Most popular posts of 2015 – #11 – Not good enough

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This is good:

The opiate-blocker naloxone is one of the year’s most celebrated drugs, breaking into the mainstream as a magic-bullet antidote that yanks overdose victims from the brink of death with a shot of nasal spray or an intravenous injection. Police take it on patrols. Emergency medical technicians keep it in their ambulances. Ordinary Americans are stocking their medicine cabinets with it. Because of it, hundreds of people who might have died this year from taking too much heroin, Oxycontin or similar painkillers remain alive.

This is not good:

But the lifesaving medication is not a cure. After it has done its job, overdose survivors are left with their cravings intact. Without follow-up care, they are likely to keep feeding their habits, putting them at risk of another overdose, one that could kill them. Treatment, however, can be very difficult to find.

Lying in the emergency room after being revived, many addicts say they experience a fleeting moment of clarity that makes them receptive to help. But that potential is often lost in a patchwork healthcare system that gives survivors little incentive to change. Many walk out of the hospital with just a list of treatment options on their discharge papers, researchers and health care workers say.

See this video on after narcan.

Beyond Narcan Why Heroin Addicts Need More Than an Overdose Antidote NBC News

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2 responses to “Most popular posts of 2015 – #11 – Not good enough

  1. So, jason, what is the answer?? You don’t believe in the use of MAT (I don’t think) and must know that “abstinence only” has extremely poor outcomes. I know that you like the physicians’ and airlines’ treatment protocols but, even if we could afford that for all opiate dependent people, there is this little incentive thing (license) that each of these groups have worked for a long, long time to get. They love what they do, yet, even some of them cannot sustain recovery, knowing that they will lose the most valuable asset they possess, outside of family.
    We had a psychiatrist with ASAM certification, board certified internal medicine, suboxone certified and a Juris Doctorate. Despite treatment, after treatment, using all of the powers of the potential elimination of the benefits that these skills bring and the best treatment in the country, he still chose to use opiates. I know that the physicians, nursing (more Nazi like) and bar, have created some viable, credible treatment protocols, but this is just not going to happen to “Joe smith” who just got out of prison with an 8th grade education and a future washing dishes. You are right, the prior format works better but it’s like comparing apples to eggs. We need to find something that works for most of the people most of the time. That is, always, better than the treatment that I got in 1980, when their best advise don’t use and go to meetings. Good advice, but we need more emphasis on science and new medications that make the opportunity to enhance life, when our brain is broken.

    • Because you comment often, I know you read this blog, so I’m not sure if your questions are seeking a response or are rhetorical.

      I’ve had several recent posts on narcan that have addressed post-rescue care. Here’s one.

      Here are some recent posts on why I don’t share your faith in maintenance meds, here, here, here and here.

      About my answer. . .

      Clearly, there’s no single answer, but here’s one recent comment on the gold standard, maintenance, drug-free treatment and the most important ingredient.

      Now, it’s pretty clear to anyone who reads this blog that I believe the preferred treatment approach should be something modeled on Physician Health Programs (PHP), and that it should be available to all addicts. (I also believe that addicts should get good informed consent and have the right to choose their treatment approach.)

      A sad fact is, for far too many people, their choices are inadequate medication-free treatment or inadequate medications assisted treatment (MAT). Given these choices, for a lot of people, inadequate MAT is probably less bad than inadequate medication-free treatment.

      This has caused me to think about something Bill White said about another treatment argument: “Arguments over whether persons in inpatient addiction treatment should stay twenty-eight days or five days, whether outpatient treatment should be five sessions or twenty sessions, or consist of Twelve Step Facilitation or Cognitive Behavioral therapy are all arguments inside this acute care paradigm.”

      I wouldn’t make this argument, but one could argue that the medication-free element of PHP’s is not a critical element in their success–that it’s the elements focused on chronic disease management (or, recovery management) that are most important.

      Here’s another post on the cost of the gold standard.

      Here’s another on the gold standard and the issue of coercion.

      Finally, your concern about an apples to eggs comparison raises some important issues related to class. Some posts related to that are here, here, here and here.