(highlight:: “Most people get better,” Wakeman, who is the senior medical director for substance use disorder at Mass General Brigham, said then. “That’s what we don’t ever talk about in the opioids conversation.”
When she says “most people,” she means most people who get long-term medication-assisted treatment (MAT), widely considered the gold standard in addiction care. It combines regular counseling and behavioral therapy with the medication methadone or buprenorphine (often prescribed under the brand name Suboxone). Both contain synthetic opioid compounds, which prevent withdrawal and cravings, and they can lower overdoses by as much as 76 percent. (A third medication, less often used, is naltrexone, which blocks the high from opioids.))
- No location available
-

Even so, our treatment paradigm has not caught up. Perhaps the clearest example of how Americans’ cultural mindset limits access to treatment is the onerous regulation of methadone. Patients can receive the medication only at federally certified clinics, which tend to be located in impoverished or high-crime neighborhoods. Most patients must appear at the clinic daily for months or years before they’re allowed to take home even a small number of doses. This means waiting in line, often for hours, missing appointments and work, having to arrange for child care. For some patients, it also means long commutes, sometimes across state lines.
- No location available
-
- [note::This reminds me of PA's Unemployment System - deliberately designed to to allow only the most determined (and with the most time) to actually get support.]

“We think of addiction, which is a lifetime-long problem, as being like pneumonia or some other kind of infection,” Ling said. “You come off [the drugs], and then people say, ‘Why can’t they just go back to their old self?’ But they can’t. Substance use has irreversible effects on the body and the brain.” Some people need to stay on MAT for years or decades — and that’s okay, Ling says.
- No location available
-

Providers on the cutting edge of addiction treatment are increasingly moving toward this approach, with greater emphasis on harm reduction, an evidence-based, albeit controversial, strategy that aims to minimize the damaging effects of drug use rather than fixating on forcing patients to get “clean.” In a society raised on the concept of total abstinence from drugs, that can be a tough sell politically — but the idea is that opioid addiction is a serious illness, and breaking an addiction to opioids is extremely hard
- No location available
-

Harm reduction measures include safe consumption sites (where people use drugs under the supervision of trained medical professionals), syringe exchange programs (where users can obtain clean needles), distribution programs for naloxone (a medication that can reverse an overdose), and fentanyl test strips (which can prevent overdoses by detecting whether someone’s drugs contain fentanyl). “Any positive change — that’s sort of the mantra of harm reduction,” said Sue.
- No location available
-

It’s not enough to have a breakthrough treatment like MAT if the people who need it can’t get it — or can’t stay in it. Among the “compounding mistakes and failures” that led to the current crisis is the fact that “our health care system is not set up well to accommodate people who are vulnerable or marginalized,” a group that includes most of those with addiction, said Joudrey, the Pittsburgh addiction doctor. “In the United States, we’ve become so focused on innovation and looking for technological solutions, we can end up neglecting the sociological and economic contributors of the overdose epidemic.”
- No location available
-
- [note::A fixation on tech-first approaches can often end up ignoring critical contributors to the problem at hand, such as sociological or economic factors.]

A 2015 study in North Carolina found that the risk of overdose was as much as 40 times higher for those recently released from prison than for other state residents.
- No location available
- overdose, formerly incarcerated individuals, incarceration,
- [note::In what other ways are formerly incarcerated individuals at risk? In the It's Basic documentary, I recall them being disproportionately likely to experience homelessness, illustrating the importance of providing unconditional cash transfers to recently released individuals.]

n 2014, Massachusetts General Hospital in Boston, where Wakeman practices, opened one of the first “bridge clinics” in the country, intended to bridge the gap between a patient’s discharge from the emergency room (after, say, an overdose) and longer-term addiction treatment — a critical moment, Wakeman told me, when the risk of relapse or overdose is high. Patients can walk into the bridge clinic without an appointment — from the emergency department down the hall, or simply right off the street — and begin buprenorphine treatment that day.
- No location available
-

Bridge clinics have been opening up at other sites, too, including dozens in California alone, and early evidence shows they’ve led to promising rates of MAT treatment and linked patients to longer-term addiction care. Those effects can ripple through other parts of the hospital. One study by researchers in Syracuse, New York, found that emergency department visits dropped by 42 percent in the six months after a bridge clinic opened. Research also indicates that bridge clinics help fill a void in care for patients with “clinically complex” cases: patients with concurrent addictions to other substances, serious mental illness, homelessness, and infections like HIV or hepatitis.
- No location available
-

