What we miss when we focus on opioid treatment and recovery

Fortunately, there’s been growing concern that advocates, policy makers, and media have to narrowly focused on the opioid crisis. Up to this point, it hasn’t reached the level of media coverage.

USA Today is one of the first to publish an article that explores the limitations of the nation’s focus on opioid treatment and recovery:

More than eight years into his opioid-addiction treatment, Paul Moore was shooting cocaine into his arms and legs up to 20 times a day so he could “feel something.”

The buprenorphine he took to quell cravings for opioids couldn’t satisfy his need to get high. Moore said he treated himself like a “garbage can,” ingesting any drug and drink he could get, but soon enough, alcohol and weed had almost no effect unless he vaped the highest-THC medical marijuana available.

Cocaine, however, especially if it was mainlined — now that could jolt him from his lifelong depression to euphoria.

The article provides several important messages:

  • The importance of addiction treatment over opioid use disorder treatment for many (if not most) patients.
  • Along similar lines, messages about opioid recovery can be misleading for patients, families, and communities.
  • These issues raise the importance of clarity about the boundaries of recovery. For example, were these people in recovery when they were in opioid use disorder treatment and reduced or quit using opioids, but were still using cocaine and experiencing poor quality of life due to untreated addiction? (This would have been an uncontroversial and easy question to answer just a few years ago. Today, there are many saying that any movement toward wellness or participation in harm reduction is recovery.)
  • The article also highlights what gets missed when agonist treatments (buprenorphine and methadone) are described as the most highly effective and highly successful treatments without more context. They rarely answer the question, effective at what? (This isn’t saying that these medications aren’t useful or don’t have a place in care. Rather, it’s important that journalists and experts do not oversell their evidence for effectiveness.)

Failure to clarify and communicate these messages are likely to result in increased stigma for addiction and recovery.

Rather than communicating that addiction is a treatable illness, the unintended message will be that addiction more closely resembles a chronic disability than a treatable illness that has a good prognosis when the patient receives treatment of adequate quality, duration, and intensity.

This century’s first wave of recovery advocacy was built upon the message that we can and do recover when we get the right help and support. In this context, recovery meant something resembling the Betty Ford Consensus Panel definition:

Recovery from substance dependence is a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship.

The traditional understanding of addiction recovery alludes to the restoration of people in their families, communities, and to a life in alignment with their goals and values.

Adjustments to that understanding are likely to result in readjustments in the public’s attitudes, which are eventually likely to result in readjustments in policy.

6 thoughts on “What we miss when we focus on opioid treatment and recovery

  1. MAT saved my life
    What this article doesent mention is that even though SOME addicts continue to use other drugs while on MAT there are a vast majority who do not

    No one disagrees that you can just hand out medicine and expect addiction to resolve itself

    However it seems as if the recovery community is throwing the baby out with the bathwater

    I have been on suboxone for 5 years, I have used no other drugs and have 5 years of UAs to prove it
    (Yeah because when prescribed correctly, there are full wrap around services including UAs)

    I take care of my family, pay taxes, work and contribute to society, my quality of life is excellent
    I will NOT be browbeaten into this notion that ‘I’ am not ‘clean’ or that somehow ‘I’ am missing out on some real ‘recovery’
    I however do need 12 step,
    and its the stigma of the 12 step recovery community that bothers me, and may be killing some people through this judgemental idiocy

    Especially these hollier than thou knuckleheads I run into at NA meetings usually some nicotine use disorder overly caffeinated, dentaly challenged glucose abuser complaining that I am not clean
    I NEED 12 step recovery to gove dorection and purpose

    (I attend a very liberal AA group that welcomes all addicts with open arms regardless of MAT)

    But heaven forbid I go to a g#$%$#@d NA meeting…..you know for my previous narcotic use… and apparently I get to go to only this group twice a week
    Traveling I attend none….thanks for that.

    Bill used LSD, why? Oh thats right, he was looking for a MEDICAL cure for alcoholism
    IE “medicine”
    (& he didnt change his birthday, just saying)

    Well they have a medical tool for OUD and if you’re a addict like me and you have literally burned out the dopamine recepters in your brain from 25 yrs of opioid use you need a medication to replace that

    Why is this so hard for you people to understand?
    Not EVERYONE needs MAT
    Especially for life
    Unfortunately for those of us who do get discriminated against by these clowns who buy into this crap that Dawn Farms is helping to sell

    That REAL recovery means to only use nicotine, caffeine, glucose and rage.

    Diabetics take meds for life
    Hypertensions take meds for life
    There are a gazillion reasons to need meds for life

    Stop playing Doctor and help foster a environment of acceptance
    I really am getting sick of this prejudiced idiotic perception that those on MAT are not ‘clean’
    Please work an inclusive program

    An addict and his/her god know whether they are clean or not

    You dont get to decide that, right..
    you need to accept that.

    1. I’m happy for you that you’ve found recovery.

      You give the impression that you are not using illicit drugs or misusing rx drugs. Further, you mention family, employment, citizenship and quality of life.

      In that case, you would fall well within the Betty Ford Consensus Panel definition of recovery. (Not that you need their endorsement.)

      This post was really about the myopic focus on opioids that leads to a failure to note and respond to problems with other substances. For example, an NPR headline said something to the effect of, “Methamphetamine Complicates Opioid Recovery.”

      My point is that we should focus on ADDICTION recovery, not opioid recovery.

      Again, it sounds like you’ve found full addiction recovery. I’m happy for you and wish you all the best.

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