Colorado Fights Against Opioid Epidemic with Opioid Treatment Grants for Hospitals

https://media.9news.com/embeds/video/8289919/iframe Opioid overdose deaths have increased three-folds in Colorado from 2000 to 2015. It’s evident that more and more Colorado residents are getting addicted to both illicit opioids, like heroin, and prescription opioids, like oxycodone, codeine and hydrocodone. To combat growing addiction rates in Colorado, the Office of Behavioral Health has given two Colorado hospitals, University of Colorado Hospital and St. Anthony North Health Campus, $400,000 grants. These grants will allow the hospitals to treat opioid addiction in emergency rooms. This will hopefully lower opioid addiction rates throughout this state. Before these grants were available, emergency rooms would often have to turn down helping opioid addicts. Overdose patients would be released once they’ve completed detox. They wouldn’t have the tools and resources necessary to face their addiction. As a result, many of these patients would turn back to opioids due to their fear of getting sick. This perpetuated a vicious cycle of addiction.

What the Grants Will Go Toward

The grants offered by the Office of Behavioral Health is part of UCHealth’s new plan. These grants offer opioid abusers Medication-Assisted Treatment (MAT). This treatment involves providing medications, like Subutex or Suboxone, to addicts. These prescription drugs are capable of combating an addiction to opioids or opiates. It helps opioid abusers get back on the path to sobriety. UCHealth has developed a model for treating opioid addictions. Instead of only treating opioid addicts for a couple of hours while they recover from an overdose, these patients are now receiving the medical attention they need until they start withdrawals. This can take up to 24 hours or longer. Once they start to experience opioid withdrawal symptoms, patients are placed on a MAT. This will help them get over their addiction. These grants allow emergency rooms to treat opioid addicts as a person struggling with a chronic disease.

“87% of patients started on MAT in the emergency departments will continue their treatment outside of the hospital.”

Hospitals in this program will also connect patients with Opioid Treatment Programs (OTP). Colorado has 23 OTP locations. Patients will have access to physicians, doctors and nurse practitioners who can prescribe the medications used in MAT. In particular, they’ll most likely prescribe buprenorphine. Patients will also receive continuity of care and increased access to MAT. Those who live in rural communities in Colorado can seek the services they need from a doctor’s office instead of an OTP location. 

What Is Medication-Assisted Treatment?

Medication-Assisted Treatment (MAT) is a treatment that uses FDA-approved medications. These medications help patients recover from substance use disorders (SUDs). This type of treatment is applicable to all types of addictions. MATs can treat an addiction to alcohol, stimulants, depressants, benzodiazepines and opioids. MATs used to treat an addiction to opioids or opiates are also often known as Opiate Replacement Therapy (ORT). This type of therapy replaces strong opioids with weaker alternatives. These weak opioids stimulate the same opioid receptors in the brain and body. However, they are less addictive and come with a lower potential for abuse. According to the Substance Abuse Mental Health Services and Administration (SAMHSA), the three most common medications used in ORT are:

• Buprenorphine
• Methadone
• Naltrexone

While these medications are incredibly effective, they must be used in conjunction with therapy and other treatment modalities. These medications treat physical withdrawal symptoms. These medications can ease opioid withdrawal symptoms and cravings. They can also reduce illicit opioid use and block the effects of other opioids. Most importantly, they help patients stay in treatment, so they have a better shot at recovery. Other treatment modalities will treat psychological withdrawal symptoms. They help patients learn how to identify triggers and how to deal with stress in a more positive manner. Each patient will need a different treatment plan.  The Food and Drug Administration (FDA) approved buprenorphine for clinical use in October 2002. This prescription medication is a partial opioid agonist. It attaches to opioid receptors to prevent opioids from bonding. It basically works in the same way as strong prescription opioids, like oxycodone. The only difference is that its effects are weaker. As a result, it’s easier to wean off of this drug. Buprenorphine also has a “ceiling effect” that makes it harder to misuse. Once a certain dose is reached, the effects of this opioid will level off. It doesn’t matter if patients continue to take a larger dose. They will not get anything more out of this prescription drug. Buprenorphine is different from other MATs since it has unique pharmacological properties. These properties include:

• A lower potential for misuse
• An increased safety in the event of an overdose
• An ability to diminish a physical dependence to opioids

This medication also has a long-acting agent. This means that patients may not have to take buprenorphine every day to get over an addiction to opioids or opiates. Another advantage of buprenorphine is that it is the first and only medication that can be prescribed or dispensed in a doctor’s office. Under the Drug Addiction Treatment Act of 2000 (DATA 2000), doctors can offer buprenorphine in various settings. They can prescribe and administer this drug from an office, a community hospital, a correctional facility and more. The benefit to this is that it increases treatment access.

