Blog
Generals Always Fight the Last War
The last war is prescription opioid abuse and addiction. The response has been to educate patients and doctors about appropriate prescribing and better management of pain through the use of non-medication alternatives. The new war is heroin. Teaching better management of the prescription of narcotic pain medications is akin to teaching fire prevention as the house is burning down.
On July 7 the Washington Post published an article headlined “Heroin deaths have quadrupled in the past decade.” In it, Thomas Frieden, the Director of the CDC called for "more judicious use of the pain-killers by physicians who," he said, "should seek other ways to manage some forms of chronic pain; expanding the use of naloxone, a drug that can temporarily block the effects of an overdose; and greater efforts by law enforcement to disrupt heroin distribution networks.”
The article fails to make even a modest mention of treatment. The prescription drug battle is the equivalent of fighting the last war.
Recently, there has been an HIV epidemic in a small county in Indiana: 160 cases and counting. Intravenous opiate is the cause. The story has been widely reported and has been correctly seen as a public health crisis. In a representative sampling of newspaper stories, not one makes mention of treatment.
- How an HIV outbreak hit rural Indiana — and why we should be paying attention
- Indiana is battling the worst HIV outbreak in its history
- Appalachian States Debate Needle Exchange Programs As Hepatitis C Catastrophe Looms
- Pence Signs Needle-Exchange Bill as HIV Outbreak Cases Grow
- CDC Official: HIV Outbreak Lessons May Spur 'Model Response'
The last article is the most distressing: it makes no mention of treatment, only of needle exchange. Needle exchange is important in preventing the spread of HIV and Hepatitis C. Naloxone is important in treating overdoses. But these are symptoms of the disease and have distracted the public and politicians from understanding the need to treat the disease itself with the only effective treatments: buprenorphine, methadone and naltrexone, in conjunction with behavioral therapy. Heroin is the new war.
