On Friday, just days before President Trump’s declaration of the opioid epidemic as a national public health emergency was due to expire, the acting director of the Department of Health and Human Services renewed it for another 90 days. The declaration sparked little progress in its first 90 days, making it seem like just another symbolic gesture. That’s a shame because the fight against addiction demands real action. With lives hanging in the balance, we urge the Trump administration to use the renewal to take strong steps to stop a vexing problem that affects communities across the United States.
The Centers for Disease Control and Prevention recently reported that more than 63,600 people died from drug overdoses in 2016 (the last year with complete statistics); more than two-thirds of those were due to opioids. It was the worst year on record — and even more families lost loved ones to opioids in 2017.
This is tragic because decades of scientific evidence show that addiction is a disease that can be effectively treated, and that proper treatment reduces the risk of overdose, helps people recover and live productive lives, and saves money. This was definitively documented in the Surgeon General’s Report on Alcohol, Drugs, and Health.
Yet only 1 in 10 Americans with a substance use disorder receive treatment for it. Even more tragic, the few who do get treatment often receive advice that isn’t based on solid evidence. At a loss for real answers, thousands of Americans are forced to navigate a scattered system of 14,000 programs that aren’t required to meet a standard set of medical qualifications.
The Trump administration could help improve the treatment of substance use disorder by following the recommendations of its own Commission on Combating Drug Addiction and the Opioid Crisis.
One recommendation urged federal agencies to analyze the quality of the various types of addiction treatment. This would give patients confidence that they are receiving treatments proven to work. It would also provide a framework for medical providers to turn to when helping their patients decide the best treatment options for their situations.
While every patient’s situation is unique and should be evaluated on an individual basis, research shows that long-term treatment with FDA-approved medications is the most effective form of treatment for those with opioid addictions. The FDA has approved three medications for this treatment: methadone, buprenorphine, and naltrexone. All three significantly increase the likelihood that individuals can recover to live healthy lives.
There are, however, significant differences in how each medication works and which one is best for which patient. Providing access to all three medications is essential — as is the case for many other diseases, the right medication and treatment plan should be focused on the patient.
Unfortunately, for decades we’ve largely avoided the science of addiction and its treatment and stigmatized the use of these medications. Today, only a small fraction of programs offer all three medications. Among those that do, unnecessary barriers are often put in place to limit access to care.
Far too many people we know, like Gary’s son, Brian, experienced this firsthand. He attended eight different addiction treatment programs. Only one of them offered effective medication treatment and a subsequent program stopped the medication. Six months later, Brian took his life, writing in a note about his anger with the treatment industry.
Imagine if we treated any other illness the way we treat addiction. If Brian had cancer and his effective chemotherapy was suddenly stopped, resulting in death, it would be medical malpractice. Instead, this is the scary reality that patients with addiction face daily.
Even as our leaders in Washington, D.C., and the states must do more, those in the private sector can also lead the way on improving treatment for Americans with substance use disorders. The Substance Use Disorder Treatment Task Force brought together health insurers, advocates, provider groups, and researchers to turn existing research into action. At the end of last year, the task force announced that 16 health care payers had adopted eight principles of care for addiction treatment. Access to FDA-approved medications and therapies based on an individual’s diagnosis, preferences, and medical necessity are key parts of those principles. And for the first time, health care insurers committed to identify, promote, and reward care that includes these medications and other recovery support services.
The medical community must also step up. More physicians, nurse practitioners, and physician assistants need to get the proper training to offer patients with substance use disorders effective medications to quell them.
Just as with cancer or diabetes or other chronic conditions, the public, private, and medical sectors have the power to save the lives of those struggling with addiction. But their efforts won’t pay off until we use every clinical tool available to us. Payers need to cover and properly reimburse all three types of medication for addiction treatment — the Trump administration can provide incentives to do that. Treatment programs need to support, offer, and fully explain their benefits — the government can issue guidelines that encourage this. Clinicians need to get on board with evidence-based treatment options. And patients need to be empowered to ask for treatment without fear of shame and stigma, and be fully assured that they are receiving the right care and advice.
To effectively fight this deadly epidemic, we need everyone to play a role and do what they can to save lives.
Sarah Wakeman, M.D., is the medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School. Gary Mendell is the CEO of Shatterproof, a national nonprofit devoted to ending drug and alcohol addiction.
It Amazes me that a world of Physicians cannot collaborate and add up all of the users that are following the rules verses the Addicts who abuse & simply deal with them.
Instead, we live in this weird Liberal world where Bad is rewarded & Good is punished!
My kids do not use drugs, nor do they drink because we as parents educated them & did not use either recreationally, which offered the best possible outcome for our children & it worked.
At 35 it all started with the diagnoses of Spinal Stenosis, then having had 12 Epidurals, then moving onto 3 Spinal Fusions in 10 years.
The only Pain medication that worked like taking Tylenol, was Methedone at 10 Mg 2 x day, 12 hours apart.
That was 15 years ago & I am still on that dose, even after getting off for 1 month period on 3 occassions to see if other lesser meds would work.
