Kevin Doyle is an associate professor and chair of the education and counseling department at Longwood University, where he also teaches in the counselor education program.
Roanoke, Roanoke County and Salem are joining a legal battle over the opioid addiction crisis by filing civil suits against drugmakers, distributors and pharmacy benefit managers. These lawsuits are part of a national push to hold companies accountable for irresponsible practices in the sale, marketing and distribution of opioid-based medications.
While these lawsuits might help somewhat, the real debate raging in the world of addiction is how best to treat it and the incorporation of medications into other long-standing treatment methodologies.
As a licensed professional counselor in Virginia, I have worked with people from all walks of life over the past 34 years. I have had the privilege of being a part of the recovery process for several thousand people dealing with what we now call “substance-use disorders.” The public hears about “addiction,” “substance abuse,” overdose deaths and the opioid crisis, but what we are facing is a human problem.
While counseling, talk therapy and self-help groups are valuable, they cannot be the only answers for everyone. We now have effective, safe medications that, when combined with traditional approaches, can give individuals with opioid and other addictions a fighting chance in the desperate battle to overcome the life-threatening consequences that often ensue.
Traditionalists continue to advocate an abstinence-based approach and often seek to blame pharmaceutical companies as in these lawsuits. Traditionalists see true recovery as consisting only of complete abstinence from mood-altering substances. Though this approach is consistent with that of many self-help groups and has certainly been helpful for millions of people, it has many holes.
People clearly benefit from prescription medications for physical or psychiatric conditions, and others are given a pass from the abstinence mentality for their use of more societally accepted substances, such as nicotine and caffeine. Effective medications, which allow people with an opioid addiction to replace high-risk opioid use with safer, “medication-assisted” therapy or treatment, are frequently frowned upon by traditionalists who insist on an outdated, one-size-fits-all model that is inconsistent with research and developing approaches.
On the other side of the debate is the medical community, supporting the use of new and promising medications that can be both lifesaving and humane. Places such as Phoenix House Mid-Atlantic, based in Arlington, are successfully incorporating approaches such as office-based opioid treatment into their treatment strategies, with much success.
Medications such as suboxone and methadone allow people with an opioid-use disorder (addiction) to replace high-risk opioid use with safer, medication-assisted therapy or treatment, while naltrexone blocks the effects of opioids and can be administered either orally or via a monthly injection known as Vivitrol. Naloxone (or the brand name Narcan), which is better-known, provides a lifesaving response in the case of an overdose, reversing the opioid’s effects and saving countless lives. These approaches, however, are too frequently criticized by the abstinence community and some segments of the general public for not being a permanent solution or simply replacing one addiction with another.
We even limit the number of patients that physicians approved to prescribe suboxone may have on their caseloads, an unprecedented and even unfathomable reality when one considers the scope of the opioid crisis.
Of course, simply throwing medication alone at a problem of this magnitude will have only a minimal impact at best. People with the complex set of problems associated with substance-use disorders need effective, trained counselors and access to a wide variety of services to enable them to return to full health and functioning.
The question, then, is when will we embrace an approach that designs and provides specific care to meet the needs of the particular individual in question. Drawing from both arenas is the only way to meet the crisis, which is claiming more than 70,000 lives annually across the United States, including more than 1,100 in Virginia. A frank, no-holds-barred dialogue is needed and immediate action required to address this public-health emergency.