Before he resigned as Health and Human Services Secretary, Tom Price created a bit of an uproar over comments about medication-assisted treatment for opioid addiction. It was reported that former Secretary Price stated that providing drugs that reduce craving for opioids is just replacing one opioid for another. To a point, that is true. But it is not that simple. Secretary Price’s comments were somewhat more nuanced but the news reports that Secretary Price suggested that medication-based treatment for opioid addiction was not an effective treatment prompted 600 medical experts and academics to pen a letter to Secretary Price asking him to reconsider.
Secretary Price is no longer head of Health and Human Services but the issue of medication-assisted treatment as one option to address this country’s opioid crisis. The medication treatments most commonly used to treat opioid addiction, buprenorphine, naltrexone, and methadone, are called “opioid agonists” or “partial agonists.” These drugs activate receptors in the brain, creating a high similar to what the addict experiences when he or she takes other opioids but the drugs do not have the same effect of physiological dependence, nor do they make the user feel euphoric.
While the treatment drugs do activate opioid receptors, they do so less strongly and they relieve drug cravings and withdrawal symptoms. It is true that with medication-assisted treatment, the addict may never be free of drugs but the drug they are taking allows them to function normally, without the causing the user to be a highly addicted individual ever searching for a stronger fix. Furthermore, the treatment drugs do not render the user unable to function normally. By substituting a medication-based treatment for an opioid addiction, the former addict has the opportunity to become a contributing member of society rather than a strung-out addict looking for the next high, possibly stealing from others to get the money to feed his or her addiction.
Medication-assisted treatment has proven to be highly effective and safe. Yet there remains a social stigma against providing addicts with another opioid to treat the addiction, especially when it is the government that is funding or providing the treatment. Yet, the treatment is more effective and safer than going “cold turkey.” Abstinence-only treatment often leads to relapse and can result in death because the person’s tolerance is reduced by the abstinence and upon relapse, he or she may overdose. But unfortunately, for about 40% of the opioid-addicted population medication-assisted treatment does not work. And then there’s that stigma issue.
But attitudes are changing. There is the recognition that addiction itself is a disease, not a matter of willpower. The disease cannot be cured but it can be managed. One powerful tool is medication-assisted treatment and the treatment is becoming more widely accepted. Even the Hazelden Betty Ford Foundation, one of the preeminent drug treatment providers in the country, and one which based on the 12-step program previously subscribed to the abstinence-only treatment model, has switched to medication-assisted treatment for opioid addiction.
It is estimated that 91 Americans die every single day from opioid overdose. Numerous studies and extensive research indicates that medication-assisted treatment can cut those deaths by half. That is an amazing outcome and one that this country can hardly afford to ignore.
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