Is Maintenance the Best Therapy for Opioid Addiction?

Ian McLoone	6:30 PM (4 hours ago)
to me

Mark

I have been having some heated discussions lately about maintenance and the science around it. A lot of people say, "well reduced drug use is great, but what about quality of life?" For example, the studies comparing buprenorphine with and without counseling - there's no difference in outcomes, but those outcomes don't measure QoL. I did some research, and most of the studies I saw found improvements, but in the case of methadone, the improvements all occurred in the first 30days of Tx. Just wondering what you say about this perceived lack of QoL in the literature. 

Thanks

Mark Willenbring	10:57 PM (3 minutes ago)
to Ian

QOL measurement is a conundrum, very difficult to measure, since it's a perception, an interpretation, and doesn't correlate well with more objective measures of function or discomfort. 

I think their argument is simply a defensive one. The counterargument is that many more people who are treated with abstinence-based therapies relapse and die. Dozens of studies, internationally. What kind of QOL do dead people have?

The fact is, the ball is in their court: if they can prove that overall QOL is better (as well as survival) with abstinence-based treatment, terrific. If not, shut the heck up. If you reject a scientific finding on ideological grounds, say so. It's fine to assert: "Yes, more people use fewer drugs and fewer die if they take medication, but they aren't "really sober", they haven't "spiritually grown. Therefore, the goods of less drug use, more remission and fewer deaths are outweighed by a moral argument that their recovery is false. It is better to die than to take medication, because maintenance is not morally acceptable." That's a potentially valid position if you agree with their assumptions, which I obviously do not.

But don't argue that the findings aren't what they are because you don't like them. More people recover using medications, fewer people have legal, job, medical or social problems, and fewer people die with medication. These are established facts that cannot realistically be challenged, other than by rejecting current scientific methods and a broad international consensus of researchers and senior clinicians, not to mention the World Health Organization, the National Institute on Drug Abuse, the VA and DOD, and the CDC. I think the burden on the other side is formidable.

As Bernard Russell said, "When the facts change, I change my mind. What do you do, sir?"

Mark