Prescription Drug Abuse: Prevention as Treatment

On October 26, 2017, President Donald Trump declared the opioid epidemic "a national public health emergency" under federal law. As a result, agencies had a 90-day window—which has been extended another 90 days—to shift their existing budgets to address the crisis. The declaration means finding the resources and money to hire staff to conduct research or the counselors to provide care to people battling opioid addiction.

But that’s just one aspect of turning the tide on the epidemic. Without any new federal funding to help slow the crisis, the President’s declaration in the eyes of many is just talk. But what should be done in order to make the declaration meaningful?

Finding Help Versus Heroin

Dr. Sarah Wakeman, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital, told Alice Park of TIME magazine, “What we need is something like the Ryan White Care Act,” in which Congress created a fund for HIV patients who could not afford the care and drugs to fight the virus. This type of federal funding is a start to seriously fighting the battle.

But even if a patient has access to care, are counselors adequately trained to handle this opioid epidemic? Addiction counselors in many cases are the last thread of hope. News stories of how people become addicted and then continue to fuel their addiction are becoming more and more common. Take Ron Hiers, who told TIME that he originally had been prescribed opioids for pain from a broken heel. But when Hiers couldn’t acquire more prescribed painkillers after visits to various doctors for lingering “pain,” he turned to heroin, which was easier to find.

How can heroin be easier to find than help? What if he had had affordable access to a counselor trained in helping people who may become addicted to prescription drugs before looking for deadly substitutes—like Fentanyl, kratom or heroin—on the streets?

“Treatment works for those who seek it and who have access to competent addiction professionals who can help them,” says our Behavioral Health Sciences director Stan Weisner. “The Certificate Program in Alcohol and Drug Abuse Studies offers the kind of quality training that is desperately needed in the field to expand the workforce.”

Specifically, the certificate elective Prescription Drug Abuse teaches counselors—both new to the field and practicing professionals—to examine the dangers associated with using commonly abused drugs and to review medical and psychological treatment options. With the number of drug overdose deaths continuing to rise, and exceeding 59,000 lives in 2016, understanding how to handle the crisis from a psychological standpoint is an urgent need.

Prescribing Prevention

In 2015, the amount of opioids prescribed would have medicated every American “around the clock for three weeks,” according to the CDC infographic on unsafe prescription practices. The infographic also states that “therapies that don’t involve opioids may work better and have fewer risks and side effects.” Instructor Susan Fitts, Psy.D., is all too familiar with these statistics. Currently, she is a clinical psychologist at Kaiser specializing in chronic pain, but previously worked as an intern in the Psychosocial Medicine Clinic at SF General and has taught behavioral medicine classes at the Wright Institute in Berkeley. Fitts sees the need to change the way we treat the underlying cause for prescribing certain drugs in the first place. That’s where counselors can begin to make the difference.

“Counselors have the potential to serve a key role in slowing this epidemic,” says Fitts. “Ideally, a patient would meet or be referred to a counselor to explore non-medication solutions prior to a prescription even being written. Most individuals need non-medication options to manage any issue, but many opt for a medication first. Exploring more behavioral options can help slow the prescription abuse epidemic. While involving a counselor prior to writing a prescription may not always be feasible, involving counselors in the process either at the first or second prescription could dramatically reduce the growing dependency on prescription opioids.”

Taking preventive measures, of course, doesn’t lie solely on the shoulders of the counselor. Fitts explains, “Prescribers usually prescribe medication with the best of intentions. They want to help and make treatment convenient. Your doctor may routinely have prescribed two months of opioids, because in the past most patients requested refills for two months. However, everyone is different.” And as individuals, we are responsible for ourselves and our own decisions on how to manage pain. Fitts continues, “To be healthy, most of us will need to make lifestyle changes. However, individuals may need help identifying when and how to make behavioral changes so that they can have the meaningful life they desire. Counselors can help with education and to guide behavioral change, so that clients have options instead of just taking a medication.”

In the Prescription Drug Abuse course, counselors—and students looking to enter the field—gain skills they can use immediately with clients who are addicted or at risk. “The objective of the class is to build confidence in working with individuals who are abusing prescriptions. During the class, you will have the opportunity to discuss treatment plans for difficult clients and roleplay difficult cases.”

Lessons for Recovery

The relationship between a client and a substance abuse counselor is a personal one, and treatment plans or counseling techniques might not be the same for everyone. It is up to the counselor to find what works, what gets the client the result that saves his or her life.

“Some clients are motivated and ready to change; others are pre-contemplative and will need help with motivation,” says Fitts. “I approach and encourage others to work with their clients to set an attainable goal, knowing that each client will be on his or her own journey. I have been fortunate to work with many patients who have worked to stop all prescription substances and are able to have nice and meaningful lives.”

Remember Ron Hiers? According to Alice Park’s TIME article, his life has been changed thanks to addictions counseling services. Although Hiers admits still thinking about getting high, the lessons and techniques he learned in counseling sessions kick in before he has a chance to dwell on the thought.

How many potential addictions could be prevented if counselors are brought in earlier? That is a statistic we need to have.

Learn more about the Certificate Program in Alcohol and Drug Abuse Studies.