Addressing the Opioid Epidemic
By Christine Martin, LMFT, CACII
National reports of a recent surge in heroin and prescription opioid abuse are putting increased attention on the issue of Opioid Use Disorders. Opioid-related overdoses are on the rise. Attorney General Eric Holder has called the national increase in heroin related deaths a national epidemic. Our own governor Nicki Haley recently established the Governor’s Prescription Drug Abuse Prevention Council.
It seems that every publication I read, whether it’s a newsletter, a journal article, my local paper, or (I’l l be honest) my favorite gossip magazine, everyone is talking about how Opioid Use Disorders are affecting our nation, our communities, our families (and our celebrities). What I am not seeing, however, is much talk about how we need to be treating these disorders. And perhaps the reason is that we continue to see the most effective treatments for Opioid Use Disorders marginalized even within the addiction treatment
Detoxification and abstinence based programs used in the treatment of Opioid Use Disorders have historically had very limited success in reducing illicit opioid use. Medication-Assisted Treatments (MAT – treatments which use the medications methadone, buprenorphine or naltrexone) on the other hand have shown significant success rates and are supported by the Substance Abuse Services and Mental Health Administration. So why don’t we see more support for these treatments? And what can we do about it?
Much of the stigma around the use of medications in addiction treatment is based on the idea that to “treat a drug-addiction with a drug” is morally wrong. But it’s important to look at how you define “drug” in this context. The definition of drug can go one of two ways: “drug” can be defined as a medication used in the treatment of an illness, or “drug” can be defined as an often illegal substance used or misused to gain euphoric or pleasurable feelings. Treating an illness (which we consider opioid use disorder to be) with a medication provides a much different framework which with to look at MAT than the idea of treating “drug addiction with a drug.”
To effectively treat Opioid Use Disorders, we must look to models of treatment which are evidenced based and supported by research rather than basing treatment on moral models of addiction. William White in his monograph titled “Recovery-oriented Methadone Maintenance” calls on us to “purge language that grew out of moral models of addiction, e.g. dirty/clean” in an effort to combat the ongoing stigma associated with addiction. We must likewise change the framework in which we view MAT to understand it as the use of medication to treat a chronic illness.
Without accepting and using the most effective treatments for Opioid Use Disorders , it is likely we will be reading about opioid-related deaths in our papers, journals and magazines for a long-time to come.