Opioid Addiction is a Chronic Illness Requiring the Right Care, in the Right Setting, at the Right Time

December 19, 2017

With communities reeling from an epidemic of opioid addiction, Pennsylvania lawmakers are understandably focused on developing legislation to address the crisis. Their instinct to help is natural and laudable.

Doctors and nurses caring for overdose survivors in Pennsylvania’s emergency departments (ED) would certainly welcome a legislative silver bullet.

Unfortunately, opioids are highly addictive. They drastically change brain receptors. These changes lead to tolerance and physiologic dependence.

Clinicians approach opioid addiction as a chronic condition—just like obesity or hypertension. Managing chronic disease takes a lifetime of patient commitment and the right care, in the right setting, at the right time.

Addiction is a Chronic Disease

Recovering from any chronic disease, including substance abuse disorders, requires:

• Patients who trust their health care providers and are ready to work on the long-term medical management and lifestyle changes needed to improve health and quality of life
• Providers who employ their knowledge of the most effective, clinically proven treatments
• Enough resources—be they clinicians, medications, hospital beds, or outpatient therapies—that are affordable enough to accommodate those seeking help

This context provides a framework for considering recent legislative proposals to allow the involuntary commitment of those suffering from addiction.

For families desperately trying to protect the lives of loved ones who refuse to acknowledge their disease or request treatment, involuntary commitment may seem like the only sure way to keep them safe and begin recovery.

If only we knew that to be the case.

Involuntary Commitment as a Treatment Tool: We Don’t Know if it Works

Recovery counselors and treatment specialists tell us that patients suffering from substance abuse must be ready—not indiscriminately forced—to start treatment. The health care community has no clinical evidence showing that involuntary commitment leads to effective treatment and successful recovery.

In fact, there’s some evidence to the contrary. Involuntary abstinence and the resulting reduced tolerance for opiates can backfire. Studies show increased risk for overdose deaths after detox and rehab.

What About Resources?

The most common frustration for families seeking treatment for their loved ones is the lack of treatment options and the long waiting lists for inpatient facilities.

Involuntary commitment would make the situation worse. The influx of unwilling patients would exacerbate the stress on already overtaxed services. Meanwhile, potentially deadly delays for those who want treatment would increase.

Overdose Survivors in the ED: What Should be Done?

Let’s return to the patient in the hospital ED who has just survived an overdose. How best do we as families, concerned citizens, and healers make the most of that moment’s potential for life-saving intervention?

Pennsylvania’s clinical leaders have been developing ways to meet overdose survivors halfway, and to help those who are, or might be, ready to begin the journey to recovery.

I’ve written about these programs and their success rates. During the course of several months in one mid-state hospital ED, more than one in five overdose survivors agreed to enter treatment.

Hospital EDs recognize and embrace the pivotal role they can play in connecting survivors to treatment opportunities. But hospitals should not be asked to become temporary prisons for unwilling patients.

Providing the right care, in the right setting, at the right time must be the goal that guides us all. Let’s focus on making sure that Pennsylvania has the resources and services to help those who are ready and willing.