Addressing the Opioid Crisis
Over-prescription of powerful opioid pain relievers beginning in the 1990s led to a rapid escalation of use and misuse of these substances by a broad demographic of men and women across the country. This has led to a resurgence of heroin use, as some users transitioned to using this cheaper opioid. As a result, the number of people dying from opioid overdoses has soared—increasing nearly four-fold between 1999 and 2014. Opioid analgesic pain relievers are now the most prescribed class of medications in the United States, with more than 289 million prescriptions written each year.
The increase in prescriptions of opioid pain relievers has been accompanied by dramatic increases in misuse and by a more than 200 percent increase in the number of emergency department visits from 2005 to 2011. Heroin overdoses were more than five times higher in 2014 (10,574) then ten years before in 2004 (1,878). Drug overdose deaths also occur due to the illicit manufacturing and distribution of synthetic opioids, such as fentanyl, and the illegal diversion of prescription opioids. Illicit fentanyl, for example, is often combined with heroin or counterfeit prescription drugs or sold as heroin, and may be contributing to recent increases in drug overdose deaths.
The opioid crisis has not sparred Indian country. But it has also not striked with equal impact. Some communities face devastating rates of opioid use, while others do not. This webpage features articles and resources to assist Wellness Courts in serving participants with opioid addictions.
American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use
Kayle Kampman and Margaret Jarvis, 9 J Addic. Med. 5 (Sept./Oct. 2015)
This publication includes recommendations that encompass a broad range of topics, starting with the initial evaluation of the patient, the selection of medications, the use of all the approved medications for opioid use disorder, combining psychosocial treatment with medications, the treatment of special populations, and the use of naloxone for the treatment of opioid overdose.
Medication-Assisted Treatment for Opioid Use Disorders in Drug Court
Benjamin R. Nordstrom and Douglas B. Marlowe, Drug Court Practitioner Fact Sheet Vol. XI, No. 3 (National Drug Court Institute, Aug. 2016)
A substantial proportion of adult drug court participants have a moderate to severe opioid use disorder. In a 2014 survey of all state and territorial drug court coordinators in the United States, opioids were ranked as the primary substance of abuse in approximately 20% of adult urban drug courts and in just over 30% of rural and suburban drug courts. This fact sheet provides a brief overview of opioid use disorders, medication-assisted treatment (MAT) available for opioid use disorders, and the best practices and legal standards for MAT in drug courts.
Naloxone: Overview and Considerations for Drug Court Programs
Caleb J. Banta-Green, Drug Court Practitioner Fact Sheet, Vol. XI, No. 3 (National Drug Court Institute, Dec. 2016)
Approximately one in five people who use heroin will have an overdose each year, and about one in one hundred will die from an overdose. Pharmaceutical opioids such as morphine, codeine, oxycodone, and methadone also are involved in many overdoses. With brief training, people who use heroin and other opioids, and members of their families and social networks, can effectively recognize and respond to an opioid overdose and successfully administer naloxone, the opioid overdose antidote. Distributing naloxone to laypersons has resulted in thousands of overdose reversals and has saved many lives.
Alternatives to Opioids for Chronic Pain Relief
Sandra Lapham, Drug Court Practitioner Fact Sheet, Vol. XI, No. 2 (National Drug Court Institute, Jun. 2016)
Chronic pain increases the risk for noncompliance with substance abuse treatment and complicates recovery efforts. An understanding of the alternatives to opiates for the treatment of chronic pain may help drug court professionals provide more effective assistance to their clients. This fact sheet provides basic information on alternatives to opioids for chronic pain management. It describes: who is most likely to suffer from non-cancer-related chronic pain; what sufferers themselves can do to manage chronic pain; and how drug court participants can relieve chronic pain without the use of opioids.
Understanding and Detecting Prescription Drug Misuse and Misuse Disorders
Sandra Lapham, Drug Court Practitioner Fact Sheet, Vol. XI, No. 1 (National Drug Court Institute, Feb. 2016)
This fact sheet is designed for court professionals. It describes prescription drug misuse and provides information on: the attributes of the most commonly misused and addictive prescription drugs; the extent and consequences of misuse; side effects and toxicity; characteristics of those who are most likely to misuse prescription drugs; signs and symptoms of misuse; ways to identify and treat those who may have developed a drug use disorder, including a section on medication-assisted treatment of opioid use disorder; and educational and technical assistance resources on this topic from SAMHSA and other organizations.
2016 Minnesota Tribal-State Opioid Summit: Final Report
(March 9, 2017)
The Dayton-Smith Administration and Minnesota’s Tribal Leaders agreed to partner on a summit focused on developing strategies and solutions to address the opioid crisis in Indian Country. The Tribal-State Opioid Summit took place on Tuesday, October 18, 2016 at the Lower Sioux Indian Community in Morton, Minnesota. This report summarizes the conversations, and policy and budget recommendations for Tribes and the State that came out of the small group discussions.
Webinar: Medication Assisted Treatment Introduction
The National Drug Court Institute (NDCI) with funding from the Office of National Drug Control Policy, Executive Office of the White House in collaboration with American Academy of Addiction Psychiatry (AAAP) developed an online training curriculum designed to educate drug court professionals on medication assisted treatments (MAT) for substance use disorders with a major focus on opioid use disorders. Nine modules were developed and are available at this website.
