Recently I have been discussing the pros and cons of drug replacement therapy in my professional life. Apparently this is a very touchy subject and people tend to either agree or disagree with it very passionately.
Drug replacement therapy is the idea of using long term drug maintenance as a treatment option. The most popular example of this is Methadone maintenance for opiate addiction. There is also a drug replacement that is similar to this called Suboxone maintenance. There are also some other untested drug therapies being developed right now that will potentially treat other substance addictions other than opiates. My personal opinion is that we will see a trend towards more and more treatment options of this nature in the future.
I’m not sure if that is a good thing or a bad thing, just that there is a high demand for pharmaceutical solutions to the problem of addiction in general. Also, understand that there is a difference between Methadone and Suboxone as a replacement therapy: Methadone is a full opiate agonist while Suboxone contains only a partial opiate agonist. What this means is that people can and do get “high” with Methadone, but the effect is much more subtle with Suboxone.
Two possible opinions
Basically, you could believe one of 2 things about drug replacment therapies.
1) For it – You are of the belief that some people absolutely need a drug replacement therapy in order to recover over the long term. That there is simply no other way for them. That they have damaged their mind and body so much through so many years of abuse that they will never feel “normal” again without the aid of replacement therapy. You believe to deny them drug replacement therapy is to condemn them to death or a lifetime of continuous addiction.
2) Against it – You are of the belief that any addict can eventually become completely drug free and fully recover. That replacing one drug for another only perpetuates the addiction and is really no solution at all. Also, in my research, I found that some arguments against replacement therapies are clearly organized plugs for other controversial opiate treatments.
It is my belief that drug replacement therapy is a desirable option for a very small percentage of recovering addicts (something like 3 percent or even less). The vast majority of recovering addicts do not actually need a replacement therapy and will in fact be taking a step backwards if they choose to go this route.
But for some of the long term drug addicts who prove to be chronic relapsers, I think replacement therapy starts to look like a viable option. Here’s why:
1) For some people, drug addiction is not their biggest problem – Which is worse: suicide, murder, life in prison, or being on drug replacement therapy? If you think drug replacement therapy is near the top of that list, then you have lost sight of what is truly important. Some people’s lives are a tangled mess of crime and desperation where addiction is only one contributing factor. In this way, replacement therapy might grant some people a new chance at life, whereas they would otherwise self destruct or end up in a much worse outcome.
2) Physical necessity – your body naturally produces a certain level of dopamine (that “feel-good” chemical). Your body does this naturally just so you can make it through your day or be able to handle some basic physical exercise or exertion. Do you know what it is like to have that baseline level of dopamine completely switched off? Imagine living with a nasty case of the flu for the rest of your life. Some long term users of opiates are basically facing a similar situation without replacement therapy.
3) When other options fail – I don’t believe drug replacement therapy should ever be a first line of defense. But after an addict makes several failed attempts at treatment, then looking at drug replacement therapy starts making more and more sense. If other treatment methods continuously fail then it might be time to try something different. The price for not experimenting with a different therapy might be very high indeed.
Keep in mind that if you are on a drug replacement therapy, then you can attend NA meetings but you are not allowed to speak at them, only to listen. NA world services decided this based on the perceived purity of the NA message being shared in their meetings. In other words, they don’t want someone speaking in their meetings that is potentially “high.”
If you’re interested in drug replacement therapy, here is what I found to be the best resource of information regarding it that is not heavily biased against it as a treatment option.