Addiction specialists and public health officials on Thursday chided HHS Secretary Tom Price for belittling the use of medications considered the standard of care for the treatment of opioid addiction.
The remarks irked specialists already worried by the Trump administration’s law-and-order stance on drug control and its tentative plans, leaked to POLITICO last week, to gut the White House Office of National Drug Control Policy. And ousted Surgeon General Vivek Murthy — fired by President Donald Trump last month — chimed in about the scientific evidence on Twitter.
During a visit to West Virginia on Tuesday, Price expressed skepticism of maintenance therapies that use milder opioid drugs, like methadone, to treat addiction.
“If we just simply substitute buprenorphine or methadone or some other opioid-type medication for the opioid addiction, then we haven’t moved the dial much,” Price told the Charleston Gazette-Mail, adding that he was encouraged by medications such as naltrexone, which “actually blocks the addictive behavior as well as the seeking behavior." Naltrexone isn’t an opioid. Price used its brand name, Vivitrol.
“That’s exciting stuff,” Price said. “So we ought to be looking at those types of things to actually get folks cured so that they can come back and become productive members of society and realize their dreams.”
But buprenorphine and methadone, known collectively as opioid replacement therapy, are considered the standard of care for treating addiction. Specialists also noted that addiction is a chronic disease that can be controlled but not, as Price said, "cured."
Asked to comment on Price’s remarks, Murthy referred to a series of tweets he’d just written that endorse buprenorphine and methadone as effective medicines.
“Some see medication-assisted treatment as substituting one substance for another and promote abstinence-only,” Murthy tweeted. “This is not backed by science.”
In another tweet, Murthy pasted in text from the authoritative 2015 opioids report he co-authored: “The science is clear,” reads the headline, “Medication-assisted treatment works.”
Opioid replacement therapy with buprenorphine or methadone is effective about two-thirds of the time when used in combination with other therapies. The patient remains dependent on the drug but is able to focus on work and family life instead of being fixated on getting high, the hallmark of addiction, specialists say.
The drug Price praised, naltrexone, is less studied. While it is effective in highly motivated patients, it can have major side effects, especially in depressed people.
Other addiction medicine specialists reacted angrily to Price’s criticism of replacement therapy, which HHS made more available during the Obama administration.
“This is a dangerous, dangerous statement,” said Camden, N.J., physician Corey Waller, chair of legislative advocacy for the American Society of Addiction Medicine. “He is moving out of the world of scientific fact into the world of alternative facts.”
Waller said he was frustrated that Price — an orthopedist who had served in Congress from 2005 until this year — had “picked a drug based on instinct or gut” rather than experience. Badmouthing methadone and similar drugs perpetuates stigma against patients who do well on them, he said.
“Dr. Price, being an orthopedic surgeon who is not trained in neurobiology, should trust the experts in this field and allow us to practice what the evidence shows is best, not what we hope or feel is best,” Waller said.
Babies of mothers who are using buprenorphine or methadone are less likely to be born premature than from mothers on heroin, and they are less likely to be born with HIV or hepatitis C, diseases often spread by shared hypodermic needles, notes Stephen Patrick, a Vanderbilt University pediatrician.
Patrick and colleagues published research Thursday showing the number of U.S. mothers infected with hepatitis C nearly doubled, to 3.4 per 1,000, from 2009 to 2014. One in 50 West Virginia babies were born to hepatitis C-infected mothers in 2014. Most of the infections were due to injected heroin use.
Patrick called for a broad, well-coordinated public health strategy to attack the opioid crisis. “It starts with prevention but includes medication-assisted treatment,” he said.
Methadone users have faced stigma for decades, and Price’s statement “goes against decades of evidence that has been extremely difficult to translate into policy,” said Northeastern University health law professor Leo Beletsky. Obamacare made maintenance therapy an essential health benefit but only 10 percent of those who need it get it, he said.
Sarah Karlin-Smith and Brianna Ehley contributed to this report.