When people hated booze, we had a 13 year war on booze.
It failed.
So we moved to cannabis - called "marijuana" by the right-wing to make it sound foreign and thus evil.
And we have had a war on cannabis since 1933. That way, the prohibition agents kept their jobs.
Now the war against cannabis has hit the breaking point and cannabis will soon become legal.
So we switch to opioids for the same job-preserving purpose.
Every day now in the corporate media we read of the "shocking and deadly" OPIOID EPIDEMIC.
We have no such thing.
What we have in America is an "I Live A Bleak, Unfulfilling, Dreary, And Traumatic Life So I Need To Escape" epidemic.
Many among us legitimately use opioids for chronic pain management. Others misuse opioids for escape or as a self-prescribed emotional coping mechanism and their misuse kills them eventually.
If we banned everything that some people misused to fatal results we would have long ago banned automobiles and handguns.
Opioid overdose is the symptom. Not the disease.
https://emcphd.wordpress.com
24
100% spot on, Rev! Occam's razor.
5
According to the Henry J Kaiser Foundation, total Medicaid spending in the United States was approximately $553.5 billion in 2016 of which the State of New York spent approximately $62.9 billion. New York is one of 50 states plus the District of Columbia. Something would seem to be wrong here. Should NY spend less or should other states spend more?
5
"They were nearly all Hispanic or black. Those who are white, like Melissa Nelson, are often unemployed or have few resources to dedicate to recovery."
Is the implication that a Hispanic or black person who does have ample resources to dedicate to recovery, or private insurance from a middle or upper middle class professional job, is somehow consigned to the same onerous regimen that the people described in the article are?
"...patients who are middle class or white being less likely to see methadone as a treatment option."
Is the author suggesting that patients who are white and poor or near poor and lack resources are somehow exempted from the unfair burdens described in the story?
6
The addicts I knew said they never got back to that first high they cherished but continued using simply because they couldn't stand the pain of withdrawal. Has anyone suggested making smoking opium legal, and cheap, for verified addicts? It would hugely undercut the gangs who make enormous profits from addiction and would reduce crime, since addicts often have to steal to support their habit. And I doubt that smoking opium can kill you, but it would avoid withdrawal.
8
Yes. I have suggested many times here all drugs should be legal, and have supported it with these arguments:
You would remove the profit motive that exists for illegal dealers. The price of heroin is high because of the fact it is illegal. Because the profit is now so high, dealers have an incentive to get somebody hooked. Legalization removes that incentive.
The crime committed for securing money for heroin would be significantly reduced. Getting money for heroin accounts for nearly 50% of crime committed in the cities as you alluded to.
The increased deaths we are now seeing is because of illegal dealers adding things like fentanyl to heroin. Heroin supplied by FDA approved labs would eliminate this problem, resulting in much less death.
The prisons are full of people as a result of the criminalization of drug abuse. What would the prison population be if drugs were legal?
The fact drugs are illegal makes them more seductive to our young people.
We learned all these lessons in the 1930's with the attempted prohibition of alcohol. Why do we have to go through it again? I think the answer is there is a lot of profit to be made from illegal drugs, and by far the biggest profiteer is the government. How much money does prohibition cost us citizens in the form of jails, law enforcement, border security, litigation, etc.? I would like to hear ONE reasoned argument for keeping drugs illegal.
9
This article overlooks the fact that there is no single path to regaining and maintaining sobriety. There actually needs to be different choices for different people because people come into, and remain in, addiction for different reasons. While some seek out addictive drugs, others fall into their addiction by accident--the result of a car accident or surgery--never knowing ahead of time that they have the propensity to opiate addiction. Some people do well on buprenorphine products while others do better on methadone. Some swear by the 12-step model as a path to sobriety. My point is that each person afflicted by addiction must own their recovery and find what works for them. If a given modality works for the individual, it is no better or worse than another.
6
Instead of going after the oil companies the city should devote resources to going after Purdue Pharma the drug company that came out with OxyContinz in or around 1995, the pain killer which has left tens of thousands of normal people, not addictive recreational user types, addicted to opioids. This stuff is not necessary. There were and are viable alternatives.
The makers of this insidious substance should be sitting right now in downtown Manhattan with El Chapo. It is said that opiod-based addiction killed 64,000 people last year. I would imagine that this figure far exceeds the harm done by El Chapo.
7
Gosh, how awful. People with more money can afford better things than people with less. How can we let this deplorable situation continue!
4
Count on the NYT to make everything about race.
It's about money, as the article makes clear.
What is Medicaid paying for those two hour taxi rides? Cannot be cheap, probably less than prescribing the other medicine that they can take at home.
7
Sorry but I don't get this--I am a social worker. It's not THAT complicated to locate suboxone providers at these clinics. They all have overusing psychiatrists/MDs who have to make regular assessments. They could recommend a change of course when appropriate.
We do have a shortage of well-trained sub abuse providers. This is the story that the Times should be doing. Also, the medical profession is partially responsible for this epidemic. Med schools should be encouraging students to address this issue.
