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6/11/2017 12:00 AM

Infants born to mothers who are in treatment for opioid use disorders with methadone are sometimes born with neonatal abstinence syndrome (NAS), a constellation of symptoms associated with opioid withdrawal. The old way of treating these infants — and the current way in many institutions — is to put them in the neonatal intensive care unit (NICU) and treat them with gradually decreasing doses of morphine. But keep out of the NICU, standardize nonpharmacologic care and empower parents, and what do you get? A reduction in the percentage of infants treated with morphine from 98 percent to 14 percent, a reduction in average length of stay (ALOS) from 22.4 to 5.9 days and a decrease in costs from $44,824 to $10,289. That is what researchers at Yale New Haven Children’s Hospital discovered when they implemented novel “plan-do-study-act” cycles in 2010 in response to a dramatic increase in the number of infants born there who had been exposed to methadone in utero (a 74 percent increase from 2003 to 2009).

Infants born to mothers who are in treatment for opioid use disorders with methadone are sometimes born with neonatal abstinence syndrome (NAS), a constellation of symptoms associated with opioid withdrawal. The old way of treating these infants — and the current way in many institutions — is to put them in the neonatal intensive care unit (NICU) and treat them with gradually decreasing doses of morphine. But keep out of the NICU, standardize nonpharmacologic care and empower parents, and what do you get? A reduction in the percentage of infants treated with morphine from 98 percent to 14 percent, a reduction in average length of stay (ALOS) from 22.4 to 5.9 days and a decrease in costs from $44,824 to $10,289. That is what researchers at Yale New Haven Children’s Hospital discovered when they implemented novel “plan-do-study-act” cycles in 2010 in response to a dramatic increase in the number of infants born there who had been exposed to methadone in utero (a 74 percent increase from 2003 to 2009).

The goal was to reduce the ALOS by 50 percent — a goal the interventions far exceeded.

There were 287 methadone-exposed infants in the study, including 55 from the baseline period (2008 to 2010) and 44 from the post-implementation period (2015 to 2016). There were no adverse events, and no infants were readmitted for treatment of NAS.

Other institutions had successfully reduced ALOS after implementing a weaning protocol for morphine and standardizing the scoring of the Finnegan Neonatal Abstinence Scoring System (FNASS), which assigns a numerical score to 21 subjective clinical signs of NAS. It is usually used in an NICU, but there is no evidence that infants with NAS require management in an NICU, and in fact, it makes rooming-in out of the question, which itself is a nonpharmacologic intervention for NAS.

The researchers at Yale “set out to change the paradigm of how we approached the management of infants with NAS,” decreasing ALOS by not using morphine. They used the interventions with all infants with NAS, but only analyzed results for those born at least 35 weeks’ gestation and whose mothers took methadone daily for at least one month before delivery, because they “considered this population to be the most likely to develop signs of withdrawal.” Infants with significant comorbidities were excluded.

During the pre-intervention period, all infants at risk for NAS were admitted directly to the NICU after birth, and infants were monitored using the FNASS. Infants were initially managed in the NICU, with those with scores justifying medication getting morphine. Then, at the discretion of the neonatologist, they were either discharged or transferred to the inpatient unit. At day 5 of life, infants who received no morphine were discharged; infants receiving morphine were discharged one day after the medication was stopped. The second year of the pre-intervention period, the researchers noted an increase in the number of infants with NAS and identified four key drivers that could reduce ALOS: nonpharmacologic interventions, simplified assessment of infants, decreased use of morphine and communication between units.

The interventions

Over the next five years, the researchers developed and implemented eight interventions aimed at reducing the ALOS of infants with NAS.

