Earlier this year, Maia Szalavitz reported on drug-court judges' refusal to allow defendants to continue their maintenance treatment, putting ailing individuals at risk for recidivism and overdose. In maintenance treatment, those addicted to heroin, OxyContin, and other opioid drugs enter counseling while taking low, daily doses of a medicine such as methadone, which is also an opioid. The steady maintenance treatment allows patients to manage their cravings without the emotional highs and lows of active drug use that prevent many addicts from holding jobs and acting as productive citizens, as Szalavitz reports. The World Health Organization, the United States' National Institutes of Health, and other medical organizations endorse the treatment, which doctors and researchers consider to be the most effective science-based practice. Finally, it seems politicians are beginning to come around as well.
Such treatment hasn't always been popular in the political sphere, since it involves patients taking a prescription opioid, albeit in doses designed for therapy. Some would prefer to see patients get totally clean without any other drug. But under 10 percent of opioid addicts beat their addiction with abstinence-based programs, as journalist Jason Cherkis reported for the Huffington Post in January.
Under 10 percent of opioid addicts beat their addiction with abstinence-based programs.
Now, however, it seems some politicians are changing their minds. In May, Democratic senator Edward Markey and Republican senator Rand Paul jointly supported a bill that would allow doctors to treat more patients with opioid maintenance medicines. Then, just this week, presidential candidate Hillary Clinton published her plan for dealing with the U.S.'s drug-addiction problem in an op-ed in the New Hampshire Union Leader. Although the published plan never says "maintenance," many aspects of it suggest such support.
"Drug and alcohol addiction is a disease, not a moral failing—and we must treat it as such," Clinton writes. That attitude is compatible with treating opioid addicts with the best, evidence-backed treatment, instead of expecting folks to overcome their addiction with willpower.
"I will direct the government to reevaluate Medicare and Medicaid payment practices," Clinton writes, "to remove obstacles to reimbursement and help integrate care for addiction into standard practice." This focus on health insurance suggests she expects folks will go into doctor-led care, which would most likely include maintenance, for opioid addicts.
In addition, the Huffington Post reported on a few aspects of Clinton's plan that more directly address maintenance treatment, which she didn't mention in her op-ed. The former secretary of state supports allowing physician's assistants and nurse practitioners to prescribe opioid maintenance medications, and changing current laws that cap how many patients doctors can treat with maintenance—an echo of the Markey-Paul bill.
Some problems remain. Clinton's published plan allows states a lot of leeway with treating opioid addicts, leaving open the possibility that some will opt for abstinence requirements or other, less effective therapies. Hopefully, however, proposals like Clinton's are a sign that more policymakers will support maintenance in the future.
Since We Last Spoke examines the latest policy and research updates to past Pacific Standard news coverage.