When NARCAN first started being supplied due to grant dollars, there was a lot of pushback about it. “Why should insulin be so expensive and NARCAN be free?” The truth is that NARCAN isn’t free; it’s paid for by our tax dollars, so that question should be “Why do we provide NARCAN but not insulin to those in need at no cost?” And my answer is, “I have no idea, but it’s not an either / or argument.” There’s no one in a government position saying, “Well, we only have enough money to provide this life-saving medication. Which disease should we address?”
Unfortunately, the silos that we’ve developed – these isolated groups that hinder communication and cooperation – aren’t helping anyone, and they certainly aren’t solving any problems in the field of addiction.
Let’s talk about the silo of research: research, far too often, happens in a vacuum. An idea is considered, but the research team is so isolated that it’s not fully developed. For example, I recently attended a conference where a researcher was presenting on how, post-mortem, cocaine, amphetamines, and fentanyl affect a specific fluid in the body. Interesting, right? The takeaway was that these three drugs may affect the body differently, as indicated by the positive tests for each singular drug. That is, the research was done on those specimens that had only a single positive for ONE of those drugs. But here’s the catch, the specimens were never even tested for alcohol, so all that research is completely useless since the fluid could be singularly affected by alcohol or the fluid could be affected by alcohol WITH that other drug.
We don’t know, because that research happened in a vacuum, just like it did in the late 1980s when we were scared witless about “crack babies” and how they were going to end our world as we knew it. Surprise…we came to find out that it wasn’t the cocaine after all. The lifelong harm these babies suffered from was due to the alcohol that the pregnant moms were using to bring them down from the cocaine high.
But it doesn’t end there. We have a shortage of communication between too many groups. Researchers research; healthcare providers provide care; and treatment providers treat…and rarely do they come together. And, while we’re at it, let’s throw the government in because they impact much of what we do and how we do it. We use different language, different approaches, and different means, despite having similar goals overall.
The problem, then, is not that there’s not interest. Rather, it’s the lack of communication. It’s the lack of bringing those from other silos to the table. Research on Fetal Alcohol Spectrum Disorders (FASDs) has been happening since the 1970s, but we still don’t have enough research to allow people to diagnose FASDs. And that means that we don’t have enough people being appropriately diagnosed. So it’s become a vicious cycle of FASDs being under diagnosed, leading to the idea that there’s not a significant problem caused by prenatal alcohol exposure.
And it’s not only the world of FASDs. Consider “opioids” and “opiates.” What’s the difference? I’m not really sure. I know that we used to make a distinction between opiates as the naturally occurring substance and opioids as the synthetic substance. But then “opioids” was determined by the government to be the catch all word to make the language clearer.
(CDC https://www.cdc.gov/opioids/basics/terms.html)
Has it helped? I’m not sure. I still hear lots of people using the terms interchangeably and inaccurately.
And let’s consider alcohol as a drug. It is, but rarely do people see it that way, as is indicated by the research I referenced above and in my previous blog (https://guidedbyguida.guide/2024/04/30/cant-we-all-just-agree-on-drugs/).
Another consideration: MAT. The American Society of Addiction Medicine (ASAM) has asked that we recognize the acronym of MAT to be “medication for addiction treatment” since medication may be THE treatment…it’s not only ASSISTING treatment. However, this hasn’t caught on, despite the recommendation coming from the premier provider of education in addiction medicine. Is there another entity that knows better, or is it that we are just not communicating from our silos? I think you know what I believe. https://www.asam.org/quality-care/definition-of-addiction/glossary-of-addiction
Other factors among others that need to be considered are addiction as a disease, stigma of addiction, harm reduction, and mental illness as the umbrella term over “substance use disorders” but providers who won’t treat the SUD unless there’s another – a different – diagnosis of mental illness. I’m talking to you, KCHC, among so many others!
Why are researchers researching?
Why are healthcare providers providing care?
Why are treatment providers treating?
All of these practices are to improve the lives of those affected by the disease of addiction. Might I suggest, then, that we keep them in mind at every turn? Consider your language, consider your research, consider your approach, and consider who you can interact with to improve their lives.
Let’s move out of our silos to make a bigger impact.
Guided by Guida 
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