They Should Understand Addiction, Or At Least Try!

They Should Understand Addiction, Or At Least Try!
Rant #4(Opinion)

Originally February 24, 2020


Somebody said that they hate when people don't understand addiction as a disease, or that sometimes, Medication Assisted Treatment (MAT) such as buprenorphine (usually called by the most famous brand name of it, Suboxone) and methadone. These treatments involve taking a person addicted to opioids and administering Suboxone or methadone to them, in order to quell withdrawal symptoms and craving. Because both are actually just different opioid drugs, it prevents those things from happening. 'Giving drugs to addicts' seems controversial, especially when somebody knows little about those treatments or the science behind it. Below, I have cleaned up the response I gave to my friend:

I am so annoyed when people say "I'd never get addicted to that because I have strong willpower" or "I've [drank/done drugs] and I never got addicted." Yes. So clearly, because you drank a lot in college, you did half a line of coke once, or took 5mg vicodin when you got surgery, that means that everybody who has severe addictions to a variety of substances must just not want to be clean, or that you are superior. I mean, the egocentric thing about the aforementioned kind of arguments comes from the fact that often the person is dismissive of their own addiction proneness, while not actually even attempting to understand the reality of it in others. But hey, he has strong willpower and one time did 'molly' that was actually just ritalin and pixie sticks, so he will be immune to any and all addictions. Yup.

Lem Mason even more frustrating than your standard layperson, frat dude or whoever not understanding addiction is the people whose job it is to handle that not understanding it. I will say that in the last few years even in the course of my own navigation thru some of these spaces, I have seen major improvement. Nonetheless, so much room for growth remains. For example, the current standard 12-step based rehab is outdated. Now, dozens of people I know have gone thru and still do AA/NA, and have stayed clean. And I don't want to take away from that accomplishment, nor would I wish that the infrastructure thru which they stay clean should vanish. Yet the success rate a 12 step program dwells in the low double if not single-digit territory: 10% is a common, nicely rounded number. You know what else yields a roughly 1 in 10 chance of ceasing use of opioids like heroin or other substances? Doing nothing and just dropping it. Somebody very close to me more or less did this, and has remained sober for like two decades. Not saying that this is the typical outcome: 1 in 10 even seems kind of high. So many go thru numerous tries before finding what works for them, which for some people involves AA/NA. But for these rehabs to charge $1,000 a day just to prescribe a one-size-fits-all approach, essentially spending 30 days prepping its patients for 12 step meetings, the whole notion that it brings about such amazing success actually can serve as a detriment to the 9 in 10 that it doesn't help. AA and Christianity share a lot in common in that both are spiritual groups that congregate and try to do something good, but claim that they are the sole way to achieve that good and that any variation from their rigidly prescribed path is invalid, it won't help and it will hurt that person severely. Like AA is fine...but when treatment professionals refuse to accept the science behind MAT (Medication-Assisted Treatment) and start putting their patients on or at least maintaining them with buprenorphine or methadone, then it gets in the way of things. Then, it begins to potentially harm people. MAT in the form of opioid replacement therapy can have nearly a 50% success rate--success being defined as 1 year away from illegitimate drugs confirmed by random urine tests and self-reporting. To triple, quadruple or more the chances of sobriety for a heroin addict who may otherwise face single-digit odds, that is huge. And to prevent its implementation because of deep-rooted 12 step ideology and sayings such as "a drug is a drug is a drug," you are actually killing people! Like, people die from this disease! Even in circumstances where a patient relapses, having been on Suboxone or methadone means that they will have built up a baseline tolerance to any opioid, since a cross-tolerance exists between anything in that class: heroin, codeine, oxycodone, Suboxone, fentanyl, methadone, Vicodin, et al. So say Patient A who has 60 days away from dope did not go on MAT and they buy a strong fentanyl-laced bag, they overdose and die because it is a shock to their system. Meanwhile, Patient B also has 60 days since they stopped using illegal drugs, but they decided to go on Suboxone maintenance indefinitely after rehab. Then he relapses on that same fentanyl-laced batch as Patient A. Yet he survives, because of the tolerance factor--that is if it even breaks through, since Suboxone at sufficient enough doses acts as a blocker (though lots of debate exists about whether fentanyl can actually overpower its blocking effects). 

Now, many major rehabs allow for MAT, some even offering to start a patient on it during their stay at inpatient or in an outpatient setting. Ideally, a better option would exist where the user can just stop, with no ill effects, and just stay stopped, with minimal discomfort. We do not live in a reality like that. Where harm cannot be eradicated, harm reduction offers the best method for combating it.

