United States / Opioid Epidemic

Treatment in a Failing Healthcare System

This article is part three in a series. Find the first part here and the second here.

As I have already discussed in this series, opioids can have a detrimental effect on towns and communities. By now, we know the effects of opioids, but our country’s current healthcare system makes treatment options inaccessible and inefficient.

The most realistic approach to solving the opioid epidemic is to treat it like a chronic, rather than a short term, illness. Addiction affects all users differently, but it often lingers for years. Doctors, psychiatrists, and citizens must accept that prescription drug addiction is a health condition. This idea has been supported by psychological research on the “spin-dry” treatment.

“Spin-drying” is a method in which patients are detoxed, “dried out,” and let go once the drugs have left their systems. Criteria for release includes less than four days of drug use per month and no positive urine screenings for opioids in two consecutive weeks. Although this helps users quit “cold turkey,” by the sixth week after beginning treatment only six to seven percent of patients are abstinent from opioids. If treatment continues, forty-six to fifty-two percent of users are abstinent by week twelve. By week sixteen, the abstinence rate decreases to between twenty-four and twenty-eight percent. And by week twenty-four, seven to ten percent are abstinent. From then on, the abstinence rate continues to fluctuate, further indicating that “spin-drying” methods are inconsistent and often ineffective. Addiction must be managed even after the opioid has left the body.

The most practical way to address long-term addiction is with the ongoing use of medication. Opioid medications like methadone and buprenorphine are drugs that fight fire with fire: they make detoxification easier by preventing symptoms of opioid withdrawal such as cravings, abdominal pain, nausea, and vomiting. These medications do not cause euphoria, and patients can gradually be weaned off of them, allowing the user to be free from physical dependence without having to endure the withdrawal symptoms that scare addicts away from recovery. These drugs are extremely important in the recovery process, especially if they are responsibly used over time. Unfortunately, long-term treatment is often inaccessible to opioid addicts due to our unsteady healthcare system.

Clinics typically charge between $10 and $15 per day for methadone doses, which costs upwards of $450 a month without insurance. Some say that addicts should be able to pay this price, given that they are spending much more on black market opioids; often, however, addicts get their drug money illegally. Therefore, the public cannot expect people to front this cost and be surprised when they commit crimes in order to do so.

On top of medication costs, recovering users often have to go to methadone clinics every day, where they might wait for hours to receive their medication. Drug counseling is mandatory for methadone clients, but the cost of transportation to the clinic is typically their responsibility. Overall, methadone prescriptions can add up to over $600 a month in treatment and transportation costs for the patient, not including the time the patient spends waiting in line and traveling that could be spent working or with their family.

This cost is at risk of increasing over the next few weeks. If Congress repeals the Affordable Care Act, they will be taking away health care plans that have revolutionized addiction treatment. Federal entitlement programs such as Medicaid and Medicare provide inpatient services, like detox support, but do not cover office visits for substance abuse treatments. The ACA covers the price of methadone, allowing many low-income addicts access to recovery. Ex-addict Tamara Nunez told For the Curious, “I know that if I didn’t have the methadone… I’d be sticking a needle in my arm, probably getting some disease by now, so Obamacare really helped me a lot.” If the Trump Administration does away with the ACA and passes the American Health Care Act, it will leave an estimated 14 million fewer people with health insurance. Because most addicts, and the majority of dependants on government health insurance, are poor, thousands could be left without access to addiction recovery. With the opioid epidemic raging, now is not the time to limit healthcare for poor citizens.

Additionally, methadone clinics create unnecessary burdens for patients, burdens that inhibit recovery. Addiction counseling is extremely important because it helps addicts avoid relapses triggered by stress, environmental cues, and relationships. Unfortunately, waiting periods, the cost of transportation, and medical expenses can make recovery programs such as counseling not seem worth the price. Methadone clinics need to create better dispensary systems that are both proactive and productive in supplying medication. In addition, more clinics need to be available statewide in order to lower transportation costs. To enable these solutions, the government needs to provide greater funding to hire more nurses for methadone clinics, fund in-home or on-the-road counseling, and provide transportation vouchers for addicts below the poverty line. Ultimately, when we make accessing methadone treatment more efficient, more addicts will find recovery worthwhile.

The current healthcare system also leaves older generations extremely vulnerable to addiction. According to the U.S. National Library of Health, the fastest growing segment of our population is people over the age of 65, with an expected population increase of fifty-three percent between 2003 and 2020. Because of the increase of life expectancy and the sizable Baby Boomer generation, 2011 saw a dramatic increase in the number of senior citizens. As this aging population keeps growing, healthcare facilities are seeing drastic increases in geriatric surgeries and mental illness.

Unfortunately, it does not seem as if healthcare providers are prepared for this increase. “We are not prepared as a nation. We are facing a crisis,” says Dr. Heather Whitson, associate professor of medicine at the Duke University School of Medicine. “Our current healthcare system is ill-equipped to provide the optimal care experience for patients with multiple chronic conditions or with functional limitations and disabilities.” With a higher population of geriatric patients, many hospitals are forced to take on more than they can handle. Opioids for geriatric surgeries are being prescribed quicker than doctors and pharmacists are being educated about their potential adverse effects. Less attention is being paid to individual patients, leading to avoidable issues like over-prescription, under-prescription, and unintended addiction.

In some cases, doctors will not even review a patient’s prescription list unless asked to do so by the patient or family. Patients are also often held responsible for their prescriptions after hospital discharge, even when they should not be caring for themselves. Many are not able to manage a consistent medication schedule relative to their pain, and may also be unaware of harmful side effects like respiratory depression, mental fogginess, or overdose death, an extreme but common consequence.

As a result, older patients are extremely vulnerable to addiction. Inexperienced doctors can easily over-prescribe pills and leave patients practicing self treatment. Some may ask why it matters that our elderly are addicted, but no person should have to spend the remaining duration of their life reliant on a substance.

The solution to this problem involves greater focus on education in medical schools, specifically when it comes to geriatric health and pharmaceuticals. Psychopharmacology plays an important role, too: older patients have different brain chemistry, and they are affected by drugs differently than younger patients. We must focus specifically on how opioids may affect the mental states of older patients and how dependency factors play into a patient’s ability to medicate themselves. Medical schools must reform their educational practices to keep up with the growing geriatric population. If medical schools place greater importance on geriatric health, the next generation of doctors will have a better understanding of the population, and therefore help prevent addiction.

Improvements in the geriatric healthcare system will also positively affect younger generations. Although the opioid epidemic is raging, doctors still prescribe medications with little hesitation. Doctors need to view opioids as potentially hazardous due to the risk of addiction, and promote a culture in which prescription medication is valued, but also approached cautiously. Young people raised in this environment will have a healthier relationship with opioids, and hopefully be less likely to experience addiction as they age.

This article concludes my series on the opioid epidemic. Of course, every solution discussed in this series is easier said than done, but I believe that with increased government funding and dedicated education in medical schools, we will be able to confront this problem properly. Our country needs to come together to create a culture in which prescription opioids are used with great caution. The epidemic must be treated as an urgent  problem that affects every one of us.