Op-ed: Indiana needs clinics that medically treat opioid addiction

When I relocated to Indiana to assume my role as chief medical officer at Fairbanks three years ago, I witnessed firsthand — on day one — the level of devastation the opioid crisis has inflicted on our communities.

Today, despite physicians’ best efforts, relentless news coverage, and the establishment of Gov. Eric Holcomb's Commission to Combat Drug Abuse, the opioid epidemic is getting worse in Indiana. 

This illness does not only afflict those from lower socioeconomic classes. The patients I see range from all walks of life, from Yale to jail. The patients are more medically, psychiatrically and socially compromised than they were just a few years ago. And they are dying at alarming rates. 

Drug overdose deaths have surged so dramatically that they now kill more Hoosiers than car crashes and gun homicides combined. They are up 500 percent since 1999. In the three years since I became a Hoosier, opioid overdose deaths have more than doubled.

While no state is immune to the opioid crisis, Indiana is especially vulnerable.  According to the Centers for Disease Control, Emergency Department visits due to opioid overdoses jumped 35.1 percent in Indiana, compared to 29.7 percent in the U.S. from 2016-2017. 

Chances are, most families have been touched by the crippling choke hold the opioid crisis has on our state. The average opioid dependent patient is not the cliché homeless man living under the bridge begging for money.  It is a young person who is employed and living in the suburbs. 

It’s the all-star athlete on your child’s football team who got hooked after an injury, or your elderly neighbor who turned to opioids after the death of a spouse, or your colleague at work grappling with debilitating arthritis pain. 

It is everyone. 

Opioid addicted patients are not out chasing a high. Most continue to use opioids because they become physically dependent and live in fear of enduring horrific withdrawal symptoms that mirror the worst type of flu imaginable. They experience intense headaches, debilitating muscle pain and aches, profuse sweating, severe stomach problems, paralyzing insomnia and overwhelming panic attacks if they try to detox unassisted, so they keep using. It’s a vicious cycle. 

Opioid Use Disorder is a chronic, neurobiochemical brain disease that requires medical intervention. We have FDA-approved medications to treat this that allow the recovery process to occur. These medications help normalize brain chemistry while blocking the euphoric effects of opioids. They relieve physiological cravings and stabilizing body functions. These medications have given many of my patients their lives back. 

For too many Hoosiers, medications to treat opioid addiction remain elusive, as there are too many barriers to access. The majority of halfway houses in Indiana do not allow residents to use lifesaving medication. This puts physicians in the unenviable position of making impossible choices for their patients. Every day, we must decide between prescribing medication or securing a roof over our patients’ heads. 

Making these decisions often keeps me up at night.  It shouldn’t be this way.

Many counties in Indiana have few or no clinics that offer medication to treat opioid use disorder. That has to change. Medications treating opioid addiction have a proven track record of reducing overdoses and giving opioid dependent patients a shot at a stable life. The stigma associated with these medications — that it “replaces one drug with another”—is unfounded and unfair, and counterintuitive to science. 

If we want to make some headway in Indiana, we need to ensure health care providers and patients have access to proven therapies. We need strong, inclusive community support systems. We need to encourage patients with this illness to come out of the shadows and into the light by shedding stereotypes and de-stigmatizing treatment.

The opioid crisis has not reached its peak. Together, we can do right by our fellow Hoosiers. Their lives truly depend on it.

Darrin Mangiacarne is medical director of Fairbanks Treatment and Recovery Center.