Don’t call them “addicts,” “users,” “drug users,” “drug abusers,” or “junkies.” Call them “patients with opioid disorder.”
And don’t say they have a “problem.” They have a “disease.”
That advice came from a panel of experts at an invitation-only roundtable Tuesday afternoon on how to tackle the opioid epidemic, as drug overdoses have become the leading killer of Americans under 50.
How we talk about the problem plays a part in how we try to address, said one of the speakers, addiction specialist Jeanette Tetrault. She said words can contribute to stigma and create barriers to accessing effective treatment — and increase the rate of overdose. In 2016 alone, 917 people died from drug overdoses in Connecticut.
The roundtable took place Tuesday afternoon at the Yale School of Medicine, which sponsored the sponsored the event along with Yale-New Haven Hospital, the Connecticut Health I-Team, and the Connecticut Opioid REsponse Initiative. Journalists and medical professionals discussed destigmatizing opioid dependence through accurate media coverage of the epidemic.
The conference began with a series of pictures of faces of opioid overdose. “Poet,” “daughter,” “one of nine children,” “fitness buff,” the slides read. Ffter this introduction to the realities of the epidemic, Gail D’Onofrio, an emergency physician, exhibited examples of errors in coverage of the epidemic in The New York Times: the newspaper of record understated the number of deaths due to opioid overdose in 2015 by 25,000, for instance.
“Words matter, and correct words matter,” D’Onofrio said.
So, the journalists present inquired: What is it that we’re missing?
The physicians present said that Connecticut residents often hear about the 917 deaths but almost never hear of the hundreds of thousands of people living and thriving on active treatment. More positive coverage could serve to destigmatize the disease and encourage others to seek treatment.
“We know you need sound bites,” D’Onofrio said as she offered her help.
The current opioid epidemic began in the late 1980s as pain became a fifth vital sign and the prescription of opioids increased. Soon after, heroin-related overdoses skyrocketed when patients were unable to obtain the expensive prescriptions that maintained their addiction and forced to resort to black market alternatives.
When questioned what impact pharmaceutical companies have had on the epidemic, Yale School of Public Health Professor Robert Heimer replied: “The free market system doesn’t always work the way we intend it.”
Often companies advertised opioids as less addictive than they actually were. In reality, these drugs alter brain functioning, specifically the brain rewards system, impulsive system, and reflective system, according to psychiatrist Richard Schottenfeld.
For treatment, there are two options: “chairs” or “beds,” as internist David Fiellin put it. Patients can choose outpatient or inpatient treatment options, though inpatient options such as detoxification or rehabilitation increase risk of overdose. Opioid agonist treatment, an outpatient option, lowers the risk. Drugs like buprenorphine and methadone prevent withdrawal symptoms without providing the euphoria characteristic of heroin, fentanyl, or prescription opioids.
In 1915, detoxification efforts failed 90 percent of the time — and that statistic has not changed, according to Heimer. Fiellin would not even call it a treatment.
However, there is a real stigma attached to maintenance prescriptions. Though recovering patients are applauded when they say they have been abstinent for months, people who say “I’m recovering on methadone” never receive that same praise though their treatment has better odds of recovery. Physicians likened methadone or buprenorphine to insulin — no diabetes patient is stigmatized for their dependency on the hormone.
The U.S. is by far the largest prescriber of opioids: There is enough for every American adult to have one bottle. Though these drugs are overprescribed, only 5 of 133 medical schools in the US had mandatory classes on pain in 2011. Few doctors understand the potential for these drugs to treat chronic pain in the first place. In fact, pain relief is modest, according to internist Daniel Tobin, who said that the drugs only reduce chronic pain symptoms by 50%.
But now physicians and pharmacists are held responsible for their prescriptions. These medical professionals must upload data to Connecticut prescription monitoring programs to track the quantity of opioids they are distributing.
In the final question and answer session, one journalist described his struggles to do justice to patient stories.He said he has found it difficult to even find patients who were willing to share their stories with the public. The physicians said they understood that hesitancy to talk to the media. Fiellin described one patient who recently had a child and became a daycare worker. For fear of her reputation, she refused to give her name to the media.
But the physicians offered their assistance in identifying patients willing to share their story. At the end of the briefing, journalists and medical professionals began a dialogue to help recovering patients come forward.