I want to be very careful in what I say here. But there is something very wrong with the following:
The White House is calling for more than a billion dollars in funding to transform opioid treatment in the United States, two top administration officials announced on Tuesday.
Until recently, the heroin treatment industry has been driven by the philosophy of “abstinence,” which insists that any form of medication is merely a crutch for an addict, and he or she ought to instead go cold turkey. The opposing view, now being pushed by the established medical community, views medication-assisted treatment that relies on FDA-approved medicines such as buprenorphine and methadone as an addict’s best chance of recovery.
Now, it’s true that opioid addicts have tremendous difficulty succeeding with a cold turkey approach. And relapses are so lethal with opioid addicts (due to rapidly declining tolerance) that anything that can minimize the chances for relapse should be strongly considered.
But neither buphrenophine (Suboxone) nor methadone will give you “recovery.” They are both opioids. They are both dangerous, especially methadone, they both have street value–which should tell you something–and they do nothing at all to break the addiction. In fact, withdrawal from Suboxone is reported to be at least as brutal as withdrawal from heroin. What these “maintenance” drugs can do, sometimes, is give you survival.
A much, much better way to go is to use naltrexone (Vivitrol). Vivitrol can be taken as a monthly injection, and it will block opioids from impacting your brain. This won’t prevent you from taking a handful of Vicodins or Oxy-Contins. It won’t keep you from shooting up. But it will prevent you from getting high if you do, and it will also prevent you from dying.
Once the addict takes his Vivitrol shot, he or she is basically safe until near the end of the month when its prophylactic effects begin to wear off.
Suboxone, on the other hand, is mainly used by addicts to prevent withdrawal symptoms and smooth over periods where they run low on opioids. You can score Suboxone on the street in Kensington right along with heroin and oxys.
It’s difficult to administer and usually requires regular supervised doctor visits. If the addict takes the drug as prescribed, they won’t suffer cravings. In this way, they can put together some sober time and let their minds and the bodies begin the process of repair. It’s not useless, and it does sometimes work. But it’s incredibly high risk because the addict really wants the euphoria and they’re not getting it with Suboxone. All they have to do is skip their treatment one time and go score, and they’re turning blue in a restaurant bathroom.
Parents have a lot of problems trying to keep their kids on Suboxone. Like I said, it has a street value, so the temptation to sell the medication is strong. It offers the opportunity to curtail your heroin use, smooth out the withdrawals, but not commit to quitting.
If a parent asked me if Suboxone was a good choice for their child, I would tell them absolutely not.
Methadone is also problematic. It’s basically heroin, and just as lethal. It also gets you genuinely high. But, administered at a clinic, it can be done safely and pretty much in perpetuity. If you’ve tried and failed to quit many times, being a methadone addict gives you a chance to live. Some people even manage to be pretty functional as methadone addicts, although it’s obviously far from ideal.
The better solution is to break the addiction. And that isn’t easy. For some people, maybe it’s simply beyond their ability. But the beginning point is putting together some sober time. And I mean genuine sober time, not time where you’re taking one opioid rather than another.
Now, in fairness to the administration, they’re responding to the fact that there are 1.2 million Americans who need treatment for opioid addiction and are currently getting nothing. These people are going to die if nothing is attempted to help them. They should at least have the option of using Suboxone. Given a choice between cold turkey and Suboxone, the latter is going to be more effective, at least statistically.
My concern is that this focus on a really flawed treatment is not the best approach. I also don’t like that the pharmaceutical companies that lobbied for the lax opioid prescription policies that created the opioid epidemic are now being given huge contracts to sell us more opioids.
If you or your loved ones get addicted to opioids, your prospects are not good. But your focus should be to get off opioids. Your choice doesn’t have to be between taking an opioid that you like and one that you don’t. You can quit, entirely, and not necessarily cold turkey.
But you’re probably going to need a lot of help.
The compromise: Kludge that rewards some powerful corporations… Our system these days.
yeah, pretty much.
