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DPMC Moderators: tryptakid
Opinion piece on RFK Jr and drug treatment policies
- Thread starter chippermonk
- Start date
ShulginsReincarnation
Ex-Bluelighter
- Joined
- Dec 8, 2024
- Messages
- 281
I didn't realize all these things about him; I never bothered looking much into it as I know he is just a sell-out based on what I saw of him during the pandemic in Europe and then to betray the political party he claimed to side with just because he was nominated by Trump?... Definitely a sell out..
But, I did think his stance on legalizing psychedelics was good, but now I hear he likes the AA program and imprisonment for drug users? Fuck that... More sell out bullshit; no surprise...
Robi
Bluelighter
Yeah???
ShulginsReincarnation
Ex-Bluelighter
- Joined
- Dec 8, 2024
- Messages
- 281
Yes, did you not see how he was part of the driving force for the beginnings of all the anti-lockdown measures protests across Europe, then sprinkled in some bits and pieces of far right conspiracy theory, but all was backed by Querdenken that literally played both sides and admitted it? lmao... Yes, RFK Jr. sides with literally whatever works best for him just like Querdenken... Like he ran for President as a democrat, but now is siding with a wholely Republican cabinet? heh... Then again, look at the fact the only reason anyone in upper levels of government in US is now elected by CIA funds essentially if you track back the original money (Peter Thiel being the common denominator here....) yet Trump and Elon claim to be "good guys" against "the deep state." HAH! Jokes... smh
Maia's points in this piece are ones I'm very familiar with. I have been a practicing clinician through the rise of fentanyl, the expansion of access to buprenorphine and naloxone, and the often repeated 'evidence-based' rhetoric parroted ad nauseum by public health officials, researchers, and harm reductionists. At my core, I am a harm reductionist and have been since I first encountered Dancesafe in 1999, bluelight in 2005, as well as my first needle exchange in 2006. I got clean in 2008 through a methadone detox while inpatient, and by immersing myself in 12-step for several years that followed. My choice to leave abstinence-based recovery spaces was a personal one that I did not take lightly. I wanted to explore psychedelics, social drinking, and what psychotherapy had to offer. I also wanted to find a path away from an identity that was based around being sick and suffering.
My career as a clinician began in 2012 as I completed my social work training and was working to finish a master's in public health. I almost immediately found work attached to MAT programs within the community health center world, where federal grants were doubling down on the 'OBOT (now OBAT)' model of treatment. This involved complex care management fronted by a nurse, which included prescribing physicians, urine toxicology screening, and typically had a behavioral health requirement which was where my role would come in. Over the years, I became increasingly ingrained in the outpatient treatment of patients who primarily struggled with opioid dependence which had very quickly started to shift away from oxycodone and diacetylmorphine to fentanyl and it's ilk. Ironically, I had tried to use buprenorphine from an outpatient prescriber previously, in 2007. I found that it didn't work well for me, leaving me feel as though I was lingering between sickness and wellness, caught in between the worlds of people using and people who didn't. I wasn't sober enough for AA, yet my social network was mostly people who used heroin. I lasted a month or so before selling most of my pills and returning to heroin.
I believe in the usefulness of long acting opioid replacements like methadone and buprenorphine. As Maia points out, they are evidence based, demonstrating a drastic reduction in death from fatal overdose. They likely reduce the transmission of HepC and HIV as they provide people in the community alternatives to injection drug use to manage their habits. At the same time, what the evidence is far less clear on, is how much they actually improve people's lives.
In my (admittedly small) experience, the jury is very much out. While in 12-step programs there are long-term powers of example who reinforce the core message that recovery is possible, and that their lives improved as a result of working the program. Jobs, marriages, children, businesses, freedom from chemical dependence, and other examples of success are evident and celebrated. Those who struggle with these things can find social support from others within the fellowship, and there are plenty who have found work through their connections within these networks. I struggle to think of many examples of exuberant recovery stories from the vast majority of people I've worked with over the past 12 years within the harm reduction world. Some find stability, consistency, freedom from sickness, and even connection to others. Many are able to outlive their friends. Many still remain connected to their MAT program, dutifully providing urine to be screened (for a tidy sum to both the health center and the lab) during their daily/weekly/monthly visit (which also charges a fee to insurance) where they're provided a prescription to last until the next (further charging a fee and possibly a copay) - rinse and repeat.
As a friend and former colleague who has been prescribing buprenorphine for almost 15 years now has often said: 'We're great at getting people onto it, and terrible at getting people off of it'. I've known more patients than I can count whose maintenance treatment has lasted many years longer than their illicit use did.
