Rehabbing Our Ideas About Addiction

Rehabbing Our Ideas About Addiction Wall Street Journal – By David M. Cordani – June 16, 2016

In March, the Centers for Disease Control and Prevention, released guidelines discouraging prescriptions that last longer than a week.

The focus on prevention is immensely important. We all know that prevention is more efficient than treatment, and without it, we would soon have more patients suffering from substance use than we could afford to treat. 

Additionally, long-term intensive recovery facilities have become the norm, even though there is very little evidence of their comparative effectiveness.  

Thirty-day inpatient programs can cost anywhere from $15,000 to $26,000, with some charging more than $100,000.

This situation provides virtually unlimited opportunities for money-making schemes.

Recovery facilities can make incredible profits for providing essentially just housing with “treatment” by uncertified “addiction specialists” whose only qualification is to have been an addict themselves.

Despite decades of failure, AA and abstinence persist as the “gold standard” for addiction treatment – at least in the addiction field. 

There is little motive to change this situation because more money is earned from a client’s failure than their success.

Clients that “fail” and relapse are expected to repeat the same ineffective program, over and over again for as long as they care to, while a successful client never has to go back.

These recovery businesses don’t have to hire and  pay medical professionals and are not limited by any regulation.

Imagine running a medical practice like this, with ex-patients giving “treatment” to new patients who have the disorder they were once treated for.

Nevertheless, the rehabilitation industry, which generates $35 billion in annual revenue, wants us to believe that these long-term residential treatment programs are “best in class.”

We have the data to tell us what care should look like for substance-use disorders.

The least restrictive levels of care—intensive shorter-term outpatient programs, for instance—are actually the most cost-effective

For too long, we have viewed behavioral health as separate from physical health. In order to stop this epidemic, we need to treat substance-use disorders the same way we treat other chronic illnesses.

If evidence-based treatment and performance-based reimbursement are the gold standard for treating physical illness, we need the same approach for treating substance-use disorders

Such evidence-based treatments, like various models of harm reduction, are rarely found in the recovery industry.

FIFTEEN YEARS INTO A NATIONAL TREND of increasing overdose deaths, there is an imperative to develop better medications to treat addiction.

Ibogaine, a chemical derived from the root bark of an African plant, may provide a key.

In animals, a single dose of ibogaine decreases signs of opioid withdrawal and produces sustained reductions in the self-administration of heroin, morphine, cocaine, nicotine and alcohol. Effects in humans closely parallel these findings.

Ibogaine is illegal in the U.S., where it has been classified as a hallucinogen since 1967, and unregulated but available in Canada and Mexico. New Zealand, South Africa and Brazil authorize the use of ibogaine by licensed medical practitioners.

In 1990, Congress mandated the National Institutes of Health to develop medications to treat addiction.

The NIH undertook a program of research on ibogaine in 1991, and developed a structurally similar and potentially safer ibogaine analogue known as 18-MC. But further development of 18-MC is stalled by lack of funding.

…because all the research these days is only looking to reaffirming the potential of addiction with opioids and trying to find benefit in “alternative medicine”.

The NIH now supports the development of medications to treat addiction with less than $100 million annually, while the cost of developing a single drug to final FDA approval can exceed $1 billion.

The need for a fundamentally new pharmacological treatment for addiction has never been more urgent.

Policy aimed at the private sector needs to better incentivize the financial risk of innovation. Creative, high-risk research, neglected in the pharmaceutical sector, needs substantial public funding.

Improving addiction treatment has a cost. The alternative, in human and economic terms, is extravagant.


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