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What Doctors Facing the Opioid Crisis Need Next

What Doctors Facing the Opioid Crisis Need Next
From TIME - November 2, 2017

How do you confront an epidemic that has claimed more lives than the HIV/AIDS crisis at its peak? How do you counteract a system that incentivizes the flow of prescription painkillers from doctors to patients and ends up getting 3 million Americans addicted each year? And how do you reverse surging demand for prescription opioids illegal substitutes, which are more damaging and toxic but far cheaper and easier to obtain?

You could start by declaring a national public health emergency. Thats what President Trump did on Oct. 26, creating a 90-day window during which federal agenciesfrom the Food and Drug Administration, which regulates prescription drugs; to the Department of Health and Human Services, which oversees guidelines for treating addiction; to the Department of Justice, which is responsible for prosecuting illegal pill makers and drug dealers; to the National Institutes of Health, which studies how people first get addictedmust shift parts of their existing budgets to address the crisis. After 90 days, the President can renew the emergency status to extend the intensified response.

This is a move in the right direction. But Trumps order did not make additional funding immediately available, leading those on the front lines of the epidemic to ask what, exactly, it will mean. Unfortunately, nothing, says Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center and former director of National Drug Control Policy in the Obama Administration. There are no new grant dollars, no new policy initiatives.

Days after Trumps declaration, his official White House commission on the crisis issued its final report, which called for many of the initiatives that are backed by experts like Botticelli. The findings make it clear that current strategies and funding are far from adequate.

What we need is something like the Ryan White Care Act, says Dr. Sarah Wakeman, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital. In 1990, Congress passed the act to provide funding for HIV patients who could not afford basic medical care and anti-HIV drugs. With $2.3 billion at its disposal, the fund currently provides care to more than half of all people infected with the virus in the U.S.

For the opioid epidemic, such additional funding would allow more people to receive medication-assisted treatment (MAT), which mimics opioids but has less addictive potential and can wean addicts off their dependence. Studies show that people given medications like methadone or buprenorphine are less likely to overdose or relapse.

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