Published in Becker's Hospital Review, September 26, 2016. View the article here
It is widely held among healthcare providers and addiction treatment specialists that individuals who report having chronic pain endure a more challenging path to achieving long-term recovery, and experience higher rates of relapse and recidivism.
While that assertion may be accurate for the general post-treatment addiction population, our latest data indicates that individuals who identify as having chronic pain are more receptive to post-treatment recovery support than individuals who do not identify as having chronic pain. This runs counter to the notion that individuals who are experiencing chronic pain do not respond well to long-term recovery support. And, results from studies have demonstrated a connection between individuals experiencing chronic pain with opioid abuse. For example, in a July 2012 issue of Pain Physician Journal, "Individuals with chronic pain and co-occurring Substance Use Disorder ... are at a higher risk for misuse of prescribed opioids." According to Maria Sullivan, M.D., Ph.D., at Columbia University, "Chronic pain serves as a pathway for problematic opioid use/addiction." MAP's empirical data, culled from more than five years of treatment outcomes collection, shines a ray of light on the darkness that has come to be associated with the nation's devastating opioid epidemic.
According to the Centers for Disease Control and Prevention (CDC), in 2014, there were 28,000 deaths due to prescription opioid pain relievers and heroin, more than any year on record (1). It is highly likely that 2015 and 2016 will show continued increases from these deaths. It is now more common than not for an American to have experienced the impact of the opioid crisis or know someone who has. The deadly epidemic has gotten the attention of most every healthcare provider, treatment professional, politician, and thought leader in the country. On August 31, 2016, the Obama administration announced $53 million in grants to be awarded to states in order to help fight the epidemic of opioid abuse. The funds are part of an ongoing administration effort to fight the rising tide of overdose deaths from prescription painkillers and heroin (2).
Drug overdose is the leading cause of accidental death in the United States, with a reported 47,055 lethal drug overdoses in 2014 (3); and that number is likely to be higher given the fact that not all deaths by overdose are reported as such. Indeed, as bad as the numbers appear to be, it is possible that they are higher than reported, and efforts to contain the epidemic have reached every state and most every community.
The CDC has acknowledged that improving data quality and timeliness to better track patterns and trends is the key to identifying individuals and communities at risk, and evaluating and implementing prevention strategies. Indeed, prevention is critical to upending the epidemic, particularly for future generations. However, treatment and resources are desperately required now for the millions of individuals who are dependent on the powerful pain relievers or illicit forms such as heroin.
Information gleaned from our data today will likely guide the manner in which the next generation receives addiction treatment and how the next generation is viewed for having an addiction or a diagnosis of Substance Use Disorder. Rather than treat individuals experiencing addiction with punitive measures or acute treatment models, increasingly we understand that treatment and extended care following treatment is the most effective way to treat and manage this chronic disease of the brain. For too long we have believed that those with chronic pain do not respond well to treatment, including post-treatment recovery support. Our data indicates otherwise.
One particular MAP study specifically looking at 2,726 individuals in our data set, demonstrates that 34% of individuals who participated in an extended care post-treatment support program identified as having chronic pain. These individuals who engaged in post-treatment recovery support had a higher post-treatment completion rate than individuals who did not report having chronic pain. Specifically, of those who successfully completed 12-15 months of post-treatment recovery support, those with chronic pain completed at a 20% higher rate than those without chronic pain. The difference in completion is significant.
Studies have previously demonstrated that extending the care continuum for individuals is the most effective method to treat and manage a chronic illness. Given that addiction and Substance Use Disorder is defined as a primary, chronic disease of the brain (4), and based on previously reported data, we know that the longer an individual engages in post-treatment support, the higher the likelihood that he or she will maintain long-term recovery.
In The Doctor's Dilemma, a manuscript published by the National Institutes of Health (NIH), Ballantyne and LaForge suggest that long-term treatment of chronic pain patients with opiates has contributed to the recent increase in opiate abuse and addiction. As more resources reach our communities, cities and states, we will be better prepared to combat, treat and prevent addiction and Substance Use Disorder and finally put an end to the senseless deaths and destroyed lives. Collecting outcomes data on every individual who is treated for addiction is imperative, and the more we glean from the data, the better armed we are to prevent an epidemic of this proportion to happen again.