The reason opioid abuse disorder (OAD) is such a huge problem is because no one’s figured out how to A) fix it while B) making a shipload of money.

Joe Paduda

Sure, there are “solutions” that address bits and pieces, including:

• Urine drug testing identifies patients who aren’t taking prescribed drugs and/or are taking other licit or illicit medications.
• Medication assisted therapy (MAT) can and does help many wean off opioids without going through withdrawal.
• Inpatient or outpatient detox is essential for some OAD patients.
• Physical therapy and exercise is helpful for many.
• Cognitive behavioral therapy (CBT) is essential for many patients.

But many patients require many of these services, while some do fine with one or two.

There is no single silver bullet.

What we aren’t doing is funding community-based treatment facilities and providers. This is essential because OAD is a long-term chronic disease, and patients need follow-up and support for years.

The real issue is threefold: Treating OAD usually requires dealing with the patient’s chronic pain as well; OAD is a lifetime disorder; and every patient is different.

The terror of withdrawal coupled with the dread of chronic pain is hugely difficult to overcome. Patients are justifiably terrified of both, and this fear must be addressed throughout the treatment process. This is a long-term process likely involving different treatment modalities delivered by diverse providers.

Some patients respond to MAT; others do not. Some have family support systems; others are pretty much on their own. Some respond to PT and exercise; others are too afraid that the effort will trigger a resurgence of pain. And the only way to find out what works for Patient X is to keep trying different approaches, providers and modalities until you find something that works.

No one has cracked the code, come up with a set process, solution or approach that works for most patients. Until someone figures out how to make gazillions fixing people with substance abuse disorder, I don’t expect the nation will make real progress.

That does NOT mean there aren’t real successes happening every day. California’s State Fund is one of the leaders, delivering remarkable results through a careful, methodical approach.

Here’s the key: OAD can be a lifetime issue. Do not fear this. Rather, accept it as reality. It’s far easier to throw one’s hands up at the difficulty of it all rather than dig in and get going, but it’s also what led to hundreds of thousands of workers' comp patients with OAD.

What does this mean for you?

Those who are in it for the long haul are going to be the difference-makers.

Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers. This column is republished with his permission from his Managed Care Matters blog.