Update

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Last week, I told my readers about a letter I sent to my local newspaper, trying to explain the usefulness of methadone (and buprenorphine) treatment for opioid addiction. Happily, my entire letter was published in our local paper under the heading of “Guest Columnist.”

I was elated, especially since this piece of writing was on a topic about which I’m passionate.

I checked Friday’s paper to see if anyone had responded to my column. There were no replies, but there was another article in that issue, titled, “Task Force Targets Schools.”

This article was about the meeting of a drug abuse task force formed earlier this year by local people. Before you ask, yes, this is in the same county where Project Lazarus, founded in 2008 in response to high drug overdose death rates, has its headquarters. And no, I do not know why people in this new task force feel the need to re-invent the wheel, particularly in an area where the prior inventors of the wheel have had such success and nationwide praise. Indeed, many other areas of the country have copied the Project Lazarus model of addressing the multifactorial causes and contributors of addiction

Anyway, I don’t know the motivations of this new task force. Interestingly, this quote was found early in the article: “Education and dissemination of information appears to be the greatest way the task force can make a difference.” This was said one of the co-chairmen of the organization. This quote was in the context of providing information to youths to prevent drug use and drug addiction.

I sure as hell wish that statement also applied to facts around treatment of addiction.

At some point, methadone apparently became the topic of discussion, which was a shame, because task force members sound like they don’t know anything about methadone. I wish they would have read my guest column two days prior!

Here’s a quote from the paper from one of the task force members: “From the way I understand it, the methadone clinics are not weaning these people off methadone. They’re going for treatments and they’re just going and going and going,” According to the article, he also said that state government should be involved in requiring plans that give people certain amounts of time to be off methadone and then with helping them.

Then the co-chair of the task force, a law enforcement trainer at the local community college, said methadone clinics are supposed to have personalized plans for people who come in for treatment. “It doesn’t appear that those plans are followed exactly the way they should be,” he added. “It’s a business model.”

I’m not sure what qualifies this man to know how long methadone should be prescribed for the purposes of treating opioid addiction. He’s not a doctor.

Then another person in the task force said the goal is for a person going to one of the clinics to be off methadone in a year, “but that doesn’t happen…. It’s a business.” She said only a small percentage kick their addictions.

Who is this second person? She is – wait for it – a Licensed Clinical Addiction Specialist. She works for a program where we have referred patients in the past.

As all my readers know, I am a calm and patient person who never takes things personally (yeah that’s sarcasm). Even more fortunately, I’m not the litigious type, because when someone says at a public forum that the local methadone clinic keeps patients on methadone because it’s a business model, that’s a defamatory statement. That implies I prescribe methadone to make money and not to help patients. This statement attacks my character as the medical director of that program, and cast dispersions on my professional integrity.

Drug addiction treatment should be about science, not opinion.

I know the right thing to do, the grown-up thing to do… call task force members and politely offer to educate them about MAT.

I’ll get there. But right now, I’m not ready to be a grown up.

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15 responses to this post.

  1. This is one of the misconceptions about MAT which bothers me the most. Addiction is the only disorder in which some find it unacceptable to treat with medication. Then you have the people who seem accepting but feel there must be a time limit to the treatment. Could you imagine being told by a psychiatrist that now that we’ve found a medication that has your depression under control we need to talk about weaning you off it. It’s particularly troubling with Buprenorphine to the point many state medicaid plans have a lifetime limit for Buprenorphine coverage. Even though we have evidence it works best as a maintenance medication. It has in France for over 20 years. In the states we are really just coming out of the dark ages of addiction treatment. The problem lies in the influence of traditional abstinence based elements in the recovery community. In NA world service bulletin #29 it says a person who is taking Methadone as prescribed for pain is clean (a word I hate and we shouldn’t use anyway in reference to addiction) but a person taking Methadone as prescribed for addiction is not and should not be allowed to share or hold any service positions. The tragic thing is many treatment centers and prescribes make their patients attend these very meetings. I would bet money the chemical dependency professional you mentioned has a background in those meetings as well.

    Reply

  2. Posted by Icecutter on September 21, 2015 at 1:47 am

    Now, now Dr. Burson, don’t get your fur ruffled. What they say reflects THEIR ignorance, not yours. If a Licensed Clinical Addiction Specialist professional thinks that opiate addiction will just go away after a year of treatment, then she had a pretty poor education and ought to be retested for her certification. As for the law enforcement guy, he is just repeating whatever crap he has heard about addiction.
    My question is, is there a physician addiction specialist on the this Task Force? If not then this group has their heads stuck in the sand. And why are methadone clinics always singled out as “being in it for the money?” Don’t cancer treatment centers make money? How about mental health treatment centers? We all have to make money, or we’d be out of business quickly and no one would get helped. Even churches have to make money. Don’t let that statement bother you.
    How we addicts all wish addiction would go away with a year’s treatment! I am entering my 15th year on methadone and I am grateful for it.
    If you could stomach it, you might attend the next Task Force meeting and ask them why they think addicts should be weaned off methadone within a certain time frame? I’d like to hear his answer.

    Reply

    • Posted by kevin on September 21, 2015 at 2:34 pm

      Yeah, good question, what about the other medical facility’s, what about the pharmacy reps that go around paying for expensive lunches and freebies just to get the doctor to prescribe a certain drug, which I imagine would be types of pain medicine too, could be half the reason some of us are in the condition we are in already.

      Reply

  3. Posted by Travis Simerly on September 21, 2015 at 2:52 am

    Dr. Burson If I were you I would seriously consider a civil lawsuit, or at least have a lawyer send them a letter. People like that are making it impossibly hard for areas like my home, Johnson City, TN, to open a much needed clinic.

