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The Disconnect Between Science and How We Treat Opioid Use Disorder

We need to invest in programs that have been shown to save lives. Here’s where we should start.

Needle exchange
Chris Burkett deposits old needles for new ones at a needle exchange program run by the Grays Harbor County Public Health and Social Services Department in Aberdeen, Washington, on June 14, 2017. (David Goldman/The Associated Press)

There’s a lot we don’t know about the origins of the opioid crisis. We can’t say for sure why some people develop an addiction to opioids, while others who use the same drugs do not. We know opioid overdoses have risen since the 1990s, but we don’t know exactly how many people have an opioid use disorder. And we can’t point to a single factor, like the over-prescription of pain killers, as the source of the problem.

What we do know is how to treat it: Years of medical research have shown that addiction is a chronic disease that affects the brain’s reward, motivation, memory, and other related circuitry. People with addiction pursue psychological reward and relief from symptoms of the disease through substance use. But public policy is still driven by the belief that opioid use disorder is a moral failing, and as a result just one in 10 people receive evidence-based treatment. We need to invest in programs that have been shown to save lives. Here’s where we should start. 

Misconception #1: The Cure for Opioid Addiction Is Detoxification and Abstinence. 

For years the country assumed detoxification and abstinence were necessary to treat addiction. We now know the opposite is true. Detoxification and abstinence interventions actually put people at greater risk of a fatal overdose because they lose their tolerance for the drug yet still suffer from biological cravings. Like diabetes and other chronic illnesses, patients go through cycles of relapse, and many will seek treatment more than once for a substance use disorder. Each time a person goes through detoxification, they face a greater risk of overdosing. 

Health research shows there usually are compounding factors, such as previous drug use and personal or family history, which make a person more likely to develop a substance use disorder. Many people with opioid use disorder get prescription pain pills from a source other than a physician, suggesting the factors leading to the disease are complex and that there’s no one-size-fits all treatment plan. Greater availability of prescription pain pills and heroin, economic decline, and lack of prevention and treatment capacity in the United States all could have played a part in creating the crisis, and so our treatment system must tackle the problem from multiple angles.

Misconception #2: Jail Is a Safe Place for Someone with Opioid Use Disorder. 

Police officers have become the first line of response to the opioid epidemic because many communities struggling with the epidemic lack dedicated intervention and treatment programs. The criminal justice system was not designed to address public health crises, however, and the majority of people with an opioid use disorder who are arrested and detained do not receive treatment while in jail. 

There is also no evidence to suggest that jailing someone with the disorder is an effective way to cure the disease. In fact, there is some data to suggest the opposite. People with opioid use disorder have died in jail and prison without access to medication, and they are at greater risk of overdose when they are released. Public health initiatives such as harm reduction programs and methadone clinics have been shown to be far more effective at reducing the public safety and quality-of-life problems associated with the opioid epidemic, and in moving people into recovery than actions that criminalize drug use. 

Misconception #3: Naloxone and Syringe Programs Are Enabling and Lead to More Drug Use.

Contrary to beliefs that enabling substance use leads to greater abuse, research shows that people who use drugs are five times as likely to enter treatment when they use a syringe program, which provides sterile syringes to people. Syringe exchanges are also critical to reversing the rates of HIV and Hepatitis C infections, which have risen as the opioid epidemic has spread. Naloxone, a spray used to reverse overdoses, and buprenorphine, a prescription opioid, are life-saving tools. Even more people would die from the disease of addiction without them.

Misconception #4: Prescribing Methadone to People with Opioid Use Disorder Is Just Replacing One Drug with Another. 

Medication Assisted Treatment, including prescription of methadone and buprenorphine, combined with behavioral supports has been shown to be the most effective form of treatment for opioid use disorder. Methadone and buprenorphine work by lessening the pain of withdrawal and blocking the euphoric effect of drugs, while behavioral therapy helps to address other social and psychological factors that drive substance use. 

Because addiction can change the chemical makeup of the brain, people with opioid use disorder often require long-term treatment. Some might never be able to abstain entirely from opioids, but patients have been able to manage the disorder using medication and counseling. Providing individualized treatment is important because as we know from the broader field of medicine, what works for one person might not work for someone else.