How Pres. Trump's Opioid Task Force Could Make a Difference

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Addiction Expert Dr. Indra Cidambi outlines easily implementable steps the opioid task force should take to help contain the opioid epidemic.

In order to make an impact, the task force should educate prescribers and the general public about the addiction potential of medications, support newer modalities of treatment, and drive decriminalization.

With over 33,000 opioid overdose deaths in 2015, there is an acute need to find solutions to get the epidemic under control. One of the root causes of this addiction is legally prescribed opiate pain pills. President Trump has turned his focus to addressing this issue head on by appointing Gov. Chris Christie to head an opioid task force. "In order to make an impact, the task force should educate prescribers and the general public about the addiction potential of medications, support newer modalities of treatment, and drive decriminalization utilizing ‘token-economy’ for possession/use related offenses," says Dr. Cidambi.

While lawmakers are introducing new laws that restrict physicians' treatment options relative to treating pain, Dr. Cidambi thinks that this could be counterproductive, as prescribers may resist interference with treatment and may develop workarounds. She further worries about treatment for other conditions that require addictive medications. "How many laws can politicians introduce? What about treatment for other conditions, such as anxiety, that require addictive medications? Are politicians going to tell physicians how to treat a host of diseases that call for medications that may be addictive?" asks Dr. Cidambi.

Dr. Cidambi has been treating individuals suffering from substance abuse disorders for over a decade and she believes a simple but comprehensive approach is needed to conquer this disease. "I truly believe the steps detailed below will help us make inroads against the opioid epidemic."

Enabling Responsible Prescribing Habits
There is already a lot of noise about legal prescriptions causing the opiate epidemic. “However, a vast majority of the opioid pain prescriptions are written by nurse practitioners and primary care physicians* (not pain management specialists) and they may not fully understand the addictive potential and diversion issues (others misusing a patient's pain pills) related to these medications,” says Dr. Cidambi.

"All prescribers should be fully educated about the dangers of opioid pain pills," says Dr. Cidambi. "An effective and easy way to achieve this objective is by integrating prescribing guidelines and information on addiction potential into continuing education credits prescribers are required to take." Repetition is also guaranteed as prescribers complete continuing education credits every year. "What about future prescribers, physicians and nurses? They could receive this education through a mandated 3-month rotation at a substance abuse treatment facility while in school so they understand how people get addicted to pain pills." Such efforts will serve to significantly slow the creation of new addicts, as evidence suggests legal prescriptions paved the way to addiction for a large number of individuals.

Arming the General Public With Information on Addictive Potential
"Although prevention campaigns that asked people to say “no to drugs” have been around since the 1980s, they have not helped to educate the public about the dangers of legally prescribed medications," says Dr. Cidambi.

A high profile, strongly funded campaign that not only informs the public about such dangers, but also encourages them to seek a full explanation from their prescriber about how the medications work could be impactful. "Make the market work! Create demand for such information and prescribers will be forced to respond and, possibly, rethink their prescriptions,” notes Dr. Cidambi. "This could also mitigate the creation of new addicts."

Embracing Newer Treatment Modalities
"The substance abuse treatment community, in general, has been resistant to new modalities of treatment, such as Ambulatory Detoxification and Medication Assisted Treatment, which deliver better outcomes," notes Dr. Cidambi.

"Resistance to the utilization of Ambulatory (Outpatient) Detoxification comes from the fear that the individual suffering from substance use disorders returns to his/her home environment each evening," says Dr. Cidambi. She pioneered the use of ambulatory detoxification for alcohol, benzodiazepines and opiates in New Jersey and has safely detoxed over 1,100 individuals in four years. “Done right, it can deliver much better outcomes relative to inpatient detoxification as the patient learns to stay sober in his/her home environment," says Dr. Cidambi. "Family interventions elevate the level of support the patient receives at home, inhibiting relapse,” adds Dr. Cidambi. The cost of Ambulatory Detoxification is also significantly lower relative to inpatient detoxification.

"The criticism of medicated assisted treatment (specifically buprenorphine) is that the prescriber is just substituting one drug for another," says Dr. Cidambi. “However, I have found that utilizing medication assisted treatment provides the physical relief from cravings and withdrawal symptoms that enables an individual to engage in therapy and make the required lifestyle changes.”

Decriminalization Utilizing Token Economy
Research** showed that 4 out of 5 drug arrests (1.5 million/year) are for use/possession, while only 1 of 5 is for manufacturing/sales. “This provides an opportunity to utilize the token-economy modality of treatment to incentivize these individuals to enter treatment,” says Dr. Cidambi. Token-economy modality of treatment is already used to treat addiction. “Instead of spending money prosecuting these cases, a chance to wipe charges off the record if these individuals enter treatment and stay sober for a length of time would help,” says Dr. Cidambi. The money saved can be redirected to treatment. While marijuana possession has been decriminalized in a number of states, the possession of other illegal substances still fetches a felony or misdemeanor charge in most states. “Not only will individuals suffering from addiction benefit from treatment, re-entering the workforce becomes easier when the charge(s) are lifted,” noted Dr. Cidambi.

For more information on opioid abuse and addiction or to learn more about the Center for Network Therapy please visit, http://www.RecoveryCNT.com.

About Dr. Indra Cidambi
Indra Cidambi, M.D., Medical Director, Center for Network Therapy, is recognized as a leading expert and pioneer in the field of Addiction Medicine. Under her leadership the Center for Network Therapy started New Jersey’s first state licensed Ambulatory (Outpatient) Detoxification program for alcohol, benzodiazepines and opiates four years ago. Dr. Cidambi is Board Certified in General Psychiatry and double Board Certified in Addiction Medicine (ABAM, ABPN). She is fluent in five languages, including Russian.

About Center for Network Therapy
Center for Network Therapy (CNT) was the first facility in New Jersey to be licensed to provide Ambulatory (Outpatient) Detoxification Services for all substances of abuse – alcohol, anesthetics, benzodiazepines, opiates and other substances of abuse. Led by a Board Certified Addiction Psychiatrist, Indra Cidambi, M.D., experienced physicians and nurses closely monitor each patient’s progress. With CNT’s superior client care and high quality treatment, Dr. Cidambi and her clinical team have successfully detoxed over 1,000 patients in four years. The Center for Network Therapy also offers step down to Partial Care (PHP) and Intensive Outpatient (IOP) levels of care.

**http://www.drugpolicy.org/sites/default/files/DPA%20Fact%20Sheet_Approaches%20to%20Decriminalization_%28Feb.%202016%29.pdf

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Jessica Moschella
Center for Network Therapy
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