Pubdate: Sun, 24 Jul 2016
Source: Boston Globe (MA)
Copyright: 2016 Globe Newspaper Company
Contact: http://services.bostonglobe.com/news/opeds/letter.aspx?id=6340
Website: http://bostonglobe.com/
Details: http://www.mapinc.org/media/52
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MAKE METHADONE EASIER TO GET

The argument against using drugs like methadone and Suboxone to kick 
heroin usually gets whittled to a cliched, and inaccurate, phrase: 
It's trading one addiction for another.

But ask Dr. Jessie Gaeta about some of the clients she treats in the 
heart of Boston's so-called Methadone Mile and she'll describe 
regimens that are about trading despair for hope. Gaeta, who is chief 
medical officer at Boston Health Care for the Homeless, knows all 
about the doomsday scenarios that often play out on the grimy blocks 
around Massachusetts Avenue and Albany Street, where a mix of 
shelters, treatment centers, and methadone clinics years ago created 
a subculture of people desperate to get help or get high. Sometimes both.

The state's opioid crisis, compounded by the 2014 closing of the 
700-bed Long Island shelter and its recovery programs, has made the 
Methadone Mile scene more pronounced. But Gaeta still sees reason for 
optimism. One example: the story of a woman in her early 20s who had 
surrendered everything to heroin, including her three children. "She 
came in absolutely ravished by homelessness," says Gaeta. It wasn't 
her first try at detox and treatment, but this time it took. Gaeta 
credits Suboxone - a combination of buprenorphine and naloxone that 
blocks the effects of other opiates if taken regularly, and eases 
withdrawal symptoms.

After a year on Suboxone, the woman had gone through a personal 
revolution. Heroin and a violence-prone boyfriend were gone, replaced 
by a home, a job, and a rekindled relationship with her family. 
"There are a lot of people like her," says Gaeta. "People who are doing well."

Their success, however, hinges on consistent Medication-Assisted 
Treatment, or MAT, which most addiction specialists agree is safer 
and more effective than other approaches, including abstinence. 
Methadone, which dates to the 1930s, is the most commonly used MAT. 
It works differently than Suboxone, but serves the same purpose - 
substituting a lethal addiction with a manageable dependence. But 
methadone is easier to abuse, which is why it's tough to get a 
prescription that eliminates the need for daily visits to a 
specially-licensed clinic.

As a July 17 Globe story by Nestor Ramos and Evan Allen graphically 
illustrated, that can worsen the odds of a methadone user staying 
free of heroin's grip. On Methadone Mile - people who work there 
loathe the label - patients have to navigate a gantlet of sidewalk 
dealers to a get their methadone, putting themselves on a path of 
temptation over and over again.

An increased police presence might periodically roust dealers and 
tamp down petty crime.

What's needed here is a patient-centered strategy that would make it 
easier for addicts well into the recovery process to avoid Methadone 
Mile. In Europe, for example, methadone sometimes is dispensed at 
pharmacies. Why not do that here? There's also the promise of better 
ways to deliver MAT. Earlier this year, the Food and Drug 
Administration approved an implantable version of buprenorphine that 
contains six months' worth of doses.

It could discourage misuse and eliminate the possibility of someone 
selling buprenorphine for street drugs.

Improved access to methadone is just one piece of the confounding 
puzzle that is addiction.

There's a need for additional residential treatment beds, better 
reimbursement rates, more behavioral health therapy - it's a long 
list. But significant progress won't come until there is wider 
acceptance of addiction as a brain disease.

Dr. Michael F. Bierer, an addiction specialist at Massachusetts 
General Hospital and president-elect of the Massachusetts Chapter of 
the American Society of Addiction Medicine, envisions a day when 
people managing addiction "sit in a doctor's waiting room with people 
going in for an annual wellness visit, as though they were actually 
getting treated like a person with any other disease."

As a society, we still attach a special ignominy to substance 
addiction, especially heroin.

It's an affliction of the down and out, inexorably connected with 
crime and disease.

We'd prefer it to be relegated to a sketchy part of town. But 
addiction does not discriminate. It permeates all social strata.

Imagine people suffering from other chronic illnesses being similarly 
shunned. Imagine a Diabetes Drive.
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MAP posted-by: Jay Bergstrom