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1/16/2017 12:00 AM

Last week, President-elect Donald Trump told reporters he considers any friendship with Russia an “asset,” and his fondness for the country — and, in particular, Russian President Vladimir Putin — is well-known.

But the two countries have very different approaches to opioid addiction. Russia bans methadone and buprenorphine treatment, and Putin closed all opioid treatment programs in Crimea after annexation, and Trump does not always listen to science. So we spent the past several weeks trying to find out what, if any, influence Russia and Putin could have on Trump’s thinking on treatment for opioid addiction.

Last week, President-elect Donald Trump told reporters he considers any friendship with Russia an “asset,” and his fondness for the country — and, in particular, Russian President Vladimir Putin — is well-known.

But the two countries have very different approaches to opioid addiction. Russia bans methadone and buprenorphine treatment, and Putin closed all opioid treatment programs (OTPs) in Crimea after annexation, and Trump does not always listen to science. So we spent the past several weeks trying to find out what, if any, influence Russia and Putin could have on Trump’s thinking on treatment for opioid addiction.

“Substitution therapy is against Russian law, just as it was in the United States between the 1920s and the late 1960s,” said George E. Woody, M.D., the University of Pennsylvania researcher on substance use who worked on the Russian Vivitrol study. He had been in a meeting in Moscow two months before we spoke to him in December, and said he saw no indication that the law would be changed.

Although there is a legal restriction against providing opioids to individuals who are opioid-dependent in Russia, buprenorphine can be prescribed for pain management for cancer patients, said Thomas Kresina, senior public health advisor in the Division of Pharmacologic Therapies of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA), who helps provide technical assistance to countries receiving PEPFAR (President's Emergency Plan for AIDS Relief) support related to substance abuse treatment and HIV. We talked to him instead of Kevin Mulvey, who is SAMHSA’s person in Kiev, and who was waiting to get approval from the embassy in Ukraine to speak to us. “I’m not clear if methadone itself is illegal in the Russian Federation, or if it could be used like buprenorphine in pain management, but all prescribers know it is illegal,” said Kresina. “Methadone is so stigmatized in the Russian medical community that I doubt anyone would use methadone for pain management.” As an aside, Kresina noted there is street methadone in Russia that is trafficked illegally there.

In fact, Russia never adopted agonist treatment, but the government does fund more than 25,000 inpatient beds for detoxification and treatment, Woody told ADAW. “These are free and have no apparent restrictions on length of stay or readmissions,” he said, noting that this is many more free beds than exist in the United States. “The problem is the high relapse rate after they leave, unless they are started on extended-release naltrexone, which is not widely available due to its cost.” Detoxification beds are widely available throughout the country, he said. Availability of extended-release naltrexone "is mostly confined to programs in Moscow and a few other places that have funds to purchase it." 

The last needle exchange in Moscow

“Why is there no methadone and buprenorphine in Russia, and why so much booze?” asked Anya Sarang, director of the Andrey Rylkov Foundation for Health and Social Justice, a grassroots organization for HIV and overdose prevention and the only group offering free needle exchanges in Moscow. “During the Soviet times there was a big opposition to the West and Western ideas, and the Russian narcologists were really against substitution treatment,” said Sarang, whom we reached via Skype in Amsterdam last month. There was some discussion of methadone in the 1990s, but no proposals that would allow for a clinical trial, she said. When Putin came to power in 2000, the ideology didn’t change. “There is no light at the end of the tunnel that Russia will change,” she said. However, there are some harm-reduction programs, first instituted in 1997–1998, involving needle exchanges and referral to testing for HIV, which is a very big problem in Russia. But by 2009 and 2010, the harm-reduction programs started getting clamped down on, and last year the Andrey Rylkov Foundation was labeled a “foreign agent” by the Russian government.

The Russian government never supported harm reduction financially, but before 2009, at least there was no open opposition, said Sarang. And there was initially some promise with government funding for HIV prevention. Asked why, she said “it’s the same reason why the programs weren’t funded in the first place — ideology and the conservative stance of the government.” And here’s the darker side: Officials don’t say it in Russia, but the common understanding is that the policy of the health ministry is to imprison injecting drug users, said Sarang. “People die of AIDS; we have a huge HIV epidemic and a rise of AIDS deaths,” she said. “We have no rehabilitation, and in prison, many people have HIV already, many get tuberculosis, and many die of AIDS.” In Russia, most people with HIV are drug users, she said. “We have to send some clients to Ukraine,” she said. “There’s no way for them to survive in Russia, but in Ukraine, they can get a combination of treatments.”

