Treat substance use disorder like disease it is

A top priority should be increasing access to medications

MASSACHUSETTS CONTINUES TO LOOK for new answers to the opioid crisis. Despite changes to state law to require insurance coverage for inpatient substance use disorder treatment, despite the increased availability of the overdose-reversing drug naloxone (Narcan), and despite significant investments in substance use prevention programs in our communities, this disease continues to claim lives and devastate families and entire neighborhoods.

Yes, a disease – I use that word intentionally. Substance use disorder arises in individuals exposed to opioids who have a genetic predisposition, history of trauma, or both. The shameless peddling of opioids by the pharmaceutical industry has resulted in widespread exposure to opioids. In individuals with substance use disorder, brain chemistry changes in ways that reinforce the disease.

There is no disease in the world that we wouldn’t consider treating with some sort of medication if it were available. We don’t think twice about prescribing medication for diabetes; substance use disorder is no different. Luckily, we have medications that have been shown in study after study to save more lives and result in more long-term recovery than detox and abstinence alone. These drugs, which currently include methadone, buprenorphine, and naltrexone, are referred to as medication-assisted treatment, or MAT.

MAT reduces withdrawal symptoms, prevents overdoses, and helps many people stay in treatment. It improves a patient’s quality of life, level of functioning, and ability to handle stress. Long-term studies show that MAT, along with Narcan and counseling services, is the most effective treatment we have to save lives.

But barriers persist and those who need MAT often cannot access it. Federal regulations governing the dispensing of methadone require those in treatment to obtain and consume their daily dose at a licensed methadone clinic – impractical for someone who doesn’t live within a reasonable distance of a clinic. Federal regulations regarding buprenorphine require providers to receive special training and obtain a federal waiver to prescribe this daily treatment that can be taken at home. An increasing number of providers are acquiring this waiver, but we have a long way to go to until it’s as easy to obtain as treatment for high blood pressure or diabetes. And, while naltrexone (Vivitrol) does not pose the same federal regulatory hurdles, it is a harder protocol to get started on, since it typically requires 7-10 days of abstinence from opioids before initiation.

MAT is the course of treatment for substance use disorder recommended by most specialists, including the American Academy of Addiction Psychiatry; American Medical Association; Substance Use and Mental Health Services Administration; and the Centers for Disease Control and Prevention. Research shows that patients receiving MAT for at least one to two years have the greatest rates of long-term success. We must increase access to MAT along with vital social supports like recovery coaches and counseling services that complement and reinforce MAT.

At the same time, we need to expand access to MAT in our jails and correctional facilities. Half of prison and jail inmates meet diagnostic criteria for substance use disorder, yet most do not have access to the treatments they need.

Those with a history of incarceration are 120 times more likely to die of an overdose upon release, according to a 2017 Department of Public Health report. In 2015 alone, approximately 50 percent of deaths among those released from incarceration were opioid-related.

In Massachusetts, a coalition of 26 advocacy and healthcare groups are urging the Legislature to require jails and prisons to provide MAT for substance use disorder to inmates. Doing so would help close the revolving door of jail, reduce recidivism, and provide inmates with treatment. If we fail to do this, there will be more arrests, more overdose deaths, and more money wasted.

Meet the Author

Cindy Friedman

State senator, Massachusetts Senate
If we are serious about combatting the opioid crisis, we need to devote our energy and resources toward methods of treatment that are proven to be effective just as we would for any other disease!

We owe it to the families who have lost loved ones to this epidemic to get this right. We need to provide a clear pathway to treatment and develop a framework that addresses this crisis at its core. Ensuring that MAT is available to all those who need it, both inside and outside the criminal justice system, is a top priority of mine in the Senate opioid bill. We must use everything at our disposal to cure this disease.

Cindy Friedman is a state senator from Arlington.