We lose 357 Americans to opioid overdose deaths every day. That is roughly one large jumbo jet crashing daily, or 15 preventable deaths per hour. Can you imagine if we had one large plane full of Americans crashing and dying daily? The FAA would immediately shut down aviation until we isolated and corrected the cause. If it’s predictable, it’s preventable. Opioid overdose deaths are both predictable and preventable. And yet, our broken pathways for treatment in the American medical system approach remain essentially unchanged. Last week, the deputy director of the Drug Enforcement Agency, Anne Milgram, stated, “The Opioid Epidemic has gone from being one of the many threats to American lives to the single greatest threat of our lifetime.”
Despite this bleak outlook, there is hope. A few simple changes we can make would reverse this troubling trajectory and save lives overnight. These changes reduce existing artificial barriers to care and make drug use less deadly.
4. Drug Enforcement Agency: Change Suboxone from a Schedule III (controlled) to a Schedule IV (non-controlled) medication
In the wake of the opioid settlements, many large pharmacy chains enacted strict internal policies to reduce the dispensing of opioid pain medications. Unfortunately, because Suboxone is also classified as a Schedule three controlled substance, it is subject to the same internal pharmacy scrutiny as medications like Dilaudid, Fentanyl, and Oxycontin. Erring on the side of caution, many busy pharmacists simply refuse to fill it. But unlike opioids, Suboxone is a life-saving medication that reduces the chances of dying from fentanyl by 50%. It quite literally doubles your chance of survival. Despite this, large-chain retail pharmacists tell me daily, “I can’t fill your prescription. It is a controlled substance.” If the DEA simply changed Suboxone’s categorization from a Schedule III controlled substance to a Schedule IV non-controlled substance, this would disentangle Suboxone from the strict opioid pharmacy dispensing protocols, immediately increasing access to this life-saving medication to millions of Americans.
3. Food and Drug Administration: Change the FDA-approved age range for Suboxone and Methadone from 18 and above to 14 and above
With the rise of fentanyl and xylazine-laced fentanyl, I’ve seen a growing number of 14-, 15-, and 16-year-old patients who need Suboxone. By the time these patients see me, they are opioid dependent and have suffered multiple near-fatal overdoses. In almost every case, these patients and their families saw at least ten doctors before me who, despite their troubling histories and very high risk of death, refused to start them on Suboxone. The refusal reason each time was, “This medicine is only FDA-approved for those 18 years and older.” On the first return appointment after a Suboxone initiation, one 17-year-old girl’s mother cried, saying, “You don’t know how grateful we are to have our daughter back. She went from failing grades to being an A-B student within one week of starting Suboxone. She failed 11th grade last year because of the opioid problems. We just wish we found you sooner.” I was the 8th physician this family had seen. It took them almost a year to find me. The seven others refused to start her on Suboxone because she was under 18. This should never happen. The scientific evidence and data are irrefutable: Suboxone saves lives- whether you are 76 or 16. We don’t need further time or studies on teenagers to prove that. With over 300 deaths daily, our young people don’t have the luxury of time.
2. US Congress: Pass the proposed “Modernizing Opioid Treatment Access Act” (MOTA) to allow Addiction Psychiatrists to prescribe Methadone outside of an OBOT
Suboxone’s older cousin, Methadone, is another critical medication that prevents overdoses and saves lives. Despite being just as effective as Suboxone, it isn’t used nearly as much as Suboxone. (I’ve basically written it off.) Why? Because it is much more difficult for patients to access and remains largely uncovered by payors. Under current law, if Methadone is being prescribed for addiction, it must be prescribed and dispensed by an Office-Based Opioid Treatment Program (OBOT). These are free-standing, for-profit Methadone clinics that require patients to come to the clinic every day between 5 am and 10 am to take their daily dose of Methadone (and also charge them a fee). They also require counseling. Most of these clinics do not take any form of insurance, leaving patients with expensive daily out-of-pocket costs between $20-$50. Finally, many are in dangerous areas of town. In the DC area where I live, 2 of the three local Methadone clinics are in places where I would never venture alone during the daytime.
Sponsored by Representative Donald Norcross, and Don Bacon, The MOTA Act would allow board-certified Addiction Psychiatrists or Addiction Medicine Physicians to prescribe Methadone through regular outpatient appointments like every other medicine, immediately removing all the artificial barriers listed above and lowering overdose rates. This is a life-saving medicine that a specialist can safely prescribe. Right now, most people can’t assess it. (There are only six methadone clinics in the entire state of Nebraska.) It is a no-brainer if you genuinely have the patient’s best interest at heart.