4
If your day revolves around the clinic, getting to the clinic, getting your does and maintaining - it doesn’t seem that any of these people are “living”. They are here, they are alive, but none of them are living. They don’t work, they can barely care for themselves and there is no plan to do anything other than maintain. What a horrible existence - it’s like purgatory.
6
This article opens with the teaser “addiction knows no color but its treatment does.” The body then conflates color with wealth. Here’s a related news flash: Wealthy people have nicer places to live, better food, cars and clothes as well as better drugs to help them rid themselves of their addictions.
The implication is everyone deserves the best treatment available no matter the costs and that “we” need to do more to help. It doesn’t matter that these people have chosen to harm themselves.
Then this:
“She and her partner, JC Marin, visit the clinic from Copiague, Long Island, in a taxi paid for by Medicaid. More than two hours each way, six days a week...”
I guess the “two hours each way” is supposed to make readers sympathetic to the time commitment they have to make. But what about the money?
I just checked. An Uber, arguably cheaper than a taxi, from NYC to Copiague is about $90 one way. That’s $180 a day, a grand a week, $52,000 a a year, taxpayers pony up for one couple to go get their free taxpayer funded medical treatments.
What’s wrong with the bus?
Perhaps if “we” spent “our” resources a little more wisely “we” might be able to afford better drugs.
8
Thought by the title that this article was going to be about poor addicts getting denied care. It's not. They all get care, but the reporter is whining about convenience. Is this what we've come to? No gratitude, no responsibility? At least the man getting help was grateful - and I congratulate him on making the effort to ditch addiction. Since this is free and available to those that need it, I see no issue. Yup, the rich or even middle class have it easier when they can go to their doctor (likely about the same distance, but) and then pay with their own money. But, isn't that why most work hard in the first place - so they can buy what they need/want? And that is now somehow racist?
7
I am a believer in the "Freedom" that we are supposed to be entitled to in the United States. "And justice and freedom for all.." right? So... we have the freedom to make choices that allow us to become addicts. As the millions of recovered and recovering addicts in Narcotics Anonymous prove, all addicts have the freedom to get sober as well. All of them. Equally. This is perfect justice. And that they suffer for doing something that is harmful to themselves also seems to smack of justice, despite the fact we may not want to agree with this. I cannot help but wonder how quickly out opioid crisis would be solved by giving all current addicts a barrel full of their drug of choice and simply saying, "Ta ta. There's an NA meeting five times a day with four blocks of you or you can, well, enjoy this barrel." That's both freedom and justice. Perhaps this is an over simplified notion but the "crisis" is hardly as complicated as this article makes out.
5
Great great reporting here, but the headline and editing in the first half of the article suggesting suboxone is the best treatment contradicts much of the rest of the article. The patients and doctors discuss in some detail why methadone and the clinics associated with them is the best option for many patients. If suboxone made available through doctors offices was the primary treatment things would be a lot worse for many patients.
2
As a woman of color, I think we need to stop focusing on the racial divide. Ultimately, the divisions and inequality in our society are really about class and income. I have expensive private insurance and a decent income. if I had an addiction that required treatment, I would not be relegated to a methadone clinic. I would incur medical bills because of co-pays and my high deductible. However, about 15 years ago I was working in an optical store across the street from Saint Barnabas Hospital in the Bronx. Next door was a methadone clinic. at the time, I had no health insurance and made very little money. If I had found myself addicted to heroin at that point in my life, even with a job, I would have had no choice but to rely on a methadone clinic, likely funded by Medicaid.
In my family, my great-grandfather was an alcoholic. Both of my grandfathers were functional alcoholics. My maternal grandmother was a drinker. Both my mother's brothers were drug addicts, and one died from a heroin overdose in the early 90s. my grandmother's sister had two sons who struggled with drug addiction throughout their lives, even though they grew up in a lovely middle class suburb in California. one of them married a white woman who was also a drug addict, but they were fortunately able to get clean for the sake of their children. So I've always been interested in the genetic component of addiction.
5
Hidden in the article is what to me is the crux of it, system is broken–couple is taxied two hours each way to a clinic, six days a week, and paid for by Medicaid
15
And that is a good thing.
Ride Assist is an important feature of Medicaid.
Getting to the doctor is vital, treatment is necessary. The rides are recorded, verified, and safe. Making an appointment for Ride Assist is not simple, it requires organization and focus, responsibility and planning.
The drivers are everyday working men and women, caring for family.
Medicaid is working. Medicaid is essential.
11
Used heroin intravenously in the late 60s/early 70s never really getting physically addicted . The heroin back then was not as potent as today from what I hear . I hated using a needle and wound up later on with Hep C . The methadone came out and was powerful , never fluctuating . Many I knew back then got on methadone and I would buy it from them off and on not wanting to get on a regulated program and loving the effect . I finally signed up and was on “ the program “ for two years . I missed a dose a few times and got very sick causing the aura of this drug to really wear off . After a while , in addition , there is no sedation from a regular dose which led me to pills and alcohol . I detoxed from methadone over a 9 month period in ‘76 but my drinking exploded . I got into AA 33 years ago and have been clean and sober the whole time . My life is great . The reason the 12 step form of recovery does not work for many is because they stop attending meetings , stop doing the spiritual work involved and neglect their mental health issues . It works if you work it ! I love living like this now and wouldn’t trade it for anything .
