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The simple idea that could help end the opioid epidemic



I reported a great deal in 2018 on complex systems and policies that could help end the opioid epidemic, which is now the deadliest crisis in US drug overdose.

Behind all the coverage, though, was a simple idea: America must treat addiction as a disease and approach addiction treatment like any other form of health care.

This simple idea was at the heart of every problem and every solution I wrote about: Virginia revised its Medicaid program to confront the opioid crisis, private insurers neglect addiction treatment, prisons that do not offer opioid drugs, and special training programs, help doctors get into addiction care. It is also at the core of some of the other stories I'm working on right now, including an upcoming article on California's efforts to offer addiction treatment in emergency rooms.

If you understand this simple idea, this is a long way to solve the opioid crisis in America. When addiction is considered a disease that requires healthcare services, many solutions seem obvious: Of course, people with addictions should have access to proven medicines. Of course, they should have access to care in the emergency room, in an emergency or in a doctor's office. Of course, the health insurance should pay for their treatment.

It is helpful to make comparisons with other chronic diseases.

Consider Statistics: According to the 2016 General Surgeon's Report, only 10 percent of people with a substance abuse disorder receive special treatment for their addiction – in large part because there are no local treatment options, or if they exist, they are unaffordable or have Waiting weeks or even months.

Think for a moment, if this were the case, apply for another disease, such as heart disease. Imagine a world in which 90 percent of Americans suffer from heart problems without access to medical care and are even allowed to die. Imagine if a person suffering from a heart attack could go to an emergency room and only learn that the emergency room has no way of treating it. Imagine the emergency department can help, but the patient who has just had a heart attack has to wait weeks or months to get treatment. Imagine if the patient went to a doctor's office to look after something, just to find out that the providers did not see his nature.

This would be a public health disaster. America's leaders would do anything in their power to eliminate such huge gaps in health care.

However, this is an addiction in America, although the current overdose crisis breaks records for deaths year after year.

The main reason for this problem is a mixture of stigmatization and misunderstandings about addiction.

In America, addiction is long considered to be not a disease but a moral error. So I've come to understand emails like these that believe that people who suffer from drug addiction deserve to die. "Darwin's theory says," The Survival of the Stronger. "These lost souls pay the price of their lives Criminal decisions and their crimes Actions: Society does not owe them multiple medical resuscitations due to their own bad judgment, criminal activity, and self-inflicted wounds. "

It would be ridiculous for anyone to have such a thing for other diseases, including heart disease, diabetes and lung cancer, which can also be caused by unhealthy acts and behaviors, but addiction has been a recurring theme in my coverage – a result of a culture, a society and a legal system that has been seeking moral and moral addiction for more than a century dealing with criminal problem

There is no clearer example of these buprenorphine and methadone misunderstandings that discourage withdrawal and longing to stabilize a person's drug use. These are potent drugs for the treatment of opioid dependence: Studies have shown that they reduce the overall mortality rate in opioid addiction patients by half or more, and far outweigh the treatment of patients than non-drug approaches.

In Richmond, Virginia, Fawn Ricciuti told me how buprenorphine helped her get her life back on track. After years of fighting painkillers and heroin use, buprenorphine helped her stop using it. She told me how she got "a better relationship with my daughter, my mother" and her dreams of founding a water shop through her recovery. "I have a business idea. I just want to do some classes and make sure I've got everything set so I do not jump over my head, "she said.


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

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

If you had medications that could halve heart disease mortality rates or cancer patients or outcomes such as ricciuti in other diseases, it would be outrageous not to provide them to the needy, and if the drugs are proven to be better than other treatments, it would be downright immoral and immoral not to provide them through the healthcare system. 19659019] But with addiction, things are not that easy.Many people, including large addicts and the former M health and care professionals are wondering if someone taking any medication, including a drug, is really recovering. Instead, the intake of buprenorphine or methadone is often considered as a "substitution of one drug with another". If you consider the struggles of a person with addiction as a moral problem, it suddenly becomes possible to question the basic concept that drugs can treat medical illnesses and disorders.

Part of it is rooted in a real misunderstanding of addiction: the myth that someone is addicted simply because he's taking drugs. The problem of addiction, however, is not the drug use itself. The problem is when drug use becomes compulsive and harmful – causing health risks, inducing someone to neglect family and children, inducing someone to commit crimes, etc.

As the story of Ricciuti shows, buprenorphine addresses these issues by: Giving her a problem dealing with her drug use without any negative impact, even if taken indefinitely. The medications do not work for everyone. Data from France and Vermont suggest that up to half of people with opioid dependence do not use the drugs, even if they are widely available. But supporting only half of the people in the US who are dependent on opioids would translate into potentially hundreds of thousands of lives saved over a decade.

However, stigma remains, making these drugs inaccessible. For example, federal data suggests that less than half of treatment facilities offer opioid drugs. These are the institutions that are primarily tasked with offering US addiction treatment, and a majority does not provide the best-known treatment for opioid addiction in the midst of an opioid crisis.