The Different Types of Buprenorphine Products Available

Buprenorphine comes in several different forms. The FDA has approved the following products:

• Bunavail, which contains buprenorphine and naloxone and comes in the form of a buccal film
• Suboxone, which contains buprenorphine and naloxone and comes in the form of a film
• Zubsolv, which contains buprenorphine and naloxone and comes in the form of sublingual tablets
• Buprenorphine-containing transmucosal products
• Probuphine, which is an under-the-skin implant that contains buprenorphine

More and more new buprenorphine products are constantly being released. These products make it easier for patients to stay compliant with a treatment plan. They also tend to be more effective in administering a steady dose of the medication.  Methadone is a full opioid agonist. It works in the exact same way as heroin and oxycodone. It changes how the brain and the nervous system respond to pain. This drug is often used in MATs. It comes in the form of a pill, a liquid or a wafer. This medication needs to be taken once a day for optimal efficacy. Its effects will last anywhere from 4 to 8 hours. Unlike buprenorphine, methadone is part of a structured clinical program. This means that it is often the drug of choice at inpatient rehab facilities. Patients who take this drug will need to be under constant supervision from a physician. This is to ensure that patients are compliant with the treatment plan and schedule. By law, only an opioid treatment program (OTP) certified by SAMHSA can dispense this medication. As a result, methadone is less accessible than buprenorphine. It can only be dispensed or administered in certain settings. This prevents the drug from being accessible to certain patients. Methadone is more effective in higher doses. As a result, it’s often used to treat long-term addictions to heroin. However, those who take methadone for longer lengths of time are more likely to develop a secondary addiction. It’s also possible for patients to overdose on this drug if they take excessive amounts of it to get high.

Naltrexone is the newest MAT approved by the FDA. This drug comes in either a pill form or as an injectable. Patients who opt for the pill will need to take a 50 mg dose once a day. On the other hand, those who opt for the injection will receive a 380 mg extended-release injection once a month. The injection is much more convenient for most patients. Before recovering opioid users can switch to naltrexone, they must abstain from using any illegal opioids or opioid medications for at least 7 to 10 days. This medication is useful in the long-term maintenance of opioid addiction. It’s not as helpful with treating physical withdrawal symptoms. Naltrexone is an opioid antagonist. It uses a different mechanism than buprenorphine or methadone. This drug will bind to and block opioid receptors to reduce cravings. The main advantage of naltrexone is that it comes with no potential for abuse. Patients who take this medication will not develop a tolerance to the drug nor a dependence on it. They also won’t be able to get high even if they were to take a dose of opioids or opiates. With that said, naltrexone can reduce a person’s tolerance to opioids. They may become more sensitive to a lower dose. As a result, if those who are treated with naltrexone relapse, they are much more likely to experience an opioid overdose if they take the same opioid dose as before.

How the Opioid Crisis Began

A fairly common question that is on many people’s mind is, “how did the opioid epidemic begin in Colorado?” Since when did so many people become addicted to opioids? While most people imagine addicts as people who abuse illicit drugs, like cocaine or heroin, the truth is that many people who are addicted to opioids began with a prescription. They may have been struggling with chemotherapy, have just gotten out of surgery or have gotten into an accident. Either way, these patients were in tremendous pain and needed help. At the time, the best thing that the doctors could do for them was to prescribe them painkillers. Prescription opioids were being pushed by pharmaceutical companies. The sales reps all claimed that these magical pills could treat pain without any major side effects. In fact, they reassured medical societies and doctors that the risk of addiction to prescription opioids was very low. As a result, more and more doctors started to prescribe prescription opioids. Unfortunately, while these drugs were effective in treating pain, they were also highly addictive. This led to the beginning of America’s struggle with opioid addiction. As doctors tried to wean patients off of the prescription painkillers, many patients were unable to comply with the taper schedule. Some patients were asked to quit cold turkey, which is basically impossible. A large portion of those who were addicted to opioids would turn to illicit alternatives, like heroin. America’s massive opioid problem was first perpetuated by pharmaceutical companies that pushed these drugs. Those who got addicted were often under the misconception that the drugs that they were taking were safe. Patients were unaware that these drugs came with a high potential for abuse even if they are taken as prescribed.

