Chasing an opiate high, hundreds of Americans die of overdoses every day. The despair I feel that we are not doing enough — urgently — to treat the opiate epidemic has become overwhelming.
The first dose of an opiate in a genetically predisposed individual can cause euphoria. Addicts generally progress from Vicodin to Percocet to heroin. The first snorting or injection of heroin can leave an indelible feeling of intense exhilaration.
As heroin use continues, the brain develops tolerance and more is needed to produce the same rush. Often, the patient miscalculates and the result is death.
Almost every day, I walk into an examination room and find a patient either sobbing or stunned at the overdose death of a family member or friend. It has never been this bad in the 20 years that I have practiced addiction medicine.
Our attention is riveted when a celebrity becomes an overdose victim, and we focus for a bit on the ravages of addiction. But the thousands of nameless, faceless victims whose obituaries euphemistically say that they “died suddenly” become mere statistics that are growing at an alarming rate.
Research shows that heroin overdose deaths decline among patients in methadone maintenance. The same effect is available through the use of Suboxone, which is a combination of an opiate (buprenorphine) and an opiate-antagonist (naloxone).
Suboxone doesn’t just take away the craving for opiates; it also prevents the rush from opiate use. A patient who injects heroin while on Suboxone is less likely to die.
Attorney General Eric Holder’s approach to the opiate epidemic — education, enforcement, and treatment — is good. But while we see efforts in the first two areas, the most urgent response to the epidemic is getting the least attention.
Social bias blames the addict for poor choices. Instead, we need to understand that addiction is a chronic disease, like diabetes and hypertension. It has the same treatability, response, and relapse rates.
It’s a familiar maxim of addiction that a patient must hit bottom before he or she achieves sobriety. In my experience, the downhill slide of opiate addiction has many ledges from which a patient cries out for help. The abyss below is either an overdose death or a catapult to recovery.
It is estimated that only one out of six addicts nationwide gets treatment. Imagine what a patient who is ready for sobriety must go through, anywhere in the country:
A patient who is in a drug-induced fugue state or in withdrawal — with the attendant anxiety, sleeplessness, sweating, diarrhea, and vomiting — fumbles through the Internet and starts to call Suboxone providers. Many providers do not have openings, do not accept the patient’s insurance, or offer an appointment many weeks away. The patient hangs up and reaches for his or her drug of choice.
We urgently need a government hot line that would provide opiate help with one call. It would operate 24/7. Trained staff would determine which treatment program is right for each patient.
One treatment option would be detoxification, followed by abstinence, counseling, and 12-step programs. Another is Naltrexone, which is not an opiate but prevents craving for opiates; it is available in pill form for daily use or via a monthly injection. A third option is Suboxone. A fourth is methadone maintenance.
A minority of patients will require residential treatment. The goal should be to reintegrate most patients into the routine of life as soon as possible.
Office-based opioid treatment provides myriad life-changing stories. The knowledgeable prescription of Suboxone is one of the most gratifying experiences in medicine.
All patients who need opiate treatment, regardless of insurance coverage, should be eligible for the appropriate program. Ohio can be a pioneer in developing a program of one call for opiate help, with workable templates and their mandatory enforcement in all towns, cities, and suburbs.
As we controlled AIDS and eradicated smallpox, we can control the opiate epidemic and limit the havoc it wreaks every day. Education highlights the dangers of addiction; charging drug dealers with murder in overdose deaths can also be a deterrent.
But more than anything else, heroin and painkiller addicts need treatment — urgently and free of roadblocks. The desire for treatment among opiate addicts lasts only as long as the phone call they make for help. We must make that call count.
Dr. Mahjabeen Islam of Perrysburg specializes in addiction and family medicine.
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