Prof. Keith Humphreys' slides from the Center for Health Journalism webinar, "Profiteers of Tragedy: Making Money Off America’s Opioid Addicts," 10.31.17 More info: https://www.centerforhealthjournalism.org/content/profiteers-tragedy-making-money-americas-opioid-addicts

1. Quality and Outcomes for Opioid
Addiction Treatment
Keith Humphreys
Esther Ting Memorial Professor, Stanford University
knh@Stanford.edu @KeithNHumphreys

2. The Roots Quality Problems in Addiction
Treatment
 Prior to 2008, poor insurance coverage for treatment, weak resource base
 Stigmatized patient population not seen as deserving high-quality care
 Separation from the rest of medicine
 It’s hard to judge quality in general within health care

4. To Judge Quality, We Have To Ask
What Are Reasonable Expectations

5. Understanding Addiction as a Chronic
Health Problem
 Addiction is not an acute health problem like a fractured
bone or influenza
 Addiction is a chronic health condition like diabetes,
hypertension, HIV, lower back pain
 As chronic health conditions can’t typically be cured, they
have to be managed long-term by the patient and the
health care system

6. Things People Say About Addiction Treatment that
They Don’t About Other Chronic Disease Treatment
(1) “When will he get off the methadone, his addiction should be treated by now?
Ever hear “When will he get off insulin, his diabetes should be treated by
now?”
(2) “She was in the hospital for 21 days of addiction treatment, why did she
relapse?”
Ever hear “She was in the hospital for 21 days for congestive heart disease
treatment, why did she have another heart attack?”
(3) He failed at addiction treatment
Ever hear “He failed at chemotherapy?”

7. What Does Good Treatment for Opioid
Addiction Look Like?
 90% of Care in the United States is OUTPATIENT and with some exceptions, that is
a fine model of care
 Multiple FDA approved medications exist and are first-line treatments
Methadone and buprenorphine
Naltrexone
 Many patients need and benefit from psychosocial interventions
Cognitive-Behavioral Psychotherapy
12-Step and Other Mutual Support Groups

8. What do Randomized Clinical Trials Find as
Typical Benefits of Quality Opioid Addiction
Treatment?
 Substantial drops in mortality
 Reduced crime
 Reduced transmission and acquisition of
blood-borne disease
 Reduced illicit drug use
 Increased employment

9. What Will It Take To Make Quality
Normative?
 Continuation of the ACA, Medicaid Expansion
 Better informed and valued consumers
 More informed as well as well as more law-abiding
insurers