With awareness about the dangers of opioid addiction high among public officials, the next steps to a solution are public acknowledgment that addiction is a disease and securing the resources required to combat it, according to experts who spoke during a recent panel discussion here.
Sen. Joe Manchin, D-W.Va., right, and Rep. Tim Murphy, R-Pa., discuss legislative efforts to address the opioid crisis during a recent panel discussion.
Legislators, public health officials and veterans group representatives participated in the panel discussion,(www.rollcall.com) titled Fighting the Opioid Crisis, that was hosted by Roll Call on July 13. Underlying the discussion were the needs to adequately fund Medicaid, which has been a valuable source of support for social services that address the issue, and to treat drug abuse as a medical problem instead of a crime.
Legislators set the stage by defining the scope of the problem.
Rep. Ann McLane Kuster, D-N.H., pointed out that 6 percent of patients who take prescription opioids for just one day -- and 35 percent of those who take them for 30 days -- will be using these medications a year later.
Sen. Joe Manchin, D-W.Va., whose state has the nation's highest rate of deaths due to drug overdose,(www.cdc.gov) said, "Twenty years ago, we did nothing to treat mental health. Now with the ACA (Patient Protection and Affordable Care Act), this is the first time people can get treatment for mental health and opioid addiction."
- Experts at a July 13 panel discussion titled Fighting the Opioid Crisis talked about successes and work that remains in addressing the issue.
- Panelists highlighted the need to treat drug abuse as a medical problem instead of a crime and to adequately fund Medicaid.
- One speaker emphasized the importance of reliably funding addiction treatment.
A bill Manchin sponsored, known as Jessie's Law,(www.congress.gov) is intended to help slow the rate of opioid addiction by making it easier for physicians to know the opioid addiction history of patients who choose to provide that information to a health care professional. The law is named for Jessie Grubb,(www.mlive.com) who died of an overdose one day after she was prescribed oxycodone after hip surgery. Her parents had told the hospital she was recovering from heroin addiction, but the physician handling the discharge did not receive the information.
Another bill, the Second Chance Reauthorization Act,(www.congress.gov) would address addiction by providing federal grant funding to help individuals who are released from jail or juvenile facilities receive mental health services, education and job training. The program targets potential repeat offenders and individuals who are considered vulnerable to drug abuse.
But a major roadblock to fighting the opioid problem is the lingering public perception that drug use and addiction are character flaws not tied to an illness, and one legislator said it is important that medication-assisted treatment includes intense counseling to address mental health.
"If we don't treat that, it's a waste," said Rep. Tim Murphy, R-Pa.
This particular misperception about addiction is widespread, speakers said.
"There is still a segment of the population that is hesitant to look at it as a disease," said Cynthia Reilly, director of the Substance Use Prevention and Treatment Initiative at the Pew Charitable Trusts.
Kuster pointed to Sullivan County in Maine as one area where this attitude is shifting. When the justice system became overwhelmed by heroin cases, judges supported the formation of drug treatment courts that would direct nonviolent drug offenders to a two-year treatment program. Participants who maintain a clean record and follow the treatment recovery plan graduate from the program with no criminal record. They also receive education and job training.
Panelists pointed out that many treatment programs are funded by Medicaid, which makes them vulnerable if federal lawmakers cut Medicaid, as recent legislation has proposed.
"Patients are getting treatment because of the Medicaid expansion," Kuster said. "Our treatment programs would close and our rural hospitals would close. We are worried we could lose that."
In Maryland, for example, one-third of patients with a substance abuse disorder depend on Medicaid.
"We cannot afford to roll back the gains we've made," said Baltimore Health Commissioner Leana Wen, M.D.
Seven hundred people in Baltimore died from a drug addiction in 2016, yet recovery facilities and health professionals trained in addiction treatment are so scarce that only 10 percent of the individuals there who need addiction treatment are getting it.
"Patients who know they need help come in, and I have to tell them, 'I'm sorry; I may be able to find you treatment in three weeks or maybe a month,'" Wen said. "That wouldn't be acceptable for any other disease."
Adding to the problem, Wen said Baltimore does not have a sufficient supply of naloxone. The city's stock of 5,000 units needs to last until 2018.
Wen emphasized the need for a reliable source of funding to cover addiction treatment and called on prescribers to remain aware of their role in addressing the issue. She also warned of the consequences if the public does not acknowledge addiction is a disease.
"As long as we view addiction as a choice, then it's OK if they end up in jail or dead," Wen said. "The stigma is preventing people from seeking treatment."
Related AAFP News Coverage
AAFP Urges FDA to Revise Plans for Physician Opioid Education
More From AAFP
AAFP Chronic Pain Management Toolkit