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transcript
This transcript was created using speech recognition software. While it has been reviewed by human transcribers, it may contain errors. Please review the episode audio before quoting from this transcript and email transcripts@nytimes.com with any questions.
My name is Jeneen Interlandi and I’m a writer for the New York Times editorial board.
[MUSIC PLAYING]
I wanted to write about addiction because I see it really as one of the leading public health crises facing the country. You have some 48 million Americans struggling with addiction, and only like 5 percent of them are getting any kind of help for that condition.
We lose 100,000 or so people every year to overdoses. And to convey how serious it is and how big a problem it is, a thought exercise often helps. So pick your favorite college football team. And imagine them playing in one of the nation’s largest college football stadiums. For me it’s University of Michigan is one of the biggest, and that’s my team.
So imagine that stadium is full. And when you pan out you just see a sea of your favorite colors and you see all of those cheering faces and shouting faces. It’s a big full stadium. Now imagine every last person in that panned out image is dead. That’s how many people we lose to overdose every year in this country.
So it’s easy when you come away from those numbers and that image and all of that death and despair, to think, well, there’s nothing we can do. A common assumption that people have is that number one, addiction isn’t treatable. And number two, even if it were treatable most, quote-unquote, “addicts,” most people who have substance use disorders, don’t have any interest in getting help anyway, so there’s no point in trying. But both of those assumptions turn out to be incorrect.
In fact, effective treatments do exist. We’ve poured many millions of dollars into addiction treatment research over the past half century. And it has yielded lots of insights about behavioral therapies and also treatments, medication treatments like methadone and buprenorphine. And it turns out that when you use those things correctly, you can actually make a difference. You can actually get people who are struggling with addiction to a stable place, and you can keep them there for a lot longer than you might imagine.
Over the course of my reporting as I began to interrogate these two central assumptions, the overarching question to me became, how do we make addiction look more like the chronic health condition that most experts tend to agree it is? So how do we make it look more like diabetes, for example, and less like this portal to despair, and death, and agony that it so often is? And the answer is that I think we have to start making addiction treatment look a lot more like the rest of medicine does.
One of the biggest problems is that we don’t have enough treatment options available. So there aren’t enough facilities. There aren’t enough programs for people to actually go to. And one of the reasons for that is that we have a very serious workforce crisis among all of behavioral health care. But addiction is a part of that. There’s two components to that workforce problem.
One is that the non-medical people who do this work, everyone from the social workers to the drug counselors to the recovery coaches, don’t get paid enough money. And so they’re fleeing the workforce. And then the other problem is that less than 1 percent of the doctors in this country specialize in addiction treatment, even though it kills so many people every year.
If you create incentives, doctors will come. More fellowships and more tuition reimbursement programs would lure people into the profession. All public university medical schools are beneficiaries of public funding, so you could see a case for saying, OK, if you want state or federal funding for your medical school, you are required to make sure that everyone that graduates from your medical school understands the fundamentals of addiction and is prepared to treat addiction.
Another challenge has to do with methadone. State and federal regulations make methadone very difficult for doctors to prescribe and for patients with opioid use disorder to access. Methadone is a complicated medication and it does come with risks. It’s an opioid itself. So we have to be mindful of that. But it has been FDA approved to treat addiction since the early 1970s. And the biggest problem with it is not its safety risks. The biggest problem with it is that it is still harder for most people to access than a bag of heroin that they could buy on the street.
Doctors cannot prescribe methadone to people to treat their opioid use disorder in their regular practices. If you have opioid use disorder and you want methadone, you have to go to a specialty clinic called an opioid treatment program. You have to have a special license to operate one of these clinics. The licenses are very difficult to get. There are not a lot of these clinics because they’re so difficult to get licensing for. And that means if you’re a person with use disorder, you might have to travel up to two hours one way to get your dose. And you have to do it every single day.
The good news on the methadone front is that lawmakers have a bill right now, the Modernizing Opioid Treatment Access Act. And it’s a bipartisan bill. And what it would do is it would allow any doctor who is board certified in addiction medicine to prescribe methadone. And it would allow pharmacies to carry methadone and to dispense it to people who have a prescription for opioid use disorder. Those things can’t happen right now. But with this law, they would be able to.
