Opioid Use Disorder a Solvable Problem

Newer therapy options can really help, says former House Speaker Newt Gingrich

http://www.medpagetoday.com/Psychiatry/Addictions/60212

Newt Gingrich, former speaker of the House of Representatives, has long had an interest in brain science mental health issues; in 1996 he worked with then-Sen. Pete Domenici (R-N.M.) to pass a mental health parity law requiring health insurers to cover mental illnesses to the same degree as other illnesses.

Gingrich recently co-founded an organization — along with former Rep. Patrick Kennedy (D-R.I.) and CNN commentator Van Jones — to support patients struggling with opioid use disorder. MedPage Today News Editor Joyce Frieden interviewed Gingrich recently about this venture.

JF: What interested you in this subject?

NG: I have had a very long interest in brain science in general and co-chaired with [former] Sen. Bob Kerrey (D-Neb.) a commission on long term care than ran for 3 years, as well as a second 3-year project on Alzheimer’s disease. Then Patrick Kennedy approached me 2 years ago on a project he was working on involving brain science. When he approached and said, “Could we do something on a bipartisan basis about an epidemic that is killing more people annually than automobile wrecks?”, it seemed like something worth paying attention to.

I am now 2/3 of the way through “Dreamland: The True Tale of America’s Opiate Epidemic,” an astonishing book about rise of heroin addiction. It’s a little challenging to read because there is so much material and it is written so well; you find yourself learning so much your brain gets overwhelmed.

JF: What additional treatment options should be available for people struggling with opioid abuse?

NG: Buprenorphine has been around in more traditional forms; one study published in 2002 says it increases the odds of not taking an opioid by 3.5 times. What’s happened in the last 2 years is that they have been introducing an implantable version — you gradually get it over 6 months. That solves the question of compliance, and in addition, it’s not resellable. That’s one of the great concerns out of local law enforcement about buprenorphine — putting something on the market at a time when people should not have access to it.

It also involves less inpatient treatment — in a lot of cases you may need a brief period of detoxing, but in the long run, this involves much more outpatient treatment and much less inpatient.

JF: What else is not well-known about this problem?

NG: One of the points the author of “Dreamland” makes is the degree to which Medicaid was a major enabler of getting the drugs as the addiction process began on the pill side, as opposed to the heroin side. It was fascinating to learn how Medicaid coverage and Medicaid policy led to extraordinary abuse of the whole system. People would “doctor shop;” they would have a $3 copay and all else was paid for by the taxpayer. People were getting treated by five different doctors and the taxpayer was in effect subsidizing their habit, and then they would go out on their own selling the drugs.

Ironically, Medicaid now has very severe restrictions against playing an appropriate role in helping people get off these drugs. I don’t believe the parity bill has been effectively implemented in Medicaid; there is overwhelming evidence of that in state after state. People can’t get to a doctor; the number of people a doctor can [use medication-assisted treatment for] is very limited. If you were implementing the parity bill, you’d never have a cap like that.

JF: What is the goal of your foundation, Advocates for Opioid Recovery?

NG: Our biggest goal is to get people to understand that this is a physiological challenge that can be met with a medication response that statistically has a very high likelihood of being effective. We’re raising awareness; we have been commissioning research and hope to have a series of reports coming out.

JF: How do you respond to concerns about patients on buprenorphine possibly having to take it for the rest of their lives?

NG: If you have a substantial population of people who are addicted, you want to find an appropriate medical response to the addiction. Otherwise, you are advocating something that’s medically obsolete — you’d never tolerate that for breast cancer, for example, or kidney disease. As for lifelong treatment, you want to discuss insulin? Or statins? It’s the nature of how we’re learning to respond to certain challenges; you can keep people alive a lot longer, but it does involve intervention.

JF: What are some of the barriers to helping people understand this problem?

NG: I think people are more aware of the problem than they are of the solution. One barrier is that there are a lot more people who are capable of being saved than we understand. Another part of the problem is that people are looking at 1-year budgets, and you don’t have kind of organized effort you have for AIDS, for example. More people are dying of opioid overdoses than from car wrecks, and yet the response from the public has not been as aggressive in demanding that we change behaviors.

JF: Do you have any misgivings about advocating that the government spend more money on this issue?

NG: When I was the Speaker of the House, we balanced the federal budget while doubling the size of the National Institutes of Health. I am very willing to spend money where appropriate, which doesn’t necessarily mean I’m for big government or for waste. This is something that is in the public interest.

Newt Gingrich, PhD, served as Speaker of the House of Representatives from 1994-1998. A former Republican Congressman from Georgia, he was the founder of the Center for Health Transformation, and is a co-founder of Advocates for Opioid Recovery, a non-partisan organization. Gingrich is a Fox News contributor and the author of 27 books.