Look beyond opioids to solve national substance use epidemic, study suggests

August 28, 2020

Overcoming the nation's opioid epidemic will require clinicians to look beyond opioids, new research from Oregon Health & Science University suggests.

The study reveals that among patients who participated in an in-hospital addiction medicine intervention at OHSU, three-quarters came into the hospital using more than one substance. Overall, participants used fewer substances in the months after working with the hospital-based addictions team than before.

The study published in the Journal of Substance Abuse Treatment.

"We found that polysubstance use is the norm," said lead author Caroline King, M.P.H., a health systems researcher and current M.D./Ph.D. student in the OHSU School of Medicine's biomedical engineering program. "This is important because we may need to offer additional support to patients using multiple drugs. If someone with opioid use disorder also uses alcohol or methamphetamines, we miss caring for the whole person by focusing only on their opioid use."

About 40% of participants reported they had abstained from using at least one substance at least a month after discharge - a measure of success that isn't typically tracked in health system record-keeping.

Researchers enrolled 486 people seen by an addiction medicine consult service while hospitalized at OHSU Hospital between 2015 and 2018, surveying them early during their stay in the hospital and then again 30 to 90 days after discharge.

Treatment of opioid use disorder can involve medication such as buprenorphine, or Suboxone, which normalizes brain function by acting on the same target in the brain as prescription opioids or heroin.

However, focusing only on the opioid addiction may not adequately address the complexity of each patient.

"Methamphetamine use in many parts of the U.S., including Oregon, is prominent right now," said senior author Honora Englander, M.D., associate professor of medicine (hospital medicine) in the OHSU School of Medicine. "If people are using stimulants and opioids - and we only talk about their opioid use - there are independent harms from stimulant use combined with opioids. People may be using methamphetamines for different reasons than they use opioids."

Englander leads the in-hospital addiction service, known as Project IMPACT, or Improving Addiction Care Team.

The initiative brings together physicians, social workers, peer-recovery mentors and community addiction providers to address addiction when patients are admitted to the hospital. Since its inception in 2015, the program has served more than 1,950 people hospitalized at OHSU.

The national opioid epidemic spiraled out of control following widespread prescribing of powerful pain medications beginning in the 1990s. Since then, it has often been viewed as a public health crisis afflicting rural, suburban and affluent communities that are largely white.

Englander said the new study suggests that a singular focus on opioids may cause clinicians to overlook complexity of issues facing many populations, including people of color, who may also use other substances.

"Centering on opioids centers on whiteness," Englander said. "Understanding the complexity of people's substance use patterns is really important to honoring their experience and developing systems that support their needs."

Researchers say the finding further reinforces earlier research showing that hospitalization is an important time to offer treatment to people with substance use disorder, even if they are not seeking treatment for addiction when they come to the hospital.
Support for the research was provided by the National Institute on Drug Abuse of the National Institutes of Health, grant award UG1DA015815, R01DA037441, and F30 DA044700UG; and the Oregon Clinical and Translational Research Institute through funding from the National Center for Research Resources of the NIH, grant award UL1TR002369.

Oregon Health & Science University

Related Addiction Articles from Brightsurf:

Opioid addiction treatment is more widely available, but only for adults
Primary care providers have expanded access to buprenorphine for adults, but use of the opioid addiction treatment has decreased among the youngest patients, find researchers at Columbia University.

Is video game addiction real?
A recent six-year study, the longest study ever done on video game addiction, found that about 90% of gamers do not play in a way that is harmful or causes negative long-term consequences.

Eating disorders linked to exercise addiction
New research shows that exercise addiction is nearly four times more common amongst people with an eating disorder.

Co-addiction of meth and opioids hinders treatment
A study published in the Journal of Substance Abuse Treatment found that methamphetamine use was associated with more than twice the risk for dropping out of treatment for opioid-use disorder.

New tool to assess digital addiction in children
A new study developed and validated a tool for assessing children's overall addiction to digital devices.

Addiction intervention in hospital is a 'reachable moment'
Patients who meet an addiction medicine consult team while they're in the hospital are twice as likely to participate in treatment for substance use disorder after they go home, according to new research.

How stress leads to Facebook addiction
Friends on social media such as Facebook can be a great source of comfort during periods of stress.

Systematic review of food addiction as measured with the Yale Food Addiction Scale
The aim of this paper was to review the clinical significance of food addiction diagnoses made with the Yale Food Addiction Scale (YFAS) and to discuss the results in light of the current debate on behavioral addictions.

Drugs of abuse: Identifying the addiction circuit
What happens in the brain of a compulsive drug user?

Pancreatic cancer's addiction could be its end
Researchers at CSHL have discovered that an inappropriately produced protein may be why some pancreatic cancer patients die exceptionally early.

Read More: Addiction News and Addiction Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.