13
I don't understand why the title of this article is insinuating that treatment options are dictated by race. The article itself clearly states that it is actually dictated by income ('those patients who are white are unemployed or have few resources to dedicate...'). Sure, as a consequence of the stratification by income, minorities will be more affected - but only because minorities tend to have lower incomes.
28
Silly, it's de rigueur! But of course!
Which still makes it dictated by race. If both options were equally available, race and the corresponding income gaps would not determine a positive/negative outcome. I'm not going to get into the complexities of how race defines income - I'm sure we're all aware that it does - but that doesn't change the face that minorities are left behind while whites get proper treatment. It's a self-defeating cycle.
3
This article, like most on this subject, contains a pet peeve of mine. Alcohol is a drug, a ubiquitous, dangerous, often lethal drug. I wish people would stop saying, "drugs and alcohol." Stop! People need to be constantly reminded that when they drink alcohol, they're using drugs. How about, "alcohol and other drugs," or "drugs, including alcohol"? I find this particularly dangerous when applied to the young, as in, "The Frat boys were drinking alcohol and using drugs." I'll go a step further, alcohol shouldn't be advertised any more than heroin is, and as in some States, should be sold at government stores, at regulated hours.
17
Why not go all the way and stop calling them just "drugs", as if there were not medicinal drugs like penicillin, the kind you get at a "drugstore". What's a good substitute, though?
2
Because unfortunately many people do not consider alcohol a drug. Probably there are folks who say 'I would never take drugs' as they stagger out of bars. If alcohol weren't specifically mentioned they might not feel spoken to.
3
How about "poison". My AA sponsor used to say,"why would I want to put that poison (alcohol) into my body again when it nearly killed me". POISON is a good word.
3
Probably more then half of suboxone doctor won’t take any insurance they want this business as cash only. This should be illegal because then it’s off the books. I doubt they report this as income. They might as well be drug dealers. These are mostly Doctors from non USA med schools foreign born US citizens who are not treating patients , they are just writing prescriptions for them, for a drug more addictive then heroin. Doctors that do take Medicare/Medicaid and can prescribe suboxone can have up to a 6 month waiting list. When your a drug addict even a 2 week wait can feel like 2 months if your gonna be in withdrawal for 2 weeks. They should change laws so emergency urgent care centers can give a supplemental prescriptions until treatment can start. Urgent care usually charges 50$ versus 150 to 300 for a cash visit to your suboxone doctor. This is going to get worse with limits on how long opioids can be prescribed the demand for treatment is going to increase.
18
Methadone patients can request "medical maintenance." To earn the privilege, they must have negative urine screens and participate successfully in counseling sessions over a period of time. With medical maintenance, patients can get a month's worth of methadone in a dry pill form from a doctor's office. Not all states are the same... but in NY State, that option is available. Some people need a high dose of methadone and for them, Buprenorphine won't work (it has a ceiling for its effect). Whichever medication is used, one needs to remember that addiction and recovery are bio-psycho-social. Medication only addresses the biology of addiction. Patients still need psychological support, usually from clinical staff, and social support. When dosing and administration are effective, medication-assisted treatment can be a good option that saves lives.
20
Not in Iowa. In Iowa, you can "earn" take-homes from the clinic based on clean urine screens. Up to one month take-home of liquid methadone doses can be earned.
1
Why vilify people who want to spend their money on health care instead of vacations or restaurants? If people have earned money and want to spend it on private treatment, that is their prerogative. Treatment that improves health is an investment.
13
This is an excellent article... however, over simplifies the complexities of the issue. I run a nonprofit, Truth Pharm in upstate NY (with multiple branches in upstate in addition to one on the west coast). In my home county (Broome), there is ONE methadone clinic which is the ONLY one in an eight-ten county region. Here, the methadone line will be primarily white pregnant women or older persons. Almost no one else, rich, poor, white or black can get it. And forget the folks in the rural communities... imagine trying to get a daily medicine if you have to drive two hours daily, one way, to get out. Suboxone access has similar limitations as reported here. But again, in upstate, it's not as much about race limitations as financial.
Furthermore, I would implore the author to consider not perpetuating the government's justification of control over these medications... because really, therein lies the actual problem. Could a person not overdose on a bottle of Oxycontin? Of course they could... and yet, where's the regulation? This is solely about discrimination, but not based on race - based on discrimination based on substance use and addiction.
13
A 70-year-old woman who takes it as the medication of last resort for a rare and severe movement disorder, I'm stigmatized as an addict by new clinicians (e.g., an anesthesiologist for my knee replacement surgery), dental specialists, drugstore personnel, etc.
