America's opioid epidemic demands a scalable solution
If there is one issue that can transcend the partisan boundaries of modern America, it is the opioid epidemic. Opioid addiction is now estimated to affect more than 2 million people, and in 2016 alone, more Americans died of drug overdoses than in the entire Vietnam War.
Over the last decade, we've taken many positive steps to help future generations avoid this curse. Opioid prescribing has been addressed, and doctors are acting with caution when it comes to opiate prescriptions. In addition, there has been a strong push for access to naloxone, the opiate reversal drug that can save lives in the event of overdose. Unfortunately, in between the end stage overdose patient and the patients who will hopefully be prevented from getting addicted in the first place are millions of people that are affected right now.
In Oregon, the state that I've called home for 35 years of my life — we've made national headlines for having one of the highest rates of prescription opioid drug abuse in the country. Every single week, an average of three Oregonians die from prescription opioid overdose.
The scale of the crisis is beyond what our health care system can accommodate. Traditionally, an addict would have two options: inpatient/residential treatment or methadone. Both have significant drawbacks.
Going away for a 28-day detox and intensive counseling sounds great. The problem is that it is prohibitively expensive and can't be scaled to meet current demand.
Methadone has been scientifically proven to be effective, but it too has a downside. Patients often must line up at 5 a.m. and wait for hours to get their daily dose of methadone — making it nearly impossible to hold down a job or raise a family. For most people, this method of treatment is not compatible with returning to a healthy, normal life.
To address this crisis, we need a scalable solution that serves patients with a low cost, sustainable treatment regimen, enabling them to heal from addiction. In my practice, we've identified that solution to be outpatient medication-assisted treatment with buprenorphine (suboxone). This modern, safe drug used for medication-assisted treatment has truly changed the landscape amongst providers for treating opiate addiction. With a better safety profile and less regulations than methadone, doctors can issue prescriptions for up to a month at a time.
The medication completely eliminates opiate withdrawal symptoms and cravings for many patients, without inducing any "high" or euphoria (unlike methadone). Combined with focused drug and alcohol counseling in an outpatient setting, this model has proved to be extremely effective — enabling patients to receive a full year of treatment for less than the cost of a 5-day detox program. Eliminating cravings allows patients to focus on underlying disorders such as anxiety, PTSD or depression which are often strong predictors of addiction. Once their lives become stable, they can decide whether to slowly taper off the medication or stay on it.
Investing in drug addiction treatment services is fiscally and socially responsible. But we can't rely on 20th century methods to combat a 21st century problem. It's not responsible to spend money on ineffective, expensive treatment methods that fail to provide long-term solutions. We need a mindset change around opioid treatment, and medication-assisted suboxone therapy is a good place to start.
Dr. Bryan Schwartz is managing partner and physician at Recovery Works Northwest, a growing provider of opioid addiction and recovery services in Portland.