Getting good treatment for opioid addiction is hard

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The NYT published an opinion piece that examines the disconnect between the recommendations (Recommendations that are rapidly becoming requirements.) of public health officials and the on-the-ground experience.

MAT advocates are already criticizing the piece as biased, ignorant, anti-science, harmful and stigmatizing. However, I respect the way it avoids simple answers and grapples with real world decisions and experiences.

Despite the criticism, there are statements for medication-assisted treatment (MAT) advocates to like:

. . . treatment with buprenorphine and methadone has been found to cut opioid overdose deaths in half when compared to behavioral therapy alone, and it’s hard to argue with that. [I took a looked at this study in a previous post.]

and

“Overwhelming evidence shows that Suboxone improves outcomes in people with opioid-use disorders,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. She cited a 2014 study of opioid addicts that found that after 42 months, 31.7 percent were clean and no longer on M.A.T., and 29.4 percent were also clean but still receiving M.A.T.

and

“Let’s be clear,” said Dr. Andrew Kolodny, a longtime Suboxone prescriber in New York and executive director of Physicians for Responsible Opioid Prescribing. “The real crisis is the severe epidemic of opioid addiction and overdose deaths that’s devastating families across the country.”

Dr. Kolodny ranks anti-Suboxone judges like Judge Moore in a category with climate-change deniers and people who believe vaccines cause autism. “When there’s really dangerous heroin on the streets, I’d rather see Suboxone out there, even if it is being prescribed irresponsibly or is being sold by drug dealers,” he said.

and

. . . he’s counted 13 drug-free babies born while he has run Tazewell’s drug court, several to mothers on M.A.T. (Like Erica, they took a drug called Subutex because Suboxone is not recommended for pregnant women.) “How do you put a price on that?” he asked.

There’s also plenty for MAT critics to like.

You can read the piece for those specifics, but the theme is that MAT is not delivering the outcomes that public health officials promise—many people are getting stuck somewhere between addiction and where they want to be (recovery?).

It leaves open the possibilities that the problem is the medication or that it’s lousy treatment providers.

photo credit: davegray

photo credit: davegray

It also give an accurate impression of the terrible state of alternative options:

He finally got clean without M.A.T., but only after long stints in inpatient rehab centers at a total cost of about $60,000.

I recently posted about the spotty quality and financial exploitation that’s rampant in the drug-free treatment industry.

Sadly, an addict stuck in limbo  due to inadequate treatment is not an island. For better or worse, communities and loved ones get stuck there too.

“I think she’s gone back to using, but she won’t admit it, ” her mother told me. “I found papers in the bathroom, like what heroin comes in.” She added, “And she went through her brother’s room and stole his clothes — that’s what addicts do.” A judge recently decided to transfer custody of Erica’s baby to his grandmothers.

To its credit the piece does not offer simple solutions. Instead, it lives with the questions.

While some people may do well with medication and others (who can come up with the money) may do well with inadequate doses of drug-free treatment, for most people with opioid addiction, it’s going to take a lot more than medication or getting insurance to cover overpriced 30 day stays in residential treatment.

We need to raise the bar for treatment providers rather than lower the bar for clients. (I’m grateful to work in a place that continues to provide hopeful, compassionate, affordable, responsible and ethical care.)

Why is this so hard to talk about?

This video’s been coming to mind a lot lately.

I’m not just sharing this to take the personal inventory of other people. There’s no doubt I’ve been guilty of these “unfortunate assumptions” at times.

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