I had the privilege last week of testifying before both the House and the Senate Health Committees in support of the governor’s proposal to address the state’s opioid epidemic. As the CEO of the largest Opioid Treatment Program network in the state, I was enthused to see the passion of our state leadership toward dealing with this important issue.
However, I was also very shocked at many of the misconceptions held by both our state leadership and by other behavioral health providers on the efficacy of treatment modalities for treating those suffering from opioid-use disorders (OUDs). In fact, these very misconceptions and the stigma that they promulgate are some of the largest reasons why people avoid seeking necessary treatment. Below are a few of the questions that were raised during these hearings.
Are there more effective treatments than medications for treating those suffering from OUD?
The addiction treatment infrastructure in the United States was built over the last several decades to primarily treat alcoholism and other substance-use disorders without the use of medications; thus when talking about addiction treatment we repeatedly hear of a need for “beds” and detox facilities, which historically have not incorporated Medication-Assisted Treatment (MAT) into their treatment protocols. However, many people erroneously think that we can rely on this infrastructure to treat the current opioid epidemic that is ravaging our nation. Research tells us that opioid dependency needs a very different modality of treatment than other types of addictions. In fact, SAMHSA, the CDC, the WHO and all other major global and national health agencies agree that MAT is the most effective treatment for those suffering from OUD and that detox and in-patient treatment without MAT works for approximately 8 percent to 10 percent of those suffering from OUD . Methadone treatment has more research behind it than any other treatment for any type of addiction ever studied and research has confirmed that MAT, and methadone treatment in particular, decreases overdose death rates by 75 percent. In fact, research tells us that if someone enters into inpatient detox treatment for OUD, they are more likely to die of an overdose after treatment than if they were to drop out of treatment prior to completion. Yet only around 20 percent of those suffering from OUD actually get MAT.
MAT is just a short-term treatment to help someone recover from the effects of opioids.
While detox and in-patient care might be appropriate for users with shorter histories of opioid use who don’t meet the diagnostic criteria for OUD, brain scan technology tells us that it takes at least 14 months for the brain of someone with a longer history of use to heal and sometimes much longer. That is why short-term treatment modalities do not work for treating OUD. According to former Surgeon General Vivek Murthy, “Patients who receive MAT for fewer than 90 days have not shown improved outcomes. Individuals who receive MAT for fewer than three years are more likely to relapse than those who are in treatment for three or more years.”
Aren’t treatments such as methadone and buprenorphine, which are both opioids, simply replacing one addiction for another?
Methadone and buprenorphine actually have more chemical similarities to the brain’s natural opiates (i.e., endorphins) than to opioids, which is why these medications don’t cause a high when given in stabilizing dose. When someone uses illicit opioids for extended lengths of time, their brain ceases to produce its own endorphins without an external stimulus; thus MAT replaces the lacking endorphins, which stabilizes the person’s brain so they can deal with the psycho-social components of their addiction.
Isn’t it sufficient to provide just one medication to those suffering from OUD?
Much like with treating other disorders, different people respond to different medications. While research shows that each medication is equally effective when matched with the right person, it is a leap to say they are equally effective for the population as a whole. For instance, researchers have identified the gene that determines if people will respond to naltrexone treatment and have shown that only a minority of the U.S. population actually carries the gene. In an attempt to determine the best treatment modality for the largest number of people, researchers have randomly assigned patients to different modalities in the same setting and found that methadone treatment works for a larger number of people than other medications. Thus limiting the options to one or two medications would substantially decrease the success rates of MAT. As such, the treatment setting along with the patient’s use history and genetics all need to be taken into account when determining the appropriate medication.
In reality, the most effective treatment modality is a combination of many treatments tailored to each individual’s needs. However, it is imperative, in the midst of this epidemic, that we base our decisions on facts and evidence rather than on philosophies, vested business interests, anecdotal evidence or personal experiences. Only then will we be able to move the needle in this arduous fight.
— Nick Stavros is chief executive officer of Community Medical Services.
The views expressed in guest commentaries are those of the author and are not the views of the Arizona Capitol Times.