Heroin and prescription opioid medication abuse are persistent national problems that are reaching deep into communities across New York State. The problem is increasingly affecting teenagers and young adults, though older New Yorkers are consistently affected.
More and more people are dying from poisonings involving these substances each year. More than 16,000 people in the U.S. died in 2013 using prescription painkillers, according to the latest National Center for Health Statistics data. Comparatively, in 2000, there were 4,400 deaths from prescription painkillers. Nationally, the annual number of deaths involving heroin has gone from 1,842 in 2000 to 8,257 in 2013. Data from the CDC just this month states that in New York State death rates involving opioid pain medications were highest among men, whites, people ages 45-64, those who reside outside of New York City, and Medicaid enrollees. In 2014, there were more than 118,000 admissions into New York State-certified treatment programs for heroin and prescription opioid abuse – a 17.8 percent increase over 2009. The largest increase in heroin and prescription opioid admissions during that time was for patients ages 18 to 34.
Young People at Risk of Addiction
According to the Center for Alcohol and Substance Abuse at Columbia University, 9 out of 10 people with addiction started using substances before they turned 18. According to the Youth Risk Behavior Survey, the percentage of New York State high school students who reported using heroin more than doubled between 2005 and 2011.
Fighting Back: New York State’s #CombatHeroin and Prescription Drug Abuse Campaign
Under Governor Andrew M. Cuomo’s leadership, New York has taken an aggressive approach to combating heroin. In June 2014, Governor Cuomo signed a package of historic bills to address the heroin and prescription opioid abuse epidemic using a collaborative approach, focusing on public health, safety, education and awareness.
The New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) has spearheaded the educational and public awareness efforts by launching a multi-faceted #CombatHeroin campaign. To help shape the campaign, NYS OASAS conducted a series of listening forums which included young people in recovery, parents, students, treatment providers, and individuals impacted by substance use disorders, including those who were specifically impacted by heroin and opioids.
The campaign evolved around individuals sharing their experiences and offering advice on how and where to reach the target audiences identified as young people ages 15-25 and adults/parents. Consistent with the campaign’s theme that “addiction can happen to anyone, any family, at any time,” 20 individuals who exemplified courage and strength were interviewed and shared their perspective. They shared personal stories about their or their loved ones’ progression into addiction, challenges they faced in accessing treatment, peer pressure, trauma, helping a loved one or family member who was battling the disease of addiction, and even recounting the devastating loss of a child due to a heroin or prescription opioid overdose.
Using some of the most impactful sound bites from these interviews, four public service announcements were produced and were aired on network and cable T.V. in the fall of 2014 and again in the winter of 2015. A digital and social media campaign ran simultaneously which was followed up with an outdoor campaign which featured highway billboards, and large campaign posters on trains, in train stations, on the Staten Island Ferry, and in high-traffic areas in select malls.
Another key component of the campaign included the development of a new website focused on educating the public about heroin and opioids. The Combat Heroin website www.combatheroin.ny.gov has received nearly 350,000 page views and contains information on prevention, warning signs of opioid use, getting help, getting involved and accessing treatment. The Real Stories section of the website features interviews with the real people referenced above who talk about addiction, withdrawal, treatment and recovery. The availability of these stories has helped to open the door to a conversation on a topic that, for many, may be uncomfortable.
Other components of the campaign included the distribution of informational flyers to help explain the warning signs of addiction, and especially how addictive heroin and opioids can be. Campaign materials also included a fact sheet with tips on how to prevent prescription drug misuse, a listing of opioids, depressants and stimulants and facts meant to raise awareness about the risk these drugs can present when taken inappropriately. Other materials point parents and young people to action steps they can take to get help or to get involved in the state-wide campaign. All of the materials are downloadable or can be ordered in bulk free of charge within New York State. They can be found on the #Combat Heroin Resources webpage: www.combatheroin.ny.gov/resources and click on the order form link on that page.
Anti-overdose Medication Trainings: Naloxone Saves Lives
Governor Cuomo’s multi-pronged approach to combating heroin also includes a commitment to train more community members to deliver the life-saving anti-overdose medication naloxone. This medication is important for reversing an overdose, but is also an important first step in ensuring that individuals who suffer from addiction have an opportunity to enter treatment and begin a road to recovery.
OASAS, through its 12 Addiction Treatment Centers, in partnership with other state agencies including the NYS Department of Health, the NYS Department of Criminal Justice Services, the State Police, the SUNY and CUNY systems, and the Division of Homeland Security and Emergency Services, has conducted hundreds of sessions to train the general public and law enforcement on the use of naloxone, a.k.a. Narcan, and has provided kits to those who have been trained so that they can deliver the medication in an emergency. To date, more than 44,000 people have been trained to administer the anti-overdose medicine and there have been over 1,250 lives saved.Additional trainings are being offered in communities throughout New York State each week. Trainings are FREE and OPEN TO THE PUBLIC. To organize or attend a training in your community, visit: www.oasas.ny.gov/atc/ATCherointraining.cfm for a listing of trainings in your area
Insurance Changes: Access to Treatment
Another critical component of the heroin and opioid epidemic legislation is to ensure that those with substance use disorders have access to treatment. To this end, one of the laws passed in June of 2014 addressed the issue of insurance coverage for substance use disorders. Those with substance use disorders and their families had reported facing struggles accessing appropriate levels of care for themselves or their loved ones. For example, individuals were told they need to “fail first” at outpatient treatment before they could be admitted for inpatient treatment, when they may have needed and qualified for a more-intensive inpatient treatment first.