  • Standardized nonpharmacologic care
  • Prenatal counseling of parents
  • Transfer from well-baby nursery (WBN) to the inpatient unit (with the mother)
  • Development of novel approach to assessment
  • Morphine given as needed
  • Empowering messaging to parents
  • Spread of change concepts to NICU

Nonpharmacologic interventions: Nonpharmacologic interventions included being placed in a low-stimulation environment with dimmed lights, muted televisions and reduced noise. Parents were continuously available to their infants; parents were strongly encouraged to room-in, to feed their infants on demand and to tend to their infant if crying. Staff were trained to view nonpharmacologic interventions as equivalent to medications — “when increased intervention was warranted, the approach was to increase the involvement of the parents before using pharmacologic treatment.” In conjunction with the well-baby nursery, clinicians encouraged breast-milk feeding of all infants for whom there were no contraindications (illicit drug use or HIV).

Prenatal counseling: The parents were given informational handouts several weeks before delivery, and told that they would be expected to stay with their infant throughout hospitalization. They were also able to ask questions, which the outpatient care coordinator would answer.

Empowering messaging to parents: On the inpatient unit, the parents were told that the most important treatment would be measures to comfort the infant, and that these measures should be performed by the mother or father (or other family member). Parents were told that they needed to be present at the hospital as much as possible. Nurses and doctors focused on supporting and coaching parents.

Novel approach to assessment: Instead of using FNASS scores for babies on the inpatient unit (these scores were still used in the WBN and the NICU), the researchers developed their own assessment focused on three parameters: the infant’s ability to eat, to sleep and to be consoled. If the infant couldn’t breastfeed or take at least one ounce from a bottle, or sleep for more than an hour, and took 10 minutes or more to be consoled when crying, nonpharmacologic interventions were maximized. If these didn’t work, morphine was either started or increased.

Morphine as needed: Instead of using rapid morphine weans on a schedule, the researchers modified their approach to give morphine as needed. “We noticed that signs of withdrawal were not always consistent throughout the day,” the researchers wrote. “In addition, sometimes we were unable to provide optimal nonpharmacologic care, such as when no parent, family member, or volunteer could be present.” If the maximal nonpharmacologic interventions were not effective, the infant would get one dose of morphine. If the infant was sleeping well, eating well and consolable within 10 minutes, additional doses of morphine were not administered.

The level IV NICU housed infants with NAS in rooms with as many as 12 infants. There was no ability for parents to room-in, and the environment was not low-stimulation. “We discontinued the practice of directly admitting infants at risk for NAS to the NICU after birth in an effort to keep the mother-infant dyad intact,” the researchers wrote. Instead, these infants were taken to the WBN, where FNASS scores were measured, and if the score was 8 or more, the babies were transferred to the inpatient unit, where the mothers could room-in and nonpharmacologic measures were initiated as soon as possible for all opioid-exposed infants, whether they had withdrawal signs or not.

Results

There were 287 infants who met inclusion criteria between January 2008 and June 2016. The ALOS decreased from 22.4 days during the baseline period to 5.9 days in the post-implementation period. In 2010, the nonpharmacologic interventions were standardized; in December 2011, the babies started being transferred directly to the inpatient unit so they could room-in; in January 2014, the novel assessment approach on the inpatient unit began; in June 2014, implementation of prenatal counseling and rapid morphine weaning began; and in June 2015, rapid morphine weaning was replaced by as-needed morphine dosing and empowering messaging to parents began. Overall, the proportion of infants treated with morphine decreased from 98 percent to 14 percent, and the average cost of hospitalization decreased from $44,824 to $10,289.

For those infants transferred from the WBN to the NICU, only 6 percent (2 of 35) received morphine. The proportion of infants who took most of their feeding from breast milk increased from 20 percent to 45 percent. The proportion of infants admitted directly to the NICU decreased from 100 percent to 20 percent. No patient admitted to the inpatient unit required transfer to an ICU. There were no seizures and no readmissions within 30 days.

Implications

The changes in treatment of NAS — to less medical and more parental involvement — went far beyond the researchers’ goal of a 50 percent reduction in ALOS. The eight plan-do-study-act cycles led to an improvement in ALOS, well below that reported in any other published studies, and “we are confident that our interventions directly resulted in the changes observed,” they wrote.

