TOP DRUG EXPERT IN NY TIMES: IS THE OPIOID CRISIS WORSENED BY SCARCITY, LACK OF ACCESSIBILITY OF EFFECTIVE TREATMENTS? NO, IT’S A LIE
New York Times interview with top drug expert affirms that long established, effective gold standard substance use treatments for opioids, other drugs have been essentially unlimited in accessibility for decades, while deaths have persistently mounted
by Clark Miller
Published June 7, 2024
In this recent post, a more recently prominent rationalization for persistently more lethal opioid and other substance use epidemics was dispensed with by simply considering that for decades the most common, affordable (or free) and assured as effective, “gold standard” treatments by the media/medical complex, are in fact available to essentially everyone, just about everywhere in America, 24/7.
That necessary but patently false rationalization for medical, public health and institutional failures follows others that held up exactly as well – that it was The Fentanyl, or The Pandemic explaining unrelenting failure and mounting deaths, trends existing pre- fentanyl and pre-, during, and post-pandemic.
We may anticipate that rationalizations next in line are Putin, China, Trump, or college protesters driving continuing substance use crises.
In a new interview in the New York Times one of America’s top drug and drug policy experts confirms that treatments that are available not just through your doctor by phone or telemedicine interview, but essentially everywhere, affordable or free in communities, without any need for a prescription, are in fact the gold-standard, industry standard, established as effective treatments that cure opioid and other substance use problems.
The interview by Ezra Klein was published May 10, featuring Dr. Keith Humphres, professor at Stanford University who specializes in addiction and drug policy and served in the Obama administration as advisor on drug epidemics and policy, as well as providing expert drug and treatment policy and guidance in the UK and elsewhere.
Somewhere past about the mid-way mark of the extensive interview, Dr. Humphreys is asked about effective treatments for compulsive opioid use and other substances involved in America’s lethal epidemics.
He corrects Klein’s statement that suggests that “We don’t have really good treatments for addiction”, explaining that in fact we do, and that the prescriptions of and participation in Alcoholics Anonymous (AA) “does work”, is actually “one of the best things we have”, reflecting the consensus saturating media, social media, entertainment, treatment industry, medical, and public health sources.
Although Dr. Humphrey’s comments were in the context of problem alcohol use, anyone familiar with AA and its approach knows that the “steps” and other program prescriptions and features are inherently generalizable and foundational, confidently applied not only to all potentially addictive substances but to behaviors as well, such as overeating, gambling and others. The approach is just that effective.
Shifting to the opioid crisis, Dr. Humphreys shared his research-based knowledge that buprenorphine (Suboxone, Subutex) is, like other medication, “effective for a great many people” in curing opioid addiction, and “So those things are all good. That’s considered the front line. You offer people medication first”.
Those gold-standard, proven treatments for substance use were the focus of the recent post here examining the rationalization of scarcity and lack of accessibility of effective treatments in the face of inexorably worsening lethal opioid and other substance use epidemics.
From that post –
“Who needs Suboxone? I got Suboxone,” said another man, who was apparently trying to sell the brand name medication for addiction treatment.
That’s from an “on the street” report from wbur reporter Deborah Becker late October of last year, about 4 months ago, from the “Mass. and Cass” area of homeless encampments and methadone clinics in Boston.
It is illustrative of the inconvenient and downplayed phenomenon known and established for decades for every American city, for every area in the U.S. where there is illicit drug use and trade.
American Medicine’s gold standard “addiction treatment medication” Suboxone (“subs”, “bupe”) is one of the most widely diverted, available, in demand, used and abused, traded and bought or sold drugs in America’s illicit street and prison economies of illicit opioid and other drug use. That’s been known and established for decades, described additionally here and here (scroll down to “The bupe economy”).
If you’re familiar with these areas of the role of Suboxone as consumable, commodity, and currency, including for fentanyl, in lethal economies of illicit drug use, scroll down to the next section, headed, “Back to our current post”.
The important and fundamental point is that for decades, from the beginning, “bupe” has been in those economies, pervasive, easily obtained, and cheap, as partly described in a recent post.
Here, for example, is another on the street description of the longstanding bupe economy from a few years ago.
“Subs. Who needs subs?” a woman called out quietly near the intersection of Kensington and Allegheny avenues on a recent afternoon. She had to be careful. This district, on the northern fringe of the city’s so-called “Badlands,” is clustered with loosely organized crews hawking pharmaceuticals from Percocet to Adderall. Drawing attention could get her banned from the corner, or possibly worse.
