This article, by Roy Miller, was originally posted on the Bangor Daily News opinion page on April 23, 2019.
By Roy Miller, Opinion regular contributor • April 23, 2019 6:00 am Updated: April 23, 2019 6:36 am
Drug overdoses caused almost twice as many deaths as motor vehicle accidents in the U.S. in 2017. This problem is present here in Maine. Addicted people lose their jobs, driver’s licenses, family and freedom. The cost to society is huge.
For the past decade I have successfully treated people with this disease by prescribing buprenorphine (Suboxone). None of them has died and almost all of them have remained free of illicit drugs.
Many patients told me that, while addicted, they were spending up to $250 a day on drugs — waking each morning wondering where to cajole, earn or steal that money before finding a dealer. Anecdotes revealed that each user was spending as much as $50,000 a year. Most of this money left the state of Maine.
Even when no longer getting a high from the drugs they could not stop because the withdrawal was unbearable. And if they did withdraw, the cravings would return and they would relapse within days or weeks.
Many of the people I treated started drugs in their early or mid-teens. When life got tough or confusing, they got high. So, when they finally sober up you have a 14-year old’s brain in a 29-year-old’s body.
Buprenorphine (a medicine that is taken under the tongue, like nitroglycerin) goes to the same receptors in the brain as narcotics. It blocks the receptors, does not make people high but now they do not withdraw or crave drugs.
Combined with counseling, people taking buprenorphine can slowly regain control of their lives. And it is slow. Relapses and dangerous behavior are common in early treatment. People start to look healthier in a few months, but it often can take over a year before brain healing and their delayed maturing allow them to work and behave normally.
The rewarding part for me as a doctor is that after a few years most in treatment are working and reestablished with their families. Many return to their previous occupation. I have also had patients who started new careers and now include a bank vice president, a manager of 200 employees, a licensed realtor, a legislative employee and many self-employed people.
But many cannot stop medication therapy. Critics complain that we are just substituting one addiction for another. But ongoing therapy with buprenorphine for addiction is no different than ongoing treatment for diabetes with insulin. It’s as if a switch has been flipped on by drug use, so their brains require the narcotic receptors to be occupied, by narcotics or by buprenorphine.
What can you do to help?
First, work to make insurance available for more people. I had the luxury of working in a rural health center and could see people for a reduced fee: This is not true everywhere. Medicaid expansion should help as is making affordable insurance available to others.
On a personal level, ask your medical provider if they are prescribing buprenorphine as part of medication-assisted treatment. If they are not, ask them why. A doctor, nurse practitioner or physician assistant has essentially been admitted to a guild with guaranteed employment. They should be providing all forms of treatment for which they are capable.
Next, make sure that the local hospital has established a way for addicted people to get the treatment they need. This involves beginning treatment in the emergency department, having counseling available quickly and having a referral network of providers to takeover prescribing.
Prevention makes the most sense. A Department of Justice report, “Promising Strategies to Reduce Substance Abuse,” discusses the importance of providing safe, drug-free activities and mentoring for children. So, support the local Boys and Girls Club, YMCA or other groups. Sponsor a trip for their kids to a museum, a play or a baseball game. Become a Big Sister or Big Brother. Talk to the local high school counselor and mentor a kid in need.
We can reduce this crisis, but we must do it together.
Roy Miller is a retired family physician. He is a member of the Maine chapter of national Scholars Strategy Network, which brings together people across the country to address public challenges and their policy implications. Members columns appear in the BDN every other week.