Pubdate: Sat, 04 Nov 2000 Source: Bangor Daily News (ME) Copyright: 2000, Bangor Daily News Inc. Contact: http://www.bangornews.com/ Author: Claude P.M. O'Donnell Note: Claude P.M. O'Donnell is the chairman of the Board of Trustees at Acadia Hospital. FACE THE HARSH TRUTHS OF OPIOID ADDICTION The pros and cons of establishing a methadone treatment program in Bangor are currently being debated in the media. There has been much discussion of the presently available and possible future modes of opioid addiction treatment. Now is a good time to revisit the central treatment issues at the heart of this important community discussion. A core issue in this discussion is the basic acceptance of the reality of significant and rapidly growing opioid addiction problems across all income levels and age groups in our community region. Over the past few years, it has become clear to community treatment providers and law enforcement officials that opioid use, including heroin, has become epidemic in northeastern Maine. Another fundamental consideration is a willingness to face the harsh truths of opioid addiction. This is not a short-term problem with a quick-fix answer. People affected by opioid addiction can progress into a lifelong affliction that requires consistent and appropriate medical and psychological treatment to be adequately controlled or overcome. The addicted population must be treated. We have fortunately opened the doors to treatment for those afflicted by cancer, degenerative conditions and medical illness. As a community, do we shut the door on treatment for an afflicted patient population? As we have done before, we must face this illness and the vital need for treatment. Third, no single treatment, prevention, education or intervention approach will be sufficient to stem the tide. Individual patients will require some treatment and not others. Some patients will be appropriate for methadone, LAAM or buprenorphine, in addition to counseling. Other patients will not need medication, but will do well with a careful detox and follow-up support. All patients should be approached as individuals with their own unique set of problems and solutions. What is important is to have the appropriate treatments available. Given the very limited success of the "war" on drugs waged over the past 30 years, it is now evident that narcotic addiction cannot be eliminated by simple prohibition. Attempting to limit the supply of narcotics, without also significantly reducing the demand for illegal use of opioids, will not achieve any long-term reduction in drug addiction or the illegal use of opioids. Demand needs to be reduced by effective treatment. Methadone has been repeatedly demonstrated in medical studies to be a valuable and necessary tool for the effective treatment of opioid addiction. It is a particularly potent treatment when used in conjunction with a broad range of counseling and support services. Gen. Barry R. McCaffrey and Attorney General Janet Reno have both endorsed and promoted the establishment of methadone treatment programs as an important and necessary step in controlling the spread of opioid addiction. In addition to methadone, other pharmacological interventions have been shown to have efficacy in treating chronic opioid dependence. LAAM (levo-alpha-acetyl-methadol) is an opioid agonist similar to methadone but longer acting, requiring less frequent visits to the treatment program. It can only be dispensed through a licensed narcotic treatment program, not by individual practitioners. Buprenorphine is a unique opioid agonist-antagonist drug currently in the process of receiving approval by the FDA for the treatment of opioid dependence. Under the provisions of the Drug Addiction Treatment Act of 2000, this medication will potentially soon be available through licensed doctors as well as through existing methadone programs. The professionals at Acadia Hospital look forward to the introduction of this new medication and will be offering it as a treatment alternative to appropriate patients once guidelines for responsibly prescribing it have been issued. However, buprenorphine does not replace methadone, LAAM or counseling. It represents another treatment option. Methadone and LAAM will continue to remain an important part of a carefully designed continuum of treatment that the Acadia Narcotic Treatment Program plans to offer. It is hoped that buprenorphine, rather than replacing methadone, will reach a new set of opioid-dependent patients who have less chronic addictions and are therefore not appropriate for methadone. It is important that law enforcement, community leaders, treatment providers and the community at large have an opportunity to ask and have answered questions they may have regarding the establishment of a program that offers medical treatment such as methadone, LAAM and buprenorphine. We invite your efforts to understand the challenges facing those who have tragically become addicted to opioids and ask you to express your support for the careful efforts of the Special Committee on Opiate Addiction. Acadia supports, and indeed joined in recommending, a committee study as the best means to respond to the very challenging questions on the complex but vital need to provide treatment to those suffering from long-term opiate addiction. The Special Committee on Opiate Addiction, with membership from both the Bangor City Council and the Acadia Hospital Board of Trustees, is currently working on a report addressing community concerns relating to methadone treatment and opioid addiction more generally. Hopefully this report will be a springboard to thoughtful action in our communities and at the state level regarding the complex issues of opioid addiction. - --- MAP posted-by: Doc-Hawk