Stigma Against Addiction Medication Limits Our Ability to End the Opioid Epidemic

Some of the most recently available data brings welcome news in the nationwide fight against the opioid epidemic. After many months of increasing overdose deaths in the wake of the Covid pandemic – a period of loneliness and struggle for many Americans – we appear to be turning the tide.

Data from the Centers for Disease Control and Prevention show that overdose deaths peaked in August 2023, but in the twelve months since that time, there was a reduction in the number of drug-overdose deaths by about one sixth.

This is an encouraging trend. But even with the significant reduction, we must still reckon with the fact that 90,000 Americans lost their lives to opioid addiction during that period. That’s about the population of Santa Barbara, California. While the change in the trajectory of deaths from overdose is positive, we still have much to do to further reduce addiction, overdoses, and deaths.

Critical to continuing this progress is making sure those in need can access effective opioid treatment programs, like those that incorporate medication for opioid use disorder (MOUD).

The three FDA-approved medications for opioid use disorder are buprenorphine, methadone, and naltrexone – all of which have been proven safe and effective. These medications, considered the gold-standard treatment, help patients prevent or reduce overdoses by relieving withdrawal symptoms and cravings.

In one representative example of the scientific literature on MOUD, a National Institutes of Health-funded study found that methadone helped adults struggling with addiction decrease the risk of overdose deaths by 59 percent.

Though MOUD can be significantly helpful in curbing overdoses, patients are unlikely to yield maximum effectiveness unless it is combined with the personalized care offered through counseling.

The Substance Abuse and Mental Health Services Administration tells us that this combination offers a “whole-patient” approach that helps people overcome substance use disorders and sustain recovery. Expert consensus on the efficacy of this approach is why federal law requires opioid treatment programs to offer counseling.

But despite the decline in overdose deaths, there seems to be a stagnation in wider acceptance of MOUD. Even as studies and personal experiences repeatedly reflect the effectiveness of MOUD, a stigma about this approach and the medication persists, complicating efforts to help more people treat their opioid use disorders.

This stigma often arises from the fact that methadone and buprenorphine activate receptors in the brain similarly to opioids. The difference is that these medications activate receptors more slowly and, for opioid-dependent people, in a way that produces no euphoria. It’s what allows patients to continue recovery with a much smaller likelihood of relapsing.

These characteristics of the medication cause some in the treatment ecosystem to mistakenly view MOUD as hardly better than heroin itself. Proponents of this viewpoint make misleading claims, such as that using MOUD is merely substituting one opioid for another.

For some folks, complete abstinence – including from MOUD – is the only appropriate treatment option, despite the much higher risk for overdosing.

Some organizations, including Narcotics Anonymous chapters and Salvation Army facilities, discourage or bar members from using MOUD, treat members who use MOUD as inferior, and sometimes even ask members not to return if they are using MOUD. Other patients encounter detox facilities, sober living homes, and rehab centers that reject this vital resource for treating addiction.

This failure to make MOUD accessible is disturbingly prevalent. A 2023 federal government survey found that over 40 percent of more than 14,000 treatment facilities did not offer methadone or buprenorphine.

The rejection of MOUD is a tragic misunderstanding of effective medication that results in avoidable overdoses instead of improved health outcomes.

Policymakers should ensure that taxpayer-funded efforts to make treatment more accessible support opioid treatment programs that offer the proven benefits of MOUD and counseling. Additionally, professionals in the addiction field should take every opportunity to combat the harmful stigma against MOUD and reinforce its ability to help patients recover.

The opioid epidemic is showing signs of waning. If we are to continue this progress, we must do a better job of embracing effective treatment and fighting dangerous stigmas. When we are facing an epidemic as widespread and lethal as opioid addiction, we should utilize all the tools we have available to save lives and preserve individuals.

Photo: Moussa81, Getty Images

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