There is methadone in Ukraine, except in Crimea, which is no longer part of Ukraine but rather part of the Russian Federation since annexation. “The federal drug control service of Russia came and said all methadone programs would be shut down in Crimea,” said Sarang. “There were some attempts at negotiation with UNAIDS [Joint United Nations Programme on HIV/AIDS], but this was unsuccessful.” For a few months, as programs were shut down and patients didn’t receive help, there were deaths — 800, said Sarang. But propaganda kept this from the West. “The U.N. Special Envoy on HIV in Eastern Europe received an official note from the Minister of Health that this is all lies and that actually people used to die even before methadone was closed,” said Sarang. “There was a diplomatic scandal, and after that, all access to data has been shut down. There was no official kind of investigation around these deaths.”

‘Badly managed’ health system

People on the ground in Russia know that “the public health system is very badly managed,” said Sarang. “There is no area in public health where people don’t complain.” But all of the power is in Putin’s central administration, she said. Local authorities are afraid of being punished by the health department, she said. “Unless you are an activist organization like ours, you don’t do it,” she said. “The local administration says, ‘Yes, yes, I understand it is bad, we have an HIV epidemic, but we cannot do harm-reduction programs here.’”

Her group does outreach every night, usually near pharmacies where people buy the eyedrops to dilute heroin with, said Sarang. “We see maybe 10 to 30 people a night, give them syringes, condoms, health information, rapid testing for HIV, counseling and legal aid,” she said. Her work is currently funded by the Global Fund to Fight AIDS, Tuberculosis, and Malaria, but taking foreign funding puts the group at financial risk. “We are the last advocacy and, to be honest, quite loud organization,” she said.

AATOD and ASAM

Mark Parrino, president of the American Association for the Treatment of Opioid Dependence (AATOD), is more concerned about who is going to head the Office of National Drug Control Policy (ONDCP) than about any connection between Russia and Trump. “If it’s a person who takes a dim view of medication-assisted treatment, that would be troublesome,” he told ADAW last month. “I can’t imagine that Trump would take any particular position to diminish OTPs, unless he has an adviser like a Giuliani type.” (Rudolph Giuliani, originally thought to be a contender for attorney general, tried to shut down OTPs in New York City when he was mayor.)

Could Trump shut down OTPs? “No, he can’t,” said Parrino. “You can’t shut down OTPs, and you can’t require patients to go on Vivitrol.”

Parrino said he couldn’t even imagine that someone would issue a directive to “de-operationalize OTPs or require them to change medication.” Ultimately, he asked, why do it? “It would be too insane,” he said, “even if Trump doesn’t understand the science.”

However, Parrino does think the Trump administration would be interested in eliminating the regulation limiting the number of patients a physician can treat with buprenorphine.

For the American Society of Addiction Medicine (ASAM), lifting the patient cap is indeed a hopeful sign of a Trump administration.

And Vivitrol is likely to be favored by many in the United States who do not like agonists, having the same biases that are seen in Russia.

Vivitrol

Indeed, Vivitrol, first approved in the United States to treat alcohol use disorders, was tested in Russia as a treatment for opioid use disorders. As Daniel Wolfe of the Open Society Foundations pointed out in The Lancet six years ago, Russia was one of the few places in the world where it would have been ethical to conduct a randomized controlled trial with Vivitrol and not include a comparison to the two medications proven to be effective for opioid use disorders (see ADAW, May 9, 2011). It would not have been ethical to give patients Vivitrol compared to nothing in a place where medications that work were available. To this day, that fact has created questions in the treatment community about the real effectiveness of Vivitrol. The criminal justice community, which has a bias against agonist medications, does approve of Vivitrol.

And while Vivitrol meets the ideological needs of the criminal justice system, some policymakers in the United States, and the Russian government, it’s expensive, doesn’t work unless people keep getting the shots and has questionable effects on craving (see ADAW, March 7, 2016).

