Dying to be Free: Great article on heroin addiction from the Huffington Post

[herbavore]

This article is long but well worth the read.

http://projects.huffingtonpost.com/dying-to-be-free-heroin-treatment

 

[herbavore]

Here are some of my thoughts while reading through the article on the first go:

Federal and Kentucky officials told The Huffington Post that they knew the move against prescription drugs would have consequences. “We always were concerned about heroin,” said Kevin Sabet, a former senior drug policy official in the Obama administration. “We were always cognizant of the push-down, pop-up problem. But we weren’t about to let these pill mills flourish in the name of worrying about something that hadn’t happened yet. … When crooks are putting on white coats and handing out pills like candy, how could we expect a responsible administration not to act?”

Hmmmm, how about ending the War on Drugs at the same time? Harm reduction clinics specifically for opiate addicts would go a long way towards this end.

Chemistry, not moral failing, accounts for the brain’s unwinding. In the laboratories that study drug addiction, researchers have found that the brain becomes conditioned by the repeated dopamine rush caused by heroin. “The brain is not designed to handle it,” said Dr. Ruben Baler, a scientist with the National Institute on Drug Abuse. “It’s an engineering problem.”

Shouldn't this say opiates, not just heroin? Once again, heroin is the bogeyman while prescription pill addiction gets passed off as somehow better and receives less stigma.

According to the medical establishment, medication coupled with counseling is the most effective form of treatment for opioid addiction.

And yet we choose to keep opting for prison and forced one-size-fits-all programs that are ordered by the courts. No one orders a doctor's care and counseling because then they would have to figure out how to pay for it.

An abstinence-only treatment that may have a higher success rate for alcoholics simply fails opiate addicts. “It’s time for everyone to wake up and accept that abstinence-based treatment only works in under 10 percent of opiate addicts,” Kreek said. “All proper prospective studies have shown that more than 90 percent of opiate addicts in abstinence-based treatment return to opiate abuse within one year.”

Where are the statistics to show this success with alcoholism?

A hundred years ago, the federal government began the drug war with the Harrison Act, which effectively criminalized heroin and other narcotics. Doctors were soon barred from addiction maintenance, until then a common practice, and hounded as dope peddlers. They largely vacated the field of treatment, leaving addicts in the care of law enforcement or hucksters hawking magical cures.

To read a great book on the history of the War on drugs, read Chasing the Scream

Something else has been lost with the institutionalization of the 12 steps over the years: Bill Wilson’s openness to medical intervention. From the start, Wilson intended AA to work with, not against or instead of, the latest and best medical science to treat addiction. In 1965, he recruited Dr. Vincent Dole to become a member of AA’s board of trustees. Along with Dr. Marie Nyswander and Dr. Kreek, Dole pioneered methadone treatment for heroin addicts.

He also accepted the use of psychedelics to connect with a larger and more spiritual context for one's own life.

At least some of the top officials overseeing Kentucky’s response to the opioid epidemic are as open to medications as Merrick is. “My perspective is whatever gets them sober, gets them well, is what we need to do,” said Van Ingram, the executive director of Kentucky’s Office of Drug Control Policy. “I don’t think we should close the door on any type of treatment that’s effective.”

Ibogaine?

Among Suboxone’s most unyielding critics are the people with the most power to dictate treatment options. The drug court judges in Northern Kentucky’s Campbell, Boone and Kenton counties are adamant in their refusal to make Suboxone available to the addicts who come through their doors. Judge Gregory Bartlett, who started the first drug court in the area in 1998 and currently presides over Kenton County’s drug court, won’t allow Suboxone as part of a defendant’s treatment plan. His reasoning: defendants in his court “have to be off drugs.”

I think that anyone that has the power to order "treatment" for people with addictions should have to undergo education that exposes them to 1) the fallacies and mythology of abstinence only programs without other supports, 2) the latest medical facts and 3) alternative therapies and their efficacy

Thomas is simply following state court policy. A sign was recently posted outside a Kenton County courtroom addressed to all “Suboxin users.” It warned: “IF YOU WANT PROBATION OR DIVERSION AND YOUR ON SUBOXIN, YOU MUST BE WEENED OFF BY THE TIME OF YOUR SENTENCING DATE.”

