By Sandy K. Johnson
Fact: 2.1 million Americans are addicted to opioids.
Fact: Only 4,000 U.S. physicians are addiction specialists.
The opioids crisis hasn’t even peaked and the medical profession can barely keep up. Part of the problem is a basic lack of understanding of what addiction is, according to Dr. Kelly J. Clark, president of the American Society of Addiction Medicine.
Addiction is a chronic brain disease, leading people to lose control of their lives. Just like any other chronic illness – such as diabetes or hypertension – people with addictions will go through cycles of relapse and remission. That’s normal for every disease including addiction, Clark said.
ASAM defines addiction thusly: “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”
Until demand for illicit drugs falls, the crisis won’t begin to abate, Clark said: “Even if not another person became addicted, we still have millions of Americans who are. … What happens if you have supply reduction and not demand reduction? You get substitutes and that’s how we got fentanyl.”
She said the appearance of powerful – and deadly – synthetic drugs are a threat that is evolving. “People with chemistry sets are very clever,” she said.
If there is a positive sign in this public health crisis, it’s that addiction is out of the closet. Clark said 44 percent of Americans know someone personally who has been affected by addiction. “When it becomes your family, your neighbor, a person at your church, it becomes real. It becomes us, not ‘them.’ It’s ubiquitous,” she said.
Another is TIP 63, a treatment improvement protocol issued by the federal government in February 2018. It stated that using medications to treat opioid addiction is recommended, putting to rest a long-simmering debate.
In her day job, Clark is chief medical officer of CleanSlate Centers, which treats more than 8,000 opioid-addicted patients.