I attended my first Rx Drug Abuse and Heroin Summit recently, the first week of April 2018.

It was a fascinating four days and gave me an entirely new level of understanding of the problem we’re facing with opioids and other drugs. That absolutely includes a better appreciation for the heroic, often thankless, job being done by the people on the front lines dealing with the ravages of addiction and the inflow of drugs into our country. The Summit made it clear to me there are a tremendous number of people who care deeply about the problem and are working every day to address it.

Although the Summit deserves and likely will result in multiple articles on our site, an overview is in order. To begin, some aspects of it concerned me — the sometimes extreme rush to Medication-Assisted Treatment (MAT) with a focus on long-term even life-long use of MAT drugs — being the primary one.

The official message of the Summit was clear: to encourage the widespread distribution and use of MAT drugs such as methadone and Suboxone. The problem with that message is only partially contained in what it says. Additionally problematic is what it doesn’t say: how to address the long term family, economic, community and personal needs of individuals and families afflicted with addiction and how to succeed at prevention.

It is just not possible to simply medicate ourselves out of the opioid and more general drug abuse crisis.

A cynic might say the single-mindedness of the message aligned well with what pharmaceutical industry marketing departments would like us to hear. Unfortunately, that observation should not be limited to the cynic — Big Pharma has had and continues to have an outsized influence over the conversation about addiction.

I left Atlanta with three new, important and  easily stated high-level policy issues that require vital address for the health of our country and all Americans. One could look at these as questions that require answers but as-yet do not appear to be integral parts of the rhetoric driving policy decisions.

These three, all related to MAT, are:

• Outcomes
• Choice
• Unintended consequences

Outcomes

Although it is important to discuss the actions we to take to address the current crisis, it is also vital we remember to talk about outcomes. When someone enters treatment, what outcomes are possible and what should we be shooting for?

Should our default, preferred outcome be rehabilitation — a person returned to a drug-free, productive life — or should we direct our efforts to keeping an addicted person on a long-term maintenance program, likely for the rest of their lives? (Those are obviously not the only possible outcomes, just two important ones.)

This isn’t to say there is a one-size-fits-all outcome for everyone. It just says we need to ensure we don’t lose sight of where we would prefer to end up.

Choice

At the Summit I heard a range of stories about people in recovery and programs that serve them. If it wasn’t clear before, it became obvious that a range of choices should continue to be a key policy imperative.

Sometimes, the way heavily MAT-oriented approaches are presented, it sounds like no one will ever successfully move into recovery without medication. But history belies that view. When statistics are presented decrying how few people receive MAT, we are never given the other side — the overwhelming number of people who have been successful in recovery without MAT, often without any treatment. We could and should study what makes those people successful and apply those learnings to help others. Unfortunately, no matter how beneficial those studies could be, they would not contribute to any large industry bottom line.

Everyone knows someone who was able to overcome an addiction and those successes come from a wide variety of approaches, sometimes including MAT. Each individual and family should be empowered to choose their recovery path. But if MAT is the only method trumpeted by the medical establishment and Big Pharma, other choices with valid and vital roles will be squeezed out. The consumer’s right to choose their treatment approach should be a key factor driving government responses to the addiction crisis.

The bottom line: choice is important.

Unintended Consequences  

A charitable view of the current opioid crisis says it is at least partially the result of the power of unintended consequences.

The “fifth vital sign,” sometimes myopic efforts to address the very real problem of chronic pain and horribly misconstrued comments about the addictive nature of opioids helped to get us into the mess we’re in. Of course, not everything that has happened is a result of unintended consequences — hundreds of lawsuits against opioid manufacturers are making the strong point that there are institutions and individuals who are culpable.

But, the history of drug policy and addiction has been rife with unintended consequences.

It is important we discuss such possibilities by asking questions like these:

• Diversion of Suboxone is already a problem — what issues will we face if it is made much more broadly available?
• What are the long-term effects of taking buprenorphine for years, even decades? We already have evidence that long-term methadone maintenance has deleterious consequences — what about buprenorphine?
• And what are the long-term effects of vivitrol? Or the next generation of treatment drugs already in the Big Pharma pipeline?

If we don’t have ongoing conversations about outcomes and we don’t support policies that strengthen and broaden treatment choices but instead put all our eggs in the MAT basket, what unintended consequences will result? For example, what happens to the thousands of treatment and support services that have operated for decades, providing help and succor to millions?  

The point is simply that when it comes to drugs, we have fallen victim to unintended consequences many times in our rush to address the current problem-at-hand. We need to more fully consider how the actions we take today will affect tomorrow.

Conclusion

Though none of these three issues — outcomes, choice and unintended consequences — were specifically called-out in the keynotes I attended, I did hear them being discussed by Summit attendees.

There is obviously a lot of work to be done and no single group or individual has the complete answer but by keeping these three subjects in mind I believe we can move towards a better solution to the crisis of drug abuse that has so devastated individuals, families, communities and the quality of life for all of us.