The stigmatization of any form of treatment for any medical problem is something that people interested in social justice must fight.
By Princess Harmony
Epidemics aren’t just issues to be dealt with by the medical community, they’re also social justice issues. This is true of any epidemic, but this is especially true of the opioid epidemic. While the victims of the epidemic who’ve gotten the most attention are typically middle-class and white, it strikes all demographics. There’s an overdose death every 16 minutes, and entire neighborhoods are affected. While there’s no magic bullet that can fix the epidemic, and the human cost of it can never be restored, there are treatments for it.
The starting point for most people trying to get treatment for addiction is detox, then rehab, followed by outpatient therapy and the use of either a 12 Step fellowship or a self-help group like SMART Recovery. Some patients, however, myself included, use an outpatient treatment called medication-assisted therapy. What is medication-assisted therapy? It is the use of methadone and buprenorphine (found in Suboxone, Subutex, Buprenorphine, or Zubsolv). Alongside these medications, patients in a MAT program also attend group and individual therapy. Whether one goes the route of complete abstinence or medicated assisted treatment, there’s help for an opioid addict looking to be free of the nightmare of drug addiction and get back on their feet. The problem, however, is that medication-assisted therapy is itself stigmatized. That’s right, some of the best and most successful tools we have in facing the opioid epidemic are stigmatized.
It’s important to understand the sources of the stigma so that one can get the facts about methadone and buprenorphine. One source of the stigma against these treatments comes from your stereotypical, middle-class NIMBY, who thinks that a handful of people who hang around clinics post-dose are symbolic of the treatments themselves. In Philadelphia, a city that’s one of the hardest hit by the epidemic, several methadone and buprenorphine clinics have had to fight against these “concerned citizens” who either don’t understand the benefits of the treatments or care more about property values and the type of people who inhabit their neighborhood. Fortunately, the law can protect clinics and their clients from discrimination by neighbors.
Another source of stigma toward medication-assisted treatments such as methadone and buprenorphine happens to come from a select group of recovering addicts themselves. Twelve-step fellowships, particularly Narcotics Anonymous, defines recovery in their fellowship as being complete abstinence from all drugs. This includes drug replacement therapies, as noted in Narcotics Anonymous’ Bulletin 29, which states, “Our program approaches recovery from addiction through abstinence, cautioning against the substitution of one drug for another. That’s our program; it’s what we offer the addict who still suffers.”
While I disagree with an abstinence-only approach to recovery, the fellowship has the right to define recovery however it likes, and its members are free to live by it. That being said, the tendency some members of Narcotics Anonymous have is to approach addiction and recovery as a one-method fits all affair where their method – and no others — are the right one for the addict who suffers. They contribute to the stigma against medication-assisted treatment by attacking those of us on it as not really being clean, or worse, suggesting that we’re weaker people for needing to even use it.
To suggest that a person is weak for using a medication or for not being able to recover from addiction the way that someone else did is cruel and does nothing positive for anyone, least of all “the addict who still suffers.”
The most powerful source of stigmatization is probably the voice of those in power. The Trump administration, which claimed to want to fight the opioid epidemic, started on a very bad foot by using its voice to add to the stigma and misunderstanding of methadone and buprenorphine. Our current Health and Human Services Secretary, Tom Price, claimed that MAT was merely “trading one opioid for another,” misunderstanding what methadone and buprenorphine do and don’t do. He treated the medication as just another way for us to get high. Drug maker Alkermes, to be expected of a corporation, has been using this misunderstanding to push its product, a medication called Vivitrol (naltrexone). Companies seeking to push their products using the stigmatization of others and the people that use them are no better than the forces that stigmatize the treatments themselves. We must challenge Alkermes and reject their method of marketing.
Those interested in social and medical justice need to understand how medications such as methadone and buprenorphine work and how they benefit the people that take them. Methadone and buprenorphine, although different, work in a similar way. They bind to the receptors in the brain that drugs like heroin, Dilaudid, and Percocet do, except they do not cause euphoria. Additionally, they bind so strongly to the receptors that while it’s in a person’s system, they cannot use other opioids in an effort to get high.
When used as directed, methadone and buprenorphine successfully keep the patient from relapsing or craving their opioid drug of choice. Most importantly, medication-assisted treatment – especially when taken alongside therapy – improves the quality of life of recovering drug addicts in a way that the media, politicians, and abstinence-only recovery and anti-drug campaigns do not report. Multiple studies concluded that the quality of life of addicts on buprenorphine and methadone is, in their words, good. These studies found that socially and psychologically, people in these treatment programs had improved while on the medicines. Studies also noted that the stigma had prevented the patients from telling others about their treatment. If the stigma was reduced or eliminated completely, just imagine how much more improvement there would be.
The voices of people struggling with addiction, especially the marginalized, need to be heard in order for the epidemic to be fought effectively. The stigmatization of any form of treatment for any medical problem is something that people interested in social justice must fight. The opioid epidemic is a social justice issue, and I call on people to start treating it like one.
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