Philip Seymour Hoffman’s death has attracted national media attention as most celebrity deaths do, especially when they relate to a drug overdose. We have seen this phenomenon shortly after the deaths of Anna Nicole Smith and Michael Jackson. There was an immediate flurry of media attention, and then other stories took center stage.
For many addiction treatment professionals and patient advocates, the issues surrounding celebrity deaths represent the daily struggles that must be confronted by a wary public. A number of issues naturally come to surface during such times about opioid addiction and treatment.
Changing Social Attitudes
We have witnessed evolving attitudes towards the use of prescription opioids and heroin. The public is still coming to grips with the fact that while prescription opioids are extremely helpful in managing pain, the reality is that they can also be dangerous when used improperly. AATOD has been involved in managing the OTP reporting system as part of the RADARS™ Signal Detection System since January 2005. Our system involves 75 OTPs in 30 states in the United States. To date, more than 70,000 patients have completed a voluntary survey as they have been admitted to treatment. We have learned a great deal about changing patterns of drug abuse during this time. Illustratively, approximately 45% of these patients report the use/abuse of prescription opioids at time of admission; of this group, just over 30% report injecting their prescription opioids. From our point of view in evaluating the data from the study, the decision to inject a prescription opioid is only a stone’s throw away from injecting heroin.
We also know that the patients in treatment at the present time are quite different from the patient population that many of our long tenured professionals in OTPs treated 20 years ago. The current population is typically younger, Caucasian, with higher employment rates and with different kinds of co-morbidity.
Changing Federal and State Oversight
We are also in a period where a more vigilant federal regulatory presence and state Prescription Monitoring Programs are having a greater impact on how prescription opioids can be used. The FDA has promulgated a number of regulatory requirements, guiding the pharmaceutical industry. There has been a greater focus on post marketing surveillance programs for branded pharmaceutical manufacturers as a method of monitoring how their medications are used and/or abused once they have been approved for distribution. Purdue Pharma providers an excellent case in point, in having succeeded in manufacturing a tamper-resistant formulation of OxyContin. One unintended consequence of the development of tamper-resistant formulations has been that a number of drug users will switch from prescription opioids, in this case OxyContin, to using intravenous heroin. Keep in mind what we have already found out about recently admitted patients to OTPs injecting prescription opioids, as stated above.
This kind of drug use obviously comes along as heroin is more available, cheaper, and easier to obtain than prescription opioids. The increasing utilization of Prescription Monitoring Programs by physicians, who are more actively monitoring if their patients are doctor shopping, has also created the effect of doctors refusing to treat patients who show up on the PMP databases. This closes off a source for the use of prescription opioids, which are typically obtained through dealers. We continue to exist in an era where Afghanistan produces 90% of the world’s heroin supply. This is an added public health problem, as the heroin trafficking trade has become far more sophisticated in reaching its intended audience in rural and suburban areas of the country.
The Opportunity to Educate
The tragedy of high profile, celebrity deaths provides our field with the opportunity to educate the public through media channels and community education. Addiction treatment providers need to work effectively with all of their natural allies in patient advocacy, municipal and state agencies, and federal agencies as a method of educating our public about what opioid addiction is and is not. There needs to be a better understanding about the dangers of such drug use without demonizing physicians who responsibly prescribe pain management medications.
There certainly needs to be a more balanced education effort about what Medication Assisted Treatment for opioid addiction is, and the value of using methadone, buprenorphine, and Vivitrol/Naltrexone products for patients who need access to such care. The balance comes in making sure that medications are used responsibly and in conjunction with other treatment interventions.
The tragedy of Mr. Hoffman’s death will inevitably be revisited by another celebrity death in the future. We will engage once again in the flurry of media stories which typically have a limited lifespan. Ultimately, we need to work effectively to change America’s perceptions about the safety and danger of prescription opioids, the danger of heroin (which is obviously not an FDA approved drug), and the value of prevention and early intervention in providing access to care. Mr. Hoffman’s death is a stark reminder of the dangers of using heroin. It is not, nor has ever been, a safe drug. The user simply does not know what the drug has been cut with or its potency.
Many people who have worked in the addiction treatment community for many years know that heroin has been adulterated with all sorts of dangerous chemicals which can lead to death. We need to continually educate the public about these issues and work with patient advocates and public policy officials to ensure that the message is consistent and sticks.