The global view

While politics shouldn’t guide science, policymakers have their own ideas. And, unfortunately, they often consult themselves instead of scientists when it comes to addiction, say medical officials. “Often policymakers are unaware of or ignorant about addiction,” said Gregory Bunt, M.D., president of the International Society of Addiction Medicine, the global counterpart of ASAM. “HIV prevalence has more than quadrupled and the opioid epidemic is raging out of control in Russia,” said Bunt, who is a clinical assistant professor in the Department of Psychiatry at the New York University School of Medicine. He noted that ignorance among policymakers is not limited to Russia. “It’s also true in the United States,” he said.

Incarceration is not treatment, and both the United States and Russia have a long way to go on that, although access to evidence-based treatment is much more accessible in the United States, said Bunt. “We need to increase access to treatment,” he said.

At the United Nations conference last spring (see ADAW, April 25, 2016), it was understood that treatment must be a priority, said Bunt. Vladimir Poznyak, M.D., Ph.D., the head of substance abuse management for the World Health Organization, has laid out a manual for the U.S. State Department that clarifies that addiction is a treatable disease. “The problem we identified is that the amount of resources devoted to interdiction, prosecution and corrections far surpasses the amount of resources devoted to treatment,” said Bunt. “The problem can’t be solved by the criminal justice system only. But treatment providers understand that under various governments, they have to work within the system. That’s true in the United States and it’s true in Russia.”

So who supports the regime in Russia that is leading to an increase in HIV, AIDS and addiction? “I talk to my circle of people and they say there is 99 percent support of Putin in Russia, but I don’t know anybody who supports Putin in Russia,” said Sarang. “Maybe somebody is happy, but we just don’t know these people.”

Bottom Line…

It’s too soon to say what a Trump presidency will mean for methadone and buprenorphine, but the anti-agonist Russian model has proven disastrous for that country in terms of addiction and HIV/AIDS.

12/19/2016 12:00 AM

It appears that the more than 650 psychiatrists and other health professionals who attended this month’s American Academy of Addiction Psychiatry annual meeting are expending more energy trying to excel in the current drug treatment system than projecting whether a new system altogether might soon emerge.

It appears that the more than 650 psychiatrists and other health professionals who attended this month’s American Academy of Addiction Psychiatry (AAAP) annual meeting are expending more energy trying to excel in the current drug treatment system than projecting whether a new system altogether might soon emerge.

Prospects of major policy shifts under a new president and Congress affected but did not dominate the discussion at the Dec. 8–10 AAAP annual meeting in Bonita Springs, Fla. “There was more of a push to understand the current system, so that providers can be more effective regardless of what might happen in the future,” Carla Marienfeld, M.D., an addiction psychiatrist and co-chair of the AAAP’s Program and Scientific Committee, told ADAW.

Discussions at the conference conveyed a sense that the opportunity of the Affordable Care Act (ACA) has not been fully realized for many individuals with substance use disorders, and that too few people in need have access to the most evidence-based treatment approaches, particularly medication treatments for opioid use disorders.

“Although coverage rates have dramatically improved for some populations, many patients with severe [substance use disorders] have yet to receive care due to lack of providers and a fragmented treatment system,” Arthur Robin Williams, M.D., fellow at the Columbia University Division on Substance Use Disorders and a conference co-presenter, told ADAW. “Many patients with [opioid use disorders] who receive treatment do not receive evidence-based care with maintenance treatment such as buprenorphine or methadone.”

Thinking more broadly

Marienfeld, an associate professor at the University of California, San Diego, said that while she senses attitudes among physicians shifting, doctors haven’t traditionally seen themselves as agents of understanding the workings of a system of care. “The opioid epidemic represents a really important challenge to the traditional ways of providing care on an individual level,” she said.

Addiction psychiatrists, Marienfeld says, are uniquely positioned to address the commonly seen substance use and mental health comorbidities that integrated approaches to care can successfully treat. That is why there was some disappointment, she said, that the recent U.S. surgeon general’s report on substance use didn’t address the mental health comorbidity issue to a great degree.

More than 650 professionals attended the regular AAAP meeting, with another 200 participating in an addictions and treatment course. Marienfeld said participants were particularly energized by the opportunity to apply current data to their everyday practice needs. Some of the more clinically oriented sessions at the meeting addressed research on attempts to quit cannabis use and progress in understanding how the use of appetitive hormones could assist in the treatment of alcohol use disorders.

