The Surgeon General published a historic paper, in 2016, outlining the present crisis in American society. The Opioid Epidemic is impacting individuals, families, communities, and our nation. The increase in substance misuse and abuse is ever increasing. With this increase, there is an ever increasing need of prevention and treatment for those struggling. The focal point of this is through the continued advocacy, support, and implementation of ongoing Medically Assisted Treatment (MAT) within local communities. Whether it is through Buprenorphine or Methadone Maintenance, the efficacy of sustained treatment is an important role to combat the rising cost of Opiate substance use, misuse, and abuse.
Not only is the efficacy of sustained and effective treatment important in addressing the rising epidemic, the need for awareness and community involvement is imperatively necessary to work toward healthy policies. According to the Surgeon General, how communities all across America “…respond to this crisis” is a test of our moral fortitude: (1) Our willingness to “take on an epidemic causing great human suffering and economic loss?”; And, (2) Are we, as American citizens, willing to live up to our “most fundamental” value of humanity by caring for one another?
What we do know is this: Substance use disorder creates a stronghold that prevents individuals from living productive and healthy lives. For this reason, “Substance misuse is a major public health challenge and priority for our nation” (Sylvia Matthews Burwell – Secretary US Department of Health and Human Services). Since this has become a major public health challenge, there is overwhelming evidence that supports policies and programs that focus on prevention, treatment, and sustained recovery (Burwell). What is leading this evidence is our advanced “…understanding of substance use…” as a “…chronic neurological disorder” (Burwell). A focused goal comes out of the report as the aligning of mainstream health care and substance use disorder treatment in order to address the overall health and wellness of an individual.
American citizen’s and policy makers need to make a cultural shift
This requires a cultural shift in our understanding of addiction. In the preface, Dr. Vivek H. Murthy, M.D., M.B.A. reports:
We … need a cultural shift in how we think about addiction. For far too long, too many in our country have viewed addiction as a moral failing. This unfortunate stigma has created an added burden of shame that has made people with substance use disorders less likely to come forward and seek help. It has also made it more challenging to marshal the necessary investments in prevention and treatment.
In the recent Advances in Addiction & Recovery, William L. White, MA focuses on the problematic direction regarding U.S. Drug Policy under a present Trump Administration. He writes:
… then-candidate Donald Trump … remained virtually silent on the major roles American Pharmaceutical companies and medical practitioners have played, and continue to play, in the current opioid epidemic.
Referencing the historic publication of the Surgeon General’s report, White reflects how ignoring “…the best scientific research and the proposed strategies of America’s leading addiction and public health experts would be a travesty and a critical lost opportunity.” He further observes the attempt by the House of Representatives and Senates “…versions of the American Health Care Act of 2017” would have eliminated “…treatment for substance use disorders as a health care benefit.” White further comments on Attorney Jeff Sessions “new directive to federal prosecutors calling for maximum sentences and mandatory minimum sentences for non-violent drug offenders and the expanded use of private prisons.” (Emphasis mine).
This becomes problematic because White expresses the following concern:
This marks a return to failed drug policies of the 1980s that spurred the largest experiment in mass incarceration in U.S. History and its broad spectrum of untoward social and economic consequences – including its destructive effects on low-income communities of color.
The failed drug policies of the 1980’s, White is referring too, proved ineffective in addressing the rise in substance use. These earlier policies showed their inadequacies because of “…excessive costs, low rehabilitative outcomes, and their harmful social effects.“
Not only do we have a need for a serious cultural shift in understanding the nature and powerful influence of substance use, we also want to shift our cultural understanding regarding medically assisted treatment for those struggling with opiate substances. Based on “…decades of scientific reports from medical and public health panels and the cumulative clinical experience of addiction treatment practitioners specializing in the treatment of opioid addiction.” comments, like the Secretary of Health and Human Services, Dr. Tom Price, regarding how medications amount to individuals “just substituting one opioid for another.”
Further complicating the issue, as White continues to observe, is the proposed ideology of enhancing “…access to inpatient psychiatric treatment and access to psychiatric medications and a decreased emphasis on community education and recovery support services.” Such proposal appeared to come from Dr. Elinore McCance-Katz, Chief Medical Officer of the Substance Abuse and Mental Health Services Administration.