Like addicts, I must sign a pledge: If my bottle of methadone gets stolen, I will not be granted more until the next scheduled prescription. Which would require my body to jerk constantly for up to one month.
Like addicts, I must obtain a brand-new prescription every single month. If an ice storm, blizzard, or (God forbid) a vacation means I can't get to the pharmacy on the precise day required, I will have to do that herky-jerking until I can pick it up (how do they imagine I'd drive?).
If this physician moves away or retires, I will have to search the state for another who will prescribe an opioid. My first prescriber was only a 30-mile round trip away. The current one is a 3-hour round trip. Where, oh where, might a third one be?
Well, at least I enjoy other side effects of methadone: severe constipation (before I worked out a 5-dose laxative regimen, I suffered several impactions and a life-threatening bowel obstruction), dry eye (one remedy for that produced ocular rosacea, which requires its own treatments), and dry mouth (which can cause tooth decay). I tell each provider why* I take methadone, and watch them not believe me.
Is magic involved? Each time I get stigmatized, somewhere an addict wakes up cured?
26
"Prescription Management" gone crazy. I am so sorry you are being labeled in this way and that your health and well being is being put at risk by the system.
7
(2) Ms. Chadwick...[to continue] I too, have had my share of 'well intentioned' pharmacists give an unwelcome stare, engage in an extended consultation with a colleague and, at times, decline to fill my valid doctor's prescription. I wish to dispel the notion (that you perhaps inadvertently articulated), that as an 'addict' I am less deserving of the same, humane and compassionate medical care that you desire solely because my pain and suffering are considered less worthy. I would argue that we must be united in our call for a more enlightened approach. That Mr. Jose A. Del Real's wonderfully written article, covering an issue involving the quality-of-life for an untold multitude of people, has yet to garner even 100 comments (in an age when the more trivial and mundane political essay can generate thousands), only reinforces, to me at least, the magnitude of the struggle that lies ahead. To paraphrase both biblical texts and President Abraham Lincoln: "A house divided against itself cannot stand."
8
(1) Ms. Chadwick, I wanted to thank you taking the time to share your unique experience and 'recommended' your contribution. I also contributed a comment, which if you’re interested in reading, can found below. I wanted to offer you another perspective for your consideration. Though I am an 'addict,' I work and contribute to society, receive no financial assistance from either the state or federal government, and do not (intentionally at least) cause harm to others. Like a diabetic who required insulin before leaving for work, I would hazard a guess that you would be none-the-wiser that I to had consumed opiates prior to meeting me. Does this reply, or for that matter my original comment, come across as having been written by someone 'under the influence?' It is my hope that society can begin to move closer to understanding 'addiction' and the 'legitimate treatment of pain' (that you seem to be advocating for), as being medical 'health' issues, BOTH of which less deserving of the stigmatization you described.
7
Oy! Give the race thing a rest. Yes, folks, people with money do have it better.
35
Long-time opiate addict. From codeine (in cough syrup) as a child to an almost unlimited supply of pharmaceutical narcotics throughout my years in high school. Most recently I found peace from my cravings (and bouts of withdrawal sickness), from treatment at a local pain clinic. This lasted until, uninsured and underpaid, I could no longer afford the $350 per visit and roughly $100, give or take, cost to fill my oxycodone prescription each month (the required urinalysis and any other lab work was comped). Towards the end, prescriptions covered only a two-week supply, after which a new visit to the clinic was required as Federal law prohibits any refills being added to a prescription for any 'schedule-two' classified medicine. I share my backstory only to help emphasize the importance to me of discovering a plant-derived supplement called Kratom. I feel compelled to mention it here to educate anyone who might be currently suffering, as I had, until I discovered it. I am not a doctor nor am I a lawyer. I suggest anyone interested in learning more about Kratom's legal status, and any possible medical benefits, to seek independent medical and legal advice from a licensed professional. For me, Kratom has proven to be a life-saving remedy in an otherwise extremely limited field of options, the more so as someone still without medical insurance and with limited financial resources.
7
Sounds like the pain clinic is a scam.
If you consider life expectancy (tied with CUBA) and how it treats it poor people, the United States is simply the richest 3rd World nation.
20
Kolondy is a big part of the Heroin and illeagl fentanyl crisis.He was a main member of the team that created the CDC guidelines for opioid perscribing.Guidelines that were made behind closed doors and are ILLEGAL.Guidelines that violated federal laws.Guidelines that were created by ppl in the addiction industry and have stake in sales of Suboxone.What he said in this article supports my previous statement.These guidelines have caused unnecessary pain and ruined lives of ppl who have taken pain meds for decades without problem.The blanket recommendation of 90mmg is killing ppl.Because of Killer Kolondy family's have been destroyed,ppl lay in bed suffering,ppl are committing suicide.Their meds have been reduced to ineffective levels.Doctors are abandoning their patients and their practices because of DEA threats.Kolodny has labeled all ppl who take pain meds as an addict.He is a walking and talking trash can of MISINFORMATION.He is a enemy of the American people!
