Medication Adherence Is a Two-Way Street
Prevention & Treatment Poor adherence to treatment recommendations undermines the care of many chronic medical disorders.
Addiction is often singled out as particularly problematic. One of its core symptoms, loss of control, causes significant impairment in the healthy decision making necessary for symptom management and longer-term recovery. This is also true of many other chronic diseases like diabetes, obesity and heart disease that often require a combination of medications, counseling, exercise, stress management and changes in lifestyle and consumption patterns.
However, the problem of poor adherence to recommended treatment practices does not exist solely in patients suffering from diseases that impair healthy compliance. The role of physician adherence to evidence based treatment practices can play a significant role in eliminating the opioid addiction epidemic in the U.S. Three changes in medical practice are essential.
Road to recovery
First, stopping the over prescription of opioids for acute and chronic non-cancer pain and complying with the prescription drug monitoring programs in most states will slow the flood of pills available for misuse by people young and old.
Second, increasing the availability and utilization of the overdose reversal medication, Naloxone, will save countless lives and families from experience the sudden death of a child, parent or grandparent.
"Our opioid epidemic will not be solved unless there is shared responsibility by providers, patients and their families for the problems of adherence to treatment recommendations that optimize healthy outcomes and save lives."
Third, improving the availability of medication-assisted treatments for prescription opioid and heroin addiction is essential for effective symptom management and recovery support while also decreasing crime and risk of HIV and Hepatitis C infection.
Addiction treatment providers who fail to assertively encourage their opioid addicted patients to take medications are not adhering to best medical practices. Naltrexone blocks the effects of opioids so that patients do not get high. It should always be discussed as a first-line treatment option after detoxification. Methadone or Suboxone, which control addiction symptoms like craving and withdrawal by substitution of a longer-acting opioid, are the treatment of choice for people with longer term or severe addiction. There is little to no evidence for the long-term effectiveness of detoxification followed by medication-free outpatient, inpatient or residential treatment.
Counseling and peer support are necessary but rarely sufficient for long-term recovery. Treatment for opioid addiction that fails to provide at least several months of medication is a risky medical practice that perpetuates addiction and premature death. Our opioid epidemic will not be solved unless there is shared responsibility by providers, patients and their families for the problems of adherence to treatment recommendations that optimize healthy outcomes and save lives.