In Drug Epidemic, Resistance to Medication Costs Lives; Too Few Health Professionals Have Training in Addiction Medicine
By Christine Vestal, Stateline, Pew Trusts*
DEADLY BIAS: Why Medication Isn’t Reaching the Addicts Who Need It, Part I
Dr. Marvin Seppala wrote a book on conquering drug addiction with counseling and group therapy. The spiritual, abstinence-based strategy pioneered by Alcoholics Anonymous helped him overcome his own alcohol and cocaine addiction when he was 19. As medical director of Minnesota's fabled Hazelden clinic, he watched it work for patients.
He believed in it — and then he changed his mind.
In 2007, Seppala began working at Beyond Addictions, a now defunct treatment center in Beaverton, Oregon. Instead of relying solely on counseling, the center gave its patients a relatively new medication, buprenorphine, to relieve their drug cravings.
Back in Minnesota, his patients had been bailing out of treatment to use illicit drugs again. In Oregon his patients on buprenorphine weren't relapsing or overdosing — they reported feeling "normal" again.
Nearly a decade later, doctors and brain researchers agree that medications such as buprenorphine, methadone and naltrexone are the most effective anti-addiction weapons available. Nevertheless, more than two-thirds of US clinics and treatment centers still do not offer the medicines. Many refuse to admit people who are taking them.
The result is that hundreds, perhaps thousands, of Americans are dying unnecessarily, victims of an epidemic that killed more than 28,000 people in 2014 — more than auto accidents, homicides or suicides.
The research is unassailable: Staying in recovery and avoiding relapse for at least a year is more than twice as likely with medications as without them. Medications also lower the risk of a fatal overdose.
Addicts who quit drugs under an abstinence-based program are at a high risk of fatally overdosing if they relapse. Within days, the abstinent body's tolerance for opioids plummets and even a small dose of the drugs can shut down the lungs.
And yet as the country's opioid epidemic worsens — every day, more than 70 Americans die from overdoses, and the numbers are climbing — only about a fifth of the people who would benefit from the medications are getting them, according to a new study by the Johns Hopkins Bloomberg School of Public Health.
"When we discovered medications that worked for AIDS, deaths immediately plummeted. It became a chronic disease instead of a terminal disease," said Dr. Andrew Kolodny, chief medical officer of the Phoenix House treatment centers, based in New York.
"This epidemic could be the same," he said. "We have medications for addiction now. But unfortunately, we're not making them available enough."
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