Treating Opioid Use Disorder
By: Elinore F. McCance-Katz, MD, PhD, Assistant Secretary for Mental Health and Substance Use
I write this today not to provide a listing of programs that my agency has funded nor an update on how we are doing in addressing the opioid crisis. I write this as a physician seeking the help of my fellow physicians and healthcare colleagues around the country.
Many of you are very familiar with the efforts that we, in the government, have put forward to stem the tide of the opioid crisis. States and communities have done the same across the country. Our commitment is real, but it is also potentially futile if we do not have providers out there, on the front lines, willing to take on treating the population of Americans living with opioid use disorder. I speak from experience when I say I recognize the difficulty that practitioners may have in doing this. I understand that it's administratively burdensome, often more time-consuming than providing care for other conditions, and potentially anxiety provoking. I fully understand all of those things.
But, I also understand that people living with opioid use disorder deserve better from us as healthcare professionals. Individuals struggling with opioid addiction who have taken that leap of faith that there is treatment available to them, and sadly, that is not nearly enough people, deserve practitioners who are willing and able to provide needed evidence-based care and treatment. If we had the training to treat them, we, as healthcare professionals, would never turn away someone with diabetes because they were too difficult to treat. If we were equipped and certified to provide someone medication for chronic heart disease in our office setting, we would never send them away without treatment.
Why then do we do it to individuals with opioid use disorder? The data tell us that a lack of people trained to treat these disorders is not the issue; a lack of trained individuals willing to do so is what appears to be the problem. We have over 62,000 healthcare professionals that today can prescribe medications to individuals with opioid use disorder. There are also approximately 1,500 opioid treatment programs available to individuals with these disorders. We have a system in place to treat the 2.1 million people with this illness. We just need to mobilize to do so.
In no way am I blaming healthcare practitioners. I know this lack of enthusiasm to treat can be for many reasons. Perhaps it is because our training didn't serve us well or serve this population well. Perhaps it is because when we went to medical school, addiction was a mere passing phrase, if even that. We did not learn about this disease in the way we learned about others in our clinical training.
Maybe it is also because we have heard the stories, the stories of doors being kicked in, offices being raided, practices being shut down because people leading our justice system may not understand the need to treat people with opioid use disorders in a certain manner. Maybe it is that we don't want to take that risk. As a physician, I understand that and reached out to my colleagues at the DEA to find out more about the practices being used. And, I am here to tell you that the anecdotal information you may have heard is the exception and not the rule. The data tell us that there is nothing to fear for the very vast majority of practitioners. Of the over 1.68 million DEA-registered prescribers, only 77 total (or less than .004%) had any administrative action taken on them.
We can no longer turn our back on this population. Our family members, friends, coworkers, and neighbors are dying. We have the tools at our disposal. Unlike other conditions, for this one, we have a clear evidence-base which tells us what to do; we have the people trained and ready to do it so let us take collective action and do so.
Practitioners alone are not the only ones needed. We must do better in the government also. And, we are working on that. We are working to address administrative burden. We are working to mainstream substance use disorder training into our schools. We have expanded efforts to provide you additional training and technical assistance in your communities. This is available to you, at no cost, and I encourage you to take advantage of it through visiting opioidresponsenetwork.org.
Our citizens deserve more than we have been giving them. We need those who have signed up to help to do so. We believe that you are ready. We believe that this can be done. We need communities across the nation to count on us to deliver. And, deliver, we will.
We at SAMHSA stand ready to help. I am not here to deliver empty words of encouragement with nothing behind them. It is not my intention to leave practitioners on their own. We have tools for you, free of charge, and we want you to use them. I want you to hold us accountable for delivering for you and I want to do the same of you. We have to hold each other accountable because we came into the healing profession for a reason. And, we must demand that our fellow citizens also hold us collectively accountable for realizing that reason. We talk continuously about addressing the opioid crisis and creating access. Access is here. We have it; we do not need much. We just need action behind a system that is primed and ready. We need willingness of people who have already demonstrated interest. If even half of you with a waiver practice to your limit, there will be ready access for most in need. I recognize that this is ambitious, but it is not impossible. I know that you, too, can experience the reward I have as a physician willing to take the chance in treating this disease. The data tell us we can do this and I know that together we can.
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