On June 21, the Vatican press office published the presentation made by Pope Francis to the 31st International Drug Enforcement Conference (IDEC) in Rome. The pope told the conferees, "The problem of drug use is not solved with drugs! … Substitute drugs are not an adequate therapy, but rather a veiled means of surrendering to the phenomenon." These comments represent an unfortunate, categorical rejection of "maintenance" treatment of opioid addiction with medications such as methadone.
In a secular field as complex and controversial as treating drug use and misuse, there inevitably is much about which people of good faith — of all faiths — will disagree. There is, however, one point on which all should be united: Those who want and need medical care for their addiction, and who with tragic frequency are destined to die without it, must receive not only our compassion but also treatment known to save lives. Accordingly, one can only hope (and pray!) that His Holiness reconsiders his position.
Addiction — whether to drugs or alcohol — has long been recognized as a chronic medical condition, much like diabetes, hypertension and chronic pulmonary disease. These illnesses, and many more, have in common that to a large extent they are caused and/or exacerbated by behavior, such as patterns of eating and drinking, smoking and failure to exercise. Furthermore, by definition, chronic medical conditions cannot be "cured" even though — happily — most can be treated with very considerable success. This most definitely is the case with addiction to drugs.
As Pope Francis urged so compellingly, we indeed must "say 'yes' to life, 'yes' to love, 'yes' to others, 'yes' to education, 'yes' to great job opportunities." While not detracting in the slightest from this compassionate, affirmative declaration, the fact is that medication-based help also is essential for many. And for our opioid-dependent fellow human beings, there is no more effective — life-saving — treatment than maintenance with methadone or similar medications. To cite a 2004 joint statement of three key United Nations agencies, including the World Health Organization: "Substitution maintenance therapy … can decrease the high cost of opioid dependence to individuals, their families and society at large by reducing heroin use, associated deaths, HIV risk behaviors and criminal activity."
Is it correct to label as "substitutes" medications utilized in the ongoing treatment of opioid dependence? Absolutely! They substitute help for abandonment. They substitute hope for despair. And for a great many — including the unborn — they substitute the prospect of a healthy life for a high risk of death.
Pope Francis noted in his remarks to the IDEC, "The Church … does not abandon those who have fallen into the trap of drug addiction, but goes out to meet them with creative love." In many instances, however, creative love must be accompanied by effective medical treatment, and over the course of almost a half-century no treatment has proven more effective than maintenance in achieving the goal so eloquently expressed by the Pope: helping those afflicted "to rediscover their dignity and to revive those inner strengths, those personal talents, which drug use had buried but can never obliterate."
An emphatic papal endorsement of all forms of care, including very specifically maintenance treatment of addiction, would have an enormous impact throughout the world and lead to saving countless lives — literally as well as figuratively. This is an extraordinary opportunity, and one that Pope Francis should seize promptly and forcefully.
Dr. Robert G. Newman is the former president and CEO of Beth Israel Medical Center in New York. In the early 1970s he established and directed the two largest addiction treatment programs in the world: the New York City Health Department Methadone Maintenance and Ambulatory Detoxification Programs, which served over 33,000 patients annually. His email is firstname.lastname@example.org.
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