CALL FOR COMMON VOICE SUPPORTING ALL FORMS OF MAINTENANCE TREATMENT:

In its August newsletter, the Tennessee Society of Adidciton Medicine includes the following appeal of the President, Richard Soper, MD:

“At this critical juncture it is time for physicians in Tennessee and nationwide to put aside their personal biases and support the maintenance model for treating opiate addiction. The evidence is clear: maintenance works, both with methadone and buprenorphine. Detoxification, regardless of the method or medication used, results in patients dropping out of treatment and relapsing to drug use. It is irresponsible and dangerous for medical professionals to send mixed messages about what treatment is effective for opiate addiction. Uninformed comments that may keep patients with opiate addiction from receiving effective treatment will cost these patients their lives.”

Right! But attacks by providers of one form of addiction treatment against different modalities is nothing new. Forty years ago (and right up to the present time!) drug-free treatment advocates vilified methadone maintenance and those who provide it. Today those who encourage expansion of buprenorphine treatment commonly state or imply that this medication is “better” than methadone, “less addictive,” “easier to get off,” etc. – claims totally lacking in empirical support. Meanwhile, the gap between need for and availability of treatment (of any and all kinds!) remains as great as ever.

At the very least, everyone should stress up front when they have a vested interest. That goes for manufacturers and providers of buprenorphine no less than for those whose livelihood is linked to delivery of methadone treatment. By expressing as fact “personal biases” both for and against specific treatment approaches professionals disgrace themselves, harm patients who receive care of one sort or another, and make it less likely than ever that the roughly 80% who today are abandoned will ever receive the help they need.