How treating opioids with more opioids has divided the recovery community

Summary and Analysis…

In this story, the PBS Newshour presents a long-form look at some aspects of the rift being generated in the recovery community by the all-or-nothing stance sometimes associated with the implementation of Medication-Assisted Treatment (MAT).

The article also helps to illuminate some of the fundamental differences in intended result — long-term maintenance versus working towards a life without drugs.

Excerpted from PBS

Excerpts from the article:

“America is at a juncture in the story of opioid treatment, with the next chapter likely to focus on how the funding is distributed, and how much of it will go to medication-assisted treatment. At the heart of that decision is an important but difficult question: is survival more important than sobriety, and at what cost?”

With regards to participants in an abstinence-based program:

“Most saw it [MAT] as a crutch, one that distracted from their efforts to get clean. Almost all said they had diverted it, meaning they either used a medication like Suboxone on the street to get high, often in combination with other drugs, or they used it to avoid withdrawals, or they sold it to someone else to buy drugs.”

Participants were also aware of the marketing efforts behind Suboxone:

“(It has also not escaped the men’s attention that Suboxone’s maker is accused by 35 states, including Florida, of violating antitrust laws to create a monopoly over its drug; to them this feels like the abuses of the pharmaceutical companies that helped create the opioid mess.)”

When discussing their own experience with Suboxone:

“… the men talked about Suboxone, how many of them had used it on the street like Garcia, or how, when taking it in combination with benzodiazepines, a depressant, it made you feel ‘robbed out of your mind.’ How they made lots of money selling it. How when they stopped taking it they got bad withdrawal symptoms: diarrhea, sweating, the feeling that your skin had bugs on it. How it blocked you from wanting to take opioids but didn’t prevent you from using drugs.

“(Clinicians say people are less likely to experience withdrawal symptoms if tapered off Suboxone slowly, with the advice of a doctor. But many acknowledge the Suboxone diversion problem, and that the medication does not block a desire to take non-opioid drugs.)”

Judge Janeice Martin, a “second-generation drug court judge” expressed concern about the way MAT is being implemented:

“Martin is also careful to never push medication in her court, she said, because she is not a doctor, and because the science is changing fast. She has also never seen medication work on its own, without therapy, which is why all the 21st Century Cures Act funding for medication scares her.

“’So far, the dollars have me a little bit worried that we’re going to be seeing medically-assisted treatment in a vacuum,’ she said, ‘without also going to clinicians who can perform the necessary treatment to accompany that.’”

“Martin hoped that more funding would be put toward trained counselors, beds in inpatient and outpatient facilities, and safe living spaces for recovering addicts.

“’Those are the resources that I see bearing the most fruit over the long haul,’ she said. ‘And we need an awful lot more of them if we’re going to get our arms around this issue.’”