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A simple idea that can help end the opioid epidemic



I spent much of the year 2018 reporting complex systems and policies that could help end the opioid epidemic, which is now the deadliest drug-borne crisis yet.

But behind all the notices I made was a simple idea: America should see addiction as a health condition and access to cure dependence as any other form of health care.

This simple idea was at the heart of every problem and solution I wrote: Virginia rewritten a Medicaid program to face the opioid crisis, private insurance companies that neglected the addiction treatment, the prisons failed to provide opioid drug addicts and special programs for training that helped physicians to engage in dependence care. It is also at the core of some of the other stories that are currently working, including the upcoming work on California's efforts to offer emergency treatment treatment.

Understanding this simple idea gives you a long way to resolve the opioid crisis in America. Once addiction is considered a medical condition that requires health services, many of the solutions seem to be obvious: Of course, people with addiction should have access to proven drugs. Of course, they should be able to get access to care at the emergency room, in emergency care, or in a doctor's office. Of course health insurance should pay for their treatment.

It is useful to compare other chronic medical conditions.

Consider a statistic: According to a general surgeon's report for 2016, only 10 per cent of people with substance abuse disorders receive special treatment for their addiction – in large part, because local treatment options do not exist, or if they exist, they are unavailable or have waiting periods of weeks or even months.

Just think, for a moment, if this is true for another health condition, such as heart disease. Imagine a world in which 90 percent of Americans with heart problems are allowed to suffer and even die without access to health care. Imagine that a person suffering from a heart attack can go to an emergency room just to say that EP has no way of treating it. Imagine that ER has a way to help, but a patient who has only a heart attack will have to wait several weeks or months to get any care. Imagine if this patient went to a doctor's office to take care only to tell him that service providers do not see his kind.

This will be a public health catastrophe. US leaders will do everything they can, under a public call, to repair such huge gaps in health.

However, this is a reality with addiction in America, even when the current overdose crisis breaks death records year after year.

Stigma is still the biggest barrier

The underlying cause of this problem is a mixture of stigma and misconceptions about addiction.

For a long time, addiction in America is not seen as a medical condition, but as a moral failure. This is the way I came to understand messages like this one who claim that people who suffer from drug addiction deserve to die: "Darwin's theory says" the survival of the strongest. " "Let these lost souls pay the price of their criminal choices and criminal actions. Society does not owe it to multiple medical resuscitation from its own bad assessment, criminal activity and self-inflicted wounds."

It would be obviously ridiculous for anyone to discuss such a thing for other medical conditions, including those like heart disease, diabetes, and lung cancer, which can also be caused by unhealthy actions and behavior. But with addiction, it's something I've heard constantly during my reporting – the result of a culture, society, and legal system that has for over a century treated addiction as a moral and criminal problem.

There is no clearer example of this from the misconceptions about buprenorphine and methadone that prevent the withdrawal and the desire to stabilize drug use in the face. These are highly effective drugs for the treatment of opioid dependence: Studies show that they reduce the mortality rate for all reasons in patients with opioid dependence by half or more and do much better work to maintain people in treatment than non-drug approaches .

In Richmond, Virginia, Foin Riccuti told me how buprenorphine helped restore life on the right track. After years of fighting with painkillers and heroin, buprenorphine helped her to stop using it. She told me about how her recovery gave her "a better relationship with my daughter, my mother," and about her dreams of starting ice in the water. "I got a business idea. I just want to make several classes and be sure that I have everything I've set up so I do not jump into something above my head," she said.


Fawn Ricciuti, 33, plays with her son Aiden, 5, in the yard of her home outside Richmond, Virginia.

Fawn Ricciuti plays with her son Aiden in the backyard of her home outside Richmond, Virginia.
Julia Randleman for Vox

If you have any medication that could halve the mortality rate of heart disease or cancer patients or produce results like Riccuti for other conditions, it would be embarrassing not to make it available to people in need. And if the drug is proven to be better than other treatment options, then it would be unethical and immoral not to be provided through the health system.

But, with addiction, things are not so clear. Many people, including drug addicts and the former Health and Human Services Secretary, are wondering if someone taking drugs, including drugs, is really recovering. Instead, taking buprenorphine or methadone is often considered a "replacement of one drug with another". Viewing the fight of a person with addiction as a moral problem, it becomes suddenly possible to dispute the basic concept that drugs can treat diseases and disease disorders.

Part of this is rooted in a true misconception about addiction: the myth that someone is addicted only because it uses drugs. But the problem of addiction is not the use of drugs on its own. The problem is when the use of drugs becomes compulsive and harmful – creating health risks, leading to nurturing the family and children, driving someone to commit crimes, and so on.

As Rikshutti's story shows, buprenorphine resolves these problems, allowing them to cope with its drug use without such negative outcomes, even if it should be taken indefinitely. Drugs do not work for everyone, with data from France and Vermont suggesting that up to half of people with opioid dependence will not take drugs even when they are widely available. But helping only half of opioid-dependent people in the United States will transmit potentially hundreds of thousands of lives saved over a decade.

