I have previously written about the more than 70 bills being introduced in Congress that addressed the opioid crisis, calling for lawmakers to expand resources and access to evidenced based solutions that are proven to work, and we offer here at Symetria Health®. My passion to speak with lawmakers about addressing the needs of the patients and communities stems from my experience seeing first-hand how Symetria Health® has transformed the lives of patients with our model of care. Over the time it took for these bills to become this historic Act of Congress I met with elected officials, policy makers, advocates, and health care executives. I even participated in an international Cross Border Health Conference on the Opioid Crisis with U.S. and Canadian leaders. What I found was a lot of really smart people aligned with the same goal listening to and learning from each other to provide solutions to those in need of addiction treatment, and on addressing prevention and recovery. Most of these stakeholders, when presented with evidence based, outcome data from Symetria’s treated patient population vs other forms of care, choices to allocate resources became more clear. That long conversation and Symetria’s position has now become law.
Those bills I wrote about passed through Congress and by the end of the summer had been introduced in the Senate, where they were passed virtually without any opposing votes. The President has signed the SUPPORT for Patients and Communities act into law, and it will save many lives because it recognizes and supports the treatment methodologies we know are effective and have spent our lives developing and improving here at Symetria Health®.
This isn’t just an anomalous moment in U.S. history, it absolutely defies precedent. Let this sink in for moment: Our Congress, which struggles to get the most basic of legislation passed on routine issues just put a bunch of smart people in a room, took their advice, included the voice of the medical AND recovery communities, and then made smart health care policy allocating ample resources with few dissenting votes. As President Trump has now signed it into law it will have an immediate mitigating effect on our leading cause of death, the opioid epidemic which The Centers for Disease Control (CDC) estimates kills 130 Americans a day. The law includes many additional sensible provisions such as helping to stop the flow of illicit opioids, making patient brokering a crime and naloxone more available. It also sets basic safety standards for recovery housing. All of this Symetria applauds. But the significance of elevating the evidence-based gold standard in opioid treatment which we have developed and deployed at Symetria cannot be overstated. The excitement it brings us to be eligible to work with any partner — public or private — who now want to be part of the Symetria Health® evidence-based proven solution is also indescribable. The field of addiction treatment has suffered from fragmentation and and lack of consensus evidence-based care for so long, this law finally puts much of the arcane and esoteric debates that cost so many lives to rest. We are aligned. We now have a game plan. This law puts us on the same page.
How Did We Get Here?
This story begins decades ago when I was at Reckitt Benckiser and we knew that a drug called buprenorphine helped ease the often-insurmountable cravings that make battling opioid addiction so difficult. I lead a team who desperately tried to get the drug, which we branded Suboxone, into the tool kit of everyone helping treat those addicted to opioids. The crisis was in its infancy, and we would see it grow to the leading cause of death over the next 20 years and take a million lives. In a move that made perfect sense at the time, we suggested and advocated for what became the 2003 Office Based Opioid Treatment Act (OBOT) which allowed non-specialized primary care physicians to prescribe up to 60 patients if they completed a short training course. The effort, which was a good start to address the emerging public health crisis, and it has since proven only somewhat effective, was based on several assumptions which have since proven to be flawed. First, we assumed that primary care physicians would insist or at least encourage patients to complete behavioral health care and counseling as they were receiving craving reducing medication. In fact, over time it became apparent that many doctors prescribed buprenorphine and never referred the patient for behavioral healthcare or in some cases, saw the patient only to prescribe buprenorphine. Second, we assumed the slow raising of the patient cap thresholds would minimize the amount of diversion that would occur. In fact, as we now see, without the proper patient oversight, management, and support of behavioral healthcare, buprenorphine has become a highly diverted drug and the street value increased. Unfortunately, those suffering with addiction began to abuse the solution. This is a normal by product of the addiction pathology. However, in our experience, myself and my team knew two things: First, the physician HAD to stay in the equation; second, addressing the pathology of cravings with a medication solution attached to a committed behavioral health provider would help many patients who simply could not reach recovery otherwise.
