I was completely taken aback by Doug Tieman's comments regarding medication assisted treatment (MAT) in his article in the July issue. Mr. Tieman lists “three key elements of harm reduction” (he identifies MAT as harm reduction) that are “highly problematic.” Not only is he wrong in his assumption that today's MAT clinic is harm reduction, but his three key elements are part of the myth that has surrounded the most successful treatment intervention for opiate addiction available today.
First, Mr. Tieman asserts that a traditional abstinence-based program is more successful in treating opiate addiction than MAT. He is wrong. Forty years of research has consistently demonstrated that methadone maintenance treatment (MMT) is the most effective treatment for opiate addiction. The National Institutes of Health states that of the treatment alternatives available, MMT “has the highest probability of being effective.” Patients in our clinics are required to have a history, physical, and lab and blood work on admission, as well as weekly counseling (by a certified substance abuse counselor supervised weekly by a master's-level, or equivalent, clinician). Medication is used to stabilize a patient so that counseling can be effective.
Mr. Tieman's second element apparently has to do with where a clinic is located and the influences there, a gross oversimplification and a statement inconsistent with the facts. We have clinics near upscale malls, in medical office buildings, and in middle-class strip malls, everywhere you would expect to find a medical clinic. Since patients are in treatment for an average of two years, a transition stage from a short 28-day treatment episode back to the patient's real world is unnecessary. If during the course of outpatient treatment a residential setting is needed, a referral is made, and then the patient returns to the outpatient setting.
Mr. Tieman's final element may be most disturbing. He assumes that a patient with a chronic disease who is taking a prescribed medication to treat that disease lacks the quality of life that that same patient would have if he/she were not taking that medication. I wonder if he believes that to be true of a person with diabetes or asthma.
The notion that MAT is harm reduction is outdated. The notion that taking a prescribed medication to treat a disease is somehow not being abstinent is archaic. I would not expect Mr. Tieman, as the president and CEO of one of the more respected treatment programs in the country, to give credibility to myths and inaccuracies about treatment. Treatment for the chronic disease of substance abuse is finally taking a giant stride forward with the development of true continuums of care and evidence-based treatment interventions. Statements like Mr. Tieman's only hold back the advancement of treatment.
Philip L. Herschman, President, Outpatient Treatment Division, CRC Health Group, Carlsbad, California