Late last week, a writer named Jason Cherkis wrote an extensive piece for HuffPo in which he claimed that there’s a treatment for heroin addiction “that actually works” and asked, “Why aren’t we using it?” I clicked to read, figuring it was going to be a feature on ibogaine (which is definitely not the “cure” for heroin addiction it is oftentimes touted as, but that’s another article). No, even better, he was talking about Suboxone.
The article introduces readers to a young man from Kentucky named Patrick Cagey who died of a heroin overdose. In true fashion for these kinds of features, Cagey is painted as a “good kid gone wrong.” The well of the article displays pictures of him in all his clean-cut glory, one with his diploma and another celebrating his 21st birthday with his mom. Further down, there’s a video of him at 16, participating in a high school wrestling match. After an injury, the article tells us, he became addicted to prescription pain medication. “Their son’s addiction was worse than they had thought,” the article reads. “It wasn’t just pain pills, Patrick told them. It was heroin.” Later it says, “He didn’t want to be a heroin addict,” as if anyone does.
Media Bias Around Addiction
It’s by no means this kid’s fault, nor the fault of his family, but set-ups like this really irk me. When it comes to addiction, the media likes to focus on the young and the loved, as if the lives of older addicts and/or people from not-so-photogenic families aren’t worth mentioning. There are good addicts—people who accidentally catch a habit—these stories imply, and then there are bad ones, people who were experimenting or medicating emotional pain. The piece also implies there’s a difference between addiction to heroin and the abuse of prescription medication, which I just don’t think is true. The truth, as I see it, is that all lives matter, and when it comes to opioid dependency, whether it’s heroin or pills, you can get addicted just the same. And some prescription medications—such as Klonopin and well, Suboxone—are even harder to come off of than dope. The HuffPo article doesn’t even consider this.
Instead, the oversized feature uses the story of Cagey and his family to make an argument that Suboxone is a fool proof cure and that 12-step is bullying people literally to death. In the first chapter, the article describes 12-step as “a philosophy of abstinence that condemns medical assistance as not true recovery.” But this is just not accurate. To the author’s credit, many pages later, he acknowledges that AA founder Bill Wilson was open to medical intervention. “From the start, Wilson intended AA to work with, not against or instead of, the latest and best medical science to treat addiction,” the author concedes, and yet the whole rest of the article is built around the claims that Bill Wilson’s intention was lost over the years.
Misreppin’ 12-Step
I’m hardly an AA advocate; I don’t even do the program anymore. But what Cherkis claims simply wasn’t my experience. Sure, there are individual members who have their own beliefs and experiences about prescription medication—and, yes, some of them have gone on to establish facilities in the name of 12 step—but “We are not doctors” is the official party line. This is what I learned as a member of the program. Never was I taught, nor did I believe, that it was my right to police another person’s sobriety. In this day and age, given the proliferation of prescription medication, including medicine for pain, most 12-steppers I know don’t even think about sticking their noses in another person’s medicine cabinet.
The reporter’s claim is that Suboxone can do what 12-step can’t and maybe, in some circumstances, he’s right. In the least, I agree that addicts ought to have a choice, and the evidence this article presents that they don’t is rightfully concerning. When it comes to recovery, there are different modalities to try. I’ve worked with active drug users who’ve tried them all, with varying degrees of success. I’ve written before that harm reduction is a model that I think ought to be welcomed, even into the rooms of AA. Suboxone may be a part of someone’s recovery, sure. But for this author to describe Suboxone as “the treatment that actually works” is a seriously irresponsible overstep.
Maintenance Comes with a Price
The maintenance medications promoted in the article—methadone, naltrexone and buprenorphine (which sells under the brand name, Suboxone)—aren’t magical cures, and addicts know this. While it’s true that Suboxone won’t get you high, being put on it will most certainly result in a wicked dependency. There are also ways to get around the blocker (the least creative of which would be to just not take it). Though not likely the cause (as HuffPo points out), Suboxone has also been associated with overdoses and deaths. Addicts who’ve gotten clean in treatment centers often want to stay that way, not return to drug dependency. These and other reasons are why many—including Patrick Cagey—choose to abstain.
