Hazelden just sent a newsletter that included a teaser about the rationale for their adoption of Suboxone over methadone.
It links to this article that describes their reasoning this way:
We found that buprenorphine was a better medication for our patient population and our goals of transitional use of MAT versus long-term medication maintenance. While methadone is very effective and useful for certain populations, most people in methadone maintenance programs commonly don’t have an abstinence orientation, which can result in continued use of benzodiazepines, cocaine, alcohol, marijuana, and other drugs.
Some context makes this interesting.
The federal government, the media, treatment providers, and medication manufacturers have put tremendous energy into promoting maintenance treatments. Most of these efforts do not differentiate between treatments.
Hazelden’s embrace of maintenance medication was seen as a sort of breakthrough for MAT.
The fact that they would characterize methadone programs in this way (and use the word “most”) is noteworthy.
Jana Burson provides a synopsis of a recent study on the role of the user’s knowledge in OD. (Her blog provides her perspective as a doctor who prescribes buprenorphine. It is worth your time.)
The findings will not be a surprise to anyone who talks with injection users about their knowledge and experience.
The authors of the study concluded that these experienced drug users were aware of common risks for overdose, yet drug intoxication from sedatives such as alcohol or benzodiazepines may have clouded the user’s thinking when injecting opioids. They also found that unexpected availability of drugs contributed to overdoses.
This presents some serious challenges for harm reduction efforts.
Another interesting finding is this:
. . . more than half of the study subjects were in some form of treatment for substance use disorder. This finding is contrary to other studies, which have found being in treatment lowered the risk for overdose. Around 46% were in medication-assisted treatment with either methadone or buprenorphine. However, some of the overdoses happened on days that the person missed dosing for some reason, and substituted another opioid such as heroin or fentanyl. Thirty-two percent of study subjects dosed with either methadone or buprenorphine in the twenty-four hours prior to experiencing their overdose.
This will be a big surprise to anyone who follows the opioid crisis in the news and/or advocacy from the feds, pharma, and others. (Not such a big surprise if you follow the research and this blog.)
There’s no doubt that maintenance medications provide some protection from OD. However, studies like this suggest that this benefit is often overstated, even when patients actually take their medication. (Of course, there’s also the issue that people discontinue their medication at high rates.)
I just learned that Bill White’s memoir Recovery Rising: A Retrospective of Addiction Treatment and Recovery Advocacy is available as an e-book on Amazon. The paper copy should be available soon.
Bill described it this way:
I have worked in the arenas of addiction treatment, recovery research, and recovery advocacy for nearly half a century and have been blessed with opportunities to work with some of the leading policymakers, research scientists, clinicians, and recovery advocates of my generation. At this late stage of my life, it seemed a worthy effort to try to pass on some of the hard-earned lessons I have drawn from this work. Such was the inspiration for turning decades of professional journaling into a book of stories that highlight, through my own experiences, some of the major milestones in the modern history of addiction treatment and recovery.
Recovery Rising contains more than 350 vignettes with accompanying reflective questions that allow readers to explore their own thoughts and experiences related to some of the most challenging issues on the frontlines of addiction treatment and recovery support.
I look forward to reading it and sharing more about it.
If you’re someone who’s a little intimidated by big books or has a pile of unread books on your nightstand, take note of the description mentioning “more than 350 vignettes.” I’m pretty sure that means there are a bunch of independent stories (organized around various themes) that are a page or two long. That means there no big commitment to read 700 pages from front to back, just a page or two whenever you choose.
It’s the kind of thing that 99.9% of people would never know, but addiction treatment related keywords have long been the most expensive keywords in Google AdWords. By far.
There are treatment programs with, say, 80 beds that have 100 websites. Some identify the provider, most do not.
A few years back I published a post about some of these practices. It’s so bad that it’s difficult to get your head around because there are so many hustles at so many levels.
At any rate, Google decided to do something about it. (Good for them, particularly since I imagine this was pretty lucrative for Google.)
Around the country today, marketers in the $35 billion addiction treatment industry woke up to an unpleasant surprise: Many of their Google search ads were gone. Overnight, the search giant has stopped selling ads against a huge number of rehab-related search terms, including “rehab near me,” “alcohol treatment,” and thousands of others. Search ads on some of those keywords would previously have netted Google hundreds of dollars per click.
“We found a number of misleading experiences among rehabilitation treatment centers that led to our decision, in consultation with experts, to restrict ads in this category,” Google told The Verge in a statement. “As always, we constantly review our policies to protect our users and provide good experiences for consumers.”
Google is the biggest source of patients for most treatment centers. Advertisers tell Google how much they want to spend on search ads per month, which keywords they’d like those ads to run against, and then pay Google every time someone clicks on their ad.
Thanks to Greg Williams for bringing it to their attention.
I recently listened to this episode from the podcast Rumble Strip. Erica Heilman interviews a high school senior whose mom and grandmother are addicted.
She’s a really impressive young woman. I hope she’s doing well in college. (This was recorded a year or two ago.)
This interview does a great job illuminating the effects of addiction on kids. Jesse seems very resilient and you get the sense she’s going to be ok. (Though it’s easy to imagine she pretty good at giving the impression everything is ok.) It’s harder to think about a kid who’s less resilient.
It’s a great illustration of what’s at stake when a parent is addicted.
We need a full array of treatment options of adequate quality, duration, and intensity accompanied by assertive outreach and good information that allows patients and families to make informed decisions in a marketplace that’s rife with hype and greed.
I’ve been thinking about methadone patients in Florida over the last few days. I can’t imagine.
Vox has a nice first person piece on what it’s like.
“It’s awful. I haven’t dosed in 5 days.”
The message popped up on my Facebook feed on August 29, a day after Hurricane Harvey first hit Texas. A woman named Clair, a methadone patient who lives near Houston, could not make it through the flood waters to get the dose she needed. She was going through withdrawal.
. . .
The desperation of Clair’s comment reminded me of my own experience trying to obtain methadone doses in the middle of a natural disaster. It was the Fall of 2013 when Boulder was hit with record floods that destroyed 1,500 homes and took the lives of eight people. On the day of the flood, I was stranded at home with no way to access a methadone clinic. I was five months pregnant. Missing my dose wasn’t just about being in pain — it was about my unborn baby, who might not have survived the physical toll of withdrawal.
Not having access to methadone was my worst fear. It’s a fear that consumed both body and mind, fueled by memories of nights without heroin, and rumors shared in the clinic waiting rooms that methadone withdrawals are even worse.
The Cincinnati Enquirer has a new piece on one week in the heroin epidemic in Cincinnati. It’s worth your time.
Here’s the closing:
It’s almost midnight on the last day of another week, and the heroin epidemic has done its damage.
18: Deaths known or suspected to be the result of overdoses.
180: Overdoses reported to hospitals in the region. This figure underestimates the actual number of overdoses because it only includes those requiring hospital treatment.
210: Inmates in the Hamilton County Justice Center, the region’s largest jail, who admitted to using heroin or other opioids. Jail officials have estimated that as many as half of all inmates, about 870 this week, have an opioid problem.
$95,550: Cost to taxpayers to house those 210 inmates for one week. If the inmate total is closer to the estimated 870, the cost would be $395,850.
15: Babies born with health problems because their mothers used heroin or other opioids.
34: Investigations opened in southwest Ohio into the well-being of a child whose parent or guardian was known or suspected of using heroin or other opioids.
102 hours, 42 minutes: Time it took first responders to tend to overdose patients. This figure is considered low by dispatch supervisors because many overdose runs are not initially called in as such.