Surgeon General’s Opiod Addiction Report, Canada’s Heroin Assisted Treatment & More

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Addiction is no longer an unseen parasite, but rather a permanent fixture in society today. That may seem grim, but it’s the unfortunate truth. When it comes down to it, there’s hardly a single person who’s not been affected by addiction in some way, which is why addiction is a topic that hits close to home for most of us. It should also come as little surprise that there are many compelling conversations happening all over the country and around the world. People are putting their heads together and trying to come up with a solution–any solution–to this burgeoning disease that affects our brothers and sisters, parents, children, romantic partners, close friends, colleagues, and ourselves.

This week it seems that much of the discussion was about opioid addiction in particular. Opioids–any substance that is opium-like in its effects but not necessarily in structure or composition–have been the most concerning chemical substance for nearly three decades. Since the genesis of OxyContin in the mid-1990s, more and more Americans have become dependent on prescription pain medication and heroin with the CDC referring to the current opioid problem in the U.S. as an “epidemic”. There are currently over 14,000 treatment facilities located across the country and even more located abroad, but will mitigating this epidemic require more than greater treatment availability?

Surgeon General to Release First-Ever Opioid Addiction Report

On Monday, May 16, during a visit to Oklahoma City to raise awareness of the opioid epidemic, Surgeon General Vivek Murthy spoke with the parents of a University of Oklahoma student who died of a drug overdose more than five years ago, among the parents of others. Regularly, the Surgeon General hears from the parents of many people who have been lost to heroin or painkiller addiction. Dr. Murthy had traveled to Oklahoma so that he could meet with healthcare professionals, observe how they are currently treating people who suffer from opioid addiction and get an idea of how they are fighting this epidemic in America’s heartland.

While speaking to reporters, Dr. Murthy admitted that hearing, in detail, about the terrible losses these people have suffered–which he attributes to the insufficient defense against the addiction epidemic that currently exists–is the most difficult part of his job. He went on to say that any death that occurs as a result of an opioid overdose is “preventable”, citing an alarming statistic that someone dies from an opioid overdose every 19 minutes in the U.S.

Additionally, Dr. Murthy announced that he will be releasing the first surgeon general’s report on substance abuse, addiction, and health later this fall. It is his hope that this report will have an effect that is comparable to that of the 1964 report on smoking, which is notable for being the first official government document to affirm that smoking tobacco is linked to poor health. In particular, Dr. Murthy said that we’re at a very important point in time, fighting an opioid addiction crisis for which we need to do anything we can to “focus our nation’s efforts and resources and attention on tackling this epidemic.”

In Dr. Murthy’s opinion, the current epidemic was caused by the sudden and widespread emphasis on the treatment rather than management of pain, physicians who knew very little–beyond the marketed effects–about the drugs they were prescribing, and excessive marketing efforts from the pharmaceutical companies making those drugs. There has been a quadrupling of the rate of opioid overdose deaths since 1999, and part of the reason Dr. Murthy had chosen Oklahoma was due to it being one of the states with the highest rates of opioid overdose deaths today.

Unfortunately, one of the main hurdles to overcome has been access to treatment. Either for financial reasons or because of an insufficient number of beds in many states, there are still so many people unable to get treatment for addiction. In areas where the need far outweighs the availability, the cost of not increasing the number of beds is, morally speaking, far greater than the financial cost of building more facilities. But the funding must come from somewhere. That’s where Surgeon General Murthy comes in.

The idea is that this report of the opioid epidemic would provide plenty of up-to-date data to show just how severe the problem has become; additionally, it would bring awareness to a whole new level just as the 1964 report did for smoking.

Harvard Med Students Demand Training for Opioid Addiction

Back on the East Coast, there’s another group calling for more recognition for the current opioid epidemic. However, this time it’s a group of Harvard Medical School students who want to be educated on opioid addiction and its treatment to better prepare them for the current landscape of healthcare in the U.S. To date, these students have actually been attempting to teach themselves since the Harvard curriculum skips the topic of opioid addiction altogether. However, rather than a blatant omission, the lack of opioid addiction education in Harvard’s program illustrates how little previous generations knew and how much we’ve only recently discovered about opioid addiction.

But there could be more to it than ignorance. After all, addiction is a very stigmatized disease, and certain forms of treatment–particularly those that involve the use of medications–are widely stigmatized as well despite growing evidence that methadone maintenance and other similar treatments are, if not suitable in every case, at least worthy of consideration for some.

For instance, the Harvard medical curriculum offers no mention or information of naloxone. Accordingly, the group of Harvard students took it upon themselves to learn about naloxone, which has garnered a ton of media attention for being the so-called “cure” for an opioid overdose and, therefore, an essential tool in any healthcare provider’s arsenal. After learning about the drug, the students went around to local pharmacies asking if they could buy naloxone, which stumped most of the pharmacists as they weren’t sure exactly how naloxone is supposed to be handed out. However, most of the students were able to buy some naloxone and later stood together for a photo in which they all held the life-saving drug in front of them.

The students also organized various education and training sessions to help each other learn about opioid addiction and treatment, even hosting sessions about the use of buprenorphine, or Suboxone. As well, the upperclassmen of the group have created a group called the Student Coalition on Addiction, which is now comprised of students from other medical schools nearby and is intended to identify and fill any gaps in their med school curricula with regard to addiction and treatment.

Canada Proposes Prescription Heroin as an Alternative to Methadone

While the Harvard students are learning how to use naloxone and Suboxone, a proposition in Canada appears to have taken some cues from the Europeans. Many of us have probably heard of heroin-assisted treatment, but for those who haven’t: Heroin-assisted treatment refers to the prescribing of pharmaceutical-grade heroin to patients who administer–by themselves or with assistance–while in a supervised environment. Proven quite effective with regard to harm reduction, heroin-assisted  treatment is very controversial and typically reserved for those who, for whatever reason, have been unable to complete traditional rehabilitation programs or replacement therapies.

Most people who are familiar with the concept of heroin-assisted treatment consider it a “European treatment” since it’s only been offered in a few European countries such as the UK, Switzerland, the Netherlands, and Denmark. Despite the controversy, the treatment has proven it can significantly reduce rates of overdose and offers heroin addicts a drastically improved lifestyle since much of their deviant behavior stemmed from having to fund and procure heroin. However, the obvious controversial point is that this form of treatment could be considered enabling, as it offers addicts a means of sustaining their addiction rather than getting off heroin.

But it seems that Canadian lawmakers see heroin-assisted  treatment as a glass-half-full situation since a new proposal, if passed, will allow people addicted to heroin access to maintenance therapy in which they’re prescribed pharmaceutical heroin, or diacetylmorphine. According to the proposal, heroin would be moved from its current status as an illicit, controlled substance to a category that makes it eligible for Special Access Programmes, or SAPs. To gain “special access” to heroin, a person experiencing extremely severe or life-threatening symptoms could put in a request to be granted emergency access to heroin when other substances or forms of treatment have been unsuccessful. In other words, a patient who has been unable to complete a traditional rehab and who has had no success in methadone maintenance and buprenorphine maintenance programs could, in theory, get a prescription for heroin.

According to a physician who oversaw a pilot study on heroin assisted therapy prior to the proposal submission, offering pharmaceutical heroin in special cases is a win-win for all involved: It gives people who would otherwise have no options left another means of getting their lives back while also costing taxpayers much less money than addictions left unchecked and unsupervised. And that seems to be the moral of the story. Given the choice between having zero control over a person’s heroin intake and being able to monitor and regulate it, which do you choose?

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