This Opiod allows me to continue working this past 15 years as a HVAC Control Specialist, which moves the pain to the background until I reach my activity limit, when numbness and tingling pain takes over.
For the last 5 years, I have added Vicadin to the mornings to help me get up and get to work after being diagnosed with Fibromyalgia, with Valium, Lyrica & Cymbalta.
Then I tried the so-called Pain Management gadgets that many Dr’s will only use & I ended up in worse pain from an installed Electronic Stimulator that created more pain then it stopped, so I had it removed 1 year later & will never try another gimic!
So, I see a Chiropractor 3 x a week for Ultrasound, Back Stretching and Tens at a high level to stop my Hypertonicity. I see a Massage therapist with a PT-A License for Deep Tissue and Trigger Point therapy. All of which keeps me working.
I do consider myself fortunate, as I have been paying my house off and providing for my College Educated Children and their own passed health concerns.
My only wish is that I didn’t have to pay for others SINS!
I do not thankfully have opioid use disorder, but I do have a great appreciation of the struggle of those with addictions. These are not “choices” and are certainly not “sins.” In fact, it’s estimated that 80% of heroin use is now connected to what began as legally and appropriately prescribed pain medication. One in three patients who are prescribed an opioid end up addicted. That is a staggering statistic.
Of course, those in pain need relief as well, and it is all about responsible prescribing. We also need to ensure that the 33% of patients who become addicted have access to the treatment that saves lives.
Again, this is not a choice people make. And these are our family, friends, neighbors, children, mothers, fathers, and grandparents.
Please remember that misunderstanding and judgment does not help people in pain, people addicted to pain medication or the healthcare professionals who treat both.
Enough is enough, addicts need to start taking their choices in to their own hands, I’m so sick of these stories about poor addicts, they have brain disease and deserve treatements, yes they do, BUT what people in pain? Opiates are most people’s last choice to help live a life not in sever pain, opiades are made for that purpose, not to get high off, but because some people choice to enjoy their “high” off of legitimate pain medications, the millions of people in pain are no longer provided the one medication that helped them, people like say, well that’s just putting a bandaid” on the pain, well YES, as many pain diseases there is no cure, and so medications are designed to help ease the disease pain, just like so many other medications one takes “is putting a bandaid” on the disease to help cope with its side effects. If addicts need treatements, why are they entitled to their “bandaid” a prescribed controlled opiate type medication that will help ease their cravings and withdrawals, CPP are not entitled to the “bandaid” any longer, like “opiades” that were designed and formatted to treat pain? How is that addicts are provided “an opiates” drug,to keep them “happy” in life, but people in pain, are told to “train their brain” 1 women I read was told by her “pain managemt” Dr, to tap her forehead, when she in pain, Really? If all these rediculious , brain trappings are actually working, (not) why are addicts, not told to tap their forehead when they have a craving for a drug, but they are NOT, addicts are provided medications and people, with cancer, MS, spinal diseases, arthritis, genetic diseases, broken bones, amputations,
Brain and nerve injuries are told to “accept their pain, be friends with your pain, do yoga, ” is anyone even thinking about the people in pain? CPP’s are not responsible for someone OD ing on
Street drugs, or drugs bought on the street, or stolen. Yet, CPP are being denied the most human rights of all, to live pain free, they and I, are being tortured, by the hands of the CDC, for no fault of our own. Patients are being given Tylenol during surgery, cancer patients are being left to suffer, because they cant even get pain medication, our VETS are killing themselves, because their life is now less important then the addict, who wants to get high, good honest hard working people, who have done nothing wrong are now, living in complete agony, and often, these days they are choosing to end their suffering, by suicide,, are we to take 3veryones drivers license away bevause “it could kill you, ” punishing CPP, cancer patients, and surgery patients, with entractible pain is not the answer, coddling those who get addicted, and providing them with endless medications, support, and away to continue their habit is not the answer either, why is methadone and suboxone (opiade) medications, being given to addicts so they will be “happy” and CPP are told to “tap their forehead” even a reasonable solution.? If it’s just a bandaid, why is it ok to give addicts their bandaid but CPP Are given nothing, many are torn from their medications over night, many Drs are not following the taper codes, and patients are suffering. People need to start looking into the real epidemic And that is untreated, torturous pain, now inflicted on millions of good people. Stop the insanity, did you know some hospitals are running out of pain meds just to do surgery? Because the suppliers have cut production? It’s time to stop the insanity, how will an addict ever learn to “cope with their disease, to be friend’s with their, disease” if they know they can be revised endless amount of times, be given “medication” to keep them “happy” and not looking to the streets for their high. Meanwhile, CPP, cancer patients and anyone else in pain is left to “suffer” horribly.its, inhumane and the pendulum has swung to far, no one person’s pain is the same, but to inflict unjust pain on one group of people, in order to assist the minority is just not the answer and what is happening is “genocide” of our own governments making, killing of CPP.
