People with Addiction Need Support, Not Judgement

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So I was reading my local newspaper this morning, and was dismayed to read a letter to the editor that criticized our county for paying for transportation for Medicaid patients to get to and from methadone clinics. The author of the letter said, and I am paraphrasing, that we should stop spending money on drug addicts.

I probably started growling without realizing it, because my fiancé asked me, “What?” I told him that I was feeling a desire to write a letter to the editor coming over me.

So I did. I wrote a letter, brief as I could make it while still containing all the facts, outlining my view of the importance of providing addiction treatment. I will send it to the newspaper, but here it is in a slightly edited version for my blog:

“I’m writing in response to an angry letter to the editor in the September 11, 2015 issue of the paper. The author expressed shock and anger that her tax dollars were going to support “drug addicts.”

First of all, who does this person think these “drug addicts” are? I can tell you – They are our friends and neighbors and fellow residents of our county. For some people, the phrase “drug addicts” may still conjure images of depraved street bums, but that’s not accurate. As the medical director of an opioid addiction treatment center, I can tell you that my patients are good people. They didn’t plan to become addicted, and they certainly don’t want the addiction to continue. Anyone can develop addiction, and that’s particularly true with opioids. If the author of that letter to the editor isn’t afflicted by addiction, she should be grateful, and feel compassion towards her neighbors who do have this potentially fatal disease.

Second, all sorts of media outlets tell us repeatedly that this country is in the middle of an opioid addiction epidemic. In the past, our area has been identified as having one of the highest rates of opioid overdose deaths in the country. Due to hard work by many key people, the opioid overdose death rate has fallen. Programs like Project Lazarus in North Carolina have played key roles. Organizations like this realized opioid addiction must be tackled on many fronts: prevention, education, better prescribing, overdose prevention kits, drug take-back days…and treatment. Is the author of the letter suggesting we should ignore patients with this disease, and not use taxpayers’ money to pay for treatment?

My third point is that treatment is essential. Once an addiction has developed, the person has lost control over drug use. Telling the person “just stop,” won’t work. It didn’t work in the 1980’s and it doesn’t work now.

Medication-assisted treatment with methadone or buprenorphine (better known under the brand name Suboxone or Subutex) has the most evidence for success. In fact, this form of treatment has more evidence to support its use than most anything else in medical practice. We now have fifty years of studies that show a patient on medication-assisted treatment is more likely to stop using opioids, have better physical health, better mental health, more likely to become employed, less likely to commit crimes to support drug use, and less likely to die of a drug overdose.

Is it the right treatment for everyone? No, of course not…there are other means of treatment and no one addiction treatment is right for everyone. But many patients get tremendous benefits from methadone treatment (and buprenorphine).

People never hear about methadone patients who are doing well. They aren’t sedated when on a proper dose, and they look like everyone else. Due to stigma against methadone, these patients quietly go about their business, telling no one about their medication. They go to work and do their jobs, they sit behind you at church, and they shop with you at the grocery store. Many of them pay taxes too. They are nice people and good neighbors.

Should taxpayers’ dollars support addiction treatment? I sure hope so! According to studies, every dollar spent on addiction treatment saves taxpayers anywhere from $4 to $8. That’s for drug addiction treatment in general, and methadone treatment saves even more than that. Most of the savings is due to lower costs for incarceration and lower costs of hospitalization. [1]

Think about it: what if one of these patients being transported for methadone treatment stops going to her treatment program? Relapse rates are very high, so it’s likely she’ll return to active addiction. If she contracts endocarditis (an infection of the heart valve seen in IV drug users), she could be in the hospital for six weeks. What’s Medicaid’s cost then? It’s not unrealistic to say the costs could run into the millions, particularly if she needed heart surgery. True, that money may come out of a different budget, but I say we can’t afford NOT to pay for transportation and treatment.”

1. http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/drug-addiction-treatment-worth-its-cost

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15 responses to this post.

  1. Thank you for another great post Dr. Burson. I hope your response is published, the media is really underutilized by we advocates. Here’s a link to a story from my local paper which came out today in which I was interviewed. http://www.goskagit.com/news/news_showcase/from-addict-to-advocate/article_ef0d38f8-49ee-5c86-9fd7-d2b69d5b6109.html

    Reply

    • I really enjoyed the article and I would love to share this with a few of my clients. It is very inspiring. Thank you for your commitment to giving back by being an advocate.

      Reply

  2. Posted by dbbc11293018112 on September 13, 2015 at 6:32 pm

    (rewritten comment, I think I will make this an OpEd to my local paper – Can delete prior and let this one through).

    Like many small towns in America, Morristown, TN has been hit hard by the drug problem, but hit even harder by the ‘war on drugs’. Local politics are driven by the ‘clean up the streets’ mantra, but after nearly two decades of massive bi-yearly round-ups of low-level addicts charged as dealers, the problem has only gotten worse – surprise, surprise!