Guess who is most vocally opposed to MOTA? The for-profit Methadone clinics who, coincidentally, stand to lose the most money if MOTA passes. Disguised under a group called “The American Association for the Treatment of Opioid Dependence,” these for-profit clinics have put out several statements- written by non-physicians- claiming outpatient physician specialists prescribing methadone would be “dangerous.” Pure nonsense. This is like Coca-Cola claiming it’s dangerous to drink Pepsi. More treatment choices for patients means fewer patients for them and less profits for them. They base this self-serving claim on studies looking at outpatient methadone prescriptions written by all types of providers (non-specialists). In contrast, the MOTA Act specifies that only board-certified addiction psychiatrists would be able to prescribe and monitor outpatient methadone. These physician specialists have the highest level of training and expertise in addiction treatment compared to other medical professionals. Most current methadone clinic providers are not Addiction Psychiatrists or Addiction Medicine Physicians. MOTA would increase access to life-saving medication while raising the existing training and specialty requirements for who can dispense it. Don’t be fooled by Coca-Cola telling you not to buy Pepsi. We need to look beyond money and do what is best for the patient, not the pocketbook: we need to pass MOTA.
1. The White House / US Congress: Provide Federal Funding to Existing Harm Reduction Initiatives
Some patients are just not ready to stop using drugs. Or can’t. The number one risk factor for fatal overdose is using alone. If folks aren’t ready to stop, we can still save lives by making drug use less deadly. The Never Use Alone Inc. line and the Massachusetts Overdose Prevention line are two overdose prevention lifelines that people can call when they are going to use drugs. These lines are operated by volunteers who stay on the phone while the person uses their substance of choice to make sure they don’t die. If they become unresponsive, the volunteer calls 911. In the past year alone, Stephen Murray (founder) and the folks at The Massachusetts Overdose Prevention Helpline have prevented 11 near-fatal overdoses! While any caller in the country can use both phone numbers, right now, both phone numbers have no federal funding source. They operate with a group of largely unpaid good Samaritans who donate their time freely to prevent people from dying. Even on a small scale, these initiatives save roughly one life per month through volunteers alone. Imagine what we could do with greater awareness of these resources and more people operating the lines. Both things require money.
Now. Some folks will say, “We shouldn’t spend taxpayer money to encourage drug use.” The auto industry also pushed back when the national seat belt law was passed in 1968. They claimed that requiring seat belts would encourage people to speed. Since that time, approximately 374,276 lives have been saved due to seat belts. Rates of speeding did not rise accordingly.
Change is hard. At the same time, the world is run by people who show up and speak up. Showing up in any way you can to support simple, common-sense solutions to the Opioid Epidemic will save lives. Whether that means advocating on Capitol Hill for MOTA, spreading the word about overdose prevention lines, or simply reposting and sharing this article with others, every little bit helps. With just a little energy, passion, and conviction, we can stop the opioid epidemic, one jumbo jet at a time.
If you or a loved one is struggling with an addiction to opioids, other drugs, and/or alcohol and need help in Maine, New Hampshire, Massachusetts, Connecticut, Rhode Island, Virginia, Georgia, Florida, Ohio, Kentucky, or Indiana, the recovery teams at Aware Recovery Care are here to help. And we come to you, regardless of where you live. Our unique in-home treatment model of care gives clients a significantly better chance of recovery than traditional inpatient rehab care. We are now offering Virtual Detox and Medication Assisted Treatment in New Hampshire, Connecticut, Virginia, Georgia, Indiana, Kentucky, and Ohio. Please get in touch with one of our Recovery Specialists to learn more.
About the author…Dr. Lauren Grawert MD.
Dr. Grawert is a double board-certified Addiction Psychiatrist. She completed her medical school training in 2009 and a General Psychiatry Residency in 2013 at the Medical University of South Carolina (MUSC). She then went on to complete an Addiction Psychiatry fellowship at MUSC, which she completed in 2014. After fellowship training, Dr. Grawert served as the Chief of Psychiatry and Addiction at Kaiser Permanente of the Mid-Atlantic. She has also worked in private practice specializing in general psychiatry, substance use disorders, and medically assisted treatment (MAT). Dr. Grawert has served as an expert for the San Diego Community Response to Drug Overdose Task Force, the Addiction Committee Leader for Kaiser Permanente National Mental Health & Addiction Leadership Organization, and a Professor of Psychiatry at Penn State College of Medicine. She likes to write, travel, and spend time with her two young children in her spare time.
