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