9
Why did you chose to present this article initially as one dealing with a racial injustice problem, when in the second half you delineate many reasons why people are still being treated with methadone over buprenorphine that have nothing to do with race (methadone is more profitable for clinics, buprenorphine actually is available at the clinics upon request but patients not pursuing the option, clinics providing counseling needed by the poor, buprenorphine eliminating withdrawal symptoms but not the desire to get high as methadone does, people wanting the discipline and human interaction of daily clinic visits, etc.). Aside from the ER, there are not many places where the privately insured and Medicaid recipients are treated side-by-side, any more than you would find them comingling at Whole Foods. You back up the racial injustice angle by saying that only 21% of the clinic’s patients are non-Hispanic whites. Since New York City is now only about 40% non-Hispanic white, that means that 50% of NYC’s non-Hispanic white addicts use methadone clinics’ services, even though whites are wealthier overall. That does not indicate any kind of racial injustice to me. And the problem of private medical practitioners not accepting Medicaid patients is pervasive, but is for hard-headed economic reasons rather than any racial bias. This highly informative article could have stood on its own merit, and did not have to be dressed up with emotional “it’s racism!” hyperbole.
21
No interest, no sympathy
If you can't keep your addictions under control, don't come crying to those of us who can.
3
Pretty strong walls in your glass house?
13
When are people going to realize all the problems listed with these programs in the many excellent comments have one common cause? These problems include, but are not limited to:
For profit methadone clinics and the various rules and regulations that accompany them.
Suboxone too expensive and hard to get.
The criminalization of drug abuse.
Unfair crack cocaine laws in the 80's.
Methadone clinics being used as dealer networks.
Etc; etc.
The cause of ALL these problems is the prohibition of drugs by the government and the essential monopoly granted to pharmacy companies by the FDA.
11
My first job as a clinical psychologist was at a private methadone clinic in 1972-3. We gave out high dosage (60 mg. per day) methadone ONCE A WEEK to our patients, who were required to have jobs. We had NO methadone overdoses. I did have two patients die, though. Both of them died on two separate weekends when the clinic was shut down by the Feds for suspected irregularities, which both times were cleared up by Monday. But the patients were frightened there treatment was over. One died of a heroin overdose, and the other shot himself. Both were deeply mourned.
17
Please don't draw the conclusion that the suicides were directly connected to the clinic closing. It may have been a "final straw", but suicide is complicated and odds are there were other significant factors involved. Thank you for your time in serving this population. These people need our help not our scorn. Nobody wants to be addicted.
7
Everyone wold like to dine at La Grenouille, too. I personally would like to have a Bentley. Some things are available to people with more money than others. This is not necessary systemic unfairness, it is life. And not just in the US.
25
Yes, but whatever is most effective should he available to anyone we can make it available to, because the cost of this addiction is enormous to all of us. It doesn't matter to society one bit if I drive an old car and others have a Bentley.
16
Hi Eileen. I think if you look at the figures, you will find that just about every treatment option no matter the cost has about the same success rate. And it is not very high.
5
Eileen...who is going to pay for making Suboxone available? The company that developed it should be able to make a profit off their investment. Personally, I would just leave junkies in a locked room with needles and a pile of fentanyl.
I am a recovering drug addict. I have been clean since October 24, 1988. I was 28 years old. I went to a Narcotics Anonymous meeting on St. Marks Place in Manhattan. I've continued to attend NA meetings ever since. 10,672 days today.
I am white, female, Jewish, I earned a Bachelors and a Masters degree while in active addiction, and I was in the process of getting divorced when I bottomed out and got clean. At the time, health insurance did not cover drug/alcohol treatment. Only the wealthy could afford to go to rehab. Hospitals would detox someone for 3 days and then release them to nothing.
Narcotics Anonymous is free group therapy, open to everyone. Addiction is an equal opportunity disease. There are people from all walks of life at NA meetings. There are more NA meetings in the US and all over the world than ever before. The power and love of one addict helping another works. The NA program works, if you work it. And live it. All you have to do is walk into a meeting. "That no addict seeking recovery need ever die."
I don't know why this is the best kept secret in the country?
54
L, the pharmaceutical companies don't want people to know about the 12-step programs and how well they work for no cost and no side effects. And NA and AA don't send press releases to New York Times reporters.
5
Clean for 29 years without a chemical substitute. That's impressive.
Well done.
9
Any serious study that has been done on the effectiveness of AA or NA programs lists the effectiveness rate at less than 10%. Not very impressive. The fact is, people quit when they decide, on their own, that the pros of quitting outweigh the cons. I know.
8
Thank you for this enlightening piece. I have long been troubled by how politicians and the media treat drug addiction today in comparison to my younger days in the 1980s. Back then, the scourge of crack cocaine prompted a War on Drugs, complete with incarceration for a large number of young African-Americans, mostly males.
Today, with opioids becoming more of a problem in rural white communities, the talk is of a more compassionate nature. The discussion centers on how to treat the epidemic and keep families together. Quite a difference!
