By Mark Crossley
The Covid-19 pandemic has spawned countless tragedies not directly tied to the virus. One distressing subplot is how the pandemic has further fueled the opioid epidemic, making a vulnerable patient population even more vulnerable. Drug positivity rates have increased since last March,1 and the United States recorded the most overdose deaths last year, a 21 percent increase from 2019.2
Despite the prevalence of substance use disorders, including opioid misuse, and the existence of effective treatments, including medication-assisted treatment, most people who need treatment do not seek or receive it. According to the 2019 National Survey on Drug Use and Health, only 10 percent of the 20.4 million people needing treatment for a substance use disorder received any – a disparity known as the “treatment gap.” This means about nine out of 10 people suffering from substance use disorder are not receiving treatment.
The bright spot in this unfolding calamity is that we know how to reverse the troubling rise in opioid misuse resulting from the pandemic. That starts by clearly defining opioid use disorder as a disease, much like diabetes and heart disease. People suffering from opioid use disorder are not “addicts.” They have a chronic brain disease, and we need to disrupt the dangerous stereotypes that perpetuate a false understanding of opioid use disorder and add to other significant barriers for patients seeking treatment. Here are five principles to guide our recovery:
- Destigmatize the disease — The first step toward normalizing this disease is how we talk about it. These are people. They have a disease called opioid use disorder. There are treatments that work. They deserve a chance. Dr. Nora Volkow, director of the National Institute on Drug Abuse, says the research shows combating stigma is a vital step to corral the epidemic.3
- Expand access to treatment — We need policies to ensure evidence-based treatment is covered and available. There should not be any prior authorization requirements or other barriers to treatment. We need a workforce sufficient and educated to meet the need for treatment. We need to leverage technology via Telehealth to bring treatment and counseling to people where they are. The American Medical Association recommends extending policies adopted by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Agency (DEA) to provide greater flexibility to patients and prescribers for the duration of the pandemic and the opioid epidemic.
- Fund treatment programs — We should provide the resources to fund coverage, treatment, systems and the workforce. This is some of the smartest money government can spend. Fortunately, Washington and state policymakers have given us reasons for hope. The bipartisan Medicaid Reentry Act makes opioid treatment available in corrections through release. In addition, the Biden administration has proposed an additional $4 billion in funding for substance use disorder and mental health treatment.
- Deploy resources strategically — We should be real about where the challenges are greatest and focus our attention and resources in those areas. For example, the prevalence of opioid use disorder in our prisons and jails is much higher than the general population, but these facilities are the least likely to offer treatment.4 Communities of color also increasingly suffer from opioid use disorder and in recent years have experienced the greatest increase in rates for overdose deaths.5
- Humanize the disease — Opioid use disorder does not discriminate. Anyone can suffer from this disease – our friends, our family, our neighbors. This begins by destigmatizing both the disease and treatments for it. Make it normal. Make it accessible. Make it our priority. By coming together to remove barriers to treatment, fight the stigma and educate the public on the science of addiction, we can address this overdose crisis and help move those struggling with opioid use disorder toward a path to recovery.
We know too much about this chronic disease for so many people to continue to struggle. It is finally time to rethink opioid addiction.
For more information, visit www.rethinkopioidaddiction.com.
1Millennium Health Signals Report™, COVID-19 Special Edition: Significant Changes in Drug Use During the Pandemic. Volume 2.1 | Published July 2020
2 Centers for Disease Control and Prevention. 12 Month-ending Provisional Number of Drug Overdose Deaths. January 3, 2021.
3 Volkow N. Addressing the stigma that surrounds addiction. Nora’s Blog, National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services. April 22, 2020.
4 Substance Abuse and Mental Health Services Administration: Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings. HHS Publication No. PEP19-MATUSECJS Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2019.
5 The Opioid Crisis and the Black/African American Population: An Urgent Issue was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS) by SAMHSA’s Office of Behavioral Health Equity.