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State audit looks at opioid crisis
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Opioid disorder: Access
to medication-assisted
A November 2017 Georgia Department of Audits and Accounts performance audit reviewed the status of Georgia’s opioid use disorder epidemic and Georgia’s Medication Assisted Treatment capacity (MAT). The audit found that we could do more to develop a comprehensive, statewide strategy to address the opioid epidemic, and should increase access to MAT.

Georgia statistics
There are an estimated 180,000 Georgians with opioid use disorder. It is estimated that in 2016, 390,000 Georgians used pain medications for a non-medical use and 13,000 Georgians used what they believed to be heroin.
The rise in the use of opioids has had serious consequences across the state. Uses of overdose reversing medications are up by 120 percent from 2012 to 2016. Reversal drugs were utilized in all but six counties in 2016. Deaths from opioid related overdoses in Georgia increased 55 percent from 2012 to 2016; there were nearly 1,000 deaths in 2016. Death and reversal drug administration rates are generally higher in rural counties.

Opioid use affecting
The Division of Family and Children Services (DFCS) has seen an 81 percent increase in children entering the foster care system due to substance abuse between FY2013 and FY2017. Juvenile courts that operate a family treatment court report a 31 percent increase in the number of caregivers with opioid use disorder between FY2014 and FY2016. The number of felony drug court participants with opioid use disorder increased by approximately 30 percent.

GBI workload increased
Additionally, the Georgia Bureau of Investigations (GBI) has had to divert time and resources that are typically reserved for casework to testing and identifying new opioids discovered during autopsies. As you may recall from last week’s column, GBI is working hard to meet the increased demand for their services and expertise. According to the Medical Examiner’s Office, nearly 70 percent of drug and alcohol-related deaths are due to opioids. The opioids in these cases tend to be present in mixtures, which generally require more testing time than single component samples. In addition, these opioids require the use of labor-intensive instrumentation in order for the chemist to discriminate between the slight differences in the molecular structures. Once in a while, the Crime Lab must pay outside labs for specialized toxicology testing in order to identify designer opioids/fentalogs.

“MAT” medication assisted treatment
Opioid abuse disorder is caused by prolonged use of opioid painkillers which change the way nerve cells function in the brain, quickly leading to dependence in the body.
Substance abuse experts recommend Medication Assisted Treatment for treatment of opioid use disorder. MAT is a combination of medication and counseling. The medication stabilizes the patient so that they can effectively participate in therapies that will assist in dealing with the underlying behaviors and issues that led to the addiction.

MAT use — methadone, buprenorphine, naltrexone
The three medications utilized in MAT are methadone, buprenorphine and naltrexone. Each medication operates differently, making each appropriate depending on the level of a patient’s addiction and the patient’s stage of recovery. Methadone and buprenorphine can step a patient down from active addiction, stabilizing a patient in sickness from withdrawal. Naltrexone can assist a patient once fully detoxed. The American Society of Addiction Recovery and the National Institute on Drug Abuse agree that there is substantial, broad, and conclusive evidence in favor of all three MAT medications.

NEXT: Access limitations to medication assisted treatment

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