The New York Times Is Dead Wrong About Drug Addiction
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In a two-part series for the New York Times last month, Deborah Sontag wrote about buprenorphine, a medication used (mostly in the form of Suboxone) to treat opiate addiction through replacement therapy. The piece was presented as a dramatic exposé, with the flashy headline: “Addiction Treatment with a Dark Side.”
But Sontag missed the mark by ignoring the concept of harm reduction and relying on the outdated view of addiction as a moral failing. Her politically correct language conceding that addiction is a “disease” is belied by descriptions of patients “cheating” on their treatment — um, we call it “relapsing” — plus an emphasis on the black-market distribution of the opiate substitute and a lack of attention to the real-world effects of drug use.
Then last week, Andrea Elliott wrote a well-intentioned five-part series for the Times profiling a homeless girl named Dasani living with her family in a Brooklyn shelter. Hidden in this highly-trafficked piece was even more demoralizing language about drug users, a population already besieged by stigma. Dasani’s parents are on opiate-replacement therapy — in their case, methadone, not the newer Suboxone. Rather than explore the positive correlates of the treatment for Chanel and Supreme (Dasani’s parents), Elliot writes dismissively that their treatment has merely “become a substitute addiction.” This language echoed Sontag’s earlier description, that “Buprenorphine has become both medication and dope.”
People struggling with opiate addiction are more than familiar with that disparaging sentiment. At the community mental health clinic where I work in Greenfield, Mass. (a hotspot of opiate use), clients on opiate-replacement therapy struggle daily with feelings of shame that their recovery “doesn’t really count.” They fear they are not really “clean.” That kind of shame is exactly what can (and does) lead to relapse.
But in spite of the stigma and shame, I also hear clients tell me about a plethora of positive outcomes that result from their treatment, none of which were highlighted by Sontag. She missed how, especially at this time of year, clients are relieved to have money (which they were once spending on heroin or expensive painkillers) to buy winter clothes for their kids. They’re also grateful to no longer be at risk at risk for HIV, Hep. C, and abscesses — diseases and infections that drug users contract through sharing needles or having unprotected sex in exchange for drugs. Lastly, these clients know that they are no longer at risk of overdosing during unmonitored drug use. (Two people die from opioid overdoses every day in Massachusetts, more than the number that die from car accidents.) Though Sontag may say that buprenorphine is “dope,” there are crucial differences between the two in ways that matter to the people actually involved, like money and safety from life-threatening disease, not to mention risk of arrest and incarceration.
Plus, buprenorphine is very unlikely to cause impairment. Yes, it’s a “drug,” like all medications are — newsflash: they mean the same thing — but a person can be in complete recovery from addiction and still take it. As Maia Szalavitz explains:
Addiction is not physical dependence on a drug. If it was, we’d have to consider all diabetics as “insulin addicts” and people who need antidepressants long-term as “antidepressant junkies.” Instead, psychiatry defines addiction as compulsive use of a drug despite negative consequences. If the use isn’t compulsive and the consequences are positive, the addiction has been resolved even if the physical dependence remains.
In hyping up the “black market” and “misuse and abuse” of buprenorphine, Sontag doesn’t acknowledge that the market is largely driven by lack of access to the very same treatment. I see clients who started out buying Suboxone on the street from their peers, and using it correctly until they could get into official treatment. Some clients also start out buying Suboxone on the street because they’re too ashamed to be seen going into the clinic; it’s a small town. For me, as well as other health care workers and activists who are actually in the field, it’s clear that reducing stigma around addiction treatment, not increasing it, is the way to save lives.