To address this, and other concerns, NYS insurance laws were changed to:
- Enact a state level parity law;
- Require utilization review agents to have behavioral health experience;
- Require insurers to pay for inpatient care during the appeals process; and
- Require NYS OASAS Commissioner approval of the level of care/medical necessity tools used by insurers to make substance use disorder (SUD) decisions.
NYS OASAS has developed a new “level of care” tool (LOCATDR 3.0) for insurers and treatment providers to use to determine the most appropriate level of care for individuals, ensuring that “fail first” policies are no longer allowed.
There is HOPE: Opioid Dependence is a Treatable Illness
Though the problem of opioid dependence is widespread, and New York State has several aggressive efforts underway aimed at curbing the epidemic, it is important to remember that opioid dependence is a treatable illness. With appropriate treatment, many people can have lasting recovery sustained over many years. Addiction, including opioid dependence, should not be thought of as a moral disorder. It is a primary disorder of the brain.
The opioid epidemic across the nation has prompted a more general and frequent discussion of addiction than that which has occurred in many years. This recent uptick in discussions will hopefully allow society to have a greater understanding of addiction, relapse and recovery. Similar to other chronic illnesses, relapse can occur and not unlike heart disease and repeated cardiac events, addiction relapse should be treated and efforts should be aimed at preventing such a relapse.
Individualized Treatment: Medication Supported and Behavioral Therapies
Treating opioid dependence includes several modalities and it is important that the treatment modality is tailored to the individual.
One treatment option is medication assisted treatment or what we in New York State prefer to call medication supported recovery. In this modality people receive medication along with some sort of psycho-social spiritual treatment, such as cognitive behavioral therapy, contingency management, dialectical behavior therapy and/or a 12-step program facilitation. This sort of treatment can be very effective in not only helping the person affected with opioid dependence to stop using opioids or other intoxicants on a regular basis, but in facilitating the individual’s reunion with her or his family. It can also help an individual gain emotional stability. Medications that are commonly used and which are quite effective include: · Methadone, which is given in an outpatient clinic that dispenses methadone called an Opioid Treatment Program.
- Buprenorphine, which is given in clinics (OTPs) or in private physician practices in which the physician is specifically certified to prescribe buprenorphine.
- Naltrexone, which can be administered by mouth once a day or through a monthly injection called Vivitrol.
A common misconception is that people who are taking one of these medications are impaired. However, according to medical professionals who utilize these medications to treat opioid dependence, these medications when they are administered properly, do not result in impairment of the individual.
Another modality is treating opioid dependence without medication. This modality is also available in New York State. There are people in the recovery community who have years of sobriety using this modality.
Recovery is Real
Recovery from addiction is possible. Those who relapse or return to opioid use should understand that they can re-enter recovery, and once in recovery can return to their work, interact in a healthy way with family members, and make valuable contributions to their communities. Individuals and families who have been affected by the disease of addiction should recognize that they are not alone. A listing of NYS OASAS-certified treatment providers can be found on the Combat Heroin website and the NYS OASAS website www.oasas.ny.gov/providerDirectory/index.cfm?search_type=2 or by using the NYS OASAS HOPEline, 1-877-846-7369, a 24/7 confidential telephone hotline to assist individuals with help and accessing treatment.
Getting Involved: Combating Heroin in Communities
New York State has taken a national leadership position in recognizing the serious nature of the heroin and prescription drug abuse epidemic and has taken decisive action to raise public awareness about this deadly epidemic and ensure that those with substance use disorders have access to treatment. NYS OASAS continues to work to implement all aspects of the historic legislation enacted in 2014 and will continue to increase public awareness through additional phases of the Combat Heroin campaign and other public education efforts.
In fact, New York State was awarded $8 million in federal funds to help 10 local communities, through community coalitions, implement environmental strategies targeting heroin and prescription abuse and overdose prevention in the 12- to 25-year-old age group. More information about these federal funds can be found on the Governor’s website at this link: http://www.governor.ny.gov/news/governor-cuomo-announces-8-million-combat-heroin-and-prescription-drug-abuse-among-young-adults.
To get involved in these and other efforts, visit the “Get Involved” section of the Combat Heroin website www.combatheroin.ny.gov/ for ideas on how you can help raise awareness in your community. Together, we can push back against this epidemic and give more New Yorkers a chance at recovery from addiction.