What HHS Secretary Tom Price said about opioid addiction treatment

Health and Human Services Secretary Tom Price raised an uproar after being quoted by a West Virginia newspaper as saying that a type of treatment for people addicted to opioids isn't very effective and suggesting there's a cure for addiction — despite research on the contrary.

"If we’re just substituting one opioid for another, we’re not moving the dial much," the Charleston Gazette-Mail reported Price saying on May 9. "Folks need to be cured so they can be productive members of society and realize their dreams."

Price was in West Virginia on a "listening tour," meeting firefighters and paramedics who respond to calls of people overdosing on opioids. Price "touted faith-based programs while showing less support for medication-assisted programs in which addicts are weaned off heroin with other opioids like Suboxone and methadone," the Charleston Gazette-Mail said. 

Price’s comments prompted hundreds of researchers and practitioners to write a letter urging him to "set the record straight" and assert that medication-assisted treatments "meet the highest standard of clinical evidence for safety and efficacy."

A spokeswoman for Price offered PolitiFact a longer excerpt that provided more context of the secretary's response to the newspaper. Price seeks to expand access to treatment and recovery services, including medication-assisted treatment, his office said.

We won't be rating Price's statements on the Truth-O-Meter because the longer version presents a more nuanced picture. Here’s an overview of the controversy and the expanded response.  

Opioid drugs cover prescribed painkillers such as oxycodone, synthetic opioids such as fentanyl (similar to morphine but much more potent), and the illicit drug heroin.

Misuse and addiction to opioids has become a national epidemic. The Centers for Disease Control and Prevention estimates that 91 Americans die daily from opioid overdose.

CDC said opioids are "the main driver of drug overdose deaths," and West Virginia in 2015 had the highest rate of death due to drug overdose, 41.5 per 100,000.

Prescription opioid dependence, abuse and overdose cost the United States $78.5 billion in 2013, according to CDC research.

PolitiFact has fact-checked several claims about opioids, but we wanted to learn more about statements coming from Price, a physician and former Georgia representative now leading the department in charge of enhancing and protecting the health and well-being of all Americans.

An HHS spokeswoman told PolitiFact that rather than discarding avenues to treatment or embracing a one-size-fits-all mantra, Price favors a broader range of options, from medication-assisted treatments — including methadone, buprenorphine, or naltrexone — to faith-based recovery programs.

"One of the five pillars of the secretary's strategy to combat the opioid epidemic is expanding access to treatment and recovery services, including medication-assisted treatment," HHS spokeswoman Alleigh Marre said. 

She offered a longer transcript of the exchange with the West Virginia reporter. Some of Price’s words in that transcript are slightly different from the quote in the Charleston Gazette-Mail. There’s more context and a broader point that what works for one person, may not work for all. But it still includes the message about not moving the dial much with opioid-type medication substitution and getting people "cured." (We’ve bolded the text that differs from the newspaper account.)

Reporter: "Last question, on the treatment...we hear a lot of debate here, faith-based or the medication assistance treatments, do you guys lean one way or the other?"

Price: "I think what I know about health care is that what's right for one person isn't necessarily right for another person, but I do know that if we just simply substitute buprenorphine or methadone or some other opioid-type medication for the opioid addiction, then we haven't moved the dial much. And so what we can do to try and find the medications that aren't the agonist, the antagonists. Vivitrol is an example. It's a medication that actually blocks the addictive behavior as well as the seeking behavior. That's exciting stuff. So we ought to be looking at those types of things to actually get folks cured so that they can come back and become productive members of society and realize their dreams." 

Vivitrol is the brand name of a form of naltrexone, a medication also used to treat opioid addiction. It is not an opioid. Naltrexone is taken after opioid detoxification.

To reinforce Price’s stance, his spokeswoman also pointed to several blog posts, op-eds and statements in which he writes about improving access to treatment and recovery services, including medication-assisted treatment.

At an April 19 summit in Atlanta where he announced the department’s strategy for fighting opioid crisis, Price noted, according to prepared remarks: "There is no miracle drug that will cure addiction."

Price’s comments as reported by the West Virginia newspaper prompted more than 600 practitioners and researchers to sign a letter asking Price to "set the record straight" about medication-assisted treatment.

"Media sources reported that you characterized these treatments as ‘just substituting one opioid for another.’ The perception that persons receiving long-term therapy with medications — especially with buprenorphine and methadone — are not actually in recovery is widespread but grossly inaccurate. You spoke about the need to enable people with opioid use disorder to become ‘productive members of society and realize their dreams,’ but these medications are precisely what enable people to regain their lives. We urge you to set the record straight: medication-assisted treatments meet the highest standard of clinical evidence for safety and efficacy."

 Opioid use disorder or opioid addiction is a chronic relapsing disease similar to diabetes and hypertension, said Gail D'Onofrio, a professor of emergency medicine and chair of the Department of Emergency Medicine at Yale University, in an interview with PolitiFact.

"It is not ‘cured,’ but can be managed effectively," D’Onofrio said.

Abstinence-only often leads to relapse, and since the person has then reduced their tolerance, reuse leads to overdose and unfortunately death, D’Onofrio said.

Information published by the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration, both within HHS, support D’Onofrio’s statement.

 "Addiction is a disease. It cannot be cured, but it can be treated with medication, counseling, and support from family and friends," said the Substance Abuse and Mental Health Services Administration. 

Medication treatments — specifically opioid agonists such as buprenorphine and methadone — are the most effective treatments for opioid use disorder, said David A. Fiellin, a professor of medicine at Yale School of Medicine.

 "These medications do not simply ‘substitute one opioid for another,’ " said Fiellin. "Rather, they have been specifically chosen based on unique pharmacologic properties that allow them to decrease withdrawal and craving while simultaneously blocking the effect of other opioids."

They also have been endorsed by the World Health Organization, the U.S. Surgeon General, the National Institutes of Health, the Substance Abuse and Mental Health Services Administration, the American Society of Addiction Medicine, the National Governor’s Association and many other leading expert organizations, he said. 

"When provided appropriately they avoid euphoria (the high), are taken once a day (rather than multiple times) and allow people with opioid use disorder to function without adverse impact from their medical condition," Fiellin said. 

The National Institute on Drug Abuse also dispels "myths" about medications for opioid addiction:

"Methadone and buprenorphine DO NOT substitute one addiction for another. When someone is treated for an opioid addiction, the dosage of medication used does not get them high — it helps reduce opioid cravings and withdrawal. These medications restore balance to the brain circuits affected by addiction, allowing the patient’s brain to heal while working toward recovery."