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Expansion of Care of Addicts Begins With Acceptance This is a National Problem

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at April 15, 2016

FoxNews.com yesterday published the very extensive article: The fed’s new ‘war on drugs’: Obama proposes $1.1 billion to expand care for opioid addicts, which further discusses President Obama’s intention to allocate $1.1 billion to expand affected individuals’ access to care— a proposal that has garnered bipartisan support.

According to the Centers for Disease Control and Prevention (CDC), nearly half a million Americans died from drug overdoses between 2000 and 2014. Opioid overdose deaths, including those from heroin, hit record highs in 2014 and saw a 14 percent increase in only one year.

Baltimore City Health Commissioner Dr. Leana Wen, who has worked as an emergency room doctor in one of the nation’s opioid addiction hotspots, said the proposal signals a shift in thinking about addiction as an individual’s problem best controlled with law enforcement, to a chronic medical condition like diabetes or heart disease that can be prevented and treated.

“That science has been around for decades, and society’s perception has caught up,” Wen told FoxNews.com.

In 2014, 259 million opioids— or enough for every American adult— were prescribed, according to the CDC. The most commonly prescribed opioid pain relievers were natural or semi-synthetic opioids like oxycodone and hydrocodone, which are involved in the most overdose deaths among opioids. The CDC recorded 813 more deaths, a 9 percent increase, from these types of opioids in 2014 than 2013.

Over the last decade, overall deaths resulting from opioid abuse and abuse of illegal narcotics like heroin have quadrupled.

The genesis of this was Big Pharma’s campaign throughout the 1990’s and 2000’s which downplayed the risks of long-term opioid abuse and encouraged their use. In 2007, OxyContin producer Purdue Pharma paid $634.5 million in fines for harmful advertising of the drug.

Data shows opioids are among the most addictive drugs on the market.  The longer and more frequently an individual takes an opioid, the more they’ll need to take to get the same sense of relief.

Despite increased public knowledge of opioids’ risks, ideals pushed by Big Pharma and the federal government still persist in doctors’ offices. All too often, doctors don’t offer patients alternatives to opioid prescriptions, nor do they always ask about their mental health or addiction history. Patients want to get better and trust their doctors, so they often don’t challenge their judgment.

The U.S. Food and Drug Administration (FDA) has already added a boxed warning, the most serious type, to immediate-release opioid painkillers, but it hasn’t yet added warnings to benzodiazepines and opioids to warn doctors and the public of their harmful reactions. Wen and other health officials have petitioned the FDA to do so.

Brendan Saloner, assistant professor of health policy and management at Johns Hopkins Bloomberg School of Public Health, said states could use the proposed funding to better integrate pre-existing programs like these.

“What we have now is not really a system so much as a fragmented network of specialty providers who oftentimes don’t work that well with physical health providers, with human service providers, and with the criminal justice systems— all of these entities that we know are very closely aligned with these populations,” Saloner told FoxNews.com.

If passed, Obama’s proposal would allocate $920 million to expand their treatment capacity and make services more affordable, $50 million in National Health Service Corps funding to expand access to substance use treatment providers, and $30 million toward researching the efficacy of treatment programs in place and then improving them.

That opioids are often a bridge to heroin abuse has made the epidemic even more pressing for health officials to address.  Eighty percent of people who use heroin started doing so by using prescription pain medication, according to government data. This may happen when a patient can no longer obtain pricier opioids and turns to the street for potentially tainted painkillers or heroin.

Many experts like Saloner argue that criminalizing addiction, which is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM)— as part of the nation’s ‘war on drugs’— has failed, leading to recidivism and wasted tax dollars.

“We tried criminalizing addiction, and we didn’t make a dent in the epidemic—and in some ways, we made it worse by driving a lot of harmful behaviors in the ground,” Saloner said. “You don’t make a meaningful or sustained impact on this problem until you create a collaborative and person-centered model, until you recognize this is someone with a medical condition.”

The Affordable Care Act (ACA) required plans in the Health Insurance Marketplace to cover substance use disorder services, but overcoming stigma is one of the biggest hurdles faced by doctors and patients affected by opioid addiction.

“What our best evidence would suggest is that using rhetoric that really stigmatizes or creates a kind of a moralistic set of overtones about addiction is not helpful in getting those people into treatment,” Saloner said, “so if were really serious about getting those people into treatment, we need to focus on a more positive and inclusive message.”

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