Posts Tagged ‘McLeod Institute at UNCC’

Opioid Addiction from Different Perspectives

Perspective is Essential

 

 

 

 

 

 

 

 

I was asked to speak as a member of a panel about opioid use disorder, at the annual addiction conference at the University of North Carolina at Charlotte (UNCC) this month, called the McLeod Institute. This conference was named after Dr. Jonnie McLeod, a great leader in the field who passed away several years ago.

I’ve spoken at this conference several times before, and it’s always a treat. It lifts my spirits to see new recruits entering the field of substance use disorder treatments, all fresh-faced and enthusiastic.

One whole day of the conference was devoted to the problem of opioid use disorders, and I’m sorry I couldn’t attend the morning’s events. After lunch, the five of us on the panel took our seats.

At one end was the operator of an abstinence based, 12-step oriented non-profit outpatient treatment program, one of the best in Charlotte. To his left was a Charlotte-Mecklenburg police officer whose focus was on interdiction of heroin flooding the streets of Charlotte. Then there was me, and to my left was Donna Hill, program director for Project Lazarus in Wilkes County. At the extreme left was Jennifer, a social worker from New Jersey with many years of experience in the substance use disorder counseling field.

We all introduced ourselves and said a little about how we approached the treatment of opioid use disorders. When it was my turn, I did my usual spiel about how treatment of opioid use disorder with medications including methadone and buprenorphine and naltrexone are the most evidence-based treatments available, yet still have the most stigma against them. I told them our country overused treatments that don’t work, sometimes over and over. I told the audience I worked for an opioid treatment program and had my own office-based practice where I prescribe buprenorphine.

The whole point of the panel was to allow the audience to hear the different viewpoints on our nation’s problem with opioid use disorders, and the panelists didn’t disappoint.

Of course the director of the 12-step oriented, abstinence-based outpatient program advocated for that form of treatment. He made some neutral-to-negative comments about MAT, but he wasn’t as vehement as I expected.

The police officer, not being involved in treatment, mainly gave facts about how awful the heroin problem is in Charlotte. He said it was one of the two hubs, along with Columbus, OH, that drug cartels were using as a base for sales to all the other towns in the Eastern U.S. He explained how the purity had risen and how fentanyl and carfentanil were now being added to heroin or being sold as heroin, because they were cheaper to make and many times more potent. He repeated the account of a police officer who had to be treated for a severe overdose that happened just from brushing heroin off his sweater. (I did read about that on the internet and had some questions regarding the story but wasn’t about to quibble with a man with a gun.)

Donna from Project Lazarus probably could have justified talking the longest, since Project Lazarus is active in so many aspects of treatment, prevention, education, and community outreach, among other things. She gave a nice summary of all the things Project Lazarus does, and encouraged people to call them if they wished to set up a similar organization in another place.

Jennifer the social worker said some good things about how all of us treating opioid use disorder need to work together and communicate, but then, in my opinion, she blew it when she said she disapproved of how treatment programs take advantage of people with opioid use disorders by charging them money to be in treatment. At first I didn’t know exactly who she was targeting but when she said clinics discouraged patients from getting off methadone and buprenorphine only because it was bad for their business, I felt my ire rising.

You know I had something to say about that.

I got a little heated, and said I didn’t think it was fair to imply opioid treatment programs were unethical because they charge patients money to be in treatment. I said other medical specialties charge money for their services, and that this was the way this country approached healthcare. I went on to say that opioid treatment programs don’t keep patients on methadone because it’s a business model; it’s because patients who leave methadone treatment at an OTP have an eight-fold increase in the risk of dying, and a high risk of relapse with all the misery that can come with it: poorer mental and physical health, fractured relationships, damaged self-esteem, lowered personal productivity.

After all, I said, is there any other medication for any other disease that reduces the risk of death by eight times, that has the stigma against it that methadone does?

OK…it’s possible I’m more lucid as I’m writing this than I was in the moment, but I blurted out something to this effect.

Other than that incident, I was relatively well-behaved.

I liked all my fellow panel members, even though we didn’t agree about everything. We all agreed on the most important thing – we all want to keep people from dying from opioid use disorder, and we all want them to find a good quality of life in their recovery.

I stayed to listen to the second panel, composed of people in recovery from opioid use disorder. There were six people on that panel, and of the six, five were either neutral or critical of methadone or buprenorphine. These five people all said that 12-step recovery in Narcotics Anonymous allowed them to quit using drugs and live a successful recovery.

The last patient was different. She gave a brief history of her recovery, and said that though she found 12-step recovery helpful, she needed methadone to return her to a place where she could function normally. She described being off opioids for some months, but being plagued with post- acute withdrawal that ultimately lead to a relapse. Now, she considers methadone a necessary medication for her, and said if she had to be on it for the rest of her life in order to feel normal, she could accept that.

I was so impressed with this lady’s courage. It had to be hard to follow five peoples’ stories that all centered on abstinence-based recovery with her story of being in a form of treatment with so much stigma against it. I was very pleased by what she was saying, and felt like she was speaking for all the people who have benefitted from medication-assisted treatment.

I was disappointed there wasn’t more diversity on this panel. I don’t doubt the other five peoples’ recovery stories, but they were very similar. One of them spoke very negatively about methadone, but later revealed she misused her methadone to an extreme degree and came off a relatively high dose “cold turkey,” which of course is not recommended. Another six people in recovery from opioid use disorder may have the opposite experience with 12-step recovery and medication-assisted treatment

I was socializing with some of the panel members before leaving, and to my surprise, the operator of the non-profit abstinence-based outpatient program told me he was sorry if it sounded like he was trying to bash methadone treatment. I was surprised and pleased, and thanked him.

I’m glad I was there, and I’m glad to see fresh recruits joining the effort to help people with opioid use disorder in their recovery.

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