Don’t follow America: finding a better treatment model for opioid overuse/abuse

oxycodone pills and us flag

US harm minimisation proponent Silver Damsen compares Australian and American approaches to the treatment of opioid abuse

As an American drug treatment reform activist, I want to commend moves to make Australian drug policy better than U.S. drug policy. 

U.S. policy, while not yet as horrific as Duterte’s policy in the Philippines, still has obscene overdose, suicide, and incarceration rates. The current U.S. President, Trump, even admires Duterte’s execution of drug dealers.

So while it is not as bad as it could be, the U.S. system is disturbingly close to the worst possible approach, which is one of a combination police state, and anarchy, where someone who is disliked by a neighbour can be eliminated by almost a wish. In the Philippines, either a phone call to the authorities or whisper to a small band of like-minded vigilantes becomes death for someone merely suspected of being a drug user or dealer.

As many others have observed, the death penalty is ineffective in stopping drug use or trafficking even as it fosters strong criminal syndicates—not to mention is a violation of basic human rights, and as such is an atrocity.

Execution is but the most extreme version of criminal punishment for drug use or drug dealing. However, any form of incarceration or punitive action is ineffective, inhumane, fosters crime, and deepens the problems of the already poor and disadvantaged.

Thus, the further that Australia moves from a punitive model, the better off Australians will be, and as I hope, Australia can then be a model for other countries.

The best treatment for opioid overuse/abuse are medications that control cravings, such as methadone and buprenorphine. Studies attribute a 50% success rate to these drugs.

I believe that the results would be even higher if U.S. studies didn’t combine the use of medications with the dominant self-help group of Alcoholics Anonymous (AA) and other related 12-Step programs.

Thus, what I want to specifically warn against is Australia following the U.S. model of 12-Step treatment, which goes hand-in-hand with the U.S. drug court system, and is also behind the very flawed Big Business of drug rehab centres.

In general, 12 Step, such as AA and Narcotics Anonymous (NA), has a 5-10% success rate for alcohol. 

The 12-Step success rate for opioids I define as zero because the work of Kenneth Anderson (as well as a casual observation of causes of death listed in any of the major sources) shows that someone just getting out of a 12-Step rehab is more likely to OD than someone who continues to use on their own. If a treatment is less successful than doing nothing, I define that as equivalent to a zero success rate.

And yet this treatment that has a zero success rate discourages the vastly more successful use of medications to control cravings. Instead, the dominant form of treatment in the U.S. advocates praying to the Higher Power of 12 Step to remove the cravings for opioids or other drugs.

Besides the obvious problem of depending on prayer as the means to solve a medical issue, another reason for this ineffectiveness is that members of 12-Step are, sometimes directly but always subtly, encouraged to binge as a way to “hit bottom” and find the Higher Power of 12-Step.

To state the obvious: an opioid user who binges is very likely to die of overdose. Also, pushing someone with a history of overuse/abuse with opioids to “hit bottom” is likely to provoke suicide at the worst, and needless suffering at the best.

However, 12-Step is popular despite not really working because it functions like a religion, and not just a religion but a religious cult, so that it isn’t just a flawed methodology to stay sober but actually an entire cult world-view system. 

As a religious cult, 12-Step has allegedly had problems with bullying, psychological harm, and endemic sexual predation—following the typical cult model of older male members preying on younger female members.

For a brief overview of the problems with 12-Step treatment, I would recommend the award-winning American documentary The 13th Step Film, by Monica Richardson.

I bring up these issues for an Australian readership to help them see what they do not want to become: a country that punishes all its citizens when it tries to punish drug offenders.

Treatment over incarceration is the most economical, practical, useful, and humane way to treat opioid “addiction.” But it will not be an improvement if treatment follows the ineffective, and even dangerous, incarceration and 12-Step model of the U.S.

Thus, I hope that the Australian approach to the growing opioid overuse/abuse issue will be to provide PBS-subsidised free medication to help those that want to stop taking opioids to stop.

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1 Comment

  1. placer

    The assertion that AA has a 5-10% success rate is a myth. Those numbers do not come from peer reviewed science; they come from a doctor with an agenda against AA who multiplied unrelated numbers together to make AA look bad.

    The real success rate depends on whether we measure the success of people who go to the effort to work the 12-step program, or whether we measure alcoholics overall. For people who choose to regularly attend meetings, the success rate is between 67% and 75%, depending on which study we look at (PMC2220012 gives the 67% success rate) — double the success rate of people who do not get involved with AA.

    Overall, if we look at dropouts, the success rate is still just under 50% (about 1/3 of the people who never go to an AA meeting get sober on their own; about 2/3 of the people who regularly go to AA get sober; the people in between have a sobriety rate directly proportional to their AA attendance).

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