    Of course, these addicts then get churned through the criminal justice system, virtually eliminating any chance of them ever breaking the cycle of abuse.

    Most recently, they started going after people who were illegally selling or exchanging Suboxone. Granted, nobody should *ever* do that, but it seems a bit odd to treat Suboxone (buprenorphine), a partial agonist that basically doesn’t get people ‘high’, the same as a full opiod agonist. It is the same charge as Heroin, or any other schedule II drug, but it really is a different class drug, pharmacologically speaking.

    Anyway, in a city of 20K, they arrested a whopping 105 people in round one of ‘Operation Sobo’. The county jail is decrepit and overcrowded, but there is no political will to spend money to house these prisoners. It should be cruel and inhumane punishment.

    Honestly, after all these years, it seems more about *appearing* to be combating the drug problem than actually doing anything about it.

    It wasn’t until the TBI came to down earlier this year that Mexican illegals in the middle of town were busted with POUNDS of Cocaine.

    Where were the local police before? They didn’t notice a high-level cocaine distribution network in the middle of town? Were they too busy busting low-level addicts so they could inflate their ‘bust count’?

    Besides the political win from busting addict, they get asset forfeiture. From criminal forfeiture to civil forfeiture, the local police department must get a large percentage of its yearly budget from these seizures.

    I don’t think this situation is unusual, but Morristown is a prime example of the war on drugs gone terribly wrong. We need to start spending our time and money on education and treatment, not incarceration and political theatre. That not only saves lives, but it saves taxpayer money (treatment costs less than incarceration, and is more effective – proven by multiple studies and common sense). Together, the citizens of this town, and others, can make that change in policy a *reality*.

    Stand up and say we want a new approach to the war on drugs. One that works. We’ve certainly tried the current failed approach long enough.

    Reply

  3. Posted by Chris on September 13, 2015 at 7:46 pm

    Obviously this person who wrote to the editor has never buried a child due to addiction. I wish I could still pay for his treatment. I’m only left with memories.

    Reply

  4. Posted by Neil Goldberg, M.D. on September 13, 2015 at 8:13 pm

    Jana is awesome. Bottom line: addiction is a medical problem (brain disease) not a character flaw; people need to be educated, and frankly get over it. Imagine not treating diabetics. My patients are desperate for high quality treatment. Many of them –particularly the women–have been brutalized. Want to know who drug addicts are? They are building your home, serving you coffee, baby sitting your kids and treating you at the doctor’s office. I treat them. I know. N.Goldberg, M.D. Charlotte.

    Reply

    • Posted by Brandi on September 13, 2015 at 9:05 pm

      And not all of us are working in service positions. Some of us are your best friends and you don’t even know it. I am a fairly highly functioning professional. I am active in my community and my children’s private school. I have been on suboxone for four years. I lost my license to practice law thanks to my addiction. I am now back in a professional position though, in sales management. I pay a lot of taxes in fact. So, some of us saved by suboxone appear just like you on the outside. I go to church. I participate in my life. But I tell no one about suboxone. Too much stigma.

      Reply

  5. Posted by Brandi on September 13, 2015 at 8:55 pm

    Thank you for the work you do to advocate on behalf of those of us whose lives have been saved by this medication. I have been on suboxone for almost 4 years. Addiction robbed me of a life that I had spent years building as an attorney. However, suboxone and becoming a Christian have allowed me to build an even better life for myself, my husband and my children. I pay taxes (a lot of them actually ;), sit quietly behind people in church and live my daily life as a productive member of society. Thank you for your advocacy.

    Reply

  6. Thank you, Dr. Burson, for your dedication to educate and inform the community. This will be another shared post of yours!

    Reply

  7. Keep getting the facts out there, Jana! You have been instrumental in helping me educate my clients and remove stigmas preventing successful treatment. Thank you!
    Randi Konikoff, LPCS, CCS, LCAS

    Reply

    • Posted by Kirsten Bray, MD, MPH on September 21, 2015 at 1:43 pm

      Have to do a “here, here”. Transportation can be a major factor in treatment issues along with the stigmas associated with addiction.

      Reply

  8. Posted by kelly tom4 on September 22, 2015 at 8:36 pm

    I am so thankful and happy to see this type of positive and educated discussion about treating opiate addiction with medication.Thank you for doing this and hopefully soon everyone will accept this as the successful therapy it is. I did 4 rehab stints and the 12 steps just weren’t a good fit for me personally. I finally just tried Subutex and have been clean almost 4 years from opiates and heroin! I can finally live a normal life and focus on anything and everything but scoring stupid drugs.I can’t understand why rehabs and their staff are so bias and ignore the evidence.They are supposed to help save lives but only do so if it is through abstinence based programs.What the hell is their problem?Anyway, thanks again and love reading this blog.

    Reply

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