HYANNIS, Massachusetts: Medical doctor, Ruth Potee, an outspoken primary care and addiction doctor, said at the recent Cape Cod Symposium on Addictive Disorders last week that detoxification units offering five to seven days of treatment will kill opioid addicts without proper follow-up.
“What we offer in this country is a joke,” Potee said. “And I run a detox.”
Potee and Michael Harle, president of the Pennsylvania addiction treatment and recovery organization Gaudenzia, also spoke to the hundreds of people who work in the field of addiction gathered for the four-day conference at the Resort and Conference Center. The two talked about how treatment needs to change 20 years into opioid epidemic.
Treatment professionals have known for decades that a weeklong stay in a detox unit alone is inadequate to change the course of an addictive disorder, Harle said. But there was a time when the stakes were not so high.
Addiction to alcohol moves more slowly than opioid dependency. And even pain medication and old-school heroin on the streets didn’t have the same potential to kill.
But now that fentanyl, an opioid 50 times powerful than heroin, is found in the majority of heroin tested in state laboratories in Massachusetts and elsewhere, the game has changed.
“The risk for death is just so much greater now,” Harle said.
Detoxification is the short-term placement where people go to wean off opioids, alcohol and benzodiazepines, because a sudden withdrawal of these drugs can cause seizures and possible death.
“I try never to use the word detox,” Potee said. “It’s really the first phase of recovery.”
Insurance fully covers detoxification, but not other forms of treatment. There are more detox beds in
Massachusetts than any other type of treatment facility. There were 916 detoxification beds in 2016 compared to 380 beds in rehabilitation facilities, according to the Massachusetts Bureau of Substance Abuse Services.
A detox treatment system can almost make things worse because users’ lower their tolerance while getting detoxed, but then go back out on the streets, said Potee, who works as a physician with the Valley Medical Group in Greenfield as well as medical director of the Franklin Recovery Center and Franklin County House of Correction.
“The concept of yanking a drug out of your brain is insane,” Potee said.
Going beyond detox
The best programs go beyond detox, so that a person is moved with a “warm hand-off” from medical detox to residential treatment or to a medication-assisted treatment program.
The topic of medication-assisted treatment brought Potee and Harle to another point. People who are addicted to heroin should be encouraged and have access to medication. There should be more providers of Suboxone and methadone, she said. These medications, in combination with counseling support, are the most effective standard of care for addiction treatment, Michael Botticelli, the former head of the National Office on Drug Control Policy, said numerous times last year.
Suboxone was approved to treat opioid addiction in 2002. Unlike highly regulated methadone, which must be distributed in special clinics, Suboxone can be prescribed by primary doctors after some short training.
Everyone from Potee’s clinic has received the Suboxone waivers, she said. But most doctors have not, she added. “Primary care doctors were supposed to do their damn job and provide this treatment but that’s not where we are.”
The most effective treatment is long term and comprehensive, but that doesn’t mean it is necessarily the most expensive, Harle said.
According to the Journal of Substance Abuse Treatment, a 2009 study of 904 physicians with addictive disorders who underwent treatment through Physicians’ Health Programs found that 78 percent of those doctors had no positive test for either alcohol or drugs over a five-year period of intensive monitoring. Post-treatment follow-up found 72 percent of the physicians were continuing to practice medicine.
The treatment involved close links to the 12-step programs with residential and outpatient treatment programs that were selected for their excellence, the study concluded.
The treatment was nothing new, Harle said. It was, basically, just made available to the patients — and it worked, he said.