The use of opioids in the United States has forced many communities and organizations to reflect on previous practices and policies. In order to do this, they must honestly acknowledge their definition of addiction and how to treat this problem. This means that decision-makers and health professionals must formulate an answer as to what is a good policy for addiction treatment?
There is still a stigma with being labeled an addict, with the addiction seen as a sign of moral weakness. This line of thought advocates drastically limiting people’s access to addictive opioid-type drugs, similar to a “tough love” approach. Other policies argue that one should allow individuals suffering from opioid addiction to gain access to opioid replacement medication like buprenorphine and naloxone. This viewpoint operates on premise that addiction is a disease much like diabetes, so it requires ongoing medical treatment. Both viewpoints want individuals suffering from addiction to successfully detox and stop use opioid drugs. However, the best policy to achieve this outcome is still debated.
According to the Washington Post and the Centers for Disease Control and Prevention, in 2015 over 52,000 individuals died from drug overdoses. The National Centers for Health Statistics states that this trend has only intensified in 2016, with drug overdoses continuing to rise largely due to the use of heroin and fentanyl. Many health professionals state that these opioid deaths were indirectly caused by an earlier exposure to highly addictive opioid drugs through prescription painkillers. As a response to these alarming rates of opioid addiction and overdoses, many states have started to enact tighter restrictions on the number of opioid-type painkillers that a physician can prescribe. The various state laws range from limiting the number of days an initial opioid prescription from 3 to 7 days to setting opioid dosage limits. At the federal level, legislation has been proposed that limits the use of an initial opioid prescription to seven days. However, this legislation excludes the treatment of cancer, chronic pain, palliative and hospice care.
At first glance, these restrictions seem like a good idea, but some doctors are concerned that their profession is being blamed for the opioid epidemic. These doctors argue that the delivery of good healthcare is personal and tailored to the individual needs of the patient. But, with the creation of inflexible mandates like this, some healthcare practitioners feel unable to perform any kind of personalization. It creates a cookie-cutter approach that overlooks the best judgment of a physician.
There are designated programs for opioid addiction, such as medication-assisted treatment (MAT) which includes opioid treatment programs (OTP). This treatment approach combines behavioral health therapy with specific medications that treat substance use disorders. Federal, state and local governments have created opioid treatment and recovery programs, but more resources are needed. In order to meet this need, the 21st Century Cures Act allocated half a billion dollars for treatment and recovery programs in 2017. Another half a billion has been allocated for 2018.
It must be remembered that the topic of opioid addiction is a divisive issue. Political debates often include arguments as to whether “addiction” is a disease or a moral failing on the part of the individual. Individuals involved in addiction recovery programs like narcotics anonymous or alcoholics anonymous are often confronted with these arguments. As a frame of reference, it should be noted that more people currently die from alcohol-related deaths than opioid-related deaths. This political uncertainty is evident when examining what MAT drugs are covered by Medicaid. Insurance coverage for some MAT medications is available, but some barriers exist for patients seeking additional treatment.
Opioid Crisis, Addiction Treatment Debate,
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