Editor’s note: This commentary is by Zach Rhoads, of Burlington, who works with teens and families and is a former board member of the Chittenden County Opioid Alliance. He is co-author, with Dr. Stanton Peele, of the forthcoming book “Outgrowing Addiction” and hosts an addiction podcast called “The Social Exchange.”
I was addicted to heroin in my 20s. But my life has changed radically since then.
I was a touring musician when I was addicted to drugs. I still play professionally. But I don’t travel. My primary career is helping children and teens, help I provide regularly to families in the Burlington area. I didn’t realize I had such strong skills in this area until I quit heroin and started looking for non-music jobs, when I lucked into a position working with kids.
I haven’t used illicit drugs for many years now. I still do drink alcohol and, truth be told, I probably have had a few too many a few times in the last decade, and I might do so again somewhere down the road. And if I undergo a medical procedure, I’ll gladly take what my doctor prescribes for pain.
I decided to quit heroin when I was hospitalized, near death, after unknowingly consuming a heroin-fentanyl mix. Since finding a new profession, I married a remarkable woman, and we are expecting our first child any time now.
I am widely respected for my work now, which wasn’t initially in the drug area (I am now also a coach for the online Life Process Program — an addiction-coaching service).
So I was a little surprised when I was invited to be part of our county opioid alliance, since few people knew of my own history with opioids at the time.
And that’s where I met Brandon del Pozo, Burlington’s chief of police. Last week, Brandon wrote a Facebook post that went viral. In it, he outlined a list of of 11 strategies for curbing addiction and drug fatalities. The list included the following three concepts (I paraphrase; you can see his full list here):
• We need to recognize addiction as a chronic disease.
• We need to continue to cut opioid prescribing rates.
• We’re not giving enough medication to people with addictions, since it’s so hard for people to cease using opioids altogether.
Naloxone (Narcan) is a drug that reverses withdrawal, while medicine-assisted treatment (MAT) includes use of methadone, buprenorphine, and Suboxone to replace street heroin and other opioids with a safer chemical substitute.
Chief del Pozo and I agree that these things can be life-saving, but our views of their role and our approaches to addiction differ in crucial ways.
While MAT has become more widely available and Narcan is readily dispensed in many places (I carry Narcan with me when I work with teens), these steps haven’t stemmed the drug-death epidemic, due not only to opioid fatalities (including painkillers and heroin, both of which have been rising), but also record levels of benzodiazepine, methamphetamine, and cocaine deaths, which altogether exceeded 72,000 in 2017. This was true even though opioid painkiller prescriptions have been reduced drastically since 2012-13, and declined especially precipitously in 2017.
This leads to a strange paradox, here described by Patrice A. Harris, MD, chair of the AMA’s 2018 Opioid Task Force: “While this progress report shows physician leadership and action to help reverse the epidemic (in this case reducing opioid prescriptions), such progress is tempered by the fact that every day, more than 115 people in the United States die from an opioid-related overdose.”
In other words, although our treatment is excellent — and accessible — the patients keep dying.
An even more direct challenge to the efficacy of MAT is that the areas where MAT is most readily available, urban areas, are now showing the greatest surge in drug deaths, usually from heroin mixtures, to wit: “Large U.S. cities see big jump in deadly opioid overdoses.”
Here’s what I think accounts for this paradox:
Creating a national mindset, as well as a way of thinking for opioid users, that they suffer from a disease they can never hope to control or reverse on their own, imbeds the very destructive behavior we are trying to reverse.
I used heroin wholeheartedly, then found its use interfered with the person I wanted to be and was able to — and did — become. And now I don’t use illicit narcotics.
I believe that the route out of addiction is personal agency, as I describe in my forthcoming book with Stanton Peele, “Outgrowing Addiction: With Common Sense Instead of “Disease” Therapy”: “Americans have a fantasy—that we can sidestep cultural, community, and personal problems and find a medical solution for addiction and mental disorders.” There is no shortcut to escaping addiction and its sometimes lethal consequences other than attending to people’s lives.
