One of the assumptions surrounding the opioid crisis in recent years is that society has made great strides in treating the issue not as one of moral failing but of addiction.
That is true, up to a point. At no time since the onset of the epidemic -- which started five, 10 or even 20 years ago, depending on where you choose to mark its beginning -- is there more readiness to accept opioid abuse as a medical issue.
Much of that acceptance has no doubt come because the wave of addiction -- more than 2,000 people died of opioid overdoses in Massachusetts last year -- has spread so far that everyone knows a friend, coworker or family member touched by tragedy. The epidemic is no longer abstract; for many of us, it is deeply personal.
Unfortunately, that acceptance may still be wider than it is deep. A new report from the state Medication Assisted Treatment Commission, released earlier this month, made clear that there are still significant barriers facing those seeking help for addiction to opioids. The medical community in many ways still needs to adapt its attitudes and treatment approaches to catch up to public sentiment.
The commission looked at access to treatment programs that use three federally approved medications aimed at weaning those addicted off opioids -- methadone, buprenorphine and naltrexone. Despite widespread public support for treatment programs using those medications, the commission found, they are out of reach to the vast majority of those suffering from addiction.
Much more troubling were the commission’s findings that there remains widespread opposition to the siting of treatment facilities in local cities and towns, and continued reluctance by doctors to treat those suffering from addiction.
“There’s a lot of stigma out there, in the community as well as in the medical field,” Dr. Norma Lopez, an addiction specialist at the Lynn-based North Shore Physicians Group, told Statehouse reporter Christian Wade. “We need to do a better job explaining that this is not a moral failing, it’s a chronic condition that requires medical treatment, no different than diabetes or hypertension.”
Making the situation more distressing is that medication-assisted treatment, or MAT, has proven effective enough that it should be widely available.
“We have the tools to stem the tide,” Mary Bassett, head of the Chan School’s FXB Center for Health and Human Rights at Harvard, said at a recent daylong conference on the topic at the university’s Cambridge campus.
At that same conference, Richard Frank, a professor of health care policy at Harvard Medical School, laid out the sobering consequences.
Only 10 to 25% of people with an opioid problem are being treated, he said, according to a report from the conference by the Harvard Gazette. Just 35% of those in treatment get therapy that is likely to be helpful. Of those, 40% remain in treatment for a year.
That means only 3.5% of people in need are getting effective treatment.
Frank and others at the Harvard conference urged care providers to update approaches to treatment that are in many ways stuck in the 1970s. Some of that requires states to update outmoded regulations that do not reflect current science.
Meanwhile, the state commission had several suggestions for improving access to MAT care, including:
working with municipalities to allow for the siting of more treatment centers;
expanding the dosing hours at already-open centers;
streamlining federal regulations to allow easier use of methadone;
exploring the possibility of allowing pharmacists to dispense MAT drugs in cooperation with a patient’s doctor; and
encouraging treatment centers to keep patients in care, rather than discharging them for minor infractions.
Other steps include following the lead of law enforcement, which has in large part shifted from treating those addicted to opioids primarily as criminals, instead trying to get them into treatment. Much of that work is happening in the state’s county jails, where a pilot program aimed at providing medication-assisted treatment is still in its early stages.
The irony is not lost on Peter Koutoujian, the Middlesex County sheriff.
“The fact is you shouldn’t have to come to jail to get good treatment,” he told Wade. “You should be able to get that in your own community so you don’t have to have your life disrupted by becoming incarcerated.”