The tragic and untimely death of Phillip Seymour Hoffman to a fatal heroin overdose has brought out pundits and ‘experts’ advocating solutions that are bound to make the problem worse. The shrillest call is to remove the present restrictions on opioid drugs, in other words, legalize drugs. Why just marijuana. We the victims of the failed ‘War on Drugs’ should have the freedom to experience a ‘high’ from whatever source it may be. The prevailing buzzword is: ‘legal high’. These calls for drug legalization are not coming from distraught parents and community leaders impacted by illegal drugs, but columnists and misguided wealthy individuals dead set on legalizing drugs. We need not look too far. The same tactics used to legalize marijuana will be used to break down the existing restrictions on the use of opioids, but with greater intensity. Let us look at the genesis of the present problem.
Why the Resurgence of Heroin
The resurgence of the heroin epidemic is directly related to the widespread and irresponsible use of opioid drugs to treat ‘chronic’ pain. We have known for years that opioids drugs are best suited to treat acute pain and they are dangerous to treat chronic pain. Yet ‘experts’, many of them medical professionals working closely with pharmaceuticals companies marketing opioids, chided the medical community for not aggressively treating ‘chronic’ pain and insisted that there is little or no danger of addiction or abuse! We know what happened next.
The drug dealers saw a growing market for providing less expensive, but more dangerous opioids, for the tens of thousands who patients who could not get or afford the prescription pain opioids. Physicians under pressure to back off from the most abused brand name opioid drugs like Oxycontin and Vicodin switched to the less expensive drugs like methadone. Little did they realize how dangerous methadone is without the built-in restrictions in place at methadone clinics. Few people are aware that methadone, described as a ‘gold’ standard to treat opioid addiction kills more people – in excess of 4000 patients a year – than any other approved pharmaceutical drug. Legalizing drugs like heroin and other opioids is complete insanity and will lead to more deaths
The ‘Gold Standard’ of Treatment has a Dark Tarnish
The so-called experts are advocating more use of methadone and buprenorphine to treat heroin addiction. Most people are not aware that methadone to treat heroin addiction can only be administered in a clinic. Initially, patients are required to go to the clinic seven days a week to ingest the methadone in the presence of a staff member. Imagine, even after 40 years, methadone remains the only medication administered in a clinic. The other ‘gold’ standard of treatment, buprenorphine, better known by the brand name Suboxone also has restrictions. Physicians are required to take a test and receive a DEA exemption to prescribe buprenorphine. The first year the physician can have only 30 patients and after that the limit is 100. Why are these restrictions on both methadone and buprenorphine? They are addicting and highly abusable drugs. Even with the restrictions, patients abuse and misuse these drugs. Many drug addicts use buprenorphine to control withdrawal symptoms as they continue their heroin habit. Yes, they found buprenorphine in Phillip Seymour Hoffman’s apartment. Expecting heroin patients to do well on methadone or buprenorphine is a stretch.
Rejecting Non-addicting Relapse Prevention Medications
Naltrexone, the first non-addicting medication was developed as a relapse prevention medication to help patients transition from inpatient residential treatment back into the community. This medication was approved 30 years ago by the FDA and remains virtually unknown. To improve compliance, naltrexone is available as a monthly shot and sold under the brand name Vivitrol. Not one of the pundits even mentioned naltrexone or Vivitrol as an option to prevent relapse.
Rehab can be Dangerous
Both celebrities, Corey Monteith and Phillip Seymour Hoffman, overdosed and died after coming out of rehab. Why is there this risk of overdose and death? The rehabs they attended did little to prepare them to come back home and resist the urge to drink or use. The stress of being away for any period of time, increases the urge to drink on use when the patient comes back home. It is not unusual for the patient to get drunk at the airport on the way home. There is a added danger that is often overlooked. When patients are off the alcohol or drugs for any length of time, the tolerance for the drug decreases. In response to the intense cravings experienced after a period of deprivation, the patient overlooks or ignores the dangers of using large doses resulting in overdose and even death. Inmates being released from jails and prison are twelve times more likely to overdose and die within the first month of release.
Protecting Patients Leaving Rehab
Vivitrol is one of the best tools we have to prevent overdoses within the first month. It gives the patient a fighting chance to make up his/her mind about long-term relapse prevention. The patient has 30 days to decide which way they want to proceed. Many patients are grateful for giving them a choice beyond methadone and Suboxone and they continue taking the Vivitrol shots and be engaged in relapse prevention counseling. It is both irresponsible and unethical on the part of the treatment centers not to offer patients a potentially important tool to prevent relapse.
It is disappointing that the tragic death of Phillip Seymour Hoffman is being used to make a case for drug legalization which will only compound the problems we presently face.