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Meet the Drug Rehab Celebrity Dispensing a Dangerous Brand of Intolerance

Bob Forrest gives the finger to opioid maintenance—and to the consensus of international scientific opinion.
 
 
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The following article first appeared on Substance.com

In a better world, there would be no conflict between abstinence-based treatment and harm reduction: As in other types of medicine, addiction care would occur on a continuum. Just as you don’t see cancer doctors blogging that radiation is a “con” and only chemo should be used in all cases, you wouldn’t see addiction counselors making a similar case that abstinence should always be used, never maintenance.

Unfortunately, thanks to the likes of Bob Forrest, that’s not the world we live in. Forrest, who identifies himself on his website as the “longtime partner of Dr. Drew,” now runs his own treatment program,  Acadia Malibu. It’s hard to believe, but yes, a man who worked on Dr. Drew’s  Celebrity Rehab actually advertises this fact to sell addiction services—despite the show having a mortality rate of nearly 13% among its “patients.”

Forrest opposes maintenance treatment—even though three of the five patients who died after their season on the show lost their lives to opioid overdose or its complications, which could have been prevented if they had been given support for maintenance, rather than told abstinence is the One True Way.

Nonetheless, here’s what Forrest—after noting, “I thought of calling this blog ‘The Open-Minded Report’”— writes about harm reduction:

“It’s a con in my opinion. I have seen the suffering and degradation it causes: the confusion it brings to the 12-step community about who is sober and who is not; the irrational fear of detox, where the list of medications designed to help you avoid actually experiencing any withdraw symptoms grows longer and longer every year; and just generally, the lies and danger and horror it is causing. The medical profession and pharmaceutical industries drive the use of Suboxone and Subutex. This is code for ‘profitable to doctors and drug companies.’”

Nearly everything about this paragraph is wrong. For one, if harm reduction—by which he means opioid maintenance here—is a “con,” why is it endorsed by every major public health organization that has investigated the issue, from the  Centers for Disease Control and the  National Institutes of Health in the US to the  National Institute for Health and Care Excellence in the UK and the  World Health Organization?

Why does the Cochrane Collaboration—an independent organization widely viewed as producing the highest-quality evidence on which to base medical decisions—say  this about methadone: “It retains patients in treatment and decreases heroin use better than treatments that do not utilize opioid replacement therapy,” while  concluding of 12-step programs that “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-Step Facilitation] approaches for reducing alcohol dependence or problems”?

And why does  research show that patients who leave methadone treatment double their risk of dying—and quintuple their risk of overdose death if they are injection drug users? Why do studies  consistently find death rates among addicted people in methadone treatment to be about one-quarter or  one-third the rate of those not on maintenance? Even if Forrest relies only on anecdote, not data, his own experience with  Celebrity Rehab deaths clearly bears this out.

OK, so it’s clear that Forrest is on the fringes here, ignoring both an overwhelming international consensus on best practices and the evidence of his own eyes. Let’s move on.

Is there any truth to the idea that maintenance treatments are simply a profit center for doctors and drug companies? While some money is being made, a look at the actual history of maintenance makes evident that if this is a pharma conspiracy, it’s an extremely strange one, because the US government basically had to pay drug companies to participate in it.

 
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