One, Two, or None?

November 8, 2020

Opioid maintenance therapy (OMT), also called medication-assisted treatment (MAT), is known as a Gold Standard addiction treatment.

That’s one Gold Standard if you are keeping count.

The model of care used by Physician Health Programs (PHP’s) is known as a Gold Standard addiction treatment.

That’s two Gold Standards if you are keeping count.

But what do they really accomplish? Let’s look at some numbers. And given our current pandemic, let’s compare them to recent COVID data:

Opioids USA¹ From 1999-2018 the total opioid overdose deaths = 450,000. For the year 2018 = 128 deaths per day.

COVID-19 USA² At the time of this writing we are in the COVID-19 pandemic. The year-to-date USA COVID-19 deaths as of 11/07/2020 = 239,000. For YTD 2020 = 770 deaths per day.

Cigarettes USA³Annual USA cigarette deaths = 480,000. In 2018 = 1,315 deaths per day. That includes second-hand smoke annual deaths = 41,000. If one excludes the deaths from second-hand smoke that leaves 2018 = 439,000 deaths. And for 2018 = 1,202 deaths per day

We have two Gold Standards? How about admitting we have none?

The “Gold Standard” of MAT and the “Gold Standard” of the PHP model both focus on disease management, symptom suppression, and promote wellness-related improvements such as personal goal attainment. And both use multi-year models.
Both permit cigarette smoking.
By default then, both permit dying later due to continuing one’s cigarette addiction while undergoing their addiction treatment.

If a person dies of emphysema from continuing to smoke cigarettes after their “addiction treatment” – did we really treat their addiction illness or did we just address disordered use of (for example) opioids or alcohol?

What does it even mean to claim to do addiction treatment for someone while the person continues their active addiction illness by way of addictive substance use (like smoking cigarettes) the entire time they undergo their so-called addiction treatment?

Who coined the term “Gold Standard”? Who decides what criteria must be met to claim it, and how is that decided?

Is an addiction treatment a Gold Standard addiction treatment if it treats one addiction while allowing or ignoring another – during the treatment?

Instead, what if we:

treat the person’s whole addiction illness during addiction treatment, rather than only treat one substance use disorder (opioids or alcohol) while ignoring another substance use disorder (cigarettes)?

rename SUD-related services as simple “SUD services” – rather than call them “addiction treatment” if they allow people to remain actively addicted while the person is undergoing their “addiction treatment”?

“So, are people getting better, or not?”

References and Additional Reading

¹https://www.cdc.gov/drugoverdose/data/statedeaths.html

²https://coronavirus.jhu.edu/map.html

³https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm#death

Coon, B. (2014). An Addiction Treatment Campus Goes Tobacco-Free: Lessons Learned. Addiction Professional. 12(1): 18-20.

Martin, L., Lee, J. L., & Coon, B. (2018). Implementing Tobacco-Free Policies in Residential Addiction Treatment Settings. Physician Health News. 25 (2):14.

White, W. & Coon, B. (2003). Methadone and the Anti-Medication Bias in Addiction Treatment. Counselor 4(5):58-63.