We have the power to prevent thousands of deaths from opioid overdoses. So why haven’t we?
With about a 200% increase in overdoses since 2000, it's clear that what we’re doing now isn’t working, and Americans from all walks of life are dying as a result. Drug overdoses now outpace car crashes as the leading cause of accidental death in the U.S. In 2014, more than 47,000 people died this way.
Compounding the tragedy, we already have innovative recovery medications that successfully stabilize people addicted to prescription painkillers like oxycodone and fentanyl, but these treatments are out of reach for most people who need them. Waiting lists for treatment can be as long as one year. Some doctors have more than 100 people on their waiting lists for receiving recovery medication.
That’s why this week we are launching Advocates for Opioid Recovery to break down barriers to treatment, so people who want help can receive treatment that works.
Science is on our side. Studies show that opioid addiction is a chronic brain disease to which some people are genetically predisposed. One patient may be prescribed painkillers after an injury or a surgery and not become addicted, while the next patient may fall into a long-term dependence. Like diabetes and asthma, it’s not likely to be beaten by sheer will power, but must be managed and treated like any other chronic disease. The Centers for Disease Control found that traditional forms of treatment tend to fail: Eighty percent or more of those in treatment for addiction will relapse. Talk therapy is part of the solution, but it is only part of the solution.
Many studies have shown that medication is effective in promoting long-term recovery by reducing cravings for opioids, lowering the risk of fatal overdoses, and increasing the chances of recovery. A study published in the New England Journal of Medicine found that the recovery drug buprenorphine reduced the craving to use an opioid by roughly 50% and increased the odds of not taking an opioid by about 3.5 times. Other drugs, like naltrexone, have also shown promise. The more quickly people living with addiction can access recovery medication, the more likely they are to succeed in long-term recovery.
Urgent change is needed.
First, Congress must fix the national shortage of physicians who are certified to prescribe opioid recovery medication. Ironically, there is no limit on the number of opioid painkillers a doctor can prescribe but there are laws that restrict the number of addicted patients a physician can treat—30 in the first year, and a maximum of 100 patients thereafter. The cap was put in place in 2000 to combat a real concern that pills or dissolvable film would be diverted for use on the street. A limit of 100 patients might have been sufficient 15 years ago, when opioid addiction was a much smaller problem, but today it is killing people on waiting lists to be treated.
Given the scale of the crisis, capping prescribers is no longer a reasonable solution, and Congress’s failure to change or eliminate these arbitrary restrictions amounts to political malpractice. Instead, government should look to the private sector for better solutions, and rapidly adopt innovations such as the recently FDA-approved Probuphine, which is implanted under the skin, dramatically reducing the likelihood of diversion and eliminating the need for caps on prescribers. We should also allow nurse practitioners and physician assistants to prescribe the medication as part of a comprehensive treatment program.
Second, public and private insurers need to start covering treatments with medication in the same manner as they cover treatments for any other chronic disease. Insurers would have a hard time denying a person with high cholesterol a statin, and the same should be true for patients recovering from an opioid use disorder. No one should be forced to wait for an insurance company to decide to cover effective treatment when the cost of such delay might be a fatal overdose.
Third, drug courts must allow and encourage treatment with medication as part of sentencing. As recently as last year, some drug courts banned the use of treatment with medicine, requiring defendants to cease treatment for their addiction before going to drug court. It makes no sense. While there has been recent progress to remove these outright bans in federally-funded drug courts, some judges’ personal bias and the spread of misinformation continue to place the burden on patients to prove that their treatment is medically necessary.
We wouldn’t tell a person with diabetes not to use insulin. We understand that nicotine replacement therapy is necessary for many smokers to quit their habit. It’s time for fear, bias and ignorance to be replaced with science and evidence. The urgency of the opioid crisis demands that we act immediately to remove the barriers to recovery medication, and give people living with addiction the treatment they need to survive and ultimately thrive in long-term recovery.