On Nov. 19, 2017, the White House’s Council of Economic Advisers estimated the opioid crisis in America cost the U.S. economy $504 billion in 2015. That is almost 3 percent of gross domestic product or six times the cost previously estimated.
On June 5, 2017, The New York Times reported that opioid overdose was now the leading cause of death in American’s under the age of 50.
Last week, in the article “Handcuffed to Opioid Addiction,” I cited that on June 22, 2017, Time Magazine reported the following facts:
- In 2016, the pharmaceutical companies that make opioid painkillers raked in $8.6 billion in sales for 336 million opioid prescriptions, according to the data firm QuintilesIMS. That’s enough to give pain pills to nine out of every 10 American adults.
- Analysts estimate that the follow-on opioid market is worth at least $3 billion a year. Given current trends, some project it will top $6 billion by 2022.
- Pharmaceutical companies made billions promoting the aggressive prescribing of opioids. Now they’ll make billions from treating the consequences of overprescription.
Now, as I read and reread these facts again and again, I cannot understand how our government continues to allow these criminals to operate with free rein. Therefore, I enlisted Percy Menzies, a pharmacist who founded the outpatient treatment clinics Assisted Recovery Centers of America in the St. Louis area, which treats more than 800 heroin patients a month.
The following interview is an attempt to understand why we are losing our war against opioid addiction.
What got you into this field?
I am a pharmacist by training and not in recovery. I worked for almost 18 years for a pharmaceutical company that developed medications derived from the opium poppy. We promoted opioids like antibiotics.
In all my years in pharmaceutical sales and educating physicians, I have never encountered such intense and vehement opposition to a new treatment modality. At that time, I thought the opposition was more on treatment philosophy, but now I realize it threatened the established business model.
I left the industry almost 17 years ago determined to bring the treatment of addictive disorders into the realm of medicine.
How is your approach different from the conventional treatment?
All our patients are medically detoxed of the drugs or alcohol under the supervision of the physicians, and they are started on the appropriate anti-craving medications. The critical component is behavioral counseling which includes individual, group and family counseling and psychiatric services. All this takes place under one roof in the patients ‘home’ environment on an outpatient basis.
The vast majority of our patients do not need inpatient or residential treatment. This approach has better outcomes as our patients learn to deal and extinguish the plethora or cues and triggers that kept the addiction going.
The benefit of this approach is there is no loss of income; most patients can go back to work within a few days; more importantly, there is no loss of confidentiality. Imagine if you had to go away for a month or two, it is not easy to explain the absence and thirdly the patients are getting well in their home environment.
Why are we losing the battle against opioid addiction?
There are several reasons but to start treatment is not standardized and based on the premise of ‘incurability.’ Opioids Substitution Treatment (OST) can work when the access to legal and illegal opioids is curbed or cut off.
We have no strategy to curb the supply of heroin, and Opioid Substitution Treatment (OST) is inadvertently feeding the heroin addiction with buprenorphine (Suboxone) and methadone.
We are using treatment approaches developed decades ago and that have not worked for the past 15 years and have virtually no chance of succeeding.
Are you saying that treating opioid addicts with opioids will not be successful?
If Suboxone and methadone were such wonderful drugs, why did 64,070 people die in 2016 from an accidental overdose of opioids?
I do not understand the current Method of Treatment for opioid addiction.
Our present treatment model of opioid substitution was initiated by the Nixon Administration as a stop-gap arrangement until more effective medications were developed.
It is shocking that after spending billions of dollars in research including promises to develop vaccines, we have just three medication, methadone, buprenorphine, and naltrexone to treat opioid addiction. Less than 10% of the opioid addicts receive medical treatment.
If non-opioid addicts were administered the dose of Suboxone or methadone given to opioid addicts every day, would they get high?
Methadone and buprenorphine (Suboxone) are very potent opioids, and if non-opioid addicts are administered these drugs, they will get high and experience all the effects of opioids - euphoria, sedation respiratory depression. In the case of methadone, the patient could even die. For that reason, there is restrictions on the administration of methadone and buprenorphine. Indeed, buprenorphine is one of the most abused pharmaceuticals in the world.
I have not heard of naltrexone. What is naltrexone and why is it so controversial?
Imagine if you could swallow a pill and be protected from all opioids including fentanyl! This pill acts as a shield in the brain protecting you from the deadly effects of opioids. It sounds far-fetched, but such a medication has been sitting on the shelves for almost forty years!
The medication is naltrexone and was the first non-opioid medication developed to prevent relapses. What is even more surprising is it was funded and developed by the federal government for only one purpose – prevention of relapse to opioid use.
Wait a minute. Why are we not using naltrexone as the number one Method of Treatment for addiction?
Big Pharma. Suboxone is a 2-billion-dollar industry. Naltrexone does not create conscious sedation that separates the addict from their present awareness. Suboxone will get you high. Suboxone is long-term maintenance treatment. Therefore, Suboxone is money.
I am not surprised you have not heard of naltrexone. The vast majority of patients and even physicians are not familiar with the drug. Naltrexone was the beneficiary of Nixon’s Infamous War on Drugs.
Naltrexone pharmacologically is the exact opposite of methadone and therefore, is called an antagonist. Never in the field of medicine do we have two medications at the opposite spectrum of treatment.
Why is abstinence so controversial in the treatment of opioid addiction?
The treatment of opioid addiction took a peculiar trajectory and contradictory to the treatment philosophy of the AA model. The AA model resolutely opposed medications especially maintenance medications.
Maintenance medications are generally not offered as a life-long treatment for other addictive disorder including cocaine, alcohol, methamphetamines, etc. Given the present situation of opioids being ubiquitous, we have to accommodate the new definition of abstinence, i.e., if the patient is abstinent from illegal opioids like heroin or illegally obtained opioids and only takes methadone, buprenorphine or naltrexone, this should be considered being abstinent.
Indeed, not being on any one of these three medications puts the patient at an unacceptably high risk of relapse and overdose.
What changes do you advocate?
My first recommendation is to stop describing opioid addiction as a ‘disease.’ The word disease has a very negative connotation. Disease implies helpless and something being incurable or untreatable. Call it a disorder, condition, or illness people can recover from and go on to lead normal lives.
My second recommendation is directed toward professionals in our field. We should have the humility to learn and incorporate the strategies that worked in the fight against AIDS/HIV and smoking cessation. We remain too isolated and insular in our present approach.
Sadly, my last recommendation is that we must be willing to eliminate profit from the Method of Treatment. The present strategy of both treatment and prevention is woefully inadequate. We are placing a band-aid on a giant sucking chest wound to create financial fortunes.
Ritchie Farrell is the author of I Am A Heroin Addict.
Follow Ritchie Farrell on Twitter: www.twitter.com/ritchiefarrell1
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.