Lately, politicians are doing a lot of talking about how to solve the opioid epidemic and how to reduce the number of overdose deaths. It’s great to hear them addressing this topic. They talk about building a wall to prevent drugs from streaming into the country or locking up more of the drug dealers to try to get these deadly drugs off our streets.
But with demand as high as it is and access to the internet making it as easy to get opioids delivered to your house as a pizza, focusing only on the supply side of the opioid epidemic may not be the solution.
Today (Feb, 8 2016) on National Public Radio's Here and Now, Dr. Andrew Kolodny, a leading expert on opioid addiction, and Dr. Leana Wen, the Baltimore City Health Commissioner, discussed the issue. They talked about the availability of naloxone and training, not just first responders, but regular citizens to use this life saving medication. Naloxone is the rescue medication that is used to revive someone who has overdosed on an opioid. Its availability is crucial to reducing overdose deaths, which are now more than eighty per day in the US. They also both wholeheartedly agreed that to truly make a difference in this national health crisis the focus needs to be on treatment availability.
Too few primary care physicians are willing to treat patients in their practices with buprenorphine. Patients seeking treatment often end up waiting many weeks for a treatment slot in a specialized program. Primary care physicians carry a negative stigma against opioid addicted patients. They don’t want that type of patient in their practice. They visualize patients in their waiting rooms in withdrawal or criminals or high need patients taking up too much of their staff’s time. The reality is different; most maintenance patients are actually low-need once they are stabilized and in a good counseling program.
The wait time to get into treatment can be deadly for an active heroin user with lethal drugs like fentanyl and carfentanyl on the streets. The options for treatment in this country are usually methadone or buprenorphine. Until recently when legislation started to loosen the patient limits in buprenorphine programs there were very limited treatment slots. Patients can still find that locating a buprenorphine program is difficult. Methadone programs can be easier to find but with a job and family going daily for dosing can be challenging for some people.