The U.S. will spend $40 billion this decade fighting addiction, yet little of it will be used based on science. We wouldn’t deny medicine for cancer or depression, so why do we deny it for addiction?
Prince wanted the best medical treatment money could buy when he decided to tackle his addiction to opioid painkillers. So he was planning to go to a rehab clinic known for using evidence-based practices—including medication—to treat his painkiller habit, according to local press reports.
The star died too soon for this approach to save him, but it could save millions of Americans. Unfortunately, for years opioid addicts seeking treatment in rehab have largely been denied this same level of care. And that’s led to deadly consequences.
“People who die of overdoses, if you look at their history, they were most likely recently in rehab or jail,” said addiction counselor Dave Malloy, shaking his head in frustration over lunch recently near the drug treatment facility where he works.
Malloy, who is 42, used heroin for years and lost many friends to the drug. He’s been clean since 2004 and is now an administrative supervisor at an outpatient program in North Philadelphia that prescribes the opiate substitute buprenorphine to roughly 50 clients.
Buprenorphine is what’s known as a “partial opioid agonist” meaning it stimulates some of the same brain receptors as drugs like heroin and oxycodone. In proper doses it eliminates craving for opiates. Together with methadone (which has been in use much longer) buprenorphine is one of the two most effective treatments for opioid dependency.
But you wouldn’t know that from how little those two drugs have actually been used to treat opioid dependence.
Unless you’ve been in treatment yourself (as I have) or have a friend or family member who’s been addicted to opiates, you probably have no idea what a mess America has made of treating opioid addiction. The vast majority of addicts who enter treatment programs fail multiple times—not because they are incapable of recovery, but because they’ve been largely denied the therapeutic interventions most likely to produce success.
Public officials in Congress and the Obama administration are now promoting several major initiatives focused on expanding treatment, but taxpayers have already shelled out $1 trillion over the past four decades fighting illicit drug use. The National Institutes for Health estimates that by the end of the decade annual expenditures for drug and alcohol treatment will exceed $42 billion, almost as big as the entire medical diagnostic and laboratories industry.
We can’t afford another failure.
To understand where America went wrong, The Daily Beast spoke with insurers, treatment professionals, and some of the nation’s leading addiction experts. They describe a legacy of treatment in which a small number of effective programs based on scientific principles of opioid dependence have been supplanted by an ideologically driven system that is uninformed by medical best practices and continues to operate largely without any oversight.
“There’s a total lack of accountability, not just from program to program, but even within treatment systems, from counselor to counselor,” said Malloy. “For years, there’s been a blank check, and when the money runs out, guess what? You’re better.”
For the better part of 40 years the recipient of that check has almost exclusively been a drug or alcohol treatment facility based on the 12 Steps of Alcoholics Anonymous—a self help-style system developed by and for alcohol abusers more than 80 years ago, when neuroscience was in its infancy.
Nevertheless these programs have a virtual monopoly on the provision of addiction treatment, so much so that even the most astute observer is unable to distinguish abstinence-only rehab from more effective treatment modalities.
For example, last month in a follow up report on heroin abuse in suburban Ohio, 60 Minutes profiled a single treatment provider called New Beginnings Outreach Ministries without asking a single question about the program’s treatment protocol—which it describes as being “based on faith in Jesus Christ, and [centered] on Christian teachings from the Bible as well as cognitive behavior methods of understanding addiction and recovery.”
It hardly needs mentioning, but that’s not considered an acceptable therapeutic approach for most diseases. It’s little wonder drug treatment fails at such a high rate.
The prevailing treatment system generally claims success rates of 30 percent—a figure many experts view as dubious. But even if we take it at face value, by the industry’s own admission 70 percent of people who go into drug rehab come out no better than they went in. And some cases even worse. One 2015 study found opioid dependent patients receiving only psychological support were twice as likely to suffer a fatal overdose than those being treated with opioid replacement medications.