Recently, I spent the morning in Judge Royal Hansen’s courtroom waiting for my daughter, who has struggled with IV heroin use for more than a decade, to be sentenced.
Her crimes are not extraordinary, violent or malicious. All are related to the lifestyle that often accompanies severe Substance Use Disorder (SUD) — retail theft, use or possession of a controlled substance and use or possession of paraphernalia.
Our system is clogged with people suffering from SUD, which the Diagnostic and Statistical Manual of Mental Disorders defines as a chronic relapsing brain disorder.
Stigma continues to influence our cultural, medical and legal response to SUD even though, as Jessica Gregg opined in a recent New York Daily News piece, “That is why we consider it a medical condition. That is why it needs to be treated. And there is no evidence that shaming or isolating or otherwise punishing someone who is addicted to drugs will cause them to want to stop using.”
The lobbies of local hospitals display statistics related to opioid prescriptions and warnings regarding the dangers of rapid physical dependency. Pharmaceutical companies are being sued, chronic pain patients and pain doctors are being scrutinized and the common media refrain is that pain medication can kill and is the culprit in soaring overdose rates.
This narrative is missing the whole story: We do not have a prescribed pain medication overdose epidemic; we have an illicit heroin, fentanyl and its frightening derivatives overdose epidemic.
Marc Lewis reported in The Guardian, “Drug overdoses are most often caused by a combination of drugs (or drugs and alcohol) and most often include illegal drugs (e.g. heroin). When prescription drugs are involved, methadone and oxycontin are at the top of the list, and these drugs are notoriously acquired and used Illicitly.”
We continue to radically undertreat or inappropriately treat people who are currently addicted to what are overwhelmingly illicit drugs, not prescribed medication.
For opiate dependence, Medication Assisted Therapy (MAT), using either methadone or buprenorphine, decreases overdose rates and inhibits relapse. Yet these medications remain inaccessible and cost prohibitive.
“This widespread rejection of proven addiction medications is the single biggest obstacle to ending the overdose epidemic. Funding isn’t the barrier: Outpatient medication treatment is both more effective and significantly cheaper than adding inpatient beds at rehabilitation centers. The problem is an outdated ideology that views needing medication to function as a form of addiction,” reports author Maia Szalavitz.
Two days after being released from a 30-day stint in jail, my daughter overdosed and was resuscitated. Opioid-dependent people who are incarcerated and not put on MAT are 12 times more likely to OD after being released.
Josiah Rich, a Rhode Island doctor who treats addiction in the prison system, and his colleagues found that providing MAT to inmates suffering from addiction could reduce overdose deaths by more that 60 percent.
Medical complications related to IV heroin use are common. Emergency rooms are another setting where MAT therapy could be initiated. Research conducted by the Yale School of Public Health concluded that initiating buprenorphine treatment for opioid addiction in hospital emergency departments was found to be more cost-effective than other interventions, and patients treated with Buprenorphine were more likely to be actively engaged in treatment 30 days after initiation of MAT.
Most addiction specialists agree that MAT is the most effective treatment for opioid use disorder. Increasing access to these life-saving medications is the most sure way to stop this pandemic free fall. It takes 17 years for evidence-based practice to reach the clinical setting. Drug overdoses have nearly doubled in a decade. We don’t have 17 years to get this right.
Paige Guión is a registered nurse and a radical proponent of public health policies that focus on harm reduction for those struggling with SUD.