When ideology and public health mix, everyone loses

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The practice of treating heroin addicts with methadone is hardly new indeed it s been common practice among addiction specialists for almost fifty years now. It is not a perfect solution, but it works pretty well. And the alternative is far worse.

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The practice of treating heroin addicts with methadone is hardly new indeed it s been common practice among addiction specialists for almost fifty years now. It is not a perfect solution, but it works pretty well. And the alternative is far worse.

Although years ago, the use of methadone was primarily intended to treat people who were addicted to heroin, the drug landscape has changed drastically in the US over the past few decades. While there are still plenty of heroin addicts, the commonest, often insidious opiate addiction now involves pills rather than injection drugs primarily those containing oxycodone (Percocet) and hydrocodone (Vicodin).

What to do? While we have often criticized the New York Times for a variety of issues, this time they were spot on: This very serious problem was discussed in the July 20th Times, in an editorial entitled Every Drug Court Should Allow Methadone Treatment.

Methadone is an imperfect solution to opioid addiction, mostly because methadone itself is a synthetic opioid, and also has abuse potential. Yet, the biggest problem in this case is not pharmacological, but rather, ideological and moralistic: that it is wrong to substitute one drug for another. Those adopting such a fundamentalist approach to this complex public health problem assert that complete abstinence is the only way to go; The addict must get clean.

This foolish and judgmental mentality is deeply ingrained in our legal system, and is guaranteed to cost more lives, so we applaud The Times for their position on this issue.

Perhaps worse is that there is nothing resembling a national (or even state) legal policy on methadone maintenance therapy (MMT). The Times demonstrates what can happen when no uniform guidelines are in place.

Judge Frank Gulotta Jr. (Nassau County, NY) forced Robert Lepolsky, a former heroin addict, who had not only kicked the habit, but was employed full time, to stop his MMT the only treatment that ever worked for him. Gulotta frowned upon the treatment option, saying that the treatment [did not enable Lepolsky] to actually [rid himself] of the addiction, and that he only permitted complete abstinence in his court. Deprived of MMT, Lepolski resumed narcotic used and died shortly thereafter from an overdose.

Gulotta s stance is hardly unique, since only half of judges who preside over drug cases permit any kind of maintenance programs. Unlike AA programs, abstinence rarely works for opioid addicts, so lumping them together is a recipe for disaster.

The Times points out, In the scientific literature, however, there s no question that maintenance works. Every expert group that has ever studied it from the Centers for Disease Control to the Institute on Medicine and the World Health Organization has determined that, for opioids, ongoing maintenance is superior to abstinence.

The Times editors urge that New York Governor Andrew Cuomo and New Jersey Governor Chris Christie sign bills that are now in front of them, which would force courts to allow maintenance treatment, something that makes perfect sense as a harm reduction measure.

We at ACSH agree wholeheartedly.

Dr. Gil Ross, ACSH director of medicine and public health, also agrees in no uncertain terms: It is not and should not be the role of Courts and judges to rule on what is essentially a public health issue. Every authoritative medical body, including the DSM code books that are so treasured by our federal medical panels, deem drug addiction to be a medical, not a legal condition, or a failure of will. Addicts, like other sufferers of disabling and often progressive diseases, need treatment based on what s best for them as well as for society in general. Harm reduction clearly works: abstinence only clearly does not, except for a fortunate few. Compassion and first, do no harm both require MMT for addicts, not jail time, and certainly not haphazard proscription by court edict from getting the best treatment and prevention we have.