Ignio
Bluelighter
- Joined
- Mar 5, 2015
- Messages
- 578
Due to a talk I had in another thread here, I have been looking at addiction treatment in the US and in ohter countries.
I did so because what I was told about addiction treatment including replacement therapy (Metadone and Burphrenorphine) and general counselling seems so different from the Danish (and European system).
This is a very long post. But if you are interested in philosphical, ideological, political, medical and socio-economic aspects of addiction and treatment hereof I hope you can get through my post and contribute with your thoughts and your stories about addiction and addiction treatment.
Below I have written a longer summation about my impression of addiction treatment in the US.
- Whether this summation reflects the actual reality of the US addiction treatment system is one the of things I would like people to comment on. If anyone at all can get through the massive amount of text that is (see the paragraph My impressions of addiction treatment in the US).
Debate about the opiate epidemic in the US and addiction in general in the entire world
There have been written extensively about the epidemic and big pharmcy have been made the scape goat, and it is probably not wronw to place some of the responsibility on big pharma. But in my opinion blaming big pharma is an obvious way to avoid looking at the bigger picture. There might be correlation between easy access to drugs and the number of addicts. And there might even be causality between the two variables, BUT easy access to drugs is not the only variable a society should consider and debate.
Why do so many people need to take drugs to get through their mundane everyday life? What is it about the modern society (not just the US) that results in so many people with psychological issues and other hardships that lead them to chemicals in order to achieve happiness. We are not bigger pussies than people living 100 or 200 hundred years ago. We can debate this to the day we die, and that is not my intention. I just think there are some basic conditions of life that we owe to ourselves so start reflecting about in order to become aware about what makes us happy and what makes us unhappy - we have a responsibility ourselves to achieve this, we cannot just expect others to deliever everything that is necessary to make us happy. But our elected politicians and other people with the means to really makes fundamental changes also have to consider whom their actions and policies benefits and who they suppress.
The causes of what intially make people do drugs is one side of the debate - another is how we treat addicts in order to help them overcome their addiction and how the societal discourse about addicts are unfolding.
Discourse about addiction
In my country, Denmark, and probably most other countries in the world, discourse about addicts results in a social constitution where we/them/the addicts are seen as parasites, lazy, people who are willingly ruining, not just their own life, but also annoying others by commiting crimies, sleeping in park benches (which obviously belongs to them as is is public property, but yet the addicts are not allowed to sleep there like they are not members of the public with the same rights as no-addicts) and so on. This is not a healthy way to talk. It obscures who addicts are and in can keep addicts in their vicious cycle of self-destruction as this discourse destroys their already stained self-image.
Treatment of addiction
The treatment available for addicts are in some cases governed by ideological, political and economic insentives instead of medical, scientific supported treatment options. I think the treatment options here in Denmark are among some of the better solutions in the world. And yet it is riddled with problems. If I come as a new patient (like I did some years ago) with three distinct, yet interrelated, disorders (physical disorders, psychological disorders and an addiction) it is in practice three difference institutions that should be responsible for my treatment and thus, they throw me from one place to another as they hope to get rid of me if the other place will take me in.
I think it is okay to say without documentation that most addictions also have psychological disorders in varying degrees. However, those I walk to about my addiction have no training to handle my psychological disorders, and those I talk to about my psychological disorders have to training to handle my addiction. As such I have three seperate but simtultaneous care trajectories that do not communicate together which in my case resulted in the prescription of different medication, some of which are a ABSOLUTE no go to take together. The combination actually resulted in the development of one more permanent disability (epilepsy) and that disability resulted in further injuries includning nerve damage and a broken shoulder which will never gain full mobility again.
Cases with similar problems like mine are common. In the last year however, the press have begun criticizing the psychological treatment available in Denmark as well as the treatment of addicts. Involvement of media is often necessary for political decisions and structural changes to take place.
Another result of their lack of communication is that I can double and even triple prescriptions when my inner addict takes over. To explain it in detail, it means that I can get diazepam, alprazolam and clonazepam prescribed at once eeeevery month (one benzo from each place) and I can get methadone prescriptions from two of the places. I do have the enough control over myself to not get double prescriptions of methadone every month, but I cannot avoid to loose controle sometimes and do it. Afterall, I am an addict. And even though it might be morally wrong, it is completely legal to do. Despite how legal my actions might be, it is still action that are reconstructing addictive behavior. I cannot just blame the system. I am the one doing it. I am the one responsible for my actions. BUT - When I achieve to get my inner addict silenced, I can say that it would be nice if the option wasn't there at all.
