Harm Reduction Harsh judgement of those still using while on ORT (methadone or buprenorphine)--Why?

[SayingSeven]

Often on forums such as Bluelight I find that when someone asks a question or makes a comment that reveals that they are using heroin or other opiates while also being on methadone maintenance or buprenorphine substitution, they are bombarded with judgement by people who say that someone who still uses while on maintenance treatment is just taking the spot of someone else who "really wants to recover". But whenever I hear experts in the field of harm reduction talk about the benefits of methadone and bupe, they talk about them as beneficial in that they reduce a person's intake of illegal street drugs, not that they always eliminate drug-taking completely. If someone is on methadone, holding down a job and paying rent, and using heroin a couple times a month when they have some extra cash, isn't that still much better than not having a job, living on the street, and having to come up with money for heroin every day?

So why all the judgement? As an advocate of harm reduction, I would say any change for the better is a good thing.

 

[szuko000]

I understand what you are trying to say and your thinking about it but those drugs are meant to get someone to change their life style, they are not meant to be withdrawal aids or hold you over to your next fix. Its meant to be about getting someone out of the life style and into a more productive one. You can claim that doing those things while using is working toward the right goal but unless the end goal is to get off illicit opiates you only make the methadone program look bad in a sense.

The problem is that these medications safe lives, they are meant to be taken instead of illicit narcotics and are not meant to simply fill the void till the next paycheck. The problem i have with it is people like that make a mockery of the whole idea of using methadone to get clean and they end up destroying the will of those around them or slipping in thoughts of doubt. People on dope tend to have dope do dope and engage in that life style and whether or not they mean to suck everyone down with them it is just something i would prefer not to have taking place at the clinic, even if they arent using there it is just not a good look for anyone.

Then theres the whole, tricking yourself into thinking you need both or thinking you can keep it up forever. My question is if you are on methadone and not getting sick then why are you using? If you are still using on methadone then you shouldnt be on methadone because you have not fixed yourself and only serve to hurt everyone around you. You can use methadone to quit heroin and lead an infinitely better life but please dont do opiates on methadone you make everyone look bad.

/rant

P.S. Some programs literally have "spots" they fill so by using dope and taking that spot you prevent someone who would stop doing all illicit opiates, make their family happy, change their life from suicidal depression to happy with a family. I have seen it and that change would not have happened if said person didnt get into a program and stop using completely. Those are the people that get their spot "stolen from" Think of it like this every time you use while on the program you potentially sentence someone to death by the life style by preventing them from getting on. Its a bit extreme and unlikely that it literally kills someone but we all know that not getting into a program can kill someone.

 

[SayingSeven]

I understand where you're coming from, and I agree that it is always better for someone on methadone or suboxone to refrain from using any illegal substances, but if they continue to struggle, I don't think that means they don't deserve their spot in treatment. Even if someone is still messing around with heroin, being on a maintenance program will allow them to live a more managable and productive life. To say that the only options are either to abstain from all illegal drugs when on ORT or to go back to having a full blown habit and addiction isn't really fair or compassionate. We're all at different places with our substance use, and just because someone uses doesn't mean they're a bad person. I think this harsh judgment of people just perpetuates the stigma placed on drug users. If someone is still using when they're on methadone, that doesn't mean they're not improving or working on the issues that lead to their addiction. The methadone will still allow them to maintain a more stable lifestyle so that they can continue to work on thesmselves and perhaps come to a place where they don't feel the need to keep using. I believe any positive change should be encouraged and supported.

It seems that people who are really coming from a position of harm reduction understand this point. The goal is progress--not perfection.

 

[szuko000]

That may be true but the idea is that once you stabilize on the program your usage should stop or you simply are not read for that step. It is unfortunate that our society doesnt allow for compassion in maintenance programs a lot of the time you dont even get a choice in the amount of time you are on the program or the dose you start at. The program i am in now is not an abstinence only program so a lot of the people dont take it seriously and its pretty obvious. This also creates a very toxic environment for everyone else as most people are not considerate enough to not discuss it in line and if not for the will power both my g/f and i have about staying clean i could see it as a very tempting place. I have even scored there the for her when i first got on subs because it was easy and that is the environment problem using while on a program create.

