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Treatment Works … Let’s Promote It

Submitted By Michael Rizzi, Chair, OTARI; Past President of CODAC Behavioral Healthcare

“The rising toll of overdoses” (Friday, 12/29), brings renewed attention on the tragedy unfolding in Rhode Island. While important to recognize the increasing availability and use of naloxone, specialized treatment in emergency rooms and screening in the State’s prisons, there is little mention of RI’s long history of providing opioid treatment and existing capacity to do so.

Currently, over 4500 Rhode Islanders are establishing, maintaining, and celebrating their recovery at RI’s 5 Opioid Treatment Programs (OTP). The Opioid Treatment Association of Rhode Island (OTARI) – Addiction Recovery Institute (ARI), Center for Treatment and Recovery (CTR), CODAC, Discovery House, The Journey to Hope, Health and Healing – provide Medication Assisted Treatment (MAT) using the three federally-approved medications for the treatment of opioid use disorder (methadone, buprenorphine, and injectable naltrexone). However, we are not only medication.

OTARI members are licensed by RI’s Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals; Department of Health; certified by the Substance Abuse and Mental Health Services Administration and the Center for Substance Abuse Treatment; registered with the Drug Enforcement Administration; and accredited by the Commission on Accreditation of Rehabilitation Facilities. Collectively, they impose over 3000 standards for quality, safety, and accountability. Forty plus years of experience, combined with evidence-based, best practice standards, makes RI’s OTPs true specialists in treating this chronic disease. We have been preventing overdoses, and saving lives since 1974.

We provide Health Home services to over 2600 patients, demonstrating how coordinated care and support reduces healthcare costs. These services are supplemental to the existing counseling, medical, and other recovery supports and include case management, accompanying patients to appointments, care coordination with primary and specialty medical practices, tobacco cessation, nutritional guidance, housing, legal, and other activities associated with improving and supporting health and wellness.

It’s no secret that many of our patients maintain their recovery in the shadows, largely due to the continuing marginalization of methadone – as if this life-saving medicine is the problem – while other medications are “better”, “nicer”, and more socially acceptable – and patients receiving methadone are branded with the equivalent of a “Scarlet M”. While this is less true for buprenorphine and naltrexone, the stigma and discrimination attached to being on any medication for this disease is enormous.

However, when treatment and related recovery support for this disease are excluded from the discussion, the illusion of “no treatment” is created. Not only is this unfair and untrue, it is dangerous. Failure to provide information about the scope and availability of treatment deprives the reader of valuable information and the opportunity to make an informed, and perhaps, life-saving choice for themselves or others.

Leaving treatment out of the discussion is another form of stigma and discrimination and discourages engagement.

It is ironic that after almost 50 years of saving lives and families, reducing criminal behavior, and preventing overdose, our patients and potential patients continue to be identified by their medication.

MAT exists for many illnesses, but where else in medicine is a patient with a chronic disease defined by their medication? There are no insulin or Lipitor clinics or patients. Nor is it ever suggested that these patients stop taking their medication. It is unlikely that a person living with diabetes will ever be told, “you’ve been on insulin long enough, it’s time to stop.” There is no moral judgement, nor are they blamed or shamed for their illness. For them, as well as those living with Opioid Use Disorder, “the right medication, at the right amount, for the right amount of time”, is the standard for good, chronic care management. Our patients deserve nothing less.

OTARI is committed to providing comprehensive, respectful care and is actively engaged in efforts to address and respond to the tragic increase in overdoses and overdose-related deaths and we continue to work with the Governor’s Task Force to expand and enhance access to care.

I suggest future conversation include discussion of this proven and effective treatment for opioid use disorder and the hope it provides for so many.