Saturday, May 26, 2018
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Assisting treatment

Scant resources and cultural biases limit the availability of medications that ease painful withdrawal symptoms

Nearly 1,000 treatment providers, judges, and others on the front lines of Ohio’s opioid epidemic got plenty of reasons for hope last week.

At a conference on opiate addiction in Columbus, Gov. John Kasich and other officials outlined how they are working with drug courts, schools, mental health and addiction boards, law enforcement agencies, and others to alleviate a public health crisis that killed more than 1,000 Ohioans last year.

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In rural and urban counties, for example, innovative drug courts provide options other than incarceration, as well as real hope to addicts and their families through intense monitoring, peer support, and effective drug treatment.

But the symposium also identified gaping holes in how tens of thousands of drug-addicted people are treated in this state, especially with so-called medication-assisted treatment. A lack of resources and, in some cases, lingering cultural biases have limited the availability of medications that ease the painful — often agonizing — withdrawal symptoms encountered by opiate addicts who are trying to get clean.

These medications, such as Suboxone, Methadone, and Naltrexone, dramatically increase recovery success rates. They should be available to every opiate addict in Ohio who seeks treatment.

Overall, as few as one in 10 Ohioans who need drug treatment get it. The vast majority of treatment provided by local mental health and addiction boards is not medication-assisted.

In Lucas County last year, nearly 70 percent of the hundreds of clients who got outpatient services funded by the Mental Health and Recovery Services Board had a history of opioid or heroin use. Yet the board could fund enough Suboxone for only 18 people — in a county with relatively good access to treatment.

That’s unacceptable in a state battling an opioid epidemic. Evidence-based treatment with proven success rates must expand, to reduce the demand for drugs that has placed an estimated 200,000 Ohioans in the throes of addiction.

Addressing last week’s symposium, Dr. Ted Parran, medical director of the Case Western Reserve University School of Medicine, called for medication-assisted treatment for every addict in Ohio who is in the early stages of recovery. Typically, medication-assisted drugs should be used — with supervision, therapy, and monitoring — during the first two years of treatment, until people reach a stage of stable recovery.

After that, most patients should be weaned off the drugs. Suboxone and Methadone can be addicting, but they’re far less so than heroin or powerful prescription painkillers.

Even with intense outpatient treatment, sponsors, and other supports, 70 to 80 percent of opiate addicts will relapse in the first six months of treatment, Dr. Parran said. With medication-assisted treatment, however, relapse rates typically drop to 50 percent or less, and the first six months of recovery are when most relapses occur.

Medication-assisted treatment has drawbacks. It can be costly — $5,000 a year or more. But those costs pay for themselves exponentially by increasing recovery rates and lowering health-care costs, as well as the costs to society in general as high rates of theft and larceny accompany opiate epidemics.

Still, money is not the only impediment to expanding medication-assisted treatment. Some treatment providers in Ohio, the birthplace of Alcoholics Anonymous, regard medication-assisted treatment with suspicion. Those suspicions have been aggravated, understandably, by a history of dangerous drugs used to treat alcohol and drug addiction decades ago.

“We still have a number of abstinence-based treatment providers that don’t understand why medications like Suboxone, Methadone, and Vivitrol are essential for [treating] this disease,” Orman Hall, the director of Governor Kasich’s Cabinet Opiate Action Team, told The Blade’s editorial page. Until February, 2011, when Mr. Kasich lifted the restriction by executive order, local agencies and boards were actually barred from using state funds for medication-assisted treatment.

Beating an opiate addiction is tough. Opiates change the brain’s chemistry in ways that make the impulse to use practically irresistible. Withdrawal symptoms include sweating, nausea, body aches, and severe depression.

Ohio needs a range of treatment options, including medication-assisted treatment, to meet the challenge posed by this public health emergency. As the opioid epidemic shifts from prescription painkillers to heroin, effective treatment will become even more essential. In many cases, effective treatment means medication-assisted treatment.

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