“One of our study’s strengths was the inclusion of all methadone-exposed infants, which allowed us to fully measure the impact of our interventions,” they wrote.

Many studies define NAS as receiving pharmacologic treatment — in other words, only babies who received morphine count as having NAS. But that definition makes it impossible to draw conclusions about the effectiveness of nonpharmacologic interventions, the researchers note. “The use of medication to treat clinical signs should not be the sole factor used to define the syndrome,” they wrote. “Although we applied our interventions to all opioid-exposed infants, we focused our evaluation on the subset of opioid-exposed infants most likely to develop withdrawal, regardless of the eventual treatment received.”

Because methadone is a long-acting opioid, infants exposed to it are more likely to have signs of withdrawal than those exposed to short-acting opioids or buprenorphine, the researchers wrote. “By initiating intensive nonpharmacologic interventions for all methadone-exposed infants from the time of birth and before the presentation of clinical signs of withdrawal, we were able to intervene earlier and to prepare parents for their critical role in treatment,” they wrote. “We believe this strategy contributed greatly to our success.”

The researchers also said there has never been validation of starting or changing pharmacologic treatment for NAS based on FNASS scores. In addition, it’s impossible to obtain an FNASS score without disturbing and unswaddling the baby, which increases the likelihood of high scores in terms of tremors, tone and cry. “Our approach encouraged providers to focus on a small number of clinically relevant factors to assess the need for treatment with morphine,” they wrote. “Ideally, all infants should feed well, sleep well, and be easily consoled. We determined that if infants with NAS met these goals, then treatment was successful irrespective of the FNASS score.”

When less is more

A decade ago, all infants with NAS were admitted straight to the NICU, where rooming-in was not permitted and the only nonpharmacologic intervention was swaddling. In this setting, 98 percent of the babies exposed to methadone required morphine. By changing the milieu, the intervention changed an entire system, to one in which parents were not only allowed to visit their baby but encouraged to be the most important part of their baby’s treatment. “This approach employed the power of the maternal-infant bond to treat NAS,” the researchers wrote.

By changing the paradigm, the researchers reduced the use of morphine, the ALOS and costs.

The study, “An Initiative to Improve the Quality of Care of Infants with Neonatal Abstinence Syndrome,” is in the current issue of Pediatrics and was funded by the National Institutes of Health, and the researchers reported they had no conflicts of interest to disclose.

5/22/2017 12:00 AM

Many people in Philadelphia, New York City and parts of New Jersey have noticed billboards recently advertising Vivitrol — the message mainly being “What is Vivitrol?” with an 800 number to call. The billboards are on highways. “They’re everywhere,” several New York City dwellers told us. “Ads for Vivitrol are everywhere,” Charles Ornstein, senior reporter at ProPublica, tweeted on May 10. Many people don’t know what the drug does — blocks the effects of opioids — but they were intrigued by the ads anyway.

Many people in Philadelphia, New York City and parts of New Jersey have noticed billboards recently advertising Vivitrol — the message mainly being “What is Vivitrol?” with an 800 number to call. The billboards are on highways. “They’re everywhere,” several New York City dwellers told us. “Ads for Vivitrol are everywhere,” Charles Ornstein, senior reporter at ProPublica, tweeted on May 10. Many people don’t know what the drug does — blocks the effects of opioids — but they were intrigued by the ads anyway.

Asked about the campaign, Matthew Henson, spokesman for Alkermes, which makes Vivitrol, told us the company “recently launched a targeted campaign in select areas of metro New York, New Jersey and Pennsylvania to help generate more awareness of Vivitrol as a treatment option for the prevention of relapse to opioid dependence,” he said. “The opioid epidemic is the public health crisis of our time and we recognize that it’s important that patients and caregivers have a better understanding of all FDA-approved treatment options so that they can have an informed conversation with their physician,” he said. “Awareness of Vivitrol as a treatment option is still relatively low and we often hear from patients and caregivers that they want to know all of their options.”

