calls the effort to sell physicians on the idea that opioid medications were safe and nonaddictive a “marketing scheme designed to persuade doctors and patients that opioids can and should be used for chronic pain.” It reads like the bleak color commentary on a slow-motion train wreck, laying out the history of how opioids came to be so widely prescribed in Arkansas and America, including claims that drug companies spent millions to downplay the risks of opioid addiction and dependency by using paid “opinion leaders,” employing “front groups” masquerading as impartial patient advocates, spending tens of millions of dollars to advertise in medical journals and using drug reps to make the case for shaky concepts such as “pseudoaddiction,” the idea that if patients taking opioids were found to be engaging in behaviors indicating addiction, that meant their pain was not well managed and their dosage should be increased. Citing what she called “staggering” statistics, Arkansas Attorney General Leslie Rutledge announced Jan. 24 that her office would bring in extra legal help to investigate several yet-to-be-named opioid manufacturers and will potentially bring lawsuits or charges against those firms if warranted. The counties association lawsuit points out several of what seem to be damning facts: The named defendants spent over $14 million to advertise their products in medical journals in 2011, triple what they’d spent in 2001, and spent $168 million in 2014 alone to market opioid drugs to doctors through “detailers” — friendly drug company sales reps who visit physicians in their offices — double what they’d spent on opioid detailing in 2000. “Manufacturer defendants also identified doctors to serve, for payment, on their speakers’ bureaus,” the lawsuit goes on to say, “and to attend programs with speakers and meals paid for by Manufacturer defendants.” Among other damages, the lawsuit calls for funds specifically to pay for opioid addiction treatment costs in Arkansas in coming years. Colin Jorgensen is litigation counsel for the Association of Arkansas Counties Risk Management Services. He said there are obvious parallels between the lawsuits filed against opioid manufacturers and those filed in the past against Big Tobacco, but also significant differences. “The parallels are mostly in the legal theory and the misrepresentation in the marketing by the companies,” Jorgensen said. “That’s what’s similar between
tobacco and the opioids — the deliberate deceit about the addictive nature of these products, knowing full well the truth. The damages are not exactly the same. We’ve got a lot more local-level impact this time with the opioid epidemic than with tobacco. … We need education, prevention and treatment, and all three of those things are extremely expensive, and they’re best deployed at the local level.” The price tag for that intervention could easily run into the billions of dollars nationwide, Jorgensen said. Jorgensen said he believes physicians have been duped about opioids just like
patients, but are quickly working to turn things around. “The awareness in the medical profession is shifting dramatically,” he said. “I think you’re probably going to see a pretty substantial drop-off in the prescription rates and things moving forward. The doctors are in a tough position because they don’t necessarily have effective alternative treatment, but they’re learning now that [opioid] treatment is ineffective, too.” Association of Arkansas Counties Executive Director Chris Villines said the financial and social impact on counties and cities in the state is shaping up to
be much more costly than that posed by tobacco addiction in the past. “We didn’t fill our jails with people using tobacco,” he said. “We didn’t have to go out and police the street for tobacco users. [Tobacco] really had more of a direct impact on health care than anything. This plague has had an impact all over: the court system, the county hospital, the county jail, policing, law enforcement, coroners, everybody.” Villines noted that while there is a clear need to curb the prescription opioid rate in the state, slowing the supply does nothing to stop the demand from
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CounselIng And MedICATIon
Work TogeTher To Help pATIenTs
In 2015, more than 33,000 Americans died from opioids … Hidden behind the terrible epidemic of opioid overdose deaths looms the fact that many of these are far from accidental. They are suicides. Dr. Maria Oquendo, President of the American Psychiatric Association Dr. Oquendo wrote these sobering words in an April blog post for the National Institute on Drug Abuse. She also cited a study in the “Journal of Psychiatric Research,” in which researchers found that prescription opioid misuse was associated with a 40 to 60 percent increased risk for thoughts of suicide in the general population. With such staggering statistics, it’s easy to understand why opioid abuse and misuse has been termed an epidemic. Stockton Medical Group is on the front lines of this epidemic, treating patients to help them overcome opioid addiction. “Most often, patients have experienced trauma, which is at the root of their addiction,” said Michael Casillas, LCSW, director of operations for Stockton Medical Group. “Their drug use is a way to mask the pain. The addiction is symptomatic of that trauma— there is quite often a direct correlation.” Thus, Stockton Medical Group employs a two-prong solution to opioid addiction: therapy and medication. While it’s true, some become addicted to opioids as a result of abusing prescriptions given to alleviate physical pain, Casillas said, often patients are fighting depression or have experienced a precipitating event. He added, “And as they use the drug more and more, they become dependent upon it and it becomes a physiological issue.” He explained the mechanics of opioid addiction. “Opioids occur naturally in the human body. They’re unique in that they are necessary for the body to function. The opioid receptors are
located in the same part of the brain that is tied to survival. When a person is abusing drugs, their brain tries to compensate to the new flood of opioids. When the new receptors are under utilized, the individual experiences withdrawal. The symptoms of which can be life threatening. This is why many individuals who try to quit without assistance, relapse. They may, as a result, experience a loss of hope.” Along with administering medication in a controlled, guided manner, the staff at Stockton Medical Group also provides on-site counseling to teach patients to how to deal with stress, especially the stresses they may be experiencing as a result of their addiction, such as financial strain, relationship issues and more. They offer individual, group, family and couples counseling. “Without a positive support system, recovery is difficult, if not impossible,” Casillas said. “Our counselors help our patients with treatment plans to help them problem solve. Our program is half pharmacological: our patients are stabilized with the medication to address the dependence, so that the counseling can address the addiction. We help them address the issues, such as past trauma, with life skills and coping skills to help them recover.” This is especially important. According to the U.S. Department of Health and Human Services (HHS), “suicide and opioid misuse and abuse risk factors, such as pain, other addictions, mental disorders and disruptions in social support, can overlap.” Casillas said the administration of medication helps patients return to work and to caring for their families, and counseling gives them the emotional support needed for a successful recovery. Stockton has fulltime, licensed counselors who see patients on a regular basis. When patients begin the program, they can participate in therapy every day, if they choose to. Eventually, patients enter a maintenance phase during which they receive counseling and medication monthly on a longterm basis, just as someone who is diabetic would receive insulin.
“We work with our patients to work toward a level of freedom and independence that they feel comfortable with, however, it’s mandated, and we require every patient to come in at least once per month, though we often encourage them to come more often.” The staff at Stockton Medical Group has specialized in addiction treatment for opioid use disorder since 1994, and Casillas said they have some patients who’ve been with them for more than 10 years. “Addiction impacts everyone, people from various economic backgrounds, people of all ages and all situations, people who have experienced serious trauma, people who have PTSD … we treat people from all walks of life. We also work with a number of behavioral health agencies and develop individual treatment plans to ensure success,” he added. The goal is to help patients enjoy a healthy, happy life. “No one should have to suffer through recovery. We are here to help. Our focus is to help patients recover, to make recovery work, and to make it last.” Stockton Medical Group operates five outpatient facilities in Arkansas. For more information, log on to stocktonmedgroup.org.
arktimes.com FEBRUARY 22, 2018
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