With all due respect to my colleagues who might feel differently, an opioid is an opioid; period. I believe the vast majority of my colleagues’ hearts are in the right place and are genuinely concerned about the wellbeing of addicts.
But that sentiment doesn’t change the fact that all opioids – including Medication-Assisted Treatment (MAT) drugs, buprenorphine and methadone being the most popular – are highly addictive and affect the same regions of the brain in essentially the same way. They all share the same adverse side effects and withdraw pain. MAT narcotics are not miracle drugs that cure addiction – they’re simply opioids. This just strikes me as a no-brainer; but I feel compelled to repeat it at the expense of sounding redundant to galvanize the point that some of my colleagues want to leave covered in the shaded background.
What many of my colleagues and most people don’t realize is that we are actually in America’s second opiate/opioid epidemic. In the late nineteenth century it was discovered that Americans consumed more habit-forming drugs per capita than the Chinese who were at the time considered to be biggest drug abusers on the planet. The German Company, Bayer, marketed heroin directly to physicians as a completely safe and non-addictive painkiller for menstrual cramps, migraines, a cough medicine, and a cure for morphine addiction. Is any of this sounding remotely familiar to you?
The epidemic became so perverse that President Roosevelt appointed Dr. Hamilton Wright to the position of United States Opium Commissioner; for all intent and purposes, our first ‘Drug Czar.’ Dr. Wright was instrumental in the crafting of The Harrison Narcotics Tax Act of 1914. This federal law mandated the regulation and taxation of the production, importation, and distribution of opiates and coca products. It was also interpreted within its framework that doctors could no longer prescribe opiate and/or opioids for the purpose of addiction treatment. There were challenges to this interpretation; but in 1919, the Supreme Court ruled that physicians could not prescribe narcotics solely for maintenance. The Harrison Narcotics Tax Act effectively ended America’s first opiate/opioid epidemic.
Fast forward fifty years later when the Narcotic Addiction Rehabilitation Act of 1966 (NARA) pealed away a layer of the Harrison Narcotics Tax Act by opening the door to methadone maintenance. The Comprehensive Drug Abuse Prevention and Control Act of 1970 cut even deeper and helped usher in methadone clinics. The Drug Addiction Treatment Act of 2000 enabled certified physicians to prescribe and/or dispense narcotics for the purpose of treating opioid dependency. An amendment to the Controlled Substances Act in 2005 allows for certified doctor to prescribe buprenorphine from the privacy of their office to as many as 30 patients per year. Just this summer (July 2016) congress patted themselves on the back as they smiled for cameras in photo-ops seen around the country. Their achievement; passing the Comprehensive Addiction and Recovery Act which allows approved doctors’ medical assistants and nurse-practitioners to prescribe buprenorphine. It is expected the White House will up the limit of the number of patients doctors can prescribe buprenorphine to, to 275. What could possibly go wrong considering the addiction rate in the medical field is above the national average and has been estimated to be as high as 15%?!
The Harrison Narcotics Tax Act of 1914 has been hollowed out; it’s a mere shell of what it once was when it kept opioid addiction levels in this country at an all time low. So what is the outcome of destroying the one good piece of legislation that was so effective at protecting us from opioid addiction? We’ve become the biggest drug abusers on the planet. With less that 5% of the global population Americans consume 80% of the global opioid supply, 99% of the global hydrocodone supply, as well as two-thirds of the world’s illegal drugs. We now hold the distinction of being the most sedated society in the world.
Having worked in the treatment field for over thirty years and being in recovery myself, I’m more sensitive to the plight of addicts than most; but the numbers are clear. This is not the way forward.
Are we doing a disservice to addicts and robbing them of true recovery by repealing laws to make opioids more readily accessible to them in the form of MAT drugs? Are we actually helping them or merely extending their addiction as Dr. Wright said would happen over 100 years ago?
There are two camps that have emerged on this issue with strongly opposing positions. For this conversation let’s keep it simple and call them the pro-opioid and the anti-opioid camps. I fall into the later and strongly believe we are impairing recoveries and casting these poor people into a life of perpetual addiction. Here are the fact that I base my opinion on.
The common mantra and central guiding principal of the pro-opioid camp goes something like this; “Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. Research shows that when treating substance-use disorders, a combination of medication and behavioral therapies is the most successful for many people.” To most this sounds impressive enough – it’s catchy and appears to be all inclusive. However it rings hollow to my ear; like an advertising slogan trying to sell something.
Not long ago there was a study published in a peer-reviewed journal that revealed it takes up to three years of abstinence before an opioid addict’s brain chemistry normalizes. I can tell you from my own first-hand experience treating addicts than the first two weeks after detox are fruitless – you might as well talk to a palm tree – you simply can’t get through to them. It takes at least a couple of weeks for any vestige of cognition to reveal itself.
This leads me to question the very foundation of the pro-opioid camp. We know that opioids have a massive negative impact on brain chemistry that leads to impaired cognitive function. Why would anyone expect counseling and behavioral therapies to achieve a successful outcome when you’re feeding addicts opioids that scramble their brain function at the same time? Counseling and opioid use are polar opposites. These are two opposing forces that constantly work against each other. Considering the fact that the longer someone uses opioids, the longer it takes to normalize brain function, the only logical conclusion a rational person can come to is that the MAT program extends peoples’ addictions.
