Why arent we using the most effective addiction treatments
if you live in the united states
then i likely don’t have to tell you
about the growing issue of opioid
overdose
in fact you may have lost someone
however if you’re unfamiliar
136 americans die every single day
to opioid overdose to put this into
perspective
you could almost fill a jumbo jet with
the amount of people that die
every single day what if i were to tell
you
that there is not one but two
medications that effectively
treat opioid use disorder and prevent
the rate of opioid overdose death by
nearly half
what if i were to tell you that
due to widespread medical negligence
that less than 20 percent
of people who are at risk for overdose
actually will receive these medications
this year
before i continue let me tell you a
little bit about myself
using illicit drugs saved my life
i grew up living with unrecognized and
untreated mental illness
things like ptsd severe anxiety a severe
mood disorder
illicit drugs is what helped me cope
until they almost killed me multiple
times
the first time i remember overdosing i
was on my bedroom floor
with my mom standing over me i’ll never
forget the look of horror on her face
or the subsequent shame that i felt
the next time i remember i was
underneath an apartment complex
staircase
this time with ems standing over me i
doubt they will ever forget the look of
horror on my face
naloxone is what saved my life naloxone
is a drug that reverses an opioid
overdose
you might have heard of naloxone as in
recent years
it’s become more widely available in
communities because of laws that have
been passed
making it easier for lay people to have
and distribute naloxone
however what made one of my overdoses so
peculiar
was that we didn’t use naloxone when i
was using
naloxone wasn’t yet widely available in
my community
in fact i’d never even heard of it we
used a different drug
it was a small orange film that we would
keep inside of our wallets
it’s a drug that’s not even proven
effective to reverse an overdose
it’s called buprenorphine actually
buprenorphine is a drug that treats
opioid use disorder
in fact it’s one of the most effective
treatments we have for opioid use
disorder
second only to methadone what makes
buprenorphine
and methadone work so well is that
they’re
agonists meaning they activate the same
receptors in the brain that illicit
opioids like heroin and fentanyl do
there are people that have been critical
of these medications
because of that reason however
what makes these drugs so special is
that the way they work
is that they’re only just mimicking
the natural opioids that are produced in
all of our brains
they’re also known as endorphins what
happens with people living with opioid
use disorder
is that they’re no longer able to
sufficiently produce enough opioids on
their own naturally
so we supplement them with medications
like methadone and buprenorphine
this is similar to how we treat someone
with diabetes
whose pancreas can no longer
sufficiently produce enough insulin
so we give them insulin to supplement
i was not fortunate enough to receive
methadone during my experiences as an
injection drug user
however i did receive a prescription to
buprenorphine
i consider myself so fortunate to have
received that
because so few have access to health
care
what i remember about the first time i
took buprenorphine
is not craving heroin which was
very unusual for me the other thing i
remember
more overwhelming but harder to put into
words
was this sense of normalcy one that had
been foreign to me for a long time
i did good for a while until my provider
found out about another prescription
medication
that i’d been taking that had been
prescribed to me
instead of having a conversation with me
about it he just discontinued my
prescription to buprenorphine
the next day i injected heroin again
things continued for me somewhat
worsening
until i was coerced into inpatient
treatment for the first time
not all treatment is created equal
the first thing i remember about
treatment is someone very unkindly
telling me that
i would have to give up the very things
that saved my life
and they told me that i couldn’t use
buprenorphine or methadone
when buprenorphine was the only thing
that had helped me before
for 14 days i was there and while i was
there i experienced harassment
even assault and i told the staff about
it
they didn’t do anything i i wanted to
leave
but the medical staff they told me that
my insurance
would not cover my treatment if i were
to leave against medical advice
i later found out that that was a lie
i’d been held hostage there
so after 14 days i took matters into my
own hands and retaliated
i was invited to leave the very next day
i injected heroin like the majority of
people that leave abstinence-based
treatment
in fact studies show that 90 of people
with opioid use disorder
that even complete detox and
psychosocial treatment alone
will return to use they also didn’t tell
me that my risk for overdose would be
heightened
because i had a tolerance before i went
tolerance is what happens when someone
uses an opioid frequently
they need more and more of it to achieve
the same response
however when someone detoxes they lose
that tolerance
and it’s much easier for them to
overdose
so a few overdoses and arrests later
i ended up in inpatient treatment again
this time voluntarily
and this treatment was much different
the the people were kind to me
some of them had even experienced what i
had experienced
however they still wouldn’t let me have
buprenorphine or methadone
which i found curious
after that with exception to one
occurrence of use
i haven’t injected drugs in over seven
years
so what made me different what made me
different when ninety percent of people
that leave abstinence-based treatment
will return to use
i think there’s a number of things the
most important one being
my melanin deficiency
i was able to avoid getting in trouble
very well
because of the way that i looked and
where i lived
i was offered treatment instead of
incarceration
however our friends and neighbors who
are black or brown have a much different
experience
they are disproportionately targeted
incarcerated
the next thing i had was a number of
resources
i had insurance a lot of people don’t
have that privilege
not only that my parents had some money
they were able to pay a copay for me to
go to a nice treatment center
when leaving treatment i didn’t have a
record because they let me go to
treatment instead of jail
so i had access to gainful employment i
had access to safe and affordable
housing
i had access to resources to a whole
community
of people in recovery willing to help me
