The Politico website provides us with this fascinating status report on the future of opioid treatment. The Federal government is considering an infusion of cash, as much as $6 billion. As you might expect, there’s some angling for shares of the money. Big Pharma will be a major player — perhaps the major player.

So we can start there. At present, Medication Assisted Treatment (MAT) falls into two main categories:

Naltrexone injections. Naltrexone has been around for years in oral form, but compliance was poor, so much effort has gone into developing a monthly injection, and eventually, a six month implant. Naltrexone injections haven’t been around that long so we have less data on outcomes. What we do have suggests it’s effective as a continuing treatment, with the caveat that a quarter of users drop out during the required detox phase. A bill has been introduced in Congress to address this problem through a system of combined detox/ induction centers.

Opioid replacement therapy. Most of us are familiar with this option. Patients needn’t go through detox, since ORT is a continuation of physical dependence on a different opioid (methadone or buprenorphine instead of heroin etc). A monthly Suboxone injection is in the works here, as well. That should reduce diversion to the street — a common problem as Suboxone brings higher prices than heroin. There are retention issues with ORT as well, but they’re further down the line. We may eventually see implant technology used here as well.

Not coincidentally, there’s a parallel search in progress for alternatives to opioids as a pain remedy.  It won’t do much for those already “hooked”, but it would certainly help address a major pathway into addiction, and also an important cause of relapse. I’m referring to medical treatment for pain.

I do wonder how much of the $6 billion will go to Big Pharma versus counseling and other services. I hope the distribution is reasonably equitable. Narcan is great but as any first responder will attest, addicted users are prone to more ODs until and unless real change occurs. Same thing happens with ORT: without support and major changes in lifestyle, clients are prone to drop out.

It’s ironic that an industry largely responsible for creation and continuation of our current opioid epidemic could become the main beneficiary of all this new treatment funding. I guess that’s how it works. Just the other day a radio pundit referred to our patched-together healthcare system as a kleptocracy — a place where government policy is designed to benefit certain individuals or corporations rather than the governed.

Pretty cynical, isn’t it? Let’s hope he was wrong.