Pubdate: Tue, 23 Dec 2014
Source: Baltimore Sun (MD)
Copyright: 2014 The Baltimore Sun Company
Author: Aaron D. Greenblatt


As a physician working on the front lines of addiction treatment and 
research in Baltimore, I read Lisa Lowe's recent op-ed with great 
interest but also with some perplexity ("Addiction services needed 
more than statistics," Dec. 18).

I share Ms. Lowe's frustration with the difficulty that many patients 
and families - especially those with private insurance - have 
accessing affordable addiction treatment and transitional housing.

However, despite her impassioned advocacy for "evidence-based 
best-practice therapies," Ms. Lowe's piece contains misleading and 
frankly false information about effective addiction treatments.

In reality, methadone maintenance therapy is one of the most studied 
interventions of any medical or psychiatric condition.

Patients enrolled in methadone maintenance are far more likely to 
stay engaged in treatment and refrain from using illicit opioids, 
including heroin, than are patients in "abstinence-based therapies."

Many studies have suggested as much as an eight-fold decrease in 
mortality rates among patients enrolled in MMT. Still other studies 
have suggested decreased rates of HIV transmission and criminal 
behavior for patients in MMT.

Although "detox" followed by abstinence is an emotionally appealing 
concept, persistent brain changes resulting from longterm opioid 
abuse mean that for most patients, addiction is better conceptualized 
as a chronic illness requiring long-term medical treatment than as an 
acute illness treatable with a short course of medication.

While it is true that methadone-related deaths increased dramatically 
in the past decade, the culprit in the vast majority of these deaths 
was not MMT - a highly regulated and regimented intervention - but 
methadone pills prescribed in ever-increasing doses for chronic pain.

For the sake of the disenfranchised, suffering people for whom she 
advocates tirelessly, I would encourage Ms. Lowe to set aside her 
disdain for statistics and her ideological and impractical rejection 
of one of medicine's most effective treatments.

Dr. Aaron D. Greenblatt, Baltimore The writer is an addiction 
medicine fellow at the University of Maryland School of Medicine.
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