    Reply

  4. Posted by Meghan on September 21, 2015 at 3:59 am

    All I can say is that I wish there were more people like you dr.burson. Oh how I wish there were more like you. I’ve been an addict my whole life and finally am hearing someone speak the truth. I have never felt I had the voice to do so myself so I am deeply grateful to have found yours. I have been on and off methadone for years and there is no doubt it has saved my life. I take it for depression and it works wonders where antidepressants do not. Thank you for speaking for those of us who cannot! I am eternally grateful.

    Reply

  5. Posted by Pat Bowman on September 21, 2015 at 11:20 am

    As I read your follow up, I was profoundly saddened that so many “professionals” still say (and seem to believe) exactly the same thing I heard almost 4 decades ago. Far too many remain opinionated and uneducated. What a shame, what a disservice, that the profession and forces they represent chose these individuals as representatives.

    Reply

  6. Posted by kevin on September 21, 2015 at 2:31 pm

    Oh my Dr. Burson I really hope you don’t let this go, people need to do some fact checking before they go puting articles in public news papers. That’s how the whole stigma starts, then we got people setting on there porch swing talking bout then ppl down there at that clinic. That one that just gives addicts what they want. They don’t know anything there talking about but they go making professional statements and make people think the wrong thing. I don’t think I could be the adult here. I hope you stew on this for a min and make sure these people know the truth and understand the problem with what they have said and done. Good article by the way

    Reply

  7. Do Probation Officers have the legal right to prevent their clients from entering or continuing inMAT?

    Dan Strickland

    Reply

  8. I have attended hundreds of committees, like the one that you describe, and each individual appears to have their own agenda, that emanates from either their own education or their own self interest. Unfortunately, there is little interest in discussing facts (maybe why the Good Doctor was not invited) and everyone expounds on their own perception of the problem and their individualized knowledge base to solve this epidemic of opiate dependence. Unfortunately, most know very little about opiate addiction and its protracted withdrawal syndrome and even less about any alternatives like buprenorphine or methadone. A good presentation, well advertised and written to convey the true breadth of this epidemic, may bring enough people into an arena, in which, the ignorance level can be addressed. Unfortunately, the bias and greed factor of most sober living homes and inpatient programs will still argue against anything that is going to reduce “heads on beds” and revenue. The greed group, will never change their opinions, but there are well intended people who are just too lazy to dig into the facts of medication assisted treatment and others whose bias is based on their own individual experience. It’s these two groups who may be open to acceptance of change.
    Having used buprenorphine, in our outpatient clinic for ten years, we have gone from the “opiate maintenance program” to being in sync with programs like Hazelden and Betty Ford Center. If they can review studies and decide that evidence trumps bias, than so can the other groups. We can’t give up, too many people are dying behind the ignorance of so many that should know so much more, based on their licensure and status in the addiction treatment field.
    When attorneys start filing wrongful death claims against addiction providers who refuse to offer MAT as an alternative, to opiate dependent patients and their families, than you will begin to see their attitudes change very quickly. That day is coming.

    Reply

  9. Posted by razorx on September 22, 2015 at 4:41 pm

    Thank you Rocky,Java and Dr B. . My feels exactly. ..raz..

    Reply

  10. Posted by Joe L. on September 23, 2015 at 7:02 am

    I confront these attitudes frequently as I have decided to be more open about being on Methadone treatment. I felt it was my duty to educate. In the beginning, when asked where I was off to so early each morning, I jokingly would reply that I’m: “Off to the Methadone clinic to suck down jungle juice with the other dirtbags.” When I realized I was the only one who found this amusing and it was what others really thought I stopped making that particular comment. When I tell someone new about my treatment, often I’m asked when I’m going to get off. I have no plans to. Eventually yes, but it’s working well for me now, I’m employed, rent a nice home, have healthy hobbies, etc. and stopping now just doesn’t make sense. I’m investigating Ibogane possibly, down the road. Others are genuinely curious, ask what Methadone effects are like. For me, it’s like I never did anything in the first place. It’s just something I have to do every morning like brushing my teeth. The ignorance I encounter here, in Seattle is surprising to me as in many other ways it’s such a progressive, educated population. Having recently read “Chasing the Scream” & “In the realm of hungry Ghosts”, “Opium Fiend”, & “On the Move: A Life” I realize decriminalization and regulation are the only solutions to the societal woes of addiction & the war on drugs, and the only way that is ever going to happen is if people from all walks of life and political affiliations are educated and shown the real evidence based proof of these solutions, stop treating addicts like criminals and learn the real results of the existing harm reduction infrastructure and simply build upon it. Dr, You and others as enlightened are the only hope for the future. I shudder to think if that arrogant real estate developer winds up in the white house what could happen to MAT, the legalization initiative, and common sense in general.

    Reply

    • amen to all the above!
      I’ve started responding to others doctors who ask me how long I keep people on methadone with: “For the same amount of time you keep an overweight diabetic on insulin.” That seems to confuse them…what I mean by that is that doctors don’t have any time limit on other medical problems caused by so-called behavioral factors, so why imagine I should have them for opioid addiction?
      I keep reminding myself that science in on our side.

      Reply

    • Oh, and we must organize and VOTE at every opportunity. That’s the way to make change. In fact, I’d like to see a drive to register voters at every OTP.

      Reply

  11. Posted by Tom Jenkins on September 28, 2015 at 3:10 pm

    It is disappointing that so many “professionals” are uneducated or refuse to look at the facts. the stigma surrounding the use of medication in the treatment of addiction will set us back in our current struggle to get this epidemic under control. some of these same attitude are perpetuated by our legislature as well and they should take more of a leadership role in discounting these myths. Furthermore, they should lift the unfounded ban on the establishment of additional Opioid Treatment Centers in the state.

    Reply

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