In November 2011, the Centers for Disease Control and Prevention (CDC) declared that prescription painkiller overdoses are a public health epidemic. Prescription painkillers refer to opioid or narcotic pain relievers. The epidemic we face today is ominous, as drug overdoses now kill more Americans than car crashes. The number of past year heroin users increased between 2007 (373,000) and 2012 (669,000), an increase of over 79%.
The epidemic is the latest dilemma in our struggle against an ancient disease. Poppy seeds dating from the Neolithic period have been found at archaeological sites and the first mention of opium dates back to Mesopotamia. The history of the misuse of opium continued through the ages. It is a story that is common to many lands and threads its way through time. Addiction to opiates has been with us from the beginning of recorded history, continues to be intractable and now kills in record numbers.
This is a bleak picture and yet, as the President of COMPA, I have great hope for the future. We are not living in the Stone Age. Today, we know a great deal more about the science of the brain and addiction than we did just a decade ago. Medical research has rapidly increased our knowledge of the biological basis of addiction leading to new medications being approved for treatment and improved use of existing medications. Methadone remains one of the most effective and least costly medications in treating opiate addition that we currently have available, especially when combined with psycho-social therapy. Scientific progress in pharmaco-genetics promises the possibility of personalized medication regimens that can be matched with targeted, informed treatment. We live in an age of infinite promise and discovery.
At the same time there are many long-standing barriers to treatment, with deeply rooted misconceptions about methadone and medication-supported treatment of addiction, and prejudice that imperils our patients and our ability to succeed.
Methadone patients continue to suffer under the preconception that only complete withdrawal is a cure; those who relapse do so by choice and are therefore weak and morally degenerate. Methadone patients face a criminal justice system, which forces them to discontinue the life-saving medication. They face 12-step groups, which shame them because they are taking medication; they can be denied housing because they are taking medication, despite doing well in their recovery. Our patients cannot take jobs because there is no commercial insurance which will help cover the cost of the medication that they must take to remain well. The often-misguided goal of complete abstinence without the benefit of much-needed medication is so universally admired that patients pursue it to their own detriment, despite mounting scientific evidence showing that for most patients, longer duration of treatment is associated with better outcomes.
Ironically, the stigmatization associated with medication has shown the opposite trend in mental health treatment. The American Psychiatric Association defines a psychiatrist as a medical doctor who conducts psychotherapy and prescribes medications and other medical treatments. Recent articles in leading psychiatric publications discuss the shift in mental health toward the necessity of a combined medication/psychosocial model of care. There is a clear standard of care for both psychotherapy and medication in mental health care. An individualized, patient-directed approach to care is achievable for substance use disorder patients. Breaking through prejudice and stigma with education and consistent advocacy is COMPA’s mission.
Our field is on the brink of great change. Medicated supported recovery, which began with the introduction of methadone by Drs. Vincent Dole and Marie Nyswander in 1964, has continued with the use of new medications, Suboxone, Vivitrol, Zubsolv, and Subutex, and more being developed. The passing of the Affordable Healthcare Act and the Final Act of the Mental Health Parity and Addiction Equity Act are steps toward fair and equitable treatment coverage. COMPA will be working to ensure that methadone is covered under these acts. There is great uncertainty concerning the effect of Medicaid Redesign and the implementation of Behavioral Health Organizations and Health Homes on Opioid Treatment Programs. We are working to ensure that our programs and the vital services they provide are not destabilized in the transition to a managed care model of care and that there is increased access to treatment during this public health crisis. These issues lead COMPA’s agenda.
COMPA works closely with New York State OASAS, the NYS Department of Health, SAMHSA, the New York City Department of Health and Mental Hygiene, and with our colleagues at the American Association for the Treatment of Opioid Dependency (AATOD) and the Association of Alcohol and Substance Abuse Providers (ASAP). There is much work to be done in this time of changing regulation, restructuring Medicaid reimbursement, rapidly evolving neuroscientific knowledge, coordinating care management, integrating electronic records and policy overhaul. The list is daunting. Our patient population is fragile and undertreated, and the need for a strong and clear voice is vital. Please join us and get involved in COMPA. Visit our website and contact us.
The epidemic is here and now. There is no time to lose.
— Allegra Schorr