One more thought on addiction as a terminal illness

Yesterday’s post included some discussion of a NEJM piece on treating addiction as a terminal illness. The article prevented the very sad case of a woman with a long history of addiction, multiple treatment episodes, and a current case of endocarditis. The patient declined surgery and opted for hospice.

The author presented this as a sound decision given the context.

I’m my previous post, I pointed to the context as something that should horrify us.

How many endocarditis patients receive anything resembling the kind of care an addicted physician gets? Conversely, how many get discharged from hospitals with opioids for pain management and no meaningful treatment?

This only makes sense and seems compassionate if we have to ask, “What the hell is water?” [A reference to the water (context) we swim in becoming invisible to us.]

I want to make a few elements of that context a little more explicit.

The erosion of the disease model increasingly frames the problem as social conditions outside of the scope and reach of medicine.

The erosion of the conceptual boundaries of recovery make full sustained recovery seem less probable.

The consistent failure to treat addiction with models that provide adequate quality, intensity, and durations of care has devastating consequences. Those consequences include the establishment of a new normal that full, sustained recovery is unlikely for most patients, and the addiction equivalent of inadequately treated bacterial infections–treatment resistant disease.

Our thinking needs to change, but the change we need is not an opening of our minds to hospice for addiction patients.