Hope Beyond Heroin

USA Today (Society for the Advancement of Education), Sept, 2000 by Andre Waismann

Treating opiate dependency as a central nervous system disorder has opened up new alternatives for coping with addiction.

SUBSTANCE ABUSE unquestionably is a major health concern in the U.S. and the world, with annual treatment costs in the billions of dollars. The social impact in relation to crime, family life, and lost productivity is immeasurable. Diseases such as hepatitis C and AIDS have become common in many communities. Heroin, one of many opiate drugs, is the key player in this rapidly growing dilemma. Opiate-dependent babies have become an everyday reality in many cities, and heroin use among eighth-, 10th-, and 12th-graders has significantly increased over the last decade. Based on the most recently published statistics by the National Institute on Drug Abuse, 600,000 people in the U.S. are addicted to heroin.

Remedies in the past have included addictive opiate replacements and long-term isolation from society in centers outside general hospitals. Rehabilitation centers were developed to offer opiate dependents an array of alternatives, all of which involved suffering through long and tormenting withdrawal symptoms. Detoxification procedures often require lengthy and costly inpatient hospitalization, with dropout rates of 30 to 50% for inpatient and 70% for outpatient clinics. Despite these statistics, governmental institutions continue to support centers for treatment of opiate-dependent patients outside general hospitals and outside the realm of mainstream medicine.

Methadone has become the treatment of choice and is widely endorsed by the scientific community as an effective remedy for heroin addiction. In fact, methadone masks the problem and simply replaces one dependency with another. Abstinence achieved by regular detoxification, psychotherapy, and methadone maintenance is not the solution.

Throughout the years, patients' demands have been in direct opposition to the options for available treatment. Most patients desired freedom from the dependency, and tried abstinence without medical assistance. As a consequence, "cold turkey" became recognized as a valid treatment. When a no-treatment treatment became a workable idea, many experts were willing to apply therapeutic values to vomiting, pain, diarrhea, and other symptoms of withdrawal. Statements such as "no pain, no gain" became part of many physicians' vocabularies. The scientific community continues to ignore the need to challenge the existing perceptions of opiate dependency and treatment.

Biotechnology has reached achievements in the clinical field of medicine unimaginable for a physician from the 1950s or 1960s. Yet, little has changed on the clinical level for an opiate-dependent patient. It is almost impossible to identify developments and improvements in the level of care, even in the most prestigious centers in the world, despite the incredible budgets for research invested in this subject. Opiate dependency seems to be perceived as an incurable condition. The scientific community has failed to challenge this concept, as well as the stereotypical view that dependent individuals have addictive or weak personalities.

For more than 30 years, opioid receptor management, through the use of agonists and antagonists, has become a standard technique used by anesthesiologists and other medical practitioners. However, all of the knowledge and techniques developed during those years in the medical field were not applied to the treatment of opiate dependency. The reason? Opiate dependency was not initially classified as a medical illness, but, rather, as a psychosocial condition. The scientific community has failed to challenge this classification.

Treatment today sees most opiate-dependent people being treated by ex-opiate-dependent individuals, social workers, psychologists, and psychiatrists. The treatment options include rehabilitation and/or detoxification centers, methadone clinics, hotel rooms, religious entities, and a few other alternatives. Despite the range of treatments available, patients are not afforded the common option offered to any other patient suffering from an illness--to go to a hospital and have the illness assessed in a professional environment with respect and dignity.

Opiate dependency is a central nervous system disorder. The primary stage of the illness is withdrawal, and opiate craving is one of the secondary by-products. Therefore, detoxification procedures combined with any other counseling therapy cannot effectively access the root of the illness. Instead, neuroregulation should be the method of treatment, and this withdrawal management should be combined with craving relief. Without immediate and effective treatment, secondary social effects result. Social dysfunction and the need for social rehabilitation are often linked to the length of time and the severity of the illness endured by the dependent individual.

A physician's duty is to provide the patient at the onset of illness with an effective, safe, and humane treatment to reverse the condition. I find that psychosocial side effects can be prevented. At the first signs of the illness, when the patient has realized that he or she is hooked and needs to cope with the situation, going to a methadone clinic or enduring a long and painful stay at a detoxification center is often not considered. The patient sees cold turkey as the only option. Most patients will try and try again, with no success. Throughout the process, the patient may resort to lying, hiding, and hunting for self-healing. It becomes an everyday reality.