Learning objective
Compare perceptions and approaches to OUD to other chronic medical
conditions.
Opioid use disorder (OUD) is often seen as only a social or moral problem and not a health problem. Imagine a patient with diabetes who presents to the hospital critically ill with diabetic ketoacidosis (DKA) related to not taking their insulin as prescribed.
Would you or your colleagues ever consider not treating them with insulin because they made “poor lifestyle choices”?
Of course not.
Yet, evidence shows that OUD is a chronic medical condition, similar to other chronic conditions like diabetes, hypertension, and asthma.1 Just like these chronic conditions, OUD
is heritable, is influenced by environmental conditions and behaviors, and responds to appropriate treatments and recovery supports, including lifestyle modifications and pharmacotherapy.2 To destigmatize OUD, it must be viewed in the context of a treatable medical disorder rather than a moral failing.
The use of any drug is voluntary and thus there is a role for personal responsibility in the form of behavioral control. However, there is still similarity to other chronic diseases that often result from a combination of genetic, environmental, and personal choices.2,3 For example, dietary choices along with family history and availability of nutritional food contribute to the development of hypertension and diabetes.
Studies have clearly shown that chronic use of specific drugs reliably produces enduring pathophysiologic changes in the brain (particularly within the “reward circuit”), in the levels of brain chemicals (neurotransmitters), and in the stress response system.
Patients who formerly used cocaine can have long-term metabolic changes in the frontal cortex of their brains three months after their last use.4
Patients who use substances inappropriately may have sustained changes in both the stress response and reward systems, even following periods of abstinence.5
Like other chronic health conditions, OUD is a treatable medical condition. For some people one treatment is enough, but for many other people, symptoms can recur and require additional treatment. Studies suggest that this frequency of recurrence is comparable to other chronic medical disorders.1
A similar rate of patients with substance use disorders, diabetes, hypertension, and asthma have a reemergence of symptoms requiring treatment in a hospital or an emergency room every year.
Stigma contributes to why OUD is approached differently from other chronic medical conditions. Think about how this approach harms patients. By framing substance use as a “social issue”, the common perception is that it requires law enforcement and criminalization, rather than how health problems should be addressed: through providing prevention and treatment.
Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.
Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.
– American Society of Addiction Medicine 2019
Viewing patients with OUD as having a chronic, relapsing-remitting illness helps create empathy and also reasonable expectations for the course of their disease. It shifts our focus to prevention and treatment, just as other medical conditions are treated, even those that have a significant “lifestyle choice” component to their presentation.