Opioid use victims need more doctors, medical options

September 21, 2018

The first time some people try opiates it may just seem to them like a simple escape from life’s complicated problems. Getting high may put off the tough stuff.

How ironic, and how bitterly true, that what follows is a far more dangerously complicated life whose only options are complex. The many aspects of an individual’s addiction — medical, psychological, social, legal — need different experts. In the throes of the opioid abuse crisis society is still learning about those needs and organizing responses to them.

State and local response teams are making steady progress in increasing public awareness and victims’ access to help, to the extent that the number of fatal overdoses per year may be leveling off. Yet as the Connecticut Mirror has reported, Connecticut still lags in the promising, federally approved approach of medically assisted treatment (MAT).

Obstacles include a shortage of primary care providers licensed to prescribe the so-called replacement drugs and resistance to the idea of such drugs as an option. Primary caregivers can prescribe oxycodone, one of the opioids behind the epidemic, but not the drugs that can help manage the brain disorder they cause.

This is the next set of complications that needs to be resolved to fight the opioid use disorder (OUD) epidemic. By its very definition, an epidemic is a public health emergency. It means many victims needing many physicians treating them with the most effective methods available.

Most important is to remove resistance to the practice of treating with such federally approved drugs as methadone — long in use for heroin addiction, through regulated dispensaries — buprenorphine, also known as Suboxone, and naltrexone. Experts consider them lifesavers because they block the cravings that drive users back to street opiates, where the odds of fatal overdose soar.

Among other roadblocks have been the specialized training needed, either in or after medical school. That should not be insurmountable; the medical schools at Quinnipiac and Yale universities and the University of Connecticut have already incorporated it.

Another is the reported reluctance of some primary care providers to be known as treating substance abuse; yet another is the question of insurance coverage for the drugs and the therapy that must go with the prescription. The statewide opioid task force should be equipped to tackle those, beginning with listening to the concerns of physicans and other providers.

All of those steps depend on addressing the belief that replacing the abused drugs just displaces the problem, rather than treating it. Rehabilitation centers that don’t use MAT, relying rather on counseling, abstinence, and supportive services, have had successes. But not every patient is the same. OUD has been described as a brain disease that is both chronic and relapsing. There is ample evidence of people on MAT returning to productive lives and of people without it relapsing repeatedly, often fatally, despite support.

Advocates of MAT say it is not only medically appropriate but also reduces criminal behavior and HIV cases. Critics point out that the use of substitute drugs is likely to be a lifetime prescription. So are insulin, thyroid drugs, anti-seizure medication, kidney dialysis, and asthma treatment. Many people need those to stay alive. Many people need opiate replacements to stay alive, too.

On Friday Gov. Dannel P. Malloy announced $20 million in federal funds that will, among other things, support access to MAT in two urban locations. Earlier in the week, a U.S. Senate bill passed with bipartisan support; it authorizes a multi-pronged approach, including authorizing such federal agencies as the National Institutes of Health and the Food and Drug Administration to encourage research by pharmaceutical companies and smaller packaging of opioids. It also seeks new funds for treatment centers, training emergency workers and researching prevention. The bill must await appropriations, compromise with the House version, and the president’s signature,

One of the guiding principles of emergency medicine is to save a life now and deal with the long-term implications if skill and luck do manage to save it. This shouldn’t be any different. Government at all levels is recognizing the need to increase MAT availability as part of an all-fronts attack on this epidemic. Who knows what alternatives future medical research may find?


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