The government is attempting to respond to the opiate crisis and make something positive happen.
CBS News says that “The 2018 spending bill provides another $1 billion for opioid crisis grants to states” and “grants are awarded to states based on a variety of factors, including overdose deaths and the number of people who can’t find treatment.”
Hopefully this kind of investment in our future can actually make a difference. Currently the problem is not really showing much signs of slowing down as the number of opiate addicts, overdoses, and teens getting hooked on opiates appears to be rising.
One of the problems with drug addiction like this is that there are no easy solutions. What that means is that there is no one clear path to fix the problem, even if that path might be very expensive or difficult to implement.
Instead, not only is the solution going to be difficult, but we don’t even really know what that solution looks like yet. Everything that we have tried up until this point has arguably failed, and we are struggling to find new tactics and strategies in this battle against opiate addiction.
One of those tactics is the idea of MAT, or “medication assisted treatment.” In the last few decades, when it came to opiate addiction, the main MAT solution was methadone. Now methadone has a bad reputation because it was used to treat heroin addicts and it was largely ineffective (some will argue).
One of the reasons that methadone was “a miss” is because it is a full opiate, meaning that it acts just like a regular opiate such as vicodin or heroin–the substance floods the brain, gives a feeling of euphoria, and can cause a person to eventually coma and even die from taking it.
Newer MAT medications–in particular Suboxone–is not a full opiate. It is a partial opiate and that means that once it fills up those opiate receptors in your brain, it stops flooding it with more. Therefore there is no euphoric effect and you do not get that dopey feeling from taking Suboxone. Instead, it just fills up those receptors and therefore minimizes (or eliminates) physical craving for more opiates.
Now a couple of issues here. Our biggest and best idea, at the present time, is to throw more money at the opiate crisis by increasing the reach of MAT, pushing it to more and more suffering addicts, hoping that this will be a solution.
When we go to publish our numbers for the world to see on how well we are responding to the opiate crisis, the MAT solution is better than anything else. Let me explain that a bit more so that you can see the danger in using this as our main solution.
An analogy, if you will: Cigarette addiction can be treated in several ways, and one way that people attempt to quit is by using NRT, which is “nicotine replacement therapy.” So people wear a nicotine patch or they chew nicotine gum in order to avoid cigarette cravings. This works very well in the short term and supposedly it helps a lot of people to quit altogether.
However, if you look at the studies that are done and do some digging, you will realize that cold turkey quitters who do not use NRT, while less successful in the short run, actually do better in terms of staying quit for the long term. What does that mean?
It means that if you want to show how effective your nicotine patch is at helping smokers to quit, just construct a study that shows short term results like 90 days or even 6 months. Compare a group of 50 smokers who are using NRT to 50 smokers who are attempting to quit cold turkey, and you will see that, in the short run, the NRT group does far better than the cold turkey group. It is no contest. Of course the NRT group is doing better, they are still taking the drug that is nicotine!
What those studies are designed to do is to show that NRT is successful, so they measure short timelines. If we stretch it out to show 3 years later, we see that most of the NRT group is back on cigarettes, while a few of the cold turkey quitters actually succeeded in quitting for good.
So this same analogy applies–to some extent–to MAT when it comes to opiate addictions. If you want to show good results in the short term then just put all of the opiate addicts on Suboxone–you will see a definite decrease in metrics such as death by overdose, hospitalizations, and so on.
The problem is that, in the long run, you haven’t changed anything really unless those opiate addicts using MAT are also doing things like therapy, group therapy, counseling, 12 step involvement, and so on.
And so the MAT supporters proudly exclaim at this point “Of course we are sending them to meetings and therapy and all of those supports, along with MAT! Of course we are doing that!”
But the problem is that when an opiate addict learns about MAT, they view it as a solution. You can try to re-frame their mindset and try to convince them that they still need to work really hard on therapy and meetings and other supports for their recovery, but based on my experiences and my observations in the world of substance abuse treatment, they aren’t really listening.
No, the opiate addict is not listening when you tell them that their MAT must be accompanied by daily NA meetings, therapy, counseling, and a well rounded and comprehensive approach to treatment. They don’t want to hear all that. “Just give me the magic pill” is what they are really saying.
Everyone secretly believes that if they have this magic pill, if they have MAT, if they have Suboxone and it magically removes their cravings–then they won’t have to do all of that hard work that they hear about in rehab: Going to NA every day, going to see a therapist, spilling their guts to people, and so on.
Everyone nods their head and agrees profusely that they are going to follow through and do all of the hard work when it comes to MAT and treatment, but that is not what I have observed.
So my fear is that we throw a billion dollars at promoting the use of MAT, only to find that what we really “bought” with our tax money was a short term boost for our report card. The real solution, I am afraid, is going to take far more hard work and dedicated treatment.