The Need for Better Addiction Care in an Unprecedented Opioid Crisis
The opioid crisis in the U.S. has been ongoing for at least 25 years. The number of people using, addicted to, and overdosing on opioids continues to grow and has reached epidemic status. The recent publication from the Stanford-Lancet Commission recommends better systematic care for substance use disorders. This includes increasing funding, health insurance reform, better training for healthcare professionals, and a focus on managing addiction as a chronic disease.
The opioid crisis in North America continues to grow in scope and in the number of people who become addicted to and die from these drugs yearly. Many factors can explain the crisis, with greedy drug companies leading the way in blame.
For experts in addiction and behavioral science, the real concern is the state of care for substance use disorders. As more people get hooked on opioids, the need for effective, evidence-based treatment also grows.
How Bad Is the Current Opioid Crisis?
The history of the opioid addiction and overdose epidemic dates to the mid-1990s, roughly when Purdue Pharma introduced OxyContin. The drug was new in that it provided a long-lasting version of oxycodone, a painkiller, narcotic, and opioid.
The company fraudulently marketed OxyContin as a less addictive alternative. It pushed for much broader use of the drug than for previous opioids. The time-release mechanism in the pills could be deactivated by crushing them, leading to the most potent opioid ever seen on the market.
OxyContin is just one of the more well-known of many prescription opioids that physicians began overprescribing in the 1990s and 2000s. Many are to blame for the resulting addiction and overdose crisis, including the pharmaceutical companies who pushed the drugs, prescribing physicians, and regulators that failed to stop the flow of harmful drugs.
Addiction to and overdoses involving opioids have grown since the introduction of OxyContin in North America. In both the U.S. and Canada, 2020 was the worst year for fatal overdoses related to opioids. In the U.S., deaths by opioid overdose rose from 51,133 in 2019 to 70,168 in 2020, an increase of 37%. Preliminary data from 2021 indicates the rise continued. Nearly 600,000 people have died of opioid overdoses in the U.S. since 1999.
Recommendations From the Stanford-Lancet Commission
The grim and growing statistics about opioid use and deaths led to the formation of a commission to study it and offer recommendations. After years of research and study, the Commission aimed to create a comprehensive summary of the failings that led to the crisis and possible solutions.
One of the recommendations is to build better care systems for people already addicted to opioids and other substances. There are several factors to consider when improving care for addiction:
1. Recognizing the Long Problem of Substance Use
Opioids have been top of mind when discussing substance use disorders for the last couple of decades. In past years, other drugs were in the news: methamphetamine in the 1990s and crack cocaine in the 1990s, for instance.
This singular focus on one substance, or one class of drugs, shifts the attention away from the fact that substance use disorder and resulting overdose is an entrenched, long-term problem. Drug-related overdoses have been increasing for 100 years or more.
In reforming addiction care, it’s essential to recognize that the prevalent substances will continue to change, but the underlying problem remains the same: people need access to quality, effective, affordable, and non-stigmatized treatment and long-term disease management.
2. Integrating Addiction Management Into Existing Health Care Systems
The current healthcare system already includes management for chronic diseases, like heart disease, kidney disease, and high blood pressure. Management includes prevention campaigns, early detection, less extensive treatment with early detection, and more serious care for advanced cases.
For other chronic illnesses, general practitioners and primary care physicians act as the first line of defense. They often treat the illness but also work in multidisciplinary teams and make referrals to specialists. This rarely happens with addiction. If this framework included substance use disorders, it would improve access to care and prevent overdoses. The infrastructure and model are already in place within the existing system.
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3. Expanding Funding for Addiction Treatment
A significant part of improving care is funding it. The Commission sees several avenues for this to occur:
- Expanding Medicaid to cover more people
- Laws requiring Medicaid and Medicare to cover the full range of substance use disorder treatments
- Guidance from states regarding what services should be covered by private health insurance plans
- Full compliance by insurers with parity laws that forbid more stringent policies on addiction care than other health conditions
The U.S. healthcare system is largely for-profit, yet substance use disorder treatment is mostly publicly funded. Insurance systems, both public and private, must finance and cover the full range of treatments for addiction to ensure better access to trained professionals.
4. Blocking Ineffective or Harmful Treatment Practices
Unlike many other health conditions, people with addiction are often subjected to treatments that are at best not backed by evidence and at worst harmful. Some treatment programs discourage the use of any substance, even proven medications that promote recovery, for instance. Others offer detox only, with no follow-up care.
Reform starts with the government insurance programs. Medicare and Medicaid must stop covering treatments that are not evidence-based or effective. Private insurers should then follow the government’s lead.
5. Improving Training for Healthcare Professionals
Finally, the Commission would like to see better training in addiction care for both specialists and general practitioners in the healthcare industry. There is generally inadequate training for substance use disorder management throughout every step of the medical education process.
If all health care professionals, including primary care physicians and nurses, have better training in addiction, they can reach more people. They would be better able to recognize signs of addiction and help patients get early interventions. Early treatments are more effective than care implemented once substance use disorder has become severe.
There are many areas of medicine in which addiction care could improve. Emergency rooms, for instance, often fail to screen patients for addiction. This is a critical link on the chain of health care where intervention could take place, but the staff needs the appropriate training.
The opioid crisis continues to take lives daily. There are many ways to improve the situation, from prevention to changing aspects of the criminal justice system. Improving care is a major component of reducing addiction and overdose rates. It must involve law and policymakers, educational systems, insurers, and the healthcare system as a whole.