Letters Page #913

Subject: RE: #897, Publish or Perish!
From: methinfex@mindspring.com
Date: Mar. 20, 1999

Dr. Daiter,

Thank you for pointing out what it is that UROD is 100% successful at achieving. Many providers of ROD techniques don't put much effort into making the distinction between success at producing a "detoxed" patient, and success in the long run, that is, in prolonging a patient's opiate free state. In promotional copy, providers simply say their service is 99% or 100% successful. Apparently caught in the hype, Barbara Walters, on the television news show 20/20, called the procedure a "miracle cure". What are the desperate parents and loved ones of addicted persons supposed to think? What do you think 100% success means to them?

To loudly and boldly claim a success rate of 100% is misleading. A few days in the pokey will also be 100% successful at producing an opiate free state. What people expect and need from new treatments for opiate addiction is 100% success in curbing illicit drug use and the harmful behavior that accompanies it.

Many of my inexpensive, at-home withdrawal attempts were 100% successful at producing an opiate free state; however, the condition was always short lived; it was not long before I returned to illicit drug use. "One hundred percent success" is not a phrase I would associate with the big picture.

Publicly, the ROD industry has done little to increase awareness among the general public, monied potential customers, and politicians eager to support a cure, of the particular difficulty that opiate addicts have in maintaining prolonged periods of abstinence from their drug of choice, and the unknown effect of ROD procedures on this critical facet of addiction. If the relapse rate after UROD is the same as after other withdrawal treatments - 80% to 90% - then the value of this very expensive treatment would seem to be quite limited - much less useful than the hype would have us believe. Indeed, I have witnessed a flurry of activity, in excitement and expectation, as drug users and methadone patients seek salvation in 6 hours. I am also aware of a number of once stable methadone patients who, to their surprise and dismay, returned to active addiction a short time after undergoing a Rapid Detox procedure.

The world has had methadone maintenance treatment for 30 years. It has been extremely successful, both at safely reducing and eliminating tortuous, painful withdrawal symptoms, and, most importantly, at drastically reducing and eliminating illicit opiate use for as long as the patient is in treatment. No other treatment has ever been able to claim such success in this area.

We need to encourage the expansion and medicalization of methadone maintenance treatment. At best, 7/8 of the opiate addicts in the US are without treatment. But rather than implement programs that we know to be effective, we are distracted by big maybes that will take years to evaluate, whose place in the treatment arsenal is as yet unknown, whose providers are notorious for overstated and under reviewed claims of success.

What elicits the term "liquid handcuffs" in regard to methadone use? Is it because it must be taken every day? Do we refer to antidepressants as "little round handcuffs?" Estrogen replacement as "sticky adhesive handcuffs?" Are people who must take medicine everyday somehow barred from experiencing the world as "their oyster?" Of course not. What makes life difficult for methadone patients is not the act of taking medicine and experiencing its benefits, but the over-regulation of the drug's disbursement, the stigma that is perpetuated by the use of terms like "liquid handcuffs", and the over-promotion of treatments that play on the War on Drugs ideal of complete abstinence (from maintenance treatments too) as the only morally acceptable goal in addiction treatment.

As a provider of UROD and MMT, I hope you will act ethically, and not only wish "everyone out there who is trying to get off methadone all the good fortune with their efforts", but also equally encourage and support those who have found success and fulfillment through continued methadone maintenance treatment.

Best regards,

Eric Peterson, MIE