Infrastructure needed to treat addiction as chronic disease doesn't exist

Infrastructure needed to treat addiction as chronic disease doesn't exist
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Johnson & Johnson and Purdue Pharma — two of the nation’s largest pharmaceutical companies and opioid manufacturers — are involved in extensive settlement talks for their contributions to the national opioid epidemic. 

These companies should be held accountable, if they are guilty of the roles they are accused of playing in this public health crisis.

Yet the scope of the crisis, which takes the lives of 130 people each day in the U.S., demands much more. Payouts by drug companies will do nothing to diminish the harm these companies caused, unless these resources go specifically towards evidence-based solution. 

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Addiction is a disease. Like other diseases, opioid addiction can be safely and effectively treated. As an ER doctor and the former Health Commissioner of Baltimore, I witnessed the hundreds of lives lost each year in my city to overdose and aimed to treat addiction the way I would any other life-threatening disease.

We issued a blanket prescription for naloxone — the life-saving antidote for opioid overdose — that made it accessible without a prescription for all 620,000 residents; made on-demand treatment available in our ERs and through a “stabilization center” and worked with law enforcement to offer treatment instead of prosecution for individuals arrested for low-level drug offenses. 

Despite these efforts, treatment at the time that a patient needs it was, and remains, hard to come by, in Baltimore and across the country. A 2018 Surgeon General’s Report found that only about 1 in 4 people with opioid use disorder received specialty treatment for their drug use in the past year. Indeed, it is not uncommon to see patients’ weeks or even months to receive the treatment they need. Consider if this were heart disease: would we ever find it acceptable to have a patient with a heart attack wait weeks or months for their ongoing, life-saving treatment? 

The infrastructure needed to treat addiction, as the chronic disease it is simply does not exist. As payouts by drug companies begin to take form, there is an opportunity to direct those funds where they are most needed, to invest in the following evidence-based interventions and end the opioid crisis once and for all 

First, naloxone must be available to everyone who is able to save a life, which is every first responder and everyone who has a loved one at risk of overdosing from opioids. At the moment, this is not possible. 

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Though naloxone is a generic medication and can be purchased for pennies in other countries, one unit of the medication can cost up to $575 in the U.S. Even the discounted price for cities and counties is up to $80 per unit.

The federal government can use its emergency powers to negotiate a much lower cost of naloxone, and settlement funds can further supplement to ensure that no first responder has to ration or family member has to go without this life-saving antidote.

Second, medication-assisted treatment (MAT), the gold standard of care for opioid use disorder, must be made widely available — at the time that patients request treatment.

A study conducted through the Johns Hopkins Bloomberg School of Public Health found that most substance use treatment facilities in the US do not offer the three medications approved by the FDA for long-term management of opioid use disorder: buprenorphine, naltrexone, or methadone. This is despite research that shows that buprenorphine and methadone reduce mortality after a nonfatal opioid overdose by 40 to 60 percent.  

This year, Massachusetts passed a law that requires emergency departments in the state to offer MAT. Other programs across the country, such as the ED-BRIDGE in California, have taken similar steps to expand access to treatment by starting patients on buprenorphine treatment on-demand in the emergency department. These successful programs set an example for treating addiction as a disease no different from diabetes or high blood pressure.  

Third, the expansion of MAT must be accompanied by wrap-around services, including counseling, mental health assistance, and supportive housing — all of which are critical to recovery.

The evidence is clear: MAT is most effective when administered in combination with psychosocial support, and individuals are more likely to participate in MAT when they have access to stable housing — which is health care. Yet these interventions are nearly impossible to implement when resources are lacking.

Last year, Rep. Elijah CummingsElijah Eugene CummingsMaya Rockeymoore Cummings, Elijah Cummings's widow, will run for his House seat Former NAACP president to run for Cummings's House seat Elijah Cummings's widow 'thinking carefully' about running for his old seat MORE (D-Md.) and Sen. Elizabeth WarrenElizabeth Ann WarrenOvernight Energy: BLM staff face choice of relocation or resignation as agency moves | Trump says he's 'very much into climate' | EPA rule would expand limits on scientific studies Krystal Ball credits Gabbard's upswing in 2020 race to 'feckless' Democratic establishment Outsider candidates outpoll insider candidates MORE (D-Mass.) introduced the Comprehensive Addiction Resources Emergency Care (CARE) Act, which would direct $100 billion to the opioid epidemic over ten years. The CARE act accounts for all of the aforementioned evidence-based interventions to fight the opioid crisis and provides a sustained investment of resources, commensurate with the scale of the disease, aimed directly at helping areas hit hardest by addiction and overdose.

This proposal mirrors the Ryan White HIV/AIDS program, which at the height of the HIV/AIDS epidemic, provided — and still provides — substantial funding for treatment, care, and prevention each year. We should look to the CARE Act — and the Ryan Program on which it was modeled — as an example for how settlement funds from pharmaceutical companies can and should be used. 

The ongoing conversations involving Johnson & Johnson and Purdue Pharma present an opportunity to turn the tide and commit a sustainable stream of resources to combatting the opioid crisis. Pharmaceutical companies can make payouts, but that money must be used with intention and purpose. We must ensure that it goes toward what we know works — and ultimately, what saves lives.  

Dr. Leana S. Wen is a visiting professor at the George Washington University’s Milken Institute School of Public Health and the distinguished fellow at the Fitzhugh Mullan Institute for Health Workforce Equity. Twitter @DrLeanaWen.