CSDAP News/Articles
Does ASAM oppose “drug-free” and “abstinence-based” paths to recovery?
The posts answered a message from a practitioner who said "I work as the Medical Director at an "abstinent based" facility. I am Board Certified in Psych and ASAM certified... I am struggling to accept the abstinence based treatment philosophy." In responding to this message, ASAM said (among other statements) that, "Patients appropriately taking a physician prescribed medication are abstinent from their substance of misuse."
The Harms of Constructing Addiction as a Chronic, Relapsing Brain Disease
As an international network of historians and social scientists who study approaches to the management of drugs across time and place, we have noticed the effort to redefine addiction as a chronic, relapsing brain disease (CRBD). The CRBD model is promoted as a route to destigmatize addiction and to empower individuals to access treatment that works within that model’s terms.1 CRBD usefully recognizes that brain-based neural adaptations place individual brains in chronic states of readiness to relapse. But brains are housed inside of people. Substance use is biological, social, and political; our concepts and approaches to complex questions surrounding substance use must be, too.2,3 By overlooking the sociopolitical dynamics and inequalities bound up with substance use, the CRBD model can paradoxically further marginalize people who use drugs by positing them as neurobiologically incapable of agency or choice. We are concerned that the CRBD model paints drug users as individuals whose exclusion from social, economic, and political participation is justified by their biological flaws and damaged brains.
A Review of Buprenorphine Diversion and Misuse Internationally
Abstract
Outpatient opioid addiction treatment with sublingual buprenorphine pharmacotherapy (OBOT) has rapidly expanded in the United States and abroad, and, with this increase in medication availability, there have been increasing concerns about its diversion, misuse and related harms. This narrative review defines the behaviors of diversion and misuse, examines how the pharmacology of buprenorphine alone and in combination with naloxone influence its abuse liability, and describes the epidemiological data on buprenorphine diversion and intravenous misuse, risk factors for its intravenous misuse and the unintended consequences of misuse and diversion.
“As an ex-heroin addict, I know getting off opioids is near impossible.”
I am a married, middle-aged woman, a taxpaying homeowner. As privilege goes, I have it. Because I’m White, I get treated better in medical settings such as hospitals and rehabs. I have health insurance. I have access to credit. My spouse could not be more supportive. But every day for a couple of years I left my house with a river view and drove downtown in South Yonkers to meet my dealer. I know a letter carrier who once worked that neighborhood. He told me there was a time when you could buy an Uzi on his route. I knew the first time I bought heroin at age 48 that doing so probably meant the end of my life. But compared to withdrawal, that was fine by me.
Former NIMH Director Makes a Case for Abolishing Psychiatry
A new book by Dr. Thomas P. Insel, who for 13 years ran the United States’ foremost mental health research institution, begins with a sort of confession. During his tenure as the “nation’s psychiatrist,” he helped allocate $20 billion in federal funds and sharply shifted the focus of the National Institute of Mental Health away from behavioral research and toward neuroscience and genetics. Dr. Insel, 70, who left N.I.M.H. in 2015, calls the advances in neuroscience of the last 20 years “spectacular” — but in the very first pages of his new book, he says that, for the most part, they haven’t yet benefited patients.
Study of buprenorphine diversion cautions against its misuse
Buprenorphine is approved in many countries for the treatment of opioid use disorder (OUD), but problems with diversion and abuse exist. There is a need to understand how and why patients use diverted buprenorphine, and whether barriers to access contribute to illicit use.
58% reported a history of diverted buprenorphine use, with 37% never receiving a prescription. Approximately one-half (52%) reported using buprenorphine to get high or alter mood, but few (4%) indicated that it was their drug of choice.