What we don't have good data on is the long-term impacts of maintenance therapy on things other than preventing overdose deaths. We don't have a good sense of how it effects people hormonally, gastrointestinally, or even dentally. I've heard of lawsuits related to the dental problems connected to chronic buprenorphine use, something that has often been a rumor with methadone maintenance as well. What lends credibility to this, in my eyes, is that buprenorphine is typically dissolved via a listerine breath strip like film sublingually dissolved and absorbed via capillaries under the tongue (methadone is consumed by pill or a linctus solution, both swallowed). Buprenorphine's evolution from pill to film strip allowed for lengthier patent rights to the manufacturer, increasing pharma profits during the rise of fentanyl. As generic strips became available a few years ago, novel patents emerged for long-acting injectable formulations of buprenorphine with dosing regimens of monthly (sublocade) to weekly (Brixadi).
As time goes on, we see that America's underclass - whose right to treatment choices are championed by physicians and researchers on twitter and on tour, whose insurance payments are gladly integrated into health centers, and pharmacy fees are fed into big pharma's pocket as the ideal opioid to prescribe and profit off of - continues to march on. Can anyone say that we have actually made an real headway in addressing the social problems, alienation, and suffering that begets addiction? We've prevented deaths and that has reduced community trauma, that is for sure. But we've also created a generation of chemically dependent patients who may struggle to connect with people outside of the treatment world.
I'm just grateful I didn't respond well to suboxone and got clean the old fashioned way. At least that freed me up to make something of myself - I don't know that I would have if I'd stayed enmeshed in the 'gray world of suboxone' as a blogger once called it.
Maybe Kennedy's a lunatic, maybe he's a bootlicker, or maybe he's someone who has some novel ideas on how to approach this stuff. His vaccine denial stuff aside, I am actually interested in seeing what he attempts to do with addiction and mental health treatment. For all of the bluster regarding involuntary and inhumane treatment of our institutional past, we almost exclusively cite the fading years of our institutional system, which occured within memory of many people alive today. These facilities were inhumane because they were poorly funded, overcrowded, and struggled to recruit or retain adequate professional staff. Kirkbride and Dix, two of the main proponents of 'the humane treatment of patients' envisioned psychiatric intervention which could provide fresh-air, sunlight, social connection, vocational rehabilitation, and above all, safety and security. Instead of investing in these systems, we cut costs and allowed conditions to atrophy, leading to the horror stories uncovered during the post-war years by LIFE magazine's Albert Maisel, or during the final years by Geraldo Rivera. They weren't designed to be hellholes, we didn't take care of them and that's how they ended up. What Bobby seems to be talking about is more in line with what Dix and Kirkbride originally proposed, rather than the atrophied system that Kennedy, LBJ, Nixon, and Reagan dismantled.
The jury's still out - maybe these will become awful places too, but I'm just putting it out there that they don't have to become that. Maybe Bobby is the best thing that comes out of a shitty presidency, maybe he's not.
My career as a clinician began in 2012 as I completed my social work training and was working to finish a master's in public health. I almost immediately found work attached to MAT programs within the community health center world, where federal grants were doubling down on the 'OBOT (now OBAT)' model of treatment. This involved complex care management fronted by a nurse, which included prescribing physicians, urine toxicology screening, and typically had a behavioral health requirement which was where my role would come in. Over the years, I became increasingly ingrained in the outpatient treatment of patients who primarily struggled with opioid dependence which had very quickly started to shift away from oxycodone and diacetylmorphine to fentanyl and it's ilk. Ironically, I had tried to use buprenorphine from an outpatient prescriber previously, in 2007. I found that it didn't work well for me, leaving me feel as though I was lingering between sickness and wellness, caught in between the worlds of people using and people who didn't. I wasn't sober enough for AA, yet my social network was mostly people who used heroin. I lasted a month or so before selling most of my pills and returning to heroin.
I believe in the usefulness of long acting opioid replacements like methadone and buprenorphine. As Maia points out, they are evidence based, demonstrating a drastic reduction in death from fatal overdose. They likely reduce the transmission of HepC and HIV as they provide people in the community alternatives to injection drug use to manage their habits. At the same time, what the evidence is far less clear on, is how much they actually improve people's lives.
