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Using Drugs to Stem Drug Abuse

Using Drugs to Stem Drug Abuse
January 28
13:05 2019

NY Times readers differ about the efficacy of medication-assisted recovery.

To the Editor:

Re “Debating the Use of Drugs to Curb the Abuse of Drugs” (front page, Dec. 30):

It’s time to dispense with the artificial “abstinence versus medication” dichotomy. Taking appropriately prescribed medicines helps the individual to achieve and maintain abstinence from the substance that is maintaining the disease of addiction. Ignorance of this has been driven by the fact that the vast majority of “treatment” programs are operated by individuals with no medical training. As a result, deaths due to opioid addiction needlessly continue to occur.

Methadone and buprenorphine are not “one drug replacing another.” They provide unique effects, repairing the stress-response system of the brain.

Using opioids repetitively leads to significant changes in the brain, especially the circuits that are used to detect stress and prepare the brain to respond to it. Over time, it is the experience of stress itself that creates craving for opioids.

By repairing these circuits with methadone or buprenorphine (naltrexone does not do this), the individual is able to learn to cope with stress without the development of craving. It is not abstinence versus medication; it is abstinence, maintained by medication.

Robert A. Moran
Lantana, Fla.
The writer is medical director of the Family Center for Recovery and a voluntary assistant professor of psychiatry at the University of Miami.

To the Editor:

As I read your article about the use of pharmaceuticals to solve the problem of drug addiction, I had to wonder if your reporter has ever met a longtime methadone user who has “solved” the problem of addiction through this government-sponsored method. I have met many. They are virtual zombies, crippled by the drug and stuck in a twilight zone forever.

Drugs do not solve drugs. The article continually refers to “experts.” And who might they be? People who run institutions that benefit from this horrific revolving door of addiction and “solution”? Or are these experts employees of the very same Big Pharma that created this problem in the first place?

Eric Bogosian
New York
The writer is the actor and playwright.

To the Editor:

I have noticed a concerning trend in discussions about medication-assisted recovery. There is rarely if ever any commentary about how impossibly difficult it is to get off methadone and other drugs like it once you are hooked.

The withdrawal is often worse and lasts much longer than for other opioids or heroin. In recovery circles, this is often discussed. Many addicts find themselves hooked on more powerful drugs than the ones they were on previously.

There needs to be more discussion about how severely addicting these alternative drugs are.

Michael White
Raleigh, N.C.

To the Editor:

We are addiction psychiatrists at a university-affiliated residential treatment program that has supported buprenorphine maintenance for opioid use disorders since 2007.

Buprenorphine and methadone are lifesaving medications for patients with a potentially fatal disease. Devaluing the recovery of those who have recovered with medication assistance is akin to devaluing the feat of climbing Mount Everest because the climber used supplemental oxygen.

Recovery from addiction should not be judged as a competitive sport, and there is no evidence that patients benefit by taking a more difficult and dangerous route to recovery.

We agree that medication-assisted treatment does not work for all patients at all times. However, offering it should be the standard of care, and patients should be informed that it has the best evidence for preventing death from opioid use disorders.

Programs that do not inform their patients of this may face another source of pressure: malpractice liability.

Jonathan I. Ritvo
Alexis D. Ritvo
Aurora, Colo.


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