Drug addiction is a chronic medical disease, and stigma about it is keeping millions of Americans – including the growing number who suffer with opioid addiction – from getting proper medical treatment, one of the nation’s foremost addiction specialists told the closing general session audience at TexMed 2019 in Dallas.
Lipi Roy, MD, the former chief of addiction medicine for New York City jails and clinical assistant professor at NYU Langone Health, says the World Health Organization lists drug addiction as the world's most stigmatized social problem, ahead of poverty, homelessness, and incarceration. The fallout from that disgrace can be seen in the fact that only 10 percent of the estimated 23 million Americans with substance-use disorder receive treatment, according to U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).
"If you told me, ‘OK, Dr. Roy, only 10 percent of your diabetes patients are getting treatment,’ that would mean the other 90 percent are going blind, getting kidney failure, dying of stroke and heart attack. I guarantee you I would lose my medical license," she said. "But the 10 percent getting treatment for addiction, we seem to be OK with that."
That attitude has been central to the severity of the spread of opioid abuse since the 1990s, Dr. Roy said in her presentation, "The Opioid Epidemic: How Did We Get Here and How Do We Get Out?" Despite having relapse rates that are comparable to other chronic medical conditions like diabetes, hypertension, and asthma, she says, most people still see drug addiction as a moral failing or weakness of character, not as a chronic medical condition in need of treatment.
Physicians also have played a role in the spread of opioid use, she says. In 1995, Purdue Pharma introduced the opioid painkiller OxyContin with a marketing campaign designed to ease physicians' concerns about prescribing opioids.
Doctors were fed false information from seemingly reputable sources that some opioids were not addictive and that treating long-term pain with opioids was evidence-based, Dr. Roy says. Most physicians received little training in either pain management or addiction in medical school, so many believed this information.
Total overdose death rates compiled by the U.S. Centers for Disease Control and Prevention have soared from about 16,000 per 100,000 in 1999 to about 72,000 in 2017, Dr. Roy says.
To improve treatment rates for opioid patients, physicians need to start by changing their vocabulary, Dr. Roy says. When stigmatizing terms like "drug abuser" and "addict" are replaced with phrases like "person with substance abuse disorder," people tend to seek treatment more often, according to a 2012 study by SAMHSA and a 2015 study by the American Society of Addiction Medicine, she says.
Drugs such as buprenorphine and methadone, which curb cravings and withdrawal symptoms, frequently are called "medication-assisted treatments" by physicians when they should simply be called "medications." Physicians also need to understand that these medications, along with naloxone, are far more effective at treating substance use disorder than abstinence.
Stress is one of the most common predisposing factors she sees in addiction, and physicians historically are prime candidates for substance use disorders. She urged physicians to guard against those factors that can lead to substance use and encouraged them to recognize when they need treatment.
"Please just ask for help," she said. "There is no shame in this. I know that as doctors, as health care professionals, we have a lot of pride. We worked damn hard to get where we are, and we tend not to ask for help. … Please don’t do that. You're not only going to be hurting your patients. You're going to be hurting yourself."
While opioid addiction presents a growing health care problem, both alcohol and tobacco kill more people each year, she says. Attitudes need to change about all types of addiction and treatment, Dr. Roy says.
"We're talking about opioids now, but this is going to fade away eventually," she said. "And then it will be the next drug, and then something else. We will never get rid of addiction. But let's create an environment where we have services to take care of people."