On February 2nd, 2016 the Obama administration announced a proposal that it would be asking Congress to spend an additional $1.1 billion next year on the opioid addiction crisis taking place in America. Focusing on the rising abuse of prescription painkillers and heroin addiction, the President said the money would be split between half allocated to increasing treatment and treatment access and the other half allocated to creating and expanding prevention education programs, law enforcement for crackdowns on drug dealing and improving and increasing access to naloxone, the lifesaving medication that reverses an opioid overdose.
Benefits of New Proposal for Drug Addiction
On the surface, this proposal is a positive step forward on a number of fronts in terms of addiction, treatment and recovery. First, it is a good thing that the President of the United States, having seen the destructive impact of addiction on the country, is taking time to focus on the issue. Additionally, it is aiding in breaking stigmas associated with addiction and it is increasing funds seemingly to increase and improve programs that will help those individuals and families in need. Finally, it is furthering the change in government and public perception that addiction is truly a public health issue and a disease that requires treatment rather than a criminal issue that we can arrest our way out of through incarceration.
However, while there are certainly positives from this new proposal from the President and his administration, there are several underlying issues that are extremely concerning. The major concern stems from the administration’s proposal that $460 million will be allocated next year to states in order to fund medication assisted treatment for opioid abuse. Medication-Assisted Treatment (also known as “MAT”) is defined by the Substance Abuse and Mental Health Services Administration (SAMHSA) as the combination of “behavioral therapy and medications to treat substance use disorders.” This includes OTPs, which are opioid treatment programs. Typically, whenever MAT is mentioned, it is in reference to FDA approved medication such as buprenorphine, Suboxone or Vivitrol (an extended-release injectable form of naltrexone.)
The major concern that comes from the leader of the free world calling for hundreds of millions of dollars to be allocated for a specific form of drug treatment is that it fails to recognize the dangers of pushing what is truly an unregulated form of treatment while inadvertently rubber stamping that same treatment as the gold standard for treating addiction. What the Obama administration fails to recognize is that, while in theory Medication-Assisted Treatment offers an evidence-based treatment practice that certainly has benefits in treating addiction, because MAT is so unregulated and there is so little training for doctors or oversight by anyone of those doctors that are performing MAT, what started out as a good idea and a supplement to clinical work has instead turned into a dangerous practice. Medication-Assisted Treatment has become Medication AS Treatment. This is setting a dangerous precedent moving forward and rather than helping those with substance use disorders, MAT can actually in many cases becoming a detriment to recovery.
History of Medication Assisted Treatment
To understand the issues, it is important to understand the history of MAT. In 2002, Suboxone became the first drug that physicians could use to treat addiction out of an office based setting, supported by the Drug Addiction Treatment Act of 2000 (DATA-2000). The thought process was that the stigma surrounding addiction was so detrimental to those in need of help that they often would refuse to seek help out of shame. Therefore, instead of making them seek help at an addiction treatment center or stand in line at a methadone clinic, DATA-2000 gave physicians the ability to treat addicts in the comfort of their practices in an office, like anyone going to see the doctor for any number of medical issues. In 2006, the law was amended so that any physician with their DATA-2000 certification for more than one year could treat up to a maximum of 100 patients.
Again, this all sounds great in theory. However, when taking a look under the hood, there are some major issues with the idea of Medication-Assisted Treatment. First, the training that physicians need to undergo in order to prescribe and dispense buprenorphine and Suboxone according to DATA-2000 is limited to say the least. A doctor can be certified to prescribe Suboxone after completing an eight-hour training. In the context of any other medical disease, that is virtually nothing at all. The medical community and society as a whole understands that addiction is a chronic, progressive disease, complex in nature with extreme variables and yet the training that a doctor requires to prescribe and dispense an important medication to aid in treating that complex disease is only an eight-hour course that can be taken online. Second, a major problem with DATA-2000 is that it suggested, but did not MANDATE, buprenorphine treatment be combined with counseling and regular drug testing. Again, addiction is complex, often exacerbated by major issues such as mental health diagnoses and trauma. However, rather than mandate that medication be used IN CONJUNCTION WITH or ALONGSIDE counseling and drug testing, DATA-2000 simply SUGGESTED it.
So in a nutshell, here is the problem with MAT: It has turned a good idea like Medication-Assisted Treatment into a horrifying, detrimental approach of Medication AS Treatment. It has taken the most important part of drug treatment (the treatment) out of the equation. Addiction has long been considered a behavioral disease (doesn’t it fall in most states under “Behavioral Healthcare” after all?) and yet MAT has taken clinical work out of the treatment of addiction. CLINICAL WORK IS THE CORNERSTONE OF ANY QUALITY TREATMENT PROGRAM. What DATA-2000 really did was let doctors with no addiction training get certified after 8 hours to prescribe a highly physically and emotionally addicting substance in the comfort of their office without having to require that the addicted patient get any counseling or drug testing. Now, years later, doctors advertise that they can “treat” your addiction with an hour evaluation, a prescription and follow up visits through telemedicine. Does this REALLY sound like treatment for a complex disease like addiction? If this approach is so effective, why is the opioid epidemic getting worse, not better? Did DATA-2000 create a supportive approach to current treatment modalities by introducing a way to add effective medications into the treatment of addiction OR did DATA-2000 create the potential for legal drug dealing, only with the dealers holding medical licenses? Sure, many of the doctors performing MAT believe that this approach is helpful to the patient, but is it really? If this seems too far-fetched, perhaps we should ask why so many doctor’s prescribing Suboxone out of their offices only charge cash? Or perhaps how a doctor with a practice that focuses on something else can still be “treating” their legal limit of 100 Suboxone patients? Is 30 minutes and a prescription really “addiction treatment”? Again, if this is too far-fetched, thinking the medical community may not be on top of some of these practices, let’s remember how the current heroin crisis really began: By overprescribing of painkillers, pushed by the pharmaceutical industry and prescribed by doctors that didn’t have enough training in pain and pain treatment. Sound familiar?
The fact remains that since DATA-2000 was introduced, the goodhearted intentions of Medication-Assisted Treatment has instead become Medication AS Treatment. For many doctors that use MAT, there is virtually no treatment to speak of. Rather, come get a prescription to “treat” your heroin addiction. Don’t worry about the mental health issues you’re dealing with, don’t worry about the past trauma, the ingrained behavioral issues, the underlying causes of your addiction. Don’t worry about that. Just come in and take this pill so you won’t get sick. This is what MAT has become and it is frightening that on February 2nd, the President of the United States called for almost $500 million to INCREASE this type of “treatment”. Individuals, families, communities, treatment professionals and those in government need to understand that there is a huge disconnect between the studies demonstrating that medication can be effective in aiding to treat addiction and what is actually occurring in the comfort of doctor’s offices throughout the country. MAT has failed miserably in many ways and before we give any more money to fund it, there needs to be regulations and oversight regarding those physicians that are prescribing these medications and requirements that any patient receiving MAT is also engaged in counseling and drug testing. Otherwise, MAT becomes Medication AS Treatment and it’s just another band aid on the gunshot wound of addiction in America.
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