In 2004, my closest friend died of an opioid overdose. Since then I’ve met hundreds of mothers, brothers and daughters who have lost loved ones, too. I’ve spent my entire career treating addiction, and it’s clear that efforts to explain the current crisis and its solutions are missing some vital points.
Recently, President Trump commissioned a group to examine how to solve this crisis, and its first suggestion was to declare an emergency. It’s been over 70 days since that report was released, and more than 6,500 people have died since. What will it take for us to act?
Most expert recommendations focus on seven key areas: increase prevention; increase insurance coverage; improve the availability of treatment including medications like buprenorphine (an anti-craving drug); reasonably restrict prescribing; decriminalize addiction to allow people to safely receive care; address the social determinants of health such as unemployment, abuse and poverty; and create public awareness to reduce stigma. These are all sensible recommendations we need to implement immediately; they are rooted in solid public health evidence.
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But they won’t turn the tide. That’s because they leave several important barriers unsolved. Here is what else is needed and why:
▪ Over half the opioid prescriptions go to people with mental health conditions. Unless we treat those first, we won’t solve the problem.
▪ Access to treatments like buprenorphine are critically important, but the majority of people who take that medication stop and then relapse. Insulin didn’t solve the diabetes epidemic; it’s unreasonable to think that any medication alone can stop a chronic disease epidemic without additional support.
▪ Addiction is a chronic disease requiring long-term, data-driven support – identification, evidence-based treatment, and coaching. We wouldn’t discharge someone with heart failure after 28 days and wish them good luck. We need to stick with these folks through thick and thin, just as we do for every other illness.
▪ People with addiction don’t trust the medical community, and there are good reasons. We need to form relationships with people who are suffering and their families, to build trust and engagement. Contrary to common opinion, the majority of people with addiction will want help at some point. Instead of asking them to trust us, we need to start by listening to them. This requires a wholesale shift in our approach.
▪ We need to move addiction treatment back into mainstream health care. Why should people with addiction be relegated to lesser quality settings that cannot address their whole health needs? Addiction should be treated in the same settings that all other health conditions are since most people with addiction have other chronic conditions, anyway. Integrated care is critical to success.
Addiction is a treatable disease. Solving this is entirely within reach. We did it for tuberculosis, we did it for polio, we did it for cigarette smoking and we did it for motor vehicle deaths with seatbelts. But unless we address all the barriers to care and make effective treatment the path of least resistance, we will continue to lose friends and family to this devastating illness.
Omar Manejwala, M.D., is the Chief Medical Officer, Catasys. He resides in Matthews. Email: firstname.lastname@example.org