Taking drug addiction seriously for once.
Editors Note: This is part two in a five-part series on a new approach to the War on Drugs. This is a nuanced topic and we present the views here as a contribution to the conversation. You can read Part I here.
There is a treatment for opioid addiction that has been shown repeatedly to reduce crime, disease and death — so much so that it is endorsed by the National Institute on Drug Abuse, the Institute of Medicine, the World Health Organization, the British Advisory Council on the Misuse of Drugs, and basically pretty much any expert committee that has ever examined the data with an open mind.
A recent study that included the entire population of people being treated for opioid addiction in the U.K. — over 150,000 participants studied over four years — found that people who enrolled in this treatment had a death rate that was 50 percent lower than those who used other methods, including those that are most popular in the U.S.; other research has found that it lowers the death rate by even more. Yet more studies find that it cuts crime, infectious disease, death rates for people already infected with HIV and, of course, relapse.
Unfortunately, the treatment I’m talking about involves long-term, possibly lifelong use of one of two medications: methadone or buprenorphine (brand name: Suboxone). That violates the politically correct stance historically taken by America’s treatment system — which is that abstinence from all drugs and participation in 12-step programs like Narcotics Anonymous is the only acceptable approach.
Consequently, because addiction is often misunderstood as being physically dependent on a substance — and these medications produce withdrawal if stopped abruptly — lifesaving drugs are denounced by public figures seen as experts, like Celebrity Rehab’s Dr. Drew. Only recently, and grudgingly, have major abstinence-focused treatment programs like the Hazelden Betty Ford Foundation begun to accept them.
This opposition is based on a misunderstanding of what addiction is. The DSM and the National Institute on Drug Abuse both define addiction, in essence, as compulsive drug use that continues despite negative consequences. Under this definition, it’s quite clear that medical use of opioids for pain or addiction treatment doesn’t qualify.
Appropriate medical use improves relationships and productive functioning — and because of a unique pharmacological property of opioids, people on a stable, regular dose are not “high” and can drive, work and live like anyone else. This is not “compulsive behavior despite consequences,” it’s merely taking daily medication, as if for diabetes or high blood pressure.
The confusion and stigma attached to the best treatment we have for opioids by those who favor the politically correct but ineffective abstinence-only approach has left America in a bizarre bind.
Doctors are free to prescribe any dose of any opioid for pain for as long as they want to as many patients as they want — but if any of those patients suffer addiction, only hyper-regulated clinics and specially trained doctors can prescribe medication treatment. Consequently, only about 40 percent of those who might benefit from this treatment receive it at all — and most of those who do only get short-term care, which is not effective.
To make matters worse, the stigma against this approach means that doctors don’t want to use it and neighborhoods resist placement of treatment centers. And, the ongoing resistance to the idea that medication treatment works to stabilize patients with opioid addiction means that in order to participate in it, patients are required to attend counseling, which deters those who don’t want to do so and adds cost — even though research finds that counseling requirements don’t especially improve outcomes. (Voluntary counseling probably does help; there’s just no evidence that requiring it is necessary.)
President Obama recognized at least some of these barriers and his administration made efforts to reduce them — for example, it raised the number of patients a doctor can treat with buprenorphine from 100 to 275. But, as Newt Gingrich and his Advocates for Opioid Recovery have argued — and as Trump stated during the campaign — that limit should be eliminated.
Obama also left the counseling requirements and the isolation of methadone treatment to special clinics intact — but here, too, there’s no scientific justification and the regulations simply deter people from getting care that could cut their risk of death in half.
If President Trump really wants to save lives, the best place to start is by cutting regulations that tie doctors’ hands in the treatment of addiction and supporting innovative approaches to make maintenance treatment more accessible.
More: Read Part I of this series here.
Photo credit: Dana Le, Creative Commons, Flickr