Like many people who are dependent on opioids in Philadelphia, the woman was freelancing—likely selling off the last of her own prescription for the popular opioid substitution medication for money to purchase heroin/fentanyl. It’s something I’ve seen countless others do during my time covering the overdose crisis.
A passer-by inquired how much. “Five dollars,” came the reply. The man kept walking. “Wait, wait,” the woman said. “Give me three.”
And with that, the man acquired his Suboxone at less than half the retail price of a customer paying in cash at their local pharmacy. . . .
Meanwhile, diverted “subs,” as they are still universally known on the street, are all over Kensington, where the sublingual orange-flavored strips typically sell for $10 a piece, equal to the cash price of the drug at pharmacy chains like CVS or RiteAid. (The pills, which are less desirable because they’re harder to split and reportedly make the mouth water, generally sell for half the price of a strip on the illicit market).
Subs are now the most commonly sold pharmaceutical here. And unlike Xanax or Percocet, which are often counterfeit pressed pills that sometimes contain fentanyl, all of the subs on the streets are diverted from legal channels. . . . Several street-level sources have told me that subs’ illicit availability has made “chipping” (using heroin only occasionally and filling in with burprenorphine) possible for them for the first time. Others carry a strip or two with them to ease the symptoms of withdrawal in jail (or turn a quick profit for the commissary) in the event they are arrested. A single 8 mg strip of Suboxone costs as much as $80 in county jail, and is typically cut into tiny pieces to maximize return. . . .
One thing seems certain though, given the sheer abundance of the drug on the street: Many people who have a prescription for Suboxone, who may get it free through county medical assistance or at a reduced cost through the Obamacare exchange, are not taking it.
There are some facts that are inescapable including these – that essentially anyone, of any age, who has come to compulsively use opioids – more true the more severe, longstanding, and most importantly risky that compulsion and use – will know how and be able to obtain licit or illicit Suboxone, free or so cheap as to almost be free. Suboxone, America’s proven, addiction treatment medicine that stops urges to use other opioids, takes that risk away, ends the compulsive need to use opioids in high-risk ways. That’s why it is, like methadone, a “miracle” drug.
Right?
Let’s think about that, trying to imagine the experience of becoming dependent on opioids, gaining tolerance, needing to use daily to avoid being dopesick, experiencing some level of severity of the problems that are associated, from loss of relationships, to legal problems, problems holding a job and functioning, to high-risk use, risk of infectious disease, and increasingly of accidental death, or homelessness and desperate misery.
And, all it would take – we know because America’s experts have assured us, the assurances everywhere we read and look – would be to spend a few dollars each day, take a sublingual strip or pill or two, and . . . that’s that. No more cravings, no more dopesick, no more overpowering, distracting impulses to find and use dope, because that’s gone, prevented by the medical cures buprenorphine and methadone.
A pill or two a day, a few dollars, and you’re free of all that. Because the truth is, American Medicine’s opioid addiction cure is everywhere and cheap. It’s like having a grave medical condition that is debilitating and with the real possibility of sudden death, like heart disease, and the option of going into remission, regaining health and functioning, essentially eliminating risk of death due to the condition, by paying a few dollars a day for pills easily available in your community even if you can’t get into a treatment setting to get them, taking a pill or two each day. Knowing they’re safe and the dose determined, like the Suboxone strips in the package. You get your life back. Would you have to think about it?
There is no scarcity. The medical cure is everywhere, safe, and cheap.
That brings us to another deception, a really huge one, hidden behind a sheen of lies, institutional normalization, and mass media portrayal, a deception driving America’s increasingly deadly substance use epidemics.
The essential core, the universal programming, of almost all addiction treatment programs in the U.S. not only forms the mainstay of programming in private and publicly funded programs, but is available without charge, in every city, nearly everywhere, everyday, with free online meetings, available to anyone and everyone. It is so established as the norm for addiction treatment that courts every day – imposing risk of serious criminal justice penalty and violating constitutional rights of each mandated individual – force individuals facing charges to attend and engage in the practices and prescriptions of the meetings.
Most importantly – this treatment is not in short supply, not limited instead is, like the medical cure buprenorphine, available everyday, nearly everywhere, and even better than bupe, is free.
It is literally nearly impossible to locate a treatment program in the U.S. that does not describe itself as “12-step based” or in any case rely on 12-step groups and programming as its core provision of treatment.