The symposium for which Williams copresented was titled “How to Realign the Drug Treatment System Under the ACA in Response to the Overdose Epidemic.” He said that one of the key takeaways from his presentation was that attempts to integrate behavioral health and primary care services might not be sufficient to help individuals with the most severe opioid use disorders and the highest level of disruption in their lives.

“Specialized provider networks such as those developed under Vermont’s hub-and-spoke system and Massachusetts’ nurse care management model likely hold more promise for connecting with patients with [opioid use disorders] and stabilizing their opioid use,” Williams said.

Williams focused his symposium remarks on a systems perspective on the ACA. Other topics addressed by his co-presenters included the integration of medication treatment into systems-based practice, combining medication-assisted treatment and 12-Step approaches, and sociocultural factors that affect access to treatment.

Williams cited several recent statistics that illustrate the magnitude of the overall access problem. He stated that only between 20 and 40 percent of patients with an opioid use disorder have received treatment in the past year. Access to maintenance medications is similarly limited.

In addition, he said that according to a study published this year, “the average patient received buprenorphine for only 53 days despite the evidence suggesting buprenorphine maintenance of a minimum one to two years is most effective at preventing relapse.”

What the future holds

Asked what he communicated to the AAAP audience about what it could expect from an incoming administration that has vowed to dismantle the ACA, Williams said that President-elect Trump and his nominee to head the Department of Health and Human Services, U.S. Rep. Tom Price, “both have made comments about giving states more control over experimenting with health care reform.”

Williams continued, “If so, the states can build on prior efforts under Medicaid waivers to loosen restrictions on reimbursement for substance abuse treatment and better incentivize quality care.” Examples of such quality variables could include the percentage of opioid use disorder patients on a form of medication-assisted treatment, or the percentage of patients retained in treatment at six months, he said.

Marienfeld said the conference audience appeared to be mainly focused on the present. Regarding the impact of possible policy shifts in Washington, “It takes a long time for these things to trickle down to everyday changes,” she said.

She added that rather than hearing much buzz about expanded capacity to prescribe buprenorphine, she heard more addiction psychiatrists expressing concern that appropriate education be provided to the physician extenders who now will be allowed to prescribe the medication.

“The increase to 275 [patients] will be meaningful in those systems that are already capable of handling that volume,” Marienfeld said. “An individual physician cannot handle 275 patients on their own.”

With an estimated 1,400 addiction psychiatrists practicing across the country, the AAAP meeting turnout represents a large proportion of the entire discipline. “While we’re getting more attendance, it still feels like a small community of folks getting the opportunity to talk to each other,” Marienfeld said. “This provides a network of support, for people who in some locations are the only addiction specialist.”

Bottom Line…

Attendees of this month’s annual meeting of the American Academy of Addiction Psychiatry appear focused on maximizing present opportunities in health reform, with many patients still lacking access to evidence-based treatments.

12/19/2016 12:00 AM

The treatment provider salary survey conducted by the National Association of Addiction Treatment Providers (NAATP) was released to contributors last week. It will be made available to all NAATP members in 2017 and later offered for sale to the public. A copy was made available to ADAW.

The treatment provider salary survey conducted by the National Association of Addiction Treatment Providers (NAATP) was released to contributors last week. It will be made available to all NAATP members in 2017 and later offered for sale to the public. A copy was made available to ADAW.

This is the first salary survey released by NAATP since 2012 (see ADAW, April 11, 2012). This tool is expected to help providers attract top talent and provide quality care, according to Marvin Ventrell, NAATP executive director.

Data for the 2016 salary survey was collected online, via a survey hosted on NAATP’s website. Data collection began on Sept. 5 and ended on Oct. 16. A total of 69 organizations/branches participated in the survey. This is the same number of organizations as participated in the 2012 salary survey, but lower than participation in some of the NAATP salary surveys of the past. Greater participation in past surveys was largely due to collaboration with other organizations, whereas for 2012 and 2016, only NAATP members participated.

