Panel Discusses Barriers to Treating and Preventing ‘Opioid Use Disorders’

A panel of medical professionals met on Wednesday in a virtual roundtable hosted by the Middlesex County Chamber of Commerce to discuss the added obstacles posed by the COVID-19 pandemic to treating and preventing opioid addiction.

Opioid overdoses and deaths have increased during the pandemic, and Dr. Michael Kalinowski, a family physician at Middlesex Health, said it’s likely that long-term addictions have increased as well. 

According to Kalinowski, COVID-related restrictions have hindered efforts to educate students and parents about opioid use, identify mental health concerns in young people, and eliminate unneeded prescription opioid medication.

Kalinowski said that because improving mental health, which is closely correlated to addiction, is an important part of preventing new substance use disorders, he was concerned that the pandemic has added significantly to the stress on students, even if they aren’t communicating it.

He said that he has seen an increase in symptoms of anxiety and depression and effects from social isolation.

He warned that although telemedicine can work well for some mental health evaluations, physcians should be cautious with diagnoses and treatments for panic and anxiety conditions, to avoid over-prescribing benzodiazepines, which increase overdose risk when combined with opioids.

He said that that remote medicine also made screening for mental health concerns more difficult during child and adolescent wellness visits.

“In some cases, the virtual aspect of these visits may have interfered with the comfort level of engaging in these sometimes sensitive and private conversations, so there may be some missed opportunities there for screening,” he said.

According to Kalinowski, about 80 percent of people who end up with an opiate use disorder began with prescription medication, and most received that medication from a friend or relative. He said that only about five percent began by buying prescription opiates from a black market drug dealer.

“Eliminating these unused medications from our households is very, very important,” Kalinowski said.

Overcoming stigma

The panel also discussed the role of social stigma as a barrier preventing people from getting help.

Dr. Hamilton Gaiani, an addiction psychiatrist at the Middlesex Health Center for Behavioral Health, said that studies have shown only about a third of people with a substance use disorder seek a form of treatment, including 12-step programs like Narcotics Anonymous.

According to Gaiani, many avoid treatment because they are afraid of the stigma surrounding addiction which can come from society, family members, even support groups.

Gaiani said for example that while Narcotics Anonymous has saved lives and done some great work, she questioned the group’s reluctance to treating addiction with medications like buprenorphine and methadone.

“We know, bar none, that these medications save lives,” Gaiani said. “I often see patients who come in with this idea that they need to get off these life-saving medications because they don’t feel like they’re really in recovery if they’re on them.”

According to Gaiani, that stigma hinders patients from receiving the help they need.

“People don’t want to necessarily disclose all the details of what’s going on with them, and it can become a hindrance to their treatment goals,” said Gaiani.

The best way to combat that is with empathy and compassion, said Gaiani, avoiding terms like substance abuse, addict, and drug abuser, with “people first” language like “substance abuse disorder” — the preferred clinical term used to diagnose patients.

“Recognize people may not want to confide in us if they feel we will judge them,” Gaiani said.

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