Switching people from one set of addictive drugs to others and calling that treatment is horrifying as a solution and rather simpleminded. Methadone a very addictive substance and a morphine derivative comes to mind.More a rhetorical bait and switch than anything else.
1) Taking a dose of a known substance is not the same thing as shooting up on street drugs. It is much safer by default. Getting people on a safe, legal medication can keep them in rehab or in therapy, or they can simply age out of their criminal behavior after some time on MAT (as Lehman points out, criminality tends to decline with age).
2) Of the three MAT medications, methadone is strong and is certainly addictive, but less so than fentanyl or heroin. Suboxone (buprenorphone) is a weak opioid with much less of a high. Naltrexone is an opioid blocker and is not an addictive drug at all.
3) People abuse drugs for a reason. Those with chronic pain may actually need a pain medication. It is common to put people on methadone for severe end of life pain, and we also use buprenorphone for chronic pain as it is much safer than other opioids. Opioids have a legitimate medical use, and particularly when services were shut down due to restrictions in the early COVID era, many patients with real pain turned to the illegal drug market. They might simply need to get back on legal medications.
Heroine maintenance works just as well and of course methadone (whether it's more or less addictive is not so clear) is often on the black market and results in deaths. I am objecting to calling a preferred officially marketed addictive drug as treatment while one that is not on the accepted economic market (deemed illegal) is demonized. Perhaps the real policy issue is why so much unhappiness is extant in our society that leads so many to seek escape.
So we probably have some degree of overlap, because I do run into this issue. I think that methadone and buprenorphine have properties which give them significant advantages in addiction treatment, but I still find that there are circumstances where it’s useful to prescribe other opioid medications, particularly for patients who are in pain. I would agree that the carveout for a couple of medications as MAT is an irrational regulatory decision.
And I would also agree that the “deaths of despair” paradigm is more informative than looking at things in terms of the pharmacology of any one specific drug of abuse. The despair that leads people into drug use is more of an issue than the drugs themselves. I use this particular term because I watched the authors of the deaths of despair book present to an audience of opioid experts at NIH, one of whom took the mic to sneer at them and ask why anyone should bother concerning themselves with the deaths of white men.
Glad to hear that you as I am is concerned by the state of our country which creates so much unhappiness with its divisive politics and lack of care about those who have fewer means to create safety nets to provide soft landings.
Switching people from one set of addictive drugs to others and calling that treatment is horrifying as a solution and rather simpleminded. Methadone a very addictive substance and a morphine derivative comes to mind.More a rhetorical bait and switch than anything else.
Several issues with this:
1) Taking a dose of a known substance is not the same thing as shooting up on street drugs. It is much safer by default. Getting people on a safe, legal medication can keep them in rehab or in therapy, or they can simply age out of their criminal behavior after some time on MAT (as Lehman points out, criminality tends to decline with age).
2) Of the three MAT medications, methadone is strong and is certainly addictive, but less so than fentanyl or heroin. Suboxone (buprenorphone) is a weak opioid with much less of a high. Naltrexone is an opioid blocker and is not an addictive drug at all.
3) People abuse drugs for a reason. Those with chronic pain may actually need a pain medication. It is common to put people on methadone for severe end of life pain, and we also use buprenorphone for chronic pain as it is much safer than other opioids. Opioids have a legitimate medical use, and particularly when services were shut down due to restrictions in the early COVID era, many patients with real pain turned to the illegal drug market. They might simply need to get back on legal medications.
Heroine maintenance works just as well and of course methadone (whether it's more or less addictive is not so clear) is often on the black market and results in deaths. I am objecting to calling a preferred officially marketed addictive drug as treatment while one that is not on the accepted economic market (deemed illegal) is demonized. Perhaps the real policy issue is why so much unhappiness is extant in our society that leads so many to seek escape.
So we probably have some degree of overlap, because I do run into this issue. I think that methadone and buprenorphine have properties which give them significant advantages in addiction treatment, but I still find that there are circumstances where it’s useful to prescribe other opioid medications, particularly for patients who are in pain. I would agree that the carveout for a couple of medications as MAT is an irrational regulatory decision.
And I would also agree that the “deaths of despair” paradigm is more informative than looking at things in terms of the pharmacology of any one specific drug of abuse. The despair that leads people into drug use is more of an issue than the drugs themselves. I use this particular term because I watched the authors of the deaths of despair book present to an audience of opioid experts at NIH, one of whom took the mic to sneer at them and ask why anyone should bother concerning themselves with the deaths of white men.
Glad to hear that you as I am is concerned by the state of our country which creates so much unhappiness with its divisive politics and lack of care about those who have fewer means to create safety nets to provide soft landings.