December 12, 2017

Tom Sullivan, M.D.

It’s the most wonderful time of the year – but not for everyone

“There’ll be much mistletoeing
And hearts will be glowing
When love ones are near
It’s the most wonderful time of the year!”
If you love the holiday season, you likely share Andy Williams’s enthusiasm for the wealth of celebrations and fun activities this time of year. But, as any fan of holiday movies know, not everyone experiences joy during the holidays: in It’s a Wonderful Life, George Bailey struggles through Christmas Eve – with depression – until an angel intervened and reminded him of the positive impact he made on others over the years.

For individuals suffering from substance use disorder (SUD), the holiday season is rarely viewed as “the most wonderful time of the year.” In fact, this time of year can be quite difficult for individuals addicted to drugs or alcohol, especially if they are socially estranged from family and friends because of their condition. According to the Central for Disease Control (CDC) the emotional strain of the holidays contributes to a spike in alcohol and drug-induced deaths in December and January.

As a physician, I have seen first-hand how the stress of the holidays leads to an uptick in opioid abuse or causes an abstainer to fall off the proverbial wagon. Whether you are a provider, a patient, or a family member, be mindful that the holidays are particularly challenging for someone struggling with addiction or in recovery. If you know someone who may feel particularly stressed, now is an appropriate time to reach out and remind them of treatment and support options.

The support of family and friends is particularly valuable for individuals seeking treatment. For example, someone with chronic pain and opioid addiction can often successfully manage both conditions with therapies that include meds—like Suboxone and others—to reduce opioid cravings, and non-opioid alternatives such as ultrasound-guided trigger point injections. A patient whose care is well-managed by a physician with addiction therapy training is less likely to engage in drug-seeking behavior or doctor shopping or to resort to less expensive and lethal “street” drugs, such as heroin or illegally-obtained Fentanyl.

This is not to claim that opioid addiction is easily managed, in part because the over-use of opioids actually changes the brain’s nerve cells. Because of the permanent physiological changes, many individuals who have discontinued taking opioids face a high risk for relapse, especially during periods of high stress, such as the holidays. Unfortunately, the U.S. also lacks an adequate number of addiction specialists to treat SUD patients, and too few primary care providers are trained on new treatment alternatives.

Fortunately, new monitoring technologies are helping providers combat opioid addiction. States have deployed prescription drug monitoring programs (PDMPs) that track the prescribing and dispensing of prescription medications. PDMPs facilitate the monitoring of patient behavior, at least in terms of their use of legally prescribed medications, and prompt providers to take proactive measures when appropriate. Though somewhat controversial, law enforcement professionals also find this very helpful if they have the authority to use these tools.

The electronic prescribing of controlled substances (EPCS) is another useful tool for addressing the opioid crisis. Prescriptions sent electronically are harder to forge, thus reducing the number of illegal prescriptions. EPCS is generally favored by addiction specialists because it eliminates the stigma that patients feel when handing a paper prescription to a pharmacy technician, especially when the medication is considered a “treatment” drug.

For most of us, the holiday season is truly a wonderful time of the year. It’s also a wonderful time to lend a bit of extra support and encouragement to individuals suffering from SUD.

About Tom Sullivan, M.D.

Thomas E. Sullivan, M.D is a board-certified specialist in cardiology and internal medicine with over 40 years of clinical practice. He currently works for DrFirst and sees patients part-time in Massachusetts. His expertise in the application of information technology to health care has helped to create an international standard (ASTM) for the exchange of medical record information called the Continuity of Care Record (CCR). With AMA, he was founding chair of their e-Medicine Advisory Committee, worked with the Physician Consortium for Performance Improvement, represented the AMA and helped create the Physician EHR Coalition and is past chair of the AMA Council on Medical Service.