The opioid epidemic brings grave costs in lives, economic costs and public health. Now the leading cause of injury-related death in the U.S. according to the Department of Health and Human Services, the prolific problem of drug overdose death totaled 33,091 deaths in 2015 from opioid overdose – 15,281 attributed to overdosing on opioids that are commonly prescribed. That same year, the DHHS estimated, the epidemic cost the country $78.5 billion. With a reported 2.1 million people misusing prescription opioids for the first time in 2015, the epidemic doesn’t appear to be abating.
Opioids, a drug class used to reduce pain, include prescription drugs like oxycodone (OxyContin), hydrocodone (Vicodin), morphine and the illegal drug heroin. Not only are these drugs effective painkillers, but they also produce euphoric feelings for users – sometimes making opioids powerfully addictive.
Since 1999, dependence has risen alongside access to opioids through prescriptions, according to the American Psychological Association. When regulation prevents access, many turn to street drugs, like the estimated 467,000 reported people who are heroin-addicted. While dire, the epidemic can be managed, in part through critical contributions from psychologists in both understanding and combating opioid abuse.
Clinical Understanding: Opioid Dependence, Symptoms and Treatment
For clinical psychologists, understanding the epidemic is vital. Dependence can occur even in patients taking medication as prescribed, as over time, many develop a tolerance to the medication, and either need to increase their dosage or suffer from symptoms of withdrawal if they cut back. Psychologists should understand the symptoms that may present in those who are addicted, including:
- Taking more medication than prescribed
- Taking alternative opioids when a prescribed medication runs out
- Taking the medication for additional reasons
- Noting a reduction in daily functioning with the medication
- Using up medication ahead of the refill schedule
- Experiencing a high from the medication
- Finding dishonest means to obtain medication, like lying, stealing or paying in cash for medicine that was not prescribed
- Trading medication
- Seeking treatment from the ER or questionable pain clinics to obtain medicine
- Taking medication despite mental or physical issues it may cause
- Taking medication despite relationship issues it may cause
If psychologists identify symptoms of dependence, it is equally important they can understand treatment options and support patients in seeking help – and that they connect with medical professionals who may also need to understand the network of treatments available.
Determining the Nature of Addiction and Chronic Pain
In the face of heightened regulation, many family physicians have begun referring patients striving to manage chronic pain to pain-management physicians, who often partner with psychologists in assessing whether the patient has chronic pain, addiction, or even both. Psychologists can also identify addiction risk factors, which serve as a guide to prescribing physicians.
Chronic pain permeates patients’ lives, and through ongoing pain, they may also suffer from job loss, loss of hobbies, depression, anger, sleep disruption and irritability. While an opioid may help manage the pain itself, psychologists can support a more holistic approach to chronic pain management, which also includes cognitive behavior therapy, alongside physical therapy and targeted procedures. In addition, psychologists can help to treat associated anxiety and depression, managing through treatment as opposed to, or at least in tandem with, prescription.
Psychotherapy Approaches
One critical way to treat opioid addiction is through psychotherapy: removing patients from triggers for use and intervening to change behaviors. Therapy options can range from cognitive-behavioral therapy (CBT) to others that focus on repairing the components of a patient’s life, like marriage and family therapy or vocational therapy, according to the APA.
Through individual psychotherapy, psychologists help patients develop methods for coping with mental health and life issues. Supporting alternate ways of managing conditions may be a key driver in reducing dependency on opioids. For example, psychologists can help patients with chronic pain learn to improve their quality of life by equipping them with pain moderation strategies, functioning through pain and improving sleep. People with depression or post-traumatic stress disorder (PTSD) are at higher risk of addiction, but psychologists can support managing these mental health disorders to prevent opioid dependence. Finally, psychologists can try out new techniques to reach more people. Some psychologists, the American Psychological Association highlights, applied learnings from CBT in opioid addicted patients to test a telephone “recovery line,” where patients could access the system at any time.
In addition to psychotherapy, patients can also undergo medication-assisted treatment, which helps manage withdrawal symptoms through a gradual reduction. Inpatient, or residential treatment, can also support detoxification and often include counseling. Finally, group therapy can play a key role in both treatment and support, and psychologists or other certified specials should lead these groups, to support evidence-based strategies in the facilitation of the group.
Designing Contingency Management Programs
Psychologists can also have a systematic impact, in part by helping to design contingency management programs. These programs reward patients for staying off illicit drugs, either with prizes, vouchers or special privileges like take-home dosing for increased freedom. More support in designing these programs may render them more effective, according to Nancy Petry, PhD, who says many programs don’t administer this approach in the way research suggests. The best outcomes occur in programs where both testing and reward are frequent, but many clinics use programs with random testing or complex reward systems.
Informing Federal Policy
Armed with the science that should drive national policy, psychologists should provide information and advocate for public policies based on proven science. The opportunity is substantial – according to the APA, President Obama allotted $1.1 billion to expand prevention and treatment programs targeted at reducing opioid use in his 2017 budget. Psychologists joined briefings helmed by the Addiction Policy Forum to foster support for the Comprehensive Addiction and Recovery Act – and the bill passed.
With President Trump declaring the opioid crisis a “health emergency” in October 2017, the research and understanding psychologists possess should continue to inform and advocate to find science-backed methods of curbing the surging epidemic of opioid abuse. APA CEO Arthur C. Evans said in a November 2017 press release, “We look forward to working with the administration to implement many of these recommendations, but Congress needs to fully fund them. Diverting money from other critical health priorities is not the answer. This crisis requires its own dedicated funding streams. We need to quickly get to the point where it is easier for someone struggling with an opioid addiction to access treatment than to get more opioids.”