Hazelden Advances into the Twenty-First Century

In last week’s edition of Alcohol and Drug Abuse Weekly, I read that Hazelden’s addiction treatment center now plans to add medications to the treatment they provide for opioid addicts. Presently an abstinence-based, 12-step recovery center, Hazelden plans to have three treatment tracks available for opioid addicts: one offering buprenorphine (Suboxone), one offering naltrexone, and the traditional non-medication program that is now provided.

Better late than never.

Naltrexone, as an opioid block, isn’t controversial, since it is an opioid antagonist and therefore gives no opioid sensation. However, it will block any other opioid from acting on the brain. I call naltrexone the “anti-opioid.” It’s useful as an insurance policy for opioid addicts because if they relapse while on it, they won’t feel any opioid effect. For patients struggling with opioid withdrawal, this medication will not help, and in fact may make their withdrawal worse. Frankly, I thought Hazelden was already using naltrexone.

Their chief medical officer, Dr. Marvin Seppala, said Hazelden decided to use medications to treat opioid addiction in response to the public health crisis of opioid overdose deaths. Now more common than fatalities in car crashes, Hazelden feels opioid overdose deaths, “Demand up-to-date, evidence-based treatment protocols that offer the brightest promise of recovery.”

He says using the buprenorphine will help stabilize patients so that they can better engage in counseling and 12-step recovery. He says the patients will be watched and monitored closely, and will be in outpatient treatment settings while they are on buprenorphine. He also says, “Ultimately, we’ll have people come off these medications.”

I have mixed feelings when I learned all of this.

Predominately, I feel happy and relieved. Finally, a respected big-name, 12-step abstinence based treatment center is going to use medication that’s been proven to prevent overdose deaths. Hazelden is taking a huge step by moving away even a little bit their anti-medication dogma. Hopefully their action will influence the rest of the treatment field that has so far rejected medication-assisted treatment for opioid addicts.

True, Hazelden’s press statement said they didn’t look at buprenorphine as a long-term solution, and set complete abstinence as the goal for opioid addicts, but it is movement movement in the right direction. They should be praised.

On the other hand…the cynic in me raised an eyebrow as I read the article. Really? Up-to-date??  I think not. Suboxone, approved in 2002, was available as of 2003. That’s nearly ten years ago. How many addicts have died because of the addiction treatment establishment’s anti-medication biases, which prevented them from endorsing buprenorphine as a viable option in a timely fashion?

I have buprenorphine (Suboxone) patients who say they wouldn’t be alive if not for this medication. Many of these folks cycled in and out of 28-day treatment programs, good ones, but that path didn’t work for them. Most weren’t told about buprenorphine as a treatment option by these addiction treatment programs. Most learned about buprenorphine from other addicts. That’s sad, and unprofessional.

Change is hard. Once an abstinence-only treatment provider myself, I know how hard it is to take a step back, and say wait a minute…here’s some real proof that this new method may be better, though it goes against my present mindset. But if doctors and other professionals treating addiction want to be taken seriously, we have to constantly re-evaluate what we are doing, to see if we are up-to-date with best practices. We must keep an open mind and a willingness to change. That’s important in all of medicine, but especially true for addiction medicine, where things change rapidly.

After all, isn’t an open mind and a willingness to change what we ask of our patients?

Kudos to Hazelden for taking a step forward.

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6 responses to this post.

  1. Posted by Caroline Kent on November 20, 2012 at 4:15 pm

    Jana, Keep up the good work! You truly understand addiction and are providing an essential service with your writings, blog and other efforts to educate, especially educate, the medical and recovery professions. I have you on a pedestal along with Drs. Dole and Nyswander. Thanks to your clear headed unhysterical analyses of addiction and its treatment, you have done all addicts and their loved ones a great service. Please don’t stop!
    Icecutter

    Reply

  2. Posted by Benjamin K. Phelps on November 20, 2012 at 10:38 pm

    Dr Buson, in response to your article here, I say “Amen, & amen.”

    Reply

  3. Wonder what took them so long??

    He says using the buprenorphine will help stabilize patients so that they can better engage in counseling and 12-step recovery. He says the patients will be watched and monitored closely, and will be in outpatient treatment settings while they are on buprenorphine. He also says, “Ultimately, we’ll have people come off these medications.”

    Grrrrr!!! These places!!! they say that they used “Evidence Based Treatment Protocols”!! but then add in the “12 step recovery”!! I sure do wish that I could get a refund for all those programs I went to !! I know that will never happen!! These places just keep taking you back, over and over again!! When they know good and well that your chance of getting well with out medication is low to NONE !!! But they take you in and charge your insurance company and 12 STEP all over you!!! anyway!!! Well at least those people that attend now have a chance with medication.. They make all the noise about Evidence but yet do not tell the attendees that 12step “therapy” has the lowest of all recovery rates !! Thier front door revolves!!! Ask me I know, I was foolish enough to do it multiple XX Times!!! Every time thinking, “This will be IT” and with in weeks afterward it was all over!! very depressing!! Thank God for MMT!!! Happy Joyous and Free, thanks to MMT!!!

    Reply

    • Nice work b. Cohen! You would love this new book. The author won his lawsuit against the state for mandating him to the cult religion known as the 12 steps after a DUI. AA had been found to be religious in 25 states and growing. Your first amendment establishment clause protects you from being forced into a religion by a court of law in the USA – and yet it happens every day.

      You’re absolutely right. These 12 step rehabs are nothing but slaughter houses of independent thinking which force people into a state of powerlessness and a fake disease. They do not want you to get well. They want you to keep coming back!

      http://www.amazon.com/A-A-Alcoholics-Anonymous-Steals-ebook/dp/B00DTNAZ5K

      Reply

  4. Our lab tests Naltrexone levels after the implant and we also do testing on Vivitrol levels after the vivitrol injections. Lab Medical Group works primarily with IOPs and Addiction Treatment Centers accross the country. Lab Medical Group also does 30 day, 60 day, and 90 day follow ups on treated patients. Wealth of data…what we have seen is Marijuana and Amphetamines definitely effect the burn rate of Naltrexone…

    Reply

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