Where do we go from here?

Today it is almost impossible to listen to the news or open a newspaper or magazine without finding something about the opioid crisis. Numerous articles summarize the problem, both on the national and local levels. Political, law enforcement, health and drug rehabilitation leaders are talking about the devastation and cost in human and financial terms and everyone is looking for or proposing solutions.

Where are we today?

The following figures are taken from an article entitled Drug overdose deaths in the United States continue to increase in 2015, a summary on the Centers for Disease Control (CDC) website. Likely, the situations has worsened since 2015.

  • Six out of ten overdose deaths involve an opioid.
  • The number of overdose deaths involving opioids (prescription and heroin) has quadrupled since 1999.
  • Deaths from prescription opioids such as oxycodone, hydrocodone, and methadone more than quadrupled since 1999.
  • More than 500,000 people died from drug overdoses between 2000 and 2015.
  • 91 Americans die every day from an opioid overdose.
  • The amount of prescription opioids sold to pharmacies, hospitals, and doctors’ offices nearly quadrupled from 1999 to 2010 without an overall change in the amount of pain being reported by Americans.

Recently, it was reported that “opioids take about 2½ months off our lives”,  contributing to a lowered American life expectancy according to an analysis published in the medical journal JAMA. See: Opioid overdoses shorten US life expectancy by 2½ months

How did we get here?

Books, such as the must-read DreamLand by Sam Quinones, tell a fascinating and horrifying story about how we got here: the mistakes that were made by the medical community, the role prescription drugs have and are playing in fostering illegal drug addiction, the deceptive marketing by opioid manufacturers and the opportunistic growth of entrepreneurial drug-pushers that deliver phone-ordered heroin in towns across the United States.

In short, the current crisis didn’t “just happen.” It was the result of systemic mistakes and the hard, dedicated work of drug pushers on both the street corner and in corporate offices.

What is the solution?

Many stakeholders contributed to the problem and it took many years to grow into the disaster it is today. Given that, it is safe to assume the problem will not go away overnight and that it will take the work and dedication of many to undo the damage. Just as there were multiple contributory factors, so too should our efforts to solve it be multi-faceted.

When it comes to treatment, no single approach is uniformly successful. So, fostering a range of options would seem to give us the best chance to make maximum progress.

When we discuss medical opioids, a major factor that accelerated the growth of the crisis was a radical shift in prescribing patterns resulting in a market flooded with addictive drugs. Fixing those patterns to discourage over-prescribing will be part of any lasting solution.

When we look at prevention, education will be key to any long-term success:

  • Broad, effective education for children, teens and parents about the dangers of opioid addiction.
  • Better education of doctors into safe prescribing practices and early recognition of developing addiction.
  • Widespread education about the benefits and risks associated with each kind of treatment and rehabilitation option.
  • More education and better general understanding of how pharmaceutical company marketing is done and its potential to obfuscate problems associated with certain kinds of medication.

How does MAT fit into it?

MAT is a treatment alternative, but it is not the only alternative. It is an example of the larger trend which is to categorize addiction as strictly a “brain disease” while effectively minimizing social, financial, family, education and economic factors. When addiction is framed as nothing more than an intractable physical disease, lifelong medication becomes the “logical” answer. This is an important philosophical disagreement that has serious downstream policy ramifications when implemented in ways that narrow the options available to addicts, their families and caregivers. For example, some MAT proponents claim it should be viewed as the only legitimate methodology for opioid treatment. That mindset is counter-productive and threatens to reduce choice within the treatment and rehabilitation field, a field that needs as many options and as much activity as possible.

It would be foolish to suggest that MAT doesn’t have a place, but it would also be foolish to believe it should be our only approach. A key purpose of this site is to examine issues surrounding the notion that addiction is nothing more than a brain or physical disease and to encourage a policy of treatment that is both inclusive and embracive of diverse modalities. It is also important that we examine any possible unintended consequences that might be attendant on a mandated, across-the-boards enforcement of MAT — we certainly have a wealth of experience that demonstrates how bad things can get when shifts in medical practice flood the market with new, powerful opioids.

The intention behind this site is to encourage a measured, multi-armed attack on a crisis that has already destroyed far too many lives.