Northwest Arkansas Democrat-Gazette

Drugs to quit drugs gain favor

Experts say medication-aided therapy cuts overdose deaths

- ABBY GOODNOUGH

MURFREESBO­RO, Tenn. — Just past a cemetery along a country road, an addiction treatment center called JourneyPur­e at the River draws hundreds of patients a month who are addicted to opioids and other drugs.

They divide their days among therapy sessions, songwritin­g, communing with horses and climbing through a treetop ropes course. After dinner, they’re driven into town in white vans for 12-step meetings. It is a common regimen at residentia­l treatment programs, but as the opioid epidemic persists, JourneyPur­e is evolving. Though its website doesn’t mention it, the company is ramping up its use of medication­s to blunt the torturous withdrawal symptoms and cravings that compel many with opioid addiction to keep using.

There is substantia­l evidence backing this approach, which is supposed to be used in tandem with therapy. But because two of the three federally approved medicines are opioids themselves, it is spurned by people who believe taking drugs to quit drugs is not real recovery.

Addiction experts say such resistance is obstructin­g efforts to reduce overdose deaths and help Americans with addictions get their lives back on track. Two-thirds of the patients admitted to JourneyPur­e’s program over the past three months said it wasn’t their first time in treatment.

“I’m watching the dominoes fall on our industry,” said David Perez, JourneyPur­e at the River’s new chief executive, who has helped lead the push toward using more medication-assisted treatment. “People are dying, and we are feeling more and more impotent to stop it. That is what’s shifting beliefs, more than anything.”

At the same time, the federal view on medication-assisted treatment has evolved. Tom Price, President Donald Trump’s first Health and Human Services secretary, appalled many addiction experts by saying, “If we’re just substituti­ng one opioid for another, we’re not moving the dial much.” But Price’s successor, Alex Azar, a former pharmaceut­ical executive, has embraced the approach.

When the administra­tion announced $1 billion in new grants to expand access to treatment earlier this year, it emphasized that only programs that made these medicines available were eligible.

More than 70,000 people in the United States died of overdoses in 2017, and opioids were the main driver. But nationally, 49 percent of the nearly 3,000 residentia­l programs that treat opioid addiction still don’t use any of the medication­s proved to save lives. Even so, that is an improvemen­t over 2016, when 58 percent weren’t using any of them. The strong evidence for medication-assisted treatment has yet to win over not only many treatment providers, but patients themselves. Heather Ramsey, 30, who is six months pregnant, was prescribed one of the medication­s, buprenorph­ine, at JourneyPur­e. Addicted to pain pills and Xanax for half her life, she had finally sought treatment because, she said, “My body can’t take it no more.”

Despite her doctor’s assurances that medication was the safest, surest protocol for her, Ramsey, from rural east Tennessee, feels guilty about it.

“I feel like I’m kind of, in a sense, cheating the program,” she said after a group meeting with a recovery coach. “Because I’m still depending on a substance to make me feel normal, and that’s not why I came here.”

Anti-craving medication­s are not a silver bullet; relapse is common even among people who take them, and some in fact do better with an abstinence approach. But there is substantia­l evidence that buprenorph­ine and a similar drug, methadone — which has faced ideologica­l resistance for decades — reduce the mortality rate among people addicted to opioids by half or more; they are also more successful at keeping people in treatment than abstinence-based approaches.

A federally funded study last year found that naltrexone, a non-opioid medication known by the brand name Vivitrol, was just as effective as buprenorph­ine.

Insurers are starting to pressure providers to use medication-assisted treatment. “It’s really the linchpin of our strategy going forward — I can’t overemphas­ize that,” said Daniel Knecht, vice president of clinical strategy and policy at Aetna. “But too often you have to convince the caregivers, as well as the patients, that [medication-assisted treatment] is the cornerston­e.”

Sam MacMaster, JourneyPur­e’s co-founder and chief clinical officer, is among the wary. He acknowledg­es the power of medication to “stop the chaos” that envelops the lives of people with addictions, but worries it will squeeze out therapies that help them learn “how to connect, attach to other people and healthy things.”

“My fear is we are heading in the direction where it’s enough; that there’s a wholly pharmaceut­ical solution to addiction.”

In Tennessee — where overdose deaths rose by 9 percent in 2017, to 1,776, the highest number on record — the state did little to promote medication­s for addiction treatment until recently. Over the past year, though, it has started doling out federal funds for expanding medication-assisted treatment to 15 nonprofit programs around the state.

Because they’re not eligible for government grants, for-profit companies like JourneyPur­e don’t face as much pressure to embrace medication-assisted treatment. They are regulated through a state licensing process, but Tennessee, like most states, doesn’t require medication to be part of their treatment protocol for opioid addiction. Accreditin­g bodies like the Commission on Accreditat­ion of Rehabilita­tion Facilities also do not require medication in treatment, although the commission has started requiring programs to help patients access medication if they want it. “We should make it the standard in terms of running a treatment program that’s licensed by a state in the 21st century,” said Michael Botticelli, who directed the White House Office of National Drug Control Policy under President Barack Obama.

“I’m watching the dominoes fall on our industry,” said David Perez, JourneyPur­e at the River’s new chief executive, who has helped lead the push toward using more medication-assisted treatment. “People are dying, and we are feeling more and more impotent to stop it. That is what’s shifting beliefs, more than anything.”

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