In 2018 there were more than 1,300 opioid-related deaths in the greater Tampa Bay area. Many of these deaths could have been avoided if a medication called buprenorphine was routinely used to fight opioid addiction. Using FDA-approved medications combined with addiction services is called Medication-Assisted Treatment (MAT). Buprenorphine, marketed under several brands including Suboxone, is considered by many the best. It is perplexing that the 12-step recovery community and the rehabilitation industry have not acknowledged buprenorphine for what it is, the gold standard of opioid addiction treatment.
In March 2019, a report to Florida’s attorney general recognized MAT as a key component of its plan to treat opioid addiction, recommending its statewide use. The endorsement was based on scientific evidence that buprenorphine lowered the risk of opioid related deaths by more than 50 percent. In France the widespread use of buprenorphine resulted in a near 80 percent drop in opioid overdose deaths. More than 1,000 lives in the Tampa Bay area lives would have been saved in 2018 had those results been duplicated here.
Yet, despite the evidence fewer than half of Florida’s 677 substance use treatment facilities offer MAT. Resistance comes from the recovery establishment. The National Academies of Sciences, Engineering and Medicine recently wrote that the underutilization of medications in addiction treatment is unethical. Patients are denied access to life-saving medications on non-medical and non-scientific grounds. Instead of treatment based on advances in addiction medicine, self-help support groups and rehab facilities offer programs based on “willpower” and “spirituality.”
Indifference to buprenorphine results in care that remains irrationally tied to abstinence-only and 12-step approaches. This stems from a system that lacks oversight, accountability and motivation to change. The disturbing truth is that people in these residential rehab and detox programs often don’t do well when they leave. More than 90 percent relapse within the first year, many in the first days after discharge. The National Center on Addiction and Columbia University criticized the current system of addiction treatment, stating it needs a significant overhaul, and then expressed concern that the country’s low standards of addiction care can actually constitute a form of medical malpractice.
It is time to recognize that buprenorphine-MAT is the new standard of care in opioid addiction treatment and accept that abstinence-only rehab and 12 step approaches are incapable of dealing with Florida’s opioid crisis. Addiction is a medical disorder of the brain, and medical illnesses are best treated with medical solutions. The opioid crisis will rage on until there is a shift in public consciousness. The scientific community recognizes this, and it’s time the recovery establishment did. For most, buprenorphine is indisputably the best approach. Buprenorphine should be embraced by those struggling with opioid addictions and not disparaged by those providing care. It’s not about turf. It’s about saving lives.
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Dr. Michael Kittay is a Harvard-trained psychiatrist certified by the American Board of Addiction Medicine.