It began with the wails of a mother on her 47th birthday as she watched her son die from an overdose, both the Statewide Opioid Summit on July 25th, and the Honorable William J. Nelson’s change of perspective on opioid addiction. The woman in the 911 call that was played to a packed room of judges, probation officers, lawyers, and others who work with drug addiction in all 92 counties of Indiana, is the Marion Superior Court Judge’s wife, and it was his stepson who died as they waited on the ambulance to arrive. Like many, Judge Nelson had seen methadone as simply substituting one drug addiction for another – he saw no role for its use in recovery. He does not feel that way today.
The theme throughout the conference was the role of medication assisted treatment, or MAT, in the opioid crisis. Each day, 115 lives around this country are lost to this crisis. Beginning with the neuroscience of addiction, a panel of doctors explained that addiction is a medical disease, recognized by the American Medical Association, which alters the user’s brain chemistry and impairs their ability to make good decisions.
According to Dr. R. Andrew Chambers from Indiana University School of Medicine, the opioid problem we are seeing today is really an untreated addiction and mental illness epidemic. One in five Americans have the disease, with the top vulnerability risk factor for addiction being mental illness.
It is Chambers’ opinion that what we are seeing today is a lethal mix of a failure of our healthcare system to treat addiction as a brain disease, and an all-out war on substance abusers. Dr. Chambers noted the 1939 “Penrose Hypothesis,” which seems to have come true in many communities: “As psychiatric infrastructure is degraded, prison populations will grow.”
The evidence-based research on MAT compared control groups of opioid addicts in recovery – those who used MAT and those who relied on counseling alone. The results were starkly clear that using MAT is so much more successful than counseling alone, that it became unethical for researchers to maintain a control group that did not have MAT. Those without MAT were relapsing on heroin, going to prison, becoming extremely sick and dying, with failure being 80 to 90 percent likely. There was no argument at the summit about the science – MAT works. So much so that it is actually now below the medical standard of care to treat a person with opioid addiction without including MAT as part of the treatment. In other words, if a doctor did not use MAT to help a person in recovery from opioid addiction, it could be considered medical malpractice.
Chambers’ recommended solution is that we need to rebuild the American behavioral health system in order to treat addiction and mental health together on a clinical level. However, many Hoosiers face roadblocks to this kind to treatment. Although recent improvements have been made with access to treatment for Medicaid recipients in Indiana, private insurance companies are another matter altogether, as no requirement for insurance companies to cover rehabilitation treatment exists. Additional barriers include a lack of services that are within a reasonable distance or have space immediately available.
If services can be made available, it is not enough, however, for them to simply be an option for voluntary use, according to Douglas Marlow, J.D., Ph.D. of the Nationals Association of Drug Court Professionals. The more in need of treatment someone is, the less likely they are to seek it out. The research suggests that involuntary civil commitment is not a feasible alternative because it has been proven to cause more harm than good in those areas that have tried it. Current best practices are coerced medical treatment leveraging the criminal justice system, where the user has a choice to either enter treatment or go to jail.
Tim Curry, Deputy Prosecutor of drug crimes in Clark Circuit Court 2, is all for MAT and alternatives to jail, but is concerned about where to find the funding. Judge Vicki Carmichael in Clark Circuit Court 4 recently procured significant funding for Clark County to expand her family treatment drug court from a capacity of 25 to 75 individuals. The economic impact of opioid addiction in Indiana is estimated at $1.5 billion per year, which doesn’t take into account the human toll. One speaker stated that for every dollar spent on MAT, we will see about a $38.00 return on investment.
In addition to making sure that individuals with addictions have access to the treatment that can help them get better, we should also consider looking at the root causes of substance use disorder: isolation, loneliness, and despair, as well as the related socio-economic factors like secure housing, transportation, food, and employment that affect the outcomes of those attempting recovery.
Having an addiction is not a moral failing, but a chronic brain disease. It would benefit us as a society to learn how to help those who are struggling. That includes embracing MAT and letting go of the stigmas surrounding addiction and mental illness. Punishment alone will not solve this, but neither, for that matter will treatment alone. Only a coordinated effort between first responders, courts, medical providers, insurance companies, communities, families, and the legislature will bring significant results. It will also cost money. However, that is true whether we expand our jail system and incarcerate people with addictions, or invest in evidence-based practices that can actually help. The roadmap to recovery is there – all we have to do is follow it.
-Anna Murray, Jeffersonville attorney and candidate for State Senate in District 46, which encompasses Floyd County and Jeffersonville Township