Yes, my concern, too, which is how we got here in the first place. Ugh.
I work with someone who has an opiod/prescription med addiction. It ain’t pretty. Person has lost a ton of weight recently. Unsure why but due to doctor shopping (and never have a GP for very long), doctors aren’t connecting the dots. One dr thought cancer but turns out it’s not that. I’m thinking some sort of liver failure, but co-worker not tested for much of anything other than cancer (and only one specific kind of cancer, so who knows…).
I don’t think the medical establishment is always connecting the dots, esp with patients/clients who dr shop and jump around. Although to me, some of the signs seem obvious.
Addiction treatment is a bear and agree that methadone and similar really aren’t that effective. I am unfamiliar with the other recommended treatment but hope it offers some addicts a means to get clean.
My limited exposure to heroin addicts several decades ago is that most need long treatment programs to really get clean. An issue with the quick fix US medical/pharma lack-of-health-care complex is that long-term doesn’t have a place in the firmament. if you can’t pay for long-term treatment on your own, such as going into some serious drug rehab program, well… good luck.
I am glad, though, that Obama is attempting to do something. There is more and more info coming out in the media about how bad this addiction epidemic has become. It’s very bad.
Good luck to all concerned.
opiod/prescription med addiction … Person has lost a ton of weight recently. Unsure why…One dr thought cancer but turns out it’s not that.
The first clue people often get about an organic illness/disease is pain. Specific or diffuse, it’s data for a doctor in narrowing down the possible causes. Druggies are without or have so distorted this sensory ability that they lack this early detection system and when they do seek medical help, they’ve tied one of the doctor’s arms behind her back.
(Pancreatic cancer would have been a good guess by a doctor — not so easy to diagnose in otherwise healthy people — but eliminating that doesn’t seem to be much of a list for illnesses with an isolated single symptom of rapid and severe weight loss.)
Exactly, pancreatic cancer will cause massive weight loss, without any liver enzyme levels rising to give doctors an easy lab to check out.
This is why having an integrated pharma dispensing system is so important. You can doctor-shop, but you get the pills through a pharma. If the doc could dial up your opioid history, he might be a bit more reluctant to give you a prescription for 100 oxy.
Liver enzyme tests can tell whether or not his liver is on its way out.
Milk thistle and lecithin are good for the liver and can be purchased for cheap. They are both known to help the liver, and are both essentially harmless.
If someone is losing a lot of weight, ask them if they are also suffering from indigestion. If so, it could be their pancreas.
Pancreatic cancer rates are skyrocketing, and it’s a very painful and aggressive form of cancer.
And that’s exactly the core of the problem. The drug companies are legalized pushers, and they make many billions addicting people to their opiates. It’s like the British pushing opium on to the Chinese in the 1800’s, except they don’t need gunboats to make our government allow it. Naltrexone should definitely be the first line of treatment, but that would threaten their ability to keep people addicted.
Naltrexone does have a whopper of a problem with poor compliance, but it’s still worth trying first.
I am a voluntary Directory and Honorary Treasurer of a community based drug treatment centre, which uses methadone for harm reduction, but in the context of a holistic philosophy and a range of other measures such as counselling, family support, peer group support, outreach, prison links and rehab programs, job training schemes, needle exchange and complimentary therapies such as acupuncture, Reiki etc.
Methadone has its uses and many of our clients have been stable on it for years, but we would never recommend it as a stand-alone therapy. The “medicalisation” of addiction is part of the problem, not the solution.
As you say, the medicalization of addiction is not a solution. How do addicts get off the addiction? Methadone is simply a legal heroin.
For some individual cases it is better than any realistic alternative (often death) but as you say,long term it does little if any good. I am personally in favour of reducing its use to an absolute minimum where it can be shown to reduce harm.
yes, good. treatment requires addressing the entire context. heard an interview on NPR last week from heads of a few community agencies in a city in Vermont (probably Rutland, but missed the opening) where they’ve done just that.