BY DR. INDRA CIDAMBI
Governor-Elect Phil Murphy,
You will be taking the reins of New Jersey from Governor Chris Christie in just a few weeks. You will inherit a state, just like large parts of America, ravaged by addiction to drugs that has left communities and families grappling with the fallout from loved ones entrapped by this disease. As per the Star-Ledger, “deaths from drug overdoses (in New Jersey) likely topped 2,000 in 2016, killing more people than guns, car accidents and suicides combined.”
I am on the frontlines of fighting this epidemic – I treat patients suffering from substance use disorders every day, as the Medical Director at Center for Network Therapy. While there are successes, often times, it can seem hopeless; individuals suffering from this chronic disease rotate through treatment facilities without getting a grip on recovery. With well over a decade of my career dedicated to helping people suffering from addiction, I have learned that individualized treatment to fit the patients’ needs that is integrated with his/her living environment is key. With right treatment, there is light at the end of the tunnel. I have faith that you will rise to the challenge and help make a dent in this epidemic. In my humble opinion, you should keep the following in mind in order to deliver better results and help save lives.
Support Innovative Treatment Modalities: When you cast an analytical eye at incumbent addiction treatment options, I am sure you will ask, “Is the traditional inpatient treatment model failing individuals with addiction issues?” It pains me to witness the current “go to” form of treatment – in-patient detoxification and rehab – failing people suffering from substance use disorders. However, I am happy to note that you plan to rein in excessive out-of-network costs. This will help keep people with addiction issues stay closer to home instead of going to “Florida” for resort-type “treatment.”
Extending that line of thinking, I believe the outpatient treatment model should be emphasized. It teaches individuals with addiction issues to stay sober in the home environment, as opposed to being isolated from it. I pioneered the use of Ambulatory (Outpatient) Detoxification in New Jersey at the Center for Network Therapy nearly five years ago and we have delivered results that are far superior to inpatient detoxification. The reasons for the higher success rate are individualized treatment, bringing the patient’s network into treatment and teaching the patient to stay sober in his/her home environment. I sincerely hope that you will examine this innovative model and embrace it, as it not only delivers higher efficacy, it also lowers costs significantly. The cost of sticking to the status quo treatment modalities in terms of human lives is just too great.
Advocate Decriminalization (Offers Dual Benefits): Just take a look at the data! As per the FBI, there were roughly 1.5 million arrests for drug law violations in 2015 and four out of five were for possession, not sales or manufacture. Decriminalization of drug possession related violations may offer the biggest bang for the buck because, according to the U.S. Department of Justice, more than 50% of the costs tied to illicit drug use are related to criminal justice and incarceration. It is time we utilize the ‘token economy’ modality of treatment that universally offers individuals a clean record upon successful completion of addiction treatment. This would cut criminal justice costs dramatically and also enable those in recovery to more easily re-integrate into the economy. Currently, I find many individuals in recovery are frustrated by their inability to re-enter the workforce due to charges on their record. It also acts as a trigger for relapse.
Focus on Prevention: You are right to highlight prevention as a first line of defnse. The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place. In 2015, 58% of overdose deaths involved prescription medication. To reverse this trend, not only should there be a vastly greater investment in educating the public about the addictive potential of some prescription medications, but also a push to allowing only physicians in certain specialties with a fuller understanding of the underlying disease requiring addictive medications to prescribe them. Another idea would be that the government mandate that every physician’s office display educational posters that warn about the addictive potential of certain medications, such as opiates (used to treat pain), benzodiazepines (used to treat anxiety), and stimulants (used to treat Attention Deficit Hyperactivity Disorder). This approach will encourage patients to have an informed conversation with their physicians about limiting the use of addictive medications.
Recognize that Medication is not a Panacea: MAT (medication assisted treatment) does not mean utilizing medication alone as treatment. Medication needs to be used in conjunction with therapy to effect life style changes needed to stay on the path to sobriety. In the recent past, an expanding class of medical professionals have been allowed to prescribe medication needed to treat addiction. There cannot be a bigger blunder than this. Even if overdose deaths dip in the near-term, it will likely prove to be the proverbial “calm before the storm.” It is well known in the addiction treatment community that ready availability of certain medications only leads to more indiscriminate use of drugs, as the user has medications on him/her to address withdrawal symptoms or, in certain cases, protect from overdose. The incentive to engage in wholesome treatment, that is desperately needed, is dramatically lowered. After all, if one has a heart condition, would it be in the patient’s best interest to obtain medications from any physician (who is not a cardiologist), nurse practitioner or physician assistant who has little knowledge of treating heart conditions? Then why so, for people with addiction issues? Is their life less valuable?
Dr. Indra Cidambi is the former Director of Detoxification and Rehabilitation at Summit Oaks Hospital in Summit.