Addiction is a medical condition. Chronic. Often even fatal. And until we treat it as such, its impact will remain catastrophic. For everyone.
Realizing Addiction is a Medical Condition
Vox Senior Correspondent German Lopez spent much of 2018 reporting on the complex systems and policies that could help end the opioid epidemic. And it all boiled down to one simple idea: America needs to see that addiction is a medical condition. Consequently, we need to approach addiction treatment like any other form of health care.
As Lopez reported, Virginia did rework its Medicaid program to confront the opioid crisis and one Vermont needle exchange even started offering on-the-spot addiction treatment. However, as he also reported, many private insurers continue to neglect addiction treatment, most prisons fail to provide opioid addiction medications, and few special training programs exist to help doctors get involved in addiction care.
But once we see addiction is a medical condition that requires health care services, solutions become evident.
- people with addiction should have access to proven medications
- people with addiction should be able to get care in emergency rooms, urgent care facilities, or at a doctor’s office
- health insurance, including Medicaid, should pay for addiction treatment
Comparing Addiction to Other Chronic Medical Conditions
Lopez cites the 2016 surgeon general’s report stating just 10% of people with a substance use disorder get specialty treatment for their addiction. Why? Largely because local treatment options don’t exist. And if they do exist, they are unaffordable or have waiting periods of weeks or even months.
Just think, for a moment, if this were true for another medical condition, like heart disease. Imagine a world in which 90 percent of Americans with heart problems are allowed to suffer and even die without any access to health care. Where a person suffering a heart attack could go to an emergency room only to be told that the ER doesn’t have any way to treat him. Imagine that the ER does have a way to help, but the patient who just had a heart attack will have to wait weeks or months to get into any care. Or if this patient went to a doctor’s office for some care only to be told that the providers there don’t see his kind.
This would be a public health catastrophe, concludes Lopez. And America’s leaders would do everything they can, under public demand, to remedy such huge gaps in health care.
Yet public calls for action remain spotty, especially considering the extent of the opioid crisis. And concerted and effective government efforts to end the epidemic remain even spottier. Unfortunately, until we all agree to see addiction is a medical condition, things are likely to remain that way. Americans will continue to die in record numbers. And America will continue to take multi-billion dollar hits to its economy.
The Stigma of Addiction
The stigma of addiction runs deep. In fact, most Americans don't see addiction as a medical condition at all. They see it as a moral failure. Consequently, their response to the crisis is at once reactionary and myopic. It can also be personal.
Take this email a reader sent German:
"Darwin’s Theory says ‘survival of the fittest.’ Let these lost souls pay the price of their criminal choices and criminal actions. Society does not owe them multiple medical resuscitations from their own bad judgment, criminal activity, and self-inflicted wounds."
Thankfully German has a sound and reasonable counter to such nonsense:
It would be obviously ridiculous for anyone to argue anything like this for other medical conditions that can also be caused by unhealthy actions and behaviors, such as heart disease, diabetes, and lung cancer.
Not so with addiction. Why? Because for more than a century our culture, our society and our legal system have all treated addiction as a moral and criminal problem.
What Health Care Systems Can Do
German notes we have a health care system that remains ill-equipped to treat addiction. Among the lapses he cites are:
- Federal law requires health care providers to go through special courses before being able to prescribe buprenorphine (i.e. Subutex), the drug most used for detox. Consequently, 47% of US counties — and 72% of the most rural counties — have no physicians who can prescribe the drug. In fact, only about 5% of the nation’s doctors have that license.
- The vast majority of emergency rooms do little to nothing to treat addiction. That's like having a person come in with a heart attack, then telling them that they’re on their own because the hospital doesn’t have any cardiologists or other specialists on-staff.
- Currently, only among the nation's 50 state prison agencies, only Rhode Island offers the opioid addiction medications buprenorphine, methadone, and naltrexone. Though some states are now experimenting more with the idea.
- Health insurers often resist paying for addiction treatment or they offer low reimbursement. That's especially true for state Medicaid programs, which cover low income people. Once Virginia boosted reimbursement rates, there was a marked increase in the number of people getting treated for addiction. There was also a drop in ER visits for opioid use disorder.
German argues that the health care system often isn’t doing even the bare minimum for addiction treatment, because we haven’t expected it to do anything for as long as the issue has existed. But once that expectation really changes, America will start to see notable progress in solving its opioid crisis.
Addiction is a Medical Condition: It's That Simple
No, notes Lopez, solving the nation's opioid crisis won't be easy. Policymaking is still hard. Health care systems are complex. And how it all works on the ground can get messy. But the crisis can be solved. Once we see addiction is a medical condition that should be treated just like any other chronic disease.
We at Recovery Boot Camp would like to applaud German Lopez for his continued -- and continually compelling -- reporting on the opioid crisis. We're especially grateful for his common sense solutions, as well as for the privilege of sharing his work here.