The fact is that chronic opiate analgesic use is only appropriate for literally a handful of diseases. The now infamous research done by the opiate manufacturers equated chronicpain treatment with end of life and cancer pain treatment. There is little evidence for treatment of any chronic pain and often when there is evidence it is weak and there are often better alternatives. http://www.agencymeddirectors.wa.gov/Files/2015AMDGOpioidGuideline.pdf
I work with chronic pain patients, legtimate CPP’s, and am one as well. I thought when I saw the picture with the bloody needle, finally someone was talk about the heroin/fentanyl epidemic, not the fake opiate epidemic. These days anyone who takes opiates for chronic pain, legitimately, is said to have “opiate use disorder”. Let’s tell the truth. MOST OD’s are from street drugs, especially heroin mixed with the fentanyl that is 100 times stronger than regular fentanyl. Therein lies the problem with so many OD’s going on. Legitimate CPP’s who follow all the rules, have a narcotics contract, use ONE doctor, ONE pharmacy, and submit to urine screening are being punished by the DEA, who is scaring the life out of some doctors and patients. If not for these meds I would not be able to function and contribute to society as a well adjusted and hard working individual. I am well below the CDC guidelines, which are GUIDELINES, not LAW. The DEA has quietly told pharma companies to produce 20% less opiates in 2018 and they did the sane thing last year, thereby creating a FAKE shortage. I deal with this every day and see the effects of this, and it is only going to get worse. When a CANCER patient cannot get their pain controlled, even when on hospice, there is something VERY wrong here. Animals are treated better than human beings. Tell me how it helps a dying brain cancer patient to reduce his pain meds so he will not “get addicted” when he has 2 months to live. This man was a Marine, the pain from his brain cancer was not treated correctly, and he took his service revolver out to the back yard at 2 am, and his wife heard the gun shot, and she knew why and had expected it. This is only ONE story. The propaganda put out by your organization and PROP (the WORST ones) are killing people. There is not a one size fits all solution to this. But, at least admit that it is mostly street drugs causing the overdoses. When a person starts really digging into it, you get the REAL numbers. Everyone who uses opiates does not have a disorder, but the latest “information” coming out, if you use opiates for ANY reason, you already have an “opiate use disorder”. This is pathetic, and legitimate pain patients are being punished for no reason. Yes, some people have addiction issues, a lot do not that follow all the rules, and those CPP’s should not be punished for taking meds that allow them to lead a fairly normal life.
Tom Petty died from prescription opiates. Lets not take this to a stigmatized view that it is only bad people who use drugs on the street and that they are the problem.
I understand the need for opiate medication. My 9 year old daughter was diagnosed with a bone tumor in her spine and I would have given her any drug I had to stop her pain when she was crying: “Help me Mommy!” We need to deal with pain and the consequences of opiate medication – but lets not pretend that they don’t exist. Rationale policies and procedures for prescribing, and close follow up with pain patients so they don’t go off the ropes.
I Agree!! Most of the OD’s ARE from heroin and heroin laced with fentnyl. We people who are on pain meds so we can get up and be a contributing citizen ARE being punished!! We take our meds as prescribed, don’t sell or give them away, obey all the rules, keep them locked up, etc. They will NEVER admit that it’s street drugs that are doing the killing.
Jumping through lots of hoops before getting NEEDED MEDICAL CARE??
Sounds like the status of legal abortion access in the USA, not the opoid abuse epidemic…
Welcome to the club!! /s
Just simply pathetic … Methadone and buprenorphine are opioids. Methadone is about 2 1/2 to 5 times more potent than morphine while buprenorphine is about 40 times more potent than morphine. I have no issue with MAT or the medications used in MAT. What I do have an issue with is the sheer hypocrisy of advocating prescription opioids to those who have a history of purposely misusing opioids, which were initially approved by the FDA to reduce physical pain, while denying that same class of medication (opioids) to those who are in severe pain.
It is not hypocrisy, it is science. Although you are correct that these medications are opiates they are opiates that when properly used actually can fix the nerves injured by opiate use disorder. The dopaminergic (addiction center) system is actually bolstered up with these medications which reduces cravings, anxiety, ADHD like symptoms that are caused by a lack of dopamine. Unfortunately the functional MRI studies investigated brain activity demonstrate it takes 2 years to improve that system. The 2 week detox centers should not exist unless there are outside providers to treat for 2 years. It is not simply a substitute it is a treatment. We would not deny treatments for diabetes because they ate too much candy would we? We have to treat the underlying disease process.
I have a better quality of life after receiving opioid treatment for a 33 year history of migraines. I have tried EVERYTHING including botox but NOTHING would touch a 10 plus pain. I’m not addicated but depended on my meds. I’m closely followed by neurologist/pain management specialist. I’m compliant with everything required of me. PLEADE allow me my somewhat quality of life and not out ALL opioid users on the same class of addicts!
I am in agreement with this article. However, after losing my grandson last June as a result of opioid addiction, at the tender age of 19, I find the photograph displayed to be most upsetting. I am sure it adds to the stigma from those with little understanding of substance use disorder and does not encourage them to read further and learn more about this disease.
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