National Institute on Drug Abuse (JAMA, 14 Jan 09): “ADDICTION IS A CHRONIC BRAIN DISEASE …”

Yet again a clear, unqualified statement by the most authoritative experts, key staff (including the director) of the National Institute on Drug Abuse (JAMA, 14 Jan 09). This article calls for “improving public health and safety” by providing treatment, including - very specifically- methadone treatment, to drug-using offenders in the criminal justice system. “Intervention opportunities” at all stages of the process are described, from arrest to “community reentry,” but – disappointingly – no mention is made of increasing access to and use of treatment outside the criminal justice system. And yet, the proportion of “prisoners (80-85%) who could benefit from drug-abuse treatment [but] do not receive it” is precisely in line with estimates for users in the general community.

Unquestionably, as the authors note, “Opiate agonist medications used for the treatment of heroin addiction . . . are underused in correctional populations” – but exactly the same observation applies to opiate-dependent individuals in all settings in America. And the underlying reason is identical: “Addiction remains a stigmatized disease not often regarded … as a medical condition …”