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U.S. Policy on the Opioid Epidemic: A State of Confusion

06-05-18 Category: Opioid

By Lise Millay Stevens

U.S. Policy on the Opioid Epidemic: A State of Confusion

When it comes to combatting the U.S. opioid epidemic, the current administration appears to be in a self-induced haze. According to WJHL News, agents from the Federal Drug Enforcement Administration raided nine clinics in Virginia, North Carolina and Tennessee that provide medication-assisted therapy, a bonafide treatment option for opioid addiction. Behavioral Health Executive reports that DCBA Law & Policy managing partner Michael Barnes expressed concern that the raids represented overreach by the U.S. Department of Justice. So, what gives?

Conflicting Messages

Ironically, the official report from The President’s Commission on Combating the Opioid Crisis and Drug Addiction repeatedly cited inadequate access to MAT, and a lack of opioid treatment programs that provide MAT, as barriers to quelling the U.S. opioid crisis. Attorney General Jeff Sessions stance on America’s drug crisis, however, has focused on ramping up law enforcement and incarceration of non-violent drug offenders, rather than facilitating treatment and recovery. As a result, DCBA Law & Policy sent a letter this past May to President Trump, calling for the Commander-in-Chief to:

  1. Dismiss Attorney General Jeff Sessions immediately
  2. Direct the DOJ to suspend all federal criminal investigations and prosecutions of federally registered prescribers of FDA-approved medications for the treatment of opioid use disorder
  3. Order the DOJ to issue regulations under which the DOJ and its agencies shall obtain a referral from a state professional licensing board before resuming, instituting, or aiding in a criminal investigation or prosecution of a federally registered prescriber of FDA-approved medications for the treatment of opioid use disorder

In a Washington Post opinion piece titled, Jeff Sessions Wants a New War on Drugs. It Won’t Work., the paper takes to task the attorney general for his law-and-order approach to solving America’s crime and drug problems. “Rather than expanding the drug war, Sessions would be smarter to examine local conditions that influence crime and violence, including policing strategies, availability of guns, community engagement and concentrated poverty,” reporters David Cole and Mark Mauer write. “Responding to those underlying problems and restoring trust through consent decrees that reduce police abuse, hold considerably more promise of producing public safety.” They add, “Sessions’ revival of the failed policies of the past, by contrast, has little hope of reducing violent crime or drug overdoses.”

Yes – Drugs Combat Addiction

Treating substance use with drugs may seem counter-intuitive. However, myriad clinical studies have shown that the use of medications such as methadone, buprenorphine and naltrexone, in combination with psychotherapy, is a very effective approach to treating addiction. These medications – which are approved by the U.S. Food and Drug Administration – help to reduce the discomfort of withdrawal, quiet cravings and, coupled with psychotherapy, allow patients to focus on recovering from addiction.

Leading U.S. and international medical organizations support the use of MAT for treating drug and alcohol use disorders.  The World Health Organization lists buprenorphine and methadone as “essential medicines.” The benefits of using MAT, according to the National Institute on Drug Abuse, include:

  • MAT decreases opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission
  • MAT increases social functioning and retention in treatment—patients treated with medication are more likely to remain in therapy compared to patients receiving treatment who do not receive MAT
  • In women with addiction issues, MAT improves outcomes for their babies, reduces symptoms of neonatal addiction syndrome and length of hospital stay

The American Medical Association, in a statement on prescription drug misuse, overdose and death, recommends: “Increase access to comprehensive treatment for opioid use disorders, including medication-assisted treatment (MAT), for example, by becoming trained to provide it or by referring their patients for this treatment.” The Substance Abuse and Mental Health Services Administration has commented, “MAT has proved to be clinically effective and to significantly reduce the need for inpatient detoxification services” and “MAT provides a more comprehensive, individually tailored program of medication and behavioral therapy.” SAMHSA adds that the use of MAT:

  • Improves patient survival
  • Increases retention in treatment
  • Decreases illicit opiate use and criminal activity among people with substance use disorder
  • Increases patients’ ability to gain and maintain employment
  • Improves outcomes among women who have substance use disorders and are pregnant

Trump’s own Health and Human Services Secretary Alex Aznar has also endorsed the use of MAT, according to a recent report in The Hill. (His disgraced predecessor, Tom Price, did not approve of it.)

A Wicked Game

Given the rising number of U.S. overdose deaths (a stunning 65,000-plus in 2016 alone), permitting police and other law enforcement officials to raid the workplaces of professional MAT providers is not only incomprehensible but also reckless. Confiscating files and other records compromises the provision of addiction care to very sick individuals, and forces clinics to close until their records are returned. Police activity might, in-and-of-itself, discourage people with substance use issues from seeking the care they sorely need. There is currently a grave shortage of addiction providers and clinics; unwarranted police actions may discourage qualified providers from opening new clinics or continuing to operate extant facilities.

The medications used in MAT are approved and supported by U.S. government agencies such as the FDA, NIH and CDC. Countless prominent medical societies have verified and supported the use of medications to treat addiction, and science has incontrovertibly proven that the therapy is effective.

Unwarranted police activity surrounding MAT stigmatizes the very patients who benefit from its use. The opioid epidemic can only intensify if police are allowed – and even encouraged – to single out the providers who seek to treat and the patients who seek to be healed. It is time for our government to take a unified approach to treating addiction in America, and adopt policies that emphasize compassion over brutality, science over stigma, support over denigration. Otherwise, the bodies will just keep stacking up.

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