This is the latest in a series of posts about drug assisted therapy (DAT) of opioid use disorder (OUD).
I will repeat things which I wrote here and here. The bottom line, so far, is that there is strong evidence that drug assisted therapy ov OUD is effective and many extremely establishment experts complain that it is not more universally available.
I think this is one issue which should be a political winner for Joe Biden. I read that “fentanyl” was one of the words most often used during the GOP presidential candidate candidate debate. As noted by Paul Waldmann “The presidential campaign is making us dumber on opioids.” The Republicans want to talk about the US Mexico border and conflate asylum seekers and fentanyl smugglers. It is estimated that 90% of fentanyl enters at legal ports of entry (it is not bulky like marijuana so it is easy to hide). Waldman notes that one year’s US demand would fit in one tractor trailer (and so be very hard to find if hidden in 100). Interception at the border is not practical. I note that most arrested smugglers are US citizens (of course it is easier to cross the border if one is) and that, as far as I know, no asylum seeker has been caught with fentanyl.
In contrast, treatment of addiction might work. I think Biden should promise free treatment including access to treatments with effectiveness demonstrated by by clinical trials for everyone who requests it without delay or cost to the patient. I think this is a political winner. There are many voters who know and care about people with OUD.
I see two delicate issues. I hint at one with “clinical trials”. I think it important that people have access to drug assisted therapy (DAT). I think there is a risk that they will get access only to alchololics anonymous like 12 step program therapy. I am very very sure that arguing against counseling based therapy is a political loser (especially if one considers that the counseling is often to open one’s heart and feel the love of Jesus). I am quite sure that an option to try without medication must also be offered (for political reasons). I think that (even with the current Supreme Court) it will be possible for the executive branch to say that patients must be treated even if they don’t participate in counseling sessions (that is drugs alone must be available as recommended jointly by the National Academies of Sciences, Engineering, and Medicine. But, since money is required, this would have to be snuck past Congress.
The other is Hunter Biden. I think that Joe Biden can mention that he has been there and dealth with a similar problem in his family. I suspect that Republicans will claim the initiative is an effort to distract attention from Burisma and Hunter’s Chinese dealings. I think this can work out (many will not find the GOP line despicable but there is no hope of reaching them anyway). I wonder if Hunter Biden could become the spokesman for the effort (you know to undo some of the damage he did to his dad’s career).
I think that this (like universal at no cost to the patient access to contraception including long acting reversible contraception) is a political winner.