Health Systems Still Do not Do It Enough [19659025] The stigma and misunderstandings are deep-rooted and culminate in a health care system poorly prepared for addiction treatment.

This applies to individual service providers who, according to federal law, have to undergo special training to prescribe buprenorphine. According to the White House Opioid Commission Report of 2017, 47 percent of US states – and 72 percent of rural areas – do not have a doctor who can prescribe buprenorphine. Only about five percent of statewide physicians are licensed to prescribe buprenorphine.

This applies to emergency rooms, the vast majority of which contribute little to addiction treatment. The result is the equivalent of a person with a heart attack coming in and telling them that she is on her own – because the hospital has no cardiologists or other specialists.

This applies to health care in other settings, such as prisons. When I asked the state prison authorities if they offered drugs for opioid addiction, only Rhode Island – only one state – reported that they offered the three drugs (buprenorphine, methadone, and naltrexone). This is true today, though some states are now experimenting more with the idea.

This applies to health insurers who often refuse to pay for addiction treatment. In Virginia, Medicaid's addiction treatment programs covering low-income people are known to have been underpaid until the most recent reforms of the program increased reimbursement rates. This led both to an increase in the number of people treated and to a decrease in ER visits for opioid disorder, suggesting that there were a significant number of under-served and under-treated people.


  Mandy's recovery from opioid addiction, in photos.

Mandy's recovery from opioid addiction, in photos.
Photos by Mandy; Collage by Javier Zarracina / Vox

In Illinois, I also talked to Mandy, a patient who was trying to get her private health insurance to pay her buprenorphine prescription. As a result, Mandy had to pull out more than $ 200 a month – until Blue Cross and Blue Shield of Illinois finally agreed after a long appeal.

Of course there are problems Insurance companies are constantly refusing to pay for what they should, even outside the addiction area. However, the problem is particularly severe in addiction treatment, as shown by the fact that these problems continue to reappear after federal and state laws have passed, forcing insurers to cover addiction treatment.

At the heart of each of them These examples are the same problem: The health care system often does not even make the most of the addiction treatment, because we did not expect it to take so long – thanks to stigmatization and misunderstandings exist.

If this expectation really changes, America will see remarkable progress in resolving its opioid crisis. (In fact, some of the countries that saw a reduction in the number of overdose deaths in 2017, such as Vermont, Rhode Island, and Massachusetts, moved in that direction.) It will not be easy; Policy-making is still difficult, health systems are complex, and how everything works on-site can be confusing.

But ultimately, everything is rooted in a simple concept: approach to addiction treatment like any other form of health care.

A Review of My 2018 Stories About Opioids

I spent much of the year traveling, reporting, and writing about the opioid epidemic. If you want to delve deeper into the subject, here are some key stories I wrote this year:

  • We really have a solution to the opioid epidemic – and one state shows it works: I am in Virginia traveled to see how the state has reformed its Medicaid program to improve access to addiction treatment. The big result: by increasing the reimbursement rates, Virginia Medicaid seemed to bring more people into addiction treatment and seemed to see fewer visits to emergency departments related to opiate addiction.
  • How America's Prisons Fuel the Opioid Epidemic: I've interviewed all 50 state prisons to find out if they had full access to anti-opioid drugs. Only Rhode Island has done so and an early study has shown that the program has helped to reduce the number of overdose deaths among released inmates by more than half.
  • American doctors can defeat the opioid epidemic. How to get them on board: I went to New Mexico to see how the ECHO project is training healthcare providers to offer opiate addiction therapy, especially buprenorphine. Some of the obstacles are stigmata, but many problems are more typical misunderstandings about addiction and how difficult it is to actually do that kind of work.
  • Needle exchange helps combat the opioid crisis. However, there remains a stigma: Needle replacement is one of the most well-supported public health measures, based on decades of evidence and major health organizations. But in Orange County, government officials forced the only needle change to close. The whole story offers a very important lesson in stigmatization for people who consume drugs and drug addiction.
  • A vermont needle change is not just about dispensing syringes. It offers on-site treatment: As the opioid epidemic continues, more and more places are trying to make addiction treatment as accessible as possible. In Vermont, a single needle change even provides on-site treatment – a rare, innovative approach. It is an example of how the current crisis requires all hands on deck.
  • Solve the paradox of the American painkiller: One of the main causes of the opioid epidemic was the spread of painkiller prescriptions. But how do you withdraw painkillers without hurting the pain patients who really benefit from them? I've talked to a number of experts about this, not prescribing, forcing, prescribing, and offering better alternative pain treatments over the longer term in a mix of prescribing solutions that include prescribing medication.

This is just a small selection of a part of the work I did. For more information, see the Hub page and Vox Storystream for the Opioid epidemic. Thank you for reading!


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