Healthcare industry ‘restrained’ from properly treating fentanyl addiction: Experts
Anna Giaritelli
At a time when the fentanyl epidemic and opioid-induced deaths are at all-time highs, the U.S. healthcare system’s ability to respond is “restrained” because safe-use treatment options remain little-known or stigmatized, according to public health experts.
The healthcare industry’s problem treating fentanyl addiction is not due to a shortage in infrastructure but a difference of opinion on how to treat it, experts say.
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As the fentanyl crisis rages and drug use is on full display in certain city streets, medical professionals behind the scenes are calling for more progressive treatment options, such as safe-use sites and replacement medicines, which they argue are more effective than classic rehab protocols.
The medical community’s response to helping people dependent on opioids has been “restrained from being able to properly address the problem,” said Dr. Jeffrey A. Singer, senior fellow at the libertarian Cato Institute think tank in Washington and fellow of the American College of Surgeons, during an interview with the Washington Examiner.
Fentanyl is a man-made drug that, in its purest form, can be 100 times stronger than morphine and 50 times that of heroin. More than 100,000 people in the U.S. died from a drug overdose last year, the most ever. The Centers for Disease Control and Prevention said synthetic opioids such as fentanyl “appear to be the primary driver of the increases in overdose deaths.”
Despite the sudden surge in deaths as fentanyl was introduced to the market in recent years, medical providers have decades of experience in offering treatment for opioid addiction. Certain localities are loosening laws on drug users with a focus on long-term help over criminal prosecution.
In Vancouver, British Columbia, all hard drugs have been decriminalized when found in small amounts. In 2021, New York City opened the nation’s first supervised drug injection sites, and Rhode Island became the first state to pass legislation to legalize safe injection sites.
However, the more progressive methods have yet to gain widespread acceptance and implementation in the U.S. Proposals to create safe injection sites where drug users can receive new syringes, be monitored while taking a drug, and not face arrest in places where possession is illegal, are strongly opposed by the International Association of Chiefs of Police, the world’s largest association of police leaders.
One method of treatment is medication-assisted treatment or replacement therapy that stabilizes a person but also monitors his or her use of similar substances. This type of treatment can last months to decades. It is a type of harm reduction treatment as opposed to completely stopping illicit drug use through a 12-step program or abstinence.
The National Academies of Sciences, Engineering, and Medicine found such medicine-based treatments are effective and needed to be deployed more often to stem the crisis.
Singer said the fear of facing aggressive withdrawals upon stopping the use of opioids can be a major obstacle to regaining control of one’s life. Drugs methadone and buprenorphine are both approved by the Food and Drug Administration to treat opioid use disorder by binding the opioid receptors from craving the normal version of the drug without giving the patient the euphoric feeling associated with being high.
“There’s tons of substance use treatment that is funded by the federal government,” said Dr. Susan Sherman, professor at Johns Hopkins Bloomberg School of Public Health in Baltimore. “Buprenorphine and Methadone are great opioid replacement treatments.”
A person on either treatment can stick to a relatively normal schedule rather than be hospitalized or at a rehabilitation facility. Because the replacement drugs do not cause the normal high feeling, a person receiving this type of treatment is capable of holding down a job and carrying out standard responsibilities.
“All of a sudden you have a lot of time on your hands,” Singer said. “Something like Methadone or Buprenorphine works at least to stabilize your life so that you can get to what makes you feel compelled to this behavior in the first place.”
For Rebecca Kiessling, a Michigan woman whose two adult sons died from fentanyl, recovery services such as in-patient rehabilitation where a person cannot leave proved ineffective. As part of the terms for one of her son’s release from jail in 2020, he was required to complete rehab, Kiessling said in an interview with the Washington Examiner.
“They said, ‘Don’t worry. It’s federally funded. It’s got federal and state funds,’” Kiessling said. “But it was a flophouse. It was essentially a halfway house.”
Kiessling’s son died from consuming fentanyl within weeks of leaving that rehab.
“Getting out of treatment is one of the biggest risk factors for [overdosing] again,” Sherman said. “That just doesn’t show to work as well for many people.”
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Rep. Tony Gonzales (R-TX), whose district comprises the largest chunk of U.S.-Mexico border, said the top priority in responding to the fentanyl epidemic should be preventing it from entering the U.S. in the first place.
“This should be uniting us, not dividing us,” Gonzales said in a phone interview with the Washington Examiner Monday. “How do we stop it from getting in our country? How do we stop it from killing our people? Three, if somebody is responsible for killing our people, how do we hold them accountable? And then how do you help those that have gone through this and lived on the other side of it?”