The nation’s top health official this week perpetuated a dangerous, even deadly myth about drug addiction — right as the US struggles with its massive opioid epidemic.
Speaking on Tuesday at an event about the drug overdose crisis (the deadliest in US history), Health and Human Services Secretary Tom Price was asked about drug treatment. “If we’re just substituting one opioid for another, we’re not moving the dial much,” Price responded. “Folks need to be cured so they can be productive members of society and realize their dreams.”
Price was referring to what’s known as medication-assisted treatment. This is when a drug user takes a medication — for opioids, typically methadone or buprenorphine — to satiate cravings and stave off withdrawal. This allows people to then go about their lives as normal, without facing as much of a desire to use potentially dangerous drugs. There are literally decades of research behind this approach.
Price, however, used a common myth to denigrate the value of this treatment, arguing that taking opioids like methadone or buprenorphine to treat opioid addiction is really just substituting one opioid for another.
This doesn’t just go against decades of research; it also fundamentally misunderstands addiction. The issue isn’t just that someone is using drugs, but that someone is using drugs in a way that endangers them. Yet this myth has been used time and time again to deny medication-assisted treatment to opioid users — sometimes to literally deadly results.
Medication-assisted treatment works. Period.
Under the Diagnostic and Statistical Manual of Mental Disorders, it’s not enough for someone to be using drugs to qualify for a substance use disorder. After all, most US adults use drugs — some every day or multiple times a day — without any problems whatsoever. Just think about that next time you sip a beer, glass of wine, coffee, tea, or any other beverage with alcohol or caffeine in it, or any time you use a drug to treat a medical condition.
The qualification for a substance use disorder is that someone is using drugs in a dangerous or risky manner, putting himself or others in danger. So someone with a substance use disorder would not just be using opioids but potentially using these drugs in a way that puts him in danger — perhaps by feeling the need to commit crimes to obtain the drugs or using the drugs so much that he puts himself at risk of overdose and inhibits his day-to-day functioning. Basically, the drug use has to hinder someone from being a healthy, functioning member of society to qualify as substance use disorder.
The key with medication-assisted treatment is that while it does involve continued drug use, it turns that drug use into a much safer habit. Methadone, which is typically administered in a supervised setting, and buprenorphine, which is offered in take-home doses, are both meant to supplant dangerous drug habits. When taken as prescribed, these drugs can eliminate someone’s cravings for opioids and withdrawal symptoms — to help avoid relapse — without producing the kind of euphoric high that heroin or traditional painkillers can.
So instead of stealing to get heroin or using painkillers so much that he puts his life at risk, a patient on medication-assisted treatment can simply use methadone or buprenorphine to meet his physical cravings and otherwise go about his day — going to school, working, whatever.
This isn’t just hypothetical. Decades of research have deemed medication-assisted treatment effective for treating drug use disorders. The Centers for Disease Control and Prevention, National Institute on Drug Abuse, and World Health Organization all acknowledge its medical value. Experts often describe it to me as “the gold standard” for opioid addiction treatment.
Yet the myth Price propagated has been used time and time again to restrict the use of these drugs. For example, the federal government currently caps the number of patients for whom a doctor can prescribe buprenorphine.
The federal government argues that the cap is needed to ensure buprenorphine isn’t diverted to the black market for recreational use, but the myth likely plays a role in keeping the cap in place as well. Besides, restrictions on buprenorphine may lead to more diversion, because they force patients to rely on the black market to get their medications. Some research backs this up: A 2012 study in Drug and Alcohol Dependence found that a big contributor to the diversion of buprenorphine was a lack of access to affordable buprenorphine treatments for opioid addiction.
There’s also evidence that these and other government restrictions on medication-assisted treatment can literally get someone killed.
The myth Price perpetuated is deadly
In 2013, Judge Frank Gulotta Jr. in New York ordered an opioid user arrested for drugs, Robert Lepolszki, off methadone treatment. On January 2014, Lepolszki died of a drug overdose at 28 years old — a direct result, Lepolszki’s parents say, of failing to get the medicine he needed. In his defense, Gulotta has continued arguing that methadone programs “are crutches — they are substitutes for drugs and drug cravings without enabling the participant to actually rid him or herself of the addiction.”
This is just one case, but it shows the real risk of denying opioid users treatment: It can literally get them killed by depriving them of lifesaving medical care. (After the death, Gulotta defended his position, claiming that he lets people stay on medication-assisted treatment with a doctor’s recommendation — which Lepolszki apparently didn’t have.)
There has been some movement away from this mentality in recent years, as Price’s predecessor, former Health and Human Services Secretary Sylvia Mathews Burwell, sought to relax restrictions on medication-assisted treatment. She raised the cap on buprenorphine. Under her leadership, the Obama administration also unlocked more funding for medication-assisted treatment. And with support from her and President Barack Obama, Congress passed a law that, in part, allocated hundreds of millions of dollars that could potentially go to funding more medication-assisted treatment.
Drug policy experts widely agree that more of this kind of action is needed — to unlock not just more medication-assisted treatment, but also more drug treatment and prevention in general. According to a 2016 report by the surgeon general, just 10 percent of the people with a drug use disorder obtain specialty treatment. The report found that the low rate was largely explained by a shortage of treatment options, including medication-assisted treatment.
Yet Price, by repeating one of the most dangerous myths about medication-assisted treatment, has suggested that the Trump administration may move in another — and, frankly, deadly — direction.