Matt Mossburg’s path to addiction recovery is laudable. We admire his courage in sharing his experience with addiction and his desire to help others achieve recovery. But everyone’s pathway to recovery is different, and denigrating the evidence-based approaches that help others achieve and sustain wellness is both counter-productive and stigmatizing.
In his recent commentary in Maryland Matters, Mossburg argues that treating opioid addiction with medication is simply replacing one drug for another [“The Opioid Epidemic – Why We Are Losing,” Jan. 2]. Consider this argument for another chronic medical illness: Type 2 diabetes.
This illness often results in damage to the pancreas which makes it impossible for a patient to naturally produce the insulin needed to regulate glucose levels. Some patients are able to successfully treat Type 2 diabetes with changes in diet and exercise. But it would be unfathomable for a legislator to suggest that those who were not able to do so – for whatever reason – should not have access to life-saving insulin.
For many with opioid addiction, stable recovery is not possible without medication. This is because opioid use can actually change the function and circuitry of the user’s brain, making the impulse to use again so strong that the director of the National Institute of Drug Abuse likens it to having one’s mind “hijacked.”
As Mossburg points out, synthetic opioids – such as fentanyl – are driving the rapid escalation of overdose deaths in Maryland. What he does not mention is that these drugs also increase the pace of physiological changes to the person – including impacting the brain function – making it even more difficult to overcome addiction without the assistance of medication. Just as some people with Type 2 diabetes may require insulin to support normal functioning of the pancreas, so too do some people with opioid addiction may require medications to support normal brain function.
Fifty years of research have clearly shown that the most effective treatment for opioid addiction includes the use of one of the FDA-approved medications, methadone, buprenorphine and naltrexone. Medications are associated with improved outcomes across multiple domains including, increased employment and reductions in drug use, HIV transmission and involvement in criminal activity. This approach is recommended by all major medical associations as well as all federal agencies involved in public health.
But as Mossburg rightly notes, medication alone may not be sufficient treatment for all patients with opioid addiction, and it is critical that comprehensive services, including medications, and counseling and behavioral therapy, be available and affordable to all Marylanders in need of care.
As he also rightly notes, policies and practices must be centered on the treatment of substance use disorders and not in response to any specific drug. While medication-assisted-treatment is considered the gold standard for opioid addiction, there is currently no medication to treat cocaine or methamphetamine addiction, and the effectiveness of medication in treating alcohol addiction has been more limited. In treating addiction (or diabetes, cancer, heart disease or any other chronic medical condition), one size does not fit all.
In order to truly change the trajectory of the addiction epidemic in Maryland, it is critical to expand access to the full continuum of treatment services for all forms of substance use disorder and to provide comprehensive care for co-occurring mental health disorders.
For some individuals, medication may be a part of this continuum; for some, inpatient hospitalization might be necessary, and for some, intensive psychotherapy might be needed. For many, successful treatment will require a combination of approaches. Just like the treatment of other chronic medical illnesses, a patient’s treatment plan should be dependent on their particular health care needs and goals.
Additionally, just like other chronic illnesses, insurers should cover the full range of evidence-based treatment options; and under the federal Mental Health Parity and Addiction Equity Act, substance use and mental health disorder services must be covered at the same level as plans cover other medical services.
Maryland has been a national leader in the effort to expand treatment access in private insurance and Medicaid, and to require that coverage be at parity with medical services. The state has taken numerous steps to achieve this, including passing legislation to require insurers offering commercial plans to cover medications used for the treatment of opioid use disorders without requiring prior authorization. The state recently amended its mandated benefit for substance use disorder coverage to ensure that private insurers cover the full continuum of treatment services for substance use disorders in plans sold in Maryland.
The Maryland Insurance Administration has just issued new quantitative standards for provider networks that will help ensure that plans have an adequate number of mental health and substance use providers, which will increase access to prompt and affordable care. Through its Medicaid 1115 waiver, the state has increased the availability of residential treatment services to alleviate wait times for treatment and has removed other barriers to substance use disorder treatment.
Maryland’s response to the opioid epidemic – unlike Mossburg’s prescription in the recent article – has been aligned with decades of research into how best to treat the disease of addiction.
As the opioid epidemic continues to ravage communities across Maryland, we must continue to focus our efforts on building an effective and robust treatment infrastructure in the state. Increasing access to the full continuum of care for substance use disorders will help people get the care they need to get and stay well – both immediately and for the next generation of Marylanders.
This strategy will ensure that we are treating people who have an addiction to opioids, or cocaine, or alcohol, or methamphetamine, or marijuana, or any other substance that a person struggles with or that might fuel a future epidemic.
–ELLEN WEBER AND DR. ANIKA ALVANZO
Ellen Weber is vice president for health initiatives at the Legal Action Center, and Dr. Anika Alvanzo is president of the Maryland-D.C. chapter of the American Society of Addiction Medicine.