Dr. Michael J. O'Connell, PainCare, New Hampshire, recently commented that he read with interest the article by Meghan Barr in the Manchester Union Leader regarding the dearth of inpatient treatment programs for opioid addicts inNew Hampshire, indeed in the nation. This begs the question, is inpatient treatment necessary or even desirable? The current debate about the cost of healthcare (this is why the Affordable Care Act was passed, right?) would suggest that a balance between cost and efficacy is the “right” method – to obtain the biggest bang for the healthcare buck. Increasing capacity for inpatient care does not sound “right.” Residential treatment is both expensive and due to the nature of addiction, often unsuccessful.
Currently, only a tiny percentage of addicts can access inpatient treatment, and even if they do, if the stay is not long enough, or if intensive outpatient follow-up not provided, all these resources are wasted in the form of relapse and starting over. Is it a heretical idea that maybe inpatient treatment, while a noble goal perhaps, is entirely unrealistic and not at all cost effective; that comprehensive outpatient treatment is the direction that addiction treatment needs to take?
While inpatient services surround the addict with an artificial environment, protected from user ‘friends’ and dealers that they must eventually confront and expunge from their lives, intensive outpatient care assists the addict in the complicated process of reprogramming their social existence, starting with what the addict faces from day to day. When combined with buprenorphine, the medication that is appropriately replacing methadone as a staple product to mitigate opioid cravings, outpatient treatment will be the most important part of the answer in combating the current enormous (and growing) heroin problem.
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