In my (admittedly small) experience, the jury is very much out. While in 12-step programs there are long-term powers of example who reinforce the core message that recovery is possible, and that their lives improved as a result of working the program. Jobs, marriages, children, businesses, freedom from chemical dependence, and other examples of success are evident and celebrated. Those who struggle with these things can find social support from others within the fellowship, and there are plenty who have found work through their connections within these networks. I struggle to think of many examples of exuberant recovery stories from the vast majority of people I've worked with over the past 12 years within the harm reduction world. Some find stability, consistency, freedom from sickness, and even connection to others. Many are able to outlive their friends. Many still remain connected to their MAT program, dutifully providing urine to be screened (for a tidy sum to both the health center and the lab) during their daily/weekly/monthly visit (which also charges a fee to insurance) where they're provided a prescription to last until the next (further charging a fee and possibly a copay) - rinse and repeat.
As a friend and former colleague who has been prescribing buprenorphine for almost 15 years now has often said: 'We're great at getting people onto it, and terrible at getting people off of it'. I've known more patients than I can count whose maintenance treatment has lasted many years longer than their illicit use did.
What we don't have good data on is the long-term impacts of maintenance therapy on things other than preventing overdose deaths. We don't have a good sense of how it effects people hormonally, gastrointestinally, or even dentally. I've heard of lawsuits related to the dental problems connected to chronic buprenorphine use, something that has often been a rumor with methadone maintenance as well. What lends credibility to this, in my eyes, is that buprenorphine is typically dissolved via a listerine breath strip like film sublingually dissolved and absorbed via capillaries under the tongue (methadone is consumed by pill or a linctus solution, both swallowed). Buprenorphine's evolution from pill to film strip allowed for lengthier patent rights to the manufacturer, increasing pharma profits during the rise of fentanyl. As generic strips became available a few years ago, novel patents emerged for long-acting injectable formulations of buprenorphine with dosing regimens of monthly (sublocade) to weekly (Brixadi).
As time goes on, we see that America's underclass - whose right to treatment choices are championed by physicians and researchers on twitter and on tour, whose insurance payments are gladly integrated into health centers, and pharmacy fees are fed into big pharma's pocket as the ideal opioid to prescribe and profit off of - continues to march on. Can anyone say that we have actually made an real headway in addressing the social problems, alienation, and suffering that begets addiction? We've prevented deaths and that has reduced community trauma, that is for sure. But we've also created a generation of chemically dependent patients who may struggle to connect with people outside of the treatment world.
I'm just grateful I didn't respond well to suboxone and got clean the old fashioned way. At least that freed me up to make something of myself - I don't know that I would have if I'd stayed enmeshed in the 'gray world of suboxone' as a blogger once called it.
Maybe Kennedy's a lunatic, maybe he's a bootlicker, or maybe he's someone who has some novel ideas on how to approach this stuff. His vaccine denial stuff aside, I am actually interested in seeing what he attempts to do with addiction and mental health treatment. For all of the bluster regarding involuntary and inhumane treatment of our institutional past, we almost exclusively cite the fading years of our institutional system, which occured within memory of many people alive today. These facilities were inhumane because they were poorly funded, overcrowded, and struggled to recruit or retain adequate professional staff. Kirkbride and Dix, two of the main proponents of 'the humane treatment of patients' envisioned psychiatric intervention which could provide fresh-air, sunlight, social connection, vocational rehabilitation, and above all, safety and security. Instead of investing in these systems, we cut costs and allowed conditions to atrophy, leading to the horror stories uncovered during the post-war years by LIFE magazine's Albert Maisel, or during the final years by Geraldo Rivera. They weren't designed to be hellholes, we didn't take care of them and that's how they ended up. What Bobby seems to be talking about is more in line with what Dix and Kirkbride originally proposed, rather than the atrophied system that Kennedy, LBJ, Nixon, and Reagan dismantled.
The jury's still out - maybe these will become awful places too, but I'm just putting it out there that they don't have to become that. Maybe Bobby is the best thing that comes out of a shitty presidency, maybe he's not.
Foreigner
Bluelighter
NYT is no longer credible news. I will wait to see what RFK's actually policies are.
It's actually an opinion piece, not a news report. I've seen Maia Szalavitz speak before and in general I appreciate her perspective to some degree, but it's one that speaks to a population that is liberal, educated, and generally out-of-touch with the lived experience of the majority of users. It's also one that sells books and makes people go 'hmm!' while listening to her guest spots on NPR, and sounds good at a professional or academic conference as it plays up the right to self-determination and the medical model.
Foreigner
Bluelighter
Fair enough. I boycotted the NYT years ago. I just can't support their leftist claptrap reporting anymore, even if some writers are okay.