There are three main roadblocks that often stand in the way of opioid addicts receiving treatment with MAT:
(1) Lack of access to MAT in most correctional facilities;
(2) Lack of physicians and clinics that provide MAT services
(3) Lack of understanding about addiction, and the consequent stigmatization of the disease.
Beating the opioid crisis requires removing each one of these roadblocks, and this requires work on all of our parts. It won't be easy, but it has to be done, and here are some ways we can do it:
The Criminal Justice System
- Stop forcing abstinence on incarcerated opioid addicts
- Incorporate OUD treatment, including MAT, into the criminal justice process
- Focus on recovery and rehabilitation as opposed to punitive measures
- Automatic treatment or diversion programs for drug offenders
- Accepting relapse as a normal part of the disease process
- Eliminate court-ordered forms of treatment and allow the individual and their healthcare provider determine the best approach
- Training and education for probation/parole departments about the disease model of addiction
Or just accept that addiction is a disease, not a moral failure or a crime and stop criminalizing it!
The Medical Community
- Integration of MAT into primary care settings and ERs
- Buprenorphine waivers for all primary care physicians**
- Increased medical school and residency training in the treatment of addiction
- Remove the stigma of addiction, substitution therapy with buprenorphine or methadone
- Telemedicine to connect patients with doctors who can provide MAT
- Mobile treatment services in economically disadvantaged areas
- Broaden access through specialized community pharmacies, mobile treatment services, and hub-and-spoke model of care
**France did this in 1995 and cut the overdose rate by 79% in just four years
The scope of reform is daunting, but necessary. Our current efforts over the last two decades have fallen short and we need new, effective ways to address the opioid crisis, rather than outdated programs that are unwilling or unable to evolve.
Now, let's get to work.
The Rest of Us
- Shifting our attitudes to remove the stigma of addiction and approaching it as a disease, not a moral failure
- Approach opioid addicts with dignity and compassion as opposed to judgment and condemnation
- Do not force abstinence on someone who is actively using and is not ready to quit
- Be familiar with ways to quickly obtain naltrexone, like pharmacies that sell it OTC or home-delivery services like FiduScript
- Increase access to naltrexone ineconomically disadvantaged areas
- Education is key! raise awareness about the disease of addiction and the need for treatment and medication—not punishment