Patricia Hincken

Legislation on opioid addiction is a huge step forward

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The opioid epidemic is devastating families and communities that are struggling to deal with the loss of seemingly healthy young adults. In response, government officials, treatment providers, law enforcement, the medical community, family advocacy groups, and the recovery community have come together to find solutions.

This has resulted in new legislation. The comprehensive Addiction and Recovery Act was recently passed by Congress, and on the state level, Gov. Andrew Cuomo last month signed into law a landmark package of laws that address the epidemic.

We can now see that the increasing use of opioids (which were intended as treatment for pain) resulted in a heroin crisis. The response was slow to materialize, largely due to confusion about the appropriate use of pain medicine and the symptoms of addiction. As well, the addiction treatment community has focused on abstinence models, and discouraged the use of medication.

The exception was Methadone Maintenance, which was developed in the 1960s to treat heroin addicts. The idea was to use medication to block the euphoric effect of opioids and to allow patients to function. Methadone was also used to treat symptoms of withdrawal so patients could successfully stop using heroin. But methadone clinics were stigmatized both in the treatment field and in communities — in spite of research in the U.S. and Europe that found a high rate of success in helping patients lead productive lives.

So, a new drug crisis grew out of an attempt to treat an illness, and an effective response was limited because physicians were slow to address opioid dependence, and because of the stigmatizing of a successful model of treatment.

Addiction medicine is a relatively new specialty that has been steadily growing as the medical community has recognized the extent of the problem and the need to address it. Research into effective treatment has led to better outcomes. Evidenced-based models of treatment developed over the past 10 years focus on addiction as a chronic disorder, much like other illnesses.

The American Society of Addiction Medicine endorses medication-assisted treatment as the standard for opioid addiction. As with all chronic illnesses, some patients will need to maintain a medication regimen for the rest of their lives, while others may be able to overcome addiction through behavioral changes. But the importance of medication is clear: Patients who are not on an addiction medicine are twice as likely to die of an overdose.

There are three medications approved by the U.S. Food and Drug Administration that are proven to be effective: methadone, buprenorphine and naltrexone. The new federal and state legislation address critical problems with access to these medications. Nurse practitioners and physician’s assistants will be able to prescribe buprenorphine (which, as of now, can only be prescribed by physicians). Both in-patient treatment programs and the criminal justice system are being encouraged to provide medication as part of their protocols, because the risk of overdose increases sharply for those who are taken off medication.

The obstacles to covering treatment and medication with insurance are also addressed in the legislation. And overdose-prevention programs, including the use of naloxone to reverse overdoses, will be more readily available, and recovery programs are receiving grant money to help support those struggling with long-term addiction. The new laws also address the overprescribing of medication, physician education, the tracking of prescriptions across state lines, and criminal activity connected with the sales of narcotics.

The federal and state legislation is a huge step forward, and it is the result of hard work by government officials, law enforcement, families, treatment providers and the recovery community. We hope it will help break down the barriers of stigma and change the public perception of people battling substance abuse. It is our hope that one day, opioid addiction will be seen as just another chronic illness, with the same challenge of finding the right treatment — medication, if needed — so patients can face life with renewed hope, and health.
 
Patricia Hincken, a licensed clinical social worker and an alcohol- and substance-abuse counselor, is the director of addiction recovery services at the Zucker Hillside Hospital in Glen Oaks.