FDA Commissioner Scott Gottlieb Goes to Bat For Evidence-Based Opioid Policies

Gottlieb isn't a perfect harm reduction advocate, but he's a hell of a lot better than the D.C. status quo.


FDA Commissioner Scott Gottlieb. Photo source: Douliery Olivier/Sipa USA/Newscom

Food and Drug Administration Commissioner Scott Gottlieb is now the highest-ranking member of the Trump administration to say in plain language that America can't address the opioid crisis by relying on outdated prevention campaigns or forcing dependent and addicted users to quit cold turkey.

"[G]iven the scale of the epidemic, with millions of Americans already affected, prevention is not enough," Gottlieb said in a statement to the House Committee on Energy and Commerce this week. He also pledged his agency would do everything in its power to "break the stigma associated with medications used for addiction treatment."

A physician and former resident fellow at the American Enterprise Institute, Gottlieb's testimony provided a dramatic and welcome contrast to the blunt and shallow statements of other Trump administration officials.

Whereas former Health and Human Services Secretary Tom Price said that methadone and buprenorphine therapy—which can reduce opioid-related mortality by 50 percent—amount to "just substituting one opioid for another," Gottlieb acknowledged this week that some people with opioid use disorders will need "a lifetime of treatment." His agency, he added, is "revising the labels of these medical products to reflect this fact."

He has also instructed Food and Drug Administration staff to develop more extensive guidelines for "non-abstinence-based" products that "address a fuller range of the symptoms of addiction such as craving."

Lastly, Gottlieb delivered a rousing rebuttal to the idea that addiction and dependence are no different:

Because of the biology of the human body, everyone who uses opioids for any length of time develops a physical dependence—meaning there are withdrawal symptoms after the use stops. Even a cancer patient requiring long-term treatment for the adequate treatment of metastatic pain develops a physical dependence to the opioid medication.

That's very different than being addicted.

Addiction requires the continued use of opioids despite harmful consequences. Addiction involves a psychological craving above and beyond a physical dependence.

Someone who neglects his family, has trouble holding a job, or commits crimes to obtain opioids has an addiction.

But someone who is physically dependent on opioids as a result of the treatment of pain but who is not craving more or harming themselves or others is not addicted.

The same principle applies to medications used to treat opioid addiction. Someone who requires long-term treatment for opioid addiction with medications—including those that cause a physical dependence—is not addicted to those medications.

Here's the bottom line:

We should not consider people who hold jobs, re-engage with their families, and regain control over their lives through treatment that uses medications to be addicted.

Rather, we should consider them to be role models in the fight against the opioid epidemic.

Others have drawn this distinction before, so I hesitate to applaud Gottlieb for acknowledging what his peers have said for years. But this is Washington, a place where drug policy experts are often drowned out by quacks, drug cops, and prosecutors. Gottlieb is not the most progressive reformer in this debate—he may end up calling for the removal of still more opioids from the market, which will hurt legitimate pain patients and likely drive non-medical users to the black market—but his perspective on using opioid therapy to treat opioid addiction puts him head and shoulders above the D.C. status quo.

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  1. He also pledged his agency would do everything in its power to “break the stigma associated with medications used for addiction treatment.”

    “Except, of course, the stigma associated with marijuana.”

    1. Are his views on marijuana widely known? Trump basically has no opinion on anything and his administration is full of opposites in every different position. Wouldn’t be surprised if this guy wound up loosening some restrictions around medical uses of marijuana. I may be wrong, though.

  2. Mike Riggs once went to bat to eat all the opoid evidence before the police got there. He ate the whole bat with a nice Chianti and still had room for whole steak.

  3. “Opioid use disorder ”

    Thomas Szasz is spinning in his grave.

  4. I just don’t see how he’s going to pound this nail out of the way by using a teddy bear.

    1. Easy. Just freeze the teddy bear.

  5. Most people become addicted to opioids after receiving the drugs for a medical condition, said Dr. Scott Gottlieb, commissioner of the Food and Drug Administration.

    Wrong. Most people get ‘addicted’ after stealing the drugs from someone who was prescribed them. And this causes a ‘disease’ that makes them steal drugs. Yes this is proven.

  6. “[G]iven the scale of the epidemic, with millions of Americans already affected, prevention is not enough,” Gottlieb said in a statement to the House Committee on Energy and Commerce this week.

    I’ll bite (and I’ll accept the possibility that this is a dumb question). Why is this part of a statement to the House Committee on Energy and Commerce? I’m guessing it’s because of some kind of link between “Commerce” and the pharma industry? If so, I guess it makes sense. But, I think there are probably other/better venues where he should be making this argument. For example, while tossing Jeff Sessions in a wood chipper.

  7. Addictions carry at least some personal responsibility.
    I’ve had five major surgeries where I received prescriptions for opioids. They came along with the other prescriptions for antibiotics, blood pressure meds ect, filled them all of course without questioning the doctor’s orders. Can count on one hand how many I’ve taken on one hand with fingers left over.

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