And who is the criminal?

“I talked to the people at the [Narcotics Anonymous] national office. And NA privately recognizes that it is extremely important that there’s treatments for opioid dependence besides just abstinence,” Seppala said. “They recognize that. However, their public stance is as it always has been if you’re on a maintenance medication – methadone or bupe – you can’t hold an office in a meeting or service position nor can you speak at the meetings.”

These entrenched attitudes have to change as well as those that prevent people from being n SSRIs etc.

So, I have read through the entire article now. It's hard for me to read this kind of stuff. I cry. I think of my son. I think what does it matter, now that he is gone? But it does matter that as a whole community, a nation, a world we educate ourselves so that families can be supportive, so that treatment really is treatment and not punishment, so that people who are trying to take responsibility for their own lives are met more than halfway with scientific and creative solutions and not hardline dogmas that exclude criticism.

The article is a lot to get through in one sitting. I would be interested to hear what others think (especially opiate users, people on methadone or suboxone). The parts I pulled out and responded to are just random quotes that made me want to respond--they are in no way characteristic of the whole article.

 

[Prescottdave]

An interview on NPR discusses the recent article "Dying To Be Free" on All Things Considered. http://www.npr.org/2015/02/04/38378...eporter-finds-treatment-centers-don-t-use-the

 

[LeftAndLeft]

Huffington Post. Heartstring-pullers and oversimplified solution presenters.

Suboxone helps a lot of people. Its difficulty of acquisition is tragic.

That said, if the goal is being opiate-free, it will just delay the process and make the withdrawal process more difficult when it happens. That can be worth it, particularly if it lets an addict get their life on track and work through any root causes that may be motivating their use. But it is a difficult drug to come off of, and not mentioning that in an article that pushes it so strongly is irresponsible.

If maintenance is accepted as a potentially life-long state, then it's perfect. Solves the problem and lets people live. The only problem is the stigma and the monetary expense (either of which, independently, can be problematic for an addict to live with).

When the world accepts that people's brains are all wired differently, and that addicts aren't weak-willed or dumb, is when this sort of solution will be useful. As it is, there's so much blame, and addicts internalizing it is half of the problem.

If the stigma didn't exist, the majority would happily stay on maintenance and be able to live perfectly normal lives. Well, aside from needing some extra medication to suppress symptoms, but there are lots of conditions with that caveat.

Then abstinence programs could be for those who genuinely value being drug-free for its own sake, and failure could mean accepting medication rather than relapsing.

For abstinence programs to work you have to be able to control your thoughts, emotions, and actions in a way that addicts have, by definition, proven they cannot do. (Not saying all addicts are compulsive in all of these areas -- I, for one, am not compulsive in my actions -- but failing to control some or all of those things when it comes to one or more drugs is how addiction is defined.) Some can learn to do it, but they are in the marked minority, and the fact that it's often the only currently-presented solution is remarkably unhelpful. I agree with the article there, for certain.

I don't know. It's just a difficult problem.

 

[herbavore]

When the world accepts that people's brains are all wired differently, and that addicts aren't weak-willed or dumb, is when this sort of solution will be useful. As it is, there's so much blame, and addicts internalizing it is half of the problem.

This is precisely my problem with practically the whole field of addiction theory--we all want one definitive theory and one clear path to recovery. In the field of cancer therapy researchers are recognizing that in order to treat people who may all have the exact same cancer, they still have to understand with genome mapping how that cancer exists in any given individual's body for the most effective treatment to occur. Why would addiction of all things (being that it centers in the brain which is about as full of variation as the universe itself) be any different? Yes, there are overlapping behaviors, overlapping experiences--this is why an empathetic and understanding community is so important--but that community must embrace difference and complexity in addiction, addicts and treatment.

Any problem is an invitation to exploration. We need more exploration that is truly open-ended and welcoming of challenge and the ability to embrace multiple truths/realities.