The opioid overdose epidemic was the centerpiece of U.S. Secretary of Health and Human Services Tom Price, MD’s West Virginia listening tour recently. While the tour was billed as an opportunity to gain knowledge on the epidemic, his response to his observations illustrates just how difficult it is to change attitudes and beliefs with information alone.
In response to Herculean state-based and volunteer efforts to keep people alive — not to mention efforts to get the latest evidence-based medical treatments to a population of young people who are dying at unprecedented levels, and to women, for whom heroin overdose deaths have tripled in the last few years — Price stated that medication for the treatment of opioid use disorder may be “just substituting one opioid for another,” and “we’re not moving the dial much,” according to the Charleston Gazette-Mail.
Price’s statement defies decades of scientific research and practical advancements in the treatment of opioid use disorder. Indeed, he sounds like he just stepped out of his neurobehavioral science lecture hall in Ann Arbor, Michigan, where he attended medical school 40 years ago.
Two of Price’s recognized goals of treatment are to help individuals “become productive members of society and realize their dreams.” Evidence-based research supports the use of medications to achieve these goals.
Evidence shows that treatment with medication is effective in treating opioid dependence and reducing drug-related disease and criminal recidivism. Additionally, studies have shown that individuals receiving treatment with medication were 75 percent less likely to die from a drug overdose than those not receiving treatment with medication. Additionally, treatment with medication episodes has been associated with lower total health care expenditures than behavioral treatment without medication, with savings ranging from $153 to $223 per month.
And by the way, according to the Substance Abuse and Mental Health Services Administration, only an estimated 20 percent of individuals with opioid use disorder who need treatment receive it.
The addicted brain is complex, and its diseases not totally understood. But the science is clear: an addiction is not a character flaw or a moral failing, and the use of medication to treat this brain disorder is not just a mere crutch or substitution scheme.
Opioid use disorder requires long-term, multifaceted disease management. Treatment is most successful when medications are given along with family involvement and psychosocial support, ranging from individual case management, to psychotherapy, to 12-step programs. Vocational, housing, and legal assistance also help. Counseling and will-power are important, but alone rarely succeed at helping the opiate-addicted individual achieve long-term remission.
According to the Centers for Disease Control and Prevention, 91 people die of an opioid-related overdose every day. Overdose deaths are at an all-time high, and millions more are sick and dying from opioid use disorder; people who could respond to medically-based treatment if it were available. Research shows that fewer than half of private-sector treatment programs offer medications approved for the treatment of opioid use disorder; and of patients attending programs offering such medications, only a third actually receive them.
Many people with addiction are not able to access treatment that includes effective medications because of beliefs, not facts; ignorance, not information; and biases, not individualized care. Stigma and its attendant discrimination, and sometimes a subtle desire to punish rather than treat with compassion, are the sources of these reactions. These beliefs encourage a unitary response of blocking the brain receptors so that patients are unable to experience the effects of heroin and prescription drugs, rather than using medications that occupy those receptors to prevent withdrawal and encourage recovery. The ignorance continues age-old practices which deny access to modern advances in medications and delivery systems and arbitrarily limit the dose or duration of treatment, if and when allowed. These biases allow policy makers and funders to define the acceptable and permissible, rather than letting the physician and patient arrive at a plan that meets the individualized needs of the patient and is informed by the latest research and practice.
Aside from the excess morbidity and mortality caused by addiction, this disease tears apart the fabric of our families, communities, and country. It also devastates health care professionals when we must witness the deadly results of misinformation, discrimination, and senseless barriers to treatment. Modern medicine is not delivered under standards developed in response to a decades-old medical education. We expect physicians to regularly update their understanding as research evolves — and so too must our fund of knowledge. While Secretary Price should represent the best of our knowledge and ideals in health care, no one expects him to know everything in medicine. We do, however, expect him to surround himself with individuals who are familiar with what is needed to address the largest health care crisis in our lifetime. And, we expect him to advocate for that which can work, for all.
Genie Bailey is an associate clinical professor of psychiatry and human behavior, Brown University, Providence, RI. Andrea Grubb Barthwell is founder and chief executive officer, EMGlobal LLC.
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