– Antoinette,
Behavioral Health Director,

– Antoinette,
Behavioral Health Director,

Whether you work as a healthcare provider, a therapist or counselor, or in law enforcement, you are in a position to impact the lives of people struggling with a substance use disorder (SUD) and their families. Substance use disorder can happen to anyone, and anyone can get help. 

Substance use disorder, also known as addiction, is a treatable medical disorder. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines a moderate to severe substance use disorder as someone’s frequent and/or continued use of drugs or alcohol over a period of time, despite serious and negative consequences. 

In 2021, over 80,000 people in Colorado said they needed substance use treatment but did not get it: 77% of those people said they didn’t seek treatment because of stigma (feeling shame and judgment).

How We Treat People Matters.

When people with SUDs are made to feel stigma or shame for their substance use—especially from people who are in a position to help them like doctors and nurses, therapists, or law enforcement—they are less likely to seek help or treatment in the future.

One study showed that healthcare providers who held stigmatizing attitudes and behaviors resulted in patients with an opioid use disorder (OUD) delaying seeking treatment by five to six years. Receiving discriminatory care and internalizing stigma delay treatment and perpetuate an individual’s ongoing use for years. People who delay treatment are at risk for additional harm due to their substance use, including overdose and death.

Dr. Nora Volkow, the Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health, states, “Stigma on the part of healthcare providers who tacitly see a patient’s drug or alcohol problem as their own fault leads to substandard care or even to rejecting individuals seeking treatment. People with addiction internalize this stigma, feeling shame and refusing to seek treatment as a result.”

Additionally, Dr. Sarah Wakeman, Medical Director for the Massachusetts General Hospital Substance Use Disorder Initiative and Assistant Professor of Medicine at Harvard Medical School, has argued that stigma in the medical community and the criminal justice system as the biggest barrier to fighting the opioid epidemic, underscoring the incredible importance of removing it in interactions with individuals with an SUD.

Seeking treatment for a substance use disorder is a major decision. People who work in the medical, behavioral health, and criminal justice fields can be an incredible support to someone who is ready to start their recovery, as well as people in active use—recurrence of use, also known as relapse, happens and is normal, but it’s essential that individuals know they can ask for help and they’ll receive it. It’s important to promote positive interactions and reduce stigma with every person you encounter—not just those who are ready for treatment.

Power of Language

Key Steps to Help Someone with a Substance Use Disorder

Use person-first language.

Person-first language emphasizes the individuality and dignity of someone, putting the person before their diagnosis, and showing respect for them as an individual. It’s important to be intentional about our words when talking about substance use disorder and recovery—even common terms can reinforce stigma. To learn more about person-first language and the terms you should be using, visit NIDA Words Matter.

Be an ally.

Provide support to individuals with SUD and connect their loved ones to support. When discussing treatment options with someone, it’s important to meet them where they are at and share that you support all pathways to recovery.

Ask

Ask patients about substance use when in a healthcare setting, including when providing care in a jail. You are already treating them—this provides the opportunity for someone to feel comfortable asking for help, and you can provide more holistic and effective care. 

Substance use disorders are treatable and recovery is always possible.

Your support and compassion can make a huge difference in someone’s substance use journey, no matter where they are in readiness for change. Within the healthcare field, in particular, patient-centered care empowers patients with information that helps them make better treatment decisions and reduce preventable harm from active substance use.

Educate yourself

Educate yourself on SUD and treatment options in your community so you can connect with someone to help. You can find more treatment options here and information on financial options for treatment here.

Additional Resources:

Those in health care can fight against stigma through the Reducing Stigma Education Tools (ReSET) program here. Learn how to implement evidence-based harm reduction strategies here.

The Basics of Medications to Treat Opioid Use Disorder

FDA-approved prescription medications such as buprenorphine, methadone, and naltrexone are used to treat opioid use disorders (OUD). These medications are safe to use for months, years, or even a lifetime, depending on the needs of each individual, and it has been proven that the longer they are taken, the less likely an individual is to overdose.

The science demonstrating the effectiveness of medication for OUD is strong. For example, methadone, extended-release injectable naltrexone (XR-NTX), and buprenorphine were each found to be more effective in reducing illicit opioid use than no medication in randomized clinical trials.

However, only about 19 percent of adults with opioid use disorder received medication for treatment in 2019, according to the National Survey on Drug Use and Health.

  • Buprenorphine and methadone relieve opioid withdrawal, suppress cravings and block the euphoric effects of opioids. 
  • Naltrexone doesn’t relieve physical withdrawal, but it suppresses cravings, blocks the euphoric effects of opioids and can also be used to treat alcohol use disorder.

Methadone can be accessed via Opioid Treatment Programs, while buprenorphine and naltrexone can be prescribed by licensed practitioners. Medications to treat opioid use disorder are effective and should be widely available, including through primary care, emergency departments, behavioral health facilities, and in jails.

Learn more about medications to treat opioid use disorder and the other strategies and services needed to support recovery in SAMHSA’s Treatment Improvement Protocol (TIP) 63 publication (executive summary can be found here).

“What’s wonderful about where we are in the treatment of OUD, is that we have medications that work and are safe. But we underutilize them. Medications are the gold standard.”

Dr. Lesley Brooks
Greeley, CO

Medications for Treating Opioid Use Disorder

Burprenorphine – Prescribing By the Numbers: 2019

9.9 Miles

is the median distance traveled by patients in Colorado to receive medications to treat OUD (varies by county).

> 60 Miles

is the median distance in 17 Colorado counties patients traveled for treatment. In eight of those counties, the median distance was greater than 100 miles. 

