The opioid epidemic has touched the entire country. That includes New Mexico, which has one of the nation’s highest rates of overdose deaths. Now some local healthcare providers are learning how to treat opioid addiction with medication.
Early in his career as a head and neck surgeon, Harris Silver developed chronic pain. He started taking painkillers and eventually became addicted.
“I have opioid use disorder,” Harris says. “I worked my way into getting sick with my disease through chronic pain, and in retrospect I can tell you I was also medicating emotional pain” from a turbulent childhood. “Opioids gave me euphoria for a couple hours. Even to get that couple hours of relief, because I did not have coping skills that I needed.”
It’s been a long path to recovery, but Silver now works as a healthcare and drug policy analyst. And he’s become a big proponent Medication Assisted Treatment, or MAT.
“We actually have medication to treat opioid use disorder, or addiction to opioids,” he says. “This is incredible. We actually have medicine that treats it.”
The federal government has approved three medications to treat opioid addiction: naltrexone, methadone, and buprenorphine. These drugs curb cravings for stronger opioids and prevent withdrawal symptoms. Doctors can apply for a special waiver to prescribe the medications. A growing body of research suggests MAT is the gold standard for treating addiction, when combined with behavioral healthcare.
“The more behavioral healthcare that people get like one-on-one therapy, group therapy, the more support group attendance there is, other things they do to enhance change in themselves, then it starts to be more of a treatment,” Harris says. “But Medication Assisted Treatment is so much safer to use than heroin and prescription opioids.”
New Mexico has one of the highest rates of overdose deaths in the country. In some counties, the rates are more than five times the national average. The opioid crisis has hit northern New Mexico especially hard. But there’s still a strong need for treatment in the southern part of the state.
John Andazola directs the Southern New Mexico Family Medicine Residency Program at Memorial Medical Center. “The problem is we don’t have a lot of people getting treated because we don’t have people providing the treatment,” he says.
Andazola says there are about 1,700 primary care physicians statewide. Nearly 700 have a waiver to prescribe buprenorphine, but only about 150 are currently treating ten or more patients.
He says there are several barriers to care. Some physicians say they don’t want to be inundated with patients who are struggling with opioid addictions. Others believe MAT is just replacing one addiction with another, or fear their patients might divert the medication - that is, sell it or give it away. Andazola attributes a lot of reluctance to bias and stigma.
“One big barrier to this beyond the stigma that I talk about is just the physicians’ comfort,” Andazola says. “And so they feel like they need more education and support. And there are studies that show that if they had a mentor, if they had some sort of provider to be paired with, they’d be more likely to do this. And so if we can provide that support, that’s what we’re gonna try to do.”
To address that stigma and offer that support, Andazola helped organize a workshop on MAT for healthcare providers in Doña Ana County.
On a Friday afternoon, dozens of providers filed into the County Government Center. Andazola began the workshop by urging them to see opioid use disorder as a medical condition - just as common, and just as important to treat, as asthma or pulmonary disease.
“I’m telling you it’s a medical condition,” he said to the healthcare providers. “I’m telling you it’s really common. I’m telling you we have treatments to treat it. And I’m also telling you that we’re not doing a really good job about it.”
Andazola and other experts, like Harris Silver, discussed the science behind and benefits of MAT. Some healthcare providers shared their first-hand experience with the treatment.
Janette Espinoza is a psychiatric mental health nurse practitioner with the New Mexico Public Health Department. She says with a waiver to prescribe medication, she can think a lot more autonomously about how help each individual patient.
“Becoming a prescriber has just opened up my options and the different modalities that I can offer the patient,” Espinoza says. “If I had to say one word about what my experience has been, it has been totally rewarding.”
John Andazola says this workshop is really an introduction to MAT.
“This is just one step in our community’s response,” he says. “So this one is just exposure to what opioid use disorder is and how to treat it and the stigma and biases surrounding that, and the next steps are actually giving the tools to the providers.”
There are currently seven locations in Doña Ana County offering MAT. Andazola hopes that, after this workshop, that number will increase.
Note from Alkermes, a manufacturer of naltrexone: “While all three medications reduce opioid use and cravings, naltrexone prevents relapse in individuals with opioid dependence while buprenorphine and methadone prevent withdrawal symptoms.”
