To Stop Opioid Overdoses, America Needs to Face Two Truths and a Big Lie
June 14, 2018
Congress is in the midst of considering many proposals focused on solving the opioid addiction crisis. With more than 115 people dying every day, it is a tragedy of epidemic proportions. We have watched for nearly two decades as the crisis has ruined families, laid waste to communities, and crippled our workforce.
Yes, Congress must take swift action, but true progress will depend on new policies that are guided by the irrefutable medical evidence — and not the bias and stigma that has traditionally permeated the debate and government decision-making.
When it comes to doing the right thing for America, Congress needs to embrace and understand two fundamental truths about opioid addiction — and acknowledge and dispose of a big, deadly lie.
Here’s the first truth: Recovery medication works, and it needs to be the frontline approach to solving this crisis. The gold standard of care for opioid addiction is a combination of recovery medication, behavioral counseling, and social support — what has been dubbed medication-assisted treatment (MAT) or medication-assisted recovery.
As I write in my new book, “Trump’s America: The Truth About Our Nation’s Great Comeback”, MAT’s effectiveness is supported by the U.S. Centers for Disease Control and Prevention, the National Institute on Drug Abuse, the American Society of Addiction Medicine, the World Health Organization, and the United Nations Office on Drug Policy. However, only 41 percent of treatment programs offer any kind of medication-assisted treatments, according to a recent study in Health Affairs.
Shockingly, fewer than 3 percent of treatment programs offer all three of the medications available to help fight opioid addiction. This is a problem because each of the three recovery medications (buprenorphine, naloxone, and methadone) in the market has its own benefits and drawbacks. There is not a one-size-fits-all opioid addiction medication.
Truth number two: Opioid addiction is unique, fundamentally different than other common addictions, and needs to be approached and treated differently as a result. Our current system for opioid addiction treatment is antiquated, based on outdated information, and biased against the use of medication. The traditional behavioral and abstinence-based treatments that work amazingly well for other addictions, such as alcohol addiction, are not working as stand-alone therapies for people living with opioid addiction. In fact, they can be deadly.
Opioid use, even over a short time, changes the brain’s chemistry. When a brain is dependent on opioids and the person stops taking them, the body goes into withdrawal. If that person relapses and attempts to take the same dose of opioids he or she is used to, the brain overloads and shuts down the body, resulting in death. For this reason, we cannot treat opioid addiction like we treat other common addictions, but we do.
Despite these stark facts, we seem to have accepted the lie that pouring resources over and over again into traditional rehabilitation will get someone with an opioid addiction a different result. This is not only the definition of insanity — it is deadly.
This lie, that abstinence-only in-patient rehabilitation for opioid use disorder is the gold standard of care, is without evidence. In fact, the evidence clearly argues against abstinence-only rehab. A full 80 percent of people with opioid use disorders relapse within a month after stints in these programs. Shockingly, a person is more likely to overdose and die after going to an abstinence-only, in-patient rehabilitation center than had he or she never sought treatment at all, according to the American Society of Addiction Medicine. It’s easier to think that this uniquely American crisis is the moral failing of a select group of people, rather than a fundamental failure of our health system to accept the clear evidence that addiction is a brain disorder that affects people differently.
In light of these two truths and the big lie, what should Congress do? The answer lies in breaking down ridiculous barriers we have erected for recovery medication — far steeper than any regulatory barriers on opioids alone. Congress should also ensure that government-sponsored health care programs are following the evidence base and covering effective and lifesaving recovery treatments.
This includes extending Medicare to opioid treatment programs and eliminating the discriminatory cap on the number of patients a provider prescribing these recovery medications can treat. Fundamentally, this cap makes no sense. No other medications have such restrictions — including the pain management opioid prescriptions that have helped cause this problem.
Furthermore, in the criminal justice system, we should be treating people with addictions and small drug possession charges more like patients and less like prisoners by advancing drug and veteran courts.
Like President Trump, I want to “Make America Great Again” for all Americans — including those with addictions to opioids and other drugs.
We can’t live up to this ideal if we are stuck in the past or building a treatment system that ignores the stark realities of what it actually takes for people to get well, recover, and reclaim their lives.