Elevate Spotlight: Best Practices in Opioid Addiction Treatment

Duke University Experts Will Address Comorbidities and Suicide Risk Assessment

A little more than a decade ago, as he prepared to deliver a Medicine Grand Rounds session at Duke University, Richard Weisler, MD, submitted a routine request to the North Carolina health department for the most recent data on suicides and poisoning deaths in the state.

He was not prepared for what he received.

“I can still remember that 2009 day being totally stunned and shaken by the number of deaths, deemed intentional or unintentional, related to opioids in North Carolina,” said Dr. Weisler, a psychiatrist in private practice in Raleigh, North Carolina, who also serves as an adjunct psychiatry professor at Duke University in Durham and UNC Chapel Hill Medical Center in Chapel Hill.

Dr. Weisler quickly reached out to his professional network, including Duke colleague and substance abuse expert Ashwin Patkar, MD. Agreeing on the urgent need to sound an alarm, Drs. Weisler and Patkar teamed up with Centers for Disease Control and Prevention opioid crisis expert Leonard Paulozzi, MD, and got to work publishing and presenting on what Dr. Weisler calls “the opioid disaster.”

Drs. Weisler and Patkar will take their campaign to Elevate by Psych Congress, being held July 25-27, 2020, where they will deliver a session titled “Opioid Addiction and Overdoses: Recent Advances in Treatment and Prevention.”

Although awareness surrounding opioids has grown over the years, the crisis continues.

“Sadly, opioids have now claimed more American lives than the battlefields of both World Wars combined,” Dr. Weisler said. “The United States suffered 53,402 deaths in World War I and another 291,557 in World War II, for a total of 344,959 lives lost in battle in both wars. That is more than 5000 fewer deaths than the opioid epidemic's projected death toll in the United States at the end of 2017.”

“This epidemic has unfolded in three waves,” explained Dr. Patkar, psychiatry professor and medical director of addictions programs at Duke University School of Medicine. “In the 1990s, it was primarily a prescription opioid overdose epidemic. In 2010, we started seeing a marked rise in heroin overdose deaths. And since 2013, synthetic opioids such as fentanyl have become a major contributor to opioid overdose deaths.”

On the practice level, that translates to a handful of calls each week from new patients whose lives have been dramatically altered by opioid misuse, such as a 21-year-old Dr. Patkar saw just days ago. Brought to the office by his parents, the young man had overdosed on fentanyl twice, had contracted hepatitis C, had lost a brother to a heroin overdose, and had two friends who were also heavily addicted.

“It is also worth pointing out that hospitals, including Duke Hospital where both Dr. Weisler and I teach, have seen the tragedy of a dramatic increase in newborns with opioid withdrawal, termed neonatal abstinence syndrome, because mothers were addicted to opioids during pregnancy,” Dr. Patkar said.

More From Drs. Weisler and Patkar: Opioid abuse and overdose: Keep your patients safe

With the far reach of the opioid epidemic and the high comorbidity of opioid addiction with other psychiatric disorders, Dr. Patkar and Dr. Weisler’s Elevate session will be relevant to all attendees, not just those in addiction medicine. During their time, the pair will discuss current treatments for opioid addiction, how to engage patients in treatment, best practices for managing patients with comorbid mood and anxiety disorders, and the importance of suicide risk assessment in the population.

More than 40% of suicide and overdose deaths in 2017 were known to involve opioids, Dr. Weisler pointed out. It is likely, he added, many more had opioid involvement, albeit unrecorded.

Opioid disaster or not, the presenters urge mental health clinicians to equip themselves and persevere in the fight against opioid overdoses.

“As bad as it sounds, there is some cause for optimism,” Dr. Patkar said. “The latest data indicate the year-to-year rate of increase of overdose may have slowed or even decreased. For example, in North Carolina there was a 9% decrease from 2017 to 2018 in opioid overdose deaths. It does appear that the treatment and prevention efforts across the country to address this epidemic may be bearing fruit, although much needs to be done.”

“As a field,” Dr. Weisler said, “we can help most people struggling with these disorders—while saving and improving lives of our patients, families, and their communities.”

—Jolynn Tumolo