Tuesday, September 25, 2018

The negative stigma of addiction is hampering effective treatment

Our country faces some serious problems today, as it has throughout its history. One of the most serious, one that claims the lives of thousands of Americans each year, is death from opioid overdoses.

This comes as no surprise to most of us, but perhaps the scale of the problem and the difficulties faced in addressing it might surprise many of us.

Facts about opioid abuse:
** In 2016 opioid overdoses killed 13 of every 100,000 people across the nation.
** America makes up about 4 percent of the world’s population but accounts for 27 percent of the world’s drug overdose deaths.
** On average, 175 Americans die every day from overdoses.
** Someone dies every 8 minutes from an opioid addiction.
** Overdoses kill more people than gun violence or car crashes.
** In 2017, more people died of an unintended drug overdose than in the entire 20-year Vietnam War conflict.
** Opioid prescriptions dispensed in 2006 were about 213 million, but rose to a peak of more than 250 million in 2012, before returning to 2006 levels four years later.

Where do people get these dangerous drugs?  Most get them from friends or relatives, but the Centers for Disease Control and Prevention tells us that those at highest risk of overdose are as likely to get them from a prescription issued by a physician.

Illegal drugs sales are also an important element, and synthetic drugs like fentanyl and other super-potent opioids pour into the U.S. through international mail and private carriers, the U.S. Customs and Border Protection reports.

Obviously, better control of legally dispensed drugs is needed, and stronger enforcement of drug laws is a must. But the other side of this coin is the way drug addicts are treated medically, and much work needs to be done there, too.

Treatment of addictions is difficult, and made more so by obstacles to using treatments effectively. Not the least of these is that our healthcare system regards addiction as a mental health problem, not a physical health problem, and the two are treated differently. Mental health problems have a lower priority than physical health problems, and therefore are underfunded, under-treated and less actively researched.

Given the lower priority, it is not surprising that the treatment protocols are antiquated. While the recent frightening increase in addiction and addiction-related deaths has brought long-needed attention to the problem, there is much to do in using available methods and effective drugs to maximize effective treatment. Surprisingly, abstinence programs and programs similar to Alcoholics Anonymous do not work well with opioid addiction.

The reality is that most people with addictions are not receiving any medical treatment, and many or most of those who are being treated are not receiving the most effective care.

According to the Substance Abuse and Mental Health Services Administration, only about one in ten people with a substance use disorder receive any type of treatment.

In his most recent book, Trump’s America,Newt Gingrich, in a chapter titled “Let’s Trump Addiction,” explains that there is a better way to treat the drug addicted. “The research is unequivocal that behavioral therapy combined with recovery medications, such as methadone, buprenorphine, and Suboxone, is the most effective way to treat opioid addiction.” This type of treatment, studies show, can reduce the mortality rate of drug-addicted patients by half or more.

Strangely, despite the strong support for this type of treatment, fewer than 3 percent of treatment programs offer all three of the effective medications available to fight opioid addiction.

Gingrich comments, “This is a problem because each of the three recovery medications in the market has its own benefits and drawbacks. There is not a one-size-fits-all opioid addiction medication.”

He cites examples of the “simple bias” against mental health issues being applied to physical health problems, noting that these barriers would be “absurd, illegal and unethical” if applied to physical health problems. But they are somehow acceptable when applied to addiction and other mental health problems.

Both insurers and Medicaid have not yet realized that their current approach to treating addiction actually prevents the most effective treatments for these problems because they interfere with the use of the three medications. Or, if they have realized it, they have not yet removed those barriers.

Doing so would save thousands of lives – which is the most important outcome – but they would also save millions of dollars that are now spent on the drug addiction problem.

Citing the Surgeon General’s Report, Gingrich explained that every dollar we invest saves money, listing these findings:
** $1 for brief primary care addiction intervention saves $27 across the system;
** $1 for addiction intervening at a hospital saves over $36 or $9 in the emergency room;
** $1 for treating substance abuse saves $4 in overall health care costs, and $7 in criminal justice costs by preventing the cycle of recidivism that often accompanies addiction.

Many people view addiction as something other than a disease, but Gingrich summarizes this chapter by saying, “Addiction is not a moral failing or a lack of strong will. It is not a choice, it is a disease.” That negative stigma plays a significant role in hampering effective treatment.

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