On Feb. 21, the University of Maine School of Nursing welcomed Dr. Noah Nesin to speak on the methods and mindset around treating patients for opioid dependence. The presentation, titled “Addiction as a Chronic, Treatable Disease,” was part of the UMaine Medicine Seminar Series, which focuses on topics relating to biomedical engineering and research and allied initiatives in healthcare that strive to serve Maine’s communities better.
Nesin’s presentation drew on his years of experience in the medical field. Nesin is a distinguished physician who started his career as a family practitioner. He has acted as the Medical Director of Health Access Network and as a physician serving the greater Lincoln region for almost 30 years. He currently works with Penobscot Community Health Care (PCHC) as chief medical officer.
To start his discussion on addiction, Nesin introduced the audience to the basic functions that drive addiction by explaining how the brain, and key chemicals within the brain, react to stimulants, producing a desirable effect. He likened the addictive response to the response that many people have when they see or smell their favorite food. Nesin explained that with things that create a positive feeling, that may taste good or make one feel good, the brain produces dopamine when exposed to them. This dopamine production is what makes people feel good about the choice they have made and tells the subconscious that this thing is good for them, so we will always create dopamine when exposed to these things. This creates the desire to keep ingesting these things, whether it is a piece of your favorite cake or an addictive substance.
“Over time, with repeated exposure to stimulants [such as alcohol, cocaine or heroin], the amount of the thing that it takes to make you as happy increases,” Nesin explained. “People keep going back, using this to avoid withdrawal and maintain dopamine levels. It is common for people [who use opioids] to say that when they use, it’s like being comforted.”
This helped Nesin then explain how, from his experience in the field, he feels as though opioid addiction is a chronic illness that must be treated much like any other chronic illness.
“It is common for chronic opioid users to want to stop,” Nesin said. “But addiction physiologically changes the brain. It changes the physical way that the brain processes chemicals, and it can take years for the dopamine levels to reset.”
Because of this dopamine reset period, treating those affected by opioid addiction can often take up to five years. This is why Nesin emphasized the need for ongoing care which also treats the chronic, long term effects of opioid use, rather than just encouraging people to get off the drug.
He demonstrated how, in trials that tested the efficiency and success of long-term treatment versus immediate addiction treatment, people who underwent long-term treatment were much more likely to stay with the program for an entire year and much less likely to relapse than those who were weaned quickly off the drug.
Nesin stated that, through programs that encourage long-term diagnostic treatment, people are much more likely to be successful and lead fulfilling lives post-treatment. However, because much of Maine’s population that has been more heavily affected by the opioid crisis lives in rural areas, continuous diagnostic care is difficult to administer. In the past, a bridge clinic had been set up by PCHC to assist rural areas with opioid addiction, but the need meant that community medical administrators were unable to keep up with demand. Most of those affected fall into a grey area for medical insurance companies and opioid addiction care is not reliably compensated.
“It is estimated that 35,000 people in Maine suffer with chronic addiction, and 80% of them are not treated or considered for treatment,” Nesin said.
The opioid crisis has become a pressing issue in Maine for both state officials and healthcare professionals. Recently, the U.S. Department of Labor allocated a $6 million grant to the state of Maine to aid in expenses for employment training in order to help mitigate the opioid crisis.
“We know that many people who are affected by substance use disorder struggle to maintain regular employment, which means that they also likely struggle to support themselves and their family financially,” Maine Department of Labor Commissioner Laura Fortman said. “The state’s economic plan estimates that at least 6,000 people have faced barriers to rejoining Maine’s workforce due to opioid use. This grant will help those workers obtain the skills necessary to be successful.”
For those seeking resources on Maine’s opioid crisis visit www.drugabuse.gov/opioid-summaries-by-state/maine-opioid-summary. For those seeking resources on substance abuse, visit 211maine.org/substance/, or dial 211, a confidential toll-free helpline.