Still, stigma remains, keeping these drugs inaccessible. Federal data suggests, for example, that less than half of the treatment facilities offer drugs for opioid dependence. These are the facilities primarily responsible for offering dependence treatment in the United States, and the majority do not offer the best treatment for opioid dependence in times of opioid crisis.

Health care systems are still not doing enough

Stigma and misconceptions are in depth, culminating in a health system that is poorly equipped to treat addiction.

This applies to individual health workers who according to federal law should go through special courses to prescribe buprenorphine. According to a report from the Oppoid White House report of the White House of 2017, 47 per cent of US countries – and 72 per cent of the most reluctant countries – do not have doctors who can prescribe buprenorphine. Only about 5% of doctors in the state have permission to prescribe buprenorphine.

It refers to emergency rooms, most of which do nothing to treat addiction. The result is equivalent to the fact that the person comes with a heart attack and tells them that they are alone – because the hospital has no cardiologists or other staff specialists.

It refers to health care in other circumstances, such as prisons. When I examined state-run agencies about whether they offer drugs for opioid dependence, for example, only Rhode Island – only one country – reported offer three drugs (buprenorphine, methadone, and naltrexone). It remains true to this day, although some countries now experiment more with the idea.

This applies to health insurance, which often opposes paying for dependence treatment. In Virginia, addiction treatment programs were well-known by Medicaid complaints, which included low-income people, while recent program reforms increased reimbursement rates – leading to an increase in the number of people who are being treated and falling into the ER visits to the use of opiate disorder, suggesting that there were earlier populations of under-care and cautious people.


Mundi recovery from opioid dependence, in photographs.

Mundi recovery from opioid dependence, in photographs.
Photos of Mendi; Collage from Javier Zarachina / Vox

In Illinois, I also talked to one patient, Mandy, who was struggling to make the private health insurer pay for a recipe for buprenorphine. As a result, Mendi had to pay more than $ 200 a month out of pocket – while, after long appeal procedures, Blue Cross and Blue Shield from Illinois finally agreed to pay.

Of course, there are problems with insurance companies that refuse to pay for what they need all the time, even outside the space for addiction. But with the treatment of addiction, the problem is particularly bad, as proven by the fact that these issues still relate to time and time again only after the federal government and the states passed laws that effectively demanded that insurers cover the treatment of addiction.

The essence of each of these examples is the same problem: The health care system often does not make the smallest minimum for treatment of addiction, because we did not expect it to do anything about this issue – thanks to the stigma and misconceptions – for as long as which existed.

Once that expectation has really changed, America will begin to notice significant progress in resolving its opioid crisis. (Indeed, some of the countries that have seen the reduction in drug overdose deaths in 2017, such as Vermont, Rhode Island and Massachusetts, have moved in this direction.) It will not be easy; policy making is still difficult, health care systems are complex, and how it works on the ground, it can be confused.

But, ultimately, everyone is rooted in a simple concept: approaching dependence on treatment as well as any other form of health care.

Take a look at my 2018 story of opioids

I spent a lot of travel, reporting and writing about the opioid epidemic. If you want to dive deeper into the topic, here are some of the main stories I wrote this year:

  • We really have a solution to the opioid epidemic – and one state shows that it works: I traveled to Virginia to see how the state reformed its Medicaid program to increase access to addiction treatment. The Great Finding: With increasing compensation rates, Virginia Medicaid appeared to attract more people into addiction treatment and seemed to be seeing less visits to emergencies about opioid dependence.

  • As prisons in America fuel the opioid epidemic: I examined all 50 state prison agencies to find out if they provided full access to opioid dependence drugs. Only Rhode Island did, and an early study found that the program helped reduce mortality from overdose in released prisoners by more than half.

  • Doctors in America can overcome the opioid epidemic. Here's how to get them: I went to New Mexico to see how the ECHO Project helps train health care providers to offer treatment for opiate dependence, especially buprenorphine. Some of the barriers are stigmatization, but many problems are typical misconceptions about addiction and how difficult it is to do such a thing.

  • Needle exchange helps fight opioid crises. But stigma remains: needle exchange is one of the most supported public health interventions, supported by decades of evidence and major healthcare organizations. But in Orange County, California, government officials forced the only needle exchange to close. The whole story offers a very important lesson in stigma to people who use drugs and drug addiction.

  • Needle exchange with Vermont is not just giving syringes. Offering on-the-spot treatment: As the opioid epidemic continues, more places are trying to make dependence treatment as much as possible. In Vermont, a needle exchange even offers treatment on the spot – a rare, innovative approach. This is an example of how the current crisis requires an effort on all hands.

  • Resolving the American pain parabola: One of the main causes of the opioid epidemic was the proliferation of prescription painkillers. But how can you pull painkillers without hurting sick patients who really benefit from them? I spoke with a bunch of experts about it, embarking on a mix of solutions that involve encouraging, not a mandate, health care providers to prescribe less and offer better alternative pain treatments in the long run.

It's just a small sample of the part of the work I've done. For more information, check out the Vox page and the main story of the opioid epidemic. Thank you for reading!


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