The Medicalization of Addiction

Most early addiction treatment programs were abstinence-based. Today, the psycho-pharmaceutical industry has convinced insurance carriers and government agencies to fund and promote “medication-assisted treatment” (MAT), in which the treatment drug is as addictive as the original one.

Nearly half a million Americans died of drug overdoses from 2000 to 2014, mostly from opioid painkillers and heroin. The treatment of drug addiction by administering yet more potentially addictive drugs isn’t just profoundly counterintuitive; it is also a case of bad science and flawed policy, since it inhibits alternative forms of comprehensive treatment and often the drug-free treatment programs are not covered by insurance — already in Maryland, which suffers from some of the highest rates of drug addiction and alcoholism in the nation, drug-free addiction treatment programs that refuse to accept patients using MAT are being denied subsidized state funding.

Welcome to medication-assisted treatment, an increasingly influential and controversial paradigm in the world of medicine that, among other things, considers addiction a chronic “brain disease” rather than a condition that can be treated by addressing the social and spiritual aspects underlying addiction.

A typical prescription for an opioid painkiller might as well read, “80 mg OxyContin daily until you graduate to heroin.”

More than 710 people in the St. Louis region died from opioid overdoses in 2016. Nationwide, prescription opioids and heroin killed more than 33,000 people in 2015. In Missouri, opioid-related deaths have increased more than 7 times for young adults age 25 to 34 from 1999 to 2014.

The response of businesses who are affected by substance abuse is to refer employees to an “employee assistance program” (EAP) which is a euphemism for a mental health care provider. The EAP then refers the addict to a MAT program.

As an example, methadone, which is used today by more than 250,000 Americans, making it the most widely used medication for treating heroin addiction, carries a high risk of death from accidental overdose, especially during the initial stages of treatment, because it tends to suppress the respiratory system. In fact, it is the prescription of methadone for pain —- not methadone from maintenance clinics —- that has been a major contributor to the nation’s high opioid painkiller overdose death rates over the past two decades.

Another major step toward the growing medicalization of addiction occurred in 2013, when the American Psychiatric Association issued its fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which insurance companies rely on for billing purposes. There are now 73 disorder diagnoses related to some kind of substance abuse, with another 20 disorders related to withdrawal symptoms. Disorders mentioning opioids number 38.

All of these so-called disorders can be prescribed a psychotropic drug for “treatment”, in addition to whatever street drug, prescription opioid, or addiction treatment drug was being used or abused.

Perhaps the most publicly visible display of Big Pharma’s political connections in recent memory occurred this past December, when, in a 94-5 vote, the U.S. Senate approved the “21st Century Cures Act,” one of the largest bills ever aimed at reforming the FDA. The $6.3 billion law, which President Obama signed before leaving office, calls for greater use of MAT and includes $1 billion for opioid prevention and treatment programs in 50 states over two years.

What can you do about this? Here’s a thought — contact your Missouri State Senator and Representative and ask them to remove all references to the DSM from Missouri State Law.

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