Sunday, May 07, 2006


NY Times News of the Week in Review, 7 May, discusses "abstinence" as a treatment goal, and contrasts it with what is described - but not named - as "harm reduction." It clearly denigrates methadone and buprenorphine by labeling each of them "a substitute drug . . . replacing one habit with another." Furthermore, prescribing these medications seems to be equated to "moderation" as a technique and a goal in treating alcoholism. In other words, the author appears to affirm the long-held myth that clinically prescribed methadone for the heroin-dependent person is analogous to "vodka for gin" for the alcoholic. Obviously, this is nonsense.

The article goes on to state, "When studying these pharmaceutical crutches and prescribing them, doctors tend to emphasize improvement over abstinence . . . " What is not stressed here is the reality, confirmed by over 40 years experience worldwide, that the former - "improvement" - is achievable for the majority of dependent individuals receiving opiate agonist treatment, while long-term "abstinence" is overwhelmingly not achievable. And "not achievable" is translated for a tragically large proportion of individuals not only as relapse per se, but criminality, arrest, incarceration, infection (with HIV or a host of other viral or bacterial agents), and death.

Finally, the author fails to make the analogy that really is on target: addiction is a chronic medical condition like diabetes, epilepsy, hypertension, coronary artery disease, hypercholesterolemia, etc. - and "improvement" rather than cure is the near-universal objective in the treatment of all of them.


At 9:20 PM, Anonymous Anonymous said...

I read this article with dismay as well. Although I believe the "recovery" community and our society needs to stop seeing addiction treatment as an "all or nothing" proposition, methadone and buprenorphine treatment can NOT be compared to someone cutting down on their use of illicit substances! With these attitudes being displayed DAILY in our media, its impossible to see there ever being MMT without overwhelming stigma associated with it.

How little people have learned in the past forty years, despite the huge success of MMT.

Kristan Hilchey
Director, ARM-ME
(Advocates for Recovery through Medicine Maine Chapter)

At 8:30 AM, Blogger RGNewman, MD said...

yes - agree. What's noteworthy is that this reporter is one of the "good guys" - someone who understands the issue and insists (and I full believe) there was no intention whatever to denigrate methadone or buprenorphine. Criticism intended as such, coming from abstinence die-hards, is easier to respond to than statements that have no negative intent but will be interpreted in a very negative way. (The guy who produced/filmed the horror methadonia claimed emphatically to have a very favorable view of methadone maintenance - but in that case the credibility is open to question). rn

At 9:59 PM, Blogger Unknown said...

I'll have been clean from heroin 8 years in june. Tonight I want it so bad, it is permeating my thoughts. Pain is my imitgating factor. I've been opiate clean all this time and just feel like I can't go on anymore. If you're hones ti w/ your Dr. they're afraid to treat you for pain,thus another turn to heroin. I've tried and have been clean, not one slip with heroin. But it calls my name ,all these years later. Prison gave me the needed time to get away and as strong as i try to be and as hard as I try to remember how sick I became, it still calls me.Is there no answer?

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