Addiction is a disease, not a moral failing.
Stigma associated with drug use is a major impediment to implementing the solutions required to prevent it. Addiction, similar to most medical diseases, including diabetes, heart disease and cancer, has many determinants, including lifestyle and health choices — but blaming individuals for their disease is detrimental to healing and health.
There are no simple solutions to the opioid epidemic.
It will require tightly interrelated efforts in awareness, prevention, prescription medicine, law enforcement, medical response, treatment, recovery, and support for families. Each of these areas is dependent on the others.
The opioid epidemic will be solved community-by-community, neighbor to neighbor.
Local, state and federal government are essential partners in crafting solutions, but real progress can only be made with engaged, informed communities focused on action.
There are three overlapping paths, including but not limited, to opioid addiction.
The first is over-prescription and over-use of prescription painkillers. The second is self-medication for a mental health issue. The third is over-use of drugs for recreation. Choice is an abstract concept in at least the first two, where a trusted doctor has prescribed medication and where underlying health issues necessitate self-medication. The latter can begin with opioid use or with a slow progression of other substances, moving into opioid use.
“Just Say No” messaging is ineffective
…especially in the case of the opioid epidemic. Using opioids changes the brain’s chemistry and removes the idea of “choice” from the equation. We do not use scare tactics to scare people into not using drugs. Instead, we provide knowledge and encourage healthy choices. Programs designed to enable young people to make these healthy choices should begin at an early age, namely, during elementary school education.
Patients and doctors should partner to decide what medications are right for pain
…but remain fully aware of the potential hazards associated with opioids. Some patients will need prescription opioids to manage their pain; others can manage pain using other methods. Insurance companies should pay for comprehensive pain management rather than simple provision of opioids. When opioids are prescribed, they should be used in as low a dose and for as short a time frame as possible. For longer term prescriptions and if appropriate, a carefully thought-out plan should be considered to gradually bring the patient off the medication.
All public and private payers—as well as pharmacy benefit management companies—must ensure that patients have access to affordable, non-opioid pain care. Additionally, doctors must disclose prescriptions that fall within the opioid drug family that may not be recognized as an opioid (i.e.: Norco, Exalgo, Hysingla, Actiq, Kadian, etc.)
Thoughtful limitations on prescription length and strength, as well as robust, cross-state prescription drug monitoring programs are essential to limiting new cases of substance use disorder.
However, this will only be effective if programs are implemented to prevent existing substance-dependent people from turning to illicit opioids.
One does not need to be in active addiction to be killed by a single dose of any drug when fentanyl and carfentanil are present.
With strong drugs like fentanyl and carfentanil entering the system, and drugs other than heroin, such as benzodiazepines (Xanax), cocaine and methamphetamines, one-time use can result in fatal consequences.
Naloxone is a safe and effective medication that can reverse an opioid overdose
…overdose by temporarily blocking the opioid receptors in the brain. Knowing how to use naloxone and keeping it within reach can save a life, especially for those who may interact with high-doses of prescribed or illicit opioids, including family and friends of people with substance use disorder and community members who interact with people at risk for opioid overdose. It is a key tool in the fight to stop the addiction fatality epidemic.
Medication Assisted Treatment (MAT) is an evidenced-based treatment that combines behavioral therapy and medications to treat substance use disorders. It is often needed to successfully maintain long-term recovery from opioid addiction.
MAT is not“substituting one drug for another.” The medication element of MAT helps stabilize individuals, enabling more effective treatment of their medical, psychological, and other problems so they can contribute effectively as members of families and of society.
Treatment and recovery for addiction is effective and can take many forms.
Whether it is faith-based, counseling, harm reduction, self-help meetings, or inpatient treatment, it must be based on what works for the person seeking treatment and recovery, not what others think or say.
Addiction treatment should include careful screening for any associated mental health disorders.
A separate mental health issue is very frequently associated with addiction. Thus, mental health must be a component of any treatment program. Moreover, greater care needs to be taken in prescribing drugs (such as Adderall) for people diagnosed (or misdiagnosed) with a mental health issue such as anxiety or depression.
Patients who survive an overdose and are then released without immediate follow-on support are in grave danger of overdosing again and death.
Treatment and recovery in the wake of an overdose are far more likely to be successful with immediate counseling to accept an initial dose of craving-reducing medication followed by expeditious handoff to an inpatient or outpatient treatment program. This process is commonly referred to as a “warm handoff.” When followed by successful transition into a recovery program, this end-to-end protocol provides both lifesaving treatment and transition into the care a patient needs for their underlying medical condition.
The transition out of in-patient treatment for opioid addiction must be carefully managed,
…with robust follow-up step-down support including, recovery support services, and recovery housing options clearly present. Coming out of treatment, the opioid receptors have been re-sensitized, and an application of the same level of the drug that was necessary during deep addiction can quickly lead to a fatal overdose.
Marijuana should be avoided by anyone under the age of 25 unless taken under the direction of a medical doctor, unless and until the relevant science is clarified.
There is simply not enough research to allow definitive statements about the linkage of marijuana to mental health and other drugs. Meanwhile, marijuana is far stronger than it used to be, and is being aggressively marketed as being safe and in some cases beneficial. Research shows brain development is not complete until age 25, and there is considerable evidence that marijuana inhibits development. Also, there is evidence that early use increases the risk of substance use disorder. We believe that where marijuana sales are legal, packaging should include warning labels in the same manner as alcohol.
Overdose Prevention Use Sites should be prudently and carefully considered and tested.
These sites are not intended to foster sales or use of illicit drugs. Rather, they are intended to prevent diseases transmitted by used needles, to allow trained professionals to prevent overdoses from becoming fatal, and to provide a pathway for encouraging people to seek treatment and recovery.
Arresting people who are only users, not dealers, will not eliminate the epidemic.
When addiction is a factor in criminal behavior, the underlying addiction must be addressed to prevent the cycle of relapse, reoffending, and recidivism. Those selling small amounts solely to support their own addiction should be minimally prosecuted or diverted to treatment and recovery support services. Diversion programs and Drug courts are a far more cost-effective and preferable method for rehabilitating these types of drug offenders than conviction and confinement. However, those who are dealers and not users or who are selling larger amounts should be prosecuted to the full extent of the law before they cause a fatal overdose rather than after.
Far more treatment and recovery support services should be made available within the jail and prison system in the United States.
Treatment should include drug counseling and carefully-provided medication assisted treatment. Recovery support services should include access to a peer worker or a recovery coach within the jail or prison. Special attention should be paid to people with substance use disorder who leave jail or prison, since this transition is a particularly dangerous time for overdose and death.
There should be significantly more medical providers who treat and insurance plans who cover substance use disorder.
Substance use disorder is a disease and should be treated alongside other health concerns. The medical community should support all efforts to increasing patient access to high-quality substance use disorder prevention, treatment, and recovery services. Insurance plans should make sure such access is covered and accessible.