Prescription meds are absolutely worsening opioid crisis: MSBI doc

Mount Sinai Beth Israel has the world’s oldest and largest opioid treatment program. (Photo by Maria Rocha-Buschel)

By Sabina Mollot

On Tuesday, the mayor announced a lawsuit targeting major pharmaceutical companies, who he said have contributed to the city’s opioid explosion by getting people hooked on prescription drugs.

In 2016, more than 1,000 people in New York City died in a drug overdose that involved an opioid, the highest year on record. Additionally, according to city data, more New Yorkers died from opioid overdoses last year than from car accidents and homicides combined.

The suit is asking for a half million dollars to cover current and future costs to combat the crisis at hospitals not to mention costs relating to courtrooms and the morgue.

The suit names Johnson & Johnson, Purdue, Cephalon, Janssen and other manufacturers of painkillers, accusing them of engaging in longterm, deceptive advertising tactics that make taking the drugs, which are habit forming, seem less risky than they are.

In response to the bombshell announcement, a doctor at Mount Sinai Beth Israel, which runs the oldest and largest opioid treatment program, confirmed that there’s no question that the easy availability of prescription meds have contributed to the growing problem.

However, Dr. Grant Mitchell, chair of the psychiatry department at Mount Sinai Beth Israel, stressed he couldn’t comment on whether the defendants would be found responsible since there are still many questions about specifics.

“I think what this is going to come down to is, what did these companies know and when did they know it?” he said. “That sounds like what this case will revolve around.”

As for the rise in addictions, Mitchell said what is trending now as opposed to the heroin epidemic 20 years ago, is that drug dependencies often begin with use of painkillers patients have in their medicine cabinets, either for themselves or family members.

“Not that they weren’t available before, but they’ve become more widely available over the past decade,” said Mitchell. “Twenty years ago, it was opioids that were only sold on the street,” he said.

Now, once prescriptions for drugs like oxycodone and codeine expire, users are turning to black market versions of those pills. Other times, they’ll transition to heroin, because, explained Mitchell, “In some cases it’s less expensive. There is a definite shift.”

These black market drugs are naturally more dangerous since they’re cut with other substances. “You don’t buy pure heroin on the street,” said Mitchell.

Another change is that these days, people are getting hooked younger than they used to. There are now more teens and twenty-somethings whereas in the 1970s, the average patients seeking treatment were in their thirties and forties.

The third change Beth Israel is seeing is that younger people are rejecting methadone as treatment.

“The problem is the medication often requires daily visits to the clinic to pick it up and young people really don’t want to be tethered to a program,” said Mitchell. “The older folks have gotten used to the routine.”

In response, the hospital has started trying to spread awareness about alternative medications that can be administered at home like Buprenorphine. This drug, which is the most common alternative treatment, suppresses withdrawal symptoms and decreases cravings.

“Once a patient is stabilized,” said Mitchell, “they don’t have to come in every day.” This process varies on the patient but is usually a few weeks while doctors determine the appropriate dosage.

However, like with methadone, there is a commitment to continued use. “In general, the risk of relapse is high without treatment, so we recommend longterm treatment,” he said.

Mount Sinai Beth Israel’s program, which began in the 1960s, sees 6,000 people seeking opioid treatment on any given day. Over the course of the year, that amounts to a million visits. There are 12 separate treatment programs at a handful of facilities in Manhattan as well as Brooklyn. Asked if MSBI is seeing more patients than ever before as a result of the epidemic, Mitchell said there have never been more than the current 6,000 patients at once, though that amount has held steady for a while. There is however, always room for more people seeking treatment. Mitchell added that all forms of insurance are accepted and the hospital tries to connect patients with coverage if they don’t have it. But, Mitchell added, one thing that hasn’t changed over the decades, whether a person has developed an addiction through painkillers or heroin, the disease does not discriminate.

“It’s every ethnic group, every racial group, every religion,” said Mitchell. “It knows no bounds.”

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