A Conservative Approach to Battling Maryland’s Opioid Addiction

I still remember the first time I heard about the opioid crisis. As a college student years ago at Frostburg State we were studying the effects of heroine and prescription painkiller abuse during my Criminal Justice in Action course and I couldn’t help but think how distant this “crisis” seemed to me. I had never known anyone with an opioid addiction, and the people we discussed in class all seemed like those people you watch on Cops – surreal.

After graduation I was hired to work as a District case manager for Congressman Roscoe Bartlett, a job that afforded me the opportunity to learn more about the issues facing Marylanders – especially those that weren’t given a lot of attention in those days. As I became more involved in the community I witnessed firsthand the havoc that addiction can wreak on individuals, families and communities, and how it was specifically affecting Maryland. In addressing these issues facing our constituents, I found myself drawn back to what I learned at Frostburg, especially when it came to the importance of truly understanding the opioid problem and how to fully go after it.

Plato’s tripartite theory of the soul is often called “theory of the psyche.” Plato split a person into three (not wholly equally) parts: the logical, the appetitive, and the spirited. The just soul finds the spirited and the logical in alignment and resisting the impulses from the appetitive portion of the soul. In the unjust soul, the spirited aligns more with the appetitive, ignoring the logical portion and feeding the desire for bodily pleasure.

Because modern science has marginalized philosophy, we rarely approach issues like the opioid crisis with a nod to the brilliant thinkers of the past. However, better understanding the opioid crisis afflicting Maryland’s families with that philosophic foundation can help us better understand how we can find the best solutions and holistic ways to better order someone’s soul so that they can be just again.

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Between January and September of 2016, 1,468 people died from overdoses in the state of Maryland. Drugs now officially account for more deaths than guns and cars according to the CDC. West Virginia is the state most affected by drug overdose deaths per 100,000 people – an unfortunate and grim characteristic shared by much of Appalachia, including Western Maryland.

When drugs aren’t taking away loved ones, they’re the cause of increased crime in our cities, the source of destruction in our families that reverberate through the communities, and contribute to increased cost and overcrowding in our prisons.

So when I talk about approaching the opioid crisis with Plato’s teachings in mind it might seem a little far-fetched. However, across the country states and jurisdictions are discovering the need to approach the opioid crisis with a more holistic approach. Gone are the days of “the beatings will continue until moral improves” – style thinking that advocated strict punishments and complete abstinence for substance abuse offenders. Instead even red states like Arizona have abandoned any hardliner stance toward opioid addiction in favor of Medication-Assisted Treatment (or MAT) to help combat opioid recidivism.

Recently the American College of Physicians published a paper in the Annals of Internal Medicine that called substance use disorders of both prescription and illegal drugs a “serious public health issue” and encouraged that they be considered “treatable chronic medical conditions.” Despite the rise in heroine-related deaths as well as deaths from prescription painkillers, researchers found that “80 percent of people with an opioid addiction are not getting treatment.”

Programs that optimize MATs to ensure more promising success rates are becoming key to helping us better combat opioid dependency. MATs contribute to dealing with that coupling of the spirited and appetitive parts of the soul, which drive people to break laws and ruin relationships during their quest for a greater high.

Research into the treatment of opioid addiction has found “Buprenorphine treatment significantly decrease[s] the number of opioid-positive drug tests; multiple studies found a 75-80 percent reduction in the number of patients testing positive for opioid use.” But even with the success of buprenorphine treatments, not all buprenorphine treatments are created equal and Maryland learned that first hand. Maryland’s Medicaid department recently removed Suboxone from the preferred drug list because of the unintended consequences like black-market smuggling in Maryland’s prisons, illicit street use, and over-prescription, that came along with it.

Suboxone is dispensed much like a Listerine strip as opposed to a tablet or pill, which was how Suboxone used to be made available before the manufacturer changed the delivery vehicle in order to game the patent system. Problems arose however, as the strips made limiting prescribing precise dosages more difficult. Couple that with the fact that the drug was no longer a pill but now more of a very thin “film strip” and Suboxone became easy to divide and divert for illegal sales and conceal and smuggle into Maryland’s prisons.

As a result, Maryland’s Medicaid department replaced Suboxone with Zubsolv, which is the same type of treatment only in pill form and contains 30% less active ingredient, making it less likely to be used recreationally. The Washington Times reports that “Since Suboxone film strips were removed from the Medicaid Preferred Drug List in July, the amount of the drug recovered in Maryland correctional facilities as contraband has decreased by 41 percent, according to Maryland’s Department of Public Safety and Correctional Services.” In short, Maryland is looking to solve not just one aspect of the crisis on the state level, but implementing programs that help each person battle back against opioid addiction by balancing myriad techniques, and learning from those that work.

Just like the unjust soul tipped out of balance, solving the Free State’s opioid crisis is going to require an approach that helps each person bring balance into his or her life. Not all treatments for opioid addiction are created equally and Maryland’s P&T committee recognized this when they voted unanimously to change the preferred drug list to help curb the secondary effects of Suboxone in the prisons and in homes. There are no simple solutions to this problem, but Maryland’s steps toward fighting the opioid epidemic are heading in the right direction and making sure it is addressed more comprehensively… which is to everyone’s benefit.

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