If there is one thing Americans love it’s a quick fix. Once a country built on elbow grease and self-realized dreams, we have allowed amazing advances in technology corrupt us and make us literally and figuratively soft. We take escalators instead of stairs, use remote controls to change channels and have even made our bicycles electric. So it’s no surprise that, when it comes to addiction recovery, more people are throwing in the towel on hard work and introspection and going the way of medication-assisted treatment (MAT) to avoid the pesky discomfort of opiate withdrawals (or having to actually change). But The New York Times recently posted a story showing us the other side of America’s latest get-clean-quick scheme.
Meet April Hileman, a 24-year old single mom from Lebanon, Virginia—an area of the state that is kinda, sorta in the middle of nowhere yet a major hub for Oxycontin (or what some call “hillbilly heroin”) abuse. Hileman, like many other young people in the area became hooked opioid pain medication as a teen and has been trying to kick it, off an on, for several years. Ironically, a common treatment for opioid addiction is Suboxone, a prescription that combines buprenorphine (an opioid) with naloxone (an opioid blocker), with the idea that addicts can take wean off harder drugs with and not only avoid painful withdrawals but also dramatically lower their disk of overdosing (unlike methadone). That is, of course, if it is taken as prescribed. If it isn’t, then Suboxone is addictive. It can definitely fuck you up, even kill you, when smoked, snorted or mixed with benzodiazepines (Xanax, Klonopin, Valium) which many people, including Hielman, are doing.
Though opioid addiction treatment with Suboxone, now referred to as MAT, has shown some promising results (or at least trackable ones), a large number of addicts, like Hileman, are either abusing it, misusing it or selling their prescription to score their drug of choice. Even the people who are taking it just to avoid getting sick are often using it instead of actually getting clean; as long-term solution rather than as it was intended, as bridge to sobriety. This has created the “Box wars,” where addicts chase down Suboxone to manage their addiction. So what was supposedly created to alleviate the problem as made it worse. As my grandmother would say, “Oy veys mere.”
You Were Saying Something About Best Intentions?
So how did we get here? Innocently enough I suppose. At some point in the last 20 years, it seems doctors began handing out powerful drug ‘scrips out like candy, a seeming redux from the Quaalude extravaganza of the 1980s, and people got hooked. But with the advancements of pain medication, it’s very possible that MD’s weren’t fully informed about how potent or addictive the meds were. It’s not like they are testing it themselves, so how would they know? They only know as much as the pharmaceutical reps tell them and the last time I heard, door-to-door salesmen don’t take ethical oaths.
But now we are really in trouble. While no one can deny that we had a drug problem in this country before Oxycontin hit the market—and even though crack and meth abuse are rampant (not to mention marijuana but that is a whole other story)—everyone is focused opioid addiction. Why? Well first of all because it’s killing people, a lot of people, many of them young. We don’t like it when young people die. Second, because unlike crack and meth, a significant number of the afflicted got hooked by accident, by simply taking pain medication prescribed by a doctor. And third, the fact that the drug often comes in pill form, quite possibly in a bottle, inferring that is not a dangerous and likely fatal drug but rather something that is medically regarded as safe and might even be purchased at Walgreens (though I don’t think you can actually get it at Walgreens).
Forced to Follow the Suboxone Brick Road
Last year, Hillary Clinton proposed a $10 billion plan to help arrest the ever-growing rate of opioid-related deaths in this country—one that has quadrupled since 2005—by dumping a shit-ton of money into government-funded treatment using MAT. And recently, President Obama proposed a 2017 budget that includes one billion for the expansion of MAT, so regardless of what we may be seeing on ground level, it appears that from the White House’s POV, MAT is the answer.
I suppose if temporarily saving lives is the bottom line, then it is. Statistics show that treatment with buprenorphine has decreased opioid overdose deaths by 50% when compared to behavioral therapy alone. Which makes me want to scream, “Duh!” since chemical addiction isn’t known to respond to behavioral therapy alone. Plus the fact that EMTs (and now civilians) have access to Naloxone pens has greatly contributed to this. But I would love to know how many of the people whose lives were saved have turned around and got high almost immediately after.
I am not saying MAT is a total wash—there are certainly reports that suggest, like anything, it works if you work it properly. It’s not intended to be a pill popped and forgotten as someone goes about their day; it’s supposed to be a component to a larger program. An aid during the difficult and fragile withdrawal period where many end up relapsing. But if used as a crutch, as an ala carte half-measure so addicts can avoid working on themselves, then it is my prediction that the results will continue to be disastrous.
If we are going to offer Suboxone, we need to focus on it as a temporary solution, figure out how to how to monitor people and keep them and ourselves accountable. Though I am sure financially, we can’t afford to, at this point, it seems we can’t afford not to.