As the death toll from opioid addiction continues to soar with nearly 64,000 people dying in 2016 alone, scientists and public health experts are calling on clinics and rehab facilities to make sure they’re using the latest science to treat the condition.
So this week, the main professional society of addiction scientists launched a pilot program that gives treatment centers a grade based on a set of research-backed criteria designed to ensure patient health and safety. The program is being spearheaded by the American Society of Addiction Medicine, which announced a partnership with nonprofit healthcare accreditation group CARF International.
Among other requirements, the criteria includes providing people with access to medications like naltrexone that help curb cravings and reduce withdrawal symptoms. That kind of treatment, also known as medication-assisted treatment or MAT, has been controversial in the past. Thousands of rehabs still refuse to offer it, instead encouraging people to abstain from medications altogether in accordance with the guidance of 12-step programs like Alcoholics Anonymous or Narcotics Anonymous.
But medication-assisted treatment is a powerful tool to help curb deaths from addiction, according to leading scientists and several peer-reviewed studies.
“Medications are an effective treatment for opioid addiction,” Kelly J. Clark, president of the American Society of Addiction Medicine, told Business Insider in April.
So as part of the new program, treatment centers “have to provide access to medication-assisted treatment,” Paul Earley, an addiction medicine physician and board member of the American Society of Addiction Medicine, told Business Insider on Wednesday.
‘These treatments are life-saving and they work’
Currently, only about half of private-sector treatment programs for opioid use disorder offer access to the medications, and of those, only a third of patients actually receive them, according to a study published in the Journal of Addiction Medicine.
But dozens of experts and several studies suggest the medicines are powerful tools to help prevent deaths.
“These treatments are life saving and they work,” Sarah Wakeman, the medical director of the substance use disorder initiative at Massachusetts General Hospital and an assistant professor at Harvard, told Business Insider in April.
The problem is that the medications are surprisingly difficult to obtain.
In someone with opioid use disorder, as addiction to painkillers like OxyContin and Vicodin is formally known, using the drugs is not often a pleasurable experience. Instead, it’s a practice that has become a necessary fact of life. Being without the drugs leads to painful symptoms that can include severe nausea, shaking, diarrhea, and depression. The need to use is simultaneously a physical and emotional compulsion — the lines between those kinds of pain are blurred.
One of the main misconceptions about medication-assisted treatment is that the medications for drug addiction simply replace the drugs that hooked users — leading to more highs and fueling a pattern of repeated use.
But that view is outdated and ill-informed, experts say. Instead, the drugs work by staunching cravings and reducing or preventing withdrawal and relapse. Buprenorphine and methadone help suppress cravings, while naltrexone blocks the euphoric and sedative effects of opioids so users don’t experience a high.
And not surprisingly, as access to medication rises, drug overdose deaths fall.
A study of heroin overdose deaths in Baltimore between 1995 and 2009 published in the American Journal of Public Health, for example, found that in places where methadone and buprenorphine were available, the number of fatal overdoses fell by 50%.
“People ask me all the time, ‘well, aren’t they just substituting one drug for another?’ The answer is no. These are evidence-based treatments and they work,” Patrice A. Harris, the chair of the American Medical Association’s opioid task force and a board certified psychiatrist, told Business Insider in April.
From jail to court to rehab, medication-assisted treatment is hard to find
Despite the evidence behind them, medications for addiction are surprisingly difficult to obtain.
One of the hardest-to-access forms of medication for recovery is methadone. In the US, the medication can only be accessed in specialized clinics; because of the way the treatment works, people using medication-assisted treatment must come to a facility to get their dose daily. But those facilities typically have negative reputations because of policies that restrict them to locations considered seedy or run-down. And patients who come for treatment often have to push past active drug users — a big trigger for someone with substance use disorder — on their way to and from the clinic.
“You can access heroin pretty easily, yet we make it really hard to get a treatment that’s life-saving and allows you to live healthily,” Wakeman said.
In April, the US Food and Drug Administration issued a new set of guidelines aimed at underlining the important role that medication-assisted treatment should play treating opioid use disorder.
“Unfortunately, far too few people who suffer from opioid use disorder are offered an adequate chance for treatment that uses safe and effective medications,” FDA commissioner Scott Gottlieb said.
Other countries take a very different approach to medication-assisted treatment that makes the treatments easier to obtain. In Canada, for example, methadone is distributed in pharmacies.
Rehabilitation facilities and courts in the US often don’t offer medication-assisted treatment either. Instead, most operate on an abstinence-based model, in which patients must detox and then are offered counseling. They’re encouraged to attend 12-step meetings like Narcotics Anonymous, which remains opposed to medication-assisted treatment despite the growing body of evidence behind it.
Among staff at rehab centers across the US, many workers maintain the belief that the medication doesn’t work and say clients will “abuse” medications. Stephanie Rogers, an intake coordinator at Talbott Recovery, an Atlanta-based addiction treatment center, told Business Insider in April that she “honestly believed” that medication-assisted was “just substituting one drug for another.”
This trend runs in sharp contrast to the way treatment for other conditions has changed based on new research. When it comes to type 2 diabetes, for example, a large body of scientific evidence demonstrated that the medication insulin helped curb the symptoms of the illness. Those findings prompted medical professionals across the country to uniformly endorse and offer it.
Even among rehab center workers who do understand the potential of medication-assisted treatment, many told Business Insider that their facilities aren’t licensed to provide medication-assisted treatment in the first place. San Diego-based drug treatment center AToN, for example, lacks the proper licensing to provide methadone to patients, according to its program director.
Turning the tide requires buy-in from officials and medical providers
Some officials, including judges who preside over courts that see people brought in on drug offenses, are trying to update their policies to incorporate the most recent research on addiction treatment.
Judge Desiree Bruce-Lyle presides over several such courts at the Superior Court of San Diego County. She told Business Insider in April that she became convinced of the efficacy of medication-assisted treatment after attending an American Society of Addiction Medicine conference and speaking to some of its leaders, including Kelly Clark and vice president Penny S. Mills.
“I didn’t believe in [medication-assisted treatment] until I met Penny and Kelly last year and they convinced me why it was a good thing and then I heard from a lot of the speakers that were attending that we needed to take a look at it,” Bruce-Lyle said.
Still, out of roughly 50 participants in the reentry court that Bruce-Lyle helps oversees, only one or two were on medication-assisted, she said in April. In their veterans court, which includes roughly 60 people, three or four were using the program.
“I’d like to see more of it,” Bruce-Lyle said, but added that she felt she’d need to convince key players at the court — including the Sheriff and other leaders — of the treatment’s efficacy.
A handful of physicians and social workers are also helping to lead the charge by calling attention to the scientific evidence that shows medication-assisted treatment is more effective than an abstinence-only model. Wakeman, the assistant professor at Harvard, travels around the country giving presentations at conferences like the one that helped change Bruce-Lyle’s mind.
“Medication-assisted treatment saves lives,” Wakeman said. “You can also just call it ‘treatment’ and drop the two words in front of it.”
This post was originally published in April 2018 and has been updated.