This article highlights this gap in approaches. Perhaps not all that surprising, when we see comments such as those offered yesterday by the guy who won the rigged Electoral College (but lost the popular vote).
12
I don't disagree about how addiction has been presented in the press. But if you examine the crack cocaine drug wars of the 80's, you will find that the biggest push for the harsh laws came from black activists who saw the destruction it was causing in the cities.
9
What is the point here? Of course having more money gives a person more choices. Would you rather methadone clinics did not exist? Are you arguing for forcing rich people to use these same clinics?
24
Suboxone and Methadone treatment are not equal. Suboxone seems good because of high priced PR, but does not quell cravings like Methadone does.
In PA, the "counseling" at Methadone clinics is a joke. Imagine 3 hour group sessions with 11 other people three times a week in addition to daily attendance requirements to receive Methadone. It's a money grab. Methadone is an effective, cheap generic- the clinics have to make their money somehow, so ....... "counseling". Let's take a look at the effective way Portugal and Switzerland are dispensing Methadone- thru pharmacies.
20
I just remember my uncle nodding off on methadone and burning himself with his cigarette. I'd driven him to the methadone clinic and waited outside. I saw what happened to him. He also said congregating with other addicts at the methadone clinic made it easy to get high/ fail in his mission to get sober. However, the Subutex helped him for years. Always seemed just fine, life together, etc. I think it was @ 8 yrs. It cost a lot. Until he fell off the wagon and lost both of his legs from needles and gangrene and died from a heart infection two yrs ago. Subutex should be more available to people like him- and everyone affected by this epidemic. My friend's child just died 4 months ago at 21. It's all so tragic. The City should re-assess.
12
Suboxone is not cheaper and more widely available due to the essential monopoly granted by the FDA to the pharmacy companies.
11
Is anyone else astounded that Medicaid funds a taxi service to ferry methadone users 2+ hours each way every day? In an Uber, this is at least $70 each way - or almost $50,000 per year in cab fare alone! Why shouldn't Medicaid just buy these folks a new Camaro each year, and throw in a gas card? It would cost less than the cab fare. And it seems like Ms. Neilson is basically self-directing her care, having decided that one opioid (Suboxone) is not to her taste and choosing a vastly more expensive option (4+ hour driving, paid for by Medicaid, plus the raft of other assistance payments she and her partner surely receive, as neither of them work). It feels like a massive failure of Medicaid - neither cost-effective nor helpful to the patients, who have no incentive or ability to gain employment and self-sufficiency.
Look - I understand why Medicaid is a sacred cow, and how work requirements and other obstacles can make it difficult to get access to services. But clearly there is room for improvement, and there has to be some sort of end-game (even if it means methadone maintenance for years or decades) that is more cost-efficient and less manifestly absurd than funding 4+ hours of cab fare in NYC every day.
54
I am a recovering drug addict. I am a 53 year old female, well educated and well traveled. I have come off both methadone in 2000 and Suboxone 2016. They are both insidious drugs that give addicts an excuse to continue to use. I can also tell you that it takes a Herculean effort to get off both of these medications. It is a walk in the park to get off heroin compared to Methadone and Suboxone.I do not understand when these articles are written why NO ONE can view this from the side of someone that has done the blood, sweat, and tears to get to the other side. That is not what makes me angry. What makes me angry is quoting someone who takes a two hour taxi ride to get Methadone( which does make you high) as someone that should be felt sorry for. Try getting Medicaid to pay for rehab not a taxi!
Methadone and Suboxone will be around forever because people will take it forever. They will use it as an excuse not to work, when, in fact, Methadone clinics open at 5 am. Did they tell you that? Did they tell you there are rehab facilities that do not charge but you have to work? They also pay for your flight.
What you didn't find out about drug addiction and the plight of the heroin addict is ASTOUNDING. Let's stop expecting so little of people and expect a lot.
12
Roje asks why Medicaid pays for taxi service to methadone users.
It's because driving while under the influence of any opioid, including methadone, is dangerous. It would be grounds for an OUI/DWI.
I take a very small dose of methadone, and out of great caution have not driven for years. Addicts take a far larger dose. Don't be angry. Be grateful that they are not driving impaired.
12
When we lived in Maine, we read in the paper that cabs would pick up several -- up to 5 or 6 -- patients and charge for each. The methadone clinic was about a mile from the "marijuana store" for medical marijuana.
5
What's the big deal? Treatment is available to both affluent and poor addicts, but the former receive it on a more convenient and pleasant basis. The same could be said of many other aspects of their respective lives.
20
Even with newer drugs available, methadone is still recognized as the gold standard for treatment of opioid addiction.
One reason why a methadone treatment regime is more effective, especially for those with co-occurring psychological and addiction issues, is arguably the support provided by the very counseling and monitoring requirements that some clients find so onerous.
It is also worth noting that methadone is safe for nursing mothers and pregnant women. Suboxone is not. (Buprenorphine is safer, but still carries some risk of NAS - Natal Abstinence Syndrome.)
