active drug users have a generally positive view of NA and seek help through NA through a variety of influences, including contact with an NA member, referral by a treatment agency, or encouragement from family members. Attraction or aversion to NA depend upon such factors as personality, problem severity, degree of religious orientation, and social network norms.
Dropout rates from NA are comparable to those in AA (approximately 40% at one-year follow-up)60 and are lower than dropout rates of other interventions into alcohol and other drug problems as well as rates of adherence to prescribed management of other chronic health conditions. In the case of addiction treatment in the United States, which usually transpires over 30-90 days, only 43.4% of admitted patients successfully complete treatment. Thirty-four percent of patients admitted to addiction treatment in 2015 either dropped out prior to treatment completion or were administratively discharged by the facility prior to treatment completion. Only 5.2% of admitted patients remain involved in addiction treatment for more than one year,61 and the majority of patients completing a primary course of addiction treatment do not participate in sustained continuing care activities delivered by addiction professionals.
“…freely available AA and NA networks could provide a cost-effective long-term therapeutic adjunct to professional SUD approaches for youth.”104
“Twelve-step programs represent a readily available resource for individuals with substance use disorders. These programs have demonstrated considerable effectiveness in helping substance abusers achieve and maintain abstinence and improve their overall psychosocial functioning and recovery….it is possible to increase twelve-step involvement and that doing so results in reduced substance use.”105
“AA/ NA participation is a valuable modality of substance abuse treatment for teens and much can be done to increase teen participation, though more research is needed.”107
“Though not the only model for post-treatment recovery support, research to date suggests that similar to adults, adolescents’ involvement in 12-step groups predicts improved AOD use outcomes, and greater participation (i.e., frequency, duration, and extent of involvement) predicts abstinence and SUD remission better than attendance alone. Moreover, 12-step participation reduces the associated healthcare costs for adolescents with SUD. Despite these benefits, in 2015 <2% of AA’s and NA’s total membership comprised people under 21 years old.”110
“Manualized AA/TSF interventions usually produced higher rates of continuous abstinence than the other established treatments investigated. Non-manualized AA/TSF performed as well as other established treatments. AA/TSF may be superior to other treatments for increasing the percentage of days of abstinence, particularly in the longer-term. AA/TSF probably performs as well as other treatments for reducing the intensity of drinking (of alcohol). AA/TSF probably performs as well as other treatments for alcohol-related consequences and addiction severity. Four of the five economics studies found substantial cost-saving benefits for AA/TSF, which indicate that AA/TSF interventions probably reduce healthcare costs substantially.”111
In summary, NA studies, NA-inclusive 12-Step studies, and published reviews of 12-Step research (including Twelve-Step Facilitation treatment approaches) all report a strong association between NA participation and reduced drug use and increased rates of abstinence. Confirmation and clarification of this relationship awaits additional studies of increased methodological rigor using larger and more diverse population samples, including non-treatment samples. The available evidence suggests the potential value of NA participation in recovery initiation and long-term recovery maintenance.
Effects of NA Participation on Global Health.
Christo and Sutton compared 100 NA members to a control group of 60 students and found that diminishment of anxiety, improvement in self-esteem, and increased employment linked to duration of NA participation.117
Beygi and colleagues compared the coping styles of NA members and patients in methadone maintenance treatment (MMT) in Iran. NA members had higher ratings for interpersonal relationships, physical health, and positive coping skills than patients in MMT.118
Taallaei and colleagues compared quality of life scores of NA members, members of a therapeutic community and patients enrolled in methadone maintenance treatment in Iran. Participation in all three of the interventions increased quality of life scores, with the NA group scoring highest on quality of life.120
Akhondzadeh and co-investigators compared the personalities of 100 NA members and 100 patients in MMT in Iran. NA members scored lower on neuroticism and higher on agreeableness.121
Mansooreh conducted a study of the quality of life of 110 male NA members in Iran. The authors concluded: “an increase in the membership duration in NA was associated with lower levels of depression and physical pain and higher levels of general health and positive emotions.”124
Azkhosh and co-investigators compared 20 NA members, 20 methadone maintenance patients, and 20 patients receiving acceptance and commitment therapy (ACT) in Iran. The ACT group scored higher on psychological well-being and psychological flexibility.126
Hosseini and colleagues studied the psychological well-being of 368 NA members in Iran. The study concluded: “consistent participation in NA self-help groups can significantly lead to an increase in quality of life.”128
Time is a critical ingredient to achieving effects via NA participation. For example, while reduced drug use and initiation/stabilization of abstinence can occur early within NA participation, recovery of psychological health may take up to five years following cessation of drug use.137 Positive outcomes related to NA participation are dependent on two factors: Intensity of participation and duration of participation
Table 12: Suggested Actions to Increase Youth Participation in NA and other 12-Step Groups
Conclusion: Systematic reviews of professional treatment of substance use disorders whose primary goals and methods focus on engagement and increased participation and retention in NA (e.g., 12-Step Facilitation) confirm that such an approach is as effective, but not more effective, than other treatment approaches on several outcomes. Twelve-Step Facilitation that includes assertive linkage to NA is recognized as an evidence-based practice by the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, The National Association of Addiction Treatment Providers, the American Psychological Association, and is listed in the Directory of Evidence-based Practices for Substance Use Disorders.
A first-of-its-kind review and meta-analysis of specialized literature suggests that mind-body therapies, such as meditation and cognitive behavioral therapy, can help ease physical pain and prevent the development of opioid use disorder.
"Practitioners should consider presenting MBTs (Mind Body Therapies) as nonpharmacologic adjuncts to opioid analgesic therapy. [...] Behavioral healthcare professionals working alongside physicians could feasibly integrate MBTs into standard medical practice through coordinated care management."