But the ads don’t make product claims, such as calling Vivitrol a treatment option for the prevention of relapse. They just get the brand name out there. Alkermes, as the patent holder of Vivitrol (it expires in 2029), can invest in such advertising. Methadone and buprenorphine, both generic, can’t afford such advertising.

A year ago, when a similar blitz took place in Boston, there was great concern among the medical community, who said it would be better if patients were given a more general public service campaign about substance use disorders and the availability of all kinds of treatment.

Even the more extensive print ads we have seen do not give the most important information about the medication — extended-release naltrexone — that is used to treat opioid use disorders. This information is that the patient must be opioid-free for a week before the shot can be given. Otherwise, severe withdrawal, which is painful and life-threatening, could ensue. It seems like the kind of thing it would be important for consumers to know in what is called “direct-to-consumer advertising,” or DTCA as the term is known. So we asked the Food and Drug Administration (FDA), which is responsible for regulating prescription pharmaceutical advertising. It turns out that this responsibility only goes so far. First of all, unlike labeling, the advertising doesn’t have to be submitted to the FDA for approval first. “In most cases, federal law does not allow the FDA to require that drug companies submit ads for approval before the ads are used,” said Jeremy Kahn, trade press officer for the FDA. “We see many ads at about the same time the public sees them.” If the FDA thinks an ad violates the law, it sends the drug company a letter asking that the “ads be stopped right away,” said Kahn.

As for the Vivitrol ads in particular, “FDA does not comment on specific promotion for one product/company,” said Kahn.

“FDA encourages drug companies to use language that is clear and understandable to the general public,” he said.

The key is whether the ad makes a product claim. If it does, it must also tell at least one approved use for the drug, the generic name of the drug and “all the risks of using the drug,” said Kahn. This may be why the Vivitrol ads don’t make any claim, but simply give an 800 number to call or a website to go to. There, patients can get more information, and if they choose to, look up adverse effects.

“The problem with such ads is that the onus is eventually on the consumer to learn as much as needed about the medicine, including caveats about side effects or drug interactions,” Ed Silverman, senior writer at STAT News and Pharmalot columnist, told us last week. “Alerting consumers to the existence of a medicine is fine, but it’s not the whole story.”

For more information from the FDA on prescription advertising, go to https://www.fda.gov/Drugs/ResourcesForYou/Consumers/PrescriptionDrugAdvertising/ucm076768.htm#control_advertisements.

5/22/2017 12:00 AM

In what he has probably come to see as a big mistake, Health and Human Services Secretary Tom Price, M.D., went to West Virginia two weeks ago and disparaged methadone and buprenorphine treatment for opioid use disorders, telling the Charleston Gazette-Mail, “If we’re just substituting one opioid for another, we’re not moving the dial much” (see ADAW, May 15).

In what he has probably come to see as a big mistake, Health and Human Services (HHS) Secretary Tom Price, M.D., went to West Virginia two weeks ago and disparaged methadone and buprenorphine treatment for opioid use disorders, telling the Charleston Gazette-Mail, “If we’re just substituting one opioid for another, we’re not moving the dial much” (see ADAW, May 15).

“His statement is deplorable,” Charles O’Brien, M.D., Kenneth E. Appel Professor of Psychiatry and vice chair of psychiatry at the Perelman School of Medicine at the University of Pennsylvania, told ADAW last week. “I would be happy to tutor him on the science of addiction. He is obviously not aware of the science. Is there any addiction scientist in Atlanta who knows him? He is an orthopedic surgeon so he should be able to understand science.”

The sad fact is that Price’s language is similar to the language of many educated people — including physicians — who do not understand the science of addiction. “Trading one addiction for another” is the shibboleth haunting the treatments with evidence of success for opioid use disorders — methadone and buprenorphine.

