For the last 6 months I’ve been working on a book directed toward the army of Masters level behavioral health clinicians who will be trained to work in primary care. As part of the Affordable Care Act, the federal government has made a commitment to integrate behavioral health with physical medicine. In line with learning as much as I can, I’ve been attending every symposium and workshop. In May, I attended a workshop sponsored by SAMSHA on using technology to enhance clinical care.
Understandably, the workshop presenters were proud of their web sites informing consumers of available treatments. Unfortunately, the available treatments for depression were mostly drugs. This did not surprise me. What did surprise me was the newly developed website on options for those who are addicted to opiates. The SAMSHA website was a better drug advertisement for buprenorphine, methadone, and naloxone than even the pharmaceutical companies could have developed. Under the guise of consumer choice, SAMSHA is encouraging substitute opiate receptor stimulating drugs (buprenorphine and methadone) as a first option. They think people should be given this option, even before they try sobriety.
As everyone knows, the rates of opiate addiction are sky high. As acknowledged by a May 2014 New England Journal of Medicine article written by Tom Frieden, Director of the CDC, and Nora Volkow, head of the NIDA, (along with several others) most current opiate addiction is attributable to physician-induced drug dependence. When the cost of oxycontin becomes excessive, people switch to street heroin. The NEJ article extoled the virtues of the “evidence-based” switch to methadone or burprenorphine as a form of recovery.
I should clarify my objections to the federal government’s promotion of opiate receptor stimulating drugs. I’m pretty much of a civil libertarian on the issue of drugs. Prior to the first federal law against opiates (the Harrison Act of 1914), opiates were not much of a problem in this country. The Harrison Act was passed in order to ingratiate the United States to China, where opiates were a problem. I agree with Michele Alexander’s viewpoint as expressed in “The New Jim Crow”: American drug laws have been an excuse to imprison African American men and rob them of their civil liberties. I’m against laws making drugs illegal, but I am not for the federal government becoming the drug pusher.
If the federal government decides that opiate addiction is ok, as they seem to have conceded, shouldn’t the question be “what is the cheapest and the safest opiate?” In Europe, heroin is an option right along with buprenorphine and methadone. All of the opiate receptor stimulating drugs can induce lethal overdoses. As drugs go, other than OD potential, opiate agonist drugs are relatively benign (provided one does not use a dirty needle). However, methadone is arguably worse than heroin. Methadone is associated with cardiac arrhythmias and need for a pacemaker. Heroin does not induce this problem. The withdrawal from methadone is more severe and protracted than from heroin. As noted before, heroin is cheaper, which ought to be a consideration for Medicare and Medicaid. So why not just legalize heroin and call it recovery?
Physicians have saddled America with addiction to antidepressants, antipsychotics, and benzodiazpines. It seems to me that the “back-door” legalization of opiates under the guise of “treatment” ought to at least be debated out in the open.
By the way, if anyone is willing to share a short description of his/her withdrawal from an antidepressant or antipsychotic to be printed in my book, please e-mail me at [email protected] Thanks.