Why It Matters

These numbers demonstrate just how challenging finding treatment can be and the need for more clinicians to familiarize themselves with buprenorphine prescribing and to become active prescribers. Waivers are no longer required to prescribe buprenorphine. Treatment should be available to anyone interested. Removing stigma and barriers to treatment, and increasing the number of clinicians educated on prescribing buprenorphine is essential to helping people.

What You Can Do

All professionals in the field can direct people to LiftTheLabel.org/GetHelp to find treatment resources in their area. If you’re a medical professional, you can learn how to start a hospital-based MOUD program and how to provide MOUD in the acute care setting

Fentanyl & Naloxone

Fentanyl is a synthetic opioid 50 times more potent than heroin. Although fentanyl is an FDA-approved pain medication, the current opioid overdose crisis is being driven by illicitly manufactured fentanyl.

Fentanyl potency is extremely unpredictable—its effects are felt quickly and do not last very long (about 30–60 minutes).

As a result, people with an OUD may use it multiple times a day to stave off withdrawal symptoms. While some people use fentanyl intentionally, many individuals consume it unknowingly or unintentionally because it is present in other non-opioid substances such as methamphetamine, cocaine, etc. It is important to note that fentanyl cannot be absorbed by touch, so you cannot overdose from simply touching fentanyl.

Fentanyl test strips can identify the presence of fentanyl in unregulated substances. Being aware that fentanyl is present allows individuals to take the steps to reduce the risk of an overdose. Learn more about life-saving fentanyl test strips and find out if there are fentanyl test strips available near you.

Naloxone is an opioid antagonist used for the emergency reversal of opioid overdose, and is an essential tool in combating opioid and fentanyl overdose deaths. Learn more about where to get naloxone at OpiRescue.com. NARCAN® naloxone nasal spray can now be found over-the-counter in stores. 

The duty of first responders is preservation of human life, regardless of the person’s condition. Every person deserves a chance for recovery, and reversing a person’s overdose can provide them that opportunity. By Colorado law, anyone can obtain and administer naloxone to help someone who may be experiencing an opioid-related overdose. Good Samaritan and third-party laws protect health care providers and law enforcement from liability should they need to administer naloxone.

Law Enforcement & The Importance of Naloxone 

Law enforcement agencies can greatly benefit from requiring officers to carry naloxone and training them to administer it. Officers are often the first on the scene and are uniquely positioned to save someone’s life. Officers have also reported that the requirement to carry and administer naloxone improves the public perception of law enforcement within a community.

If you administer naloxone, you have an opportunity to connect an individual and/or their friends and family with resources for treatment.

Medical Professionals: Prescribing Naloxone

Medical professionals should prescribe and/or recommend a nasal spray form of naloxone to:

  • Patients who are prescribed opioids for pain
  • People with active OUD
  • Patients receiving medications for OUD
  • People who have been discharged from emergency medical care following opioid poisoning or intoxication
  • People being released from incarceration
  • Friends and family of individuals at risk for an opioid overdose

Law Enforcement: Incarceration & Overdose

The risk of overdose death is drastically higher for individuals with an opioid use disorder (OUD) upon release from incarceration, particularly if an individual uses the same amount of opioids they used pre-incarceration, due to a significantly lower tolerance. According to a SAMHSA report, in jails and prisons that do not offer medications to treat OUD, relapse rates exceed 75% after release from custody.

As of July 1, 2023, Colorado has a statutory requirement that requires jails to screen inmates and offer medications for treatment such as methadone or buprenorphine.

Overdose death rates are 10 to 40 times higher for previously incarcerated people than for the general population, making drug overdose the leading cause of death for individuals re-entering society after incarceration. This highlights the incredible need for post-release support and treatment.

There’s a simple yet extremely effective way you can help: connect people to treatment facilities that offer medications to treat opioid use disorder and distribute naloxone upon release to reduce overdose deaths. Additionally, screening each person entering into custody for a SUD and taking medications to treat OUD (buprenorphine, methadone, and naltrexone) available while incarcerated has shown promising results for getting and keeping people in treatment and recovery, reducing recidivism.

What You Can Do 

Criminal justice professionals can act as advocates for policy change. They can also educate themselves on treatment programs and options to recommend when interacting with people struggling with an SUD. Adopting a non-judgmental tone and approach when interacting with people with an SUD goes a long way. Law enforcement professionals can carry naloxone and encourage fellow officers to do so, and become educated on local treatment resources.

Further Reading on Incarceration and MOUD

Read more about jail-based medications for opioid use disorder in the National Sheriff’s Association and National Commission on Correctional Health Care’s guide and the Jail Based Behavioral Health Services (JBBS) Program in Colorado here.

Behavioral Health Professionals: Medications to Treat Opioid Use Disorder (MOUD) and Counseling

Medication to treat OUD should be integrated with outpatient and residential treatment. Some patients may benefit from different levels of care at different points in their lives, such as outpatient counseling, intensive outpatient treatment, inpatient treatment, or long-term therapeutic communities. Patients treated in these settings should have access to medications to treat OUD.

Under federal law 42.CFR 8.12, patients receiving treatment in Opioid Treatment Programs (OTPs) must receive counseling, which may include different forms of behavioral therapy. These services are required along with medical, vocational, educational, and other assessment and treatment services. Regardless of how medications are provided, it is more effective when counseling and other behavioral health therapies are included to provide patients with a whole-person approach.

From the Experts

Donna
Dr. Lesley Brooks
Antoinette
Chief Rick Brandt
Marvina
Dr. Kaylin Klie
Bryan
Victor
Sheriff Jamie Fitzsimons
Kory