Our country's approach to the opioid epidemic, I believe, is headed in the wrong direction as it has resulted in the deaths of nearly one million people over the past two decades. I can’t retire. Not until the Opioid Epidemic finally becomes a chapter in our country’s past.

Chapter 1

It gets more complicated for doctors than just mixed messages from government overseers and big pharma meddling.

Chapter 2

Nationwide cutbacks in prescriptions for opioids fueled a spike in heroin overdoses.

Chapter 3

Cash is king not only out on the street but in some doctors’ offices too. Both patients and doctors alike have their reasons for embracing a cash model of care.

Chapter 4

In 2006, after years of feeling powerless to help those addicted to opioids, benzodiazepines, and stimulants, I joined the American Society of Addiction Medicine and earned my certification to treat patients with addictions.

Chapter 5

There was no training about addiction in American medical schools or residency programs in the 20th century.

Chapter 6

Given that U.S. policies and law enforcement are failing to win the war on drugs in catastrophic proportions, why not let medical science have another shot to fix this problem?

More Chapters
People needed opiates to treat pain, but dependence continued to compromise attempts by researchers to use drugs to treat both pain and dependence.All the while Suboxone was being overregulated and underutilized, a window opened for Oxycontin, in large part because of one article. DEA Officials claimed the slow-release tablets were attractive for selling on the street simply because one pill would provide much more of a high. As diversion of opioids slowed, an increase in the supply and a drop in the price of heroin caused former opioid addicts to transition into heroin. If a patient stays clean during pregnancy and follows the due process, they will have a healthy pregnancy and delivery leading to a safe and healthy baby. MAT does not end abuse. It does not erase emotional scars. It cannot wipe away the horrors that Molly endured as a child.
Laws were passed, and regulations were rightfully tightened to restrict access to these drugs. You must understand that doctors are trying to comply with the literally 1,000s of regulations that have been thrown at them. If some doctors are unable to follow those regulations down to every detail, they face serious punitive consequences. The error was that the legislation simply was not aggressive enough. And why would an OUD sufferer take a drug that was designed to rob them of the high opioids offered? There’s only ever one reason: withdrawal. The technology changed, but the laws remain decades behind. This has created nightmares for all doctors, not just those practicing addiction or pain management. Many doctors don’t want to sacrifice “desirable” patients to help a few patients suffering from addiction.
After prolonged discussions, my current patients have gone through gradual dose reductions of Suboxone by 50 percent over a 3-year period since 2017. If these barriers are removed and addiction doctors are considered on par with other specialties, that may encourage future doctors to consider addiction medicine as their preferred field of practice. Respecting an addict's basic human dignity means they must have access to treatment. If they do not, we confirm their lives are not worth saving. Treatment is not a matter of asking the right questions in therapy, prescribing the right dose of Suboxone, and completing the steps of a checklist. Even small, day-to-day strides in treatment need to be noted and celebrated. Based purely on my experience, it is best that everyone prescribed suboxone have it legitimately available. If this is the case, I don’t believe there will be major instances of diversion.
There is no Diversion Control Plan (DCP) for narcotics. If there was one, we would not have an opioid epidemic. But there is one for suboxone/buprenorphine. If getting CPAP supplies to a patient in need – something which should be so simple because, after all, they aren’t regulated the way scheduled drugs are - was so absurd, inefficient, and difficult, imagine how much more it is to get addiction treatment for a patient in need. I urge that every physician should use this program, especially if they are writing any restricted drugs. However, it currently remains a best practice for physicians but not a requirement. I could better treat my patients if excessive regulation did not equate to risk. Period. "Drug testing should not face undue restrictions; decisions about types and frequency of testing should be made by ordering physicians, and arbitrary limits on reimbursement by payers interfere with the physician's judgment and violate federal law parities." Two things were common in patients who were abusing Neurontin and who had died overdose deaths: They had Gabapentin in their pockets or in their possession at the time of death.
The medical profession is trusted to save lives. It's a good reminder that we might not always need a Cadillac model of treatment; it only matters that we have what is essential and the right people providing it. I also sympathize with doctors treating patients while receiving no extra money for personal protection equipment, cleanliness, or even Covid swabs. "Jails are big business,” she once told me. “They have more funding than schools." Today, only 25 percent of American doctors are members of the AMA. "Sometimes I think that it was easier for me to fix somebody's aortic aneurysm than it is to start them on Suboxone in the office," said Dr. John Kitzmiller.
We really need to focus on success stories about how well about two million people are doing on MAT in America. I have several hundreds of these patients who express their gratitude for being alive and are now productive citizens. First is the misguided and irrational belief that breaking an addiction only needs to happen once. This simply isn’t the case. The population at large and the families left behind or still struggling with their loved ones still need help, and no one is looking and asking what can and should be done. As of 2021, we have only enough to care for no more than two million patients, which may cover only about 10 percent of addicts in the United States.