I admit I’ve been a little obsessed with Tennessee’s misguided approach to treating opioid addiction. It sticks in my craw. I can’t get over how backward their attitudes and approaches to the treatment of prescription opioid addiction have been, and I’m struggling to find out why Tennessee is the way it is. I hate bad science and ignorance. It grieves me to see the senseless suffering of the state’s addicted citizens.
I’ve been combing the internet and have found information that makes my right eyelid twitch. In the January 28, 2012 issue of the Tennessean, (1) Doug Varney is named as the new head of Tennessee’s Department of Mental Health. According to this article, he says Tennessee’s opioid treatment programs should to do a “better job” of weaning people off methadone and into detoxification programs. He says there’s no evidence to show methadone helps pain pill addicts as it does heroin addicts. He feels there are more appropriate treatments. In the past, Mr. Varney has been on record as saying methadone doesn’t accomplish anything because it’s merely switching one drug to another.
Yikes. This shows he understands about as much as the person who says methadone is “like giving whiskey to the alcoholic.” I’m not surprised when an average person says such things, because most people don’t know much about methadone, and are misinformed. But this person is the head of Tennessee’s Department of Mental Health!
I suspect he’s also behind the new proposed rules for Tennessee’s opioid treatment centers. Some of the proposed rules are good, and deal with quality of care. And others are harmful, and contradict what we know to be good medical practice.
For example, the new rules say an opioid addict needs to fail at two attempts at drug-free treatment before being allowed to enter an opioid treatment program. Where’s the science to back up that position? There is none. I challenge Mr. Varney to produce evidence showing two attempts at drug-free treatment do anything to help the addict. We know with detoxification alone, relapse rates are consistently in the range of 92-98%. We’ve known this since the old days at the Lexington, KY Narcotic Farm, established in 1935. The data are unchanged today with pain pill opioid addicts.
Besides, where will Tennesseans get this drug-free treatment? I’ve tried, and watched addition counselors try for hours to get opioid addicts into drug-free treatment in Tennessee. On the rare occasions when I’ve seen an opioid addict from Tennessee for whom methadone isn’t the best treatment, it’s next to impossible to find an inpatient treatment center eager to admit this patient. Even if there’s no waiting list for beds, the patients don’t have the money to afford it. And if state money pays for treatment, opioid addicts are rarely kept long enough to really help them. As above, short inpatient admissions accomplish little besides just detoxification, and that’s insufficient. With opioid addiction, patients need more than a month-long admission if drug-free treatment is undertaken. Otherwise it’s a waste of time and money, sets the addict up for failure. and their family for disappointment.
The proposed rules say that after four positive urine drug screens within six months, the patient on methadone maintenance should be discharged from treatment. Are you kidding me? That runs counter to good medical practice.
Of course, people could say I’m biased because I make my living treating opioid addicts. OK, don’t take my word for it. Let’s consult the American Society of Addiction Medicine, the nation’s most prestigious group of medical doctors, educated and dedicated to the treatment of addiction. The Society has a position paper regarding methadone maintenance which says,
“Discontinuation of methadone maintenance should be attempted only when strongly desired by the rehabilitated patient…” (2) ASAM’s paper correctly explains the high risk of death for a patient discharged from methadone maintenance. The literature shows death rates for patients who leave or who are terminated from opioid treatment programs spike significantly, to at least eight times the rate of patients who stay in medication-assisted treatment.
Another ill-advised new rule says that permission must be granted for doses higher than 120mg, and the state methadone authority must be notified for any dose rising about 100mg. Again, what does the evidence show? Let’s go to ASAM’s position paper: “Arbitrary caps on the number of patients who can be treated by a physician, the dosage of medication which is allowed, or the duration of treatment with methadone are not supported by medical evidence and should not be imposed by law, regulation, or health insurance practices.” Their position paper is backed by numerous study citations, and thus based on solid eveidence, not personal feelings.
In other words, the addiction medicine physicians have warned against the very actions that Mr. Varney is proposing. ASAM says it’s bad medical practice. They are physicians. Mr. Varney is not.
Mr. Varney needs to realize how serious this is. These proposed new rules for opioid treatment programs have the potential to further increase Tennessee’s opioid overdose death rates. It’s high enough as it is, as 13th highest in the nation. And remember from my past blogs, Tennessee is second highest in the nation for number of opioid prescriptions written, adjusted for population.
How did this guy get into a position of such power? What a disaster! State officials with this kind of authority to impact the lives of citizens have a moral obligation to do what’s best for citizens. Clearly, Tennessee’s Department of Mental “Health” is allowing personal prejudice to get in the way of sound medical practice. Is this even legal?? It makes me wish I lived in Tennessee, if only to vote against whichever administration selected this man to run the state’s Department of Mental Health.
There are actions we can take. Write to Mr. Varney and let him know you don’t think he should propose legislation for actions that knowledgeable physicians have deemed bad medical practice.
Here’s the mailing address:
Tennessee Department of Mental Health
11th Floor, Andrew Johnson Tower
710 James Robertson Parkway
Nashville, Tennessee 37243
Or, even quicker, send an email: OCA.Tdmh@tn.gov
Join with other advocates of appropriate, evidence-based medication-assisted treatment at the website of the National Alliance of Medication Assisted Recovery. You’ll see on their homepage that Tennessee is at the top of the list of their advocacy concerns: http://www.methadone.org/ They have some alternative email and regular mail addresses that may work better than the ones above.