November 2021

Face to Face with the Evolving Opioid Crisis

November 18, 2021    |  

“These are numbers we have never seen before.” Those sad words were spoken by Nora Volkow, MD, director of the National Institute on Drug Abuse, a division of the National Institutes of Health. On Nov. 17, the National Center for Health Statistics reported during the first full year of the pandemic, from April 2020 to April 2021, a record 100,000 Americans died of a drug overdose. That’s an increase of nearly 30 percent from the prior year.

Most of those people were young — under 35 — and about two-thirds of the deaths resulted from opioid misuse. Opioid use disorder tears apart families, fills up jails, leads to terrible health consequences, and imposes a tremendous economic cost on everyone. A 2017 survey by the Centers for Disease Control and Prevention (CDC) estimated the cost to the nation of opioid use disorder and opioid overdose deaths was more than $1 trillion that year.

Opioid misuse is not new. Street drugs like heroin and overprescribed painkillers have menaced health care for decades. But it has exploded in recent years, now involving an estimated 2 million Americans, largely due to the proliferation of powerful synthetic opioids like fentanyl.

The most effective treatment, according to Eric Weintraub, MD, professor of psychiatry at the University of Maryland School of Medicine (UMSOM) and medical director of University of Maryland Medical Center Psychiatric Emergency Services, is medication-assisted treatment. The Substance Abuse and Mental Health Services Administration says medication-assisted treatment greatly reduces the likelihood of death, improves retention in treatment programs, helps patients do things like get and keep a job, and improves birth outcomes among pregnant women.

Weintraub joined University of Maryland, Baltimore President Bruce E. Jarrell, MD, FACS, on the Nov. 18 edition of Virtual Face to Face with President Bruce Jarrell to discuss the opioid crisis and a novel approach he and colleagues are using to expand treatment in rural areas.

“The distribution has totally changed in the last 30 years,” Weintraub explained. “It used to be on the street corner, there’s a drug dealer and you could trace the drug all the way back to Colombia. Now, you know, things are being sent in small packages through the internet and the Postal Service because these medications are so potent, and then they’re mixed with other drugs and sent to these rural areas.”

“So, what attracted you to start that in some of these areas that you went to? Why did you start there?” Jarrell asked.

“Opiate addiction had primarily been an urban issue for many years. In Baltimore, we had a problem since the late ’60s, early ’70s. Baltimore’s been known as the heroin capital of the country. It’s a port city; a lot of drugs would come through,” Weintraub said.

In 2015, a colleague set up a treatment program in Hagerstown, in Western Maryland. The center was providing medication-assisted treatment and the colleague asked Weintraub for help. Driving to and from Hagerstown and Baltimore seemed untenable, so Weintraub and collaborator Christopher Welsh, MD, associate professor of psychiatry, thought to adapt the existing UMSOM telehealth program to connect with patients.

“We found that delivering this type of treatment through telehealth in an already established treatment program wasn’t that much different than doing it face-to-face. They had counseling, we were able to get their drug screens. We did some chart reviews and found that our patients were doing as well as those that we were seeing in person. And that was back in the fall of 2015,” Weintraub said.

Now, Weintraub and the team have taken telemedicine down a new road — actually, you could say, a lot of roads, country roads for the most part. For the last two years, they’ve been teamed up with the Caroline County Health Department on the Eastern Shore, providing mobile telemedicine. Their 36-foot, purple-and-white telemedicine van uses an encrypted video circuit to connect patients and providers. The van also is staffed with a nurse, a substance use counselor, and a peer recovery specialist.

A study of their results, published in the Journal of the American Medical Association recently, looked at their 94 patients — all of them treated within 10 miles of their homes between June and October of last year. It showed the treatment was just as effective as traditional in-person, medication-assisted treatment. Nearly 64 percent remained in treatment after two months and 58 percent after three months.

The virtual audience pursued many lines of questioning, including the use of cannabis or CBD to help reduce the use of opioid painkillers in medical treatment, the growing acceptance of telehealth, the role of government in reducing the influx of dangerous synthetic opioids, and more.

Watch the entire program by accessing the link at the top of this page.