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2012′s most popular posts #8 – Another Reaction to Hazelden’s Adoption of Suboxone

Posted Jan 05 2013 6:38am

Perhaps I’m the Wrong Tool by Tall Jerome

Mark Willenbring, a former Director of the Treatment and Recovery Research Division of the National Institute on Alcohol Abuse and Alcoholism/National Institutes of Health weighs in on Hazelden’s embrace of Suboxone

Hazelden’s new approach is a seismic shift that is likely to move the entire industry in this direction. I told Marv that it was like the Vatican opening a family planning clinic! However, although this is a major positive step, they continue to be wedded to a strictly 12-Step approach along with the medication. I don’t see this ever changing. Hazelden has always seemed to operate like a Catholic hospital: science was ok as long as it didn’t conflict with ideology, and when it did, ideology won out.

His post betrays the trope that 12 steppers control the treatment world.

What are the beliefs driving his celebration of buprenorphine maintenance? In another post he offers what he believes should be the informed consent statement offered to opioid addicts entering treatment. [emphasis mine]

The only treatment proven effective for treating established opioid addiction is maintenance on a medication such as Suboxone or methadone, often with adjunctive counseling. Studies show that maintenance treatment reduces illness, mortality and crime, and is highly cost-effective. Therefore, it is the first-line treatment and the treatment of choice. There is no evidence of effectiveness for abstinence-based treatment.”

Wow. “The only treatment proven effective“? “There is no evidence“?

Mark Willenbring is a doctor. What kind of treatment would he receive if he became an opioid addict? Would he get Suboxone maintenance?

No. He would not.

Why? We don’t treat doctors with Suboxone maintenance. They get abstinence-based treatment .

Wait, what!?!?!? They get treatment for which there is “no evidence of effectiveness”?!?!?!?

Actually, there’s evidence that they have great outcomes with abstinence-based treatment .

All of the finger wagging about maintenance as the treatment approach with the strongest evidence-base raises some important questions:

  • Why do the most culturally empowered opiate addicts with the greatest access to the evidence base reject this evidence base with respect to their own care and the care of their peers?
  • What does this say about the evidence and its designation as an evidence-based practice? That this evidence doesn’t offer a complete picture?
  • What does it say that health professionals get one kind of treatment and give their patients another?
  • Why are some addiction physicians and researchers so indignant when others question their advocacy of a treatment approach that they and their peers refuse to use on themselves?
  • Does this advocacy of a medicalized approach have anything to do with the fact that they are indispensable in this medicalized approach?
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