It is so frustrating to read about policymakers and their obsession with identifying the "numbers of heroin users." While they're busy counting, addicts are dying while on waiting lists for treatment.
Parents are burying their children at unprecedented rates. Policymakers need to act now to expand prevention, treatment and recovery services and to create policy and programs that save lives, rather than attempting to calculate the incalculable.
The Baltimore heroin task force misses the mark when they call for "better access to treatment." There is no "better access" to services that don't exist or are so backed up that access to them is severely limited. Family peer support volunteers at Heroin Action Coalition, which provides navigation services for those seeking treatment, are well aware of the enormous gap between those who need treatment and those who get it. They spend inordinate amounts of time working to place individuals on waiting lists for detox and recovery services that are woefully inadequate to meet the demand.
Parents attempt to save their children's lives by mortgaging homes and cashing out retirement plans or life savings to pay for expensive treatment in other states. They're sending away very sick, barely adult-age children who have never left home before. Quite often, these young adults will be blamed for their own failure in a system with little standardization or oversight — and often fraught with corruption due to unscrupulous, profit-seeking rehab providers who prey upon desperate families and provide little in the way of evidence-based best-practice therapies.
Gov. Martin O'Malley cut Maryland's treatment budget by $6.4 million recently, while at the same time promising to lower the overdose death rate by 20 percent. He's not provided any explanation as to how, but advocates are making some well-educated guesses.
The promotion of Methadone Maintenance Treatment (MMT) at the expense of treatments that promote abstinence, has become ominously apparent. MMT is significantly cheaper than abstinence based treatments, which focus on changing deep-rooted behavior patterns and typically require prolonged stays in residential programs in order to reach the desired outcome.
I recently attended a two-hour presentation, billed as a discussion of "Behavioral Health Integration" by Department of Health and Mental Hygiene (DHMH) Secretary Dr. Joshua Sharfstein in Frederick. Dr. Sharfstein and his wife, Dr. Yngvild Olsen, a methadone treatment proponent, spent a significant portion of the allotted time espousing the benefits of MMT.
In another attempt to shove MMT down the throats of consumers, the administration recently offered financial incentives only to halfway- and sober-living- houses that accept methadone patients, without equal incentives to halfway houses that support abstinence. For the administration to promote one form of treatment simply because it's cheaper for the state is grossly unjust.
Studies show that methadone causes more overdose deaths than any other opiate, and there's a higher rate of mortality among MMT patients from liver and respiratory diseases and homicide than from abstinence based therapies. Studies also suggest that MMT causes nerve damage in brain cells; deficits in learning, memory, attention and problem solving; and impaired capacity for emotional response. Other studies show a much higher rate of relapse among MMT patients then those who are in a long term abstinence based program.
MMT substitutes one drug for another — one that many perceive is more addictive and dangerous than heroin. Patients in MMT reach such high dosages that even if they wanted to switch to an abstinence program, they're unable to find a detox facility willing to accept them because the detox period for methadone is much longer and more excruciating than for heroin, and insurance will not pay for the extra time required to detox them. Hence, many methadone patients refer to it as "liquid prison."
Importantly, recovering addicts who abstain often complain that their own recovery is jeopardized when they witness others on methadone, obviously high and "nodding out," in their group therapy or 12-step programs.
Hopefully, the Baltimore task force will invite those who actually utilize the system, their family members and substance use disorder advocates to sit at the policy table — as opposed to the usual cast of characters: ivory tower policy wonks, mental health advocates without lived experience with substance abuse treatment and those with vested financial interests.
We cannot allow the pharmaceutical industry — from manufacturers to prescribers — to benefit at the expense of our families, our communities and our shared future.