My impressions of addiction treatment in the US
I have seen people telling that they have to travel great distances each day to get to their 'methadone clinic' (the name I see many use here) and get their daily dose. This is an unpleasent trip for many as they start withdrawing and so on. Despite of this, they have to go to the clinic every day to get their dose whereas a better solution in cases where the person can handle it would be to give them enough methadone to cover 7 days or something.
I also see people telling they have to turn in urine tests and if they get tested positive for - lets say benzodiazepines - they get a x percent reduction in their methadone dose. That is, punishment as a tool - negative reinforcement. In different contexts there is plenty of evidence showing the negative reinforcement does not work. Therefore, this surprised me as getting reduced in dose as punisment in my eyes increases the likelihood of returning to illicit ways of getting enough drugs.
In another post I saw that in California - I think it was - if you are incarcerated you get methadone for 15 days and then nothing. This is a set routine which doesn't take into account whether you come with a habit of 10 mg oxycodone each day or several grams of heroin each day.
Then today I read an article called The Last Shot (https://www.propublica.org/article/vivitrol-opiate-crisis-and-criminal-justice). It about a drug named Vivitrol that gets administered every by a shot in the buttocks every month and thus effectively blocking the effects of opiats for 28 days. Each shot costs 1000 USD.
Due to the steep price the company could not find a market amongst regular addiction treatment, so they got the bright idea of turning to markets where the consumer choise is non-existent - drug courts. In other words, you can choose to get the shot or go to jail.
In drug courts, judges are in effect making medical decisions when they choose if this particular drug addict are to receive a jail sentence, methadone or Burprenorphin replacement therapy and counselling or a shot of Vivitrol and counselling.
In my eyes these judges are at best finding themselves in a moral grey area. How can you let non-medical personel make medical decisions that affect a perons life in this degree? Drug court judges represented a ripe market for Vivitrol. They were at the front lines of the [opiat] epidemic ... They lacked medical training - a survey of drug court judges published in 2014 revealed widespread ignorance about treatment options. And while the whole purpose of their courts was to offer treatment as an alternative to incarceration, the judges (who were often elected) tended to reflect local cultural biases about addiction, viewing it as moral weakness that called for tough paternalism. (Cited from the article).
The company behind Vivitrol spend millions of millions of dollars lobbying about their product and they have been a little too much creative in the interpretation of the statistics about the success of Vivitrol, ODs related to Vivitrol et cetera and in other forums I have seen claims that the company have fabricated false reports based on inflated numbers about the number of people in methadone and burprenorphin treatment that relapse back to their initial illicit drug habit (but this claim was undocumented).
I did so because what I was told about addiction treatment including replacement therapy (Metadone and Burphrenorphine) and general counselling seems so different from the Danish (and European system).
This is a very long post. But if you are interested in philosphical, ideological, political, medical and socio-economic aspects of addiction and treatment hereof I hope you can get through my post and contribute with your thoughts and your stories about addiction and addiction treatment.
Below I have written a longer summation about my impression of addiction treatment in the US.
- Whether this summation reflects the actual reality of the US addiction treatment system is one the of things I would like people to comment on. If anyone at all can get through the massive amount of text that is (see the paragraph My impressions of addiction treatment in the US).
Debate about the opiate epidemic in the US and addiction in general in the entire world
There have been written extensively about the epidemic and big pharmcy have been made the scape goat, and it is probably not wronw to place some of the responsibility on big pharma. But in my opinion blaming big pharma is an obvious way to avoid looking at the bigger picture. There might be correlation between easy access to drugs and the number of addicts. And there might even be causality between the two variables, BUT easy access to drugs is not the only variable a society should consider and debate.
Why do so many people need to take drugs to get through their mundane everyday life? What is it about the modern society (not just the US) that results in so many people with psychological issues and other hardships that lead them to chemicals in order to achieve happiness. We are not bigger pussies than people living 100 or 200 hundred years ago. We can debate this to the day we die, and that is not my intention. I just think there are some basic conditions of life that we owe to ourselves so start reflecting about in order to become aware about what makes us happy and what makes us unhappy - we have a responsibility ourselves to achieve this, we cannot just expect others to deliever everything that is necessary to make us happy. But our elected politicians and other people with the means to really makes fundamental changes also have to consider whom their actions and policies benefits and who they suppress.
The causes of what intially make people do drugs is one side of the debate - another is how we treat addicts in order to help them overcome their addiction and how the societal discourse about addicts are unfolding.
Discourse about addiction
In my country, Denmark, and probably most other countries in the world, discourse about addicts results in a social constitution where we/them/the addicts are seen as parasites, lazy, people who are willingly ruining, not just their own life, but also annoying others by commiting crimies, sleeping in park benches (which obviously belongs to them as is is public property, but yet the addicts are not allowed to sleep there like they are not members of the public with the same rights as no-addicts) and so on. This is not a healthy way to talk. It obscures who addicts are and in can keep addicts in their vicious cycle of self-destruction as this discourse destroys their already stained self-image.