Let me just state this for the record. In over thirty-years of treating addicts, I have never met a single living person who was successfully treated for addiction with an opioid of any kind. Not one. Nor have any of my friends and associates in the treatment field (and I have a lot of them) met one. In fact, we are not aware of any disease, disorder and/or condition that have ever been successfully treated with an opioid. All opioids are highly addictive painkillers and nothing more, they don’t cure anything. With that being said and at the risk of asking the obvious; why on earth would you ever think treating an opioid addict with another dangerous and highly addictive opioid could ever produce a successful outcome?!
Speaking of successful outcomes; there is something else pro-opioid camp mantra leaves unanswered that needs to be addressed; “How many people are now addicted to buprenorphine and methadone?” These narcotics are more addictive than heroin and harder for an individual to get off of. They’re also more potent. For example; one milligram of the popular MAT narcotic Suboxone is equal to 40 milligrams of a morphine derivative.
I’d also like to know how many addicts have been weaned of the MAT drugs in the last year. To the best of my knowledge no one is keeping track. Judging from the extremely limited studies I was able to find, I’d speculate a very, very small percentage stopped using the MAT narcotics. If addicts continue to be added to the MAT program and only a handful weaned off of the narcotics, than the pool of addicts using these dangers drugs is only going to grow exponentially.
That may be great news for the manufacturers, distributors and sellers of buprenorphine and methadone, but it’s a sad day for our culture. All that the new addiction related legislation is really accomplishing at this point is opioid replacement. Addicts are being herded away from Mexican heroin and prescription pain killers towards buprenorphine and methadone.
Switching addicts from opioids bought and sold in the streets to a name brand pharmaceutical opioid sold by doctors and calling it evidenced-based science is really lowering the bar. This is merely a word salad intended to make you believe the MAT program is the answer to your addiction issues; and that has strong appeal to an addict’s core psyche; always looking for the quick fix. Is this really that much different than the Bayer Company marketing heroin directly to physicians as a completely safe and non-addictive cure for morphine addiction? Sure sounds similar.
None of these recent bills lays out a requisite monitoring program or time-table for weaning addicts off of the MAT narcotics. There is no incentive given for addicts to get off these drugs. No one is asking addicts to take responsibility for their actions – they’re just given a free pass and a 90 day prescription to buprenorphine under the guise of compassion.
Isn’t this course of action just extending someone’s addictions into perpetuity and robbing them of their recovery? Millions of people are living happy and fulfilling lives after freeing themselves of opioids and there is every reason to think others can do it too.
There are other medications that are safer in helping patients overcome opioid addiction by blocking the effects of opioid drugs. Naltrexone was approved by the FDA in 1984 for opioid addiction. In combination with counseling for underling issues, Naltrexone used for up to six months has shown to be an effective modality and easier to get off of. Because addiction is a mosaic, there is no one therapy that is effective for everyone. However I will have more alternative therapies showing great promise in a future article.
Another common refrain from the pro-opioid camp is that MAT helps addicts get reconnected to the people that they used to be and to their loved ones. It enables them to hold jobs and be productive members of society. This is simply balderdash. I contributed to a study lead by my good friend and colleague Dr, Kenneth Blum – discoverer of the addiction gene, also known as the reward gene – where we took a look at the long-term emotional effects of Suboxone. We found that over the long-term, people developed muted emotional responses. They couldn’t feel joy or sorrow. They didn’t know if they were happy or sad. Sure, they might be able to hold down a menial low paying job as the pro-opioid camp suggests; but they’re never going to feel the bliss of a loving relationship or the joy of bringing a new person into the world. For lack of a better term, over time Suboxone turns its users into zombies.
We are better than this. America’s Second Opiate/Opioid Epidemic has been grabbing headlines for the last few years, forcing congress to act. As these lobbyist guided lawmakers tend to do, congress turned to a solution with a positive economic impact for major industry; more specifically in this case, PhRMA. What we have today is an addiction treatment model that is being driven by market growth and quarterly profits rather than common sense and effective evidenced-based and scientifically-proven modalities. Profit driven treatment centers are popping up like hamburger joints on every street corner. Buprenorphine centers have begun taking root in our communities. Whether they grow to become the next pill mills has yet to be seen; but not hard to imagine.
The fatal flaw in congress’s assessment of this epidemic was not recognizing it as the humanitarian issue that it is rather than an economic one. Their solution is a mere sweeping of the problem under the carpet, out of the headlines and public view. Problem solved. The reality is that congress has done nothing more for addicts that rearrange the chairs on the Titanic for them to sit in and extended the deck size to accommodate the influx of the new group addicted to PhRMA’s poison. The manufacturers, middle men and sellers will continue to grow their profits year after year for the foreseeable future from this epidemic while people continue to die from it. Lives will be destroyed, families will continue to be ruined and innocent people are going to continue to be harmed until our government stops flooding the market with opioids.
There is only one way out of this crisis and it doesn’t include more opioids. As Dr. Wright so clearly pointed out over a century ago; using an opioid to treat an opioid addiction only extends the addiction and robs that individual of his recovery.
Primum non nocere – “First do no harm,” A doctor’s creed from the The Hippocratic Oath.
