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One of the penalties for refusing to participate in politics is that you end up being governed by your inferiors. -- Plato (429-347 BC)

Thursday, October 27, 2016

Thinking A New About Addiction

by Newt Gingrich: On Monday at the American Enterprise Institute, I had the pleasure of participating in a panel discussion on combating America’s opioid crisis. You can watch the discussion here.

I participated in the panel with two partners who you would probably not expect to see at a conservative think tank, especially two weeks before this heated presidential election – former Democratic Congressman Patrick Kennedy and former Obama administration advisor Van Jones. It was moderated by Sally Satel – a resident scholar at AEI and a staff psychologist at an addiction recovery clinic in Washington, DC.

As you may remember from an earlier newsletter, Van, Patrick and I are the founding members of Advocates for Opioid Recovery (AOR)– a nonpartisan advocacy group dedicated to enhancing access to medication assisted addiction treatment.

One of the reasons why the issue of opioid addiction is cutting across party lines is because everyone is affected. Opioid overdose has become the leading cause of accidental death in the United States, surpassing car accidents. With nearly 30,000 Americans dying in 2014 from opioid overdose and 2.4 million Americans struggling with an opioid use disorder, virtually everyone in America knows someone affected by this crisis.

Another reason why there is a growing consensus on the issue is because it is becoming clear that the way forward is less about bridging an ideological or party divide than it is about discarding old, inaccurate dogmas about addiction and mental health that are not based on science.

For instance, in a roundtable discussion with rehabilitation practitioners after the AEI event, we learned that the popular 28 and 30-day drug detoxification program model was not developed based on any scientific evidence about the optimum length of a treatment program. Instead, it is an artifact of Air Force personnel rules which did not require men and women to be reassigned if they were away from duty for 30 days or less. Recent studies have shown that the longer a person stays in rehabilitation the less likely they are to relapse.

To be clear, the pioneers who developed these addiction recovery programs are heroes who have helped millions to regain control over their lives. They simply didn’t have much science to draw upon.

Modern medicine dates back almost 200 years, however, it has only been the past three decades during which we began to make progress understanding the workings of the human brain. This historic gap in understanding between the brain and the rest of the human body caused the medical community to treat mental health and physical health as two separate things. In fact, we now know that a person’s mental state is largely governed by actual physical phenomenon in the brain which can be impacted through medicine.

However, despite this new scientific understanding of the brain, a false dichotomy between mental and physical health still exists throughout the healthcare industry. These legacy policies and practices must be changed so that more Americans receive the treatment they need.

This challenge directly impacts how we treat addiction in America.

Addiction is still seen as a weakness or character flaw which must be solved through willpower alone instead as a physiological problem which requires medical intervention. We now know that when someone develops an addiction, a chemical change occurs in their brain which makes it extraordinarily difficult for them to make responsible decisions with regards to taking the drug. Furthermore, genetics plays a huge role in a person’s susceptibility to developing an addiction.

Acknowledging this does not mean removing responsibility from the individual with the addiction to make the changes they need to get better. Ultimately, they are the only one who can overcome their addiction. Nor does it excuse them from bearing responsibility for the choices that led to them becoming addicted in the first place (though for many with an opioid addiction, they were only following their doctor’s instructions).
However, this new knowledge about how addiction affects the brain does mean that we must create a health environment that will increase the likelihood of success for those seeking treatment for addiction – and that means making medication assisted treatment more readily available.

We have known for more than a decade that medication assisted addiction treatment works. Patients receiving medicine to curb their cravings for opioids are more than twice as likely to complete their treatment programs than those without. Tests using a placebo showed that those receiving the medicine had an almost 50% higher success rate in avoiding an opioid relapse.

Despite the overwhelming evidence, however, less than 15 percent of Americans seeking treatment for addiction receive medication assistance.

One of the reasons is that insurance – both public and private – creates unnecessary hurdles to accessing these types of therapies. It is a shameful irony that any doctor in the country can prescribe opioids with little interference from insurers but the medicine used to treat opioid addiction is often trapped behind layers of prior authorization and other bureaucratic requirements.

Last month, AOR released a study which showed huge variations throughout the country in each state’s Medicaid programs prescribing buprenorphine – an opioid addiction medicine. Forty percent of all buprenorphine prescriptions in Medicaid come from just 8 states while 12 states account for just 10 percent of all prescriptions. Notably, eight of the ten states with the highest rate of opioid use have lower than average rates of buprenorphine prescriptions.

These hurdles and disparities are not just bad medicine – they are potentially against the law. The Mental Health Parity Addiction Act – passed in 2008 – requires insurers to treat mental health treatments the same as medical and surgical benefits in their plans.

There are other bureaucratic obstacles imposed by federal regulations. Doctors are limited in the number of patients they can treat for addiction using certain highly effective medications. The recently passed Comprehensive Addiction and Recovery Act (CARA) raised that limit to 275 from 100. However, it also created additional requirements for those who want to expand beyond the 100 patients. Again, there exists no such cap for doctors when it comes to prescribing the opioids which get people addicted in the first place.

When it comes to treating America’s opioid crisis, it is time, in the spirit of Abraham Lincoln, “to think anew, and act anew.” We must “disenthrall ourselves” from the old way of looking at mental health as distinct from physical health, and move forward with our new knowledge to save our country.

I encourage you to visit www.opioidrecovery.org to learn more and find out how you can help.
----------------------
Newt Gingrich is a former Georgia Congressman and Speaker of the U.S. House. He co-authored and was the chief architect of the "Contract with America" and a major leader in the Republican victory in the 1994 congressional elections. He is noted speaker and writer. The above commentary was shared via Gingrich Productions.

Tags: Newt Gingrich, commentary, new addiction, Opiods, opioid crisis To share or post to your site, click on "Post Link". Please mention / link to the ARRA News Service. and "Like" Facebook Page - Thanks!
Posted by Bill Smith at 9:30 AM - Post Link

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