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Challenges, progress, solutions: A Q&A with MUSC's Dr. Kathleen Brady about opioids

Opioid Crisis Settlement

Distributors of opioids flooded South Carolina with 300 million pills in 2017, according to the Attorney General's Office. File/AP

In many ways, the opioid crisis in South Carolina is getting worse.

Overdose deaths are on the rise, up to 816 in 2018, which is a 9 percent increase since 2017, when 749 overdose deaths were recorded. The number of prescriptions for opioids has dipped in recent years, down to 79 for every 100 patients in 2017, but the sheer number of pills dispensed, 300 million in that year alone, remains vastly out of proportion to the need, experts say.

The opioid-related death rate in South Carolina exceeds the national average. 

South Carolina recorded 15.5 deaths per 100,000 people compared to the national rate of 14.6 deaths per 100,000 people, according to the National Institute on Drug Abuse. 

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A scene from "Ocean Boulevard" by Zoe Miller. Provided/Zoe Miller

The opioid problem is the subject of a new film, "Ocean Boulevard," which will be screened in Charleston on Dec. 1. 

The good news is that medical professionals are better trained to address the crisis, according to Kathleen Brady, vice president of research at the Medical University of South Carolina. Brady's research focus is substance abuse.

Q: What are the biggest challenges in South Carolina facing those coping with opioid addiction? Are there sufficient treatment options? Is there sufficient access? What if the patient is uninsured?

Kathleen Brady

Kathleen Brady, vice president of research at the Medical University of South Carolina. Provided 

A: Access to evidence-based treatment can be a problem, particularly in rural areas, but the state agency, S.C. Department of Alcohol and Other Drug Abuse Services (DAODAS), has done much to try to overcome this issue. One of the main problems is that medication-assisted treatment (MAT) is the treatment with the best evidence base, but there are too few medical providers working in substance abuse treatment, i.e. too few qualified to prescribe MAT and work with patients receiving MAT to make sure they are receiving the other psycho-social services and counseling that is needed for recovery.

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DAODAS, in collaboration, has made a great effort to train more medical practitioners in MAT and substance-use disorder treatments. For example, in 2016, only 18 percent of substance use disorder-treatment agencies had the capability of providing MAT. In 2019, 58 percent have medical practitioners on-site to provide MAT. So, while there is still work to be done, access to evidence-based care is improving.

If a patient is uninsured, there are currently monies from the federal government that have been made available to allow access to MAT, counseling and other evidence-based care. The problem is that these monies have been made available on a year-to-year basis because of the opioid overdose epidemic. The plan for sustaining this level of care for uninsured patients when the federal subsidies go away is not clear.

Q: What progress has been made in recent years, locally and nationally, in addressing the opioid crisis? Have new, effective treatment practices been identified and implemented? What are medical professionals learning about the problem?

A: Much progress has been made, both locally and nationally, in addressing the opioid crisis. As stated above, DAODAS, in collaboration with MUSC, has started a major practitioner training initiative. In addition to training practitioners in MAT and substance-use disorder care, we have been working with primary care physicians to train them to use the Physicians Drug Monitoring Program, recognize substance-use disorders and refer ... (We have been) training counselors on MAT so they can better support their patients who are on MAT.

We have also implemented a program for emergency rooms in South Carolina to “fast track” opioid patients to treatment with funding from S.C. DHHS (Department of Health and Human Services). Also, DAODAS has made naloxone, a drug to reverse opioid overdose, widely available throughout South Carolina.

Nationally, new drugs have been developed to treat opioid use disorders (and) curriculum to better train (students) in medical schools about opioid prescribing, pain management and substance-use disorders has been developed and implemented.

Q: If you could wave a magic wand to create an ideal scenario for pre-empting opioid addiction, what would you change?

A: Magic wand... What a tough question. I would definitely make “treatment on demand” available to anyone — no more insurance coverage barriers. But if I could really do anything, I would put more resources into good parenting, preventing child abuse and neglect, poverty and other things that are the precursors to the development of substance-use disorders, including school programs to help socialize kids. In addition, early recognition of depression, PTSD and anxiety disorders would help to decrease substance use disorders.

Contact Adam Parker at aparker@postandcourier.com or 843-937-5902.

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