Follow the evidence to treat opioid addiction

On Friday, just days before President Trump’s declaration of the opioid epidemic as a national public health emergency was due to expire, the acting director of the Department of Health and Human Services renewed it for another 90 days. The declaration sparked little progress in its first 90 days, making it seem like just another symbolic gesture. That’s a shame because the fight against addiction demands real action. With lives hanging in the balance, we urge the Trump administration to use the renewal to take strong steps to stop a vexing problem that affects communities across the United States.

The Centers for Disease Control and Prevention recently reported that more than 63,600 people died from drug overdoses in 2016 (the last year with complete statistics); more than two-thirds of those were due to opioids. It was the worst year on record — and even more families lost loved ones to opioids in 2017.

This is tragic because decades of scientific evidence show that addiction is a disease that can be effectively treated, and that proper treatment reduces the risk of overdose, helps people recover and live productive lives, and saves money. This was definitively documented in the Surgeon General’s Report on Alcohol, Drugs, and Health.

Yet only 1 in 10 Americans with a substance use disorder receive treatment for it. Even more tragic, the few who do get treatment often receive advice that isn’t based on solid evidence. At a loss for real answers, thousands of Americans are forced to navigate a scattered system of 14,000 programs that aren’t required to meet a standard set of medical qualifications.

The Trump administration could help improve the treatment of substance use disorder by following the recommendations of its own Commission on Combating Drug Addiction and the Opioid Crisis.

One recommendation urged federal agencies to analyze the quality of the various types of addiction treatment. This would give patients confidence that they are receiving treatments proven to work. It would also provide a framework for medical providers to turn to when helping their patients decide the best treatment options for their situations.

While every patient’s situation is unique and should be evaluated on an individual basis, research shows that long-term treatment with FDA-approved medications is the most effective form of treatment for those with opioid addictions. The FDA has approved three medications for this treatment: methadone, buprenorphine, and naltrexone. All three significantly increase the likelihood that individuals can recover to live healthy lives.

There are, however, significant differences in how each medication works and which one is best for which patient. Providing access to all three medications is essential — as is the case for many other diseases, the right medication and treatment plan should be focused on the patient.

Unfortunately, for decades we’ve largely avoided the science of addiction and its treatment and stigmatized the use of these medications. Today, only a small fraction of programs offer all three medications. Among those that do, unnecessary barriers are often put in place to limit access to care.

Far too many people we know, like Gary’s son, Brian, experienced this firsthand. He attended eight different addiction treatment programs. Only one of them offered effective medication treatment and a subsequent program stopped the medication. Six months later, Brian took his life, writing in a note about his anger with the treatment industry.

Imagine if we treated any other illness the way we treat addiction. If Brian had cancer and his effective chemotherapy was suddenly stopped, resulting in death, it would be medical malpractice. Instead, this is the scary reality that patients with addiction face daily.

Even as our leaders in Washington, D.C., and the states must do more, those in the private sector can also lead the way on improving treatment for Americans with substance use disorders. The Substance Use Disorder Treatment Task Force brought together health insurers, advocates, provider groups, and researchers to turn existing research into action. At the end of last year, the task force announced that 16 health care payers had adopted eight principles of care for addiction treatment. Access to FDA-approved medications and therapies based on an individual’s diagnosis, preferences, and medical necessity are key parts of those principles. And for the first time, health care insurers committed to identify, promote, and reward care that includes these medications and other recovery support services.

The medical community must also step up. More physicians, nurse practitioners, and physician assistants need to get the proper training to offer patients with substance use disorders effective medications to quell them.

Just as with cancer or diabetes or other chronic conditions, the public, private, and medical sectors have the power to save the lives of those struggling with addiction. But their efforts won’t pay off until we use every clinical tool available to us. Payers need to cover and properly reimburse all three types of medication for addiction treatment — the Trump administration can provide incentives to do that. Treatment programs need to support, offer, and fully explain their benefits — the government can issue guidelines that encourage this. Clinicians need to get on board with evidence-based treatment options. And patients need to be empowered to ask for treatment without fear of shame and stigma, and be fully assured that they are receiving the right care and advice.

To effectively fight this deadly epidemic, we need everyone to play a role and do what they can to save lives.

Sarah Wakeman, M.D., is the medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School. Gary Mendell is the CEO of Shatterproof, a national nonprofit devoted to ending drug and alcohol addiction.