Experts say effective treatments for addiction exist, including methadone, buprenorphine and naltrexone, but are currently underused in the medical community.
Medications that effectively treat opioid addiction remain underused in the United States according to the nation’s top medical advisers, who estimated that only a small portion of the estimated two million people addicted are receiving these medications. A report was recently published by the National Academies of Sciences, Engineering and Medicine, and the group, which advises the federal government, is calling for increased prescribing of these drugs and other changes to reduce barriers to access.
Government-approved medications, which include methadone, buprenorphine and naltrexone, help control cravings and reduce the unsettling mental and physical withdrawal symptoms like nausea, muscle aches, pain, and anxiety. Their use is backed by the medical community at large. However, there are also many skeptics who say that they contribute to the problem by allowing addicts to continuing using while they are trying to get clean. These anti-addiction drugs can also be highly addicting, and advocates of twelve-step programs have long argued that total sobriety should be the only option.
The report concludes that “patients taking the medicines fare better over the long term and are 50 percent less likely to die than if they weren’t on them. An ‘all-hands-on deck’ response is needed — including doctors, law enforcement and family members — to expand access to treatment.” Data from the U.S. Surgeon General revealed similar statistics and the findings were included in the most recent report. The fourteen-member panel, which included addiction and rehabilitation specialists, summed up several reasons behind the low use including stigma and restrictions on use.
“Stigma and misunderstanding about the nature of addiction remains one of the biggest barriers to treatment in part because two of the medications used to treat opioid addiction — methadone and buprenorphine — are themselves opioids,” the report concludes. The panel said this contributes to the “mistaken belief that it’s ‘just substituting one drug for another.’” Those taking the anti-abuse drugs are often seen as simply using a band-aid rather than focusing on long-term sobriety.
However, experts in the anti-addiction community argue that these medications are given at doses big enough to fend off withdrawal, but which are too small to produce the high the addicts are used to experiencing in their illicit drugs of choice. Patients can still successfully function in their day-to-day routines, including driving and returning to work.
The medicines are subject to restrictions that place limits their use, too. Methadone, for instance, can only be given at government-regulated clinics, which can require patients to commute back and forth. Many don’t ever make it through the door. Buprenorphine can only be prescribed by certified health professionals who must complete eight hours of training. Federal rules also cap the number of patients that these physicians can treat to 275. So, this can potentially mean that all addicts who need treatment cannot. The authors also note that medications are often not available to prison inmates.
“Addiction treatment has long been excluded from mainstream medical training,” the report states, “which means many doctors, nurses and social workers don’t receive training on treating drug addiction.” The panel of medical experts is asking to incorporate addiction programs into standard medical education moving forward.