We have treatments for opioid addiction that work. So why is the problem getting worse?
We have treatments for opioid addiction that work. So why is the problem getting worse?
Opioid addiction doesn’t get as many headlines as it used to, but the crisis is as bad as ever. It doesn’t have to be.
Looking at these statistics, I thought back to something that addiction specialist Sarah Wakeman told me when I was reporting on the opioid crisis five years ago. “Most people get better,” Wakeman, who is the senior medical director for substance use disorder at Mass General Brigham, said then. “That’s what we don’t ever talk about in the opioids conversation.”
When she says “most people,” she means most people who get long-term medication-assisted treatment (MAT), widely considered the gold standard in addiction care. It combines regular counseling and behavioral therapy with the medication methadone or buprenorphine (often prescribed under the brand name Suboxone). Both contain synthetic opioid compounds, which prevent withdrawal and cravings, and they can lower overdoses by as much as 76 percent. (A third medication, less often used, is naltrexone, which blocks the high from opioids.)
The philosophy of MAT — a departure from the moralizing, abstinence-based rehab and 12-step programs that dominated addiction care for most of the 20th century — began to take shape in the early 2000s, when the Food and Drug Administration approved buprenorphine and a federal law authorized primary care physicians to prescribe it.
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Why are Drug Addictions getting worse?
Before I start out: These are some thoughts - based on reading various papers, and coming across older studies like the Rat Park Experiment. It also has to do with the interactions I have had with people who partake in recreational substance use of various kinds who do not have addictions, can go weeks, and months without using the substances in question. And there are some through lines that need to be addressed.
The reason Drug Addiction, and other Substance abuses are ultimately on the rise - is the same reason Crime is on the rise in various area's (like car theft in Canada). These issues are Symptoms of a wider problem - which relates to Affordability, lowered standard of living, and a lack of Community. We have Modern Communities built where everyone drives into their garage, parks, gets out IN their house (because attached garage) and never really interact with their neighbors. We have delivery done where people never interact with the delivery person - and it's a huge lack of human interaction going on, especially considering you can now literally get away with NEVER leaving your house: You can work from home, order food in, order your groceries in, order clothes in, and so on. You never actually have to leave and there are people doing this. And Loneliness is absolutely a recipe for addiction.
What is your vice? Is it Video games (this used to be me)? Porn? Alcohol? Marijuana? Or is it something harder? Even worse - if you are in this state of vulnerability for being lonely - and are prescribed an opioid, there is a non zero chance you are addicted FROM THAT POINT ON. It's game over.
If you have a strong community around you, fall through the cracks, and get access to Medication Assisted Treatment - It can work. But if you lack a community already - then, one of the most important things is a Community that REPLACES the Drug consuming community you likely ended up apart of do to needing to source your drugs. You need a community of people who will keep you honest, encourage you to keep going, check on you if you fail to show up - and generally speaking: Our medical system can't do that effectively.
And then we have to talk about Methadone for a moment. Methadone was a drug used prior as a replacement in the treatment of drug addiction to opioids - but heres the kicker: 30% of drug overdoses investigated at one point, had methadone involved in said overdose. It makes up about 2% of painkillers prescribed and is a slow acting opioid. Buprenorphine is basically the same thing all over again.
So My guess? The reason it's not done? Because anyone who actually studies addiction, and it's source cause understands if you do not resolve the underlying problem: Loneliness and lack of community, then you are only delaying the inevitable. And replacing one drug with another can absolutely lead to a relapse where someone ends up accidentally overdosing because they dosing as they were before, with another substance acting in their body and well: That's how you get a dead person, that you were trying to help.
Fixing addiction can't start with a pill. That has to be a last resort - we as a community, as a society, need to do better in creating an environment where people don't start down the path in the first place. Because as it stands - poor, or rich end up in a similar problem. If your life is work, and you are isolated from family and what not - drug addiction is a very real possibility, especially if you start trying to maintain performance through fatigue using performance enhancing drugs. And if you are poor - and gain access? Well: It takes a bit of the misery for awhile. Both of those groups share a form of misery - wildly different in everything else going on in their life, except for the isolation and loneliness.
And so: Maybe we should stop trying to fix things with pills, making pharmaceutical companies billions for patching a problem they in effect created. And maybe we should start looking at the very reason addiction, and crime, are so pervasive in our societies - and in some area's: Growing to massive degrees - and unironically, these two problems are growing in the same damn places.
I agree with a couple of the points you made but in general, I don't agree. No one recovers when they're dead and in the middle of a toxic unregulated drug crisis that is killing people, the first line of defence is to get people to use safe substances. Abstinence may be fine for you but you have no right to preach it to other people. The most important thing is to keep people alive.
Abstinence may be fine for you but you have no right to preach it to other people.
What part of knowing people who take drugs recreationally and having had chats on the subject - and seen that people can infact take drugs without issue made you think I'm preaching about Abstinence? I am just really curious.
The most important thing is to keep people alive.
No, the most important thing is to give people a reason to be alive and get up every day looking forward to it - or at least, having a reason to struggle through the bad days because there is something on the other side of that struggle.
Without Community, and a place to exist, and a sense of purpose - what you get is a recipe for all kinds of problems. Addiction is simply one of them. Suicide is another - though that one is unlikely to occur purposefully, but functionally when a person is taking drugs in an attempt to mute emotional pain (usually something like alcohol, but all sorts of drugs work as well) what you have is a person that is literally doing things to silence the outcry of their mind so they stop hurting, so they stop feeling alone.
Study after Study have been done that very much show addiction happens in people who are isolated. Addiction happens when people are hopeless.
We can treat the symptoms of this problem all we want - but until the actual underlying cause is dealt with: People will keep dying of drug overdoses, Crime rates will keep climbing, and the level of homelessness will keep growing. Because like it or not - these problems all stem from the same damn place.
What part of knowing people who take drugs recreationally and having had chats on the subject - and seen that people can infact take drugs without issue made you think I’m preaching about Abstinence? I am just really curious.
Fixing addiction can’t start with a pill. That has to be a last resort Maybe we should stop trying to fix things with pills, making pharmaceutical companies billions for patching a problem they in effect created