Still, his statement more closely mirrors the philosophy of a rural legislator than anything seen from the federal government. The Substance Abuse and Mental Health Services Administration, the Food and Drug Administration, the National Institute on Drug Abuse, the Office of National Drug Control Policy (ONDCP) and Elinore McCance-Katz, M.D., Ph.D., President Trump’s nominee for assistant secretary for mental health and substance use at HHS, all support methadone and buprenorphine treatment, as well as naltrexone, as approved medications to treat opioid use disorders.

Mark Parrino, president of the American Association for the Treatment of Opioid Dependence (AATOD), is also hoping McCance-Katz will provide valuable input when she is confirmed. “In my judgment, the secretary may not have a full understanding of the value of medication-assisted treatment for opioid use disorders,” Parrino told ADAW. “I am confident that Elinore will be able to provide all of the necessary material to the secretary in support of this work once she receives Senate confirmation.”

Price likes Vivitrol

Alleigh Marre, national spokeswoman for HHS, tried to put out the fire by sending reporters a transcript of the Gazette-Mail interview. In that transcript, however, Price goes straight from damning methadone and buprenorphine to praising Vivitrol:

“I think what I know about health care is that what’s right for one person isn’t necessarily right for another person, but I do know that if we just simply substitute buprenorphine or methadone or some other opioid-type medication for the opioid addiction, then we haven’t moved the dial much. And so what we can do to try and find the medications that aren’t the agonist, the antagonists. Vivitrol is an example. It’s a medication that actually blocks the addictive behavior as well as the seeking behavior. That’s exciting stuff. So we ought to be looking at those types of things to actually get folks cured so that they can come back and become productive members of society and realize their dreams.”

There are only three medications approved for the treatment of opioid use disorders: methadone, buprenorphine and naltrexone. Vivitrol is the patented form of extended-release naltrexone — a once-a-month, $1,200 injection that blocks the effects of opioids, and requires at least a week of opioid abstinence before it can be administered. Vivitrol is an antagonist; methadone and buprenorphine are both agonists, and are opioids. The federal government has never picked one of the medications over another — until Price made his comments in West Virginia.

Outrage

Outrage from medical societies, physicians, treatment professionals and researchers ensued. On May 15, National Public Radio released a letter signed by more than 700 researchers calling Price’s language “unscientific” and “damaging” (see http://www.npr.org/sections/health-shots/2017/05/16/528614422/prices-remarks-on-opioid-treatment-were-unscientific-and-damaging-experts-say).

Ousted Surgeon General Vivek Murthy, M.D., took on Price with a response on Twitter (https://twitter.com/vivek_murthy/status/862776718632857601).

The American Society of Addiction Medicine (ASAM) was preparing its own sign-on letter. In the meantime, ASAM President Kelly J. Clark, M.D., told ADAW that “ASAM was discouraged to hear of Secretary Price’s initial comments regarding medications to treat opioid addiction.” She added: “The evidence is clear that all FDA-approved medications can help patients enter and sustain recovery when offered as part of an individualized treatment plan. As a physician, Dr. Price is well-versed in evaluating the evidence and implementing corresponding policies. We hope the addition of a second physician with specific addiction expertise in the assistant secretary role will magnify the attention the administration can bring to evidence-based approaches.”

Clark said ASAM looks forward to working with Price and the entire administration “to improve access to evidence-based addiction treatment and reverse the course of the opioid epidemic.”

All three medications

“The Office of National Drug Control Policy, which drafts and oversees implementation of the president’s drug control strategy, promotes evidence-based approaches to addressing drug use and its consequences,” said Mario A. Moreno Zepeda, spokesman for the ONDCP. “Among other things, that includes expanding access to medication-assisted treatment [MAT], not only in traditional health care settings, but also the criminal justice system.” He added, “When I say ONDCP supports expanding access to MAT, that includes all three FDA-approved medications.”

