Shuchin Shukla MD MPH: Pills can kill! But can they heal?
The 9th Judicial District Accountability and Recovery Courts, which covers Wayne, Lenoir and Greene Counties, are celebrating the month of May as National Treatment Court Month. This is one of four articles submitted by the Accountability and Recovery Court.
Most Americans take prescription medication. Whether for diabetes, high blood pressure, or asthma, people take medications to help them feel better and live longer, healthier lives. Minor side effects may occur but are worth the benefits that have been proven in research. As a family medicine physician, I have delivered babies, provided hospice care, managed chronic illnesses, and treated hepatitis C and HIV in countless patients over 15 years of practice. Like my colleagues, I have taken an oath to ensure that my decision making helps my patients, their families, and their communities.
Opioid use disorder is no different than other medical problems that I treat as a primary care doctor. Without medication treatment, people can suffer harm that worsens their health and may result in death. Methadone and Buprenorphine, both FDA-approved first-line standard-of-care treatments for opioid use disorder, have been used successfully for decades. Extensive research shows that these two medications for opioid use disorder reduce opioid misuse, reduce risk of HIV and hepatitis C transmission, and reduce overdose. Research also shows that these medications improve public safety: by reducing criminal activity that is driven by individual misbehaviors due to addiction and by disrupting the demand for drugs from traffickers and criminal networks. Thus, per the National Institute on Drug Abuse, these medications save money: not only through reduced healthcare expenditures like emergency room visits and hospitalizations but also improved workforce participation and reduced criminal justice system costs. From an economic and public safety perspective, let alone the health and moral perspective, this is a no-brainer.
Unfortunately, grave misconceptions persist about these medications. Top of that list: “people are getting high on these medications.” As an addiction medicine expert, I can assure you that this is untrue. While methadone, when taken excessively, can cause intoxication and even overdose, extensive federal and state regulations prevent this. Specialized clinics called Opioid Treatment Programs have specific protocols and staff in place to ensure that patients receive the right dose that reduces their risk of harm and continued drug use, but not enough to cause intoxication. And buprenorphine’s unique chemical profile prevents intoxication, even at extreme dosage levels. Because of this built-in safety feature, buprenorphine does not need the same regulatory framework and can be prescribed by any licensed provider and dispensed by any licensed pharmacy. Both medications are equally effective at the population level, but at the individual patient level, some will do better on one medication over the other. I have had countless patients with opioid use disorder, often with chaotic lives, poor social support, and terrible suffering. And I have seen countless times how these individuals start methadone or buprenorphine and almost immediately feel better, more clear-headed, and less driven by their addiction. I have seen mothers regain custody of their kids, fathers regain the ability to put food on the table, teens regain the ability to go to school and make a life for themselves. I have seen individuals who have repeatedly overdosed, almost dying more times than they can count… and then it all gets better once they start the medication.
Addiction at the population level is undoubtedly a complicated issue, with roots in childhood trauma, social circumstances, and even economic policies. But at the individual level, treating opioid use disorder with buprenorphine or methadone is more straightforward, more effective at improving life, and more gratifying for me as a physician than any other health condition I have ever treated. The treatment works, but it is up to us as a community to ensure it is accessible to all people who need it. Otherwise, we will continue to see the consequences in our communities: in our jails, in our homeless encampments, in our hospitals, and, unfortunately, in our morgues.
Shuchin Shukla MD MPH is a family medicine and addiction medicine physician in Durham, NC. He works for the North Carolina Technical Assistance Center, which provides free training and technical assistance to any agency in North Carolina that serves people at risk of incarceration and/or addiction.
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