POINT OF VIEW: The only safe way to treat opioid addicts


“I’m detoxing.” This is the sort of news that delights the families of patients who are addicted to heroin. The promise of a seven-day detox solution is seductive.

But detoxification is actually extremely dangerous. Nearly every addict who successfully completes a week-long detox program without further treatment relapses, and in a world with increasingly powerful synthetic drugs on the market, the risk of overdosing and dying during a relapse has become evermore threatening.

So when someone says, “I’m detoxing,” I ask, “And then what are you going to do?”

“Detoxing” refers to treatment designed to get patients off drugs that can kill them. But detox is also a place, usually a hospital-like setting where a drug user will stay for up to seven days, medically supervised, to get tapered off drugs.

Unfortunately, it is an extraordinarily rare person who uses opioids for months or years and quits it cold without a period of medication treatment - regardless of willpower, self-confidence or support from family and friends. Even with the best clinicians working with the best detoxification protocols, most patients delude themselves that detox alone is enough. The reality is that patients detox, relapse, detox and relapse again.

As fentanyl — a potent, synthetically born killer — infiltrates the drug supply, the epidemic of overdose deaths will only worsen. There were about 60,000 overdose deaths in 2016, and there will likely be more in 2017. Fetanyl now laces most heroin (and, increasingly, cocaine) bought on the street. Some 75 percent of fatal overdose victims in New England last year tested positive for fentanyl.

Detoxification programs need to change their mission and their magical promises. They should become short-term refuges where people can begin long-term treatment. They should become sites where medication is begun for all seeking to live without illicit drugs. They should offer seven cloistered days to deal with acute medical or psychological issues and to discuss treatment with any of the three well-known and effective medications for opioid users, which, if taken correctly, can reduce the risk of relapse and possibly save lives.

As the White House and state leaders commit to strategies that combat opioid deaths, there must be a parallel revolution in our understanding of treatment. A detoxification program is not treatment but rather the site for the beginning of treatment. Making the best use of short-term inpatient programs is critical, but patients are best served when such programs put them on the long road of recovery with the help of a daily medication covered by all insurers and a caring prescriber.

MICHAEL STEIN, WASHINGTON

Editor’s note: Stein is chair of health law, policy and management at the Boston University School of Public Health.



Reader Comments ...


Next Up in Opinion

Editorial: 25-story One Flagler too much for West Palm waterfront
Editorial: 25-story One Flagler too much for West Palm waterfront

It looks beautiful in the drawings. The proposed One Flagler in West Palm Beach — designed by renowned architects Skidmore, Owings & Merrill, of New York’s Freedom Tower — is less an office tower than a work of art: tiered, slender, luminous, yet restrained. The tower’s developers, The Related Cos., admirably intend to preserve...
Letters: Time to rethink placement of hardwood trees
Letters: Time to rethink placement of hardwood trees

It appeared to me that most of the damage during the recent storm was done by falling trees and tree branches. But with few exceptions, palms were not the problem. Hardwood trees were. In my community, the standard set by Palm Beach County for a typical 5,000 square-foot property is followed, and that calls for one palm tree and two hardwood trees...
POINT OF VIEW: Public school financing must change

With the increasing federal drumbeat to spend a trillion dollars rebuilding our nation’s infrastructure through public-private partnerships, public school districts should seize the same opportunity. Since the public sector often is criticized for paying too much and taking too long, it is time to enlist the private sector’s expertise and...
Commentary: Why didn’t Equifax protect your data?
Commentary: Why didn’t Equifax protect your data?

When the credit-reporting agency Equifax announced this month that hackers had accessed the accounts of 143 million of its customers — over 40 percent of the population of the United States — it was another example of how little power consumers have over their own money and personal information. Indeed, it unfolded in a familiar way: Equifax...
Palm Beach Post editorial cartoon: Sept. 24
Palm Beach Post editorial cartoon: Sept. 24

CARTOON VIEW LISA BENSON
More Stories