THE COMMONWEALTH is in the midst of an opioid epidemic and, commendably, many have mobilized in an attempt to stymie it. Governor Deval Patrick pledged $20 million for addiction treatment and recovery services after at least 185 residents died from heroin overdoses during a recent four-month span. Boston Mayor Marty Walsh proposed a new Office of Recovery Services to strengthen coordination and collaboration among health care providers. Families affected by opioid addiction, led by such stalwart organizations as Learn to Cope, have clamored for additional residential treatment beds for their loved ones.
With all of these undoubtedly well-meaning efforts ongoing, however, it is shocking to see these groups — patients, their families, and government officials — overlook treatments that have been proven to work.
Medication-assisted treatment for opioid addiction has been shown in multiple rigorous clinical trials to increase the likelihood that patients will be able to remain abstinent from the heroin or prescription opioids like oxycodone that fueled their addiction. Buprenorphine and methadone are opioids that prevent patients from feeling “dope sick” or overrun by withdrawal symptoms like cold sweats, muscle aches, and anxiety that often lead to relapse. Naltrexone is an opioid blocker that prevents the powerful highs of opioids. All three of these medications have success rates around 50 percent after three months when the patient also participates in counseling. Research also shows, chillingly, that over 90 percent of those with opioid addiction relapse without the sustained effects of medication-assisted treatment. Patients are prescribed these medications because their addiction has caused problems in multiple areas of their lives such as work, school, or relationships. When medication-assisted treatment works, patients get back to functioning in work or school and can begin to make amends in their relationships.
There is a stigma against medication-assisted treatment, though, so many involved in the treatment of opioid addiction don’t want to use these medications, despite the data supporting their effectiveness.
Patients and their families worry about “trading one addiction for another.” Many do not see addiction as a chronic medical illness like asthma, diabetes, or high blood pressure, conditions for which few think twice about taking a medication. Sadly, it has become increasingly more common for self-help groups like Alcoholics Anonymous and Narcotics Anonymous to pressure attendees to rely upon willpower instead of medications. Sometimes it is difficult to convince these groups, as well as residential treatment facilities with 12-step orientations (the core of AA and NA), to see both self-help groups and medications as critical pieces of a successful treatment plan.
The lack of an endorsement of medication-assisted treatment by government officials is noticeable as well. In fact, the City of Boston recently announced plans to close the Public Health Commission’s Frontage Road methadone clinic, widely regarded as an outstanding and integral part of the addiction treatment landscape in Boston.
Even some doctors have joined the chorus against prescribing or recommending medication-assisted treatment. Many have become discouraged with research suggesting that patients with opioid addiction need medications for months or even years. These doctors prefer to detox, or taper off all opioid medications quickly, although we know that this strategy usually does not work.
Lives are on the line right now in the Commonwealth. We have seen, sadly, how easy it can be for overdoses to occur when opioid addiction is untreated and, importantly, when it is undertreated. So while it is encouraging to see so many mobilizing for such an important cause with enthusiasm and ideas, we must first make sure that we are taking full advantage of the resources that are already available.Dr. Kevin P. Hill is director of Substance Abuse Consultation Service at McLean Hospital.