Hazelden to start opioid maintenance

This has gotten a lot of attention [emphasis mine]:

…for the first time, Hazelden will begin providing medication-assisted treatment for people hooked on heroin or opioid painkillers, starting at its Center City, Minnesota facility and expanding across its treatment network in five states in 2013.  This so-called maintenance therapy differs from simply detoxifying addicts until they are completely abstinent. Instead, it acknowledges that continued treatment with certain medications, which can include some of the very opioid drugs that people are misusing, could be required for years.

What’s their case? [italics mine]

The science, however, is getting harder to ignore. Studies show that people addicted to opioids more than halve their risk of dying due to their habit if they stay on maintenance medication.  They also dramatically lower their risk of contracting HIV, are far less likely to commit crime and are more likely to stay away from their drug of choice if they continue maintenance than if they become completely abstinent.

The first 3 points are not in dispute. Maintenance does reduce risk of overdose, contracting HIV and committing crimes.

However, the last point makes it sound like people put on maintenance are less likely to use heroin than people in drug-free treatment. In truth, she’s referring to the fact that once people are put on maintenance, there was “nearly universal relapse” when researchers tried to taper them off the drug.

Why opiate replacement?

“For most people using opioids daily, they are no longer getting high, even when they are still using.  It’s just become maintenance,” Seppala says. The effect is similar to the tolerance people experience with caffeine.  “If you drink caffeine on a daily basis, after a while, you don’t notice the effect of one cup of coffee,” he says, “But if you drank two, you would.”

Really? They weren’t getting high before they entered treatment? It’s like coffee?

Ok, moving on, but why do they think maintenance is a good idea for opiate addicts?

…with opioids, there is no significant mental, emotional or physical impairment if someone  regularly takes the exact same dose. In fact, research shows that patients addicted to opioids who are on maintenance doses of anti-addiction drugs like buprenorphine can drive safely, work productively and engage emotionally like those who aren’t addicted.

This isn’t our reading of the research. For example, the data on driving is mixed, at best.

On the issue of emotional engagement, the data doesn’t look too convincing either. Further, we know that opioid addicts benefit from talk therapy based addiction treatment, UNLESS they are on buprenorphine.

How long will patients be on the drug? [emphasis mine]

Hazelden will start using buprenorphine maintenance cautiously at first.  The drug will not be provided to people who have been addicted to opioids for less than a year and complete abstinence will remain the ultimate goal for most patients, even as the program recognizes that years or even lifetime maintenance on the drug may sometimes be needed.

Keep in mind, that there’s more than a little money involved:

If an addict is fully informed and wants buprenorphine, I have no objection. But this is a terrible direction for the field to take. As we’ve pointed out before, opioid addiction is relatively common among health professionals, we DO NOT treat them with opioid maintenance, they get 12 step and abstinence oriented treatment and they have great outcomes.

Read our position paper for more on why Dawn Farm does NOT use opioid maintenance treatment.

11 Comments

Filed under Controversies, Dawn Farm, Harm Reduction, Policy, Treatment

11 responses to “Hazelden to start opioid maintenance

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  9. Haley

    You are extremely ignorant. You have no idea what it’s like to be a heroin addict- which is awesome for you, I wouldn’t wish it upon ANYONE. But you need to be a bit more understanding of just how powerful this addiction is. Its strength is NOT comparable to any other- cocaine, meth, alcohol, etc. It changes everything about you. I’ve spoken to people who have been clean for decades and STILL are haunted by the thought of getting high almost daily- it never goes away no matter how far you’ve come.
    It IS INDEED comparable to a cup of coffee. Opioid tolerance increases very quickly- your brain stops making its own dopamine and other chemicals because you’re getting them from the drug. I would get clean, relapse and get high, then after that first time I’d get sick within hours, and feel the rush less and less. By the next day or so, I would NOT feel high anymore. I’d feel deliriously miserable, soaked in sweat, shaking, aching to my bones, dope sick, then shoot up and feel NORMAL. The only thing I’d get was relief for a brief moment that I had the opiates in me and i could somewhat function for the next few hours until I’d be sick again. It is a never ending hell. And even once you’re clean for months or years, the obsession never leaves you, your brain still feels off, and you still get post acute symptoms.
    I am a recovering IV heroin addict, I have about 50 days clean. I went to Hazeldens youth rehab in Plymouth where they didn’t give me any sort of maintenance, I was in heavy withdrawal and they were giving me antidepressants (which have never done anything for me). My counselor straight up told me she couldn’t handle my addiction. I did not even receive helpful therapy. I was too sick to focus on anything, my mind was completely consumed with thoughts of getting high no matter how hard i tried to push them out. And I paid over 20,000. I desperately wanted to stay clean, but I relapsed as soon as I left. I am now on a Suboxone program and I’m doing amazing, I feel somewhat normal again. It doesn’t by ANY means take away all the discomfort and cravings or make it easy- but it makes it more manageable. Everyone coming out an addiction is very fragile and has a lot of pain from the experience – it is SO helpful to have a medication to ease the cravings and w/d so they can get the therapy they need to stay clean after meds. If some need to be on it forever, who the hell are you to judge them? It’s no different than judging a diabetic for taking his insulin. It he didn’t take it, he would get very sick and possibly die. It’s the same for many addicts.
    If I had gotten MM I certainly would have gotten more out of it and probably stayed clean. I have tried so many times, I’ve done every treatment out there, and the withdrawal and cravings were too great no matter how hard I tried. It’s one of the most painful things anyone could experience. Especially when there is such a stigma surrounding you of people thinking you’re weak, morally corrupt, or that all you care about is getting high. All I cared about was getting clean, and the fact that I couldn’t was so heartbreaking and I felt so awful about myself. It is true misery, I imagine it is what being in hell would actually feel like. It is awesome that Hazelden is doing MM- they will save countless lives.
    Shame on you for ragging on something that will help those who are suffering and save lives. ESPECIALLY because you work in the field!!! I feel sorry for the addicts that go to your rehab if everyone there is half as bigoted as you just proved yourself to be, Educate yourself and open your mind and your heart. We all want the same things- to live happy lives. If MM can give us that, then what’s wrong with it? Have you even looked at the statistics?!? They say it all! It’s NOT your place to judge a disease you have never suffered from.

    • Well, what I want is for you and every other opiate addict to have the same treatment options that opiate addicted doctors have and to be fully informed of the pros and cons of each option. (There are pros and cons to each. This blog is full of links to research.)

      My opinions are based on research, professional experience and personal experience, not ignorance and bigotry. (I’m sure that’s not very convincing. I suppose every person motivated by ignorance and bigotry denies those motivations.)

      I am a recovering addict and alcoholic, though my primary problem was not opiates. I’ve worked with opiate addicts for 20 years, people active in their addiction and people who are recovering for years. I have many friends who were heroin and/or Rx opiate addicts. They are no longer haunted by wanting to get high. It does get better.

      I don’t begrudge anyone their path to recovery. I wish you nothing but the best of luck with your journey.

      “If an addict is fully informed and wants buprenorphine, I have no objection. … As we’ve pointed out before, opioid addiction is relatively common among health professionals, we DO NOT treat them with opioid maintenance, they get 12 step and abstinence oriented treatment and they have great outcomes.”

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