In trying to determine routes to abstinent recovery there’s a legitimate debate to be had about whether opioid replacement therapy (ORT) is a catalyst to abstinence or if it slows the process down. Some have suggested that methadone is too ‘sticky’ for recovery. On the other hand, as others have said, ‘dead people don’t recover’. I think there are questions to be asked about the quality of intervention that goes alongside the prescription and what choices are on the menu for folk on long term methadone, many of whom are in primary care treatment settings. Could we do better? Almost certainly.
But the shoe is now firmly on the other foot. In a research summary I spotted today, one of the barriers to patients accessing opioid maintenance is detailed as ‘abstinence-based treatment models’. To be fair, the context is the USA where access to ORT is not as even as here in the UK and many other barriers are detailed… but abstinence treatment ‘a barrier’? Really?
I guess, when you think about it a bit, long term abstinent recovery is also a barrier to ORT. Better put out a warning!