From Prescription Painkillers to Heroin

Prescription opioid abuse will most likely lead to heroin abuse. In fact, 80% of heroin addicts started off abusing a prescription painkiller before turning to this illicit drug. The reason why many addicts turn from prescription pain medications to heroin is because they’re both opioids. Both of these substances have the same effect on the body. They cause users to experience the same type of high and euphoria. The only difference is that one of these drugs are produced by pharmaceutical companies, and the other is produced by drug dealers. Those who are addicted to prescription pain pills will need to continue to get a prescription. Those who fail to do so may look to illegal ways of obtaining their drug of choice. Unfortunately, black market prescription pain medications are rather costly. Addicts can get the same type of high at a fraction of the cost if they switch to heroin. They’ll also be able to find heroin much more easily. It’s easy to find a drug dealer who traffics heroin in almost every city.

An Unusual Observation: Opioids Abusers More Likely to Use Methamphetamine

Polydrug abuse is not an uncommon phenomenon. Those who are addicted to opioids are more likely to abuse other drugs, like methamphetamine. Studies show that past month use of methamphetamine increased from 18.8% to 34.2% in those who are seeking treatment for an opioid use disorder. America’s opioid epidemic has indirectly caused a significant increase in methamphetamine use. This has resulted in a higher prevalence rate of methamphetamine use as years go by. There are many reasons why methamphetamine may be so popular among opioid users. Those who abused opioids and methamphetamines did so because they were:

• Using the methamphetamines as a substitute for the opioids
• Attempting to achieve a synergistic high with the two drugs
• Trying to balance the effects of the opioids, so they could function normally

It’s vital for more research to be conducted in this area. Addiction specialists should figure out whether intervention methods and addiction treatment strategies should account for polysubstance use. In particular, these agencies may need to look deeper into meth use in Colorado.

Holding the Opioid Manufacturers Responsible

It’s evident that the opioid manufacturers pushing these drugs to doctors knew just how addictive the prescriptions opioids could be. There’s also a lot of evidence that these companies did nothing to stop the growing opioid epidemic. In fact, they may even have contributed to it. They offered doctors more incentive for prescribing these drugs. They also constantly pushed doctors to prescribe them. To hold these companies responsible for their actions, Colorado currently has a lawsuit against Purdue Pharma. It’s the 28th state to do so. The lawsuit against Purdue Pharma claims that the reps were aware of the growing opioid addiction rates, but did nothing to stop it.

“Their corporate focus on making money took precedence over patients’ long-term health, and Colorado has been paying the price in loss of life and devastation of its communities as they struggle to address the ongoing opioid crisis.”

~ Colorado Attorney General Cynthia Coffman

How did Purdue Pharma contribute to the growing opioid addiction rates? The lawsuit states that these opioid companies have violated many laws and regulations. To prevent abuse, federal law requires drug companies to inform the DEA if they notice any suspicious prescribing patterns. Many doctors were overprescribing the opioids pushed by Purdue Pharma. They were prescribing opioids even when they weren’t necessary. There’s evidence that Purdue Pharmacy visited many doctors close to 100 times. While the sales reps were aware of the overprescription patterns in Colorado, they did nothing. They never reported any red flags shown by practices that prescribed their opioids. They turned a blind eye when doctors prescribed these medications to people who didn’t necessarily need them. In fact, there’s evidence that Purdue sales representatives methodically encouraged and manipulated Colorado doctors to prescribe higher and higher doses. A higher dose comes with an increased risk of addiction, but the reps didn’t care. They convinced doctors to set aside any concerns that they may have about addiction. To make matters worse, these opioid manufacturers hid just how addictive their drugs were. They downplayed the potential for abuse. They made it look like it was difficult to develop a dependence on these drugs when the reality was that it is very easy to get hooked on these opioids. 