and that community did help me i learned
tons of life-saving information
and received tons of help over the years
however along the way these well-meaning
folks also
offered me some dangerous misinformation
they told me that buprenorphine the drug
that had once helped me
is bad and it’s cheating methadone as
well
they said that they discouraged people
from taking buprenorphine or methadone
and if they did they said that they
weren’t clean which i guess the
implication is that they’re dirty
some groups wouldn’t allow people using
buprenorphine or methadone to
participate or share
part of my privilege allowed me the
opportunity to go back to school
and not only finish my bachelor’s but my
master’s in social work
after they even let me become a licensed
social worker
i learned a lot while i was there but it
challenged me
i internalized those biases that i
learned in the recovery community
in fact i remember in my first social
work class we had a guest speaker
and he worked at a clinic that provided
buprenorphine to people with opioid use
disorder
and based on what i’d been told at the
end of the class i scoffed and told him
that he was killing people
i’ve come a long way since then through
formal education and
more importantly from people who are
directly impacted
some of the things i learned included
reading this study that was published in
the journal of american medicine
one of the world’s leading medical
publications
in this study they followed 40 000
americans with an opioid use disorder
for 12 months and what they found
is that the only treatments associated
with reducing
opioid overdose were buprenorphine
and methadone that is staggering
that should quash any moral or
philosophical arguments against the use
of medicine to treat opioid use disorder
alone
however what’s also staggering in the
study
is that out of the 40 000 adults
followed only 1 in 10 of them received
methadone
and less than one in five of them
received buprenorphine
the stigma against these medicines are
so ingrained in our society
that even the professionals we look to
to help our loved ones with opioid use
disorder will not utilize them
another study showed that out of all the
treatment providers in the united states
only 36 percent of them are even
offering just one of those medications
to treat opioid use disorder that is
because of the stigma
of the providers that do do this many of
them are for profit
people will pay as much as 12 to 20
dollars a day
to receive their medicine every morning
in my community
there is a non-profit that will provide
medicine to people
that are uninsured or without money to
otherwise pay for it
this is a great thing however there’s a
number of barriers in the way
for one for folks to be admitted into
the program
they have to have failed an
abstinence-based treatment before
and document that once they’re in
they have to show up every single
morning to receive their medicine
and wait in line behind others and have
their medicine administered to them
through a window
this is quite the barrier for people
with no transportation
also if they get accepted in the program
they have to do an intensive outpatient
treatment program
what this means is that four days a week
for three hours a day
they go into a group with other patients
and a licensed professional
this is a good thing right we want our
folks to
have their needs met with therapy as
well however when it’s required
it often serves as a barrier and
prevents access to the medication
i mean could you imagine having diabetes
and going to see your provider
and you’re expecting the standard of
care
insulin and they tell you well
you know before i provide that you’re
gonna have to try and manage your
nutrition
so you try that and it doesn’t work and
you go back to the provider and they say
okay well now i can give you some
insulin
but for me to give it to you you have to
go to these nutrition management classes
they’re four days a week for three hours
a day
and if you can’t go or you stop going
i’m gonna have to withhold your insulin
we would never allow that right that’s
because in the united states
when we withhold the standard of care
for a medical condition
that has a name and that name is medical
negligence
yet this is common practice in opioid
treatment across the country
i’m so fortunate because for the past
few years i’ve had the opportunity to
provide harm reduction services to
people in the community
what this means is i distribute things
like syringes
and naloxone the drug that reverses an
opioid overdose
even more i’ve had the privilege of
meeting more than a thousand
amazing people in our community all of
them at risk for opioid overdose
and i can say confidently that if
tomorrow morning
we had a provider open up that had
accessible buprenorphine and methadone
we would have hundreds of people show up
the very next day
they wouldn’t end up like my friend josh
my friend josh lived in this community
and he was a special person
he saved countless lives with naloxone
so one day he got sick he was admitted
to the hospital
with an infection related to his
injection drug use
he would have to be there for six weeks
getting treated
soon after getting there he went into
withdrawal
withdrawal is what happens to someone
who is dependent on opioids
that is no longer taking them it’s like
having
the worst flu imaginable
in the hospital because of his injection
drug use
history wouldn’t give him medicine to
treat it
they wouldn’t even give him
buprenorphine or methadone
the standard of care in fact the
hospital
didn’t even have an order set to give
him that if they wanted to
well josh was resourceful so
he decided if they weren’t going to
manage his symptoms then he would
so he had a friend come in and bring him
some illicit opioids
when the hospital caught wind of this
they banned
josh from having any visitors so now
once again sick
and in the hospital and now alone
without any friends or family
he left and who could blame him
over time josh’s condition worsens
and he was readmitted to the hospital
only this time
he’d be leaving in a body bag
he died there sick without his symptoms
managed
alone not allowed to have friends or
family visit him
and likely very afraid
it is because of people like my friend
josh
and the many others that are denied
basic health care
that we have to have reform in our
policies with addiction treatment
we have to do what we know works
i personally am sick and tired of
burying people that i love
knowing that we have the means to
prevent this
but simply being unwilling to do it
there should be no one listening that’s
left wondering why it is
that we have a jumbo jet full of people
die every single day to opioid overdose
thank you