Is Dr. Drew Too Dangerous for Prime Time?
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Most experts say that methadone detox, done slowly, even after decades of use, needn’t be either extremely painful or dangerous, merely unpleasant and at times seriously uncomfortable. But Starr was withdrawn quickly, producing pain—and drama. He vomits voluminously at one point, leaving the puke to fester overnight when no one comes to clean it up. Sanitation issues are not the main problem, however.
O’Brien says that allowing people to suffer by abruptly stopping methadone is unethical. “It's a moral thing, and it doesn’t have anything to do with recovery,” he says. “Why should we be sadistic and want people to suffer just because they’ve become addicted? There’s not a shred of evidence that it’s good. This has absolutely no benefit.”
On day two of Starr’s detox, Pinsky describes his withdrawal as “so bad that he’s becoming confused, paranoid and rageful.” However, the doctor apparently does not slow the detox process to ease these symptoms. Indeed, as Starr kicks things, curses at the staff, makes obscene gestures and demands the cameras be turned off, the production continues, ignoring what appears to be a removal of consent to tape.
By day four, Starr has broken a lamp and refuses to get out of bed. Dr. Drew considers sending him to a lockdown psychiatric center, describing the musician as “overtly psychotic, a complication of his methadone withdrawal.”
However, psychosis is not considered a symptom of methadone withdrawal, according to O’Brien. “If someone becomes psychotic during withdrawal, it might be underlying schizophrenia,” he says, explaining that many people with addictions also suffer other psychiatric conditions. “We have seen people who are doing well on methadone go to pieces when they are taken off abruptly,” he says. “That’s why you take them off slowly. The best way is long-term detox over months as an outpatient.” That is, not 21 days’ inpatient like Dr. Drew’s program—and probably not at all if the patient does poorly without the drug.
Celebrity Rehab also reinforces negative stereotypes and myths about addiction—primarily the idea that abstinence through the 12 Steps is the only hope for recovery. That idea may have been deadly for Starr and some of the other patients, like bodybuilder and actor Joey Kovar, who overdosed on opioids last year, and actor Jeff Conaway, who died of pneumonia that was probably sparked by an opioid overdose in 2011.
For one, Pinsky’s repeated insistence that abstinence through 12-step programs is the only way to recover is a fundamental deviation from evidence-based best practices. In a voiceover on the show, Pinsky says, “12-step meetings are the cornerstone of recovery. Therefore, attendance is mandatory.” He also states, “Without 12-step, in my experience, there is no possibility of recovery."
In a statement a spokesperson for the National Institute on Drug Abuse (NIDA) disagreed, saying, “Different treatment approaches are needed for different people, since not everyone afflicted with addiction responds to the same intervention.”
Indeed, it’s not clear why a methadone patient like Starr should have been encouraged to stop that medication at all. Studies have shown conclusively that methadone reduces opioid use, cuts death rates and lowers crime: it is at least as effective as abstinence-based treatment on these measures, and in some cases, more so.
While some methadone patients can achieve lasting abstinence, the risk of relapse and resulting death by overdose is extremely high. As a result, expert advice is generally to support attempts at abstinence but not to disparage maintenance or oppose a return to it if the patient isn’t doing well.
In fact, a 2007 consensus statement convened by a panel of experts by the Betty Ford Center—not exactly a hotbed of support for non-abstinence treatments—recognized that people on stable maintenance should be seen as being in recovery, just like those in 12-step programs. The experts wrote, “formerly opioid-dependent individuals who take…methadone as prescribed and are abstinent from alcohol and all other nonprescribed drugs would meet this consensus definition of sobriety.”