Becky Vaughn, vice president of the Addiction Policy Forum, said there are “powerful, evidence-based tools in our treatment toolbox for those with opioid addiction,” she told ADAW. Vaughn was at a meeting sponsored by TCA on May 17 where Sarah Arbes, principal deputy assistant secretary for legislative affairs of HHS, was on the panel. Vaughn requested that Arbes get the message to Price that “we need his public support as well as financial resources to ensure that everyone has access to these medications when they are appropriate,” said Vaughn. Arbes “replied that he is in full support of all modalities of treatment, including medication-assisted therapies.” Vaughn spoke to Arbes afterward and was told HHS is “trying to tamp this down.”

The National Association of Addiction Treatment Providers (NAATP), whose members are mainly residential rehabilitation treatment programs, had a slightly different take on the debate. “For myself, I don’t view the secretary’s comments as alarming,” NAATP Executive Director Marvin Ventrell told ADAW. “The intention of HHS is not entirely clear to me,” he said. “But if what he has said is that MAT alone, without other evidence-based integrated components of care, is insufficient, I wouldn’t disagree,” he said. “We wouldn’t want HHS to discount the value of MAT, but we also want them to embrace time-honored psychosocial treatments.”

In making these incendiary remarks — possibly quite innocently — Price may have done everyone a favor by finally bringing the agonist-antagonist debate into the sunlight. Medication-assisted treatment has come to mean all three medications. But since different camps favor one or the other and use the phrase to mean different things, maybe it’s time to stop using it. Law enforcement, corrections and drug courts favor Vivitrol. But the choice is one that should be made by the patient. So let’s take the first part of Price’s response — “I think what I know about health care is that what’s right for one person isn’t necessarily right for another person” — and move on from there.

Bottom Line…

HHS Secretary Tom Price outraged addiction treatment experts by calling methadone and buprenorphine “just substituting one opioid for another.”

In Case You Haven’t Heard
10/10/2016 12:00 AM

The Office of National Drug Control Policy (ONDCP) is asking everybody to change their language when talking about addiction. Actually, they prefer substance use disorder. They also say to stay away from words like “dirty,” “abuse” and “dependence.” All good. After all, even the Diagnostic and Statistical Manual of Mental Disorders no longer uses “abuse” or “dependence” (to describe a pathology), and only the worst kinds of people use the word “dirty” to describe a urine test that is positive for drugs. The ONDCP is even asking for comments on this, in what must be the most frustrating time of the year for substance use disorder treatment advocates who have been trying to pry pennies from Congress for the worst opioid epidemic the country has ever seen. If you want to comment, here’s the draft: https://www.whitehouse.gov/ondcp/changing-the-language-draft. We would like to put in a plug for a change that has been due for some time: “medication-assisted treatment.” What does that even mean? In the field of substance use disorders, we have medications approved for alcohol use disorders (acamprosate, naltrexone) and for opioid use disorders (methadone, buprenorphine, naltrexone). The ONDCP and, increasingly, Congress use “medication-assisted treatment” to mean treatment for opioid use disorders. There’s a huge difference between methadone, which is only dispensed in opioid treatment programs; buprenorphine, which, like methadone, is an agonist (or partial); and naltrexone, which most of the time means the patented extended-release version: Vivitrol. Now “MAT” is in the lexicon — of legislation and regulation — and nobody knows what it means. So can we stop using the phrase “medication-assisted treatment” and just call it medication?

