This article; ‘Medication-Assisted Therapies – Tackling the Opioid-Overdose Epidemic’ that appeared recently in the New England Journal of Medicine makes some serious omissions in its promotion http://www.nejm.org/doi/full/10.1056/NEJMp1402780?query=TOC
The article espouses the value of underutilized OST’s in the USA, and the need to increase use of pharmacotherapies (in some instances over) Talking Therapies and Therapeutic communities.
What, to us, is glaring in its omission is that the authors of the piece seem to willfully avoid ‘sunset clauses’ on such therapies and site lower death rates as key agenda. Whilst that is noble it is not good health practice, let alone good drug policy. If the ‘therapy’ does not facilitate the lessening to cessation of drug use, then it is inadvertently espousing the life-long enabling of the dangerous use of psychotropic toxins; toxins that promote other mental and physical health diminishing issues, and still with no guarantee of ‘death free’ use.
The concerns, as we are all aware, is that ‘drug policy’ is now simply a ‘health policy’ and has next to nothing to do with drug use cessation, that’s why many Rehab providers are cynical of OST’s that are unleashed, unsupervised and with no ‘end date’ prescribed.
We have no problem with pharmacotherapies being engaged for the expressed, planned and determined process of ceasing drug use in a prescribed time period. We are (as should all caring health advocates/providers) very concerned about carte blanche approach to O.S.T/M.A.T. dispensing at taxpayers/healthcare providers expense with no recourse for change/rehabilitation in the drug user.
Another concern is the growing use of ‘medical mantras’ (i.e. ‘drug dependence generally is a NCD (Non-Communicable Disease) that can only be managed’) that continue to dis-empower people and enable ‘victim-hood’ to dependence. These do not only do a great disservice to the hapless drug user, but also make the non-drug using populous ‘responsible’ for, not ‘user’ recovery, but incredulously, their ongoing drug and often, poly-drug use. This is untenable on a number of levels and serious review of any policy that enables unabated drug use is imperative.