This year’s Silfen Forum explored solutions to America’s drug crisis.

“More than 130 people in the United States will die of an opioid overdose today,” Penn President Amy Gutmann told a crowded Irvine Auditorium in early April during the 2019 David and Lyn Silfen University Forum. Gathered on the stage with her were a doctor, a professor, and three politicians, representing a variety of backgrounds and perspectives on what’s been called the worst drug crisis in American history.

On the panel were Penn professor of emergency medicine Jeanmarie Perrone, who has served on opioid task forces in Philadelphia and Pennsylvania; Harvard professor of psychobiology Bertha Madras, who currently sits on the President’s Commission on Combating Drug Addiction and the Opioid Crisis, appointed by President Donald Trump W’68; former vice president Joe Biden, Penn Presidential Professor of Practice; former Florida governor Jeb Bush, Penn Presidential Professor of Practice; and Philadelphia Mayor Jim Kenney.

In a candid and complex discussion, the experts discussed the overprescription of opioids, how to prevent illegal drugs from entering the US, and the difference between addiction and lack of willpower.

“Addiction is a biobehavioral disease,” explained Madras. The brain actually changes after the introduction of drugs and begins to adapt to abnormal signals. It’s not a matter of willpower, she said. Without the use of medication-assisted treatment (MAT), “you cannot really climb out of that uncontrollable urge.”

In the excerpt below, Perrone further explained why MAT is so important when treating opioid addictions, and why it should not be stigmatized.

“So how many of you all are carrying naloxone? Narcan and naloxone are more likely to save lives than any of you who are trained in CPR. If somebody is unresponsive, [the bottle] just goes right up their nose. There’s no needles, there’s no injections. You just depress it, and it atomizes an antidote that can save lives. … But you should know that about 10 percent of people who are resuscitated with naloxone are dead within a year. If we don’t get them into treatment right from that moment, we’re losing an opportunity and people are dying.

[Philadelphia] has now started a new program where, when patients are resuscitated with naloxone but don’t want to come to the hospital, something called an alternative response unit comes to the patient’s side, with social workers and certified recovery specialists who try to get them into treatment. We cannot miss these opportunities. Acute resuscitation needs to be followed by treatment, intervention—or just engagement, just connection to care, with people who are peers who can speak to the patient, who can say, ‘I’ve been there, I know what you’re going through.’

There are medications that help substantially, [but they are] stigmatized. There is the drug methadone, which is a full opioid agonist, so it acts like heroin. Some people say it’s like trading one addiction for another, but that’s completely untrue, because it stabilizes the brain. There is a need to replace that drug that’s been taken away, but it prevents the addictive behavior, prevents that behavioral impulse to go out and seek the drug, so they can stabilize, they can work, they can go back to their families, they can take care of their kids.

Methadone is an amazing drug that has been around since the late 1960s, but it can only be available by going to a treatment program every single day. It’s highly regulated. … Suboxone is another very viable treatment for opioid use disorder. It works like methadone except it’s safer. It’s not a full agonist, it’s a partial agonist, but it has a “ceiling effect” so it prevents people from overdosing. But it also prevents them from using heroin or fentanyl. It’s tremendously helpful.

People can’t make appointments when they’re going through the cycle of withdrawal and craving and using, so they can’t get into treatment. We need low-barrier treatment. [In our emergency department] we can start them with their very first dose [of suboxone] on that visit, and it makes a huge difference. But, in concert with that, they need the support of certified recovery specialists. They take that patient’s hand, and they guide them to their first appointment, to their treatment.” —NP

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