Prescribing fewer opioids not enough to combat epidemic
Solving the opioid epidemic requires a “whole person” approach that includes nonpharmacological treatment for pain, as well as ensuring that people have the employment, education and housing supports they need for long-term recovery, the chief executive officer of the American Psychological Association (APA) told a congressional panel.
“Research shows that the most effective treatment of opioid use disorder requires psychosocial interventions in combination with medications,” APA CEO Arthur C. Evans Jr., PhD, said in prepared remarks (PDF, 199KB) to the House Committee on Oversight and Reform. “The three forms of treatment with the strongest evidence base for use in treating opioid use disorders are contingency management, cognitive behavioral therapy and multidimensional family therapy.”
Contingency management therapy uses positive reinforcement to encourage abstaining from drugs. Cognitive behavioral therapy helps patients recognize, avoid or cope with situations in which they are likely to use drugs. Multidimensional family therapy, developed for adolescents with drug use problems, addresses a range of personal and family influences on drug use patterns.
Speaking in support of the Comprehensive Addiction Resources Emergency (CARE) Act, H.R. 2569, Evans noted that APA “strongly supports the use of medication-assisted therapy drugs in treating opioid use disorder, and we support policies to ensure that the full range of such drug therapies are available to patients and their providers.”
“However, it is important to remember that term ‘medication-assisted treatment’ means that the use of medications is assisting in treatment. … Just as we do not treat diabetes solely by providing patients with a packet of insulin and syringes, we will not be successful in treating opioid use disorders solely by providing medication without the full range of psychosocial treatments and supports that people need to initiate and sustain recovery.”
With 30 years of work experience in the areas of substance use and mental health disorders, Evans referred to studies showing that psychological support programs, including those focused on providing people with stable housing and family therapy, and addressing employment problems, “can help people with substance use disorders stick to an effective treatment plan.”
“For example, research has shown that programs such as Housing First, which helps homeless individuals with substance use disorders find stable housing without first needing to demonstrate abstinence, is an effective entryway into treatment,” he said. Other studies have shown that involving family members and concerned significant others in treatment for opioid use disorder can improve outcomes, especially for youths.
Evans noted that the U.S. health care system has begun to turn away from indiscriminate use of opioids for treating pain, and that opioid prescription rates are beginning to fall. But, he added, “There is still substantial room for improvement in our management of acute and chronic pain. … Psychologists have been at the forefront of the shift away from responding to pain as solely a physiological condition and toward an understanding of pain as a biopsychosocial phenomenon involving the biological, psychological and social aspects of the individual’s health and functioning.”
Modeled on the Ryan White CARE Act, enacted in 1990 to combat the HIV/AIDS epidemic, the CARE Act would authorize $100 billion in funding directly to states, U.S. territories, counties and cities, tribal nations and other qualified public/nonprofit entities over 10 years to address the opioid crisis. Entities receiving funding would be required, with some exceptions, to offer behavioral therapies in addition to medication-assisted therapies.