As I watch the national overdose death rates continue to climb, I wonder what it will take before the physicians responsible for helping fuel this disease begin to act ethically – treating addiction as the chronic brain disease that scientific research has proven it to be.
I wonder how many deaths it will take before hospitals across our country begin to designate beds for the in-patient treatment of addiction following an overdose.
We now know that using drugs repeatedly, whether they are prescribed opioids or illegal heroin, changes both the function and structure of the brain. Drugs hijack the brain’s control circuits resulting in the compulsive behavior that defines addiction. The addict’s motivational pathways in the brain are rewired, resulting in continual drug use becoming the primary driver for the individual suffering from this disease.
Unfortunately, the public and many who practice medicine continue to believe that drug addiction is a moral failing. A flaw of character or a failure of will. Many think that if an addict wants to stop using, it’s as simple as not using ever again.
Medical research contradicts this outdated perception. The majority of the biomedical community now understands that addiction is without a doubt a brain disease manifested by the persistent changes in both brain structure and function caused by the destruction of long-term opioid use.
The National Institute on Drug Abuse has presented a detailed discussion on how addiction must be treated:
“As with other brain diseases such as schizophrenia and depression, data shows that the best approach to drug addiction treatment considers the entire individual, combining the use of medications, behavioral therapies, and due attention to necessary social services and rehabilitation. These include family therapy, mental health services, education and vocational training, and housing services.”
What society and the medical community seem to forget is that approximately 80% of those addicted started after being over-prescribed opioids for acute post-op pain or even for something as simple as a backache. Even after the addictive properties of opioids became known, physicians continued to overprescribe. Addiction is a physician-created disease. Therefore, physicians must take the lead in treating the disease they created. They have a body of knowledge and scientific research to back this up, and they should ensure that patients get the quality of treatment needed to improve outcomes.
When comparing the state of Delaware to the rest of the nation, The Center for Disease Control gave my state the highest ranking for opioid prescriptions. The number one position meant that Delaware physicians had a significant role in fueling the epidemic in my state. Why has nothing changed in how we treat this brain disease?
The definition of insanity is continuing to do the same thing over and over but expecting a different result. Unfortunately, this is how we continue to treat addiction in Delaware. I call it the revolving door of treatment. A few days here, a few days there. We lack continuity of care. Providers continue to think that 5 to 10 days in detox followed by outpatient care will keep addicts clean. That is insanity.
Our state Insurance continues to limit both the number of in-patients and out-patient days per year, while our medical center refuses to provide long-term, comprehensive treatment in hospitals – something that could result in the decline of overdose deaths. Increased time in treatment improves the outcomes. Why should the disease of addiction be any different?
Christiana Care Health Systems in Delaware is one of the country’s most extensive healthcare systems, ranked 21st in the nation and 10th on the East Coast for admissions. What they don’t have is a specific unit for those suffering from the brain disease of addiction.
We have units for cardiac patients, trauma patients, even bariatric surgery patients, but for the disease that is killing more people than gun violence and motor vehicle accidents combined, we have no addiction unit. Of Christiana’s 1,100 beds, not one is reserved for treating an overdose victim after revival with Naloxone. Not one bed in a major medical center, located in a state ranked number one for prescribing high dose opioids. That is insanity.
Many patients report being discharged onto the streets, alone, after being revived by Naloxone. During my son’s addiction, I knew of patients discharged from the emergency department with no handoff or information on where to turn next. My son was told his vitals were stable and handed discharge papers. I was lucky he called me.
Sadly, this practice continues today. Parents have reported never being notified that their child suffered an overdose. The emergency department points to HIPAA – patient record confidentiality – that states that addicts are adults and responsible for their care. I wonder why families are notified of a motor vehicle accident that involves a loved one, but not an overdose?
To my knowledge, no other disease is treated as shabbily as addiction. As a registered nurse, the practice of discharging patients who have been brought back from death without supervision or follow up treatment enrages me. How many more young Americans must die before major medical centers recognize the insanity of addiction treatment in emergency departments? When will they realize that those revived by Naloxone require in-patient stabilization? When will parents be given the peace of mind that their adult son or daughter will be transferred to a bed in a monitored, safe environment instead of being placed back on the streets?
Policies and protocols must be put in place to ensure that those who survive an overdose get treated with the same compassion and care as someone who survives a cardiac event. Discrimination against the disease of addiction must stop. Physicians and nurses in emergency departments must become educated about addiction in the same way as every other chronic, treatable disease. Compassion must replace stigma.
Addiction must be recognized as a chronic, treatable brain disease, not a moral failing.
It’s in everyone’s best interests to approach addiction as a treatable disease, ensuring that those suffering from substance abuse disorders receive scientific-based, long-term treatment. Until then, mother’s like myself will continue to bury our children.
Read more on the opioid epidemic that’s gripping America: “This Should Scare You More Than Terrorism: The Opioid Epidemic”