Greg interviews Dr. Darin Neven, an emergency department physician practicing at Providence Sacred Heart Medical Center in Spokane, Washington. Dr. Neven explores the need to change the culture and practice in terms of treatment for substance use disorders in general and opioid addiction in particular. He points to one effective method to identifying a problem is through Washington’s state-wide tracking of patients’ ED visits, following their appearance pattern and history.

He notes how much the ED has changed by saying: “In the past, it was the epicenter for alcoholics where the treatment was to let patients sleep it off and get them through the physiological effects. We never applied addiction science.” Greg further pursues with him this issue of “treat em and street em.” Dr. Neven is trying to help spearhead a retreat from that approach. He supports treatment with Suboxone which he says he believes is most effective. The next issue he raises is the need for patients to get to treatment centers. He explains a loophole that can be used to keep patients in the ED for three days employing a hospital DEA number, but they still need a destination afterward. Greg inquiries about success stories and Dr. Never reveals that after 30 days in treatment, about 70% are still enrolled in treatment facilities and about 50% are there after 60 days. He explains that his treatment method replaces addiction with dependence, a process by which a patient transitions from having no control and using excessively to needing another drug that has no adverse side effects. Medication-assisted treatment is the best solution, he says. “The hardest part is getting off for the first seven days,” he reports. The process primarily involves experiencing nausea, diarrhea and sweating. “We need to calibrate how we treat this issue which is not about moral failing and hopelessness.”

Listen to the podcast to discover how the issue of opioid addiction treatment is shifting and success is being found with Suboxone.