In testimony to the House on Wednesday, FDA Commissioner Scott Gottlieb said that his agency plans to leverage the use of medications for opioid addiction, including methadone, buprenorphine, and naltrexone, to confront America’s drug overdose crisis.
“There’s a wealth of information supporting the use of these medications,” Gottlieb said, according to STAT. “We’re focusing on the data in the drug labeling that can help drive broader and appropriate prescribing. So one concept that FDA is actively pursuing is the research necessary to support a label indication for medication-assisted treatment for everyone who presents with an overdose, based on data showing a reduction in death at a broader population-level. Such an effort would be a first for FDA.”
As the nation’s primary drug regulator, the FDA can push doctors to make greater use of some medications — by, for example, tinkering with drug labeling to combat stigma attached to certain drugs. Based on Gottlieb’s remarks to Congress, that seems to be the goal here.
There is overwhelming evidence behind MAT. Studies, including systematic reviews of the research, have found that MAT cuts all-cause mortality among opioid addiction patients by half or more. The CDC, National Institute on Drug Abuse, and World Health Organization acknowledge its medical value. That doesn’t mean it’s for everyone (it’s not), but there’s enough evidence that experts generally consider it the gold standard of opioid addiction care.
But MAT has long been held back by stigma, particularly the misconception that using medications to combat addiction — especially opioids like methadone and buprenorphine — is simply replacing one drug with another. Former Health and Human Services Secretary Tom Price, for example, previously argued, “If we’re just substituting one opioid for another, we’re not moving the dial much. Folks need to be cured so they can be productive members of society and realize their dreams.”
But the danger isn’t whether someone is merely using drugs; most Americans, after all, use caffeine or alcohol regularly throughout their lives with few problems. According to the definition in the Diagnostic and Statistical Manual of Mental Disorders, drug use transforms into addiction when habitual drug use begins hurting someone’s function — by, for example, leading them to steal or commit other crimes to obtain heroin, or, in the worst-case scenario, resulting in death.
While medication-assisted treatment does involve continued drug use, it turns that drug use into a safer habit. When taken as prescribed, medications like methadone and buprenorphine can eliminate someone’s cravings for opioids and withdrawal symptoms without producing the kind of euphoric high that heroin or traditional painkillers can. It addresses the core problem of addiction, even if in some cases it does mean a patient will have to use a certain drug for the rest of his life. But the alternative isn’t a drug-free patient; the alternative is a continually relapsing patient — one who has to salve their addiction with dangerous street drugs.
Some states have taken steps to make MAT more available, but the data suggests not enough have. According to a 2016 report by the surgeon general, only 10 percent of people with a drug use disorder get specialty treatment — a finding that the report attributed to low access to treatment, which can cause weeks- or months-long waiting periods for lifesaving care.
The FDA has an opportunity to make a difference here — and it seems that Gottlieb, at least, is taking that chance seriously.
For more on MAT’s role in combating the opioid epidemic, read Vox’s explainer.