When it comes to drug abuse, particularly prescription drug abuse, are we getting the whole story?

A lot of reporters have won awards reporting on the drug overdose situation. One can be forgiven for thinking that the avalanche of award-winning articles have presented the only take on the drug overdose epidemic. A relatively recent piece by Randy Richmond, of The London Free Press, touches on some of the ideas that have not been widely discussed but note the article was written in late 2021. The linked article below was written a full three years earlier and there are other similar pieces going back decades. An under reported position, I'd say.

For another perspective, read:

We Can’t Go Cold Turkey: Why Suppressing Drug Markets Endangers Society
Nick Werle and Ernesto Zedillo

Today, opioid agonist treatment (OAT) for addiction maintenance is the gold standard for treating opioid use disorder. As a chronic, relapsing mental health condition, opioid use disorder is not susceptible to a cure, per se. But evidence-based treatments employing OAT can help patients stabilize their lives, manage their addictions, reintegrate into society, and reduce the harmful consequences of drug use.

 

Maintenance therapy has been shown to be more clinically effective and more cost effective than detoxification.12 Abstinence-based treatments are common in the United States, where they often follow the model for alcohol abuse treatment, with the goal of lifetime abstinence, but there is little evidence of clinical efficacy.

 

Abstinence-based treatment can increase mortality risk: While heroin withdrawal itself is rarely life-threatening, putting people with opioid use disorder into withdrawal poses a high risk of overdose, because a period of abstinence leads to reduced tolerance.14 This risk of overdose explains why abstinence-based treatment approaches for alcoholism are dangerous when applied to people with opioid use disorder: Relapse to alcohol use is rarely fatal, but relapse to fentanyl-laced heroin often kills.

The government has long sought to suppress consumption with a medication that would “cure” opioid addiction outright. But evidence shows that this goal can be deadly, because using medication to keep someone abstinent further raises overdose risk. Many drug courts and treatment programs now rely on naltrexone, which is sold under the brand name Vivitrol as a wonder drug for stopping opioid use. Naltrexone is an opiate antagonist that triggers immediate withdrawal and blocks opioids’ pharmacological effects. But this abstinence is costly: Overdoses are more common following cessation of naltrexone treatment.