No more ‘what if’ Treatment works for opioid users

In the early 1970s in Oregon I met the first person I ever knew who was addicted to heroin. He was in recovery and doing well, an incredibly charismatic young man from New York City. Now, almost 50 years later, two things about him stand out in my memory.

He told me that, for him, giving up heroin was like giving up sex. And the 1953 Ford pickup I sold him for $200 he resold a few months later for $40 to buy heroin. I do not know what happened to him.

In those days I was doing some GED tutoring in an Oregon county jail. One of my students was another young man with substance-use problems. A day or two after he was released from jail, he came by my office to say hello. A carload of young men waiting for him on the street impatiently honked the horn. He warmly said goodbye to me and left. A few days later his obituary was in the paper—dead from a drug overdose.

Treatment for those two men was available back then. Behavioral-health providers valiantly worked to support people in recovery to help them sustain abstinence from drugs, but there were no effective medicines, and relapse was common.

In Arkansas today we have very effective medications available for treating opioid use disorder, the one most frequently used being Suboxone.

Suboxone occupies the opioid receptors in the brain, but it blocks cravings and does not cause euphoria. People can work, raise families, and lead normal lives. Abundant medical evidence proves the effectiveness of this medication-assisted treatment. It saves lives.

Sadly, even with Suboxone available in Arkansas, families continue to lose loved ones to overdoses. I know two of them.

One young man successfully started on Suboxone at the excellent UAMS program and was doing very well, well enough to go get an outdoor job that he loved in south Arkansas. Unfortunately, he could not find a doctor near his job that prescribed Suboxone. For a doctor to prescribe Suboxone, federal law requires eight hours of training and the obtaining of a Drug Enforcement Agency waiver. Arkansas does not have an adequate number nor geographic distribution of Suboxone prescribers with the DEA waiver even though the training is conveniently available online. After he relapsed, he tried an abstinenceonly treatment program, but he left and subsequently died of an overdose.

Another young man led a life with much chaos brought about by his addiction. He never did get linked up with a treatment program, though in his last days he tried.

The mother of one of these young men is a nurse, and she allows herself to play “What If”—not to relive the tragedy of losing her son, but in the spirit of motivating Arkansans to do a better job of making Suboxone and medication-assisted treatment available.

What if every emergency room doctor in Arkansas had the DEA waiver and could prescribe Suboxone for patients with opioid use disorder? I am unaware of any Arkansas emergency rooms currently offering this service. What if every family practice doctor in Arkansas had the DEA waiver? Very few currently do. What if every residency program in Arkansas, regardless of specialty, required all their graduating residents to have the DEA waiver? What if every physician considered a faculty member at a residency had the DEA waiver and could train new doctors regarding how valuable medication-assisted treatment can be to patients?

Completing the eight hours of training does not mean a doctor is required to prescribe Suboxone, but more doctors would; and all doctors would, I think, be more understanding of people with opioid use disorder and the doctors who treat them.

What if? What if? What if? Since 1999, we have had almost 500,000 Americans die of an opioid overdose. Aren’t we tired of “What if”?