- The death toll from the opioids epidemic continues to soar.
- Experts say we already have a science-backed treatment that works: medication-assisted treatment, or MAT.
- The problem, however, is that very few people can get it.
The death toll from the opioids epidemic continues to soar – nearly 64,000 people died in 2016 alone. Scientists are working to find creative tools to fight it, and President Donald Trump has called the overdose crisis a public health emergency. But he has not yet outlined any targeted solutions aside from calling for drug dealers to be given the death penalty.
A growing cadre of health professionals say we already have a science-backed treatment that works. It’s called medication-assisted treatment, or MAT, and it involves administering FDA-approved medications that help curb cravings and reduce the excruciating symptoms of withdrawal.
“Medications are an effective treatment for opioid addiction,”Kelly J. Clark, president of the American Society of Addiction Medicine, told Business Insider.
The problem is that very few people can get those medications.
Only about half of private-sector treatment programs for opioid use disorder currently offer access to MAT, and of those that offer it, only one third of patients actually receive the medication, according to a study published in the Journal of Addiction Medicine.
There are many reasons for this lack of access to medication. Some stem from a misconception about how the treatments – which can include buprenorphine, methadone, or naltrexone – work. The stigma surrounding drug use and addiction plays a role, too. Still other issues include federal and state laws that restrict the availability of the medications.
“It’s more of an implementation problem than a basic science problem,” Clark said, “because we know what works.”
Medications do not ‘substitute one drug for another’
In someone with opioid use disorder, using the drugs is often not a pleasurable experience, but rather a practice that has become a necessary fact of life. Being without the drugs leads to painful symptoms that can include severe nausea, shaking, diarrhoea, and depression. The need to use is simultaneously a physical and emotional compulsion – the lines between those kinds of pain are blurred.
One of the main misconceptions about medication-assisted treatment is that medications simply replace the drugs that hooked users – leading to more highs and fuelling a pattern of repeated use.
But that view is outdated and ill-informed, experts say. Instead, the drugs work by staunching cravings and reducing or preventing withdrawal and relapse. Buprenorphine and methadone help suppress cravings, while naltrexone blocks the euphoric and sedative effects of opioids so users don’t experience a high.
“People ask me all the time, ‘well, aren’t they just substituting one drug for another?’ The answer is no. These are evidence-based treatments and they work,” Patrice A. Harris, the chair of the American Medical Association’s opioid task force and a board certified psychiatrist, told Business Insider.
Several large studies suggest that as access to MAT rises, drug overdose deaths fall. A study of heroin overdose deaths in Baltimore between 1995 and 2009 published in the American Journal of Public Health, for example, found a link between the increasing availability of methadone and buprenorphine and a roughly 50% decrease in the number of fatal overdoses.
“These treatments are life saving and they work,” Sarah Wakeman, the medical director of the substance use disorder initiative at Massachusetts General Hospital and an assistant professor at Harvard, told Business Insider.
From jail to court to rehab, medication-assisted treatment is hard to find
Despite the evidence demonstrating MAT’s effectiveness, it is surprisingly difficult to obtain.
One of the hardest-to-access forms of medication for recovery is methadone. In the US, the medication can only be accessed in specialised clinics; because of the way the treatment works, people on MAT must come to a facility to get their dose daily. But those facilities typically have negative reputations because of policies that restrict them to locations considered seedy or run-down. And patients who come for treatment often have to push past active drug users – a big trigger for someone with substance use disorder – on their way to and from the clinic.
“You can access heroin pretty easily, yet we make it really hard to get a treatment that’s life-saving and allows you to live healthily,” Wakeman said.
On Friday, the US Food and Drug Adminstration issued a new set of guidelines aimed at underlining the important role MAT should play treating opioid use disorder.
“Unfortunately, far too few people who suffer from opioid use disorder are offered an adequate chance for treatment that uses safe and effective medications,”commissioner Scott Gottlieb said.
Other countries take a very different approach to medication-assisted treatment that makes the treatments easier to obtain. In Canada, for example, methadone is distributed in pharmacies.
Rehabilitation facilities and courts in the US often don’t offer medication-assisted treatment either. Instead, most operate on an abstinence-based model, in which patients must detox and then are offered counseling. They’re encouraged to attend 12-step meetings like Narcotics Anonymous, which remains opposed to MAT despite the growing body of evidence behind it.
Among staff at rehab centres across the US, many workers maintain the belief that the medication doesn’t work and say clients will “abuse” medications. Stephanie Rogers, an intake coordinator at Talbott Recovery, an Atlanta-based addiction treatment center, told Business Insider that she “honestly believed” that MAT was “just substituting one drug for another.”
This trend runs in sharp contrast to the way treatment for other conditions has changed based on new research. When it comes to type 2 diabetes, for example, a large body of scientific evidence demonstrated that the medication insulin helped curb the symptoms of the illness. Those findings prompted medical professionals across the country to uniformly endorse and offer it.
Even among rehab center workers who do understand the potential of medication-assisted treatment, many told Business Insider that their facilities aren’t licensed to provide MAT in the first place. San Diego-based drug treatment center AToN, for example, lacks the proper licensing to provide methadone to patients, according to its program director.
Turning the tide requires buy-in from officials and medical providers
Some officials, including judges who preside over courts that see people brought in on drug offenses, are trying to update their policies to incorporate the most recent research on addiction treatment.
Judge Desiree Bruce-Lyle presides over several such courts at the Superior Court of San Diego County. She told Business Insider that she became convinced of the efficacy of MAT after attending an American Society of Addiction Medicine conference and speaking to some of its leaders, including Kelly Clark and vice president Penny S. Mills.
“I didn’t believe in [MAT] until I met Penny and Kelly last year and they convinced me why it was a good thing and then I heard from a lot of the speakers that were attending that we needed to take a look at it,” Bruce-Lyle said.
Still, out of roughly 50 participants in the reentry court that Bruce-Lyle helps oversees, only one or two are on MAT, she said. In their veterans court, which includes roughly 60 people, three or four are on MAT.
“I’d like to see more of it,” Bruce-Lyle said, but added that she felt she’d need to convince key players at the court – including the Sheriff and other leaders – of the treatment’s efficacy.
A handful of physicians and social workers are also helping to lead the charge by calling attention to the scientific evidence that shows MAT is more effective than an abstinence-only model. Wakeman, the assistant professor at Harvard, travels around the country giving presentations at conferences like the one that helped change Bruce-Lyle’s mind.
“Medication-assisted treatment saves lives,” Wakeman said. “You can also just call it ‘treatment’ and drop the two words in front of it.”
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