We Need Doctors More Than Legislators

As the overdose rate from opioids and heroin continues to rise, families are begging for expanded treatment options and are expecting medical doctors to advise and direct them to care. But primary care doctors that understand addiction medicine are few and far between and those that are available may actually have views that are dated or conflict with what the patient is looking for.

Unlike cancer and heart medicine, addiction medicine and psychiatry does not have the glamour, accolades or public support as other medical fields. While still in residency programs medical interns are encouraged to practice in another field and are steered away from servicing individuals that use drugs or are in need of addiction treatment. Treating those that use drugs carry it's own set of stigma that the relationship between physician and patient is tenuous at best. Patients hide their true amount of drug and alcohol use from their doctors and until complications arise many patients stay away. Even though the federal government has increased the amount of patients that doctors may distribute addiction medication to, doctors are not seeing enough patients.

When actively looking for a physician or treatment facility, patients are further dismayed and disappointed by the complexity of addiction services. Left unguided by their own physican, families have a difficult time navigating and understanding their needs. Facilities may offer out of date care, may push expensive inpatient treatment that may or may not be warranted, demand minimum 30 day, 60 day stays and may or may not offer medication for those that are in need. Treatment centers may not provide a doctor's care and may rely on uneducated counselors and advocacy volunteers to provide care and unregulated sober houses to pick up the slack. Those treatment centers working under abstinence only protocols victimizes patients. Maia Szalavitz's article further highlights the ineffective treatment that families encounter.

As many in the medical field continue to disagree about treatment options and stay passive, advocates and legislators with the best of intentions try to legislate their way out of this public health crisis. Advocates and legislators push for 911 Good Samaritan Laws, naloxone distribution legislation, specific drug testing of newborns, as well as prescription monitoring programs (PMP). Legislators may gloat when these laws are passed and money is appropriated but when the legislation has limited legal protection, the laws are ineffective. Legislators and advocates accepting legislation that include harsh penalties and forced testing as success, does nothing to help families that are struggling. Although trying to save lives, the legislation has not curtailed the overdose rate as the death toll continues to rise.

To varying degrees each of the legislative efforts have clauses that allow the criminal justice system to intervene and arrest. Each state has their own set of laws that are so complex that families that have members that use drugs have no idea whether they may keep naloxone in their homes, call 911 without repercussions, talk with their doctors without fear of being placed on a doctor shopping list supplied to police or whether to go to the hospital to have their babies.

Furthermore when 911 Good Samaritan and naloxone laws are too difficult to understand the public goes unaware. There is no trust in complex legislation and police continue to arrest and prosecute.

Naloxone programs may be funded in larger cities, larger pharmacy chains may have naloxone over the counter but rural communities where overdose rates are rising have little access. PMP's, which could be an effective tool for physicians and patient care discussion, instead are monitored by police agencies and have numerous privacy concerns that have doctors and patients on edge. Instead of opening the conversation to help patients get the care that they need, each are afraid to honestly speak with one another, neither wants to be viewed as an addict or drug pusher.

There are rays of hope from the medical community that looks promising and may be a model going forward. A recent announcement from the pubic health sectors and Boston Medical Center is particularly promising. Instead of legislation, the medical community is working together to provide urgent care for opioid use and is coming together to take the lead to help those that come through their doors.

The new center, called Faster Paths to Treatment, is run in collaboration with the Massachusetts Department of Public Health (DPH) and the Boston Public Health Commission (BPHC), and is funded by a four-year, $2.9 million grant from the DPH. It's housed in BMC's Yawkey Ambulatory Care Center, and will use inpatient and outpatient services to help individuals with detoxification and follow-up care. (Boston Magazine)

When doctors and public health work together and advocate for compassionate care that is best for their patients that use and also misuse drugs more individuals will seek out services. Primary care physicians as well as hospital staff need to accept these patients without stigmatizing them as addicts. They need to inform legislators that coercive legislation that involves law enforcement is not effective in saving lives; it turns individuals away from services. Opening the doors to all without the fear of the criminal justice system will allow physicians to treat patients and improve pubic health for all. We cannot continue to have legislation that allows law enforcement to take the lead because the medical field will not or cannot. We will have no other recourse if physicians continue to stay passive; arrests will continue, legislation will fail to help those that are most in need of emergency care, access to naloxone will stay limited and the rehab industry with no medical or research oversight will continue to flourish, mislead and pry upon innocent families that have no where to turn