To combat the opioid epidemic, focus on the forgotten addict

To combat the opioid epidemic, focus on the forgotten addict
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In an attempt to combat one of the worst public health crises in the nation’s history, U.S. Senate committees are now debating a varied and wide range of  legislation to fight the opioid epidemic. This follows the approval by the House of dozens of such bills. At first blush, it might seem like reason for optimism.

But the legislation, while well intended, leaves a gaping hole in federal drug policy. It does not even mention, much less engage, with the most severely disordered drug abusers. I am talking about those who are often ignored and neglected — the hundreds of thousands who are so sick they can no longer function normally in society, have lost their family and employment ties, and have few resources to get the treatment they so desperately need.

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They are the ones most likely to be among the nearly 200 Americans who die every day from drug overdoses.

 

As a practicing addiction psychiatrist for more than 50 years, I have seen first-hand the destruction caused by drug dependence. I have also seen thousands of desperately disordered addicts enter recovery and rebuild their lives. In fact, 24 million Americans today are in recovery from drug addiction or alcoholism.

But the anti-opioid measures now under consideration offer little to these forgotten addicts. For them, life is a daily struggle to stay high or to stave off the agony of withdrawal. Getting the next fix — heroin or opioids or the potent synthetic opioid fentanyl, which is driving the spike in overdose deaths — more often than not leads to criminal and destructive behavior.

The addicts are isolated by their illness. Captives of their habit, their brains hijacked by the “morphine molecule,” they are unlikely to voluntarily knock on the door of a treatment center and ask for help. And even if they did, recovery attempts for these substance abusers often involve serial relapses and cycling in and out of rehab.

Given the scope of this epidemic, addiction programs have scrambled to treat the swelling number of patients, yet most don’t have what’s needed for these addicts.  An effective course of therapy — known as medication-assisted treatment (MAT) — is too often provided as outpatient care and is relatively short-term. This is just not enough to help the most sick, vulnerable and addicted people.

What we need for those with severe social and behavioral pathologies is longer-term services, preferably in a residential setting. These treat the whole person with intensive psychotherapy accompanied by withdrawal medications to ease cravings. In my experience, this is an effective way to give many addicts the chance to function again and eventually lead productive lives.

Numerous studies support this approach for the most vulnerable addicts. The longer a patient is in treatment the more likely the outcome of reducing drug and alcohol use and antisocial behavior, despite frequent relapses on the long road to recovery.

This must be the goal of opioid legislation and funding now before Congress: creating a pathway to treatment for the most severely disturbed addicts. We need outreach to these people on the streets and in healthcare centers and emergency rooms and in correctional facilities.

The neglected addict can be helped. We have the experience and the expertise of the past half-century to guide us. Now Congress must support this effort by committing to expanding treatment services with a special focus on the most vulnerable and forgotten.

Mitchell S. Rosenthal is a psychiatrist who founded Phoenix House, the national substance abuse treatment organization, and is now president of The Rosenthal Center for Addiction Studies in New York City.