Use of anti-addiction medicines lags behind rates of opioid addiction
William Evans grew up in Brookfield, a high school tennis player from a family with an Ivy League pedigree. By the time he was working at his first job after college, he was addicted to opioids, spending $25,000 in less than a year and driving to Philadelphia twice a week to buy drugs on the street.
Now 37, Evans hasn’t used illegal drugs since 2006. He is married and has a 3-year-old daughter, a home in Trumbull, and a sales job at a software company. He attributes his sobriety to counseling and medication to treat his addiction.
“It’s allowed me to live a life,” he said.
Research shows that medication-assisted treatment for opioid addiction is effective because it eliminates drug cravings, but the use of MAT in Connecticut is not keeping up with the epidemic, said Dr. David Fiellin, director of the Yale Program in Addiction Medicine, who works with the state to address the opioid crisis.
“We are, at some level, playing catch-up,” Fiellin said. “I think it’s going to take, unfortunately, a number of years” to meet the need for MAT in the state, he said.
The need and treatment gaps
In 2017, 1,038 people died of opioid overdoses in Connecticut, up from 729 in 2015 and 917 in 2016, state medical examiner figures show. Connecticut ranks in the top 10 of states with the highest rates of fatal opioid overdoses, according to the National Institute of Drug Abuse, which said the state rate more than quadrupled from 5.7 deaths per 100,000 people in 2012 to 24.5 in 2016.
There are no “reliable estimates” of the number of Connecticut residents with opioid use disorder Fiellin said. Roughly 2 million people are addicted to opioids in the U.S., with 72,000 fatalities in 2017, according to preliminary figures from the Centers for Disease Control and Prevention.
Three drugs have federal approval for treatment of opioid use disorder. They are methadone, administered only in federally regulated sites; buprenorphine, for which medical professionals must be trained before prescribing; and naltrexone, for which training isn’t required, but is in limited use because patients must be drug-free for seven days before taking it.
Addressing opioid addiction with medication-assisted treatment reduces overdoses, illicit drug use, cases of HIV and criminal behavior, Fiellin said. The practice is endorsed by federal health agencies and the state government.
About 3,800 practitioners are licensed in Connecticut to prescribe buprenorphine, according to federal figures provided by the state Department of Consumer Protection. That number includes doctors, psychiatrists, nurse practitioners, and physician assistants who work in private practices, emergency rooms, health clinics and substance abuse facilities.
But state and local health officials say there’s a dearth of primary care physicians who treat opioid use disorder with MAT. Also, few residential treatment programs use MAT, opting for no-medication, an approach that increases overdose risk after discharge, Fiellin said.
Private practitioners in addiction care are mainly psychiatrists and addiction specialists, not primary care doctors, experts said.
One exception is Dr. Peter Rostenberg of New Fairfield, a primary care doctor and internist who has been using MAT since 2003. He has prescribed Suboxone, a brand name of buprenorphine, to some 500 patients. As part of their treatment, he requires them to attend group therapy.
“Isolation is addiction and socialization is recovery,” Rostenberg said.
Rostenberg said his typical patients come to him “in desperation,” often after being unsuccessful in residential abstinence programs. Generally, after taking buprenorphine, they “flourish in life,” he said. “They feel really good because they are losing that craving.”
Emergency departments in 11 acute care hospitals and VA Connecticut Healthcare now prescribe buprenorphine, which also eases withdrawal symptoms. In the first four months of 2018, there were at least 3,090 ER visits for suspected drug overdoses among state residents, the state Public Health Department reports.
Fiellin said treatment gaps are statewide, but are most acute in northwestern and northeastern Connecticut. Even in cities with several treatment options, there is not a sufficient mix of services, which can mean long waits, inadequate hours of operation and insurance hurdles, he said.
About 50 percent of the people being treated for opioid use disorder are covered by Medicaid, 30 percent by private insurance, and the rest either have no insurance or are covered by federal veterans’ benefits, Fiellin said.
Lauren Siembab, MAT director for the state Department of Mental Health and Addiction Services, said she knows of just 15 primary care doctors who take Medicaid and treat opioid use disorder with medication.
For Evans, life “drastically changed for the better” after getting treatment from Rostenberg. Evans said he began snorting opiates in college and eventually became consumed with getting increasing amounts as his tolerance grew.
He spent the $10,000 his grandmother gave him for graduation and exhausted his salary at a car rental company. “I knew I was going to hit a wall where I was not going to be able to support this addiction anymore,” he said.
Evans said his addiction robbed him of the ability to maintain relationships, save money and achieve goals, and made him unreliable. Suboxone, he said, doesn’t make him high, but takes away his cravings and allows him to feel normal.
Counseling and support groups helped him change, he said. He stopped associating with friends who took drugs, changed his phone number so dealers couldn’t reach him, and avoided bars. Two friends have died of overdoses, Evans said.
He’s been married for five years. He dotes on his daughter. He plays tennis, golf and guitar. And, he said, “people can count on me.”
The state Department of Mental Health and Addiction Services provides information on medication-assisted treatment options. For information click here.
The Substance Abuse and Mental Health Services Administration provides a list of 1,137 doctors, nurse practitioners and physician assistants who are licensed to administer buprenorphine and have requested to be listed. To find CT licensed practitioners click here.
Editor’s note: An earlier version of this article included an incorrect headline saying a Yale program urged greater use of anti-addiction medicines. While Dr. David Fiellin, director of the Yale Program in Addiction Medicine, is quoted in the story, the program has not called for more use of medication-assisted treatment.
This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org).