Drug treatment for drug addiction
The debate over medication-assisted treatment continues
It’s an approach that research evidence and many in recovery say makes sense — but one that some advocates say has it all wrong.
One of the most effective ways of treating those suffering from opioid addiction is with drugs. There are two types of drugs used. Methadone and a newer drug, buprenorphine, are opioids that substitute for the drugs someone with an addiction problem craves, but don’t produce a high. A different type of drug, naltrexone, blocks the brain’s opioid receptors, making it impossible to get high from opioids.
The Globe’s Felice Freyer dives into the issue of treating drug addiction with drugs in today’s paper. She drives home both the effectiveness of the approach — and huge stigma attached to it — by profiling “Mike” a young Financial District suit who swallows a buprenorphine tablet each morning before grabbing his briefcase and heading off to blend in with the downtown crowd.
She says Mike, who doesn’t want his last name used and is photographed only from behind, “faces a double stigma — against addiction and against the medication that enabled him to overcome it.”
Those given drug treatment with methadone or buprenorphine have much lower rates of relapse or overdose than those who attempt addiction recovery without medication. But not everyone supports the approach. “If I’m taking an opiate every day, how am I sober,” one leader of a recovery group tells Freyer.
A Quincy doctor she speaks with falls in a middle ground, prescribing buprenorphine for some patients, but warning that it has a “dark side,” with some patients unable to wean themselves off it. “The death rates are going down, but it’s not a life worth living,” the doctor says.
One of the biggest debates over medication-assisted addiction treatment has to do with US prisons, where sometimes a third or more of inmates arrive with an addiction problem. While neighboring Rhode Island is the one state in the country that makes all three drug treatments available to inmates, Massachusetts only makes naltrexone, which is administered through an injection, available to prisoners.
Dr. Warren Ferguson, an addiction specialist at the University of Massachusetts Medical School, writes in CommonWealth about a patient who was forced to detox “cold turkey” from methadone when he landed in a county jail where he was not provided the treatment.
“Eliminating methadone without proper planning wreaks havoc on the mind and body,” writes Ferguson, who thinks such a forced withdrawal by correctional facilities “should be illegal.”He may have powerful company. The Justice Department informed state officials in March that it was investigating whether stripping inmates of such treatment when they land behind bars violates the Americans with Disabilities Act.
That was welcome, if surprising, news to Ferguson and others who have called on the state to make methadone and buprenorphine available to inmates. A provision that would have mandated that was pulled out of the final version of the recent criminal justice bill passed on Beacon Hill.