Critics of medication-assisted treatment, many of whom were competing for cultural and economic ownership of the problem of heroin addiction, alleged that MM: 1) substitutes one drug/addiction for another; 2) conveys a societal attitude of permissiveness toward drug use; 3) fails to address the characterological or social roots of heroin addiction; 4) cognitively, emotionally, and behaviorally impairs MM patients; 5) is a tool of racial oppression and genocide; 6) is financially exploitive; and 7) as a result of these factors, is morally unacceptable.He later states:
We concluded in the first two articles that it was time we as a country and a professional field stopped debating the morality of methadone maintenance and focused our energies instead on elevating the quality of methadone maintenance treatment.I didn't see where another kind of objection is addressed. What about the concern that MM is a manifestation of stigma? That it's based on the premise that drug-free recovery is not possible for opiate addicts (or, certain kinds of opiate addicts)? That it's a form of treatment that doctors never use for their addicted colleagues? That it's born from the failure of drug-free treatment of inadequate intensity, duration and quality and, when we choose to address those inadequacies, outcomes for opiate addicts are very, very good.
Whenever I'm talking with a professional helper about a loved one, one of my first questions is, "What are our options?" followed by, "What would you do if this was your child/parent/spouse?" That's where we determine the ideal course of action and second best options. I'd like to have this conversation with people who have been exposed to the best of both approaches to treatment.
2 comments:
The link to the White article was informative, but I failed to notice that it directly supports your supposition. Methadone (and buprenorphine) are often (usually?) incorporated into treatment for opiate addicted physicians. That White does not mention this in his paper is neither here nor there; he doesn't exclude it either. The use of methadone or buprenorphine in the absence of such proactive methods for treatment are certainly less effective, with higher rates of relapse. It is important to note that opiate-based maintenance therapy is just part of what is ideally a comprehensive treatment program.
The conception of these programs were not made with any stigma in mind; neither is their continuation. It is their success. The unflagging continued promotion of opiate based maintenance by physicians who treat addiction are not due to any financial motivation (it would be nice... but it's just not the case; big money is not to be made in the treatment of addiction), but rather due to the observations of the physician of the status of the addict and the effectiveness of therapy, when the deficiencies induced by addiction are compensated for by addiction. Because... Addiction is a Disease.
I believe that much of the fuel for MM is stigma--the belief that opiate addicts can't achieve drug-free recovery. We don't use benzo maintenance with alcoholics. And, at least in the U.S., we do not use MM with health professionals. They tend to get long-term drug-free treatment with long-term monitoring and recovery support. Why not give this to all opiate addicts?
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