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Pyatt: Constructing an effective way to fight opioids

There are lots of contributing factors to and consequences from opioid addiction. But the one statistic that captures everybody’s attention is deaths. The presentation of deaths in various geographical areas has been calculated and highlighted by the Center for Disease Control (CDC) and presented in the many news articles.

But more significant are the “dead people walking” who have reached the point where they don’t care about anything except their next fix. Whether they die tomorrow from heroin laced with fentanyl or from prescription drugs or a combination thereof in a few years doesn’t matter to them. Their families and/or spouses know the score, and they are all gloomily held captive and often watching this slow descent into hell.

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It is not unusual to find that high school students have tried alcohol or drugs — according to the Centers for Disease Control, nearly two in three high school students has used alcohol and according to the U.S. Dept. of Health and Human Services 50 percent of teens have misused prescription or illicit drugs. Prevention is never discussed. This process can often take many years but must be fully worked out. Who makes it and who doesn’t? And how do we improve the odds?

Based on my own research, and after contacting some staff who provide opioid addiction treatment for a career — this is like the Mueller team; nobody wants to say much — I’m not sure Carroll County’s planned lawsuit against pharmaceutical companies will help the situation. It could make it worse. But it’s politically expedient. And it gets the attention off the frustrated efforts to date.

I am an acquaintance of Frank Iliano of Mount Airy who recently won the William Donald Schaefer award for his “intervention” method copied from alcoholics anonymous to treat opioid addiction in Mount Airy.

I also reviewed a pre-print copy of the just completed National Academy of Science, Engineering and Medicine Report on “Medications for Opioid Use Disorders Save Lives” mentioned in a recent Times article hoping to get some insights. This report makes a rather compelling case and presents copious references and data to conclude that opioid treatment by various drugs save more lives than non-drug intervention. I’m not sure death is the best metric, but that’s what they used for this six-month study, perhaps to be consistent with CDC statistics.

But the National Academy Report does not address costs, and it seems to me that it is suggesting or highly implying rehab clinics are the answer — but not stated as such in the conclusions. Certainly costs will be huge. The National Institute of Drug Abuse estimates that the average cost for a full year of methadone maintenance treatment — not including physician cost — is approximately $4,700 per patient, though there is some disagreement on this figure.

Psychiatrists — taking about 16 years of medical training to fully ripen — have the skills needed to dispense a wide array of medications and continue treatment, but are rare birds these days. Luring one to Carroll County is akin to asking Manny Machado to throw in a few pro bono games at third. They have to work on the side and have 15-minute appointments — it is like using a Ferrari to get a quart of milk at the nearest convenience store — in order to make a living.

Addiction physicians are somewhat better but usually demand the right for private practice to make ends meet. Unfortunately, and regrettably, board-certified addiction physicians are among the lowest paid, and there are not many of them because of that.

The medical directors of today are like Eric DeCosta of the Ravens — I need a middle linebacker (addiction specialist), an elite wide receiver (psychiatrist), several offensive linemen (addiction psychologists), and a return specialist (pharmacist) and must somehow get under the salary cap.

I see two rays of sunshine in Carroll County: Mr. Illiano’s approach of “homestyle” intervention with some limited drug awareness and Access Carroll’s limited yet professional focus on non-drug intervention first coupled with a gradual foray into the use of drugs to combat addiction.

The challenge is to take business mogul Illiano, doing all of this for gratis to help out his employees, add in Access Carroll staff and meld these two approaches together with the National Academy report into an effective package, or at least a more coherent one. Perhaps the transparency of this process will help with public acceptance and understanding of this formidable problem.

I am pessimistic that the current medical establishment — which often sees a malady as a business opportunity and is very good at hiding true intentions — will be of much assistance in the short term. The bulk of the work probably will be done robotically — along with routine blood pressure checks and diabetes treatment — with minimally trained PAs and NPs until they get the necessary experience. All of this could negate the assumptions of the supporting studies in the National Academy Report.

Yet we still have to confront that this problem is embedded in the medical establishment — pain medication and access to affordable opioids for medical procedures — and we have to better understand the opioid flow progression leading up to and after addiction before we take bold steps to change the flow process. I’m not sure we’re there yet.

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