Since the public health emergency was declared in 2016, more than 30,000 people have died from opioid-related overdoses in Canada.
On June 6, 2023, British Columbia (BC) became the first Canadian province to provide universal treatment for opioid addiction. Previously, in BC, people struggling to overcome an addiction to opioids had to pay for their treatment drugs. The government has now removed financial barriers to treatment programs.
This article explores the arguments for and against providing free opioid addiction treatment.
Addiction and Opioid Use Disorder
People can become addicted to various types of opioids, including both prescription opioids and illicit drugs. Prescription opioids like oxycodone, morphine, and codeine are medications prescribed by healthcare professionals to manage pain. Illicit opioids like heroin, fentanyl, and carfentanil are obtained and used without a valid prescription. They are produced in clandestine laboratories or illegally diverted from legitimate sources.
Addiction can develop from legitimate medical use of prescription opioids and recreational or illicit use. Opioids have the potential to produce euphoria, pain relief, and relaxation, which can lead to misuse, dependence, and addiction.
Opioid use disorder (OUD) occurs when a person unsuccessfully attempts to cut down or when substance use leads to social problems and a failure to fulfill obligations at work, school, and home. OUD often occurs after the person has developed opioid tolerance and dependence, which makes it physically challenging to stop opioid use and increases the risk of withdrawal.
What does free opioid addiction treatment look like?
Treatment typically provides access to opioid agonist medications such as methadone or buprenorphine. It may also include counselling, behavioural support, and harm reduction measures without any direct cost to the individuals receiving the treatment.
Medical assessment and monitoring
Opioid agonist treatment typically begins with a medical evaluation to determine the appropriate medication and dosage for each individual. A healthcare professional will monitor the individual regularly to evaluate treatment progress, adjust dosages if necessary, and address any concerns or side effects.
Medication
Opioid agonist treatment drugs, like methadone or buprenorphine, work by occupying the same receptors in the brain as opioids and help reduce cravings and withdrawal symptoms without causing a person to get high.
Counselling and behavioural support
Addiction treatment often includes counselling and behavioural support services. These can involve individual therapy, group counselling, or support groups to address psychological and emotional health, help people develop coping mechanisms, and support long-term recovery.
A comprehensive treatment plan can offer additional healthcare services to address the holistic needs of individuals. The program may include access to primary healthcare, infectious disease screening (e.g., HIV or hepatitis C), mental health services, and social support services.
Harm reduction measures
Treatment programs often emphasize harm reduction strategies to promote the overall well-being of individuals. This service can include providing access to clean syringes, naloxone — an opioid overdose reversal medication, education on safer drug use practices, and referrals to other harm reduction services.
The specific details and structure of free opioid agonist treatment programs can vary depending on the healthcare system, country, and local resources. These programs are often implemented with input from healthcare providers, addiction specialists, and community organizations to ensure comprehensive care and support for individuals struggling with opioid addiction.
Some disagree with providing free opioid agonist treatment
There are various reasons why some people disagree with providing free opioid agonist treatment.
Moral concerns
Some individuals view opioid addiction as a consequence of personal choices and believe that providing free treatment could enable or condone addictive behaviour. They argue that individuals should bear the responsibility for their actions and that offering free treatment removes the consequences of their decisions.
Economic considerations
Critics might argue that providing free opioid agonist treatment places a significant financial burden on society. They claim that the costs associated with treatment, including medications, counselling, and support services, are too high and unsustainable in the long run. They may argue for allocating limited resources to other pressing healthcare needs.
Stigma and discrimination
Some individuals hold negative views or stereotypes about people with substance use disorders, including opioid addiction. They believe that offering free treatment encourages dependency and perpetuates the negative perception of individuals struggling with addiction. This perspective may reflect a lack of understanding of the complex nature of addiction and the potential for recovery with appropriate support.
Concerns about effectiveness
Some people question the effectiveness of opioid agonist treatments, such as methadone or buprenorphine, in addressing addiction. They may argue that providing these medications substitutes one addiction for another and does not solve the underlying issues. Additionally, critics might express concerns about the potential diversion or misuse of these medications.
Philosophical or ideological reasons
Opponents of free opioid agonist treatment may have philosophical or ideological objections to government intervention in healthcare or the concept of providing treatment as a public service. They advocate for a more limited role of government and believe that individuals should seek and pay for their own treatment.
While these viewpoints exist, the medical and public health consensus supports providing evidence-based treatment, including opioid agonist treatment, for individuals with opioid addiction. Many experts argue that offering free treatment can save lives, reduce harm, and improve public health and societal well-being.
Benefits of providing free addiction treatment
Finding the money to pay for treatment is one of the main reasons people don’t seek or get the help they need. When people can get free, safe treatment, they are far less likely to purchase illicit opioids from the toxic street drug market. Removing financial barriers and helping people get treatment leads to healthier, safer communities.
Other countries have had success with free treatment programs
Several countries have effectively implemented free opioid addiction treatment programs.
Portugal has successfully implemented a comprehensive approach to drug addiction, including opioids. In 2001, Portugal decriminalized the possession and use of drugs and redirected resources toward prevention, harm reduction, and treatment. This approach includes free access to opioid agonist treatment, such as methadone and buprenorphine, and a range of support services.
Over the years, Portugal has significantly reduced drug-related deaths, HIV transmission rates, and drug-related criminality. Portugal switched from treating addiction as a disease rather than a crime. Shifting from a criminal approach to a public health one — the so-called Portugal model — has dramatically reduced the number of heroin users in Portugal.
“You cannot work with people when they’re afraid of being caught and going to prison,” says psychologist Francisco Miranda Rodrigues, president of the Ordem dos Psicólogos Portugueses. “It’s not possible to have an effective health program if people are hiding the problem.”
Switzerland has a long history of offering free opioid addiction treatment programs, including heroin-assisted treatment. In this approach, individuals with severe opioid addiction who have not responded well to other treatments are given pharmaceutical-grade heroin under medical supervision. This program and other comprehensive treatment services have shown positive outcomes in reducing illicit drug use, improving health outcomes, and reducing criminality.
Australia has implemented various initiatives to provide free opioid addiction treatment. For example, the state of Victoria has established free community-based opioid treatment services, including access to medications like methadone and buprenorphine, counselling, and other support services. These programs have contributed to improved health outcomes, reduced overdose rates, and better retention in treatment.
These are just a few examples of countries that have successful free opioid addiction treatment programs. The success of these programs often relies on a combination of evidence-based treatment approaches, harm reduction strategies, and comprehensive support services tailored to the needs of individuals struggling with opioid addiction.
When people reach out for help, communities should offer them support. Everyone should have the opportunity and right to access free treatment for substance addiction, irrespective of income. When governments remove financial barriers to treatment, people can get the care they need to overcome their addictions, leading to safer, healthier communities.
Opioid agonist medications are cheap to manufacture. Providing free treatment medications is an inexpensive, easy, evidence-based way governments can address an urgent and deadly public health crisis.
