The horrible reality of maintenance opioid replacement drugs

Summary and Analysis…

This detailed article focuses on the important issue of class and race discrepancies in the availability of opioid treatment but tangentially gives a rather stark and disturbing view of what life is like on maintenance forms of Medication-Assisted Treatment (MAT). Specifically, the following:

  • The article only makes passing reference to counseling offered to those on methadone maintenance. The impression from the article, and from statements made by some of the people highlighted in it, is that patients interviewed will stay on methadone for long periods of time. Conspicuously missing is reference to what one would hope would be large numbers of people working to end their dependence on drugs.
  • Also absent is any mention of the “dark side” of Suboxone, a newer MAT drug, though that dark side was a major point of an earlier article by the Times itself.
  • Dr. Andrew Kolodny, an “opioid addiction expert affiliated with Brandeis University” complains about the regulatory burden requiring doctors to complete an eight-hour certification requirement before prescribing Suboxone. In the next sentence the article says Dr. Kolodny claims that many doctors who are certified decide not to prescribe after “realizing the complicated task of treating patients with substance abuse problems.” Of course treating patients with drug abuse problems is complicated and requires a variety of skills — far more than could possibly be delivered in an eight-hour seminar.
  • Dr. Kolodny further comments that Suboxone may cut against “the business interests of for-profit methadone clinics” which the article claims are “becoming more common nationally.” No effort is made in the article to point out the obvious, inherent conflict of interest that may explain why patients at the methadone clinics don’t seem to be actively working to become free of their drug dependence.
  • Though the article generally suggests Suboxone should be made more generally available, a patient is quoted complaining about Suboxone when compared with methadone — apparently she experienced some of Suboxone’s “dark side.” After trying it, she concludes that she’s “never getting off” methadone.

Excerpted from New York Times

On a street lined with garbage trucks, in an industrial edge of Brooklyn, dozens of people started filing into an unmarked building before the winter sun rose. Patients gather here every day to visit the Vincent Dole Clinic, where they are promised relief from their cravings and from the constant search for heroin on the streets.

Robert Perez exited the clinic on a recent Wednesday and walked toward the subway, along the Gowanus Canal. Within the clinic’s antiseptic blue walls, he had just swallowed a red liquid from a small plastic cup. The daily dose of methadone helps Mr. Perez, 47, manage withdrawal symptoms as he tries to put decades of drug abuse behind him.

“I wish I didn’t have to come here every day, but I have to,” Mr. Perez said outside the clinic. “If you don’t do it, you’re sick. You wake up sick.”