One problem driving the opioid epidemic—aside from the carelessness or actual avarice of the pharmaceutical companies —is that it can be easier and cheaper (not safer) to continue to take opioids than to get drug addiction treatment for it. That must change if we want to end the epidemic.
The website Vox recently reported on a woman who became addicted to Vicodin, which her insurance paid for in full, but who found when she sought opioid addiction treatment that insurance wouldn’t cover her medication-assisted treatment (MAT) plan’s drug, the mild opioid buprenorphine.
Why would insurance pay for the cause of her addiction but not the cure?
Vox couldn’t get an answer, but there are many possibilities. It’s true that buprenorphine can be abused, but so can Vicodin, and much more easily.
The most likely explanation may be that many people—insurers included—don’t trust or believe in MAT. If you’re addicted to a drug, conventional wisdom states that the solution should be to stop taking drugs, not taking a different drug. That’s just replacing one addiction with another.
That’s been the rap on methadone, a MAT for heroin addiction that some consider just another addictive drug. That’s one way to look at it, but it is a very narrow-minded and judgmental view which probably results from the fact that many people still think drug addiction is just a matter of choice, of weak morals or a lack of concern to the costs of addiction on family, friends and society, not just one’s self.
That belief, though still widely held, is obsolete. Addiction is primarily a chronic brain condition, similar to a disease or a mental illness. Some people are more prone to addiction than others, and some have a tougher time quitting.
MAT is one of the most effective ways of controlling addiction. While methadone and buprenorphine can be abused, at prescribed doses they control the symptoms of addiction that make normal life next to impossible, such as cravings and withdrawal. On methadone or buprenorphine, many addicts can level off and hold down a job.
Chronic pain sufferers might experience similar results with cannabis (marijuana) where it is legally available, or cannabidiol (CBD), a non-psychoactive component of marijuana (no high).
If ending the number of deaths is important to society and the authorities, then greater harm reduction policies, such as needle exchanges, also are needed. Though controversial, they succeed at reducing the spread of HIV and hepatitis.
Safe injection sites—places where addicts can bring their drugs for testing (making sure they weren’t mixed with deadlier and more powerful drugs such as fentanyl, or otherwise contaminated) and inject them without fear of arrest but with a nurse or doctor present in case of life-threatening complications—are another.
Can these programs encourage people to use drugs or continue using drugs? Perhaps, though there is little evidence of it. It might be distasteful, but it may be the price we have to pay for allowing Big Pharma to enable the opioid epidemic in the first place.