Tuesday, November 6, 2012

Hazelden Starts Suboxone Maintenance!

Many of you may already have heard that Hazelden is starting a pilot project involving Suboxone maintenance treatment. This landmark shift is primarily due to the skill and persistent effort of Marv Seppala, MD, Hazelden's Chief Medical Officer. Marv and I go way back. I was on the faculty in the Department of Psychiatry at the University of Minnesota when Marv was a resident and then, subsequently, an addiction psychiatry fellow. He and I have stayed in touch ever since, and he and I and Carol Falkowski, another member of the old guard in Minnesota get together for lunch every few months. Marv is a great guy in addition to being a top-notch physician and psychiatrist. He is one of the few people who could make something like this happen. He is widely respected in the 12-Step and addiction treatment worlds, yet he is also a true professional who reads the research and believes in science. When he returned here to Minnesota from Oregon (where his true home still is) to work at Hazelden the second time (he was Chief Medical Officer for a period of time, then left due to disagreements with the then-CEO of Hazelden, then came back to work under a new CEO) we had dinner one night. I argued that not providing Suboxone and/or methadone maintenance treatment to opioid addicts was negligent given how strong the support was in the literature, and at that time, he said that their outcomes for opioid addicts was similar to those of other patients. More recently, as we discussed this new initiative, he told me that one of the primary forces driving the Board to adopt this shift was the number of poor outcomes from strictly abstinence-based 12-Step treatment. (No news to me, some of my Suboxone patients have completed multiple 12-step treatments including at Hazelden.)

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. It is still pretty much like that I think, but to their credit they have been prescribing anti-relapse medications for alcohol dependence for some time. To those rabid, fundamentalist 12-Steppers who consider anti-relapse medications a "crutch" (in a negative way), my reply is that when you break your ankle, a crutch facilitates healing, and anti-relapse medications do so as well. Rather than "weaken" recovery, they can help some people achieve long-term recovery who would otherwise fall by the wayside. It will be interesting to see how this all plays out in the 12-Step community. My patients tell me that in Narcotics Anonymous there has been increasing acceptance of Suboxone in particular, in contrast to methadone maintenance, which is still regarded as "using" by many because you can still get high while taking it.



  1. Great news and a long time coming. Thanks, as always, for telling it like it is and for your tireless efforts for maintenance treatment for opioid dependence. Let's hope this starts that seismic shift throughout the traditional treatment community.

    Anne Fletcher, author of Inside Rehab (forthcoming in 2013) and Sober for Good


    Regarding Methadone and Other
    Drug Replacement Programs:
    see www.na.org/?ID=bulletins-bull29

    Very interesting read. I believe Alcoholics Anonymous has no opinion in this area seeing it as an outside issue best handled by medical professionals.


Comments are welcome.