Increase In Death Rates Paper. Woolf
This paper was discussed extensively in the press a few weeks ago, but there are key points here that may have been lost in translation. first there is a clear increase in death rates starting at age 14 (figure 2) and in the 21-65 range, I think its more striking in the younger adults 25-45, due to overdose and suicide.
In particular Dr. Woolf also looks at geography and how this disproportionately affects rural areas
While there have been some important advances at APA with regards to teaching psychologists on non-opioid pain management, much more is needed. There needs to be workshops not only on pain management but also on screening and treatment of opioid dependence. This affects all clinical areas. Those of us in child and pediatrics see the impact on families when parents are opioid dependent. Those who work in geropsychology see the impact when grandparents suddenly have to take over raising their grandchildren. It is a problem that impacts all of us no matter which population we are working with.
We psychologists, as a group, are not fully engaged at all in treatment of those who are opioid dependent. We know that the primary care physician and nursing groups have been actively working to inform and teach their clinicians to overcome stigma and bias to provide medication assisted treatment, and psychiatry has joined in that effort. There has been very little, if any, action by psychology to teach our clinicians on how to effectively treat patients with opioid dependence and how to work with primary care clinicians who are providing medication assisted treatment.
We do have members working in the field doing this work to help those with opioid dependence, and presenting workshops, but their work has not been highlighted by APA. We are many years into this crisis. APA should be taking the lead on this, not sitting back and hoping that one workshop on one topic of pain management will solve this problem. That workshop is a critical first step but there needs to be much more.
When the AIDS crisis hit more than 30 years ago, APA was able to respond, form a committee that lasted for many years, join with other organizations and address the issue. In the fall you can walk into APA building and see the AIDS quilts from 25 years ago. This is a similar, and in fact, a much larger crisis. There are the same problems of stigma and discrimination against those affected by this epidemic. A similar response is needed now.
Thank you for raising these issues Doug. As psychologists contemplate their involvement in the world of OUD treatment I would suggest they entire this work with an open mind and willingness to learn from the expertise of other disciplines. Most of us received graduate training that is poor fit for the current realties. A few areas to think about -
1) The limits of SBIRT. SBIRT only improves outcomes in settings where evidence-based “T” is available. T = treatment. For many substance use disorders we do not have effective interventions that can be deployed in real-world settings. Treatment of stimulant use disorders is one example of a condition that we simply don’t know how to treat effectively. The “S” in SBIRT is the easy part. It is easy to setup universal screening protocols. But screening won’t move the needle on outcomes in the absence of effective treatment. And in most communities effective treatment is simply not available, particularly in rural communities like those discussed in the Woolf article. Before we set up screening protocols we need to be sure we have sufficient evidence-based treatment capacity for a given condition.
2) Primary care and public health professionals have quite a bit they can teach psychologists about harm reduction. There are many important life saving interventions that psychologists can offer that are associated with harm reduction. Likewise, patients who use substances have expertise they can teach psychologists about harm reduction. Some patient’s with SUD will set abstinence as their goal. Other patients will not. Psychologists can help all of these patients live better lives.
3) Psychologists can aggressively advocate against the criminalization of SUD. In 1980 the US incarcerated 40,000 individuals for drug related crimes. As of 2016 the US incarcerated 450,000 individuals for drug related crimes. The racial disparities in these numbers have been well documented. Criminalizing a health problem is unethical and ineffective. Psychologists and APA should refuse to participate in or profit from the criminalization of SUD. (https://www.sentencingproject.org/publications/trends-in-u-s-corrections/)
I would also suggest people take a look at this article from Science:
This article documents a remarkable increase in mortality associated with drugs that began long before the opioid epidemic. The current SUD crisis is not strictly a story about pain management and opioids. It started before the current opioid crisis and its ongoing trajectory is fueled by both opioid use and non-opioids, particularly methamphetamine.