Call opi­oid ad­dic­tion what it is — and act

It’s an emer­gency and a pre­ventable dis­ease

USA TODAY US Edition - - OPINION - Jay C. But­ler Jay C. But­ler, chief med­i­cal of­fi­cer at the Alaska De­part­ment of Health and So­cial Ser­vices, is the im­me­di­ate past pres­i­dent of the As­so­ci­a­tion of State and Ter­ri­to­rial Health Of­fi­cials.

An­other opi­oid over­dose death. An­other drug-re­lated crime. An­other bil­lion dol­lars spent on in­ef­fec­tive treat­ments. News about the opi­oid cri­sis keeps get­ting worse. Sim­ple so­lu­tions haven’t changed the epi­demic’s course.

The num­ber of deaths has con­tin­ued to in­crease, driven by an in­flux of il­licit fen­tanyl laced into coun­ter­feit pain pills, heroin and other il­le­gal drugs. To ef­fec­tively treat this evolv­ing pub­lic health cri­sis, we must rec­og­nize opi­oid ad­dic­tion for what it is:

❚ Opi­oid ad­dic­tion is an emer­gency. Just as pro­vid­ing first aid for car­diac ar­rest re­quires a de­fib­ril­la­tor and first aid for se­vere bleed­ing re­quires a tourni­quet, first aid for an opi­oid over­dose re­quires nalox­one. Last year, Alaska Gov. Bill Walker de­clared the state’s opi­oid epi­demic a pub­lic health emer­gency and made nalox­one more read­ily avail­able. The U.S. sur­geon gen­eral’s re­cent health ad­vi­sory calls for in­creas­ing the drug’s pub­lic avail­abil­ity. And just as other emer­gen­cies fol­low first aid with im­me­di­ate med­i­cal care, the same strat­egy should be used for opi­oid ad­dic­tion.

❚ Opi­oid ad­dic­tion is a chronic dis­ease that re­quires on­go­ing care. Ad­dic­tion rewires parts of the brain that process re­ward and mo­ti­va­tion, re­sult­ing in in­ex­pli­ca­bly self-destructiv­e be­hav­ior. Like other chronic dis­eases, opi­oid ad­dic­tion can be man­aged. Peo­ple who’ve ex­pe­ri­enced ad­dic­tion can re­turn to suc­cess­ful and pro­duc­tive lives. Yet only one in 10 with opi­oid ad­dic­tion is re­ceiv­ing treat­ment. Why? A lack of treat­ment providers is one bar­rier. An equal chal­lenge is stigma — for too long, ad­dic­tion has been con­sid­ered a moral fail­ing or a ha­bit­ual se­ries of “bad choices.” Drug ex­per­i­men­ta­tion is a bad choice, but no one chooses a life hi­jacked by opi­oid ad­dic­tion any more than a smoker chooses lung cancer.

❚ Opi­oid ad­dic­tion is treat­able with med­i­ca­tion. Com­bined with psy­cho­log­i­cal and so­cial sup­port, med­i­ca­tion-as­sisted treat­ment is the most ef­fec­tive path to re­cov­ery. Yet too many peo­ple dis­miss MAT as ex­chang­ing one ad­dic­tion for an­other. Just as peo­ple with Type II di­a­betes or asthma do best with a com­bi­na­tion of med­i­ca­tion and life­style changes, a mul­ti­pronged ap­proach that in­cludes med­i­ca­tion is the best way to treat opi­oid ad­dic­tion. Like other chronic ill­nesses, ad­dic­tion re­quires long-term man­age­ment. Also, many do not know that the risk of over­dose in­creases af­ter a pe­riod of ab­sti­nence; thus, a few weeks in detox is not enough with­out fur­ther treat­ment and can lead to re­lapse or death.

❚ Opi­oid ad­dic­tion is pre­ventable. Pre­ven­tion re­quires ad­dress­ing sup­ply and de­mand. On the sup­ply side, sound pain-man­age­ment strate­gies will re­sult in bet­ter pain con­trol, fewer peo­ple be­com­ing ad­dicted to pre­scrip­tion opi­oids, and fewer painkiller­s sit­ting in our medicine cab­i­nets for oth­ers to mis­use. In­ter­dic­tion by law en­force­ment can also re­duce the amount of il­licit drugs en­ter­ing the mar­ket. How­ever, ad­dress­ing the sup­ply side alone will not solve this cri­sis. We have to ad­dress the de­mand for opi­oids. This means con­fronting the thorny is­sues that make opi­oids an at­trac­tive es­cape for many, in­clud­ing un­em­ploy­ment, home­less­ness, poverty, bore­dom and racism. It will re­quire learn­ing how to pre­vent and mit­i­gate the life­long ef­fects of ad­verse child­hood ex­pe­ri­ences, and build­ing re­silient peo­ple and com­mu­ni­ties.

How can we pos­si­bly do all this? An Inu­piat whaler re­cently of­fered me his in­sight on the opi­oid cri­sis by ask­ing, “How do you eat a whale?” As I con­sid­ered this very Alaskan ver­sion of an old saw about ele­phants, he ex­plained: One per­son does not go into the sea to take a whale. One per­son does not butcher a 100-ton whale. And, no, you do not eat a whale one bite at a time.

You take and eat a whale as a com­mu­nity.

Iso­la­tion is the fer­tile ground in which ad­dic­tion blos­soms and our re­sponses fail. It is time for us to come to­gether as com­mu­ni­ties, tribes and states to call opi­oid ad­dic­tion what it is, and re­spond ac­cord­ingly.

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