Best advice for people serious about managing their addiction, especially if they are women of child-bearing age: nobody ever said that recovery would be easy or convenient. Get into a well-run methadone program and embrace it as if your life depends upon it. Because it does.
15
Methadone is a synthetic opioid.
Putting opioid or heroin addicts on methadone is simply substituting one heroin addiction for another. It's not managing anyone addiction. It's continuing addiction.
Stop pushing the myth.
6
I am a physician who is buprenorphine licensed and I practice in NY. Buprenorphine is vastly preferred by many of us addiction specialists. Buprenorphine is a partial antagonist at the opioid receptors and has a ceiling effect - which means that it is extremely difficult to overdose on buprenorphine. Also, due to being a partial antagonist, it does not get people high like those oon methadone ( a pure agonist).
Buprenorphine has become a preferred opiate to use in pregnancy as well - again, little risk of overdose and just as safe as methadone.
Buprenorphine is equally efficacious in promoting abstinence as methadone.
Perhaps stick to philosophy and refrain from spreading misinformation about a life-saving medication.
20
I think you are wrong.
1
Addicted to opiates, my nephew, who had a good job with good insurance, looked at treatment options and chose suboxone...reluctantly. He was surprised to find out how much these doctors were charging to initiate treatment--I believe he had to put together nearly $700 for a first visit, then monthly doctor visits that he had to pay in cash to renew the prescription. Plus, even with his insurance, the co-pay was steep (no way this drug can be purchased without insurance unless you are wealthy). He once said to me, "I feel like I've just replaced one dealer with another." Yes, it worked for him, but he had a difficult time getting off suboxone. Many don't realize that it's more powerful than morphine and there are withdrawal difficulties. As I recall, he waited until he had vacation time to go through a suboxone withdrawal due to loss of energy and just overall malaise. But he did it! Still, treatment should not be so profit driven and should be more available to all.
46
Best wishes and congratulations to your nephew!
11
Other color issues are there.
But the most important color issue in America is green.
46
As it should be.
1
"More affluent patients can avoid the methadone clinic entirely, receiving a new treatment directly from a doctor’s office. Many poorer Hispanic and black indiv"
What you meant to say is "less affluent." Where do poor whites get their treatment?
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Winter - the NYTimes did not 'mean' to say less affluent. For the NYTimes, everything is about race and racism and 'unfairness' to minorities. The truth is, Medicaid pays a great deal for these 'free benefits' and any that receive them should be grateful. Sadly, having worked in healthcare with Medicaid patients, few have any gratitude at all.
1
We should have seen this coming at least fifty years ago, but due to the fact that only minorities and non affluent whites were affected, it was no big deal. Now that the scourge of addiction is rearing its ugly head no matter what race or social status one might have, as they would say in the hood, it is suddenly becoming serious bitness in America. What is now transpiring in this country, and around the world answers the question often posed as to why we should be concerned about what happens to others is now being answered in the most brutal of ways. Remember, today it is them, and tomorrow it could very well be you.
11
To read today's headline one would think President Trump was the only racist in the world. After reading this perhaps there may one or two others. Doh! But it's okay so long as it's institutional. That's why confessional booths are limited to only one seat.
3
In our current economic 'two-tiered' society, why is this at all surprising?
It is called a third world country and we are currently living in one. A Fascist one at that.
Poor people always go to prison for their drug use. Rich people obtain expensive lawyers and go to rehab hotels.
33
This story is heartbreaking. Surely there is a better way. Why can't we figure it out? My daughter was taking methadone in pill form for her unrelenting pain but was so ashamed to be taking methadone she switched to oxycodone. On more than one occasion she was accused of being a heroin addict by medical professionals while on methadone. So now she takes oxy that is not as effective at relieving her pain. Reading this story, I was horrified to realize how the treatment has become all-consuming leaving no time for jobs, family or life.
24
Odious inequality causing a huge differential in outcome, justice denied again. Universal healthcare insurance would solve this wit ease. Could we apply the 'golden rule' for once? If there is not the will, no possible equirable solution can be entertained.
16
I have been taking Suboxone for nearly 2 years now after nearly a decade of taking hydrocodone. Aside from the flexibility it provides, it is actually a different treatment than methadone in that it contains an inhibitor that dulls the receptors in the brain which are effected by opioids. This means that even if you try to relapse by taking an opioid, the opioid doesn’t really work. I have had to learn to manage my pain from severe psoriasis, which was the reason I originally started taking hydrocodone but it’s better than the alternative. I am surprised to find out that it is so difficult to find a Suboxone doctor. I found mine in the yellow pages and he even takes my insurance. It is a travesty that everyone who could benefit form Suboxone can’t get it. That has to change soon.
32
It’s sad the state or any doctor would perpetuate an addiction for more than a decade.
