When I was fourteen years old, I fell in love with a girl. A long and intricate relationship followed, with stops and starts and more complexity than I could ever articulate to the world. Yet, one thread of clarity ran through it all, plain and simple to us both: as long as we lived on this planet together, our relationship would never end. This turned out to be true, just proven too soon: fifteen years later, she was gone. An overdose from an accidental addiction to opioids, like 47,000 other Americans that year.
It was a tragic ending to a beautiful story, but it was the start of a new one for me: my mission to solve the opioid crisis through a startup I’ve named Ophelia. It has a happy ending, I promise. It’s just that I need your help writing it. Read on.
This story is not about her.
It’s about 3 million Americans just like her, on the edge of a cliff today – with jobs and families and privacy concerns that make “rehab” simply unfeasible. Thousands of dollars? Months off work? Gossiping friends and family? Opioids are hard, but rehab sounds impossible. Then add to the pitch the simple fact that rehab rarely works anyway, and any other alternative sounds better.
It might come as a surprise, but the average American addicted to opioids looks a lot like the average American: 87% urban, 85% insured, 65% employed. After all, many got hooked by accident – through a painkiller prescription after surgery, funded by private insurance. They didn’t choose to be “drug addicts,” and they certainly don’t identify as such, so why enter rehab with the rest of “them” and get stuck with that label for life? The consequence: 80% are getting no help at all – and every 11 minutes, another one slips, lost to an overdose forever.
This story is one of hope, not tragedy.
In fact, its conclusion is overwhelmingly positive: a solution to the opioid problem exists, and it looks nothing at all like rehab. Decades of science have given us a treatment that works and is low cost, convenient, and discreet. In many ways, it resembles the treatment for anxiety or depression that 1 in 6 of us is getting: medication to stop the withdrawal and cravings, plus support and therapy where helpful. It increases survival rates by 600%, with similar adherence to treatment for other chronic disorders such as diabetes, depression, and high blood pressure. Most people know it as “Medication-assisted treatment" (MAT), and virtually no one in the medical community disputes its efficacy. So, why are so few people getting it?
This story has too many villains.
Rehabs: Without medication, 90% of opioid users relapse within 3 months. Yet, 2/3rds of rehab clinics do not prescribe medication, and most don’t even employ doctors. Meanwhile, the clinics that do offer medication still ignore the science: they’re either (1) short-term detox facilities with no discharge plan (not how you treat a chronic disorder) or (2) outpatient clinics with excessive requirements just to fill your prescription. That’s right: rehab is not just expensive, inconvenient, and stigmatizing – it doesn’t work, and the industry as we know it will soon disappear.
Government: The medication that stops withdrawal (e.g. Suboxone) is easier to get from a drug dealer than a doctor. Remarkably, any doctor in America can prescribe you painkillers, but in order to prescribe the antidote, you need a special waiver – which very few doctors have. Go to your primary care doctor or psychiatrist and tell them you have an opioid problem: odds are they can’t help you, and they won’t know where to send you either. No wonder the black market for buprenorphine is booming.
Insurers: Insurance reimbursement for MAT is too low to incentivize most doctors to do it. Here are your options: (1) low quality clinics that accept insurance but are booked up for weeks or (2) private psychiatrists who don’t accept insurance and charge upwards of $400 per visit. The strangest part of it all: paying more for MAT would save insurers money. It’s more effective, more accessible, and less expensive than what they’re paying for today. Let me be clear: if insurers simply paid more for MAT, more doctors would do it, fewer people would die, insurance profits would rise, and premiums would fall for the rest of us. That’s it: the stroke of a pen.
Naysayers: The dialogue around MAT sounds a lot like the climate debate: lay-people with personal biases vs. scientists. Opponents of MAT include (1) a proud minority in the recovery community who quit without medication and assume everyone else can too and (2) rehab owners who don’t have medical degrees, can’t offer medication to customers, and feel threatened. Even Narcotics Anonymous (NA) will shame you for using medication, bound to the dogma that what works for alcohol (AA) also works for opioids. So, the naysayers spread the myth that it’s “rehab or nothing,” 80% of addicted Americans choose “nothing” – and 115 more die every single day.
This story needs more heroes – like you.
There’s a happy ending to the opioid crisis, and it goes like this: (1) regulate rehabs, (2) let doctors offer MAT, (3) reimburse them enough that they’ll do it, and (4) make people aware that it exists and it works. The logic is straightforward. Here’s the problem: humans don’t respond to logic. We respond to emotion, through stories about other humans.
This is where I need your help.
If you have a story about someone’s struggle with opioids, please share it. How did it start? Did they get help? Did it work? You don’t need to use real names (“Ophelia” works fine), and it doesn’t have to be long. It’s the moral of our stories that matters: opioid users are normal people, there’s a solution, and it isn’t rehab. Somewhere in the shadows of social media, there’s someone who needs to hear it.