Dopesick - Beth Macy Page 0,87
Narcotics (precursor to the DEA) was rabidly against using drugs to treat drug addiction. The FBN framed methadone as “unsafe”—read: and maybe even pleasurable—after studies revealed that morphine addicts liked it. The FBN also harassed the handful of doctors who used it in the 1960s to treat morphine and heroin addiction. Such controversies continue to this day and illustrate the blurry line between lethal and therapeutic, between the control of pain and suffering and the pleasure of a cozy high.
Over the next decade, into the 1970s, that criticism spurred researchers to improve on methadone and to develop compounds that would both block the euphoric feelings and the dangerous respiratory depression brought on by opioids, including methadone. Such compounds led to the development of next-level maintenance drugs: buprenorphine and naltrexone (now known by the brand name Vivitrol).
Vivitrol, an opiate blocker and anticraving drug given as a shot that lasts around a month, has no abuse potential or street value, and would therefore later become the favored MAT of law enforcement. While naltrexone was approved for treatment of opioid and alcohol addiction in 1984, it was slow to gain social acceptability among doctors or addicted patients despite one researcher’s belief that it was the “pharmacologically perfect solution.” It wasn’t widely used until its maker began aggressively marketing the injection to drug courts and jails, beginning around 2012.
Buprenorphine also blunts cravings, and it’s less dangerous than methadone if taken in excess, which is why regulators allowed physicians to prescribe it in an office-based setting rather than clinics that have to be visited on a near-daily basis. “I don’t think anyone thought the street value of bupe would be significant,” the historian Nancy D. Campbell told me. “That is generally thought of as quite a surprise.”
But the long shadow of “the heroin mistake,” as researchers thought of Bayer’s 1898 development for most of the twentieth century, was not forgotten by the medical or criminal justice communities. They remained wary of the notion of treating opioid addiction with another opioid and sought opioid antagonists for that very reason.
Looking back, it was almost quaint how, for most of the last century, the underdeveloped pharmaceutical industry was dominated by governmental agencies like the National Research Council and the Committee on Drug Addiction. These organizations were composed of university researchers and regulatory gatekeepers who focused most of their energies on preventing new addictive compounds from coming to market in the first place.
As early as 1963, progressive researchers conceded that designing the perfect cure for addiction wasn’t scientifically possible, and that maintenance drugs would not “solve the addiction problem overnight,” considering the trenchant complexities of international drug trafficking and the psychosocial pain that for millennia has prompted many humans to crave the relief of drugs.
When complicated lives need repair, and even the best-intentioned doctors are rushed, it was as clear then as it is now: Medication can only do so much.
While methadone remained on the fringes of medical respectability for decades, the Nixon administration sought it out as a way to control crime and respond to concerns over the fact that 20 percent of Vietnam veterans (at a rate of fourteen hundred soldiers per month) were returning home addicted to opium or morphine. Doctors weren’t trusted, though, to both dispense the drugs and control for their illicit diversion in an office setting, so highly regulated, stand-alone methadone clinics became the norm.
Such skepticism toward the medical establishment seems extraordinary now, viewed through the more recent prism of hospital hallways dotted with pain as the fifth vital sign wall charts and embroidered OxyContin beach hats, hallmarks of an era when doctors were encouraged to prescribe high-powered opioids for months at a time. But as liberally as doctors could prescribe opioid painkillers up through 2016, they remained regulated as hell when it came to treating opioid addiction with methadone and buprenorphine—the latter of which only came to market in 2002, after a thirty-year quest for a new addiction-treatment drug.
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The battle lines over MAT persist in today’s treatment landscape—from AA rooms where people on Suboxone are perceived as unclean and therefore unable to work its program, to the debate between pro-MAT public health professionals and most of Virginia’s drug-court prosecutors and judges, who staunchly prohibit its use. Those unyielding viewpoints remain, I believe, the single largest barrier to turning back overdose deaths. In 2016, not long after a Kentucky appeals court mandated its drug courts to allow MAT, President Obama’s Office of National Drug Control Policy announced it would deny funding to drug