(highlight:: “Most people get better,” Wakeman, who is the senior medical director for substance use disorder at Mass General Brigham, said then. “That’s what we don’t ever talk about in the opioids conversation.”
When she says “most people,” she means most people who get long-term medication-assisted treatment (MAT), widely considered the gold standard in addiction care. It combines regular counseling and behavioral therapy with the medication methadone or buprenorphine (often prescribed under the brand name Suboxone). Both contain synthetic opioid compounds, which prevent withdrawal and cravings, and they can lower overdoses by as much as 76 percent. (A third medication, less often used, is naltrexone, which blocks the high from opioids.))
- No location available
-

Even so, our treatment paradigm has not caught up. Perhaps the clearest example of how Americans’ cultural mindset limits access to treatment is the onerous regulation of methadone. Patients can receive the medication only at federally certified clinics, which tend to be located in impoverished or high-crime neighborhoods. Most patients must appear at the clinic daily for months or years before they’re allowed to take home even a small number of doses. This means waiting in line, often for hours, missing appointments and work, having to arrange for child care. For some patients, it also means long commutes, sometimes across state lines.
- No location available
-
- [note::This reminds me of PA's Unemployment System - deliberately designed to to allow only the most determined (and with the most time) to actually get support.]

“We think of addiction, which is a lifetime-long problem, as being like pneumonia or some other kind of infection,” Ling said. “You come off [the drugs], and then people say, ‘Why can’t they just go back to their old self?’ But they can’t. Substance use has irreversible effects on the body and the brain.” Some people need to stay on MAT for years or decades — and that’s okay, Ling says.
- No location available
-

Providers on the cutting edge of addiction treatment are increasingly moving toward this approach, with greater emphasis on harm reduction, an evidence-based, albeit controversial, strategy that aims to minimize the damaging effects of drug use rather than fixating on forcing patients to get “clean.” In a society raised on the concept of total abstinence from drugs, that can be a tough sell politically — but the idea is that opioid addiction is a serious illness, and breaking an addiction to opioids is extremely hard
- No location available
-

Harm reduction measures include safe consumption sites (where people use drugs under the supervision of trained medical professionals), syringe exchange programs (where users can obtain clean needles), distribution programs for naloxone (a medication that can reverse an overdose), and fentanyl test strips (which can prevent overdoses by detecting whether someone’s drugs contain fentanyl). “Any positive change — that’s sort of the mantra of harm reduction,” said Sue.
- No location available
-

It’s not enough to have a breakthrough treatment like MAT if the people who need it can’t get it — or can’t stay in it. Among the “compounding mistakes and failures” that led to the current crisis is the fact that “our health care system is not set up well to accommodate people who are vulnerable or marginalized,” a group that includes most of those with addiction, said Joudrey, the Pittsburgh addiction doctor. “In the United States, we’ve become so focused on innovation and looking for technological solutions, we can end up neglecting the sociological and economic contributors of the overdose epidemic.”
- No location available
-
- [note::A fixation on tech-first approaches can often end up ignoring critical contributors to the problem at hand, such as sociological or economic factors.]

A 2015 study in North Carolina found that the risk of overdose was as much as 40 times higher for those recently released from prison than for other state residents.
- No location available
- overdose, formerly incarcerated individuals, incarceration,
- [note::In what other ways are formerly incarcerated individuals at risk? In the It's Basic documentary, I recall them being disproportionately likely to experience homelessness, illustrating the importance of providing unconditional cash transfers to recently released individuals.]

n 2014, Massachusetts General Hospital in Boston, where Wakeman practices, opened one of the first “bridge clinics” in the country, intended to bridge the gap between a patient’s discharge from the emergency room (after, say, an overdose) and longer-term addiction treatment — a critical moment, Wakeman told me, when the risk of relapse or overdose is high. Patients can walk into the bridge clinic without an appointment — from the emergency department down the hall, or simply right off the street — and begin buprenorphine treatment that day.
- No location available
-

Bridge clinics have been opening up at other sites, too, including dozens in California alone, and early evidence shows they’ve led to promising rates of MAT treatment and linked patients to longer-term addiction care. Those effects can ripple through other parts of the hospital. One study by researchers in Syracuse, New York, found that emergency department visits dropped by 42 percent in the six months after a bridge clinic opened. Research also indicates that bridge clinics help fill a void in care for patients with “clinically complex” cases: patients with concurrent addictions to other substances, serious mental illness, homelessness, and infections like HIV or hepatitis.
- No location available
-