Opioids- The Facts

You may not be aware of it, but everybody knows someone living with Opioid Addiction.  However, the breadth and depth of widely held fictions about the disease are breathtaking. I’m a doctor, but for years, I had ignorant views about these patients and their disease. It wasn’t until I started taking care of these patients, that I began to understand the truth and grasp the impact of this disease has. Now, I owe it to my patients and to you to share some facts about the OUD epidemic. 

Opioid Addiction has already killed more Americans than we lost in the Civil War or World War I or World War II. [1]

• This epidemic was created by the healthcare system- drug companies, healthcare administrators, and even doctors. It was not created by the patients- the victims of the disease. [2]
• Opioid use disorder is a chronic, relapsing, brain disease.[3] It is not a weakness, character flaw, or lack of self-discipline that drives the addict to crave and then use opioids. The missteps of the victim have to live with the results of their actions, but lose the judgment lest you find yourself in their shoes. My patients have often said to me: “Why do people look at me like I am such a ‘low’ person? Do you think that I want(ed) to live like this (that)?”
• Cravings are an all-but-irresistible a brain-generated psychological and physiological state. Cravings are created by the brain itself, independent of reason or will power. Without Medication Assistant Treatment,[4] cravings will most likely be present for life.[5] [6] [7]
• “Abstinence Only” Treatment Programs for Opioid Use Disorder are clearly ineffective relative to the efficacy of Medication-Assisted Treatment (M.A.T.) [8]Each chemical addiction is different. Some heal primarily with social support- like alcoholism. Some require medications and psychosocial support. Cocaine addiction is an example of that. Opioid addiction is unique. Abstinence, psychosocial support, or both are practically useless without medication.
• There is a reliable and practical treatment for the disease, and it’s much better than Methadone- it’s called Buprenorphine.[9] Buprenorphine has been around since 1972. It comes in generic forms. No other addiction is more easily treated. It will put patients almost immediately into remission- and keep them in remission.
• M.A.T. is simple and life-saving for OUD. However, it is very difficult for patients with OUD to get. There are lots of reasons for this lack of access. For one thing, only about five percent of doctors prescribe it. [10]  That means that only about ten percent of patients who want treatment can get it. It’s a national disgrace of the highest order and impact. 
• Buprenorphine can be prescribed by your primary care doctor if they go through the steps to get a “waiver.” To get that, all the doctor has to do is complete easy training and fill out about thirty minutes of paperwork. It takes about a month from completion of the application to receive permission from the Federal Government.

We will talk about the reasons for this in upcoming entries.

More importantly, we will get honest about what has to be done.

[1] https://www.cdc.gov/injury/features/prescription-drug-overdose/index.html

[2] https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

[3] https://www.psychiatry.org/patients-families/addiction/what-is-addiction

[4] https://www.fda.gov/drugs/information-drug-class/information-about-medication-assisted-treatment-mat

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728888/

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728888/

[7] https://addiction.surgeongeneral.gov/sites/default/files/Spotlight-on-Opioids_09192018.pdf

[8] https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder

[9]https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine

[10] https://www.medpagetoday.com/psychiatry/addictions/71169