Since when is treating a disease, returning people to productive lives and preventing premature death a "good idea gone wrong?"
Several statements from the June 30 article, "Drug that was supposed to stem Kentucky's heroin epidemic creates a whole new problem," warrant further discussion.
First, Suboxone is not a medication that should be considered a temporary or quick fix. I wish there were such a solution because addiction is a devastating, chronic, relapsing brain disease that destroys communities, families and lives.
The medical evidence clearly shows that treatment with medications such as methadone and buprenorphine/naloxone decreases criminality, injection-drug use and behaviors known to spread HIV and hepatitis C. Similar to medications for diabetes or ADHD, the medication allows patients the chance to live productive lives and have meaningful relationships — but it is not a cure or magic bullet.
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A person with diabetes, for example, must modify behavior and take medication to optimize treatment. When diabetics struggle with their treatment plan, we do not dismiss them from our practice or say we will no longer prescribe medication to them. Nor do we talk about regulating treatment of other diseases, even ADHD, which is treated with a controlled substance that is often diverted.
We should apply the same logic when talking about buprenorphine and opioid-use disorders, being sure not to demonize the medication, the illness or the people who want treatment. Doing so will only take us further from helping those suffering and from solving this problem that affects us all.
The article mentions "cash clinics," suggesting that these are bad doctors who charge cash for treatment involving buprenorphine. However, until 2014 in Kentucky, Medicaid would not pay for a physician visit for opioid-use disorder. The only model of care that was possible was cash payment. Despite the new coverage by Medicaid for these services, there continue to be long waiting lists at our clinic,]at the University of Kentucky and even a year-plus wait list at the public methadone clinic. People are literally dying while waiting for treatment.
Would we tolerate this if we were talking about diabetes treatment, while people were losing their eyesight, having strokes and dying prematurely? Why won't more doctors provide the treatment for Medicaid patients? Perhaps the Herald-Leader can investigate this.
Lastly, the article addresses the increased Medicaid spending on buprenorphine and the fact that it's diverted and abused. Drs. Michelle Lofwall and Jennifer Havens of the University of Kentucky have shown that lack of access to treatment is the primary cause of buprenorphine diversion in our state.
If you were diabetic but you couldn't get in to see a doctor, wouldn't you get insulin through other means?
While Medicaid is spending more money on buprenorphine, we know that every dollar invested in addiction treatment saves up to $12 in health care, drug-related crime and criminal justice costs. Until we recognize opioid-use disorder as a medical issue primarily and a law-enforcement issue secondarily, we won't make progress in fighting Kentucky's opioid epidemic.
Every person in this state is related to or knows someone living the daily hell of this disease, yet many continue to pass judgment on those affected and demonize the medications used to treat it.
It's time for everyone in Kentucky — including the media, politicians and physicians — to work together to fight this epidemic.