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.”

He originally went to the renowned Hazelden Betty Ford Foundation clinic in Minnesota, which at the time, in 2011, used an abstinence-only approach that relied on the 12-step program pioneered by Alcoholics Anonymous. He relapsed soon after.

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.”

Meet the Author

Michael Jonas

Executive Editor, CommonWealth

About Michael Jonas

Michael Jonas has worked in journalism in Massachusetts since the early 1980s. Before joining the CommonWealth staff in early 2001, he was a contributing writer for the magazine for two years. His cover story in CommonWealth's Fall 1999 issue on Boston youth outreach workers was selected for a PASS (Prevention for a Safer Society) Award from the National Council on Crime and Delinquency.

Michael got his start in journalism at the Dorchester Community News, a community newspaper serving Boston's largest neighborhood, where he covered a range of urban issues. Since the late 1980s, he has been a regular contributor to the Boston Globe. For 15 years he wrote a weekly column on local politics for the Boston Sunday Globe's City Weekly section.

Michael has also worked in broadcast journalism. In 1989, he was a co-producer for "The AIDS Quarterly," a national PBS series produced by WGBH-TV in Boston, and in the early 1990s, he worked as a producer for "Our Times," a weekly magazine program on WHDH-TV (Ch. 7) in Boston.

Michael lives in Dorchester with his wife and their two daughters.

About Michael Jonas

Michael Jonas has worked in journalism in Massachusetts since the early 1980s. Before joining the CommonWealth staff in early 2001, he was a contributing writer for the magazine for two years. His cover story in CommonWealth's Fall 1999 issue on Boston youth outreach workers was selected for a PASS (Prevention for a Safer Society) Award from the National Council on Crime and Delinquency.

Michael got his start in journalism at the Dorchester Community News, a community newspaper serving Boston's largest neighborhood, where he covered a range of urban issues. Since the late 1980s, he has been a regular contributor to the Boston Globe. For 15 years he wrote a weekly column on local politics for the Boston Sunday Globe's City Weekly section.

Michael has also worked in broadcast journalism. In 1989, he was a co-producer for "The AIDS Quarterly," a national PBS series produced by WGBH-TV in Boston, and in the early 1990s, he worked as a producer for "Our Times," a weekly magazine program on WHDH-TV (Ch. 7) in Boston.

Michael lives in Dorchester with his wife and their two daughters.

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.

“I never thought something like this would come out of the Trump administration,” Ferguson told the Globe in March when news of the Justice Department inquiry broke. “I was like ‘Wow, this is the best thing I’ve heard in a long time.’”