Learning from the AIDS epidemic

 

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The American Journal of Medicine has an interesting commentary examining parallels between the AIDS epidemic and the opioid epidemic.

While the early history of government inaction, public fear, and stigmatization of HIV/AIDS is a shameful stain on this country’s conscience, 30 years later we have achieved tremendous victories, and the disease has transitioned from a veritable death sentence to a chronic condition for which most live a normal life, many with just a pill a day. The collaboration of affected communities, the public health system, physicians, and ultimately, government agencies to advance scientific understanding and disseminate an effective model of care provides lessons applicable to our current opioid epidemic.

To effectively address opioid addiction in this country, we need a comprehensive campaign for prevention, diagnosis, and treatment. Standard-of-care treatment models must be developed and disseminated based on existing evidence. Enhanced education of the medical community is necessary, and educational resources for addiction in medical training should be equivalent to that of other chronic diseases. While the intertwined issues of educational opportunity, employment, safe housing, and poverty must be acknowledged, remedying social determinants of health is not a prerequisite for implementation of effective treatment. Lastly, we could learn a lot from the HIV/AIDS campaign of “nothing for us without us” and involve patients with addiction in the design and implementation of programs meant to serve them.

There are immediate steps that can be taken to address the catastrophic death toll from unintentional overdose. Routine distribution and training in the use of naloxone, an opioid antagonist, is an effective and scalable intervention that is proven to save lives. Efforts to reformulate pain medications and decrease the availability of painkillers through physician education, prescription drug-monitoring programs, and crackdowns on “pill mills” also are important in preventing future addiction. However, we must be cognizant of those already addicted who, as the availability of pharmaceutical opioids declines in the absence of effective treatment, may turn to illicit opioids thereby introducing many other problems.

Ryan_2From the perspective of a provider who has worked with a few AIDS patients, it seem that the sea change moment was the passing of the Ryan White CARE act when we started making very expensive care available to low income AIDS patients, regardless of their insurance or ability to pay.

The average annual cost of HIV care in the ART era was estimated to be $19,912 (in 2006 dollars; $23,000 in 2010 dollars).3 The most recent published estimate of lifetime HIV treatment costs was $367,134 (in 2009 dollars; $379,668 in 2010 dollars).4

What would happen if we passed legislation that allowed all addicts to access the same kind of treatment that addicted health professionals get? How would the cultures of addiction treatment and addiction change. How would cultural attitudes toward addiction change? If there was a way out? For everyone?

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