Most rehabs don’t offer a science-backed treatment for drug addiction. A new initiative aims to change that.

A
liquid dose of methadone at a clinic.
AP Photo/Kevin D. Liles

• To treat addiction to opioid
  painkillers like OxyContin and Vicodin, scientists say we
  should be using something called
  medication-assisted treatment, which involves giving
  patients access to medications that appear to curb overdose
  deaths.
  
• Few rehabs or treatment centers offer the medications,
  however.
  
• Instead, many centers follow the guidance of 12-step
  programs like Alcoholics Anonymous (AA) or Narcotics Anonymous
  (NA), which often encourage completely abstaining from all
  drugs.
  
• But part of a new initiative launched this week to
  grade those treatment centers includes making sure they provide
  access to medications.
  

---

As the death toll from opioid addiction continues to soar with
nearly
64,000 people dying in 2016 alone, scientists and public
health experts are calling on clinics and rehab facilities to
make sure they’re using the latest science to treat the
condition.

So this week, the main professional society of addiction
scientists launched a pilot program that gives treatment centers
a grade based on a set of research-backed criteria designed to
ensure patient health and safety. The program is being
spearheaded by the American Society of Addiction Medicine, which
announced a partnership with nonprofit healthcare accreditation
group CARF International.

Among other requirements, the criteria includes providing people
with
access to medications like naltrexone that help curb
cravings and reduce withdrawal symptoms. That kind of treatment,
also known as medication-assisted treatment or MAT, has been
controversial in the past. Thousands of rehabs still
refuse to offer it, instead encouraging people to abstain
from medications altogether in accordance with the guidance of
12-step programs like Alcoholics Anonymous or Narcotics
Anonymous.

But medication-assisted treatment is a powerful tool to help curb
deaths from addiction, according to leading scientists and
several peer-reviewed studies.

“Medications are an effective treatment for opioid addiction,”

Kelly J. Clark, president of the American Society of
Addiction Medicine, told Business Insider in April.

So as part of the new program, treatment centers “have to provide access to medication-assisted
treatment,” Paul Earley, an addiction medicine physician and
board member of the American Society of Addiction Medicine, told
Business Insider on Wednesday.

‘These treatments are life-saving and they
work’

Fentanyl
AP

Currently, only about half of private-sector treatment programs
for opioid use disorder offer access to the medications, and of
those, only a third of patients actually receive them, according
to a study
published in the Journal of Addiction Medicine.

But dozens of experts and several studies suggest the medicines
are powerful tools to help prevent deaths.

“These treatments are life saving and they work,” Sarah
Wakeman, the medical director of the substance use disorder
initiative at Massachusetts General Hospital and an assistant
professor at Harvard, told Business Insider in April.

The problem is that the medications are surprisingly difficult to
obtain.

In someone with opioid use disorder, as addiction to painkillers
like OxyContin and Vicodin is formally known, using the drugs is
not often a pleasurable experience. Instead, it’s a practice that
has become a necessary fact of life. Being without the drugs
leads to painful symptoms that can include severe nausea,
shaking, diarrhea, and depression. The need to use is
simultaneously a physical and emotional compulsion — the lines
between those kinds of pain are blurred.

One of the main misconceptions about medication-assisted
treatment is that the medications for drug addiction simply
replace the drugs that hooked users — leading to more highs and
fueling a pattern of repeated use.

But that view is outdated and ill-informed, experts say. Instead,
the drugs work by staunching cravings and reducing or preventing
withdrawal and relapse. Buprenorphine and methadone help suppress
cravings, while naltrexone blocks the euphoric and sedative
effects of opioids so users don’t experience a high.

And not surprisingly, as access to medication rises, drug
overdose deaths fall.

A study of heroin overdose deaths in Baltimore between 1995 and
2009 published
in the American Journal of Public Health, for example, found
that in places where methadone and buprenorphine were available,
the number of fatal overdoses fell by 50%.

“People ask me all the time, ‘well, aren’t they just substituting
one drug for another?’ The answer is no. These are evidence-based
treatments and they work,” Patrice A.
Harris, the chair of the American Medical Association’s
opioid task force and a board certified psychiatrist, told
Business Insider in April.

