Blog
Editor's Comments
This week’s offering are both numerous and hefty. Your elective reading-time will be sufficiently occupied without my opinions or analyses, but some comments are warranted about the relationships between professionals in addictions, and politicians.
The spur to this is the group of policy items below – the Maine Governor’s initiative proposing a reduction in MMTP services in deference to buprenorphine dispensing; and the Portman and Whitehouse efforts to reconsider the CARA (Comprehensive Addiction and Recovery Act). Both invite strong feelings on the parts of legislators and doctors. In the case of Maine, there is the risk of dismantling the single most effective pharmacotherapy program for addiction in the history of this country, but doubtless out of the well-intentioned misapprehension that it will result in lower risk – when, in fact, both pharmacotherapies are needed. In the case of CARA, the risk is on the other side, not so much one of physicians angry that their patients may not get the care they need, as of legislators being concerned that resources will be diverted from others who “…need them more.”
There is a long-standing belief that is not completely untrue, that many of those with addictions either aggravate the problem, or make it difficult to provide them with care. This tends to subtract from even the most humane public servant’s concern. But interestingly, these are traits also shared by the population of diabetics, by those with chronic pain from rheumatologic disorders, sickle-cell anemia, hemophilia – and, really, anybody with a chronic, progressive, and relapsing disorder. It is the fate of those who are hopelessly unhappy to share their unhappiness. And the fact is, using many of those with diabetes as one example, there is little appeal in accepting treatment. They see a future of injections, tests, weight loss, dietary limits, accompanied by blindness, immobility, and dialysis. Treatment can be painful, it is limiting, it is restrictive, and in addition to being unpleasant it is associated with no promise of greater health, but merely a hope for slowed deterioration. Thus do many become angry, or demoralized, and adopt the classic response patterns of the addict: they lie (about medications, about diet, about activity); they do not follow instructions.
In the effort to explain the basis for our medical opinions about the management of the equally demoralizing and dehumanizing cluster of syndromes we call addiction, it is terrifically important to identify to those politicians who would be our allies, but have not yet had our experience of positive consequences, just what the singular attraction is to treating somebody with addictions: they not merely stop getting sick; but in so many cases they get better. And better. And better.
The spur to this is the group of policy items below – the Maine Governor’s initiative proposing a reduction in MMTP services in deference to buprenorphine dispensing; and the Portman and Whitehouse efforts to reconsider the CARA (Comprehensive Addiction and Recovery Act). Both invite strong feelings on the parts of legislators and doctors. In the case of Maine, there is the risk of dismantling the single most effective pharmacotherapy program for addiction in the history of this country, but doubtless out of the well-intentioned misapprehension that it will result in lower risk – when, in fact, both pharmacotherapies are needed. In the case of CARA, the risk is on the other side, not so much one of physicians angry that their patients may not get the care they need, as of legislators being concerned that resources will be diverted from others who “…need them more.”
There is a long-standing belief that is not completely untrue, that many of those with addictions either aggravate the problem, or make it difficult to provide them with care. This tends to subtract from even the most humane public servant’s concern. But interestingly, these are traits also shared by the population of diabetics, by those with chronic pain from rheumatologic disorders, sickle-cell anemia, hemophilia – and, really, anybody with a chronic, progressive, and relapsing disorder. It is the fate of those who are hopelessly unhappy to share their unhappiness. And the fact is, using many of those with diabetes as one example, there is little appeal in accepting treatment. They see a future of injections, tests, weight loss, dietary limits, accompanied by blindness, immobility, and dialysis. Treatment can be painful, it is limiting, it is restrictive, and in addition to being unpleasant it is associated with no promise of greater health, but merely a hope for slowed deterioration. Thus do many become angry, or demoralized, and adopt the classic response patterns of the addict: they lie (about medications, about diet, about activity); they do not follow instructions.
In the effort to explain the basis for our medical opinions about the management of the equally demoralizing and dehumanizing cluster of syndromes we call addiction, it is terrifically important to identify to those politicians who would be our allies, but have not yet had our experience of positive consequences, just what the singular attraction is to treating somebody with addictions: they not merely stop getting sick; but in so many cases they get better. And better. And better.