In Case You Haven’t Heard
10/3/2016 12:00 AM

As syringe programs, safe-injecting facilities and harm reduction in general enter the mainstream, what does “harm reduction” even mean anymore? Does it still mean encouraging drug users to get treatment? We asked the policy director of the Harm Reduction Coalition these questions. He is concerned about drug users being left behind as the field gets more mainstream. “Harm reduction has always been grounded in reaching and engaging people who use drugs to support their health needs, including overdose and HIV risk but also substance use itself,” Daniel Raymond told ADAW last week. “So I hope that we’re moving towards building deeper relationships with the treatment and recovery communities so that we can support each other and create a stronger continuum of care.” Raymond also wants to see “more engagement with health care, housing and criminal justice/re-entry,” he said. “Harm reduction philosophy and strategies have a lot to offer and share with these sectors. More broadly, we’re looking at addressing the broader structural issues like stigma, trauma, homelessness and mass incarceration that intersect with substance use and multiply vulnerability and harm.” For more on Raymond’s concerns about mainstreaming the harm reduction agenda, see his piece on the Midwest Harm Reduction Institute’s annual conference, published last week: https://medium.com/@danielraymond/holding-space-for-the-unredeemed-harm-reduction-and-justice-1d70ca675f25#.pbn8uqhcy.

From the Field
9/19/2016 12:00 AM

Opioid addiction is a disorder of brain structure and function. It is an illness. And the most effective treatment for this illness is medication. And as with any illness, the medication that should be used is the one that proves most effective for that patient. And yet, there are those that argue we should limit the medications we use to fight this epidemic of opioid addiction and death.

We’re dying out there. Look at the number of overdoses that have occurred in the last month to heroin and to fentanyl- or carfentanyl-laced heroin. If something, anything, can be used to save lives, then please, let’s put ideology aside and let’s do that. When used as a medication, prescribed by a physician, diacetylmorphine — prescription heroin — stabilizes brain function and allows the person to become well, stay well and, most importantly, stay alive. And this treatment is for those that are refractory to the other medications used to treat this medical condition. Methadone and buprenorphine don’t work for them. So, because those treatments failed, should we just discard the people?

According to the NAOMI study, the countries that have established heroin treatment programs — Switzerland, the Netherlands, the United Kingdom, Germany, Spain, Denmark, Belgium, Canada and Luxembourg — have all reported positive results for those individuals who are refractory to methadone and buprenorphine treatment.

It sounds radical, the provision of heroin to those addicted to heroin. But do understand, a drug is just a drug. It just does what it does. This controversy over using heroin as a treatment to control opioid addiction — it’s not about the data. It’s not about the research. It’s about stigma, ideology and people protecting their turf.

In a previous ADAW issue, Robert Lubran, then with the Substance Abuse and Mental Health Services Administration, stated, “It’s not difficult to find individuals who will prefer access to heroin over methadone maintenance treatment” (see ADAW, Aug. 31, 2009). He seems to believe this is a bad thing. I do not. If we can get more people into treatment, if heroin treatment will do that, how many lives can we save? And every life is someone’s son, it is someone’s daughter, and we would not only be saving them but also their mothers and fathers from the devastating loss of their child. We should be doing everything we can to keep them alive. And, yes, that includes treatment with diacetylmorphine.

The NAOMI studies show that, for those refractory to methadone or buprenorphine, heroin-assisted treatment is effective, with retention rates of about 88 percent. But there seems to be a problem. The acceptance of this form of treatment is opposed by some in the treatment field.

This is not a game. This is not a “my treatment is better than your treatment” contest. This is about saving lives. Heroin can produce addiction, or it can be used to stabilize (with medication) an addiction. It is how we use it that determines its effects. In this epidemic, we have an obligation to do everything we can to save lives. If the use of heroin-assisted treatment will do that, and the data show that it will, then please, put the ideologies aside, put the financial interests aside, push back on the stigma and let’s do everything we can to reduce the harm of this epidemic to those who suffer from this disorder of brain structure and function we call opioid addiction. Because every death, every loss, is someone’s son or daughter, and their lives are precious too.

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  • Meet the Editor

    Alison Knopf
    Editor

    Alison Knopf is a professional journalist who began covering the addiction field in 1984 as founding editor of Substance Abuse Report. She has been the editor of Alcoholism & Drug Abuse Weekly since 2005.
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