Where does this leave us regarding the need for a cultural shift? Instead of eroding the present advancement in addressing, prevention, treatment, and recovery of individuals from opiate substance use disorder: We do well to erode regressive policies that pose a threat toward those suffering, their families, and our local communities (White).
How MAT helps individuals suffering opioid disorder is integral
NAADAC, the association for Addiction Professionals, published a statement on the Opioid Epidemic. With an estimated 2 million American Citizens meeting diagnostic criteria for opiate substance use disorder (pain medication); and, approximately 600,000 meeting diagnostic criteria for a disorder that is specifically related to heroin use: The increase in Opiate related overdoses have increased since 1999.
Referencing the Comprehensive Addiction and Recovery Act (CARA) of 2016, NADAAC referenced the first Federal Regulations within 40 years in addressing provisions to curtail the epidemic:
- Improvement of education for providers within the health care field regarding pain management and prescribing safe practices
- Creation for widespread availability of Naloxone, an overdose reversing drug, as well as training for first responders
- Expansion of medically assisted treatment, that includes counseling and urine drug screening, availability for individuals suffering opiate substance use disorder
- Increasing the availability for monitoring programs concerning prescription drug
- Expansion on prevention programs, including programs aimed at misuse of heroin and other opioids; And,
- Improving the availability of long term recovery support services
Along with the law being signed by, then, President Obama in 2016; The Cures Act assisted with provisional funding of approximately $1 Billion over two years.
Thus, the focus of MAT is on treating the whole person and not merely provide medication. These are not stand-alone treatment objectives. The impact OUD (Opiate use disorder) has on a person’s life is multifaceted. The main areas impacted are one’s emotional, physical, psychological, relational, financial, and spiritual health. This is where evidence-based treatment modalities assist patient’s in restoring their overall health and well-being.
By engaging in working with a therapist, addressing any co-occurring issues through mental health interventions and counseling, attendance with community based sober support meetings, treatment and recovery becomes possible. This is due, in part, to how “Opioid agonist medications will hold off withdrawal symptoms and may help to heal some of the impact other drugs have had on brain function…”
Professionals are highly sought and needed in the field
One of the problematic issues impacting the opioid epidemic is the need for qualified substance use disorder counselor’s. The present condition of the field is facing a shortage. This is according to Gerard J. Schmidt, MA, LPC, MAC, NAADAC President. Citing a 2004 SAMHSA (Substance Abuse and Mental Health Service Administration), there is an insufficiency in the field of addiction treatment and mental health services to accommodate those seeking such services.
Since the epidemic is now a nationally focused social issue (among other pressing social issues) the demand for intervention and treatment is ever increasing. Schmidt observes three specific factors associated with the inability for treatment service providers to expand delivery of services fast enough:
- High Staff Turnover
- Aging workforce
- Stigma toward those with SUDs
What this means, according to Schmidt, is a lack in qualified and trained addiction treatment professionals to meet the present demand for services.
Where does this leave us and where do we go next?
Greater awareness, education, and prevention within local communities is a start for advocating additional resources. Presently, Everett, Washington is considering adding another Methadone Clinic in the downtown area. This has caused some concern among business owners and associates, as well as residents. Advocacy to provide expanded treatment services will help alleviate those suffering OUD. Along with drawing in more experts within the field to speak in public forums to address preventive strategies concerning the present opiate epidemic. Local Churches may also do well to host forums in how Pastor’s and Lay ministers are able to assist in providing referral services in those individuals struggling with substance use (outside of referring to faith based sober support meetings).
Shifting from the perspective that addiction is a moral failing on the individual to an actual chronic and progressive disease, community members may be able to come along side treatment agencies and policy makers for a more appropriate and holistic approach in alleviating those suffering. This may include advocating for greater resources for housing, better policies in addressing medical issues, aligning medical, dental, and vision treatment for those engaged in substance use and mental health services. Expansion of availability for mental health intervention and treatment.
Finally, implementing training within various community colleges in order to develop qualified individuals to meet the demand for services within local communities. Not only training, increasing the income for those presently working in the field as they take on more demand for services through increased case load management.