Is a Medical Model Necessary to Address the Drug and Alcohol Epidemic

All attempts to get physicians involved in the battle against the opioid and alcohol epidemic have failed. Why the failure? A more relevant question to ask is: Is it necessary, and could it be a hindrance? We need to look at the past and the present to come up with answers.

Less than 10% of the 23 million patients impacted by drugs and alcohol receive medications. This is a shocking number but not a surprise. Part of the reason is that we have just six medications, with two—methadone and buprenorphine—having restrictions on prescribing them​ (NIAAA)​​ (National Institute on Drug Abuse)​.

The treatment of alcoholism is dominated by self-help groups like AA and 12-Step programs that generally eschew medications. Attempts to ‘medicalize’ the treatment have not been successful. The treatment of opioid addiction is dominated by opioid substitution with either methadone or buprenorphine. Methadone is a highly regulated drug administered in a clinic setting. The restrictions on buprenorphine were seen as rather onerous, and less than 5% of US physicians obtained the required DEA waiver, which is now waived​ (National Institute on Drug Abuse)​.

There is much we can learn from the phenomenal success of naloxone (Narcan). This prescription medication, approved in 1971, languished for decades. It took the opioid epidemic crisis to look at this medication differently. The major bottleneck for utilizing this highly effective and safe reversal agent was the prescription requirement. Most states issued a statewide prescription for naloxone, allowing a patient to obtain the medication without obtaining a prescription from a physician. Harm reduction organizations were able to obtain bulk supplies of naloxone and make this life-saving medication widely available. The FDA finally granted naloxone OTC status. Now millions of doses of naloxone are widely available without any restrictions​ (National Institute on Drug Abuse)​​ (NIAAA)​.

Why stop only at naloxone? Naltrexone, closely related to naloxone, should be the next medication to follow. It is a highly effective medication to prevent relapse to opioid use—a huge problem given how ubiquitous illegal opioids like fentanyl are. Naltrexone is also approved for the treatment of alcoholism, a growing problem since the Covid epidemic. This medication can be utilized in two ways: to maintain sobriety or cut down on drinking. Issuing a statewide prescription would greatly increase access to this highly effective medication​ (National Institute on Drug Abuse)​.

A two-step approach would make a lot of sense in the fight against opioid and alcohol use disorders. Remove the prescription requirements for all opioid antagonists approved by the FDA and allow all licensed physicians with a valid DEA license to prescribe buprenorphine and methadone​ (National Institute on Drug Abuse)​​ (NIAAA)​.

If you would like to reach out to Percy Menzies, you can contact him via email at pmenzies@arcamidwest.com. For more information, please visit the website at www.arcamidwest.com

Sources:

1. National Institute on Drug Abuse (NIDA) - Reports that only 22% of people with opioid use disorder received medications to treat it in 2021.

2. National Institute on Alcohol Abuse and Alcoholism (NIAAA) - States that less than 10% of individuals with past-year alcohol use disorder receive any treatment, and only 2.2% receive medication-assisted treatment.

3. National Institute on Drug Abuse (NIDA) and CDC Study - Highlights the low percentage of physicians obtaining the required DEA waiver for buprenorphine and the success of naloxone due to relaxed prescription requirements.

These sources provide a comprehensive view of the current state of medication-assisted treatment for substance use disorders and suggest potential pathways to improve accessibility and effectiveness.