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The Paradox(es) of Addiction Care

I intended to write this blog post at the start of summer, shortly after our first Addiction Care Grantee Meeting on May 31.  Instead, I am writing it as we prepare for our second Addiction Care Grantee Meeting on September 13.  I’m glad I waited.  As our Addiction Care grantees are well aware, although I am overseeing this program, I am new to my role at MeHAF and new to the issue of substance use and addiction.  With every day, I take in new pieces of information that enhance my understanding of our past, present, and future opiate crisis. 

By now, it is common knowledge that we are in the midst of a public health crisis that will require a multi-pronged, cross-sector, coordinated and collaborative approach to address.  This issue is incredibly complex, requiring prevention, treatment, and harm reduction interventions.  Adding to this complexity, there are (at least) three paradoxes of addiction care that I have identified in my early interactions with our Addiction Care grantees that merit some reflection: 

Role in problem and solution:

  • Problem: the over-prescribing of opiates by providers has been a contributing factor to the current crisis (other contributing factors have included: the intense “focus on the pain score number,” engendered by Joint Commission standards[1]; aggressive promotion and marketing of opioids for pain, while misrepresenting the risk of addiction[2]; and increased availability of heroin[3].)  We know that four in five new heroin users started out misusing prescription painkillers.[4]   
  • Solution: a critical part of the solution to the current crisis is engaging more prescribers in offering medication-assisted treatment (MAT) with buprenorphine for patients with opiate use disorder.

Rapid access and long-term recovery:

  • Rapid access: there is a limited window of opportunity when a person struggling with addiction is able and willing to engage in treatment.  Rapid access may also refer to a person’s ability to find immediate relief from their symptoms.
  • Long-term recovery: addiction, like diabetes or hypertension, is a chronic, often relapsing disease.  As the Maine Alliance for Addiction Recovery states on their website, “recovery is a lifelong and personal journey requiring courage and commitment to live in new ways that strengthen a healthy lifestyle free of alcohol or illicit drugs.”[5]

Stigma and peer recovery:

  • Stigma: despite the science that shows that addiction is a brain disease, the view of addiction as a choice or moral failing persists for some; consequently, people who are struggling with addiction often face blame and judgment in their communities.
  • Peer support: although there is limited data available to draw definitive conclusions, according to a literature review published by the National Center for Biotechnology Information, the inclusion of peer support groups in addiction treatment show a lot of promise.[6]  We must not let stigma stand in the way of pursuing the promising practice of peer recovery support for people struggling with addiction.

Beyond reflection, this complex, paradoxical issue requires flexible, adaptive, customizable solutions and a willingness to try, fail, and learn.  For MeHAF, early reflection and learning has already led us to broaden our understanding of the technical assistance needs of our Addiction Care grantees beyond MAT planning and implementation to include stigma reduction, social determinants of health, and community engagement.

We invite you to learn with us as we move through this two-year grant cycle and encourage you to visit our website to access Addiction Care Grantee Meeting materials.  We look forward to sharing the evaluation findings from the USM Muskie School of Public Service, as they work with our Addiction Care grantees to identify elements contributing to successful expansion of MAT.

 
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740947/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/
[3] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm
[4] Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers - United States, 2002-2004 and 2008-2010. Drug Alcohol Depend. 2013 Sep 1;132(1-2):95-100. doi: 10.1016/j.drugalcdep.2013.01.007. Epub 2013 Feb 12
[5] http://maar.thealliancemaine.org/about-us/
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047716/

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