Physicians' group: Treat opioid addiction as a chronic medical condition

Opioid epidemic ideas

One of the nation’s most prominent medical organizations is calling for a serious rethinking of the way doctors and public health officials confront the opioid epidemic that’s plaguing the country.

In a paper published in the Annals of Internal Medicine, the American College of Physicians (ACP) calls substance use disorders involving prescription and illegal drugs a “serious public health issue” and says they should be considered “treatable chronic medical conditions.”

Drug overdose deaths, particularly from opioids such as prescription pain relievers and heroin, is a rising epidemic,” Dr. Nitin S. Damle, president of ACP, said in a statement. “Substance use disorders are treatable chronic medical conditions, like diabetes and hypertension, that should be addressed through expansion of evidence-based public and individual health initiatives to prevent, treat, and promote recovery.”

Currently, access to care is limited and doesn’t begin to keep up with the demand. The group points out that in 2014, 22.5 million people in the United States needed treatment for drug or alcohol problems but only 18 percent of them received it. This is far below treatment rates for other major health issues like hypertension (high blood pressure), with 77 percent receiving treatment, or even major depression, which has a 71 percent treatment rate.

Dr. Andrew Dunn, one of the authors of the new guidelines, emphasized the need to promote treatment for addiction rather than focusing on it as a criminal problem and throwing people in jail. 

“The stigma that’s been associated with this condition over years has led to a lack of treatment options,” he told CBS News.

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The group released a set of public policy recommendations for the prevention and treatment of substance use disorders involving both illegal and prescription drugs.

Misuse of these drugs “pose[s] a heavy societal burden, endangering individual and family health and well-being, tearing through communities, and sapping resources from the health care system,” the ACP states in the paper. “These disorders are common in the general population and occur at even higher rates among those who are incarcerated.” 

To help combat the opioid epidemic, the ACP urges physicians to become familiar with and follow clinical guidelines related to pain management and controlled substances such as prescription painkillers. Those guidelines are designed to reduce the risk of a patient getting prescribed the drugs inappropriately. The group also calls for improved training in the treating of substance use disorders, and the establishment of a national Prescription Drug Monitoring Program.

“Physicians can help guide their patients towards recovery by becoming educated about substance use disorders and proper prescribing practices, consulting prescription drug monitoring systems to reduce opioid misuse, and assisting patients in their treatment,” said Dr. Damle.

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ACP makes some public health recommendations, as well. The group calls for the expansion of access to naloxone, also known as Narcan — a life-saving drug used to reverse a narcotic overdose in an emergency — to opioid users, law enforcement, and emergency medical personnel. Additionally, ACP recommends creating more treatment-focused programs as an alternative to incarceration or other criminal penalties for nonviolent drug users.

Further recommendations include requiring health insurance to cover mental health conditions, including evidence-based treatment of substance use disorders; expanding the workforce of professionals qualified to treat these disorders; and studying the effectiveness of other public health interventions to combat them.

“Substance use disorders have been regarded as a moral failing for centuries, a mindset that has helped establish a harmful and persistent stigma affecting how the medical community confronts addiction. We now know more about the nature of addiction and how it affects brain function, which has led to broader acceptance of the concept that substance use disorder is a disease, like diabetes, that can be treated,” the paper concludes. “Communities across the country are confronting an opioid epidemic that has taken tens of thousands of lives, leading physicians to take a more active role in managing the condition and spurring policymakers to reassess the nation’s drug control policy.”