UW expert: The best way to treat opioid addiction

Treating opioid addiction as a medical condition is emerging as the best way to combat the opioid crisis, according to one expert who spoke with the Candy, Mike, and Todd Show on KIRO Radio.

“If you find someone who has an addiction to pills or who has transitioned from pills to heroin, really, the mainstay of treatment, and the most effective way to keep people alive, is medications for opioid use disorder,” Dr. Joseph Merrill said.

“Those medicines are quite effective,” he said. “From a policy angle, really what you need to do is figure out how you are going to help people access treatment, not just in cities, but in rural areas which were really hard hit by the opioid problem.”

“Expanding treatment is the bottom line,” he added.

When and where opioids were spread across Washington

Merrill is a doctor of internal medicine who works at the University of Washington and Harborview Medical Center. He has developed a specialty in addiction medicine, which he says is a relatively newer field. He evaluates people with addiction issues and uses medication as treatment. Merrill says this emerging specialty is expanding around the nation as the need for it also grows.

And the need has certainly grown. Recently-released data maps where opioid prescriptions were more or less provided around the nation. Merrill says there is a correlation between the places that were more heavily supplied with prescribed opioid pills and addiction rates. In Washington state, some areas (mostly rural) were provided far more access to opioids than others between 2006 and 2012. Addiction and overdose rates rose in those same areas.

“We’ve seen this in other data that prescribing rates and addiction rates go together as part of the opioid epidemic,” he said, noting that the epidemic peaked between 2006 and 2012 as the pills were frequently prescribed.

“The recognition of the opioid epidemic and the problems that have come from prescribing too many opioids were coming into focus,” he said. “It is a huge amount of pills (that were prescribed between 2006 and 2012) … and the US is way ahead of other countries in terms of how much opioids are prescribed … it is remarkable, and the growth and prescribing that happened, even before this data, is also remarkable.”

There are many reasons for the growth of opioid prescriptions over that time, Dr. Merrill says. Such as using pain as an evaluating factor – doctors and nurses being graded on alleviating pain. The simplest way to alleviate pain is with a pill.

“It was very much promoted, however, by the pharmaceutical industry who were making opioid medications … a big finger needs to be pointed in that direction,” he said.

The emerging response to treating addiction is now leaning toward treating it as a medical condition.

“The strategies have been diverse,” Merrill said. “Some are around reducing prescribing. Some are around making new rules for prescribing. I think at this point in the epidemic, a big focus needs to be, and is, on increasing access to treatment or addiction. That has been a big focus of ours at Harborview.”

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