We could cut the opioid death rate by 50% – but we’re not | Maia Szalavitz


Well, I think like in terms of—seeing famous
people that we love die from drugs should make us question why we so stigmatize and
attack people with addictions. I mean some of our most beloved artists, musicians,
writers have been addicted. I mean I find it kind of interesting that
we don’t see addiction as a “white problem” when you have like William Burroughs and Lou
Reed and Kurt Cobain—and I could list 20 other heroin addicted rock stars. So, this is a condition that can affect not
just anybody, but people who are in some sort of emotional pain. Addiction kicks people who are already down. And it doesn’t look like celebrities should
be that kind of person. But I think that a lot of the drive and the
grit and the, you know, what you need in order to achieve great success is also a risk for
addiction. Because in order to be a successful rock star
you have to process despite rejection a lot and you need to be able to just keep going
and keep going. And if that kind of drive and passion gets
focused on a drug it is particularly destructive. So, I think in order to help deal with opioid
addiction, for one we need to have naloxone in every first aid kit. There is absolutely no reason why people who
are surrounded by other people should ever die of an overdose. If you are injecting and other people are
there—which is the case 50 to 60 percent of the time—naloxone should be there. And this is not going to encourage more drug
use, because it’s an awful experience to get awakened with naloxone, but it will save lives. And so that’s one way we can turn the tide
on this. The other way that I think we can turn the
tide on opioid addiction is we really need to provide greater access to drugs like methadone
and Suboxone, which is also called buprenorphine. Those two drugs taken indefinitely, i.e. potentially
for life, are the only thing that cut the death rate by 50 percent. And if we really want to solve this problem
we could get rid of half of it if we could enroll many more people in these maintenance
programs. Now there’s a lot of the barriers to that. One is that we only allow doctors prescribing
buprenorphine to see a hundred patients—now they just raised it to 200—this is ridiculous. They can prescribe opioids for pain to 10,000
patients but you can only prescribe for addiction to a hundred patients? This is really silly. We also have this idea that you can’t provide
these medications without also providing counseling. And we don’t to do that for any other medical
service. We don’t say, “You can only get your insulin
if you do X counseling on diet,” or whatever. We realize that people need the tools to stay
alive regardless of if they are improving as quickly as we would like them to do. And forced counseling doesn’t actually help
anyway. So what we should do is we should have different
thresholds for treatment. So with buprenorphine some people may just
want to show up and get a dose, and that’s it. And that will work as sheer harm reduction. That should be available in emergency rooms. You need to register people so that you don’t
end up with people getting multiple doses, and you need to be a little more careful with
methadone than with buprenorphine because there is a big overdose risk for patients
who are naïve to methadone, and it’s a difficult drug to prescribe. So that needs to be a little more controlled,
but we have it way too controlled and isolate it from the rest of medicine in a way that
we don’t do with any other drug. So, we have the tools to dramatically reduce
the death toll for celebrities and for everybody else—we’re just not using them.

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