We Can Treat Addiction, But It’s Harder to Treat Stigma
By: Zac Talbott
Addiction is complicated. It is incredibly difficult for each person who is trying to get through it to the other side. It is tough on their families. It is also a disease. It is a health issue. Sadly, that fact is too often forgotten by those who develop policy. Right now, Tennessee is embroiled in a debate about the fetal assault law, a policy that threatens pregnant women and mothers who have used drugs as a type of scare tactic to try to get them to seek treatment.
I have worked with many people who are in recovery or who are trying to get there. Addiction can be treated, but it needs to be done from a public health approach, not a punitive one. Medication-assisted treatment is a protocol that uses medication along with individual counseling, group therapy and other psychosocial support. If a person is addicted, medication allows them to stabilize functioning by eliminating physical withdrawal symptoms and psychological cravings. It is not as some suggest substituting one addictive drug for another. If used properly, the medication does not create a new addiction. It simply helps people manage their addiction so that they can move forward. It is substituting illicit drug use with a legal, proven effective medication.
Medication assisted treatment is the recommended, evidence based standard of care for pregnant women, but right now people in Tennessee face many obstacles. There are only 12 licensed opioid treatment programs that provide methadone-based treatments throughout Tennessee. That means that people living in rural areas may have to travel – sometimes hours each way - to get to the closet center. Imagine having to travel hours every day to get medical care. Additionally, TennCare and most other health insurances discriminate against these evidence-based approaches and will not cover services received from opioid treatment programs. Methadone treatment in Tennessee typically costs between $13-$16 a day. That’s $362-$448 per month and more than $4,700 a year. Many people who are struggling with prescription pain killer and/or heroin addiction just cannot afford that kind of out of pocket health care cost.
Another option for medication assisted treatment is buprenorphine (known by the trade names Suboxone, Subutex or Zubsolv). This option is covered by TennCare by prescription at a physician’s office (but not in a comprehensive opioid treatment program), but in January of this year there were limits placed on buprenorphine benefits. The state drug treatment association received calls right away after these changes went into effect from pregnant women who could not afford the extra cost that comes when they have to increase their dosage to accommodate for their pregnancy, but are also told that if they utilize TennCare benefits they will have to pay more out of pocket.
Addiction can be managed. FDA-approved medications are important tools in helping people move forward to regain a healthy, productive life. The financial barriers to treatment are challenging, but it is made even tougher when women are also faced with the prospect of jail time.
Recovery is about creating a better life for the individual and their loved ones. Threats of jail or policies that perpetuate judgment on people who have used drugs do not help anyone. The current policy has made women afraid to seek prenatal care. It has wasted tax dollars incarcerating mothers while doing nothing to expand access or improve the affordability of the range of treatment options or the support that will actually improve the health of women and their babies.
The Tennessee fetal assault law is not helping people who live in rural areas where there is no care available. It is not helping low-income women who cannot afford to pay for substance abuse treatment out of pocket. That is what people really need. If Tennessee is serious about supporting the health of women and their families, if Tennessee is serious about confronting the opioid addiction and overdose epidemic plaguing our state and nation, they should stop putting more money into criminal justice system responses to what is a public health crisis and start supporting evidence-based, proven effective medication-assisted treatments for the disease of opioid addiction.
Zac Talbott is a native resident of Maryville, Tennessee, the Director of the Tennessee and Northwest Georgia chapter of the National Alliance for Medication Assisted Recovery (NAMA), and a co-owner and the program director of Counseling Solutions of Chatsworth, an opioid treatment program in Chatsworth, Georgia. He is a certified medication assisted treatment advocate (CMA), an alcohol & drug abuse counselor, and an individual living in longterm, sustained recovery from prescription painkiller and heroin addiction himself.