Some general information: Most (59 percent) of the overall reimbursement came from health insurance, followed by self-pay (25 percent). Most of the capacity was adult outpatient (average 918) followed by adult inpatient (178), adolescent inpatient (7) and adolescent outpatient (1).

The survey includes detailed information about benefits and more. Below is a summary of some of the findings.

  • CEO/executive director — average: $236,536, minimum: $66,000, maximum: $546,000
  • Chief operating officer/director of operations — average: $166,585, minimum: $50,000, maximum: $323,462
  • Chief financial officer/director of finance — average: $145,648, minimum: $85,000, maximum: $311,000
  • Chief compliance officer/compliance director — average: $164,358, minimum: $48,000, maximum: $434,000
  • Internal auditor — average: $68,075, minimum: $35,000, maximum: $93,000
  • QA/QI/UR director — average: $81,663, minimum: $48,000, maximum: $138,695
  • HR director — average: $86,895, minimum: $28,000, maximum: $211,640
  • Marketing director — average: $108,878, minimum: $42,483, maximum: $222,183
  • Nursing director — average: $95,865, minimum: $95,000, maximum: $156,811
  • Program director — average: $83,437, minimum: $13,908, maximum: $171,392
  • Director of development — average: $104,563, minimum: $57,400, maximum: $162,067
  • Intake/admissions director — average: $74,607, minimum: $30,000, maximum: $145,000
  • Food services director — average: $64,643, minimum: $42,000, maximum: $112,000
  • Housekeeping director — average: $56,757, minimum: $29,000, maximum: $105,000
  • Facilities/grounds director — average: $64,647, minimum: $30,000, maximum: $150,000
  • Compliance director — average: $86,460, minimum: $30,000, maximum: $174,677
  • Information systems director — average: $98,394, minimum: $52,500, maximum: $208,588
  • Business office manager — average: $62,439, minimum: $30,098, maximum: $95,000
  • Alumni coordinator — average: $48,975, minimum: $35,000, maximum: $80,000
  • Physician — average: $194,893
  • Psychiatrist — average: $191,989
  • Physician’s assistant — average: $110,225
  • Ph.D. psychologist — average: $92,605
  • Registered nurse — average: $63,622
  • Nurse practitioner — average: $97,471
  • Counselor (certified, no degree) — average: $39,776
  • Counselor (certified, bachelor’s) — average: $43,830
  • Counselor (licensed, master’s) — average: $52,898
  • Intake/admissions counselor — average: $40,707
  • Case manager — average: $38,714 
  • 24-hour residential unit staff — average: $31,784
  • Registered activity therapist — average: $44,483
  • Family therapist — average: $54,891
  • Executive assistant — average: $45,694
  • Secretary — average: $31,319
  • Receptionist — average: $29,312
  • Marketing representative — average: $65,131
  • Billing clerk — average: $39,430
  • Information systems support — average: $48,363
  • Accounting support staff — average: $48,800
  • Outreach specialist — average: $49,353
  • Alumni support staff — average: $37,272
  • Housekeeping — average: $24,899
  • Food services — average: $26,854
  • Insurance support staff — average: $45,038
  • Maintenance staff — average: $35,000

The 2016 salary survey contents include:

  • Survey Participants
  • Location
  • Annual Gross Revenue
  • Organizational Profit Structure
  • Organizational Classification by Type of Facility
  • Type of Treatment Provided
  • Service Area
  • Affiliations, Licenses and Memberships
  • Organization Services Delivered
  • Sources of Revenue
  • Facility Capacity
  • Number of Clinical and Medical Staff per Type of Patient
  • Benefits
  • Paid Time Off
  • Annual Salary Increases
  • Health Insurance
  • Other Health Benefits
  • Additional Employee Benefits
  • Cost of Employee Benefits
  • Cost of Health Insurance
  • Executive Benefits
  • Staff Characteristics
  • Total Staff
  • Staff Demographics
  • Executive and Management Staff Demographics
  • Contractors
  • Salaries
  • Executive Positions
  • Management Positions
  • Clinical/Medical Staff
  • Support Staff

Salaries are given in average, median, minimum and maximum amounts, with the number of providers responding, and represented, indicated. In many managerial positions, whether the program was profit or not-for-profit affected average salaries.

The next NAATP salary survey of addiction treatment providers will take place in 2018.

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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