Tuesday, February 24, 2015

Shame, Injustice Separate Addiction, Other Diseases

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,