My quest to address the challenges and pitfalls began many years ago. I spoke with many experts in the addiction treatment community and listened to patients who had been successfully treated and those who had failed about their experience. These critical interactions and learnings, led me to build a model that solved many of the barriers to evidence-based treatment success the original Suboxone launch revealed. These obstacles were systemic, embedded in the treatment culture, and compounded by policy makers and a general public with no concept of the true nature of the disease and harbored no empathy for the suffering addicted person. As the death toll increased, it became even more evident that the aggregated elements of what was working and was backed up by evidence into a treatment methodology was the solution. A physician familiar with addiction who prescribed ANY of the medication tools to help with cravings, which now included methadone, buprenorphine, naltrexone and once a month Vivitrol, combined with a team of behavioral health clinicians to deliver individual and group counseling as well as assess any co-occurring depression or anxiety, while simultaneously teaching recovery supports (e.g.-peer to peer programs) seemed to have the highest success rate. We began to see that even the patient who was deep on the spectrum — the most severely addicted who had failed after several attempts — could still respond and succeed with this combination of services. So, I gathered the best and the brightest in the business and put them all under one roof, one team sharing the same records and united in the same mission. From that, Symetria Health® was born.
Concurrently, in 2015 U.S. Surgeon General Vivek Murthy commissioned the first ever Surgeon General’s report on addiction, largely in response to the now exploding opioid crisis. When the report was made public in 2016, it outlined that the evidenced based gold standard of treatment for opioid addiction was medication assisted treatment combined with a comprehensive psycho-social regimen of services. Without saying it directly, this “best approach” described exactly what Symetria Health® was delivering in Illinois, and it was very affirming. Once the Surgeon General’s Report validated the treatment we were delivering, it was very clear to me that I had to perfect it further, making it as cost effective as possible and as widely available as possible. By this time, it a visible sea change was occurring in our national conversation on opioid addiction, much of the stigma began to disappear and the Comprehensive Addiction and Recovery Act passed virtually unanimously in 2016. That was a pre-cursor to today’s legislation. But as Symetria Health® set out to amplify its effective treatment method, encouraged by smart public policy, the country underwent a seismic political change and the opioid crisis continued to increase. Would the cooperation and urgency survive in the new landscape? Miraculously it did.
While the political landscape was changing, discussion and efforts continued. However, in the background and with continuing attempts by various government agencies to address a growing opioid epidemic public health challenge, we found our nation now in an opioid addiction CRISIS. Throughout this, Symetria Health® was still delivering an effective solution that saved lives, in fact we had achieved a success rate of 70% of patients achieving 12 months in recovery without relapse. A few years ago no one would have believed that a 70% success rate was possible and I have watched jaws drop in presentations to insurance company executives as I go through the data. But this success rate is achievable anywhere if the RIGHT treatment is given to the patient according to their individual needs. The exciting news is now that we know what works, this legislation will enable us and others to do more of it. The more Symetria Health® Method we deliver, the more lives are saved and rebuilt, the more families stay intact, the more employees return to work and lead a productive life.
So this is a great day. Symetria Health® can impact more communities and patients and families will get more help. This is a political “win” of a different kind — as we are unaccustomed to this type of cooperation and bipartisanship –it’s a win for both sides of the aisle and a win of the best kind. It speaks volumes to the gravity of the opioid crisis, and the suffering which addiction causes families, that a bridge can be built on such a troubled political sea. It proves when we focus on the noble goal of cooperating to treat a disease, everyone wins. If you are around the world of recovery long enough you will see fleeting moments of grace: a son returning home to his family, a mother celebrating two years sober, a counselor delivering active healing in a circle of chairs…. Today that fleeting moment of grace was the stroke of a pen in the least expected of places.