Opioid use disorder is characterized by a pattern of opioid use that causes clinically significant impairment or distress. This medical condition often includes a strong desire to use opioids, increased tolerance to opioids, and withdrawal syndrome when opioids are abruptly discontinued. Addiction and dependence are components of a substance use disorder and addiction represents the most severe form of the disorder. Opioid dependence can manifest as physical dependence, psychological dependence, or both.
Opioid dependence is a complex disease involving physiological, psychological, genetic, behavioral and environmental factors. It shares features of other drug dependencies but often requires unique treatment strategies. No single treatment approach is effective in all cases. While abstinence is generally accepted as the primary goal of treatment, it is not feasible as an exclusive goal for all opioid dependent persons.
Opioid-related overdose fatalities have increased markedly over the last ten years in epidemic proportions. In 2017, there were over 47,000 U.S. deaths attributable to opioid use, both prescription and illicit. These alarming numbers eclipse the total mortality related to other substantial mortality/morbidity crises recently experienced by the U.S. including peak automobile accidents, the Vietnam War, HIV/AIDS, and gun violence.
Prescription drug abuse continues as a health care problem in our nation and state. Even though the NYS PDMP (Prescription Drug Monitoring Program), has yielded a 75% improvement in “doctor shopping” for opioid prescriptions, since 2013, death by overdose on prescription opioids remains significant in NYS (4.9/100,000 in 2012,2013,2014).
An increasing proportion of those opioid deaths are tied to heroin use. Though the most recent data in NYS shows a significant increase in heroin and fentanyl in overdose deaths (4.2/100,000), prescription opioids remain a major source of addiction, and overdose deaths. The opioid epidemic highlights the important role of appropriate use of opioids along with preventive measures to reduce prescription drug misuse and abuse.
Preventing prescription drug misuse, and opioid use disorder requires a public health approach that includes prevention, early intervention, treatment, and recovery support services. Appropriate opioid use is an important step in preventing opioid use disorder and addiction. National guidelines support shared decision-making for appropriate use and misuse.
NYS guidelines limit the initial opioid prescription for acute pain. A practitioner may not initially prescribe more than a 7-day supply of an opioid medication for acute pain.
Acute pain is defined as pain, whether resulting from disease, accidental or intentional trauma, or other cause, that the practitioner reasonably expects to last only a short period of time. This does NOT include prescribing for chronic pain, pain being treated as a part of cancer care, hospice or other end-of-life care, or pain being treated as part of palliative care practices. Upon any subsequent consultations for the same pain, the practitioner may issue, in accordance with existing rules and regulations, any appropriate renewal, refill, or new prescription for an opioid.
For more information on acute pain guidelines, read the Opioid & Sedative Guidelines for Emergency Department & Urgent Care Providers.
For more information on prescription drug abuse, go to DEA.gov or call 1-800-822-9539.
Opioid Guidelines for Adult Patients
Community Principles of Pain Management (CPPM) Toolkit
Prescription Drug Misuse and Abuse
Opioid Overdose Prevention Toolkit
Opioid Risk Tool – Revised (ORT-R)
Pain Management Agreement & Informed Consent
Physicians for Responsible Opioid Prescribing
Because of possible danger and misuse, opioids are closely controlled by medical providers and by the law. Patients who use opioids should have their prescriptions written and monitored by one physician and have the prescriptions filled at the same pharmacy.
Physicians in New York have a duty to consult the NYSDOH’s Prescription Monitoring Program (PMP) since August 27, 2013. To access the PMP, physicians need a Health Commerce System (HCS) account. Physicians can apply for an HCS account on the NYSDOH here.
The Bureau of Narcotic Enforcement (BNE) is responsible for protecting the public health by combating the illegal use and trafficking of prescription controlled substances. The Bureau also prevents prescription drug abuse through educational materials and presentations for parents, educators, and healthcare professionals.
New York Public Health Law Section 3331(8) requires a written treatment plan in a patient’s medical record for any opioid prescribed for pain that has lasted longer than three months or past the time of normal tissue healing, effective April 1, 2018. Certain limited exceptions include patients who are being treated for cancer that is not in remission, who are in hospice or other end-of-life care, or whose pain is being treated as part of palliative care practices. Documentation requirements are outlined here.
For more information on opioid prescribing in New York State, visit the Bureau of Narcotic Enforcement’s webpage.
Buprenorphine may be used for the treatment of substance abuse disorder by qualified prescribers.
Medication Assisted Therapy (e.g., Buprenorphine, LAAM, Methadone Maintenance Treatment, Ultra-rapid Detoxification), Opioid treatment (PDF) Policy 3.01.04 (posted 9/13/17)
SAMHSA’s MATx Mobile App empowers health care practitioners to provide effective, evidence-based care for opioid use disorders. This free app supports practitioners who currently provide medication-assisted treatment (MAT), as well as those who plan to do so in the future. Features include:
Medication-Assisted Treatment (MAT) Training is available.
American Society of Addiction Medicine Online Training (CME)
BupPractice: Buprenorphine Training & Practice Tools (CME)
Buprenorphine Training from SAMHSA
CDC guidelines suggest clinicians should offer naloxone when factors that increase the risk for overdose are present, such as a history of overdose, history of substance use disorder, higher opioid doses (>50 mg oral morphine equivalents/day) or concurrent benzodiazepine use.
In 2005-2014 unintentional injury (where overdoses are classified) was the Number one cause of death for ages 15-44. (Suicide was number 4. Homicide number 5 for this age group). According to the 2009 Partnership Attitude Tracking Study, over half of teens agree prescription drugs are easier to get than illegal drugs. Most teens surveyed believe that the prescription drugs are being taken from the family medicine cabinet. 1 in 7 teens in grades 9-12 have reported taking a prescription pain reliever for non-medicinal purposes in the past year.
Families dealing with addiction are often devastated by medical, financial and psychological ordeals, car accidents, lost jobs, derailed college experiences, incarceration and sometimes death by accident, homicide, overdose or suicide.
Partnership for Drug-Free Kids
Active Parenting of Teens: Families in Action
The National Council on Alcoholism and Drug Dependence, Inc. (NCADD), founded in 1944, is a national, nonprofit organization combating alcoholism, other drug addictions, and related problems. NCADD’s major programs include prevention and education, public information, public policy advocacy, and publications. NCADD’s network of more than 100 State and local nonprofit affiliates conduct similar activities in their areas and provide information and referral services to families and individuals seeking help with an alcohol- or other drug-related problem. NCADD sponsors National Alcohol Awareness Month in April and Alcohol and Other Drug-Related Birth Defects Week in May. NCADD operates a toll-free number, (800) NCA-CALL, for information about alcoholism and the name of the NCADD affiliate in your area.
The Rochester New York nonprofit affiliate, NCADD-RA, aims to reduce the incidence and prevalence of the disease of alcoholism and other drug dependence. NCADD-RA provides evidence-based substance use and problem gambling prevention services to a diverse population through education, support, resources, advocacy and referral. For more information, visit ncadd-ra.org.
Greater Rochester Area OASAS Treatment Providers
Five Levels of Care
Monroe County
For the Monroe County version of this directory, visit llncaddra.org.
Seneca and Wayne Counties
Genesee, Orleans and Wyoming Counties
For the most updated version of this directory, visit ncadd-ra.org.
Below is a list of resources providing information to help with addiction.
OASIS.ny.gov serves as a guide to services, educational information and source to locate available treatment programs and beds in New York.
Urine Drug Testing, immunoassay, presumptive testing, confirmatory testing (PDF) Policy 2.02.50 (posted 1/17/17)
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