Low expectation treatment for OUDs will yield poor outcomes over the long term


photo – Death Valley in bloom 

Currently, there is a lot of discussion about treatment for opioid use disorders. Here in Pennsylvania part of our policy discourse is on the prescribing of MAT such as suboxone and whether there should be some requirement to include treatment with the prescribing of the medication. Missing in most of such discussions is the fact that the vast majority of persons who are addicted to opioids are using other drugs like alcohol, cocaine and methamphetamine to get high.  We must address whole person care over the long term – five-year recovery models yield 85% recovery rates. We must get away from narrowly focused, short term panaceas posing as recovery.

MAT medications certainly can and are helpful in the treatment and recovery process. We are seeing people get their lives back with suboxone as part of their recovery process, but we cannot forget that it is an addictive, schedule III drug that need to be managed with treatment and oversight for greatest efficacy. Suboxone is being used successfully to get people into recovery but as part of whole person care.  We seem to forget at times that these medications are also diverted and abused with tragic consequences.

We cannot also forget that the vast majority of people addicted to opioids are using other drugs and that this drug use is destructive to them and their families. When the ceiling is reached from an MAT like suboxone or methadone and there is no euphoria people can use medications like benzodiazepines, gabapentin or even some OTC medications to potentiate the high.  We are also seeing people who are on a stable dose of suboxone and who I would characterize as still in addiction using drugs like alcohol, cocaine and methamphetamine to get high.  We see a whole lot of people die from these drugs, and they most often do not get whole person care, which is why we must focus on long term recovery strategies for everyone.

It seems like all current policy discussions related to OUD focus on short term reduction in overdose deaths. Slow death from addiction is horrible. Deaths from car crashes and other things related to active addiction are also terrible. All these deaths are preventable and we do recover and do great things with our lives when we get what we need to get well. Recovery is the probable outcome when we provide proper treatment and recovery support services over the long term.

Simply providing a person a scheduled III addictive drug and expecting them to get better without treatment and support is tantamount to prescribing chemotherapy to a cancer patient without follow up on efficacy of the drugs and coordination of care to  help a person recover.

There are reasons why we focus on five years of care coordination for cancer – it is a complex condition that requires a lot of focus. Addiction is similar, there is no panacea.  Low expectations of recovery yield care poor short term focused models that do not meet our needs.

It is just not acceptable, yet sadly predictable.