As we work to address the nation’s opioid crisis, we must recognize that a disproportionate share of prescription painkillers is being consumed by people with anxiety and depression. We at the New York State Office of Mental Health (OMH) are partnering with the Office of Alcohol and Substance Abuse Services (OASAS) and the Department of Health (DOH) and other state agencies in several initiatives to treat both the addiction and the underlying conditions of the individual.
More than half of drug overdose deaths in recent years have been attributed to opioid pills and heroin. The number of opioid deaths by 2015 had doubled since 2010, while the number of heroin-involved deaths in 2015 was five times higher than in 2010.
Particularly alarming is the recent sharp increase in deaths associated with fentanyl. According to the National Center for Health Statistics of the Centers for Disease Control and Prevention, fentanyl deaths have increased by more than 500 percent in the past three years.
We have a public health crisis on our hands. Lives are being lost, state and local governments have finite resources, and this crisis is threatening to overwhelm our health care system.
Integrated Treatment for Mental Illness and Addiction
Studies have shown that nearly one-third of people with a mood or anxiety disorder – and about half of people living with severe mental illness – also have a substance abuse problem. In the same manner, more than half of drug abusers also experience symptoms associated with a mental illness.
While a subset of opioid users is using the drugs to numb their struggle with their mental illness, research indicates that they may, instead, be making their problem worse. Studies indicate that for someone suffering from depression, opioids for pain can be less effective. Part of the problem may lie in the way opioids can change the brains’ reward and pleasure systems and hormone levels.
Ten percent of more than 100,000 patients in a St. Louis University study who were prescribed opioids for back pain, headaches, and arthritis developed symptoms of depression after one month. None had received a diagnosis of depression prior to treatment. Meanwhile researchers at Dartmouth-Hitchcock Medical Center in New Hampshire and the University of Michigan found that nearly 19 percent of people with mental health disorders in their study received at least two prescriptions for opioids during a year.
OMH recommends that primary care physicians or other medical professionals screen patients for symptoms of depression prior to giving them an opioid prescription and periodically during a treatment episode of opioids. We also remind mental health professionals in New York State that – even though they occur at the same time – addiction and mental illness must be treated as intertwined disorders. Many people find that intensive outpatient or inpatient treatment is necessary to curb addiction and learn healthy coping strategies for depression. Leaving one problem untreated threatens any progress the patient has made on the other.
Medications are available to help treat opioid dependence, and antidepressants can help reduce depressive symptoms. But patients should also receive peer group support for addiction and depression, individual and family counseling, and follow-up support as part of a treatment plan tailored to their individual needs.
New York State Initiatives
Governor Andrew M. Cuomo has implemented a series of aggressive reforms to address heroin and opioid addiction on several levels — increasing support for individuals, stepping up enforcement, and providing information and education.
In 2012, Governor Cuomo signed legislation updating the Prescription Monitoring Program (PMP) Registry (also known as I-STOP) to require pharmacies to report “real time” information about controlled substances dispensed, require health care practitioners to consult the PMP Registry before prescribing or dispensing certain controlled substances, and require electronic prescribing to curb fraud and abuse. By the end of 2015, I-STOP had led to a 90 percent decrease in “doctor shopping” – when patients visit multiple prescribers and pharmacies to obtain prescriptions for controlled substances within a three-month time period.
In 2016, the Governor’s Heroin and Opioid Task Force listened to health care providers, family groups, educators, law enforcement officials, and community members throughout the state. It recommended:
- Removing insurance barriers to inpatient treatment by eliminating prior approval for admission for necessary medical care as long as such inpatient treatment is needed.
- Mandating that insurers use objective, state-approved criteria when making coverage determinations for necessary inpatient treatment.
- Increasing the number of treatment beds and program slots for substance use disorder across the state.
- Mandating prescribers to complete ongoing education on pain management, palliative care, and addiction.
- Limiting opiate prescriptions for acute pain from 30-days to no more than a seven-day supply, with exceptions for chronic pain and other conditions.
- Mandating that pharmacists educate patients on the risks associated with prescription opioids.
- Expanding access to lifesaving overdose-reversal medication by providing insurance coverage for family members and permitting certain licensed professionals to administer the medication in emergency situations without risk to their license.
Governor Cuomo also signed a life-saving law which makes it legal in New York State for non-medical persons to administer Naloxone to another individual to prevent an opioid/heroin overdose from becoming fatal. All registered opioid overdose programs are furnished Naloxone (Narcan) by DOH.
In April of this year, Governor Cuomo signed legislation to invest in supporting prevention, treatment, and recovery programs targeted toward chemical dependency, residential service opportunities, and public awareness and education activities. The 2018 State Budget will invest $213 million to address the heroin and opioid crisis in New York, representing an increase of over 100 percent from the 2011 State Budget year.
To help address a statewide gap in access to care for people with opioid addiction and mental illness, New York State is opening new Certified Community Behavioral Health Clinics (CCBHCs) in communities across the state. New York was one of only eight states selected to participate in a two-year demonstration program to develop CCBHCs. Starting this past July, these clinics are integrating community-based physical and behavioral healthcare and promoting access to improved primary care, mental health, and substance-use disorder services. CCBHCs provide “no wrong door” access to services, treating individuals with mental illness and substance use when and where they need treatment.
In summary, when individuals have timely access to services and community supports that meet their needs, then successful recovery from mental illness and substance use is possible. New York State is committed to making this hope and recovery a reality.