It is the “gold standard” of American substance use treatment, a typical program describing its services patients will experience with descriptions like these:
12-step meetings six days a week
Obtaining and working with your sponsor to construct your own recovery program
There are many challenges to overcome when you first get clean and sober. Where will I find meetings?
A “sponsor” is a member of the religious subculture AA (Alcoholics Anonymous), a person with no training, background or ability to provide therapy, assessment, case management, counseling, or any other service that potentially would have benefit for someone affected by problem substance use.
And describing overall treatment and recovery approach with descriptions like this:
During your first month, you’ll be expected to look for employment or attend school and participate in group and individual sessions. You’ll also need to find a temporary sponsor.
That’s how central and defining of treatment in America the practices of AA are – it is treatment.
It must be highly effective!
That’s why -think about it – in the manufactured consensus of rationalizations for opioid overdoses and deaths continueing to surge through the COVID pandemic, it was conveyed without dissension or deviation in media accounts that a large factor in the pandemic-period mounting deaths was that AA participants under restrictions were not able to attend in persons their recovery treatment meetings. If only they had been able to, things would have been different, by addiction expert consensus.
So clearly, AA recovery meetings and associated engagement including working with a sponsor do constitute the core of addiction treatment in America, so much so that when restrictions curtailed continuous involvement, opioid overdoses and deaths surged.
The very important truth and point for our consideration in this post is that, just as America’s gold standard addiction treatment medication is available at negligible or no cost essentially everywhere, always and to everyone as distinct from being scarce or unavailable, so too America’s gold standard nonpharmacological recovery treatment for addiction is available at no cost, essentially everywhere in-person, or online, every day, to everyone.
And there’s more – acolytes in this gold standard treatment religious subculture will be provided and encouraged to use the services of a counselor and case manager all rolled into one – their “sponsor” – who will not only provide the therapeutic guidance treating addiction, but will serve as a resource for solving problems in living and to link to other community resources. And be available for urgent needs, by phone call. Sponsors provide, in effect, individual therapy sessions, aimed specifically at addiction and working through the 12 Steps. Please remember – this gold standard treatment is established by expert opinion and widespread media messaging as effective, adopted by America’s addiction treatment system as core treatment programming.
If these features of the AA and NA religious subcultures were not effective in addition to being unversally available and free, we wouldn’t be using public healthcare dollars to employ “peers” whose jobs are largely to provide rides and shepherding of those who are coerced or court-mandated to the meetings.
Back to our current post –
Let’s not ignore or leave out elements for our consideration of these questions that have the most value – those conveyed over the course of America’s lethal opioid and substance epidemics by the most credible and trusted sources, America’s health and research experts and the medical and major media outlets vetting information for the benefit of an increasingly at risk public.
A search of information on opioid medication assisted treatment (MAT) effectiveness would necessarily reveal, for example, that it is established as an effective stand-alone cure for opioid addiction, without the requirement of accessory or “adjunct” treatments, like counseling. In fact, any such requirements have been seen as barriers, inhibiting individuals needing treatment from accessing the “proven“, life-saving cure buprenorphine. Simply taking a dose of the medication daily is sufficient, because it takes away the cravings that can lead to high-risk opioid use. Naturally, it must be sufficient, or experts, regulators and institutions would never have relaxed safety and monitoring standards to make it so easy now to get – as easy as a phone call.
So, someone obtaining bupe to stop their opioid addiction should do just as well finding it in their community without a prescription as they would by initial telemedicine call then picking it up at the pharmacy. And with less risk of stigmatization, a huge factor according to our experts.
And another point from a top expert, Dr. Humphreys, who has found that individuals accessing the therapeutic treatments of AA (or NA) do just as well or better than by having sessions with someone like him, a trained PhD psychologist! And AA is free!
Let’s think about that. Try getting in to see a qualified psychologist or lisenced therapist these days! And costs can be $150 to $200 or more for a weekly session.
Not only is AA free, but it’s everywhere. In any sizable town there are meetings daily, and in sizable cities multiple meetings through each day, along with the other supports associated with AA involvement, noted above. Now, with virtual meetings available online, accessibility to this gold standard, effective American addiction treatment model is truly unlimited.
So, the scarcity and lack of accessibility rationalization for increasingly lethal epidemics is, to say it directly, a lie.
It must be something else, something obscured, factors that cannot be seen.
