Shame, methadone and recovery

The Boston Globe has an article on the shame that successful methadone patients carry.

It makes me sad to hear of anyone doing the deal feeling shame about being a recovering addict.

People with opioid addiction ought to have access to methadone, if that’s what they want. Without shame.

They also ought to have access to the gold standard for addiction treatment—the same care that an opioid addicted health professional gets.

They also ought to get accurate information about the various pros and cons of each approach.

For example, they ought to know that the gold standard demands a lot of the patient, and existing models have relied on using the health professional’s license as a contingency to maintain compliance with these demands. They also ought to know that the approach hasn’t been studied on the general population of opioid addicts because no one has been willing to invest in it.

They also ought to know that despite all of the arguments that research proves “methadone maintenance is the most effective treatment for opioid addiction”, the evidence base for methadone focuses on reduced drug use, reduced OD, reduced criminal activity and reduced disease transmission.

Bill White, a researcher and methadone advocate, summarizes the evidence this way:

As a professional field, we know a great deal about what methadone maintenance treatment can eliminate from the lives of patients, but we know very little from the standpoint of science about what it adds. In fact, we know very little about the stages and styles of long-term medication-assisted recovery.

This lack of quality of life evidence is exemplified by the Boston Globe article:

They come to this methadone clinic . . . at around 6 in the morning — a time set aside for working men and women to get doses before heading to their jobs. About 400 of the 4,000 patients here work full time.

10% work full time?

In the article, a successful patient points to the dosing line that forms after the employed patients have gone to work.

Josh, 29, gestured at the line of men and women waiting outside. Workers’ hour had passed. Some of the people there now looked broken and wasted, like the stereotype that persists even though we’re constantly hearing that addiction can strike anyone.

“Would you want those people in your house when you’re not home?” asked Josh, who installs central air. “Hell, no. People don’t see the flip side — the dental assistants, the lawyers, the doctors.”

I don’t want to interfere with access to maintenance and I don’t want methadone patients living with shame. At the same time, all the advocacy for maintenance treatments misses that there are real reasons for the persistent skepticism about them. When a lot of people look at the population of patients, they don’t see an outcome that they’d want for themselves or loved ones.

via Shame of methadone use clouds heroin addicts’ recovery – Metro – The Boston Globe.