The Times, Trenton

It's Urgent That Physicians Screen And Intervene In Opiate Abuse

The Times of Trenton — Thursday, July 24, 2014

Times Op-Ed
By Daniel J. Meara

Great loss sometimes offers the solace of bestowing clarity. Such hard-won understanding seems to be found in the wake of the many opiate deaths in New Jersey and across the country. From the unsettling number of lives lost to overdose and the sharp rise of addiction has emerged widening recognition that drug addiction is, at its core, a public health matter — as two responses to the crisis, issued by the American Medical Society (AMA) and the Centers of Disease Control (CDC), attest.

Earlier this year, the CDC weighed in, holding that opiate misuse had reached epidemic levels. Overdoses have surpassed car crashes in causing the greatest number of accidental deaths. To reduce this toll, CDC Director Dr. Tom Frieden said, "Health care providers need to screen for abuse risk and prescribe judiciously by checking past records in state prescription drug monitoring programs. It's time we stop the source and treat the troubled."

Acting in concert with the CDC, the AMA issued a statement identifying an urgent need for expanded addiction treatment and prevention to confront the worsening drug problem. Speaking of the issue's considerable complexity, AMA President Dr. Robert M. Wah said, "We recognize that this is a multipronged problem and have long advocated for an evidence-based, public health approach to address this crisis."

The AMA also calls for "enhanced educational opportunities for physicians." This is in keeping with the Affordable Care Act's goal to integrate primary care with behavioral health. The AMA's proposed training on addiction for physicians and other medical personnel should encompass a model called "screening, brief intervention and referral to treatment" (SBIRT). This is a method with which a doctor or nurse practitioner can identify and potentially interrupt a patient's drug misuse before it becomes full-blown addiction. It will both save lives and greatly curb medical costs arising from organ failure, heart disease and the like when addiction progresses to an advanced stage.

SBIRT begins with a series of questions that reveal signs of a patient's excessive alcohol or other drug use. If the patient's use appears to be heavy and/or a contributing factor to his or her health problems, medical personnel examine the issue more deeply and, if appropriate, refer the individual for specialty addiction treatment. Two organizations in the state, the National Council on Alcoholism-New Jersey and New Jersey Citizen Action, are collaborating to promote its widespread adoption in a variety of medical and community settings, with a focus on the young.

The importance of a doctor being able to recognize drug misuse was touched on during a recent conference on advances in pain medication in Newark. There, an expert from the Integrative Pain Center in Arizona said that when a primary care doctor diagnoses a drug problem in the course of a patient examination, it is paramount to care for that problem before addressing a physical ailment, the source of which may well be drug use. His reasoning was clear: If the drug problem persists, any related physical health problems will surely worsen or recur.

The urgency for screenings and intervention is apparent, as the prescription drug and heroin problem now extends throughout New Jersey. An area of the state not generally known for being plagued by drug problems, the New Jersey shore — specifically Ocean and Monmouth counties — has seen some of the worst fallout. Certainly, parents living along the state's coast never imagined they would find themselves in the midst of an opiate epidemic.

The many prescription drug and heroin deaths in two shore counties illustrate a second truism about addiction: It strikes indiscriminately. A variation on that fact is the theme of a new campaign in the state, "Addiction Does Not Discriminate," launched in mid-May at, appropriately, Jersey Shore Medical Center in Monmouth County. This initiative promotes awareness through billboards and a website,

Among the speakers at the Addiction Does Not Discriminate campaign's unveiling was a hospital executive. Of the hundreds of opiate deaths and thousands of cases of addiction, he said, "We have never seen anything like this." The urgency in his voice was professional, but also unmistakably paternal.

Daniel J. Meara is public information manager of the National Council on Alcoholism and Drug Dependence-New Jersey.

Copyright 2014

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