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Published On Jan 19, 2017

Clinical Care

Hope in the Face of Addiction

Peter L. Slavin and Thomas J. Lynch Jr. discuss the hospital’s responsibility in treating opioid addiction.

Despite far-reaching efforts by health care providers, law enforcement agents and public officials, the opioid crisis continues to steal far too many lives and devastate families. According to the Centers for Disease Control and Prevention, drug overdose, powered by opioid addiction, has become the leading cause of accidental death in the United States. In 2014 more than a thousand people in Massachusetts alone died from opioid-related overdoses. And in 2015, for the first time, heroin-related deaths surpassed homicides involving guns.

In its quest to relieve pain and keep patients comfortable, the health care industry has played an unintended role in this crisis. The vast majority of new heroin users acquired their habit after taking prescription painkillers, either acquired illegally or through the prescription of a provider, who must walk a fine line between controlling pain and limiting the chance of addiction.

The problem of addiction has many dimensions. Proto’s feature “Lost in the Middle” explores a new rash of suicides and “despair deaths”—including those from misuse of alcohol and drugs—that occur amid a landscape of disappointed expectations and feelings of hopelessness. Treating such despair may require sweeping changes, including a new awareness at hospitals, where physicians sometimes have a tiny window to catch patients contemplating suicide.

New pharmaceuticals may also offer hope. In “Build a Better Painkiller,” Proto looks at researchers developing medications that aim to sidestep the addictive properties of opiate-based drugs. These include new formulations of cannabinoids, medicines that explore the role of glial cells in causing or amplifying pain, and drugs that focus on variations on the mechanisms of opioids.

For now, however, hospitals must face the epidemic with the tools we have. Several years ago, at Massachusetts General Hospital, we made substance use disorder a centerpiece of our strategic plan. We now have consult teams for admitted patients with addiction disorders and help for patients in our outpatient practices and Emergency Department. A “bridge clinic” provides short-term care after discharge, and recovery coaches work with patients in their communities. We have updated our opioid-prescribing policies and conducted education and training for providers. We also continue to work to change the culture from what has traditionally been considered a disorder of choice to widespread recognition that addiction is a chronic, treatable disease.

Meanwhile, as we await better, less addictive choices for relieving pain, such efforts here and across the nation may be our best change to save and improve lives.

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