This was the title given to the Opinion article that was printed in The Enquirer on February 21st. Due to space constraints my article was edited for the paper. Below is the unedited version that, while lengthy, echoes much of what was heard at the 2015 Regional Opiate Summit that was held yesterday and today. Please consider responding to the 'Call to action' that is found at the end of the article.
Amidst the conversations about the heroin epidemic, there
have been more than a few varying viewpoints.
Some have chosen to lay blame at the feet of our legislators for their
inability to pass legislation in 2014.
Others have commented that this is a public health issue and belongs
outside the realm of our legislative body.
How did it happen that the treatment of a chronic, relapsing brain
disease was ever placed in the hands of lawmakers? In order to have a comprehensive
understanding of, among other related topics, the evolution of addiction
treatment to criminalization of the disease, William L. White’s 390 full-page
book might be a good place to start. Slaying
the Dragon, The History of Addiction Treatment and Recovery in America is
the culmination of 10 years of extensive research conducted by this nationally
recognized author and recovery advocate.
To sum up in this article his work on how the transition between these
two paradigms occurred would not only be impossible, but presumptuous to even
attempt such a feat. So, let’s leave it
to William L. White in some of his closing remarks, “The meager
results of our best efforts — along with our history of doing harm in the name
of good — calls for us to approach each client, family and community with
respect, humility, and a devotion to the ultimate principle of ethical
practice, ‘First, do no harm’.”
Has the intention ever been to
do harm? No, it has been a matter of
lack of education about the disease of addiction. Why has there been such depravity? That can be summed up in 3 words – shame,
stigma and discrimination. Those three
words have deprived people who have this disease from accessing medical
treatment for decades, or more accurately centuries. The treatment that has been meted out is not
based on research or best practices but rather on philosophical beliefs or
prejudices about what is or is not appropriate for a person who is addicted,
regardless of other mitigating factors.
No other disease, except perhaps mental illness, has endured such
injustice. Any other disease is treated
according to what has been established as the best standard of care, care that
is individualized. People who have the
disease of addiction have been mandated to the same treatment regardless of
whether or not it is appropriate. Then,
if the treatment proves unsuccessful, somehow it becomes the failure of the
person who received the treatment rather than those who failed to correctly assess
that person’s needs and treat accordingly.
What if other chronic illnesses
were treated in such a system as we have created for addiction? Dr. Tom McLellan poses a similar question, “Imagine if we began to
treat diabetes in a system such as we have designed for addiction.” (Dr. Tom
McLellan: Addiction and Segregation)
Conversely, imagine if we
treated addiction in the same system of care as we have created for diabetes,
or hypertension, or COPD, or cancer?
There would specialists knowledgeable about the disease and the
treatment that would be most likely to restore health. There would be not one specialist but
several to choose from so that access would be more readily available. Treatment would be individualized. The patient would be deemed worthy of an
appointment in a primary care setting prior to a crisis situation. There would be follow up appointments and
periodic assessments about whether or not the course of treatment was
effective. If in fact the treatment was
not working, there would be adjustments made, not dismissal from
treatment. How long the treatment lasted
would be determined by the physician and the patient rather than a third party
who decides that time is up on a treatment even though the patient is
recovering and could benefit from continued care. Incarceration would not be a prerequisite for
treatment because in this system the ambulance would be ‘parked at the top
rather than the bottom of the cliff’.
If there were new proven methods
of treatment for any of these and other chronic diseases, would there be
a moment’s hesitation in utilizing them?
However, skepticism abounds when
it comes to the treatment of addiction often veiled in an unwarranted reticence
of acceptance based on opinion and not fact.
There have been many years of not knowing what best practices are for treating
this disease. We know more now. When we know better, we can do better. To do anything less is unethical.
What we know is that there are
methods of treatment that work for many chronic illnesses, such as the disease
of addiction. To stop treating any
illness, including addiction, because there is a casualty would be
criminal. For all other chronic
illnesses, casualties serve to inform medical professionals about the efficacy
of medications and the critical need for research and the possibility of improved
treatment options. The response would
be life saving and life restoring rather than a moratorium on the value of
treatment and the people who need it.
Right now the Kentucky
Legislature is in the midst of deliberations on the best way to address the
heroin epidemic. Now is the time to let
your voice be heard. Now is the time to
advocate for your loved ones. Now is the time to let your legislators know that
addiction needs and deserves to be treated as any other chronic, progressive
potentially fatal illness.
Your advocacy efforts can take
many forms. It can be done through the
Kentucky Legislative website, www.lrc.ky.gov where legislators are listed according to counties and
emails and addresses are available for letters.
A quick call can be made to the Legislative Toll-Free Message Line at
1-800-372-7181 where a courteous person will take your message and send it
directly to the appropriate person or legislative body. Put simply, advocacy is about talking –
talking about this public health issue at every opportunity and making those
opportunities often.
Now is the time to break the
silence, to stare down the shame, stigma and discrimination.
Now is the time because by our
silence, we will be defined and the epidemic will remain undefeated.
Thank you for your advocacy,
Charlotte
