5 healthcare workers offer their take on opioid addiction

As Americans continue to die of drug overdoses at record-setting rates, The New York Times reached out to more than 100 healthcare professionals to get their take on treating patients with opioid addiction. 

Here are a portion of responses from five clinicians.

1. On what remains unknown about opioid addiction: "I don't think that we know why one person can be prescribed oxycodone after surgery and take it for five days and then stop and another person becomes addicted," Heather Schwemm, MD, a Kennebunkport, Maine-based primary care internist, told the Times. "I don't think that anybody wants to be a drug addict. I don't believe in 'victimhood,' but if we don't understand the events that led to a person's becoming addicted to opioids, we'll never be able to find solutions to the problem. There is no 'one size fits all' model for treatment.

2. On barriers to care: "One of the biggest challenges is helping patients access quality mental-health services and counseling both for the addiction issues and the almost always present untreated mental health issues," said Sarah Butler, a Livonia, Mich.-based physician assistant. "Mental healthcare and medical care for addiction is expensive. Medications that prevent withdrawal symptoms and block the high (or do one or the other) are excellent for tools for reducing the chance of relapse, but at an out-of-pocket cost of $500 to $700 per month, it is too expensive for many patients. Patients can end up buried under mountains of debt simply because they were responsible and sought treatment for their addiction."

3. On the stigma of addiction: "The misconception about opioid use is the belief that it's a choice," Rebecca Jones, MD, a Brattleboro, Vt.-based dermatologist, told the Times. "There has been so much research that links opioid addiction with attachment disorder. So you have people who have suffered from poor parental bonding getting hooked on opioids often at the hands of the medical community; they go to jail, lose their jobs, children, freedom, and when they get out they can't get jobs, they have no emotional support, and they blame themselves for their vulnerability. Why wouldn't they? The rest of the world blames them. No wonder they go back to using drugs. Addicts need love, support, connection."

4. On burn out: "I got burned out and left my job about a year and a half ago because I couldn't deal with addicts anymore," said an unnamed Brooklyn-based licensed mental health counselor. "They turn treatment on its head — it becomes a sort of 'game on' when they enter programs and proceed to break every rule, in a giant game of distraction, which invariably leads back to relapse. It's an exhausting and grim business treating addicts because one can't help but conclude in the end that most of them don't really want to change. It's been heart-wrenching for me to become so disillusioned with the whole thing."

5. On recovery: "The biggest misconception about opioid abuse is that folks cannot get better," a licensed clinical social worker in Syracuse, N.Y., identified only as Christine, told the Times. "I saw with intensive outpatient treatment over a year with Suboxone that miracles do happen. I saw folks get better and become productive members of society. I saw them turn around and give back to other addicts. I saw their families heal with them. But the investment of resources is significant. They also need continuing care for many years — less frequent treatment but they still need to attend groups at least once a week sometimes for years and continue on their Suboxone."

More articles on opioids: 
How to solve the opioid crisis with $100B — 30 experts weigh in 
Standing Rock Sioux file lawsuit against 24 opioid makers, distributors 
Opioid use linked to increased risk for meningitis, pneumonia

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