As a psychiatric Nurse Practitioner who, for ten years, worked in the field of drug addiction and recovery, first at a Methadone clinic, then at one of Boston’s leading treatment centers, and now in Norwell, I’ve seen addiction at its absolute worst. In the city, just a short distance from Mass and Cass, we treated many of the city’s most vulnerable populations. Some were homeless. Others weren’t. However, they are all contending with two significant challenges: desperation and a dreadful disease.
I’ve seen far too many people attempt Suboxone two, three, or even more times. I’ve witnessed countless times of people not staying on it, Methadone, or other opioid use disorder medications because they have plans that weekend, or they can’t get to the clinic on a daily basis, which is a huge issue for many. These situations often lead to relapse. There were patients who have entered rehab 30 times! Over and over they go. And over and over they start Suboxone again.
It is evident that what works for some may not be a long-term solution for others. Therefore, it is crucial that long-acting injectables (LAIs) be included in the treatment discussion if we aim to address drug addiction effectively.
LAIs, similar to Wegovy or Zepbound used for treating obesity, could significantly impact addiction treatment by reducing cravings. These medications are administered as a once-monthly injection, eliminating the need for daily clinic visits and increasing the likelihood of adherence.
Considering this, LAIs could play an essential role in helping individuals maintain their recovery. Repeating the same ineffective methods does not benefit those struggling with this severe disease. This is not the fault of the person struggling with a powerful addiction. The system needs to incorporate treatments with higher success potential.
Part of that system lies with health insurers, which I believe should cover the cost of LAIs. At the very least, insurers should mandate LAIs after a person has failed or relapsed on Suboxone three times.
A new report by Avalere Health indisputably found that LAIs are the best tool for treating Opioid use Disorder (OUD).
Staying on the path to recovery is challenging. The problem is bigger than people/policy makers realize. For many people struggling to stay healthy means meeting onerous requirements that can make failure almost certain. There are not only the daily trips for the medications, but there are also weekly urine samples, life surprises that get in the way of compliance and other hindrances. All of these come with a cost, to society, to families, to communities, and to taxpayers. Add it all up and the Avalere report shows that the cost of OUD to the state of Massachusetts and its cities and town is nearly 150 billion dollars annually.
Most people who are drug dependent will tell you they want to be sober. Many simply aren’t ready to give it up. Long-acting injectables take that decision equation out of their hands in a painless way.
I can tell you firsthand what a difference they can make. I’ve had patients tell me LAIs have given them their lives back. They are now productive members in their communities, and many are trying to help others.
We have the ability to solve this. But it will take education, a willingness to listen, and investment. There is a path forward. We just need to take that first step.
John Manion is a nurse practitioner at New England Medical Group in Norwell.