Ease in restrictions to benefit substance abuse recovery

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Dear Editor,

 

Amid the calls for changes for the administration of methadone and other medically assisted treatment drugs, there is an interesting observation.

To get you up to speed, there have been recent developments in the distribution of substance abuse recovery medications, specifically methadone, due to the COVID-19 pandemic. To prevent the spread and contraction of the virus, medical facilities have been allowed to loosen their restrictions to make these drugs more readily available.

This change has been welcomed by many who feel the restrictions placed on this medication are unnecessary and make it harder for people to follow their treatment plan. An individual undergoing this type of treatment is usually required to go to a clinic daily to receive their dose of medicine. Some feel this is too much to ask from a demographic that is already lacking resources and that it makes becoming sober more difficult.  Regardless of the validity of their claims, it’s interesting to note that many who feel this way are insistent that they are stable and doing well, making these restrictions unnecessary. This is where things get interesting.

The fact that individuals feel so stable says something about the current operating basis and effectiveness of restrictions. It’s thought-provoking that someone can claim to be doing so well and in the same breath call for changes to the system in place that got them to that place of stability. Before going any further, let us examine a brief history of this form of treatment.

It’s easy for people unfamiliar with substance and addiction recovery to view these drugs as no different than other prescribed medications. But the truth is there is nothing similar to addiction when you take into account the mental and behavioral nuances of the condition. There has also been a long-standing debate on the real efficacy of Medically Assisted Treatment or MAT.

In the past, substance abuse was seen as a strictly behavioral issue.  This viewpoint led to the forms of treatment many are familiar with, like the 12-step model and counseling.  These work on changing the behavior of the addict, but many feel these approaches are outdated. And when the disease model of addiction was presented, it led the way for the medical community to do what they do best; create a drug to fix it. The interesting thing is that their solution was merely a different form of an individual’s drug of choice, opiates. You can see the controversy in this.

Now we have a situation where we have two schools of thought battling it out. The behavioral side claims individuals are replacing one drug for another. The advocates of the disease model are playing the stigma card, and claiming addiction is no different than diabetes.  You wouldn’t put restrictions on someone getting insulin, so why would you do it for those suffering from addiction? This is a common argument you might hear from this viewpoint. But regardless of what side you fall, it appears that both are oversimplifying a very complex issue.

This brief overview of the current scene illustrates why restrictions to these medications are so controversial. Based on the prevalence of addiction in our society, it’s obvious our country has not figured out a real solution to the problem.  Until we do, it may be best to err on the side of caution when it comes to prescription opioids regardless of how they are being utilized. Policy changes in the face of COVID-19 may prove to have unforeseen consequences, but only time will tell.  No matter how much individuals lobby for fewer restrictions, it’s hard to ignore the problems created over the last two decades by the overprescribing of opioids.

What some people fail to realize is that these issues have brought to light an alarming situation.  We are in a state of affairs where restrictions are put in place for doctors even more so than patients.  With rampant overprescribing prevalent in the past, it is hard to overlook. So, while many claim stigma and feel slighted, it is merely an effort to protect those who need it most.  We already see huge changes in the way opioid medication is being allocated to those without a history of abuse.  It only makes sense to ensure those at higher risk are not in a potentially dangerous situation.  A situation that, ironically, may have been created by lack of restriction.

 

Sincerely,

/s/ Joseph Kertis, Author, Healthcare Professional Addicted.org