Our view: To save lives, expand the use of these medications
Walter Ginter began using heroin in the early 1970s while serving in the Army. By 1977, desperate to kick the habit, he turned to daily doses of methadone, a synthetic opioid that eases withdrawal and decreases cravings. The treatment worked.
“I have a good life today,” says Ginter, 69, project director for the New Yorkbased Medication Assisted Recovery Support Project. “I wouldn’t have it without medication.”
Ginter was a member of a National Academies of Sciences, Engineering and Medicine committee that examined the three medications — methadone, buprenorphine (typically sold under the Suboxone brand name) and extended-release naltrexone (Vivitrol) — that the government has approved to treat opioid addiction.
Two days before the Mueller report landed at the Justice Department, the National Academies’ report was released on March 20 with little fanfare and less attention than it deserves. Its recommendations, if more widely embraced, have the potential to significantly reduce the toll of the nation’s opioid epidemic.
The findings are unambiguous: “These are highly effective medications, and they save lives,” says Alan Leshner, chairman of the panel that prepared the study. Yet most people who could benefit from the drugs don’t receive them.
More than 2 million people in America are estimated to have opioid use disorder, but less than 20% are being treated with these medications. Of the residential treatment programs in the USA, only 36% offered any medications in 2016, and only 6% offered all three.
The medications, of course, aren’t a panacea. It can be difficult to get people who are addicted to accept treatment, and to stick with it once they begin. Some people can succeed without medications, but the vast majority who try to do so end up relapsing.
Like any medication, each of the three Food and Drug Administrationapproved drugs has drawbacks.
Methadone is typically administered only through doses given out daily at regulated clinics; areas around the clinics have been known to serve as magnets for heroin dealers looking for customers. Buprenorphine tablets and under-the-tongue films can be misused or diverted. Naltrexone can only be administered to people who’ve been off opioids for about a week, and it has high discontinuance rates.
Even so, all of the drugs reduce relapse and death rates. For people who stay on the approved medications for the long term, the risk of mortality drops by 70%, according to Nora Volkow, director of the National Institute on Drug Abuse, which co-sponsored the National Academies report.
Why aren’t these life-saving drugs used more widely?
One reason is that opioid addiction is too often regarded as a moral weakness or failure of willpower, rather than a treatable chronic brain disorder.
Other reasons include inadequate education and training of personnel who work with people who are addicted, excessive regulations surrounding distribution of the medications, and highly fragmented payment policies.
Among the steps that can and should be taken:
❚ Allow methadone to be distributed, by prescription, in settings such as doctors’ offices or drugstores.
❚ Certify more doctors to prescribe buprenorphine, and loosen the unnecessarily strict training requirements.
❚ Require prisons to offer the medications, and Medicaid to cover them.
❚ Do more research into which combinations of medications and behavioral interventions are most effective.
Opioid overdoses killed more than 47,000 people in 2017 alone. An additional 500,000 lives could be lost in the next decade. How many people survive and how many die will depend in part on how many receive the best treatment, based on scientific evidence and availability. “We have to take the shame out of this,” says Walter Ginter.