Advanced metastatic cancer is a serious, life-threatening illness. No one doubts that.
Severe addiction is also often lethal (in 2017, more than 70K people died from drug overdoses, 2/3rds involving opioids1), but it clearly does not get the same attention as cancer care does, for a lot of diverse reasons ranging from stigma and lack of appropriate funding, to systemic issues related to how care, especially mental health, is organized in our country.
Our societal priorities, the way we “see” one disease vs the other, clearly shape how the care is delivered. It is painfully obvious in the case of a patient with severe addiction who gets diagnosed with a metastatic cancer.
Both of the diagnoses are serious and life threatening. However, one has a vastly better functioning system to deal with the disease than the other (only 25-50% of patients receive substance use treatment in a given year and over 2 millions are candidates for such treatment2). Shouldn’t both be addressed with the same level of intensity, resource allocation, and care coordination? It only seems logical, but rarely happens.
Let’s consider two scenarios:
Can metastatic cancer be treated effectively if the addiction is not addressed? Can a person be given e.g. intense chemotherapy course that aims at the cancer and yet his heroin addiction does not get addressed in the process? What is likely to happen then?
And vice versa. Treating a patient with heroin addiction with medication assisted therapy, while providing intense psychotherapy and support system (Btw. highly unlikely situation) is not enough if they suffer from a metastatic lung cancer that is ignored. This is not likely to work either.
Of course. Both diseases affect the same person!
Unfortunately, in the era of “personalized medicine,” our fragmented and siloed health care system, often forgets about the person.
The question is: how do we want our health care to look like?
Here is one book that can profoundly change the way you think about addiction. And some stats on the subject. And here and here are two editorials that elaborate on the subject of addiction and advanced malignancy.
It is time to change our approach.