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My Turn/Potee: Missing mark on addiction

The real killer is cheap, potent heroin

  • POTEE



Sunday, March 20, 2016

Gov. Charlie Baker’s signature on the “most comprehensive measure in the country to combat opioid addiction” may have made a real difference three or four years ago.

Reducing the over­prescription of opioids — while still having them available to those helped with their chronic, severe pain — is a critical step in shifting this public health emergency. Limiting the number of unused pills sitting in medicine cabinets around the Commonwealth reduces risk to children, adolescents, and others susceptible to this disease. Allowing a patient to pick up two Vicodin after a root canal instead of 20 is in keeping with the best practices of patient self­determination.

But the pills are no longer our main problem. Massachusetts has been in the bottom quintile of opioid prescribers in the nation for years. Most (80 percent) of pills used for a person’s addiction don’t come from a legitimate prescription; they come from diversion. The vast majority of oxycodone that came to Massachusetts prior to 2011 did not come from the prescription pads of Massachusetts prescribers. It came from pill mills in strip malls throughout Florida.

Believing that limiting short­term prescriptions for acute pain is going to significantly reduce the opioid epidemic is misleading and misguided. By fighting the last war, it prevents us from focusing on the real killer: cheap, potent, often tainted heroin.

For the first time in my 14 years providing care for those struggling with an opioid addiction, I am seeing people whose first drug was heroin. They did not have a pill problem, they did not smoke cigarettes and they had an indifferent relationship with marijuana. They are 14­ to 18­year­olds who struggle with anxiety, depression, and a virtually universal history of childhood trauma.

There is nothing in this long­awaited bill that helps those who are currently battling addiction.

There is not one word about improving access to evidence­based treatment and decreasing the focus on short term “detox” stays that cause more harm than good.

There is no funding for long­term structured sober living facilities where our sickest patients can go to get away from their local triggers that cause recurrent relapse.

There is no increased funding or programmatic mandates for the only structured sober living facilities that do exist (i.e., jails) to help inmates get better during their incarceration. “Game­changing” legislation would have involved the Commonwealth of Massachusetts serving notice that it was no longer abiding by bizarre federal regulations that both restrict how many patients a doctor can treat with buprenorphine and prohibit nurse practitioners and physician assistants from prescribing this life­saving medicine.

On the other side of the pendulum, those who suffer with chronic pain and show clinical benefit from long­term monitored use of opioids are the newly stigmatized. Repeatedly we are told that this chronic opioid use is “highly addictive” or “as addictive as heroin.” This is not true. The National Institutes of Health puts the percent who may develop addiction at 5 percent, a number found in repeated studies. Is this a proportion we should work to reduce? Certainly. Every effort should be enacted to make sure that patients using opioids for chronic pain are getting true benefit and that their use is not causing harm to themselves or to society.

Insurance companies were fine shelling out billions of dollars to pay for prescription drugs over the last 20 years but no insurance company has proposed a comprehensive approach to help those patients who suffer with pain. There is no state mandate urging coverage for acupuncture, massage therapy, somatic functional therapy, or cognitive behavioral therapy. Blue Cross Blue Shield bragged about a 54 percent decrease in opioid prescriptions in their 2014 annual report but did not mention a single effort they put forth to reduce the experience of chronic pain in their patients’ lives. The money that is no longer going to pay for pain prescriptions should fund support groups, gentle yoga, free memberships to local Ys, and water therapy. Co­pays for physical therapy and effective trauma­informed therapy should be waived for those with chronic pain.

The death rate from opioid overdose did not decrease in 2015 and this new legislation in not likely to alter the death rate in 2016. I am not going to join the self­congratulatory crowd. This is one small step forward but we have a long path to travel before the Bay State can be held as the nation’s model for reducing harm and improving treatment for those who struggle with addiction to opioids.

Ruth A. Potee, MD, ABAM, is co-chair of Healthcare Solutions Opioid Taskforce of Franklin County and North Quabbin.