America’s Opioid Problem-2020; A Brief Update
Unfortunately, Opioid Use Disorder (OUD) is alive and well in 2020. Today approximately 150 People are dying each day due to opioid overdose. The CDC noted that from 1999 to 2017 approximately 399,000 people died in the United States from Opioid overdose. Related to chronic pain, this is one of the greatest failures in American medicine; perhaps, now medical training (as well as all mental health and social work training) will include sufficient clinical exposure to Substance Use Disorders ((SUD). Sufficient exposure goes way beyond Motivational Interviewing. Since many 
recognize addictions as America’s number one healthcare problem, all healthcare providers and school counselors, social workers, psychologist, etc. should receive proper clinical training in the prevention, intervention, and treatment of SUDs. It is about time!
Although in most parts of the country opioid dependence is still quite common, there is hope. Medically Assisted Treatment is being used, which in the best cases (Vermont’s model) includes medications to help reduce opioid cravings and psychoactive effects AND counseling to resolve mental health and addictions problems that lead to OUD in the first place. I, myself, a long time ago was part of a clinical team that established the first methadone clinic in Vermont under the jurisdiction a community mental health center (The Howard Center). As Clinical Director, and with lots of clinical experience and training in co-occurring disorders and the help of many, we were ready to act. Some thought Vermont did not need such a clinic, but on our first day of operation we had a waiting list of over 100 people hoping to receive these services. There is a risk here: current funding models short-change the clinical psychosocial interventions and enhance the medical interventions. For treatment to work long-term, people need BOTH! Even if people are successful at harm reduction regarding OUD, relapse is just around the corner if they do not receive therapy for pre-existing psychological problems (anxiety, depression, trauma, other addictions, and eating disorders). It is estimated that 90% of clients who do not take MAT medications may relapse. MAT with psychosocial clinical interventions sports a success rate of about 50%, which is great considering the severity of OUD. Let’s not be penny-wise and dollar-foolish; let’s not reduce psychosocial interventions that prevent relapse and enhance long-term health status.
For more information refer to The National Psychologist, 28(1), Winter, 2020, pages 1 and 5.
Anthony R. Quintiliani, PhD., LADC
From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton Sangha
Author of Mindful Happiness