I think the single biggest missed opportunity by far to turn the tide of addiction rests with the criminal justice system. Roughly half of the people in this country who are incarcerated struggle with some form of substance use disorder. If we can get them when they’re incarcerated access to medications and to therapies that can help them, we can make a huge difference in how they fare once their incarceration is over.
A really good example, in Rhode Island back in 2016 when they figured out that an inordinate portion of the people who were dying from overdoses in their state were dying just within the first few weeks after being discharged from prison or jail. And so what they did was, say, OK, we’re going to create a program that gives every single inmate access to a full suite of treatment while they’re incarcerated. So that means that we offer them one of three primary medications to treat opioid use disorder. We’re going to create warm hand-offs for them, so that when they get out of incarceration they actually have a way to continue that treatment. And we’re going to give them all of the other supports that they need for treatment to actually work.
And guess what happened. You flash forward to just a couple years later, the overdose rate among their inmate population post incarceration went down by 60 percent. That’s not by coming up with something that didn’t already exist. That’s by providing medications that have been available in this country for years.
So it’s easy to look at addiction and see an impossible, intractable, unsolvable problem and say this is just the way it is. And it’s the way it’s always been. But America has faced intractable, impossible, difficult problems before. And we’ve risen to meet them. Think about the AIDS crisis. Think about tobacco consumption. Those were huge public health challenges. And we rose to meet them and we addressed them in constructive productive ways. We can do the same thing with addiction.
[MUSIC PLAYING]
transcript
This transcript was created using speech recognition software. While it has been reviewed by human transcribers, it may contain errors. Please review the episode audio before quoting from this transcript and email transcripts@nytimes.com with any questions.
My name is Jeneen Interlandi and I’m a writer for the New York Times editorial board.
[MUSIC PLAYING]
I wanted to write about addiction because I see it really as one of the leading public health crises facing the country. You have some 48 million Americans struggling with addiction, and only like 5 percent of them are getting any kind of help for that condition.
We lose 100,000 or so people every year to overdoses. And to convey how serious it is and how big a problem it is, a thought exercise often helps. So pick your favorite college football team. And imagine them playing in one of the nation’s largest college football stadiums. For me it’s University of Michigan is one of the biggest, and that’s my team.
So imagine that stadium is full. And when you pan out you just see a sea of your favorite colors and you see all of those cheering faces and shouting faces. It’s a big full stadium. Now imagine every last person in that panned out image is dead. That’s how many people we lose to overdose every year in this country.
So it’s easy when you come away from those numbers and that image and all of that death and despair, to think, well, there’s nothing we can do. A common assumption that people have is that number one, addiction isn’t treatable. And number two, even if it were treatable most, quote-unquote, “addicts,” most people who have substance use disorders, don’t have any interest in getting help anyway, so there’s no point in trying. But both of those assumptions turn out to be incorrect.
In fact, effective treatments do exist. We’ve poured many millions of dollars into addiction treatment research over the past half century. And it has yielded lots of insights about behavioral therapies and also treatments, medication treatments like methadone and buprenorphine. And it turns out that when you use those things correctly, you can actually make a difference. You can actually get people who are struggling with addiction to a stable place, and you can keep them there for a lot longer than you might imagine.
Over the course of my reporting as I began to interrogate these two central assumptions, the overarching question to me became, how do we make addiction look more like the chronic health condition that most experts tend to agree it is? So how do we make it look more like diabetes, for example, and less like this portal to despair, and death, and agony that it so often is? And the answer is that I think we have to start making addiction treatment look a lot more like the rest of medicine does.
One of the biggest problems is that we don’t have enough treatment options available. So there aren’t enough facilities. There aren’t enough programs for people to actually go to. And one of the reasons for that is that we have a very serious workforce crisis among all of behavioral health care. But addiction is a part of that. There’s two components to that workforce problem.
One is that the non-medical people who do this work, everyone from the social workers to the drug counselors to the recovery coaches, don’t get paid enough money. And so they’re fleeing the workforce. And then the other problem is that less than 1 percent of the doctors in this country specialize in addiction treatment, even though it kills so many people every year.
