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State Project To Encourage Doctors To Treat Opioid Addiction With Medication

Schedule 2 narcotics: Morphine Sulfate, OxyContin and Opana are displayed for a photograph in Carmichael, Calif., Jan. 18, 2013.
Associated Press
Schedule 2 narcotics: Morphine Sulfate, OxyContin and Opana are displayed for a photograph in Carmichael, Calif., Jan. 18, 2013.

State Project To Encourage Doctors To Treat Opioid Addiction With Medication
State Project To Encourage Doctors To Treat Opioid Addiction With Medication GUEST:Dr. Carla Marienfeld, addiction psychiatrist, UC San Diego Health

This is KPBS Midday Edition I am Maureen Cavanaugh. We've all heard about the rising rates of opioid addiction across America. These powerful painkillers run the gamut from the frequently prescribed Vicodin to the street drug heroin. Tens of thousands of Americans die each year from accidental overdose. A newly funded program California may make it easier for people to be addictions. Doctors will be instructed in the use of medically assisted forms of opioid treatment. Joining me as an addiction psychiatrist who will be speaking on opioid addiction treatments at a form in San Diego tonight. Walking to the program. San Diego has seen and alarming increase in the use of opioids in recent years but in some parts of the country it is at a crisis level. Before this new medication -assisted treatment what is the standard treatment for patients assisted to opioids. San Diego is seeing increases that are mirroring what we see in other parts of the country that have had terrible problems. Medication -assisted treatment is not a new idea. He came around in the late 1960s and 70s and has a very interesting history but was largely in response to returning veterans to the Vietnam war that had been exposed to OPM and morphine at that time and there were some doctors who are doing controversial work at that time but got a medication called methadone that helped them no longer have the creative means which drive does cravings which drive the cycle of use. Medication assistance in addition to other things we know are helpful which helped them get back to having a normal life. Methadone was really the only medication that we used for a long time in addition to some of the other types of community support and psychosocial treatments that I mentioned until around 2000 and it literally took another act of Congress to pass a law firm been orphaned to be prescribed. It was able to be prescribed in an office space in an outpatient setting which really increases access to care because of the -- Is Buprenorphine less expensive ? It is -- it depends how you determine the cost. Because there is a lot of rolls around the structure of methadone and how it needs to be delivered at cost a fair amount of nursing oversight and physician oversight and those kind of things. Buprenorphine as a medication itself cost more but because it is delivered in more common healthcare settings there are less cost associated with some of the structure supporting the medication. Apparently some doctors have been leery about prescribing this drug. Why is that Many doctors do not have the training or knowledge about it. This was not around for a lot of decisions to we are working to train physicians so they understand how to use it. When we are talking about the opioid epidemic in the country a lot of the concern is about opioid overdose. That's the main thing. We want to prevent mortality and make sure people are making/living healthy lives. This medication on its own is hard to overdose on. If it is combined with other sedating medications you can still see an increase in overdose. Talking about opioids probably a lot of the overdoses are involving combinations with alcohol other sedating medications plus the opioids. This combination is really deadly. When you are prescribing something that you know has a potential interaction or potential overdose risk you want to be sure you are doing so safely. In addition to that sometimes patients will be afraid of the stigma associated with it. They are hesitant to seek out healthcare. There is a large black-market term for this medication word is diverted from the person for it is intended. There are people treating this as withdraw or try to prevent the use of more dangerous drugs. What is the success rate of Buprenorphine in order to get people off of their opioid addiction. It is very high. In comparison to other medications we have in psychiatry and general medicine it is very effective. Take patients who are using illicit opioids daily going down to 20 -- 10 or 20% which is a dramatic and -- decrease and this is determined by monitoring random urine drug screens and seeing if patients are actually using opioid or not. He talked about treating people with substances abuse problems. Are they treated separately? They are in many settings many people have higher rates of depression and anxiety and other mental health problems. People that have mental health problems also have higher rates of substance use. It makes sense that we treat them together but unfortunately because of stigma and other historical reasons it is often treated separately. Really we know now and there is lots of good models supporting this that integrating all three of those results in the best outcomes. As much as we can try to advocate for mental health or advocate for addiction. It is really the integration of all of your healthcare together that will be best for the full game. We will discuss opioid addiction tonight at the UC Morris cancer center. The talk is free but you must register to attend. Thank you so much. It is a pleasure to be here.

California public health officials are encouraging doctors to use buphrenorphine in the fight against opioid addiction.

A federally-funded project will provide support, education and training for doctors that prescribe the drug, Marlies Perez with the California Department of Health Care Services told Capital Public Radio.

Unlike methadone, a narcotic used to treat opioid addiction that can only be prescribed through treatment programs, buprenorphine can be prescribed through a doctor's office.

Dr. Carla Marienfeld, an addiction psychiatrist at UC San Diego Health, said the drug has a high success rate.

"In comparison to other medications that we have in psychiatry and in general medicine, buprenorphine is very effective. So you take patients who are using illicit opiates daily maybe 70 or 80 percent of the time going down to 10 or 20 percent, which is a dramatic decrease in the amount of illicit opioid use," Marienfeld said.

Opioid-use is driving overdose deaths, the leading cause of accidental death in the United States.

Opioids include heroin and prescription pain medications like Oxycontin and Vicodin.

Marienfeld will be discussing medication-assisted treatment for opioid addiction on Thursday at 6 p.m. at the UC San Diego Moores Cancer Center Goldberg Auditorium. The talk is free and open to the public, but those planning on attending must register.

Marienfeld will join Midday Edition on Thursday to talk about opioid addiction and using medication to treat it.