The fact is that some people prefer abstinence-based treatment, and this article would have made a stronger case if he had included this perspective. It would have been interesting if the author had leaned into the reasons why the people in recovery that he encountered rejected Suboxone, and not so obviously dismissed their point of view entirely. Instead of exploring the controversy from both sides, a large piece of the reporting is a review of institutions who’ve obviously misused the 12-step philosophy over the years—programs that use everything from coercion and bullying to brainwashing and terrorizing, public humiliations meant to “reprogram” addicts. These brutal situations sound nothing like the 12 step recovery I went through. Confrontation was not a part of my inpatient program, nor was it what I encountered in meetings. I know it happens, but shaming addicts is not the AA way.
Tools Beyond Medication
Addiction is not a “moral failing,” it’s a medical issue—on that, this author and I agree. But prescription medication is not the only “medical approach” a sick and suffering addict needs. While 12-step may not ease a detox, you can’t prescribe away the need for human intervention. Twelve-step fills a necessary gap, especially for people lacking other resources. A 12-step program offers a strategy for living one day at a time and rebuilding a life. It’s a program for dealing with the reasons people used beyond the chemically driven cravings. The article criticizes treatment facilities for overdose rates once the person leaves rather than looking critically at the environmental forces that drive people to use drugs. The reality is that recovery is hard, especially when you’re surrounded by people who don’t get it. Well-meaning loved ones are inadvertently meddling. Mom making cinnamon rolls and calling her friends in AA when, after three days, her son still hasn’t found a sponsor—sorry, but that’s the opposite of helpful. I’m in no way blaming the families of addicts but when a society just doesn’t get it, an AA family can.
The experts in the article admit that drug therapy is not enough. “‘Although many patients may do well with buprenorphine alone, many—probably most—need counseling along with the medication,’” argues Dr. Herbert Kleber, a professor of psychiatry at Columbia University and director of the New York State Psychiatric Institute’s Division on Substance Abuse. I wish the author of this exposé had focused on the ways these two treatments are compatible, rather than positioning them as at odds.
Starting at the Source
The opioid epidemic is the worst of its kind in US history, but the problem is not heroin treatment. The article itself makes this point: the problem begins with pill mills—“clinics that dispensed painkillers proliferated with only the loosest of safeguards.” There are also a bunch of drug dealers out there masquerading as doctors. That, and the fact that heroin is a cheaper, more readily available, alternative got us into this mess. We need to focus on not getting people addicted in the first place. That means cracking down on quack doctors handing out pills like candy. Then, once addiction occurs, treatment ought to be a comprehensive approach. Maybe that includes medical interventions that continue after detox. But it sounds like, in Patrick Cagey’s case, that wasn’t what he wanted. It’s not like Cagey didn’t know about Suboxone. He knew it was an option, and he chose to not use it. There are reasons why people in recovery make this choice. We need to listen to addicts and meet them where they’re at.
A final word: if the author really wanted to use Cagey’s story to help addicts, he’d have made a better case for promoting the availability of naloxone. The author criticizes the 12-step approach for acknowledging that relapse may be a part of an addict’s recovery. It’s a fact that a sober addict leaves a treatment program with the physical cravings still strong but his tolerance gone, and that shooting the same amount of heroin as before treatment can more easily lead to a fatal overdose. Tragically, this is probably what happened to Cagey. In the case of an overdose, naloxone revives an addict. Naloxone could have saved Cagey’s life. Why wasn’t it even mentioned? By the way, there’s no such thing as naloxone addiction.
Reporters, repeat after me: there’s no easy cure for addiction. Certainly nothing fast. And certainly nothing that comes in the form of another addictive pill.
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