Like much of the country, New York State is experiencing a public health crisis of a magnitude never before seen related to prescription opiate and heroin overdose and addiction. While efforts to address this crisis are multifaceted, many of those in need of treatment are unable to get the help they need and frequently lives are lost to overdose.
In August 2013, New York State launched a Prescription Monitoring Program (PMP) called I-Stop, requiring prescribers to consult the PMP registry when writing prescriptions for Schedule II, III and IV controlled substances. Prescribers are able to view patients’ dispensed controlled substance prescription histories and determine whether there may be abuse or non-medical use and consequently they can better evaluate the appropriateness for these medications in the treatment of their patients.
Since its launch, the widespread abuse of narcotic medications like Oxycontin, Oxycodone, Hydrocodone, Hydromorphone, Fentanyl, Levorphanol, Codeine, Lorcet, Lortab, Norco, Oncet, Procet, Vicodin, Xodol and Zydone has declined due to decreased availability. Unfortunately, many individuals already addicted to opioids turned to heroin to support their addiction – especially if treatment was not readily available.
In June 2014 Governor Cuomo signed legislation to combat the heroin and opioid epidemic in New York State. The Combat Heroin campaign increased hope among the prevention, treatment and recovery community for additional support.
The campaign has raised awareness of the epidemic in communities across the state.
The combatheroin.ny.gov website has a wealth of information and assists in reducing stigma. One of the resources on the website is a link to treatment providers; unfortunately, many of these providers are not able to meet the increased demand, in particular for medication-assisted treatment.
For more than 30 years, Crouse Hospital in Syracuse has provided safe, quality methadone treatment in our community. Our Opioid Treatment Program (OTP) provides a critically important service and has saved many lives by supporting individuals on their road to recovery.
Crouse presently operates the only methadone program in the Central New York region and our patients come from a radius covering close to 20 counties. The demand for opioid treatment services is so great that other centers could open in our surrounding counties and be filled to capacity in short order.
In December 2013, our opioid clinic was approved to expand from 500 to 800 patients. In 2014 we admitted 215 patients, offset by 152 discharges, and the program is presently at a census of 570 patients and has a wait list of 550 individuals.
Our efforts to expand quickly and safely have been hampered by lack of available physical space, finding qualified RNs and limited outside funding to help offset losses incurred in providing this essential service to the community.
Current Medicaid rates for Opioid treatment services do not adequately cover the cost to deliver the care. In 2013, the unfunded operating loss of the program was $1 million. In 2014 the loss was $1.8 million.
Over the last decade other forms of medication-assisted treatment have gained market share. Buprenorphine and the combination of Buprenorphine/naloxone and naltrexone can be viable alternatives to methadone for many patients. Unfortunately, the availability of physicians prescribing Buprenorphine is extremely limited. Physicians must obtain a waiver to dispense or prescribe buprenorphine for maintenance treatment or detoxification treatment. After obtaining the waiver physicians are limited to 30 patients during the first year and 100 patients after that. There are presently not enough physicians who have the waiver and some of those who have it will not take Medicaid as a form of payment, providing this service on a cash-only basis.
Legislation is needed to make this treatment available to more patients. One way to accomplish this would be by allowing physician assistants and nurse practitioners to prescribe narcotics for maintenance treatment (they are already allowed to prescribe narcotics for the purpose of pain management).
Organizations like the NYS Association of Alcoholism and Substance Abuse Providers (ASAP) and the Coalition of Medication-Assisted Treatment Providers and Advocates (COMPA) continue to advocate for the specific needs of individuals struggling with opioid use disorders and the allocation of additional state and federal funds being made available to the New York State Office of Alcoholism and Substance Abuse Disorders (OASAS) to support providers of this life-saving treatment.
This growing epidemic leaves no age group or socio-economic class unscathed. In Onondaga County, the rate of infants born with drug-related problems passed on in utero is significantly higher than New York State and national averages.
According to New York State Health Department Statistics for 2007-2009 the number of newborns with drug related problems per 1,000 hospital discharges was 26. Women who use substances during pregnancy are more likely to seek prenatal care late and less likely to deliver a full-term, healthy baby.
As the area’s largest provider of obstetrical and neonatal intensive care services, Crouse cares for the majority of these mothers and infants, which results in additional clinical and financial burdens on the healthcare system.
Concerted efforts across systems need to be based on a three-pronged approach. Prevention of new cases of opioid addiction, on demand treatment for individuals who are already addicted and supply control through medical boards and law enforcement to reduce overprescribing and black-market availability.
Parallel to this approach we need to continue to remove the stigma associated not only with addiction, but specifically with medication-managed treatment and recovery. Individuals on maintenance therapy live productive lives and return to a level of functioning where they can be successful in their roles within their family, place of employment and society as a whole.