In a practical world, the criminal justice system would not have stacks on stacks of criminals whose records include only drug and drug-related crimes. Again, the proprietors of society have chosen the more complicated (albeit politically expedient) option. Yet the US has millions upon millions of otherwise law abiding citizens (maybe not all the classiest of folk, but certainly not all the scum of the earth) who have to answer to officers of the law who don't seek out criminals, they simply maintain those who they already have caught. Correctional officers aka prison guards as well as probation officers fit this mold. Both segments of the CJS need thorough remodeling, and are deserving of an entire rant of their own. As it relates to addiction and maintenance, the probation department in Chester County now allows MAT in the form of Suboxone, methadone or naltrexone. However, they discourage methadone, while naltrexone solely blocks opioids from effecting someone, it doesn't conquer withdrawal syndrome or cravings. Yet the prison does not condone any of this--even for detox. That's right, a newly admitted inmate is given nothing other than maybe a Zofran for the nausea to augment the recovery effort. Whether an individual comes to prison following a ridiculous $200 a day heroin habit or having faithfully followed the rules of Suboxone maintenance for a year ever since their arrest, it does not matter. Both will endure a horrible withdrawal. Unfortunately, the Suboxone or methadone patient will likely endure a more painful experience because those drugs' withdrawal period last longer: and yes, Suboxone and methadone do lead to a withdrawal not unlike 'dopesickness' when abruptly ceased. Because they both have long half-lives which require infrequent administration (once a day for methadone, once or twice for Suboxone), they make ideal maintenace drugs because it diminishes the reinforcing behavior of continuously taking something, and also it means the patient will have to go a long time after their last dose on MAT before they can use a recreational opioid like heroin, because proper doses act as blockers of those receptors, with some exceptions. Heroin's effects do not last a full day, nor do those of oxycodone or fentanyl; therefore, a user has to constantly re-dose on them to stay high (or at least not sick). They don't last as long, but their withdrawals also end sooner: within 5 to 7 days, the addict's *physical* condition will begin to improve. For Suboxone, make that more like 3 weeks, and for methadone, even longer. The MAT drugs don't seem to have as intense of a peak, but withdrawal is withdrawal--if you get five fingers or just two chopped off, you still lost fingers, and it'll still hurt like hell. Well, for the prison to deny detox drugs to ANYONE dependent on opioids, especially for drug court offenders who come in for 2 or 4 day stints or whatever, this just sets them up for failure upon release. Imagine somebody goes to jail for 2 days because they forgot to take a urine test, they fail one for weed or miss a fine payment. They were on Suboxone, go to jail, and 48 hours later come out dopesick. The chance that the person will go home and take their medication to alleviate it has decreased. Also, I can tell you firsthand that many have the mindset of "if they're gonna lock me up for something stupid, I might as well do something worth while." They go use heroin, and go back to jail a week later, or maybe they die. That is a very realistic outcome. Montgomery County and another few jails have just begun to put inmates on Suboxone maintenance--Philly jails have done this for some time now. That will literally save lives and millions of taxpayer dollars on recidivism and the damage that they may otherwise do. Now, the probation office--to my knowledge--has yet to accept medical marijuana as legitimate among parolees and probationers. While I sort of see their logic in the sense that anyone could just get a card for anything as a license to smoke pot all day, it also represents the arrogant hubris of the justice system here because rather than surrendering their deeply entrenched position ('drugs are bad, mkay?'), they will continue to endorse this see-through charade. Not to mention the stupidity of the probation department refusing to accept what a medically-licensed doctor has prescribed, they would avoid SO much trouble were they to allow medical marijuana users to partake while on probation. Maybe not advertise the fact, but allow it. Some people do genuinely benefit from it: I've heard of some cases about ex-opioid addicts smoking weed as their variation of maintenance, and having success with it; plenty of convicts have trauma and PTSD, which cannabis can help with apparently; for pain, it would make more sense to allow a parolee to smoke bud rather than go on a highly addictive opiate such as Oxycontin; also, more generalized mental health problems like anxiety or depression may see some relief vis-a-vis marijuana. All those accounts are anecdotal. Personally, I think better options exist than weed for specific ailments...but that applies to me. For the probation department to just blanket ban it under any circumstances despite legal and medical clearance simply perpetuates the retention of some individuals. In PA, a probation term frequently restarts when the individual on it commits a violation. Somebody might get 2 yrs probation beginning in March 2020, but fail some urine tests for weed (weed which they have a medical card for), and get a violation of their probation's terms in May 2021. The judge then 'reimposes' that probation--extending it until May 2023. Then they get another violation in Feb 2023 for not having paid fines--another 2 years, then. Judges don't need to restart the clock on probation every time, but they do it a lot--like, A LOT. Part of me thinks the weed thing has yet to change simply because it gives them a solid head count of parolees and prisoners to guarantee the jobs of dozens upon dozens upon dozens of correctional and probation officers, and attorneys, judges, court clerks, and so on. Yet the criminal justice system supposedly exists to rehabilitate those caught in it--they could simply convert C.O.s to rehab workers, P.O.s to therapists and social workers. I understand the need for a degree of genuine jails, parole officers and such. The other 90% of the system urgently needs an update.

Now, my cynicism isn't absolute because I have seen so many changes in just the last half-decade regarding both the medical and legal treatment of addiction. 12 step programs show the volume of good people in remission from a disease who truly want to help not just themselves, but others. I've encountered so many dedicated people working in therapy settings who want to heal patients, and who adapt to the newest techniques--albeit slowly. And some of the probation officers, the younger ones, have degrees in social work; they truly see their job more as the social worker for the convict than the big bad cop who locks them up. Unless a parolee commits a new crime, it is at the PO's discretion if and when to violate them. If they don't care about medical marijuana, then that convict can fail 100 tests for weed and never see a judge so long as the PO remains the same or the next PO is also ok with that. In the scenario that they do get violated, the judge would then see the 50 positive THC urine tests...nonetheless, things will get better, so long as those with better ideas and fire inside them continue to speak and act and demand that change; only when the public's loud demand for progress dwindles will the engine of change also.