If you create incentives, doctors will come. More fellowships and more tuition reimbursement programs would lure people into the profession. All public university medical schools are beneficiaries of public funding, so you could see a case for saying, OK, if you want state or federal funding for your medical school, you are required to make sure that everyone that graduates from your medical school understands the fundamentals of addiction and is prepared to treat addiction.
Another challenge has to do with methadone. State and federal regulations make methadone very difficult for doctors to prescribe and for patients with opioid use disorder to access. Methadone is a complicated medication and it does come with risks. It’s an opioid itself. So we have to be mindful of that. But it has been FDA approved to treat addiction since the early 1970s. And the biggest problem with it is not its safety risks. The biggest problem with it is that it is still harder for most people to access than a bag of heroin that they could buy on the street.
Doctors cannot prescribe methadone to people to treat their opioid use disorder in their regular practices. If you have opioid use disorder and you want methadone, you have to go to a specialty clinic called an opioid treatment program. You have to have a special license to operate one of these clinics. The licenses are very difficult to get. There are not a lot of these clinics because they’re so difficult to get licensing for. And that means if you’re a person with use disorder, you might have to travel up to two hours one way to get your dose. And you have to do it every single day.
The good news on the methadone front is that lawmakers have a bill right now, the Modernizing Opioid Treatment Access Act. And it’s a bipartisan bill. And what it would do is it would allow any doctor who is board certified in addiction medicine to prescribe methadone. And it would allow pharmacies to carry methadone and to dispense it to people who have a prescription for opioid use disorder. Those things can’t happen right now. But with this law, they would be able to.
I think the single biggest missed opportunity by far to turn the tide of addiction rests with the criminal justice system. Roughly half of the people in this country who are incarcerated struggle with some form of substance use disorder. If we can get them when they’re incarcerated access to medications and to therapies that can help them, we can make a huge difference in how they fare once their incarceration is over.
A really good example, in Rhode Island back in 2016 when they figured out that an inordinate portion of the people who were dying from overdoses in their state were dying just within the first few weeks after being discharged from prison or jail. And so what they did was, say, OK, we’re going to create a program that gives every single inmate access to a full suite of treatment while they’re incarcerated. So that means that we offer them one of three primary medications to treat opioid use disorder. We’re going to create warm hand-offs for them, so that when they get out of incarceration they actually have a way to continue that treatment. And we’re going to give them all of the other supports that they need for treatment to actually work.
And guess what happened. You flash forward to just a couple years later, the overdose rate among their inmate population post incarceration went down by 60 percent. That’s not by coming up with something that didn’t already exist. That’s by providing medications that have been available in this country for years.
So it’s easy to look at addiction and see an impossible, intractable, unsolvable problem and say this is just the way it is. And it’s the way it’s always been. But America has faced intractable, impossible, difficult problems before. And we’ve risen to meet them. Think about the AIDS crisis. Think about tobacco consumption. Those were huge public health challenges. And we rose to meet them and we addressed them in constructive productive ways. We can do the same thing with addiction.
[MUSIC PLAYING]
By Jeneen Interlandi
Produced by Jillian Weinberger
In America, 48 million people struggle with addiction. Very few get the help they need. But Jeneen Interlandi, a member of the editorial board, believes we have effective tools to address this public health crisis. In this audio essay, she argues that Americans need to view addiction as a chronic health condition, and treat it as such.
The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.
Follow the New York Times Opinion section on Facebook, X (@NYTOpinion) and Instagram.
This episode of “The Opinions” was produced by Jillian Weinberger and edited by Kaari Pitkin and Annie-Rose Strasser with help from Alison Bruzek. Mixing by Isaac Jones. Original music by Carole Sabouraud and Isaac Jones. Fact-checking by Mary Marge Locker and Kate Sinclair. Audience strategy by Shannon Busta and Kristina Samulewski.
Jeneen Interlandi is a member of the Times editorial board and a staff writer at The New York Times Magazine. She writes primarily about public health. @JInterlandi
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