A wise man once told us that the difference between staying off drugs and staying off drugs is the difference between a wedding and a happy marriage.

“A wedding is a big deal, but it has nothing to do with a happy marriage,” observed Walter Ling, professor of psychiatry and founding director of Comprehensive Addiction Programs at the University of California, Los Angeles, when we began tracking tragedies in the industry. addiction treatment. “Now our whole treatment system is wedding-oriented.”

Ling’s research – and the work of many others – has shown the effectiveness of drugs in the fight against drug addiction. California was pushing its 1,800 licensed medical facilities to accept these drugs for years — drugs that bind to the brain’s opioid receptors and prevent opioid highs, helping people manage cravings, prevent overdoses, and generally pave the way for a happy marriage.

But a huge portion of treatment plants in California – 41% – are resisting. They did not provide “pharmacotherapy services” to their patients at all, despite the dramatic increase in overdoses and deaths, according to data compiled by the Substance Abuse and Mental Health Services Administration.

Only 22% of outpatient facilities in California – where treatment is most often offered – offered methadone, buprenorphine, or naltrexone treatment. These are the gold standards for dealing with opioid addiction.

And only 59% of rehabilitation programs offer overdose education and naloxone, a drug that can reverse opioid overdoses and virtually bring people back from the dead.

why? It’s a holdover from the abstinence-only “don’t substitute one drug for another” philosophy that drives so many 12-step programs in the state — especially in Orange County, the hotbed of California’s drug industry — and it’s an outrage. Researchers from The Pew Charitable Trusts initiative for the prevention and treatment of the use of psychoactive substancespushing states like California to adopt very specific data tracking that can shed light on what works and what doesn’t – and save lives.

Follow the numbers

California and many states have public ones dashboards tracking overdose deaths, emergency room visits, hospitalizations, and opioid prescriptions. “But too few track the full range of indicators, including how many people are diagnosed with OUD (opioid use disorder), the number of providers available to treat them, the use of FDA-approved medications, or the length of treatment and outcomes,” Pugh said. .

You can’t manage what you can’t measure, the old saying goes, but officials won’t agree what should be measured. So Pew convened its own panel of experts, and it settled on key dimensions in the life cycle of chronic disease, the “cascade” from initial diagnosis to final outcome. The approach is used around the world to fight hepatitis C, HIV, diabetes and other chronic diseases, and it could be used here, they said.

What should be tracked? Try the percentage of people with a documented diagnosis of OUD. How many were assessed using a standardized screening tool. Who receives medication as part of a treatment plan. The number of providers and treatment programs that can provide the medication. Percentage of those using medication for at least six months; who receive follow-up for substance use or overdose within seven and 30 days of an emergency department visit for substance use issues; and a few other relevant things.

“My hope is that states across the country will adopt this set of measures and start to understand what’s really going on in treatment,” said Pew’s Frances McGuffey. It should then be used to implement the most effective policies.

Drug addiction treatment it’s a $42 billion business in the US, most of it is paid for by the government and private insurers who, last time we checked, got their money from you and me. Orange and Los Angeles counties are home to more than half of the state’s licensed or certified substance abuse treatment programs. Of course, it would be nice to spend that money where it works best. With over 100,000 overdose deaths in one year, something is clearly wrong.

In Orange County, 503 people died of opioid overdoses and 1,181 went to the emergency room. according to 2020. In a county of 3 million people, more than 1 million opioids were prescribed.

Steps forward

State officials could not share their thoughts on the Pew program by deadline, but Dr. David Kahn, an addiction medicine specialist and past president of the California Society for Addiction Medicine, believes they would be very helpful.

“Overall, they have the right metrics, from diagnosis to treatment, from soup to nuts,” Kahn said, speaking only for himself.

But there are things he would like to see added — including the involvement of methadone and the distribution of naloxone. According to him, naloxone is not a cure, but a preventative measure – the drug is the most proven treatment for fatal overdoses, with drug treatment (buprenorphine, etc.) coming in second. Knowing who receives naloxone and how it affects survival would be most valuable: Among people who survive an overdose, nearly 10% die within a year, Kahn said.

According to SAMHSA, there are more than 1,700 substance abuse treatment facilities in California that treat more than 70,000 clients, including more than 2,000 children. When we first began reporting on the industry in 2017, there were only 1,000 physicians with a federal buprenorphine waiver. Today there are more than 5 thousand of them.

“From 30,000 feet, I’d say we’re doing better in terms of treatment,” Kahn said.

But we clearly have a way to go before we reach the “happily married” stage.