From jail to court to rehab, medication-assisted
treatment is hard to find

Black-tar
heroin
REUTERS/Lucy
Nicholson

Despite the evidence behind them,  medications for addiction
are surprisingly difficult to obtain.

One of the hardest-to-access forms of medication for recovery is
methadone. In the US, the medication can only be accessed in
specialized clinics; because of the way the treatment works,
people using medication-assisted treatment must come to a
facility to get their dose daily. But those facilities typically
have negative reputations because of policies that restrict them
to locations considered seedy or run-down. And patients who come
for treatment often have to push past active drug users — a big
trigger for someone with substance use disorder — on their way to
and from the clinic.

“You can access heroin pretty easily, yet we make it really hard
to get a treatment that’s life-saving and allows you to live
healthily,” Wakeman said.

In April, the US Food and Drug Administration issued a
new set of guidelines aimed at underlining the important role
that medication-assisted treatment should play treating
opioid use disorder.

“Unfortunately, far too few people who suffer from opioid use
disorder are offered an adequate chance for treatment that uses
safe and effective medications,” FDA commissioner Scott Gottlieb
said.

Other countries take a very different approach to
medication-assisted treatment that makes the treatments easier to
obtain. In Canada, for example, methadone is distributed in
pharmacies.

Rehabilitation facilities and courts in the US often don’t offer
medication-assisted treatment either. Instead, most operate on an
abstinence-based model, in which patients must detox and then are
offered counseling. They’re  encouraged to attend 12-step
meetings like Narcotics Anonymous, which remains opposed to
medication-assisted treatment despite the growing body of
evidence behind it.

Among staff at rehab centers across the US, many workers maintain
the belief that the medication doesn’t work and say clients will
“abuse” medications. Stephanie Rogers, an intake coordinator at
Talbott Recovery, an Atlanta-based addiction treatment center,
told Business Insider in April that she “honestly believed” that
medication-assisted was “just substituting one drug for another.”

This trend runs in sharp contrast to the way treatment for other
conditions has changed based on new research. When it comes to
type 2 diabetes, for example, a large body of scientific evidence
demonstrated that the medication insulin helped curb the symptoms
of the illness. Those findings prompted medical professionals
across the country to uniformly endorse and offer it.

Even among rehab center workers who do understand the potential
of medication-assisted treatment, many told Business Insider that
their facilities aren’t licensed to provide medication-assisted
treatment in the first place. San Diego-based drug treatment
center AToN, for example, lacks the proper licensing to provide
methadone to patients, according to its program director.

Turning the tide requires buy-in from officials and medical
providers

Some officials, including judges who preside over courts that see
people brought in on drug offenses, are trying to update their
policies to incorporate the most recent research on addiction
treatment.

Judge
Desiree Bruce-Lyle presides over several such courts at the
Superior Court of San Diego County. She told Business Insider in
April that she became convinced of the efficacy of
medication-assisted treatment after attending an American Society
of Addiction Medicine conference and speaking to some of its
leaders, including Kelly Clark and vice president Penny S. Mills.

“I didn’t believe in [medication-assisted treatment] until I met
Penny and Kelly last year and they convinced me why it was a good
thing and then I heard from a lot of the speakers that were
attending that we needed to take a look at it,” Bruce-Lyle said.

Still, out of roughly 50 participants in the reentry court that
Bruce-Lyle helps oversees, only one or two were on
medication-assisted, she said in April. In their veterans court,
which includes roughly 60 people, three or four were using the
program.

“I’d like to see more of it,” Bruce-Lyle said, but added that she
felt she’d need to convince key players at the court — including
the Sheriff and other leaders — of the treatment’s
efficacy.

A handful of physicians and social workers are also helping to
lead the charge by calling attention to the scientific evidence
that shows medication-assisted treatment is more effective than
an abstinence-only model. Wakeman, the assistant professor at
Harvard, travels around the country giving presentations at
conferences like the one that helped change Bruce-Lyle’s mind.

“Medication-assisted treatment saves lives,” Wakeman said. “You
can also just call it ‘treatment’ and drop the two words in front
of it.”

This post was originally published in April 2018 and has been
updated.