As overdose deaths in New Mexico have surged during the pandemic, recent research shows a searing gap in treatment available for Opioid Use Disorder at the state’s hospitals. One of the study’s authors, Dr. Eileen Barrett, Director of Continuing Medical Education at the University of New Mexico, spoke with KUNM about the status of opioid use and treatment in the state.
EILEEN BARRETT: New Mexico has had a pretty severe epidemic of Opioid Use Disorder and associated overdose deaths for a lot longer than a lot of the rest of the country, and also a lot of the states that are in the Intermountain West. Even before the national headlines were talking about the Opioid Use Disorder that was really driven by a flooding of the market with prescriptions for Oxycodone. That landscape for us has been going on for a lot longer and has been a lot more severe, and then really just became worse coincident with what has happened with the rest of the country.
KUNM: Your recent research looked at the availability of medications for opioid use at acute care hospitals in New Mexico, specifically Buprenorphine/Naloxone. Can you break down what these medications are and how they're used?
BARRETT: Buprenorphine/Naloxone is a combination medication called "Suboxone." The Naloxone part is the drug that is used to reverse overdoses. Versus the buprenorphine part of it is an opioid. Buprenorphine allows someone to be able to reduce the risk of overdose if they do inject snort or take other pills. And it also decreases the risk of overdose because it isn't as sedating and also doesn't really induce euphoria in the same way. And then the combination of them, why that's so powerful, is because it's a deterrent. For the vast majority of people, if they are taking this medication, they are taking it to manage their own withdrawal. They're not taking it to be high, if you will.
KUNM: What does accessibility to this medication look like in New Mexico?
BARRETT: In an ideal scenario, whenever someone who has an Opioid Use Disorder wants to get treatment, they're able to get treatment the same day. We should think of being able to access treatment for a substance use disorder as a medical emergency. We would never not have an antibiotic, right? So in our case, when we contacted all the hospitals in the state, what we found was that roughly half didn't have Suboxone. Why that was also sort of surprising and disappointing is that we did ask, 'are you able to get it within 24 hours?' Because the person will withdraw without it. And what we found was that places couldn't.
KUNM: What is the impact of a hospital not having these medications on hand or available quickly? What happens?
BARRETT: The consequences are that the patient can't be treated for their Opioid Use Disorder. What that could mean for someone is they are likely to withdraw, and that withdrawal will increase their risk of leaving the hospital against advice, which then puts them in a risk to relapse into injecting or smoking behaviors. Then they're at increased risk for overdosing, because when they go back to using that dose may likely be too much for them.
KUNM: Is there a unique risk when rural residents in particular don't have access to this treatment?
BARRETT: It really is. Rural areas are much less likely to have any treatment for Substance Use Disorder, so if they can't get it at the hospital, they probably won't be able to get it someplace else. Ideally, we want people to not have to travel a great distance to be able to receive what should be regarded as a foundational primary care to help people be well and to avoid harm.
KUNM: Why do nearly half of our hospitals not have this treatment available?
BARRETT: There is a persistent stigma against people with Opioid Use Disorder. That could be one reason, and it very likely is the main driver. There also is a persistent misunderstanding that one has to receive different or advanced training, or have a special certification, to be able to prescribe Suboxone in the hospital, and that's not actually the case. The last one is that sometimes people think that these medications don't work – the mistaken belief that you substitute one addiction for another. Instead, we should think about medications for Opioid Use Disorder just like chemo and insulin, which is that it's just another medication that helps someone achieve health.
KUNM: What can be done to increase the availability of these medications at New Mexico acute care hospitals?
BARRETT: Every person who is a healthcare worker, every person who is a patient should contact the hospital where they receive care or where their loved one has received care – whether it was for opioid use disorder or not – and ask them if this is available, and ask them to add it. Because your voice matters, and if we want to assume that there's good intent, just asking the question may help people do the right thing. The last thing I think that we would come to would be if regulatory agencies, such as the Board of Pharmacy, were to collaborate with those hospitals to make sure that everybody has this available.