Price's drug addiction treatment comments echo debate in recovery community
HHS Secretary Dr. Tom Price's concerns about medication-assisted treatment for drug abuse underscore an ongoing debate about its use within the treatment community itself.
Price was visiting West Virginia—a state hit hard by the opioid abuse epidemic in recent years—when he said he favored faith-based programs that promote total abstinence from drug use instead of medications such as buprenorphine and methadone to help patients reduce their dependence on opioid painkillers or heroin.
"If we're just substituting one opioid for another, we're not moving the dial much," Price said as reported in the Charleston Gazette-Mail on Tuesday. "Folks need to be cured so they can be productive members of society and realize their dreams."
Addiction treatment specialists felt Price's statements reflect an inherent misunderstanding about using medications to reduce physical harm caused by addiction.
"It is dangerous to further perpetuate the untrue and unscientific statement that medication-assisted treatment is somehow substituting one drug with another," said Dr. Leana Wen, health commissioner for the city of Baltimore. "We would never say that if the disease was diabetes—in the same way, we need to have the same scientific understanding when it comes to the disease of addiction."
Wen said she hoped Price would show strong support for the combined use of MAT and psychosocial supports given the growing amount of evidence that has shown patients who undergo such treatments have a better chance of a succesful recovery than those who receive psychosocial counseling alone. According to the American Society of Addiction Medicine, patients who recieve drug maintenance therapy are 75% less likely to die from their addiction compared to those who do not receive those medications.
Medication-assisted treatment has received bipartisan support in recent years, culminating in last year's passage and signing of the Comprehensive Addiction and Recovery Act. Among the law's provisions was a call to expand access to such therapies.
Clinicians consider MAT the standard treatment option. But these less invasive treatment alternatives to methadone, such as buprenorphrine, have only been around 20 years.
The majority of drug treatment clinics in the U.S. don't offer such medications. Most provide more traditional 12-step, faith-based programs operated by non-medical professionals who advocate for abstinence from any chemicals, including medication-assisted treatment to curb addiction.
The result has limited access to MAT even as drug overdoses skyrocket.
"There are many people who unfortunately see addiction as a choice or a moral failing rather than as the chronic brain disease that science shows that it is," Wen said.
Price in his comments did refer to addiction as a "public health issue" rather than a "criminal justice issue", and that immediate resources were needed.
But Dr. Joshua Sharfstein, associate dean for Public Health Practice and Training at the Johns Hopkins Bloomberg School of Public Health, believes Price's comments on MAT reflect a misnomer shared by a lot of Americans, "including a lot of physicians."
He says addicts continue to use drugs despite the harm on their body and that methadone curbs those physiological effects.
Price's statement on MAT also contradicts President Donald Trump's position during his campaign last year when he said part of his strategy for addressing the opioid epidemic included lifting a cap on the number of patients a doctor can prescribe MAT to.
Patient advocates say that besides setting up a commission tasked with finding solutions on curbing the opioid epidemic, the Trump administration has done little to curb the opioid epidemic. In fact, treatment could be further affected by the Republican-led effort to repeal the Affordable Care Act. Early estimates on the bill to replace President Barack Obama's signature healthcare reform bill found 24 million Americans would lose healthcare coverage over the next 10 years. Coverage for drug recovery treatment is guaranteed as one of the ACA's 10 essential benefits. Expansion of Medicaid has also provided access to many who previously had no insurance.
"Truly being concerned about the opioid epidemic is not compatible with supporting legislation that would undermine Medicaid and throw 24 million Americans off health insurance," Sharfstein said.
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