Treatment of addiction
The treatment available for addicts are in some cases governed by ideological, political and economic insentives instead of medical, scientific supported treatment options. I think the treatment options here in Denmark are among some of the better solutions in the world. And yet it is riddled with problems. If I come as a new patient (like I did some years ago) with three distinct, yet interrelated, disorders (physical disorders, psychological disorders and an addiction) it is in practice three difference institutions that should be responsible for my treatment and thus, they throw me from one place to another as they hope to get rid of me if the other place will take me in.
I think it is okay to say without documentation that most addictions also have psychological disorders in varying degrees. However, those I walk to about my addiction have no training to handle my psychological disorders, and those I talk to about my psychological disorders have to training to handle my addiction. As such I have three seperate but simtultaneous care trajectories that do not communicate together which in my case resulted in the prescription of different medication, some of which are a ABSOLUTE no go to take together. The combination actually resulted in the development of one more permanent disability (epilepsy) and that disability resulted in further injuries includning nerve damage and a broken shoulder which will never gain full mobility again.
Cases with similar problems like mine are common. In the last year however, the press have begun criticizing the psychological treatment available in Denmark as well as the treatment of addicts. Involvement of media is often necessary for political decisions and structural changes to take place.
Another result of their lack of communication is that I can double and even triple prescriptions when my inner addict takes over. To explain it in detail, it means that I can get diazepam, alprazolam and clonazepam prescribed at once eeeevery month (one benzo from each place) and I can get methadone prescriptions from two of the places. I do have the enough control over myself to not get double prescriptions of methadone every month, but I cannot avoid to loose controle sometimes and do it. Afterall, I am an addict. And even though it might be morally wrong, it is completely legal to do. Despite how legal my actions might be, it is still action that are reconstructing addictive behavior. I cannot just blame the system. I am the one doing it. I am the one responsible for my actions. BUT - When I achieve to get my inner addict silenced, I can say that it would be nice if the option wasn't there at all.
My impressions of addiction treatment in the US
I have seen people telling that they have to travel great distances each day to get to their 'methadone clinic' (the name I see many use here) and get their daily dose. This is an unpleasent trip for many as they start withdrawing and so on. Despite of this, they have to go to the clinic every day to get their dose whereas a better solution in cases where the person can handle it would be to give them enough methadone to cover 7 days or something.
I also see people telling they have to turn in urine tests and if they get tested positive for - lets say benzodiazepines - they get a x percent reduction in their methadone dose. That is, punishment as a tool - negative reinforcement. In different contexts there is plenty of evidence showing the negative reinforcement does not work. Therefore, this surprised me as getting reduced in dose as punisment in my eyes increases the likelihood of returning to illicit ways of getting enough drugs.
In another post I saw that in California - I think it was - if you are incarcerated you get methadone for 15 days and then nothing. This is a set routine which doesn't take into account whether you come with a habit of 10 mg oxycodone each day or several grams of heroin each day.
Then today I read an article called The Last Shot (https://www.propublica.org/article/vivitrol-opiate-crisis-and-criminal-justice). It about a drug named Vivitrol that gets administered every by a shot in the buttocks every month and thus effectively blocking the effects of opiats for 28 days. Each shot costs 1000 USD.
Due to the steep price the company could not find a market amongst regular addiction treatment, so they got the bright idea of turning to markets where the consumer choise is non-existent - drug courts. In other words, you can choose to get the shot or go to jail.
In drug courts, judges are in effect making medical decisions when they choose if this particular drug addict are to receive a jail sentence, methadone or Burprenorphin replacement therapy and counselling or a shot of Vivitrol and counselling.
In my eyes these judges are at best finding themselves in a moral grey area. How can you let non-medical personel make medical decisions that affect a perons life in this degree? Drug court judges represented a ripe market for Vivitrol. They were at the front lines of the [opiat] epidemic ... They lacked medical training - a survey of drug court judges published in 2014 revealed widespread ignorance about treatment options. And while the whole purpose of their courts was to offer treatment as an alternative to incarceration, the judges (who were often elected) tended to reflect local cultural biases about addiction, viewing it as moral weakness that called for tough paternalism. (Cited from the article).
The company behind Vivitrol spend millions of millions of dollars lobbying about their product and they have been a little too much creative in the interpretation of the statistics about the success of Vivitrol, ODs related to Vivitrol et cetera and in other forums I have seen claims that the company have fabricated false reports based on inflated numbers about the number of people in methadone and burprenorphin treatment that relapse back to their initial illicit drug habit (but this claim was undocumented).
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