Detox: The missing bridge to opioid recovery

Becoming clean and staying clean are two separate issues:

Nationally, more than 81,000 Americans died from drug overdoses between May 2019 and May 2020, according to the Centers for Disease Control and Prevention. The CDC noted that this was the highest number of overdose deaths ever recorded in a one-year period.

On Thursday, NC Attorney General Josh Stein announced a $573 million multi-state settlement with consulting firm, McKinsey & Company, as a result of the group’s alleged role in advising opioid manufacturers on how to promote their drugs. North Carolina will receive $19 million from that settlement, which Stein said will be used to address the consequences of opioid addiction in communities across the state.

Whether an addict ends up in the emergency room due to an overdose, or because of a mental health crisis associated with addiction (including withdrawal symptoms), that person is in critical need of detox. If going to the hospital is the first step, this is the second, and possibly the most critical one. Follow me down for a deeper look:

The problem is, in most cases, that person is sent right back out the door as quickly as possible, to open up ER beds. When that happens, the only way to stop withdrawal pains is to use again. And in their desperation to end that pain, a fatal dose is often the result. Hospitals will sometimes move somebody into their mental health wing to detox if there is room, but that's the exception and not the rule. They also might make some calls for you, to see if there are beds available anywhere close by at a rehab facility. But that very often requires a wait of 10-20 days. Back out the door, good luck with that.

There are some good efforts being made to follow-up with overdose survivors:

The rapid response team with the addiction recovery program Healing Transitions in Raleigh has been a lot busier during the pandemic, reporting a 64 percent increase in referrals from 2019 to 2020.

The team is responsible for making contact with people who overdosed the day before, referred to them by the Wake County EMS system. Alex Peacock, a graduate of the Healing Transitions program, joined that team last April. His job is to go out with EMS to check-in on these folks and offer support, presenting them with recovery options, detox, medication-assisted treatment, harm reduction supplies or simply a listening ear.

This is a great organization, but they only offer non-medical detox. That doesn't just mean no prescription medications are available, it means there are no medical people on staff. Detox itself can be fatal if it's not monitored and managed properly.

But let's take a few steps back and look at why it is so important to build a step 2 bridge. When somebody is brought to the ER or shows up on their own to get help, there is (usually) a desire to get clean. That motivation needs to be nurtured, not rejected. Many folks I've spoken with take the position that if somebody really wants to get clean, they will. If they don't, they won't. But such a long-term commitment is impossible until the body has completely purged the drugs out of its system, and the physical need is gone.

Frankly, this is the easy part, although it's incredibly painful and discomforting for the addict. It's the residual psychological need that is (by far) the most difficult. But that's a story for another day, and extremely complicated story that involves money, religion, personal freedom, and even modern-day slavery in some cases.

We need to construct a sound detox bridge to recovery. We should not send somebody back out the door who is on the verge (or in the middle) of opioid withdrawal. We need regional detox facilities, either operated by the state or closely monitored grant-funded non-profits. 8-10 days of detox, free of charge, and then assistance finding longer treatment programs. This will save many lives, and make full recovery easier to achieve.