A slave to Opioids and its Comorbidity with Behavioral Health
Recently, you may have noticed President Trump identified opioid addiction as a national emergency. Tales of young men and women dying of overdose, destroyed families and disheveled faces wrought with the pain of addiction are thrown around your monitors. Perhaps you know someone who has battled the beast of opioid addiction or maybe you know this beast all too well.
According to the Center for Disease Control and Prevention, the rate of death involving an overdose of opioids has shown an upwards trend over the past few years with no signs of that slowing down. Additionally, approximately 20% of all overdose related deaths are unable to pinpoint a specific drug (CDC, 2017). In my years of interacting with drug addicts, it is common to see the comorbidity of drug abuse alongside a behavioral health diagnosis such as depression, bipolar, anxiety or a range of other debilitating conditions. What often began as self medicating to feel “normal” turns into an all-consuming drug addiction where normal simply means numb, not puking and running away from the root cause.
The Cycle of Comorbidity
Comorbidity by definition simply means two or more chronic illnesses operating simultaneously within a person. These conditions may be exacerbating the other and it creates a vicious cycle. A dual diagnosis of a psychiatric disorder alongside an addiction presents a difficult yet not uncommon hardship for patients and their providers. Do you focus on the psychiatric condition while ignoring the addiction in the hopes this will cause a domino effect or do you treat the addiction while ignoring the root cause of their need to self medicate? Can you treat both simultaneously? This is a delicate balance, but it should be noted that ignoring addiction will not make it magically go away and a replacement “happy pill” can present a secondary addiction that is labeled as acceptable because it has a doctor’s note alongside it.
Suboxone is a treatment sometimes prescribed for opioid addiction recovery, a medication made up of buprenorphine and naloxone. It has effects like that of opiates yet less intense, curves cravings as well as withdrawal symptoms and if an addict intakes heroin alongside suboxone they will be unable to achieve their “ultimate high”. Sounds great right? Perhaps for an initial detox period and beginning maintenance, but what happens months down the line if the patient is chasing suboxone clinics while ignoring their Psychiatric illness. The Psychiatric illness remains a concern often left untreated and the addiction has shifted to another drug, albeit a safer drug, but still replacing one crutch for another. Some may say this illustrates a trend of reliance upon drugs without treating the root cause.
Treating the Psychiatric Disorder Alongside the Opioid Addiction
When facing off against the beast of opioid abuse one should look at the source of pain and need within the patient. One patient may suffer from PTSD (post traumatic stress disorder) and realize their opioid medication helped to reduce their panic attacks so they keep taking more, another patient is bipolar and during a manic episode they use opioids to calm their racing mind, one patient might be running from the trauma of sexual abuse so they stick a needle in their arm to chase away the depression and ignore the pain. Yet we know that the first patient needs therapy and positive coping skills to handle and reduce panic attacks as well as recognize their own triggers, we know a bipolar patient can take other mood stabilizers that are not as habit forming and learn to recognize when a manic episode is approaching, the abused patient can greatly improve by using Cognitive Behavioral Therapy techniques to help them gain true control. Don’t get me wrong, medications have a time and place and I am not against a properly managed prescription, but a drug is not a cure all and we cannot ignore the underlying reason why a patient is addicted to an opiate.
An opioid addict may get labeled as a man/woman without willpower, society views the drug addict as dangerous and throwing their life away, the addict is a less desirable in the eyes of many and some ignore the growing opioid crisis within our society. Yet we cannot ignore the fact that prescription opioid addicts are often getting their medications from a licensed provider, heroin addicts often begin as prescription addicts. Society often turns away from the sufferer of PTSD with comments like “in my day we didn’t have PTSD” so the patient feels a need to hide and act tough while internally it is a war and more U.S Soldiers die from suicide than actual combat once the drugs cease to be strong enough. We live in a society where 1 in every 6 women is a victim of sexual abuse and it is approximated that these women are 10 times more likely to abuse drugs (RAINN, 2016). Patients with serious psychiatric conditions may feel stigmatized and avoid therapy to escape such labels yet they pop pills everyday to mask the problem without addressing the root. The comorbidity of opioid addiction and psychiatric disorders cannot be overlooked, providers have a duty to their patients to find a balance in treating both concerns while patients have a responsibility to be honest with themselves and do the work required to build a better quality of life for themselves and their family.
CDC. (2017). Wide ranging online data for epidemiologic research. Drug Overdose . Opioid data analysis. Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/data/analysis.html
RAINN. (2016). Victims of Sexual Violence. Retrieved from RAINN: https://www.rainn.org/statistics/victims-sexual-violence