The Opioid Fix: America's Addiction Crisis and the Solution They Don't Want You to Have

I wrote The Opioid Fix: America’s Addiction Crisis and the Solution They Don’t Want You to Have for two reasons.

First, I wanted to bring to light the stories of people whose lives have changed through medication-assisted treatment (MAT) for opioid addiction. These people, sometimes for the first time in decades, have reunited with family members, exited the criminal justice system, established stable living conditions, and started normal day-to-day activities (like working, cooking, taking care of children) instead of seeking drugs from sunup to sundown. I wanted to validate their stories, which twelve-step support groups had told them to keep quiet and criminal justice administrators had told them are not evidence of “real” recovery.

Second, I wanted to untangle the mess of legal, health service, and cultural barriers standing in the way of equitable, quality care with MAT. I already knew from decades of scientific research that MAT, especially methadone and buprenorphine, decrease morbidity and mortality. What I was less prepared for was the unwillingness of physicians to have “those kinds of patients” in their waiting rooms, the refusal of drug court judges and probation officers to believe that MAT was effective, for rehab center staff with no education about MAT dissuading clients from taking it, and for the two hour per day drive of rural patients to and from methadone clinics.

Once I started researching the history of MAT regulations, the reasons for all of these barriers became obvious: the U.S. created an addiction treatment system outside of mainstream medicine, because people with addiction have long been considered immoral and criminal. Even in the early 1900s, psychiatric hospitals refused to accept patients with addiction in case they should spread immoral behavior to innocent mental health patients. Education for mental health professionals and addiction treatment professionals diverged, with the latter left largely to those who had recovered from addiction through twelve-step support group methods. Diffusion of evidence-based treatments into such an isolated healthcare sector was understandably difficult. It wasn’t until the FDA approval of buprenorphine that opioid addiction treatment had any hope of entering mainstream medical treatment, since primary care providers could finally offer lifesaving medication directly to patients rather than just referring them to the black box of rehab centers.

Throughout my research I found beacons of hope. I saw federal agencies and state agencies beginning to explicitly promote MAT through press conferences, websites, and targeted grants. I saw judges who had previously opposed MAT starting to allow court participants to access the medications. I saw the number of social science articles about MAT dissemination and implementation skyrocket.

MAT seemed a lot more controversial just a few years ago. I will never forget the first time I tried to submit an article about the benefits of MAT and its potential for drug courts to a peer-reviewed law journal – one I will not name. This was back in 2015. I received a response from the editor stating that he was not convinced of MAT’s efficacy, despite citations in the article to systematic literature reviews proving exactly this point. Around the same time, I asked for the opportunity to provide a local county board with education about evidence-based addiction treatment. They responded that they preferred to keep patients out of the hands of doctors, since doctors started this whole problem of opioid addiction to begin with.

Times have certainly changed. But even if attitudes are improving towards MAT, access is still minimal. And stigma towards people with addiction still exists everywhere, even in medical facilities. People with addiction don’t want to risk being perceived as criminals or as immoral – not by their families, employers, friends, or healthcare providers. Until the stigma of addiction significantly decreases, people may not access treatment, no matter how many regulatory barriers and health service barriers are peeled away. Throughout my book I advocate for a person-centered, low-barrier treatment approach, because it is the only kind of approach that acknowledges how incredibly hard it is for patients to take the first step. So many patients with addiction also have underlying trauma from childhood, co-occurring mental health disorders, unstable living conditions, and limited funding for transportation. Merely making the phone call for an appointment with a physician, let alone getting to the appointment, is huge progress and should be celebrated.

Several people whom I interviewed, whose names I have promised to keep confidential, have reached out to me after reading The Opioid Fix. They are thrilled with what they have read. Some of them cried. They have seen validation of their own stories. They are passing the book on to their family, friends, and peer support network. This is the highest form of praise. I can’t wait for others to read it too.

Order The Opioid Fix: America’s Addiction Crisis and the Solution They Don’t Want You to Have – published on April 21, 2020 – at the following link: https://jhupbooks.press.jhu.edu/title/opioid-fix

Dr. Barbara "Basia" Andraka-Christou, an assistant professor in the Department of Health Management and Informatics at the University of Central Florida, with a secondary joint appointment in the College of Medicine, received her JD and PhD from Indiana University–Bloomington. Her research has been published in numerous journals, including the Journal of Substance Abuse Treatment and the International Journal of Drug Policy. She is the author of The Opioid Fix: America’s Addiction Crisis and the Solution They Don’t Want You to Have.