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Wednesday, June 15, 2016

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I've provided outpatient opiate addiction treatment for more than 30 years. A substantial portion of those I've seen who left methadone treatment prematurely were terminated involuntarily by the programs for usage of other drugs or missed doses.
The statistics shown do not reflect this type of premature termination. I think that such terminations deserve special attention and should be reflected in the statistics.

This information is not new, and corroborates studies dating back into the early 1970s, including a very good study in JAMA by Karen Sees from San Francisco over 10 years back, which showed that 2 years appeared to be the dividing point. However, as long as we have an ideology in 12 step treatment advocates that equates maintenance treatment with continued use of street drugs, we will never get the support, and will never rid ourselves of the stigma connected not only with methadone, but with buprenorphine treatment. 12 step treatment is very successful for a subset of patients, but people within this subset, seeing only each other, do not understand what a selection bias means, and think that everybody can do what they did, and they are just not trying hard enough. Elsewhere, this would be called blaming the victim. However, in 12 step circles, the trick is to blame "money hungry legalized drug pushers" (like me and thousands of my colleagues), not allow people on MAT to speak at meetings, not consider them "clean or sober," pressure them to discontinue their treatment, and other indignities. It also allows these same people to violate 12 step traditions and take political action in restricting funding for MAT as well as influencing legislators, regulators and the general public into restricting adequate funding for programs that can help far more people than does 12 step treatment.

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