Who Is Most At Risk for Getting Addicted to Opioids?

Addiction does not discriminate. This disease can affect anyone. With that said, some people are more likely to get addicted to prescription opioids than others. These people have the following risk factors:

• An addiction to other drugs or substances, like alcohol or tobacco
• A family history of addiction; research shows that a huge part of addiction is linked to genetic factors
• A younger age; prescription opioid abuse is most common in young adults
• The presence of a mental illness; those who struggle with a condition like anxiety, depression or posttraumatic stress disorder (PTSD) are more likely to self-medicate

Those who were prescribed these pills or know a family member who takes these drugs are more likely to get hooked on them. Anyone can abuse or get addicted to prescription opioids. Many people who are addicted were prescribed the drug. They may not necessarily be aware of the dangers associated with the drugs when taking them. In fact, they may be under the misconception that these prescription pain pills are safe because they were prescribed by a medical professional. Addiction can affect anyone regardless of their ethnicity, age, or even income. Many notable celebrities are or were addicted to opioids. In fact, take a look at the video below to see how Kanye West himself became addicted to opioids. His experience shows that many doctors are not shy to prescribe these drugs. He also details how the doctors easily upped his dosage.

How 10 Colorado ERs Are Reducing Opioid Use while Still Easing Pain

To fight back against the opioid epidemic, the Colorado Hospital Association (CHA) launched an initiative known as the Colorado Opioid Safety Collaborative. 10 Colorado hospitals participated in this six-month pilot project. The goal of this project was to ease pain without the use of prescription painkillers. The project aimed to address the opioid epidemic through emergency departments. It relied on four main pillars, which include:

• Limiting opioid use and prescription in emergency departments
• Finding and using alternative treatments for pain relief
• Treating opioid addiction among patients in the emergency departments
• Finding harm reduction strategies

The main goal of this project was to reduce opioid use in the emergency departments by 15%. It was able to achieve a lot more than that. The participating hospitals were able to cut their use of prescription painkillers by an average of 36%.

“We all see the carnage that this opioid epidemic has brought… We all see how dangerous it’s been for patients, and how damaging it’s been for our communities. And we know that we have to do something radically different.”

~ Dr. Don Stader, an emergency physician at Swedish Medical Center

Thanks to this initiative, 35,000 fewer opioid doses were prescribed in 2016. This project shows that it’s possible to use alternative treatments for pain. It, however, requires coordination between providers, pharmacies, administrators and clinical staff. It’s a joint effort. The results of this project will be published soon. The strategies and methods used will revolutionize how the medical industry approach patients and pain. Ultimately, this may help put an end to America’s opioid epidemic. This initiative is particularly important to Colorado residents. After all, Colorado heroin and opioid overdose rates have quadrupled since 2002. After seeing the results of this project, many addiction specialists and experts that these new protocols will revolutionize how emergency departments deal with pain.  Those who are having difficulties dealing with pain can still take advantage of these pain relief strategies by going to one of the 10 hospitals involved in the collaboration. The 10 hospitals that participated in this collaboration include:

• Boulder Community Health
• Gunnison Valley Health
• Sedgwick County Health Center
• Sky Ridge Medical Center
• Swedish Medical Center
• UCHealth Greeley Emergency and Surgical Center
• UCHealth Harmony Campus
• UCHealth Medical Center of the Rockies
• UCHealth Poudre Valley Hospital
• UCHealth Yampa Valley Medical Center.

These hospitals, still, actively use the strategies they’ve developed. They’ve seen first-hand how it is possible to treat patients without using addictive opioids. Patients interested in this project can contact the experts at these hospitals for more information.