Believe me if society were perfect then there would be a thing like "you can use for the first 3 months on the program but if you continue to fail tests you will be booted" as it is simply not the place to be if you are using. The goal is progression as an averaged whole so your using impacts everyone and lowers everyones progression just by nature of introducing opiates into a clinic whether on purpose or just by the act of using while on the program. Thats why it has to be the way it is.

 

[chrisincville]

I understand where you're coming from, and I agree that it is always better for someone on methadone or suboxone to refrain from using any illegal substances, but if they continue to struggle, I don't think that means they don't deserve their spot in treatment. Even if someone is still messing around with heroin, being on a maintenance program will allow them to live a more managable and productive life. To say that the only options are either to abstain from all illegal drugs when on ORT or to go back to having a full blown habit and addiction isn't really fair or compassionate.

Agreed. There should be a middle ground. I don't where exactly it ends, but it shouldn't be black and white.

 

[da man]

Agreed. There should be a middle ground. I don't where exactly it ends, but it shouldn't be black and white.

I AGREE WITH 7 IF YOU CAN GET AND HOLD DOWN A JOB, AND cut down your use then thats a great step in the right direction. It can take years to stop using altogether heroins a very powerful drug that fucks with your head, and stopping completely is a massive task and can take years. Using on top of maintenance is fine in my eyess as long as u are trying to help yourself and cutting down with a goal to stop when your ready. I do aGREE that shouting out about using with people around you trying to stop using, is moronic and very counter productive, tempting for peope cesstating aswell tho. I gues im saying its a long process to quit for some people and heroin addicts have the biggest relapse profile of all drugs and this should be taken into consideration on maintenance programs.

 

[chrisincville]

.Using on top of maintenance is fine in my eyess as long as u are trying to help yourself and cutting down with a goal to stop when your ready

Yep. It may seem counterproductive, but it's part of the process for some people.

If they didn't have any methadone, they would certainly be taking to the streets for dope.

 

[SKR]

It's a tricky subject which tends to polarise those that choose to debate it. The same argument comes up in regards to immigration "Letting Immigrants in just means they take our jobs, no wonder I can't get off welfare!"

 

[Felonious Monk]

It's a tricky subject which tends to polarise those that choose to debate it. The same argument comes up in regards to immigration "Letting Immigrants in just means they take our jobs, no wonder I can't get off welfare!"

That's actually a really good comparison. Both are pretty arbitrary limits, especially a program capacity at a methadone clinic. IMO, every person should have access to ORT, so it can be part of an HR program. Faulting a single user for messing up their own program is just confusing the societal issue (not enough spots in ORT) for the individual's issue (inability to stop using drugs), and coming down hard on the user because the societal problem exists is not really going to help either problem get better.

 

[SluttyPeach]

It seems like the difference is whether you're actively trying to quit and just slip up sometimes or if you're using it just for when you're out of dope. Basically if you are serious about quitting you won't sell half your script for dope money and use the rest for when you're out. I know a lot of people who do this with their suboxone.

It does perpetuate stigmas and stereotypes concerning addicts (dishonest, only care about getting high, etc) but like with everything else... You gotta just focus on yourself and not worry what others think. In the long run that would be better for everyone.

 

[SayingSeven]

That's actually a really good comparison. Both are pretty arbitrary limits, especially a program capacity at a methadone clinic. IMO, every person should have access to ORT, so it can be part of an HR program. Faulting a single user for messing up their own program is just confusing the societal issue (not enough spots in ORT) for the individual's issue (inability to stop using drugs), and coming down hard on the user because the societal problem exists is not really going to help either problem get better.

Wow, so well-stated! This is exactly it.

 

[vicapro]

Imo methadone will take care of all wd and cravings if the dose is right so the only reason to keep using heroin while on mmt is so you can keep feeding your need for the rush that only heroin gives yo. and your definitely not making a smart decision leaving yourself with a hell of a tolerance from the methadone and that psychological need to feel that heroin high which you'll continually crave unlike people who use solely meth. Not to mention all the legal and family problems that most likely won't get any better since your still going through the same old routine albeit maybe a little less. Just my 2c, I've been heroin free for 5yrs by using suboxone/methadone and i don't even think about nor remember how heroin feels and I'm better bc of it.

 

[Mad Dash]

I do my very best to applaud people who do ORT. In fact I am someone who does, I must have missed these posts because I have usually found nothing but support for people on ORT here, with a minority of people being against it. As a matter of fact if you get any shit about it in the future and any of the remarks are disparaging in any way I will take care of it.

