Ideology vs. Science

Joshua Sharfstein in JAMA discusses the opioid abuse epidemic and what to do about it. This is an opinion piece that doesn't have references, but I can assure you that he is right on the facts. People with opioid addiction seldom succeed in maintaining long term recovery without what we call Medication Assisted Treatment. That means either methadone or buprenorphine, both of which are themselves opioids. As Sharfstein tell us, "Many still believe that those who take methadone or buprenorphine are 'trading one addiction for another,' 'in bondage,' or 'taking a cop-out.'" People who are using these medications may face reprisals from judges or social service agencies.

Here is the reality. People on Medication Assisted treatment don't get high, and are not impaired. These particular opioids have a pharmacokinetic profile (as we say) that keeps them at a fairly steady concentration in the blood for a long time, meaning that they can eliminate craving without the side effects of intoxication. That means people can work, go to school, take care of their families, whatever they need to do. They are no longer committing crimes or at risk for overdose.

There are lots of chronic diseases for which people have to take medications every day, for a lifetime. These include diabetes, HIV, high blood pressure, high cholesterol . . . If you are over 45 or so, you probably take at least one medication every day yourself. If you didn't, you would be at higher risk for death and if you are, say, an insulin dependent diabetic or have HIV, you will certainly die. Do you consider yourself to be "in bondage," or that you have an addiction? No. You're just stayin' alive.

Now, these are true facts about medication assisted treatment for opioid addiction. There is no defensible reason to oppose it other than an ideological commitment to the principle that "Drugs" (meaning some drugs, when used by some people, in some contexts) are evil. This is also the reason why people who are caught with small amounts of opioids are put in jail, thereby ruining their lives and making recovery all the more difficult. That is pointless, but it happens because people morally condemn addicts. And why is that? Nobody sets out to become addicted, just as nobody tries to become diabetic. It's a disease.

As Lawrence Gostin tells us in the same issue, the present administration has abandoned truth:

Science and technology have not been salient in the Trump administration, including taking longer than any other modern president to name a science adviser, tasked with providing scientific guidance in “areas of national concern.”⁷ The administration has fired or reconfigured several science advisory boards, including at the Environmental Protection Agency (EPA), Interior Department, and National Oceanic and Atmospheric Administration. Scientific information regarding climate change was removed from official websites at the White House, EPA, and Department of Energy. Lesbian, gay, bisexual, and transgender (LGBT) content was removed from White House and State Department websites, and HHS removed LGBT questions from its survey of priority health needs for older US residents. . . .

The administration plans to eliminate the ACA’s Prevention and Public Health Fund. In addition, the president proposed deep budget cuts to research agencies, such as the National Institutes of Health, CDC, and the Energy Department.

The reason is, of course, that reality has a well-known liberal bias. The Republicans want to take us back to the 12th Century, before the Enlightenment, where truth was what the Pope said it was and the sun went around the earth.