The Real Dangers of Equating Opioid Dependence with Addiction

On Tuesday, November 19, the National Prevention Science Coalition with support from the Congressional Addiction, Treatment and Recovery Caucus conducted a Capitol Hill briefing on the opioid crisis in terms of dependency and addiction. The briefing focused on how the significant difference between the two conditions and how policymakers misunderstandings are affecting pain management.

A panel of five speakers participated in the panel discussion. The panel included Dr. Susan Glod, Associate Professor of Medicine, Penn State University, Dr. Patrick Byrne, Penn State University and John’s Hopkins University, Dr. Brendan Salone, Associate Professor of Health Policy from the Johns Hopkins’ Bloomberg School of Public Health, Dr Nora Volkow, Director of the NIH National Institute of Drug Addiction (NIDA), and Dr. Philip Graham, Center on Social Determinants, from RTI International.

Dr. Volkow talked about the opioid epidemic and how it is three different surges of the drug epidemic starting with opioids, shifting to heroin, and now to fentanyl. She talked in great detail about the difference between dependence and addiction and how many policymakers have combined the two.

Dependence is a state that many patients of these pain killers have experienced, but it is more physical and more easily dealt with while addiction can be much more severe and has an impact on the brain and is more challenging when it comes to treatment. Dr. Volkow pointed out that we have little hard science in terms of what percentage of the population that suffer from addiction with a wide range of estimates because the data is not clear. As a result, some of our policy options and decisions the last several years dealing with the opioid epidemic has classified much of the problem as an addiction. That has resulted in severe restrictions on the use of pain medication even in cases where patients have severe pain, such as those patients dealing with cancer.

Dr. Susan Glod talked about her work, which specializes in hospice and palliative medicine. She spoke about the difficulty of some of her patients as they tried to deal with medical conditions. In a year, there are 2 million cancer patients, and 600,000 will die. These patients need a voice in any of the decisions that are being made regarding opioid control policy and legislation. She posed the question, what amount of suffering are we willing to accept on behalf of this population that is trying to deal with their severe pain and the quality of their life.

Dr. Patrick Byrne discussed his own experiences dealing with his pain management circumstances. He suffers from a severe back ailment. He emphasized that it is important how we talk about pain relief because there has been a great deal of misinformation. Dr. Byrne urged the lawmakers and attendees to seek out people and hear their stories and have a more informed basis when making these policy decisions.

Dr. Brendan Salone talked about the opioid crisis in three waves: In the late 90s, it was prescription opioid medication until 2010, then it became more of a heroin epidemic, and then switched over to fentanyl more recently. He called for a public health strategy, which he summarized as risk reduction, data-driven analysis that encompasses individuals, tailoring policy to individual populations, and taking a long term and intergenerational view toward policy.

Finally, Dr. Philip Graham, Center and Social Determinants from RTI International, made the argument for prevention. He indicated that he did a recent Google research search of prevention papers in terms of opioids and found only 213 documents, but when Dr. Graham did the same kind of search on treatment, he found 230,000 papers. His point was that much more attention is paid to the after results—treatment rather than the early intervention or preventions that might shut off some of these problems. He highlighted the reality that prevention is frequently the last resort, and he talked about some of the recent increases in the opioid funding that are going out to the states. He gave an observation about how many of the programs in states are faced with a deadline to spend funds. When they get near the last months of the funding period with a possible loss of unspent funds, only then does prevention get attention and dollars. Rather than turn the money back, they will then go to communities and different entities within the state to find prevention rather than lose the dollars. Prevention is an afterthought. He advocated for more prevention that is dedicated and consistently funded.

Mid-way through the briefing Congressman Bobby Scott (D-VA), the Chair of the Education and Labor Committee in the House of Representatives, gave remarks. He thanked the panel and the organizations for making prevention a focus of the briefing. He talked about the reality that there has been little constituency for investing in prevention, and more support is needed to raise the profile.

About the Author:

John Sciamanna is CWLA's Vice President of Public Policy.

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