Fueled by the opioid-abuse crisis, the medical community is on the cusp of major change in how it treats chronic pain, a first-ever Pima County opioid symposium was told Friday.
Chronic pain is the most common pre-existing condition leading to an opioid overdose, state data show.
And unresolved trauma, which is a major risk factor for substance-use disorders, is also a characteristic in some chronic-pain patients, Dr. Bennet Davis of the Integrative Pain Center of Arizona told those in attendance.
“Trauma changes brain function. These changes lead to symptoms that respond to opioids,” he said. “The drug makes them feel more calm. ... But there is a cost to unknowingly treating developmental trauma with opioids.”
An at-capacity crowd of nearly 300 treatment providers attended the Southern Arizona Opioid Abuse Prevention Symposium, which was hosted by the Community Prevention Coalition of Southern Arizona. The event, held at the Westward Look Wyndham Grand Resort and Spa, had a waiting list of dozens who couldn’t get in.
The event was organized due to an increasing number of illnesses and deaths brought on by opioid use.
For example, since 2008 in Pima County there has been a nearly twofold increase in number of emergency department and inpatient hospital stays related to opioid misuse, said Dr. Francisco Garcia, chief medical officer of the Pima County Health Department.
Five takeaways from Friday’s event:
Substance-use disorders are a disease, not a character flaw
A culture shift is needed, said Shana Malone, clinical initiatives project manager at the Arizona Health Care Cost Containment System.
Substance-use disorders are a brain disease that should be treated like cancer, diabetes or any other public health disease, she said.
“We’ve got to change the way we are talking about this,” she said.
Several medical experts in attendance said low-cost screening for trauma and non-pharmacological interventions like peer support, exercise, yoga, meditation and cognitive-behavior therapy could go a long way in addressing the underlying cause of some substance misuse.
Trauma in this context typically refers to “adverse childhood events,” such as emotional, sexual or physical abuse in childhood, exposure to violence, or having parents who were substance abusers.
Low-cost screening for trauma can eliminate the need for opioids in some patients and cut down on the costs of treating chronic pain, Davis said.
It’s not just opioids
“If we focus exclusively on opioids, we miss half the boat,” Garcia said. “When we focus on the disease du jour we miss the forest for the trees. The forest we are working on really has to be the forest of substance misuse in all its complexity, in all its messiness.”
Methamphetamine, cocaine and alcohol are among other substances that are an ongoing challenge, along with opioids, he said.
Of the 263 overdose deaths in Pima County last year, half were single-drug use, and half were multi-drug use, he stressed.
Opioid use among pregnant women
One in 10 women in Pima County who use opioids is pregnant, county data show. And the vast majority of those women have unintended pregnancies, medical experts said.
While those women are very motivated to change their behavior for their unborn baby, they have a high rate of relapse post-partum, said Dr. Gina Connolly, medical director for obstetrical services at Tucson Medical Center.
The biggest users are 15 to 25 years old, and that is when the brain is the most developmentally at risk for addiction, Connolly said.
More education is needed to prevent opioid use during pregnancy, including letting women know that it’s not just illicit drugs that can harm unborn babies — it’s also prescribed drugs like Vicodin, Dilaudid and Percocet, said Dr. Moira Richards, a Tucson Medical Center neonatologist.
It will take more than just the medical community to solve the problem
“The treatment community cannot individually wrap its arms around this,” said Dr. Leonard Ditmanson, medical director of the SUN Clinic and Connections Access. “It takes a collective societal response.”
Government, faith-based communities. law enforcement and the medical community will all need to step up, he and others said.
Within the medical community specifically, more integrated care is needed, experts said.
More prevention work is needed in schools
One-fifth of 12th-graders in Pima County self-reported having tried opioids at least once, the 2014 Arizona Youth Survey showed.
“This is very concerning. These children are not being prescribed opioids by their physician. This pharmacologic opioid use is the consequence of diversion from parents and grandparents’ medicine cabinets, from their friends’ parents,” Garcia said.
“To me, that is very concerning and to me, here is an opportunity for prevention,” Garcia said. “That is where I don’t see a tremendous investment on the part of the feds. ... You can put all the resources you want into the treatment system, but unless we adequately resource the prevention system, we will always be behind.”
There have been three overdose deaths among local youths so far this year — children who should still be alive today, Garcia said.
The average age a child starts misusing prescription drugs is 13, Malone added.
“You cannot start your prevention programs in junior high school or high school,” she said. “A third of the kids who are using and misusing prescription drugs and certainly heroin are reporting that they are misusing and using because they are coping with stress and ‘life stuff.’
“What does that tell you from a prevention perspective? ... We absolutely have to start enveloping trauma-informed care into what we’re doing,” Malone said.