I’ve been wondering about why we avoid medication in the treatment Opioid Use Disorder (OUD)  that has been proven to lower mortality rate by 50-70%, in favor of abstinence-based rehab which has… well, not as much nor as positive  documented efficacy.  In fact it’s clear that abstinence-based treatment of OUD increases mortality. In other words; a patient has a greater chance of dying upon discharge, than before treatment.  Since this makes no logical sense, I’m trying to understand why only 20-45% of residential programs even offer Medication.  Here’s a thought:

  1. Right now, read this statement out loud; ‘I understand concerns about antibiotics, but I haven’t heard of a better option. Not perfect, but what we have, for now.’
  2. Now, substitute [burpenorphine] for [antibiotics] then read it out loud again. If it feels any different, that’s called Stigma.
  3. Now substitute [Supervised Injection Facilities]; then, [methadone]; each in place of [buprenorphine]. Any discomfort is a result of our cultural biases/stigma; and not based on the strong medical evidence..

The Science-based medical/policy decision-making most likely to be effective, may sometimes feel uncomfortable, or even ‘feel wrong’. We need to use approaches that have been proven effective; our job is not necessarily to ‘feel good’. Science is true whether or not we believe in it.

As a professional familiar with the research supporting Medication treatment of OUD, I admit to feeling at times uncomfortable explaining it to a family. That’s a result of my own internalized stigma. We have also been influenced by the drug treatment industry, which is overwhelmingly abstinence based and warns us that ‘medication is not true recovery’. I accepted that for many years thinking, ‘they’re the experts, they must know what they’re doing’; until the drug overdose epidemic escalated and I saw people with OUD relapse so quickly after residential rehab without medication. I familiarized myself with the science, and learned that medication greatly improved one’s chances of recovery.

There are multiple paths to recovery, and some have gotten there through abstinence. More power to them. With OUD when the next use may be the last; do we really want to take that chance?