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December 17, 2018

Opioid Solutions promotes collaborative approach to epidemic

April 18, 2018

Opioid Solutions promotes collaborative approach to epidemic

About 115 Americans die each day from an opioid overdose — almost five every hour — and the numbers are increasing. Millions more misuse prescription opioid medications, or use illicit opioids, with an annual economic toll of $115 billion.

A wide range of University of Michigan researchers are working to tackle the root causes of, and potential solutions for, this national crisis. Now, a new network encourages and coordinates their efforts across campus to find solutions to what the federal government has declared a public health emergency.

The new Opioid Solutions community, a resource developed by the U-M's Office of Research, Injury Prevention Center and Institute for Healthcare Policy and Innovation, serves as a central hub for U-M research, educational activities and community outreach related to opioids.

"The opioid epidemic is now the single deadliest drug epidemic in United States history, but in order to address the full complexity of this public health threat, we have to integrate the perspectives of multiple disciplines to find solutions," said S. Jack Hu, vice president for research.

The network draws on nearly 100 U-M faculty — in fields ranging from psychiatry, pharmacy and public policy to basic science, dentistry and law — whose research explores opioid misuse and overdose. Some examples include:

• Chad Brummett, associate professor of anesthesiology and co-director of the Michigan Opioid Prescribing Engagement Network, who with colleagues developed a comprehensive approach for surgical teams to prescribe opioids more wisely.

The team also researches the role of surgery-related prescriptions in increasing the likelihood of opioid misuse, and is working through the Precision Health Initiative to find new ways of tailoring pain treatment to suit patients' characteristics.

• Amy Bohnert, associate professor of psychiatry, studies opioid addiction treatment and overdose, and explores ways to reduce misuse and overdose through counseling.

She also leads a program that is offering help to physicians, nurse practitioners and physician assistants across Michigan who want to begin prescribing medications that can help people overcome opioid addiction.

• Rebecca Haffajee, assistant professor of health management and policy, is also an attorney whose work intersects law and public health.

Her research looks at the effects of behavioral health and pharmaceutical policies on opioid prescribing, including initiatives aimed at reducing "doctor shopping" by people dependent on prescription opioids.

Opioid Solutions not only encourages collaboration among researchers, but it also keeps federal, state and local health agencies apprised of U-M projects and programs that aim to reduce and prevent opioid misuse and overdose.

"Our University of Michigan faculty members are a vital resource for state and federal policymakers, community leaders and health care providers who are working to prevent and treat the consequences of opioid misuse and overdose," said John Ayanian, director of the Institute for Healthcare Policy and Innovation.

More than 42,000 Americans died in 2016 as a result of opioid overdose. The nature of the epidemic is evolving to include illicitly-sourced opioids, but demand for these drugs is intimately related to an increase in opioid prescriptions. The number of prescription opioids sold to pharmacies, hospitals and doctors' offices nearly quadrupled from 1999 to 2014, yet federal data shows no overall change in the amount of pain Americans reported.

As an emergency medicine physician and substance abuse researcher, Rebecca Cunningham works with legislators and her physician colleagues to inform safe prescribing practices and reverse the opioid epidemic.

"The opioid epidemic in our communities does not discriminate by race or socioeconomic status," said Cunningham, associate vice president for research who helped develop Opioid Solutions. "I have seen firsthand that this medical illness affects everyone — rich, poor, rural, urban, educated and uneducated, young adolescents and elderly adults."

Comments

Kari Dumbeck
on 4/18/18 at 8:28 am

I hope in your research you are looking at medical CANNIBUS as a replacement for opioids. The research is already there for those States that are allowed to use it.

David Cooke
on 4/18/18 at 10:19 am

At the risk of having things degenerate into a pro/anti marijuana argument, I do want to respond to the above comment. I am a physician at UM who works both in primary care and at the Pain Clinic, and I spend most of my time in my pain role trying to get people off opioids, so I'm no opioid apologist.

There is an unfortunate idea spreading in the general public that marijuana is the magical solution to opioids and chronic pain, and that this has research proving it. It's not true. While I'm all in favor of researching marijuana for pain, the data is far from convincing, and most of it involves small, short-term studies with serious flaws in their design, or very indirect population level comparisons which are subject to a lot of confounding issues. Certainly, Michigan does not have a lower rate of opioid use, despite having one of the most liberal medical marijuana laws in the US, Even with these caveats, the data have not been at all uniformly in favor of marijuana; there are a lot of negative results.

There is also a lot of reasoning along the lines of "opioids are bad, so marijuana must be good" going on. While it remains an unresolved question whether marijuana is effective for pain, it is clear that marijuana has some serious risks associated with it, and there is a lot of additional research that needs to be done regarding its safety, independent of efficacy. Is marijuana safer than opioids? Probably. Does that make it a good idea? Not necessarily. Putting it another way, being shot with a gun is generally worse than being stabbed with a knife, but I don't think anyone would argue that being stabbed is therefore harmless.

As for getting people off opioids, I've heard the arguments, but in addition to the lack of data, I've not seen it work in real life. As you would expect, I have seen a lot of patients who use opioids, and who have used marijuana for pain. I have yet to see a single instance where a patient reduced or stopped opioids through marijuana use. Not once. I have also never seen a case where marijuana use allowed someone to meaningfully improve their functionality or quality of life. Not once.

Maybe there are people out there who are able to live normal lives because of medical marijuana, but I have yet to meet one. Until I do, I will remain a skeptic.

Mark Osbeck
on 4/18/18 at 3:01 pm

Yeah, actually researchers from the UM's own Medical School published a study in 2016 in the Journal of Pain Management, concluding that medical marijuana use for pain management was associated with a 64% decrease in opioid use compared to patients who did not use marijuana to help relieve pain. Here is the Abstract:
"Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015. Data collected included demographic information, changes in opioid use, quality of life, medication classes used, and medication side effects before and after initiation of cannabis usage. Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n = 118), decreased number and side effects of medications, and an improved quality of life (45%). This study suggests that many CP patients are essentially substituting medical cannabis for opioids and other medications for CP treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications. More research is needed to validate this finding."

Howard Bromberg
on 4/18/18 at 6:47 pm

Let me see, a physician who is apparently proposing as the standard personally meeting a specific patient versus a 2016 Journal of Pain Management Study.

I'm going with 2016 Journal of Pain Management Study.

Ruth HAEFNER
on 4/18/18 at 8:29 am

I read this article with interest. As a Physical Therapist working in the home care arena, I see many senior citizens and other home care patients who have been taking opioids for years. We see first hand both the suffering brought on by their pain and the difficulty they have as now many are finding that their physicians are no longer easily renewing the opioid prescription they have grown to rely on to manage their pain. We also see that some of our patient's are being put on medications to assist them with overcoming their opioid addiction but often the patient is not well informed about the goals of treatment. I would like to see some Physical Therapy input in this conversation. Not only do we have interventions that can assist with pain management but as members of the team treating these patients, we can be helpful in supporting the goals for treatment established by the patient's medical team if we are aware of the treatment goals.

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