Alternative Treatments Discovered by the Colorado Opioid Safety Collaborative

Opioids are not the only way that hospitals can effectively treat pain. Thanks to this project, Colorado hospitals have developed and discovered multiple other effective strategies. Some of these strategies include:

• Using non-opioid patches for pain
• Using ultrasound to guide non-opioid painkillers to targeted sites
• Using safer and less addictive medications, like ketamine and lidocaine
• Taking ibuprofen or ibuprofen with Tylenol and other non-addictive painkillers
• Using heating pads plus stretching measures in conjunction with non-opioids

Thanks to this initiative, ketamine use increased by 144%. With that said, methadone use dropped by 51%, and oxycodone use dropped by 43%. Fentanyl use dropped by about 11%. Emergency departments no longer needed to rely on potent and strong prescription painkillers to treat pain. The emergency departments participating in this collaboration discovered many other strategies and methods. They were able to use different techniques that were more personalized to various scenarios. These protocols for treating pain helped keep many patients off of opioids.

Recent Bills that Have Passed in Colorado

Colorado lawmakers have been working overtime to come up with legislation and bills that can fight the opioid epidemic. In 2018, 5 out of 6 opioid-related bills were able to go through the Colorado legislative session. These bills all have to do with opioid addiction prevention, treatment, insurance coverage, and more. These bills understand that addiction is not necessarily a choice. It’s a disease and needs to be treated as such. Let’s take a look at the bills below:

• SB18-040: Substance Use Disorder Harm Reduction Bill. This bill allows hospitals to provide clean syringe exchange sites. It also allows them to create a supervised injection facility program. Those who participate in these programs will receive immunity. This bill also allows schools to administer naloxone and develop policies surrounding this drug.
• SB18-022: Clinical Practice For Opioid Prescribing Bill. This bill restricts the number of opioid pills that health practitioners can prescribe. Patients can only receive a 7-day supply initially. They can also get a 7-day refill, with certain exceptions. This prevents overprescription of addictive opioids.
• HB18-1003: Opioid Misuse Prevention Bill. This bill provides funding for studying prevention, treatment, harm reduction and recovery from opioids.
• HB18-1007: Substance Use Disorder Payment And Coverage Bill. This bill ensures that individual and group health insurance plans all provide coverage for a 5-day supply of buprenorphine. It makes it easier for opioid users to get addiction treatment.
• SB18-024: Expand Access Behavioral Health Care Providers Bill. This bill reimburses educational costs of studying addiction for mental health professionals. This may increase the number of addiction specialists in certain areas. Many cities are lacking in this department.

While these bills may help prevent opioid and opiate abuse, we are still a long way away from tackling this enormous issue. We still have a long way to go.  The previous bills are not the only attempt that Colorado has made to prevent opioid addiction. In April 2015, Colorado passed the Senate Bill 15-053. This bill expanded access to the life-saving prescription medication known as naloxone. Naloxone is an opioid-reversing drug. It’s an opioid antagonist. It is administered via a nasal spray or an intramuscular injection. It can reverse an opioid overdose by blocking the opioid receptors in the central nervous system (CNS). It prevents opioids from attaching to the receptors. Previously, it was difficult for Colorado residents to get their hands on this drug. Thanks to this new bill, opioid users can easily get a prescription from a doctor or from a medical professional with prescriptive authority. This drug can then be dispensed by other designated individuals, like harm reduction organizations or pharmacists. Naloxone becomes much more readily available. This means that it’s easier for family member and friends of addicts, first responders and opioid abusers to get their hands on a supply of naloxone. With this drug readily available, they are less likely to experience the harsh consequences often associated with opioid overdoses. In extreme cases, opioid overdoses can result in coma, seizures and death.

A Combined Effort from Multiple Agencies Will Help Colorado Beat Its Opioid Epidemic

Many agencies and institutions are doing the best they can to contribute to the fight against opioid addiction. Here, at AspenRidge North, we hope to help opioid abusers and addicts get their life back on the right track. We are a drug and alcohol rehab facility that offers both inpatient and outpatient care. We treat addiction as a mental health condition, and believe that the right addiction treatment can help anyone change his or her lives for the better. If you’re struggling with an opioid addiction, our addiction specialists can offer you the support and assistance you need. Our therapists will listen to you to better understand your situation. We respect your values and will do our best to come up with an individualized treatment plan that fits your needs. Our active approach will get you the help that you’re looking for. If you have any further questions, don’t hesitate to reach out to us. You can contact us via our online contact form or call us at (877) 212-1238. Anytime is a good time. We’re here to lend a sympathetic ear or a helping hand 24 hours a day, 7 days a week.