Health and Human Services Secretary Tom Price, having identified the opioid addiction crisis as a top priority, recently made negative comments about methadone and buprenorphine for the treatment of opioid addiction. His words triggered a response from former Surgeon General Vivek Murthy who emphasized the benefits of such medications. What to make of Dr. Price’s comments and their possible impact on addiction treatment going forward?
Medication, when used correctly, can help in treating some illnesses. Addiction treatment has unfortunately been marked by the relative paucity of useful medications. My own experience reflects that of physicians worldwide in that opioid addicts are less likely to relapse if methadone and buprenorphine are used properly.
Before Tom Price moved into politics, he was a physician. In order to be a successful one, he must have followed best practices based on scientific evidence. His derogatory remarks about methadone and buprenorphine (“If we’re just substituting one opioid for another, we’re not moving the dial much…Folks need to be cured…”) are more often expressed by the lay public and ideologues in the addiction treatment community who hold to a rigid and narrow definition of recovery. His reference to the “cure” is not compatible with the mainstream medical approach toward substance use disorders which are defined as chronic conditions that do not lend themselves to cure any more than diabetes does.
An HHS spokesperson, rushing to calm the waters, emphasized Dr. Price’s support for a variety of treatment approaches – an implicit acknowledgment that he made a mistake. But what does he actually believe and what does he intend to do? The stigma surrounding methadone and buprenorphine has been slowly diminishing after years in which resistance to their use added to the death toll from opioid addiction. My hope is that a reversion to his medical roots will allow Dr. Price to examine the evidence and conclude that these medications should not be discouraged.