Now, one thing I will mention is if you are using ORT as a substitute for when you can't find dope and you are doing nothing more than abusing the system. Then I have no sympathy for you. You either are using this to get off of your current addiction or you are abusing the system. So be very clear what you are saying here. I have no tolerance for people that take advantage of the system.

 

[cj]

Why? Ignorance, Jealousy, or Some fucked up sense of moral superiority, And people are just generally assholes.

Do you and just try to ignore the hecklers in the audience. Bupe saved my life even though I continued to use heroin off and on the entire time I was prescribed to it. By allowing me a cushion to fall back on when funds ran low I never had to resort to crime. This kept me out of jail/prison and has made picking up the pieces of my life so much easier.

 

[speedballs_over]

My view is ORT should be available to anyone who seeks it and has a legitimate dependency. Beyond that it is a personal issue.

Just my thoughts. If I hadn't been afforded a few slip ups I'd never have lived a productive life the last decade. Access to treatment is the real issue here imo. Equal and for all. My dedication to recovery took a few months to "stick", had I been thrown out of a clinic during my first few months for positive UAs, I'd have never made it this far - a great distance from my former daily user self. I occasionally, about once every two years, use dope for short proud. I'm on Subutex, pay for private insurance and in whole for my physician. I'm not holding up anyone from getting treatment, our medical system and govt are in the way. Raise my taxes, I want more people to have free access to treatment. Seriously.

Peace.

 

[Mad Dash]

This is really a discussion for a different thread but allow me to go off topic for a second. If we decriminalized all drugs thus ending the "war on drugs" we would be saving prison for the actually dangerous people in this country. Addicts are only ever dangerous when they can't get their fix, if we had government programs that used the money we saved from the war on clinics by treating it as a health issue instead of a criminal issue we would be so much better off.

But this country still has a ways to go. I was watching I think CNN or MSNBC or some news channel the other day in the waiting room at the VA and Sir Richard Branson was on as a guest advocating decriminalization, and he made wonderful and valid points. And of course the reporter first things she did was bring up bullshit stats from Colorado saying traffic accidents have increased by 92%... really? Stupid bitch. After some of the daft and ridiculous things she said he actually was at a loss of words and started stuttering and trying to find words. Now as a typical American idiot they think AH HA! She got 'em! But the truth of the matter is he is so respectful he wasn't going to straight up call bullshit on the crap she was spewing so he had to go off cuff and try his best to be nice. The whole thing was a disaster and to the untrained eye it looked like she "won" the debate.

Before we make any real progress in this country we need to educate the masses and de-stigmatize addiction. That starts at the ground level, that is why I volunteer with youngsters. So that maybe one day if they ever end up leaders of the free world they might change something.

 

[speedballs_over]

^^ 100% agree with Sir Richard and MadDash. That stat about Colorado is absolutely wrong. The only reason there's an increase in fatal accidents tied to marijuana (usually alcoho is involved too, but I don't have reliable numbers on that at hand, but it's the case for certain) is b/c the state is now compiling numbers on those incidents for the first time, testing all drivers in fatal accidents for cannabis metabolites and reporting those separately from the former numbers on "drugged driving". That's new, so the stats are seriously skewed, but not by as much as stated by the ignoramus interviewer.

Colorado is fine. I've been there. It's all good. Well, mostly good. Better than many expected and I don't see the legality being changed again. Fuck Christie from NJ, singling out CO and stating in sum, "Enjoy getting high in Colorado now b/c when I'm President I'm going to stop it." Heavily paraphrased. What about the other four, and likely increasing, number of states that have legalized recreational marijuana?

Thankfully, I very legitimately (per the law in my state) have medical access to cannabis. It's now my DOC again, first time in decades!

Stop the drug war now.

Yeah, sorry to go of topic.

 

[Phoenix_rising]

I believe that taking Buprenorphine is the better alternative as a maintainenance therapy as it blocks most other opioids/opiates,so once using theres no going back really,no other opiate will get you high and it takes ages to leave your body and being a drug addict there isn`t much time you can go before the sickness kicks in.The only thing with addicts is that its never enough,so being on Buprenorphine you start looking for something else that will get you high and end up with poly drug habits.

No simple answer,except,legalise drugs for addicts,but have it regulated,so you get pure gear in a sterile environment.Give addicts what they need as they will just keep on keeping on untilthey die.