Sunday, August 06, 2017

White House backing for methadone in jails?

I don't understand the Trump Administration's position on the Drug War at all. Grits was under the impression that "beleaguered" Attorney General Jeff Sessions was ramping it back up, but then we see that the Administration apparently supports methadone treatment for addicts in county jails. From the New York Times:
maintenance treatments like methadone, if uninterrupted, are proven to reduce arrests and increase employment, and for many with addiction are the only thing that works. In July, a White House commission on opioid addiction called for increasing inmates’ access to addiction medication.
Somebody help me out here, I can't keep track any more: is that a liberal or a conservative position?

Grits also wanted to flag a medication being used on addicts in jails (or more often, as they are discharged), of which I hadn't previously heard:
A growing number of jails, especially in rural areas, have opted to treat inmates not while they are in jail, but on the way out, giving them a one-time shot of a newer medication, Vivitrol, as they are released. Vivitrol, which unlike methadone and Suboxone is not a narcotic and has no street value, blocks opioid receptors in the brain, making getting high nearly impossible. It is far more expensive, and far less proven, than methadone and Suboxone, but its manufacturer often gives it to jails free. Its effect lasts about a month.
The full Times story - "Opiod Users Are Filling Jails. Why Don't Jails Treat Them?" - is well worth a read. MORE: NPR covered Vivitrol this week as well, an alert reader informed me.


Steven Michael Seys said...

Vivitrol sounds like something George Orwell would have come up with.

Anonymous said...

More methadone in jails? A thousand times NO! Methadone treatment is "replacement" therapy in which one opioid, like heroin or hydrocodone is replaced with another opioid, methadone. It's not really "treatment," but rather, choosing the lesser of evils. Start handing out methadone in jails and you'll see people who got kicked out of methadone clinics and other opioid addicts getting arrested just to get the methadone. Opioid withdrawal can be treated in other ways. Suboxone is one option, albeit more expensive in the long-run. And opioid withdrawal can be treated, usually in an inpatient setting, without methadone or Suboxone.

It's not a conservative or liberal position--just ill-informed, like so many of Trump's other ideas.

Paul Komarek said...

In today's environment, where the death rate rises and falls with what cartels are putting in the drug supply, methadone and other medicine assisted treatments make more sense than ever. The street drug death rate is so high, we need to focus on rescuing the people who use drugs and not waiting for an idealized and unrealistic version of recovery. This means addressing criminal drug-seeking behavior, the fatal risk of overdose, the medical risk of infections, and the likelihood of relapse fatalities with various therapies, needle exchanges, naloxone distribution and medical treatment. Medicine assisted treatment is the only path that fully addresses these sorts of risks.

There is no research that shows stopping medicine assisted treatment improves a person's life chances -- to the contrary, cessation of treatment boosts relapse risk.

Many people are able to move away from drug use without much help, but with relapse being so deadly, it makes sense to work one's way out of it cautiously and with appropriate supervision and support. There's a lot of he-man talk around addictions and mental health issues; that is not appropriate at a time when a "sampler" dose of street drugs is likely to kill someone.

As for the Trump administration, I think that it is stuck over the issue of ACA repeal. It wants to see medicine treatment more available, but can't bring itself to say that it's important for people to have healthcare insurance coverage or Medicaid that pays for it.