Addiction Epidemic is More than Just Opioids

The Commonwealth of Virginia is devoting more time and resources to battling the opioid crisis. Part Two of our two-part discussion with Dr. Mary McMasters focuses on the disease of addiction and ends with a message of hope.

Dr. McMasters is a Virginia physician who is also board certified in addiction medicine and does consulting work for the Commonwealth specific to addiction.

Q: What progress has been made in combating the opioid epidemic here in Virginia?

McMasters: One of the biggest steps forward is that we are coming out of the closet and talking about the problem. Because of this, we are now getting more education about addiction into our medical schools. This is a disease that affects as many people as are affected by diabetes. Yet many of our healthcare providers have learned absolutely nothing about it. It’s great that addiction medicine is now being included in our medical school and healthcare curriculum.

Q: Why is the opioid epidemic so complex and multilayered?

McMasters: First of all, it’s not just opioids. It’s an addiction crisis and it’s been going on for a long time. No one has talked about it, and now it’s a huge problem. Addiction is not substance specific. It includes things that are legal, like tobacco and alcohol, and things that are illegal, like cocaine. And it also includes a lot of people who were legitimately exposed to things that trigger the disease of addiction, like pain pills.

Q: What strategies are being used here to combat the epidemic?

McMasters: Our Prescription Monitoring System, our relatively new tool for tracking whether people are obtaining multiple addictive prescriptions, is probably one of the best in the country. We are also working very hard here in Virginia to destigmatize the disease of addiction. And in 2017, Virginia introduced Addiction and Recovery Treatment Services (ARTS) which has enabled our Medicaid population to get evidence-based treatment for addiction.

Q: What is the difference between substance misuse and addiction?

McMasters: Well, the language surrounding the disease of addiction is confusing. An example of substance misuse is having a fourth drink of wine when you know you shouldn’t, and you know you’re going to get a hangover. The difference between misuse and addiction is a really big one. With addiction, you have loss of control. You can no longer control that decision about whether to have the fourth or fifth or eighth glass of wine or the fifth or six or seven hits of cocaine or heroin. Addiction is loss of control over choice.

Q: Can you explain medication assisted treatment for those suffering from addiction?

McMasters: The big problem with the disease of addiction, the subjective symptom that people have, is cravings, which can be absolutely overwhelming. That’s why people relapse.. Many times, people are  aware of the risk, but the cravings have overwhelmed them. Medication assisted treatment decreases the cravings so that people are not overwhelmed and so that hopefully they can engage in their recovery activities. The two medications we use for opioid addiction are Buprenorphine and Methadone.

Q: Medication assisted treatment drugs are often a controversial topic and people with addiction using them are often stigmatized. How can we change this?

McMasters: Yes, there is a stigma about medication assisted treatment, and I think it’s because of the misunderstanding that people think you’re substituting one opioid for another. That’s not really true. The opioids that people use addictively are causing dopamine spikes. They’re bouncing the dopamine in the brain up and down. When Buprenorphine and Methadone are used appropriately, they are calming the cravings down. People with a disease of addiction need to remember that the medicine is assisted addiction treatment. It is not the primary treatment. The primary treatment is learning to think differently. People need counseling. They need to go to their community support groups. Quite frankly, if you’re doing the medication assisted treatment and you’re not doing those other parts, it’s not going to work very well. It would kind of like be good being giving insulin to a diabetic patient without teaching them how to watch their diet.

Q: What does the recovery process include?

McMasters: Recovery is a lot more than just not using the substance. It’s a continued growth emotionally, spiritually and physically. Many people with the disease of addiction don’t need medicine. It’s just like diabetes. Many people with diabetes don’t need insulin, but they do have to watch their diet. People with the disease of addiction need to develop those lifelong support groups that they have in their communities. Other people need more. In addition to that, they may need counseling.

Q: The addiction epidemic seems insurmountable at times, yet you do believe there is hope.

McMasters: Yes there is. Addiction is a treatable disease.  Sometimes the first time we know somebody who has the disease of addiction is when they’re in intensive care unit with an overdose. Not every treatment fits every patient. But it’s important to follow a standard of care. And we have that for addiction just like we have for the disease of diabetes, for example. I love treating addiction because people get better and they get better in a hurry. The other thing about treating addiction and doing it right is not only does the patient get better, but you have an entire family system and a social system that gets better. So yes, there is hope.