- Module 1: What are Substance Use Disorders?
- Module 2: What is Medication-Assisted Treatment?
- Module 3: Medication Assisted Therapies: Using Medication for Treatment of Opioid and Alcohol Disorders?
- Module 4: Strategies to Reduce Diversion of Abusable Medications
- Module 5: Primary Components of Evidenced Based Treatments for Addictions
- Module 6: Pros and Cons of MAT
- Module 7: Drug Courts and MAT: The Legal Landscape
- Module 8: Long-term Opioid Therapy and Chronic Pain: Understanding and Mitigating Risk
- Module 9: Interpretation of Drug Testing Results in Medication-Assisted Treatment (MAT)
Webinar: Holistic Treatment of Substance Use Disorders: MAT and Beyond
This is the third session in a three-part on-demand webcast series entitled Medication Assisted Treatment in Context. Originally filmed on September 14, 2016 in Mt. Pleasant, Michigan. This final installment of the series focuses on using MAT within an integrated health treatment model and how to use MAT in regards to monitoring, pain management, and with other medications. Learning Objectives: 1. Describe the different MAT monitoring practices and why they are needed (CHES Area of Responsibility 1.6.1, 1.6.4) 2. Identify that MAT can be part of a holistic solution to substance use disorders (1.6.1, 2.1.1) 3. Define the challenges of managing pain for patients on MAT (1.6.4)
Webinar: Substance Use Disorders As A Public Health Issue
This is the second session in a three-part webcast series entitled Medication Assisted Treatment in Context, originating on August 24, 2016 at the Nimkee Memorial Wellness Center in Mt. Pleasant, MI. This session will include an overview of substance use disorders, specifically focusing on opioid misuse, and will provide a discussion of the need to approach prevention and treatment from multiple perspectives. Learning Objectives: 1. Describe how addiction affects the brain (CHES Area of Responsibility 1.4.1, 1.4.2) 2. Recognize the current issue of substance use disorders within tribal communities, specifically in Michigan (1.4.1, 1.4.2) 3. Identify opportunities and resources for action around substance use disorders in Michigan (2.1.3, 6.1.2)
Webinar: Medication Assisted Treatment: An Evidence Based Treatment Option
This is the first session in a three-part webcast series entitled Medication Assisted Treatment in Context. This session originated on July 15, 2016 at the Nimkee Memorial Wellness Center in Mt. Pleasant, MI. This session will provide an introduction to the different MAT options, including a look at the advantages and disadvantages of MAT and the evidence-base supporting this treatment approach. Learning Objectives: 1. Describe MAT as an evidence-based treatment option for substance use disorders (CHES Area of Responsibility 1.6.1, 1.6.2) 2. List the advantages and disadvantages of MAT (CHES Area of Responsibility 1.6.1, 1.6.2) 3. Identify the difference between methadone, buprenorphine, naloxone, and naltrexone (CHES Area of Responsibility 1.6.1, 1.6.2)
Prescription Medication Abuse: Knowledge and Skills for Drug Court Practitioners
James W. Finch
Presented as part of the www.TreatmentCourts.org series. (Note: Webinar is a free, but requires registration.)
In this webinar, attendees will explore what is different and what is similar when abusing prescription medications as compared to illicit drugs or alcohol; apply these concepts to the process of evaluation and intervention within the context of the judicial system; understand the current “standard of care” related to rational, low-risk prescribing of opioid analgesics for pain management; apply this understanding in the context of communicating and working collaboratively with medical providers regarding these medications; and recognize the magnitude of the current epidemic of prescription medication abuse and understand some of the social issues underlying the epidemic.
 HHS, Surgeon General’s Report at 1-14, citing Kolodny, A., Courtwright, D. T. Hwang, C. S. Kreiner, P., Eadie J. L., Clark, T. W., & Alexander, G. C., The Prescription Opioid and Heroin Crisis: A Public Health Approach to An Epidemic of Addiction, 36 Annual Review of Public Health 2015, 559-574.
 Id., citing Volkow, N. D., America’s Addiction to Opioids: Heroin and Prescription Drug Abuse, Senate Caucus on International Narcotics Control: National Institute on Drug Abuse (2014).
 Id., citing Levy, B., Paulozzi, L., Mack, K. A., & Jones, C. M., Trends in Opioid Analgesic–Prescribing Rates by Specialty, US, 2007–2012, 49(3), American Journal of Preventive Medicine, 2015, 409-413 and Volkow, N. D., McLellan, T. A., Cotto, J. H., Karithanom, M., & Weiss, S. R. B., Characteristics of Opioid Prescriptions in 2009, 305(13) JAMA 2011, 1299-1301.
 Id., citing Crane, E. H., The CBHSQ Report: Emergency Department Visits Involving Narcotic Pain Relievers, (Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2013).
 Id., citing Rudd, R. A., Aleshire, N., Zibbel, J. E., & Gladden, R. M., Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014, 64(50) MMWR 2016, 1378-1382, and Drug Enforcement Administration, DEA Report: Counterfeit Pills Fueling U.S. Fentanyl and Opioid Crisis: Problems Resulting from Abuse of Opioid Drugs Continue to Crow (2016).
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