Another Reaction to Hazelden’s Adoption of Suboxone

Perhaps I’m the Wrong Tool by Tall Jerome

Mark Willenbring, a former Director of the Treatment and Recovery Research Division of the National Institute on Alcohol Abuse and Alcoholism/National Institutes of Health weighs in on Hazelden’s embrace of Suboxone

Hazelden’s new approach is a seismic shift that is likely to move the entire industry in this direction. I told Marv that it was like the Vatican opening a family planning clinic! However, although this is a major positive step, they continue to be wedded to a strictly 12-Step approach along with the medication. I don’t see this ever changing. Hazelden has always seemed to operate like a Catholic hospital: science was ok as long as it didn’t conflict with ideology, and when it did, ideology won out.

His post betrays the trope that 12 steppers control the treatment world.

What are the beliefs driving his celebration of buprenorphine maintenance? In another post he offers what he believes should be the informed consent statement offered to opioid addicts entering treatment. [emphasis mine]

The only treatment proven effective for treating established opioid addiction is maintenance on a medication such as Suboxone or methadone, often with adjunctive counseling. Studies show that maintenance treatment reduces illness, mortality and crime, and is highly cost-effective. Therefore, it is the first-line treatment and the treatment of choice. There is no evidence of effectiveness for abstinence-based treatment.”

Wow. “The only treatment proven effective“? “There is no evidence“?

Mark Willenbring is a doctor. What kind of treatment would he receive if he became an opioid addict? Would he get Suboxone maintenance?

No. He would not.

Why? We don’t treat doctors with Suboxone maintenance. They get abstinence-based treatment.

Wait, what!?!?!? They get treatment for which there is “no evidence of effectiveness”?!?!?!?

Actually, there’s evidence that they have great outcomes with abstinence-based treatment.

All of the finger wagging about maintenance as the treatment approach with the strongest evidence-base raises some important questions:

  • Why do the most culturally empowered opiate addicts with the greatest access to the evidence base reject this evidence base with respect to their own care and the care of their peers?
  • What does this say about the evidence and its designation as an evidence-based practice? That this evidence doesn’t offer a complete picture?
  • What does it say that health professionals get one kind of treatment and give their patients another?
  • Why are some addiction physicians and researchers so indignant when others question their advocacy of a treatment approach that they and their peers refuse to use on themselves?
  • Does this advocacy of a medicalized approach have anything to do with the fact that they are indispensable in this medicalized approach?



16 thoughts on “Another Reaction to Hazelden’s Adoption of Suboxone

  1. I enjoy reading the news and studies on different methods of treating addiction. I failed miserably being treated with Suboxone for my heroin addiction, however I am doing well on methadone maintenance. I also did well for two years while on MMT until a rapid detox due to my health insurance being canceled unexpectedly.
    I believe the Suboxone failed for me bc of the way it is administered here in Massachusetts. It’s a cash biz. Only a certain number of Doctors, like the one I had, are allowed to prescribe it. They do not take insurance. You pay outnof pocket. On average about $150-200 a week for the 15 min visit and scrip.
    No counseling. No meetings. No help with the mental part of addiction and recovery.
    Just pay. See the doc and get that piece of paper.
    Since only a certain number of docs can prescribe Suboxone and they are limited to abt 50 patients each (up from 30 last year) there are months long wait lists to see one of them.
    I called 13 doctor offices in a 10 mile radius of my home. I was put on 12 wait lists. This was back in April. It’s now November and only one has called me with an available spot.
    It’s pretty sad state of affairs when addicts seeking help are denied bc of money, and big cat insurance companies.
    I believe in 12 step, Abstinance treatment as well. However, MMT has been the most successful for me personally. Along with counseling and NA meetings.
    Keep posting!

    1. I hated suboxone or subutex also. I didn’t feel right on them. Methadone is working for me now for over two years. I’m also on a low dose now 35mg. I have no problem being on it for life as I agree with the research and feel I am definitely need a form of opiate attached to my receptor sites all the time. I know if I was to come off (even with my programs, sponsor etc. I’d be finished. It’s a shame Doctors only want cash for it and will not take insurance. Why isn’t anyone talking about that? It’s also extremely expensive compared to methadone.

      1. Thanks for the comment.

        I keep hearing stories like yours. Even people who are not fans of methadone saying that methadone is probably a better option than suboxone.

  2. “There is no evidence of effectiveness for abstinence based treatment’.

    As you say: what!? Of course there is plenty of evidence and you are right to point to the anomaly that doctors don’t, in general, get prescribed opiate substitution. Instead we get access to quality treatment for adequate duration and excellent post-treatment support and monitoring. That’s something a lot of our patients would love to have in the UK where opiate maintenance treatment is the first (and too often only) port of call.

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