access to addiction medication

(Twenty-ninth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

Our family loves the art of Dutch mathematician and artist M. C. Escher: the buildings that open into themselves, the school of fish that become a flock of birds, the circuitous stairways that go up and down throughout multiple buildings without an end point. Yes, stairways that never get you where you want to go, but keep you endlessly retracing your steps. They are no longer interesting art to wonder at. They now mirror how John and I have felt many times since August 2nd—regrets—retracing the steps of our entire lives.

In a conversation with a friend, she felt that drug addiction was basically related to poor choices and that recovery was also just a matter of choosing to stop. I guess at the core of it, she is right. An addict needs to decide they want to stop – but then what? Do they just exert will power, go through withdrawals and possibly a 12-step program, then all is well?

Sadly, this simplistic approach will not work for most opiate addicts. The physical changes that have taken place in the brain that cause the addiction need time – and lots of it – to even partially regenerate. The Ohio Society of Addiction Medicine recently posted this (https://ohsam.org/2018/01/12):

“Studies…have found that opioid addiction medications in general cut all-cause mortality among opioid addiction patients by half or more. The CDC, National Institute on Drug Abuse, and World Health Organization acknowledge their medical value.”

The blog continues to discuss the lack of access that the majority of addicts in America have to the three medicines that specifically treat opioid addiction and some of the reasons for it:

“A major reason for that is stigma. These medications are often characterized as ‘replacing one drug with another’…This fundamentally misunderstands how (opioid) addiction works. The problem is not drug use per se; most Americans, after all, use caffeine, alcohol, and medications without major problems. The problem is when drug use becomes a personal or social burden — risk of overdose or leading someone to commit crimes to obtain drugs. Medications for opioid addiction, by staving opioid withdrawal and cravings without leading to a significant risk of overdose, mitigate or outright eliminate those problems — treating the core concerns with addiction.”

Then there is the issue of large segments of the country without doctors who can prescribe buprenorphine/naloxone due to licensing limits – and the costs for patients.

“In a 2016 report by the surgeon general, just 10 percent of Americans with a drug use disorder obtain specialty treatment…attributing the low rate to severe shortages in the supply of care, with some areas of the country lacking affordable options for any treatment — which can lead to waiting periods of weeks or even months.” By then, it is too late for many addicts seeking help.

“Another reason for the treatment gap is a lack of federal attention…the Cures Act committed $1 billion over two years…woefully short of the tens of billions annually that experts argue is necessary to deal with the opioid epidemic…the total economic burden of prescription opioid overdose, misuse, and addiction of $78.5 billion in 2013, about a third of which was due to higher health care and addiction treatment costs.”

I can say that our son desperately wanted to be free of his addiction that started when he was too young to realize the ball and chain that would drag him down and keep him from his hopes and dreams – and eventually take his life. Thankfully, he did have access to some medical help. Incredibly, even after so many relapses, his father and I felt he could beat his addiction without medication – if he just worked harder. We were sadly mistaken.