The opiate addiction epidemic has recently been exacerbated by the pandemic and the availability of fentanyl and other hyper-deadly drugs. Record numbers of fatal overdoses are being recorded, and millions of Americans need help with Opioid Use Disorder (OUD).
The medical and behavioral tools that addiction doctors use have improved by leaps and bounds in the last decade.
As such, we need to address some of the outdated misconceptions about opiate addiction treatment. Often, the public perception is that:
• treatment adversely affects patient lifestyle and freedom
• treatment is expensive
• the success rate of treatment is low
Recent changes to insurance policies, increased access to treatment, and advances in Medication Assisted Treatment (MAT) have improved the outlook for patients who are addicted to opiates, like heroin and fentanyl. Few people are aware that the success rates for opiate treatment are equal to the success in treating other common chronic health conditions, such as hypertension or diabetes.
Misconception #1: Opiate Addiction Treatment is Cost-Prohibitive
Insurers, including Medicare and Medicaid, are required to provide coverage for addiction treatment and they do for other health emergencies and chronic conditions such as diabetes. This is a recent development and part of legislation enacted Under the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.
Treatment covered under that act includes “medication assisted treatment” (MAT), clinical detox, and many types of outpatient treatment.
In the past, some insurance providers fought against paying for lengthy or intensive treatment, although length of treatment and acuteness of environment is clearly correlated with better outcomes. Recently, this has changed for the better. Insurance companies realize that treating OUD with an eye towards cost cutting leads to increased expenses due to relapse and overdose. Medical evidence supports that treatment which includes longer-term counseling combined with MAT can provide the best outcomes.
Many insurance providers now agree to provide the best long-term care for each recovering patient. Many addiction rehabilitation programs are in network with insurers (including medicare and Medicaid) so that the patient costs are extremely low. For example, the copay to start addiction treatment for some Medicaid patients is $3.
Misconception #2: Patients Have to Spend Months in Residential Addiction Programs
Residential treatment may be advantageous for certain patients in need of recovery from addiction. However, access to such treatments may not be available for cost or geographic reasons. . Outpatient treatment is extremely effective for opiate use disorder, and is increasingly being facilitated remotely via telehealth. Even opiate detoxification can often be done in an outpatient setting. Virtually all insurance providers have embraced telemedicine treatment for OUD treatment. This increase accessibility for treatment has been particularly helpful in rural areas where ‘on-site’ medical appointments are difficult to arrange.
Treating Addiction via TeleHealth
While ‘virtual’ doctor appointments had already been increasingly common in recent years, the Covid-19 pandemic has really increased the availability and usage of this technology.
A thorough medical evaluation can be done via Telehealth, and addiction programming can start immediately after, sometimes on the same day. Prescriptions for drugs like Suboxone and Vivitrol can be prescribed electronically to any pharmacy. Patients can receive frequent addiction counseling sessions from home via their phone, computer, or tablet.
There are many patients who have achieved long-term sobriety from opioid drugs without physically visiting an ‘on-site’ addiction treatment rehab. A wide variety of interactions, including group and individual therapy, medical consultations and medication adjustments can be done online. Participation in self-help groups like the 12-step program of Alcoholics Anonymous are widely available online.
Misconception #3: Drug Rehabilitation for Opiates Doesn’t Work
According to the American Society of Addiction Medicine, treatment for addiction works as well as treatment for other chronic diseases, like diabetes. Every person is unique and requires a personalized treatment plan to “meet them where they are” and give them adequate support.
Relapse is not necessarily a ‘failure’. As with other chronic diseases, individuals recovering from opiate addiction can relapse. Relapse rates for opiate addiction are similar to diabetes and hypertension. But with the a support system for addiction recovery, a person’s relapse can be learned from and avoided in the future.
Using Medication to Treat Opiate Addiction
According to the Centers for Disease Control, the best treatment outcomes for opiate addiction combine medication treatment with counseling. One large study showed that recovery rates for opiate addiction are as high as 92% at four years, when counseling and medication treatment are used. Medical treatments for opiate addiction such as buprenorphine should be seen the same as insulin is for diabetes: a medical treatment for a medical condition.
Because opiate addiction is a chronic disease, long-term treatment is recommended. Many patients matriculate to a program of self-help groups during or after the first year of recovery. Most common one is Alcoholics Anonymous, but there are many more alternatives.
The Disease Model of Addiction Justifies MAT
Most people would not suggest that a diabetic should recover without insulin when it is medically indicated. Medications like Suboxone and Vivitrol have been overwhelmingly proven to be the most effective treatment for addiction. Unfortunately, “abstinence-based” treatment, with no medication support, has a very low success rate (of about 5%).
It is strongly recommended that someone with an opiate addiction find a doctor who is certified to administer medication like Suboxone (when medically indicated). This drug has greatly reduced overdose and death, while reducing cravings which improves the quality of life during early recovery. It is also important to have prompt treatment available for this life-threatening disease.
Dr. Francis Corrigan has been treating patients for addiction and pain management for 20 years in North Carolina at Solas Health.