February 20th, 2015

Heroin Addiction: 2 Barriers To Using Buprenorphine In Treatment

“There’s a treatment for heroin addiction that actually works. Why aren’t we using it?” Huffington Post investigative reporter Jason Cherkis posed this poignant question as to the premise of an excellent article he wrote about the resistance to using an effective new treatment despite an increase in heroin addiction, failed recovery attempts, and subsequent overdoses.

The treatment to which he refers is the use of buprenorphine, a stabilizing medication that prevents relapses to heroin and pain pills, together known as “opioid” drugs. And his question is one that has been on my mind for many years, given the increase in heroin addiction.

Cherkis ultimately reached the conclusion that use of buprenorphine to treat heroin addiction should be more widespread. This has been my position for quite some time, and I was happy to see it conveyed so articulately.

If, as Cherkis documented, there is clear evidence that this approach could save lives, why isn’t it being readily accepted? In my experience, there have been two significant sources of opposition to adopting this treatment method, despite the increase in heroin addiction.

  1. Narcotics Anonymous: Their concern is that the short-term benefit of using buprenorphine will lead to longer term negative consequences. Members of NA are not shy about telling my patients that they “are not really clean.” They are welcome to come to meetings, but are treated as second-class citizens.
  2. Traditional, “12-Step based” residential rehabilitation facilities:  These treatment centers built their reputations on their successful treatment of alcoholism. I believe that they make a fundamental mistake when they treat addiction to opioids as being identical to addiction to alcohol rather than similar with important differences. As Cherkis points out, some of those staff members who are in recovery themselves apply to others what had worked for them.

Fortunately, the article reports the good news about the changes going on at Hazelden, the oldest and arguably the most influential of the 12-Step based residential treatment programs in the country.  In 2012, Dr. Marvin Seppala, Hazelden’s chief medical officer, began the planning process for integrating medications, including buprenorphine, into its programs and working to win over staff.  Hazelden introduced medically assisted treatment the following year and is collecting data to document the impressive improvements that they have seen in the success of their treatment. It is an excellent step to overcome the increase in heroin addiction.

As part of their research and planning process, Seppala and his staff consulted with Kolmac (referenced in Cherkis’ article as “a clinic in Washington, DC”) about what we have learned about the effective use of buprenorphine, which has been an important part of our program since it became available in 2003. Our basic position has been that heroin addicts have differences from other addicts that must be addressed. As such, we provide buprenorphine to our clients. However, we recognize that it’s not for everybody.

Its use has to be individualized. Each client has to figure out how it works for him or her. For instance, I am commonly asked, “How long should you stay on the medication?” At Kolmac, we don’t base use of buprenorphine on a time period, but rather a task parameter.  If the person’s life is back on track and he or she has a solid recovery plan, then it may be time to stop taking the medication.

However, at this juncture, our community needs to focus more on starting rather than stopping the use of maintenance medications. What do you think is holding us back? For so many people, this issue really is a matter of life and death.

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