Monday, February 24, 2014

Maintenance, not abstinence, will save addicts' lives

Read Dr W's Op-Ed in this week's Star Tribune:


  1. They finally published my comment:

    As an author who spent 10 years researching addiction treatment and recovery for 2 different books (Inside Rehab and Sober for Good) I have to say that Dr. Willenbring's views are supported by countless studies and leading experts in the field. To say medication maintenance treatment isn't "real recovery" is sad and like saying that overweight people with Type 2 diabetes who are on insulin are "cheating." It would be great if we had medications as effective as Suboxone and methadone to help people with addictions to other drugs and alcohol, but we don't - at least not yet. If we really view addiction as an illness, disorder, or disease, why shouldn't it be treated that way? Instead, people who are strong-armed to believe that "complete abstinence" is "the way" are often made to feel ashamed if they begin using drugs again. That's when they may be found dead on hotel room floors.

  2. Here is my comment I sent to the Star-Trib:

    Mark makes a number of valid points. In fairness, the basis of opposition to this approach among some in 12-step recovery comes from their own transformational experience and the wish to not deprive any addict seeking recovery of the depth of growth and change they've had. This is well-meaning but misguided in that medication-assisted and 12-step based recovery are not mutually exclusive, many are unable or unwilling to immerse themselves in a 12-step program, and the lethality potential of opiate relapse compels the search for alternative approaches as discussed in this article. As Dan Cain commented, methadone and buprenorphine clearly induce an immediate opioid effect especially during the initial dose adjustment, and they are certainly drugs of abuse in their own right. However, they are not sought by opioid addicts if they have access to other opioids. Persons I have interacted with who were receiving either methadone or buprenorphine maintenance (after stable dosing is achieved) have not seemed impaired, buzzed, or experiencing a drug effect. Methadone has also been increasingly used in the treatment of chronic pain, and is very effective for some forms. However, methadone use in pain patients is very tricky owing to its pharmacology: Pain relief can last 5-8 hours while in some patients the half-life is 72 hours or longer. Numerous prescription and OTC drugs can further slow its clearance from the body; these and other factors account for the fatality risk when used as a painkiller which is incentivized by its ultra-low cost to third-party payers and health plans. Pain patients cannot be compared with opioid addicts on the dimension of safety because unlike pain patients, the patients that Mark describes have undergone long-term and possibly permanent alteration in brain function from the chronic presence of opioids. However, having said all this, I would really like to research try to identify patients in treatment for opiate addiction who possess the capacity to either not require, or only require short-term stabilization and then taper with buprenorphine or methadone, assuming they involve themselves in some form of recovery program.

    Mark Edmund Rose, MA
    Licensed Psychologist


Comments are welcome.