According to the Centers for Disease Control and Prevention (CDC), from April 2020 to April 2021, over 100,000 people died of drug overdose in the United States. This sobering statistic shatters the previous record for overdose deaths over a 12-month period. It is a reminder that the opioid epidemic is rapidly accelerating in the midst of the COVID-19 pandemic.
Thankfully, this crisis has not lost the attention of the nation’s health care professionals. Bassett Healthcare Network clinical psychologist Dr. James Anderson, along with colleagues at the Bassett Research Institute and the University of Massachusetts, recently received national recognition for a paper detailing their efforts to curtail this epidemic across Bassett’s eight-county service area.
A Complex Problem
In its third decade, the opioid epidemic is not the same crisis it was when it began. It started in the mid-1990s with under-the-radar addictions to prescription painkillers. When doctors tried to mitigate the trend in the 2000s by limiting prescriptions, many patients struggling with addiction sought out illicit drugs, like heroin, to continue their physiological needs to self-medicate. That growing market for illegal drugs has blossomed since to include new opioids and new mixes of drugs.
As if this constant evolution isn’t challenging enough, the crisis’ geography introduces additional obstacles. The epidemic rages in rural areas that lack essential resources. The drug methadone, for example, has been an essential tool for overcoming opioid use disorder for decades. But being a highly addictive opioid itself, the Drug Enforcement Agency (DEA) keeps tight control on its use and distribution. For patients living in an area like the one Bassett serves in Central New York, methadone treatment could mean driving an hour or more each way every day for treatment.
“Practically speaking, I am greedy for my patients,” says Dr. Anderson. “Yes, I want them to not use heroin; but I want more than that for them. I want them to be able to reengage with their families, get a job and live their lives. Even if driving two hours for daily treatment is possible for you, what kind of life is that?”
The Makings of a Solution
In 2016, Dr. Anderson and a group of Bassett colleagues formed a workgroup to improve services for patients struggling with opioid use disorder (OUD). Their effort centered on a newer drug called buprenorphine.
Like methadone, buprenorphine is an opioid. Unlike methadone, it does not produce euphoric highs—at a certain point, a body levels off its processing. What’s more, it blocks the body from processing other opioids. The result is that it can fend off cravings with a much lower risk of misuse.
The lower risk of misuse also increases accessibility. Any primary care doctor, nurse practitioner, or physician assistant with a DEA prescribing license can become buprenorphine certified. “Bassett’s primary care system is both familiar to our OUD patients and close to where they live,” explains Dr. Anderson. “Empowering them to treat OUD with buprenorphine makes medication-based treatment accessible.”
Building a New System
As Bassett’s team studied the experiences of other rural health systems, they became concerned that certifying caregivers in primary care offices wouldn’t be enough. “A recent study reviewed all doctors credentialed to prescribe buprenorphine in Vermont,” says Dr. Anderson. “Half of them were treating either no patients or only one. Practitioners need to use their licenses, or they don’t do any good. We wanted a better record than that here.”
Dr. Anderson and his colleagues complemented their push for buprenorphine licensing with virtual learning and discussion. “These sessions include the expert advice from the folks who have been doing this for a long time as well as support from peers who are just starting,” says Dr. Anderson. “That community builds confidence and competence to bridge the gap between licensing and use.”
According to Dr. Anderson’s paper, that innovation has made a significant difference in the success of Bassett’s program. And so now Bassett’s model of building that supporting framework and community has become a valuable contribution to the field of treating opioid use disorders.
Building a New Culture
As Bassett’s third round of sessions begin, the program is going strong. But this is just part of the overarching goal. “We ultimately want to create a low-threshold for treating OUD,” says Dr. Anderson. “We want to make it easy for folks to get into treatment and hard for them to get kicked out. Buprenorphine makes treatment accessible and frees patients to have a life.
“The next step is changing how we think about addiction. In the past, the policy for medication-based OUD treatment was, ‘You use? You’re gone.’ But if someone slips up on their diet or exercise routine, and their weight, blood sugar or hypertension get worse, we don’t kick them out. Our hope is that this is progress towards seeing addiction as another chronic health condition.”
Dr. Douglas Causey is Professor of Biological Sciences at the University of Alaska Anchorage and Senior Fellow of the Arctic Initiative, Harvard Kennedy School. An ecologist and evolutionary biologist by training, he has authored over two hundred publications on topics as diverse as the biology of Arctic marine birds, high Arctic coastal ecosystems, and zoonotic diseases. He has published extensively on policy issues related to Arctic environmental security, dynamics of change in Arctic marine ecosystems, and bioterrorism and public health.
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