A Broken System of Addiction Treatment Requires Reimagining Recovery
Isolation, added stress, uncertainty—these feelings are the new normal during COVID times. For an individual suffering from addiction and substance use disorders, these added life hurdles and disruptions are resulting in increased overdose and fatality rates. We can all agree that there is an opioid crisis plaguing our country and have seen its mounting growth in almost every community over the past few decades.
According to the most recent data from SAMHSA from 2016, more than 2.7 million people in the United States had an opioid use disorder. Experts project that there will be a large rise in opioid-dependence and deaths due to COVID-19, along with a significant increase in co-occurring mental health and other addiction issues.
With so many Americans suffering from opioid use disorders, we certainly have a system in place to provide specialized treatment for this specific addiction, right? Wrong.
Currently, only about 17.5% of the 2.7 million people suffering from opioid use disorders receive specialized treatment. SAMHSA’s Treatment Episode Data Set (TEDS) 2016 shows that only 34.5% of individuals with heroin addiction and 28.5% of those addicted to other opioids entered treatment programs that involved "planned medication-assisted treatments,” despite it being one of the most effective treatment modalities for opioid use disorders, according to the National Institute on Drug Abuse. The rest participated in generalized treatment programs along with those suffering from alcohol addiction or other types of drugs. The problem with this approach is that most recovery programs focus on abstinence-only treatment and do not integrate the use of medications. This can be very dangerous for opioid users for whom the relapse rate is very high. Many opioid-caused deaths occur because when someone gets completely “sober,” their tolerance for opiates diminishes. If that person then experiences a relapse, they often decide to use the same amount they were previously accustomed to, which can result in overdose or death.
A fractured system and a missing link
In light of these statistics, why is there such a slow adoption rate for MAT amongst treatment providers when it is often the best treatment option for those wanting to start their recovery journey? The answer lies in the fractured system we have in the United States to treat opioid addiction.
For example, in Colorado where I live, individuals seeking continuing care for opioid dependence and needing supportive meds like naltrexone, Suboxone or methadone are subject to a severely fractured system. A small fraction of Colorado’s addicted population have the financial means to attend comprehensive addiction rehabilitation. According to the 2014 Health Insurance Status of Adult Substance Abuse Treatment Admissions data from SAMHSA, 89.5% of Americans seeking treatment didn’t have private (commercial) health insurance. Though that number has decreased due to a variety of factors in recent years, we know that even with an increase of Coloradans on private insurance, according to research conducted by Colorado Public Radio, 1 in 4 cannot cover their yearly deductible, and the less financially stable someone is, the more likely they are to experience addiction. Those who don’t fall into this minority of Coloradans, who seek treatment and have private insurance and can afford their deductible, either end up being treated by doctors who demand high self-pay reimbursements, or at clinics that treat literally thousands of patients at a given time.
These providers call their services “treatment,” yet the end result is a prescription for long-term opioid replacement drugs such as methadone or Suboxone. Further, these treatment models frequently fail to offer structured counseling services, instead offering a rare monthly therapy session. Further still, when a life event, such as a death in the family, divorce, etc. demands real clinical care, they simply increase a patient’s dosage.
The aforementioned population that constitutes a majority of the people getting opioid "treatment" in Colorado don’t actually see much of a quality of life improvement beyond the replacement of IV and street opioids. Though certainly getting off of recreational opioids is a major improvement, these individuals are no better prepared to find the sort of life one can achieve through evidence-based therapy, a supportive and accountable community, and integrated medication-assisted treatment services.
This fractured care model makes sense, however, because the clinics are looking to get as many people off IV drugs as possible for the sake of public health, not to improve each individual’s quality of life. That’s why between 2015 and 2018, the number of people in OTPs (methadone clinics) rose from an average of 1,967 to 5,242 in Colorado despite there only being 12 OTPs in Colorado in 2015 (with a recent uptick to 22) according to state government data. Though we can agree that looking after public health is a noble cause, it does not take the needs of each individual with an addiction into account.
I believe recovery programs should be designed to provide an outpatient MAT program coupled with individualized and comprehensive treatment experience. Why doesn’t this exist already? A doctor’s prescription doesn’t address mental health concerns that are often the root of the addiction, quitting opioids “cold-turkey” is just plain dangerous for the user, and residential detox means putting one’s entire life on hold. Shouldn’t we provide care and treatment that actually works for the individuals who are suffering from opioid use disorder without them having to give up their life, family, and career? You wouldn’t treat a broken leg with a flu shot, so why isn’t MAT coupled with counseling and mental health services the norm for treating opioid use? Why aren’t all opioid users treated with a focus on the needs of the patient as opposed to simply arresting the development of the addiction?
Generally speaking, more must be done to help educate the general public, healthcare and even recovery community on the effectiveness of a fully integrated MAT program. The more folks with opioid use disorder who can receive MAT, the more evidence will exist to support the use of these programs as an effective agent to fight the opioid epidemic. The more folks who maintain successful recovery, the brighter our collective futures will be.
Cortland Mathers-Suter is the managing partner of Colorado Medication Assisted Recovery.
