Doctor And Nurses Discussing Treatment Plan
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Opioid Fight Needs Better Physician Payment, Education

September 25, 2018

Progress is being made despite several obstacles to expanding treatment access for substance use disorders, according to people of all various medical and political backgrounds. The demand for physicians who are qualified to intervene and diagnose an addiction problem including the overall stigma attached to addiction all contribute to low rates of treatment.  According to the 2017 National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration (SAMHSA), of the estimated 2.1 million people with opioid use disorder, only 30% of those individuals received treatment at a special facility or private doctor’s office.

One way to combat this is to continue to fight the stigma surrounding addiction and addiction treatment.  On one hand, it seems like there is a drastic overall lack of providers willing to treat patients with opioid use disorder.  On the other hand, it is common for many people with substance abuse disorder to feel as if they don’t need treatment for their addiction.  A tightly linked network of complicated components including lack of resources, patient apprehensiveness, stigma, and lack of provider training all contribute to this.  Stigma can be a major roadblock for people seeking treatment for their addiction, especially when they are surrounded by people who use vocabulary such as “junkies” who are “immoral” or “dirty” as well as “responsible” for getting themselves in this position.   All of this is discouraging to someone who already feels isolated in their addiction.  Another, all-too-common phrase that people who don’t understand the disease of addiction like to throw around is “trading one addiction or drug for another”.  Referring to FDA approved medication such as buprenorphine, which is very commonly prescribed to people in treatment for opioid disorder.

Physical dependence does not have to equal addiction and using this statement to facilitate an argument with people who engage in Medication Assisted Treatment (MAT) services does a huge disservice to people who are honestly trying to change their lives for the better through treatment and recovery. One solution to alleviating the stigma is by raising awareness of success stories through outlets such as social media or in person visits.  Another useful resource is employing people as peer recovery support specialists, which BrightView does at all of our locations.  These are people who have lived experience with addiction and have years of sobriety behind them.  They can combine experience with empathy and walk with a patient through those doors on day one and connect with them.  This is an example of breaking the stigma, showing people who were once “just like these patients” who have come out on the other side – healthy, mentally and emotionally strong, and employable.

Special populations are at risk of being stigmatized as well.  Pregnant women with opioid problems can be an easy target for stigmatizing. Many women fear that if their opioid use is detected, they will lose custody of their children, which is not an irrational concern.  Most states are catching on now to the idea that is most effective that if a pregnant woman is seeking treatment, they are to be given “priority access” to drug treatment programs funded by the state.  BrightView prides itself on our pregnancy program that we offer at three of our locations, one in Dayton, Ohio, and the others in Cincinnati, Ohio.

Another obstacle to treatment that can be almost consistently agreed upon across all facets is affordability.  Payment policies are one of the biggest barriers to obtaining treatment. One common problem is that the payment for office visits is insufficient to support the time required to diagnose and treat patients, explained Shawn Ryan, MD, MBA, president and chief medical officer at BrightView.

Another heavily debated hurdle that prevents addiction treatment from being so obtainable is the lack of providers who are qualified to screen, diagnose and treat patients.  Also, getting physicians and clinicians on board with medication assisted treatment and evidence based practices.

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