On Wednesday, April 17th, 2019 the Appalachian Regional Prescription Opioid Strike Force charged 60 people in 7 states as part of the largest government takedown during our National Opioid Epidemic. The charges were for illegally prescribing and distributing millions of pills such as opioids, benzodiazepines, and other drugs.
Among the defendants were 53 doctors, pharmacists, nurse practitioners, and other medical professionals. A fair question after removing so many doctors, pharmacists, and medical professional from their posts is what does this mean for those patients and communities?
For the patients, it means an opportunity for better, safer treatment. Access to quality, evidence-based care, and treatment for those who are fighting an addiction to opioids or other drugs is essential. For the communities, it means they too will become safer. One of the doctors charged was accused of prescribing opioids in exchange for sexual favors. Others were providing staff with blank pre-signed prescriptions to offer to patients, and another doctor was prescribing a single patient 15 opioid pills per day. Some of the accused doctors were providing prescriptions to personal friends who paid and Facebook friends. It’s discouraging to hear how doctors, who are to be trusted with our personal health and safety took advantage of people in vulnerable positions. No doubt creating some doctor-induced opioid addictions for their own prosperity.
The treatment of opioid use disorder (OUD) has come a long way over the past 50 years. We now have an excellent arsenal of therapies to combat this chronic, but deadly disease. OUD, like other addictions, can be successfully managed but there is no cure and relapse is always a threat. Like other chronic diseases, the clinical progression of addictive disorders, including OUD, can be best characterized by periods of exacerbation and periods of remission but the patient is never disease-free.
For too long, those in the fight of their lives over an opioid addiction thought when the supply of opioids tightened their only option was to turn to the streets or wake up at 4am to stand in line at a for their daily dosage of medication. This just isn’t right quality care is affordable and available. It’s time that those of us not fighting this addiction realize we are graciously only one injury away from not being prescribed the same pain medication that caused the battle of addiction these same, good people are suffering from today. It’s vital to lay the stigma surrounding addiction to rest and be committed to supporting those with substance abuse disorders find a treatment that is evidence-based and effective.
Today, we have strong evidence supporting the use of basic medication approaches to the treatment of opioid use disorder. Two of these medication approaches is partial agonist therapy in the form of buprenorphine, and antagonist therapy in the form of naltrexone.
It is essential to understand that there is not a “one size fits all” approach to treating the complex disease of addiction. Peer support groups such as AA/NA may work well for some, while others may respond better to individualize, private counseling. Some patients will respond best to naltrexone while others may require treatment with buprenorphine. Throughout their disease, the treatment drug of choice may even change. Patients may need to stabilize on buprenorphine then move to antagonist therapy with naltrexone. The process may reverse itself requiring the patient to go back to buprenorphine after a period of stabilized care on antagonist therapy or complete abstinence from all medication. No single FDA approved drug class used in the treatment of OUD is the best option for all patients. It is vital that doctors and patients have access to medications like naltrexone and buprenorphine to employ the use of the right medication for the right patient at the right time.
It is also crucial that treatment providers be in constant review of best practices. As a treatment provider, we are committed to bringing access to the best, evidence-based care to those who need treatment for OUD and other substance abuse disorders. Our biggest obstacles often are the policies that are set in place to protect communities. We have the opportunity to treat in several states, and every state has different procedures for governing treatment. It’s never without difficulty and obstacles that we work hard to help the addiction community recover. Like the laws that determine our speed limits, we must be willing to be advised to caution our pace in effort to protect those around us, not just ourselves. At Pathway Healthcare we understand we must follow all relevant federal and state laws and requirements and we maintain high standards within our programs as an effort to remain committed to the rights of our patients and reach as many people as possible with the very best, evidence-based care available.
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