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Disabling conditions may lead to addiction to opioids

July 31, 2018

A 2014 study by the Dartmouth Institute for Health Policy & Clinical Practice found that people with disabilities who were under 65 and receiving Social Security Disability Insurance and Medicare were using opioids at higher rates than the general population.

The researchers theorized that the higher opioid use rate for this population was due to a rapid rise in eligibility because of musculoskeletal conditions, which were often treated with powerful prescription painkillers.

In 2011, musculoskeletal conditions such as back pain were the most common SSDI-qualifying diagnoses, accounting for 33.8 percent of program participants.

The shift in the composition of disabling conditions, combined with national trends of increasing prescription opioid use and prescription opioid overdose deaths, suggests the potential for substantial opioid use in the SSDI population, the Dartmouth study said, and raises concerns about the overall health and safety of these patients.

The study results also suggest a need for alternative forms of pain management, rather than addictive opioid painkillers.

Alternative treatment for chronic pain might include cognitive-behavior therapy, exercise therapy or complimentary medicine such as physical therapy or acupuncture.

Another option is naprapathy, a state-licensed treatment in New Mexico that is available in Santa Fe. It involves hands-on body manipulation to reduce pain and increase flexibility.

A joint memorial was approved this year by the New Mexico Legislature asking the state Department of Health to conduct a study of the efficacy of naprapathic medicine in treating acute and chronic pain management.

According to a 2017 examination of insurance claims published in the Journal of the American Medical Association, more than 2 million people may transition to persistent opioid use following elective, ambulatory surgery each year. When inpatient surgical procedures are included, the number may be much higher.

The findings show that patients receiving an opioid prescription in the 30 days before surgery had almost twofold higher odds of persistent opioid use after surgery.

Another study, conducted by Brigham and Women’s Hospital and Harvard Medical School, found that nearly 9 percent of patients were still taking opioids six months after spinal surgery, and that opioid use before surgery was the main risk factor for continued use.

Addiction can develop after only months of opioid use and can be difficult to overcome. Patients often are treated with opiate-based medications such as methadone and buprenorphine to ease the effects of withdraw while recovering from addiction.

And opioid addiction carries a high risk of relapse for years without proper treatment.

A recent story by All Things Considered on National Public Radio featured Aware Recovery Care In Home Addiction Treatment, a medication-assisted treatment program that connects people suffering from addiction with a nurse, a primary care doctor, a therapist, peer support, a case manager and 12-step meetings.

The program is covered in two states, Connecticut and New Hampshire, through Anthem health insurance. An Anthem spokesperson told All Things Considered that 72 percent of the Aware program clients are either sober at the end of one year or still in active treatment, which is twice the success rate of traditional inpatient treatment programs.

The National Institute on Drug Abuse recommends a combination of therapies and services to meet the needs of a patient with opioid addiction, including support with housing and employment, if necessary.

Recovering addicts who are not using illegal drugs and have a substantial limitation on one or more major life activities are protected by the Americans with Disabilities Act and may be eligible for job training and other services provided by the New Mexico Division of Vocational Rehabilitation.

Andy Winnegar has spent his career in rehabilitation and is based in Santa Fe as a training associate for the Southwest ADA Center. He can be reached at a@winnegar.com.

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