Arguably the hardest part of finding recovery is embedded in the process of transitioning—into treatment, out of treatment, cold turkey detox centers, from interventions to professional care, hospitals. When a person makes the decision to stop abusing illicit substances, it’s really not until action is taken that the road to recovery truly begins. Unfortunately, much of this decision-making doesn’t take place until it’s almost too late; according to an article recently published by the Center on Addiction and Substance Abuse at Columbia University (CASA Columbia), more men and women than ever are dying from prescription opioids, with a quadrupling of deaths since 1999. In 2013, more than 16,000 people died from overdoses in the U.S., with an additional 2 million misusing or dependent on the drugs. 2011 saw about 700,000 emergency room visits related to opioid misuse.
The evidence is clear: something needs to be done. As is often the case, history has shown that the best place to start is when a person is at their “bottom.” Although not always the case, that can often be when the individual has succumbed to an overdose and finds themselves in medical care at a hospital. For a brief period, this person is isolated from their poor behavior, from all the triggers, pressure, and most importantly, the need to abuse. It’s also very conducive for intervention. According to CASA Columbia, “a promising approach that can be implemented in emergency rooms, primary care, and pediatric clinics is called SBIRT, which stands for Screening Brief Intervention & Referral to Treatment. It consists of a conversation between a health care provider and the patient and is designed to screen for substance misuse, motivate the individual to cut down or stop using, and seek treatment if necessary.”
The biggest thing to take from SBIRT’s success is that it does work, but seemingly only on those with less severe problems—for example, someone who might’ve overdosed after experimenting with prescription drugs for the first time is probably not as likely to continue abusing said drugs. This is in opposition to, say, someone who has overdosed a couple of times, or has been abusing prescription drugs for an extended period of time. For the latter individual, simple intervention or treatment recommendation isn’t going to be enough. It’s kind of like telling a person that they’re killing themselves—the same person who was just brought back from clinical death. They already know.
But what if the treatment process began inside the medical facility in which the patient was brought, in effect taking out the transition stage of going from the hospital of having to relocate to a treatment facility? The Yale School of Medicine seems to think such an avenue would be highly beneficial, and indeed, have the desired effect of lowering the cost of human lives.
Of the different types of treatment for opioid addiction, an approved medication called buprenorphine is well known for its use by clinicians in helping patients wean off of illicit substances such as heroin and other opiates by managing the symptoms of withdrawal and cravings. The question is whether it can also be used in conjunction with SBIRT to enhance the latter’s effect on recovery.
According to the article, the Yale School of Medicine conducted a four-year study to find these answers. Individuals at Yale-New Haven Hospital who were addicted to opioids and agreed to be a part of the study were divided into three groups:
“The first group was given a screening for substance use and referral to treatment by being provided with a list of local treatment programs (referral group).
The second group was given a screening, brief intervention and facilitated referral, in which a health care provider arranged treatment for the patient with an outside agency (brief intervention group).
The third group was given a screen and brief intervention, and then treatment with buprenorphine while in the emergency room, and was then referred to a primary care physician in a nearby Yale clinic for a 10-week follow-up (buprenorphine group).”
In a 30-day follow-up, 78% of patients in the buprenorphine group were receiving treatment—a significantly higher rate than the other two groups; patients in the buprenorphine group reported the greatest reduction of days of opioid use per week; and patients from the other two groups used inpatient addiction treatment services at higher rates, “indicating that they needed higher levels of addiction care than those who received the medication.”
It’ll be interesting to see how this model plays out as more and more medical facilities implement SBIRT in helping individuals find recovery; the Yale School of Medicine findings already corroborate those of North Shore Long Island Jewish Health System’s use of SBIRT. Only time will tell—the act of fighting fire with fire is nothing new, but buprenorphine’ status as a Schedule III controlled substance, narcotic analgesic leaves plenty of room for the need to see a success rate on a grander scale.