Article By: Chief Executive Officer – Patrick McGinn – MS, MA, LLP, CAADC, CCS-M
Our society is in the middle of an extraordinary opioid epidemic which has been described as a crisis. Odds are, any time you read the news, there is something mentioned about this issue. More people have died (6 out of 10 overdose deaths) from opioid over doses than in any other period of our history.
How did we get here?
A brief history of pain management.
Pain is an element of the human condition. Our understanding of pain has varied over the centuries. What was once considered a philosophical interpretation that men, women, and children endured physical suffering was inevitable; the meaning, rather than the fact of pain, was what mattered to leading a good life, to a medical/neurobiological understanding of pain lead by research and scientific discovery. Progress made on the study of human biology and recognizing the brain’s role in interpreting pain, lead to an entirely new way of thinking about pain management. https://www.opioids.com/pain-management/history.html
The science of administering drugs for pain has been advancing for centuries, as well as our societies desire to feel instant relief from the discomfort caused by pain. Prescription drug manufacturing companies are driving this idea among the medical community and the general public, developing products that will meet the desires of their customers. As a result of the availability of these ‘good’ drugs, doctors have been over prescribing pain pills without realizing the ‘bad’ impact this was having on their patients. In their efforts to help people with chronic pain, many doctors overestimated the benefits of prescription opiates, while underestimating the risks of potential addiction problems.
Many Drugs Contribute to Today’s Health Epidemic
Recently, the Surgeon General’s Report on Alcohol, Drugs and Health (2016) was released. This report discusses the struggles across the US of all substance use problems in terms of cost to society, rising health care costs, lost productivity, the devastating effects on lives, future plans and lost lives. Below is an excerpt from that report:
“Over 175 million persons aged 12 and older (65.7 percent of this population) reported alcohol use in the past year, with over 66 million (24.9 percent) reporting binge drinking in the past month. More than 36 million (13.5 percent) reported using marijuana in the past year, 12.5 million reported misusing prescription pain relievers, and over 300,000 reported using heroin in the past year. Almost 8 percent of the population met diagnostic criteria for a substance use disorder for alcohol or illicit. Although 20.8 million people (7.8 percent of the population) met the diagnostic criteria for a substance use disorder in 2015, only 2.2 million individuals (10.4 percent) received any type of treatment. Of those treated, 63.7 percent received treatment in specialty substance use disorder treatment programs.”
What Action is Being Taken?
There is an opportunity to bring substance use disorder treatment and mainstream health care systems into alignment so that they can address a person’s overall health rather than treating one or the other in isolation from each other. This discussion is on the agendas of both the Federal government and Michigan legislature.
The initiative is based on Section 298 in the Public Act 268 of 2016. The Section 298 Initiative is a statewide effort to improve the coordination of physical health services and behavioral health services in Michigan.
This is a statewide effort is to “improve the coordination of behavioral and physical health services for individuals with mental illnesses, intellectual and developmental disabilities, and substance use disorders.”
Addressing the Issue on a Regional Level
This initiative has spurred the on-going conversation at Harbor Hall board meetings as to how to meet the changing practice polices as directed by the State of Michigan and the Federal government and to address to the best of our ability the ongoing opioid crisis. Harbor Hall has always recognized that integrating substance use disorder services with primary care and mental health treatment as being essential in successful recovery for many years. We cannot however, deny the facts that with the ongoing opioid crisis, the publication of the Surgeon Generals’ report and the State of Michigan 298 initiative, this treatment philosophy has become more relevant than ever to the services we provide in northern Michigan.
What Our Research Shows
In conducting our own research internally of the people who receive treatment services at Harbor Hall facilities, we have recognized some trends in Northern Michigan. Below is a synopsis of actual data as derived from information gathered at Harbor Hall over the past 3 years.
| Primary Drug | 2014 | 2015 | 2016 |
| Alcohol | 37.34% | 39.34% | 44.5% |
| Heroin | 12.65% | 14.65% | 28.7% |
| Prescription Opiates | 37.34% | 32.34% | 16.8% |
| Cocaine/Crack | 3.61% | 4.61% | 1.4% |
| Methamphetamine | 5.42% | 6.42% | 5.9% |
| Poly dep/abuse* | 88.9% | 90.1% | 92.3% |
When combined, all opiates (prescription/heroin) in 2014 represented 50% of all admissions, in 2015 this decreased to 47% of all admissions and in 2016 it’s even lower: 46% of all admissions. We believe it is very clear that as prescribing practices of opiate type medications has changed (2016), and there has been a significant shift from prescription opiate addiction to heroin addiction. * (Poly abuse is abusing more than one drug at the same time, i.e. alcohol and opiates and cocaine.)
Alcohol is Still the Leading Drug of Choice
With this data, alcohol admission numbers are just as alarming as the prescription opioid/heroin numbers. Our statistics shown above only addresses the clients’ primary drug of choice. Most people who have sought treatment at Harbor Hall are using more than one substance when they are admitted.
While the national spotlight seems to be shining on prescription opioids, we cannot ignore the years of data we have collected. This data matches what is happening nationally, however, our approach to this issue is to be pro-active, not reactive. The treatment methodologies at Harbor Hall have evolved with science, as science has changed the way we think about addiction.
