Seattle Times: Opioid treatment available but limited by funding, stigma

Originally published on, June 7, 2016.


Opioid-use disorders need to be recognized for what they are: a chronic, relapsing medical condition. It is a brain disease, not a moral failing.


By Molly Carney, Special to The Times


PHILIP Seymour Hoffman, Heath Ledger, Cory Monteith and now Prince — all talented lives cut short by opioid overdoses. For many of us, these names usher in feelings of loss: lost talent, lost art and lost potential. But the opioid epidemic is not just an artist’s tragedy. It is a national tragedy and a Washington state tragedy.

There’s another list: daughters, sons, friends, co-workers, neighbors — some of the hundreds of people in Washington who have recently died from opioid-related overdoses. These people are rarely headline news, but they are deeply mourned by their communities.

While it is already too late for the victims of overdose, there are many more people for whom heroin and prescription-opioid abuse do not have to spell the end. I see every day in my work with Evergreen Treatment Services that people do recover, and many will fight fiercely for the chance. They need our help, not our judgment. We have to increase access to and acceptance of the tools in our toolbox, particularly medication-assisted treatment.

Medication-assisted treatment is the standard-of-care treatment that pairs Food and Drug Administration-approved medications with wraparound services including counseling, and is proven to have a significant impact on relapse and reducing risk for overdose. Yet stigma against this treatment keeps too many people from embracing it. We hear of many overdose victims who tried to quit but felt that they did not want to use any medication to manage their recovery.

Opioid-use disorders need to be recognized for what they are: a chronic, relapsing medical condition. They are a brain disease, not a moral failing. For many people in the grip of addiction, the cravings and withdrawal are so disruptive that they can only be successfully controlled with the assistance of a brain-stabilizing medication like methadone or buprenorphine. There is no shame in someone who uses heroin or other opioids benefiting from medication-assisted treatment, just as there is no shame in a diabetic taking insulin to stay alive.

While medication-assisted treatment is the best option that we have, it is not an easy fix. Any one of our patients can attest that treatment is hard — it takes time and real physical and emotional work. Patients must come to our federally accredited opioid-treatment program six days a week to take the medication that keeps their brain chemistry stable. They must engage with a counselor, work with our medical providers and be screened regularly for drug use. They must do this while facing the reality of lost jobs, families, homes — and often everything that is important to them.

We also need to make treatment more accessible to those who need it. In Seattle, waiting lists for publicly funded treatment are often months-long. For many people in rural areas — where the epidemic has become rampant — medication-assisted treatment simply is not available. Instead, our patients travel sometimes four and five hours every day to get their medication.

We are seeing progress, however. Evergreen Treatment Services, with the support of the national Substance Abuse and Mental Health Services Administration, is working with the state to try an integrated-treatment initiative we call FlexCare — the first of its kind in Washington state. FlexCare expands medication-assisted-treatment access by using doctors, working side-by-side with nurses, to provide prescriptions of the medication Suboxone. This offers an alternative to traditional treatment in clinics that dispense daily doses of medication. If patients have difficulty stabilizing, doctors can refer them to Evergreen Treatment Services for backup clinical services and support. In short, FlexCare provides patients with options and we can treat more people.

But much more work needs to be done. Given the daily struggle of someone on heroin, waiting a month to enter treatment is too long. Commuting an hour or more each way — every day — to get to a medication-assisted-treatment clinic makes it impossible for patients to do much more than just be in treatment. And low Medicaid-reimbursement rates for doctors prescribing Suboxone prevent many doctors from taking these patients. Thus, low-income Washingtonians, in particular, are unable to get the treatment that they need.

Every overdose is a tragedy. This is someone’s loved one. We have tools we need to bring this epidemic under control, but we must first drop the stigma that shames people with opioid-use disorders into the shadows. We must also get serious about funding access to treatment and get creative about ways we can reach as many people as possible.

We don’t have a minute to lose. We can’t afford to add another name to the list of overdose victims.


Molly Carney is the executive director of Evergreen Treatment Services, a nonprofit organization that provides medication-assisted treatment to more than 2,500 people in Western Washington.

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