5
Some pain is just intractable. There's a difference between dependence and addiction. You haven't walked in the shoes of Mike L, so you don't know how much he suffers and how he deals with pain. There's nothing wrong with being on suboxone for life. We don't criticise people who use insulin for life, and some scheduled drugs like lyrica for epilepsy for life (which have about the addictive potential as suboxone IMO - I myself find it hard to believe one can get addicted to suboxone but apparently it happens).
15
So the poor must visit the clinic daily while those with some means get to take their fix at home. Fair? No? But isn't that the way with just about everything in America? There are two sets of standards, one for the haves and the others for the have nots. I don't see that changing any time soon.
17
So those who can afford to go to a Doctor's office are looked down upon because of their affluence. I see. Those who can afford to go are probably paying high deductibles and you know medical insurance of some kind. While those who don't have insurance are getting their doses of methadone gratis at the expense of those of us who pay for insurance.
13
But if everyone were required to buy basic health insurance Like here in Switzerland, the number of those coverered will increase, and the cost of care will decrease, and then you won’t have anything to complain about, thus making you personally more productive, so you can use the time to increase your income stream. Happy now?
25
ER Physician- Suboxone does give more flexibility to patients, but one thing that is not mentioned is that the opioid crisis has made it can be a dangerous thing to have the ability to prescribe. A doctor that I know went through the coursework only to have patients show up at odd hours threatening him as well as his family if he did not prescribe what they wanted. He stopped doing it altogether.
60
I prescribe suboxone and I recently had to leave a clinic where I treated opiate addicts, as there was no security and some patients were harassing me.
I have a small private practice and I screen all my potential patients carefully. I have on one occasion had to call the police.
This is why primary care doctors can't really treat opiate addicts in a primary care practice - these patients can be extremely difficult to manage and at times present as threatening.
35
I would much-appreciate the specific "opiod" being treated. There are quite-literally millions of us who use prescription opiods--hydocodone, mostly--for the treatment of chronic pain. We are, for the most part, tightly managed and supervised. We are not addicts: we are, rather, habituated to a medication that keeps us going. Use of the word "opiod" lumps legitimate users in with recreational users, the consequence of which is that those with medical needs are finding it ever-more difficult to find a physician who will prescribe, or a pharmacy that will fill.
This is not to denigrate those trying to solve their substance abuse problem: far from it. It is to simply ask for more clarity in this report.
40
I was of that line of thinking for a decade. It’s a dead end street. A cop out basically. I still have severe chronic pain but I kicked the opioids 2 years ago. Got tired of life revolving around pills. I know there are many folks like me out there but no matter how you put it - you’re addicted to the opioid substance and therefore by definition you are an addict. Like it or not it’s the truth.
13
I can’t agree, for over 25 years I treated chronic pain as a primary care provider. I had many patients for example with severe chronic neuropathic pain, well controlled on 50-60 hydrocodone monthly, up to 4800 mg Neurontin, and in some cases I would reccomend CBD. Currently here where I am living in Switzerland you can buy CBD with less than 1 percent THC. No high, but effective for neuropathic pain. As well it is mildly anxiolytic, but much safer than benzodiazepines, and less abuse potential. While I was practicing many patients were on a regimen like this that allowed them to remain productive and WORKING members of their communities. I can think of only one client in all my years of practice that was scamming me. State wide reporting of narcotics has helped providers recognize the problem children.
24
Mike L, I think you're okay with using suboxone for life, but it is an opiod. Buprenorphine is a partial opioid agonist.
1
Really fascinating take on a complicated subject.
Drug treatment is a time-consuming, painful process that takes patience, resources, and skilled professionals who build relationships with clients. When done effectively, it looks like treatment for chronic mental illness -- psychiatry, medication, therapy, supportive case management, subsidized services to help people move from passive despair to active involvement in their futures. It looks like mental health treatment because addiction IS a mental health disorder. And you can't treat mental illness just by handing out a pill.
Methadone is a great alternative to pain pills and heroin, but it is an opioid and by most accounts more painful to withdraw from than heroin. Suboxone, which combines the opioid buprenorphine with the buzz-stopping drug naloxone, is a more elegant solution. But it is habit-causing too. Programs that treat opioid addicts should never deny drugs that prevent withdrawal, but the idea of saving tax dollars by dispensing a chemical solution is only putting off the inevitable. Many of the methadone clinics require weekly counseling, and that's smart, but addicts lack many of the coping tools that healthy people take for granted. The answer, as this article mentions, is a philosophy that helps people in pain but teaches them that tapering off the methadone or Suboxone while rebuilding a life is the real answer, difficult and expensive and time-consuming and resource-heavy as it is.
13
So you think people who take drugs for life for epilepsy or diabetes or a host of chronic diseases are only putting off the inevitable? I suppose they are, because everyone dies in the end.
I think methadone and suboxone are two different things, chemically and functionally, though the principles are the lame. Methadone is an opiod with a long half life. Buprehnorphine is a partial opiod agonist/antagonist. With naloxone, it is even more powerful at curbing cravings. I think if one use the SAME dose of suboxone for life, it is no different than any other indication for which you are treated chronically. Food is "habit causing" too, but we don't stop eating because it is.
8