Clinton's Behind Medication-Assisted Treatment and I'm Officially Scared

Clinton’s Behind Medication-Assisted Treatment and I’m Officially Scared

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I have good news and bad news and then more kind of bad news.

Hilary Clinton, the Democratic front-runner for the 2016 Presidential election, has proposed a $10 billion dollar plan to attack the opiate addiction epidemic in the United States. With heroin-related death having quadrupled in the last 10 years and prescription pain killer deaths tacking in at approximately 15,000 deaths per year, fatal opiate overdoses are steadily making their way up the ranks to one of the leading causes of death. So programs aimed to counteract these statistics are good news, right?

Treating Opiates with Opiates

Before you start lining up behind Camp Clinton, you should know that the gist of the former Secretary of State’s plan is to allot funds towards more medication-assisted treatment (MAT), sometimes called Opiate Replacement Therapy (ORT), a form of “treatment” where heroin addicts are giving other opiates, like methadone and Suboxone, to lessen the pain of withdrawal. If this sounds like trading one addiction for another then it sounds like exactly what it is.

Really The Best Results?

But according to HuffPo, the World Health Organization and other federal agencies that fund drug treatment in the US say that, in conjunction with counseling, MAT has shown the best results in “getting addicts sober and keeping them that way,” a statement I may find easier to understand if certain follow up questions were answered. For example, if you’re on these medications, does that mean you’re  sober? If so, are these sober addicts expected to be on the meds for life? If not, how are we measuring the success rate of those who stay sober after MAT: clean for a month? Six months? Six years?

The other problem, of course, is that a lot of people don’t seek medical treatment or rehab at all; they might get clean and sober in an 12-step program and therefore will never be factored into any statistics. What I will tell you is that being a sober person in 12-step recovery in Los Angeles, I know a lot of former heroin addicts yet I don’t know a single person who has gotten and stayed clean by using ORT. That isn’t to say it doesn’t work, it’s just hard to believe it’s yielding the “best results” when it comes to long-term recovery.

Will This Be a Free-For-All?

Another thing to consider about Clinton’s plan to cure opiate addiction with opiates is that it involves a lift on the current federal regulations around MAT, which requires certification by SAMHSA to disperse ORT drugs. It is unclear whether, with these regulations nullified, a more lax policy on distribution will take its place or if drugs like methadone and Suboxone will become as easy to get as Plan B. Either way, according to Clinton and others concerned about the growing opiate addiction epidemic—like Tym Rourke of New Hampshire’s Governor’s Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery—addicts need easier access to this form of treatment.

I’m Officially Scared

This really scares me, especially when I think about my friends from high school who have started using Suboxone to get high. Why? Because apparently it’s not as intense as Oxycontin or heroin and just as easy to get. And now we are making it even easier! What’s next? The need to get cracking on yet another pill that will lessen the pain of ORT drug withdrawal because God forbid anyone is uncomfortable while they kick an expensive and lethal addiction?

Photo Courtesy of U.S Government [Public domain], via Wikimedia Commons (resized and cropped)

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  1. Medication-assisted treatment (MAT) lumps addictive substances like methadone and buprenorphine (in Suboxone) in with others like antabuse, Campril, Vivitrol, etc. I think using the term opiate replacement therapy (OPT) is better and less confusing. I think you’re right about OPT replacing one addiction for another. I’ve read academic journal articles where methadone maintenance is called the “gold standard” treatment for opiate addiction.

    There is a redefinition or expansion of terminology going on. The term “treatment” (medical care given to a patient for an illness or an injury), is used in referring to OPT, but the touted changes are typically social: reduction in the use of illegal drugs; reduction in criminal activity; reduction in needle sharing; cost-effectiveness; reduction in commercial sex work; improvements in social health; etc. OPT is better understood as social control than “treatment” as I’ve defined it here.

    Another thing to know about methadone and buprenorphine is that they both have longer half lives than most other opioids. Heroin, morphine, oxycodone, etc. generally have half lives (how long it takes your body to metabolize half of what you ingested) of around 3 or 4 hours. Methadone’s half life is around 20 hours. So someone dosing at a clinic at 6 am is beginning to go through withdrawal at 2 am the next day. Thus one reason for the waiting lines that often start forming at methadone clinics hours before they open. Buprenorphine’s half life is around 40 hours!

    My personal theory is that the extended half lives for methadone and buprenorphine are both related their greater difficulty in tapering or withdrawing from them. Regularly I hear from opioid addicts that both methadone and buprenorphine are much harder for them to withdraw from or taper off than heroin. Watch the documentary “Methadonia” to see one view of methadone maintenance. It’s available on Netflix (as a disk) as well as a YouTube video.

    By the way, some geniuses are close to having buprenorphine (in ALKS-5461) approved as a fast-acting antidepressant. Google “The coming depression apocalypse” if you are interested in reading an article i wrote on this up-and-coming antidepressant.

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Danielle Stewart is a Los Angeles-based writer and recovering comedian. She has written for Showtime, E!, and MTV, as well as print publications such as Us Weekly and Life & Style Magazine. She returned to school and is currently working her way towards a master’s degree in Marriage and Family Therapy. She loves coffee, Law & Order SVU, and her emotional support dog, Benson.