“Sweet fire calling
” ‘You can’t deny me …’ ”
– Joni Mitchell, Cold Blue Steel and Sweet Fire
What’s the best treatment for drug addiction? The one that works. Unfortunately there is still a belief among too much of the population that the way to stop abusing drugs or alcohol is to just stop: “Just say no.”
That might help prevent someone trying drugs or alcohol (or tobacco) in the first place, but it’s poor regimen for ongoing addiction. Most people aren’t addicted because they want to be or choose to be. Addiction gets its hooks in you, and it can be almost impossible to stop on your own.
Some do. Some become star athletes or win the Nobel Prize for Chemistry. Dedication and hard work are components of such success, but there’s undeniably a genetic element as well. Your economic and social circumstances matter, too.
Because of these differences, substance use disorder treatment cannot be a one-size-fits-all program. Psychotherapy may be the most important piece of the puzzle, but it’s not the only one. Sometimes medication can play a role in easing detox – “cold turkey” can be fatal with some addictions – or substituting dangerous addictive opioids for less less dangerous and less addictive replacement opioids (methadone, buprenorphine or Suboxone), administered by a doctor.
Such medication-assisted treatment (MAT) is considered suspect by the same people who think addiction is a matter of will or morals, but there is plenty of science and evidence to support the practice. Equally suspect and equally proven practices include needle exchanges and safe-shooting sites.
If those practices are frowned upon by some, they’ll really hate HAT: heroin-assisted treatment, that is using pharmaceutical-grade heroin for heroin rehab instead of MAT with a weaker opioid. Why? Because it has worked, sometimes better than methadone or other meds, in specialized clinics in Europe. Even the National Institute on Drug Abuse (NIDA) agrees.
HAT reduces cravings and withdrawal symptoms longer than MAT, with a more pronounced improvement on mental and physical health. Illicit drug use also was more curtailed, and possibly less participation in criminal activity and risk of incarceration.
On the negative side, HAT is more expensive than MAT, according to the Drug Policy Alliance (DPA). Then there’s the fact that it uses actual heroin. But it’s pure heroin, no dangerous additives such as fentanyl or carfentanil that can easily turn the dosage lethal. Then it’s administered by a doctor, so if there is an overdose or other negative health reaction, it can be taken care of quickly and appropriately.
The US needs to overcome its fear of using drugs to fight drugs. Cannabis and some hallucinogens also may have addiction fighting properties. We need to explore all options to stop the wave of opioid prescription drug addiction overdoses.
