The Dec. 29 editorial (“The rising toll of overdoses”) brings renewed attention on the tragedy unfolding in Rhode Island. While it is important to recognize the increasing availability and use of naloxone, specialized treatment in emergency rooms and screening in the state’s prisons, it is also important to look at Rhode Island's long history of providing opioid treatment and its capacity to do so now.
Currently, more than 4,500 Rhode Islanders are being treated at Rhode Island's five opioid treatment programs. The Opioid Treatment Association of Rhode Island (OTARI) — made up of the Addiction Recovery Institute, Center for Treatment and Recovery, CODAC, Discovery House and The Journey to Hope, Health and Healing — provide medication assisted treatment using the three federally-approved medications for the treatment of opioid use disorder (methadone, buprenorphine, and injectable naltrexone). However, we are not only about providing medication.
OTARI members are licensed by the state departments of Health and of Behavioral Healthcare, Developmental Disabilities, and Hospitals. They are certified by the Substance Abuse and Mental Health Services Administration and the Center for Substance Abuse Treatment. They are registered with the Drug Enforcement Administration, and accredited by the Commission on Accreditation of Rehabilitation Facilities.
These organizations impose more than 3,000 standards for quality, safety and accountability. Forty-plus years of experience, combined with evidence-based, best-practice standards, makes Rhode Island's programs true specialists in treating this chronic disease. We have been preventing overdoses and saving lives since 1974.
We provide health home services to more than 2,600 patients, demonstrating how coordinated care and support reduces health-care costs. These services are supplemental to the existing counseling, medical, and other recovery supports and include case management, accompanying patients to appointments, care coordination with primary and specialty medical practices, tobacco cessation, nutritional guidance, housing, legal help and other activities associated with improving and supporting health and wellness.
Many of our patients maintain their recovery in the shadows, largely because of the marginalization of methadone — as if this life-saving medicine is the problem. Patients receiving methadone are branded with the equivalent of a “scarlet M." While this is less true for buprenorphine and naltrexone, the stigma and discrimination attached to being on any medication for this disease is enormous.
Treatment and related recovery support for this disease should be part of the discussion of this problem. Information about the scope and availability of treatment provides valuable information and the opportunity for people to make an informed, and perhaps, life-saving choice for themselves or others.
Medication assisted treatment exists for many illnesses, but where else in medicine is a patient with a chronic disease defined by his or her medication? There are no insulin or Lipitor clinics or patients. Nor is it ever suggested that these patients stop taking their medication. It is unlikely that a person living with diabetes will ever be told, “you’ve been on insulin long enough, it’s time to stop.” There is no moral judgment, nor are they blamed or shamed for their illness.
For them, the right medication, at the right amount, for the right amount of time is the standard for good, chronic care management. Our patients deserve nothing less.
OTARI is committed to providing comprehensive, respectful care and is actively engaged in efforts to address and respond to the tragic increase in overdoses and overdose-related deaths. We continue to work with the Governor’s Task Force to expand and enhance access to care.
Future conversation about the opioid crisis should include discussion of the proven and effective treatment for opioid use disorder and the hope it provides for so many.
Michael Rizzi is chair of the Opioid Treatment Association of Rhode Island and past president of CODAC Behavioral Healthcare.